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Background The ileocecal valve (ICV) is considered to be one of the most difficult locations for endoscopic submucosal dissection (ESD). The objective of this study was to evaluate the efficacy and safety of traction-assisted ESD in this situation. Methods All patients who underwent traction-assisted ESD for an ICV lesion at three centers were identified from a prospective ESD database. En bloc and R0 rates were evaluated. Factors associated with non-R0 resection were explored. Results 106 patients with an ICV lesion were included. The median lesion size was 50 mm (interquartile range 38–60) and 58.5% (62/106) invaded the terminal ileum. The en bloc and R0 resection rates were 94.3% and 76.4%, respectively. Factors associated with non-R0 resection were lesions covering ≥75% of the ICV (odds ratio [OR] 0.21. 95%CI 0.06–0.76; P=0.02), and involving the anal lip (OR 0.36, 95%CI 0.13–0.99; P=0.04) or more than two sites on the ICV (OR 0.27, 95%CI 0.07–0.99; P=0.03). Conclusion Traction-assisted ESD for treatment of ICV lesions was a safe and feasible option. Large lesions and anal lip involvement appeared to be factors predictive of difficulty. [ABSTRACT FROM AUTHOR]

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Worldwide, gastric adenocarcinoma is a major public health problem, accounting for 6% of all cancers. In France, the incidence of gastric adenocarcinoma has been stabilized at around 4,700 new cases/year, thanks to better control of risk factors, in particular the eradication of Helicobacter pylori. Around 3% of all cases are hereditary forms of the disease, which are part of cancer predisposition syndromes resulting from the presence of constitutional pathogenic variants in some tumor suppressor genes. The best-known predisposition syndromes that increase the risk of developing gastric adenocarcinoma are hereditary diffuse gastric cancer syndrome (CDH1 and CTNNA1 genes; estimated lifetime risk of around 40%), Lynch syndrome (germline alteration of one of the genes in the Mismatch Repair (MMR) system for repairing DNA mismatches (MLH1, PMS2, MSH2, MSH6); estimated lifetime risk of around 10 %) or certain digestive polyposis (Peutz-Jeghers syndrome linked to STK11, juvenile polyposis linked to SMAD4, GAPPS syndrome linked to APC). Identifying these patients is essential in order to implement preventive strategies and screening for gastric adenocarcinoma in unaffected relatives, as well as to be able to guide treatment strategies in patients with gastric adenocarcinoma (prognostic impact, treatment and risk of second cancer). Screening strategies for gastric adenocarcinoma in these patients include upper gastrointestinal endoscopy, and sometimes lead to discussion of prophylactic surgery, warranting management in an expert centre with a multidisciplinary referral committee. Although these syndromes are rare, the role of oncogenetics in the management of patients at high risk of developing gastric adenocarcinoma (or suffering from this cancer) is crucial, and new predisposition genes are regularly described which may also have therapeutic implications. [ABSTRACT FROM AUTHOR]

Background Clinically significant delayed bleeding (CSDB) is a frequent, and sometimes severe, adverse event after colorectal endoscopic submucosal dissection (ESD). We evaluated risk factors of CSDB after colorectal ESD. Methods We analyzed a prospective registry of 940 colorectal ESDs performed from 2013 to 2022. The incidence of bleeding was evaluated up to 30 days. Risk factors for delayed bleeding were evaluated by multivariate logistic regression. A Korean scoring model was tested, and a new risk-scoring model was developed and internally validated. Results CSDB occurred in 75 patients (8.0%). The Korean score performed poorly in our cohort, with a receiver operating characteristic (ROC) curve of 0.567. In the multivariate analysis, risk factors were age ≥75 years (odds ratio [OR] 1.63; 95%CI 0.97–2.73; 1 point), use of antithrombotics (OR 1.72; 95%CI 1.01–2.94; 1 point), rectal location (OR 1.51; 95%CI 0.92–2.48; 1 point), size >50 mm (OR 3.67; 95%CI 2.02–7.14; 3 points), and American Society of Anesthesiologists (ASA) score of III or IV (OR 2.26; 95%CI 1.32–3.92; 2 points). The model showed fair calibration and good discrimination, with an area under the ROC curve of 0.751 (95%CI 0.690–0.812). The score was used to define two groups of patients, those with low–medium risk (0 to 4 points) and high risk (5 to 8 points) for CSDB (respective bleeding rates 4.1% and 17.5%). Conclusion A score based on five simple and meaningful variables was predictive of CSDB. [ABSTRACT FROM AUTHOR]

Malignant distal biliary obstructions are becoming increasingly common, especially in patients with cancers of the pancreatic head, despite progress in medical oncology research. ERCP is the current gold standard for management of such strictures, but the emergence of EC-LAMS has rendered EUS-CDS both safe and efficient. It is a "game changer"; originally intended for ERCP failure, two randomised clinical trials recently proposed EUS-CDS as a first-intent procedure in palliative settings. For resectable diseases, the absence of iatrogenic pancreatitis associated with a lower rate of postsurgical adverse events (compared with ERCP) leads us to believe that EUS-CDS might be used in first-intent as a pre-operative endoscopic biliary drainage. [ABSTRACT FROM AUTHOR]

Large flat colorectal polyps are often encountered during screening colonoscopies. The most frequently used approach for resecting these polyps is endoscopic mucosal resection, which is associated with a substantial rate of recurrent or residual adenoma, necessitating routine follow-up colonoscopy within months. An alternative endoscopic resection technique, endoscopic submucosal dissection, may enable en bloc resection of such polyps, potentially reducing the rate of recurrent or residual adenoma. This randomized controlled trial compared these 2 endoscopic resection techniques in terms of the rate of neoplastic local recurrence during the 6-month follow-up colonoscopy. Visual Abstract. Endoscopic En Bloc Versus Piecemeal Resection of Large Nonpedunculated Colonic Adenomas: Large flat colorectal polyps are often encountered during screening colonoscopies. The most frequently used approach for resecting these polyps is endoscopic mucosal resection, which is associated with a substantial rate of recurrent or residual adenoma, necessitating routine follow-up colonoscopy within months. An alternative endoscopic resection technique, endoscopic submucosal dissection, may enable en bloc resection of such polyps, potentially reducing the rate of recurrent or residual adenoma. This randomized controlled trial compared these 2 endoscopic resection techniques in terms of the rate of neoplastic local recurrence during the 6-month follow-up colonoscopy. Background: Endoscopic resection of adenomas prevents colorectal cancer, but the optimal technique for larger lesions is controversial. Piecemeal endoscopic mucosal resection (EMR) has a low adverse event (AE) rate but a variable recurrence rate necessitating early follow-up. Endoscopic submucosal dissection (ESD) can reduce recurrence but may increase AEs. Objective: To compare ESD and EMR for large colonic adenomas. Design: Participant-masked, parallel-group, superiority, randomized controlled trial. (ClinicalTrials.gov: NCT03962868) Setting: Multicenter study involving 6 French referral centers from November 2019 to February 2021. Participants: Patients with large (≥25 mm) benign colonic lesions referred for resection. Intervention: The patients were randomly assigned by computer 1:1 (stratification by lesion location and center) to ESD or EMR. Measurements: The primary end point was 6-month local recurrence (neoplastic tissue on endoscopic assessment and scar biopsy). The secondary end points were technical failure, en bloc R0 resection, and cumulative AEs. Results: In total, 360 patients were randomly assigned to ESD (n  = 178) or EMR (n  = 182). In the primary analysis set (n  = 318 lesions in 318 patients), recurrence occurred after 1 of 161 ESDs (0.6%) and 8 of 157 EMRs (5.1%) (relative risk, 0.12 [95% CI, 0.01 to 0.96]). No recurrence occurred in R0-resected cases (90%) after ESD. The AEs occurred more often after ESD than EMR (35.6% vs. 24.5%, respectively; relative risk, 1.4 [CI, 1.0 to 2.0]). Limitation: Procedures were performed under general anesthesia during hospitalization in accordance with the French health system. Conclusion: Compared with EMR, ESD reduces the 6-month recurrence rate, obviating the need for systematic early follow-up colonoscopy at the cost of more AEs. Primary Funding Source: French Ministry of Health. [ABSTRACT FROM AUTHOR]

The article discusses the use of lumen-apposing metal stents (LAMS) for biliary drainage in patients with obstructions. The technique, known as endoscopic ultrasound guided choledochoduodenostomy (EUS-CDS), has become increasingly popular due to its simplicity and high success rates. The article highlights the need for prevention and treatment of LAMS dysfunction, as well as the importance of identifying risk factors and developing management strategies. The authors emphasize the technical expertise required for the procedure and the potential impact on oncological treatment. [Extracted from the article]

Prior to such treatment, cholangiocarcinoma cytopathological characterization must be determined, because 5 %-25 % of indeterminate bile duct stenoses are benign and 3 %-7 % of patients who undergo surgery for a suspected malignant bile duct stenosis have a benign disease [1][6][7][8]. Additional sampling methods were performed during the same endoscopic procedure in most patients, including: intracholedochal biopsies under fluoroscopy in 29/51 patients (57 %), EUS-FNB in 19/51 patients (37 %), and intraductal cholangioscopy-guided biopsies in 2/51 patients (4 %). Graph Introduction Cholangiocarcinoma is the most frequent cause of jaundice in patients with intraductal bile duct stricture [1]. [Extracted from the article]