Special articleGIE Editorial Board Top 10: advances in GI endoscopy in 2021
Section snippets
Optimizing Colonoscopy: Water Exchange, Adenoma Detection, Artificial Intelligence, and Bowel Preparation
Several randomized controlled trials (RCTs) and meta-analyses of the inverse relationship between adenoma detection rate (ADR) and interval cancers moved the field forward in 2021 by focusing on 3 major factors: water exchange (WE) colonoscopy, cap- and Endocuff-assisted (Endocuff, Olympus, Tokyo, Japan) colonoscopy, and artificial intelligence (AI) with computer-assisted detection and diagnosis (CADe/CADx) algorithms. These were complemented by an ASGE-endorsed, rigorous, modified-Delphi
Bariatric Endoscopy: Advances in Balloons, Mucosal Resurfacing, and Other Promising Options
Data supporting endoscopic bariatric and metabolic therapies for the management of obesity and its associated comorbid conditions continued to emerge in 2021. In 1 pivotal multicenter RCT, Abu Dayyeh et al15 randomized 288 patients to receive either a novel adjustable intragastric balloon (IGB) with lifestyle intervention (diet and exercise) or lifestyle intervention alone. Patients were followed for 32 weeks, with those in the adjustable IGB group achieving 15% total body weight loss compared
Pushing the Needle: EUS Needle Guidance, Sampling the Cyst Wall, Tissue Sampling, and All-Purpose Drainage
Feasibility and efficacy of various EUS-guided interventions continued to be a major focus of endoscopic study in 2021 and were covered in an American Gastroenterological Association white paper that detailed the continued evolution of EUS from a diagnostic to an interventional modality.24 Lending credence to EUS-guided gallbladder drainage as a viable option to laparoscopic cholecystectomy, Teoh et al25 performed a matched analysis and found the 2 procedures to have comparable procedure
Poetry Abounds: POEM, Gastric POEM, Zenker POEM, and Cricopharyngeal POEM
Endoscopic submucosal tunneling continues to evolve as a fundamental approach to the treatment of various GI disorders. In particular, esophageal peroral endoscopic myotomy (POEM) was solidified as an established treatment option for achalasia and esophageal spastic motility disorders in a 2021 ASGE-endorsed core curriculum statement that outlined the essential technical, nontechnical, and cognitive skills involved in its performance.33 Advances in POEM focused on correcting its historic
Close the Door, Stop the Bleed: Advances in Defect Closure, Fistula Management, Managing Perforations, and Hemostasis
As the luminal boundaries of endoscopy continue to be pushed, interest in the endoscopic management of iatrogenic defects and bleeding has abounded in both feasibility and clinical trials. Beyond multiple studies exploring the use of clips,40 endoscopic suturing, and endoscopic vacuum therapy41 for the closure of GI perforations and fistulas, new techniques such as the injection of polyglycolic acid sheets and fibrin glue42 and emulsified adipose tissue stromal vascular fraction43 were also
The “Woke” Endoscopist: Gender and Racial Disparities in Endoscopy as a Profession and Patient Outcomes, Environmental Impact of Endoscopy, and Importance of Endoscopic Wellness
A number of 2021 publications concerning endoscopic practice amplified what is becoming a powerful appeal for fair and honest dialogue to make gastroenterology a truly inclusive field through the exploration of gender, ethnic, and racial disparities in our graduate medical training programs, endoscopy suites, and medical societies.48 In a follow-up study to their 2020 GIE editorial, Rabinowitz et al49 published results of an anonymous survey of more than 400 fellows and practicing
Endohepatology: Advances in EUS-Guided Liver Biopsy Sampling and Measuring Portal Pressures
Over the last few years, multiple prospective, single-arm and retrospective comparative studies have shown safety and adequate diagnostic yield of EUS-guided liver biopsy sampling (EUS-LB) compared with percutaneous approaches.68, 69, 70, 71 A 2021 meta-analysis involving 23 studies and 1326 patients suggested optimal specimen adequacy of EUS-LB when using fine-needle biopsy (FNB) needles, despite few prospective RCTs on the topic.72 The wisdom of this conclusion was called into question by a
FNA Versus FNB Sampling: And the Winner Is…
EUS-guided FNA has become the criterion standard for diagnosis of pancreatic neoplasm, although limitations can include inadequate aspirated sample cellularity, especially in the presence of desmoplastic fibrosis. FNA also requires cytologic expertise, and its efficacy to date has been somewhat reliant on rapid onsite evaluation by pathologists. More recently, FNB sampling has been proposed to have improved diagnostic accuracy and need for fewer needle passes,80 although its limitations have
EMR Versus ESD: The Western Hemisphere Is (Finally) Catching Up
Data supporting the safety and efficacy of endoscopic submucosal dissection (ESD) for the management of superficial GI neoplasms continued to emerge over 2021, suggesting that differences between Asian and Western endoscopic practice in this area may be a transient phenomenon. In particular, 2 large multicenter, prospective studies from North America (n = 692) and Germany (n = 1000) independently demonstrated that ESD of superficial lesions in the upper and lower GI tract is associated with
The Cold Revolution: Cold Snare Polypectomy
Cold snare polypectomy (CSP) is accepted as a standard resection method for sessile colorectal polyps <10 mm in size that reduces electrocautery risks. However, contradictory evidence regarding the risks of leaving residual polypoid tissue when using CSP to treat large polyps >10 mm continues to fuel questions and doubts. To investigate the residual polyp rate after CSP for large polyps, McWhinney et al95 retrospectively surveyed patients and found at least 8% of 566 polyps resected by cold EMR
Conclusion
The 10 topics discussed in this article represent consensus among the GIE Editorial Board regarding the most significant, globally transformative advances in diagnostic and therapeutic GI endoscopy over calendar year 2021. Although the Editorial Board recognizes that far more research occurred last year in our professional GI world than was possible to cover, it also hopes this review is of value to today’s practitioners and investigators and perhaps will even inspire the endoscopic pioneers
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Duodenal mucosal resurfacing: proof-of-concept, procedural development, and initial implementation in the clinical setting
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Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes: 6-month interim analysis from the first-in-human proof-of-concept study
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A tale of gastroenterology & endoscopy: It was the best of times
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2023, Gastroenterology and Hepatology
DISCLOSURE: All authors disclosed no financial relationships.