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Juvenile polyposis syndrome (JPS) is a hereditary hamartomatous polyposis syndrome characterized by gastrointestinal juvenile polyps and increased risk of gastrointestinal cancer. Germline pathogenic variants are detected in SMAD4 or BMPR1A, however in a significant number of patients with JPS, the etiology is unknown. From Danish registers, and genetic department and laboratories, we identified all patients in Denmark with a clinical diagnosis of JPS and/or a pathogenic variant in BMPR1A or SMAD4. In patients where no variant had been detected, we performed genetic analysis, including whole genome sequencing. We collected clinical information on all patients to investigate the phenotypic spectrum. Sixty-six patients (mean age 40 years) were included of whom the pathogenic variant was unknown in seven patients. We detected a pathogenic variant in SMAD4 or PTEN in additional three patients and thus ≈ 95% of patients had a pathogenic germline variant. Endoscopic information was available in fifty-two patients (79%) and of these 31 (60%) fulfilled the clinical criteria of JPS. In 41 patients (79%), other types of polyps than juvenile had been removed. Our results suggest that almost all patients with a clinical diagnosis of JPS has a pathogenic variant in mainly BMPR1A, SMAD4, and more rarely PTEN. However, not all patients with a pathogenic variant fulfil the clinical criteria of JPS. We also demonstrated a wide clinical spectrum, and that the histopathology of removed polyps varied.

Background and Objectives: During recent years, the demand for EUS has increased. However, standardized training programs and assessments of clinical quality measures are lacking. We therefore aimed to establish a basic curriculum for EUS fellows that includes a prioritized list of interpretational capabilities and technical skills. Materials and Methods: International key-opinion leaders were invited to participate in a Delphi process. An electronic three-round iterative survey was performed to attain consensus on skills that 70% of the participants found either very important or essential for a newly graduated endosonographer. Results: Of 125 invited experts, 77 participated in the survey. Initially, 1,088 skills were suggested, resulting in a core curriculum containing 29 interpretational skills and 12 technical skills. The top-five interpretation skills included abilities to discern between normal anatomy and pathology, to identify the entire pancreas and ampullary region, to identify solid versus fluid-filled structures, to detect bile duct and gallstones, and to identify a pancreatic mass of 5 mm or larger. For technical skills, ability to insert the endoscope from the mouth to the second part of duodenum, to obtain FNA adequately and safely, to navigate the scope tip to follow anatomical landmark structures, to achieve endoscopic position of each of the four stations, and to perform passage of the scope past a hiatal hernia were given the highest ranking. Conclusions: After a structured Delphi process involving 77 international experts, a consensus was reached for a basic curriculum for EUS fellows to be included during training.

Gastric antral vascular ectasia is characterized endoscopically by stripes of dilated blood vessels in the antrum. It is a well-known cause of gastrointestinal blood loss, anaemia, and recurrent need for blood transfusion. The treatment may be challenging, and an overview is given in this review. Pharmacological treatment has not been effective, endoscopic treatment is more tolerable than abdominal surgery. The endoscopic modalities, including argon plasma coagulation, endoscopic band ligation, and radiofrequency ablation are safe and relative efficient. Comparative studies are sparse but indicate the modalities as equally effective.

Additional file 2: Supplementary Table 2: Surveillance strategies for each Hereditary Polyposis Syndrome.

INTRODUCTION: Endoscopic sleeve gastroplasty (ESG) represents a novel endoscopic bariatric procedure. It is performed with an endoscope equipped with a suturing device; sutures are placed so that they create a tube-shaped stomach, thereby facilitating weight loss. The aim of this study was to conduct a systematic review evaluating the effectiveness and safety of ESG for treatment of obesity. METHODS: This review was conducted in accordance with the PRISMA guidelines; a protocol was registered with PROSPERO before the start of the study. MEDLINE, Embase and Clinicaltrials.gov were searched through 20 February 2020. RESULTS: A total of 1,088 articles were assessed. In all, 23 studies met the inclusion criteria. The average total weight loss at 12 months was 16.3%. ESG was associated with a significantly greater weight loss than both intragastric balloon insertion (21.3 ± 6.6 versus 13.9 ± 9.0% total weight loss (TWL) at 12 months, p < 0.05) and “high-intensity diet and lifestyle therapy” (20.6 ± 8.3 versus 14.3 ± 10.2% TWL at 12 months, p < 0.05). In contrast, ESG was associated with a significantly lower weight loss than laparoscopic sleeve gastrectomy (17.1 ± 6.5 versus 23.6 ± 7.6% TWL at six months, p < 0.05). ESG had a significantly lower rate of adverse events than both laparoscopic sleeve gastrectomy (5.2 versus 16.9%, p < 0.05) and intragastric balloon placement (5.2 versus 17%, p < 0.05). CONCLUSIONS: ESG is a safe method for treatment of obesity and facilitates a significant weight loss.