Pancreatic cysts are very common with the majority incidentally identified. There are several types of pancreatic cysts; some types can contain cancer or have malignant potential, whereas others are benign. However, even the types of cysts with malignant potential rarely progress to cancer. At the present time, the only viable treatment for pancreatic cysts is surgical excision, which is associated with a high morbidity and occasional mortality. The small risk of malignant transformation, the high risks of surgical treatment, and the lack of high-quality prospective studies have led to contradictory recommendations for their immediate management and for their surveillance. This guideline will provide a practical approach to pancreatic cyst management and recommendations for cyst surveillance for the general gastroenterologist.

Our meta-analysis indicates that targeted biopsies with acetic acid chromoendoscopy, electronic chromoendoscopy by using narrow-band imaging, and endoscope-based CLE meet the thresholds set by the ASGE PIVI, at least when performed by endoscopists with expertise in advanced imaging techniques. The ASGE Technology Committee therefore endorses using these advanced imaging modalities to guide targeted biopsies for the detection of dysplasia during surveillance of patients with previously nondysplastic BE, thereby replacing the currently used random biopsy protocols.

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EMR has become an established therapeutic option for premalignant and early-stage GI malignancies, particularly in the esophagus and colon. EMR can also aid in the diagnosis and therapy of subepithelial lesions localized to the muscularis mucosa or submucosa. Several dedicated EMR devices are available to facilitate these procedures. Adverse event rates, particularly bleeding and perforation, are higher after EMR relative to other basic endoscopic interventions but lower than adverse event rates for ESD. Endoscopists performing EMR should be knowledgeable and skilled in managing potential adverse events resulting from EMR.

Background The American Society of Anesthesiologists’ (ASA) physical status classification is a measurement of co-morbidity and is a predictor of peri-operative morbidity and mortality. Objective To assess the predictive ability of the ASA class for peri-endoscopic adverse events Design retrospective cohort analysis Setting 74 sites in the USA comprised of academic, community/HMO and VA/Military practices affiliated with the Clinical Outcomes Research Initiative (CORI) database Patients ≥ 18 years who underwent an endoscopic procedure between 2000–2008 Interventions EGD, colonoscopy, flexible sigmoidoscopy, ERCP Main outcome measurements immediate adverse event requiring an unplanned intervention Results A total of 1,590,648 endoscopic procedures were performed on 1,318,495 unique patients. The majority of patients were designated as ASA class I or II (I: 27%, II: 63%). An immediate adverse events occurred in 0.35% of all endoscopic procedures (n=5,596) and was proportionally highest for ERCPs (1.84%). Increasing ASA class was associated with higher prevalence and a stepwise increase in the odds ratio of serious adverse events for EGD (II: 1.54 [95% CI 1.31–1.82]; III: 3.90 [95% CI 3.27–4.64]; IV/V: 12.02 [95% CI 9.62–15.01]); and colonoscopy COL (II: 0.92 [95% CI 0.85–1.01]; III: 1.66 [95% CI 1.46–1.87]; IV/V: 4.93 [95% CI 3.66–66.3]). This trend was not significant for FS and ERCP. Limitations retrospective, end point is a surrogate for peri-procedure morbidity Conclusions ASA class is associated with increased risk of adverse events at endoscopy, particularly for EGD and colonoscopy. It is useful in endoscopic risk stratification and is an important quality indicator for endoscopy.