Endoscopic retrograde cholangiopancreatography (ERCP) carries a post-ERCP pancreatitis (PEP) rate of 2–10%, which could be as high as 30–50% in high-risk cases. PEP is severe in up to 5% of cases, with potential for life-threatening complications, including multi-organ failure, peripancreatic fluid collections, and death in up to 1% of cases. The risk of PEP is potentially predictable and may be modified with pharmacological measures and endoscopist technique. This review covers the definition, epidemiology and risk factors for PEP, with a focus on the latest evidence-based medical and endoscopic strategies to prevent and manage PEP.

Received: 21 May 2023 Accepted: 12 June 2023 Article published online: 01 August 2023 © 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Objective: We performed an international cross-sectional study to investigate the procedural standards and challenges of endoscopically guided nasojejunal tube (NJT) insertion among healthcare professionals. Methods: A 16-item online questionnaire was created on SurveyMonkey and distributed internationally to healthcare professionals engaged in NJT insertion, between 26 March and 10 May 2024, through professional networks, institutional email lists and social media platforms (WhatsApp and X). The questionnaire evaluated (1) NJT insertion and sedation procedures, (2) clinician rankings of their perceived most technically challenging and discomforting steps in through-the-scope (TTS) NJT insertion, (3) sustainability concerns related to the use of single-use instruments during the procedure. ORs were calculated from χ² tests to evaluate associations between procedural steps and perceived technical challenge or patient discomfort . Results: From 148 respondents, most were medical endoscopists (87.8%), primarily based in the UK (72.3%), with a mean experience of 8.2 years in NJT insertion, predominantly solely using the TTS method (66.9%), with fewer (10.8%) solely using transnasal endoscopy. Among TTS users, rerouting from mouth to nose was most frequently perceived as the most uncomfortable (80.5%; OR 37.6, p≤0.001) and technically challenging step (52.9%; OR 5.63, p<0.001) of TTS insertion. Furthermore, 81.1% of respondents had environmental concerns about single-use instrumentation. Conclusion: The TTS method was the preferred method for NJT insertion; however, its rerouting step was perceived as both discomforting and technically challenging. Broader training in multiple techniques may help optimise insertion to accommodate patient factors, while the development of novel devices may help to mitigate the limitations of rerouting.

Third-space endoscopy, including peroral endoscopic myotomy (POEM) and endoscopic submucosal dissection (ESD), has become an established therapeutic option for various gastrointestinal disorders. A newly developed slim therapeutic gastroscope aims to improve maneuverability and provide easier access to the submucosal space and also to enhance ergonomic aspects of tedious therapeutic procedures. The aim of this study (The Slim Scop3 Trial) was to evaluate the subjective workload and usability of the novel slim therapeutic gastroscope during third space procedures. Secondary outcomes included technical and clinical performance as well as adverse events (AEs). This was a prospective, single-arm, single-center study comprising 30 patients undergoing third-space endoscopy in a high-volume center in Germany. Subjective workload and usability were assessed with the NASA-Task load index (NASA-TLX) and the System Usability Score (SUS), respectively. Clinical outcomes and AEs were recorded prospectively. The slim gastroscope showed a low NASA-TLX and high SUS score, which correlates with a low subjective workload and high usability. POEM showed a tendency toward lower NASA-TLX and higher SUS compared with ESD. For ESD, the en-bloc and curative R0 resection rate was 100%. No device-related AE events occurred. A novel slim gastroscope offers high usability with a low subjective workload for third space procedures. The slim gastroscope has the potential to reduce ergonomic strain on endoscopists during complex therapeutic interventions.

HemoPill is a commercially available ingestible electronic capsule that detects hematin and blood through photometric measurements. An examination with HemoPill requires no special preparation and can be done bedside. Its major advantage is noninvasive luminal blood detection, requiring only a small amount of blood or hematin (> 20 mL) for a positive result, making it especially suitable in multimorbid and/or geriatric patients not primarily fit for endoscopic diagnostic allowing rapid and uncomplicated bleeding detection.Recent clinical reports showed that HemoPill is useful in stratifying patients with anemia and bleeding in the setting of an Emergency Department. The second generation with an extended battery capacity of 9 hours opens the possibility of detecting blood in the middle and lower gastrointestinal tract.Herein we report another advantage of the extended battery capacity allowing noninvasive bleeding detection in the middle and lower gastrointestinal tract, leading to early endoscopic diagnosis of gastrointestinal malignancies with occult bleeding in comorbid patients with severe anemia.