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Background: Lumen-apposing metal stents (LAMS) have displaced double-pigtail plastic stents (DPS) as the standard treatment for walled-off necrosis (WON),β but evidence for exclusively using LAMS is limited. We aimed to assess whether the theoretical benefit of LAMS was superior to DPS. Methods: This multicenter, open-label, randomized trial was carried out in 9 tertiary hospitals. Between June 2017, and Oct 2020, we screened 99 patients with symptomatic WON, of whom 64 were enrolled and randomly assigned to the DPS group (n= 31) or the LAMS group (n= 33). The primary outcome was short-term (4-weeks) clinical success determined by the reduction of collection. Secondary endpoints included long-term clinical success, hospitalization, procedure duration, recurrence, safety, and costs. Analyses were by intention-to-treat. ClinicalTrials.gov, NCT03100578. Results: A similar clinical success rate in the short term (RR, 1.41; 95% CI 0.88–2.25; p= 0.218) and in the long term (RR, 1.2; 95% CI 0.92–1.58; p= 0.291) was observed between both groups. Procedure duration was significantly shorter in the LAMS group (35 vs. 45-min, p= 0.003). The hospital admission after the index procedure (median difference, − 10 [95% CI − 17.5, − 1]; p= 0.077) and global hospitalization (median difference − 4 [95% CI − 33, 25.51]; p= 0.82) were similar between both groups. Reported stent-related adverse events were similar for the two groups (36 vs.45% in LAMS vs. DPS), except for de novo fever, which was significantly 26% lower in LAMS (RR, 0.26 [0.08–0.83], p= 0.015). Conclusions: The clinical superiority of LAMS over DPS for WON therapy was not proved, with similar clinical success, hospital stay and similar safety profile between both groups, yet a significant reduction in procedure time was observed. Trial registration number: ClinicalTrials.gov, NCT03100578. Graphical abstract:

ABSTRACT:In this article, the authors navigate how equity, diversity, and inclusion (EDI) projects tether us to the neoliberal university in seductive and ultimately, limited ways. The topical triad of EDI, explored through the Canadian Congress of Humanities and Social Sciences' "Igniting Change: Final Report and Recommendations," holds important stories about how disability, race, and broadly speaking, normalcy, matter to academic institutions. How is disability storied within the neoliberal university? How are we called to belong within, and be members of, the university through the promise of progress? A poetic engagement creates space for wonder, simultaneously effacing stories that claim to know disability, race, and other forms of being-in-the-world codified as non-normal. As an expression of feeling as freedom, embodied poetry is a creative response to white-settler hegemonic interests that foreclose possibilities for meanings of disability and race; embodied poetry potentiates dreams of living otherwise within, against, and beyond the ivory.RÉSUMÉ:Dans le présent article, les auteurs évaluent la manière dont les projets d'équité, de diversité et d'inclusion (EDI) orientent les étudiants de manière séductrice, mais finalement limitée, vers l'université néolibérale. La triade thématique de l'EDI, explorée par la lorgnette du document Créer une étincelle pour le changement : Rapport final et recommandation du Congrès des sciences humaines et sociales, contient des récits capitaux sur l'importance des handicaps, de la race, et de manière générale, de la normalité dans les établissements universitaires. Comment ce handicap est-il recensé dans les universités néolibérales? Comment sommes-nous appelés à appartenir à l'université et à nous y intégrer par la promesse du progrès? Un engagement poétique crée un espace d'émerveillement, tout en effaçant les récits qui prétendent connaître les handicaps, la race et d'autres formes d'être-dans-le-monde codifiés comme n'étant pas normaux. Expression des sentiments de liberté, la poésie incarnée est une réponse créative aux intérêts hégémoniques des colons blancs, qui élimine les possibilités de signification des handicaps et de la race, qui potentialise les rêves de vivre autrement au sein du milieu blanc, contre ce milieu et au-delà.

Seattle protocol biopsies for Barrett's Esophagus (BE) surveillance are labour intensive with low compliance. Dysplasia detection rates vary, leading to missed lesions. This can potentially be offset with computer aided detection. We have developed convolutional neural networks (CNNs) to identify areas of dysplasia and where to target biopsy. 119 Videos were collected in high‐definition white light and optical chromoendoscopy with i‐scan(Pentax Hoya, Japan) imaging in patients with dysplastic and non‐dysplastic BE (NDBE). We trained an indirectly supervised CNN to classify images as dysplastic/non‐dysplastic using whole video annotations to minimise selection bias and maximise accuracy. The CNN was trained using 148,936 video frames (31 dysplastic patients, 31 NDBE, two normal esophagus), validated on 25,161 images from 11 patient videos and tested on 264 iscan‐1images from 28 dysplastic and 16 NDBE patients which included expert delineations. To localise targeted biopsies/delineations, a second directly supervised CNN was generated based on expert delineations of 94 dysplastic images from 30 patients. This was tested on 86 i‐scan oneimages from 28 dysplastic patients. The indirectly supervised CNN achieved a per image sensitivity in the test set of 91%, specificity 79%, area under receiver operator curve of 93% to detect dysplasia. Per‐lesion sensitivity was 100%. Mean assessment speed was 48 frames per second (fps). 97% of targeted biopsy predictions matched expert and histological assessment at 56 fps. The artificial intelligence system performed better than six endoscopists. Our CNNs classify and localise dysplastic Barrett's Esophagus potentially supporting endoscopists during surveillance.