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Endoscopy units are considered to be at an increased risk of infection by SARS-CoV-2. Our aim is to assess the correlation between pre-endoscopic screening with reverse-transcription-polymerase-chain-reaction (RT-PCR) in asymptomatic individuals scheduled for elective endoscopy and the epidemiological data published by the local Health Administration.Observational retrospective study collecting the results of our screening strategy spanning June/2020-June/2021, the effective potential growth (EPG), an index measuring the outbreak risk, and the 7 and 14-day cumulative incidence (CI). Indication, delay and the findings of the endoscopic examinations were registered for RT-PCR positive patients.A total of 5808 tests were performed, yielding 125 positive results (2.15%). All positive tests occurred in weeks of high/very high risk (EPG100) with the highest monthly rate being 9.36%, recorded in January/2021. A significant correlation (rho=0.796; p0.001) between weekly positive rates and EPG was observed, and a significantly lower weekly number of positive tests was recorded when EPG100. Planning the screening strategy one week ahead according to EPG100 would have avoided up to 826 tests with only one positive result to account for. One hundred and thirteen individuals tested positive and 89 endoscopies were delayed. The most common findings were colon polyps, colorectal cancer and gastric metaplasia. Oncological diagnosis was delayed 50±3 days.No positive RT-PCR test were registered out of high-risk periods. Epidemiological administrative data in the preceding two weeks showed a significant correlation with screening results and could be useful to plan pre-endoscopic screening and avoid unnecessary tests.

Background Endoscopic submucosal dissection (ESD) in colorectal lesions is technically demanding and a significant rate of noncurative procedures is expected. We aimed to assess the rate of residual lesions after a noncurative ESD for colorectal cancer (CRC) and to establish predictive scores to be applied in the clinical setting. Methods Retrospective multicenter analysis of consecutive colorectal ESDs. Patients with noncurative ESDs performed for the treatment of CRC lesions submitted to complementary surgery or with at least one follow-up endoscopy were included. Results From 2255 colorectal ESDs, 381 (17 %) were noncurative, and 135 of these were performed in CRC lesions. A residual lesion was observed in 24 patients (18 %). Surgery was performed in 96 patients and 76 (79 %) had no residual lesion in the colorectal wall or in the lymph nodes. The residual lesion rate for sm1 cancers was 0 %, and for > sm1 cancers was also 0 % if no other risk factors were present. Independent risk factors for lymph node metastasis were poor differentiation and lymphatic permeation (NC-Lymph score). Risk factors for the presence of a residual lesion in the wall were piecemeal resection, poor differentiation, and positive/indeterminate vertical margin (NC-Wall score). Conclusions Lymphatic permeation or poor differentiation warrant surgery owing to their high risk of lymph node metastasis, mainly in > sm1 cancers. In the remaining cases, en bloc and R0 resections resulted in a low risk of residual lesions in the wall. Our scores can be a useful tool for the management of patients who undergo noncurative colorectal ESDs.

Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult, including large (20 mm) laterally spreading tumors (LSTs), has increased in the last decade. All LSTs should be assessed carefully, looking for suspicious areas of submucosal invasion (SMI), such as nodules or depressed areas, describing the morphology according to the Paris classification, the pit pattern, and vascular pattern. The simplest, most appropriate and safest endoscopic treatment with curative intent should be selected. For LST-granular homogeneous type, piecemeal endoscopic mucosal resection should be the first option due to its biological low risk of SMI. LST-nongranular pseudodepressed type has an increased risk of SMI, and en bloc resection should be mandatory. Underwater endoscopic mucosal resection is useful in situations where submucosal injection alters the operative field

Introduction Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric malignancies. In recent years, the ESD technique has been implemented in Western countries with increasing use. Objectives To describe the results of gastric ESD in a Western country with a low incidence of gastric cancer. Patients and Methods The prospective national registry was conducted over 4 years in 23 hospitals, including 30 endoscopists. Epithelial and subepithelial lesions (SEL) qualified to complete removal with ESD were assessed. The technique, instruments, and solution for submucosal injection varied at the endoscopist's discretion. ESD was defined as difficult when: en‐bloc resection was not achieved, had to be converted to a hybrid resection, lasted more than 2 h or an intraprocedural perforation occurred. Additionally, independent risk factors for difficult ESD were analyzed. Results Two hundred and thirty gastric ESD in 225 patients were performed from January 2016 to December 2019 (196 epithelial and 34 SEL). Most lesions were located in the lower stomach (111; 48.3%). One hundred and twenty‐eight (55.6%) ESD were considered difficult. The median procedure time was 105 min (interquartile range [IQR]: 60–150). The procedure time for SEL was shorter than for epithelial lesions (90 min [45–121] vs. 110 min [62–160]; p = 0.038). En‐bloc, R0, and curative resection rates were 91.3%, 75.2%, and 70.9%, respectively. Difficult ESD had lower R0 resection rates than ESD that did not meet the difficulty criteria (64.8% and 87.6%; p = 0.000, respectively). Fibrosis and poor maneuverability were independent factors associated with difficult ESD (OR 3.6, 95%CI 1.1–11.74 and OR 5.07, 95%CI 1.6–16.08; respectively). Conclusions Although the number of cases is limited, the results of this analysis show acceptable en‐bloc and R0 rates in gastric ESD considering the wide variability in experience among the operators. Fibrosis and poor maneuverability were associated with more difficulty in completing ESD., Key Summary Summarize the established knowledge on this subject Endoscopic submucosal dissection (ESD) is the standard of care for treatment of early gastric cancers (GC). Due to a lower incidence of GC in European countries, the introduction of gastric ESD has been more gradual than in the East.ESD complications, technical and clinical success depend on the endoscopist's experience, the presence of submucosal fibrosis or invasive cancer, and poor access location. What are the significant and/or new findings of this study? This study shows the results from a prospective nationwide registry of gastric ESD in a low GC incidence country. Despite a relative low number of cases, quite acceptable outcomes (en‐bloc, R0 and curative resection of 91.3%, 75.2% and 70.9%, respectively) were observed considering the wide variability in experience among the operators.Difficult ESD were mainly associated with the presence of submucosal fibrosis and poor maneuverability; however, independent pre‐procedural factors were not identified. There was a trend of association between ESD difficulty and the location of the lesion in the upper/middle stomach

Underwater endoscopic mucosal resection (UEMR) is an alternative procedure to conventional endoscopic mucosal resection (CEMR) to treat large nonpedunculated colorectal polyps (LNPCL). In this multicenter randomized clinical trial, we aimed to compare the efficacy and safety of UEMR versus CEMR on LNPCL.We conducted a multicenter randomized controlled clinical trial from February 2018 to February 2020 in 11 hospitals in Spain. A total of 298 patients (311 lesions) were randomized to the UEMR (n=149) and CEMR (n=162) groups. The main outcome was the lesion recurrence rate in at least one follow-up colonoscopy. Secondary outcomes included technical aspects, en bloc resection rate, R0 and adverse events, among others.There were no differences in the overall recurrence rate [9.5% UEMR vs. 11.7% CEMR; absolute risk difference -2.2% (CI 95%: -9.4% to 4.9%)]. However, considering the polyp sizes between 20 and 30 mm, the recurrence rate was lower for UEMR [3.4% UEMR vs. 13.1% CEMR; absolute risk difference -9.7% (CI 95%: -19.4% to 0%)]. The R0 resection showed the same tendency, with significant differences favoring UEMR only for polyps between 20 and 30 mm. Overall, UEMR was faster and easier to perform than CEMR. Importantly, both techniques were equally safe.UEMR is a valid alternative to CEMR of LNPCL and could be considered the first option of treatment for lesions between 20-30 mm due to its higher en bloc and R0 resection rates.

Barrett's esophagus (BE) is an entity with a known histological progression to malignancy. The insulin-like growth factor (IGF) system is involved in the carcinogenesis through obesity-related mechanisms that include IGF and it has been associated with several types of cancer.To evaluate the serological levels of IGF-1 and IGFBP-3 in patients with BE and esophageal adenocarcinoma.Prospective study of patients with BE and esophageal adenocarcinoma who underwent upper endoscopy between September 2012 and December 2015. A baseline determination of IGF-1 and IGFBP-3 was performed. We included a control group of patients without BE.One hundred sixteen patients were included: 36 controls, 62 with BE (42 without dysplasia and 20 with dysplasia) and 18 with adenocarcinoma. IGF-1 and IGF-1/IGFBP-3 molar ratio showed a progression to high levels in BE and adenocarcinoma than in controls (IGF-1: 135.55±66.07ng/ml, 148.33±81.5ng/ml, 108.19±46.69ng/ml, respectively; P=.049) (molar ratio: 0.23±0.91, 0.29±0.11, 0.19±0.06, respectively; P=.001), without differences between the histological types of BE. Fifty-four out of the 65 patients with BE were followed up (median of 58.50 months, range 12-113) and 11 of them (20.4%) presented progression to low-grade dysplasia (n=8) or high-grade dysplasia/adenocarcinoma (n=3), without differences in the IGF system compared with patients without progression.Patients with BE and esophageal adenocarcinoma have changes in the IGF system although the serological levels of IGF-1 and IGFBP-3 do not correlate with histological progression of BE.

Resumen Introduccion En la actualidad, la incidencia del cancer gastrico (CG) esta disminuyendo, sin embargo, la supervivencia continua siendo baja. El cancer gastrico precoz (CGP) ofrece un mejor pronostico y la posibilidad de tratamientos endoscopicos curativos. Pacientes y metodos Estudio observacional de una cohorte retrospectiva de todos los pacientes con CG en un periodo de 5 anos en un area sanitaria de Espana. El CGP incluyo los pacientes con afectacion mucosa o submucosa (T1) independientemente de la afectacion ganglionar, mientras que el avanzado fueron los T2-T4. Resultados Se incluyeron 209 pacientes de los cuales 26 (12%) fueron CGP. El CGP no tuvo diferencias en comparacion con el avanzado en la edad, sexo, infeccion por HP, lesiones premalignas ni tipo histologico; sin embargo, tuvo diferencias significativas en la localizacion (antro e incisura en un 76% vs. 38%, p = 0,01), sintomas de alarma (69% vs. 90%, p Discusion La frecuencia del CGP fue baja en nuestra area sanitaria (12% de los CG). El CGP tuvo sintomas de alarma en un alto porcentaje, se localizo en el tercio distal del estomago (antro e incisura) y tuvo mejor pronostico en relacion con el CG avanzado. Se deben implementar medidas para incrementar la deteccion y tratamiento endoscopico del CGP.

Resumen Objetivo Evaluar la eficacia y seguridad de la terapia de vacio endoscopica (TVE) en perforaciones y dehiscencias del tracto digestivo superior. Pacientes y metodos Estudio retrospectivo observacional donde se incluyeron todos los pacientes que presentaron algun defecto del tracto gastrointestinal superior y que fueron sometidos a TVE en el periodo comprendido entre abril de 2017 y febrero de 2019 en 3 centros espanoles. Para ello se utilizo el unico sistema de terapia de vacio aprobado para uso endoscopico hasta la fecha (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Alemania). Resultados Un total de 11 pacientes fueron sometidos a TVE como tratamiento de una dehiscencia de sutura anastomotica tras esofaguectomia (n = 7), gastrectomia (n = 2), como tratamiento de una perforacion esofagica tras septomiotomia endoscopica de Zenker (n = 1) y tras una perforacion esofagica espontanea o sindrome de Boerhaave (n = 1). La mediana del tamano de la cavidad fue de 8 × 3 cm. De mediana, la TVE se inicio a los 7 dias de la cirugia inicial. La mediana de duracion de la TVE fue de 28 dias. La mediana de esponjas colocadas fue de 7 y el intervalo de recambio de las esponjas, de 3,7 dias. En 10 casos (91%) se consiguio el cierre del defecto y en 9 casos (82%) la resolucion clinica del cuadro infeccioso asociado. Cinco pacientes presentaron algun evento adverso: 3 estenosis anastomoticas, un episodio de dolor retrofaringeo y un caso de neumonia de nueva aparicion. La mediana de estancia hospitalaria desde el inicio de la TVE fue de 45 dias. Un paciente fallecio debido a complicaciones septicas secundarias a la dehiscencia de sutura. Conclusion La TVE tiene una eficacia superior al 90% en las perforaciones y fugas anastomoticas del tracto digestivo superior. Adicionalmente es una terapia segura, siendo los eventos adversos leves.

An endoscopic full-thickness resection with FTRD system (Ovesco Endoscopy, Tübingen, Germany) was performed in a 69-year-old man with a granular laterally spreading tumor (G-LST) with non-lifting sign in the ascending colon. Histology showed a low-grade dysplasia tubulovillous adenoma, R0 resection. At surveillance colonoscopy after 12 months, the clip was found with a polypoid tissue with regular mucosal surface pattern trapped inside. Since the length of time the clip was left in place ensured proper healing and in order to avoid any recurrence of adenoma in the area, the polypoid lesion and the clip were resected en bloc. The histological study revealed a polypoid formation with muscular tissue surrounded by healthy mucosa, suggesting a leiomyoma. Immunohistochemical actine staining confirmed the presence of muscularis mucosae and the muscularis propria inside the polypoid lesion, due to a full-thickness clip entrapment of the colon wall, with the development a leiomyoma-like clip artifact. The presence of foreign bodies such as clips at the resection site may produce artifacts leading to confusion in the diagnosis as in this case in which it has been able to produce an abnormal growth of the muscularis propria. The detection of a clip artifact leiomyoma has not yet been reported and highlights the importance of transmitting correct information about the case and the technique to the pathologist in order to achieve a correct diagnosis.