Gastric intestinal metaplasia (IM) is a key precursor lesion in gastric cancer progression, as described by the Correa model. Image-enhanced endoscopy (IEE) with magnifying endoscopy has significantly improved the visualization of the mucosal surfaces and microvascular structures, aiding in the accurate diagnosis of IM. While histological evaluation remains the gold standard, IEE might provide a practical and cost-effective alternative for the risk stratification of gastric IM.

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths and the third most common cancer worldwide. Detecting adenomas during colonoscopy reduces the CRC risk, with higher adenoma detection rates (ADRs) correlating with lower CRC incidence and mortality. Endocuff Vision (EV) enhances mucosal visualization and may improve ADRs. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed, Embase, and Cochrane databases were searched through April 2025 for studies comparing EV-assisted and standard colonoscopy. The primary outcomes of interest were the ADRs, polyp detection rates (PDRs), and adverse events (AEs). Outcomes were pooled using a random-effects meta-analysis model and are presented as risk ratios (RRs) and mean differences. Heterogeneity in the pooled outcomes was assessed using the Higgins I². Thirty-four studies (43,702 participants) were included. EV significantly improved ADRs (RR, 1.15; 95% confidence interval [CI],1.07-1.25) and PDRs (RR, 1.16; 95% CI, 1.10-1.23). EV also improved lesion detection in the left colon (RR, 1.23; 95% CI, 1.11-1.35) and right colon (RR, 1.19; 95% CI, 1.09-1.29). No significant improvement was observed in advanced ADRs or cecal intubation. EV use was associated with more AEs. EV-assisted colonoscopy improved ADRs and PDRs in both colonic regions and enhanced CRC screening despite increased AEs.

Endoscopic ultrasound (EUS)-guided elastography is an advanced imaging technique designed to improve assessment of lesion characteristics and disease diagnosis. It allows real-time assessment of tissue stiffness and is currently available in the form of strain elastography (SE) and shear wave elastography (SWE). While EUS-guided SE has high sensitivity for diagnosing malignant solid pancreatic lesions, its specificity remains modest. SWE is a novel technology currently available on the EUS platform. Promising data have been reported on the utility of EUS-guided SWE in various diseases of the pancreas and liver. This review aims to discuss the applications of EUS-guided SE and SWE in pancreatic and liver diseases.

The International Society for Gastrointestinal Hereditary Tumors polyposis scoring system (IPSS) categorizes familial adenomatous polyposis (FAP) according to the burden of colorectal polyps and histology. However, the prognosis of patients with uncolectomized FAP has not been established. Medical records of patients diagnosed with FAP between 1991 and 2021 were reviewed, and the IPSS stage was determined. The cumulative upstaging rate and risk factors for IPSS upstaging during surveillance were analyzed in patients without colectomies. Among 237 patients, 35 (28.9%) with IPSS stages 0-2 did not undergo colectomy. The cumulative risk of upstaging was 0%, 31%, 54%, and 73% at 1, 3, 7, and 10 years after FAP diagnosis, respectively. In univariate analysis, age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01-1.08; p=0.014) and having an ampulla of Vater adenoma (HR, 3.95; 95% CI, 1.17-13.30; p=0.027) were associated with upstaging. Multivariate analysis revealed that each 1-year increase in age was an independent risk factor of upstaging (adjusted HR, 1.04; 95% CI, 1.01-1.09; p=0.027). In our analysis, patients with uncolectomized FAP and IPSS stages 0-2 at diagnosis showed a time-dependent progression in the IPSS stage.

Endoscopic ultrasound (EUS)-guided liver biopsy in patients with coagulopathy remains unexplored mainly because of the lack of effective hemostatic techniques in the event of post-biopsy bleeding. This study evaluated the feasibility and safety of a novel technique, EUS-guided plugged liver biopsy (EUS-PLB), which incorporates coil embolization for tract hemostasis. In a pilot study, 20 patients with coagulopathy (platelets 20,000-50,000/μL or international normalized ratio 1.5-2.5) underwent EUS-PLB using a modified heparinized wet suction technique. Hemostasis was achieved via real-time EUS-guided deployment of 1 to 2 coils (0.035-inch, 5-cm length, 3-mm diameter coil) into the needle tract. Outcomes included technical and clinical success, sample adequacy, and adverse events. Coil placement was technically successful in all patients. Persistent needle-tract bleeding occurred in five cases and was effectively controlled. The clinical success rate for preventing significant bleeding (early or delayed) was 100%. Adequate biopsy samples were obtained in 18/20 patients (90%), with a mean total specimen length of 3.34±0.88 cm and median complete portal tracts of 18 (range, 6-25). Histological diagnosis was possible in 95% of cases. One patient experienced a mild adverse event (5%). This novel EUS-PLB technique with coil embolization may offer a safe and effective biopsy solution for patients with coagulopathy and warrants further investigation.