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Background and aims: G-POEM is an emerging method for treatment of severe gastroparesis. Safe mucosal closure is necessary to avoid adverse events. The aim of this study was to compare the efficacy of two closure methods: clips and endoscopic suturing (ES) after G-POEM. Methods: We performed a single center, prospective study. The closure method was assigned at the discretion of an endoscopist prior to the procedure. The main outcome was the proportion of subjects with successful closure. Unsuccessful closure was defined as a need for a rescue method, or a need for an additional intervention or incomplete closure-related adverse events. Secondary outcomes were the easiness of closure (VAS score 1 = very difficult, 10 = easy), closure time, and cost. Results: A total of 40 patients [21 female; mean age, range 47.5; (20–74)] were included; 20 received ES and 20 clips [mean number of clips 6; range (4–19)]. All 20 patients with ES (100%, 95% CI 84–100%) and 18 patients with clips (89%, 95% CI 70–97%) had successful closure (p= 0.49). One patient needed a rescue method (KING closure) and the other patient an additional clipping on POD1. Closure with clips was quicker [mean time 9.8 (range 4–20) min vs. 14.1 (5–21) min; p= 0.007] and cheaper [mean cost 807 USD (± 402) vs. 2353 USD (± 145); p< 0.001]. Endoscopist assessed the easiness of ES and clips as comparable [mean VAS, range 7.5 (3–10) (ES) vs. 6.9 (3–10) (clips); p= 0.3]. Conclusions: Both ES and clips are effective methods for mucosal closure in patients undergoing G-POEM. However, centres using clips should have a rescue closure method available as clips may fail in some patients. Closure with ES is more costly than with clips. Graphical abstract:

L’endoscopie par capsule (EC) utilisant le système Given Imaging, est disponible en République tchèque depuis fin 2002. Le but de cette étude rétrospective a été d’évaluer l’expérience existante de la capsule endoscopique dans cinq centres de gastroentérologie de notre pays. Soixante dix-huit EC ont été colligées (de novembre 2003 à avril 2004) concernant 38 hommes et 40 femmes (âge moyen: 54 ans). L’EC était indiquée comme dernière étape dans l’algorithme diagnostique. La totalité de l’intestin grêle a pu être investiguée dans 54 cas sur 78 (69 %). Les angiodysplasies ont été le plus fréquemment retrouvées (16 patients), puis la maladie de Crohn (8 patients) et enfin, les tumeurs du grêle (7). L’EC a été suivie d’un geste chirurgical chez 15 patients, d’une entéroscopie per opératoire chez 9 patients et un traitement médical a été initié ou modifié chez 26 patients. Une rétention de la capsule a été observée dans 5 cas (6 % et une impaction dans le grêle dans 3 cas); un échec technique a été rapporté dans 5 cas (6 %). L’EC est une méthode complémentaire qui n’entre pas en compétition avec les autres outils diagnostiques d’investigation du grêle. L’EC est particulièrement précieuse en cas de saignement GI obscur. Cependant, notre expérience reste jusqu’à présent, assez limitée. Capsule endoscopy (CE), using a Given Imaging system, is available in the Czech Republic since late 2002. The aim of this retrospective study was to evaluate the existing experience with CE in five gastroenterology centers in the Czech Republic. Seventy-eight CE were reviewed (Nov 2002 – Apr 2004), 38 men, 40 women (mean age 54). CE was indicated as the last step in diagnostic algorithm. The entire small bowel was investigated in 54/78 cases (69 %). The most frequent findings were angiodysplasias (16 patients), Crohn’s disease (8) and small bowel tumours (7). CE was followed by surgery (15 pts), intraoperative enteroscopy (9 pts) and medical treatment was introduced or changed in 26 pts. Capsule retention was found in 5 cases (6 %; small bowel impaction in 3 cases), technical failure was noticed 5 times (6 %). CE is complementary, not competing with other diagnostic tools in the investigation of the small bowel. CE is helpful namely in obscure GI bleeding. However, the existing experience is limited so far. [ABSTRACT FROM AUTHOR]

Background & Aims: Hereditary pancreatitis is an autosomal dominant disease that is mostly caused by cationic trypsinogen (PRSS1) gene mutations. The aim was to determine phenotype-genotype correlations of families in Europe. Methods: Analysis of data obtained by the European Registry of Hereditary Pancreatitis and Pancreatic Cancer was undertaken using multilevel proportional hazards modelling. Results: There were 112 families in 14 countries (418 affected individuals): 58 (52%) families carried the R122H, 24 (21%) the N29I, and 5 (4%) the A16V mutation, 2 had rare mutations, and 21 (19%) had no PRSS1 mutation. The median (95% confidence interval [CI]) time to first symptoms for R122H was 10 (8, 12) years of age, 14 (11, 18) years for N29I, and 14.5 (10, 21) years for mutation negative patients (P = 0.032). The cumulative risk (95% CI) at 50 years of age for exocrine failure was 37.2% (28.5%, 45.8%), 47.6% (37.1%, 58.1%) for endocrine failure, and 17.5% (12.2%, 22.7%) for pancreatic resection for pain. Time to resection was significantly reduced for females (P < 0.001) and those with the N29I mutation (P = 0.014). The cumulative risk (95% CI) of pancreatic cancer was 44.0% (8.0%, 80.0%) at 70 years from symptom onset with a standardized incidence ratio of 67% (50%, 82%). Conclusions: Symptoms in hereditary pancreatitis start in younger patients and endpoints take longer to be reached compared with other forms of chronic pancreatitis but the cumulative levels of exocrine and endocrine failure are much higher. There is an increasingly high risk of pancreatic cancer after the age of 50 years unrelated to the genotype.