Hello, welcome to this edition of ASGE's Thursday Night Lights. I'm Stephanie Kinnan, the Senior Managing Editor of ASGE's Publications family. Tonight, we will be joined by Editor-in-Chief Doug Adler, who will share some important things you may have missed in GIE this year. During the webinar, you will be able to submit questions and comments through the Q&A box. We also want to encourage you to reach out to GIE's editorial office with any additional questions you may have after we conclude tonight. The recording of this webinar will be available to you in your GIE Leap account next week. Now without further ado, I'll turn it over to Dr. Adler to tell us all about the great things GIE has been up to this year. Good evening, everybody. Thanks for coming. I know it's often tough to make these things after a long day of work. As I was just saying to Stephanie, I was literally in a procedure about 10 minutes ago, so I get it. We appreciate your time. I've been Editor of GIE now for just under two years, and in that time, we've made a lot of changes to the journal. The journal evolves, so one of the many duties of the Editor-in-Chief is to keep the journal current and fresh and innovate. One of the things I wanted to do today was just take about 10 or 15 minutes to go over some of the changes we've made in GIE and why we think that they're good for the journal, and then I can open it up and we can kind of do a Reddit-style ask me anything about GIE, and then if there's time at the end, I can maybe just point out some of the interesting papers that we published recently that I think maybe are worth a little extra consideration. So we have really, really put a lot of time and effort and thought into some new features for the journal, and again, I'm sure that the Editor-in-Chief after me will make changes to what I make, and that's okay, but from the Editor-in-Chief seat, you're always looking for ways to innovate, make the journal more attractive to readers and authors alike. So I'll just go through these, and we can sort of talk about them at the end if you guys have any questions. Oops, it's going to go up. So one of the features that we're most excited about that you may have noticed appeared just last month for the first time is the Best-of series. You know, in the modern world, I think we're all very aware that there's a lot of journals and there's a lot of information that comes at you very, very quickly all the time, and it's often difficult to separate kind of the wheat from the chaff. Like it's hard to know, like, is this a paper that's going to change my practice or is it not? And especially if you're reviewing or looking at data or papers across a lot of different journals. So we've decided to implement a Best-of series, and these will appear every year in the November and the December, maybe the October issue in each year to sort of cover some key topics for GI endoscopy and have experts in the field pick their 10 or so top papers of the year on that topic. And this is not just GIE, this is across the endoscopy literature. Obviously a lot of these papers are going to be in GIE because that's what we focus on and publish, but it's sort of a way that, you know, you can get a sense of what were the key papers across endoscopy, and that sort of saves you from having to subscribe or read 10 different journals every month. So we had seven Best-of articles this year that collectively, I think, reviewed about 90 or included about 90 papers. So just by reading, you know, like if you didn't read anything else this year and you read these seven Best-of articles, you would essentially have the core knowledge from about 90 endoscopy papers published around the world. Shelby Sullivan, who used to be here in Colorado at the university and has since moved to Dartmouth, did a really nice Best-of piece on endobariatrics, that's her area of specialty. Mike Wallace, my predecessor and the former GIE editor-in-chief, wrote a great piece on artificial intelligence. I think for a lot of people, AI is one of the toughest topics to tease apart because there are so many AI software programs being developed at academic places and industry, and it's really, really hard to figure out, like, which one of these programs is going to break through, which one of these algorithms is going to be relevant to my practice. Jen Maranke at Penn State wrote a beautiful Best-of piece on ERCP. David Diehl did a nice one on colonoscopy. Muhammad Othman down in Texas did, not a surprise, endoscopic subucosal dissection, his passion. Our Biostats editor, Babu Mohan, did a really, really interesting Best-of piece on systematic reviews and meta-analyses. You know, 10 years ago or 15 years ago, meta-analyses were hardly done in GI because there was just too much, and now there's quite a lot of them, and I'll talk a little bit more about that tonight. And then I did a Best-of series on endoscopic ultrasound. So again, just make sure to check out those Best-of series. They'll be in the November and the December issues, and that'll become a yearly feature, something you guys can look forward to at the end of the year to recap things. So something else that I was really interested in doing for a long time, and I instituted very early on in my tenure as editor-in-chief, was sort of a focused communication section, right? Some papers are admittedly very complicated and address complicated topics and require a lot of space to really tease them apart and figure out everything that the authors are saying. But other papers are actually often very, very simple, and they make a very, very focused point or sort of convey something that's really, really succinct. And I wanted to have a special section just for that. And the nice thing about that is these papers are short. They have a very, very tight word limit of only 1,500 words. 1,500 words sounds like a lot. Believe you me, 1,500 words is very, very little when you're writing a scientific paper. But what it does is it forces the authors to be extremely concise and really, really make every word count. Focused communications has a short, abstract, very limited number of references. They can only include the key references on the paper that the reader needs to at least be aware of. And we've made it even tighter by letting them have two figures or tables. So that means two images, two tables, or one image and one table. And it's actually proven to be one of the most popular sections of the journal. Initially, we were getting a lot of submissions that we felt were too long. We were asking the authors to convert it down to a focused communication. And a lot of people said, oh, there's no way I could convert my 3,000-word paper down to 1,500 words. But they did it every time. And now that the section has become established and people know what it is, we're getting a lot of submissions directly for focused communications. And I think authors and readers like it. For authors, it allows them to write a shorter manuscript, which is in some ways easier. And for the readers, it really lets you just in a few minutes read an entire paper from start to finish and get everything you need to know about it. We typically have anywhere from two to five focused communications per issue. That number might be expanding as the section increases in popularity. But please make sure every month to check out the focused communications section. So long-time readers of the journal, you may notice, especially in the coming months, that you are going to see a sharp increase in the number of editorials in GIE. Editorials are very, very important to the journal. And they're very, very helpful and sought after by readers. They allow somebody in about 1,000 to 2,000 words to take a study that we publish in GIE and kind of put it in the context of other research and look at some bigger issues that maybe the authors of the paper didn't have room for in their rigid sort of structure of a scientific paper. Part of the point of the editorial is not to sort of laud the paper, but it's really to sort of talk about what are the pros and the cons of this paper, what are the limitations of the study, what are the next steps in research. And in the past, GIE had relatively few editorials per issue, often sometimes one or two or three. And now we're sharply increasing our editorial content. We're maybe about, you could see anywhere from six to ten editorials per issue. I think that there's a hunger for it on the part of the readers. And I think that the people writing the editorials are often very, very glad for that opportunity. The editorials will almost always be written by people who are actually reviewers for the paper when it went through, or content experts that we thought would be the perfect person to write the editorial for that paper. Editorials are kind of fun to read. Sometimes they can get a little tongue-in-cheek or lighthearted, but it's sort of a way to know the paper in a different way than the paper knows itself. So I will tell you, I've written a lot of editorials. It's fun to write. And when I pick up a journal, whether it's GIE or another journal, sometimes I will read the editorial even before I read the paper so that I sort of know exactly what to expect when I dive in. It's very, very helpful. It's often a lot of fun. Another big change, and I think this is going to be very, very welcome to large segments of our readership, is you should already be seeing or noticing the return of review articles. So many years ago, when I was a fellow or a junior faculty, GIE often featured review articles, but the last five to 10 years saw this practice largely fade away to the point that most issues of GIE had zero review articles, and there maybe would be one or two a year. And I think part of that was there was just so much original content to publish that maybe there wasn't a perception that there was room in the journal for reviews. So we recently, I've appointed two of our associate editors, Shivangi Kothari at University of Rochester and Thiruvanantham Munaraj at Yale to be our dedicated associate editors focused on review articles. And what the three of us have done working together is we have commissioned quite a lot of review articles on really kind of like, as they would say at NASA, mission critical topics, right? Like topics that people are really, really interested in that are very timely and relevant to their daily practice every day, especially where there isn't 100% clarity on how to do a particular procedure or how to handle a specific clinical situation. The goal that I've set for the journal is to have one review article per issue. So that's a big, big, big commitment. Review articles are a lot of work. Like if you're at DDW or ACG and you run into somebody who wrote a review article for GIE, like throw your arms around them and give them a big hug because writing a review article is very, very, very serious work. It often involves the author or authors reading hundreds of papers and trying to distill a vast amount of knowledge down to just a few thousand words, which sounds easy, but let me tell you it's not. Reviews are also often highly cited. So that's good for the journal. And again, we're really, really excited. We've already had a couple of these come out. I think Andy Tao's review article on hemostasis has come out and we have a bunch lined up for 2025. So a lot of people tell me that that's the first thing they look for in a journal. And if they're busy to the point that they really only have time to read one paper a month, it's going to be a review article. So that's something that we're really, really excited about. I mentioned this earlier and we are now having, I think, more attention focused on systematic reviews and meta-analyses. And again, systematic reviews and meta-analyses are not review articles, even though sometimes journals will categorize them as reviews. They're actually really original data. In the old days, these were very, very hard to do. And I remember the very first meta-analysis I ever did with Darmendra Verma when I was in Texas 20 years ago. It was an incredible amount of work. A lot of it was done on relatively primitive software or paper with a pencil. And it was a profoundly demanding thing. Now, it's still quite a lot of work and I don't want to minimize that, but we have much better statistical software. There's a lot more people doing meta-analyses of much higher quality that were done in years past. And those of you who read the journal or other journals know that I do quite a lot of systematic reviews and meta-analyses with my research group. But meta-analyses allow the reader to get a 10,000 foot view of a lot of papers at once. Meta-analyses typically compare randomized trials of the same things. So you can take five randomized trials that each had, say, 200 patients, add them all together, and all of a sudden you have a randomized trial of, say, 1,000 patients. And a meta-analysis is sometimes a way to get clarity or to resolve conflicting studies, like one study favored X, the other studied favored Y. But when you pool the data, you can often get clarity on which procedure or drug or methodology or treatment or imaging study is the better of the things being compared. We're very, very fortunate at the journal to have Babu Mohan to be our Biostats editor. I don't think it's an exaggeration to say that Babu is probably the foremost systematic review and meta-analysis expert in GI on planet Earth. Babu has really, really dedicated himself to systematic reviews and meta-analyses, and he has written about it and spoken about it and thought about it more than anyone I know. Our systematic review and meta-analysis section with the journal is now much, much more muscular than it used to be. It's very robust, and we're averaging about three to four of these systematic reviews in each issue of GIE. So, again, you can kind of see, like, between the reviews and focused communications and systematic reviews, like, we're working very hard at GIE to try to give the reader as much information as possible in the tightest possible space of one issue a month. I'm going to pause it there. I have some other – I just wanted to touch base on some articles if we have time. But honestly, what I'd really like to do is hear from you guys and take questions and sort of see, like, what's on your mind. Any question you have, this is AMA style, ask me anything. So I'll open it up for now. Maybe we could close this window for now and then go into sort of the Q&A. And I think Steph Kinnan is going to help us and be our moderator. Yes, so if you have questions for Doug, please go ahead and pop them in the Q&A box right now. But while people are thinking and typing up their questions, Doug, I was going to ask you if you could give our readers a little bit of information on how they can get involved with the journal outside of just submitting articles. That's a great question. Thanks, Steph. So the best way to start, if like if you're reading GIE and you're looking at the math tab and you're looking at the names and the institutions and the people who are involved and you say, as I said, 25 years ago, I'd like to get involved. The best and first thing to do is to become a reviewer. Reviewing is incredibly interesting work because it's kind of, you get to peek behind the curtain and see how the sausage is made. So when you're a reviewer, you'll get a paper sent to you or papers, depending on how much you're interested and how many you wanna do. You'll have papers sent to you and then you do the review, right? And whether that paper is from somebody you haven't heard of or one of the most famous gastroenterologists on planet earth, you get to do the review and you get to make your comments and concerns known and the authors have to respond, right? So you get to decide or have a significant voice in how that paper goes through the review process at GIE. So that's actually where I started when I was a first year fellow at Mayo Clinic in Rochester, Minnesota. I wrote a paper letter that I put in an envelope with a stamp and I sent it off. I think Deb Bowman answered me back and that I started reviewing in 1999. So that's kind of how I started. And I always recommend it to people. People often say like, hey, can I become an editor for GIE? Well, usually editors are chosen from people who have worked for the journal and have shown significant commitment and really that all begins on the reviewer level. Great. Are there any hot topics that you have your eye on in terms of future content? So I think, that's a really good question. So I think some of the really hot topics that we're dealing with, I think top of the list is AI. And AI, I think has proven to be a very, very tricky topic. I think for both GIE and a lot of journals because I am not a computer programmer and like I don't know how to code per se. And many of us have Medtronic GI genius in our labs and for a lot of GIs, like that's kind of the extent of their AI involvement or understanding. And GIE, I don't think it's an overstatement to say we are getting an enormous number of AI submissions. And a lot of them are very, very dense technical papers that are really written by computer programmers and engineers, not so much clinicians. They're not always written for clinicians. And we're working hard at GIE to go through these papers and try to pick the ones that are most relevant to the readers. Part of the problem, like I mentioned this earlier but it's relevant here is that there's so many people developing AI software. I mean, literally there's hundreds and hundreds of AI labs around the world. And it's often hard to kind of know which one of these programs is ever gonna be clinically relevant and which one of these is gonna be really obscure or never ever make it to market or it's really just sort of something that somebody developed in-house at a university that's never gonna see the light of day in clinical practice. So I think that we're spending a lot of time talking and thinking about AI, but we're being very, very careful to curate the AI papers that I think would help the readers most. I think that there's lots of places where AI papers could go besides GIE, many of which are computer science journals. And that's actually probably the most frequent negative comment we get from reviewers on a lot of these AI papers is they'll say like, this really has no business in GIE, this belongs in a computer journal. So we're trying hard to keep those from the readers and get the ones in front of the readers that are the most relevant. Other topics that are really, really hot now that we're very eager and interested in are interventional EUS. It's something very, very interesting to me. I do interventional EUS all day, every day, but there's still a relative paucity of high quality data on interventional EUS, especially endohepatology. So another passion of mine, endohepatology is a set of EUS procedures that involve liver dedicated interventions, portal pressure measurement, variceal treatment with coils, glue injection, liver biopsy, and other procedures. But again, we're really looking for the high quality data on that. I think those are some things, and even though it's 2024, almost 2025, we're still looking for good papers on general GI and ERCP. People come up to me all the time and say, well, there's nothing left to say about ERCP. And I say, well, you know, that's not actually true. And every month we seem to find two or three or four really, really interesting papers on ERCP. 50 years after it was clinically introduced, we're still finding new and novel things to say on ERCP. So those are just some of the key topics that we're kind of very interested in. But again, Steps has heard me say this a hundred times. I say this constantly, like what's the title of the journal? Title of the journal is Gastrointestinal Endoscopy, and that is what we care about. So anything under that umbrella is fair game for the journal. Great, thanks, Doug. It doesn't look like we have any questions right now, if you wanted to talk a little bit about your favorite articles. So I just picked, I just kind of skimmed a couple of issues of GIE, and I picked four papers that I thought just kind of gave authors a sense of sort of the breadth of stuff that we're publishing in GIE lately. Let's see. Okay, so this is a paper, first author is Mike Bobet, and Doug Rex is our senior, I believe, and corresponding author. This is from the IU group. And this is, again, sort of showing like there's still something to say about colonoscopy after half a century, just like ERCP. There are novel and interesting things to say about colonoscopy. So this was safety of first surveillance colonoscopy at 12 months after piecemeal EMR of large non-pendunculated colorectal lesions. And what they're really kind of getting at here, right, is if you take out a lesion that's greater than two centimeters, right, in a piecemeal EMR, which is very, very common. Again, despite all the talk about endoscopic submucosal dissection, 99.7% of GIs on planet Earth are not doing ESD. They're doing EMR, just like we've always done. But it's often unclear when to bring these people back. Like if you take off a big sessile lesion in the colon, right, when do you bring them back? So what they did at IU is they have a prospectively maintained database that they maintain about all of their polypectomies and colonoscopies. And they ended up with over 500 lesions greater than 20 millimeters. And they basically looked and they said, well, what happened, right, when you looked at 12 months, right? And they basically found that 12 months was an acceptable period for 20 millimeter lesions or greater removed by EMR, right? A lot of people would say, maybe I should look at three months, make sure I got it all out. Maybe I should look at six months. It's very, very unclear to know exactly what to do and people worry about leaving this tissue behind or God forbid, something turning into a cancer. But they basically said that 12 months appears to be an acceptable window, although they didn't suggest in their conclusion, which I kind of had to, it scrolled onto another page step. So I had to sort of write the conclusion at the bottom there. Oops, let's go back up one. That they suggested that it might be worth having a prospective trial comparing six months to 12 months in the future. I thought that was interesting because, it addressed perhaps an unspoken fear that many endoscopists fear, right? Or that they feel like they don't know when to bring the patient back. And then, you don't wanna bring them back too soon and waste resources, like maybe three months is too soon, but you also don't wanna wait too long and give that Apollo a chance to turn into a cancer. So that I thought was pretty interesting. So kudos to Bobet and Rex and their team on that one. Another one I thought was interesting, and this is actually a paper from my group. And again, I'm not trying to toot our own horn, but it's just sort of a good example of the type of systematic reviews and meta-analyses we're doing. Saheem Singh was the first author on this, although everybody played a big role, especially Vishnu Kumar. And we looked at lumen-opposing metal stents for U.S. guided biliary and gallbladder drainage, really looking at which was better, right? And again, in America, we think about Axios because that's the only lumen-opposing metal stent that we have in the United States. And I do quite a lot of U.S. guided biliary and gallbladder drainages in my practice. But around the world, there's other ones, right? But the other major one that people outside the U.S. have access to is the Spaxus stent. And the Spaxus stent looks very, very similar, but it is a different device made by a different company. And this is kind of what I was talking about. You know, we were able to take 18 studies and pool the data, right? And end up with 433 patients. And 433 patients for a trial on U.S. guided biliary and gallbladder drainage is basically higher than anybody could do at their own institution. And we were very, very focused on technical success, clinical success, adverse events, and things like that. And what was interesting was we sort of saw that the technical and clinical success rates with Axios and Spaxus stents were very similar, although adverse events occurred in a higher number of patients with Axios stents compared to Spaxus. Is that because of the stents themselves? Maybe. Is that because the patients that were getting Axios stents were sicker? Maybe. It's hard to know exactly, but it was interesting that there were differences in adverse events. Now, again, in the United States, we don't have a choice, right? Like if you want to put a luminoprotein stent in in the 50 states, you have to use an Axios. But for readers around the world, it does sort of, you know, who may have more than one of these devices on their shelf, this is a paper that may affect their clinical practice. And again, in the paper, we go into some detail about why these differences in the stents and their outcomes may exist. But what's interesting is technical and clinical success was, for all intents and purposes, the same. So I thought that was an interesting paper. Two others I want to highlight. One is another systematic review and meta-analysis. And this was looking at EUS versus ERCP for biliary drainage for malignant biliary obstruction. So again, you know, for the last, I don't know, 50, 40 years, ERCP has been first-line therapy for people with malignant biliary obstruction, most commonly pancreatic or biliary cancer. But, you know, the last 10 years has seen a huge rise in the number of people doing EUS-guided biliary drainage. It went from something that nobody did to like, oh, that one expert at the university, three states over, will do it twice a year, to now that there's so many people training in advanced endoscopy fellowships, we're seeing just a lot more people do these procedures of higher volume. So the point that, you know, a lot of people are saying that maybe EUS-guided biliary drainage should be first-line therapy in some cases. So one of the reasons I wanted to highlight this study is I'm not gonna show the abstract, I'm just gonna show the graphical abstract, and that's something that we're really, really proud of at GIE is our graphical abstracts. There's the regular text abstract, but there's sort of an image, often with like a cartoon or a picture, that kind of can sum up the whole study in just an image for the reader. So it's really a great thing, and I've always been a big fan of the graphical abstracts. So you can see, right, they had six randomized controlled trials of a total of 577 patients. And what's interesting is like, look at how much data we're able to get in this one image, right? So you can see the technical and the clinical success is very, very, very close. Maybe favors EUS-BioGoc a teeny bit, but pretty darn close. I would call that a wash. Stent patency and survival time were higher in the EUS-Guided biliary drainage group, whereas re-intervention rates, adverse events, pancreatitis were lower in the EUS-BioGoc group, but the cholangitis rate favored ERCP. And again, procedure time was shorter and hospital stay was shorter with ERCP. So again, you can kind of get a sense that, you know, in this one image, you can absorb a huge amount of data. And this is kind of a good way also to convey how much complicated information you can get into a single graphical abstract. One other paper I'll highlight, and then that'll be the last one. I can open up to questions again. And I wanted to show kind of an AI type paper. So this is a paper from a sort of a multinational consortium in Europe looking at computer aided diagnosis, looking at real-time characterization of Barrett's esophagus by general endoscopists, not people who are like super hardcore esophageal people, just general endoscopists. And again, they use what's called a CADx, which is Computer Aided Diagnostic System. And they used, again, I'm gonna sort of summarize this because again, I'm not an AI computer person myself, but the upshot is they use sort of a video test set to train people and then saw how they did when they scored Barrett's neoplasia in real time. And basically they show that this sort of like CADx system significantly increased people's characterization performance of Barrett's esophagus. And it really brought you up to the level of an expert's system. So again, it might be something that if it was incorporated into clinical practice could have a meaningful effect on people's actual outcomes in real life. And again, we get a lot of these sort of AI CADe or CADx studies. And this was a good example of something that crossed over from like, wow, this isn't just somebody playing with computers at a university. This is somebody developing something that actually could affect real life clinical practice for GIs seeing real patients in the real world every day. So again, that's just four papers. I mean, it'd be hard to pick the top ones, but I just kind of wanted to show these top four here today to kind of highlight some of the sort of like interesting things that we're seeing or the breadth of new research in endoscopy, both from the realm of general endoscopy, Barrett's esophagus, colonoscopy, to EUS interventions, ERCP, and things like that. I'll just take this moment to make a shameless plug and please follow the journal on X, formerly Twitter. Please follow me on X as well. I post almost daily and GIE has quite a lot of content across social media, especially on Twitter and Facebook. X. It doesn't appear that there are any more questions. Okay. Well, I would say thank you to everybody for attending. And again, this will be up on GI Leap if you guys want to check in on the future. Anything else you want to add, Steph? I just want to thank you all for attending this edition of Thursday Night Lights. And thank you, Doug, for joining us tonight to talk about GIE. Like Doug said, this will be available in your GIE Leap account. And if you have any further questions for Dr. Adler or me or our editorial office, please feel free to reach out to us at GIE at ASGE.org. Thank you, everybody. Thank you.

GIE journal

Best-of series

Focused Communication

AI in gastroenterology

surveillance colonoscopy

LAMS for biliary drainage

journal reviewer