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The EndoRings device is a distal attachment consisting of two layers of circular flexible rings that evert mucosal folds. The aim of this study was to investigate whether EndoRing assisted colonoscopy (ER) improves polyp and adenoma detection compared to standard colonoscopy (SC).Multicenter, parallel group, randomized controlled trial.Total of 556 patients randomized to ER (n = 275) or SC (n = 281). Colonoscopy completed in 532/556 (96%) cases. EndoRings removed in 74/275 (27%) patients. Total number of polyps in ER limb 582 vs. 515 in SC limb, P = 0.04. Total number of adenomas in ER limb 361 vs. 343 for SC limb, P = 0.49. A statistically significant difference in the mean number of polyps per patient in both the intention to treat (1.84 SC vs. 2.10 ER, P = 0.027) and per protocol (PP) (1.84 SC vs. 2.25 ER, P = 0.004).Our study shows promise for the EndoRings device to improve polyp detection.

A 54-year-old man presented to our institution with severe dysphagia. Gastroscopy revealed a 10-mm submucosal lesion, with a blue tinge, in the esophagus, 30 cm from the incisors (Fig. 1A). An EUS demonstrated a 10-mm, predominantly fat, hypoechoic, submucosal lesion extending to, but not infiltrating, the muscularis propria. Color Doppler did not identify blood flow through the lesion (Fig. 1B). Endoscopic follow-up was recommended. During follow-up the patient described having progressive dysphagia and odynophagia. Management options of surgery, endoscopic resection, and endoscopic follow-up were discussed. Endoscopic submucosal dissection (ESD) was performed to resect the lesion (Video 1, available online at www.giejournal. org). The procedure was successfully completed without any significant adverse events. The resection specimen showed benign squamous mucosa with an ectatic blood vessel, in keeping with a benign cavernous hemangioma. At follow-up, the patient’s symptoms have improved. The use of ESD of vascular lesions in the esophagus is high risk. However, if the correct submucosal plane is identified, large blood vessels can be avoided. In this case, it became apparent to us at a very early stage that it was a vascular lesion, so dissection was performed in the deeper planes. This case demonstrates the successful treatment of an esophageal submucosal cavernous hemangioma by ESD, avoiding the morbidity associated with esophagectomy.

Background Currently, various advanced endoscopic techniques are available with varying success rates. These technologies are manufacturer dependent, which has financial implications in the current era of austerity. Acetic acid is a commonly available dye that has been used in the detection of neoplasia within Barrett's esophagus. It has been shown to be effective in detecting neoplasia in high-risk subgroups, but its efficacy in a low-prevalence surveillance population remains unproven. Objective This study aimed to investigate the effectiveness of acetic acid chromoendoscopy in a Barrett's esophagus surveillance population. We aimed to compare the neoplasia yield of acetic acid chromoendoscopy (AAC) with the neoplasia yield from standardized random biopsy (SBP) protocol–guided biopsies in the routine surveillance of patients with Barrett's esophagus. Design Retrospective cohort study. Setting Tertiary referral hospital in the United Kingdom. Patients Patients 18 years of age and older with a diagnosis of Barrett's esophagus undergoing surveillance gastroscopy. Interventions AAC versus standardized random biopsy protocol (SBP) for Barrett's esophagus surveillance. Main Outcome Measurements Neoplasia detection in 2 groups. Results The overall neoplasia detection rates for all grades of neoplasia were 13 of 655 (2%) in the SBP-guided biopsy cohort and 41 of 327 (12.5%) in the AAC cohort ( P = .0001). On per-patient analysis, a 6.5-fold gain in neoplasia detection was seen in the AAC cohort compared with the SBP cohort (0.13 vs 0.02, P = .000). In the SBP cohort, a total of 13 of 655 (2%) neoplasias were detected, of which 3 of 655 patients (0.5%) had low-grade dysplasia, 7 of 655 (1%) had high-grade dysplasia, and 3 of 655 (0.5%) were found to have superficial cancer (T1a/T1b). In the AAC cohort, a total of 41 of 327 neoplasias (12.5%) were found, of which 9 of 327 patients (2.7%) had low-grade dysplasia, 18 of 327 (5.5%) had high-grade dysplasia, and 14 of 327 (4.2%) were found to have superficial cancer. The number of biopsies required to detect 1 neoplasia was 15 times lower in the AAC cohort (40 biopsies) than in the SBP cohort (604 biopsies). On per-biopsy analysis, a 14.7-fold increase in neoplasia detection was seen in the AAC cohort per biopsy compared with the SBP cohort (0.025 vs 0.0017; P = .000). Limitations Not a randomized, controlled study. Conclusions Our study demonstrates that acetic acid detects more neoplasias than conventional protocol-guided mapping biopsies and requires 15 times fewer biopsies per neoplasia detected.

Introduction Despite advances in endoscope technology there is still a significant miss rate of neoplastic lesions during gastroscopy. Mucosal views are frequently impaired by residual bubbles and mucus. Method We conducted an RCT in 126 patients attending for routine gastroscopy. Subjects were randomised in a 1:1:1 ratio to receive a pre-procedure drink of water, simeticone and n-acetylcysteine (Group A), water alone (Group B) or no preparation (Group C). Study endoscopists were blinded to group allocation. 4 digital images were taken at pre-defined locations during the procedure – lower oesophagus, upper body, antrum and fundus. Images were rated for mucosal visibility (MV) using a 4 point scale (1 = best, 4 = worst) by 4 blinded experienced endoscopists. Primary outcome measure was mean MV score. Secondary outcome measures were procedure duration and volume of flush required to achieve adequate mucosal views. Results Groups were well matched for age, gender or indication for endoscopy. Mean MV score for group A was significantly better than for group B and group C (p Subgroup analysis of MV scores at each location demonstrated significantly better mucosal visibility in group A compared to group B and group C at all locations (p Conclusion A pre-procedure drink containing simeticone and n-acetlycysteine significantly improves mucosal visibility during routine gastroscopy and reduces the need for flushes during the procedure. This may improve detection of early neoplasia and other pathology during gastroscopy. Subanalysis of separate locations demonstrates significant benefit in the lower oesophagus, demonstrating potential benefit in Barrett’s surveillance procedures. Disclosure of interest None Declared.