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Novel Developments in Digestive Endoscopy

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A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (20 February 2026) | Viewed by 8967

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Editor

Prof. Dr. Arnaldo Amato

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Guest Editor

Department of Digestive Endoscopy and Gastroenterology, ASST Lecco, 23100 Lecco, Italy
Interests: GI endoscopy; interventional endoscopy; ERCP; EUS; IBD

Special Issue Information

Dear Colleagues,

Digestive endoscopy has undergone significant transformation in recent years, driven by technological innovation and a growing emphasis on early detection and minimally invasive treatments. Traditional endoscopic procedures, once limited to diagnostic purposes, are now increasingly being used for therapeutic interventions, revolutionizing the management of gastrointestinal (GI) diseases.

Advanced imaging techniques have enhanced the visualization of mucosal patterns, allowing for more accurate detection of early neoplasia.

Artificial intelligence (AI) is one of the most exciting developments. It can assist endoscopists in the real-time detection and characterization of polyps and lesions, thereby improving diagnostic accuracy and reducing inter-operator variability. Additionally, advancements in endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) have expanded the possibilities for staging cancers, drainage procedures, and delivering targeted therapies.

Therapeutic innovations such as endoscopic submucosal dissection (ESD), peroral endoscopic myotomy (POEM), and endoscopic bariatric procedures offer less invasive alternatives to surgery with shorter recovery times and fewer complications.

Overall, the field of digestive endoscopy is rapidly evolving, promising better outcomes, increased patient comfort, and enhanced precision in both the diagnosis and treatment of GI disorders.

Prof. Dr. Arnaldo Amato
Guest Editor

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Keywords

endoscopy for IBD
AI in endoscopy
therapeutic endoscopy
EUS
interventional EUS
AI in digestive endoscopy
quality in endoscopy

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Published Papers (7 papers)

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Review

27 pages, 1599 KB

Open AccessReview

Innovations in Advanced Endoscopic Resection of Early Upper Gastrointestinal Cancer

by Andrea Sorge, Pieter Jan Poortmans, Michele Montori, Maria Eva Argenziano, Edoardo Vincenzo Savarino and David J. Tate

J. Clin. Med. 2026, 15(12), 4530; https://doi.org/10.3390/jcm15124530 - 11 Jun 2026

Viewed by 617

Abstract

Endoscopic resection (ER) has become the preferred curative-intent treatment for early upper gastrointestinal cancer, given its superior safety profile compared to surgery. Over the past decade, technological and procedural innovation has substantially expanded the scope, safety, and precision of endoscopic submucosal dissection (ESD) and related techniques. This review synthesises current evidence on key advances relevant to upper gastrointestinal ESD practice. Enhanced imaging modalities have improved lesion detection and characterisation, as well as recognition of intraoperative anatomical structures during third-space endoscopy. A new generation of therapeutic endoscopes combines high-definition optics with substantially improved tip-down angulation and channel size, addressing a longstanding gap between diagnostic-class image quality and procedural capability. Resection strategies—including mechanical traction systems, saline immersion therapeutic endoscopy (SITE), and luminal drainage techniques—have reduced procedural complexity and improved dissection conditions. Dedicated closure technologies have improved management of large resection defects, potentially reducing resection-related morbidity. Deep resection techniques, including submucosal tunnelling endoscopic resection (STER), device-assisted endoscopic full-thickness resection (FTRD), knife-assisted full-thickness resection (kFTR), and endoscopic intermuscular dissection (EID), are extending organ-preserving resection to deeply invasive cancers and subepithelial lesions. Management of non-curative ESD resections is being refined through multicentre risk stratification studies. Advances in simulation, competency-based training, and artificial intelligence hold promise for standardising technique acquisition and real-time procedural support. Together, these innovations are reshaping upper gastrointestinal oncology by positioning minimally invasive, organ-preserving digestive endoscopy as a central therapeutic strategy. Full article

(This article belongs to the Special Issue Novel Developments in Digestive Endoscopy)

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19 pages, 2004 KB

Open AccessReview

Sedation in Gastrointestinal Endoscopy: From Drug-Centered Protocols to Personalized, Technology-Supported Pathways: A Narrative Review

by Giuliano Francesco Bonura, Paola Soriani, Noemi Gualandi, Pablo Cortegoso Valdivia, Tommaso Gabbani, Arianna Parrella, Anastasios Koulaouzidis and Mauro Manno

J. Clin. Med. 2026, 15(11), 4281; https://doi.org/10.3390/jcm15114281 - 1 Jun 2026

Viewed by 1143

Abstract

Background/Objectives: Sedation is a fundamental component of gastrointestinal endoscopy, improving patient comfort, procedural quality, and overall satisfaction. However, traditional drug-centered sedation models are increasingly challenged by rising procedural volumes, aging populations, and limited anesthesiology resources. The aim of this narrative review is to provide an integrated overview of evolving pharmacological agents, monitoring strategies, organizational models, and future directions toward personalized, technology-supported sedation pathways. Methods: A structured literature search was conducted across PubMed/MEDLINE, Scopus, and Web of Science for studies published between January 2010 and December 2025. Relevant guidelines, randomized controlled trials, meta-analyses, and large observational studies were included. Evidence was synthesized qualitatively, emphasizing clinical applicability and real-world relevance. Results: Propofol remains the most widely used sedative agent due to its rapid onset and recovery profile, although its narrow therapeutic window and lack of antagonist limit its safety in high-risk patients. Emerging agents such as remimazolam and ciprofol demonstrate comparable efficacy with improved respiratory and hemodynamic safety profiles, particularly in elderly populations. Adjunctive strategies, including procedure-specific approaches such as spinal anesthesia, may further optimize sedation. Advanced monitoring tools, such as capnography, bispectral index, and high-flow nasal cannula, show potential in enhancing safety, especially in selected high-risk groups. Structured training programs and standardized discharge criteria are essential for ensuring quality and safety. Conclusions: Sedation in gastrointestinal endoscopy is transitioning from a standardized, drug-centered approach to a personalized, risk-adapted, and technology-supported model. Integration of novel pharmacological agents, advanced monitoring, and structured training will be key to improving patient safety, procedural efficiency, and healthcare sustainability. Full article

(This article belongs to the Special Issue Novel Developments in Digestive Endoscopy)

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18 pages, 1434 KB

Open AccessReview

Therapeutic Endoscopic Ultrasound in Biliopancreatic Disease

by Aurelio Mauro, Carlotta Crisciotti, Giulio Massetti, Daniele Alfieri, Stefano Mazza, Davide Scalvini, Alessandro Cappellini, Guglielmo Aprile, Gianmaria La Rosa, Francesca Torello Viera, Letizia Veronese, Marco Bardone and Andrea Anderloni

J. Clin. Med. 2026, 15(8), 2848; https://doi.org/10.3390/jcm15082848 - 9 Apr 2026

Viewed by 851

Abstract

Therapeutic endoscopic ultrasound (t-EUS) has transformed the management of biliopancreatic diseases by enabling minimally invasive access and intervention through the gastrointestinal wall. This narrative review summarizes current indications and evolving roles of t-EUS in benign and malignant biliary disease, with a focus on the different modalities of transmural drainage, EUS-guided gastroenterostomy (EUS-GE), and EUS-guided radiofrequency ablation (EUS-RFA). In benign settings, EUS-gallbladder drainage (EUS-GBD) has emerged as a minimally invasive alternative to percutaneous cholecystostomy for high-risk patients with acute cholecystitis, offering internal drainage with fewer tube-related adverse events. In malignant biliary obstruction, transmural drainages are consolidated alternatives of endoscopic retrograde cholangiopancreatography (ERCP) as first-line or rescue strategies, providing durable internal biliary drainage, avoiding post-ERCP pancreatitis without deteriorating quality of life. In surgically altered anatomy, t-EUS overcomes the limitations of enteroscopy-assisted ERCP by creating direct access routes to the biliary tree or pancreatic duct. EUS-guided pancreatic duct drainage offers a rescue or primary approach in benign strictures, anastomotic stenosis, and disconnected duct syndrome. EUS-GE has rapidly become a preferred modality for palliation of gastric outlet obstruction in pancreatic cancer, while EUS-RFA provides a platform for locoregional therapy in selected cases of pancreatic neuroendocrine tumors, adenocarcinoma, and pancreatic cystic neoplasms. Collectively, these applications position t-EUS as a central tool in the multidisciplinary management of complex biliopancreatic disease, with ongoing innovations expected to further expand its indications and safety and to refine patient selection and training pathways. Full article

(This article belongs to the Special Issue Novel Developments in Digestive Endoscopy)

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22 pages, 931 KB

Open AccessReview

Endoscopy for Metabolic Diseases

by Maria Valeria Matteo, Jana Kefah Ibrahim Hussein, Giorgio Carlino, Vincenzo Bove, Valerio Pontecorvi, Loredana Gualtieri, Martina De Siena, Mariachiara Di Vincenzo, Lorenzo Zileri Dal Verme, Daniele Salvi, Clarissa Ferrari, Cristiano Spada and Ivo Boskoski

J. Clin. Med. 2026, 15(8), 2832; https://doi.org/10.3390/jcm15082832 - 8 Apr 2026

Viewed by 1099

Abstract

Endoscopic bariatric and metabolic therapies (EBMTs) offer minimally invasive treatment options for obesity and related metabolic disorders such as type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD). These therapies are broadly categorized into gastric and small bowel interventions. Gastric EBMTs, including intragastric balloons and endoscopic sleeve gastroplasty, promote weight loss primarily through mechanical restriction and delayed gastric emptying, thereby improving metabolic outcomes. Small bowel therapies target the proximal intestine to modulate nutrient-sensing and hormonal pathways, providing metabolic benefits that may occur independently of weight loss. Techniques such as duodenal mucosal resurfacing, electroporation-based re-cellularization, and duodenal-jejunal bypass liners demonstrate promising effects on glycemic control, insulin sensitivity, and liver health. Emerging technologies utilizing thermal, vapor, and laser ablation further expand therapeutic possibilities. While these interventions show favorable safety profiles and potential as standalone or adjunctive treatments, further long-term studies and randomized trials are necessary to optimize patient selection and procedural protocols. Collectively, EBMTs represent an evolving paradigm in the management of obesity and metabolic diseases, bridging the gap between conservative medical therapies and bariatric surgery. Full article

(This article belongs to the Special Issue Novel Developments in Digestive Endoscopy)

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24 pages, 962 KB

Open AccessReview

New Technologies for IBD Endoscopy

by Cristina Bezzio, Valeria Farinola, Giuseppe Privitera, Arianna Dal Buono, Roberto Gabbiadini, Laura Loy, Gianluca Franchellucci, Erica Bartolotta, Giulia Migliorisi and Alessandro Armuzzi

J. Clin. Med. 2026, 15(7), 2539; https://doi.org/10.3390/jcm15072539 - 26 Mar 2026

Cited by 1 | Viewed by 1334

Abstract

Background: Endoscopic assessment is central to the management of inflammatory bowel disease (IBD), particularly within treat-to-target strategies. However, conventional high-definition white-light endoscopy (HD-WLE) is limited by interobserver variability and its inability to reliably reflect microscopic inflammation or predict long-term outcomes. Over the last decade, multiple technological innovations have reshaped the role of endoscopy in both disease activity monitoring and dysplasia surveillance. Methods: This narrative review provides a comprehensive and clinically oriented overview of emerging endoscopic technologies in IBD, including image-enhanced endoscopy, ultra-high-magnification techniques, artificial intelligence (AI), and molecular imaging. We discuss their diagnostic performance, prognostic implications, and potential integration into clinical practice. Results: Image-enhanced endoscopy improves visualization of subtle mucosal and vascular alterations and demonstrates stronger correlation with histological activity compared with HD-WLE alone. Confocal laser endomicroscopy and endocytoscopy enable in vivo microscopic assessment of epithelial architecture and barrier integrity, redefining remission beyond macroscopic healing. AI systems have shown expert-level performance in grading inflammatory severity in ulcerative colitis and high sensitivity in capsule endoscopy for Crohn’s disease, supporting objective and reproducible assessment. In surveillance, targeted high-definition inspection has replaced random biopsies, while adjunctive optical and AI-based tools enhance lesion detection and characterization. Molecular imaging introduces a predictive dimension by enabling visualization of drug–target engagement and dysplasia-specific pathways. Conclusions: Endoscopy in IBD is evolving from a descriptive modality toward a multimodal precision tool integrating enhanced imaging, AI-driven standardization, and molecular profiling. Although further validation and cost-effectiveness studies are required, these innovations have the potential to improve therapeutic stratification, surveillance strategies, and long-term patient outcomes. Full article

(This article belongs to the Special Issue Novel Developments in Digestive Endoscopy)

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20 pages, 833 KB

Open AccessReview

Interventional Endoscopy for the Management of Post-Surgical Leaks and Fistulas: A Scoping Review

by Tommaso Pessarelli, Irene Maria Bambina Bergna, Cinzia Boemo, Alberta De Monti, Marta La Milia, Cristina Marfinati Hervoso, Michela Pagliarulo, Alessandra Piagnani, Mauro Zago and Arnaldo Amato

J. Clin. Med. 2026, 15(6), 2291; https://doi.org/10.3390/jcm15062291 - 17 Mar 2026

Cited by 1 | Viewed by 827

Abstract

Background/Objectives: Leaks and fistulas are serious surgical complications associated with substantial morbidity and mortality. Traditional management has relied on surgical reintervention or percutaneous drainage, both of which carry significant risks. In recent decades, interventional endoscopy has emerged as a minimally invasive alternative, offering a growing range of therapeutic options. This scoping review aimed to systematically map the available evidence on endoscopic management of post-surgical leaks and fistulas, with a focus on techniques used, indications, outcomes, and gaps in the literature. Methods: This scoping review was conducted according to PRISMA-ScR guidelines. PubMed/MEDLINE, Embase, and Scopus were searched from inception to 5 December 2025. Eligible studies included original studies, systematic reviews, and narrative reviews reporting therapeutic endoscopic interventions for post-surgical leaks or fistulas in any patient population. Case reports and case series with fewer than 20 patients were excluded. Data were charted on study design, surgical context, endoscopic techniques, and reported outcomes. Results: A total of 69 studies were included, comprising 46 original studies involving 2550 patients, along with 11 systematic reviews and 12 narrative reviews. Endoscopic techniques identified included through-the-scope and over-the-scope clipping, stenting, endoscopic vacuum therapy, internal drainage, tissue sealants, endoscopic suturing, and hybrid devices such as VAC-Stent^®. Reported technical and clinical success rates varied widely across techniques and clinical settings, influenced by defect characteristics, timing of intervention, anatomical location, and operator experience. Endoscopic vacuum therapy was supported by the most consistent evidence, particularly for esophageal and colorectal leaks. Conclusions: Interventional endoscopy represents an increasingly central component in the management of post-surgical leaks and fistulas, enabling individualized, less invasive treatment strategies. However, the current evidence base remains heterogeneous and largely retrospective, underscoring the need for well-designed, multicenter prospective studies. Full article

(This article belongs to the Special Issue Novel Developments in Digestive Endoscopy)

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18 pages, 682 KB

Open AccessReview

Artificial Intelligence in Pancreatobiliary Endoscopy: Current Advances, Opportunities, and Challenges

by Aastha V. Bharwad, Rohan Ahuja, Pragya Jain and Vaibhav Wadhwa

J. Clin. Med. 2025, 14(21), 7519; https://doi.org/10.3390/jcm14217519 - 23 Oct 2025

Cited by 3 | Viewed by 2369

Abstract

Pancreaticobiliary endoscopy, encompassing endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), and digital single-operator cholangioscopy (DSOC), is essential for diagnosing and managing pancreatic and biliary diseases. However, these procedures are limited by operator dependency, variable diagnostic accuracy, and technical complexity. Artificial intelligence (AI), particularly through machine learning (ML) and deep learning (DL), has emerged as a promising tool to address these challenges. Early studies show that AI can enhance lesion detection, improve differentiation of pancreatic masses, classify cystic lesions, and aid in diagnosing malignant biliary strictures. AI has also been used to predict post-ERCP pancreatitis risk and reduce radiation exposure during ERCP. Despite this promise, current AI models are largely experimental—limited by small, single-center datasets, lack of external validation, and no FDA-approved systems for these indications. Major barriers include inconsistent data acquisition, limited interoperability across hardware platforms, and integration into real-time workflows. Future progress depends on multicenter data sharing, standardized imaging protocols, interpretable AI design, and regulatory pathways for model deployment and updates. AI can be developed as a valuable partner to endoscopists, enhancing diagnostic accuracy, reducing complications, and supporting more efficient, personalized care in pancreaticobiliary endoscopy. Full article

(This article belongs to the Special Issue Novel Developments in Digestive Endoscopy)

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