Colorectal cancer (CRC) prevention depends on effective colonoscopy; yet variability in adenoma detection rates (ADRs) and missed lesions remain significant hurdles. Artificial intelligence-powered computer-aided detection (CADe) systems offer promising advancements in enhancing polyp detection. This review examines the role of CADe in improving ADR and reducing adenoma miss rates (AMRs) while addressing its broader clinical implications. CADe has demonstrated consistent improvements in ADRs and AMRs; largely by detecting diminutive polyps, but shows limited efficacy in identifying advanced adenomas or sessile serrated lesions. Challenges such as operator deskilling and the need for enhanced algorithms persist. Combining CADe with adjunctive techniques has shown potential for further optimizing performance. While CADe has standardized detection quality; its long-term impact on CRC incidence and mortality remains inconclusive. Future research should focus on refining CADe technology and assessing its effectiveness in reducing the global burden of CRC.

Background and aims: Hereditary colorectal cancer syndromes (HCCS), including familial adenomatous polyposis (FAP) and Lynch syndrome (LS), are the two most important high-risk conditions for colorectal cancer (CRC). Inflammatory bowel disease (IBD) increases the risk by two to six times compared with that in the general population. The intersection of these two conditions has rarely been documented in literature. We aimed to summarize the prevalence, pathogenesis, and current evidence-based management of IBD and HCCS and the underlying molecular mechanisms of accelerated carcinogenesis due to combined inflammation and genetic predisposition. Methods: PubMed and Scopus were searched until June 2024 to identify relevant studies investigating the epidemiology, pathogenesis, and management of IBD and coexisting hereditary CRC syndromes. Results: Co-occurrence of IBD and hereditary CRC syndromes is exceptionally uncommon. Individuals with LS and IBD tend to develop CRC at a younger age than those without IBD, with patients with ulcerative colitis facing particularly elevated risks. The interaction between mismatch deficiency and chronic inflammation requires further investigation.

Gastroesophageal reflux disease has a high incidence and prevalence in the general population. Clinical manifestations are heterogenous, and so is the response to medical treatment. Proton pump inhibitors are still the most common agents used to control reflux symptoms and for healing esophagitis, but they are not a one-size-fits-all solution for the disease. Patients with persistent troublesome symptoms despite medical therapy, those experiencing some adverse drug reaction, or those unwilling to take lifelong medications deserve valid alternatives. Anti-reflux Nissen fundoplication is an effective option, but the risk of adverse events has limited its spread. In recent years, advancements in therapeutic endoscopy have been made, and three major endoluminal alternatives are now available, including (1) the delivery of radiofrequency energy to the esophago–gastric junction, (2) transoral incisionless fundoplication (TIF), and (3) anti-reflux mucosal interventions (ARMI) based on mucosal resection (ARMS) and mucosal ablation (ARMA) techniques to remodel the cardia. Endoscopic techniques have shown interesting results, but their diffusion is still limited to expert endoscopists in tertiary centers. This review discusses the state of the art in the endoscopic approach to gastroesophageal reflux disease.

Aims: Lumen-apposing metal stents (LAMSs) in ultrasonography-guided gallbladder drainage (EUS-GBD) have become increasingly important for high-risk surgical patients. Our study aims to evaluate the technical and clinical success, safety, and feasibility of endoscopic ultrasonography-guided gallbladder drainage using a new dedicated LAMS. Methods: This is a retrospective multicenter study that included all consecutive patients not suitable for surgery who were referred to a tertiary center for EUS-GBD using a new dedicated electrocautery LAMS for acute cholecystitis at eight different centers. Results: Our study included 54 patients with a mean age of 76.48 years (standard deviation: 12.6 years). Out of the 54 endoscopic gallbladder drainages performed, 24 (44.4%) were cholecysto-gastrostomy, and 30 (55.4%) were cholecysto-duodenostomy. The technical success of LAMS placement was 100%, and clinical success was achieved in 23 out of 30 patients (76.67%). Adverse events were observed in two patients (5.6%). Patients were discharged after a median of 5 days post-stenting. Conclusions: EUS-GBD represents a valuable option for high-surgical-risk patients with acute cholecystitis. This new dedicated LAMS has demonstrated a high rate of technical and clinical success, along with a high level of safety.

Third-space endoscopy is standard practice for neoplastic and motility disorders; however, it carries a high risk of intraprocedural bleeding. Such risk may be reduced by prophylactic coagulation of submucosal vessels, but this requires instrument exchange. A new approach involves pre-sealing submucosal vessels under saline immersion using standard electrocautery settings and the same knife. Patients undergoing third-space procedures (endoscopic submucosal dissection or peroral endoscopic myotomy) were randomized to receive either targeted saline-immersion pre-sealing (intervention group) or conventional coagulation (carbon dioxide insufflation, control group) for prophylactic management of vessels ≥1.2 mm. Dissection settings were identical. Rate of per-patient intraprocedural bleeding requiring re-treatment for vessels ≥1.2 mm was the main outcome. Per-vessel analyses were also performed. The use of an adjunctive device and coagulation time were also assessed. 70 patients (37 immersion, 33 control) with 864 ≥1.2-mm vessels were included. Saline-immersion pre-sealing significantly reduced bleeding rates: per patient (32.4% vs. 75.8%; relative risk [RR] 0.43, 95%CI 0.26–0.71; number needed to treat [NNT] 2.3; P < 0.01); per vessel (6.3% vs. 29.9%; RR 0.21, 95%CI 0.14–0.31; NNT 4.2; P < 0.01). Use of coagulation forceps for bleeding treatment also decreased (0% vs. 24.2% and 0% vs. 8.3%; P < 0.01). A significant reduction in mean (SD) coagulation time was reported in the saline-immersion group (22.7 [26.4] vs. 29.6 [49.8] seconds; P < 0.01). A substantial reduction in the risk of intraprocedural bleeding was achieved by saline-immersion pre-sealing in per-patient and per-vessel analyses, prompting its implementation in clinical practice.