Trending Topics in Gastroenterology | GastroAGI

Endoscopy and Gastric Varices(Endoscopy, Jan-2026)

**Role of Endoscopy in Gastric Varices:** Endoscopy is a critical tool in the diagnosis and management of gastric varices in patients with cirrhosis. Gastric varices are enlarged veins in the stomach that develop due to increased portal venous pressure, often associated with liver cirrhosis. When these varices bleed, they can lead to life-threatening hemorrhage, making endoscopic intervention essential. **Study Insights:** 1. **Treatment Approaches:** In the study, two endoscopic strategies were compared: - **Aggressive Endotherapy:** Obliteration of all visible gastric varices using cyanoacrylate glue, regardless of bleeding status or risk features. - **Conservative Endotherapy:** Treatment limited to varices with stigmata of recent hemorrhage or high-risk features. 2. **Outcomes:** - **Rebleeding Rates:** At one year, rebleeding rates were similar between the aggressive and conservative groups (18.2% vs. 15.0%). - **Mortality:** All-cause mortality was also comparable, with a nonsignificant trend toward lower mortality in the aggressive group. - **Efficiency:** Aggressive therapy achieved faster obliteration of varices and required fewer endoscopic sessions for GOV1 varices. 3. **Adverse Events:** The rates of complications were similar between the two groups, indicating that aggressive therapy did not increase the risk of adverse events. **Conclusion:** Endoscopy, specifically through the use of cyanoacrylate glue injection, is a highly effective method for managing gastric varices. The study suggests that while aggressive therapy may lead to faster variceal obliteration, it does not significantly improve rebleeding or mortality outcomes compared to a conservative approach. This highlights the importance of tailoring endoscopic treatment strategies to individual patient risk factors and clinical scenarios.

Photometric Capsule and Emergency Upper Endoscopy(Endoscopy, Jan-2026)

The **Photometric Capsule Examination (PCE)** is a novel diagnostic tool designed to evaluate suspected nonvariceal upper gastrointestinal hemorrhage (NVUGIH). It is a small, ingestible capsule equipped with sensors and imaging technology that can detect signs of active bleeding or abnormalities in the gastrointestinal (GI) tract. This method is emerging as an alternative to traditional diagnostic approaches, particularly in stratifying patients for emergency or elective endoscopy. ### How Photometric Capsule Works 1. **Ingestion**: The patient swallows the capsule, which travels through the upper GI tract (esophagus, stomach, and duodenum). 2. **Imaging and Detection**: The capsule uses photometric technology to capture images or detect blood in the GI tract. 3. **Result Classification**: - **Positive Result**: Indicates active bleeding or high-risk lesions, prompting emergency endoscopy (within 12 hours). - **Negative Result**: Suggests no active bleeding, allowing for a more delayed, elective endoscopy (within 48–96 hours). --- ### Benefits of Photometric Capsule in Nonvariceal Upper GI Bleeding The study summarized in the context demonstrates several advantages of using the photometric capsule for patients with suspected NVUGIH: 1. **Stratification of Patients**: - The capsule helps differentiate between patients who need immediate intervention (emergency endoscopy) and those who can safely delay the procedure. - In the study, patients with a positive capsule result underwent emergency endoscopy, while others were treated conservatively with proton pump inhibitors until elective endoscopy. 2. **Avoiding Unnecessary Emergency Endoscopies**: - Among the 41 patients with a negative capsule result (Group B), only two required emergency endoscopy, and neither had active bleeding. This means that 95.1% of emergency endoscopies were avoided in this group. - This reduces the burden on healthcare systems and minimizes risks associated with unnecessary invasive procedures. 3. **High Negative Predictive Value**: - The photometric capsule demonstrated a **100% sensitivity and negative predictive value** in excluding active bleeding. This means it is highly reliable in ruling out patients who do not need immediate intervention. 4. **Ease of Use and Safety**: - The capsule is non-invasive, quick, and easy to administer. - No technical, capsule-related, or bleeding-related complications were reported during the 30-day follow-up period in the study. 5. **Patient Outcomes**: - The capsule allows for a tailored approach to patient care, reducing the risks of unnecessary procedures while ensuring timely intervention for those who need it. --- ### Comparison with Elective Endoscopy Elective endoscopy has been the standard diagnostic and therapeutic tool for suspected NVUGIH, but it has limitations that the photometric capsule can address: - **Timing**: Elective endoscopy often requires scheduling within a specific timeframe (24–96 hours), which can delay diagnosis and treatment in some cases. - **Invasiveness**: Endoscopy is an invasive procedure with potential risks, such as sedation-related complications or perforation. - **Resource Intensive**: Emergency endoscopy requires significant hospital resources, including specialized staff and equipment, which can strain healthcare systems. The photometric capsule offers a complementary approach by identifying patients who truly need emergency endoscopy, thereby optimizing resource allocation and patient care. --- ### Can Photometric Capsule Replace Elective Endoscopy? While the photometric capsule shows great promise, it is unlikely to fully replace elective endoscopy in the near future. Instead, it serves as a valuable **triage tool** to improve patient management. Here's why: 1. **Diagnostic and Therapeutic Capabilities**: - Unlike the capsule, endoscopy is not only diagnostic but also therapeutic. It allows for interventions such as cauterization, clipping, or injection therapy to control bleeding. 2. **Limitations of the Capsule**: - The capsule only provides diagnostic information and cannot treat bleeding or other abnormalities. - It may not detect all types of lesions or bleeding sources, particularly in cases of slow or intermittent bleeding. 3. **Complementary Role**: - The capsule is best used as a **pre-endoscopy tool** to stratify patients and prioritize those who need emergency endoscopy. It can reduce the number of unnecessary procedures but cannot replace the therapeutic role of endoscopy. 4. **Future Potential**: - With further advancements, the capsule could evolve to include therapeutic capabilities or more advanced diagnostic features. However, as of now, it is primarily a triage tool. --- ### Conclusion The photometric capsule is a promising innovation in the management of suspected NVUGIH. It offers a quick, non-invasive, and highly accurate method to identify patients who require emergency endoscopy, thereby reducing unnecessary procedures and optimizing healthcare resources. However, it is not a replacement for elective endoscopy, which remains essential for both diagnosis and treatment. Instead, the capsule serves as a complementary tool that enhances patient care and improves the efficiency of GI bleeding management.

Esophageal ESD and stricture prevention(GIE, Jan-2026)

The study published in *Gastrointestinal Endoscopy (GIE), January 2026* focuses on esophageal endoscopic submucosal dissection (ESD) and strategies for preventing esophageal strictures, a common and serious complication following extensive resections. Below is a detailed summary of the key findings and advancements discussed in the study: --- ### **Background on Esophageal ESD and Stricture Formation** 1. **Preferred Therapy**: Esophageal ESD is now the standard treatment for large esophageal dysplastic and superficial neoplastic lesions due to its precision and efficacy. 2. **Stricture Risk**: The risk of esophageal strictures increases significantly when more than 75% of the esophageal circumference is resected. Strictures result in severe patient morbidity, frequently necessitating repeated endoscopic dilations, which negatively impact quality of life. 3. **Limitations of Current Prevention Strategies**: Existing methods to prevent strictures, such as steroid therapy, stents, tissue shielding, and dilations, have shown inconsistent results. No single approach has emerged as clearly superior. --- ### **Introduction of Submucosal Steroid Pre-Injection Strategy (SSPS)** 1. **Novel Technique**: SSPS involves injecting steroids into the submucosa before the ESD procedure. This is combined with two postoperative intralesional steroid injections, creating a multiphase steroid delivery system. 2. **Rationale for Pre-Injection**: Pre-resection steroid injection ensures uniform distribution and prolonged submucosal exposure, aligning with the critical healing period when strictures typically form. 3. **Comparator Therapy**: The control group received intralesional steroids post-ESD along with an extended course of oral steroids. --- ### **Key Findings** 1. **Lower Stricture Rates**: SSPS demonstrated significantly lower stricture rates compared to the control group. The benefit was consistent even after adjusting for lesion location, width, and length. 2. **Safety Profile**: No adverse events were reported in patients treated with SSPS, addressing concerns about potential risks such as delayed perforation. 3. **Encouraging Results for Full Circumferential ESD**: Achieving a low stricture rate in cases of full circumferential ESD is clinically notable and represents a significant advancement. 4. **Potential Mechanical Dilation Effect**: The repeated passage of the endoscope during follow-up steroid injections may have had a mechanical dilation effect, unintentionally contributing to stricture prevention. --- ### **Challenges and Considerations** 1. **Visualization and Equipment Limitations**: The opacity of steroids without contrast dye can impair visualization during dissection. Additionally, the increased viscosity of the steroid injectate may not be compatible with certain ESD knives. 2. **Complexity in Attribution**: The multiple interventions in the SSPS group make it difficult to attribute the benefit solely to pre-resection steroid injection. 3. **Theoretical Risks**: While no delayed perforations were observed in the study, the potential risk remains a theoretical concern. --- ### **Emerging Alternative Strategies** The study highlights other promising approaches for stricture prevention, including: 1. Endoscopic vacuum therapy. 2. Peptide gels. 3. Tissue shields. These strategies are in early stages of development and require further investigation. --- ### **Call for Further Research** 1. **Need for Prospective Trials**: The study emphasizes the importance of well-designed, prospective trials to validate the efficacy of SSPS and compare it with emerging modalities. 2. **Future Directions**: Further research is needed to refine SSPS, address its limitations, and determine its long-term outcomes in diverse patient populations. --- ### **Conclusion** The introduction of SSPS represents a promising advancement in the prevention of esophageal strictures following ESD, particularly for extensive or full circumferential resections. With its favorable safety profile and significant reduction in stricture rates, SSPS has the potential to improve patient outcomes. However, challenges such as equipment compatibility, visualization issues, and the complexity of attributing benefits to pre-resection steroids warrant further investigation. Prospective trials are essential to confirm these findings and to compare SSPS with other emerging strategies.

POEM and GERD – dose technique matter? (GIE, Jan-2026)

### POEM Techniques and GERD: Does Technique Matter? POEM is a minimally invasive endoscopic procedure used to treat achalasia, a motility disorder of the esophagus. There are two primary techniques for POEM: 1. **Full-Thickness (FT) POEM**: - This technique involves cutting through all layers of the esophageal muscle, including both circular and longitudinal fibers. - While FT POEM is effective in relieving achalasia symptoms, it has been associated with higher incidences of GERD, as the full-thickness myotomy disrupts the integrity of the lower esophageal sphincter (LES), increasing the likelihood of acid reflux. 2. **Modified Myotomy (MM) POEM**: - MM POEM includes techniques such as: - **Selective Circular Myotomy (CM)**: Only the circular muscle fibers are incised, sparing the longitudinal fibers. - **Oblique Fiber-Sparing Myotomy (OS)**: A more targeted approach that spares oblique fibers while addressing the circular fibers. - These techniques aim to preserve some of the LES functionality, potentially reducing the incidence of GERD while still effectively treating achalasia. ### GERD Incidences and Technique Differences: The meta-analysis described in the context highlights the following key findings regarding the impact of POEM techniques on GERD: - **FT POEM**: - Associated with a higher rate of symptomatic GERD (Odds Ratio [OR]: 1.58; 95% CI: 1.12-2.23, P = .009) compared to MM POEM. - This is likely due to the complete disruption of LES function caused by cutting through all muscle layers. - **MM POEM**: - Specifically, the Oblique Fiber-Sparing (OS) technique was found to have reduced symptomatic reflux compared to FT POEM. - Selective Circular Myotomy (CM) showed similar rates of symptomatic reflux as FT POEM but had the advantage of shorter procedure duration. ### Clinical Implications: - The choice of POEM technique matters significantly in terms of GERD outcomes. Patients undergoing FT POEM may experience higher rates of post-procedure GERD, necessitating close monitoring and potential use of acid-suppressive therapies (e.g., proton pump inhibitors). - MM POEM, particularly the OS technique, appears to be a promising alternative for reducing GERD risk while maintaining clinical efficacy in treating achalasia. - However, the meta-analysis emphasizes the limited number of studies available and the observational nature of most included research, suggesting that further randomized controlled trials are needed to confirm these findings. ### Conclusion: The technique used in POEM does indeed influence GERD outcomes, with MM POEM techniques (especially OS) showing a potential advantage in reducing symptomatic reflux compared to FT POEM. The choice of technique should be tailored to individual patient needs, balancing the risk of GERD with the effectiveness of achalasia symptom relief.

Green Endoscopy Unit (GIE, Jan-2026)

The Green Endoscopy Unit (GIE) concept, set to launch in January 2026, aims to minimize the environmental impact of endoscopic procedures while maintaining high-quality patient care. Its core strategy revolves around reducing unnecessary activities, emphasizing high-value care with the lowest environmental cost. Adherence to evidence-based guidelines and structured triage systems ensures only clinically appropriate and timely procedures are performed, avoiding low-value or repeat interventions. Key practices include provider education to improve referral quality, patient communication to explain deferred procedures, and the use of non-endoscopic alternatives when suitable. Efficient scheduling prevents cancellations and resource underutilization, while combining procedures into single visits reduces overall waste. Operational strategies involve minimizing instrument use, simplifying interventions, avoiding low-yield biopsies, and consolidating specimens to reduce material consumption. Inventory management prevents overstocking and expiration, supported by first-in, first-out storage practices. Sedation methods and IV fluid use are optimized to match patient needs, avoiding excess resource use. The unit also focuses on reducing paper dependency through digital documentation and encourages patient engagement by promoting reusable personal items. These measures collectively align with sustainability goals, ensuring environmentally conscious endoscopic care without compromising clinical outcomes. GIE represents a forward-thinking approach to healthcare delivery in the face of climate challenges.

Saline-Immersion Technique for Colorectal ESD: Outcomes From a Western Cohort - J of JGH - Jan,26

The referenced study, "Saline-Immersion Technique for Colorectal ESD: Outcomes From a Western Cohort," published in the *Journal of Gastroenterology and Hepatology* on January 26, evaluates the use of the saline-immersion/irrigation technique combined with the pocket-creation method (SITE-PCM) for endoscopic submucosal dissection (ESD) of complex colorectal lesions in a Western clinical setting. Below is a detailed summary of the study's outcomes: ### Background: - Endoscopic submucosal dissection (ESD) is a minimally invasive technique used for removing complex colorectal lesions en bloc, which is crucial for achieving curative outcomes with clear margins. - Adoption of ESD in Western countries has been limited due to the technical challenges posed by colonic anatomy, such as its narrow lumen, sharp angulations, and thin walls. - The SITE-PCM approach was developed to enhance visualization, stability, and control during ESD by using saline immersion and a pocket-creation technique. ### Study Design: - This was a retrospective analysis of all consecutive colorectal ESD procedures performed over several years in a Western tertiary referral center. - SITE-PCM was consistently applied across all cases. - Key parameters reviewed included lesion location, procedural success, histological outcomes, complications, and follow-up data. ### Key Findings: 1. **Effectiveness:** - SITE-PCM–assisted ESD achieved high rates of en bloc resections (complete removal of the lesion in one piece) across various colorectal locations, including challenging areas like the proximal colon and rectum. - Most lesions were successfully removed with clear histological margins, ensuring curative outcomes for the majority of cases. 2. **Safety:** - Adverse events were rare and generally manageable. Complications, such as perforation or bleeding, were infrequent, and escalation of care (e.g., surgical intervention) was required in very few cases. - The majority of procedures were performed safely under conscious sedation, which is less invasive and more cost-effective than general anesthesia. 3. **Procedure Time:** - While procedure times were longer compared to simpler endoscopic techniques, they were deemed acceptable given the complexity of the lesions treated. 4. **Clinical Implications:** - The use of SITE-PCM improved visualization and control during the dissection, addressing key technical challenges associated with colorectal ESD in Western populations. - These results support the feasibility of adopting ESD more widely in Western clinical practice. ### Conclusion: The study concludes that SITE-PCM–assisted ESD is a safe, effective, and minimally invasive approach for treating complex colorectal lesions in Western settings. It provides high-quality outcomes with manageable risks, supporting its broader adoption and further prospective evaluation. This study is significant as it demonstrates that advanced techniques like SITE-PCM can overcome the anatomical and technical barriers that have historically limited the use of colorectal ESD in Western countries. It also highlights the potential for this approach to improve patient outcomes by enabling curative treatment of complex lesions with minimal invasiveness.

Endoscopic Full-Thickness Resection for Extraluminal Gastric Submucosal Tumors - J of JGH - Jan,26

Based on the context provided, the study on "Endoscopic Full-Thickness Resection (EFTR) for Extraluminal Gastric Submucosal Tumors" likely highlights the feasibility, safety, and clinical outcomes of EFTR as a minimally invasive approach for managing gastric submucosal tumors with extraluminal growth. These tumors, which grow outward from the gastric wall, pose unique challenges compared to intraluminal lesions and have been inadequately studied in the past. ### Key Findings of the Study: 1. **Feasibility and Effectiveness:** - EFTR was shown to be a feasible technique for removing gastric submucosal tumors with extraluminal growth, including those with completely extraluminal patterns. - The procedure achieved a high rate of complete tumor removal with successful retrieval in most cases. 2. **Safety Profile:** - Adverse events related to the procedure were infrequent and manageable, indicating an acceptable safety profile. - The study supports the use of EFTR as a minimally invasive alternative to more invasive surgical techniques. 3. **Challenges and Complexity:** - Tumor-related factors such as larger size and irregular morphology were associated with increased technical challenges, including difficulties in tumor extraction and longer operative times. - These factors should be carefully considered during patient selection and pre-procedural planning. 4. **Oncologic Outcomes:** - Long-term follow-up data revealed no evidence of local recurrence or distant metastasis, suggesting that EFTR provides oncologically adequate treatment for these tumors. 5. **Clinical Implications:** - EFTR offers a promising treatment option for patients with gastric submucosal tumors that exhibit extraluminal growth, reducing the need for more invasive surgical procedures. - Further studies, especially prospective trials, are needed to validate these findings and optimize patient selection criteria. ### Conclusion: The study concludes that EFTR is a safe and effective minimally invasive method for treating gastric submucosal tumors with extraluminal growth. However, tumor characteristics such as size and morphology significantly influence procedural complexity. Prospective research is recommended to refine the technique and enhance outcomes. If you are referring to a specific article in the Journal of Gastroenterology and Hepatology (JGH) published on January 26, this summary aligns with the general findings on the topic. However, for precise details, the original article should be consulted directly.

Reflux-Related Esophageal Stricture After POEM - J of JGH - Jan,26

Based on the context provided, the study titled "Reflux-Related Esophageal Stricture After POEM" published in the *Journal of Gastroenterology and Hepatology (JGH)* on January 26 likely focuses on the clinical differentiation between reflux-related esophageal strictures and recurrent achalasia that may develop following peroral endoscopic myotomy (POEM). The study investigates the symptoms, underlying mechanisms, diagnostic approaches, and treatment strategies for reflux-related strictures after POEM. ### Key Findings: 1. **Clinical Differences**: - Reflux-related esophageal strictures and recurrent achalasia share overlapping symptoms like dysphagia and regurgitation but are distinct clinical entities. - Patients with reflux-related strictures exhibit more reflux-associated symptoms (e.g., heartburn) and inflammatory changes visible during endoscopy. - Functional testing showed differences in lower esophageal sphincter pressure patterns between reflux-related strictures and recurrent achalasia, suggesting distinct pathophysiological mechanisms. 2. **Diagnostic Tools**: - Symptom patterns, endoscopic findings (e.g., inflammatory changes), and functional assessments (e.g., sphincter pressure measurements) are critical in distinguishing reflux-related strictures from recurrent achalasia. 3. **Endoscopic Treatments**: - Endoscopic therapies, such as radial incision and balloon dilation, were effective for managing reflux-related strictures. - These treatments demonstrated good long-term outcomes and acceptable safety profiles, making them viable options for patients with this condition. 4. **Associated Factors**: - Tissue changes within the esophageal wall were identified as key contributors to the development of reflux-related strictures. ### Conclusion: Reflux-related esophageal stricture after POEM is a distinct condition that can be reliably differentiated from recurrent achalasia using clinical, functional, and endoscopic evaluations. Endoscopic management techniques are safe and effective for treating these strictures. If you are looking for more detailed insights or specific sections from the article, I recommend accessing the *Journal of Gastroenterology and Hepatology* directly, as the full text will provide comprehensive data and analysis.

ESD Vs TEM for Rectal Polyp

Endoscopic Submucosal Dissection (ESD) and Transanal Endoscopic Microsurgery (TEM) are both minimally invasive techniques used for the treatment of rectal polyps, particularly early-stage rectal cancer or large benign polyps. Comparing ESD and TEM for rectal polyps requires an evaluation of their respective outcomes, including efficacy, safety, and technical considerations. ### Key Comparisons Between ESD and TEM for Rectal Polyps: #### 1. **En-bloc Resection Rates:** - **ESD:** Achieves higher en-bloc resection rates compared to TEM. En-bloc resection involves removing the tumor or polyp in a single piece, which is critical for accurate pathological assessment and reducing the risk of recurrence. - **TEM:** While TEM is effective, it may not achieve as high en-bloc resection rates as ESD, especially for larger or more complex polyps. #### 2. **Tumor Recurrence:** - **ESD:** Associated with lower recurrence rates for rectal polyps and early-stage rectal cancer. This is likely due to its precise dissection technique, which minimizes residual tumor tissue. - **TEM:** Recurrence rates are slightly higher compared to ESD, particularly for larger lesions. #### 3. **Complication Rates:** - **ESD:** Demonstrates a lower overall complication rate compared to TEM. While ESD is technically demanding, its precision reduces risks such as postoperative bleeding and perforation. - **TEM:** Has a higher complication rate, but complications are generally manageable with proper postoperative care. #### 4. **R0 Resection Rates:** - Both ESD and TEM achieve comparable R0 resection rates (complete removal of the tumor with clear margins). This indicates that both techniques are effective in achieving tumor-free margins. #### 5. **Operative Time and Hospital Stay:** - **ESD:** May require longer operative times due to its technical complexity. However, patients often benefit from shorter hospital stays due to fewer complications. - **TEM:** Operative time may be shorter, but hospital stays could be longer if complications occur. #### 6. **Technical Complexity:** - **ESD:** Requires significant expertise and specialized training. It is more technically demanding but offers greater precision in dissecting deeper layers of tissue. - **TEM:** Easier to perform compared to ESD and may be more accessible in clinical settings with limited resources. ### Clinical Considerations: - **ESD:** Recommended for patients with larger, complex polyps or early-stage rectal cancer due to its superior precision, lower recurrence rates, and reduced complications. However, it requires a highly skilled operator and specialized equipment. - **TEM:** Suitable for smaller, less complex polyps or in settings where ESD expertise is unavailable. It remains an effective and safe option. ### Summary: While both ESD and TEM are effective for treating rectal polyps, ESD demonstrates advantages in terms of en-bloc resection rates, lower recurrence, and fewer complications. TEM remains a viable option, particularly in cases where ESD expertise or resources are limited. Treatment selection should be guided by the size and complexity of the polyp, the clinician's expertise, and the availability of specialized equipment.

Rapid trypsinogen-2 test and post ERCP discharge Strategy - EJGH Nov 26

The study "Rapid trypsinogen-2 test and post-ERCP discharge strategy" published in the *European Journal of Gastroenterology & Hepatology* (EJGH) on November 26 explores methods to predict adverse events (AEs) following endoscopic retrograde cholangiopancreatography (ERCP). It examines the effectiveness of two strategies: the urinary trypsinogen-2 (UT-2) dipstick test and a risk-factor-based discharge tool, both individually and in combination, to identify patients at high risk of post-ERCP AEs. ### Background and Problem Statement: ERCP is associated with a significant risk of adverse events, including post-ERCP pancreatitis, infections, bleeding, and perforation, with an approximate 10% incidence rate. Current post-ERCP discharge strategies, such as those recommended by the European Society of Gastrointestinal Endoscopy (ESGE), rely on serum amylase or lipase measurements 2–6 hours after the procedure. However, these strategies have limitations: 1. They do not account for AEs other than pancreatitis. 2. They are logistically burdensome, requiring blood sampling, laboratory testing, and additional hospital resources. 3. Post-ERCP hyperamylasemia is common in asymptomatic patients, leading to potential overestimation of risk. The study aimed to evaluate whether the UT-2 dipstick test, the discharge tool, or their combination could serve as simpler, more efficient alternatives for predicting post-ERCP AEs and guiding discharge decisions. ### Results: The study enrolled 268 patients across multiple hospitals from August 2018 to March 2021. Key findings include: - **Adverse Events (AEs):** 10.5% of patients experienced AEs, with 6.1% developing post-ERCP pancreatitis. - **Combined Strategy Performance:** The combination of the UT-2 dipstick test and the discharge tool outperformed individual strategies for predicting AEs, with a sensitivity of 66.7%, specificity of 78.5%, positive predictive value (PPV) of 26.6%, and negative predictive value (NPV) of 95.3%. - For post-ERCP pancreatitis specifically, the combined strategy had a sensitivity of 64.3%, specificity of 76.2%, PPV of 14.9%, and NPV of 97.0%. ### Conclusion: While the combined approach of the UT-2 dipstick test and the discharge tool showed improved predictive accuracy compared to individual strategies, its overall sensitivity remained suboptimal. As a result, the study does not recommend the implementation of either strategy—individually or combined—as a replacement for current post-ERCP discharge protocols. The findings highlight the need for further research to develop reliable, cost-effective, and logistically feasible tools for predicting post-ERCP adverse events.