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Background A pharyngeal pouch or Zenker’s diverticulum (ZD) is a mucosal out-pouching in the cervical oesophagus. It arises from the posterior oesophageal wall in a structural weakness between horizontal and oblique cricopharyngeus fibre known as Killian’s dehiscence located between the oblique and horizontal muscle fibre layers of the Cricopharyngeus (CP) muscle Killian.The aim of the treatment is to provide symptom relief and improve quality of life. Literature on ZD consisted of small series, retrospective studies. With wide variation in the procedure technique using different cutting Devices. Some experts would use general anaesthesia, some use Propofol, or midazolam. There was variation in use of clips, antibiotics to be used. Methods and results We looked at the deficiencies in the knowledge that that provided the justification to start our research on treatment of Zenker’s diverticulum. We carried out the first systematic review and meta-analysis (MA) of the literature focusing on Flexible Endoscopic Septum Division (FESD) for Zenker’s diverticulum including in-depth evaluation of its efficacy safety and limitation. WE introduced new comprehensive symptom scoring tool that we validated in prospective study. We explored the incidence and aetiology of intubation failure in endoscopy to assess the predictors of intubation failure and predictors of pathology in patient’s pharyngeal symptoms. We introduced concept of two stage sedation using HFNOT in a prospective observational study. We conducted the first study with large number of patient with longest follow up and looked at the predictors of recurrence. Conclusion Our studies on all aspects of ZD to address gaps in literature but also highlighted implication for future research

Background A pharyngeal pouch or Zenker’s diverticulum (ZD) is a mucosal out-pouching in the cervical oesophagus. It arises from the posterior oesophageal wall in a structural weakness between horizontal and oblique cricopharyngeus fibre known as Killian’s dehiscence located between the oblique and horizontal muscle fibre layers of the Cricopharyngeus (CP) muscle Killian.The aim of the treatment is to provide symptom relief and improve quality of life. Literature on ZD consisted of small series, retrospective studies. With wide variation in the procedure technique using different cutting Devices. Some experts would use general anaesthesia, some use Propofol, or midazolam. There was variation in use of clips, antibiotics to be used. Methods and results We looked at the deficiencies in the knowledge that that provided the justification to start our research on treatment of Zenker’s diverticulum. We carried out the first systematic review and meta-analysis (MA) of the literature focusing on Flexible Endoscopic Septum Division (FESD) for Zenker’s diverticulum including in-depth evaluation of its efficacy safety and limitation. WE introduced new comprehensive symptom scoring tool that we validated in prospective study. We explored the incidence and aetiology of intubation failure in endoscopy to assess the predictors of intubation failure and predictors of pathology in patient’s pharyngeal symptoms. We introduced concept of two stage sedation using HFNOT in a prospective observational study. We conducted the first study with large number of patient with longest follow up and looked at the predictors of recurrence. Conclusion Our studies on all aspects of ZD to address gaps in literature but also highlighted implication for future research

Oliver Bendall,1 Joel James,1 Katarzyna M Pawlak,2 Sauid Ishaq,3,4 J Andy Tau,5 Noriko Suzuki,6 Steven Bollipo,7,8 Keith Siau1 1Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK; 2Endoscopy Unit, Department of Gastroenterology, Ministry of Interior and Administration, Szczecin, Poland; 3Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK; 4Medicine, Birmingham City Hospital, Birmingham, UK; 5Austin Gastroenterology, Austin, TX, USA; 6Wolfson Unit for Endoscopy, St. Mark’s Hospital, London, UK; 7School of Medicine & Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; 8Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, New South Wales, AustraliaCorrespondence: Keith SiauDepartment of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, TR1 3LJ, UKEmail keithsiau@nhs.netAbstract: Delayed post-polypectomy bleeding (DPPB) is a potentially severe complication of therapeutic colonoscopy which can result in hospital readmission and re-intervention. Over the last decade, rates of DPPB reported in the literature have fallen from over 2% to 0.3– 1.2%, largely due to improvements in resection technique, a shift towards cold snare polypectomy, better training, adherence to guidelines on periprocedural antithrombotic management, and the use of antithrombotics with more favourable bleeding profiles. However, as the complexity of polypectomy undertaken worldwide increases, so does the importance of identifying patients at increased risk of DPPB. Risk factors can be categorised according to patient, polyp and personnel related factors, and their integration together to provide an individualised risk score is an evolving field. Strategies to reduce DPPB include safe practices relevant to all patients undergoing colonoscopy, as well as specific considerations for patients identified to be high risk. This narrative review sets out an evidence-based summ

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, SCOPUS: re.j, info:eu-repo/semantics/published

SCOPUS: re.j, info:eu-repo/semantics/published

In the above-mentioned article, the institution of Daniel Pohl has been corrected. This was corrected in the online version on June 24, 2020., SCOPUS: er.j, info:eu-repo/semantics/published

SCOPUS: er.j, info:eu-repo/semantics/published

Background and Aims: Colorectal cancer (CRC) is largely preventable with routine screening and surveillance colonoscopy; however, interval cancers arising from precancerous lesions missed by standard colonoscopy still occur. An increased adenoma detection rate (ADR) has been found to be inversely associated with interval cancers. The G-EYE device includes a reusable balloon integrated at the distal tip of a standard colonoscope, which flattens haustral folds, centralizes the colonoscope's optics, and reduces bowel slippage. The insufflated balloon also aims to enhance visualization of the colon during withdrawal, thereby increasing the ADR. Methods: In this randomized, controlled, international, multicenter study (11 centers), patients (aged ≥50 years) referred to colonoscopy for screening, surveillance, or changes in bowel habits were randomized to undergo either balloon-assisted colonoscopy by using an insufflated balloon during withdrawal or standard high-definition colonoscopy. The primary endpoint was the ADR. Results: One thousand patients were enrolled between May 2014 and September 2016 to undergo colonoscopy by experienced endoscopists; 803 were finally analyzed (standard colonoscopy n = 396; balloon-assisted colonoscopy n = 407). Baseline parameters were similar in both groups. Balloon-assisted colonoscopy provided a 48.0% ADR compared with 37.5% in the standard colonoscopy group (28% increase; P =.0027). Additionally, balloon-assisted colonoscopy provided for a significant increase in detection of advanced (P =.0033) flat adenomas (P <.0001) and sessile serrated adenomas/polyps (P =.0026). Conclusion: Balloon-assisted colonoscopy yielded a higher ADR and increased the detection of advanced, flat, and sessile serrated adenomas/polyps when compared with standard colonoscopy. Improved detection by the G-EYE device could impact the quality of CRC screening by reducing miss rates and consequently reducing interval cancer incidence. (Clinical trial regist

Background and Aims: Colorectal cancer (CRC) is largely preventable with routine screening and surveillance colonoscopy; however, interval cancers arising from precancerous lesions missed by standard colonoscopy still occur. An increased adenoma detection rate (ADR) has been found to be inversely associated with interval cancers. The G-EYE device includes a reusable balloon integrated at the distal tip of a standard colonoscope, which flattens haustral folds, centralizes the colonoscope's optics, and reduces bowel slippage. The insufflated balloon also aims to enhance visualization of the colon during withdrawal, thereby increasing the ADR. Methods: In this randomized, controlled, international, multicenter study (11 centers), patients (aged ≥50 years) referred to colonoscopy for screening, surveillance, or changes in bowel habits were randomized to undergo either balloon-assisted colonoscopy by using an insufflated balloon during withdrawal or standard high-definition colonoscopy. The primary endpoint was the ADR. Results: One thousand patients were enrolled between May 2014 and September 2016 to undergo colonoscopy by experienced endoscopists; 803 were finally analyzed (standard colonoscopy n = 396; balloon-assisted colonoscopy n = 407). Baseline parameters were similar in both groups. Balloon-assisted colonoscopy provided a 48.0% ADR compared with 37.5% in the standard colonoscopy group (28% increase; P =.0027). Additionally, balloon-assisted colonoscopy provided for a significant increase in detection of advanced (P =.0033) flat adenomas (P <.0001) and sessile serrated adenomas/polyps (P =.0026). Conclusion: Balloon-assisted colonoscopy yielded a higher ADR and increased the detection of advanced, flat, and sessile serrated adenomas/polyps when compared with standard colonoscopy. Improved detection by the G-EYE device could impact the quality of CRC screening by reducing miss rates and consequently reducing interval cancer incidence. (Clinical trial regist