Pradeep Bhandari

Live endoscopy events (LEEs) have become a valuable educational tool in gastroenterology, providing a real-time demonstration of advanced endoscopic techniques. This article reflects on the BSG EndoBridge meeting held in January 2026, which successfully transmitted mixed endoscopy cases live from the UK and India. LEEs deliver unique educational benefits by showcasing expert decision-making, adaptive responses to unexpected challenges and interactive discussions in real-time. They facilitate knowledge sharing, networking and the exchange of practical tips across diverse audiences from trainees to specialist endoscopists. Live demonstrations capture the unscripted complexities of real-life clinical scenarios, including unpredictable patient anatomy and time-sensitive decision-making. Successful delivery requires careful attention to technology (Unified Communication platforms), robust infrastructure, thorough pre-event testing and strict adherence to patient safety guidelines. Key structural elements include a course director with overriding responsibility for safety, experienced moderators and panellists, and patient advocates. Clear communication protocols, minimal distractions in the procedure room and the ability to instantly cut the feed if needed are essential to maintain clinical standards. To ensure both patient safety and educational effectiveness, the course must adhere to rigorous ethical standards. Beyond compliance, these standards foster a culture of transparency by prioritising patient well-being and a robust informed consent process. The course creates a safe environment for delegates to critically analyse real-world complications and adverse events, which is essential for deep clinical learning. When properly structured, LEEs balance high-value interactive education with patient safety, remaining a powerful resource for endoscopy training in the digital era.

Objective: PuraStat is a topical haemostatic agent used for treatment and prevention of bleeding. Our aim was to evaluate the efficacy and safety of using PuraStat during advanced endoscopic resection procedures in a multicentre prospective setting. Design/methods: This is a multicentre prospective evaluation on efficacy and safety of PuraStat when used in the treatment of intraprocedural bleeding and prevention of delayed bleeding during the study period from 2019 to 2021. High-risk tissue resections (HRTR) with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for large and complex lesions from the oesophagus, stomach, duodenum and colon were included. Data on the type of bleed, haemostatic measures used, and efficacy and safety of PuraStat were prospectively collected. A descriptive analysis was performed and expressed as proportions. Results: PuraStat was used in a total of 448 patients with HRTR. PuraStat was used for treatment of intraprocedural bleeding in 105 patients. Overall haemostatic efficacy in this group was 91.43%. All 448 patients had prophylactic application of PuraStat on the resection base to prevent delayed bleeding. The observed overall delayed bleeding rate for the entire cohort was 1.34%. On subgroup analysis, we found that this was highest in the duodenum (8.69%) followed by 1.80% in the right colon (EMR and ESD). There were no delayed bleeds in the oesophagus, stomach and left colon. Conclusions: Our data demonstrates that PuraStat is safe and appears to be effective in the treatment of intraprocedural bleeding and prevention of delayed bleeding after high-risk endoscopic resections. Trial registration number: NCT03983707 .

These guidance statements represent a practical approach to tissue sampling in the upper gastrointestinal tract during endoscopy in adult patients, outlining instances when biopsies should and should not be taken. Analysis of data from the UK National Endoscopy Database has shown wide variations in biopsy practice among endoscopists. Endoscopy providers with high rates of post-endoscopy upper gastrointestinal cancer take more inappropriate and less appropriate biopsies during endoscopy. This guidance document was commissioned by the British Society of Gastroenterology (BSG) as part of its Upper Gastrointestinal Endoscopy Quality Improvement programme and developed in line with the BSG guidance methodology. A systematic literature review was performed to review the evidence base. However, due to the low quality of evidence in this area, application of GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was not possible and therefore Good Practice Statements, along with Expert Opinions, were used for recommendations. In total, 32 statements or recommendations were initially created and voted on by members of the Guidance Development Group on a five-point scale (strongly agree to strongly disagree). Statements achieving over 80% agreement were adopted. Following voting, one statement did not achieve consensus and was removed, and one statement was amended. All statements achieved over 80% agreement following a second round of voting. In formulating this guidance document, we hope that it will standardise biopsy practice for upper gastrointestinal endoscopy. Outlining when not to undertake tissue sampling will in turn reduce pressure on histopathology services, reduce costs in the National Health Service, and improve sustainability in endoscopy and pathology.

Background Cancers of the oesophagus and stomach are a major cause of morbidity and mortality. Research is crucial to improving outcomes. However, to maximise value and impact, areas of focus should be prioritised in partnership with patients. Objective We undertook a comprehensive analysis of UK and Ireland patient and healthcare professional (HCP) priorities for research into oesophagogastric cancers across the domains of prevention, diagnosis and staging, treatment, palliative care and survivorship. Design A scoping exercise sourced research questions from patients and HCPs. These were consolidated and then confirmed by systematic review to represent a true research uncertainty. Research questions were scored on potential impact by an interdisciplinary group of HCPs and prioritised using a weighting derived from a patient survey. Results There were 835 (395 HCP, 440 patient) respondents to the scoping (n=455) and prioritisation (n=380) surveys. Across these, 4295 suggested research uncertainties were consolidated to 92 uncertainties that were prioritised. HCP respondents represented 25 professional groups from community and hospital settings. Patient weighting changed 22.2–46.3% of priority rankings established by HCPs. All domains were represented by the 20 highest priority questions, 5 of which focused on personalising and optimally combining treatment modalities. Two other key themes related to optimising nutrition and improving quality of life during and after treatment, including in patients not cured of their cancer. Conclusion This work highlights the impact of patient input on HCP-ranked research priorities and provides a robust list of priorities to guide funders, policymakers and researchers to support and undertake impactful research.

ESD is a preferred technique for en bloc resection of large (≥2 cm) non-pedunculated colorectal polyps or adenomas, offering high R0 resection and low recurrence rates.1 2 However, its adoption in Western countries remains limited due to technical complexity, long procedure times and associated adverse events.3 Underwater ESD, which replaces CO₂ insufflation with a saline-filled environment, has been proposed to enhance visualisation, traction and submucosal dissection, improving procedural outcomes.4–6 Additionally, saline impedance allows prophylactic underwater vessel coagulation when swift coagulation (effect: 4.0; electrosurgical generator: VIO3, Erbe Elektromedizin GmbH) is applied, improving submucosal vessel sealing to reduce intraprocedural bleeding.7–10

Artificial intelligence (AI) holds significant potential for enhancing quality of gastrointestinal (GI) endoscopy, but the adoption of AI in clinical practice is hampered by the lack of rigorous standardisation and development methodology ensuring generalisability. The aim of the Quality Assessment of pre-clinical AI studies in Diagnostic Endoscopy (QUAIDE) Explanation and Checklist was to develop recommendations for standardised design and reporting of preclinical AI studies in GI endoscopy. The recommendations were developed based on a formal consensus approach with an international multidisciplinary panel of 32 experts among endoscopists and computer scientists. The Delphi methodology was employed to achieve consensus on statements, with a predetermined threshold of 80% agreement. A maximum three rounds of voting were permitted. Consensus was reached on 18 key recommendations, covering 6 key domains: data acquisition and annotation (6 statements), outcome reporting (3 statements), experimental setup and algorithm architecture (4 statements) and result presentation and interpretation (5 statements). QUAIDE provides recommendations on how to properly design (1. Methods, statements 1–14), present results (2. Results, statements 15–16) and integrate and interpret the obtained results (3. Discussion, statements 17–18). The QUAIDE framework offers practical guidance for authors, readers, editors and reviewers involved in AI preclinical studies in GI endoscopy, aiming at improving design and reporting, thereby promoting research standardisation and accelerating the translation of AI innovations into clinical practice.

Objective: The aim of this study was to quantify lymph node metastasis (LNM) risk and outcomes following treatment of early esophago-gastric (EG) adenocarcinoma. Background: The standard of care for early T1N0 EG cancer is endoscopic resection (ER). Radical surgical resection is recommended for patients perceived to be at risk of LNM. Current models to select organ-preserving versus surgical treatment are inconsistent. Methods: CONGRESS is a UK-based multicenter retrospective cohort study. Patients diagnosed with clinical or pathological T1N0 EG adenocarcinoma from 2015 to 2022 were included. Outcomes and rates of LNM were assessed. Cox regression was performed to assess the impact of prognostic and treatment factors on overall survival. Results: A total of 1601 patients from 26 centers were included, with median follow-up 32 months (IQR 14–53). 1285/1612 (80.3%) underwent ER, 497/1601 (31.0%) underwent surgery. Overall rate of LNM was 13.5%. On ER staging, tumour depth (T1bsm2-3 17.6% vs T1a 7.1%), lymphovascular invasion (17.2% vs 12.6%), or signet cells (28.6% vs 13.0%) were associated with LNM. In multivariable regression analysis, these were not significantly associated with LNM rates or survival. Adjusting for demographic and tumour variables, surgery after ER was associated with significant survival benefit, HR 0.33 (0.15–0.77), P=0.010. Conclusions: This large multicenter data set suggests that early EG adenocarcinoma is associated with significant risk of LNM. These data are representative of current real clinical practice with ER-based staging, and suggests previously held beliefs regarding reliability of predictive factors for LNM may need to be reconsidered. Further research to identify patients who may benefit from organ-preserving versus surgical treatment is urgently required.