Endoscopic submucosal dissection (ESD) is the preferred technique for en bloc resection of superficial colorectal neoplasms. Resection of extensive lesions with ESD can be challenging, owing to loss of orientation in the submucosal space. In this case series, we describe the double-tunneling (DoT) butterfly method for ESD of extensive rectal neoplasms. The key feature of the DoT butterfly method is the creation of 2 tunnels that are transformed into bilateral flaps, leaving a submucosal septum between them. Four rectal neoplasms measuring (maximum diameter) 7 cm, 8 cm, 9 cm, and 18 cm, respectively, were resected in 4 patients by use of the DoT butterfly method. The lesions included recurrent adenoma (n = 1) and dysplasia (n = 1) in longstanding ulcerative colitis. Curative R0 resection was confirmed in all 4 cases. Histologic examination showed tubular adenomas with low-grade dysplasia in 1 of 4 patients and focal high-grade dysplasia in 3 of 4 patients. One patient experienced postprocedural bleeding that required endoscopic reintervention. The DoT butterfly method appears to be useful for the resection of extensive rectal neoplasms. A prospective study is required to assess whether these results can be reproduced in a large cohort of patients.

The Functional Lumen Imaging Probe (EndoFLIP^®) system is an impedance-based technology providing real-time measurements of cross-sectional area (CSA) and intraballoon pressure across a luminal segment. Initially developed for esophagogastric junction (EGJ) evaluation in achalasia, the application of EndoFLIP has subsequently expanded to the assessment of both sphincteric and non-sphincteric regions throughout the gastrointestinal tract in a variety of clinical conditions, including eosinophilic esophagitis (EoE), post-fundoplication states, and gastroparesis. Its unique ability to be utilized in both the diagnostic and therapeutic settings, including the assessment of treatment response, makes it a valuable tool in the overall management of gastrointestinal motility disorders. The present review extends beyond a simple overview of EndoFLIP applications by providing a comprehensive evaluation of its performance in comparison with other diagnostic modalities, as well as the current knowledge gaps regarding its use. Study limitations and procedure-related aspects requiring further investigation are critically discussed, with the aim of supporting and guiding future research in this field.

Introduction The ‘Speedboat-RS2’ (Creo-Medical/Wales/UK) is the first multi-modality device, incorporating bipolar-radiofrequency energy for cutting, microwave energy for coagulation, an integrated needle for submucosal injection, and a rotatable blade with a heat insulated hull. Methods A prospective database from June 2018 to Jan 2019 was analyzed including 20 consecutive patients (mean age: 69.7±15.18 years, 50% males) with 20 colorectal Lateral Spreading Tumours/LSTs. Two operators performed all colonic endoscopic submucosal dissections/ESDs. Results Sixteen procedures were performed under conscious sedation and 4 general anaesthesia (Olympus/CF-HQ290ZL/13.2 mm tip diameter). Median lesion size was 4 cm (range 1–9 cm). The LSTs and procedural characteristics are described in table 1. 1/20 case was abandoned during dissection. Endoscopically en-bloc resection was achieved in 11/19 (57.8%) cases and 10/19 cases (52.6%) resections were R0 histologically. In 8/19 patients snare excision was used to facilitate resection with a median of 2 resection pieces. Microwave energy was utilized to pre-coagulate and control active bleeding successfully in 17/19 (89.5%) cases and haemostatic monopolar forceps was required in 2 cases. Histology showed dysplasia in 15/19, NET in 1/19 and T1 cancer in 3/19. 2/3 patients with T1 cancers had endoscopic surveillance with no recurrence and 1 had surgery and no residual tissue. 3/19 patients experienced delayed bleeding all requiring endoscopic hemostasis. No perforation was seen. Conclusions This early experience with SRS2 shows colorectal submucosal dissections are feasible with an acceptable safety profile. Resection times for lesions ≤4 cm were relatively quick and microwave coagulation appeared to be effective in most cases.

Background/Objectives: Colonoscopy, as the modality of choice for Colorectal cancer (CRC) screening, has a well-documented impact on decreasing CRC incidence. Although starting CRC screening at the age of 50 for average-risk individuals is widely recommended, several studies suggest the need for an earlier onset. Methods: Study of 353 average-risk individuals aged 40-54 years old who underwent colonoscopy investigation. Out of the study population, 3 age groups (40-44, 45-49, and 50-54 years old) were formed. Adenoma detection rate (ADR), polyp detection rate (PDR), sessile serrated lesions detection rate (SDR), and rate of advanced colorectal neoplasia (ACRN) and colorectal cancer (CRC) were compared between the groups. Results: Comparing age groups 40-44 vs. 50-54 years old we found a statistically significant difference in terms of PDR and ADR (p-value= 0.038 and 0.045 respectively). On the contrary, no statistically significant difference was found between the age groups 45-49 and 50-54 years old, in terms of PDR, ADR, SDR, and CRC detection rate (p-value= 0.063 for PDR, 0.2 for ADR, 0.3 for SDR, >0.9 for CRC). ACRN rates were comparable between the age groups 45-49 and 50-54 years old. As for patients’ gender, males 50-54 had increased ADR and PDR in comparison with groups 40-44 and 45-49. In contrast, females bared no statistically significant difference in terms of ADR and PDR in all groups. Conclusions: Age group 45-49, sharing comparable detection rates with group 50-54, could also be considered for colorectal cancer screening.