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This article discusses the use of endoscopic submucosal dissection (ESD) as a treatment option for proximal colonic lesions. ESD is commonly used for rectal lesions due to the high risk of submucosal invasion, but its use for proximal lesions is not widely adopted. The study aimed to assess the technical and clinical outcomes of patients treated with ESD for lesions located proximally to the splenic flexure. The results showed that ESD and hybrid ESD were feasible for high-risk proximal colonic lesions, with a high rate of complete resection achieved. The study suggests that ESD may be a curative technique for patients with high-risk histological features. [Extracted from the article]

This article, published in the journal Endoscopy, presents the findings of a multicenter study conducted at six Italian referral centers. The study aimed to evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for lesions involving the ileocecal valve (ICV) compared to other right-side colon lesions. The results showed that ESD is a safe and effective treatment for right-side neoplasia involving the ICV when performed by expert endoscopists in Western referral centers. The study found no significant differences in en-bloc resection rate, R0 resection rate, procedure time, or rates of adverse events between the ICV group and the non-ICV group. [Extracted from the article]

This article discusses a new technique called saline immersion (SI) vessel pre-sealing that aims to reduce bleeding during third-space endoscopy (TSE) procedures. TSE procedures often require coagulation forceps to stop bleeding from large vessels, which can slow down the procedure and increase costs. The SI pre-sealing technique involves using electrocautery coagulation with the tip of the knife under saline solution to seal the vessel, eliminating the need for coagulation forceps. The study found that the SI pre-sealing technique reduced the need for coagulation retreatment and the use of dedicated hemostatic devices, without affecting procedural length or safety. The authors suggest that this technique could be beneficial for less experienced endoscopists. [Extracted from the article]

This article discusses the use of cold snare endoscopic mucosal resection (CS-EMR) as a new trend in treating large colorectal adenomas. The study aimed to assess the feasibility, safety, and efficacy of CS-EMR for proximal large adenomas. The results showed that CS-EMR had a 100% technical success rate with no adverse events. The recurrence rate at 6 months was 5.2%, but all recurrences were successfully re-treated in the same procedure. The study concludes that CS-EMR is both feasible and safe for treating large colorectal adenomas, but further research is needed to validate its efficacy. [Extracted from the article]

This article, published in the journal Endoscopy, presents a meta-analysis and systematic review of the use of Hybrid Argon Plasma Coagulation (H-APC) in the treatment of Barrett's esophagus. The study aimed to assess the safety and efficacy of H-APC compared to other techniques. The analysis of six studies involving 331 patients found that H-APC demonstrated promising efficacy and safety, with a high rate of complete eradication of intestinal metaplasia. The study also highlighted a favorable patient tolerability profile for H-APC. [Extracted from the article]

This article discusses a study that evaluated the effectiveness and safety of endoscopic submucosal dissection (ESD) for high-risk colorectal colitis-associated neoplasia (HR-CAN) in patients with inflammatory bowel disease (IBD). The study included 91 IBD patients who underwent ESD or hybrid-ESD for HR-CANs. The results showed that ESD was effective and safe, with high rates of en bloc and R0 resection. Adverse events occurred in 12.5% of cases but were managed endoscopically and conservatively. The study suggests that ESD can be a viable option for treating HR-CANs in IBD patients, but further research is needed to assess long-term outcomes. [Extracted from the article]

This article presents the initial results of a multicenter observational study on the Hybrid-APC (H-APC) technique for treating Barrett's esophagus (BE). The H-APC technique combines argon plasma coagulation (APC) with a saline injection for ablation therapy. The study collected data from 57 patients with BE who underwent H-APC ablation, with 38 patients completing the treatment so far. The results show that H-APC has high efficacy and safety, with a high tolerability profile and a limited number of treatment sessions required. However, further randomized comparative studies are needed to confirm its effectiveness. [Extracted from the article]

This article discusses a prospective study that aimed to evaluate the clinical efficacy and safety of endoscopic dilation with EsoFLIP in patients with benign esophageal strictures. EsoFLIP is a novel dilation balloon that uses high-resolution impedance planimetry to provide real-time visualization and monitoring of dilation. The study enrolled 10 patients with various types of esophageal strictures, and all dilation procedures were technically successful with no adverse events. After the procedure, there was a significant decrease in the severity and frequency of dysphagia, as well as an increase in stricture diameter and distensibility index. The authors conclude that endoscopic dilation with EsoFLIP is clinically effective and safe, and may potentially reduce fluoroscopy time exposure compared to traditional dilation methods. [Extracted from the article]

This article, published in the journal Endoscopy, examines the outcomes of different anesthesia techniques used in the endoscopic treatment of Zenker Diverticulum (ZD). The study, conducted at the Humanitas Research Hospital, analyzed data from January 2015 to November 2023 and compared outcomes between deep sedation (DS) and orotracheal intubation (IOT). The results showed that DS was non-inferior to IOT in terms of safety and efficacy, with similar rates of severe adverse events and recurrence. The study suggests that DS can be a viable option for ZD treatment in a tertiary setting with expertise in anesthesiology and therapeutic endoscopy. [Extracted from the article]

This article evaluates the efficacy, safety, and patient satisfaction of switching from off-label swallowed topical steroids (STCs) to budesonide orodispersible tablets (BOT) for the treatment of eosinophilic esophagitis (EoE). The study included 31 EoE patients who were non-responders to proton pump inhibitors and were receiving off-label STCs. The results showed that the switch to BOT was effective in achieving deep remission and maintaining previous remission. Patients also reported a higher willingness to take BOT compared to STCs. The study concludes that the switch to BOT is a safe and well-tolerated treatment option for EoE patients. [Extracted from the article]

This article, published in the journal Endoscopy, presents the results of a study that aimed to establish evidence-based guidelines for the safe and effective use of fluoroscopy in gastrointestinal endoscopic procedures. The study used a modified Delphi method to achieve consensus among 46 experts from six continents. After three rounds of voting, 31 statements achieved consensus, covering various categories such as patient safety, staff safety, education, pregnancy, and family planning. The accepted statements were rated highly in terms of priority, with mean scores ranging from 7.28 to 9.36 on a scale of 1 to 10. The guidelines aim to mitigate the risks of radiation exposure while maintaining the benefits of fluoroscopy, promoting a culture of safety in healthcare settings. [Extracted from the article]

This article discusses the Resect and Discard strategy for colorectal polyps, which suggests that endoscopists can use real-time prediction (optical diagnosis) of polyp histology during colonoscopy instead of post-polypectomy pathology. The study conducted a meta-analysis to estimate the accuracy of computer-aided diagnosis (CADx) systems in this strategy. The results showed that CADx-alone had a high sensitivity and negative predictive value, indicating good optical diagnosis performance. However, there were some outliers, highlighting the need for thorough investigation of CADx systems before use. It is important to note that not all CADx systems used in the study were regulatory approved, and most endoscopists had extensive experience in optical diagnosis. [Extracted from the article]

Background and study aim: Intrapapillary capillary loops (IPCLs) show distinct pattern changes corresponding to tumor progression and depth of invasion, important for in vivo characterization of superficial squamous cell carcinoma (SCC). We examined the relation between invasion depth and histopathologic IPCL diameter. Patients and methods: Prospectively, before lesion resection, magnification endoscopy and narrow band imaging were used to identify IPCL patterns of type V1 (corresponding to tumors limited to the mucosa; 10 patients) and type Vn (submucosally invading tumors; 10 patients). Post-resection, IPCL samples (type I [normal mucosa], n=103; V1, n=113; Vn, n=100) were stained with hematoxylin & eosin, CD34, and desmin, and vessel diameter measured using light microscopy. Results: Mean (standard deviation [SD]) histopathologic calibers of IPCLs of types I, V1, and Vn were significantly different, being 7.7 (2.8) μm, 21.9 (7.4) μm, and 65.2 (22.9) μm; type 1 vs. V1, P<0.001; V1 vs. Vn, P<0.001. Conclusions: Magnification endoscopy observation of IPCLs allows in vivo discrimination between intramucosal and submucosally invasive [ABSTRACT FROM AUTHOR]

Background and study aims: Resection of submucosal tumors by means of endoscopy has been reported using a variety of techniques, but cannot be performed safely in tumors originating from the muscularis propria. Using the submucosal tunnel created by the technique of peroral endoscopic myotomy (POEM), we report the first series describing the new technique of submucosal endoscopic tumor resection (SET) for tumors of the esophagus and cardia. Patients and methods: SETwas attempted in nine consecutive patients with tumors (size >2cm) of either the esophagus or cardia with clinical indications for lesion removal. Following creation of a submucosal tunnel from 5cm above the tumor, as described previously, the tumor was dissected from the overlying mucosa/submucosa and then carefully removed from the muscular layer using triangle-tip and insulated-tip knives. Following specimen retrieval through the tunnel, the orifice was closed by clips. Results: Of the nine patients, two had tumors that were too large (60mm and 75mm, respectively) to allow safe removal due to loss of endoscopic overview. All remaining tumors (maximal tumor extension 12-30mm) could be resected safely using this method. No complications occurred and follow-up was unremarkable. On histology, all tumors were resected completely (one gastrointestinal stromal tumor, five leiomyomas). The technique had to be modified in one patient with an aberrant pancreas. Conclusions: SET is a promising new technique for selected submucosal tumors in the esophagus and cardia up to a size of 4cm and should be studied further. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 3-year old female patient with down syndrome who was presented with growth retardation and achalasia. Achlasa was suspected due to vomiting, recurrent cough and aspiration pneumonia. The article discusses the pediatric use of peroral endoscopic myotomy (POEM) in treating achalasia.