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Esophageal cancer, comprising two histological types, adenocarcinoma and squamous cell carcinoma, has a poor prognosis because it is frequently diagnosed at advanced stage. In contrast, survival of patients with superficial cancer is excellent. Improvement of endoscopic devices (high-definition, chromoendoscopy, zoom) and the development of new endoscopic classification has significantly improved the ability to detect and characterize esophageal lesions. Endoscopic treatments are now recognized as the gold standard treatment for superficial esophageal cancers, with an excellent curative resection rate, and a lower morbidity compared to surgery. For superficial tumors, in the absence of ulceration, or stricturing lesion, en-bloc "staging" resection can be proposed. Pathology will define the curative nature of the resection. In case of a non-curative resection, rescue treatment (surgery, radiotherapy or radiochemotherapy) may be proposed. Digestive endoscopy has a major role in the management of Barrett's esophagus to prevent adenocarcinoma and limit the risk of metachronous cancer after curative resection. Artificial intelligence should play an important role in the detection and characterization of esophageal lesions in the future, but has not been validated in clinical practice, yet. [ABSTRACT FROM AUTHOR]

The incidence of esophageal squamous cell carcinoma (ESCC) has been divided by 3 in France over the last 30 years, but this tumor remains associated with a poor prognosis. The main prognostic factor is the tumor stage at the time of diagnosis. ESCC does not cause any symptom in its early stages and is often diagnosed at an advanced stage: less than 10 % of ESCCs are diagnosed at a localized stage (≤ T2). No screening program exists in France nationwide or in high-risk individuals. Early (T1) ESCCs are eligible for endoscopic resection by endoscopic submucosal dissection (ESD), which is as effective as surgery in terms of overall survival and recurrence-free survival, and associated with a much lower morbidity and mortality. ESD is considered curative in case of an en-bloc resection, histologically complete, and with a limited metastatic risk, as evaluated based on histopronostic factors present on the resection specimen. In case of positive deep resection margins, deep submucosal invasion, poorly differentiated tumor, or lymphatic and/or vascular invasion, the resection is considered non-curative and further treatment should be considered. After each ESD for superficial ESCC, the need for further treatment is discussed at a dedicated tumor board, weighting the risk of metastases against the patient's age and co-morbid conditions, and the risks associated with the treatment. [ABSTRACT FROM AUTHOR]

Adenomas or adenocarcinomas of the ampulla are rare and mostly diagnosed fortuitously during an endoscopy performed for another indication. For a long time, surgical resection by pancreatic duodenectomy was the standard, at the cost of a significant morbidity and mortality. Transduodenal papillectomy is a less morbid surgical alternative. Nowadays, advances in interventional endoscopy allow a minimally invasive approach. Ampullary adenomas can be completely removed by endoscopic resection which should be the first treatment to propose. The risks of endoscopic papillectomy are dominated by acute pancreatitis and hemorrhage. This endoscopic technique could be proposed under certain conditions for localized adenocarcinomas without lymph node risk. The purpose of this review is to focus on the management of localized ampullary lesions that can benefit from endoscopic or surgical management. [ABSTRACT FROM AUTHOR]

The management of upper gastrointestinal hemorrhage has improved considerably with advances in endoscopic management techniques and peri-interventional care. Although traditional endoscopic treatments remain irreplaceable to date, new endoscopic techniques are emerging and could rapidly change our practices. For instance, in ulcer disease, OTSC (over-the-scope-clip) has a high success rate as a rescue treatment or as first-line treatment for bleeding ulcers that are difficult to treat. Hemostatic powders are safe, easy to use and allow rapid rescue hemostasis especially for diffuse or difficult to treat lesions. The use of endoscopic suture systems is also under development. In case of refractory bleeding, embolization during arteriography or hemostasis surgery should always be considered. In the management of gastrointestinal bleeding secondary to portal hypertension, elastic ligation of esophageal varices or injection of glue into gastric varices remain the first-line treatments. The use of echo-endoscopy to better guide the injection of biological glue in the treatment of gastric varices is a technique under development. A covered self-expanding metal esophageal stent may be considered as an alternative to the tamponade tube (Blackmore) for refractory bleeding. In this paper, we will discuss the main advances in endoscopic hemostasis techniques for upper gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

Early gastrointestinal cancers or T1 cancers are limited to the mucosa or the submucosa. Virtually all of these tumors are eligible to a complete endoscopic resection by endoscopic mucosal resection or submucosal dissection, allowing avoiding upfront surgical resection. However, endoscopic technical difficulties or uncertainties in endoscopic histological prediction can lead to histologically incomplete resections, requiring salvage treatment. Other tumors, although entirely resected, are considered to have a significant risk of metastasis, warranting adjuvant therapy, depending on histological criteria on the resection specimen. The management of these lesions needs to take into account several parameters, among which the patient comorbid conditions, wishes, endoscopic resection modality, lesion location, qualitative and quantitative histological criteria. This is the role of a multidisciplinary tumor board dedicated to early gastrointestinal cancers. Involving gastrointestinal endoscopists, oncologists, digestive surgeons, pathologists, radiation oncologists and radiologists, its aims at stating the curative nature of the endoscopic resection procedure, or indicating additional treatments. [ABSTRACT FROM AUTHOR]

Zenker's Diverticulum, named after Dr Friedrich Albert von Zenker (1825-1898) who in 1877 reported a series of 23 cases and first hypothesized its pathophysiology, is an uncommon pathology, occurring in elderly patients, predominantly males. It is suspected by the association of dysphagia and regurgitation, and diagnosed by a barium swallow radiography with video fluoroscopy. For a long time, its treatment was reserved for open surgery, then rigid endoscopy performed by ENT surgeons, despite a high morbidity rate for the former and technical limitations for the latter. Finally, the first septotomy with a flexible endoscope was reported very recently in 1995 by two different teams. Since then, endoscopic techniques have been adapted over the last two decades with increasing success and safety profile replacing conventional surgery as first line treatment according to ESGE recommendations (European Society of Gastrointestinal Endoscopy). This mini-review aims to provide a synthesis of therapeutic methods with emphasis on the availability of flexible endoscopy and its future progress with the advent of Z-POEM. [ABSTRACT FROM AUTHOR]

Adverse events in digestive endoscopy are hopefully rare, but they can have a significant impact on the morbidity and mortality of each patient. They are responsible for sometimes lengthy management that can alter the comfort of life, or for emergency surgical management with its own morbidity. Moreover, the ease of access to diagnostic endoscopy and the increase in techniques and indications for therapeutic endoscopy mean that, despite technical progress, the number of complications following endoscopic management remains significant. Moreover, the population concerned by these procedures is composed of older patients with comorbidities exposing them to more severe complications. It is therefore essential for each gastroenterologist to be aware of these clinical situations in order to clearly inform the patients, to know how to identify those who are at higher risk, and to adopt the most appropriate preventive attitude. A good knowledge of these risks also allows each operator to define the best therapeutic attitude for each patients. [ABSTRACT FROM AUTHOR]

After wide-spreading of carbon dioxid use in endoscopy, underwater procedures are the next big step for the endoscopic technical improvement. In the field of diagnosis, water-assisted colonoscopy is associated with best patient reported outcomes such as pain, but also with higher quality criteria such as cæcal intubation rate, bowel cleanliness and adenoma detection rates. Despite its need for a longer examination duration, water-exchange colonoscopy should be preferred to water-immersion colonoscopy. The better tolerance of water-assisted colonoscopy with excellent outcomes should lead to more examinations without general anesthesia, allowing quicker care for patients. Underwater mucosal resection is a technique of choice, especially for sessile or flat lesions, without prior submucosal injection, providing a distance between the muscular layer and the lesion thanks to flotation effect and the minimal distension of the colonic wall during immersion. Underwater mucosal resection improves the en-bloc resection rate and complete resection rate compared to conventional mucosal resection without increasing the adverse event rate, in particular perforation. This strategy is also feasible and safe in the duodenum. Underwater techniques also reduce the environmental footprint since fewer devices are needed and bacteriological mastered water can be used. [ABSTRACT FROM AUTHOR]

Résumé: Les tumeurs superficielles œsophagiennes sont des lésions fréquentes, de mauvais pronostic oncologique. Compte tenu des progrès de l'endoscopie diagnostique, ces lésions sont diagnostiquées à des stades de plus en plus précoces, autorisant des résections endoscopiques pour les stades superficiels. L'ESGE a édité en 2015 des critères permettant de considérer comme curative une résection de lésion superficielle œsophagienne. Ces critères diffèrent en fonction du type histologique (adénocarcinome ou carcinome épidermoïde), notamment en raison d'un risque d'invasion ganglionnaire plus élevé en cas de carcinome épidermoïde. À ce jour, peu de données existent concernant la résection endoscopique des cancers superficiels de l'œsophage dans un contexte de cirrhose ou d'hypertension portale, alors que des facteurs de risque confondant existent entre maladies hépatiques et risque de cancer œsophagien. Dans cette mini-revue, nous recensons les quelques études de cas ou séries rétrospectives à effectifs limités, décrivant différentes techniques visant à diminuer le risque hémorragique, telles que la ligature de varices œsophagiennes, la pose d'un shunt intrahépatique par voie transjugulaire, ou la technique du « ligate and let go ». Il existe plus de données concernant la résection endoscopique de lésions gastriques en cas de cirrhose ou d'hypertension portale, ainsi qu'une étude traitant de la résection de tumeurs superficielles toutes localisations confondues (tube digestif haut et bas) chez le patient cirrhotique. Superficial esophageal tumors are common lesions with a poor oncological prognosis. With advances in diagnostic endoscopy, these lesions are being diagnosed at increasingly earlier stages, allowing endoscopic resections for superficial stages. The ESGE published criteria in 2015 to classify as curative a resection of a superficial esophageal lesion. These criteria differ according to the histological type of tumor (adenocarcinoma or squamous cell carcinoma), in particular because of a higher risk of lymph node invasion in the case of squamous cell carcinoma. To date, few data exist concerning endoscopic resection of superficial esophageal cancers in the context of cirrhosis or portal hypertension. There are only case reports or small retrospective series describing different techniques to reduce the risk of bleeding from portal hypertension, such as endoscopic band ligation of esophageal varices, Transjugular intrahepatic portosystemic shunt, or the "ligate and let go" technique. There are more data about endoscopic resection of gastric lesions in cirrhosis or portal hypertension, as well as one study about resection of superficial tumors in all locations (upper and lower gastrointestinal tract) in the cirrhotic patient. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is a frequent condition with a significant morbidity and mortality (approximately 20% are complicated forms). Peripancreatic collections are a very common complication. The 2012 Atlanta classification distinguishes between 4 types of peripancreatic collections. Acute peripancreatic fluid collections and pseudocysts develop after acute interstitial oedematous pancreatitis and acute necrotic collections. Walled-off necrosis develops after acute necrotizing pancreatitis. Although these collections are mostly asymptomatic, it is sometimes necessary to drain them when symptoms appear. Management by endoscopic ultrasound (EUS) is the gold standard. In this review of the literature, we will focus only on the pseudocysts' drainage. With the rapid development of therapeutic EUS, new stents have been developed: lumen apposing metal stent (LAMS). Several studies focused on their use in peripancreatic collections drainage and particularly in pseudocysts. The technical and clinical successes are very high for this type of stent, above 90% for these two criteria. However, the cost of these stents is significant. LAMS redefine the management of peripancreatic collections. However, it is necessary to manage this type of condition in a collegial manner, due to sometimes-serious complications at the time of insertion or afterwards. Their superiority seems undeniable in the management of walled-off necrosis, but as far as pseudocysts with fluid content are concerned, the debate remains open. New studies should be carried out to clarify the position of these stents and their complications, especially in the management of pseudocysts. [ABSTRACT FROM AUTHOR]