Introduction

There were conflicting results on the association between Vater ampulla type, success rate, and incidence of pancreatitis after Endoscopic Retrograde Cholangiopancreatography (ERCP). The objective of this investigation was to examine the frequency of pancreatitis characterized by ampulla of Vater type in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), as well as to assess the rate of success in treating such cases.

Aims & Methods

Between January 2021 to December 2022, a total of 517 ERCP-associated procedures were conducted in Sayyad Shirazi Hospital, Gorgan, Iran. Prior to the procedure as well as at 6-, and 24-hours post-procedure, levels of serum amylase were assessed. Furthermore, the patient underwent an assessment to detect any indications of pancreatitis. Of all 517 individuals underwent ERCP, 69 patients were excluded due to a history of endoscopic sphincterotomy or papillary balloon dilatation in the past or who exhibited hyperamylasemia. Written informed consent was obtained from all included patients.

Results

A total of 448 patients with a mean (SD) age of 59.90 (16.03), and 57.1% being female met the inclusion criteria of the study (Table 1). The incidence of pancreatitis after ERCP in type 1, type 2, and type 3b Vater ampulla was 2.6% (5/191), 3.6% (1/28), and 12.5% (1/8), respectively. Post-ERCP pancreatitis was not observed in type 3a, type 4, and type D Vater ampulla. There was no statistically significant relationship between the type of Vater ampullar and the occurrence of post-ERCP pancreatitis (P-value= 0.259). Moreover, the success rate of the procedure in type 1, type 2, type 3a, type 3b, type 4, and type D Vater ampulla was 90.1, 69.0%, 79.7%, 55.6%, 90.9%, and 88.9%, respectively (P-value < 0.005).The result of the final diagnosis based on the Vater Ampulla type is shown in Table 2.

Conclusion

There was a significant relationship between Vater ampulla type and ERCP success rate, while the Vater ampulla type was not associated with the incidence of post-ERCP pancreatitis.

Introduction

Crohn's disease (CD) is a chronic inflammatory bowel disease, characterized by a progressive course that leads to structural bowel damage (SBD). There is no clear definition of SBD. The Lémann index has been proposed, but it's too complicated to calculate. However, the presence of detectable complications through imaging techniques, such as strictures, fistulas or abscesses is widely accepted to describe SBD. Their presence is strongly associated with the severity of the disease and predicts the risk of hospitalization and surgery. Therefore, reversing structural bowel damage is an emerging medical goal in the time of biological treatments.

Aims & Methods

The main objective of this study was to assess the ability of biological treatments to reverse structural bowel damage monitored by intestinal ultrasound (IUS) and compare the disease course of patients with CD with inflammatory behaviour vs complicated behaviour (stricturing or penetrating -abscesses and fistulas-).
This was a longitudinal observational study, which included patients with CD who started a biological treatment in our center and that were monitored with IUS. Clinical, laboratory and ultrasound variables were collected at the beginning of biological treatment, after 12 weeks and after one year of treatment in order to study the evolution of the disease.
To achieve our objective, we compared the transmural healing (TH) at 12 weeks and one year after starting biological treatment. TH is defined as intestinal parietal thickness ≤3 mm, with no detectable Doppler signals and absence of complications.
As a secondary objective, we compared the need for medical treatment, hospital admission and surgery during the first year of biological treatment

Results

A total of 137 patients with CD were included in this study. Their characteristics and treatments are shown in Table 1.

Conclusion

Patients with SBD showed a significantly lower rate of TH compared to patients with an inflammatory behaviour after 12 weeks of biological treatment. Additionally, the need for corticosteroid therapy, hospital admission, and surgery was significantly higher in patients with a complicated CD. However, after one year, the TH rate showed no differences between groups. This suggests that reversing structural bowel damage is possible but that the treatment of these patients is more complex.

References

1. Wilkens, Rune et al. Relevance of monitoring transmural disease activity in patients with Crohn's disease: current status and future perspectives. TherapAdvGastroenterol. 2021 Apr 16;14:17562848211006672.
2. Paredes, José María et al. Clinical Impact of Sonographic Transmural Healing After Anti-TNF Antibody Treatment in Patients with Crohn's Disease. Dig Dis Sci. 2019 Sep;64(9):2600-2606
3. Muñoz, Fernando et al. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the use of abdominal ultrasound in inflammatory bowel disease. GastroenterolHepatol. 2021 Feb;44(2):158-174.
4. Calabrese, Emma et al. Ultrasonography Tight Control and Monitoring in Crohn's Disease During Different Biological Therapies: A Multicenter Study. ClinGastroenterolHepatol. 2022 Apr;20(4):e711-e722
5. Fraquelli, Mirella et al. Impact of intestinal ultrasound on the management of patients with inflammatory bowel disease: how to apply scientific evidence to clinical practice. Dig Liver Dis. 2020 Jan;52(1):9-18.
6. Wilkens, Rune et al. Relevance of monitoring transmural disease activity in patients with Crohn's disease: current status and future perspectives. TherapAdvGastroenterol. 2021 Apr 16;14:17562848211006672
7. Roda, Giulia et al. Crohn's disease. Nat Rev Dis Primers. 2020 Apr 2;6(1):22
8. Fiorino, Gionata et al. Impact of therapies on bowel damage in Crohn's disease. United European Gastroenterol J. 2020 May;8(4):410-417

Introduction

Aims & Methods

Results

Conclusion

References

Introduction

Thermal ablative methods (such as argon plasma coagulation (APC) and soft tip snare coagulation (STSC) are commonly used to treat polyp margins.

Aims & Methods

We aim to appraise the current literature and compare clinical outcomes between patients with treated (with APC vs STSC) and non-treated EMR margins.
We searched major databases from inception until November 2023 for RCTs comparing EMR of large non-pedunculated colorectal polyps with and without treated margins. Pooled data was analyzed for the primary outcome of recurrence at first screening colonoscopy, as well as adverse events. Analysis was performed using a random effects model and data was reported using 95% confidence intervals (CI).

Results

A total of five RCTs were found which included 1020 polyps (577 in treatment and 443 in control groups). Three studies included treatment with STSC and three studies used APC as the modality for margin ablation. Of included patients, 53% were female and average age was similar between treatment and control groups (65.9 vs 66.1 years). Overall, 71% of lesions were proximal to the splenic flexure. Mean follow up to first colonoscopy and average polyp size were comparable (6.3 vs 6.2 months; 28.2 mm vs 28.0 mm, respectively). Pooled analysis showed that margin ablation was associated with significantly lower rates of recurrence (OR = 0.267, 95% CI 0.18 - 0.4, P< 0.001) with low heterogeneity between studies (I²=0%, P = 0.47). Pooled analysis showed no significant difference between STSC and APC in terms of recurrence (OR = 0.6, 95% CI 0.27 - 1.7, I²=0%, P=0.3) or adverse events (OR = 0.67, 95% CI 0.3 - 1.6, I² 13%, P = 0.46).

Conclusion

Our study shows that ablation of EMR margins is very effective at preventing recurrence at first surveillance colonoscopy. We found no difference between STSC or APC in terms of polyp recurrence or adverse outcomes.

Introduction

Malnutrition, sarcopenia, and frailty constitute the three vertices of a nutrition-status-determined physio-pathological triangle constantly featuring and dramatically burdening the prognosis of advanced chronic liver disease (ACLD) patients.
Dysgeusia is defined by a distortion of the sense of taste whose prevalence, relationship with the progression of the disease, and the direct contribution to malnutrition (and consequently, sarcopenia-frailty) in ACLD have never been systematically explored.

Aims & Methods

This observational study aimed to explore the prevalence of dysgeusia in a cohort of ACLD patients and evaluate the impact of this disorder on appetite levels and nutritional status (malnutrition, sarcopenia, and frailty), as well as to prospectively estimate the repercussions of dysgeusia-induced impaired nutritional status on liver-related events (LREs) occurrence. For this purpose, 40 controls, 50 chronic-liver disease-affected individuals staging initial-mild fibrosis (<F3), and 150 ACLD patients of various etiologies were enrolled. Anthropometrical, biochemical, clinical, and nutritional [European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire] data were collected. The opportunely modified Chemotherapy-induced Taste Alteration Scale (CITAS) questionnaire was used to assess the dysgeusia. Child-Pugh (CP) and Liver Frailty Index (LFI) calculations, Liver Stiffness Measurement (LSM), and Bioelectrical Impedance Analysis (BIA) were performed. Skeletal Muscle Mass (SMM) index (SMMI) (SMM/height²) < 7 kg/m² (male) and < 5.7 kg/m² (female) defined sarcopenia. ACLD patients were 3 years followed up semiannually and LREs (including ascites, hepatic encephalopathy, and bleeding) were collected.

Results

The prevalence of dysgeusia was significantly higher in ACLD (68%) in comparison to <F3 (8%) individuals and controls (5%) and in decompensated ACLD (dACLD) than compensated (cACLD) (54% vs 6%) patients (all p<0.0001). In line, CITAS-dysgeusia severity positively correlated with CP (R:0.81), as well as with the levels of appetite impairment (R:0.93) (both p<0.0001). Logistic regression analysis, appropriately weighted for factors notoriously impacting food intake in ACLD patients (low-sodic diet, drugs/supplements taken, physical activity frequency, occurrence of encephalopathy and ascites episodes in the previous 2 weeks), revealed the level of impairment of the appetite as a factor significantly associated with dysgeusia [HR: 2.12; p:0.02]. Compared to no-dysgeusia-affected dACLD (p:0.03), dysgeusia-affected dACLD patients (dys-dACLD) showed a decreased daily protein intake, reduced Free Fat Mass % (p<0.0001), and SMMI (p<0.0001: p:0.04), in contrast with increased LFI (p<0.0001). Consistently, dys-dACLD patients showed a higher prevalence (59% vs 39%) of sarcopenia (p:0.0002). The Kaplan-Meier Log-Rank Test analysis on LREs occurrence showed HR:3.53 [95% C.I: 1.58-4.92] for dys-dACLD individuals.

Conclusion

The prevalence of dysgeusia, increasing in parallel to the worsening of liver disease, promoted sarcopenia-frailty pictures, negatively influencing ACLD patients' outcomes.

References

1. Jafari A, Alaee A, Ghods K. The etiologies and considerations of dysgeusia: A review of literature. Journal of oral biosciences. 2021;63(4):319-26.
2. Sieber CC. Malnutrition and sarcopenia. Aging clinical and experimental research. 2019;31(6):793-8.
3. Tandon P, Montano-Loza AJ, Lai JC, Dasarathy S, Merli M. Sarcopenia and frailty in decompensated cirrhosis. Journal of hepatology. 2021;75 Suppl 1(Suppl 1):S147-s62.

Introduction

Proton pump inhibitors (PPIs) are frequently used in daily clinical practice, but often without a valid indication. Strategies to identify inappropriate PPI use are widely available, although the true challenge is to discontinue PPIs in these patients without developing rebound symptoms. There is therefore a need for a tool to guide patients during this process.

Aims & Methods

We aimed to evaluate the effect of a smartphone app that provides an individualized educational approach as a tool to achieve sustained PPI discontinuation. This multicenter randomized controlled trial included adult patients on daily PPI for at least four weeks without chronic PPI indication from the outpatient clinics of Internal Medicine, Gastroenterology, Rheumatology and Nephrology in two community hospitals and one university hospital in the Netherlands. Patients were excluded in case they could not understand the study (procedures) or in case of a limited life span. Patients were randomly assigned to either the smartphone app providing timely information on PPI discontinuation (intervention group) or usual care which consisted of patients receiving a brochure explaining how to stop PPI and manage symptoms providing all information at once (control group). Primary endpoint was the discontinuation rate at 2-months follow-up, defined as self-declared intake of a maximum of one tablet in the previous 14 days. Patient recruitment has ended and we anticipate final results in August 2023. We now only present preliminary numerical data.

Results

Preliminary follow up results are based on 129 (2-months) and 99 (4-months) of 165 included patients (median age 55 y/o [IQR 46-64 y/o], 61 males [47%]). More patients succeeded to discontinue PPI use at 2-months follow-up in the intervention group: 54/62 (87%) vs. 44/67 (66%). This was also seen after 4-months follow-up: 44/55 (80%) patients in the intervention group vs. 41/61 (67%) patients in the control group.

Conclusion

A smartphone app intervention providing timely guidance in discontinuing inappropriate PPI use seems to be an effective tool to improve the discontinuation rate of inappropriate PPI use compared with a one-time information folder. These preliminary data suggest that patients are able to successfully discontinue inappropriate use of medication without the time-consuming support of a healthcare worker. (Clinical trial registration number: NCT05348252).