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Objectives: The health-care sector contributes 4.6% of global greenhouse gas emissions, with gastroenterology playing a significant role due to the widespread use of gastrointestinal (GI) endoscopy. In this review, we aim to understand the carbon footprint in gastroenterology practice associated with GI endoscopy, conferences and recruitment, identify barriers to change, and recommend mitigating strategies., Methods: A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted to explore the carbon footprint in gastroenterology practice, focusing on endoscopy, inpatient and outpatient settings, and recruitment practices. Recommendations for mitigating the carbon footprint were derived., Results: This narrative review analyzed 34 articles on the carbon footprint in gastroenterology practice. Carbon footprint of endoscopy in the United States is approximately 85,768 metric tons of CO 2 emission annually, equivalent to 9 million gallons of gasoline consumed, or 94 million pounds of coal burned. Each endoscopy generates 2.1 kg of disposable waste (46 L volume), of which 64% of waste goes to the landfill, 28% represents biohazard waste, and 9% is recycled. The per-case manufacturing carbon footprint for single-use devices and reusable devices is 1.37 kg CO 2 and 0.0017 kg CO 2 , respectively. Inpatient and outpatient services contributed through unnecessary procedures, prolonged hospital stays, and excessive use of single-use items. Fellowship recruitment and gastrointestinal conferences added to the footprint, mainly due to air travel and hotel stays., Conclusion: Gastrointestinal endoscopy and practice contribute to the carbon footprint through the use of disposables such as single-use endoscopes and waste generation. To achieve environmental sustainability, measures such as promoting reusable endoscopy equipment over single-use endoscopes, calculating institutional carbon footprints, establishing benchmarking standards, and embracing virtual platforms such as telemedicine and research meetings should be implemented., (© 2023 Japan Gastroenterological Endoscopy Society.)

Description: The purpose of this American Gastroenterological Association (AGA) Institute Rapid Clinical Practice Update (CPU) Communication is to review the available evidence and provide expert advice regarding the evolving management of patients taking GLP-1 receptor agonists prior to endoscopy., Methods: This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This communication incorporates important and recently published studies in this field, and it reflects the experiences of the authors who are experts in bariatric medicine and/or endoscopy., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

The present paper reflects the position of the Italian Association for Neuroendocrine Tumors (Itanet), the Italian Society of Gastroenterology (SIGE), and the Italian Society of Digestive Endoscopy (SIED) regarding the management of patients affected by gastric, duodenal, and rectal neuroendocrine neoplasms (NENs) amenable to endoscopic treatment. The key questions discussed in this paper are summarized in Table 1. Data were extracted from the MEDLINE database through searches; expert opinions and recommendations are provided in accordance with the available scientific evidence and the authors' expertise. Recommendations are presented alongside a level of evidence and grade of recommendation based on the GRADE system. This paper specifically focuses on subgroups of NENs considered suitable for endoscopic management according to current international guidelines: i. well-differentiated gastric neuroendocrine tumors (gNET) type 1 < 2 cm and selected cases of type 3; ii. well-differentiated duodenal, non-functioning, non-ampullary NET with size < 2 cm; and well-differentiated rectal NET with size < 2 cm., Competing Interests: Conflict of interest None., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID), whose prevalence has widely increased in pediatric population during the past two decades. The exact pathophysiological mechanism underlying IBS is still uncertain, thus resulting in challenging diagnosis and management. Experts from 4 Italian Societies participated in a Delphi consensus, searching medical literature and voting process on 22 statements on both diagnosis and management of IBS in children. Recommendations and levels of evidence were evaluated according to the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was reached for all statements. These guidelines suggest a positive diagnostic strategy within a symptom-based approach, comprehensive of psychological comorbidities assessment, alarm signs and symptoms' exclusion, testing for celiac disease and, under specific circumstances, fecal calprotectin and C-reactive protein. Consensus also suggests to rule out constipation in case of therapeutic failure. Conversely, routine stool testing for enteric pathogens, testing for food allergy/intolerance or small intestinal bacterial overgrowth are not recommended. Colonoscopy is recommended only in patients with alarm features. Regarding treatment, the consensus strongly suggests a dietary approach, psychologically directed therapies and, in specific conditions, gut-brain neuromodulators, under specialist supervision. Conditional recommendation was provided for both probiotics and specific fibers supplementation. Polyethylene glycol achieved consensus recommendation for specific subtypes of IBS. Secretagogues and 5-HT4 agonists are not recommended in children with IBS-C. Certain complementary alternative therapies, antispasmodics and, in specific IBS subtypes, loperamide and rifaximin could be considered., (© 2024. The Author(s).)

Competing Interests: Disclosure The following authors disclosed financial relationships: G. G. Konijeti: Consultant for Abbvie; speaker for Takeda and Lilly. B. P. Abraham: Consultant for Abbvie, Bristol Myers Squibb, Celltrion, Lilly, Fresenius Kabi, Janssen, Medtronic, Pfizer, Prometheus, Bioepis, and Takeda; speaker for Abbvie, Bristol Myers Squibb, Janssen, Pfizer, and Takeda. A. Abegunde: Consultant for Ferring Pharmaceuticals; research support from Finch Therapeutics. F. A. Farraye: Consultant for AbbVie, Avalo Therapeutics, Bristol Myers Squibb, Braintree Labs, Fresenius Kabi, GI Reviewers, GSK, IBD Educational Group, Iterative Health, Janssen, Pharmacosmos, Pfizer, Sandoz Immunology, and Viatris. T. Kowalski: Consultant for Boston Scientific. A. Kumar: Consultant for Olympus and Boston Scientific. All other authors disclosed no financial relationships.

Gastrointestinal endoscopy has long been a reliable backbone in the diagnosis and management of hepatobilary disorders and their complications. However, with evolving non-invasive testing, personalised medicine has reframed the utility and necessity of endoscopic screening. Conversely, the growing interest and use of endoscopic ultrasound (EUS) and advanced endoscopy within gastrointestinal units has also opened novel diagnostic and therapeutic avenues for patients with various hepatobiliary diseases. The integration of "advanced endoscopy" within the practice of hepatology is nowadays referred to as "endo-hepatology". In essence, endo-hepatology consists of two pillars: one focusing primarily on disorders of the liver parenchyma, vascular disorders, and portal hypertension, which is mainly captured via EUS, while the other targets the hepatobiliary tract via endoscopic retrograde cholangiopancreatography and advanced imaging. Applications under the umbrella of endo-hepatology include, amongst others, EUS-guided liver biopsy, EUS-guided portal pressure gradient measurement, coil and glue embolisation of gastric varices as well as cholangioscopy. As such endo-hepatology could become an attractive concept wherein advanced endoscopy might reinforce the medical management of patients with hepatobiliary disorders and their complications after initial basic work-up. In this review, we discuss current trends and future developments within endo-hepatology and the remaining hurdles to overcome., (Copyright © 2023 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Competing Interests: The authors have no conflict of interest or financial disclosures to declare., (© 2023 Aerzteverlag medinfo AG.)

Introduction: the COVID-19 pandemic had a strong impact on the healthcare model. The Sociedad Española de Patología Digestiva (SEPD) offered gastroenterology care units (UAAD) an instrument (EFIC&#95;AD) to record and analyze their efficacy and efficiency. Thus, the impact of the pandemic on the activity of UAAD was assessed., Methods: A descriptive study, based on the EFIC&#95;AD registry for the period 2019-2021, of activity regarding admissions, clinic visits, and endoscopic as well as non-endoscopic tests, and endoscopy room performance., Results: data were collected from up to 42 hospitals (22 with ≥ 500 beds). Overall, activity during 2020 compared to 2019 decreased by 12.30 % for admissions and 40 % for pH-metries (16.70 % for new clinic visits; 14.34 % for referrals from primary care; 24.70 % for gastroscopies; 32.50 % for colonoscopies; 31.00 % for endoscopic ultrasounds; 18.20 % for endoscopic retrograde cholangiopancreatography (ERCPs); 38.00 % for manometries; 23.60 % for abdominal ultrasounds; 36.17 % for liver transient elastographies [Fibroscan®]). The levels achieved during 2019 were not fully recovered during 2021 except for digestive motility studies, and virtually for endoscopy room performance rate (88.15 % in 2019; 67.77 % in 2020; 85.93 % in 2021)., Conclusions: during 2020 the COVID-19 pandemic led to a markedly decreased in specific activities at UAAD, which was not fully recovered in 2021 despite endoscopy room performance return to normal.

The exchange of gastrointestinal endoscopy between Japan and China began in 1972. Half a century ago, Japan's endoscope technology was still developing. At the request of the Japan-China Friendship Association, I was invited to Peking Union Medical Hospital and gave a demonstration of gastrointestinal endoscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography., (© 2023 Japan Gastroenterological Endoscopy Society.)

Competing Interests: Die Übersicht über die Interessenkonflikte der Autorinnen und Autoren sind im Leitlinienreport veröffentlicht.

Background and Aims: Pediatric advanced endoscopy consists primarily of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) and is becoming more common in pediatrics. This study aims to characterize the current landscape of pediatric advanced endoscopy training and practice by directly surveying independently practicing pediatric advanced endoscopists (PAEs). We also aim to ascertain expert opinion on competency in pediatric ERCP and EUS., Methods: A 66-question REDCap survey and a 73-question Qualtrics survey were distributed to members of the ERCP Special Interest Group of North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Respondents currently performing ERCP or EUS independently in children were included. Statistical analysis was performed using Mann-Whitney U test., Results: Of 41 PAEs surveyed, 38 (92.7%) responded and 27 independent practitioners were included. Thirteen respondents performed EUS. PAEs who completed an advanced endoscopy fellowship (AEF) were more comfortable performing American Society for Gastrointestinal Endoscopy grade 3 or grade 4 ERCPs ( P < 0.0008) and felt more prepared to practice EUS independently than other trainees. Expert opinion of PAEs felt a threshold of 200 procedures was needed to attain competency in either ERCP or EUS. Pediatric duodenoscope exposure improved comfort in performing ERCP in children <10 kg ( P = 0.009)., Conclusions: Training of pediatric gastroenterologists in ERCP and EUS are highly variable, though the skills attained are similar. AEF-trained specialists reported greater training volumes and felt more prepared to practice independently than those who did not. Competency thresholds determined by expert PAEs for ERCP and EUS agree with American Society for Gastrointestinal Endoscopy guidelines for adult advanced endoscopy trainees., Competing Interests: Dr Mark received a one-time consulting fee from EvoEndo; however this company does not produce any products for endoscopic retrograde cholangiopancreatography or endoscopic ultrasound. No other authors have any conflicts of interest to report., (Copyright © 2023 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Competing Interests: Die Übersicht über die Interessenkonflikte der Autorinnen und Autoren sind im Anhang veröffentlicht.

Competing Interests: Die Interessenkonflikte sind im Leitlinienreport angegeben.

Essential innovations in interventional endoscopy have significantly broadened the treatment armamentarium in gastroenterology. The treatment and complication management of intraepithelial neoplasms and early forms of cancer are increasingly being primarily addressed endoscopically. In cases of endoluminal lesions with no risk of lymph node or distant metastases, endoscopic mucosal resection and endoscopic submucosal dissection have become established as standards. For broad-based adenomas, coagulation of the resection margins should be performed in the case of a piecemeal resection. Submucosal lesions can be reached and resected by tunneling techniques. Peroral endoscopic myotomy in cases of achalasia is a new treatment option for hypertensive and hypercontractile motility disorders. In addition, endoscopic myotomy for gastroparesis has shown very promising results. In this article, new resection techniques and so-called third space endoscopy are presented and critically discussed., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Screening for colorectal cancer (CRC) is effective in reducing CRC related mortality. Current screening methods include endoscopy based and biomarker based approaches. This guideline is a joint official statement of the Asian Pacific Association of Gastroenterology (APAGE) and the Asian Pacific Society of Digestive Endoscopy (APSDE), developed in response to the increasing use of, and accumulating supportive evidence for the role of, non-invasive biomarkers for the diagnosis of CRC and its precursor lesions. A systematic review of 678 publications and a two stage Delphi consensus process involving 16 clinicians in various disciplines was undertaken to develop 32 evidence based and expert opinion based recommendations for the use of faecal immunochemical tests, faecal based tumour biomarkers or microbial biomarkers, and blood based tumour biomarkers for the detection of CRC and adenoma. Comprehensive up-to-date guidance is provided on indications, patient selection and strengths and limitations of each screening tool. Future research to inform clinical applications are discussed alongside objective measurement of research priorities. This joint APAGE-APSDE practice guideline is intended to provide an up-to-date guide to assist clinicians worldwide in utilising non-invasive biomarkers for CRC screening; it has particular salience for clinicians in the Asia-Pacific region., Competing Interests: Competing interests: FKLC is Board Member of CUHK Medical Centre. He is a co-founder, non-executive Board Chairman and shareholder of GenieBiome Ltd. He receives patent royalties through his affiliated institutions. He has received fees as an advisor and honoraria as a speaker for Eisai Co. Ltd., AstraZeneca, Pfizer Inc., Takeda Pharmaceutical Co., and Takeda (China) Holdings Co. Ltd. MCSW is the honorary medical advisor of GenieBiome. He is an advisory committee member of Pfizer, external expert of GlaxoSmithKline, a member of the advisory board of AstraZeneca and has been paid consultancy fees for providing advice on research. ATC is a member of the AGA Governing Board and has received grant funding from Freenome for a colorectal cancer screening study. HM-C is the principal investigator, Taiwan CRC Screening Program, Asian Chair of WEO CRC screening committee and secretary general of the Gastroenterological Society of Taiwan (GEST), received research funding from Volition Rx, Eiken Chemical and Aether AI, and lecture honorarium from Olympus, Fuji and Eiken Chemical. JEE has served on clinical advisory boards for Paion, has served on the clinical advisory board and has share options in Satisfai Health and reports speaker fees from Falk, Jannsen and Medtronic. He was also part of the British Society of Gastroenterology guideline working group for 'Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC)'. He is funded by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. KW has served as an advisory board member for BioChain (Beijing), Ferring, Janssen, Takeda and Abbvie, and a speaker for BioChain (Beijing), Ferring, Janssen, Abbvie, Everest and Takeda. He is named inventor of patent applications held by the FMMU and BioChain (Beijing) that cover the diagnostic use of ctDNA related to gastrointestinal cancers. SCN has served as an advisory board member for Pfizer, Ferring, Janssen, and Abbvie and received honoraria as a speaker for Ferring, Tillotts, Menarini, Janssen, Abbvie, and Takeda. SCN has received research grants through her affiliated institutions from Olympus, Ferring, and Abbvie. SCN is a scientific co-founder and shareholder of GenieBiome Ltd. SCN receives patent royalties through her affiliated institutions., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Antiplatelet and/or anticoagulant agents (collectively known as antithrombotic agents) are used to reduce the risk of thromboembolic events in patients with conditions such as atrial fibrillation, acute coronary syndrome, recurrent stroke prevention, deep vein thrombosis, hypercoagulable states and endoprostheses. Antithrombotic-associated gastrointestinal (GI) bleeding is an increasing burden due to the growing population of advanced age with multiple comorbidities and the expanding indications for the use of antiplatelet agents and anticoagulants. GI bleeding in antithrombotic users is associated with an increase in short-term and long-term mortality. In addition, in recent decades, there has been an exponential increase in the use of diagnostic and therapeutic GI endoscopic procedures. Since endoscopic procedures hold an inherent risk of bleeding that depends on the type of endoscopy and patients' comorbidities, in patients already on antithrombotic therapies, the risk of procedure-related bleeding is further increased. Interrupting or modifying doses of these agents prior to any invasive procedures put these patients at increased risk of thromboembolic events. Although many international GI societies have published guidelines for the management of antithrombotic agents during an event of GI bleeding and during urgent and elective endoscopic procedures, no Indian guidelines exist that cater to Indian gastroenterologists and their patients. In this regard, the Indian Society of Gastroenterology (ISG), in association with the Cardiological Society of India (CSI), Indian Academy of Neurology (IAN) and Vascular Society of India (VSI), have developed a "Guidance Document" for the management of antithrombotic agents during an event of GI bleeding and during urgent and elective endoscopic procedures., (© 2023. Indian Society of Gastroenterology.)

The fields of gastroenterology and hepatology, along with endoscopic practice, have seen significant changes and innovations to practice in just the past few years. These practice changes are not limited to gastroenterology, but maternal fetal medicine and the care of the pregnant person have become increasingly more sophisticated as well. Gastroenterologists are frequently called on to provide consultative input and/or perform endoscopy during pregnancy. To be able to provide the best possible care to these patients, gastroenterologists need to be aware of (and familiar with) the various nuances and caveats related to the care of pregnant patients who either have underlying gastrointestinal (GI) conditions or present with GI and liver disorders. Here, we offer a clinical update with references more recent than 2018, along with a few words about SARS-CoV-2 infection and its relevance to pregnancy., Competing Interests: Competing interests: SVK is consultant to Boerhinger Ingleheim, Bristol Meyers Squib, Fresenisus Kabi, Gilead, InveniAI, Janssen, PredicaMed, Seres Therapeutics, TechLab, Takeda. She is Section Editor for UptoDate. NR is consultant to AbbVie, Gilead, Intercept, Salix and Research support from Eiger., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

The quality and safety of gastrointestinal endoscopy varies considerably across regions and facilities worldwide. In this field, quality management has traditionally focused on individual performance of endoscopists, with most indicators addressing process measures and limited evidence of improvement in health outcomes. Indicators of quality can be classified according to their nature and sequence. The various professional societies and organizations have proposed many systems of indicators, but a universal system is necessary so that healthcare professionals are not overburdened and confused with a variety of quality improvement approaches. In this paper, we propose guidelines by the Saudi Gastroenterology Association pertaining to quality in endoscopic procedures aiming to improve the awareness of endoscopy unit staff toward important quality indications to enhance and standardize quality of care provided to our patients., Competing Interests: None

Endoscopic ultrasound (EUS) has been an indispensable and widely used diagnostic tool in several medical fields, including gastroenterology, cardiology, and urology, due to its diverse therapeutic and diagnostic applications. Many studies show that it is effective and safe in patients with liver conditions where conventional endoscopy or cross-sectional imaging are inefficient or when surgical interventions pose high risks. In this article, we present a review of the current literature for the different diagnostic and therapeutic applications of EUS in liver diseases and their complications and discuss the potential future application of artificial intelligence analysis of EUS.

Profound and pervasive GI divisional changes maximized clinical resources devoted to COVID-19-infected patients and minimized risks of transmitting infection. Academic changes degraded by massive cost-cutting while offering institution to about 100 hospital systems and eventually "selling" institution to Spectrum Health, without faculty input., Competing Interests: Conflicts of interest The author declares no conflict of interest. In particular, Dr M.S. Cappell, as a member of the United States FDA Advisory Committee for Gastrointestinal Drugs, 2013 to 2018,(21) affirms that this article does not discuss any proprietary, confidential, pharmaceutical data submitted to the FDA and reviewed by Dr M.S. Cappell. Dr M.S. Cappell was more than 3 years ago a member of the speaker’s bureau for AstraZeneca and Daiichi Sankyo, comarketers of Movantik. Dr M.S. Cappell had one-time consultancies for Mallinckrodt and Shire more than 3 years ago. This study does not discuss any drug manufactured or marketed by AstraZeneca, Daiichi Sankyo, Shire, or Mallinckrodt. Dr. M. S. Cappell dedicates these two related special critical review articles in this issue to Dr. Anthony Fauci, the Head of Infectious Diseases at the National Institutes of Health, who has served selflessly in this capacity or other positions as a public servant at the National Institutes of Health over a long career, and who despite this dedicated service was the subject of vitriol because of advocating vaccination for the pandemic that has been proven to have saved millions of lives throughout the world. Disclaimer Dr. M. S. Cappell is employed as a gastroenterologist at the Aleda E. Lutz Veterans Administration Hospital in Saginaw, MI and by the United States Government. These institutions do not have an opinion on the views expressed by Dr. Cappell herein., (Published by Elsevier Inc.)

The irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction. IBS is still associated with areas of uncertainties, especially regarding the optimal diagnostic work-up and the more appropriate management. Experts from 7 Italian Societies conducted a Delphi consensus with literature summary and voting process on 27 statements. Recommendations and quality of evidence were evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was defined as >80% agreement and reached for all statements. In terms of diagnosis, the consensus supports a positive diagnostic strategy with a symptom-based approach, including the psychological comorbidities assessment and the exclusion of alarm symptoms, together with the digital rectal examination, full blood count, C-reactive protein, serology for coeliac disease, and fecal calprotectin assessment. Colonoscopy should be recommended in patients with alarm features. Regarding treatment, the consensus strongly supports a dietary approach for patients with IBS, the use of soluble fiber, secretagogues, tricyclic antidepressants, psychologically directed therapies and, only in specific IBS subtypes, rifaximin. A conditional recommendation was achieved for probiotics, polyethylene glycol, antispasmodics, selective serotonin reuptake inhibitors and, only in specific IBS subtypes, 5-HT3 antagonists, 5-HT4 agonists, bile acid sequestrants., Competing Interests: Declaration of Competing Interest The following authors declare the following paid or unpaid consultancies, business interests or sources of honoraria payments for the past three years, and anything else which could potentially be viewed as a conflict of interest: GB: Aboca, AB Biotics, Agave, Alfa Sigma, AGPharma, Bayer, Bromatech, Cadigroup, Biocodex, Sanofy, GE Healthcare, Mayoly, Diadema, Sofar; CC: Sofar, Interalia Pharma, Schwabe Pharma; consultation fees from Alfa Sigma; MB: is consultant for GE Healthcare, Aboca, Diadema, Norgine, Alfasigma, SOFAR, Agave; MC: is consultant for Arena, RB, Takeda, Mayoly, Biocodex and Sanofi and is Co-Chief Investigator in a research grant funded by Sanofi; LF: is consultant for Alfasigma e Norgine; GM: served as an advisory board member for EG Pharma; received lecture grants from AlfaSigma, Bromatech, Echosens, Ferring and Schwabe Pharma. EVS, has served as speaker for Abbvie, AGPharma, Alfasigma, EG Stada Group, Fresenius Kabi, Grifols, Janssen, Innovamedica, Malesci, Pfizer, Reckitt Benckiser, Sandoz, SILA, Sofar, Takeda, Unifarco; has served as consultant for Alfasigma, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Diadema Farmaceutici, Falk, Fresenius Kabi, Janssen, Merck & Co, Reckitt Benckiser, Regeneron, Sanofi, Shire, SILA, Sofar, Synformulas GmbH, Takeda, Unifarco; he received research support from Reckitt Benckiser, SILA, Sofar, Unifarco; AS: is clinical investigator for Janssen Biologics B.V., Eli Lilly Cork Limited and Novalac; consultant for Aboca, Abbott, Angelini e Novalac; was clinical investigator for Aboca and PAREXEL International. VS: Alfa Sigma, Bayer, Coloplast, GE Healthcare, Menarini, Norgine. All the other authors declared no conflicts of interest., (Copyright © 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

GI endoscopy is highly resource-intensive with a significant contribution to greenhouse gas (GHG) emissions and waste generation. Sustainable endoscopy in the context of climate change is now the focus of mainstream discussions between endoscopy providers, units and professional societies. In addition to broader global challenges, there are some specific measures relevant to endoscopy units and their practices, which could significantly reduce environmental impact. Awareness of these issues and guidance on practical interventions to mitigate the carbon footprint of GI endoscopy are lacking. In this consensus, we discuss practical measures to reduce the impact of endoscopy on the environment applicable to endoscopy units and practitioners. Adoption of these measures will facilitate and promote new practices and the evolution of a more sustainable specialty., Competing Interests: Competing interests: SS has received speaker honoraria from Pentax Medical. ST-G has received speaker honoraria from Olympus. ARajendran has received sponsored visit and conference fees from Pentax. BB is Director of an insourcing endoscopy company., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The 9-member Editorial Board of the American Society for Gastrointestinal Endoscopy performed a systematic literature search of original articles published during 2021 in Gastrointestinal Endoscopy and 10 other high-impact medical and gastroenterology journals on endoscopy-related topics. Votes from each editorial board member were tallied to identify a consensus list of the 10 most significant topic areas in GI endoscopy over the calendar year of study, with a focus on 3 criteria: significance, novelty, and global impact on clinical practice. The 10 areas identified collectively represent advances in the following endoscopic topics: colonoscopy optimization, bariatric endoscopy, endoscopic needle sampling and drainage, peroral endoscopic myotomy, endoscopic defect closure, meeting systemic challenges in endoscopic training and practice, endohepatology, FNA versus fine-needle biopsy sampling, endoscopic mucosal and submucosal procedures, and cold snare polypectomy. Each board member contributed a summary of important articles relevant to 1 to 2 of the consensus topic areas, leading to a collective summary that is presented in this document of the "top 10" endoscopic advances of 2021., (Published by Elsevier Inc.)

The Korean Society of Gastroenterology (KSG) and the Korean Society of Gastrointestinal Endoscopy (KSGE) have tried to promote high-quality patient care, and safety in the field of gastrointestinal (GI) diseases. In 2017, the training guidelines for GI fellows have been made, and the education board of KSGE revised 2 year- program of GI fellows. The guideline includes the total number of assigned patients, the number of GI endoscopy procedures, attendance of academic conferences, and research presentations. The traditional training model of GI fellowship is known as an "apprenticeship". Unfortunately, it might increase confusion between what trainees are observing and prior information. Now, practical hands-on training system using simulator helps to provide a support program for GI fellowship education. In order to facilitate training program, trainers will need to carefully plan the teaching. Therefore, it improves knowledge and performance for trainers. What we should keep in mind is that this hands-on program has the goal of making a good gastroenterologist, not just making an endoscopist. At same time, the application of cognitive education in GI fellow training must be performed. On the other side, the privileging and credentialing for endoscopic subspecialty should be made. The provision of benefits could serve as an important foundation for maintaining GI specialist board system.

Objectives/hypothesis: This study defines essential data elements to be recorded during an aerodigestive "triple endoscopy" to form the foundation of a standardized multicenter registry and to clearly define measurement of each consensus item., Study Design: Modified Delphi process., Methods: Modified Delphi consensus with six survey rounds. Twenty-four expert pediatric otolaryngology, pulmonology, and gastroenterology aerodigestive clinicians from eight large academic pediatric aerodigestive programs formed the Delphi panel. After achieving consensus through the Delphi process, outside validation was performed at 2019 national Aerodigestive Society conference. Consensus, near-consensus, or exclusion was obtained for each proposed data element. Concordance was then measured between expert panel conclusions and validation group conclusions., Results: Overall response rate was 94.4%. 73/167 proposed items reached consensus in six domains (flexible bronchoscopy, bronchoalveolar lavage, microdirect laryngoscopy and bronchoscopy, esophagogastroduodenoscopy with biopsies, and esophageal impedance and pH probe). Measurement of all items was defined; classification/grading systems were selected for 11 items. Validation group endorsed importance of 82/167 data items; compared to expert consensus, overall, inclusion, and exclusion concordance rates were 94.5%, 98.7%, and 90.9%., Conclusion: Triple endoscopy is a central component of aerodigestive care. This study identifies and defines data elements to be recorded for all triple endoscopy procedures. The list is of usable length, and clear definitions were created for all items, with explicit classification/grading systems selected for 11 items. Face validity was confirmed with an independent multispecialty sample of aerodigestive providers. This consensus provides the foundation for a triple endoscopy registry but also is immediately applicable to standardize clinical documentation in aerodigestive care., Level of Evidence: 5 Laryngoscope, 132:2251-2258, 2022., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives Esophagogastroduodenoscopy (EGD) is one of the most practiced procedures in paediatric gastroenterology. As with all other procedures, it is guided and controlled by specific guidelines developed and approved internationally. The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and the American Society for Gastrointestinal Endoscopy (ASGE) guidelines are two of the most followed guidelines in paediatric gastroenterology. This study aimed to determine how optimal patient condition management is when following international paediatric gastroenterology guidelines and to correlate the appropriateness of EGD and other variables with positive or negative findings on EGD., Design: A cross-sectional retrospective cohort of all first-time diagnostic upper endoscopies was conducted between 1 January 2016 and 1 February 2020, in Prince Hamzah Hospital in Jordan., Participants: Paediatric patients between 9 months and 14 years of age with indications for EGD., Results: Overall, 529 diagnostic EGDs were performed during the study period. Helicobacter pylori -associated gastritis was the most common final diagnosis in 247 patients (47%). Furthermore, 488 (92%) EGDs were deemed appropriate, while 41 (7.7%) were considered inappropriate. Finally, 74.0% of all biopsies performed had positive contributive findings., Conclusions: Abiding by international guidelines in paediatric gastroenterology can optimise care for paediatric patients. General paediatricians are urged to follow guidelines rigorously when referring patients to minimise inappropriate procedures., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Helicobacter pylori infection is very common and affects more than one-third of adults in Italy. Helicobacter pylori causes several gastro-duodenal diseases, such as gastritis, peptic ulcer and gastric malignancy, and extra-gastric diseases. The eradication of the bacteria is becoming complex to achieve due to increasing antimicrobial resistance. To address clinical questions related to the diagnosis and treatment of Helicobacter pylori infection, three working groups examined the following topics: (1) non-invasive and invasive diagnostic tests, (2) first-line treatment, and (3) rescue therapies for Helicobacter pylori infection. Recommendations are based on the best available evidence to help physicians manage Helicobacter pylori infection in Italy, and have been endorsed by the Italian Society of Gastroenterology and the Italian Society of Digestive Endoscopy., Competing Interests: Conflict of interest None declared., (Copyright © 2022. Published by Elsevier Ltd.)

The promotion of quality and best practices in gastroenterology and endoscopy is an ongoing effort. For upper GI endoscopy, quality indicators derived from clinical studies and expert consensus have been long established but remain variably obtained. To date, data on interventions aimed to improve these indicators are scarce. We systematically reviewed the literature to identify interventions and measures demonstrated to improve the performance of previously established upper endoscopy quality indicators. We also identified evidence gaps and opportunities for improvement in this area., (Copyright © 2022 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Background and Aims: Gastrointestinal (GI) endoscopy is a limited health resource because of a scarcity of qualified personnel and limited availability of equipment. Non-adherence to endoscopy appointments therefore wastes healthcare resources and may compromise the early detection and treatment of GI diseases. We aimed to identify factors affecting non-attendance at scheduled appointments for GI endoscopy and thus improve GI healthcare outcomes., Methods: This was a single-center retrospective cohort study performed at a tertiary hospital gastroenterology endoscopy unit, 12 months before and 12 months after the start of the COVID-19 pandemic. We used multiple logistic regression analysis to identify variables associated with non-attendance at scheduled appointments., Results: Overall, 5,938 appointments were analyzed, and the non-attendance rate was 18.3% (1,088). The non-attendance rate fell significantly during the pandemic (22.6% vs . 11.6%, p < 0.001). Multivariable regression analysis identified the absence of deep sedation (OR: 3.253, 95% CI [2.386-4.435]; p < 0.001), a referral from a physician other than a gastroenterologist (OR: 1.891, 95% CI [1.630-2.193]; p < 0.001), a longer lead time (OR: 1.006, 95% CI [1.004-1.008]; p < 0.001), and female gender (OR: 1.187, 95% CI [1.033-1.363]; p = 0.015) as associated with appointment non-attendance., Conclusions: Female patients, those undergoing endoscopic procedures without deep sedation, those referred by physicians other than gastroenterologists, and with longer lead time were less likely to adhere to appointments. Precautions should be directed at patients with one or more of these risk factors, and for those scheduled for screening procedures during the COVID-19 pandemic., Competing Interests: The authors declare that they have no competing interests., (© 2022 Yılmaz and Kocyigit.)

The European Society of Gastrointestinal Endoscopy and United European Gastroenterology have defined performance measures for upper and lower gastrointestinal, pancreaticobiliary, and small-bowel endoscopy. Quality indicators to guide endoscopists in the growing field of advanced endoscopy are also underway. We propose that equal attention is given to developing the entire advanced endoscopy team and not the individual endoscopist alone.We suggest that the practice of teams intending to deliver high quality advanced endoscopy is underpinned by six crucial principles concerning: selection, acceptance, complications, reconnaissance, envelopment, and documentation (SACRED)., Competing Interests: R. Bisschops is supported by the Research Foundation – Flanders (FWO); he has received research support from FujiFilm, Medtronic, and Pentax (2015 to present) and speakersʼ fees from Norgine (2016 to present), Ipsen (2020), and Pentax (2015 to present); he has provided consultancy to FujiFilm, Pentax (2015 to present), Norgine (2016 to present), GI Supply, and CDx diagnostics. M. Keuchel is a member of the guideline group for quality in endoscopy of the German Society of Gastroenterology (DGVS; 2014 to present). M. Rutter is a member of the endoscopy groups of both the British Society of Gastroenterology and the Joint Advisory Group (JAG; ongoing). I.A. Azmy, P. Bhandari, H.-L. Ching, T. Gyökeres, A.D. Hopper, R. Kuvaev, M.S. Lau, P. Leclercq, E. Macken, D.S. Sanders, M. Thoufeeq, and A.M. Veitch declare that they have no conflict of interest., (European Society of Gastrointestinal Endoscopy. All rights reserved.)

SpyGlass DS is a peroral cholangioscopy system, associated with improved image quality and configuration. Currently, there is diversity in its use and little information on its implementation, including clinical outcomes and adverse events. To describe the experience of using SpyGlass DS in several gastroenterology reference centres in Colombia, mentioning efficacy and possible adverse events. This is an observational study (case series). The main indication was choledocholithiasis (n:204), followed by biliary stricture (n:40) and pancreatolithiasis (n:16). 49.2% were male, mean age 58.6 years, clinically with predominance of abdominal pain (80.5%) and jaundice (86.1%). All cases had previous imaging (CT scan, MRI or ultrasound), 98.07% previous endoscopic retrograde cholangiopancreatography (n:255) and 75% biliary plastic stent. Laser was used in 78/220 patients and electrohydraulic lithotripsy in 142/220 patients, with single-session resolution rates of 96.15% and 95.07%, respectively. Seven cases required a second lithotripsy session and 3 patients required surgical management, one for pancreatolithiasis with basal pancreas divisum and 2 for hepatolithiasis. 40/260 patients presented with biliary stricture, 32/40 with malignant findings (cholangiocarcinoma) and 8/40 with benign pathology (primary sclerosing cholangitis, non-specific inflammatory changes) after histopathological studies. As complications, 6 cases of bacteraemia (2.5%) were recorded, being more frequent in cases of stenosis. The mean postoperative stay was 2.04 days. We concluded that the use of SpyGlass DS is feasible in our setting, being effective for diagnosis and treatment of biliary lesions, and with low risk of adverse events.

GASTROSWOT is a strategic analysis of the current and projected states of the different subspecialties in gastroenterology that aims to provide guidance for research, clinical, and financial planning in gastroenterology. We executed a consensus-based international strengths, weaknesses, opportunities, and threats (SWOT) analysis. Four general coordinators, six field coordinators, and 12 experts participated in the study. SWOTs were provided for the following fields: neurogastroenterology, functional gastrointestinal disorders, and upper gastrointestinal diseases; inflammatory bowel disease; pancreatology and biliary diseases; endoscopy; gastrointestinal oncology; and hepatology. The GASTROSWOT analysis highlights the following in the current state of the field of gastroenterology: the incidence and complexity of several gastrointestinal diseases, including malignancies, are increasing; the COVID-19 pandemic has affected patient care on several levels; and with the advent of technical innovations in gastroenterology, a well trained workforce and strategic planning are required to optimise health-care utilisation. The analysis calls attention to the following in the future of gastroenterology: artificial intelligence and the use of big data will speed up discovery and smarter health-care provision in the field; the growth and diversification of gastroenterological specialties will improve specialised care for patients, but could promote fragmentation of care and health system inefficiencies; and furthermore, thoughtful planning is needed to reach an effective balance between the need for subspecialists and the value of general gastroenterology services., Competing Interests: Declaration of interests EdM is a consultant for Takeda Pharmaceutical Company, Abbott, and Mylan. WA received consultancy fees from AbbVie, Amgen, Arena Pharmaceuticals, Dynacare, Janssen, Merck, Novartis, Pfizer, Sandoz, and Takeda. SL received speaker and advisor fees from Gilead and AbbVie, and grants from Gilead. RP is a consultant to HCL Technologies, and on the scientific advisory board at Nestlé. VKS is consultant to AbbVie and Nestlé Health Science and has received grant funding from Orgenesis and Theraly. JV is a consultant to Olympus America, and on the scientific advisory board at Aspero Medical. AC consults for, is on the advisory board of, and has received education grants from from AbbVie, Takeda, Janssen, and Pfizer. The Radboud University Medical Center, on behalf of JPHD, received honoraria or research grants from Gilead and AbbVie. All other authors declare no competing interests., (Crown Copyright © 2022 Published by Elsevier Ltd. All rights reserved.)

A series of workshops entitled "Advanced endoscopy in the management of inflammatory digestive disease" was held at the 97 th to 100 th biannual meeting of the Japan Gastroenterological Endoscopy Society. During these core sessions, research findings concerning various endoscopic practices in the field of inflammatory bowel disease (IBD) were presented, and meaningful discussions were shared on the evolving role and future challenges of endoscopy in IBD. This article reviews these core sessions and discusses current topics on the role of endoscopy, focusing on the diagnosis, disease monitoring, mucosal healing assessments, cancer surveillance, and therapeutic interventions in IBD., (© 2022 Japan Gastroenterological Endoscopy Society.)

The Japan Gastroenterological Endoscopy Society published the second edition of the "Guidelines for Colorectal Endoscopic Submucosal Dissection/Endoscopic Mucosal Resection" in 2019 to clarify the indications for colorectal endoscopic mucosal resection (EMR) and endoscopic submucosal dissection and to ensure appropriate preoperative diagnoses as well as effective and safe endoscopic treatment in front-line clinical settings. Endoscopic resection with electrocautery, including polypectomy and EMR, is indicated for colorectal polyps. Recently, the number of facilities introducing and implementing cold polypectomy without electrocautery has increased. Herein, we establish supplementary guidelines for cold polypectomy. Considering that the level of evidence for each statement is limited, these supplementary guidelines must be verified in clinical practice., (© 2022 Japan Gastroenterological Endoscopy Society.)

Introduction: High-quality procedure reports are a cornerstone of high-quality pediatric endoscopy as they ensure the clear communication of procedural events and outcomes, guide patient care and facilitate continuous quality improvement. The aim of this document is to outline standardized reporting elements that achieved international consensus as requirements for high-quality pediatric endoscopy procedure reports., Methods: With support from the North American and European Societies of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used Delphi methodology to identify key elements that should be found in all pediatric endoscopy reports. Item reduction was attained through iterative rounds of anonymized online voting using a 6-point scale. Responses were analyzed after each round and items were excluded from subsequent rounds if ≤50% of panelists rated them as 5 ("agree moderately") or 6 ("agree strongly"). Reporting elements that ≥70% of panelists rated as "agree moderately" or "agree strongly" were considered to have achieved consensus., Results: Twenty-six PEnQuIN group members from 25 centers internationally rated 63 potential reporting elements that were generated from a systematic literature review and the Delphi panelists. The response rates were 100% for all three survey rounds. Thirty reporting elements reached consensus as essential for inclusion within a pediatric endoscopy report., Discussion: It is recommended that the PEnQuIN Reporting Elements for pediatric endoscopy be universally employed across all endoscopists, procedures and facilities as a foundational means of ensuring high-quality endoscopy services, while facilitating quality improvement activities in pediatric endoscopy., Competing Interests: Conflicts of interest: P.B. has served on the advisory boards of Biocodex, Nutricia, and Avanos. P.B. has received honoraria for speaking engagements from AbbVie, Nutricia, and Avanos. N.M.C.'s institution received speaker fees, advisory board fees, and research funding on his behalf from AbbVie, Eli Lilly, Takeda, Shire, Pfizer, and 4D Pharma. D.S.F. has received royalties from UpToDate (“Pediatric Caustic Ingestions”). I.H. has received honoraria for speaking engagements from BioGaia, Oktal Pharma, Nutricia, Abela Pharm, and Nestle. H.Q.H. has received research support from Janssen, AbbVie, Takeda, and Allergan. H.Q.H. has served on the advisory boards of AbbVie and Jansen. K.J. has received research support from Janssen, AbbVie, and the Center for Drug Research and Development (CDRD). K.J. has served on the advisory boards of Janssen, AbbVie, and Merck and participates in the speaker's bureau for AbbVie and Janssen. D.G.L. has received consultant fees from EvoEndo. J.R.L. has received research support from AbbVie and an honorarium from Mead Johnson. A.R.O. has received research support from Janssen, AbbVie, Pfizer, and Eli Lilly. A.R.O. has served on the advisory boards of Janssen, AbbVie, and Eli Lilly and participates in the speaker's bureau for AbbVie and Janssen. J.R.R. has received research support from AbbVie and Janssen. J.R.R. has served on the advisory boards of Janssen, BMS, Eli Lilly, and Pfizer. C.M.W. has received research support from AbbVie., (Copyright © 2021 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Competing Interests: M. Dinis-Ribeiro has provided teaching consultancy to Boston Scientific (2019) and consultancy to Medtronic (2020); his department receives an educational grant from Olympus (ongoing) and a research grant from Fujifilm (ongoing); he is Co-Editor-in-Chief of Endoscopy. B. Fehrke has received a lecture fee from Olympus (2021) and a presenter's fee from Ambu (2021). C. Hassan has received research support from Medtronic, Fujifilm, AlfaSigma, and Norgine (all 2020–2021). M.F. Kaminski has provided consultancy to Olympus (from 2016) and Erbe (from 2021), and lectures for Boston Scientific (from 2016) and Recordati (from 2020). H. Messman, in the past 3 years, has received benefits from the following endoscopy companies: Apollo Endosurgery, Biogen, Boston Scientific, CDx Diagnostic, Cook Medical, CSL Behring, Dr. Falk Pharma, Endo Tools Therapeutics, Erbe, Fujifilm, Hitachi, Janssen-Cilag, Medwork, Norgine, Nutricia, Olympus, Ovesco Endoscopy, Servier Deutschland, and US Endoscopy; he has received grants from Amgen, Bayer, Dr. Falk Pharma, MSD, Novartis, Olympus and Roche; he has received honoraria from Covidien, Dr. Falk Pharma, and Olympus, and consultancy fees from Boston Scientific, CDx Diagnostics, Covidien, Erbe, Lumendi, Norgine, and Olympus; he has received research support from Olympus (ESD-Register) and Satisfai. E. Rodriguez de Santiago has received a speaker’s fee from, and engaged in educational activities for, Olympus (2020–2021). P. Siersema has received or is receiving research support from Pentax (2019–2021), The E-Nose Company (2018–2021), Lucid Diagnostics (2021–2022), MicroTech (2019–2022), Magnetiq Eye (2021–2022), and receives research support from and is advising Motus GI (2018–2022); he is Editor-in-Chief of Endoscopy. G. Antonelli, M. Arvanitakis, U. Beilenhoff, P. Bhandari, R. Bisschops, M. Bretthauer, A. Ebigbo, A. Fuchs, M. Gazic, T. Gjergek, V. Lorenzo-Zuniga, S. Maasen, M. de Pater, T.C. Tham, K. Triantafyllou, A. Tringali, A. Voiosu, W. Waagenes, and G. Webster have no competing interests to declare.

Competing Interests: M. Dinis-Ribeiro has provided teaching consultancy to Boston Scientific (2019) and consultancy to Medtronic (2020); his department receives an educational grant from Olympus (ongoing) and a research grant from Fujifilm (ongoing); he receives a fee as a Co-Editor-in-Chief of Endoscopy. I.M. Gralnek has provided consultancy to Boston Scientific, Medtronic, Motus GI, Neurogastrx, Simbionix, and Vifor Pharma; he has received research funding from AMG Gastro, AstraZeneca, and CheckCap. C. Hassan has received research support (2020 to 2021) from Medtronic, Fujifilm, Alfasigma, and Norgine. H. Messman, in the past 3 years, has received benefits from the following endoscopy companies: Apollo Endosurgery, Biogen, Boston Scientific, CDx Diagnostic, Cook Medical, CSL Behring, Dr. Falk Pharma, Endo Tools Therapeutics, Erbe, Fujifilm, Hitachi, Janssen-Cilag, Medwork, Norgine, Nutricia, Olympus, Ovesco Endoscopy, Servier Deutschland, and US Endoscopy; he has received grants from Amgen, Bayer, Dr. Falk Pharma, MSD, Novartis, Olympus and Roche; he has received honoraria from Covidien, Dr. Falk Pharma, and Olympus, and consultancy fees from Boston Scientific, CDx Diagnostics, Covidien, Erbe, Lumendi, Norgine, and Olympus; he has received research support from Olympus (ESD-Register) and Satisfai. U. Beilenhoff, R. Bisschops, M. Matharoo, P. Meier, M. Rutter, and A. Veitch have no competing interests to declare.

Background: Functional dyspepsia (FD) is a disorder that presents with chronic dyspepsia, which is not only very common but also highly affects quality of life of the patients. In Japan, FD became a disease name for national insurance in 2013, and has been gradually recognized, though still not satisfactory. Following the revision policy of Japanese Society of Gastroenterology (JSGE), the first version of FD guideline was revised this time., Method: Like previously, the guideline was created by the GRADE (grading of recommendations assessment, development and evaluation) system, but this time, the questions were classified to background questions (BQs, 24 already clarified issues), future research questions (FRQs, 9 issues cannot be addressed with insufficient evidence), and 7 clinical questions that are mainly associated with treatment., Results and Conclusion: These revised guidelines have two major features. The first is the new position of endoscopy in the flow of FD diagnosis. While endoscopy was required to all cases for diagnosis of FD, the revised guidelines specify the necessity of endoscopy only in cases where organic disease is suspected. The second feature is that the drug treatment options have been changed to reflect the latest evidence. The first-line treatment includes gastric acid-secretion inhibitors, acetylcholinesterase (AChE) inhibitors (acotiamide, a prokinetic agent), and Japanese herbal medicine (rikkunshito). The second-line treatment includes anxiolytics /antidepressant, prokinetics other than acotiamide (dopamine receptor antagonists, 5-HT4 receptor agonists), and Japanese herbal medicines other than rikkunshito. The patients not responding to these treatment regimens are regarded as refractory FD., (© 2022. The Author(s).)

High-frequency electrosurgery has been widely applied in digestive endoscopy with constantly expanding indications. However, high-frequency electrosurgery may cause possible complications such as hemorrhage or perforation during or after the procedure, of which endoscopists must be cautious. Digestive endoscopists must have a firm grasp of the principles of high-frequency electrosurgery as well as its safety issues so as to improve the safety of its clinical application. To this end, experts in gastroenterology and hepatology, digestive endoscopy, surgery, nursing and other related fields were invited to draft a consensus on the clinical application of high-frequency electrosurgery in digestive endoscopy based on relevant domestic and international literatures and their experiences., (© 2021 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)