A 39-year-old woman presented with a small submucosal tumor in the posterior wall of gastric lower body ([Fig. 1]). She reported nonspecific gastrointestinal symptoms such as recurrent epigastric pain and abdominal distension for 4 years. There was no significant medical history. Physical examination revealed no obvious abnormalities. Endoscopic ultrasonography showed the hypoechoic tumor with a clear boundary and an endoluminal growth pattern, which originated from the muscularis propria ([Fig. 2]). Enhanced computed tomography confirmed the tumor in the gastric body ([Fig. 3]). Following a strong request from the patient, we performed endoscopic submucosal excavation (ESE) using a dual knife ([Video 1]). Complete resection of the tumor was achieved ([Fig. 4]). Pathology showed a collagenous nodule under gastric mucosa, and the vertical margin was normal muscularis propria ([Fig. 5]). Immunohistochemistry revealed that the tumor was positive for CD34, but negative for CD117, DOG-1, Desmin, SMA, S100, and IgG4. Therefore, the diagnosis of gastric calcified fibrous tumor (CFT) was made. The patient kept fasting for 24 hours and began to drink after 1 day. She received proton pump inhibitors and antibiotic prophylaxis. Her recovery was uneventful, and she was discharged after 2 days. Gastric CFT is an extremely rare mesenchymal benign tumor with unclear pathogenesis, which is easily confused with common spindle cell lesions of the gastrointestinal tract, especially leiomyoma and gastrointestinal stromal tumors [1]. The clinical implication of gastric CFT is not clear, and surgical resection remains the main treatment [2]. Our experience suggests that ESE can be an alternative for resection of gastric CFT. Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB Article published online: 21 November 2023 © 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Background: Bowel preparation compliance is an important intervenable factor that affects bowel preparation quality, and improving compliance is an important way to optimize bowel preparation outcomes. Despite its importance, the compliance rate and its influencing factors have not been thoroughly evaluated. Objective: This study aimed to investigate the overall compliance with bowel preparation instructions in patients undergoing colonoscopy. Methods: From September 2024 to March 2025, a cross-sectional questionnaire-based study was conducted at West China Hospital of Sichuan University, recruiting 740 participants via convenience sampling. We used an 8-item self-report scale to evaluate compliance with bowel preparation instructions. Items were rated on a 4-point Likert scale (0=completely noncompliant to 3=completely compliant), yielding a total score of 0‐24. Higher scores reflected greater compliance, with ≥95% of the maximum score considered adequate compliance. Univariate analysis and multivariate logistic regression analysis were used to assess factors (age, educational level, knowledge of bowel preparation, satisfaction with the taste of the laxative, physical discomfort during bowel preparation) influencing bowel preparation compliance. Results: In this study, 42.0% (311/740) of patients demonstrated adequate compliance with bowel preparation instructions. In the univariate analysis, hypertension history, knowledge of bowel preparation, laxative type, satisfaction with the taste of the laxative, anxiety during bowel preparation, and physical discomfort during bowel preparation all had statistically significant influences. Multivariate analysis showed that older age (odds ratio [OR] 2.27, 95% CI 1.16-4.49), higher educational level (OR 3.29, 95% CI 1.41-8.33), adequate knowledge of bowel preparation (OR 1.59, 95% CI 1.14-2.24), satisfaction with the taste of the laxative (OR 2.11, 95% CI 1.48-3.02), and no physical discomfort during bowel preparation (OR 0.45, 95% CI 0.31-0.64) were key factors for adequate bowel preparation compliance. Conclusions: Personalizing bowel preparation instructions according to patients’ age and education level, and selecting a laxative that suits the patients’ taste preferences when available, are feasible ways to improve compliance with bowel preparation.

INTRODUCTION: Based on endoscopic mucosal resection with ligation (EMR-L), we developed double band ligation-assisted endoscopic submucosal resection (ESR) for complete resection of small submucosal rectal neuroendocrine tumors (NETs). Both procedures use a multiband device to perform resection, with the only difference being that ESR adds an additional band to obtain deeper resection margin. The aim of this retrospective study was to validate its feasibility, safety, and effectiveness compared with EMR-L. METHODS: This retrospective study included consecutive patients with small (≤10 mm) suspected submucosal rectal NETs who underwent ESR (n = 45) or EMR-L (n = 26) between June 2018 and October 2023 at West China Hospital. En bloc resection rate, complete resection rate, procedure time, margin distance, and adverse events were compared between 2 groups. RESULTS: En bloc resections were achieved in all patients. The complete resection rate of ESR was higher than EMR-L (100% vs 88.5%, P = 0.045). The vertical margin distance and lateral margin distance were significantly longer in ESR group than EMR-L group (vertical margin distance 782.31 ± 359.45 μm vs 363.84 ± 222.78 μm, P < 0.001; and lateral margin distance 4,205.75 ± 2,167.43 μm vs 3,162.94 ± 1,419.22 μm, P = 0.008, respectively). There were no significant differences in procedure time, adverse events, postprocedural hospital stay, or medical cost between 2 groups. In addition, there was no evidence of recurrence or metastasis during the follow-up. DISCUSSION: ESR seems to be safe and effective for complete resection of small submucosal rectal NETs. Larger, multicenter, prospective studies are needed to further assess this technique.