A detailed study design with systematic biopsies of inconspicuous scars reveals a significant number of residual adenomas after completed resection. However, these residual neoplasias can be effectively treated at follow-up colonoscopies.

BACKGROUND AND STUDY AIMS: Motorized spiral enteroscopy (MSE) has been shown to be safe and effective for deep enteroscopy in studies with limited numbers of patients without previous abdominal surgery at expert centers. Aim of this study was to investigate the safety, efficacy, and learning curve associated with MSE in a real-life scenario with inclusion of patients after abdominal surgery and with altered anatomy. PATIENTS AND METHODS: Patients with indications for deep enteroscopy were enrolled in a prospective observational multicenter study. Primary objective: serious adverse event rate (SAE); Secondary objectives: diagnostic and therapeutic yield, procedural success, time, insertion depth. Data analysis was subdivided into training and core (post-training) study phases at centers with different levels of MSE experience. RESULTS: Two hundred ninety-eight patients (120 females; median age 68 years; 19-92) were enrolled. 21.5% (n=54) had previous abdominal surgery, 10.0% (n=25) had surgically altered anatomy. Overall, SAEs occurred in 2.3% (7/298) 95%CI 0.9%-4.8%. The SAE rate was 2.0% (5/251) in the core group and 4.3% (2/47) in the training group and was not increased after abdominal surgery (1.9%). Total enteroscopy was achieved in half of the patients with planned total enteroscopy (n=42). In 295/337 procedures (87.5%) the anatomical region of interest could be reached. CONCLUSIONS: This prospective multicenter study showed that MSE was feasible and safe in a large cohort of patients in a real-life setting after a short learning curve. MSE was shown to be feasible in postsurgical patients and patients with altered anatomy without AE rate increase. NCT03955081 (clinicaltrials.gov)

INTRODUCTION: The current therapy of neoplastic Barrett's esophagus (BE) consists of endoscopic resection plus ablation, with radiofrequency ablation as the best studied technique. This prospective trial assesses a potential alternative, namely hybrid argon plasma ablation. METHODS: Consecutive patients with neoplastic BE undergoing ablation after curative endoscopic resection (89.6%) or primarily were included into this prospective trial in 9 European centers. Up to 5 ablation sessions were allowed for complete eradication of BE (initial complete eradication of intestinal metaplasia [CE-IM]), by definition including BE-associated neoplasia, documented by 1 negative endoscopy with biopsies. The main outcome was the rate of initial CE-IM in intention-to-treat (ITT) and per-protocol (PP) samples at 2 years. The secondary end points were the rate of recurrence-free cases (sustained CE-IM) documented by negative follow-up endoscopies with biopsies and immediate/delayed adverse events. RESULTS: One hundred fifty-four patients (133 men and 21 women, mean age 64 years) received a mean of 1.2 resection and 2.7 ablation sessions (range 1–5). Initial CE-IM was achieved in 87.2% of 148 cases in the PP analysis (ITT 88.4%); initial BE-associated neoplasia was 98.0%. On 2-year follow-up of the 129 successfully treated cases, 70.8% (PP) or 65.9% (ITT) showed sustained CE-IM; recurrences were mostly endoscopy-negative biopsy-proven BE epithelium and neoplasia in 3 cases. Adverse events were seen in 6.1%. DISCUSSION: Eradication and recurrence rates of Barrett's intestinal metaplasia and neoplasia by means of hybrid argon plasma coagulation at 2 years seem to be within expected ranges. Final evidence in comparison to radiofrequency ablation can only be provided by a randomized comparative trial.