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Check the ESGE  guidelines

The AGA guidelines recommend random biopsies of the cardia and distal 2 cm of the tubular esophagus.

Check the guidelines

In the guidelines they mention the increasing resistance of  Hpylori strains in the US to Clarithromycin (20-30%)  and Levofloxacin (approaching 40%) , therfore supporting antibiotics with much lower resistance rates (such as amoxicillin, tetracycline, and rifabutin that are all 5%)

That is why this guidelines say Clarithromycin- and levofloxacin-containing treatment regimens should be avoided in the absence of demonstrated macrolide and quinolone susceptibility, respectively.

Clarithromycin- and levofloxacincontaining treatment regimens remain an important option for selected patients, especially treatment-experienced patients with confirmed persistent H. pylori infection with strains that are known to be susceptible to these antibiotics

Vonoprazan is potassium-competitive acid blocker (PCAB) that inhibits the H⁺, K⁺-ATPase enzyme system in a potassium-competitive manner.    This is the same target as PPI but this class  of drugs  are acid-stable and thus do not require enteric coating or optimal dosing administration 30 minutes prior to meals , are more potent acid suppression, rapid onset of action, and long-lasting half-life.   Penicillin dual therapy was superior to lansoprazole-clarithromycin triple therapy among patients with clarithromycin-resistant H. pylori strains (70% vs 32%, P , 0.0001).

When treating with Vonoprazan + Amoxicillin, exceptionally we can add Clarithromycin as first line even in naive patients.

The protective effect on colon cancer has been suggested in <70 yo. A meta-analysis of five RCTs showed a 24% decrease in the risk for developing CRC (HR 0.76, CI 95% 0.60–0.96). Daily low-dose aspirin also showed a 40% reduction for the risk of CRC mortality (HR 0.60, CI 95% 0.42–0.86). However, the ASPREE trial studied low-dose aspirin among >70yo without cardiovascular disease. Secondary analyses demonstrated that aspirin use was associated with a higher risk for cancer-related mortality (HR 1.31, CI 95% 1.10–1.56) and colorectal cancer-related mortality.  This significance is uncertain and we should be cautious. Check preliminary results here. DOI: 10.1056/NEJMoa1803955

The protective effect preventing HGD and adenocarcinoma in Barrett’s was seen in several studies such as Aspect trial (DOI:https://doi.org/10.1016/S0140-6736(18)31388-)

According to the  2020 BSG  post-polypectomy surveillance guidelines   we recommend no surveillance if life expectancy is less than 10 y or patient older than 75 yo.  However this can be flexible depending on the patient situation. For example, if histology show incomplete resection margins or colonoscopy was suboptimally prepared then it could be reasonable to repeat the test in 1 year.

If this same case was in a fit and younger patient (e.g  65 yo patient ) then given that we removed 5  adenomas (premalignant) - this would be the cutoff to have another colonoscopy in 3 years

In fact, the majority of the guidelines suggest 3 year follow up if 5 or more small(<10mm)  adenomas are removed.  2020 AGA recommend 3 years followup if 5-10 adenomas, 5 years if 3-4 adenomas and up to 7-10 years if only 1-2 adenomas (or SSL).

For example, if a 65 yo patient had only 4 small adenomas with en bloc resection and good bowel cleaning,  no further surveillance and return to bowel screening according to the British guidelines but would need 5 year colonoscopy according to the AGA guidelines. 

Underwater EMR offers the advantage of keeping the polyp surface small in flat polyps (opposite to when we inject lifting solution where the polyp keeps spreading and this makes grabbing the polyp en bloc more difficult) this explains why is a good method to remove en bloc lesions bigger than 10mm (Ideally even bigger than 20mm, although even with U-EMR the bigger the polyp, the more difficult to obtain full resected piece en bloc. This results are published in endoscopy in this meta analysis

Misty mesentery refers to a non-specific radiological finding characterized by increased attenuation within the mesenteric fat on computed tomography  imaging.  It mimics mistiness as localised fat stranding in the mesentery.  Many processes can lead to the appearance including infiltration by inflammatory cells, oedema, lymphatic accumulation, haemorrhage, tumour infiltration, and fibrosis.  Tipically reflects mesentery panniculitis  ( rare  benign condition characterized by chronic inflammation  of adipose tissue mainly of the small bowel mesentery) But can be the results of any inflammatory or neoplasic process. That is why it is needed to consider also vasculitis, lymphomas, inflammatory process or GI neoplasia.

Underwater EMR is a technique in which instead of gas, the colon is insuflated with liquid (usually water, less common saline). The water makes the mucosa 'float' by reducing the wall tension and this separates the layers of the mucosa-submucosa naturally without injecting lifting solution.  This makes flat polyps easy to get grasped. Scar appears small after resection, but when water is aspirated and air insuflatted, one can see the scars are usually much bigger than they appear with water.  See this image from Spadaccini et al 

Kudo II (asteroid or stellate pits) which are star or cross-shaped.  This is very typical of hyperplastic polyps (non neoplastic)  or serrated lesions.