Endoscopic Ablation Research Articles

Posterior urethral valves: Clinical audits of presentation, diagnostic and therapeutic intervention in a nigerian teaching hospital.

We described our experience in the management of PUV at UNIOSUN Teaching Hospital, Osogbo, Osun State. This was a retrospective analysis of patients with diagnosis of PUV carried out over a 4year period (2019-2023). Demographic characteristics, clinical presentation, diagnosis and mode of therapeutic interventions were the variables analysed. A total of 17 patients with PUV were managed during the study period. Median age at presentation and surgery were 10months (range 3.0-48.0) and 13months (range 3.0-49.5), respectively. Most common presentation was poor urinary stream, 11 (64.7%). Mean PCV was 34.42%. Klebsiella aerogens was the predominant 9 (52.9%) organism isolated. A patient had prenatal USS diagnosis suggestive of PUV, majority (52.9%) had bilateral grade 1V hydronephrosis at presentation. Voiding cystogram was diagnostic in 14 patients, (82.4%) while urethrocystoscopy was done in 14 (82.4%) patients. Median creatinine level were 116, 76.5 and 51.0 (micromol/l) pre- and post-catheterization and 1month post-surgery, respectively. There was positive correlation between the age and post- surgery creatinine but a negative correlation between the PCV and grade of hydronephrosis. All patients had Mohans valvotomy. We had mortality in a patient from urosepsis. At 6months-1year follow-up, 15 patients had good urine stream with stable renal function. Early intervention assist in optimizing renal and bladder function and minimize risk of urosepsis. Where there is no facility for endoscopic valve ablation, Mohans valvotomy remains a viable treatment option.

Utilizing artificial neural network system to predict the residual valve after endoscopic posterior urethral valve ablation.

To build, train, and assess the artificial neural network (ANN) system in estimatingthe residual valve rate after endoscopic valve ablationand compare the data obtained with conventional analysis. In a retrospective cross-sectional study between June 2010 and December 2020, 144 children with a history of posteriorurethral valve (PUV) who underwent endoscopic valve ablation were enrolled in the study. MATLAB software was used to design and train the network in a feed-forward backpropagationerror adjustment scheme. Preoperative and postoperative data from 101 patients (70%) (training set) were utilized to assessthe impact and relative significance of the necessity for repeatedablation. The validated suitably trained ANN was used to predict repeated ablation in the next 33 patients (22.9%) (test set)whose preoperative data were serially input into the system. To assess system accuracy in forecasting the requirement for repeatablation, projected values were compared to actual outcomes. The likelihood of predicting the residual valve was calculatedusing a three-layered backpropagating deep ANN using preoperativeand postoperative information. Of 144 operated cases, 33 (22.9%) had residual valvesand needs to repeated ablation. The ANN accuracy, sensitivity, and specificity for predicting the residual valve were 90.75%,92.73%, and 73.19%, respectively. Younger age at surgery, hyperechogenicity of the renal parenchyma, presence of vesicoureteralreflux (VUR), and grade of reflux before surgery were among the most significant characteristics that affectedpostoperative outcome variables, the need for repeated ablation, and were given the highest relative weight by the ANN system. Conclusions: The ANN is an integrated data-gathering tool for analyzing and finding relationships among variables as a complex non-linear statistical model. The results indicate that ANN is a valuable tool for outcome prediction of the residualvalveafter endoscopic valve ablation in patients with PUV.

Endoscopic Ultrasound-Guided Radiofrequency Ablation (EUS-RFA) for Pancreatic Adenocarcinoma: A Review.

Pancreatic ductal adenocarcinoma (PDAC) is still one of the deadliest neoplasms in the world. Although various advancements in the treatment and management of this disease have been made, no significant overall survival benefit has been achieved. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has been proposed as a treatment for patients who are unfit for surgery or with inoperable PDAC. We conducted a literature review of the PubMed and Embase databases to identify and analyze studies on the use of EUS-RFA in inoperable PDAC. Eleven studies with a total of 122 patients were analyzed to assess the population characteristics, feasibility and safety of the procedure, and overall survival of the population. Technical success was achieved in 95.1% of cases, and no intraoperative complications were reported. The most common early complication reported was abdominal pain (21 out of 122 patients) with a total early complication rate of 29.6%, and none of these complications affected hospital stays or post-procedure recovery. Late complications were reported in four patients (3.2%). Post-procedure cytoreduction was achieved in all patients, although disease progression was reported in 119 of 122 patients. The overall survival rate did not differ from that reported in the literature. We found that EUS-RFA could be a valid palliative option for inoperable patients,a bridge for surgeryreducing the size of the tumor and its vascular relationship, or a first-line therapy in a subset of selected patients. Larger cohort and prospective studies should be conducted to establish guidelines for this procedure.

S4017 Endoscopic Ultrasound-Guided Radiofrequency Ablation for Symptomatic Pancreatic Gastrinoma

S4017 Endoscopic Ultrasound-Guided Radiofrequency Ablation for Symptomatic Pancreatic Gastrinoma

Predicting Regression of Barrett's Esophagus-Can All the King's Men Put It Together Again?

The primary pre-neoplastic lesion of the lower esophagus in the vicinity of the gastroesophageal junction (GEJ) is any Barrett's esophageal lesions (BE), and esophageal neoplasia has increased in the US population with predispositions (Caucasian males, truncal obesity, age, and GERD). The responses to BE are endoscopic and screening cytologic programs with endoscopic ablation of various forms. The former have not been proven to be cost-effective and there are mixed results for eradication. A fresh approach is sorely needed. We prospectively followed 2229 mostly male veterans at high risk for colorectal cancer in a 27-year longitudinal long-term study, collecting data on colorectal neoplasia development and other preneoplastic lesions, including BE and spontaneous regression (SR). Another cross-sectional BE study at a similar time period investigated antigenic changes at the GEJ in both BE glandular and squamous mucosa immunohistochemistry and the role of inflammation. Ten of the prospective cohort (21.7%) experienced SR out of a total of forty-six BE patients. Significant differences between SR and stable BE were younger age (p < 0.007); lower platelet levels (p < 0.02); rectal p87 elevation in SR (p < 0.049); a reduced innate immune system (InImS) FEREFF ratio (ferritin: p87 colonic washings) (p < 0.04). Ancillary testing showed a broad range of neoplasia biomarkers. InImS markers may be susceptible to intervention using commonplace and safe medical interventions and encourage SR.

769. CLINICAL EVALUATION OF CRYOBALLOON ABLATION FOR BARRETTS OESOPHAGUS: A UK FIRST MULTI-CENTRE EXPERIENCE

Abstract Introduction The Cryoballoon Focal Ablation System (CbFAS) (Pentax Medical Inc) is an innovative device designed for the endoscopic ablation of Barrett's-related neoplasia. This system has been shown to provide advantages such as reduced stricture rates and improved patient tolerance compared to the conventional standard of care, radiofrequency ablation (RFA). We report early outcomes from a prospective UK first multi-centre registry of consecutive patients who underwent Cryoablation for the endoscopic eradication (EET) of Barrett’s-related neoplasia. Methods Patients were prospectively enrolled from two tertiary referral centres for Barrett’s Oesophagus (BE). Inclusion criteria included patients with a BE segment no longer than 5cm with histologically-proven dysplasia on biopsy or endoscopic resection specimens suitable for EET of BE after MDT review. Cryoablation sessions were conducted at 3-month intervals until endoscopic eradication was complete. The standardised protocol involved administering 8 seconds per ablation for all enrolled patients with the CbFAS. Our primary outcome was complete eradication of BE. Secondary outcomes included the number of ablations performed, adverse events, device malfunction, stricture rate, patient tolerance, and endoscopist satisfaction which was evaluated using a 10-point Likert scale (1=poor, 10=excellent). Results Between January 2020 and December 2023, a total of 16 patients (35 treatment sessions) were treated. The median BE length was C0M2. Complete eradication of BE was achieved in 89% (8/9) of patients who had completed treatment. No instances of device malfunction or intraoperative adverse events were recorded. A stricture rate of 12.5% (2/16) was observed, both of which were successfully managed through endoscopic dilatation. All patients were recorded as tolerating the procedure well with sedation. The median endoscopist satisfaction score was 9 (+/- 2.4) with only one recorded instance of difficulty attributed to balloon positioning. Conclusions These preliminary results from the UK cryoablation registry suggest that cryoablation with the CbFAS is a safe and effective therapy for BE-related dysplasia. The stricture rate appears to be comparable to that observed with RFA and similar studies. With the planned enrolment of further centres and suitable patients, this registry will further enhance our understanding of the long-term efficacy and safety profile of cryoablation using the CbFAS.

356. TUMOUR BURDEN CORRELATES WITH THE RISK OF RECURRENCE AFTER PIECEMEAL ENDOSCOPIC RESECTION OF EARLY-STAGE ADENOCARCINOMA IN BARRETT’S OESOPHAGUS

Abstract Background Endoscopic resection (ER) is curative for Barrett’s oesophagus-related early-stage oesophageal adenocarcinoma (EAC) without high-risk features, such as lymphovascular invasion (LVI), positive margins (R1), and deep submucosal invasion (T1bsm2-3). Piecemeal endoscopic mucosal resection (pEMR), often used for lesions larger than 15mm, prevents assessment of lateral margins and therefore complicates precise risk estimation for residual EAC at the first post-ER endoscopy. Thus, we investigated alternative clinical factors that could potentially be used to assess the risk for residual and recurrent EAC post-ER. Methods We performed a longitudinal cohort study of patients who underwent ER between 2006-2023. Inclusion criteria were: T1a or well/moderately differentiated T1bsm1 EAC; LVI-, and R0 resection. ER was categorised as pEMR (n=106) or en-bloc ER (n=22 en-bloc EMR, n=9 endoscopic submucosal dissection). The primary outcome was residual EAC at first post-ER endoscopy. Secondary outcomes were residual HGD at first post-ER endoscopy, EAC and HGD recurrence at any post-ER endoscopy, and remission of EAC, HGD and intestinal metaplasia (IM) at latest endoscopy. Multivariate logistic regression, receiver operating characteristics, chi-squared, and Kaplan Meier analyses were performed to investigate possible associated risk factors. Results Rates of EAC/HGD recurrence were higher post-pEMR versus en-bloc ER (p=0.019), with residual EAC at first post-ER endoscopy accounting for 34% of post-pEMR recurrence. The percentage of pEMR specimens with EAC (p=0.022) and T1bsm1 staging (p=0.013) were independent risk factors for residual EAC at first post-pEMR endoscopy (Table 1). A 53.5% cut-off of involved pEMR specimens was identified as the optimal threshold for residual EAC prediction (specificity=0.68, sensitivity=0.67). Indeed, residual (p=0.012) and recurrent (p=0.00077) EAC rates were higher when EAC involvement was &amp;gt;53.5%. However, rates of EAC (p=0.13), HGD (p=0.19) and IM (p=0.76) remission were unaffected by high EAC burden. Conclusions High burden of EAC on pEMR specimens correlates with increased risk of residual and recurrent EAC at post-pEMR endoscopy. Post-pEMR site check is recommended prior to endoscopic ablation, particularly in patients where more than 50% of pEMR specimens show EAC and in cases of flat subtle lesions. This will ensure eradication of any residual disease and high success rates for treatment of early EAC using endotherapy.

Endoscopic Gastric Fundal Mucosal Ablation Induces Weight Loss in Adults With Obesity

Endoscopic Gastric Fundal Mucosal Ablation Induces Weight Loss in Adults With Obesity

Open surgical excision vs. endoscopic radiofrequency ablation in managing congenital pyriform sinus fistula-a comprehensive analysis of 166 cases.

Congenital pyriform sinus fistula (CPSF) is uncommon congenital abnormality, and the optimal definitive treatment has not yet been established. The aim of the present study was to comparatively evaluate patients with CPSF regarding the indications and outcomes of treatment with open surgical excision (OSE) vs. endoscopic Radiofrequency Ablation (RA), and the advantages of both therapeutic procedures were also analyzed. An observational, longitudinal, retrospective, analytical and comparative study was conducted on 166 consecutive pediatric patients with CPSF treated at Shanghai Children's Hospital between December 2018 and September 2023. In this study, there were 79 males and 87 females. The median age at operation was 4.8 years (8 days to 15 years). OSE and Endoscopic RA were respectively performed in 48 and 118 children. The gastric tube retention time after RA was longer (3 days vs. 14 days) than after OSE. Patients with a history of incision and drainage (I&D) tended to choose OSE (75.0% vs. 39.0%, P < 0.01). There were no significant differences in postoperative complications and recurrence rates between these two groups (P > 0.05), but the hospitalization duration was shorter for RA group compared to OSE group [2 (2-3) vs. 4 (3-5), P < 0.01]. Both OSE and RA are recognized as first-line treatment options for CPSF, which show no significant differences in prognosis, except hospitalization duration and the gastric tube retention time. Nevertheless, the indications for OSE and RA differ, which are influenced by factors such as the inflammatory stage, specific typing, previous treatments, and the surgeon's expertise. The selection of surgical approach should be carefully determined based on individual circumstances.

A Rare Cause of Macroscopic Hematuria: Ureteral Fibroepithelial Polyp: A Case Report

Fibroepithelial polyps are rare, benign, non-epithelial tumors of the urinary system. They can occur throughout the entire urinary system, including the renal pelvis, ureter, bladder, and urethra, which are lined with urothelium. These polyps originate from the stromal structure, formed by the combination of mesodermal and urothelial cells. The most common clinical complaint of patients with fibroepithelial polyps is unilateral flank pain. In some cases, this pain may be accompanied by hematuria, dysuria, and pollakiuria, which are irritative lower urinary tract symptoms. In this case report, a case of a giant ureteral fibroepithelial polyp in a patient who was admitted to our clinic with macroscopic hematuria and left flank pain was presented. Following the diagnosis of a giant polyp in the left ureter, we treated the patient with endoscopic ablation using a Holmium-YAG laser device under ureteroscopy guidance.

The effect of use of alpha-blockers in posterior urethral valve pediatric patients postvalve ablation in the absence of further outlet obstruction.

The objectives of this study were to detect whether the use of alpha-blockers in posterior urethral valve (PUV) pediatric patients after valve ablation will improve the persistent obstructive symptoms despite the absence of obstruction and if there are associated side effects of its use. Methods: A prospective, single-blinded randomized study was conducted at the urology department of two hospitals on 50 male children between September 2019 and June 2021 with PUV. All children were treated by endoscopic ablation of PUV using the cold knife and were followed clinically for voiding symptoms and with ultrasonography and laboratory tests. All patients underwent second-look cystoscopy 1 month after primary valve ablation to see residual valves as a routine procedure confirming no remnant of the valve and still complaining of obstructive symptoms. They were divided into two equal groups 25 patients each. Group A was given alpha-blockers and Group B placebo for 1 month. Marked improvement of obstructive symptoms in Group A reaching about 90% (21 patients), whereas no mentioned improvement in Group B was noticed with no side effects of both medication the alpha-blocker and the placebo during its use. The use of alpha-blockers improves the obstructive symptoms in pediatric patients with PUV after valve ablation and in the absence of any further urethral obstruction with no side effects noticed during the period of its use.

Endoscopic Ablation of Perihilar Biliary Malignancies

Endoscopic Ablation of Perihilar Biliary Malignancies

PET CT and ultrasound-guided endoscopic radiofrequency ablation: almost a one-stop, minimally-invasive cure for hypertension due to an aldosterone-producing adenoma

PET CT and ultrasound-guided endoscopic radiofrequency ablation: almost a one-stop, minimally-invasive cure for hypertension due to an aldosterone-producing adenoma

Systematic review and meta-analysis: the efficacy and safety of radiofrequency ablation for early superficial esophageal squamous cell neoplasia

Background and AimEsophageal squamous cell neoplasia (ESCN) is predominant in Asia. Endoscopic mucosal resection and endoscopic submucosal dissection (ESD) have both been recommended worldwide, however the application of endoscopic radiofrequency ablation (RFA) for treatment of early superficial ESCN remains inconclusive. We conducted a meta-analysis to study the effectiveness of RFA for early superficial ESCN.MethodsThree major bibliographic databases were reviewed for the enrollment of case series and cohort trials prior to August 23, 2023. We included adults diagnosed with early superficial ESCN who had been receiving endoscopic RFA or ESD if the treatments were available. Our focus was on the 12-month histological complete response rate (CR) and 3-month histological CR, as well as the acute and late postoperative adverse events (AEs) rate during the at follow-up periods.ResultsNine studies were enrolled for qualitative synthesis of narrative review, with eight trials involving a total of 447 participants for analysis. The pooled 12-month and 3-month histological CR were 0.83 (95% CI, 0.59–0.94, I2 = 80%) and 0.74 (95% CI, 0.67–0.80, I2 = 0%), respectively. As for safety, the acute and late postoperative AEs were 0.11 (95% CI, 0.05–0.26, I2 = 68%) and 0.19 (95% CI, 0.14–0.26, I2 = 0%), respectively. In subgroup analysis, the incidence of bleeding, laceration and perforation after endoscopic RFA showed 0.06, 0.06 and 0.02, respectively. When compared with ESD, RFA showed lower acute AEs and late AEs without any obvious significance.ConclusionsFor early superficial ESCN, endoscopic RFA achieved both higher 12-month complete remission and late complication postoperatively when compared to 3-month histological CR and acute AEs separately, while the stricture was encountered most commonly. The choice between endoscopic RFA and ESD remains inconclusive.

Automated Upper Tract Urothelial Carcinoma Tumor Segmentation During Ureteroscopy Using Computer Vision Techniques.

Introduction: Endoscopic tumor ablation of upper tract urothelial carcinoma (UTUC) allows for tumor control with the benefit of renal preservation but is impacted by intraoperative visibility. We sought to develop a computer vision model for real-time, automated segmentation of UTUC tumors to augment visualization during treatment. Materials and Methods: We collected 20 videos of endoscopic treatment of UTUC from two institutions. Frames from each video (N = 3387) were extracted and manually annotated to identify tumors and areas of ablated tumor. Three established computer vision models (U-Net, U-Net++, and UNext) were trained using these annotated frames and compared. Eighty percent of the data was used to train the models while 10% was used for both validation and testing. We evaluated the highest performing model for tumor and ablated tissue segmentation using a pixel-based analysis. The model and a video overlay depicting tumor segmentation were further evaluated intraoperatively. Results: All 20 videos (mean 36 ± 58 seconds) demonstrated tumor identification and 12 depicted areas of ablated tumor. The U-Net model demonstrated the best performance for segmentation of both tumors (area under the receiver operating curve [AUC-ROC] of 0.96) and areas of ablated tumor (AUC-ROC of 0.90). In addition, we implemented a working system to process real-time video feeds and overlay model predictions intraoperatively. The model was able to annotate new videos at 15 frames per second. Conclusions: Computer vision models demonstrate excellent real-time performance for automated upper tract urothelial tumor segmentation during ureteroscopy.

Endoscopic ultrasound-guided radiofrequency ablation of pancreatic tumors.

Surgery is a cornerstone in the management of pancreatic cancer and precancerous pancreatic lesions. However, many patients are not suitable candidates for surgery at the time of diagnosis for various reasons. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) appears to be a promising treatment option for patients who are ineligible for surgery for management of pancreatic adenocarcinoma (PDAC), and pancreatic neuroendocrine tumors (PNETs), and pancreatic cystic lesions (PCLs). EUS-RFA may serve as an adjunct to chemotherapy or palliative measures for inoperable cases of PDAC. Given its feasibility and efficacy, EUS-RFA has an evolving niche as a minimally invasive and potentially definitive treatment for PNETs and high-risk PCLs such as intraductal papillary mucinous neoplasms (IPMNs). EUS-RFA is a generally well tolerated procedure, with abdominal pain and acute pancreatitis being the most common adverse effects, though the risk can be mitigated through prophylactic measures. There is an increasing body of evidence to support the use of EUS-RFA in managing pancreatic lesions, either as definitive, adjunctive, or palliative treatment, depending on lesion type.

Rates of Recurrent Intestinal Metaplasia and Dysplasia After Successful Endoscopic Therapy of Barrett's Neoplasia by Endoscopic Mucosal Resection vs Endoscopic Submucosal Dissection and Ablation: A Large North American Multicenter Cohort.

Endoscopic eradication therapy (EET) combining endoscopic resection (ER) with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) followed by ablation is the standard of care for the treatment of dysplastic Barrett's esophagus (BE). We have previously shown comparable rates of complete remission of intestinal metaplasia (CRIM) with both approaches. However, data comparing recurrence after CRIM are lacking. We compared rates of recurrence after CRIM with both techniques in a multicenter cohort. Patients undergoing EET achieving CRIM at 3 academic institutions were included. Demographic and clinical data were abstracted. Outcomes included rates and predictors of any BE and dysplastic BE recurrence in the 2 groups. Cox-proportional hazards models and inverse probability treatment weighting (IPTW) analysis were used for analysis. A total of 621 patients (514 EMR and 107 ESD) achieving CRIM were included in the recurrence analysis. The incidence of any BE (15.7, 5.7 per 100 patient-years) and dysplastic BE recurrence (7.3, 5.3 per 100 patient-years) were comparable in the EMR and ESD groups, respectively. On multivariable analyses, the chances of BE recurrence were not influenced by ER technique (hazard ratio 0.87; 95% confidence interval 0.51-1.49; P = 0.62), which was also confirmed by IPTW analysis (ESD vs EMR: hazard ratio 0.98; 95% confidence interval 0.56-1.73; P = 0.94). BE length, lesion size, and history of cigarette smoking were independent predictors of BE recurrence. Patients with BE dysplasia/neoplasia achieving CRIM, initially treated with EMR/ablation, had comparable recurrence rates to ESD/ablation. Randomized trials are needed to confirm these outcomes between the 2 ER techniques.

Long-Term Outcomes of Endoscopic Ultrasound–Guided Ablation Vs Surgery for Pancreatic Cystic Tumors

Endoscopic ultrasound-guided pancreatic cyst ablation (EUS-PCA) is performed as an alternative to surgical resection in selected patients with pancreatic cystic tumors (PCTs). We aimed to directly compare the long-term outcomes between EUS-PCA and surgery for PCTs. We reviewed a PCT database to identify patients with unilocular or oligolocular PCTs who underwent EUS-PCA or surgery between January 2004 and July 2019. We performed 1:1 propensity score matching based on potential confounding factors. The primary outcome was long-term morbidities. Secondary outcomes included early (≤14 days) and late (>14 days) major adverse events (MAEs), development of diabetes mellitus, readmission, length of hospital stay, and therapeutic efficacy. A total of 620 patients (EUS-PCA, n= 310; surgery, n= 310) were selected after propensity score matching. The EUS-PCA group showed a lower 10-year rate of cumulative long-term morbidities (1.6% vs 33.5%; P= .001) as well as lower rates of early MAE (1.0% vs 8.7%; P= .001), late MAE (0.3% vs 5.5%; P= .001), and readmission (1.0% vs 15.2%; P= .001). The EUS-PCA group had a shorter hospital stay (3.5 vs 10.3 d; P= .001) and a lower incidence of diabetes mellitus (2.2% vs 22.8%; P= .001), whereas the surgery group had a higher complete resolution rate (76.5% vs 100%; P= .001) and a lower relapse rate (4.6% vs 0.3%; P= .001). For select patients with PCTs, EUS-PCA showed superior results to surgery in terms of long-term safety profile and preservation of pancreatic function.

Endoscopic duodenal mucosa ablation techniques for diabetes and nonalcoholic fatty liver disease: A systematic review

Type 2 diabetes mellitus (T2DM) is increasing at an alarming rate, and only 50% of patients with T2DM achieve or maintain adequate glycemic control with pharmacological therapies. Metabolic surgery demonstrated superior efficacy compared to medical therapy but is unfeasible for most patients with T2DM. Duodenal mucosal resurfacing (DMR) by hydrothermal mucosal ablation, recellularization via electroporation therapy (ReCET), and photodynamic therapy are novel endoscopic procedures that use thermal, electrical, and photochemical energy, respectively, to ablate and reset dysfunctional duodenal mucosa. We assessed the data on the effects of these techniques on glycemic control and nonalcoholic fatty liver disease (NAFLD). We systematically searched independently and in duplicate English and non-English language publications through January 31st, 2024. Outcomes assessed were an improvement in different metabolic health parameters and the safety of duodenal mucosal ablation (DMA) procedures. Outcomes were presented descriptively. We selected 12 reports reporting results from 3 randomized and 6 uncontrolled trials (seven evaluating DMR, two evaluating ReCET, all with a low risk of bias) for a total of 317 patients enrolled. DMA reduced HbA1c, fasting plasma glucose, and liver fat. When combined with newer antidiabetic drugs, it allowed insulin discontinuation in up to 86% patients. No major safety signal emerged. All DMA techniques improve glucose homeostasis; DMR and ReCET appear to be safe in patients with T2DM. If confirmed by future randomized trials and by trials with histological endpoints in NAFLD, then DMA appears to be a promising alternative or complement option to medications for T2DM and NAFLD treatment. This study received no funding.

Endoscopic duodenal mucosa ablation: the future of diabetes treatment?

Duodenal mucosa ablation (DMA) is a novel approach to treat diabetes, consisting of endoscopic ablation of dysfunctional diabetic duodenal mucosa, which, following the healing response, is replaced by normally functioning mucosa. Two techniques, duodenal mucosal resurfacing (DMR) and recellularization via electroporation therapy (ReCET), recently showed promise in type 2 diabetes mellitus (T2DM) patients.