Background: Mucosal closure after gastric per-oral endoscopic myotomy (G-POEM) can be difficult due to the thick gastric mucosa. We evaluated the use of a novel through-the-scope (TTS) suture system for G-POEM mucosotomy closure. Methods: Single center prospective study on consecutive patients who underwent G-POEM with TTS suture closure between February 2022 and August 2022. Technical success was defined as complete mucosotomy closure with TTS suture alone. On subgroup analysis, we compared performance on TTS suturing between the advanced endoscopist and the advanced endoscopy fellow (AEF) under supervision. Results: 36 consecutive patients (median age 60 years; interquartile range [IQR] 48.5-67]; 72% women) underwent G-POEM with TTS suture of the mucosotomy. Median mucosal incision length was 2 cm (IQR: 2-2.5). Mean mucosal closure and total procedure time were 17.5±10.8 and 48.4±16.8 minutes, respectively. Technical success was achieved in 24 patients (66.7%) and 100% of the cases were adequately closed with a combination of TTS suture and clips. When compared to the advanced endoscopist, the AEF required > 1 TTS suture system for complete closure significantly more frequently (66.7% vs. 8.3%; p=0.009) and more time for mucosal closure (20.4±12.1 vs. 11.9±4.9 minutes; p=0.03). Conclusions: TTS suturing is effective and safe for G-POEM mucosal incision closure. With experience, technical success is high, and most closures may be achieved using a single TTS suture system alone, which has important cost and time implications. Additional comparative trials with other closure devices are needed.

Objectives Endoscopic submucosal dissection is a technically demanding procedure. The pilot study aimed to prospectively evaluate the efficacy and safety of a novel single‐operator through‐the‐scope dynamic traction device among trainees with limited endoscopic submucosal dissection (ESD) experience. Methods Randomized, controlled, pilot study comparing traction‐assisted ESD (T‐ESD) versus conventional ESD (C‐ESD) in an ex‐vivo porcine stomach model. Trainees were randomized to group 1 (T‐ESD followed by C‐ESD) and group 2 (C‐ESD followed by T‐ESD). Lesions were created on the gravity‐dependent area of the stomachs. The primary outcome was submucosal dissection speed. Secondary outcomes included differences in en‐bloc resection, adverse events, and workload, assessed by the National Aeronautical and Space Administration Task Load Index (NASA‐TLX). Results Five trainees performed two T‐ESD and two C‐ESD each, for a total of 20 procedures. Submucosal dissection speed was significantly faster in the T‐ESD group compared to the C‐ESD group (43.32 ± 22.61 vs. 24.19 ± 15.86 mm2/min; p = 0.042). En‐bloc resection was achieved in 60% with T‐ESD and 70% with C‐ESD (p = 1.00). The muscle injury rate was higher in the C‐ESD group (50% vs. 10%; p = 0.21) with 1 perforation reported with C‐ESD and none with T‐ESD. NASA‐TLX physical demand was lower with T‐ESD compared to C‐ESD (4.5 ± 2.17 vs. 6.9 ± 2.50; p = 0.03). Conclusion T‐ESD resulted in faster submucosal dissection and less physical demand when compared to C‐ESD, as performed by trainees in an ex‐vivo gravity‐dependent model. Future studies are needed to assess its role in human ESD cases.

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Methods: We conducted a retrospective study of all confirmed COVID-19 adult patients .18 years of age, admitted in our center for a period of 6 weeks during March-April 2020. We extracted demographic, clinical and outcomes data from patient's electronic medical records. Primary outcomes were death, discharge, or transfer in patients with or without GI symptoms and comorbidities. Charlson comorbidity index (CCI) was used for analysis of mortality using the receiver operating characteristic (ROC) curve. Results: From 124 patients included in this study, 103 had comorbidities (83%). Among them 48.5% had GI symptoms. Mortality among patients with GI symptoms was 34% & 14.2%, in patients with and without comorbidities, respectively. Mortality was significantly higher among the patients with both GI symptoms and comorbidities, lowering down the survival rates (P, 0.01). The ROC curve showed that CCI yielded better cut-off for predicting death in COVID-19 with higher area under the ROC, which supports the importance of comorbidities in the severity of . Conclusion: Our main finding was that GI symptoms in comorbid patients are significant risk factors for mortality after age and sex adjustment. ACE-2 receptor, expressed in epithelial cells of GI tract, is the target for SARS-CoV-2 binding. Its expression is increased in comorbid conditions; henceforth increasing the risk and severity of COVID-19 infection. COVID-19 patients with GI symptoms and having comorbidities are more likely to develop more severe course and progression of the disease. Further studies are needed to evaluate the outcomes in these group of patients.

Nine studies, including 1439 patients, met our inclusion criteria and were included in the final meta-analysis. Sarcopenia was associated with significantly higher post-tips HE rate than non-sarcopenia (RR:1.68, CI: 1.33-1.989, p50.001, I250%), as well as a significantly higher post-TIPS mortality rate (RR: 1.75, CI:1.027-2.98, p50.04, I2586%). Conclusion: Our study found significant associations between Sarcopenia and increased rates of post-TIPS HE and mortality. To develop a reliable pre-procedure prognostic method to weigh the risks and benefits of TIPS in patients with cirrhosis, further studies are needed to determine the clinical relevance of important risk factors such as Sarcopenia on post-TIPS outcomes.