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Main Statements: This ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1 ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2 ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3 ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4 Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5 ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7 ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee's maintenance of competence. 9 ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10 ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees. [ABSTRACT FROM AUTHOR]

Despite a growing body of evidence, there are limited data regarding the impact of hands-on training on patient safety, with most studies of trainee performance reporting adverse events (AEs) as either a secondary outcome [8][9] or not at all [10][11]. Study groups As there is significant variation in training programs and credentialing across European centers, trainees were defined as endoscopists who had performed fewer than 200 ERCP procedures independently and were working under the direct supervision of an experienced endoscopist (> 1000 ERCP procedures). Graph Introduction Endoscopic retrograde cholangiopancreatography (ERCP) remains one of the most challenging endoscopic procedures to master, as it is both technically demanding and incurs significant risk [1]. [Extracted from the article]

Background: Endoscopic duodenal stenting is the current standard treatment for malignant gastric outlet obstruction (GOO) in patients with limited life expectancy. However, duodenal stenting is prone to stent dysfunction. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel technique with potentially superior stent patency. We compared clinical success, safety, and stent dysfunction of EUS-GE and duodenal stenting in patients with malignant GOO using propensity score matching.Methods: This international, multicenter, retrospective study analyzed consecutive patients undergoing EUS-GE or duodenal stenting for GOO between 2015 and 2021 in three European centers. Primary outcomes were clinical success (GOO scoring system [GOOSS] ≥ 2) and stent dysfunction (GOOSS ≤ 1 after initial clinical success). A propensity score matching (1:1) analysis was performed using age, sex, underlying disease, disease stage, ascites, and peritoneal carcinomatosis as variables.Results: 214 patients underwent EUS-GE (n = 107) or duodenal stenting (n = 107). After propensity score matching, 176 patients were matched and compared. Technical success rates for EUS-GE and duodenal stenting were 94 % (95 %CI 89 %-99 %) vs. 98 % (95 %CI 95 %-100 %), respectively (P = 0.44). Clinical success rates were 91 % (95 %CI 85 %-97 %) vs. 75 % (95 %CI 66 %-84 %; P = 0.008). Stent dysfunction occurred in 1 % (95 %CI 0-4 %) vs. 26 % (95 %CI 15 %-37 %) of patients (P < 0.001). Adverse event rate was 10 % (95 %CI 4 %-17 %) vs. 21 % (95 %CI 12 %-29 %; P = 0.09).Conclusion: EUS-GE had higher clinical success and lower stent dysfunction, with similar safety, compared with duodenal stenting, suggesting that EUS-GE may be preferred over duodenal stenting in patients with malignant GOO. [ABSTRACT FROM AUTHOR]

1:  ESGE recommends a prolonged course of a prophylactic broad-spectrum antibiotic in patients with ascites who are undergoing therapeutic endoscopic ultrasound (EUS) procedures.Strong recommendation, low quality evidence. 2:  ESGE recommends placement of partially or fully covered self-expandable metal stents during EUS-guided hepaticogastrostomy for biliary drainage in malignant disease.Strong recommendation, moderate quality evidence. 3:  ESGE recommends EUS-guided pancreatic duct (PD) drainage should only be performed in high volume expert centers, owing to the complexity of this technique and the high risk of adverse events.Strong recommendation, low quality evidence. 4:  ESGE recommends a stepwise approach to EUS-guided PD drainage in patients with favorable anatomy, starting with rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP), followed by antegrade or transmural drainage only when RV-ERP fails or is not feasible.Strong recommendation, low quality evidence. 5:  ESGE suggests performing transduodenal EUS-guided gallbladder drainage with a lumen-apposing metal stent (LAMS), rather than using the transgastric route, as this may reduce the risk of stent dysfunction.Weak recommendation, low quality evidence. 6:  ESGE recommends using saline instillation for small-bowel distension during EUS-guided gastroenterostomy.Strong recommendation, low quality evidence. 7:  ESGE recommends the use of saline instillation with a 19G needle and an electrocautery-enhanced LAMS for EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) procedures.Strong recommendation, low quality evidence. 8:  ESGE recommends the use of either 15- or 20-mm LAMSs for EDGE, with a preference for 20-mm LAMSs when considering a same-session ERCP.Strong recommendation, low quality evidence. [ABSTRACT FROM AUTHOR]

1: ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available.Strong recommendation, moderate quality evidence. 2: ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers.Weak recommendation, moderate quality evidence. 3: ESGE recommends that EUS-guided pancreatic duct (PD) drainage should only be considered in symptomatic patients with an obstructed PD when retrograde endoscopic intervention fails or is not possible.Strong recommendation, low quality evidence. 4: ESGE recommends rendezvous EUS techniques over transmural PD drainage in patients with favorable anatomy owing to its lower rate of adverse events.Strong recommendation, low quality evidence. 5: ESGE recommends that, in patients at high surgical risk, EUS-guided gallbladder drainage (GBD) should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions in EUS-GBD.Strong recommendation, high quality of evidence. 6: ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery.Strong recommendation, low quality evidence. 7: ESGE recommends that EUS-GE may be considered in the management of afferent loop syndrome, especially in the setting of malignancy or in poor surgical candidates. Strong recommendation, low quality evidence. 8: ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP.Weak recommendation, low quality evidence. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) was planned using the Wireless Simplified Technique (WEST) [1]. 1 Endoscopic ultrasound (EUS) images of the first EUS-guided gastrojejunostomy showing: a electrocautery-assisted advancement of the lumen-apposing metal stent with a challenging visualization of the puncture trajectory and cautery effect visible (arrows), initially suggesting successful jejunal access; b the catheter tip (arrow) at the end of the placement procedure. [Extracted from the article]

During WEST, this is achieved by catheter-based saline instillation, leading to small-bowel distension and subsequent gastric wall approximation. In the last decade, EUS-guided gastroenterostomy (EUS-GE) has evolved into a first-line approach to managing patients with malignant gastric outlet obstruction (GOO) [1]. The first technique (direct technique over a guidewire) uses an EUS-guided fine-needle aspiration needle to instill diluted contrast and/or saline into the target loop, followed by stepwise deployment of a wire-guided lumen-apposing metal stent (LAMS). [Extracted from the article]

Whereas retrospective literature confirms the comparable clinical success of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) and surgical gastrojejunostomy (SGJ) [1][2], no head-to-head comparison exists of their caliber and long-term patency. 4 Surgical gastrojejunostomy caliber evaluated with a 20-mm dilation balloon, perfectly fitting the anastomosis. [Extracted from the article]

Michiel Bronswijk received grants from Prion Medical, Taewoong as well as Takeda, and has consultancy agreements with Prion Medical - Taewoong. However, long-term PEG feeding, improper feeding tube care, and potentially smaller or harder discs have been associated with development of buried bumper syndrome in approximately 1.5 % of patients [1][2][3][4]. [Extracted from the article]

Various diseases have been associated with hepatobiliary cysts, such as autosomal dominant polycystic liver disease (ADPLD) and primary bile duct cysts. These cystic lesions may develop in the intrahepatic and/or extrahepatic bile duct wall and correlate with peribiliary gland ectasia on histology [1]. Magnetic resonance imaging (T2 RARE sequence) shows significant intrahepatic and extrahepatic bile duct lesions without clear signs of neoplasia or diffusion-restrictive lesions. [Extracted from the article]

B Video 1 b Treatment of an impacted pancreatic duct stone by snare-assisted stone extraction and pancreatoscopy-guided lithotripsy. Our case illustrates the usefulness of snare-assisted treatment of impacted MPD stones, and highlights the multimodal treatment occasionally required to achieve complete ductal clearance. [Extracted from the article]

3 Fluoroscopic image revealing distal migration of the self-expandable metal stent (SEMS) into the small bowel lumen, while another fully covered SEMS is being placed into the left bile duct, creating an EUS-guided hepaticogastrostomy. Both the migrated SEMS and double-pigtail stent were scheduled for double-balloon enteroscopy-assisted retrieval after completion of endoscopic biliary leak treatment. With the left-sided bile duct dilation and surgically altered anatomy in mind, EUS-guided antegrade stenting was attempted. [Extracted from the article]

Chest computed tomography (CT) subsequently revealed signs of perforation (Fig. At our center, cap-assisted upper GI endoscopy was performed with the patient under general anesthesia and showed a longitudinal laceration of the cricopharyngeal muscle, extending into the proximal esophagus (Fig. 3 Computed tomography (CT) image of the thorax showing a favorable outcome after cap-and-suction hemoclip closure, without any residual signs of perforation. [Extracted from the article]

An abdominal computed tomography (CT) scan was performed to rule out neoplasia. Surprisingly, the scan revealed extensive gastroduodenal distention and a high-grade stenosis of the third part of the duodenum (D3) caused by extrinsic compression by the superior mesenteric artery (Fig. 1 Computed tomography imaging revealing significant gastric distention and dilatation of the proximal duodenum. [Extracted from the article]

None An 11-year-old patient was referred to our endoscopy unit following two bouts of acute pancreatitis of unclear cause. However, our case illustrates that when sphincterotomy fails, needle-knife-assisted cystotomy can provide sufficient drainage in patients with type III choledochal cysts. [Extracted from the article]

The authors declare that they have no conflict of interest. letter In the November issue of I Endoscopy i , the Dutch endoscopic full-thickness resection (eFTR) group shared the results of their 3-year colorectal eFTR registry [1]. Conversely, in lesions that completely involve the appendiceal orifice, obstruction may perhaps have occurred during lesion progression well before the procedure, and eFTR-induced occlusion may therefore not lead to significant additional luminal obstruction, potentially explaining the lower rates of appendicitis. [Extracted from the article]