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This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations., Competing Interests: Competing interests: FR has received speaker fees from Bristol-Meyers Squibb, Pfizer and Boehringer Ingelheim. Dr Alikhan has received fees from Alexion, Bayer, Boehringer Ingelheim, Bristol-Meyers Squibb, Daiichi, Pfizer and Portola. WL has received speaker fees from Sanofi Aventis and Leo Pharma, speaker fees and advisory board fees from Bayer, Daichii Sankyo, Pfizer and Boehringer Ingelheim, and support to attend a scientific meeting from Boehringer Ingelheim. JEV-H has received departmental research grant support from Cook Medical and Abbott, lecture fees from Medtronics and Cook Medical, and consultancy fees from Boston Scientific and Olympus., (© 2021 European Society of Gastrointestinal Endoscopy, British Society of Gastroenterology, the Author(s) or their employer(s).)

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Résumé: Autrefois considérée comme une maladie rare, l'œsophagite à éosinophiles (EoE) suscite depuis une vingtaine d'années un intérêt croissant et est devenue l'une des affections les plus couramment diagnostiquées au cours de l'endoscopie digestive haute pour dysphagie chez l'enfant et l'adulte. La physiopathologie de cette affection est complexe et regroupe plusieurs mécanismes, notamment une réponse immunitaire anormale vis-à-vis d'antigènes environnementaux, une altération et fibrose de la muqueuse œsophagienne. Le diagnostic d'EoE est à la fois clinique avec dysfonction œsophagienne et histologique avec une infiltration de la muqueuse œsophagienne par les polynucléaires éosinophiles. L'arsenal thérapeutique pour traiter cette maladie est relativement large : règles hygiéno-diététiques, traitements pharmacologiques tels que les inhibiteurs de la pompe à protons et corticoïdes topiques, mais aussi les anticorps monoclonaux, en cours d'étude. L'endoscopie occupe également une place de choix dans la prise en charge thérapeutique avec une innocuité bien établie, notamment dans les formes fibro-sténosantes où l'efficacité des traitements pharmacologiques est souvent mise en défaut. Enfin, l'endoscopie a également un intérêt dans le suivi de la maladie avec un score de référence endoscopique « EREFS » (pour Exsudats, Anneaux, Œdèmes, Sillons et Sténoses) utilisé comme outil standardisé pour mieux évaluer et surveiller la maladie. Nous nous intéresserons ici particulièrement au rôle de l'endoscopie dans le diagnostic, le traitement et le suivi de l'EoE. Previously considered as a rare disease, eosinophilic esophagitis (EoE) has aroused growing interest over the past twenty years and has become one of the most currently diagnosed disease during upper digestive endoscopy in the context of dysphagia in children and adults. The pathophysiology of esophagitis is complex and involves several mechanisms, including, an abnormal immune response to environmental antigens, alteration of the esophageal mucosa, and the development of fibrosis. The diagnosis of EoE is both clinical with esophageal dysfunction and histological with infiltration of the esophageal mucosa by eosinophilic polynuclei. The therapeutic arsenal to treat this pathology is relatively broad and calls upon hygienic-dietary rules, pharmacological treatments such as proton pump inhibitors and topical corticoids, and also monoclonal antibodies currently under studies. Endoscopy also occupies an important role in therapeutic management, particularly in fibro-stenosing forms of EoE where the efficacy of pharmacological treatments is often challenged, with well-established safety. Finally, endoscopy also has an interest in the follow-up of the disease with an endoscopic reference score which is EREFS (exudates, rings, oedemas, furrows and stenoses) used as a standardized tool to better evaluate and monitor EoE. Here we will focus on the role of endoscopy in the diagnosis, treatment and follow-up of EoE. [ABSTRACT FROM AUTHOR]

This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles, and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion Endoscopic ultrasound‐guided gastrojejunostomy (EUS‐GJ) is an alternative to duodenal stenting and surgical GJ (SGGJ) in malignant gastric outlet obstruction (MGOO). European Society of Gastrointestinal Endoscopy guidelines restricted EUS‐GJ for MGOO only, because of misdeployment. The aim was to evaluate its outcomes focusing on benign indications.This was a retrospective study conducted from 2016 to 2023 in a tertiary center. Patients included had malignant or benign GOO indicated for EUS‐GJ. Techniques were the direct approach until August 2021, and the wire endoscopic simplified technique (WEST) afterwards. The main objective was to compare outcomes in benign vs. MGOO. Secondary end‐points were technical success, adverse events rates, and describing the evolution of techniques and indications.In all, 87 patients were included, 46 men, mean age 66 ± 16.2 years. Indications were malignant in 60.1% and benign in 39.1%. The EUS‐GJ technique was direct in 33 patients (37.9%) and WEST in 54 (62.1%). No difference was found in terms of technical, clinical, or adverse events rates. The initial technical success rate was 88.5%. The final technical and clinical success rates were 96.6% and 94.25%, respectively. In the last year, benign exceeded malignant indications (70.4% vs. 29.6%, P < 0.05). Seven misdeployments occurred, six being addressed with the rescue technique. The misdeployment rate was significantly decreased using the WEST approach compared to the direct one: 3.7% vs. 18% (P < 0.05). The severe postoperative adverse events rate was 2.3%.This study demonstrated similar outcomes of EUS‐GJ between benign and MGOO, with a decreasing misdeployment rate (<4%) applying WEST. This represents an additional step towards recommending EUS‐GJ in benign indications. [ABSTRACT FROM AUTHOR]

1: ESGE recommends that all duodenal adenomas should be considered for endoscopic resection as progression to invasive carcinoma is highly likely.Strong recommendation, low quality evidence. 2: ESGE recommends performance of a colonoscopy, if that has not yet been done, in cases of duodenal adenoma.Strong recommendation, low quality evidence. 3: ESGE recommends the use of the cap-assisted method when the location of the minor and/or major papilla and their relationship to a duodenal adenoma is not clearly established during forward-viewing endoscopy.Strong recommendation, moderate quality evidence. 4: ESGE recommends the routine use of a side-viewing endoscope when a laterally spreading adenoma with extension to the minor and/or major papilla is suspected.Strong recommendation, low quality evidence. 5: ESGE suggests cold snare polypectomy for small (< 6 mm in size) nonmalignant duodenal adenomas.Weak recommendation, low quality evidence. 6: ESGE recommends endoscopic mucosal resection (EMR) as the first-line endoscopic resection technique for nonmalignant large nonampullary duodenal adenomas.Strong recommendation, moderate quality evidence. 7: ESGE recommends that endoscopic submucosal dissection (ESD) for duodenal adenomas is an effective resection technique only in expert hands.Strong recommendation, low quality evidence. 8: ESGE recommends using techniques that minimize adverse events such as immediate or delayed bleeding or perforation. These may include piecemeal resection, defect closure techniques, noncontact hemostasis, and other emerging techniques, and these should be considered on a case-by-case basis.Strong recommendation, low quality evidence. 9: ESGE recommends endoscopic surveillance 3 months after the index treatment. In cases of no recurrence, a further follow-up endoscopy should be done 1 year later. Thereafter, surveillance intervals should be adapted to the lesion site, en bloc resection status, and initial histological result. Strong recommendation, low quality evidence. [ABSTRACT FROM AUTHOR]

1: ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.Strong recommendation, low quality evidence. 2: ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.Strong recommendation, low quality evidence. 3: ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).Strong recommendation, moderate quality evidence. 4: ESGE recommends en bloc resection of ampullary adenomas up to 20-30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.Strong recommendation, low quality evidence. 5: ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.Weak recommendation, low quality evidence. 6: ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.Strong recommendation, moderate quality evidence. 7: ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.Strong recommendation, moderate quality evidence. 8: ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.Strong recommendation, low quality evidence. [ABSTRACT FROM AUTHOR]

Background: Gastric hyperplastic polyps (GHPs) have a risk of neoplastic transformation reaching 5 %. Current endoscopic resection techniques appear suboptimal with a high risk of local recurrence. This study assessed the outcomes of endoscopic resection for GHPs and identified risk factors for recurrence and neoplastic transformation.Methods: This retrospective, multicenter, European study included adult patients with at least one GHP ≥ 10 mm who underwent endoscopic resection and at least one follow-up endoscopy. Patients with recurrent GHPs or hereditary gastric polyposis were excluded. All data were retrieved from the endoscopy, pathology, and hospitalization reports.Results: From June 2007 to August 2018, 145 GHPs in 108 patients were included. Recurrence after endoscopic resection was 51.0 % (74 /145) in 55 patients. R0 resection or en bloc resection did not impact the risk of polyp recurrence. In multivariate analysis, cirrhosis was the only risk factor for recurrence (odds ratio [OR] 4.82, 95 % confidence interval [CI] 1.33 - 17.46; P = 0.02). Overall, 15 GHPs (10.4 %) showed neoplastic transformation, with size > 25 mm (OR 10.24, 95 %CI 2.71 - 38.69; P < 0.001) and presence of intestinal metaplasia (OR 5.93, 95 %CI 1.56 - 22.47; P = 0.01) being associated with an increased risk of neoplastic transformation in multivariate analysis.Conclusions: Results confirmed the risk of recurrence and neoplastic transformation of large GHPs. The risk of neoplastic change was significantly increased for lesions > 25 mm, with a risk of high grade dysplasia appearing in polyps ≥ 50 mm. The risk of recurrence was high, particularly in cirrhosis patients, and long-term follow-up is recommended in such patients. [ABSTRACT FROM AUTHOR]

The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 : ESGE recommends colonic stenting to be reserved for patients with clinical symptoms and radiological signs of malignant large-bowel obstruction, without signs of perforation. ESGE does not recommend prophylactic stent placement.Strong recommendation, low quality evidence. 2 : ESGE recommends stenting as a bridge to surgery to be discussed, within a shared decision-making process, as a treatment option in patients with potentially curable left-sided obstructing colon cancer as an alternative to emergency resection.Strong recommendation, high quality evidence. 3 : ESGE recommends colonic stenting as the preferred treatment for palliation of malignant colonic obstruction.Strong recommendation, high quality evidence. 4 : ESGE suggests consideration of colonic stenting for malignant obstruction of the proximal colon either as a bridge to surgery or in a palliative setting.Weak recommendation, low quality evidence. 5 : ESGE suggests a time interval of approximately 2 weeks until resection when colonic stenting is performed as a bridge to elective surgery in patients with curable left-sided colon cancer.Weak recommendation, low quality evidence. 6 : ESGE recommends that colonic stenting should be performed or directly supervised by an operator who can demonstrate competence in both colonoscopy and fluoroscopic techniques and who performs colonic stenting on a regular basis.Strong recommendation, low quality evidence. 7 : ESGE suggests that a decompressing stoma as a bridge to elective surgery is a valid option if the patient is not a candidate for colonic stenting or when stenting expertise is not available.Weak recommendation, low quality evidence. [ABSTRACT FROM AUTHOR]

Résumé: Aujourd'hui, la grande majorité des polypes coliques est accessible à un traitement endoscopique, mais pour cela, il existe plusieurs « pièges » à éviter lors des différentes étapes de la résection. Avant une résection colique, toutes les conditions permettant une prise en charge optimale doivent être réunies ; de l'information du malade au matériel et au personnel formé en endoscopie, en passant par la préparation colique. Toute endoscopie thérapeutique et chaque résection devrait aujourd'hui s'effectuer avec une insufflation au dioxyde carbone (CO2) ce qui permet de réduire significativement le nombre de complications. L'analyse du polype est primordiale avant toute tentative de résection. L'utilisation des classifications (Kudo, Paris...) permet de ne pas méconnaître une lésion suspecte d'invasion sous muqueuse, rendant inconsidéré un geste endoscopique. Certaines localisations « à risque » doivent également amener l'endoscopiste à reconnaître ses propres limites et à savoir parfois adresser le patient en centre expert, en rappelant qu'un simple soulèvement, une tentative de surélévation ou la réalisation de biopsies rendent souvent difficile le geste de résection. La prévention de l'hémorragie à l'aide de moyen mécanique et la gestion des complications telles que les perforations sont des étapes cruciales lors d'une résection colorectale. Le conditionnement des polypes et leur analyse histologique sont des étapes aussi importantes que la résection, car de celles-ci sont déterminées la suite de la prise en charge et la surveillance du malade. Today, the majority of colonic polyps are accessible to endoscopic treatment, but several "traps" have to be avoided during the different steps of resection. Before resection, all the conditions for optimal management must be met from patient information, bowel preparation to equipment and trained team in endoscopy. All therapeutic endoscopy and resection should nowadays be performed under carbon dioxide (CO2) insufflation, which significantly reduces the number of complications. Polyp characterization is essential before any resection attempt. The international classifications (Kudo, Paris...) are useful to diagnose a lesion suspected of submucosal invasion, making an endoscopic procedure inconsiderate. Some "at risk" locations must also lead the operator to recognize his own limits and sometimes to know how to refer the patient to an expert center. A simple lifting or the carrying out of biopsies often makes the subsequent resection procedure difficult. The prevention of delayed bleeding by mechanical means and managing complications such as perforation are crucial steps. Finally, the conditioning of polyps and their histological analysis are as important steps as resection, as they are the next step in the management and monitoring of the patient. [ABSTRACT FROM AUTHOR]

ESGE recommends against routine preoperative biliary drainage in patients with malignant extrahepatic biliary obstruction; preoperative biliary drainage should be reserved for patients with cholangitis, severe symptomatic jaundice (e. g., intense pruritus), or delayed surgery, or for before neoadjuvant chemotherapy in jaundiced patients. Strong recommendation, moderate quality evidence. ESGE recommends the endoscopic placement of a 10-mm diameter self-expandable metal stent (SEMS) for preoperative biliary drainage of malignant extrahepatic biliary obstruction. Strong recommendation, moderate quality evidence.ESGE recommends SEMS insertion for palliative drainage of of extrahepatic malignant biliary obstruction. Strong recommendation, high quality evidence. ESGE recommends against the insertion of uncovered SEMS for the drainage of extrahepatic biliary obstruction of unconfirmed etiology. Strong recommendation, low quality evidence. ESGE suggests against routine preoperative biliary drainage in patients with malignant hilar obstruction. Weak recommendation, low quality evidence.ESGE recommends uncovered SEMSs for palliative drainage of malignant hilar obstruction. Strong recommendation, moderate quality evidence.ESGE recommends temporary insertion of multiple plastic stents or of a fully covered SEMS for treatment of benign biliary strictures. Strong recommendation, moderate quality evidence.ESGE recommends endoscopic placement of plastic stent(s) to treat bile duct leaks that are not due to transection of the common bile duct or common hepatic duct. Strong recommendation, moderate quality evidence. [ABSTRACT FROM AUTHOR]

1:  ESGE suggests using contrast-enhanced computed tomography (CT) as the first-line imaging modality on admission when indicated and up to the 4th week from onset in the absence of contraindications. Magnetic resonance imaging (MRI) may be used instead of CT in patients with contraindications to contrast-enhanced CT, and after the 4th week from onset when invasive intervention is considered because the contents (liquid vs. solid) of pancreatic collections are better characterized by MRI and evaluation of pancreatic duct integrity is possible. Weak recommendation, low quality evidence. 2:  ESGE recommends against routine percutaneous fine needle aspiration (FNA) of (peri)pancreatic collections. Strong recommendation, moderate quality evidence. FNA should be performed only if there is suspicion of infection and clinical/imaging signs are unclear. Weak recommendation, low quality evidence. 3:  ESGE recommends initial goal-directed intravenous fluid therapy with Ringer's lactate (e. g. 5 - 10 mL/kg/h) at onset. Fluid requirements should be patient-tailored and reassessed at frequent intervals. Strong recommendation, moderate quality evidence. 4:  ESGE recommends against antibiotic or probiotic prophylaxis of infectious complications in acute necrotizing pancreatitis. Strong recommendation, high quality evidence. 5:  ESGE recommends invasive intervention for patients with acute necrotizing pancreatitis and clinically suspected or proven infected necrosis. Strong recommendation, low quality evidence.ESGE suggests that the first intervention for infected necrosis should be delayed for 4 weeks if tolerated by the patient. Weak recommendation, low quality evidence. 6:  ESGE recommends performing endoscopic or percutaneous drainage of (suspected) infected walled-off necrosis as the first interventional method, taking into account the location of the walled-off necrosis and local expertise. Strong recommendation, moderate quality evidence. 7:  ESGE suggests that, in the absence of improvement following endoscopic transmural drainage of walled-off necrosis, endoscopic necrosectomy or minimally invasive surgery (if percutaneous drainage has already been performed) is to be preferred over open surgery as the next therapeutic step, taking into account the location of the walled-off necrosis and local expertise. Weak recommendation, low quality evidence. 8:  ESGE recommends long-term indwelling of transluminal plastic stents in patients with disconnected pancreatic duct syndrome. Strong recommendation, low quality evidence. Lumen-apposing metal stents should be retrieved within 4 weeks to avoid stent-related adverse effects.Strong recommendation, low quality evidence. [ABSTRACT FROM AUTHOR]

Background and study aims: Endoscopic techniques have demonstrated their effectiveness in metabolic surgery, notably through a gastrointestinal (GI) liner, with a less invasive approach than conventional surgery. Our study evaluates the safety and efficacy of endoscopic GI anastomosis (EGIA) using a lumen-apposing stent to secure the anastomosis. Materials and methods: EGIA was performed using the transgastric approach with a two-channel endoscope with a novel stent (Cousin Biotech). First, a safety study with a follow-up of 12 months was performed on five piglets. Then, metabolic changes were investigated in a minipig model (n = 10) before and after EGIA or open GIA (OGIA). Results: EGIA was technically successful with no complications observed during clinical monitoring. Endoscopic and postmortem examinations during the second part of study showed a secure anastomosis between the stomach and the intestinal limb in all except one minipig. Both minipigs subjected to EGIA and those in the control group (OGIA) exhibited increased postprandial glucagon-like peptide-1 (GLP-1) production (incretin secretion) and impaired D-xylose absorption (malabsorption effect). Conclusion: Performing EGIA with this dedicated stent appears safe, technically feasible, durable, and reproducible in providing a simple and effective endoscopic GI bypass capable of ensuring metabolic effect. [ABSTRACT FROM AUTHOR]

Background and study aims Endoscopic sphincterotomy plus large-balloon dilation (ES-LBD) has been reported as an alternative to endoscopic sphincterotomy for the removal of bile duct stones. This multicenter study compared complete endoscopic sphincterotomy with vs. without large-balloon dilation for the removal of large bile duct stones. This is the first randomized multicenter study to evaluate these procedures in patients with exclusively large common bile duct (CBD) stones. Methods Between 2010 and 2015, 150 patients with one or more common bile duct stones ≥ 13 mm were randomized to two groups: 73 without balloon dilation (conventional group), 77 with balloon dilation (ES-LBD group). Mechanical lithotripsy was subsequently performed only if the stones were too large for removal through the papilla. Endoscopic sphincterotomy was complete in both groups. Patients could switch to ES-LBD if the conventional procedure failed. Results There was no between-group difference in number and size of stones. CBD stone clearance was achieved in 74.0 % of patients in the conventional group and 96.1 % of patients in the ES-LBD group (P < 0.001). Mechanical lithotripsy was needed significantly more often in the conventional group (35.6 % vs. 3.9 %; P < 0.001). There was no difference in terms of morbidity (9.3 % in the conventional group vs. 8.1 % in the ES-LBD group; P = 0.82). The cost and procedure time were not significantly different between the groups overall, but became significantly higher for patients in the conventional group who underwent mechanical lithotripsy. The conventional procedure failed in 19 patients, 15 of whom underwent a rescue ES-LBD procedure that successfully cleared all stones. Conclusions Complete endoscopic sphincterotomy with large-balloon dilation for the removal of large CBD stones has similar safety but superior efficiency to conventional treatment, and should be considered as the first-line step in the treatment of large bile duct stones and in rescue treatment.Trial registered at ClinicalTrials.gov (NCT02592811). [ABSTRACT FROM AUTHOR]

The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage versus thrombosis due to discontinuation of therapy. P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor) For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation); For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation). For high- risk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation). Warfarin The advice for warfarin is fundamentally unchanged from British Society of Gastroenterology (BSG) 2008 guidance. Direct Oral Anticoagulants (DOAC) For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation); For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ≥48 h before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30-50 mL/min we recommend that the last dose of DOAC be taken 72 h before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation). [ABSTRACT FROM AUTHOR]

Background and Study Aims: The rendezvous endoscopic approach, already described, might be an interesting technique in complete esophageal obstructions (CEO).Patients and Methods: This retrospective report on nine patients referred because of CEO classified patients into two groups based on length of their esophageal disruption: the long (> 5 cm) group were three patients (esophageal stripping at stent removal [n = 2] and caustic ingestion [n = 1]; two patients having superior esophageal sphincter [SES] destruction); the short (< 5 cm) group were six patients (anastomotic or post-radiotherapy). The procedures were performed under radiographic guidance.Results: All the reconstructions were successful. In four patients, a neo-SES was created, by transillumination (n = 2) or surgery (n = 2). The first dilation was performed by hydrostatic balloon, with additional metal stents (n = 4) and nasogastric tubes (n = 2) used. All the patients were able to eat after the procedure. Two delayed bleeds occurred, which were managed endoscopically. The patients underwent a median of seven dilations (range 3 - 55) over 8 months (2 - 32 months), with dilations ongoing in five patients, but all able to eat normally.Conclusion: Endoscopic rendezvous for CEO is safe and effective, even in patients with long disruptions and complete loss of SES. [ABSTRACT FROM AUTHOR]

The article looks at innovations in endoscopy that were presented at the 2014 Digestive Disease Week in Chicago, Illinois. An innovative and simple application of optical coherence tomography was presented. The use of paclitaxel-eluting covered metal stents in obstructive esophageal squamous carcinoma in an animal model was evaluated. A novel prep-free colonic imaging capsule systems was evaluated.

Background and study aim: Video capsule endoscopy (VCE) is recommended as the first exploration in obscure digestive bleeding. The efficiency of the PillCam SB2 (Given Imaging) has been widely reported. The CapsoCam capsule (Capsovision) has four cameras allowing the exploration of the small bowel through 360° lateral viewing. This system does not include a recording system so the capsule has to be retrieved by the patient after expulsion in order for the film to be downloaded. The aim of this study was to evaluate diagnostic concordance (kappa value) of the Pill- Cam SB2 and CapsoCam capsules in the same patients. Methods: This was a prospective comparative study in four French referral endoscopy units. Consecutive patients ingested the two capsules 1 hour apart and in a randomized order. Results: In the 73 included patients there were 13 technical issues (11 CapsoCam, 2 PillCam SB2). Of the 60 patients with analyzable data, and following expert reviewof all discordant cases, a concordant positive diagnosiswas obtained in 23 (38.3 %) and a negative diagnosis was obtained and 26 patients (43.3 %). Concordancewas good, with a kappa value of 0.63 in analyzable patients, and 46.7% diagnosis with CapsoCam vs. 48.3% with PillCam SB2.CapsoCam and PillCam SB2 procedures identified 81.8% (27 /33) and 84.8% (28 /33) of positive patients, respectively (P=0.791). In a per lesion analysis, the CapsoCam capsule detected significantly more lesions (108 vs. 85 lesions; P=0.001). Reading time was longer for CapsoCam procedures (32.0 vs. 26.2 minutes; P=0.002). Conclusion: This studyshowscomparable efficiency of the CapsoCam and PillCam SB2 capsule systems in terms of diagnostic yield and image quality. [ABSTRACT FROM AUTHOR]

Abstract: Background: Oesophago-gastroduodenoscopy is the standard method for the diagnosis of recurrent oesophago-gastric varices after endoscopic treatment and eradication. The aim of this study was to evaluate the PillCam®Eso capsule endoscopy in this setting. Methods: Prospective, multicentre study in which patients with history of oesophageal varices treated by band ligation underwent PillCam®Eso capsule and oesophago-gastroduodenoscopy. Capsule recordings were blindly read by two endoscopists. Indication for a new prophylactic treatment and patient satisfaction were determined for both procedures. Results: 80 patients (80% males, mean age: 57±12 years) were included, after a median delay of 16 months from last endoscopic treatment. Recurrent oesophageal varices requiring a new prophylactic treatment were detected in 26 patients (32.5%). The mean oesophageal transit time of the capsule was 153s (range 2–930s). Capsule sensitivity, specificity, negative and positive predictive values for indication of new prophylactic treatments were 65%, 83%, 83%, and 65%, respectively. Capsule adequately classified 77.5% of the patients for prophylaxis indication. Inter-observer concordance for capsule readings was 88% for the prophylaxis indication. Conclusion: This study demonstrates that accuracy of PillCam®Eso capsule for the diagnosis of recurrent oesophageal varices after endoscopic eradication is suboptimal. PillCam®Eso capsule might therefore be proposed in patients unable or unwilling to undergo oesophago-gastroduodenoscopy. [Copyright &y& Elsevier]

L'obésité et le surpoids s'avèrent être des problèmes de santé publique de manière pandémique réduisant significativement l'espérance de vie des personnes touchées et présentant un impact médicoéconomique important, en lien avec les traitements qu'ils requièrent et leurs comorbidités. En France, la prise en charge thérapeutique de cette pathologie se résume à une modification du mode de vie ou à une approche chirurgicale. L'endoscopie a permis le développement d'alternatives thérapeutiques ces dernières années, bien que ces méthodes ne soient à l'heure actuelle pas toutes recommandées en France alors même que des résultats probants aient été démontrés. À l'heure de l'avènement de l'endoscopie interventionnelle préservant les organes, des procédures thérapeutiques novatrices mini-invasives ont vu le jour et vont tendre à se développer afin d'occuper une place à part entière dans le traitement de cette maladie chronique. Avec la mise à disposition de nouveaux traitements médicamenteux efficaces comme les agonistes du GLP-1, des approches combinées « endoscopie-médicament » pourraient être nouvellement définies permettant d'atteindre une efficacité clinique sans précédent. L'objectif de cette mise au point est de rappeler les techniques endoscopiques actuelles existantes dans la prise en charge de l'obésité, d'exposer les innovations dans le domaine en cours de développement et d'esquisser quel pourrait être l'avenir de l'endoscopie bariatrique. Obesity and overweight are proving to be pandemic public health problems that significantly reduce the life expectancy of those affected. Obesity has a significant medico-economic impact, in relation to the treatments it requires and its comorbidities. In France, the therapeutic management of this pathology is limited to a lifestyle modification or a surgical approach. Endoscopy has allowed the development of therapeutic alternatives in the management of obesity in recent years, although not all of these methods are currently recommended in France, even though convincing results have been shown. With the advent of organ-sparing interventional endoscopy, innovative minimally invasive therapeutic procedures have emerged and will tend to develop in order to take a full place in the treatment of this chronic disease. More ambitious endoscopic procedures could also be combined, thus combining the different modes of action of each of them. Finally, with the availability of new effective drug treatments, combined "endoscopy-drug" approaches could be newly defined to achieve unprecedented clinical effectiveness. The objective of this review will be to present the current endoscopic techniques available for the management of obesity, to discuss the innovative procedures under development and to outline the future of bariatric endoscopy, either by combining procedures or by combining them with medical therapies. [ABSTRACT FROM AUTHOR]