Identifying early gastric cancer under magnifying narrow-band images via deep learning: a multicenter study
In this study, we aimed to develop a computer-aided diagnostic model, EGCM, to analyze and assist in the diagnosis of EGC under ME-NBI. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 25, 2020 Category: Gastroenterology Authors: Hao Hu, Lixin Gong, Di Dong, Liang Zhu, Min Wang, Jie He, Lei Shu, Yiling Cai, Shilun Cai, Wei Su, Yunshi Zhong, Cong Li, Yongbei Zhu, Mengjie Fang, Lianzhen Zhong, Xin Yang, Pinghong Zhou, Jie Tian Source Type: research

Want to improve your adenoma detection rate? Work with a fellow!
Training gastroenterology fellows to perform high-quality endoscopy is a core objective of gastroenterology fellowship programs.1 The foundation of teaching and learning endoscopic skills remains centered on the apprenticeship model, in which a trainee performs endoscopic procedures on real patients under the supervision of an attending endoscopist.2 Introducing a fellow into a procedure, however, changes the environment in several ways —from the perspective of both the patient and the attending—and with these changes come potential impacts on the quality of care provided. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Navin L. Kumar, John R. Saltzman Tags: Original article Source Type: research

The importance of the “endoscopic oncologist” in the treatment of nonoperable cholangiocarcinoma
In contrast to pancreatic ductal adenocarcinoma, whereby the gastroenterologist provides a role in the palliation of biliary obstruction and pain, successful and sustained biliary drainage for the patient with extrahepatic cholangiocarcinoma (CCA) prolongs life.1,2 CCA is rare (approximately 1 per 100,000 persons in the United States); yet, its incidence rate continues to increase exponentially, with the majority of individuals having unresectable disease and a poor prognosis.3-5 The majority (60%-70%) of CCA originates in the perihilar region and requires referral to a center having expertise in ERCP and interventional ra...
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Srinivas Gaddam, Gregory A. Cot é Tags: Original article Source Type: research

Optimal stent placement for malignant hilar biliary obstruction
We read with great interest the article by Xia et  al,1 a retrospective study addressing optimal stenting for malignant hilar biliary obstruction. Their analysis suggests that bilateral stent placement and the use of metal stents are superior to unilateral and plastic stents. They acknowledged that missing “size/shape of the stents” is a limit ation, but we want to raise an additional concern. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Sasan Mosadeghi, Martin L. Freeman Tags: Letter to the Editor Source Type: research

Bringing real-time live feedback to esophageal dilations, but not ready for prime time
Esophageal dilation has been a cornerstone of medical practice for centuries. The use of a piece of carved whalebone for dilation in the setting of achalasia has been described since the 17th century,1 whereas use of bougienage for dilation of esophageal strictures was first reported in 1821.2 Since that time, our array of dilators has evolved significantly as more versatile materials became available and now include flexible bougies (mercury-filled or tungsten-filled Maloney and Hurst dilators), wire-guided polyvinyl Savary-Gillard dilators, through-the-scope balloon catheters, and pneumatic balloon dilators. (Source: Gas...
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Dhyanesh A. Patel, Michael F. Vaezi Tags: New methods Source Type: research

Endoscopic submucosal dissection for esophageal neoplasia in the West: Are we there yet?
Evidence continues to accumulate supporting the role for endoscopic submucosal dissection (ESD) in the resection of large esophageal neoplasia.1 Genere et  al2 recently reported their single-center experience on ESD with a scissor-type knife in comparison with widespread EMR. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Chelsea Jacobs, Peter V. Draganov, Dennis Yang Tags: Letter to the Editor Source Type: research

Piecemeal resection of 20- to 25-mm colorectal polyps necessitates short-term surveillance colonoscopy to reduce local recurrence similar to en  bloc removal
We read with great interest the article by Tate et  al,1 who described long-term outcomes after EMR for 20- to 25-mm colorectal polyps. They concluded that en bloc EMR (e-EMR) offers no advantage and should be avoided because of comparably low recurrence rates between piecemeal EMR (p-EMR) and e-EMR (2.4% vs 1.4%, P = .49) at 18-month surveillance colonoscopy (SC) and increased perforation in e-EMR. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Kenichiro Imai, Kinichi Hotta, Sayo Ito, Yuichiro Yamaguchi, Yoshihiro Kishida, Hiroyuki Ono Tags: Letter to the Editor Source Type: research

Stricture prevention after esophageal endoscopic submucosal dissection
Over the past 2 decades, there has been a paradigm shift in the treatment of early esophageal cancer. Previously, esophagectomy was favored, but with advances in endoscopic technique, the morbidity and mortality of surgery could be avoided in most cases, and endoscopic resection rapidly became the preferred treatment modality. Initially, EMR allowed for en bloc resection of small tumors or piecemeal resection of larger lesions. Now, endoscopic submucosal dissection (ESD) allows for the en bloc resection of even very large superficial tumors. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Amit Bhatt, Neal A. Mehta Tags: Original article Source Type: research

The dilemma in the management of suspected upper GI bleeding in patients with COVID-19 pneumonia
This study is very interesting and important; however, we would like to put forth some suggestions. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Zhihui Duan, Kun Liu, Shengyun Zhou Tags: Letter to the Editor Source Type: research

Endoscopic retrograde appendicitis therapy: the true proof of the pudding is in the eating
We read with great interest the article by Costamagna1 in Gastrointestinal Endoscopy about endoscopic retrograde appendicitis therapy (ERAT). Many doubts remain unsolved regarding the possibilities of using ERAT for appendicitis in daily clinical practice. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Mauro Podda, Salomone Di Saverio, Ferdinando Agresta, Adolfo Pisanu Tags: Letter to the Editor Source Type: research

Fully covered metal stents versus plastic stents: The new kid on the block or the old standby?
Anastomotic biliary strictures (ABSs) are a common adverse event after orthotopic liver transplantation, occurring in 10% to 20% of patients.1 The risk factors for the development of ABSs include preceding bile leak, Model for End-Stage Liver Disease score at the time of transplantation, degree of graft steatosis, age, and reperfusion injury.2 Typically, ABSs are asymptomatic and are usually suspected in the context of cholestatic liver test result abnormalities when alternative causes, such as graft rejection, have been excluded. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Rohit Das, Adam Slivka Tags: Original article Source Type: research

Response
We thank Imai et  al1 for their letter concerning our article.2 (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Mayenaaz Sidhu, David J. Tate, Michael J. Bourke Tags: Letter to the Editor Source Type: research

Response
I thank Podda et  al1 for their timely comments on my Perspectives article, “Acute appendicitis: will a novel “organ-sparing” approach change the treatment paradigm?”2 Actually, I never ate the pudding, and therefore I cannot have a true proof of it. I was simply amazed by the ingenuity of this potential ap proach to a common clinical condition, which has historically been managed by surgery or antibiotic therapy, and was therefore prompted to write this provocative article.2 I totally agree with Podda et al1 when they argue that the routine application of endoscopic retrograde appendiciti...
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Guido Costamagna Tags: Letter to the Editor Source Type: research

Cool it now: a new addition for resecting 10- to 14-mm polyps
In this month ’s Gastrointestinal Endoscopy, Yabuuchi et al1 present their prospective data on the safety and efficacy of cold snare EMR of polyps measuring 10 to 14 mm. The authors use a rigorous standard of “histologic complete resection,” defined by visual en bloc resection, a pathologically negative vertical margin, and no neoplastic tissue in 4-quadrant biopsy specimens taken around the resection margin. This leads to some illuminating data, and there are lessons to learn from the results. But let’s first ask an important question. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Cyrus Piraka Tags: Original article Source Type: research

Endotherapy for gastroesophageal reflux disease: Another chance of success?
Endotherapy for GERD has been a topic of interest over the past 25 years, with successive waves of enthusiasm and disappointment. However, until now, it has not really entered routine clinical practice. The first techniques to be investigated included injection of bulking agents (Enteryx, Boston Scientific, Marlborouth, Mass, USA), submucosal implants (Gatekeeper, Medtronic, Minneapolis, Minn, USA), suturing techniques (Endocinch, Bard and Plicator, NDO), injection of collagen, and radiofrequency of the muscle layer around the lower esophageal sphincter. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Jacques Devi ère Tags: Original article Source Type: research

Emerging role of artificial intelligence in GI endoscopy
Artificial intelligence (AI) is a broad descriptor term that includes machine learning (ML) in which the algorithm, based on the input raw data, analyzes features in a separate dataset without specifically being programmed and delivers a specified classification (Fig.  1). Deep learning techniques such as convolutional neural networks (CNNs) are transformative ML techniques that enable rapid and accurate image discrimination and classification and as such have many applications within medicine. In gastroenterology, CNNs have been used in several areas of GI endo scopy, including colorectal polyp detection, and classif...
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Rahul Pannala, Kumar Krishnan, Joshua Melson, Mansour A. Parsi, Allison R. Schulman, Shelby Sullivan, Guru Trikudanathan, Arvind J. Trindade, Rabindra R. Watson, John T. Maple, (previous Committee Chair, 2016-2019), David R. Lichtenstein, (American Societ Tags: Technology at the forefront Source Type: research

Response
We thank the Drs Jacobs, Draganov, and Yang1 for their kind remarks regarding our submission.2 As we have previously shown, careful endoscopic submucosal dissection (ESD) can be very safe when using an articulating knife. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Yuri Hanada, Kenneth K. Wang Tags: Letter to the Editor Source Type: research

Contents
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Source Type: research

Editors
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Source Type: research

Focus on...
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Source Type: research

ASGE update
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Source Type: research

In upcoming issues...
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Source Type: research

Information for readers
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Source Type: research

Continuing Medical Education Exam: December 2020
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 20, 2020 Category: Gastroenterology Authors: Karthik Ravi, William Ross, Ara Sahakian, Brian Weston, Prasad G. Iyer, Amit Rastogi, Michael B. Wallace Tags: CME Examination Source Type: research

Multicenter cohort study of patients with buried bumper syndrome treated endoscopically with a novel, dedicated device
Buried bumper syndrome (BBS) is a rare adverse event of percutaneous endoscopic gastrostomy (PEG) placement in which the internal bumper migrates through the stomal tract to become embedded within the gastric wall. Excessive tension between the internal and external bumpers, causing ischemic necrosis of the gastric wall, is thought to be the main etiological factor. Several techniques for endoscopic management of BBS have been described using off-label devices. The Flamingo-Set is a novel, sphincterotome-like device, specifically designed for BBS management. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 18, 2020 Category: Gastroenterology Authors: Deborah Costa, Edward J. Despott, Nikolaos Lazaridis, Jeremy Woodward, Pavel Kohout, Timo Rath, Louise Scovell, Ian Gee, Pieter Hindryckx, Ewan Forrest, Coral Hollywood, Stephen Hearing, Imtiyaz Mohammed, Claudia Coppo, Nikolaos Koukias, Rachel Cooney, He Source Type: research

A Tracheoesophageal Fistula Closed after Being Patent for Over Half a Century
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 18, 2020 Category: Gastroenterology Authors: Douglas G. Adler Source Type: research

Prediction of technically difficult endoscopic submucosal dissection for large superficial colorectal tumors: a novel clinical score model
Endoscopic submucosal dissection (ESD) is a promising technique for removing superficial gastrointestinal tumors, but ESD is technically difficult. The aims of this study were to establish a clinical score model for grading technically difficult colorectal ESD (CR-ESD). (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 18, 2020 Category: Gastroenterology Authors: Bing Li, Qiang Shi, En-Pan Xu, Li-Qing Yao, Shi-Lun Cai, Zhi-Peng Qi, Di Sun, Dong-Li He, Ayimukedisi Yalikong, Zhen-Tao Lv, Ping-Hong Zhou, Yun-Shi Zhong Source Type: research

Endorectal formalin instillation or argon plasma coagulation for hemorrhagic radiation proctopathy therapy: a prospective and randomized clinical trial
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 17, 2020 Category: Gastroenterology Authors: Fl ávia Siqueira Furtado, Gildo Barreira Furtado GB, Alessandrino Terceiro Oliveira, Francisco Antônio Araújo Oliveira, Cibele Silveira Pinho, João Paulo Aguiar Sampaio, Ana Márcia Lima Feitosa, José Ruver de Lima Herculano Junir Source Type: research

Association for Bariatric Endoscopy systematic review and meta-analysis assessing the American Society for Gastrointestinal Endoscopy Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for aspiration therapy
A subcommittee of the Association for Bariatric Endoscopy, a division of the American Society for Gastrointestinal Endoscopy (ASGE) comprising experts in the subject area, performed this systematic review and meta-analysis. The systematic review and meta-analysis was reviewed by the ASGE Technology Committee and was ultimately submitted to the ASGE Governing Board for approval. The systematic review and meta-analysis underwent peer review by outside experts in statistics and meta-analysis before receiving final ASGE Governing Board approval. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 17, 2020 Category: Gastroenterology Authors: Pichamol Jirapinyo, Nitin Kumar, Monica Saumoy, Andrew Copland, Shelby Sullivan Tags: ABE committee special article Source Type: research

A rare finding from a colonoscopy and laparoscopy of a patient with mesenteric panniculitis mimicking cancerous peritonitis
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 12, 2020 Category: Gastroenterology Authors: Masahiro Sakata, Tatsuya Toyokawa, Ryosuke Hamano, Shinya Otsuka, Masaru Inagaki Source Type: research

ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction
This American Society for Gastrointestinal Endoscopy guideline provides evidence-based recommendations for the endoscopic management of gastric outlet obstruction (GOO). We applied the Grading of Recommendations, Assessment, Development and Evaluation methodology to address key clinical questions. These include the comparison of (1) surgical gastrojejunostomy to the placement of self-expandable metallic stents (SEMS) for malignant GOO, (2) covered versus uncovered SEMS for malignant GOO, and (3) endoscopic and surgical interventions for the management of benign GOO. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 7, 2020 Category: Gastroenterology Authors: Terry L. Jue, Andrew C. Storm, Mariam Naveed, Douglas S. Fishman, Bashar J. Qumseya, Autumn J. McRee, Mark J. Truty, Mouen A. Khashab, Deepak Agrawal, Mohammed Al-Haddad, Stuart K. Amateau, James L. Buxbaum, Audrey H. Calderwood, John DeWitt, Christopher Tags: Guideline Source Type: research

Biomechanical risk factors associated with distal upper extremity musculoskeletal disorders in endoscopists performing colonoscopy
Endoscopists experience upper extremity musculoskeletal injuries. The primary aim of this study was to compare distal upper extremity biomechanical risk factors during colonoscopy to established risk thresholds. Secondary aims were to determine which subtasks during colonoscopy are associated with the greatest risk and to evaluate an intervention to reduce risks. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 5, 2020 Category: Gastroenterology Authors: Amandeep K. Shergill, David Rempel, Alan Barr, David Lee, Anna Pereira, Chih Ming Hsieh, Kenneth McQuaid, Carisa Harris-Adamson Source Type: research

Comparing diagnostic accuracy of current practice guidelines in predicting choledocholithiasis: outcomes from a large healthcare system comprising both academic and community setting
The American Society for Gastrointestinal Endoscopy (ASGE) 2010 guidelines for suspected choledocholithiasis were recently updated by proposing more-specific criteria for selection of high-risk patients to undergo direct ERCP, while advocating use of additional imaging studies for intermediate- and low-risk individuals. We aim to compare the performance and diagnostic accuracy of 2019 versus 2010 ASGE criteria for suspected choledocholithiasis. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 4, 2020 Category: Gastroenterology Authors: Aswathi Chandran, Shahrooz Rashtak, Prithvi Patil, Assaf Gottlieb, Elmer Bernstam, Sushovan Guha, Srinivas Ramireddy, Ricardo Badillo, Roy Tomas DaVee, Lillian S. Kao, Nirav Thosani Source Type: research

Early transluminal drainage of pancreatic necrotic collections
We read with keen interest the study by Oblizajek et  al1 and congratulate the authors for demonstrating that endoscopic intervention of pancreatic necrosis is effective and safe even in the early phase of illness. Delayed endoscopic transluminal drainage (ETD) of pancreatic necrosis is safe and is associated with excellent clinical success, lower re intervention rates, and lower mortality.2 However, there have been concerns with performing ETD in the early ( (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Surinder S. Rana, Rajesh Gupta Tags: Letter to the Editor Source Type: research

Predicting the risk of esophageal high-grade lesions in opportunistic screening
We read with interest the article by Liu et  al1 and were particularly intrigued by the 89% discrimination power, which is much higher than those of previous models,2,3 even those reported by the same group,4 or well-known models such as the Gail model for breast cancer.5 For a disease with a very high mortality, screening by a simple noninv asive model can offer clear survival benefits. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Arash Etemadi, Sanford M. Dawsey, Christian C. Abnet, Michael M. Mwachiro Tags: Letter to the Editor Source Type: research

EUS-directed pancreatic duct drainage: Mainstream miracle or proceed with caution?
Abdominal pain is the foremost adverse event (AE) of chronic pancreatitis (CP). The mechanism of pain in CP is incompletely understood and likely multifactorial, including mechanical (intraductal pressure/obstruction), inflammatory, malabsorptive, and neurogenic/neuropathic changes in the pancreas and surrounding organs.1 In addition, patients with CP can have nonvisceral pain associated with high levels of psychologic stress. The intensity of pain and  frequency of pain attacks compromise the quality of life in CP patients. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Rajesh Krishnamoorthi, Andrew Ross Tags: Original article Source Type: research

Endoscopic ablation of pancreatic cysts: not yet ready for general application
I would like to thank Dr Canakis and colleagues1 for the comprehensive updated review on ablative treatment of pancreatic cyst lesions (PCLs) recently published in Gastrointestinal Endoscopy. The options, unanswered questions, and limitations of the previous pioneering studies were well summarized in the conclusions. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Daniel Schmitz Tags: Letter to the Editor Source Type: research

Is lower GI bleeding on weekend admissions associated with worse outcomes?
We have read the recent article on the "weekend effect" phenomenon for lower GI bleeding (LGIB) by Li et  al.1 The authors demonstrated that the outcomes of weekend admissions were not significantly different from those of weekday admissions regarding mortality, length of stay, or charge, using a large retrospective billing-based dataset with an estimated 12,462 inpatients for LGIB. As they discussed as a limitation, this dataset does not allow for clinical information, including antithrombogenic drug use or blood pressure. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Tsutomu Nishida, Ryota Niikura, Dai Nakamatsu, Mitsuhiro Fujishiro Tags: Letter to the Editor Source Type: research

Cold snare piecemeal EMR of large sessile colonic polyps > 20 mm: a call for dedicated snares
The evidence surrounding the application of cold snare resection of polyps  20  mm, suggesting also that in this context the application of cold snare resection is safe and efficacious. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Michiel Bronswijk, Ingrid Demedts, Raf Bisschops, Philip Roelandt Tags: Letter to the Editor Source Type: research

EUS-guided celiac plexus neurolysis versus medication alone for unresectable pancreatic cancer
We read with great interest the research by Kanno et  al,1 in which the authors assessed the effectiveness of celiac plexus neurolysis (CPN) with EUS guidance (EUS-CPN) for patients with pancreatic cancer–associated pain to compare medication using oxycodone and/or fentanyl with and without EUS-CPN. The final result indicated that compared with pat ients who did not undergo EUS-CPN and who were medicated with oxycodone/fentanyl, EUS-CPN did not seem to improve pain, quality of life, and opioid dosage. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Yufeng Gao, Xiaohong Zhao Tags: Letter to the Editor Source Type: research

Management of sigmoid volvulus: somewhere in between endoscopic detorsion and immediate surgery
We read the American Society for Gastrointestinal Endoscopy (ASGE) guidelines about colonic volvulus with great interest.1 The guidelines clearly describe the management and strategy of sigmoid volvulus. The first step is to judge the patient ’s unstable condition, including peritonitis or perforation, that requires emergency surgery. If the patient’s condition is stable, the next step is endoscopic detorsion (ED). (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Kazuya Inoki, Athushi Katagiri, Hitoshi Yoshida Tags: Letter to the Editor Source Type: research

Long-term surveillance in individuals with serrated polyposis syndrome
A challenging issue for endoscopists in colorectal cancer (CRC) surveillance is the management of polyposis syndromes.1 Serrated polyposis syndrome (SPS) in comparison with other polyposis syndromes may seem more challenging, owing in part to the relatively recent recognition of this disease. A recent study from a major referral center observed that  ≤40% of SPS cases were not recognized by endoscopists.2 Many of the other polyposis syndromes are associated with a known genetic mutation, making identification of patients easier. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Dmitriy Kedrin, Joseph C. Anderson Tags: Original article Source Type: research

Gross morphology predicts the presence and pattern of invasive cancer in laterally spreading tumors: Don ’t overlook the overview!
The timely detection and complete removal of colonic polyps by high-quality colonoscopy is a pivotal strategy in the prevention of colorectal cancer.1 Most polyps are small (10  mm in diameter, that spread laterally and circumferentially along the colonic wall. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Sergei Vosko, Michael J. Bourke Tags: Original article Source Type: research

EUS-guided fine-needle injection for pancreatic cancer: back to the future
In this issue of Gastrointestinal Endoscopy, Lee et  al1 report a phase I trial of EUS-guided fine-needle injection (EUS-FNI) of modified adenovirus with “double suicide” genes, a second-generation oncolytic virus, for locally advanced pancreatic cancer. The treatment was safe without dose-limiting toxicity during the first 8 weeks; partial resp onse was seen in 1 patient, and the disease was stable in the remaining 8 patients at 12 weeks. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Yousuke Nakai, Kenneth J. Chang Tags: Original article Source Type: research

The impact of COVID-19 on endoscopy training needs to be considered in the context of a global pandemic
The international survey by Pawlak et  al1 of the impact of COVID-19 on endoscopy training has reported that 93.8% of 770 trainees from 63 countries have had reduced endoscopy training, with associated anxiety. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Jonathan P. Segal, Philip J. Smith, Ajay M. Verma Tags: Letter to the Editor Source Type: research

Feedback interventions in colonoscopy: Good, but can we do better?
Feedback is a core facet of adult learning. It can be considered crucial in reinforcing or adapting a learner ’s knowledge, skills, or behaviors. Within healthcare, “audit and feedback” is a specific type of intervention that aims to use feedback to improve performance. Here, healthcare professionals are provided with summaries of their clinical performance prompting them to assess and adjust their ap proach accordingly.1 One need only look to the surgical literature to see the potential benefits of audit and feedback on performance. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Srivathsan Ravindran, Siwan Thomas-Gibson Tags: Editorial Source Type: research

Response
On behalf of all study authors, we thank Segal et  al1 for their reply to our article.2 It is challenging to contextualize the balance of endoscopic training with the substantial disruption in provision of endoscopy service to patients. Our study adds value because it provides data on the impact of the pandemic on endoscopic trainees, which, indep endently of the major clinical impact of the pandemic on patients, remains a real and tangible gap that must be addressed by endoscopic educators. We believe that it can be a disservice to the education and welfare of future endoscopists to de-emphasize this gap, as the lett...
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Katarzyna M. Pawlak, Aline Charabaty, Rishad Khan, Keith Siau Tags: Letter to the Editor Source Type: research

Response
We thank Etemadi et  al1 for their interest in our study,2 and we would like to address their questions. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Zhonghu He, Yang Ke Tags: Letter to the Editor Source Type: research

Response
Discussion section. To draw more robust conclusions using a theoretically perfect design with ideal statistics, a large sample size was required. However, studies with a large population were inappropriate because of a lack of previous phase II studies to justify conducting phase III studies for EUS-guided celiac plexus neurolysis (EUS-CPN). (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Yoshihide Kanno, Shinsuke Koshita, Kei Ito Tags: Letter to the Editor Source Type: research

Response:
We respond with appreciation to the letter by Nishida et  al, “Is lower gastrointestinal bleeding on weekend admissions associated with worse outcomes?”1 Briefly, the goal of their commentary was to highlight the effect of weekend admission on lower GI bleeding outcomes in a prospectively collected cohort. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - November 1, 2020 Category: Gastroenterology Authors: Joseph D. Feuerstein, Daniel J. Stein, Brian Li Tags: Letter to the Editor Source Type: research