Esophagus to Small Intestine

Gastrointest Endosc. 2023;97(6):1100−8

Wang H, Sidhu M, Gupta S, Cronin O, O’Sullivan T, Whitfield A, Burgess NG, Bourke MJ

Cold snare EMR for the removal of large duodenal adenomas

Background and aims: Large (≥ 15 mm) duodenal adenomas (DAs) are premalignant and require removal. Existing endoscopic resection tech-niques are compromised by serious adverse events (SAEs), most notably postprocedural bleeding (PPB) and perforation. To ameliorate these problems, the authors sought to evaluate the novel technique of cold snare endoscopic mucosal resection (CS-EMR) against the emerging stand-ard of conventional EMR with thermal ablation of the postresection margin (EMR-T) for the safe and effective removal of DAs.
Methods: Consecutive patients were enrolled in a single tertiary center for CS-EMR and prospectively analyzed against a previously reported cohort of EMR-T from the same center. The primary outcome was rate of SAEs. Secondary outcomes were residual or recurrent adenoma at first surveillance endoscopy (SE1) at 6 months and technical success per lesion.
Results: Between October 2019 and July 2022, a total of 50 DAs ≥ 15 mm were removed via CS-EMR (median size, 30 mm [interquartile range {IQR}, 19−40 mm]; mean ± standard deviation [SD] patient age, 70 ± 9.2 years) compared with 54 DAs via EMR-T (median size, 30 mm [IQR, 19−40 mm]; mean patient age, 68 ± 12.2 years). CS-EMR had a significantly lower rate of intraprocedural bleeding (2.0% vs. 37%, p < 0.001) and PPB (4.0% vs. 16.7%, p = 0.036). Two cases (4.0%) of immediate perforation occurred in CS-EMR; these were recognized immediately and closed with clips without sequelae. Total SAEs (16.0% vs. 16.7%, p = 1) and technical success (100% vs. 100%, p = 1) were identical. Recurrence at SE1 was significantly higher with CS-EMR (24.4% vs. 2.3%, p = 0.002).

Conclusions: Cold snare endoscopic mucosal resection reduces intraprocedural bleeding and postprocedural bleeding. However, it may increase the risk of immediate perforation and is associated with a significantly higher rate of recurrence at first surveillance endoscopy. Further technical refinements are required to optimize endoscopic resection techniques for duodenal adenomas.

Prof. Dr. M.J. Bourke, Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia,
E-Mail: mi-chael@citywestgastro.com.au

DOI: 10.1016/j.gie.2023.01.040

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Esophagus to Small Intestine

Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg)

Gut. 2023;72:1054−72

Burgos-Santamaría D, Nyssen OP, Gasbarrini A, Vaira D, Pérez-Aisa Á, Rodrigo L, Pellicano R, Keco-Huerga A, Pabón-Carrasco M, Cas-tro-Fernandez M, Boltin D, Barrio J, Phull P, Kupcinskas J, Jonaitis L, Ortiz-Polo I, Tepes B, Lucendo AJ, Huguet JM, Areia M, Brglez Jurecic N, Den-kovski M, Bujanda L, Ramos-San Román J, Cuadrado-Lavín A, Gomez-Camarero J, Jiménez Moreno MA, Lanas A, Martinez-Dominguez SJ, Alfaro E, Marcos-Pinto R, Milivojevic V, Rokkas T, Leja M, Smith S, Tonkić A, Buzás GM, Doulberis M, Venerito M, Lerang F, Bordin DS, Lamy V, Capelle LG, Marlicz W, Dobru D, Gridnyev O, Puig I, Mégraud F, O’Morain C, Gisbert JP; Hp-EuReg Investigators

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Esophagus to Small Intestine

Ten-day vonoprazan-amoxicillin dual therapy as a first-line treatment of Helicobacter pylori infection compared with bismuth-containing quadruple therapy

Am J Gastroenterol. 2023;118(4):627−34