Background and aims: Currently available resection techniques for small polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). We aimed to compare CSP vs HSP in 5-9 mm polyps in terms of complete resection and adverse events rates. Methods: Multicenter, randomized trial conducted in 7 Spanish centers between February-November 2019. Patients with ≥1 5-9mm polyp were randomized to CSP or HSP, regardless of morphology or pit pattern. After polyp removal, two marginal biopsies were submitted to a single pathologist blind to polyp histology. Complete resection was defined as the only finding of normal mucosa or burn artifacts in the biopsies. Abdominal pain was only assessed in patients without <5mm or >9mm polyps. Results: A total of 496 subjects were randomized; 237 (394 polyps) to CSP and 259 (397 polyps) to HSP. Complete polypectomy rates were 92.5% with CSP and 94% with HSP (difference 1.5%, 95%CI: 4.9% to -1.9%). Intraprocedural bleeding appeared in 3 (0.8%) CSPs and 7 (1.8%) HSPs (p=0.34). One (0.3%) lesion per group presented delayed hemorrhage. Post-colonoscopy abdominal pain presented similarly in both groups 1 hour after the procedure (18.8% in CSP vs 18.4% in HSP), but, after 5 hours, it was higher in HSP group (5.9% vs 16,5%, p=0.02). CSP presented a higher proportion of asymptomatic patients 24h after the procedure than HSP, 97% vs 86.4% (p=0.01). Conclusions: We observed no differences in complete resection and bleeding rates between CSP and HSP. CSP reduces the intensity and duration of post-colonoscopy abdominal pain (ClinicalTrials.gov number: NCT03783156).

Background and Aim Endoscopic ultrasonography (EUS)‐guided drainage (EUS‐D) has become the standard treatment for peripancreatic fluid collections. Its use in other intra‐abdominal abscesses has been reported, although there is limited evidence. Methods We carried out a single‐center retrospective cohort study comparing percutaneous drainage (PCD) and EUS‐D of upper abdominal abscesses between January 2012 and June 2017. Pancreatic fluid collections and liver transplant recipients were excluded. Primary endpoints were technical and clinical success rates. Results We included 18 EUS‐D (nine hepatic and nine intraperitoneal abscesses) and 62 PCD. There were no differences regarding age, gender and etiology. Size was larger in the PCD group (80 vs 65.5 mm, P = 0.04) and perivesicular location was more frequent in the PCD group (24.2% vs 11.1%, P = 0.003). In the EUS‐D group, metal stents were deployed in 16 (88.9%) subjects (eight lumen‐apposing metal stents and eight self‐expandable metal stents), coaxial double‐pigtail plastic stents in six (33.3%) and lavage/debridement was carried out in five (27.8%). There were no significant differences in technical success (EUS‐D: 88.9%, PCD: 96.8%, P = 0.22) or clinical success (EUS‐D: 88.9%, PCD: 82.3%, P = 0.50), with no relapses in the EUS‐D group and 10 (16.1%) in the PCD group (P = 0.11). There were four (22.2%) adverse events in the EUS‐D group, none of them severe, and 13 (21%) in the PCD group (P = 0.91). Conclusions EUS‐D is an alternative to PCD in the treatment of upper abdominal abscesses, reaching similar success, relapse and adverse events rates.

Summary Background Thiopurines are the most widely used immunosuppressants in IBD although drug‐related adverse events (AE) occur in 20%‐30% of cases. Aim To evaluate the safety of thiopurines in elderly IBD patients Methods Cohort study including all adult patients in the ENEIDA registry who received thiopurines. Patients were grouped in terms of age at the beginning of thiopurine treatment, specifically in those who started thiopurines over 60 years or between 18 and 50 years of age. Thiopurine‐related AEs registered in the ENEIDA database were compared. Results Out of 48 752 patients, 1888 started thiopurines when over 60 years of age and 15 477 under 50 years of age. Median treatment duration was significantly shorter for those who started thiopurines >60 years (13 [IQR 2‐55] vs 32 [IQR 5‐82] months; P < .001). Patients starting >60 years had higher rates of all types of myelotoxicity, digestive intolerance and hepatotoxicity. Thiopurines were discontinued due to AEs (excluding malignancies and infections) in more patients starting >60 years (67.2% vs 63.1%; P < .001). Elderly age and female sex were independent risk factors for most AEs. Conclusion In elderly IBD patients, thiopurines are associated with an increased risk of non‐infectious, non‐neoplastic, AEs.

Fig. 2 Images following injection of contrast through the buried lumen-apposing metal stent (LAMS) showing: a on endoscopic view, the cannulation of the fistulous orifice; b on fluoroscopic view, the distended gallbladder (*); the guidewire coiled inside the gallbladder; and the distal flange of the LAMS still in place (arrowheads).

Background: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has proved effective in patients with cholecystitis at high surgical risk. The long-term risks of gallstone-related disease and stent-related adverse events are unknown. Methods: We performed a retrospective evaluation of a case series including subjects who underwent EUS-GBD using lumen-apposing metal stents (LAMS). Patients were identified from a prospective LAMS registry at a single tertiary center. Patients with a stent indwell time <1 year were excluded. Data regarding stent deployment and adverse events were retrieved from the prospective LAMS registry, while emergency room visits, admissions and causes of death were retrieved from electronic medical records. Results: We included 22 patients with a median age of 88.3 years (interquartile range [IQR]: 82.6-92.7), 14 (63.6%) were male. Median follow up was 24.4 months (IQR: 18.2-42.4) and median time to the last available imaging procedure was 607 days (IQR: 463-938). No LAMS-related adverse events were identified beyond the first year of follow up. During follow up, 12 patients (54.5%) visited the emergency room 34 times (1 visit/patient, IQR: 0-3) and a total of 36 hospital admissions were required, with a median of 1 admission/patient (IQR: 0-3). Fourteen (63.6%) patients died during follow up. Only 1 patient (4.5%) required new hospital admissions for gallstone-related disease. Conclusions: There were no adverse events beyond the first year after stent deployment, with only 4.5% of subjects requiring gallstone-related admissions. Permanent EUS-GBD with LAMS may be a definitive treatment for acute cholecystitis in patients ineligible for cholecystectomy.