EUS-guided interventions have become widely accepted therapeutic management options for drainage of peripancreatic fluid collections. Apart from endosonographic skills, EUS interventions require knowledge of the endoscopic stenting techniques and familiarity with the available stents and deployment systems. Although generally safe and effective, technical failure of correct stent positioning or serious adverse events can occur, even in experts' hands. In this article, we address common and rare adverse events in transmural EUS-guided stenting, ways to prevent them, and management options when they occur. Knowing the risks of what can go wrong combined with clinical expertise, high levels of technical skills, and adequate training allows for the safe performance of EUS-guided drainage procedures. Discussing the procedural risks and their likelihood with the patient is a fundamental part of the consenting process.

Endoscopic submucosal dissection (ESD) has become the main treatment for early esophageal cancer. While treating the disease, ESD may also cause postoperative esophageal stricture, which is a global issue that needs resolution. Various methods have been applied to resolve the problem, such as mechanical dilatation, glucocorticoids, anti-scarring drugs, and regenerative medicine; however, no standard treatment regimen exists. This article describes and evaluates the strengths and limitations of new and promising potential strategies for the treatment and prevention of esophageal strictures.

Patient safety is a key element of high-quality healthcare. Digitalization, new eHealth applications and data-based algorithms have high potential to make a significant contribution. This article presents current technological developments along a simplified patient journey from emergency medical triage, diagnosis and therapy to follow-up. The technical interventions are highly diverse and mostly accompanied by a low level of evidence, since most of them are from single academic projects or start-ups. Although there should be no doubt that technology is an important instrument for increasing patient safety, new technologies also involve new risks. Furthermore, technical measures must always be embedded in an overall concept of organizational measures, adequate education, training and accompanying research in order to generate the highest possible benefits and lowest possible risks.

Endoscopic ultrasound (EUS)-guided drainage is the optimal method for treatment of pancreatic fluid collections (PFCs), and is associated with ease, safety, and efficiency. Bleeding is one of the main procedure-related complications, and often requires surgery or radiologic interventions. Indeed, endoscopic management of this complication is limited.

A 42-year-old man presented for evaluation of abdominal pain and distention for approximately 2 wk. Abdominal computed tomography revealed a pancreatic pseudocyst located in the tail of the pancreas. EUS-guided pancreatic pseudocyst was performed. After stent placement, massive bleeding was noted from the fistula. Finally, hemostasis was successfully achieved using hemostatic forceps within the fistula.

Bleeding vessel grasp and coagulation may represent a successful treatment for a fistula hemorrhage during EUS-guided drainage for a PFC, which may be tried before application of balloon or stent compression.

Recently, with the advancement of techniques, endoscopic ultrasound-guided therapies have shown distinct advantages, especially in relieving benign and malignant gastric outlet obstruction (GOO), as well as in postoperative pancreaticobiliary diseases. Herein, we present five currently used approaches in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumenapposing biflanged metal stents (LAMS), along with several examples of LAMS-based EUS treatment of pancreaticobiliary diseases. Compared with traditional treatment methods, EUS-guided procedures have - to some degree - shown higher success rates, both technical and clinical. Moreover, EUS-guided therapies reduce the risk of multiple surgical adverse events, including delayed gastric emptying, prolonged hospital stay, increased costs, and delay in cancer treatment. Particularly in terms of postoperative pancreaticobiliary diseases, EUS-guided therapy has assumed an essential role as a treatment option in cases where traditional methods are difficult to perform. Nevertheless, EUS-guided gastrointestinal procedures are still relatively new, with some clinical failures, and additional prospective clinical trials are warranted.