INTRODUCTION: Hybrid endoscopic submucosal dissection (H-ESD), which utilizes ESD knife along with snare-based resection, has been developed to overcome the technical complexity of conventional ESD (C-ESD). The aim of this study was to compare the therapeutic outcomes of H-ESD vs C-ESD for nonpedunculated colorectal lesions ≥20 mm in size. METHODS: We conducted a multicenter randomized controlled trial to compare H-ESD and C-ESD (Short-ESD trial). Patients with colorectal lesions between 20 and 50 mm in size were randomly assigned (1:1) to H-ESD or C-ESD. Primary outcome was procedure time/speed. Secondary outcomes were en bloc and complete (R0) resection rates and adverse event rates. RESULTS: A total of 89 patients (median age 63 years; 49.3% women) with the median polyp size of 30 mm underwent H-ESD (n = 40) and C-ESD (n = 49). The mean procedure time of H-ESD was significantly shorter than that of C-ESD (41.1 ± 16.3 vs 54.3 ± 28.2 minutes; P = 0.007). The en bloc and R0 resection rates trended lower in the H-ESD vs C-ESD groups (77.5% vs 87.8%; P = 0.26% and 72.5% vs 79.6%; P = 0.46) without reaching statistical significance. Adverse event rate was similar between H-ESD and C-ESD (10% vs 8.2%; P = 1.00). DISCUSSION: Both H-ESD and C-ESD were safe and effective for resection of large colorectal lesions. H-ESD was associated with a shorter procedure time. H-ESD may represent a viable alternative to C-ESD, with the main advantage being easy applicability of a snare-based technique for colorectal lesions. Future studies are needed to further define the most suitable lesions for H-ESD, as to optimize efficiency and safety without compromising resection outcomes. ClinicaTrials.gov NCT NCT05347446.

Self-expanding metal stents play a crucial role in the management of patients with biliary obstruction. Endoscopic extraction of uncovered metal stents (UCMSs) and partially covered metal stents (PCMSs) could be challenging because of tissue ingrowth. No standardized technique can guarantee universal success. We present our technique and experience of endoscopic extraction of biliary stents in two patients with a UCMS and three patients with a PCMS. Three of the five patients had a previous failed attempt of stent extraction at an outside hospital. Overall, our composite success rate was 80% (4/5). The individual success rate was 100% (3/3) for PCMSs and 50% (1/2) for UCMSs. The stent-in-stent technique, in which a fully covered metal stent is placed through an existing UCMS/PCMS, was used in 60% (3/5) of the cases, with a success rate of 66.7% (2/3). We share our algorithmic approach to each case, with detailed emphasis on the technical aspects of the procedure.

Gastro-jejunal (GJ) anastomotic strictures occur in up to 30 % of patients after Roux-en-Y gastric bypass (RYGB). Endoscopic therapies such as balloon dilatation and stent placement are generally considered first-line, but a subset of patients remain refractory and require highly morbid revisional surgery. We report on consecutive RYGB patients with GJ stenosis with ≥2 failed prior endoscopic therapies, who underwent Endoscopic ultrasound-assisted gastric outlet remodeling (EUS-GOR). Twelve patients [mean age 59.08 years (range=45-85), 83.3% female] underwent attempted EUS-GOR between 2024 and 2025. Technical success was achieved in 10 of 12 patients (83.3%). Two attempts were aborted due to inability to identify a safe window for LAMS deployment. Amongst the technically successful cases (n=10), clinical success was achieved in 9 patients (90%). Mean GOOSS improved from 1.3 ± 0.8 pre-procedure to 2.8 ± 1.5 at follow-up (p=0.002). BMI increased from 24.8 ± 13.3 kg/m² to 25.8 ± 15.8 kg/m² (p=0.067), and serum albumin improved from 3.1 ± 1.2 g/dl to 4.1 ± 1.4 g/dl (p=0.02) at follow up. There were no major adverse events. At mean follow up of 23.4 weeks (range= 4- 63 weeks), one patient experienced significant re-stenosis of the anastomosis. No patients required surgical revision. EUS-GOR is technically feasible, safe and clinically effective in patients with refractory GJ strictures post-RYGB. This technique may offer a minimally invasive alternative to surgical revision in high-risk patients.

Objectives: Endoscopic mucosal resection (EMR) is an alternative to surgery for the treatment of large laterally spreading lesions. Residual or recurrent adenoma is a major limitation. This study aimed to quantify early and late recurrences and to assess its associated risk factors. Methods: The study was a single-center, multiendoscopist, longitudinal study conducted between January 1, 2013...