GI Signals - Endoscopy

Hemostatic Efficacy and Safety of the Hybrid Injector ClearCoajet in Endoscopic Mucosal Resection of Large Colorectal Polyps: A Multicenter Randomized Trial.

Mon, 24 Aug 2026 19:12:09 +0000

Digestive diseases and sciences. For hemostasis of intraprocedural bleeding during large polyp EMR, snare-tip hemostasis remains the standard approach; ClearCoajet offers a potential alternative if available, but this underpowered trial does not demonstrate clear superiority. No change in current hemostasis practice is required based on this evidence.

Influence of artificial intelligence on the performance of endosonographers in detection of solid pancreatic tumors: a tandem randomized video study.

Mon, 24 Aug 2026 19:12:09 +0000

Endoscopy. No direct bedside action yet: this video-based performance study does not establish real-world EUS workflow, patient-level diagnostic confirmation, or clinical consequences of improved detection. Clinical translation requires evaluation in live EUS procedures to assess specificity, false-positive impact, and whether improved accuracy changes patient management.

Antibiotic Prophylaxis for Peroral Cholangioscopy: A Systematic Review and Meta-analysis.

Mon, 24 Aug 2026 19:12:09 +0000

Gastrointestinal endoscopy. The evidence is too weak to change current practice in either direction. The confidence interval is wide and crosses near-equivalence, sensitivity analyses were unstable, and the authors explicitly call for prospective studies before recommendations shift. Whether you currently use prophylaxis or not, this evidence does not argue for a change. Individualize based on local practice patterns until stronger evidence emerges.

Standardized Assessment of Complete Colorectal Polyp Resection for Polyps <20 mm (SCOPE): a Delphi Consensus.

Mon, 24 Aug 2026 19:12:09 +0000

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. Adopt standardized resection assessment protocols in your practice: use HD white-light inspection as the primary assessment method (supplement with image-enhanced inspection for 10-19 mm polyps), document post-resection photographs for 10-19 mm polyps, ensure histopathological margin assessment for all non-fragmented and en bloc resections, and monitor your personal incomplete resection rate (IRR) for 10-19 mm polyps as a quality assurance metric.

Self-Directed Mikoto Simulator Training for Colonoscopy in Gastroenterology Trainees: An International Multicenter Randomized Trial.

Mon, 24 Aug 2026 19:12:09 +0000

Journal of gastroenterology and hepatology. Simulator training shows promise as a feasible adjunct to standard colonoscopy training. Although the trial was small (n=12 total) and did not achieve statistical significance for the between-group comparison, the simulator group demonstrated significant within-group improvement in cecal intubation rate from 60.0% to 80.0% (p=0.003) and reduction in procedure time. These findings support using simulation as an educational adjunct in training programs, though larger trials are needed to confirm the magnitude of benefit.

Clinical and endoscopic features of checkpoint inhibitor-induced colitis and their association with selective immunosuppressive therapy use.

Mon, 24 Aug 2026 19:12:09 +0000

Inflammatory bowel diseases. In ICI colitis, escalation to immunosuppressive therapy is primarily determined by ICI type and clinical progression, not mucosal endoscopic appearance. Do not use IMCES (AUC 0.57) or endoscopic features (erythema, exudate) to predict escalation. Monitor for clinical worsening-progressive diarrhea especially bloody, fever, severe abdominal pain, or laboratory decline (rising CRP, falling albumin)-as signals for escalation need. ICI type carries dominant risk; ipilimumab and aCTLA-4-based therapies warrant particular vigilance. Base escalation decisions on symptom trajectory and known ICI immunobiology, not endoscopic severity scoring.

Forward- vs. Oblique-Viewing Endoscope for Duodenal Papillectomy: A Comparative Study on Efficacy and Safety.

Mon, 24 Aug 2026 19:12:09 +0000

Digestive diseases and sciences. For adenoma papillectomy, oblique-viewing endoscopy achieved higher en bloc resection rates (80% vs. 61.5%) at the cost of longer procedure time (39 vs. 21 min). However, follow-up outcomes did not differ between approaches; the clinical benefit of higher en bloc rates remains unproven. Technique (particularly avoiding submucosal injection when feasible) may influence outcomes as much as endoscope choice.

AI-assisted second forward-view examination of the right colon significantly improves the adenoma detection rate: a multicenter randomized controlled trial.

Mon, 24 Aug 2026 19:12:09 +0000

The American journal of gastroenterology. Implement AI-assisted second forward-view examination of the right colon during colonoscopy to improve adenoma detection, particularly for small, flat, and hard-to-reach lesions. This combined strategy was effective across all levels of endoscopist experience.

Colonoscopy complications and associated costs and mortality in a Swedish colorectal cancer screening program.

Thu, 20 Aug 2026 18:40:03 +0000

Endoscopy. Continue recommending colonoscopy as the preferred screening modality, as real-world data confirm complications occur in <1% of screening procedures with no increase in mortality and minimal program costs.

Pragmatic real-world evaluation of computer-aided detection in colonoscopy: A within-endoscopist comparative study.

Thu, 20 Aug 2026 18:40:03 +0000

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. Consider adopting computer-aided detection systems in routine colonoscopy as an adjunctive tool. CADe remains independently associated with improved adenoma detection (aOR 1.31, 95% CI 1.11-1.55, p=0.002) after adjustment for endoscopist variation, confirming incremental benefit beyond endoscopy technique alone.

Review Article: Immune Effector Cell-Mediated Enterocolitis Following CAR-T Cell Therapy-Clinical Features, Pathophysiology and Management.

Thu, 20 Aug 2026 18:40:03 +0000

Alimentary pharmacology & therapeutics. If a patient presents with gastrointestinal symptoms after CAR-T therapy, suspect immune effector cell-mediated enterocolitis. Pursue early diagnosis via endoscopy and biopsy. Implement multidisciplinary care with supportive measures, infection assessment, and step-up pharmacotherapy using inflammatory bowel disease agents (biologics and small molecules). Early recognition and multidisciplinary treatment may improve patient outcomes.

Transformer-Based Deep Learning Framework for Automated Lesion Detection in Capsule Endoscopy: A Comparative Study With CNN Architectures.

Thu, 20 Aug 2026 18:40:03 +0000

Journal of clinical gastroenterology. No clinical action yet: this is algorithm benchmarking on public datasets with acknowledged frame-level data leakage. Clinical implementation requires external validation on patient-stratified data, demonstration of improved detection in clinical workflows, and assessment of patient-level outcomes.

An artificial intelligence-based endoscopic ultrasonography risk assessment and stratification for gastric stromal tumors.

Thu, 20 Aug 2026 18:40:03 +0000

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. No clinical action yet: this model is tested on retrospective EUS images without prospective validation or head-to-head comparison to current GIST risk stratification (Miettinen criteria from pathology). Implementation would require prospective clinical validation demonstrating improved prediction of clinically relevant outcomes.

Upper Versus Lower Gastrointestinal Bleeding in Percutaneous Coronary Intervention Hospitalizations: A National Analysis, 2016-2022.

Thu, 20 Aug 2026 18:40:03 +0000

Digestive diseases and sciences. Upper GI bleeding occurred in 83% of GI complications during PCI hospitalizations with 12.4% in-hospital mortality versus 6.1% for lower GI bleeding (adjusted odds ratio 1.74, 95% CI 1.36-2.23), while UGIB incidence rose from 0.90% to 1.13% over 2016-2022.

Oropharyngeal airway integrated with capnography and oxygenation for sedated gastrointestinal endoscopy in obese patients: a randomised trial.

Thu, 20 Aug 2026 18:40:03 +0000

Endoscopy. Use the COMBO device during sedated endoscopy in obese patients (BMI ≥28) to substantially reduce hypoxia risk compared to standard nasal cannula. The device maintains airway patency and enables continuous capnography monitoring, providing an effective strategy for high-risk patients.

Management Strategies and Outcomes for Type 1 Gastric Neuroendocrine Tumors Measuring More Than 1 cm.

Thu, 20 Aug 2026 18:40:03 +0000

Clinical and translational gastroenterology. For T1g-NETs >1cm, prefer ESD or modified EMR when feasible to achieve better progression-free survival; recognize lesions ≥24mm as at higher risk for recurrence, potentially warranting surgical consideration if endoscopic resection not feasible.

Colonoscopy complications and associated costs and mortality in a Swedish colorectal cancer screening program.

Thu, 20 Aug 2026 21:35:47 +0000

Sarcopenia as a prognostic marker in inflammatory bowel disease: Implications for endoscopic outcomes and loss of response to biologic therapy-A systematic review with narrative synthesis.

Thu, 20 Aug 2026 21:35:47 +0000

Inflammatory bowel diseases. Do not implement routine sarcopenia assessment for IBD risk stratification or treatment decisions. The evidence is observational and heterogeneous with inconsistent findings; sarcopenia may reflect disease severity, malnutrition, or inflammatory burden rather than independently predict outcomes.

Use of Artificial Intelligence for Duodenal Biopsy for Celiac Disease: Developing a Prediction Model for Histopathology Diagnosis.

Thu, 20 Aug 2026 21:35:47 +0000

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. No direct clinical action yet. This is a retrospective proof-of-concept study demonstrating an AI model can classify archived biopsies, but prospective validation in real clinical practice and comparison to standard pathologist review would be required before clinical deployment. The next step is validating the tool on prospectively collected biopsies.

Diagnostic and Clinical Performance of Single-Use Versus Reusable Gastrointestinal Endoscopes: A Systematic Review and Meta-Analyses.

Thu, 20 Aug 2026 21:35:47 +0000

Journal of gastroenterology and hepatology. Maintain current practice with reusable endoscopes and rigorous reprocessing protocols. Single-use devices offer no diagnostic or technical advantage, and documented infection risk from reusable endoscopes is low. For ERCP specifically, single-use duodenoscopes (EXALT Model D) required conversion to reusable in 7% of procedures, limiting their utility as a standalone option.

Advanced cannulation techniques vs early EUS-BD in case of difficult biliary cannulation in patients with DMBO: an international propensity score-matched analysis.

Thu, 20 Aug 2026 21:35:47 +0000

The American journal of gastroenterology. When standard biliary cannulation fails at ERCP in a patient with malignant obstruction and dilated common bile duct (>12 mm), consider early EUS-guided drainage as the preferred alternative to advanced cannulation techniques if EUS expertise is available. The lower adverse event rate (particularly post-procedural pancreatitis at 12% with advanced ERCP) and higher technical success with EUS-BD support its use as a safer, more technically effective option for failed biliary access.

Confounding by Indication in Real-World Indomethacin Use for Post-ERCP Pancreatitis: Implications for Severity and Cost.

Thu, 20 Aug 2026 21:35:47 +0000

Digestive diseases and sciences. This observational study cannot reliably determine indomethacin's protective effect due to confounding by indication (drug use associated with procedural difficulty rather than independent risk reduction). While severe pancreatitis occurred only in the non-indomethacin group (underpowered), confounding precludes attributing this to the drug. RCT-based guidelines recommending indomethacin should continue to direct practice.

Endoscopic Management of Cystic Duct Remnant Stones Causing Post-Cholecystectomy Syndrome: A Multi-Center Experience.

Thu, 20 Aug 2026 21:35:47 +0000

Gastrointestinal endoscopy. For symptomatic cystic duct remnant stones causing post-cholecystectomy syndrome, ERCP is a less-invasive alternative to surgical excision. Anticipate escalation to cholangioscopy in approximately 43% of cases, with EHL required in most cholangioscopy cases (89%). Counsel patients on a 10% risk of mild post-ERCP pancreatitis.

Clinical impact of disposable elevator-cap duodenoscopes on post-ERCP cholangitis: a prospective cohort study.

Thu, 20 Aug 2026 21:35:47 +0000

Gastrointestinal endoscopy. DEC duodenoscopes do not reduce post-ERCP cholangitis in routine practice. Although surveillance cultures showed superior sterilization, this study does not support institutional adoption of DEC equipment specifically to prevent post-ERCP cholangitis.

Long-term risk of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric cancer.

Thu, 20 Aug 2026 21:35:47 +0000

Endoscopy. Extend endoscopic surveillance beyond 5 years after curative ESD for early gastric cancer, particularly in patients with family history of gastric cancer or extensive intestinal metaplasia. All detected metachronous neoplasms were early-stage (stage I) with no gastric cancer-related deaths.

EUS-guided biopsy using 19-gauge Franseen needle versus percutaneous ultrasound-guided biopsy using 18-gauge full-core cutting needle for parenchymal liver disease: A randomized controlled, non-inferiority trial.

Thu, 20 Aug 2026 21:35:47 +0000

Gastrointestinal endoscopy. EUS-guided liver biopsy with 19-gauge Franseen needle achieved specimen adequacy (length ≥15 mm and ≥8 complete portal tracts) in 97.8% versus 64.4% with percutaneous 18-gauge biopsy; median specimen lengths were 6.9 cm versus 2.0 cm and median complete portal tracts 42 versus 9.

Cost-effectiveness and environmental impact of artificial intelligence-assisted colonoscopy with the resect-and-discard strategy: a microsimulation study.

Thu, 20 Aug 2026 21:35:47 +0000

Endoscopy. This is a modeling study comparing strategy costs and outcomes, not a clinical trial of patient outcomes. It suggests that computer-aided detection improved adenoma detection without improving health outcomes compared to non-AI resect-and-discard; adding diagnostic AI (CADx) increased costs without clinical benefit. The findings suggest improved adenoma detection alone may not justify added costs and environmental impact if baseline health outcomes remain unchanged. However, these are model-based conclusions dependent on input assumptions about adenoma progression, detection accuracy, and mortality rates. Real-world adoption decisions about AI tools should consider actual performance, costs, and environmental impact in your setting. Individual gastroenterologists should not change current resect-and-discard practice based on this model.

Endoscopic submucosal dissection versus transanal endoscopic surgery in rectal neoplasms: Meta-analysis of randomized controlled trials and trial sequential analysis.

Thu, 20 Aug 2026 21:35:47 +0000

Endoscopy. Both ESD and TES remain acceptable organ-preserving options for selected rectal neoplasms with no significant differences in resection and oncologic outcomes; however, certainty of evidence is very low for these outcomes. TES was faster by 21.93 minutes. Safety outcomes were also not significantly different but remain inconclusive (trial sequential analysis). Choose technique based on lesion characteristics, local expertise, and existing proficiency rather than evidence of superiority from this comparison.

Pragmatic real-world evaluation of computer-aided detection in colonoscopy: A within-endoscopist comparative study.

Thu, 20 Aug 2026 21:35:47 +0000

Review Article: Immune Effector Cell-Mediated Enterocolitis Following CAR-T Cell Therapy-Clinical Features, Pathophysiology and Management.

Thu, 20 Aug 2026 21:35:47 +0000

An artificial intelligence-based endoscopic ultrasonography risk assessment and stratification for gastric stromal tumors.

Thu, 20 Aug 2026 21:35:47 +0000

Upper Versus Lower Gastrointestinal Bleeding in Percutaneous Coronary Intervention Hospitalizations: A National Analysis, 2016-2022.

Thu, 20 Aug 2026 21:35:47 +0000

Intrapancreatic Fat Deposition and Risk of Post-ERCP Pancreatitis: A Systematic Review and Meta-Analysis.

Thu, 06 Aug 2026 18:00:11 +0000

Pancreas. consider intrapancreatic fat deposition when assessing post-ERCP pancreatitis risk and severity.

Optimal Management of Conventional Adenomas in 2026: Current and Evolving Recommendations and Ongoing Controversies.

Thu, 06 Aug 2026 18:00:11 +0000

Journal of clinical gastroenterology. No clinical action yet: a guideline review synthesizing existing recommendations and controversies without new human evidence.

Rectal Nonsteroidal Anti-Inflammatory Drugs, Aggressive Hydration With Lactated Ringer's Solution, Somatostatin or Combinations for Prophylaxis Post-ERCP Acute Pancreatitis: A Network Meta-Analysis.

Thu, 06 Aug 2026 18:00:11 +0000

Pancreas. Consider combining rectal indomethacin and somatostatin for high-risk ERCP patients to prevent pancreatitis and hyperamylasemia, given its superior efficacy and safety profile compared to placebo, but note that direct RCT evidence is limited.

World Endoscopy Organization Position Statements for the Role of Endoscopy on the Diagnosis and Treatment of Superficial Non-Ampullary Duodenal Epithelial Tumors.

Thu, 06 Aug 2026 18:00:11 +0000

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. Consider endoscopic resection for SNADETs in elective cases with routine complete wound closure to mitigate complications; prioritize high-definition endoscopy and image-enhanced endoscopy (IEE) for diagnosis and characterization. Defer ER in high thromboembolic risk patients.

Endoscopic Papillectomy for Ampullary Tumors in Older Patients: Balancing Oncologic Benefit and Geriatric Risk.

Thu, 06 Aug 2026 18:00:11 +0000

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. Consider integrated assessment of oncologic and geriatric factors (comorbidity burden, life expectancy) rather than chronological age alone when selecting older patients (≥75 years) for EP or surveillance of ampullary tumors. Use standardized geriatric assessment tools (specific tools not detailed in abstract) to aid decision-making.

Improving follow-up of abnormal stool test results used for colorectal cancer screening.

Thu, 06 Aug 2026 18:00:11 +0000

Gastrointestinal endoscopy. Implement coordinated strategies such as patient navigation, digital tools, and open access colonoscopy to improve follow-up colonoscopy rates after abnormal stool tests.

Spiral basket geometry improves procedural efficiency and reduces device escalation in small bile duct stones: a multicenter randomized controlled trial (ESCAPE trial).

Thu, 06 Aug 2026 18:00:11 +0000

Endoscopy. Consider spiral-configured baskets for first-line ERCP extraction of small (≤8 mm) bile duct stones where available (currently primarily in Japan), given higher efficiency and lower cost without added risk.

A multimodal artificial intelligence method for accurate diagnosis of autoimmune gastritis.

Thu, 06 Aug 2026 18:00:11 +0000

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. No clinical action yet: a diagnostic AI tool not yet validated in real-world practice.

Management of Gastric Leaks After Bariatric Surgery: Proposed Endoscopic Treatment Algorithm Based on 10-Year Experience.

Thu, 06 Aug 2026 18:00:11 +0000

Digestive diseases and sciences. Consider an algorithmic approach to endoscopic treatment of post-bariatric leaks, selecting modalities based on clinical condition, timing, and fistula characteristics. Be aware of procedure-related complications (19.7%) and prioritize early intervention for leaks without self-limited cavities, as these were associated with failure (p=0.009).

Endoscopic Ultrasonography for Diagnosing Common Bile Duct Stones With Negative Initial Imaging: A Multicenter Prospective Exploratory Study.

Thu, 06 Aug 2026 18:00:11 +0000

Journal of hepato-biliary-pancreatic sciences. Consider EUS to confirm or exclude CBDS in high-likelihood patients (per ASGE criteria) with negative initial imaging before proceeding to ERCP.

Suspected Small Bowel Bleeding: A Single-Center Retrospective Study on Long-Term Prognosis and Predictive Factors.

Thu, 06 Aug 2026 18:00:11 +0000

Journal of clinical gastroenterology. Monitor hemoglobin closely in SSBB patients with levels <8.0 g/dL and consider targeted interventions for anemia management, given its association with mortality.

Cold snare polypectomy for 5-9mm small-bowel polyps in patients with Peutz-Jeghers syndrome by double-balloon enteroscopy: a prospective clinical trial.

Thu, 06 Aug 2026 18:00:11 +0000

The American journal of gastroenterology. Consider CSP for 5-9mm stubby/wide pedicle or sessile small-bowel polyps in PJS patients aged 8-60 years during double-balloon enteroscopy, as it is feasible and safe with low bleeding risk, though larger polyps (8mm) carry higher bleeding risk.

AGA Clinical Practice Update on Surveillance of Metaplastic and Premalignant Conditions of the Esophagus and Colorectum in Older Adults: Expert Review.

Thu, 06 Aug 2026 18:00:11 +0000

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. Use comorbidity assessment and life expectancy tools to guide decisions on endoscopic surveillance in older adults ≥65, particularly for Barrett's esophagus and colorectal cancer, balancing potential benefits and harms.

Artificial Intelligence Automated Assessment of Colonoscopy Quality Metrics.

Thu, 06 Aug 2026 18:00:11 +0000

The American journal of gastroenterology. No clinical action yet: a validation study showing AI can measure colonoscopy quality metrics from videos, but not yet proven to improve outcomes.

Clinical Efficacy of Endoscopic Ultrasound-Guided Gastroenterostomy, Enteral Stenting, and Surgical Gastrojejunostomy for Malignant Gastric Outlet Obstruction: A Network Meta-Analysis.

Thu, 06 Aug 2026 18:00:11 +0000

Gastrointestinal endoscopy. Consider EUS-GE as a preferred intervention for malignant gastric outlet obstruction in expert centers, given its lower re-intervention rates, higher clinical success, and shorter hospitalization compared to enteral stenting and surgical gastrojejunostomy, pending further studies in non-expert settings.

Effect of a single dose antibiotic prophylaxis in scheduled bile duct interventions in Primary Sclerosing Cholangitis.

Thu, 06 Aug 2026 18:00:11 +0000

Gastrointestinal endoscopy. Consider single-dose antibiotic prophylaxis for scheduled ERCP in PSC patients as a potential alternative to multi-day regimens, balancing reduced antibiotic exposure against the risk of increased cholangitis severity.

Modified endoscopic mucosal resection versus endoscopic submucosal dissection for rectal neuroendocrine tumors ≤10 mm: a systematic review and meta-analysis of randomized controlled trials.

Thu, 06 Aug 2026 18:00:11 +0000

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. Consider m-EMR as a reasonable first-line option for rectal NETs ≤10 mm, given comparable histologic efficacy to ESD, shorter procedure time, and lower cost, but confirm alignment with ENETS guidance.

Thirty-day Mortality Among Jehovah's Witness Patients with Gastrointestinal Bleeding Who Decline Blood Transfusion: A Retrospective Cohort Study.

Thu, 06 Aug 2026 18:00:11 +0000

The American journal of gastroenterology. Consider bloodless management strategies (e.g., anemia-directed therapy, bloodless medicine consultation) for JW patients with GIB, as outcomes were similar despite lower discharge hemoglobin levels (median nadir 6.6 g/dL in both groups). No change in transfusion thresholds is supported by this study.

Neoplastic recurrence after colorectal endoscopic submucosal dissection at scheduled endoscopic surveillance: a systematic review and meta-analysis.