Best Practice & Research Clinical Gastroenterology最新文献

{"title":"Developing and operating a high-quality endoscopic resection unit: insights from western institutions","authors":"Samer Al-Dury,&nbsp;Sinan Sharba,&nbsp;Yahya Al Hammada,&nbsp;Noora Alzadjali,&nbsp;Noor Mohammed","doi":"10.1016/j.bpg.2026.102132","DOIUrl":"10.1016/j.bpg.2026.102132","url":null,"abstract":"<div><div>The increasing detection of early gastrointestinal neoplasia and large precursor lesions across Western health systems has expanded the role of organ-preserving endoscopic therapies. Endoscopic mucosal resection (EMR). endoscopic submucosal dissection (ESD) and other related endoscopic resection techniques can provide curative-intent treatment with accurate histopathologic staging, but their safe and reproducible delivery depends on robust service design rather than technical expertise alone. This narrative review synthesizes practical insights from Western institutions on the development and operation of a high-quality endoscopic resection unit. Key domains include service model and referral pathways, patient selection and peri-procedural planning, procedural environment, equipment and accessories, multidisciplinary support, complication rescue pathways, workforce training, quality monitoring, and institutional sustainability. Particular emphasis is placed on standardization, multidisciplinary integration, prospective audit, and governance structures that support consistent outcomes and long-term program viability. High-quality resection units should be regarded not simply as procedural services, but as organized clinical platforms that deliver safe, scalable, and organ-preserving treatment, with resilience built within the team framework.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"82 ","pages":"Article 102132"},"PeriodicalIF":5.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitigating risk following upper gastrointestinal Endoscopic Submucosal Dissection: preventing bleeding, perforation and stricture formation","authors":"Giulio Calabrese,&nbsp;Rossella Maresca,&nbsp;Livio Bonacci,&nbsp;Tommaso Rozera,&nbsp;Giuseppe Spinosa,&nbsp;Federico Barbaro,&nbsp;Sandro Sferrazza","doi":"10.1016/j.bpg.2026.102126","DOIUrl":"10.1016/j.bpg.2026.102126","url":null,"abstract":"<div><div>Endoscopic submucosal dissection (ESD) is an effective organ-sparing technique for superficial neoplasia in the upper gastrointestinal tract, although it remains associated with a non-negligible risk of complications. This narrative review provides an integrated overview of the entire ESD pathway, from pre-procedural risk stratification to intraprocedural management and post-procedural care.</div><div>Adverse events should be interpreted as the result of the interaction between patient-related factors, lesion characteristics, and procedural complexity. During the procedure, maintaining stable control of the submucosal plane is central; in this context, strategies such as anticipatory vessel coagulation, optimized dissection, traction, and saline immersion contribute to improve visualization and reduce bleeding and perforation risk.</div><div>Post-procedural risk is largely site-specific, with stricture predominating in the esophagus, delayed bleeding in the stomach, and both bleeding and perforation in the duodenum. A risk-adapted approach is therefore essential to improve safety and optimize outcomes.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"82 ","pages":"Article 102126"},"PeriodicalIF":5.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training in endoscopic submucosal dissection: Current models and future needs","authors":"Pieter Jan Poortmans,&nbsp;David James Tate","doi":"10.1016/j.bpg.2026.102128","DOIUrl":"10.1016/j.bpg.2026.102128","url":null,"abstract":"<div><div>Endoscopic submucosal dissection (ESD) has transformed the management of superficial gastrointestinal neoplasia but remains technically demanding, with a steep learning curve posing significant training challenges, particularly in Western countries where case volumes are lower than in East Asia. This review summarizes current ESD training models including ex vivo and live animal models, simulation platforms, and traction devices. We examine learning curve evidence demonstrating that structured supervision reduces the learning curve from approximately 250 to 30-40 cases. Regional differences between Eastern and Western training paradigms are analysed. We propose a five-phase competency-based training pathway and identify priorities for future research including curriculum validation, artificial intelligence-assisted assessment, and scalable mentorship strategies.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"82 ","pages":"Article 102128"},"PeriodicalIF":5.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies in endoscopic resection for gastrointestinal neoplasia: A Western perspective","authors":"Julia L. Gauci,&nbsp;Francesco V. Mandarino","doi":"10.1016/j.bpg.2026.102134","DOIUrl":"10.1016/j.bpg.2026.102134","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"82 ","pages":"Article 102134"},"PeriodicalIF":5.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in endoscopic strategies for oesophageal squamous cell carcinoma","authors":"Pieter Sinonquel,&nbsp;Jeremie Jacques,&nbsp;Raf Bisschops,&nbsp;Philippe Leclercq","doi":"10.1016/j.bpg.2026.102133","DOIUrl":"10.1016/j.bpg.2026.102133","url":null,"abstract":"<div><div>Endoscopic management of early oesophageal squamous cell carcinoma (ESCC) is progressively moving from a binary curative versus non-curative approach towards a risk-adapted strategy. Accurate optical assessment remains essential, but its limitations support the use of endoscopic resection, particularly endoscopic submucosal dissection (ESD), as both a therapeutic and a staging procedure. Compared with endoscopic mucosal resection, ESD provides higher en-bloc and complete resection rates, better histological assessment and lower local recurrence, although it requires dedicated expertise. Post-resection management should integrate depth of invasion, lymphovascular invasion, differentiation, margin status, comorbidities and patient preferences. Circumferential lesions represent a specific challenge because of the important risk of refractory stenosis. Definitive chemoradiotherapy remains a major organ-preserving option, either after non-curative ESD or as primary treatment, while salvage endoscopic therapy may be considered for selected superficial local failures. Multidisciplinary discussion is therefore central to balance oncological control, treatment morbidity and quality of life.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"82 ","pages":"Article 102133"},"PeriodicalIF":5.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced rectal lesions: Best practices for assessment and management","authors":"Mayan Eitan,&nbsp;Nicholas G. Burgess","doi":"10.1016/j.bpg.2026.102119","DOIUrl":"10.1016/j.bpg.2026.102119","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and aims&lt;/h3&gt;&lt;div&gt;Advanced rectal lesions (ARLs), including large laterally spreading lesions (LSLs), villous or high-grade dysplastic adenomas, and early rectal cancers, constitute a critical transitional category between benign adenoma and invasive carcinoma. Historically, radical surgery was liberally employed for these lesions, often resulting in significant morbidity and permanent stoma formation. Contemporary endoscopic and transanal techniques permit curative resection while preserving anorectal function, but careful assessment is mandatory to avoid undertreatment of covert cancers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We reviewed international guidelines and key studies on ARL assessment and management, focusing on endoscopic imaging, staging modalities and therapeutic techniques. Evidence from ESGE, ASGE, NCCN and BSG/ACPGBI guidelines, prospective trials, and observational cohorts was appraised and summarized. Points of divergence between society guidelines are highlighted where relevant to rectal lesion management.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The rectum has distinct anatomical and vascular characteristics which strongly influence endoscopic and surgical decision making. Lesions in the rectum have a higher risk of submucosal invasive cancer (SMIC) compared to the remainder of the colon andare more likely to be larger, nodular and villous in nature. Rectal surgery is complex and has a higher risk of stoma formation and adverse events than colon surgery. Appropriately selected organ preserving techniques reduce risk and preserve function for patients.&lt;/div&gt;&lt;div&gt;High-definition white-light endoscopy with virtual or dyebased chromoendoscopy permits accurate optical diagnosis of ARLs. Assessment of surface features and morphology allows the endoscopist to predict the risk of covert cancer. Routine biopsy is discouraged to avoid fibrosis. Endoscopic ultrasound and pelvic MRI are used selectively for lesions suspicious for deeper invasion or when planning transanal surgery.&lt;/div&gt;&lt;div&gt;Endoscopic resection is appropriate for the majority of lesions in the rectum and a selective strategy ensures that the appropriate technique can be chosen to optimize oncological outcomes. Lesions with features of deep invasive cancer should be carefully appraised and discussed in a multidisciplinary setting. Selected lesions with a low risk of covert cancer may be resected by endoscopic mucosal resection (EMR) with margin ablation. Endoscopic submucosal dissection (ESD) provides superior en-bloc and curative resection rates for higher risk lesions. Emerging data demonstrates that ESD has equivalent or superior outcomes compared to transanal endoscopic microsurgery (TEM), or transanal minimally invasive surgery (TAMIS) for larger rectal lesions. Hybrid techniques (e.g., underwater EMR, tip-in EMR, full-thickness resection devices) may also be utilised in the therapeutic framework.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;An evidence-b","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"82 ","pages":"Article 102119"},"PeriodicalIF":5.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controversies in technique selection for endoscopic resection of Barrett's neoplasia","authors":"Julia L. Gauci,&nbsp;Yusuke Fujiyoshi,&nbsp;Tony He,&nbsp;Christopher Teshima","doi":"10.1016/j.bpg.2026.102120","DOIUrl":"10.1016/j.bpg.2026.102120","url":null,"abstract":"<div><div>Barrett's esophagus-related neoplasia is now predominantly managed with endoscopic eradication therapy. This strategy combines endoscopic resection of visible lesions with ablation of residual Barrett's mucosa, offering excellent safety and long-term disease control. Two endoscopic resection techniques are used in current practice: endoscopic mucosal resection and endoscopic submucosal dissection. Existing guideline recommendations for technique selection vary but are largely based on the suspected depth of invasion and preference for R0 resection. However, the unique biological and clinical features of Barrett's challenge this framework. Neoplasia arises within a field of metaplastic change, and the ultimate goal is not simply complete resection but durable eradication of disease. The traditional oncologic endpoint, R0 resection, may be less meaningful in this context, while more clinically relevant outcomes, such as recurrence, disease-free survival, and patient-centred measures, remain inconsistently defined and reported. Furthermore, technical and procedural considerations, including histopathological accuracy, safety, and resource use, add further complexity to decision-making. This review explores the evolving evidence, highlights ongoing debates in technique selection for Barrett's neoplasia, and proposes considerations to inform patient-centred clinical decision-making and future research priorities.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"82 ","pages":"Article 102120"},"PeriodicalIF":5.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accurate histology prediction before resection of colorectal polyps: Is artificial intelligence shaping the future of optical diagnosis?","authors":"Alexander Jans,&nbsp;Raf Bisschops","doi":"10.1016/j.bpg.2026.102125","DOIUrl":"10.1016/j.bpg.2026.102125","url":null,"abstract":"<div><div>Artificial intelligence (AI) is increasingly entering colonoscopy practice, with computer-aided detection (CADe) systems improving polyp and adenoma detection. However, the next challenge is not only to detect more lesions, but to determine in real time which lesions require resection, histopathological assessment, surveillance adjustment or surgical referral. Computer-aided diagnosis (CADx) systems aim to support this step by predicting colorectal polyp histology before resection and enabling optical diagnosis strategies such as “resect-and-discard” and “diagnose-and-leave”.</div><div>The clinical value of CADx should not be judged by diagnostic accuracy alone. To become clinically meaningful, CADx must safely guide management decisions, meet established ASGE and ESGE thresholds, integrate into real-time workflow and remain valid across endoscopy platforms, imaging modalities, lesion subtypes and operator expertise. Although systems such as CAD EYE, GI Genius, POLAR and endocytoscopy-based algorithms show promising diagnostic performance, recent meta-analyses suggest that CADx has not yet provided clear incremental benefit for “diagnose-and-leave” or “resect-and-discard” strategies when added to endoscopist assessment. This may reflect high baseline confidence among endoscopists, but also current limitations including binary classification schemes, inconsistent handling of sessile serrated lesions, lack of calibrated confidence scores and limited explainability.</div><div>Beyond diminutive-polyp characterisation, AI is also being explored for invasion-depth prediction in larger or suspicious colorectal lesions, where incorrect predictions may lead to undertreatment or overtreatment. Moreover, AI-assisted colonoscopy remains dependent on high-quality mucosal exposure, adequate bowel preparation, careful inspection and trained endoscopists. Overall, CADx remains promising, but broader implementation requires prospective real-world validation, explainable and interoperable systems, robust human-AI interaction and clinically relevant outcomes before it can safely substitute histopathology in selected settings.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"82 ","pages":"Article 102125"},"PeriodicalIF":5.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ preservation in early-stage rectal cancer: a narrative review of biological rationale, treatment strategies, and future directions","authors":"Sen N. Verhoeve,&nbsp;Pieter J. Tanis,&nbsp;Barbara A. Bastiaansen,&nbsp;Johannes H.W. de Wilt,&nbsp;Martijn P.W. Intven,&nbsp;Miangela M. Lacle,&nbsp;Sjoerd G. Elias,&nbsp;Leon M.G. Moons","doi":"10.1016/j.bpg.2026.102103","DOIUrl":"10.1016/j.bpg.2026.102103","url":null,"abstract":"<div><div>Recent advances in rectal cancer treatment and evolving insights into tumour biology have expanded the opportunities for organ preservation in early-stage rectal cancer. Historically, these tumours were managed by rectal resection, but less invasive, step-up approaches are now increasingly being adopted. This narrative review summarizes current treatment strategies for early-stage rectal cancer (cT1b-T2N0). Organ preservation may start with local excision, followed by adjuvant (chemo)radiotherapy (CRTx), completion surgery, or active follow-up with salvage treatment in case of recurrence. Alternatively, management may begin with (C)RTx, followed by a response-based approach: a watch-and-wait strategy in case of clinical complete response, local excision or contact X-ray brachytherapy (CXB) in case of minimal residual intramural cancer, and completion surgery in case of poor response. The oncological and functional outcomes of these strategies are reviewed, aiming to support multidisciplinary discussion and shared decision-making in the management of early rectal cancer.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"82 ","pages":"Article 102103"},"PeriodicalIF":5.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of non-exposed endoscopic full thickness resection in the gastrointestinal tract","authors":"Daniel R. Quast,&nbsp;Mousa Ayoub,&nbsp;Oscar Cahyadi,&nbsp;Alanna Ebigbo","doi":"10.1016/j.bpg.2026.102105","DOIUrl":"10.1016/j.bpg.2026.102105","url":null,"abstract":"<div><div>Endoscopic full-thickness resection (EFTR) has emerged as an innovative approach for the management of complex gastrointestinal lesions not amenable to conventional endoscopic techniques. EFTR enables <em>en bloc</em> transmural resection with reliable defect closure, achieving high R₀ resection rates in non-lifting colorectal adenomas, subepithelial tumors, and selected early T₁ cancers. The technique offers a minimally invasive alternative to surgical intervention in appropriately selected cases. Technical failure and adverse event rates remain low when evidence-based patient and lesion selection criteria are considered. Structured training may further reduce technical failure rates. Ongoing studies will further clarify the role of EFTR and hybrid approaches in therapeutic endoscopy. This practice-oriented review presents the current evidence on the clinical efficacy, safety, and technical advances associated with EFTR, with a focus on non-exposed EFTR and the Full-Thickness Resection Device (FTRD).</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"82 ","pages":"Article 102105"},"PeriodicalIF":5.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}