Endoscopy International Open最新文献

{"title":"The Classification for Adverse Events in GastRointEstinal Endoscopy (AGREE): Three-Year Evaluation and Additional Recommendations.","authors":"Querijn N E van Bokhorst, Hessel Bierma, Karlijn J Nass, Evelien Dekker, Manon van der Vlugt, Paul Fockens","doi":"10.1055/a-2965-6729","DOIUrl":"https://doi.org/10.1055/a-2965-6729","url":null,"abstract":"<p><p><b>Background</b> In 2021, a novel classification for gastrointestinal endoscopy-related adverse events (AEs) was introduced: the AGREE classification. This classification was developed to minimize subjectivity in AE assessment and facilitate more robust comparisons of endoscopic and surgical procedures. We conducted a comprehensive review of the classification three years after its introduction. <b>Methods</b> A citation analysis of the original AGREE publication was performed through March, 2025. Identified articles were reviewed to evaluate the classification's adoption, application, use for intra- and interdisciplinary comparisons, and comparability with other classifications. Accuracy of AE classifications was assessed based on review of unique scenarios reported across identified articles. Variability in the definition and reporting of AEs across studies was evaluated. <b>Results</b> In total, 167 unique articles, involving 33 countries across 5 continents, were identified. A notable year-over-year increase was observed. Available studies illustrated feasibility of the AGREE to facilitate both intra- and interdisciplinary comparisons, alongside significant correlations between AGREE-based AE severity assessments and assessments using other classifications. Accuracy of gradings was estimated at 85%. Misclassifications mostly involved overclassification of events without sequelae for the patient. Inconsistencies in grading, definition, and reporting of AEs were identified. Findings were used to establish recommendations for grading specific (challenging) AE scenarios and develop a checklist to support more standardized AE reporting. <b>Conclusions</b> A gradual increase in the annual citations of the AGREE classification was observed, suggesting growing awareness and academic interest. The recommendations provided could support more consistent grading, definition, and reporting of AEs, thereby improving opportunities for endoscopy quality evaluation.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"14 ","pages":"a29656729"},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Video-Based Artificial Intelligence Platform for Measuring Esophagogastroduodenoscopy Duration and Suggesting Real-Time Landmark Documentation.","authors":"Zohar Levi, Shani Brosh, Manor Shpriz, Ziv Varsano, Daniel Khodyrker, Dotan Asselman, Sari Maril, Keren Hod, Hadar Edelman-Klapper, Sapir Eizenstein, Ian M Gralnek, Inbar Segol, Naim Abu-Freha","doi":"10.1055/a-2965-6499","DOIUrl":"https://doi.org/10.1055/a-2965-6499","url":null,"abstract":"<p><p><b>Background and Study Aims</b> The European Society of Gastrointestinal Endoscopy (ESGE) sets key quality indicators for esophagogastroduodenoscopy (EGD), including a minimum procedural time of 7 min and photodocumentation of landmarks. We evaluated AI-derived procedural times, physician variations, and the impact of AI suggestions on landmark documentation rates. <b>Methods</b> This retrospective multicenter study included 78,336 EGDs performed by 213 physicians (01.01.2024-31.12.2025). A video-based AI platform (Theator Inc., Palo Alto, USA) measured procedural time, provided real-time landmark suggestions, and measured landmark documentation. Two blinded experts performed confirmatory validation of 500 procedures, with concordance defined as agreement within 2 s. <b>Results</b> Median procedural time was 3.30 min (IQR: 2.27-4.65). AI timestamps were concordant with expert review in 98.5% of cases (95% CI: 97.1-99.3%). Among 203 physicians performing at least 50 procedures, procedural time varied from 1.35 to 7.56 min (a 5.6-fold difference), with only 6.1% of procedures meeting the ESGE-recommended 7-min threshold. AI landmark suggestions reduced zero-landmark procedures by 42.6% (15.8 vs. 27.5%; <i>P</i> < 0.001), with improvements across all seven anatomical sites ( <i>P</i> < 0.001 for each). Physicians in the slowest total EGD time quintile had fewer normal examinations than those in the fastest quintile: 19.8 versus 31.7% ( <i>P</i> = 0.002), an association that persisted when physicians were restratified by biopsy-free procedural time. <b>Conclusions</b> Video-based AI accurately measured EGD procedure times and improved landmark documentation rate with AI-generated suggestions. A median procedural time of 3.3 min reveals a significant gap in quality standards. Automated, unattended measurement offers a scalable route to auditing upper endoscopy quality.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"14 ","pages":"a29656499"},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Modified Double-snare-assisted Endoscopic Mucosal Resection for Small Rectal Neuroendocrine Tumours: A Preliminary Study.","authors":"Xiwei Ding, Tianlu Huang, Fan Zhou, Supeng Wang, Wei Zhang, Nina Zhang, Liangliang Shi, Dehua Tang, Ying Lv, Lei Wang","doi":"10.1055/a-2938-5538","DOIUrl":"https://doi.org/10.1055/a-2938-5538","url":null,"abstract":"<p><p><b>Background</b> Modified double-snare-assisted endoscopic mucosal resection (mDS-EMR) through single-channel endoscopy has been reported as a promising technique for treating rectal neuroendocrine tumours (NETs). We evaluated the efficacy and safety of mDS-EMR for small rectal NETs. <b>Methods</b> This retrospective study included consecutive patients who underwent mDS-EMR between January 2025 and December 2025 at a single centre. Clinical data and therapeutic outcomes were analysed. <b>Results</b> Thirty-five patients with 38 rectal NETs were included. The median lesion size was 5 mm (range: 1-13 mm). The technical success rate was 100%. R0 resection was achieved in 37 out of 38 lesions (97.4%), including the largest lesion. The 95% confidence interval for R0 resection rate is 86.5-99.5%. The en bloc resection rate was 97.4%. The median resection time was 2.5 min per lesion (range: 1-9 minutes). The delayed bleeding rate was 2.6% (one patient). Perforation did not occur during or after the procedure. The median length of hospital stay after the procedure was 2 days (range: 0-5 days). The median cost of the device used for mDS-EMR is $237.4 (range: $186.7-537.2). <b>Conclusions</b> mDS-EMR appeared to be a safe, and effective method for resecting small rectal NETs.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"14 ","pages":"a29385538"},"PeriodicalIF":2.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Which patients with palliative malignant biliary obstruction will benefit most from biliary drainage: Development and validation of a prognostic score.","authors":"Raphael Olivier, Estelle Antoine, Marie Morvan, Augustin D'Aubigny, Jean Baptiste Nousbaum, Noemie Reboux, Enrique Perez Cuadrado Robles, Lucille Queneherve","doi":"10.1055/a-2963-7763","DOIUrl":"https://doi.org/10.1055/a-2963-7763","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1055/a-2760-6318.].</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"14 ","pages":"a29637763"},"PeriodicalIF":2.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial Results from a Novel Video Cholangiopancreatoscope: An International Multicenter Study.","authors":"David M de Jong, Willem J Lammers, Akin Inderson, Rogier P Voermans, Jan Werner Poley, George J M Webster, Heng Chi, Mark Ellrichmann, Jörn Arne Meier, Michael Praktiknjo, Cecilia Binda, Carlo Fabbri, Marco Spadaccini, Alessandro Repici, Andrea Anderloni, Aurelio Mauro, Marco J Bruno, Pieter Jan F de Jonge","doi":"10.1055/a-2965-6616","DOIUrl":"https://doi.org/10.1055/a-2965-6616","url":null,"abstract":"<p><p><b>Background</b> Novel 8.9-Fr and 11-Fr digital cholangiopancreatoscopes (Scivita Medical) have recently become available in Europe, but data on technical performance and safety remain limited. We report initial real-world experience with the Scivita platform. <b>Methods</b> This international, multicenter, retrospective cohort study included consecutive patients undergoing digital single-operator cholangioscopy (dSOC) or pancreatoscopy (dSOP) between March and October 2025 at 10 European centers. The primary outcome was technical success, defined as achievement of the intended procedural goal. Secondary outcomes included intra- and post-procedural complications, classified using the AGREE classification. <b>Results</b> In total, 77 patients (54.5% female; median age 70 years [IQR: 60-76]) were included. In 68 patients, 78 dSOC procedures achieved an overall technical success rate of 91% (71/78): choledocholithiasis 87% (33/38), biliary strictures 96% (24/25), selective cannulation 100% (2/2), evaluation of intraductal margins 50% (1/2), and migrated stent removal 100% (1/1). In all, 9 patients underwent 11 dSOP procedures, with an overall technical success rate of 63.6% (7/11): stone clearance 66.7% (4/6), intraductal papillary mucinous neoplasm assessment 50% (1/2), bridging pancreatic duct disruption 0% (0/1). No intraprocedural complications occurred. Postprocedural complications followed six dSOC procedures: cholangitis in two, mild post-ERCP pancreatitis in two, and abdominal pain without a clear substrate in two. One patient developed mild pancreatitis after dSOP. <b>Conclusion</b> Scivita dSOC demonstrated high technical success and an excellent safety profile. Larger prospective studies are warranted to validate these findings and define the role of dSOC and dSOP of Scivita cholangiopancreatoscopy in clinical practice, while also taking into account cost-effectiveness and environmental impact.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"14 ","pages":"a29656616"},"PeriodicalIF":2.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An in vivo Insect-based Platform for Preclinical Endoscopic Imaging.","authors":"Ronaldo A González García, Adrian P Regensburger, Benno Weigman, Sophie Wilhelm, Maximilian J Waldner, Joachim Wölfle, Gabriele A Krombach, Ferdinand Knieling, Anton G Windfelder, Hannah Vogt-Wolz","doi":"10.1055/a-2967-5493","DOIUrl":"https://doi.org/10.1055/a-2967-5493","url":null,"abstract":"<p><p><b>Background and Study Aim</b> Advanced endoscopic imaging technologies are routinely optimized and validated using vertebrate animal models. We present a novel, high-throughput insect model that provides a biologically realistic, reproducible, and ethically unproblematic alternative for evaluating endoscopic imaging modalities. <b>Methods</b> <i>Manduca sexta</i> larvae (fifth instar, 6.6 ± 0.23 g) were used for the demonstration of endoscopic imaging. Healthy controls ( <i>n</i> = 27) were compared with chemically (5% dextran sodium sulfate, <i>n</i> = 20) and bacterially ( <i>Bacillus thuringiensis</i> , <i>n</i> = 33) induced gut inflammation. <b>Results</b> Small-animal endoscopic imaging was readily feasible and revealed distinct anatomical features of <i>M. sexta</i> larvae. Animals with chemical-induced inflammation exhibited rectal swelling, melanization throughout the intestine, and increased transparency of the midgut epithelium. In comparison, bacterially induced inflammation resulted in intestinal swelling, a less extensive transparent membrane, melanization, and lesions in the hindgut and posterior midgut. <b>Conclusion</b> Endoscopic imaging of the intestinal tract of <i>M. sexta</i> larvae enabled a comprehensive examination of the internal anatomy under different inflammatory conditions. <i>M. sexta</i> larvae provide a suitable in vivo platform for studying intestinal inflammation over time. The model offers high survival rates, strong reproducibility, and cost-effectiveness, supporting the reduction of vertebrate animal experiments in accordance with the Replacement, Reduction, and Refinement principles.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"14 ","pages":"a29675493"},"PeriodicalIF":2.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Primary Endoscopic Submucosal Dissection versus Primary Endoscopic Mucosal Resection for Barrett's Esophageal Neoplasia Treatment.","authors":"Masami Omae, Annemijn D I Maan, Henrik Maltzman, Miroslav Vujasinovic, Magnus Nilsson, Fredrik Klevebro, Arjun D Koch, Francisco Baldaque-Silva","doi":"10.1055/a-2961-1399","DOIUrl":"https://doi.org/10.1055/a-2961-1399","url":null,"abstract":"<p><p><b>Background</b> Endoscopic resection of Barrett's esophageal neoplasia is commonly performed using either endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR). While submucosal dissection enables en bloc resection, institutional approaches vary. We compared clinical, histopathologic, and oncologic outcomes between a primary submucosal dissection strategy and a mucosal resection-based strategy with selective use of submucosal dissection. <b>Methods</b> This retrospective cohort study included all patients with Barrett's esophageal neoplasia treated at two European tertiary referral centers. At Karolinska University Hospital, the primary submucosal dissection strategy was adopted, whereas at Erasmus Medical Center the mucosal resection-based strategy was employed. Patients with prior endoscopic therapy or hematologic disorders were excluded. Primary outcomes were local recurrence, synchronous and metachronous lesions prior to ablation, and cancer- or treatment-related mortality. Secondary outcomes included resection quality, adverse events, and the need for repeated resections. Time-to-event analyses were performed using Kaplan-Meier and Cox regression models. <b>Results</b> A total of 332 patients were included (132 in the primary submucosal dissection group and 200 in the mucosal resection-based group). En bloc resection was more frequent with the primary submucosal dissection strategy (98.5% vs 40.0%, <i>p</i> < 0.001). Compared with the EMR-based strategy, the pESD strategy was associated with significantly lower local recurrence (3.0% vs 10.0%, <i>p</i> = 0.02) and fewer resection sessions per patient, whereas rates of synchronous and metachronous lesions were similar between groups. Adverse events and cancer- or treatment-related mortality did not differ between strategies. <b>Conclusions</b> Both strategies are safe. However, the primary submucosal dissection strategy is associated with lower local recurrence and fewer resection sessions.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"14 ","pages":"a29611399"},"PeriodicalIF":2.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trans-segmental POEM in the Management of Esophageal Asymmetry in Achalasia: Short Outcomes from a Retrospective, Single-center Study.","authors":"Jintao Xiao, Xingyang Luo, Bingbing Li, Yaochong Tan, Yu Wu, Xiaowei Liu","doi":"10.1055/a-2934-6927","DOIUrl":"10.1055/a-2934-6927","url":null,"abstract":"<p><p><b>Background and Study Aims</b> Esophageal asymmetry has been observed in some patients with achalasia, presenting as functional or structural alterations. This study aims to report a single-center experience with the trans-segmental peroral endoscopic myotomy (T-POEM) procedure for the management of esophageal asymmetry in AC. <b>Patients and Methods</b> Twenty-two patients with achalasia and severe dysphagia were included. Esophageal asymmetry and restrictive segments were assessed using the Eckardt score, HRM, barium esophagography, CT, EUS, and endoscopy. T-POEM was performed with targeted myotomy of tortuous segments, areas of localized muscular thickening, and localized restrictive muscular segments. This study evaluated the technical feasibility, safety, and observed short-term outcomes of T-POEM. <b>Results</b> T-POEM was technically successful in all 22 patients (100%), with a mean procedure time of 67 min. Three patients (13.6%) experienced documented periprocedural adverse events: one developed pneumothorax with fever, and two experienced transient retrosternal pain. All three events resolved with conservative treatment, and no event required endoscopic or surgical intervention or intensive care. Clinical success, defined as an Eckardt score ≤3 at the latest available follow-up, was observed in all 22 patients. The mean Eckardt score decreased from 6.7 to 1.3 ( <i>P</i> < 0.0001) during the available short-term follow-up. <b>Conclusion</b> In this small retrospective case series, T-POEM was technically feasible and was associated with short-term symptom improvement in selected patients with complex achalasia and marked esophageal asymmetry. These preliminary findings do not establish superiority over existing POEM techniques and require confirmation in larger prospective comparative studies.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"14 ","pages":"a29346927"},"PeriodicalIF":2.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized Selective Clipping for Persistent Immediate Bleeding after Cold Snare Polypectomy of Small Colorectal Polyps: A Prospective Cohort Study.","authors":"Dandan Zhao, Xiaoyan Zhang, Feng Gu, Rui Guo, Tianxu Jia, Shuang Yang, Wenwen Shen, Xiaocui Li, Ding Peng, Ziyu Liu, Hui-Hong Zhai","doi":"10.1055/a-2937-7891","DOIUrl":"10.1055/a-2937-7891","url":null,"abstract":"<p><p><b>Background and Study Aims</b> Delayed bleeding after cold snare polypectomy of 4-9 mm nonpedunculated colorectal polyps is rare, but persistent immediate bleeding is relatively common and lacks a standardized management framework. We prospectively evaluated 30-day outcomes of a standardized selective clipping protocol for persistent immediate bleeding after cold snare polypectomy. <b>Patients and Methods</b> In this prospective, single-center cohort study, consecutive adults with at least one eligible 4-9 mm nonpedunculated colorectal polyp resected by cold snare polypectomy between January 1 and December 31, 2024 were enrolled. All bleeding defects were irrigated and observed for 60s, and clips were applied only for persistent oozing according to a standardized selective clipping protocol. The primary endpoint was delayed bleeding within 30 days after polypectomy. <b>Results</b> Among 2176 patients with 4343 polyps, 315 patients (14.5%) and 369 lesions (8.5%) required clipping for persistent immediate bleeding. Delayed bleeding occurred in 5 patients (0.23%), all confirmed by repeat colonoscopy. Patient-level delayed bleeding rates were 0.63% (2/315) in the selective-clipping group and 0.16% (3/1861) in the group without clipping. Lesion-level delayed bleeding rates were 0.54% (2/369) in clip-treated lesions and 0.13% (5/3974) in unclipped lesions. Exploratory analysis suggested chronic kidney disease and five or more synchronous polyps as candidate risk factors. <b>Conclusions</b> Under a standardized selective clipping protocol, delayed bleeding after cold snare polypectomy of 4-9 mm nonpedunculated colorectal polyps was infrequent in both groups, and all confirmed bleeding events were successfully managed endoscopically.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"14 ","pages":"a29377891"},"PeriodicalIF":2.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Biliary Cannulation Masterclasses Improve Self-reported Knowledge and Teaching Confidence in Needle-knife Fistulotomy.","authors":"Shabbir Jivanjee, Damien Durkin, Noor H Bekkali, Sajjad Mahmood, Umesh Basavaraju, Vikramjit Mitra, Oliver Reed, John Anderson, Trevor Brooklyn, Srisha Hebbar","doi":"10.1055/a-2965-6853","DOIUrl":"10.1055/a-2965-6853","url":null,"abstract":"<p><p><b>Background and Aims</b> Needle-knife fistulotomy (NKF) is widely used for difficult biliary access, yet formal training is inconsistent and teaching confidence remains low. We aimed to characterise baseline NKF experience among independent endoscopic retrograde cholangiopancreatography (ERCP) practitioners and evaluate the self-reported educational impact of a national advanced biliary cannulation masterclass series. <b>Materials and Methods</b> Ten 1-day masterclasses were delivered for 152 independent ERCP practitioners, combining video-based case discussion, didactic teaching, and supervised hands-on simulator training. Pre-course questionnaires captured baseline NKF use. Post-course questionnaires used a retrospective before-and-after format across six cannulation domains. Wilcoxon signed-rank tests were applied. <b>Results</b> Of 126 pre-course respondents, 82.5% had used NKF, but only 33.3% had received formal training and 27.0% had trained a trainee. Prospective pre-course NKF knowledge was 5.8/10 and teaching confidence was 3.7/10. On retrospective post-course assessment ( <i>n</i> = 122), median NKF knowledge increased from 5/10 (interquartile range [IQR], 4-7) to 9/10 (IQR, 8-9; <i>p</i> < 0.001) and teaching confidence increased from 4/10 to 7/10 ( <i>p</i> < 0.001); the proportion rating ≥7/10 rose from 14% to 53%. Post-course, 94.3% intended to use NKF more often, and 79.8% would consider primary fistulotomy in selected cases. <b>Conclusions</b> NKF is commonly used despite limited formal training and low teaching confidence. A national masterclass series was associated with improvements in self-reported knowledge and teaching confidence. A planned longitudinal prospective audit will determine whether these gains translate into changes in practice and patient outcomes.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"14 ","pages":"a29656853"},"PeriodicalIF":2.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}