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Main Recommendations ESGE recommends the use of a graded pneumatic dilation protocol in achalasia, starting with a 30-mm dilation and followed by a 35-mm dilation at a planned interval of 2-4 weeks, with a subsequent 40-mm dilation when there is insufficient relief, over both a single balloon dilation procedure or the use of a larger balloon from the outset. Strong recommendation, high quality of evidence, level of agreement 100%. ESGE recommends being cautious in treating spastic motility disorders other than achalasia with peroral endoscopic myotomy (POEM). Strong recommendation, very low quality of evidence, level of agreement 87.5%. ESGE recommends against the routine use of botulinum toxin injections to treat patients with non-achalasia hypercontractile esophageal motility disorders (Jackhammer esophagus, distal esophageal spasm). However, if, in individual patients, endoscopic injection of botulinum toxin is chosen, ESGE recommends performing injections into four quadrants of the lower esophageal sphincter and in the lower third of the esophagus. Strong recommendation, low quality of evidence, level of agreement 78.6%. ESGE recommends that endoscopic pylorus-directed therapy should be considered only in patients with symptoms suggestive of gastroparesis in combination with objective proof of delayed gastric emptying using a validated test, and only when medical therapy has failed. Strong recommendation, very low quality of evidence, level of agreement 100%. ESGE recommends against the use of botulinum toxin injection in the treatment of unselected patients with gastroparesis. Strong recommendation, high quality of evidence, level of agreement 92.9%. ESGE recommends consideration of gastric peroral endoscopic myotomy (G-POEM) in carefully selected patients only, because it is an emerging procedure with limited data on effectiveness, safety, and durability. G-POEM should be performed in expert centers only, preferably in the context of a clinical trial. Strong r

ESGE suggests flexible endoscopic treatment over open surgical treatment as first-line therapy for patients with a symptomatic Zenker's diverticulum of any size.Weak recommendation, low quality of evidence, level of agreement 100 %.ESGE recommends that emerging treatments for Zenker's diverticulum, such as Zenker's peroral endoscopic myotomy (Z-POEM) and tunneling, be considered as experimental; these treatments should be offered in a research setting only.Strong recommendation, low quality of evidence, level of agreement 100 %.ESGE recommends against the widespread clinical use of transoral incisionless fundoplication (TIF) as an alternative to proton pump inhibitor (PPI) therapy or antireflux surgery in the treatment of gastroesophageal reflux disease (GERD), because of the lack of data on the long-term outcomes, the inferiority of TIF to fundoplication, and its modest efficacy in only highly selected patients. TIF may have a role for patients with mild GERD who are not willing to take PPIs or undergo antireflux surgery.Strong recommendation, moderate quality of evidence, level of agreement 92.8 %.ESGE recommends against the use of the Medigus ultrasonic surgical endostapler (MUSE) in clinical practice because of insufficient data showing its effectiveness and safety in patients with GERD. MUSE should be used in clinical trials only.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends against the use of antireflux mucosectomy (ARMS) in routine clinical practice in the treatment of GERD because of the lack of data and its potential complications.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends endoscopic cecostomy only after conservative management with medical therapies or retrograde lavage has failed.Strong recommendation, low quality evidence, level of agreement 93.3 %.ESGE recommends fixing the cecum to the abdominal wall at three points (using T-anchors, a double-needle suturing device, or

Probe-based confocal laser endomicroscopy (pCLE) provides microscopic imaging during an endoscopic procedure. Its introduction as a standard modality in gastroenterology has brought significant progress in management strategies, affecting many aspects of clinical care and requiring standardisation of practice and training.

Item does not contain fulltext, BACKGROUND: Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe. GOALS: We present the operating characteristics and performance of TC-325 in the largest registry to date of patients presenting with NVUGIB in everyday clinical practice. METHODS: Prospective anonymized data of device performance and clinical outcomes were collected from 10 European centers using the multicentre SEAL survey (Survey to Evaluate the Application of Hemospray in the Luminal tract). TC-325 was used as a monotherapy or as second-line therapy in combination with other hemostatic modalities at the endoscopists' discretion. RESULTS: Sixty-three patients (44 men, 19 women), median age 69 (range, 21 to 98) years with NVUGIB requiring endoscopic hemostasis were treated with TC-325. There were 30 patients with bleeding ulcers and 33 with other NVUGIB pathology. Fifty-five (87%) were treated with TC-325 as monotherapy; 47 [85%; 95% confidence interval (CI), 76%-94%] of them achieved primary hemostasis, and rebleeding rate at 7 days was 15% (95% CI, 5%-25%). Primary hemostasis rate for TC-325 in patients with ulcer bleeds was 76% (95% CI, 59%-93%). Eight patients, who otherwise may have required either surgery or interventional radiology, were treated with TC-325 as second-line therapy after failure of other endoscopic treatments, all of whom achieved hemostasis following the adjunct of TC-325. CONCLUSIONS: This multicentre registry identifies potentially useful characteristics of Hemospray (TC-325) when used either as monotherapy or as a rescue therapy in a wide variety of ulcer and nonulcer NVUGIB.

[EN] Computer assisted transcription tools can speed up the initial process of reading and transcribing texts. At the same time, new annotation tools open new ways of accessing the text in its graphical form. The balance and value of each method still needs to be explored. STATE, a complete assisted transcription system for ancient documents, was presented to the audience of the 2013 International Medieval Congress at Leeds. The system offers a multimodal interaction environment to assist humans in transcribing ancient documents: the user can type, write on the screen with a stylus, or utter a word. When one of these actions is used to correct an erroneous word, the system uses this new information to look for other mistakes in the rest of the line. The system is modular, composed of different parts: one part creates projects from a set of images of documents, another part controls an automatic transcription system, and the third part allows the user to interact with the transcriptions and easily correct them as needed. This division of labour allows great flexibility for organising the work in a team of transcribers., [ES] Las herramientas de ayuda a la transcripción automática pueden acelerar el proceso inicial de la lectura y transcripción de textos. Al mismo tiempo, las nuevas herramientas de anotación aportan nuevas formas de acceder al texto en su forma original gráfica. Sin embargo, todavía es necesario evaluar las bondades y capacidades de los distintos métodos. STATE, un completo sistema de asistencia a la transcripción de documentos antiguos, se presentó a la audiencia del International Medieval Congress de 2013 celebrado en Leeds. El sistema ofrece un entorno de interacción multimodal para ayudar a las personas en la transcripción de documentos antiguos: el usuario puede teclear, escribir en la pantalla con un lápiz óptico o corregir usando la voz. Cada vez que el usuario cambia de esta forma una palabra, el sistema utiliza la corrección para buscar errores en el resto de la línea. El sistema está dividido en diferentes módulos: uno crea proyectos a partir de un conjunto de imágenes de documentos, otro módulo controla el sistema de transcripción automática, y un tercer módulo permite al usuario interactuar con las transcripciones y corregirlas fácilmente cuando sea necesario. Esta división de las tareas permite una gran flexibilidad para organizar el trabajo de los transcriptores en equipo.

Computer assisted transcription tools can speed up the initial process of reading and transcribing texts. At the same time, new annotation tools open new ways of accessing the text in its graphical form. The balance and value of each method still needs to be explored. STATE, a complete assisted transcription system for ancient documents, was presented to the audience of the 2013 International Medieval Congress at Leeds. The system offers a multimodal interaction environment to assist humans in transcribing ancient documents: the user can type, write on the screen with a stylus, or utter a word. When one of these actions is used to correct an erroneous word, the system uses this new information to look for other mistakes in the rest of the line. The system is modular, composed of different parts: one part creates projects from a set of images of documents, another part controls an automatic transcription system, and the third part allows the user to interact with the transcriptions and easily correct them as needed. This division of labour allows great flexibility for organising the work in a team of transcribers., Las herramientas de ayuda a la transcripción automática pueden acelerar el proceso inicial de la lectura y transcripción de textos. Al mismo tiempo, las nuevas herramientas de anotación aportan nuevas formas de acceder al texto en su forma original gráfica. Sin embargo, todavía es necesario evaluar las bondades y capacidades de los distintos métodos. STATE, un completo sistema de asistencia a la transcripción de documentos antiguos, se presentó a la audiencia del International Medieval Congress de 2013 celebrado en Leeds. El sistema ofrece un entorno de interacción multimodal para ayudar a las personas en la transcripción de documentos antiguos: el usuario puede teclear, escribir en la pantalla con un lápiz óptico o corregir usando la voz. Cada vez que el usuario cambia de esta forma una palabra, el sistema utiliza la corrección para buscar errores en el resto de la línea. El sistema está dividido en diferentes módulos: uno crea proyectos a partir de un conjunto de imágenes de documentos, otro módulo controla el sistema de transcripción automática, y un tercer módulo permite al usuario interactuar con las transcripciones y corregirlas fácilmente cuando sea necesario. Esta división de las tareas permite una gran flexibilidad para organizar el trabajo de los transcriptores en equipo.

Rainbow trout (Oncorhynchus mykiss) were subjected to unilateral ovariectomy (ULO) during early vitellogenesis to examine the endocrine responses mediating the recruitment and growth of oocytes in the secondary (vitellogenic) growth phase. ULO induced recruitment of a second population of primary oocytes into the vitellogenic growth phase that then grew at a faster rate than oocytes in the control fish. Seven days post-ULO, the concentration of plasma salmonid FSH (sFSH = GtH I) was significantly higher than in controls and was elevated for at least 54 days. Maximal concentrations of sFSH in ULO fish (Day 21 post-ULO) were twice (10 ng/ml) those in controls. The data show that sFSH plays a primary role in mediating vitellogenic development. After ULO, plasma concentrations of estradiol-171 were significantly lower than in controls up until 21 days post-ULO. Thereafter, plasma concentrations of estradiol-17 1 did not differ from those in controls. The changes in concentrations of plasma estradiol-170 and sFSH in the ULO fish demonstrated that the secretion of sFSH is probably not controlled by negative feedback of estradiol-17 alone; in fish, as in mammals, it is likely that intragonadal autocrine/paracrine factors, such as inhibin and activin, also participate in the regulation of sFSH secretion. Plasma concentrations of testosterone did not appear to differ between the control and ULO fish. The responses in the production of estradiol-17j3 and testosterone indicate that the dynamics of sex steroid synthesis in ovarian follicles in ULO fish was different than in the ovaries of control fish.

Starting and keep going of a small local library is described, with special addresses for sustainable agriculture