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Mistakes in gastrostomy insertion and how to avoid them

Tom Welbank

Summary

AI Generated

This article combines author opinion with evidence to address management and patient selection for long-term gastrostomy feeding, topics less extensively covered in the published literature despite clear clinical guidelines and numerous studies on the intervention itself.

  • Long-term enteral nutrition via gastrostomy is a relatively common intervention for patients at risk of malnutrition who have an accessible and functioning gastrointestinal tract
  • Clear clinical guidelines exist describing principles of practice, supported by numerous retrospective and non-randomised controlled studies and case series
  • Fewer publications offer advice and guidance specifically on management and patient selection for gastrostomy interventions
  • The article presents a combination of the author's views alongside the available evidence base
  • Clinicians involved in gastrostomy decision-making or management would benefit from this perspective on patient selection
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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7
1.
Westaby D, Young A, O’Toole P, et al. The provision of a percutaneously placed enteral tube feeding service. Gut 2010; 59: 1592–1605. [Link]
2.
National Collaborating Centre for Acute Care (UK). Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. London: National Collaborating Centre for Acute Care (UK), 2006. [Link]
3.
Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40: 4745–4761. [Link]
4.
Boullata JI, Carrera AL, Harvey L, et al. ASPEN Safe Practices for Enteral Nutrition Therapy. J Parenter Enter Nutr 2017; 41: 15–103. [Link]
5.
Chang C-M, Yin W-Y, Wei C-K, et al. Adjusted Age-Adjusted Charlson Comorbidity Index Score as a Risk Measure of Perioperative Mortality before Cancer Surgery. PLOS ONE 2016; 11: e0148076. [Link]
6.
Cullinane M, Gray AJG, Hargraves CMK, et al. ‘Scoping our practice’. The 2004 Report of the National Confidential Enquiry into Patient Outcome and Death. United Kingdom: NCEPOD, 13 October 2004. [Link]
7.
Lim JH, Choi SH, Lee C, et al. Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis. Intest Res 2016; 14: 333–342. [Link]
8.
Zettervall SL, Holzmacher JL, Radomski M, et al. Comparison of Complications Following Laparoscopic and Endoscopic Gastrostomy Placements. J Gastrointest Surg 2017; 21: 1396–1403. [Link]
9.
Sutcliffe J, Wigham A, Mceniff N, et al. CIRSE Standards of Practice Guidelines on Gastrostomy. Cardiovasc Intervent Radiol 2016; 39: 973–987. [Link]
10.
Partovi S, Li X, Moon E, et al. Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently. World J Gastroenterol 2020; 26: 383–392. [Link]
11.
Sandquist M, Davenport T, Monaco J, et al. The Transition to Adulthood for Youth Living with Rare Diseases. Children 2022; 9: 710. [Link]
12.
Di Lorenzo C, Colletti RB, Lehmann HP, et al. Chronic Abdominal Pain In Children: A Technical Report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: AAP Subcommittee and NASPGHAN Committee on Chronic Abdominal Pain. J Pediatr Gastroenterol Nutr 2005; 40: 249. [Link]
13.
Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clin Nutr Edinb Scotl 2020; 39: 5–22. [Link]
14.
Hvas CL, Farrer K, Blackett B, et al. Reduced 30-day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study. J Hum Nutr Diet 2018; 31: 413–421. [Link]
15.
Gaspar R, Ramalho R, Coelho R, et al. Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure. GE - Port J Gastroenterol 2023; 30: 61–67. [Link]
16.
Menni A, Tzikos G, Chatziantoniou G, et al. Buried bumper syndrome: A critical analysis of endoscopic release techniques. World J Gastrointest Endosc 2023; 15: 44–55. [Link]
17.
Yuan Y, Zhao Y, Xie T, et al. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev 2016; 2016: CD009198. [Link]
18.
Fugazza A, Capogreco A, Cappello A, et al. Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques. World J Gastrointest Endosc 2022; 14: 250. [Link]
19.
McCulloch A, Roy O, Massey D, et al. Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates. Frontline Gastroenterol 2018; 9: 105–109. [Link]
20.
Serrano Aguayo P, Herguido N, Campos J, et al. New laparoscopic assisted percutaneous gastrostomy. Description and comparison with others gastrostomy types. Clin Nutr ESPEN 2016; 16: 24–29. [Link]
21.
Bhambani S, Phan TH, Brown L, et al. Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department. West J Emerg Med 2017; 18: 770–774. [Link]
22.
Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 5th ed. Oxford University Press, 2001. [Link]
23.
Arvanitakis M, Gkolfakis P, Despott EJ, et al. Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 81–92. [Link]
24.
Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev 2009; 2009: CD007209. [Link]
25.
Welbank T, Kurien M. To PEG or not to PEG that is the question. Proc Nutr Soc 2021; 80: 1–8. [Link]
26.
Chisholm J, Burton S, Campbell R, et al. Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent: Guidance for decision-making in England and Wales. United Kingdom: British Medical Association, Royal College of Physicians, 2018. [Link]
27.
Mental Capacity Act 2005. legislation.gov.uk, https://www.legislation.gov.uk/ukpga/2005/9/contents (2005, accessed 19 February 2024). [Link]

Abstract

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.

Topics

Small Intestine & Nutrition Stomach & H. Pylori

Citation

Welbank T, Mistakes in gastrostomy insertion ingestion and how to avoid them. UEG Education 2024; 24: 8-11.

Published

2024

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UEG Mistakes In Articles
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Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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Mistakes in the evaluation and management of dysphagia and how to avoid them

Amir Mari, Edoardo Vincenzo Savarino, Jawad Hindy

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7
1.
Westaby D, Young A, O’Toole P, et al. The provision of a percutaneously placed enteral tube feeding service. Gut 2010; 59: 1592–1605. [Link]
2.
National Collaborating Centre for Acute Care (UK). Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. London: National Collaborating Centre for Acute Care (UK), 2006. [Link]
3.
Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40: 4745–4761. [Link]
4.
Boullata JI, Carrera AL, Harvey L, et al. ASPEN Safe Practices for Enteral Nutrition Therapy. J Parenter Enter Nutr 2017; 41: 15–103. [Link]
5.
Chang C-M, Yin W-Y, Wei C-K, et al. Adjusted Age-Adjusted Charlson Comorbidity Index Score as a Risk Measure of Perioperative Mortality before Cancer Surgery. PLOS ONE 2016; 11: e0148076. [Link]
6.
Cullinane M, Gray AJG, Hargraves CMK, et al. ‘Scoping our practice’. The 2004 Report of the National Confidential Enquiry into Patient Outcome and Death. United Kingdom: NCEPOD, 13 October 2004. [Link]
7.
Lim JH, Choi SH, Lee C, et al. Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis. Intest Res 2016; 14: 333–342. [Link]
8.
Zettervall SL, Holzmacher JL, Radomski M, et al. Comparison of Complications Following Laparoscopic and Endoscopic Gastrostomy Placements. J Gastrointest Surg 2017; 21: 1396–1403. [Link]
9.
Sutcliffe J, Wigham A, Mceniff N, et al. CIRSE Standards of Practice Guidelines on Gastrostomy. Cardiovasc Intervent Radiol 2016; 39: 973–987. [Link]
10.
Partovi S, Li X, Moon E, et al. Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently. World J Gastroenterol 2020; 26: 383–392. [Link]
11.
Sandquist M, Davenport T, Monaco J, et al. The Transition to Adulthood for Youth Living with Rare Diseases. Children 2022; 9: 710. [Link]
12.
Di Lorenzo C, Colletti RB, Lehmann HP, et al. Chronic Abdominal Pain In Children: A Technical Report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: AAP Subcommittee and NASPGHAN Committee on Chronic Abdominal Pain. J Pediatr Gastroenterol Nutr 2005; 40: 249. [Link]
13.
Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clin Nutr Edinb Scotl 2020; 39: 5–22. [Link]
14.
Hvas CL, Farrer K, Blackett B, et al. Reduced 30-day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study. J Hum Nutr Diet 2018; 31: 413–421. [Link]
15.
Gaspar R, Ramalho R, Coelho R, et al. Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure. GE - Port J Gastroenterol 2023; 30: 61–67. [Link]
16.
Menni A, Tzikos G, Chatziantoniou G, et al. Buried bumper syndrome: A critical analysis of endoscopic release techniques. World J Gastrointest Endosc 2023; 15: 44–55. [Link]
17.
Yuan Y, Zhao Y, Xie T, et al. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev 2016; 2016: CD009198. [Link]
18.
Fugazza A, Capogreco A, Cappello A, et al. Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques. World J Gastrointest Endosc 2022; 14: 250. [Link]
19.
McCulloch A, Roy O, Massey D, et al. Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates. Frontline Gastroenterol 2018; 9: 105–109. [Link]
20.
Serrano Aguayo P, Herguido N, Campos J, et al. New laparoscopic assisted percutaneous gastrostomy. Description and comparison with others gastrostomy types. Clin Nutr ESPEN 2016; 16: 24–29. [Link]
21.
Bhambani S, Phan TH, Brown L, et al. Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department. West J Emerg Med 2017; 18: 770–774. [Link]
22.
Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 5th ed. Oxford University Press, 2001. [Link]
23.
Arvanitakis M, Gkolfakis P, Despott EJ, et al. Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 81–92. [Link]
24.
Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev 2009; 2009: CD007209. [Link]
25.
Welbank T, Kurien M. To PEG or not to PEG that is the question. Proc Nutr Soc 2021; 80: 1–8. [Link]
26.
Chisholm J, Burton S, Campbell R, et al. Clinically-assisted nutrition and hydration (CANH) and adults who lack the capacity to consent: Guidance for decision-making in England and Wales. United Kingdom: British Medical Association, Royal College of Physicians, 2018. [Link]
27.
Mental Capacity Act 2005. legislation.gov.uk, https://www.legislation.gov.uk/ukpga/2005/9/contents (2005, accessed 19 February 2024). [Link]

Abstract

Dysphagia is a common symptom with a broad differential diagnosis encompassing structural, inflammatory, infectious, functional, neurological, and oesophageal motility disorders. Despite major advances in endoscopy, high-resolution manometry (HRM), impedance planimetry (EndoFLIP), and swallowing assessment, diagnostic delays and inappropriate management remain common. In most cases, these shortcomings reflect errors in clinical reasoning rather than limitations of available investigations.1

Increasing recognition of eosinophilic oesophagitis (EoE), functional dysphagia, opioid-induced oesophageal dysfunction, and complex motility disorders has further emphasised the importance of integrating clinical history with endoscopic, histological, physiological, and complementary radiological findings. Optimal evaluation increasingly requires multidisciplinary collaboration involving gastroenterologists, otolaryngologists, neurologists, speech–language pathologists, radiologists, and surgeons.1–5

In this article, we discuss the most common mistakes in the evaluation and management of dysphagia and provide practical, evidence-based recommendations to help clinicians avoid them.

Dysphagia is a common symptom with a broad differential diagnosis encompassing structural, inflammatory, infectious, functional, neurological, and oesophageal motility disorders. Despite major advances in endoscopy, high-resolution manometry (HRM), impedance planimetry (EndoFLIP), and swallowing assessment, diagnostic delays and inappropriate management remain common. In most cases, these shortcomings reflect errors in clinical reasoning rather than limitations of available investigations.1

Increasing recognition of eosinophilic oesophagitis (EoE), functional dysphagia, opioid-induced oesophageal dysfunction, and complex motility disorders has further emphasised the importance of integrating clinical history with endoscopic, histological, physiological, and complementary radiological findings. Optimal evaluation increasingly requires multidisciplinary collaboration involving gastroenterologists, otolaryngologists, neurologists, speech–language pathologists, radiologists, and surgeons.1–5

In this article, we discuss the most common mistakes in the evaluation and management of dysphagia and provide practical, evidence-based recommendations to help clinicians avoid them.

Topics

Neurogastroenterology & Motility

Published

2026

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UEG Podcast Episode
UEG Podcast
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Coeliac disease with David Sanders

David S. Sanders, Pradeep Mundre

Summary

AI Generated

Summary is not available for this content yet.

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Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Small Intestine & Nutrition

Published

2026

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European Interdisciplinary Guidelines on Pain Management in Acute Pancreatitis: UEG, EPC, EDS, ESDO, EAGEN, ESPGHAN, ESGAR, and ESPCG Evidence-Based Recommendations

Sanjay Pandanaboyana

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Guideline

ABSTRACT

Pain is often the presenting symptom of acute pancreatitis (AP) and has a prognostic significance, with poorly treated pain affecting patient outcomes. Despite this, there are currently no international recommendations for pain management in patients admitted with AP. This current guideline was developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. Nine working groups were formed to develop statements on pain management in AP from admission to discharge. After systematic literature reviews, the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted using three rounds of Delphi method. The guidelines concluded that acute postoperative pain management guidelines are applicable for treating acute pain due to AP. The numerical rating scale is preferred for pain assessment because of better compliance. Opioids currently form the cornerstone of severe pain management. Potent opioids such as buprenorphine and pentazocine provide superior pain relief over non-opioid medications and decrease the need for rescue analgesia. Current evidence does not consistently demonstrate harm from opioids in AP. In patients with severe pain, safety concerns should not delay the timely use of opioids to ensure adequate pain management. Specific recommendations concerning the use of epidural analgesia, acupuncture and management of pain in the paediatric population and during pregnancy are provided based on evidence and expert opinions. Finally, the unmet needs for future research were discussed and proposed.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

United European Gastroenterology Journal, 2026

Published

2026

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UEG Mistakes In Articles
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Mistakes in abdominal distension and how to avoid them

Elizabeth Barba Orozco, Alberto Ezquerra-Durán

Summary

AI Generated

Summary is not available for this content yet.

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7
1.
Westaby D, Young A, O’Toole P, et al. The provision of a percutaneously placed enteral tube feeding service. Gut 2010; 59: 1592–1605. [Link]
2.
National Collaborating Centre for Acute Care (UK). Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. London: National Collaborating Centre for Acute Care (UK), 2006. [Link]
3.
Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40: 4745–4761. [Link]
4.
Boullata JI, Carrera AL, Harvey L, et al. ASPEN Safe Practices for Enteral Nutrition Therapy. J Parenter Enter Nutr 2017; 41: 15–103. [Link]
5.
Chang C-M, Yin W-Y, Wei C-K, et al. Adjusted Age-Adjusted Charlson Comorbidity Index Score as a Risk Measure of Perioperative Mortality before Cancer Surgery. PLOS ONE 2016; 11: e0148076. [Link]
6.
Cullinane M, Gray AJG, Hargraves CMK, et al. ‘Scoping our practice’. The 2004 Report of the National Confidential Enquiry into Patient Outcome and Death. United Kingdom: NCEPOD, 13 October 2004. [Link]
7.
Lim JH, Choi SH, Lee C, et al. Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis. Intest Res 2016; 14: 333–342. [Link]
8.
Zettervall SL, Holzmacher JL, Radomski M, et al. Comparison of Complications Following Laparoscopic and Endoscopic Gastrostomy Placements. J Gastrointest Surg 2017; 21: 1396–1403. [Link]
9.
Sutcliffe J, Wigham A, Mceniff N, et al. CIRSE Standards of Practice Guidelines on Gastrostomy. Cardiovasc Intervent Radiol 2016; 39: 973–987. [Link]
10.
Partovi S, Li X, Moon E, et al. Image guided percutaneous gastrostomy catheter placement: How we do it safely and efficiently. World J Gastroenterol 2020; 26: 383–392. [Link]
11.
Sandquist M, Davenport T, Monaco J, et al. The Transition to Adulthood for Youth Living with Rare Diseases. Children 2022; 9: 710. [Link]
12.
Di Lorenzo C, Colletti RB, Lehmann HP, et al. Chronic Abdominal Pain In Children: A Technical Report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: AAP Subcommittee and NASPGHAN Committee on Chronic Abdominal Pain. J Pediatr Gastroenterol Nutr 2005; 40: 249. [Link]
13.
Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clin Nutr Edinb Scotl 2020; 39: 5–22. [Link]
14.
Hvas CL, Farrer K, Blackett B, et al. Reduced 30-day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study. J Hum Nutr Diet 2018; 31: 413–421. [Link]
15.
Gaspar R, Ramalho R, Coelho R, et al. Percutaneous Endoscopic Gastrostomy Placement under NIV in Amyotrophic Lateral Sclerosis with Severe Ventilatory Dysfunction: A Safe and Effective Procedure. GE - Port J Gastroenterol 2023; 30: 61–67. [Link]
16.
Menni A, Tzikos G, Chatziantoniou G, et al. Buried bumper syndrome: A critical analysis of endoscopic release techniques. World J Gastrointest Endosc 2023; 15: 44–55. [Link]
17.
Yuan Y, Zhao Y, Xie T, et al. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev 2016; 2016: CD009198. [Link]
18.
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Abstract

Abdominal distension and bloating are among the most frequently misunderstood complaints in gastroenterology. They are often used as interchangeable terms, a conceptual mistake that continues to drive diagnostic errors and ineffective treatment. According to Rome IV, bloating and distension may represent either a primary disorder of gut–brain interaction (DGBI) or occur as symptoms with other DGBIs, such as irritable bowel syndrome (IBS), functional dyspepsia (FD) or functional constipation (FC).

Topics

Neurogastroenterology & Motility

Citation

Barba-Orozco E and Ezquerra-Durán A. Mistakes in abdominal distension and bloating and how to avoid them. UEG Education 2026; 26: 5-9.

Published

2026

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Third N-ECCO Consensus Statements on the Nursing Roles in Caring for Patients with Inflammatory Bowel Disease

Susanna Jäghult

Summary

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Guideline

Introduction

The Nurses Committee of the European Crohn’s and Colitis Organisation (N-ECCO) is an active Committee of the ECCO that aims to improve access to nurse education in inflammatory bowel disease (IBD) throughout Europe and to provide a link with national nursing networking organisations. The first N-ECCO Consensus Statements were published in 2013 and sought to identify the positioning of nurses in the care of patients with IBD and to provide a consensus on the ideal standard of minimum care that patients with IBD might expect. The first update was made in 2018. The N-ECCO Consensus Statements have been widely distributed internationally, guiding IBD centers and IBD nurses to establish the most optimal quality of care in IBD. High-quality IBD care requires working within a multidisciplinary team (MDT). Core team members should include at least one IBD nurse, a gastroenterologist, a colorectal surgeon, a radiologist, and a dietitian. In this MDT, the IBD nurse has a clear role as coordinator between the patient and the different disciplines, with the objective of providing a holistic approach to care.1,2 In addition to administering and monitoring treatments, IBD nurses provide education, support, counselling, and advocacy for patients. Even if the role of the IBD nurse has become more established in recent years, several differences between countries remain, including variations in education and role. In the two previous N-ECCO Consensus Statements, the statements were divided into fundamental and advanced IBD nursing. Due to the different conditions across countries, this division was removed in this update.

The overall aim of ECCO is to improve the care of patients with IBD through development of guidelines, education, and research. The N-ECCO Consensus Statements seek to realise this aim from an IBD nursing perspective, by providing statements and evidence to guide and ensure the ideal standard of care.3,4 This third update aims to provide a framework for IBD nurses to continue delivering high-quality and evidence-based care, to consider the needs of diverse patient populations, and to include new technical tools.

Publisher

European Crohn’s and Colitis Organisation logo
European Crohn’s and Colitis Organisation

Guideline

Consensus

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 7

Published

2026

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The European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer: Methodological Protocol

Laura Leeuwenburgh

Summary

AI Generated

Summary is not available for this content yet.

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Guideline

ABSTRACT

Background

Pancreatic cancer remains one of the most lethal cancers despite extensive efforts and research conducted over the past decades. To effectuate groundbreaking improvements in pancreatic cancer treatment, interdisciplinary and international collaboration is essential. Evidence-based guidelines, including state-of-the-art evidence and expert opinion, are crucial to guide medical specialists, researchers, and patients, especially on issues where consensus is still lacking. This article describes the methodological protocol for the development of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer. The guideline aims to identify current knowledge gaps on pancreatic cancer management, develop questions based on these knowledge gaps, and answer these questions with evidence-based recommendations supplemented, when evidence is lacking, with expert advice for treatment and future research.

Methods

This guideline development protocol is developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The process is structured into six stages: First, 13 theme-based multidisciplinary working groups are established, comprising representatives from 30 European medical and patient societies. Second, these working groups identify the most relevant current knowledge gaps on pancreatic cancer within their theme and formulate key questions. Third, the available evidence to answer these key questions is obtained through systematic reviews and the certainty of evidence is assessed using the GRADE approach. Fourth, recommendations are developed based on the available evidence. Fifth, all participants reach consensus on the recommendations through a modified Delphi process. Sixth, the recommendations are discussed during an open conference, including an external validation committee.

Discussion

This methodological protocol of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer is designed to identify key knowledge gaps across 13 themes and formulate evidence-based recommendations. This guideline initiative unites 30 European medical and patient societies for pancreatic cancer.

Summary

  • Methodological protocol of an international multi-disciplinary guideline involving 30 European medical and patient societies.

  • This protocol highlights the six stages of the guideline development process, adhering to the key principles of the GRADE methodology, and thereby aims to maximise transparency and methodological quality.

  • With addressing knowledge gaps, this guideline will uncover areas with limited evidence. A priority rating for research needs, based on a survey, will be established, highlighting areas where future research is most warranted.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

Clinical and Public Health Guidelines 3 (2026)

Published

2026

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