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Background and Aims: Efficacy and safety of EUS-guided placement of lumen-apposing metal stents (LAMS) has been reported yet advantage of using 15-mm LAMS over 10-mm LAMS yet to be explored., Methods: International, retrospective, case-matched study of patients with intra-abdominal abscess who underwent EUS-guided drainage with 15-mm (case) and 10-mm (control) LAMS between 03/2019 and 09/2022., Results: 51 patients underwent EUS-guided drainage using LAMS [15-mm 29 (57%), 10-mm 22 (43%)]. The most common location of the abscess was peri-pancreatic 43%. Technical success rate was achieved in 97% of cases and 100 % of controls (p=0.412), while clinical success was achieved in 98% and 96%, respectively, (OR 1.3; p=0.089). AE occurred in 7.8% of the cases. Patients with 15-mm LAMS underwent fewer total endoscopic procedures (mean 2.5 vs.3.6; P < 0.023)., Conclusion: Both sizes showed comparable clinical success and safety profiles, with a significant trend of the need for fewer endoscopic procedures with the 15-mm LAMS., (Copyright © 2025 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Background and Aims: Treatment of large esophageal neoplasia is gradually evolving from piecemeal to en bloc resections. Endoscopic submucosal dissection (ESD) is known to achieve more complete resections than piecemeal EMR for large lesions, yet it remains underused in the West because of technical and safety concerns with traditional electrosurgical knives. We aimed to evaluate a novel endoscopic articulating knife used with ESD (ESD-AR) to determine its safety and efficacy for large esophageal neoplasms in comparison with EMR., Methods: We retrospectively studied clinically indicated cases of ESD-AR and EMR for esophageal lesions that were 15 mm or greater. All EMR cases had at least 3 simultaneous EMRs to adequately compare resection area. Rates of perforation, GI bleeding, technical performance, and pre- and postendoscopic resection diagnoses were evaluated., Results: Seventy-two ESD-AR and 72 widespread EMR cases were evaluated for Barrett's esophagus (56%), adenocarcinoma (36%), squamous nodularity (2%), and squamous cell carcinoma (6%). There were no statistical differences in age, sex, Barrett's esophagus length, and lesion or resection size between the 2 groups. No perforations occurred. Two adverse events were recorded with ESD-AR and none with EMR (3% vs 0%, P = .50); these were associated with anticoagulation use (P = .04) and greater resection area (P = .02). There were more upgraded diagnoses post-ESD versus EMR (27% vs 12%, P = .05)., Conclusions: ESD-AR by an experienced endoscopist has a comparable safety profile with widespread EMR for large esophageal neoplasia and may have advantages for diagnostic staging., (Copyright © 2020. Published by Elsevier Inc.)