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Competing Interests: Edward J. Despott has acted as a consultant for Boston Scientific and Ambu. He has also received academic grants and speaker honoraria from Fujifilm, Aquilant Endoscopy, Norgine, and Olympus. Alberto Murino has acted as a consultant for Boston Scientific and GI Supply He has also received academic grants from Fujifilm, Aquilant Endoscopy, Norgine, and Olympus. All other authors have no conflicts of interest to declare.

Background: The pocket-creation method (PCM) was developed to overcome the technical difficulties of endoscopic submucosal dissection (ESD), although opening the pocket remains challenging. We developed a novel technique of PCM with single-clip traction (PCM-CT), which uses a reopenable clip as a traction device to maintain stability during the procedure. No prospective study has compared the efficacy of PCM-CT and PCM. This study aimed to investigate the effectiveness of PCM-CT vs. PCM in a randomized controlled trial., Methods: This randomized controlled clinical trial was conducted at four Japanese institutions. Patients with superficial colorectal neoplastic lesions were included following Japanese guidelines for colorectal cancer. Seven moderately experienced endoscopists performed the ESD procedures using either PCM-CT or PCM., Results: 100 patients were enrolled in the study. Compared with PCM, PCM-CT achieved significantly faster mean (SD) dissection speed (21.4 [10.8] vs. 27.0 [14.5] mm2/min [95%CI 0.5 to 10.7], P = 0.03), and reduced the mean procedure time (81.8 [57.9] vs. 64.8 [47.6] minutes [95%CI -38.2 to 4.3], P = 0.12) and pocket-opening time (37.8 [33.0] vs. 30.0 [28.9] minutes [95%CI -20.2 to 4.6], P = 0.22). En bloc and R0 resection rates were not significantly different between the two groups (100% vs. 100%, P >0.99; 100% vs. 96%, P = 0.50, respectively). No significant differences were observed in adverse events between the two groups., Conclusion: ESD facilitated by the novel PCM-CT method appeared to be significantly faster than PCM. Both methods achieved high R0 resection rates., Competing Interests: H. Yamamoto: patent holder for a double-balloon endoscope and small caliber tip transparent hood produced by Fujifilm; consultant for Fujifilm; honoraria, grants, and royalties from Fujifilm. T. Morikawa, D. Nemoto, T. Kurokawa, T. Yamashina, Y. Hayashi, M. Kitamura, M. Okada, T. Takezawa, Y. Nakajima, Y. Kowazaki, H. Fukuda, T. Nomura, N. Lazaridis, N. Fukushima, and K. Sunada declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: Device-assisted enteroscopy (DAE) has become a well-established diagnostic and therapeutic tool for the management of small-bowel pathology. We aimed to evaluate the performance measures for DAE across the UK against the quality benchmarks proposed by the European Society of Gastrointestinal Endoscopy (ESGE)., Methods: We retrospectively collected data on patient demographics and DAE performance measures from electronic endoscopy records of consecutive patients who underwent DAE for diagnostic and therapeutic purposes across 12 enteroscopy centers in the UK between January 2017 and December 2022., Results: A total of 2005 DAE procedures were performed in 1663 patients (median age 60 years; 53% men). Almost all procedures (98.1%) were performed for appropriate indications. Double-balloon enteroscopy was used for most procedures (82.0%), followed by single-balloon enteroscopy (17.2%) and spiral enteroscopy (0.7%). The estimated depth of insertion was documented in 73.4% of procedures. The overall diagnostic yield was 70.0%. Therapeutic interventions were performed in 42.6% of procedures, with a success rate of 96.6%. Overall, 78.0% of detected lesions were marked with a tattoo. Patient comfort was significantly better with the use of deep sedation compared with conscious sedation (99.7% vs. 68.5%; P <0.001). Major adverse events occurred in only 0.6% of procedures., Conclusions: Performance measures for DAE in the UK meet the ESGE quality benchmarks, with high diagnostic and therapeutic yields, and a low incidence of major adverse events. However, there is room for improvement in optimizing sedation practices, standardizing the depth of insertion documentation, and adopting marking techniques to aid in the follow-up of detected lesions., Competing Interests: E.J. Despott has received educational and travel grants and speaker’s honoraria from Fujifilm, Aquilant, Diagmed, Laborie, and Medtronic (2007 to present); his department has received educational grants from Fujifilm, Pentax, Olympus, ERBE, Norgine, and Medtronic (2012 to present). The remaining authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: Dr Despott and Dr Murino have received unrestricted educational grants from Olympus Medical, Fujifilm, Pentax and Medtronic. Dr Despott has received speaker honoraria from Olympus medical, Fujifilm and Norgine, and consultant honoraria from Boston Scientific, Fujifilm and Ambu. Dr Murino has received speaker honoraria from GI supply and consultant honoraria from Boston Scientific and Pentax.

Competing Interests: Dr. Despott and Dr. Murino receive research/education support from Aquilant Medical, Fujifilm, Olympus, and Pentax Medical. Professor Yano receives research/education support from Fujifilm. All other authors have no conflict of interest to disclose.

Competing Interests: Alberto Murino has acted as a consultant for Boston Scientific and GI Supply. He has also received academic grants from Fujifilm, Aquilant Endoscopy, Norgine, and Olympus. Edward J. Despott has acted as a consultant for Boston Scientific and Ambu. He has also received academic grants and speaker honoraria from Fujifilm, Aquilant Endoscopy, Norgine, and Olympus. The other authors declare that they have no conflict of interest.

Competing Interests: Edward J. Despott has acted as a consultant for Boston Scientific and Ambu. He has also received academic grants and speaker honoraria from Fujifilm, Aquilant Endoscopy, Norgine and Olympus.Alberto Murino has acted as a consultant for Boston Scientific and GI supply. He has also received academic grants from Fujifilm, Aquilant Endoscopy, Norgine and Olympus.Tomonori Yano has received educational and speaker honoraria from Fujifilm corporation.All other authors declare that they have no conflict of interest.

Competing Interests: E. J. Despott receives research support from Aquilant Medical, Olympus, Pentax Medical, and Fujifilm. A. Murino receives research support from Aquilant Medical, Olympus, Pentax Medical, and Fujifilm. All other authors disclosed no financial relationships relevant to this publication.

Competing Interests: Dr. Despott has received research and education support from Fujifilm, Aquilant Medical, Pentax, and Olympus. Dr. Murino has received research and education support from Fujifilm and Aquilant Medical., (© Georg Thieme Verlag KG Stuttgart · New York.)