Digestive EndoscopyVolume 35, Issue 1 p. 152-159 WEO NewsletterFree Access WEO Newsletter First published: 12 January 2023 https://doi.org/10.1111/den.14491AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat WEO Newsletter Editor: Nalini M Guda MD, FASGE, AGAF, FACG, FJGES EDITORIAL Asadur Tchekmedyian, MD, FASGE, FSIED, Endoscopy Department, Asociacion Española, Montevideo, Uruguay At the beginning of 2022, I was proud to receive an invitation from Professor Nalini M. Guda (USA), Chair of WEO's News and Communication Ad hoc Committee, to contribute as guest editor to this issue of the WEO-DEN newsletter. The chance to contribute to this publication is highly appreciated and provides the opportunity to share relevant information and resources from the Americas and beyond. First, however, despite the passage of time, I would like to comment on the historic ENDO 2020 collaboration between the World Endoscopy Organization (WEO) and the Interamerican Society for Digestive Endoscopy (SIED). ENDO 2020 was the largest endoscopy congress in history, with more than 3000 participants on site, in a comprehensive and exclusive event dedicated solely to digestive endoscopy. That congress set a milestone in the history of endoscopy and, as if fate had decided, ENDO 2020 ended a day before the pandemic took over our continent. Undoubtedly, these will be everlasting memories in WEO and SIED records. Moving on to the present, in this (and the next) issue of the WEO-DEN newsletter, we have been honored with the kind support of distinguished authors from all over the world, who have generously contributed their expertise, addressing a wide range of topics in endoscopy. In these two issues we will cover a broad range of content with a common framework, which is to provide basic and advanced updates on relevant issues in our field. Dr Roque Saenz from Chile will share his expertise in basic techniques in colonoscopy with essential tips and tricks, a must-read article for beginners. Dr Noriya Uedo from Japan addresses an important topic of current relevance: the validity of on-site observership and person-to-person interaction, despite the high penetrance of online activities. Last but not least, we are excited to have input from the Radiation Protection of Patients Unit of the International Atomic Energy Agency (IAEA): the article by Dr Jenia Vassileva (Austria) covers basic information about radioprotection that every interventional endoscopist must take into account. With this information, we intend to spread the word about radiation protection, increasing the awareness of this issue. We take this opportunity to encourage all of you to include this topic in upcoming events in your countries. Radioprotection is a culture that we must integrate into our daily practice. I hope you find these resources helpful and that you can apply the information to deliver high quality procedures while protecting our patients, teammates, and ourselves. Please circulate this newsletter among your colleagues as this is the best way to spread the voice of endoscopy around the world. As the slogan for ENDO meetings says, we are very glad to “connect the world of endoscopy.” USEFUL TIPS IN COLONOSCOPY SHORTENING, SLIDE-BY, JIGGLING, HOOKING, AND WATER: TRYING ALL BEFORE GIVING UP Roque Sáenz, MD, FASGE, FACG, FSIED, Professor of Medicine, Universidad del Desarrollo; Consultant, Clínica Alemana Santiago; SIED Education Committee Asadur Tchekmedyian, MD, FASGE, FSIED, Endoscopy Department, Asociacion Española, Montevideo, Uruguay To achieve a complete colorectal exploration, the application of basic colonoscopy techniques is always necessary and useful. Even today, with the availability of advanced technologies and artificial intelligence, basic skills are mandatory. The cecal intubation rate (CIR) is a crucial measure in quality control in colonoscopy. The CIR must be over 95% in screening colonoscopies. Several approaches have been suggested to assist and improve the difficult detection of right-colon polyps. These include taking multiple views of the right colon, the use of novel technology, and obtaining a retroflexed view of the right colon. Incomplete exploration means missed lesions. We describe here some of the multiple aids to achieving a high CIR. We recommend the chapter “Insertion Technique,” by C.B. Williams, in Colonoscopy: Principles and Practice,1 which is of great help with useful basic techniques, and the review “Tips for better colonoscopy from two experts” by D.K. Rex and M. Bourke.2 Training in colonoscopy has been a must in Japan, where becoming a board-certified endoscopist of the Japan Gastroenterological Endoscopy Society requires extensive endoscopic experience.3 Before we start the procedure, we need to be aware of the several situations that allow us to anticipate a difficult colonic exploration (Table 1), and we may raise the timeless question: Is a complete colonoscopy always necessary? Maybe not. Table 1. Conditions presaging a difficult colonoscopy Previously failed colonoscopy Female sex, low body mass index Previous abdominal surgery (hysterectomy) “Endless” colon (tall patients/fixed segments) Prominent belly Redundant, floppy, or angulated colon Poor bowel preparation Poor sedation (discomfort and intolerance) Aged patient Patient with risk (comorbidity, cardiovascular disorder, etc) Stenotic lesions (diverticular disease, obstructive cancer) Active colitis For example, a complete colonoscopy is not needed when the aim is resection of a distal colonic lesion or monitoring of a scar, and there has been a recent complete and satisfactory colonoscopy. Also, during diagnosis of active ulcerative colitis or ischemic colitis, the performance of certain maneuvers is risky and outweighs the benefits. Performing colonoscopy Endoscopists carry out several maneuvers during insertion, mostly simultaneously and unconsciously. Most repeat colonoscopies are successfully completed using routine endoscopes and a proper technique. In the majority of colonoscopies complete insertion is obtained; this is thanks to proper training and a satisfactory learning curve. With practice comes greater expertise and competence. There are multiple tricks and tips that we will not deal with in this short review, such as position changing, abdominal compression by external pressure, uses of the scope guide system, or mastering the technique of traversing the ileocecal valve and entering the ileum, etc. Shortening “Shortening” is a prime technique and should always be applied. “Pull back” is the constant advice of Professor Jerome Waye for his trainees, and this is true in every colonoscopy. Keep the colonoscope as short as possible throughout the procedure. For example, shortening helps in negotiating an angulated colon; it counters bowing of the scope; and helps to obtain direct transmission of movement to the tip of the scope. Shortening also minimizes looping along the shaft of the scope, thereby improving tolerability for patients. Slide-by technique In 1976, Professor K. Heinkel in Stuttgart described two main ways to perform colonoscopy: the “slalom” technique using torque, and the “sliding” technique, using gentle and unforced advance of the instrument. The main instruction is to advance with visualization of the lumen ahead. Blind insertion must be avoided as it could be traumatic and is inherently risky. Sometimes curves or adhesions make progression of the scope difficult, and “sliding” may be of help. It is used to advance the endoscope by pushing the tip slightly forward in the anticipated direction of the colonic lumen direction. This may be of help if the next direction of the colon cannot be visualized because of acute angulation or because of many folds in the colon. The scope should not be advanced against resistance. “Red-out” is the term used to describe what is seen when the tip of the scope is placed too close to the bowel wall mucosa. In this situation, the reflection of light off the vascularized tissue produces a red haze. By slightly withdrawing the scope, the endoscopist can regain a clear view of the bowel. The “red-out” sign must be avoided, since its presence is a marker of risk. Both experienced and inexperienced endoscopists should always avoid maneuvers that could cause iatrogenic perforation. If risks occur, the endoscope should be withdrawn. Try different actions such as position change, external compression, water insertion, etc. Jiggling and shaking The “jiggling” technique involves moving the scope in and out by short distances of 5 to 10 cm, always keeping the lumen in view. This technique is useful to shorten and straighten the colon, and is also helpful in gaining advance through the lumen. The “shaking” technique involves quickly moving the scope from side to side, which frees the colonoscope from sticking to the colonic luminal wall. Hooking In this technique, a mucosal fold is “hooked” by deflecting the colonoscope tip 30 to 90 degrees behind the fold, thus anchoring the scope position. The scope is then pulled back using a clockwise torque, thereby reducing loops and shortening the colon by telescoping the colon onto the shaft of the scope. A counterclockwise torque may be useful if clockwise fails. It must be associated with appropriate withdrawal. This hook and pull-back motion of the scope can help to straighten a tortuous colonic segment. The tip of the colonoscope is used to hook a mucosal fold, and as the scope is withdrawn 5 to 10 cm it pulls the segment of tortuous colon backward. Water-aided methods A water interphase has been progressively used, not only for easier access to the proximal colon, but also for performing endoscopic underwater treatments and resections. There are two main water-assisted procedures: in water exchange the previously infused water is removed at colonoscope insertion; in water immersion it is removed at withdrawal. Pain and insertion time are significantly reduced, and colon cleansing is privileged. On the other hand, withdrawal time may be longer due to aspiration of the fluid. There is increasing evidence that water exchange allows a better adenoma detection rate, both in procedures overall and for right colon evaluation.4, 5 Water immersion favors the use of warm water, decreasing discomfort. It straightens the colon; reduces angulations; lessens looping; and reduces the spasm associated with air insufflation. Water exchange produces a clean colon, and is useful in known redundant colon. A water pump is desirable for facilitating the maneuver, and distilled water rather than tap water is preferred in cases of endoscopic mucosal resection or endoscopic submucosal dissection. Specialized caps and other colonic lumen-expanding devices Several devices are available, such as the Endocuff, EndoRings, etc.6 To begin with, short or long caps are useful for better diagnosis and for facilitating the removal of certain lesions. In some situations, a long cap makes insertion time shorter, but for experienced endoscopists it does not seem to make major differences. The Endocuff, an endoscopic cap with plastic projections, may improve colonic visualization and adenoma detection. Whether increased detection ultimately results in a lower rate of interval carcinomas is not yet known.7 Final remarks Finally, we need to emphasize that the imperative target of complete colonoscopy has a counterpart: safety. While performing colonoscopy, applying your skills and using the abovementioned tips and tricks, if difficulties arise, think of someone else in the unit who can help. Also consider the use of virtual colonography or even capsule endoscopy, or ask about a new attempt with a different scope (pediatric, upper GI endoscope, enteroscope, etc.). Complications due to unwarranted persistence, are catastrophic. Always avoid complications – “Primum non nocere.” REFERENCES 1Waye JD, Rex DK, Williams CB. Colonoscopy: Principles and Practice, 2nd edn. Hoboken: Wiley-Blackwell, 2009. 2Bourke M, Rex DK. Tips for better colonoscopy from two experts. Am J Gastroenterol 2012; 107: 1467– 72. 3Hatanaka H, Yamamoto H, Lefor AK, Sugano K. Gastroenterology training in Japan. Dig Dis Sci 2016; 61: 1448– 50. 4Leung FW, Amato A, Ell C et al. Water-aided colonoscopy: A systematic review. Gastrointest Endosc 2012; 76: 657– 66. 5Cadoni S, Ishaq S, Hassan C et al. Water-assisted colonoscopy: An international modified Delphi review on definitions and practice recommendations. Gastrointest Endosc 2021; 93: 1411– 20. 6Rex D, Repici A, Gross S et al. High-definition colonoscopy versus Endocuff versus EndoRings versus full-spectrum endoscopy for adenoma detection at colonoscopy: A multicenter randomized trial. Gastrointest Endosc 2018; 88: 335– 44. 7Van Doorn SC, van der Vlugt M, Depla A et al. Adenoma detection with Endocuff colonoscopy vs conventional colonoscopy: A multicentre randomised controlled trial. Gut 2017; 66: 438– 45. OBSERVERSHIP OF ENDOSCOPIC FULL-THICKNESS RESECTIONS OF GASTRIC GASTROINTESTINAL STROMAL TUMORS IN SHANGHAI Noriya Uedo, MD, PhD, Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan A gastrointestinal stromal tumor (GIST) is the most common sarcoma of the gastrointestinal (GI) tract. Although standard treatment for localized GISTs involves complete surgical excision,1 endoscopic resection of the gastric submucosal tumor (SMT) is gradually becoming common among advanced endoscopy units around the world. From an oncological point of view, GISTs do not require lymph node dissection, nor a generous surgical margin, therefore they are theoretically suitable for treatment by local endoscopic excision. Superficial epithelial tumors can be removed by endoscopic submucosal dissection but SMTs need to be removed by endoscopic full-thickness resection (EFTR) and muscle defects need to be closed endoscopically. Benefits of endoscopic resection of gastric GISTs include minimal gastric wall defects, no or minimal excess gastric tissue damage, and no corporal scarring, resulting in organ/function-preserving minimally invasive surgery. Zhongshan Hospital is one of the leading hospitals for therapeutic endoscopy in Shanghai, China. Professor Ping-Hong Zhou, the chief of the endoscopy unit, started conducting the EFTR procedure for gastric SMTs around 2006 and his team has performed more than a thousand EFTR procedures to date.2, 3 In the past, it was very difficult to access information about new endoscopic procedures, but recent improvements in the infrastructure of information technology makes this easier than before. However, it is important to know that virtual experience cannot replace a real experience. Endoscopists have provided many videos and explanations on the internet regarding endoscopic procedures, but these are usually edited and the information is limited. Therefore, these videos are not as useful as in-person observation of real endoscopic procedures. To best learn a new endoscopic technique, one should observe not only the endoscopic maneuver, but the preparation, surrounding settings, patient management, etc. by visiting an endoscopy unit where experts perform the technique regularly. I have flown to Shanghai twice, once in 2017 and then in 2018. To save time, I took night flights after finishing my daily work, spent a few days in Shanghai, and then took another night flight home after observation of the procedures, returning to my hospital for outpatient clinic in the morning. In Shanghai, I learned the following tips for EFTR of gastric SMTs: A multibending double-channel videoendoscope (EVIS-2TQ260M; Olympus, Tokyo, Japan) was useful to approach the fornix or the upper body where GISTs are often prevalent. There is no need for a mucosal margin from the tumor because it causes a large mucosal/muscle defect and makes wound closure very difficult. It is better to perform tissue dissection along the tumor margin under visualization of the tumor surface, because this avoids capsule injury. Total exposure of muscle attachments around the tumor before muscular incision is important, because it minimizes the time to complete muscular incision. The abdominal paracentesis is performed at the Munro point using an 18-gauge needle and a 20-mL syringe filled with a normal saline. Purse-string closure with clips (SureClip; Micro-Tech, Nanjing, China) and endoloop (HX-400U-30; Olympus) is performed with six to eight clips and, in the case of incomplete closure, it is repeated for the remaining defect, among other techniques. We received approval to perform the EFTR procedure for gastric SMT from our institutional review board in 2018 and from the Japanese Ministry of Health for Special Medical Care in 2020. We are now accumulating clinical data in order to be able to perform the procedure and to have it covered by typical social insurance.We are grateful to Ping-Hong Zhou, Jian-Wei Hu, and other doctors at the Zhongshan Hospital for allowing my visit and for teaching me this procedure. Some experts may keep their techniques to themselves to prevent competition, but widespread teaching would disseminate the procedure, contribute to patient care, and eventually increase the standing of the expert rather than the competitors. After the COVID-19 pandemic, we hope international endoscopist relationships will resume. Observership of the endoscopic full-thickness resection procedure conducted by Dr Jian-Wei Hu (left) at the Zhongshan Hospital, Shanghai, China. REFERENCES 1Casali PG, Blay JY, Abecassis N et al. Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2022; 33: 20– 33. 2Zhou PH, Yao LQ, Qin XY et al. Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria. Surg Endosc 2011; 25: 2926– 31. 3Zhu Y, Xu MD, Xu C et al. Microscopic positive tumor margin does not increase the rate of recurrence in endoscopic resected gastric mesenchymal tumors compared to negative tumor margin. Surg Endosc 2020; 34: 159– 69. RADIATION PROTECTION IN ENDOSCOPY SUITES: GUIDANCE AND TOOLS FROM THE INTERNATIONAL ATOMIC ENERGY AGENCY Jenia Vassileva, Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria Asadur Tchekmedyian, MD, FASGE, FSIED, Endoscopy Department, Asociacion Española, Montevideo, Uruguay The International Atomic Energy Agency (IAEA) is the world's center for cooperation in the nuclear field and seeks to promote the safe, secure, and peaceful use of nuclear technologies. An important statutory function of the IAEA is to establish or adopt standards of safety1, 2 and provide for the application of these standards in practice. The mission of the World Endoscopy Organization (WEO) is to be the world leader in endoscopic education while supporting international cooperation to achieve optimal practices in endoscopy. The fluoroscopy-guided procedures performed in endoscopy suites involve exposure to radiation of both medical staff and patients. The involvement of endoscopists in interventional endoscopy practice has considerably increased and endoscopy has experienced a transition from a diagnostic procedure to a more complex, demanding, and interventional modality. Proper use of X-ray equipment and dose-reduction approaches applied by interventional endoscopists can help avoid unnecessary exposure of patients and staff to potentially harmful radiation. Thanks to the cooperation of endoscopists from all Latin-American countries, a survey was carried out to evaluate the access to radiation protection measures in endoscopy suites.3 The results showed disparities in availability of these measures, and especially in the use of individual dosimeters and in access to radiation protection courses (Table 1). Table 1. Results from the survey of radiation protection practice in endoscopy suites3 Use of: Yes (%) Lead aprons 97.3 Lead googles 13.5 Thyroid collars 73.9 Individual dosimeters 42.3 Radiation protection courses 21.6 In 2008 the IAEA and the Uruguayan Ministry of Industry, Energy and Mining organized a regional course to train Latin-American doctors in this emerging field. After this successful meeting, a fruitful cooperation between gastroenterologists and the IAEA was begun, and there was the first publication of a newsletter in 2011.4 This newsletter served as an online source of information on both activities and resources for gastroenterologists and endoscopists in Latin America and beyond. Along with numerous courses, conferences, and activities during national and international congresses, this helps to raise awareness about radiation protection both locally and internationally. The activities that have been carried out by the IAEA and the Interamerican Society of Digestive Endoscopy (SIED) (as a member of WEO), are a part of the International Action Plan5 and Bonn Call for Action6 projects that aim to improve radiation protection practice in medicine throughout the world. In the Latin-American and Caribbean region, the activities are also a part of the objectives of the IAEA regional project aimed at end-users, which includes the IAEA concern of radiological safety in medicine. Similar regional and national projects are being carried out in other regions, as a part of the IAEA technical cooperation program. They help to implement in practice the International Basic Safety Standards1 for radiation protection and safety and the guidance of the Safety Guide on Radiation Protection and Safety in Medical Uses of Ionizing Radiation.2 These standards reflect international consensus and good practice worldwide. All these activities have been carried out by cooperation of the gastroenterological and endoscopy societies with the IAEA. More information and material can be accessed online at the specialized IAEA website.7 This presents frequently asked questions, and information about approaches to reduction of radiation exposure for patients and staff. Tips for radiation protection There are many actions that can be taken to reduce radiation exposure of patients and staff, as summarized in Table 2. Table 2. Actions to reduce patient and staff radiation exposure in fluoroscopy Remember! Reducing patient dose always results in staff dose reduction! Here are the main actions that can be taken: Procedure-related Minimize exposure time by minimizing the use of fluoroscopy and take as few radiographic images as possible. Use collimation to confine the X-ray beam to the area of interest. Use electronic magnification (zoom) only when really needed. Use an under-couch X-ray tube fluoroscopy system. Maximize distance between X-ray tube and patient. Minimize distance between patient and image receptor (image intensifier or flat-panel detector). Avoid use of oblique projections. If they are needed, stand on the side of the transmitted beam (by the image receptor). Keep hands outside the primary beam unless totally unavoidable. Equipment-related Use the lowest manufacturer's setting of fluoroscopic dose rates and the highest kVp consistent with maintenance of image quality. Use pulsed fluoroscopy rather than continuous and use the lowest pulse frequency compatible with adequate image quality. Use last image hold and image capture. Be aware of alarm levels for time and higher dose rates in fluoroscopy. Keep records for every patient of fluoroscopy time and patient dose quantities provided by your equipment. Make sure appropriate quality control is performed. Additional actions for staff protection Wear individual protective devices – lead aprons, thyroid protection, and lead glasses – and handle them properly. Use ceiling suspended screens, lateral shield, table curtains or/and mobile shield. Always wear your individual dosimeters and know your dose. Update your knowledge about radiation protection. Address your concerns about radiation protection to the radiation protection officer or medical physicists of your facility. These simple dose reduction approaches are summarized in posters8 available in over 20 languages for free download and use: 10 Pearls: Radiation Protection of Staff in Fluoroscopy 10 Pearls: Radiation protection of Patients in Fluoroscopy 10 Pearls: Radiation protection for children in interventional procedures Also, SIED has developed a poster with 10 tips for radiation protection9 that can be accessed online. The IAEA provides 13 free practical tutorials10 with short videos to help doctors learn how these dose-reduction factors influence staff and patient doses. The course is available in English and Russian language in three different forms: for direct viewing and learning, for e-learning with certification, and for free downloads by trainers. Trainers can also download a free training package11 consisting of seven lectures with PowerPoint slides, to explain what radiation can do, to understand radiation units, to describe the anatomy of X-ray equipment, to explain how to reduce staff dose and how to reduce patient dose, and to describe what international standards and recommendations exist. Every year, the IAEA organizes training courses in different countries and in different languages, to help medical professionals improve their knowledge about radiation protection and to increase awareness. The IAEA free webinars12 are another form of sharing knowledge and learning from leading experts. For those who miss live participation, recordings of all previous webinars are available for free view. The worldwide awareness of radiation exposure in endoscopy practice is growing daily. Our aim is to bring this topic to the fore and to commit ourselves to implementing good radiation practice in our daily work. This will allow reduction of doses to patients and staff, while achieving image quality that serves the medical objective. REFERENCES 1 International Atomic Energy Agency. Radiation protection and safety of radiation sources: International basic safety standards [Internet]. Vienna: International Atomic Energy Agency; 2014 [cited 2022 Dec 15]. Available from: https://www-pub.iaea.org/mtcd/publications/pdf/pub1578_web-57265295.pdf 2 International Atomic Energy Agency. Radiation protection and safety in medical uses of ionizing radiation [Internet]. Vienna: International Atomic Energy Agency; 2018 [cited 2022 Dec 15]. Available from: https://www-pub.iaea.org/MTCD/Publications/PDF/PUB1775_web.pdf 3Tchekmedyian A, Trigo T, Rodríguez M et al. Encuesta latinoamericana de radioprotección en endoscopia digestiva. Rev Gastroenterol Mex 2012; 77 (Suppl 2): 47– 8. 4Tchekmedyian A (ed). Network of Gastroenterologists in Radiation Protection in Latin American Countries. Newsletter IAEA project. Issue No. I January 2011. 5 International Atomic Energy Agency. International action plan for the radiological protection of patients [Internet]. Vienna: International Atomic Energy Agency; 2002 [cited 2022 Dec 15]. Available from: https://www-ns.iaea.org/downloads/rw/radiation-safety/PatientProtActionPlangov2002-36gc46-12.pdf 6 International Atomic Energy Agency. Bonn Call for Action platform [Internet]. Vienna: International Atomic Energy Agency; 2022 [cited 2022 Dec 15]. Available from: https://www.iaea.org/resources/rpop/resources/bonn-call-for-action-platform 7 International Atomic Energy Agency. Radiation protection of patients (RPOP) [Internet]. Vienna: International Atomic Energy Agency; 2022 [cited 2022 Dec 15]. Available from: https://www.iaea.org/resources/rpop 8 International Atomic Energy Agency. Posters and leaflets about radiation protection [Internet]. Vienna: International Atomic Energy Agency; 2022 [cited 2022 Dec 15]. Available from: https://www.iaea.org/resources/rpop/resources/posters-and-leaflets 9 Interamerican Society of Digestive Endoscopy. Endoscopy tips [Internet]. Interamerican Society of Digestive Endoscopy; 2022 [cited 2022 Dec 15]. Available from: https://siedonline.org/2022/endoscopy-tips/ 10 International Atomic Energy Agency. Radiation protection in interventional procedures: Practical tutorials [Internet]. Vienna: International Atomic Energy Agency; 2022 [cited 2022 Dec 15]. Available from: https://www.iaea.org/resources/rpop/resources/online-training-in-radiation-protection#5 11 International Atomic Energy Agency. Training material for doctors using fluoroscopy outside radiology [Internet]. Vienna: International Atomic Energy Agency; 2022 [cited 2022 Dec 15]. Available from: https://www.iaea.org/resources/rpop/resources/training-material#11 12 International Atomic Energy Agency. Webinars in radiation protection [Internet]. Vienna: International Atomic Energy Agency; 2022 [cited 2022 Dec 15]. Available from: https://www.iaea.org/resources/rpop/resources/webinars KEEP IN TOUCH! THE WEO EVENTS CALENDAR WEO upcoming events Please note that some events may have been cancelled or re-scheduled because of the COVID-19 pandemic. ENDO 2024 July 4–6, 2024 – Seoul, Korea WEO-endorsed events 25th Düsseldorf International Endoscopy Symposium 2023 February 2–4, 2023 – Düsseldorf, Germany (hybrid format) For a full list of upcoming events and WEO Centers of Excellence live courses, please see www.worldendo.org/events. Volume35, Issue1January 2023Pages 152-159 ReferencesRelatedInformation