Background: Esophagectomy is recommended after endoscopic resection of an early esophageal cancer when pejorative histoprognostic criteria indicate a high risk of lymph node involvement. Our aim was to analyze the clinical outcomes of a non-surgical, organ preserving management in this clinical setting. Patients and Methods: This retrospective study was performed in two tertiary centers from 2015 to 2020. Patients were included if they had histologically complete resection of an early esophageal cancer, with poor differentiation, lymphovascular invasion or deep submucosal invasion. Endoscopic resection was followed by chemoradiotherapy or follow-up in case of surgical contraindications or patient refusal. Outcome measures were disease-free survival (DFS), overall survival (OS), cancer specific survival (CSS) and toxicity of chemoradiotherapy. Results: Forty-one patients (36 with squamous cell carcinoma and 5 with adenocarcinomas) were included. The estimated high risk of lymph node involvement was based on poor differentiation (10/41; 24%), lympho-vascular invasion (11/41; 27%), muscularis mucosa invasion or deep sub-mucosal invasion (38/41; 93%). Thirteen patients (13/41; 32%) were closely monitored, and 28 (28/41; 68%) were treated by chemoradiotherapy or radiotherapy alone. In the close follow-up group, DFS, OS and CSS were 92%, 92% and 100%, respectively vs. 75%, 79% and 96%, respectively in the chemoradiotherapy group at the end of the follow-up. Serious adverse events related to chemoradiotherapy occurred in 10% of the patients. There were no treatment-related deaths. Conclusions: Our study shows that close follow-up may be an alternative to systematic esophagectomy after endoscopic resection of early esophageal cancer with a predicted high risk of lymph node involvement.

Objective: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a promising alternative for biliary decompression in patients with malignant distal biliary obstruction (MDBO), used either as a first-line approach or after other interventions have failed. This study aimed to evaluate the aggregated efficacy and safety of EUS-GBD in this patient population. Methods: A comprehensive literature search was carried out across PubMed/Medline, Embase, and Cochrane databases up to 9 January 2024, to identify studies reporting outcomes of EUS-GBD in MDBO cases. The primary endpoint assessed was clinical success, while secondary endpoints included technical success and the incidence of adverse events (AEs). Pooled outcomes were calculated using a random-effects model and presented with 95% confidence intervals (CIs). Results: Seven studies encompassing a total of 193 patients were included in the analysis. The combined clinical success rate for EUS-GBD was 88.1% [95% CI: 78.9–94.9%], while the technical success rate was 99.2% [95% CI: 97.5–100%]. The overall AE rate was 13.7% [95% CI: 9.3–18.8%], with the majority being mild to moderate in severity; no fatal complications were reported. Subgroup analyses indicated that use of smaller lumen-apposing metal stents (LAMS) (<15 mm) was associated with slightly higher clinical success (93.3% [95% CI: 72.4–99.9%]) compared to larger stents (≥15 mm) (87.1% [95% CI: 78.8–93.5%]), and a marginally lower rate of AEs (12.3% [95% CI: 6.4–19.7%] vs. 15.2% [95% CI: 6.5–26.6%]). Conclusions: EUS-GBD demonstrates excellent technical performance, high clinical efficacy, and a manageable safety profile in patients with MDBO and a patent cystic duct.

The indications for biliary drainage in cases of pancreatic head tumors with biliary obstruction are well established. ERCP with stent placement has long been the gold standard technique, outperforming surgery or percutaneous drainage. However, in cases of distal malignant biliary obstruction, ERCP becomes more complex, increasing the risk of complications. The advent of therapeutic endoscopic ultrasound (EUS), particularly EUS–choledochoduodenostomy (EUS-CDS) and EUS–hepaticogastrostomy (EUS-HGS), has transformed the management of distal malignant biliary obstruction in the case of pancreatic cancer. EUS-CDS creates communication between the duodenum and the common bile duct. Lumen-apposing metal stents (LAMSs) simplify the procedure, offering high technical and clinical success rates and making the technique easier to perform. Nevertheless, long-term dysfunction rates remain high, necessitating careful definition of procedural indications. EUS-HGS, a more complex technique, connects dilated left bile ducts to the stomach and requires advanced expertise; it is associated with a higher rate of complications. However, its clinical efficacy and technical success are comparable to those of EUS-CDS, and it is the preferred technique in cases of duodenal obstruction or altered anatomy. European and American guidelines currently position EUS-guided biliary drainage (EUS-BD) as a second-line approach after ERCP failure or when ERCP is not feasible, but there is a growing trend toward earlier use. Other techniques are emerging, such as EUS-guided gallbladder drainage (EUS-GBD) and combining EUS-HGS with antegrade stenting, offering valuable alternatives when conventional techniques fail or are inaccessible.

Endoscopic submucosal dissection (ESD) is considered the recommended technique by the European Society of Gastrointestinal Endoscopy (ESGE) for the treatment of colorectal lesions greater than 2 cm, especially those presenting risks of limited submucosal invasion [1]. To facilitate ESD, various traction techniques have been described. The combination of a clip and orthodontic elastic is commonly used [2]. Recently, a new European Conformity (CE)-marked traction device has become available. This system consists of a clip attached to four aligned rubber rings allowing multipoint traction during ESD. This device has not been previously described in the literature; here we present a case report illustrating its use. The case involves a 41-year-old woman with a 6-cm non-granular laterally spreading tumour located in the transverse colon. The lesion was classified as Paris IIa, Kudo Vi, Sano IIIa ([Fig. 1]). Due to the presence of a non-granular component and lesion size, resection via ESD was selected, employing the novel traction device ([Video 1]). The system was introduced through the operating channel and rotated to facilitate precise positioning. Initially, the clip connected to the traction rings was applied to one edge of the lesion. Then, a hemostatic clip secured the distal ring to the opposite edge ([Fig. 2]). Finally, a third clip provided traction by attaching one of the central rings to the opposite colonic wall, exposing the submucosal space widely for optimal dissection ([Fig. 3]). At the end of the procedure, the lesion was retrieved by pulling a free ring with coagulation forceps. The lesion was removed after a 60-minute procedure, yielding a specimen measuring 60 × 40 mm ([Fig. 4]). Pathology demonstrated an adenoma with high grade dysplasia with R0 margins, confirming curative resection. This new through-the-scope traction device allows multipoint and stable traction with wide submucosal exposure. Further studies are warranted to compare its efficacy with existing devices. Endoscopy_UCTN_Code_TTT_1AQ_2AD_3AD Article published online: 13 October 2025 © 2025. 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 Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany