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Colorectal cancer is the third leading cause of cancer deaths worldwide, and its incidence is rising. Colonoscopy prevents the onset of colorectal cancer and reduces associated mortality, thanks to the endoscopic resection of polyps, particularly adenomatous polyps. However, adenomatous polyps are not the only type of polyp, and their resection can vary according to several factors: size, shape, degenerative aspect, suspicion of submucosal invasion, etc. Significant technical advances (endoscopic submucosal dissection, artificial intelligence, etc.) have been made in recent years. Where do we stand? It is essential to use the appropriate classification tools to characterize colonic polyps in order to best guide the type of resection. [ABSTRACT FROM AUTHOR]

Gastrointestinal angiodysplasia are the most common vascular lesions of the digestive tract. Risk factors include age, aortic stenosis (Heyde syndrome), chronic renal failure, cirrhosis and von Willebrandt's disease. Diagnosis is often made in the setting of occult or overt gastrointestinal bleeding. Due to their preferential location in the jejunum and colon, most lesions are diagnosed during upper endoscopy or colonoscopy. In cases where small bowel bleeding is suspected, capsule endoscopy is the gold standard diagnostic exam. A meta-analysis has recently shown that its diagnostic yield is optimal within 48 hours following an overt bleeding episode, and it is recommended to respect this time frame (European Guidelines). Capsule endoscopy is ideal in terms of patient tolerance. However, it is tedious and time-consuming to interpret and requires expertise. In the recent years artificial intelligence applied to capsule endoscopy has developed significantly. Its contribution is now major, with improved diagnostic yield and reduced interpretation time. Argon plasma coagulation during endoscopy is the first-line treatment for gastrointestinal angiodysplasia. Deep enteroscopy is the preferred procedure for ablation of small bowel angiodysplasia. Motorized spiral enteroscopy has enabled easier access to deep small bowel lesions and a shorter procedure time, since it was first used in 2016. However, it has been withdrawn from the market since July 2023, given the occurrence of serious adverse events (perforations). More centres should be equipped with double-ballon enteroscopes in France. The recent results from the randomized controlled OCEAN trial confirm that long-acting release somatostatin analogues (Octreotide) significantly reduce transfusion needs when endoscopic treatment has failed. Thalidomide is also an interesting treatment option, as demonstrated in a randomized control trial published in November 2023, with a reduced recurrence rate of bleeding after 4 months of treatment and during the following year. In the specific case of Heyde syndrome, percutaneous aortic valve replacement (TAVI) also reduces transfusion requirements. [ABSTRACT FROM AUTHOR]

Early gastrointestinal cancers or T1 cancers are limited to the mucosa or the submucosa. Virtually all of these tumors are eligible to a complete endoscopic resection by endoscopic mucosal resection or submucosal dissection, allowing avoiding upfront surgical resection. However, endoscopic technical difficulties or uncertainties in endoscopic histological prediction can lead to histologically incomplete resections, requiring salvage treatment. Other tumors, although entirely resected, are considered to have a significant risk of metastasis, warranting adjuvant therapy, depending on histological criteria on the resection specimen. The management of these lesions needs to take into account several parameters, among which the patient comorbid conditions, wishes, endoscopic resection modality, lesion location, qualitative and quantitative histological criteria. This is the role of a multidisciplinary tumor board dedicated to early gastrointestinal cancers. Involving gastrointestinal endoscopists, oncologists, digestive surgeons, pathologists, radiation oncologists and radiologists, its aims at stating the curative nature of the endoscopic resection procedure, or indicating additional treatments. [ABSTRACT FROM AUTHOR]

Background: EUS-guided choledoco-duodenostomy using electrocautery-enhanced lumen-apposing metal stents (ECE-LAMS) is becoming the gold standard in case of endoscopic retrograde cholangio-pancreatography failure for distal malignant obstruction. Long-term data in larger samples are lacking., Methods: This was a prospective monocentric study including all patients who underwent EUS-guided choledochoduodenostomy (CDS) between September 2016 and December 2021. The primary endpoint was the rate of biliary obstruction during follow-up. Secondary endpoints were technical and clinical success rates, adverse event rates, and identification of risk factors for biliary obstruction., Results: One hundred and twenty-three EUS-guided CDS using ECE-LAMS were performed at Limoges University Hospital were performed during the study period and included in the study. The main cause of obstruction was pancreatic adenocarcinoma in 91 (74.5%) cases. The technical and clinical success rates were 97.5% and 91%, respectively. Twenty patients (16.3%) suffered from biliary obstructions during a mean follow-up of 242 days. The clinical success rate for endoscopic desobstruction was 80% (16/20). In uni- and multivariate analyses, only the presence of a duodenal stent (odds ratio [OR]: 3.6, 95% confidence interval [CI] 95%: 1.2-10.2; P = 0.018) and a bile duct thinner than 15 mm (OR: 3.9, CI 95%: 1.3-11.7; P = 0.015) were the significant risk factors for biliary obstruction during the follow-up., Conclusion: Obstruction of LAMS occurred in 16.3% of cases during follow-up and endoscopic desobstruction is efficacious in 80% of cases. The presence of duodenal stent and a bile duct thinner than 15 mm are the risk factors of obstruction. Except in these situation, EUS-CDS with ECE-LAMS could be proposed in the first intent in case of distal malignant obstruction., Competing Interests: None