Background and Aims: Colorectal cancer (CRC) is largely preventable with routine screening and surveillance colonoscopy; however, interval cancers arising from precancerous lesions missed by standard colonoscopy still occur. An increased adenoma detection rate (ADR) has been found to be inversely associated with interval cancers. The G-EYE device includes a reusable balloon integrated at the distal tip of a standard colonoscope, which flattens haustral folds, centralizes the colonoscope's optics, and reduces bowel slippage. The insufflated balloon also aims to enhance visualization of the colon during withdrawal, thereby increasing the ADR. Methods: In this randomized, controlled, international, multicenter study (11 centers), patients (aged !50 years) referred to colonoscopy for screening, surveillance, or changes in bowel habits were randomized to undergo either balloon-assisted colonoscopy by using an insufflated balloon during withdrawal or standard highdefinition colonoscopy. The primary endpoint was the ADR. Results: One thousand patients were enrolled between May 2014 and September 2016 to undergo colonoscopy by experienced endoscopists; 803 were finally analyzed (standard colonoscopy n Z 396; balloon-assisted colonoscopy n Z 407). Baseline parameters were similar in both groups. Balloon-assisted colonoscopy provided a 48.0% ADR compared with 37.5% in the standard colonoscopy group (28% increase; P Z .0027). Additionally, balloonassisted colonoscopy provided for a significant increase in detection of advanced (P Z .0033) flat adenomas (P < .0001) and sessile serrated adenomas/polyps (P Z .0026). Conclusion: Balloon-assisted colonoscopy yielded a higher ADR and increased the detection of advanced, flat, and sessile serrated adenomas/polyps when compared with standard colonoscopy. Improved detection by the G-EYE device could impact the quality of CRC screening by reducing miss rates and consequently reducing interval cancer incidence.

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Background and AimAcute gastrointestinal bleeding carries poor outcomes unless prompt endoscopic hemostasis is achieved. Mortality in these patients remains significant. Hemospray is a novel intervention that creates a mechanical barrier over bleeding sites. We report the largest dataset of patient outcomes after treatment with Hemospray from an international multicenter registry.Patients and MethodsProspective data (Jan 2016–May 2018) from 12 centers across Europe were collected. Immediate hemostasis was defined as endoscopic cessation of bleeding within 5 min after application of Hemospray. Rebleeding was defined as subsequent drop in hemoglobin, hematemesis, persistent melena with hemodynamic compromise post‐therapy.ResultsThree hundred and fourteen cases were recruited worldwide (231 males, 83 females). Median pretreatment Blatchford score was 11 (IQR: 8–14) and median complete Rockall score (RS) was 7 (IQR: 6–8) for all patients. Peptic ulcer disease (PUD) was the most common pathology (167/314 = 53%) and Forrest Ib the most common bleed type in PUD (100/167 = 60%). 281 patients (89.5%) achieved immediate hemostasis after successful endoscopic therapy with Hemospray. Rebleeding occurred in 29 (10.3%) of the 281 patients who achieved immediate hemostasis. Seven‐day and 30‐day all‐cause mortality were 11.5% (36/314) and 20.1% (63/314), respectively (lower than the predicted rates as per the RS). Similar hemostasis rates were noted in the Hemospray monotherapy (92.4%), combination therapy (88.7%) and rescue therapy (85.5%) groups.ConclusionsThese data show high rates of immediate hemostasis overall and in all subgroups. Rebleeding and mortality rates were in keeping/lower than predicted rates.

Introduction Upper gastrointestinal bleeding (UGIB) is a leading cause of morbidity and associated with a 2-17% mortality in the United Kingdom (UK) and USA [1]. Peptic ulcers account for 50% of UGIB’s. Endoscopic intervention in a timely manner can improve outcomes. Hemospray (Cook Medical, North Carolina, USA) is an endoscopic haemostatic powder for GI bleeding. This multicentre registry was created to collect data prospectively on the immediate Endoscopic haemostasis of GI bleeding in patients with peptic ulcer disease when Hemospray is applied as endoscopic monotherapy, dual therapy or rescue therapy. Methods Data were collected prospectively (January 2016 – March 2019) from 14 centres in the (UK, France, Germany and the USA). The application of Hemospray was decided upon at the endoscopist’s discretion. Results 202 patients with UGIB secondary to peptic ulcers were recruited. Immediate haemostasis was achieved in 178/202 (88%) of patients, 26/154 (17%) had a re-bleed, 21/175 (12%) died within 7 days, 38/175 (22%) died within 30 days (all-cause mortality). Hemospray combination therapy with other endoscopic modalities had an associated lower 30-day mortality (16%, P <0.05) relative to Hemospray monotherapy or rescue therapy. There were high immediate haemostasis rates across all PUD Forrest classifications. Conclusions This is the largest case series of outcomes of peptic ulcer bleeds treated with Hemospray. There were high immediate haemostasis rates with Hemospray in oesophageal and peptic ulcer bleeds.

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