Graphical Abstracts
Automated artificial intelligence scoring systems for the endoscopic assessment of ulcerative colitis: How far are we from clinical application?
Artificial intelligence (AI) is going to drastically change our approach to diagnostic endoscopy. In contrast to its human counterpart, AI can manage an exceptional amount of data simultaneously, does not get fatigued, and can be highly effective and efficient. In the past couple of years, we have witnessed a literal blossom of AI systems applied to digestive endoscopy. Industries have been leading this first part of AI application, with the launch of real-time automated polyp detection and characterization systems to screening colonoscopy.Impact of second-generation transoral incisionless fundoplication on atypical GERD symptoms: a systematic review and meta-analysis
Transoral incisionless fundoplication (TIF) using the EsophyX device (EndoGastric Solutions, Inc, Redmond, Wash, USA) is a minimally invasive endoscopic fundoplication technique. Our study aimed to assess the efficacy of TIF for atypical GERD symptoms in patients with chronic or refractory GERD.Early (<4 weeks) versus standard (≥4 weeks) endoscopic drainage of pancreatic walled-off fluid collections: a systematic review and meta-analysis
Previous studies have demonstrated that the ideal time for drainage of walled-off pancreatic fluid collections is 4 to 6 weeks after their development. However, some pancreatic collections, notably infected pancreatic fluid collections, require earlier drainage. Nevertheless, the optimal timing of the first intervention is unclear, and consensus data are sparse. The aim of this study was to evaluate the clinical efficacy and safety of EUS-guided drainage of pancreatic fluid collections <4 weeks after development compared with ≥4 weeks after development.Reduction in mortality after percutaneous endoscopic gastrostomy tube insertion is likely due to careful patient selection
The insertion of a percutaneous endoscopic gastrostomy (PEG) tube is an invaluable tool to gain long-term nutritional support for patients who cannot meet their nutritional needs for any of several reasons, with a vast volume of data showing that for certain conditions this procedure can improve patient outcomes. Unfortunately, PEG tube insertion has several adverse events, such as aspiration pneumonia, bleeding, infection, leakage, and tube dysfunction or displacement. Minor adverse events can be common and under-reported; more major adverse events arise in approximately 3% of PEG tube insertions.Safety and efficacy of over-the-scope clips versus standard therapy for high-risk nonvariceal upper GI bleeding: systematic review and meta-analysis
Upper GI bleeding (UGIB) is a common condition associated with significant morbidity and mortality. Endoscopic hemostasis remains the mainstay of therapy and is mainly aimed at effective hemostasis and prevention of rebleeding. Lesions with high-risk stigmata can have rebleeding rates of as high as 26.3%. Rebleeding is associated with increased mortality and reduced success rates of endoscopic retreatment. The over-the-scope-clip (OTSC) is a device with widespread endoscopic indications including hemostasis for nonvariceal UGIB (NVUGIB).Robotics in therapeutic endoscopy (with video)
Since its inception, endoscopy has evolved from a solely diagnostic procedure to an expanding therapeutic field within gastroenterology. The incorporation of robotics in gastroenterology initially addressed shortcomings of flexible endoscopes in natural orifice transluminal endoscopy. Developing therapeutic endoscopic robotic platforms now offer operators improved ergonomics, visualization, dexterity, precision, and control and the possibility of increasing proficiency and standardization of complex endoscopic procedures including endoscopic submucosal dissection, endoscopic full-thickness resection, and endoscopic suturing.Clip closure to prevent adverse events after EMR of proximal large nonpedunculated colorectal polyps: meta-analysis of individual patient data from randomized controlled trials
After EMR, prophylactic clipping is often performed to prevent clinically significant post-EMR bleeding (CSPEB) and other adverse events (AEs). Prior evidence syntheses have lacked sufficient power to assess clipping in relevant subgroups or in nonbleeding AEs. We performed a meta-analysis of individual patient data (IPD) from randomized trials assessing the efficacy of clipping to prevent AEs after EMR of proximal large nonpedunculated colorectal polyps (LNPCPs) ≥20 mm.Pooled rates of adenoma detection by colonoscopy in asymptomatic average-risk individuals with positive fecal immunochemical test: a systematic review and meta-analysis
Current adenoma detection rate (ADR) benchmarks for colonoscopy in individuals positive for a fecal immunochemical test (FIT) are ≥45% in men and ≥35% in women. These are based on weak, low-quality evidence. We performed a meta-analysis to ascertain the pooled ADR in FIT-positive colonoscopy.Comparative diagnostic performance of end-cutting fine-needle biopsy needles for EUS tissue sampling of solid pancreatic masses: a network meta-analysis
Evidence is limited on the comparative diagnostic performance of newer end-cutting fine-needle biopsy (FNB) needles for tissue sampling of pancreatic masses. We performed a systematic review with network meta-analysis to compare the diagnostic accuracy of available FNB needles for sampling of solid pancreatic lesions.Diagnostic and therapeutic yields of early capsule endoscopy and device-assisted enteroscopy in the setting of overt GI bleeding: a systematic review with meta-analysis
Small-bowel capsule endoscopy (SBCE) and device-assisted enteroscopy (DAE) are essential in obscure GI bleeding (OGIB) management. However, the best timing for such procedures remains unknown. This meta-analysis aimed to compare, for the first time, diagnostic and therapeutic yields, detection of active bleeding and vascular lesions, recurrent bleeding, and mortality of “early” versus “nonearly” SBCE and DAE.Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis
Endoscopic full-thickness resection (EFTR) is a novel endoscopic technique for the resection of GI lesions not amenable to standard endoscopic therapy. The primary aim of this study was to perform a systematic review and meta-analysis to evaluate EFTR for the resection of colorectal lesions.Comparative efficacy of different methods for difficult biliary cannulation in ERCP: systematic review and network meta-analysis
Several methods with variable efficacy have been proposed for difficult biliary cannulation in ERCP. We assessed the comparative efficacy of different strategies for difficult biliary cannulation through a network meta-analysis combining direct and indirect treatment comparisons.Beyond the SCENIC route: updates in chromoendoscopy and dysplasia screening in patients with inflammatory bowel disease
Patients with Crohn’s disease affecting the colon and ulcerative colitis are known to be at increased risk for the development of dysplasia and colorectal cancer (CRC).1,2 Unlike patients with sporadic CRC, patients with longstanding inflammatory bowel disease (IBD) who develop malignancy do so through different pathophysiologic mechanisms and with foreshortened time frames.3,4 Furthermore, the gross appearance of dysplasia exhibits greater morphologic range in IBD patients, with subtler, flat lesions being commonplace.Pancreatic cyst fluid glucose in differentiating mucinous from nonmucinous pancreatic cysts: a systematic review and meta-analysis
Recently, low levels of intracystic glucose acquired with EUS-guided pancreatic cyst fluid sampling have been shown to help to differentiate mucinous from nonmucinous cystic neoplasms. The aim of this study was to perform a systematic review and meta-analysis to evaluate the diagnostic characteristics of pancreatic cyst fluid glucose compared with carcinoembryonic antigen (CEA) for pancreatic cystic lesions.Efficacy and histologic accuracy of underwater versus conventional endoscopic mucosal resection for large (>20 mm) colorectal polyps: a comparative review and meta-analysis
Major limitations with conventional EMR (C-EMR) include high rates of polyp recurrence and low en-bloc resection rates, especially for lesions >20 mm in size. Underwater EMR (U-EMR) has emerged as an alternate technique for en-bloc resection of larger lesions. We conducted a systematic review and meta-analysis comparing the efficacy and safety of the 2 techniques.Underwater versus conventional EMR for colorectal polyps: systematic review and meta-analysis
Underwater EMR (UEMR) has emerged as an attractive alternative to conventional EMR (CEMR) for the resection of colorectal polyps. The purpose of this systematic review and meta-analysis was to compare UEMR and CEMR for the resection of colorectal polyps with respect to efficacy and safety.Endoscopic full-thickness suturing plus argon plasma mucosal coagulation versus argon plasma mucosal coagulation alone for weight regain after gastric bypass: a systematic review and meta-analysis
Endoscopic transoral outlet reduction (TORe) has been used to manage weight regain after Roux-en-Y gastric bypass. We conducted a meta-analysis to summarize the efficacy and safety of the two most commonly used techniques: full-thickness suturing plus argon plasma mucosal coagulation (ft-TORe) and argon plasma mucosal coagulation alone (APMC-TORe).Performance of artificial intelligence in colonoscopy for adenoma and polyp detection: a systematic review and meta-analysis
One-fourth of colorectal neoplasia are missed at screening colonoscopy, representing the main cause of interval colorectal cancer. Deep learning systems with real-time computer-aided polyp detection (CADe) showed high accuracy in artificial settings, and preliminary randomized controlled trials (RCTs) reported favorable outcomes in the clinical setting. The aim of this meta-analysis was to summarize available RCTs on the performance of CADe systems in colorectal neoplasia detection.Endoscopic gastrointestinal anastomosis: a review of established techniques
Technologic advancements in the field of therapeutic endoscopy have led to the development of minimally invasive techniques to create GI anastomosis without requiring surgery. Examples of the potential clinical applications include bypassing malignant and benign gastric outlet obstruction, providing access to the pancreatobiliary tree in those who have undergone Roux-en-Y gastric bypass, and relieving pancreatobiliary symptoms in afferent loop syndrome. Endoscopic GI anastomosis is less invasive and less expensive than surgical approaches, result in improved outcomes, and therefore are more appealing to patients and providers.Covered versus uncovered metal stents for malignant gastric outlet obstruction: a systematic review and meta-analysis
Self-expandable metal stents (SEMSs) are used for palliation of malignant gastric outlet obstruction (GOO). Studies comparing covered SEMSs (C-SEMSs) and uncovered SEMSs (U-SEMSs) have led to inconclusive results. We compared efficacy and safety of C-SEMSs versus U-SEMSs in patients with GOO.The status of training in new technologies in advanced endoscopy: from defining competence to credentialing and privileging
The landscape of advanced endoscopy continues to evolve as new technologies and techniques become available. Although postgraduate advanced endoscopy fellowships have traditionally centered on ERCP and diagnostic EUS, the breadth of training has increased over the years in response to the ever-growing demand for therapeutic endoscopy. The increasing diversity and complexity of emerging endoscopic techniques accompanied by the shift in focus toward competency-based medical education requires innovative changes to the curriculum that will ensure adequate training yet without compromising best patient practices.A primer on artificial intelligence and its application to endoscopy
Artificial intelligence (AI) has emerged as a powerful and exciting new technology poised to impact many aspects of health care. In endoscopy, AI is now being used to detect and characterize benign and malignant GI lesions and assess malignant lesion depth of invasion. It will undoubtedly also find use in capsule endoscopy and inflammatory bowel disease. Herein, we provide the general endoscopist with a brief overview of AI and its emerging uses in our field. We also touch on the challenges of incorporating AI into clinical practice, such as workflow integration, data storage, and data privacy.Low-residual diet versus clear-liquid diet for bowel preparation before colonoscopy: meta-analysis and trial sequential analysis of randomized controlled trials
The aim of this study was to compare a low-residual diet (LRD) with a clear-liquid diet (CLD) for bowel preparation before colonoscopy.EUS-guided through-the-needle biopsy sampling of pancreatic cystic lesions: a pathologist’s guide for the endoscopist
Pancreatic cystic lesions (PCLs) are often an incidental finding related to the increased use of cross-sectional imaging,1 and risk stratification and management are a challenge for the multidisciplinary team. EUS examination with FNA of cyst fluid for cytology serves as a cornerstone in the evaluation of PCLs with worrisome features.2 However, microscopic evaluation of cytology samples is a challenge for the pathologist, and the reported sensitivity for the differentiation between mucinous and nonmucinous cysts is as low as 54%.Associations between endoscopist feedback and improvements in colonoscopy quality indicators: a systematic review and meta-analysis
Colonoscopy quality indicators such as adenoma detection rate (ADR) are surrogates for the effectiveness of screening-related colonoscopy. It is unclear whether endoscopist feedback on these indicators improves performance. We performed a meta-analysis to determine whether associations exist between endoscopist feedback and colonoscopy performance.
