Trending Topics in Gastroenterology | GastroAGI

Digital Family History Assessment Improves CRC Risk Stratification in Endoscopy | Endoscopy

Introduction Family history remains a critical but underused tool in colorectal cancer (CRC) risk assessment. Despite its importance in identifying individuals at increased hereditary risk, family history is often incompletely captured in routine endoscopy practice, leading to missed opportunities for genetic referral, inappropriate surveillance and inefficient colonoscopy use. Problem Statement Conventional family history assessment in endoscopy services is inconsistent, time-intensive and frequently insufficient for accurate CRC risk stratification. This creates two major clinical problems: overuse of colonoscopic surveillance in low-risk individuals and under-recognition of patients who may warrant enhanced surveillance or genetic evaluation. A practical, scalable approach is needed to integrate standardized hereditary risk assessment into routine endoscopy workflows. Summary This service improvement project demonstrates that integrating a digital family history questionnaire with a dedicated endoscopy genetic counsellor can substantially improve CRC risk stratification and surveillance efficiency within a modern endoscopy unit. In patients already undergoing family history–based surveillance, standardized reassessment led to clinically meaningful changes in surveillance recommendations for most patients, predominantly by downgrading unnecessary colonoscopy intensity, resulting in major reductions in avoidable procedures and substantial cost savings. In symptomatic patients, the same digital pathway identified previously unrecognized familial CRC risk, including individuals warranting moderate- or high-risk surveillance and potential genetic evaluation. These findings show that embedding structured family history assessment into routine endoscopy is both feasible and clinically impactful, improving risk stratification while optimizing resource utilization. The model is particularly valuable because it simultaneously reduces over-surveillance in low-risk patients and improves detection of individuals with clinically relevant inherited CRC risk. This scalable approach offers a practical framework for integrating precision prevention and genetic triage into everyday endoscopy practice.

Single-Dose NSAIDs in ERCP: Gastroenterology | May 2026

Introduction Post-ERCP pancreatitis (PEP) remains one of the most common and serious complications of Endoscopic Retrograde Cholangiopancreatography. Rectal NSAIDs such as Indomethacin and Diclofenac are strongly recommended for PEP prevention. However, concerns about renal safety—especially in elderly patients and those with chronic kidney disease—have limited their widespread use in clinical practice. This large multicenter prospective study evaluates whether a single peri-procedural dose of NSAIDs truly increases the risk of kidney injury, addressing an important clinical hesitation. Problem Statement Despite strong evidence supporting NSAIDs in reducing PEP, many clinicians avoid their use due to fear of acute kidney injury (AKI) or acute kidney disease (AKD). Current guidelines often recommend caution or avoidance in patients perceived to be at higher renal risk. This creates a clinical dilemma: 👉 Should we compromise effective PEP prevention due to theoretical renal risks, or is this concern overstated? Summary In a large cohort of over 11,000 patients undergoing ERCP, approximately half received a single dose of rectal NSAIDs. The study found: No significant association between NSAID use and AKI or AKD Low absolute rates of kidney injury (0.5%–0.8%), even in high-risk groups Consistent findings across: Elderly patients Patients with pre-existing chronic kidney disease Propensity-matched analysis Importantly, NSAIDs were also not associated with increased bleeding or other major adverse events. These findings suggest that single-dose NSAIDs are safe from a renal standpoint in the ERCP setting, challenging the routine avoidance of these drugs.

OTSC vs Band Ligation in Diverticular Bleeding: GIE | April 2026

Introduction Colonic diverticular bleeding is an increasingly common cause of lower gastrointestinal bleeding, particularly with aging populations. Although many cases resolve spontaneously, recurrent or severe bleeding often requires endoscopic intervention. Techniques such as endoscopic band ligation and over-the-scope clip have emerged as effective hemostatic options. While EBL is widely used and known for reducing rebleeding, OTSC is a newer modality with strong mechanical closure capabilities. However, direct comparative data between these techniques remain limited. Problem Statement There is insufficient evidence to determine whether OTSC or EBL provides superior outcomes in preventing rebleeding in colonic diverticular bleeding. Summary This propensity score–matched cohort study provides important comparative insights between OTSC and EBL in the management of CDB. Both techniques demonstrated similar effectiveness in achieving initial hemostasis, with no significant differences in need for transfusion, additional interventions, or adverse events. However, OTSC showed a clear advantage in reducing early (30-day) rebleeding rates and was associated with a shorter hospital stay. This suggests that while both methods are equally effective for immediate bleeding control, OTSC may offer more durable hemostasis. Clinically, these findings support considering OTSC as a preferred option in patients at high risk of rebleeding, particularly where long-term hemostatic durability is critical. Nevertheless, factors such as availability, expertise, and cost may influence real-world decision-making.

GLP-1 Therapy vs Bariatric Endoscopy: Obesity Surgery | April 2026

Introduction The management of obesity and type 2 diabetes has rapidly evolved, with GLP-1 receptor agonists emerging as highly effective pharmacological options, while bariatric endoscopic therapies provide minimally invasive procedural alternatives. Traditionally, metabolic bariatric surgery has been the gold standard, but newer less invasive options are reshaping treatment paradigms. Direct comparative evidence between GLP-1 therapies and endoscopic bariatric techniques remains limited, making clinical decision-making challenging. Problem Statement It is unclear whether GLP-1 receptor agonists or bariatric endoscopic therapies provide superior outcomes in weight loss and metabolic control in patients with obesity and type 2 diabetes. Summary This meta-analysis including eight studies with over 600 patients demonstrates that, in the short term (4–12 months), there is no significant difference between GLP-1–based therapies and bariatric endoscopic interventions in key outcomes such as weight loss, BMI reduction, glycemic control, or diabetes remission. These findings suggest that both approaches may offer comparable efficacy in early treatment phases. However, important distinctions exist in safety profiles. GLP-1 therapies are associated predominantly with gastrointestinal side effects, whereas endoscopic bariatric therapies carry risks related to device intolerance and procedural complications. A key limitation of the evidence is the high heterogeneity and predominance of retrospective data, along with short follow-up duration, which prevents firm conclusions regarding long-term durability and comparative effectiveness. Clinically, this study supports a personalized approach—where treatment selection should be guided by patient preference, comorbidities, risk tolerance, and resource availability—while emphasizing the need for robust long-term randomized trials to define optimal strategies.

Should We Continue Colonoscopy surveillance After 75?: JAMA | April 2026

Introduction Colorectal cancer (CRC) screening and surveillance have significantly reduced cancer-related mortality. However, in adults aged ≥75 years, clinical decision-making becomes complex. While cancer risk increases with age, competing risks—particularly non-cancer mortality and frailty—also rise substantially. Current guidelines provide limited clarity on when to stop surveillance colonoscopy, especially in patients with prior adenomas, where the perceived cancer risk often drives continued procedures despite uncertain benefit. Problem Statement In older adults ≥75 years, it is unclear whether the risk of colorectal cancer justifies continued surveillance colonoscopy, particularly when competing risks of mortality are high. Summary This large Veterans Affairs cohort study of over 90,000 older adults provides important clarity. Over a 10-year follow-up, the risk of CRC remained low—even in those with prior adenomas (1.1% incidence, 0.5% CRC mortality)—and only marginally higher than those without adenomas. In stark contrast, non-CRC mortality approached nearly 50%, far exceeding cancer-related risks across all frailty levels. Even among high-risk groups (prior adenoma, increasing frailty), the likelihood of dying from non-cancer causes was substantially higher than developing or dying from CRC. These findings highlight that the benefit of continued surveillance colonoscopy diminishes significantly with age and comorbidity burden. Clinically, this study supports a paradigm shift—from routine surveillance to individualized decision-making. In many older adults, especially those with frailty, it may be more appropriate to deprioritize colonoscopy and focus on overall health, quality of life, and management of comorbid conditions.

BSG Interim Position on LAMS Use After AXIOS Recall: FG | April 2026

Introduction Lumen-apposing metal stents (LAMS) have become central to therapeutic endoscopic ultrasound (T-EUS), especially for pancreatic fluid collection drainage, EUS-guided gallbladder drainage, choledochoduodenostomy, gastrojejunostomy, and EDGE procedures. In December 2025, the urgent recall of selected Hot AXIOS stents created an immediate gap in the delivery of several urgent and complex interventions. Because AXIOS has been widely used in the UK, this recall has major practical implications for endoscopists, referral networks, and patient safety. Problem Statement The recall of commonly used AXIOS stent sizes has disrupted routine T-EUS practice, creating uncertainty about which alternative devices, rescue techniques, and governance pathways should be used to maintain safe and effective care. Summary This British Society of Gastroenterology interim technical review provides pragmatic guidance for clinicians navigating the post-recall period. The key message is that T-EUS can continue safely, but endoscopists must adapt device choice and technique according to the indication. For pancreatic fluid collections and EUS-guided gallbladder drainage, unaffected AXIOS sizes and alternative LAMS such as HOT SPAXUS and Z-EUS remain reasonable substitutes, while plastic stents or percutaneous drainage may be used when appropriate. The greatest technical challenge is in malignant distal biliary obstruction, because the recalled smaller AXIOS sizes were commonly used for EUS-guided biliary drainage. In these situations, clinicians may need to consider larger LAMS in selected patients, alternative LAMS platforms, tubular metal stents, rendezvous procedures, hepaticogastrostomy, or antegrade stenting depending on anatomy and expertise. For EUS-guided gastrojejunostomy and EDGE, the review advises greater caution, use of staged approaches, and careful case selection. An important contribution of this paper is its emphasis on salvage strategies for maldeployment or failure of expansion, reminding clinicians that recognition must be immediate and that rescue plans should be predefined. Just as important, the document stresses governance: regional collaboration, expert case discussion, careful documentation, and prospective data capture are essential while device availability remains unstable. Overall, this is a highly practical position statement. Its value lies not in introducing a new technique, but in helping clinicians preserve procedural safety, maintain access to urgent T-EUS interventions, and standardize decision-making during a period of device limitation.

AI in Colonoscopy Withdrawal Time Accuracy: Endoscopy | April 2026

Introduction Withdrawal time during colonoscopy is a key quality indicator directly linked to adenoma detection and colorectal cancer prevention. However, accurate measurement in routine practice is often inconsistent, especially during procedures involving interventions. This variability limits standardisation and quality benchmarking, prompting interest in artificial intelligence (AI)-based systems to objectively measure withdrawal time. Problem Statement Despite the importance of withdrawal time, current measurement relies on manual estimation by endoscopists, which is prone to error and inconsistency, particularly when procedures involve therapeutic interventions. There is a lack of prospective validation of AI systems to determine whether they can reliably and accurately standardise this critical quality metric. Summary In this prospective study of 126 patients, AI demonstrated superior accuracy in measuring withdrawal time compared to physicians, with significantly lower error, especially during interventional procedures. In non-interventional cases, AI and physicians performed similarly. Additionally, the AI system generated high-quality procedural image reports with strong endoscopist satisfaction. Overall, this study highlights the potential of AI to improve standardization, enhance quality metrics, and streamline workflow in colonoscopy practice.

GLP-1 Agonists Before Endoscopy (OCULUS Trial): JAMA | April 2026

Introduction Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) agonists have rapidly become integral in the management of type 2 diabetes, obesity, and metabolic diseases due to their effects on glycemic control and weight loss. A key mechanism underlying their efficacy is delayed gastric emptying, which raises concerns in procedural settings such as upper endoscopy, where retained gastric contents may increase the risk of aspiration. Despite widespread adoption of precautionary guidelines recommending withholding these agents before procedures, robust prospective evidence has been lacking. Problem Statement Current clinical practice is largely guided by expert opinion and limited retrospective data, leading to variability in recommendations regarding whether GLP-1/GIP agonists should be withheld before endoscopy. This uncertainty has practical implications, including procedure delays, cancellations, and potential compromise of metabolic control, highlighting the need for high-quality randomized evidence. Summary The OCULUS randomised clinical trial demonstrated that continuing GLP-1/GIP agonists significantly increased clinically relevant residual gastric volume compared to holding one dose before endoscopy (25% vs 3.1%). However, importantly, this did not translate into an increased rate of aspiration-related adverse events. Notably, patients undergoing combined procedures with a prior clear liquid diet showed negligible risk, suggesting a potential mitigating strategy. Overall, the study provides the first high-quality evidence supporting a balanced, individualised approach, where holding medication reduces gastric residue, but continuation may still be safe in selected settings, particularly with appropriate dietary preparation.

NBI and Acetic Acid Chromoendoscopy in Barrett’s Oesophagus: BMJ Open Gastroenterology | March 2026

Introduction Barrett’s oesophagus represents a well-established precursor to oesophageal adenocarcinoma, with progression from intestinal metaplasia to dysplasia and invasive cancer. Given the poor prognosis of advanced disease, early detection through surveillance endoscopy remains critical. Conventional surveillance relies on high-definition white light endoscopy combined with the Seattle protocol of random biopsies, which is labour-intensive and prone to sampling error. Emerging advanced imaging modalities, particularly narrow band imaging (NBI) and acetic acid chromoendoscopy (AAC), aim to enhance dysplasia detection and enable more targeted biopsy strategies. Problem Statement Despite technological advances, current surveillance strategies remain inefficient, with random biopsies risking missed dysplasia and increasing procedural burden. The key challenge is whether advanced imaging techniques can reliably replace or reduce reliance on the Seattle protocol while maintaining diagnostic safety. Summary This systematic review of 44 studies demonstrates that NBI-guided biopsies improve overall dysplasia detection compared with white light endoscopy, while AAC offers higher sensitivity for neoplasia detection and reduces biopsy burden. However, neither technique alone is sufficient to replace the Seattle protocol due to the risk of missed lesions. The findings support a hybrid approach, integrating advanced imaging with systematic biopsies, while emphasising the need for high-quality randomised trials to define cost-effectiveness and optimise surveillance strategies in Barrett’s oesophagus.

Choosing the Right Snare in Gastrointestinal Endoscopy

Introduction Endoscopic resection has evolved rapidly, with increasing emphasis on precision, safety, and complete lesion removal. While advances in techniques such as EMR and ESD have transformed outcomes, one fundamental aspect—snare selection—remains underappreciated. The physical properties of the snare, including wire thickness, stiffness, and shape, play a crucial role in determining cutting efficiency, tissue capture, and procedural success. Problem Statement In daily practice, snare selection is often based on personal preference rather than a structured, lesion-specific approach. This can lead to suboptimal resection, incomplete removal, or increased complications, particularly in challenging lesions such as flat, large, or fibrotic polyps. The lack of a standardised strategy results in variability in outcomes despite the availability of a wide range of devices. Summary A lesion-tailored approach to snare selection can significantly improve outcomes. Thin-wire snares enhance cutting efficiency and are ideal for cold techniques in small lesions, whereas thick-wire snares provide better grip for larger or fibrotic lesions. Soft snares adapt well to mucosa, while stiff snares offer better control in flat or large lesions. Similarly, snare shape influences effective tissue capture in different anatomical scenarios. Matching snare characteristics to lesion type—from diminutive polyps to large laterally spreading tumours—can optimise resection quality and safety. Moving toward a structured, evidence-informed snare selection strategy represents an important step in improving everyday endoscopic practice.