Background: Esophageal cancer (EC) is the sixth-leading cause of cancer-related deaths in the world. Esophagectomy is the most effective treatment for patients without invasion of adjacent organs or distant metastasis. Complications and relevant problems may occur in the early post-operative course or in a delayed fashion. Here, innovative endoscopic techniques for the treatment of postsurgical problems were developed during the past 20 years. Methods: Endoscopic treatment strategies for the following postoperative complications are presented: anastomotic bleeding, anastomotic insufficiency, delayed gastric passage and anastomotic stenosis. Based on a literature review covering the last two decades, therapeutic procedures are presented and analyzed. Results: Addressing the four complications mentioned, clipping, stenting, injection therapy, dilatation, and negative pressure therapy are successfully utilized as endoscopic treatment techniques today. Conclusion: Endoscopic treatment plays a major role in both early-postoperative and long-term aftercare. During the past 20 years, essential therapeutic measures have been established. A continuous development of these techniques in the field of endoscopy can be expected.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is crucial to the treatment of biliopancreatic diseases with iatrogenic perforation as a potential complication. As of yet, the wall load during ERCP is unknown, as it is not directly measurable during an ERCP in patients. Methods: In a life-like, animal-free model, a sensor system consisting of five load cells was attached to the artificial intestines (sensors 1 + 2: pyloric canal–pyloric antrum, sensor 3: duodenal bulb, sensor 4: descending part of the duodenum, sensor 5: distal to the papilla). Measurements were made with five duodenoscopes (n = 4 reusable and n = 1 single use). Results: Fifteen standardized duodenoscopies were performed. Peak stresses were found at the antrum during the gastrointestinal transit (sensor 1 max. 8.95 N, sensor 2 max. 2.79 N). The load reduced from the proximal to the distal duodenum and the greatest load in the duodenum was discovered at the level of the papilla in 80.0% (sensor 3 max. 2.06 N). Conclusions: For the first time, intraprocedural load measurements and exerting forces obtained during a duodenoscopy for ERCP in an artificial model were recorded. None of the tested duodenoscopes were classified as dangerous for patient safety.

Background: For endoscopists, knowledge of the available hemotherapeutic devices and materials as well as competence in using them is a life-saving expertise in the treatment of patients with acute gastrointestinal bleeding. These competences can be acquired in training on live animals, animal organs, or simulators. We present an animal tissue-free training model of the upper gastrointestinal tract for bleeding therapy. Methods: An artificial, animal tissue-free mucosa and submucosa with the opportunity of injection and clipping therapy were created first. Patches with this artificial mucosa and submucosa were placed into silicone and latex organs with human-like anatomy. Esophageal bleeding situations were imitated as variceal bleeding and bleeding of a reflux esophagitis in latex organs. Finally, a modular training model with human anatomy and replaceable bleeding sources was created. Evaluation of the novel model for gastroscopic training was performed in a multicentric setting with endoscopic beginners and experts. Results: Evaluation was carried out by 38 physicians with different levels of education in endoscopy. Evaluation of the model was made with grades from one (excellent) to six (bad): suitability for endoscopic training was 1.4, relevance of the endoscopic training was 1.6, and grading for haptic and optic impression of the model was 1.7. Conclusions: The creation of a gastroscopic model for the training of hemostatic techniques without animal tissues was possible and multiple endoscopic bleeding skills could be trained in it. Evaluation showed good results for this new training option, which could be used in every endoscopic unit or other places without hygienic doubts.

Heterotrimeric G_i proteins are crucial modulators of G protein-coupled receptor signaling, with Gα_i2 ubiquitously expressed and implicated in diverse physiological processes. Previous reports described partial lethality in Gnai2-deficient mice, but the timing and mechanism of death remained unclear. Here, we demonstrate that impaired neonatal respiratory adaptation contributes to mortality in Gnai2-deficient neonates. Despite normal Mendelian distribution at birth and no overt malformations, at least 20% of the expected Gnai2-deficient neonates died within minutes after birth, displaying abnormal breathing, cyanosis, and features resembling neonatal respiratory distress syndrome (RDS). Histological and ultrastructural analyses revealed reduced alveolar surface area, thickened septa, increased mesenchymal tissue, and impaired surfactant ultrastructure, despite unaltered alveolar surfactant phospholipid levels. These findings suggest that Gα_i2 modulates the structural deployment and functional organization of surfactant within alveoli, although the incomplete phenotype and survival of some neonates indicate a regulatory rather than indispensable role of Gα_i2. Our data underscore the complexity of neonatal respiratory adaptation and highlight potential systemic and intercellular mechanisms underlying alveolar stabilization.

Background: Simulation-based learning constitutes a valuable component of medical training, with immersive 3D simulations and physical simulations being commonly used. Immersive 3D simulation training has been proven to enhance procedural skills and their transfer, whereas physical simulators allow for haptic feedback. However, direct comparative evidence between these 2 simulation modalities is scarce and often does not address cognitive, motivational, and perceived learning outcomes, which also have an effect on actual learning outcomes. Objective: The objective of this study is to evaluate whether immersive 3D simulation (a primarily screen-based, PC- or tablet-delivered simulator with optional virtual reality elements) can serve as a complementary or preparatory modality to physical simulator training when teaching novice trainees endourological laser-based procedures. Specifically, we investigate whether pretraining on an immersive 3D simulator facilitates the transfer of procedural knowledge and technical skills to the physical simulator, alongside its effects on cognitive load, motivation, and perceived learning. Methods: We will conduct a single-center, 2-group randomized controlled trial with 70 medical students who are currently in the clinical phase of their undergraduate medical studies. Each participant will complete one training session on either the immersive 3D simulation or the physical simulator, followed by one posttraining test on the physical simulator. Technical performance will be assessed by 2 experts using an objective structured assessment of technical skills–based composites, a critical error checklist as an indicator of safety, and time to task completion as an indicator of efficiency. Furthermore, we will measure motivation, cognitive load, and perceived learning. To analyze group differences in the primary and secondary outcomes, we will use independent-sample t tests (1-tailed), with nonparametric or Welch-corrected alternatives in cases in which assumptions are violated, and regression analyses to examine associations between the secondary outcomes and technical performance. Results: Recruitment will start in September 2026. We will begin with the training sessions and posttraining tests in November 2026. We expect to complete data collection by December 2026 and finish analyzing by February 2027. Consequently, we expect to publish the results in April 2027. Conclusions: By integrating technical performance with cognitive, motivational, and perceived learning outcomes, this study will clarify not only whether but also how immersive 3D simulation can support and prepare novice trainees for physical simulator training in endourological laser-based procedures. Furthermore, it aims to inform the evidence-based development of hybrid, simulation-based curricula in medical education.