Current status and further directions of endoscopic ultrasound-directed transgastric ERCP and endoscopic ultrasound-directed transenteric ERCP in the management of pancreaticobiliary diseases in surgically altered anatomy: a comprehensive review.

Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) and endoscopic ultrasound-directed transenteric endoscopic retrograde cholangiopancreatography (EDEE) are innovative endoscopic techniques developed to overcome the challenges of biliary access in patients with surgically altered gastrointestinal anatomy. EDGE facilitates the creation of a gastro-gastric anastomosis, enabling endoscopic access to the excluded stomach and subsequent duodenum for endoscopic retrograde cholangiopancreatography (ERCP) procedures. Similarly, EDEE involves creating a gastro-jejunal anastomosis, allowing endoscopic access to the jejunum and hepaticojejunostomy for ERCP.

Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE): Techniques, Outcomes and Safety Profiles.

Patients with Roux-en-Y gastric bypass (RYGB) are a significant challenge for endoscopic retrograde cholangiopancreatography (ERCP) due to the altered anatomy. Endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) has emerged as a valuable alternative to standard methods like enteroscopy-assisted (EA-ERCP) and laparoscopy-assisted (LA-ERCP) ERCP. EDGE involves creating a temporary fistula between the gastric pouch and the excluded stomach under EUS guidance, typically using a lumen-apposing metal stent (LAMS).

Malignant gastric outlet obstruction: The emerging role of endoscopic ultrasound-guided gastroenterostomy.

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is emerging as a preferred approach for managing malignant gastric outlet obstruction. This technique offers a balance between the durability of surgical gastrojejunostomy (SGJ) and the minimally invasive nature of endoscopic methods. Compared to enteral stenting, EUS-GE shows superior outcomes, including higher long-term patency, lower symptom recurrence, and fewer reinterventions.

Topical hemostatic agents in endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review.

Gastrointestinal (GI) endoscopy has evolved from a diagnostic tool into a therapeutic modality, leading to a higher incidence of bleeding complications during and after procedures. To address this issue, various hemostatic agents have been developed, including injectable, mechanical, thermal, and topical products. Topical hemostatic agents, available in powder or gel forms, can be used as standalone treatments or as adjuncts to traditional hemostatic therapies to control or prevent bleeding.

The Role of Vitamin D in Inflammatory Bowel Diseases: From Deficiency to Targeted Therapeutics and Precise Nutrition Strategies.

Background: Vitamin D plays a crucial role in immune modulation, gut barrier integrity, and inflammation regulation, making it highly relevant in inflammatory bowel disease (IBD). IBD patients often exhibit vitamin D deficiency, which has been linked to increased disease activity, impaired mucosal healing, and a higher risk of complications, including infections and osteoporosis.

Methods: This review examines the biological functions of vitamin D in maintaining intestinal homeostasis, particularly in the context of IBD.

Devices and techniques for bariatric and metabolic endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review.

Endoscopic bariatric and metabolic therapies (EBMTs) are increasingly recognized as valuable tools for managing obesity and related metabolic disorders. As the prevalence of obesity continues to rise globally, there is a growing demand for effective, safe, and less invasive treatment options. This review provides a comprehensive summary of the available EBMTs, including both stomach-targeted and small-bowel-targeted devices.

Endoscopic Ultrasound-Guided Pancreatic Cystic Fluid Biochemical and Genetic Analysis for the Differentiation Between Mucinous and Non-Mucinous Pancreatic Cystic Lesions.

Pancreatic cystic lesions (PCLs) are increasingly identified via computerized tomography (CT) and magnetic resonance (MR), with a prevalence of 2-45%. Distinguishing mucinous PCLs (M-PCLs), which include intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) that can progress to pancreatic ductal adenocarcinoma, from non-mucinous PCLs (NM-PCLs) is essential. Carcinoembryonic antigen (CEA) remains widely used but often demonstrates limited sensitivity and specificity.

Impact of Non-Anesthesiologist-Administered Propofol Sedation for Outpatient Endoscopy in the Healthcare System.

Introduction: Non-anesthesiologist-administered propofol (NAAP) sedation for outpatient endoscopy has proven to be safe. However, implementing NAAP in Western countries faces challenges, and propofol-based sedation is still largely administered by anesthetists. For low-risk patients, anesthesiologist-administered propofol (AAP) could represent an avoidable waste of healthcare resources.

Transforming Gastrointestinal Diagnosis with Molecular Endoscopy: Challenges and Opportunities.

Molecular endoscopy represents a transformative advance in the detection, diagnosis, and management of gastrointestinal diseases, addressing the critical limitations of conventional techniques. Current diagnostic standards, such as white light endoscopy (WLE), often fail to detect early-stage lesions, particularly in high-risk populations like Barrett's esophagus or inflammatory bowel disease patients. To overcome these challenges, molecular endoscopy, using fluorescent molecular probes, may offer ultimate precision by targeting disease-specific biomarkers.

EUS-guided gallbladder drainage as a rescue in distal malignant biliary obstruction: A systematic review with meta-analysis.

Patients with distal malignant biliary obstruction (dMBO) needing biliary drainage (BD) undergo ERCP as a first approach. EUS-guided gallbladder drainage (EUS-GBD) is now accepted as a rescue alternative for the palliation of jaundice in those patients with dMBO who fail ERCP and cannot undergo EUS-BD. This is a systematic review with meta-analysis for evaluating the efficacy and safety of EUS-GBD in this scenario.

Exploring ChatGPT effectiveness in addressing direct patient queries on colorectal cancer screening.

Background And Study Aims: Recent studies showed that large language models (LLMs) could enhance understanding of colorectal cancer (CRC) screening, potentially increasing participation rates. However, a limitation of these studies is that questions posed to LLMs are generated by experts. This study aimed to investigate ChatGPT-4o effectiveness in answering CRC screening queries directly generated by patients.

Unmet Needs of Artificial Intelligence in Small Bowel Capsule Endoscopy.

Small bowel capsule endoscopy (SBCE) has emerged in the past two decades as the cornerstone for assessing small bowel disorders, and its use is supported by several guidelines. However, there are several limitations, such as the considerable time required for gastroenterologists to review these videos and reach a diagnosis. To address these limitations, researchers have explored the integration of artificial intelligence in the interpretation of these videos.

Advances in Endo-Hepatology: The Role of Endoscopic Ultrasound in the Management of Portal Hypertension.

Portal hypertension (PH) is a complication of advanced liver diseases, including cirrhosis and hepatocellular carcinoma, often leading to unfavorable outcomes. Endo-hepatology, particularly endoscopic ultrasound (EUS) has revolutionized the assessment of PH. Notably, EUS-guided portal pressure gradient (EUS-PPG) enables measurement of portal and hepatic venous pressures, offering diagnostic precision for both cirrhotic and non-cirrhotic forms of PH, including porto-sinusoidal vascular disorder (PSVD).

Endoscopic Submucosal Dissection (ESD) for the Management of Fibrotic Non-Lifting Colorectal Lesions (NLCLs): Results from a Large Multicenter Retrospective Study.

: The management of non-lifting colorectal lesions (NLCLs), often resulting from previous unsuccessful treatments or biopsies, remains challenging due to submucosal fibrosis that prevents adequate lifting. Endoscopic submucosal dissection (ESD) is a viable option for achieving complete resection in such cases. However, when standard ESD is not feasible, conversion to hybrid ESD (H-ESD) has been proposed as a rescue strategy.

Simulators and training models for diagnostic and therapeutic gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review.

Gastrointestinal (GI) endoscopy comprises both diagnostic and therapeutic procedures involving the luminal GI tract as well as the biliary tree, liver, and pancreas. GI endoscopy is challenging to learn, requiring both cognitive (nontechnical) and technical skills, and requires extensive practice to attain proficiency. Simulation-based training has been shown to assist trainees and young endoscopists in acquiring new skills and accelerating the learning curve.

The Endoscopic Management of Anastomotic Strictures After Esophagogastric Surgery: A Comprehensive Review of Emerging Approaches Beyond Endoscopic Dilation.

Anastomotic strictures are a common complication following esophagogastric surgery, with prevalence varying depending on the type of surgery and anatomical site. These strictures can lead to debilitating symptoms such as dysphagia, pain, and malabsorption, significantly impacting patients' quality of life. Endoscopic treatment of anastomotic strictures has established a role as the first-line strategy in this setting instead of revision surgery, offering benefits in terms of lower morbidity.

Validation of the GPAT - the Global Polypectomy Assessment Tool: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

BACKGROUND : Colorectal polypectomy is operator dependent, with variable rates of complete resection. The currently available assessment tools do not provide specific competency-based evaluation of provider technique. We aimed to validate the Global Polypectomy Assessment Tool (GPAT), a novel competency assessment tool for colorectal polypectomy.

Endoscopic ultrasound-guided tissue sampling: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review.

This Technical and Technology Review from the European Society of Gastrointestinal Endoscopy (ESGE) represents an update of the previous document on the technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology, including the available types of needle, technical aspects of tissue sampling, new devices, and specimen handling and processing. Among the most important new recommendations are:ESGE recommends end-cutting fine-needle biopsy (FNB) needles over reverse-bevel FNB or fine-needle aspiration (FNA) needles for tissue sampling of solid pancreatic lesions; FNA may still have a role when rapid on-site evaluation (ROSE) is available.ESGE recommends EUS-FNB or mucosal incision-assisted biopsy (MIAB) equally for tissue sampling of subepithelial lesions ≥20 mm in size.

In-hospital mortality in patients with lower gastrointestinal bleeding: development and validation of a prediction score.

Background:  Lower gastrointestinal bleeding (LGIB) is a common condition linked to increased morbidity, healthcare costs, and mortality. Currently, no prospectively validated prognostic model exists to predict mortality in patients with LGIB. Our aim was to develop and validate a risk score that could accurately predict in-hospital mortality of patients admitted for LGIB.

Diagnostic Approach to Biliary Strictures.

Biliary strictures represent a narrowing of the bile ducts, leading to obstruction that may result from benign or malignant etiologies. Accurate diagnosis is crucial but challenging due to overlapping features between benign and malignant strictures. This review presents a comprehensive diagnostic approach that integrates biochemical markers, imaging modalities, and advanced endoscopic techniques to distinguish between these causes.