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Background Resection of colorectal lesions larger than 20mm is complex and requires advanced endoscopic techniques such as endoscopic mucosal resection (EMR). Adenoma recurrence is a limiting factor especially due to micro-adenomas at the margin of the EMR mucosal defect site. This systematic review and meta-analysis aimed to determine the efficacy of thermal ablation of mucosal defect margins after EMR in reducing adenoma recurrence. Methods A comprehensive, computerized literature search from the PubMed Central, Embase, Cochrane Library, and OVID was performed with the following search terms: coagulation, mucosal defect margin, endoscopic mucosal resection, and adenoma recurrence. Three cohort studies were selected and validated using the Newcastle-Ottawa criteria. Pooled data were combined under a random-effects model. The Cochrane Review Manager Software version 5.3 was used for all analyses. Results Three cohort studies comprising of 361 patients were analyzed. In the random-effects model, the pooled odds ratio (OR) of adenoma recurrence was 0.22 (95% CI 0.13-0.39; I2 = 0%)( IDDF2021-ABS-0119. Figure 1). The pooled data of the three studies showed a trend towards a beneficial effect of thermal ablation of mucosal defect post-endoscopic mucosal resection in reducing the risk of adenoma recurrence. Conclusions Thermal ablation of the mucosal defect margins was shown to have a decreased risk of adenoma recurrence after endoscopic mucosal resection. However, further prospective randomized studies are recommended to confirm this relationship.

Pancreatic tumors usually produce painless jaundice. Other associated symptoms may be secondary, from a direct extension of the tumor, resulting in bowel obstruction. It is extremely rare that pancreatic malignancy presents with ischemic enteritis by invasion of the major arteries, and no report has documented it endoscopically. We present a rare case of pancreatic adenocarcinoma masquerading as ischemic enteritis diagnosed on enteroscopy and endoscopic ultrasound. An initial computed tomography (CT) scan performed in another hospital showed long segmental wall thickening involving the third part of the duodenum to the proximal segment of the jejunum. The patient was referred to our institution for enteroscopy, which showed a poorly distensible third part of the duodenum with purplish mucosa starting at the fourth part of the duodenum until the proximal jejunum. With suspicion of ischemic enteritis, a mesenteric CT angiography was performed, which showed a long segment circumferential wall thickening of the duodenum to jejunum with fullness of the pancreatic head and uncinate process that encases the superior mesenteric artery. Endoscopic ultrasound (EUS) showed a hypoechoic lesion at the head of the pancreas. EUS‐guided fine‐needle biopsy was performed, which revealed pancreatic adenocarcinoma on histopathology., Despite being a part of the criteria for unresectability of pancreatic malignancies, only very few published reports discuss the sequelae of pancreatic cancer invading the mesenteric vessels. This case report describes a rare case of a metastatic pancreatic disease causing vascular invasion, leading to ischemic enteritis detected endoscopically.

Background Larger colonic polyps require advanced resection techniques such as endoscopic mucosal resection (EMR) for safe and effective removal. There has been a steady accumulation of scientific evidence with regards to the technical aspects and long-term outcomes of colonic EMR compared with surgery. This study aims to determine the predictive factors of different clinical outcomes post-EMR and the diagnostic yield of JNET classification. Methods A retrospective cohort study was done on all patients who underwent colorectal EMR at the St. Luke’s Medical Center Global City within a 4-year period from 2015 to 2018. The diagnostic yield of JNET classification and clinical outcomes namely R0 resection, complications and recurrence of lesions were studied. Results A total of 282 patients were studied. The R0 resection rate was 96.3% for lesions resected en bloc. 15.2% had a complication, most commonly intraprocedural bleeding which were successfully managed endoscopically. 10.7% had recurrence post-EMR on their surveillance colonoscopy. The JNET classification exhibited good sensitivity for Type 1 (71.8%) and Type 2A (91.9%) and good specificity for Type 1 (96.9%) and Type 2B (95.5%). Accuracy was high at 91.02% for Type 1, 80.24% for Type 2A and 89.22% for Type 2B. Conclusions EMR is an important advancement in the field of therapeutic endoscopy with good clinical outcomes sparing patients from surgery. A larger lesion size of >20 mm is associated with both positive resection margin and post-EMR complications. Main predictors of recurrence include a non-granular morphology of a resected polyp and piecemeal resection. The JNET classification has a high diagnostic accuracy rate; hence is a good endoscopic tool for characterization of lesions.

Background EMR is a viable alternative to surgery for removal of large mucosal neoplastic lesions of the entire GI tract. Few studies have, however, been published on the safety, efficacy, and technical aspects of EMR in the duodenum. Objective Our purpose was to evaluate the efficacy and safety of EMR of large (>15 mm) duodenal adenomas. Design Retrospective evaluation of a defined patient cohort. Setting Tertiary academic referral center. Patients Patients with large (>15 mm) sporadic nonampullary duodenal adenomas managed by a standardized technique who were referred by other specialist endoscopists for endoscopic treatment. Methods Five-year data from patients undergoing EMR for large duodenal adenomas were reviewed retrospectively. Immediate and delayed complications were recorded. Results Twenty-one lesions were removed by EMR in 23 patients (mean age 62.2 years, 13 female, 10 male). The mean size of lesions resected was 27.6 mm (median 20 mm, range 15-60 mm). Post-EMR histologic examination revealed mucosal adenocarcinoma in 1, low-grade tubulovillous adenoma (TVA) in 16, high- or focal high-grade TVA in 3 patients, and 1 with both high-grade TVA and carcinoid. EMR was performed successfully in 18 patients during a single session. Two patients required 2 sessions and 1 required 3 sessions for complete resection. The median follow-up was 13 months (range 4-44 months). During follow-up, 5 patients had minor residual adenomas that were treated successfully with snare resection and/or argon plasma coagulation. One patient had EMR site bleeding. There were no perforations. Limitation Retrospective study. Conclusion EMR for large sporadic nonampullary duodenal adenomas is a safe and effective technique.

rine for endoscopic prevention of recurrent peptic ulcer bleeding. Gastrointest Endosc 2004;60:875-80. 9. Calvet X, Vergara M, Brullet E, et al. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high-risk bleeding ulcers. Gastroenterology 2004;126: 441-50. 10. Hachisu T. Evaluation of endoscopic hemostasis using an improved clipping apparatus. Surg Endosc 1998;2:13-7. 11. ASGE Technology Assessment Committee. Endoscopic clip application devices. Gastrointest Endosc 2006;63:746-50. 1st Department of Medicine and Gastroenterology, Petz Aladar County and Teaching Hospital, Gyor, Hungary.

Several hepatitis B virus (HBV) subtypes (subgenotypes), HBV/Aa (A1 : Asia/Africa), Ae (A2 : Europe), Bj (B1 : Japan) and Ba (B2 : Asia), have been reported with respect to clinical differences between patients infected with these subtypes (subgenotypes). HBV genotype distribution among patients with chronic liver diseases was investigated in the Philippines, where such studies have not been carried out previously. One hundred sera were obtained from such patients, consisting of 32 chronic hepatitis (CH), 37 cirrhosis and 31 hepatocellular carcinoma (HCC) patients. Nine complete genomes and 100 core promoter/precore genes of HBV were sequenced directly. Phylogenetic analyses revealed 51 HBV/A (Aa/A1), 22 HBV/B and 27 HBV/C strains. Interestingly, most HBV/C strains in the Philippines formed a specific cluster distinct from previous HBV/C strains (C1–4), indicating a novel subtype (subgenotype), HBV/C5. Moreover, most HBV/B strains fell within the specific cluster of the HBV/B subtype (subgenotype) B5, with viral characteristics of HBV/Ba (B2) carrying a recombination with HBV/C over the precore and core genes. Of the three genotypes, HBV/B and HBV/C were significantly more prevalent than HBV/A in cirrhosis and HCC patients (PP=0.044] and the core promoter mutation (OR 14.08; 95 % CI 3.62–4.74; P

A 32-year-old man developed right upper quadrant RUQ) pain, fever, and jaundice 10 days after laparotomy nd resection of a 3-cm jejunal GI stromal tumor (GIST). Abominal US revealed a dilated common bile duct (CBD), ith biliary sludge as the likely cause for cholangitis. ERCP howed a dilated CBD with irregular ridging or serration f the CBD wall (A). After sphincterotomy, purulent bile nd thick sludge were cleared. A 10F plastic stent was placed o ensure continued adequate drainage. Follow-up ERCP at weeks showed complete resolution of the previous cholngiographic abnormalities (B). A 65-year-old man with fever, jaundice, and RUQ pain, unesponsive to parenteral antibiotics, underwent an emerency ERCP. Cholangiography revealed dilatation and rregular ridging or serration of the CBD wall (C). After phincterotomy, purulent bile as well as small CBD calculi ere cleared from the duct. A double-pigtail 7F stent was nserted for biliary drainage. Repeat ERCP after 6 weeks revealed resolution of the documented bile–duct-wall abnormality; however, a previously unapparent distal CBD stricture was found, and, subsequently, the diagnosis of cholangiocarcinoma was made (D).