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. 

Crohn’s disease (CD) is a chronic inflammatory bowel condition that can present with a wide range of intestinal and extra-intestinal manifestations. This condition can develop at any age and have a significant impact and impairment on quality of life for individuals including on relationships, educational attainment and work productivity. In particular, the time around and after diagnosis often involves the most upheaval for patients, and equally the biggest opportunity for effective intervention. Several recent advances have had a major impact on optimal management of patients with newly diagnosed CD. Here, we discuss the mistakes that are commonly made when managing patients presenting with a new diagnosis of CD. We summarise the evidence base and offer helpful and pragmatic tips for practising clinicians.

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.

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.  

Tissue sampling during endoscopic procedures is a fundamental aspect of investigating digestive diseases, with histological examination playing a crucial role in almost every case. Given its prevalence, the potential for mistakes is significant. Therefore, understanding the appropriate indications, techniques, and consequences of tissue sampling is essential for gastroenterologists. Key questions to consider before taking a biopsy or acquiring tissue include: Why? What for? How? How many?

This manuscript addresses these critical questions by detailing the eight most frequent and correctable mistakes in tissue acquisition during endoscopy. The recommendations provided are largely supported by existing guidelines and evidence, with some insights drawn from the authors' professional experience.

Endoscopic resection is a widespread, advanced endoscopic technique that can be used to remove superficial lesions in the gastrointestinal tract. Lesions present in all parts of the gastrointestinal tract, such as the oesophagus, stomach, duodenum, small intestine and, above all, colon, can be removed by endoscopic resection. Lesion detection and characterization, the use of appropriate resection devices and methods, and the management of malignant polyps are all important parts of a multistep process that requires training, experience, expertise and a multidisciplinary approach.  The diagnostic and therapeutic mistakes discussed here are based on our endoscopic experience. We present the most important mistakes that are often seen in endoscopic resection in our practice and have major consequences for the patient. We propose, from our experience, a simple approach to avoid these mistakes.