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Main recommendations: Endoscopic mucosal resection (EMR) is the standard of care for the complete removal of large (≥ 10 mm) nonpedunculated colorectal polyps (LNPCPs). Increased detection of LNPCPs owing to screening colonoscopy, plus high observed rates of incomplete resection and need for surgery call for a standardized approach to training in EMR. 1 Trainees in EMR should have achieved basic competence in diagnostic colonoscopy, < 10-mm polypectomy, pedunculated polypectomy, and common methods of gastrointestinal endoscopic hemostasis. The role of formal training courses is emphasized. Training may then commence in vivo under the direct supervision of a trainer. 2 Endoscopy units training endoscopists in EMR should have specific processes in place to support and facilitate training. 3 A trained EMR practitioner should have mastered theoretical knowledge including how to assess an LNPCP for risk of submucosal invasion, how to interpret the potential difficulty of a particular EMR procedure, how to decide whether to remove a particular LNPCP en bloc or piecemeal, whether the risks of electrosurgical energy can be avoided for a particular LNPCP, the different devices required for EMR, management of adverse events, and interpretation of reports provided by histopathologists. 4 Trained EMR practitioners should be familiar with the patient consent process for EMR. 5 The development of endoscopic non-technical skills (ENTS) and team interaction are important for trainees in EMR. 6 Differences in recommended technique exist between EMR performed with and without electrosurgical energy. Common to both is a standardized technique based upon dynamic injection, controlled and precise snare placement, safety checks prior to the application of tissue transection (cold snare) or electrosurgical energy (hot snare), and interpretation of the post-EMR resection defect. 7 A trained EMR practitioner must be able to manage adverse events associated with EMR including intraprocedural bleeding and perforation, and post-procedural bleeding. Delayed perforation should be avoided by correct interpretation of the post-EMR defect and treatment of deep mural injury. 8 A trained EMR practitioner must be able to communicate EMR procedural findings to patients and provide them with a plan in case of adverse events after discharge and a follow-up plan. 9 A trained EMR practitioner must be able to detect and interrogate a post-endoscopic resection scar for residual or recurrent adenoma and apply treatment if necessary. 10 Prior to independent practice, a minimum of 30 EMR procedures should be performed, culminating in a trainer-guided assessment of competency using a validated assessment tool, taking account of procedural difficulty (e. g. using the SMSA polyp score). 11 Trained practitioners should log their key performance indicators (KPIs) of polypectomy during independent practice. A guide for target KPIs is provided in this document. [ABSTRACT FROM AUTHOR]

This article discusses the use of HaemoCer PLUS, a hemostatic powder, in the treatment and prevention of lower gastrointestinal (GI) bleeding after endoscopic resectional procedures. GI bleeding is a common complication of these procedures, and current treatments include injection therapy, mechanical therapy, and thermal therapy. The study aims to establish a multicenter registry to collect data on the use of HaemoCer PLUS for the prevention of delayed bleeding after colonic endoscopic resectional procedures. Preliminary results suggest that HaemoCer PLUS may be an effective additional therapy for preventing bleeding in patients with large colonic endoscopic resections who are on ongoing antiplatelet therapy. However, managing combined antiplatelet and anticoagulant therapy in patients with comorbidities remains challenging. [Extracted from the article]

This article discusses a case study of a 54-year-old woman who underwent endoscopic submucosal dissection (ESD) for a tumor in the rectum. The ESD procedure resulted in post-operative bleeding, and various techniques were attempted to control the bleeding without success. The Apollo Overstitch suturing system was then used, which effectively achieved immediate and long-lasting bleeding control. The article concludes that this suturing system is a safe and effective option when other methods of endoscopic hemostasis have failed. [Extracted from the article]

This article, published in the journal Endoscopy, compares the efficacy of hemostatic powder (HP) with conventional treatments for malignancy-related upper gastrointestinal bleeding (UGIB). The study analyzed data from 213 patients with UGIB, with 86 patients treated with HP and 127 patients treated with conventional hemostatic treatments. The results showed that HP had a higher initial hemostasis success rate compared to conventional treatments. However, there were no significant differences in terms of blood transfusion, rebleeding rates, length of hospitalization, and 30-day all-cause mortality. The study suggests that HP may be an effective and safe method for managing acute malignancy-related UGIB, but further research is needed. [Extracted from the article]

This article discusses the role of the expert Endoscopy Nurse in performing endoscopic full-thickness resection (EFTR) procedures. The nurse assembles the device and acts as a second operator alongside the endoscopist. The success of the procedure depends on the collaboration between the nurse and the endoscopist. The article presents the results of 46 procedures performed in their Endoscopy Unit, with all cases achieving complete resection. The histological examination revealed various findings, including low grade dysplasia, high grade dysplasia, and adenocarcinoma foci. There were no major complications, and any bleeding was successfully treated. The article concludes that EFTR is a promising technique that can be an alternative to surgery, reducing hospitalization costs. The collaboration between the physician and the experienced Endoscopy Nurse is crucial for the success of the procedure. [Extracted from the article]

The net effect is precise and clean tissue excision, limited thermal injury to the submucosal bed beneath the lesion, and sharp crisp mucosal incision margins where the lesion has been removed, which facilitates subsequent evaluation for potential residual adenoma. I inspect the mucosal defect after every resection for adequacy of resection and DMI (Fig. 2 Endoscopic views showing: a - c a 40-mm 0-IIa granular lesion treated with wide-field endoscopic mucosal resection; d - f endoscopic mucosal resection (EMR) of a 90 % circumferential 0-IIa + Is granular lesion, with snare-tip soft coagulation applied to the margin of the post-EMR defect at completion of the procedure for the prevention of adenoma recurrence. [Extracted from the article]

2 Endoscopic images showing: a the difficulty of locating the bleeding artery because of the tumor and surrounding mucosa; b successful control of the bleeding after the wound had been expanded, which allowed the transected artery to be seen. This allowed the bleeding artery to be seen and the bleeding was then controlled by precisely applying electrocoagulation (Fig. [Extracted from the article]

Introduction Although the indications for endoscopic procedures have increased in recent times, there are also some limitations. This review discusses the practical points to prevent and treat complications in microendoscopic spine surgery. Material and Methods A literature search was conducted for the relevant articles after a topic search on PubMed, Google Scholar, and Medline. The review is based on the experience of 1,574 spinal endoscopic procedures performed by the senior author. Results Advantages of endoscopic surgery include better visualization, panoramic vision, and the ability to work around corners. Limitations with endoscopic procedures include proximal blind areas, obstruction in instrument handling due to a narrow corridor, disorientation, frequent lens fogging, loss of depth perception, and difficulty in achieving hemostasis, leading to complications and longer operative time during the learning curve. Conclusion Surgeons need to learn endoscopic skills in addition to microsurgical ones to perform microendoscopic procedures properly. Attending live workshops, watching operative videos, visiting various departments, watching an experienced and accomplished endoscopic surgeon, proper case selection, a multidisciplinary team approach, practicing on models, hands-on cadaveric workshops, laboratory training, and simulators can improve results and shorten the learning curve. [ABSTRACT FROM AUTHOR]

Background and study aim: The endoscopic hemostatic therapies currently available do not always result in hemostasis of gastrointestinal bleeding. Oxidized regenerated cellulose (ORC) mesh is a widely available surgical hemostatic material. The aim of this study was to evaluate the hemostatic efficacy of ORC in experimental gastric hemorrhage after endoscopic resection. Methods: This was a prospective, two-stage experimental, Phase I, proof-of-concept study. In Stage 1, eight gastric mucosal lesions were created in anticoagulated rabbits and treated with ORC (closed or open pores). In Stage 2, the endoscopic introduction and application of ORC mesh pieceswere evaluated in a porcine model of endoscopic submucosal dissection (ESD). Results: In Stage 1, hemostasis was achieved in all lesions. Hemostasis was achieved more rapidly with closed-pore than open-pore ORC (24.5 vs. 66.5 seconds) (P<0.01). At 24 hours, all lesions showed persistent hemostasis. There were no episodes of rebleeding, complications, or mortality. In Stage 2, the endoscopic introduction of ORC pieces and application with a biopsy forceps were feasible in all ESD lesions. Conclusions: ORC was an effective hemostatic agent for bleeding lesions following mucosal resection in anticoagulated rabbits. Closed-pore ORC achieved hemostasis faster than open-pore ORC. Endoscopic introduction and release of ORC were feasible. [ABSTRACT FROM AUTHOR]

Nonvariceal upper gastrointestinal (UGI) bleeding recurs after appropriate endoscopic therapy in 10%-15% of cases. The mortality rate can be as high as 25% when bleeding recurs, but there is no consensus about the best modality for endoscopic re-treatment. The aim of this study was to evaluate clipping and detachable snaring (CDS) for rescue endoscopic control of nonvariceal UGI hemorrhage. We report a case series of seven patients from a Korean tertiary center who underwent endoscopic hemostasis using the combined method of detachable snares with hemoclips. The success rate of endoscopic hemostasis with CDS was 86%: six of the seven patients who had experienced primary endoscopic treatment failure or recurrent bleeding after endoscopic hemostasis were treated successfully. In conclusion, rescue endoscopic bleeding control by means of CDS is an option for controlling nonvariceal UGI bleeding when no other method of endoscopic treatment for recurrent bleeding and primary hemostatic failure is possible. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 53-year-old white man who presented to the emergency room with a 2-day history of hematemesis and melena, and who underwent endoscopic dual therapy for giant peptic ulcer hemorrhage.