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This article discusses a pilot study on the use of EUS-guided choledochoduodenostomy (EUS-CDS) with a lumen-apposing metal stent (LAMS) for patients with a malignant distal biliary obstruction (MBO). The study aimed to investigate whether placing a fully covered self-expandable metal stent (FCSEMS) through the LAMS could decrease the risk of stent dysfunction while maintaining high technical success and low adverse event rates. The study included 27 patients with MBO, and the technical success rate of EUS-CDS with LAMS was 89%. The study found a stent dysfunction rate of 10% following successful EUS-CDS, and the authors suggest that improving the LAMS design may reduce this rate. [Extracted from the article]

This article discusses a study that aimed to improve the sensitivity of brush cytology in patients with suspected perihilar or intrahepatic cholangiocarcinoma (pCCA/iCCA). The researchers implemented a new protocol for obtaining, handling, and rating brush cytology samples. They found that the sensitivity of brush cytology increased from 50.9% to 88.3% after the protocol implementation. The study also explored the use of next-generation sequencing (NGS), multiple brushes, and intraductal biopsies to further increase sensitivity. The findings suggest that these modifications can significantly improve the accuracy of diagnosing malignant disease in patients with suspected pCCA or iCCA. [Extracted from the article]

This article discusses the impact of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) on the intra- and post-operative outcomes of pancreatoduodenectomy (PD) compared to transpapillary drainage. The study analyzed data from 641 patients who underwent PD, including 34 who underwent EUS-CDS. The results showed that EUS-CDS was safe and did not increase major postoperative complications compared to conventional biliary drainage. Surgeons also reported no evident difficulties during most of the resections. However, the authors note that further research is needed to confirm these findings in a randomized trial. [Extracted from the article]

A recent study compared the effectiveness of endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) in patients with achalasia. The study found that both procedures were equally successful in controlling symptoms at the five-year follow-up. However, post-procedural reflux esophagitis and the need for acid inhibitors were more common after POEM. The study also noted that gastroesophageal reflux was more frequent in the POEM group compared to the LHM group. Overall, the study suggests that both procedures are effective in treating achalasia, but POEM may be associated with a higher risk of reflux. [Extracted from the article]

This article discusses the use of endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) as a treatment for malignant gastric outlet obstruction (GOO) in patients with gastric, duodenal, or pancreatic cancer. The study aimed to identify patient and disease characteristics that influence the outcomes of EUS-GE. The results showed that patients with an obstruction located in the distal duodenum had a lower probability of technical success. The etiology of the obstruction was not associated with technical or clinical success. These findings contribute to a better understanding of which patients may benefit most from EUS-GE. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the use of a virtual scale (VS) function for measuring the size of colorectal polyps during colonoscopy. The study compared the VS measurements to other measurement methods and evaluated the clinical feasibility of the VS. The results showed that the variability in polyp size measurements was significantly lower for VS measurements compared to visual and snare-aided measurements. The use of the VS led to more uniform polyp sizing and no clinically relevant systematic differences were identified. However, it should be noted that the VS measurement is not feasible for all polyps. [Extracted from the article]

Background: Irrespective of the primary test used in colorectal cancer (CRC) screening, colonoscopy needs to be performed in positive screenees. This procedure is generally perceived as burdensome. We aimed to explore the burden of the colonoscopy in fecal immunochemical test (FIT)-positive screenees. Trial Registration Number: NTR1327. Methods: Two weeks after their colonoscopy, a random sample of screenees in the Dutch CRC screening pilot who underwent colonoscopy after a positive FIT were asked to rate their experience on a five-point scale (1=not at all, 5=very) for embarrassment, pain, and burden. Aspects that would add to satisfaction and the level of disturbance of daily activity and sleep were also assessed. Results: Of 373 invited individuals, 273 (73 %) completed the questionnaire; 53% were men, mean age was 63 years (standard deviation [SD] 7). The bowel preparation received the highest burden score (mean score 2.87, SD 1.28) and was chosen as the most burdensome aspect by 56%. The highest levels of pain were assigned to postcolonoscopy abdominal complaints (2.55, SD 1.03). The procedure was rated as only slightly embarrassing (1.49, SD 0.68). Adequate explanation of the procedure, immediate discussion of preliminary colonoscopy results, and a short waiting time between FIT result and colonoscopy were selected most often as potential contributors to satisfaction. Conclusion: Bowel preparation and postcolonoscopy abdominal complaints are experienced as the most burdensome elements by persons undergoing colonoscopy in a FIT screening program. Amore easily tolerable bowel preparation, carbon dioxide insufflation, and adequate and timely communication are seen as measures to alleviate the burden and increase satisfaction with the procedure. [ABSTRACT FROM AUTHOR]

Background and study aims: Time limitations and unwanted health effects may act as barriers to participation in colorectal cancer (CRC) screening. The aim of the study was to measure the time requirements and health effects of colonoscopy and computed tomography colonography (CTC) screening. Patients and methods: Thiswas a prospective diary study in a consecutive sample within a randomized controlled CRC screening trial, comparing primary colonoscopy and CTC screening for average-risk individuals aged 50-74 years. The diary ended when all screening-related complaints had passed. Results: The diary was returned by 75% (241/322) of colonoscopy and 75% (127/170) of CTC screenees. The median interval between leaving home and returning from the examination was longer for colonoscopy (4 hours and 18 minutes [4:18], interquartile range [IQR] 3:30-5:00) than for CTC (2:30 hours, IQR 2:06-3:00; P<0.001). Similarly, the time to return to routine activities was longer after colonoscopy (3:54 hours, IQR 1:48- 15:00) than after CTC (1:36 hours, IQR 0:54- 4:42). The duration of screening-related symptoms after the examination was shorter for colonoscopy (11:00 hours, IQR 2:54-20:00) than for CTC (22:00 hours; IQR 5:30-47:00; P<0.001). Abdominal complaints were reported more frequently after CTC. Anxiety, pain, and quality of life worsened during the screening process, with no differences between the two examinations. Conclusions: Compared with colonoscopy, CTC screening required less time and allowed screenees to return to their daily activities more quickly. In contrast, CTC was associated with a twofold longer duration of screening-related symptoms. Feelings of anxiety, pain, and quality of life scores were similar during colonoscopy and CTC screening. These results should be incorporated into cost-effectiveness analyses of CRC screening techniques. [ABSTRACT FROM AUTHOR]

Background and study aims: Enteral stent placement has emerged as a safe and effective palliative treatment option for patients with malignant gastric outlet obstruction (GOO). In an attempt to further optimize this treatment new enteral stents have been designed. This study is the first to describe the results regarding technical success, clinical success, complication rate, and stent dysfunction of the Evolution duodenal stent (Cook Medical, Limerick, Ireland). Patients and methods: A total of 46 patients with symptomatic malignant GOO were included in this prospective multicenter cohort study. All patients who successfully received an Evolution duodenal stent were followed until death. Results: The technical and clinical success rates were 89% (95% confidence interval [CI] 77%-95%) and 72% (95 %CI 58%-83%), respectively. The GOO Scoring System score, the Global Health Score, and the EuroQol visual analog scale improved significantly (GOOSS and Global Health Score P<0.0001; EuroQol P=0.005) when scores before stenting were compared with scores after stent placement. Median survival was 87 days, and stent patency was observed in 67% for up to 395 days, accounting for death unrelated to the stent as a competing risk. Stent dysfunction occurred in 14 patients (30 %) (stent ingrowth n=9; stent migration n=2; extrinsic compression on the stent n=2; food impaction n=1). Conclusion: These first data on the new Evolution duodenal stent show that it is safe and effective for the palliative treatment of symptomatic malignant GOO. [ABSTRACT FROM AUTHOR]

The article presents a case study of a patient who developed esophageal stricture and buried metaplasia following the treatment of Barrett's esophagus through radiofrequency ablation (RFA). Topics discussed include dysphagia presented by the patient weeks after RFA, the results of upper endoscopy, and management of the esophageal stricture through balloon dilatation.