Gastric polyps are usually asymptomatic, with more than 90% found incidentally and a prevalence of up to 6% at upper endoscopy. Fundic gland polyps (FGPs) are the gastric polyps most frequently seen in the Western world, largely due to their long-established association with proton pump inhibitor (PPI) usage. In countries where Helicobacter pylori infection is prevalent an endoscopist is more likely to encounter hyperplastic polyps and adenomas, which are known to be associated with a higher malignant potential. Gastric polyps are often regarded as the ‘poor relation’ to their colonic counterparts and as such clinicians often feel unsure how to identify, assess and appropriately manage these lesions. Endoscopists often lack confidence in the endoscopic characterisation of gastric polyps, feel unsure when to biopsy polyps and, if they are biopsying polyps, how many they should sample, and finally they are not always certain what the longer-term management is. The British Society of Gastroenterology (BSG) guidelines provide a useful flowchart and overview of the management of gastric polyps, and the discussion here is based on those guidelines, guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) and 12 years of clinical experience.

Barrett’s oesophagus is the precursor to oesophageal adenocarcinoma, which carries a poor prognosis, and it is likely that all endoscopists and gastroenterologists will encounter Barrett’s oesophagus in their clinical practice. Careful assessment and management of patients who have Barrett’s oesophagus with endoscopic surveillance and endoscopic endotherapy aim to reduce the risk of progression to invasive adenocarcinoma. Advances in endoscopic diagnosis and therapy should, therefore, help to reduce the risk of progression. As with all premalignant conditions and surveillance programmes, careful multidisciplinary management of the patient is important to reduce the risk of causing them to become unduly concerned. Here, we present some mistakes that in our experience are commonly made in the endoscopic diagnosis and management of Barrett’s oesophagus and give advice on how to avoid them. 

Long-term enteral nutrition via gastrostomy is a relatively common medical intervention for patients at risk of malnutrition who have an accessible and functioning gastrointestinal tract. There are clear clinical guidelines describing the principles of practice as well as numerous retrospective and non-randomised controlled studies and case series. However, fewer publications impart advice and guidance regarding the management and ‘patient selection’ for these interventions. The following article provides a combination of the author’s views and the evidence base.

Colonoscopy is a complex procedure requiring both technical and non-technical skills. Performing colonoscopy also requires manual and visuospatial skills, interpretation of pathology, patient communication and a wide range of advanced therapeutic technologies. The clinical intention of colonoscopy must be individualised, and diagnostic and/or therapeutic intent rationalised, given the procedures invasive nature and associated risks. Furthermore, each colonoscopy differs due to patient factors, sedation strategy, anatomical configuration, technical challenges and endoscopist skills. Endoscopists must, therefore, demonstrate a wide range of expertise whilst working effectively in a team to manage the patient safely. It is not, therefore, surprising that mistakes in colonoscopy can occur. This article focuses on six common mistakes in colonoscopy that can be avoided to improve the procedure's safety and deliver a high-quality procedure. This, in turn, can reduce the rates of post-colonoscopy colorectal cancer (PCCRC) and improve patient experience and adherence to colonoscopy surveillance programmes. This article is based on evidence in conjunction with our collective clinical and research experience of errors in endoscopy and patient safety.

The diagnosis and management of colorectal cancer in patients who have inflammatory bowel disease is fraught with challenges and the subject is not without controversy. Optimal management requires a thorough knowledge of both diseases as well as the benefits and limitations of colonoscopic surveillance, careful IBD control, high-quality colonoscopy, robust surveillance booking mechanisms, empathic patient education and excellent communication across the multidisciplinary team looking after the patient. Make a mistake and your patient might be subjected to unnecessary life-changing surgery or exposed to an avoidably high lifetime risk of cancer. Here I discuss the mistakes that are often made when managing patients undergoing colitis surveillance. The discussion is evidence based, but where evidence is lacking, the discussion is based on my personal experience of more than 20 years in the field.  

Adequate nutrition is essential for the homeostasis of fluids and nutrients, growth and thriving, especially in children. While the underlying principle of percutaneous endoscopic gastrostomy (PEG) placement is the same for both adults and children—providing a means of enteral feeding through the stomach—the indications, considerations and techniques differ owing to anatomical differences, age-dependent physiological concerns, and the age- and disease-specific needs of the child.

If feeding via nasogastric tube (NGT) or naso-jejunal tube (NJT) is necessary for a prolonged time, placement of a PEG or percutaneous endoscopic gastro-jejunal (PEG-J) tube should be considered. A PEG tube also allows the delivery of medications and venting of the stomach when needed. Nutrition via PEG facilitates the transition to out-of-hospital care and improves the quality of life (QoL) for children and families while improving the outcome of children with chronic diseases.

There are recent clinical guidelines providing guidance for PEG tube placement in children, but little advice on, e.g., choosing the right device for the right patient, details on postoperative management, removal of the PEG tube and other specific cases. The following article provides a combination of evidence-based data and the authors’ clinical experience.