Endoscopy

Introduction Endoscopic band ligation (EBL) remains the standard of care for managing oesophagal varices, both in acute variceal bleeding and for prophylaxis. However, post-banding ulcer bleeding (PBUB) is an important and often under-recognised complication, associated with significant morbidity and mortality. Identifying patients at higher risk for PBUB is clinically relevant, particularly in acute settings where outcomes are already compromised. Problem Statement Despite increasing recognition of PBUB, risk stratification remains inconsistent in clinical practice. Recent data have suggested that urgent EBL and renal dysfunction may increase PBUB risk, but real-world validation across larger cohorts is limited, and standardised definitions are lacking. Summary In this large real-world analysis of 920 EBL procedures, PBUB occurred in 3.4% overall, with a significantly higher incidence following urgent EBL compared to elective procedures (7.5% vs 1.4%). Urgent EBL emerged as a strong independent predictor of PBUB, reinforcing the vulnerability of patients undergoing intervention during acute bleeding episodes. Additionally, renal dysfunction was identified as a key risk factor, with patients having serum creatinine ≥1.5 mg/dL demonstrating markedly higher bleeding rates and an independent risk. These findings are consistent with prior literature and highlight a simple, clinically applicable framework combining urgency of EBL and renal function to identify high-risk patients. This approach may help guide closer monitoring and preventive strategies in routine practice.

This article reviews the endoscopic approach to palliation in pancreatic cancer, emphasising that most patients present with unresectable or metastatic disease, so symptom control becomes central to care. Because of the pancreas’ location, tumour growth commonly leads to biliary obstruction, gastric outlet obstruction (GOO), and pain from neural invasion. A major focus is the management of malignant biliary obstruction, which occurs in a large proportion of patients and can cause jaundice, pruritus, nausea, malabsorption, cholangitis, and delay in chemotherapy. The article highlights that biliary decompression is now commonly achieved using endoscopic or percutaneous techniques rather than surgery. The main drainage strategies: ERCP with placement of a plastic stent or self-expandable metal stent (SEMS) directly across the obstructed common bile duct. EUS-guided rendezvous technique, where a guidewire is passed into the bile duct and through the papilla to facilitate ERCP. EUS-guided biliary drainage (EUS-BD), which creates a new tract for bile drainage above the obstruction. EUS-HGS (hepaticogastrostomy), where a biliary SEMS drains the left intrahepatic duct into the stomach. EUS-CDS (choledochoduodenostomy), where a biliary SEMS or lumen-apposing metal stent drains the common bile duct into the duodenum. EUS-GBD (gallbladder drainage), where a lumen-apposing metal stent drains the gallbladder into the stomach or duodenum. Percutaneous transhepatic biliary drainage (PTBD) as an external/internal catheter-based option. The article also notes increasing use of preemptive biliary drainage when EUS-guided tissue diagnosis shows impending obstruction. Overall, the message is that endoscopic palliation has largely replaced surgical palliation, offering effective, less invasive relief of major pancreatic cancer complications.

Introduction Gastroparesis is a chronic disorder characterised by delayed gastric emptying without mechanical obstruction, leading to symptoms such as nausea, vomiting, early satiety, bloating, and postprandial fullness. Treatment options for severe and refractory gastroparesis are limited and often ineffective. Gastric per-oral endoscopic pyloromyotomy (G-POEM) is a minimally invasive endoscopic technique that divides pyloric muscle fibres to improve gastric emptying. Although observational studies have shown promising results, high-quality randomised evidence has been limited. Summary This randomised sham-controlled pilot trial evaluated the efficacy of G-POEM in severe gastroparesis. A total of 41 patients with refractory gastroparesis (diabetic, postsurgical, or idiopathic) were randomised to G-POEM (n=21) or sham procedure (n=20). The primary endpoint was treatment success, defined as a ≥50% reduction in the Gastroparesis Cardinal Symptom Index (GCSI) at 6 months. Key findings: Treatment success: 71% with G-POEM vs 22% with sham (p = 0.005) By aetiology: Diabetic gastroparesis: 89% response Postsurgical gastroparesis: 50% response Idiopathic gastroparesis: 67% response Gastric emptying: Median 4-hour gastric retention improved from 22% to 12% after G-POEM, No significant change after sham. Crossover results: Among 12 sham patients crossing over to G-POEM, 75% achieved symptom improvement. Clinical Takeaway This sham-controlled randomised trial demonstrates that G-POEM significantly improves symptoms and gastric emptying in severe refractory gastroparesis, particularly in diabetic cases. However, results remain less conclusive in idiopathic and postsurgical gastroparesis, and larger trials are required to confirm long-term benefits.

Introduction After CT-confirmed diverticulitis, follow-up colonoscopy is routinely performed to exclude malignancy. Colon capsule endoscopy (CCE) offers a non-invasive alternative, but its impact on patient experience remains unclear. Summary In this randomized controlled trial of 159 patients, CCE was compared with colonoscopy 4–6 weeks after diverticulitis. Patients expected colonoscopy to cause greater discomfort; however, experienced physical and mental discomfort did not differ significantly between groups. Examination completion was slightly higher with colonoscopy (92%) than CCE (84%). No malignancies were detected. Nearly half of patients preferred CCE for future evaluation. The study shows that CCE is safe and patient-preferred, though colonoscopy remains diagnostically more complete.