The application of artificial intelligence in EUS

Polysaccharides as submucosal injection materials (SIMs) in endoscopic resection: A comprehensive review

Submucosal injection materials (SIMs) play a vital role in the endoscopic treatment of benign and early malignant gastrointestinal lesions by effectively elevating lesions while significantly reducing the risks of thermal injury and bleeding. However, the traditional use of normal saline (NS) presents challenges due to its rapid absorption, which necessitates frequent reapplications and complicates procedural efficiency. Therefore, there is a pressing need for ideal SIMs that are cost-effective, readily available, and suitable for personalized therapy, while also demonstrating excellent biocompatibility and physicochemical stability. Recent advancements have highlighted the potential of polysaccharide-based natural polymers, such as sodium hyaluronate, cellulose, starch derivatives, chitosan, and sodium alginate, due to their superior biocompatibility and biodegradability. These polysaccharides have exhibited enhanced operational characteristics and therapeutic efficacy in animal and clinical studies. Nevertheless, ongoing research must address several challenges, including optimizing cost-effectiveness, improving mechanical strength and bioactivity, and mitigating intraoperative and postoperative complications. This review systematically examines the progress of polysaccharide-based natural polymers in SIMs, evaluates their current status and challenges in both research and clinical applications, and proposes future directions to enhance their utilization in gastrointestinal endoscopic therapy.

Endoscopic techniques for the diagnosis of pancreatic cystic lesions

Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans, with few patients presenting with abdominal pain or other symptoms. The accurate diagnosis of cysts is important as management depends on the type (neoplastic or non-neoplastic). Cross-sectional imaging is fast being replaced with endoscopic ultrasound (EUS) and various techniques based on that such as EUS-guided fine needle aspiration, EUS-guided needle confocal laser endomicroscopy, EUS-through-the-needle biopsy, and contrast-enhanced EUS. Clinical studies have reported varying diagnostic and adverse event rates with these modalities. In addition, American, European, and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations. In this editorial, we elaborate on the clinical guidelines, recent studies, and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.