ALT Submucosal lidocaine injection did not significantly shorten procedure time, although it may serve as a useful adjunct for preventing colonic spasms during ESD.

ALT Updated classification of EUS-GE misdeployment and its treatment.

ALT Endoscopic papillectomy is a minimally invasive option for selected older patients with ampullary tumors, but its value should be interpreted beyond local tumor control. In this population, long-term outcomes may be strongly influenced by comorbidity burden, frailty, nutritional status, functional reserve, and competing non-cancer mortality. Treatment intensity should therefore be individualized by balancing oncologic risk, geriatric vulnerability, surveillance feasibility, and patient goals.