Safety and efficacy of metal stents for malignant colonic obstruction in patients treated with bevacizumab
The aim of this study was to examine clinical outcomes and adverse events (AEs) of self-expandable metal stents (SEMSs) in the management of malignant colonic obstruction (MCO). (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 21, 2019 Category: Gastroenterology Authors: Jeffrey H. Lee, Ikenna Emelogu, Keshav Kukreja, Faisal S. Ali, Garciela Nogueras-Gonzalez, Phillip Lum, Emmanuel Coronel, William Ross, Gottumukkala S. Raju, Patrick Lynch, Selvi Thirumurthi, John Stroehlein, Yinghong Wang, Yi-Quan N. You, Brian Weston Source Type: research

Submucosal injection materials other than mucosal lift
Submucosal elevation is essential for assisting endoscopic submucosal dissection (ESD) to make it easier and safer. Hence, a submucosal cushion has been a critical issue since the ESD technique came into being. Several agents are available, but it has not yet been proved which agent is preferred over another. Recently, Fujimoto et  al1 reported rebamipide solution as a modified agent for submucosal injection that could promote wound healing for post-ESD ulcers. There were few reports about the physiologic interaction between cushion agents and post-ESD defects. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Tao Dong, Lili Zhao, Li Liu, Zhining Fan Tags: Letter to the Editor Source Type: research

ERCP in patients with Roux-en-Y gastric bypass: one size does not fit  all
The study by Bukhari et  al1 comparing EUS-guided gastrostomy-assisted ERCP (EUS-GG-ERCP) versus enteroscopy-assisted ERCP (e-ERCP) in patients with Roux-en-Y gastric bypass (RYGB) contributes new and important information on the care of these challenging patients. Technical success was significantly higher with EUS-GG-ER CP (100% vs 60%; P  (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Dennis Yang, Peter V. Draganov Tags: Letter to the Editor Source Type: research

The path to quality colonoscopy continues after graduation
The effort over the past decade to improve quality in colonoscopy was marked by several essential steps forward. These included definition of quality indicators,1,2 the development and validation of objective skills assessment tools such as the American Society for Gastrointestinal Endoscopy assessment of competency in endoscopy tool, the direct observation of procedural skills (DOPS),3,4 and the investment in infrastructure to track and benchmark performance for key indicators such as the GI quality improvement consortium (GIQuIC)5 and the Joint Advisory Group on GI Endoscopy - Endoscopy Training System eportfolio in the ...
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: David M. Poppers, Jonathan Cohen Tags: Original article Source Type: research

Pancreatic stent during biliary cannulation: How can we catch 2  hares?
Unintentional guidewire insertion to the pancreatic duct commonly occurs during biliary cannulation and provokes post-ERCP pancreatitis (PEP).1 Several cannulation approaches have been reported in this setting.2,3 In a recent issue of Gastrointestinal Endoscopy, Eminler et  al4 reported that the double-guidewire (DGW) method was superior to wire-guided cannulation after pancreatic stent placement (WGC-PS) in terms of the successful cannulation rate: 90% versus 54%. Notably, they proceeded to precut sphincterotomy over a pancreatic stent after 5 minutes of cannulation attempts. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Ryunosuke Hakuta, Tsuyoshi Hamada, Yousuke Nakai, Hiroyuki Isayama, Kazuhiko Koike Tags: Letter to the Editor Source Type: research

Ensuring that endoscopists completely clear the colon of adenomas: Perhaps we try more carrots?
Colorectal cancer (CRC) screening with colonoscopy reduces the risk for CRC through the detection and removal of polyps including adenomas. However, colonoscopy is not a perfect test, as demonstrated by postcolonoscopy CRC (PCCRC).1,2 Thorough detection and complete resection of all adenomas will decrease the rate of these tumors. Measuring the success of colonoscopic clearance of adenomas can be difficult because the frequency of PCCRC is too low to make it an adequate outcome. The adenoma detection rate (ADR) was proposed almost 2 decades ago to serve as a surrogate quality indicator for colonoscopies. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Joseph C. Anderson, Charles J. Kahi Tags: Original article Source Type: research

Better too big than too small?
We read great interest the article by Martins et  al,1 “Metal versus plastic stents for anastomotic biliary stricture after liver transplantation: a randomized control trial.” The authors concluded that covered self-expandable metal stents (cSEMSs) were comparable with multiple plastic stents (MPSs) for resolution of postorthotopic liver tran splantation (OLT) biliary anastomotic stricture. Biliary anastomotic stricture is the most frequent adverse event after OLT, and several studies have been published about the superiority of cSEMSs over MPSs regarding the number of procedures. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Kazumichi Kawakubo, Masaki Kuwatani, Shin Kato, Naoya Sakamoto Tags: Letter to the Editor Source Type: research

Saline immersion therapeutic endoscopy facilitated pocket-creation method for endoscopic submucosal dissection (with video)
We read with interest the article by Harada et  al,1 who combined the pocket-creation method (PCM)2-6 for endoscopic submucosal dissection (ESD) with pocket immersion.7-9 This was described as “water-pocket ESD” (WP-ESD) and was found to be faster than standard ESD.1 (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Edward J. Despott, Yutaka Hirayama, Nikolaos Lazaridis, Nikolaos Koukias, Andrea Telese, Yoshikazu Hayashi, Yoshimasa Miura, Hironori Yamamoto, Alberto Murino Tags: Letter to the Editor Source Type: research

Inadequate colonoscopy preparation: Is it time to send out an  SMS?
A high-quality bowel preparation is the cornerstone of both diagnostic and therapeutic colonoscopy. Higher-quality bowel preparations are associated with a greater likelihood of polyp detection (both serrated and adenomatous), decreased procedure times, fewer adverse events, lower costs, and improved colonoscopy completion rates.1 Yet, despite the importance of bowel preparation, consistent achievement of a high-quality bowel preparation in practice continues to be a challenge. Consequently, there has been a variety of published quality improvement interventions aimed at improving the quality of outpatient bowel preparatio...
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Matthew J. Nelson, Rajesh N. Keswani Tags: Original article Source Type: research

Look, but don ’t touch: what not to do in managing large colorectal polyps
During a surveillance colonoscopy, a healthy 76-year-old woman is found to have a 30  × 15 mm “flat carpet lesion” in the ascending colon. The endoscopist determines that the polyp is too large to resect. He takes a biopsy specimen from the lesion, tattoos it, and refers the patient to a colorectal surgeon. Histopathologic analysis demonstrates tubular adenoma without high-gr ade dysplasia. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Ian S. Grimm, Sarah K. McGill Tags: Original article Source Type: research

Response
We thank Dr Despott et  al1 for their interests in our recent publication, “Water-pocket endoscopic submucosal dissection for superficial gastric neoplasms.”2 We agree with their descriptive term, “saline-pocket endoscopic submucosal dissection (SP-ESD).” As they pointed out, our procedure is fundamentally a pock et-creation method (PCM)3-6 with saline solution. Water-pocket endoscopic submucosal dissection (WP-ESD) with the use of saline solution also has the disadvantages of impairing the endoscopic view because of the bubbles generated by diathermy. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Hideaki Harada, Yuji Amano Tags: Letter to the Editor Source Type: research

Research design can be improved to support double-guidewire technique
We have read with great interest the article by Eminler et  al1 concerning how the method of wire-guided cannulation over a pancreatic stent (WGC-PS) increases the need for needle-knife precutting (NKP) in comparison with the double-guidewire technique (DGW) in patients with difficult biliary cannulation. This is an interesting prospective randomized study ; however, we believe that the research design can still be improved. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Di Zhang, Jia-su Li, Zhao-shen Li, Feng Liu, Dan Wang Tags: Letter to the Editor Source Type: research

Response
We appreciate the opportunity to respond to the letter entitled “ERCP in patients with Roux-en-Y gastric bypass: one size does not fit all” by Yang and Draganov.1 We thank our colleagues for their comments about our publication.2 The authors suggested that laparoscopic-assisted ERCP (LA-ERCP), rather than EUS-guided gastrostomy-assisted ERCP (EUS-GG-ERCP), s hould be the first approach for most Roux-en-Y gastric bypass (RYGB) patients who need a single ERCP in view of the comparable results with standard ERCP in patients with normal anatomy. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Majidah Bukhari, Mouen A Khashab Tags: Letter to the Editor Source Type: research

Response:
We appreciate the insightful advice on our article1 from Dr Dong and colleagues.2 The reviewers point out that 0.5% carboxymethyl cellulose (CMC), the solvent used in the rebamipide solution, may have promoted wound healing. That is, the favorable effect on ulcer healing might have been bestowed by the CMC rather than by the rebamipide treatment. When we conducted a similar experiment using CMC as a control in an earlier study, the ulcers healed more quickly in the rebamipide group than in the CMC group. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Ai Fujimoto, Toshio Uraoka, Naohisa Yahagi Tags: Letter to the Editor Source Type: research

Response:
We appreciate the interest of Kawakubo et  al1 in our article,2 presenting some appropriate comments. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Fernanda Prata Martins, Gustavo Andrade De Paulo, M ônica L.C. Contini, Angelo Paulo Ferrari Tags: Letter to the Editor Source Type: research

Optimum colonoscopy withdrawal: Is time everything?
The adenoma detection rate (ADR) is an important indicator of the quality of colonoscopy. Several factors influence the ADR, including operator factors (eg, experience), patient factors (eg, age, sex, race, underlying disease1), and procedure-related factors (eg, quality of bowel preparation, position change, use of cap-assisted colonoscopy, withdrawal time). In recent years, there has been a growing emphasis on the significance of withdrawal time and its impact on ADR. Improving ADR may help reduce the rate of postcolonoscopy colorectal cancer (PCCRC), and there is evidence that shorter withdrawal times are associated wit...
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Ahmir Ahmad, Siwan Thomas-Gibson Tags: Original article Source Type: research

Endoscopic diagnosis of colorectal polyps with the use of blue-light imaging: For experts only?
We read with great interest the work of Rondonotti et  al1 in which they conclude that blue-light imaging (BLI) outperforms high-definition white-light endoscopy (HDWL) for the prediction of subcentimetric colorectal polyp histologic features. The overall diagnostic accuracy was 84% and 92% with HDWL or BLI, respectively (P = .011). The negative pred ictive value (to exclude an adenoma) for diminutive rectosigmoid polyps was significantly increased by the use of BLI and reached 88%, close to the performance threshold of 90% recommended by the American Society for Gastrointestinal Endoscopy. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Maximilien Barret, Dalhia Thao Cao, Sophie Grabar, Romain Coriat, Stanislas Chaussade Tags: Letter to the Editor Source Type: research

Response:
We thank Hakuta et  al1 for their interest in and comments on our study.2 We agree that repeated guidewire cannulation of the pancreatic duct may increase the risk of post-ERCP pancreatitis. Although there is some debate on this isssue, we think that successful insertion of a prophylactic pancreatic stent, inadverten t cannulation of the side branches of the pancreatic duct, and injection of contrast material are among the determining factors. Additionally, there is some controversy about the timing of pancreatic stent insertion, which usually depends on the preference of the endoscopists. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Ahmet Tar ık Eminler, Erkan Parlak, Aydın Seref Koksal Tags: Letter to the Editor Source Type: research

Response:
We would like to thank Zhang et  al1 for their interest in and comments on our study.2 Randomization based on a single sequence of random assignments is defined as a simple randomization. This technique maintains complete randomness of the assignment of a subject to a particular group. It is simple and easy to implement in clinic al research. Simple randomization works well for large trials (n>100) and small to moderate clinical trials (n   (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Ahmet Tar ık Eminler, Erkan Parlak, Aydın Seref Koksal Tags: Letter to the Editor Source Type: research

Computer-aided confocal laser endomicroscopy in inflammatory bowel disease: probing deeper into what it means
Confocal laser endomicroscopy (CLE) is an endoscopic tool that enables micron-level spatial resolution and imaging of the GI mucosa during endoscopy.1 Given the potential for in  vivo assessment, this technology has the potential to improve our real-time assessment of mucosa-based disease during endoscopy.2-4 One area with emerging data regarding the use of CLE for disease-specific assessment is inflammatory bowel disease (IBD). Various studies have examined whether CLE ca n detect mucosal changes related to inflammation, and they have described features of inflamed mucosa such as irregular or tortuous crypts, wider l...
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Yecheskel Schneider, Anna M. Buchner Tags: New methods Source Type: research

Water infusion without near-complete removal during insertion by any other name is still water immersion
A network meta-analysis of randomized controlled trials (RCTs) showed that water exchange (WE) was superior to water immersion (WI) and gas (air or CO2) insufflation (air insufflation) in increasing adenoma detection rate (ADR).1 The published features of WE included water infusion to facilitate cecal intubation, gas exclusion to avoid colon elongation, and predominant (near-complete) insertion removal of water and debris to minimize distension and maximize salvage cleaning.2 For convenience (learning curve deemed unnecessary) and efficiency (less time consuming), WI did not mandate these maneuvers. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Authors: Felix W. Leung, Hui Jia Tags: Original article Source Type: research

Continuing Medical Education Exam: March 2019
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 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

Contents
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Source Type: research

Editors
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Source Type: research

Focus on...
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Source Type: research

ASGE update
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Source Type: research

In upcoming issues...
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Source Type: research

Information for readers
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 20, 2019 Category: Gastroenterology Source Type: research

White-globe appearance in gastric high-grade dysplasia
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 12, 2019 Category: Gastroenterology Authors: Masaya Iwamuro, Hiroyuki Sakae, Takehiro Tanaka, Hiroyuki Okada Source Type: research

Depressed-type adenoma in the colon is associated with advanced pathology
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 12, 2019 Category: Gastroenterology Authors: Shunsuke Yamamoto Source Type: research

Importance of tissue acquisition in gastric submucosal tumor with unusual EUS features
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 8, 2019 Category: Gastroenterology Authors: Cheng-Lu Lin, Kuan-Chih Chen, Cheng-Kuan Lin, Chien-Chen Tsai, Tzong-Hsi Lee, Chen-Shuan Chung Source Type: research

Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees
Minimum EUS and ERCP volumes that should be offered per trainee in “high quality” advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an “average” advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 7, 2019 Category: Gastroenterology Authors: Sachin Wani, Samuel Han, Violette Simon, Matthew Hall, Dayna Early, Eva Aagaard, Wasif M. Abidi, Subhas Banerjee, Todd H. Baron, Michael Bartel, Erik Bowman, Brian C. Brauer, Jonathan M. Buscaglia, Linda Carlin, Amitabh Chak, Hemant Chatrath, Abhishek Cho Source Type: research

Differential risk of disease progression between isolated anastomotic ulcers and mild ileal recurrence after ileocolonic resection in patients with Crohn ’s disease
It is standard of care to perform ileocolonoscopy within a year of ileocolonic resection for Crohn ’s disease (CD) and to guide management decisions based on the Rutgeert score (RS). The modified RS subdivides i2 into lesions confined to the anastomosis (i2a) or>5 aphthous lesions in the neoterminal ileum (i2b). There is uncertainty, however, if i2a lesions incur an increased risk of disease recurrence. The primary aim of this study was to compare the rates of endoscopic progression between i2a and i2b when compared with i0-i1. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 6, 2019 Category: Gastroenterology Authors: Jacob E. Ollech, Maya Aharoni-Golan, Roni Weisshof, Inessa Normatov, Abby R. Sapp, Aditya Kalakonda, Amanda Israel, Laura Glick, Theodore Karrison, Sushila R. Dalal, Atsushi Sakuraba, Russell D. Cohen, David T. Rubin, Joel Pekow Source Type: research

Classical features of Zollinger-Ellison syndrome, in images
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 5, 2019 Category: Gastroenterology Authors: Ali Alshati, Toufic Kachaamy Source Type: research

The pocket-creation method facilitates colonic endoscopic submucosal dissection (with video)
Colonic endoscopic submucosal dissection (ESD) is more difficult than rectal ESD because of poor maneuverability of the endoscope due to physiological flexion, peristalsis and respiratory movements. The aim of this study is to assess the usefulness of the pocket-creation method (PCM) for colonic ESD compared with the conventional method (CM) regardless of lesion shape or location. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 1, 2019 Category: Gastroenterology Authors: Takahito Takezawa, Yoshikazu Hayashi, Satoshi Shinozaki, Yuichi Sagara, Masahiro Okada, Yasutoshi Kobayashi, Hirotsugu Sakamoto, Yoshimasa Miura, Keijiro Sunada, Alan Kawarai Lefor, Hironori Yamamoto Source Type: research

Removal of intraductal migrated biliary fully covered self-expandable metal stents: the “SEMS in SEMS” technique
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - February 1, 2019 Category: Gastroenterology Authors: Pedro Marcos, Pedro Bastos, Marta Patita, Catarina Brand ão Source Type: research

Painful anal lump
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 30, 2019 Category: Gastroenterology Authors: M ónica Garrido, Fernando Castro-Poças Source Type: research

Endoscopic stricturotomy versus ileocolonic resection in the treatment of ileocolonic anastomotic strictures in Crohn ’s disease
Endoscopic stricturotomy is a novel technique in the treatment of anastomotic strictures in Crohn ’s disease (CD). The aim of this study was to compare the outcome of patients with ileocolonic anastomotic stricture treated with endoscopic stricturotomy (ESt) versus ileocolonic resection (ICR). (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 30, 2019 Category: Gastroenterology Authors: Nan Lan, Luca Stocchi, Conor P. Delaney, Tracy L. Hull, Bo Shen Source Type: research

Yield of repeat colonoscopy in asymptomatic individuals with a positive fecal immunochemical test and recent colonoscopy
A fecal immunochemical test (FIT) is often repeated annually, even after a recent colonoscopy. However, there are no published data on the proper approach to FIT-positive patients after a recent colonoscopy. We compared colorectal cancer (CRC) and advanced colorectal neoplasia (ACRN) prevalence based on the interval since the last colonoscopy. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 23, 2019 Category: Gastroenterology Authors: Nam Hee Kim, Yoon Suk Jung, Jae Wan Lim, Jung Ho Park, Dong Il Park, Chong Il Sohn Source Type: research

A phase 3, multicenter, prospective, single-blinded, noninferiority, randomized controlled trial on the performance of a novel esophageal stent with an anti-reflux valve (with video)
Self-expanding metal stents (SEMSs) when deployed across the gastroesophageal junction (GEJ) can lead to reflux with risks of aspiration. A SEMS with a tricuspid anti-reflux valve (SEMS-V) was designed to address this issue. The aim of this study was to evaluate the efficacy and safety of this stent. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 23, 2019 Category: Gastroenterology Authors: Kulwinder S. Dua, John M. DeWitt, William R. Kessler, David L. Diehl, Peter V. Draganov, Mihir S. Wagh, Michel Kahaleh, Louis M. Wong Kee Song, Harshit S. Khara, Abdul H. Khan, Murad M. Aburajab, Darren Ballard, Chris E. Forsmark, Steven A. Edmundowicz, B Source Type: research

Jumbo biopsy forceps versus cold snares for removing diminutive colorectal polyps: A prospective randomized controlled trial
Cold snare polypectomy (CSP) and jumbo forceps polypectomy (JFP) have been shown to be effective for removing diminutive colorectal polyps (DCPs) ( ≤5 mm). However, no study has compared complete resection rates between CSP and JFP for DCPs. The aim of this study was to compare the efficacy and safety of JFP to CSP for the removal of DCPs. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 23, 2019 Category: Gastroenterology Authors: Cheal Wung Huh, Joon Sung Kim, Hyun Ho Choi, I So Maeng, Sun-Young Jun, Byung-Wook Kim Source Type: research

Bleeding pyogenic granuloma of the ampulla of Vater: a rare cause of severe chronic anemia
(Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 21, 2019 Category: Gastroenterology Authors: Rohan Mandaliya, Suhua Han, Nadim Haddad Source Type: research

ERCP in patients with Roux-en-Y gastric bypass: spiral or short-type single-balloon endoscopy?
We read with interest the article by Ali et  al1 on spiral endoscopy-assisted ERCP (SE-ERCP) in patients with bariatric-length Roux-en-Y (RY) anatomy because of the impossibility of standard ERCP. They performed SE-ERCP in 31 patients (35 procedures) with bariatric RY gastric bypass (RYGB) (28 procedures) and other long-limb RY anatomy (7 pr ocedures), resulting in favorable outcomes (Table 1). Although they concluded that SE-ERCP is effective and safe in such patients, we believe that there is an effective alternative, with a short procedure time. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 19, 2019 Category: Gastroenterology Authors: Mitsunobu Matsushita, Masaaki Shimatani, Kazuichi Okazaki Tags: Letter to the Editor Source Type: research

The role of colonic stents in extracolonic malignant large-bowel obstruction
Recently, Faraz et  al1 reported that multifocal diseases and peritoneal carcinomatosis were risk factors in the technical and clinical success of stent placement in extracolonic malignant large-bowel obstruction. We would like to raise several concerns about the role of colonic stents in relieving intestinal obstruc tion. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 19, 2019 Category: Gastroenterology Authors: Yingtong Chen, Zhining Fan, Lili Zhao Tags: Letter to the Editor Source Type: research

Impact of fellowship training level on colonoscopy quality and efficiency metrics: a United Kingdom perspective
Performance metrics during colonoscopy training can be used to indicate readiness for independent practice. The study by Bitar et  al1 is therefore a welcome addition to the colonoscopy training literature. The distinguishing feature of fellow seniority (and presumably competence) was the “efficiency” or speed with which the colon was intubated and adenomas detected and removed. However, speed does not necessarily imply p roficiency. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 19, 2019 Category: Gastroenterology Authors: Keith Siau, Neil D. Hawkes, Paul Dunckley, Roland M. Valori Tags: Letter to the Editor Source Type: research

Comments on duodenoscope reprocessing study
As experts retained by the duodenoscope manufacturer in litigation involving both the manufacturer and the medical center, we obtained access to the study data produced in the litigation. Although we applaud the authors ’ communication of important information regarding the challenges of duodenoscope reprocessing, and their successful efforts to control contamination in their facility (including the implementation of a culture and quarantine protocol), we believe that the authors neglected to consider possible tr ends over time. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 19, 2019 Category: Gastroenterology Authors: Marc W. Mittelman, Duane Steffey Tags: Letter to the Editor Source Type: research

Avoiding the tube: ERCP and EUS approaches to gallbladder drainage as alternatives to percutaneous cholecystostomy in patients with cholecystitis
Cholecystitis has, for all intents and purposes, not been a disease that gastroenterologists have historically been called upon to treat. The lines of demarcation were clear and well understood. Patients with cholecystitis were the purview of surgeons who would perform cholecystectomy (CCY) whenever possible. Patients who were thought to be unfit for CCY were handed off to interventional radiologists for placement of a percutaneous cholecystostomy tube (which was often placed on a long-term or permanent basis and referred to as “destination therapy”). (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 19, 2019 Category: Gastroenterology Authors: Douglas G. Adler Tags: Original article Source Type: research

Screening for esophageal squamous cell carcinoma: insight from experience with Barrett's esophagus
We read with great interest the article by Codipilly et  al,1 which reviewed recent advances in screening for esophageal squamous cell carcinoma (ESCC) and its precursor, including endoscopic and nonendoscopic modalities. Mass endoscopic screening would present a cost-effective challenge and is not tenable in most high-incidence regions except in a few ultra–high-prevalence areas.2,3 Esophageal balloon cytology screening was once widely used in China but is no longer recommended because of its low accuracy in asymptomatic individuals. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 19, 2019 Category: Gastroenterology Authors: Fan Yang, Dan Ma, Zhaoshen Li Tags: Letter to the Editor Source Type: research

A promising countertraction method for faster adoption of endoscopic submucosal dissection in a Western setting
The prospective randomized study from Ge et  al1 provoked my strong interest. They examined the efficacy of the suture pulley countertraction method for endoscopic submucosal dissection (ESD) as used by novices for both suturing and ESD. Using an ex vivo porcine stomach model, the participants carried out each technique under the control of an ESD expert. The spectacular results showed that the mean total procedure time was significantly shorter for all participants when suture pulley ESD was performed in comparison with traditional ESD. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 19, 2019 Category: Gastroenterology Authors: Andrey Iskrenov Kotzev Tags: Letter to the Editor Source Type: research

Reimbursement for endoscopic innovations: the final hurdle
After the introduction of the cardiomyotomy by Dr Ernst Heller in 1913 for treating achalasia, surgeons have pursued a variety of different approaches to performing the procedure: transabdominal, transthoracic, thoracoscopic, and laparoscopic. But from the outset, the essence of the operation has remained the same: a longitudinal division of the lower esophageal sphincter. When the operation evolved to a per-oral endoscopic myotomy (POEM) in 2008, it was regarded as simply another iteration of Dr Heller ’s operation but by a less invasive route. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - January 19, 2019 Category: Gastroenterology Authors: Ian S. Grimm, Daniel A. Kroch, Joel V. Brill Tags: Original article Source Type: research