Rectal lesions with a risk of superficial submucosal invasion require en-bloc local resection to enable accurate histopathologic staging, assess resection margins, and determine whether additional radical surgery is necessary. In addition, in early superficial submucosal invasive rectal adenocarcinoma with favorable histologic features…an R0 resection can be considered curative. While ESD and TAMIS can both achieve en-bloc resection, prior comparative studies were largely retrospective, and DSETAMIS-2018 is a randomized controlled trial directly comparing the 2 approaches. The trial supports ESD as a potentially organ-preserving alternative to TAMIS in carefully selected early rectal neoplasms. Beyond comparable short-term local control, ESD avoided conversion to another approach, reduced hospitalization, and substantially lowered direct costs.

Using data from examinations using all indications rather than screening exams alone can be beneficial by allowing a larger sample size, which may provide a more accurate assessment of an endoscopist’s overall performance. It can also mitigate potential gaming by endoscopists to manipulate their metrics.

The term “advanced adenoma” carries an ominous connotation, as it signifies a high risk for colorectal cancer (CRC), causing concern for both patients and clinicians. Evidence, including data from the New Hampshire Colonoscopy Registry, supports this concern by showing that individuals with advanced adenomas face a higher risk of future advanced neoplasia—defined as the combined risk of CRC and other advanced adenomas—compared to those with non-advanced or no polyps.

Post-ERCP pancreatitis is the most common adverse event following biliary drainage with ERCP and may delay oncologic therapy. Strategies that reduce this risk without compromising efficacy are clinically important. In addition, there has been emerging data on EUS-CDS as a primary modality in treatment of malignant distal biliary obstruction.

Rigid adherence to performance targets—particularly for cannulation success or prophylactic pancreatic stent placement—may inadvertently encourage overly aggressive maneuvers that increase procedural risk. These indicators are intended for internal quality improvement and benchmarking, not for credentialing, reimbursement, or punitive comparison.

EUS-Guided Versus Surgical Gastroenterostomy: Which Endures? (The ENDURO trial) Margaret J. Zhou, MD Clinical Assistant Professor of Medicine, Gastroenterology &…

In this multicenter RCT of 356 patients across 19 hospitals, prophylactic clipping after EMR of large (≥20 mm) proximal colon polyps did not reduce delayed bleeding (9.0% vs. 6.1%, P = 0.30).

This summary reviews Pohl H, Rex DK, Barber J, et al. Cold snare endoscopic resection for large colon polyps: A randomised trial. Gut Published Online First: 19 May 2025. doi: 10.1136/gutjnl-2025-335075.

Surveillance Endoscopy in Barrett’s Esophagus: Does It Work? Margaret J. Zhou, MD, MS  Clinical Assistant Professor of Medicine, Division of…

EBGI summary reviews the 2025 SPHINX study published in Gut on endoscopic sphincterotomy to prevent post-ERCP pancreatitis after self-expandable metal stent placement for distal malignant biliary obstruction.