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DIFFERENCES IN MEDICAL CARE SATISFACTION OF PATIENTS WITH “FUNCTIONAL” VS “ORGANIC” ESOPHAGEAL DISEASES: ITALIAN VALIDATION OF THE PPRS-SF QUESTIONNAIRE AND ITS APPLICATION IN CLINICAL ROUTINE PRACTICE

Carlo Soldaini 1, Luigi Ruggiero 1, Annamaria Sellitti 1, Angela Caloro 1, Luca De Leo 1, Antonella SANTONICOLA 1, Paola Iovino 1

Affiliations

1 University of Salerno, Baronissi, Italy

Summary

AI Generated

An Italian validation study of the Patient-Physician Relationship Scale Short Form found that esophageal DGBI and GERD patients reported significantly lower satisfaction scores than those with eosinophilic esophagitis or achalasia, and older patients reported lower satisfaction than younger patients.

The study successfully validated the Italian version of the 12-item PPRS-SF questionnaire using a standardized forward-backward procedure overseen by a Rome Foundation clinical monitor.
Among 195 esophageal disease patients, mean satisfaction scores were highest for eosinophilic esophagitis (30.20) and achalasia (23.78), and lower for GERD (20.46) and esophageal DGBI (17.91) on a scale from -36 to +36.
Patients with disorders of gut-brain interaction and GERD reported significantly lower patient-physician relationship satisfaction compared to those with organic esophageal diseases.
Younger patients under 50 years reported higher satisfaction scores (27.1) than older patients over 50 years (20.16).
The findings suggest that diagnosis type and patient age may affect the quality of patient-physician relationships in gastrointestinal practice, though further studies are needed for confirmation.

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Abstract

Introduction

Patient-physician relationship (PPR) plays a center role in modern health care, especially within gastrointestinal (GI) medical practice, where patients affected by non-structural disorders (better described as disorders of gut-brain interaction or DGBI) tend to report a low satisfaction towards their medical care. In 2017 Kurlander et al. developed and validated a Patient-Physician Relationship Scale (PPRS), a questionnaire used in patients affected by Irritable Bowel Syndrome (IBS) to assess their degree of medical care-satisfaction. The original PPRS was later shortened and simplified by Drossman et al. in 2021 by creating a PPRS-SF (short form), consisting in a 12-item questionnaire.

Aims & Methods

The aims of this study were to validate the PPRS-SF in Italian and to administer it to both patients with functional and organic esophageal diseases, in order to highlight the differences in patient-physician relationship between the two categories.
The process of validation to Italian language of the PPRS-SF questionnaire was carried out following a standardized forward-backward procedure and each step was overseen by an independent clinical monitor assigned by the Rome Foundation itself. The Italian version of the PPRS SF was successfully administered to 50 Eosinophilic Esophagitis (EoE), 53 Achalasia (Ach), 48 Gastroesophageal Reflux Disease (GERD) and 44 esophageal DGBI patients (affected by functional dysphagia or functional heartburn).

Results

In esophageal DGBI and GERD, the degree of patients’ satisfaction was significantly lower, if calculated as a total summation, compared to that of EoE and Achalasia patients.. Between a minimum score of -36 and a maximum of +36, the mean PPRS-SF “Italian version” score for patients with EoE was 30.20 (±9.78), for patients with Ach 23.78 (±19.9); for patients with GERD 20.46 (±16.03); for esophageal DGBI 17.91 (±18.41). Moreover, there was a significant difference in PPR between younger patients (under 50 years old), who reported a score of 27.1 (±12.29) and older patients (over 50 years old), reporting a score of 20.16 (±19.72).

Conclusion

This study validated the Italian version of the PPRS-SF questionnaire and showed that the patients’ diagnosis together with other factors such as their age, can affect the quality of the PPR. In particular, patients with DGBI and older patients reported lower scores than the ones with organic diseases and the younger ones, respectively. Further studies are necessary to confirm these results.

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

More Like This:

FAMILIAL COLORECTAL CANCER HISTORY IS ASSOCIATED WITH A DISTINCT IMMUNE–GENOMIC PHENOTYPE IN MICROSATELLITE-STABLE RECTAL CANCER: A PROSPECTIVE MULTICENTRE COHORT STUDY

Marco Scarpa

Imaging is the only technique to study small bowel motility

Jaap Stoker

CLINICAL COURSE OF BLOWN-OUT MYOTOMY AFTER PERORAL ENDOSCOPIC MYOTOMY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

Yuzo Kodama

NATIONAL COLORECTAL CANCER SCREENING PROGRAM IN REPUBLIC CROATIA

Miroslava Katicic

Panel discussion: Cross-cutting: Diagnostic - invasive or not invasive

UNDERWATER VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL NEOPLASIA: A MULTICENTER, RANDOMISED CONTROLLED TRIAL

Francesco Di Matteo

UEG Presentation

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FAMILIAL COLORECTAL CANCER HISTORY IS ASSOCIATED WITH A DISTINCT IMMUNE–GENOMIC PHENOTYPE IN MICROSATELLITE-STABLE RECTAL CANCER: A PROSPECTIVE MULTICENTRE COHORT STUDY

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FAMILIAL COLORECTAL CANCER HISTORY IS ASSOCIATED WITH A DISTINCT IMMUNE–GENOMIC PHENOTYPE IN MICROSATELLITE-STABLE RECTAL CANCER: A PROSPECTIVE MULTICENTRE COHORT STUDY

Silvia Negro 1, Melania Scarpa 2, Francesca Galuppini 3, Sara Vedovato 4, Roberta Salmaso 3, Andromachi Kotsafti 2, Valerio Pellegrini 5, Luca Maria Saadeh 4, Antonio Rosato 2, Gaya Spolverato 1, Imerio Angriman 1, Cesare Ruffolo 4, Quoc Riccardo Bao 4, Anna Matteazzi 4, Lorenzo Dell'Atti 6, Dario Gregori 3, Ignazio CASTAGLIUOLO 3, Matteo Fassan 7, Angelo Paolo Dei Tos 3, Marco Scarpa 1

Affiliations

1 DISCOG, University of Padova, Padova, Italy

2 Veneto Institute of Oncology IOV-IRCCS, Padova, Italy

3 University of Padova, Padova, Italy

4 Azienda Ospedale Università di Padova, Padova, Italy

5 AULSS 2 Marca Trevigiana, Treviso, Italy

6 Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy

7 University of Padova, Treviso, Italy

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Abstract

Introduction

Most rectal cancers are microsatellite-stable (MSS) and poorly responsive to immunotherapy [1], yet the biological determinants of this immune resistance remain incompletely understood. The tumor immune microenvironment is directly involved in the therapy response but, little is known about the role of the surrounding rectal mucosa immune environment [2]. We investigated whether familial aggregation of colorectal cancer identifies a distinct MSS rectal cancer subtype.

Aims & Methods

This study was a sub-analysis of data from two multicentric observational cohort studies, IMMUNOREACT 1 (clinicaltrials.gov NCT04915326) and 2 (clinicaltrials.gov NCT04917263), that included 374 MSS rectal cancer patients, classified as sporadic (FH⁻) or familial (FH⁺), with a predefined subgroup of patients with an affected first-degree relative (FDR⁺). Immune, transcriptomic, and genomic profiling were performed on tumour-adjacent normal mucosa and tumour tissue.Sections were stained with monoclonal antibodies targeting CD3, CD4, CD8, CD8β, T-bet, FoxP3, PD-L1, CD80, MSH6, and PMS2. Epithelial cells with antigen-presenting features (pan-cytokeratin⁺, CD80⁺, CD86⁺, HLA-ABC⁺) and T-cell subsets — including activated CD8⁺ T cells (CD8⁺CD28⁺ and CD8⁺CD38⁺), inhibitory T cells (CD3⁺CTLA-4⁺), activated CD4⁺ T cells (CD4⁺CD25⁺), and regulatory T cells (CD4⁺CD25⁺FoxP3⁺) — were quantified by flow cytometry. Gene expression profiling was performed using the PanCancer IO 360™ panel (NanoString Technologies). Targeted next‐generation sequencing (NGS) for solid tumours was performed using the Archer® VariantPlex® Solid Tumor Panel, enabling detection of single-nucleotide variants and copy number variations in cancer-associated genes.

Results

Among 374 patients, 25% were FH⁺ and 17% FDR⁺. In nCRT-naïve disease, FDR⁺ cases showed higher epithelial CD80⁺ cell density in normal mucosa. After nCRT, FH⁺ patients exhibited increased activated CD8⁺CD28⁺ T cells and reduced epithelial HLA-ABC expression, while FDR⁺ cases showed lower CD3⁺ T-cell density. Transcriptomic analyses suggested a relatively quiescent familial mucosal phenotype, characterised by attenuation of DNA damage repair, proliferative, metabolic, angiogenic, and immune pathways. The impact of mutational ratio differed by familial background: in FH⁻ disease, a higher mutational ratio was associated with improved disease-free survival and with immune features, including CD8⁺ T-cell density and epithelial CD80 expression, whereas in FH⁺ cancer, it was not associated with outcome and appeared uncoupled from these immune parameters.

Conclusion

In conclusion, our findings suggest that MSS rectal cancers arising in patients with familial CRC aggregation, particularly those with an affected first-degree relative, may represent a distinct biological subgroup characterized by altered epithelial–immune coordination and impaired coupling between therapy-induced genomic stress and immune surveillance. If validated in larger and independent cohorts, these observations could have implications beyond risk stratification alone. Family history may help refine biological subclassification within MSS rectal cancer and inform the design of trials evaluating immunotherapy-based strategies in this traditionally immune-resistant disease. More broadly, these data provide a rationale for mechanistic studies aimed at clarifying the basis of altered coordination between genomic perturbation and antitumour immunity in familial MSS rectal cancer.

References

1. Cercek A, Lumish M, Sinopoli J, Weiss J, Shia J, Lamendola-Essel M, et al. PD-1 Blockade in Mismatch Repair–Deficient, Locally Advanced Rectal Cancer. New England Journal of Medicine. 2022 Jun 23;386(25):2363–76. doi:10.1056/NEJMoa2201445
2. Marchiori C, Scarpa M, Kotsafti A, Morgan S, Fassan M, Guzzardo V, et al. Epithelial CD80 promotes immune surveillance of colonic preneoplastic lesions and its expression is increased by oxidative stress through STAT3 in colon cancer cells. Journal of Experimental & Clinical Cancer Research. 2019 Dec 9;38(1):190. doi:10.1186/s13046-019-1205-0

Event

UEG Week Barcelona 2026

Topics

IBD Pancreas Gut Microbiota Endoscopy Digestive Oncology Colorectal

Submission format

Abstract

Session

Hot topics in clinical GI research

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

FAMILIAL COLORECTAL CANCER HISTORY IS ASSOCIATED WITH A DISTINCT IMMUNE–GENOMIC PHENOTYPE IN MICROSATELLITE-STABLE RECTAL CANCER: A PROSPECTIVE MULTICENTRE COHORT STUDY

Marco Scarpa

Imaging is the only technique to study small bowel motility

Jaap Stoker

CLINICAL COURSE OF BLOWN-OUT MYOTOMY AFTER PERORAL ENDOSCOPIC MYOTOMY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

Yuzo Kodama

NATIONAL COLORECTAL CANCER SCREENING PROGRAM IN REPUBLIC CROATIA

Miroslava Katicic

Panel discussion: Cross-cutting: Diagnostic - invasive or not invasive

UNDERWATER VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL NEOPLASIA: A MULTICENTER, RANDOMISED CONTROLLED TRIAL

Francesco Di Matteo

UEG Presentation

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Imaging is the only technique to study small bowel motility

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Imaging is the only technique to study small bowel motility

Jaap Stoker 1

Affiliations

1 Amsterdam UMC, Amsterdam, Netherlands

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Abstract

Event

UEG Week Barcelona 2026

Topics

Paediatrics Small Intestine & Nutrition Neurogastroenterology & Motility

Session

How to study small bowel function in 2026? From the past to the future

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

FAMILIAL COLORECTAL CANCER HISTORY IS ASSOCIATED WITH A DISTINCT IMMUNE–GENOMIC PHENOTYPE IN MICROSATELLITE-STABLE RECTAL CANCER: A PROSPECTIVE MULTICENTRE COHORT STUDY

Marco Scarpa

Imaging is the only technique to study small bowel motility

Jaap Stoker

CLINICAL COURSE OF BLOWN-OUT MYOTOMY AFTER PERORAL ENDOSCOPIC MYOTOMY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

Yuzo Kodama

NATIONAL COLORECTAL CANCER SCREENING PROGRAM IN REPUBLIC CROATIA

Miroslava Katicic

Panel discussion: Cross-cutting: Diagnostic - invasive or not invasive

UNDERWATER VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL NEOPLASIA: A MULTICENTER, RANDOMISED CONTROLLED TRIAL

Francesco Di Matteo

UEG Presentation

New

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CLINICAL COURSE OF BLOWN-OUT MYOTOMY AFTER PERORAL ENDOSCOPIC MYOTOMY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

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CLINICAL COURSE OF BLOWN-OUT MYOTOMY AFTER PERORAL ENDOSCOPIC MYOTOMY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

Hiroshi Tanabe 1, Hirofumi Abe 1, Shinwa Tanaka 1, Hiroya Sakaguchi 1, Chise Ueda 1, Tatsuya Nakai 1, Hitomi Hori 1, Shinya Hoki 1, Satoshi Urakami 1, Tetsuya Yoshizaki 1, Masato Kinoshita 1, Fumiaki Kawara 2, Takashi Toyonaga 3, Yuzo Kodama 1

Affiliations

1 Kobe University Graduate School of Medicine, Kobe-City, Japan

2 Konan Medical Center, Kobe-City, Japan

3 Kobe University Hospital, Kobe, Japan

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Abstract

Introduction

Blown-out myotomy (BOM) is a diverticular-like complication developing at the myotomy site following peroral endoscopic myotomy (POEM) or surgical myotomy. Although BOM has been associated with clinical symptom exacerbation, its incidence, clinical course, and risk factors after POEM remain poorly understood.

Aims & Methods

Aims: To elucidate the incidence, clinical course, and independent risk factors of BOM after POEM in patients with esophageal motility disorders (EMDs).
Methods: This retrospective, single-center study included 598 patients who underwent POEM for achalasia and non-achalasia EMDs at Kobe University Hospital between April 2015 and March 2023. We developed a novel endoscopic BOM classification: grade 0 (no diverticular-like changes), grade 1 (mild diverticular-like changes), grade 2 (obvious changes with a diverticular septum), and grade 3 (obvious changes with food retention); grades 2–3 were defined as endoscopic BOM. The Kaplan–Meier method was used to assess BOM progression and its impact on long-term clinical success (Eckardt score ≤3). Univariate and multivariate logistic regression analyses identified factors associated with endoscopic BOM.

Results

Of 598 patients, 28 (4.7%) developed endoscopic BOM during the study period. The 1-, 2-, and 5-year BOM incidence rates were 3.1%, 6.6%, and 8.1%, respectively. Endoscopic BOM showed almost perfect agreement with radiographic BOM (kappa=0.95, 95% CI 0.86–1.00), supporting the validity of the proposed endoscopic classification. BOM grade progression mainly occurred between 1 and 3 years after POEM, then plateaued. On multivariate analysis, male sex (OR 2.88, 95% CI 1.22–6.83; p=0.016), thin esophageal muscle layer during myotomy (OR 3.16, 95% CI 1.37–7.28; p=0.007), and post-POEM clinical reflux at 3 months (OR 5.76, 95% CI 2.27–14.6; p<0.001) were independent risk factors for BOM. In patients with post-POEM reflux, acid-suppressive therapy significantly reduced BOM incidence (3.5% vs. 17.8%, p=0.001). The BOM group showed significantly lower long-term clinical success rates compared to the non-BOM group (p=0.026).

Conclusion

The 5-year incidence of BOM after POEM is 8.1%, with grade progression occurring primarily within 3 years post-POEM. The proposed endoscopic classification demonstrated excellent agreement with radiographic findings. Male sex, thin esophageal muscle layer, and post-POEM clinical reflux are independent risk factors for BOM. As BOM is associated with reduced long-term clinical success, early surveillance and acid-suppressive therapy in high-risk patients may be clinically important.

Event

UEG Week Barcelona 2026

Topics

Mechanisms & Personalised Medicine Surgery Neurogastroenterology & Motility Endoscopy Oesophagus

Submission format

Abstract

Session

Achalasia: Beyond the bird's beak - Tailoring therapy to the patient

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

FAMILIAL COLORECTAL CANCER HISTORY IS ASSOCIATED WITH A DISTINCT IMMUNE–GENOMIC PHENOTYPE IN MICROSATELLITE-STABLE RECTAL CANCER: A PROSPECTIVE MULTICENTRE COHORT STUDY

Marco Scarpa

Imaging is the only technique to study small bowel motility

Jaap Stoker

CLINICAL COURSE OF BLOWN-OUT MYOTOMY AFTER PERORAL ENDOSCOPIC MYOTOMY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

Yuzo Kodama

NATIONAL COLORECTAL CANCER SCREENING PROGRAM IN REPUBLIC CROATIA

Miroslava Katicic

Panel discussion: Cross-cutting: Diagnostic - invasive or not invasive

UNDERWATER VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL NEOPLASIA: A MULTICENTER, RANDOMISED CONTROLLED TRIAL

Francesco Di Matteo

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NATIONAL COLORECTAL CANCER SCREENING PROGRAM IN REPUBLIC CROATIA

Neven Ljubicic 1, Natasa Antoljak 2, Ivana Brkić Biloš 3, Anita Skrtic 4, Mirjana Kalauz 5, Maja Vajagić 3, Melita Jelavić 6, Vanja Tešić 6, Natalija Malkoč 7, Miroslava Katicic 8

Affiliations

1 Clinical Hosp. Sestre Milosrdnice, Zagreb, Croatia

2 Croatian Institute of Public Health and University Zagreb School of Medicine, School of Public Health Andrija Štampar, Zagreb, Croatia

3 Croatian Institute of Public Health, Zagreb, Croatia

4 University Hospital Merkur and University Zagreb School of Medicine, Zagreb, Croatia

5 Clinical Hospital Center Zagreb, Zagreb, Croatia

6 Teaching Institute of Public Health Andrija Štampar, Zagreb, Croatia

7 Croatian Insurance Fund, Zagreb, Croatia

8 Retired, Zagreb, Croatia

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Abstract

Introduction

Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women in 2023, while it ranks first overall. According to Cancer Registry data, in 2023, colorectal cancer was diagnosed in 3,820 people (2,262 men and 1,558 women; ICD codes C18-C20). It ranks second in terms of mortality from malignant neoplasms in 2023. and 1,996 people died from colon cancer (ICD codes C18-C20), which is the lowest in the last seven years. Since 2008, the National Screening Program targeting men and women aged 50 to 74 has been implemented based on the guaiac fecal occult blood test (gFOBT). Extensive reorganization of the program is ongoing due to replacing the gFOBT with an immunochemical quantitative, more sensitive test.

Aims & Methods

Aim of this study is to present the results of 5^th cycle. Data from the National Colorectal Cancer Screening Program web-based registry in the Republic of Croatia was used, the incidence rates were obtained from the Croatian Cancer Registry, and mortality data from the mortality registry.

Results

So far, five cycles have been completed, and the sixth is underway. This means that, since the beginning of the implementation, around 2 million citizens have opportunity to be examined in one or more cycles. In the completed fifth cycle, 1,306,275 people were invited. Out of the total number of invitees, part of the people have a reason for exclusion (364,490 people), which is known through the FOBT or colonoscopy payed by Croatian insurance institute, or by response to the invitation letter or the information from the returned undelivered envelope (already being treated, died in the meantime, colon cancer was detected or colonoscopy within 24 months, FOB tested within 12 months, as well as temporarily unavailable). Out of these target 941,785 people, a total of 316,984 people (34%) responded to the written invitation. The response to the invitation letter was 24-52% depending on the county and age group. The share of examined persons by gFOBT was 25% (239,299), or 75% of the respondents. We found 6,748 people (2.8%) with positive test, so 5,966 of them (88%) were ordered to have a colonoscopy. Some citizens refuse colonoscopy as part of screening and want to do it in private units but data on this are not currently collected and included in the national program. A total of 4,611 (77%) colonoscopy were performed within the program of which polypectomy was performed in 1930 patients. On average, cancer is detected in 400-500 people per cycle, which, according to our pharmacoeconomic analysis, brings savings of about 7,000,000 euros per year. Trend of standardized mortality rates has been stable in the last 10 years, but the incidence of colorectal cancer has been increasing, about 1% per year in the last 20 years.

Conclusion

The increase in the prevalence of colorectal cancer in Croatia is contributed by the increase in life expectancy, great proportion of old inhabitants but also by the high prevalence of risk factors such as smoking, obesity, alcohol consumption, and insufficient physical activity. Colonoscopy as a method represents the gold standard for diagnostics, prevention, and partly treatment of colorectal cancer. For the implementation of comprehensive care and prevention of colon cancer, good cooperation between all teams of family doctors, community nurses, and preventive public health teams is necessary, as well as the joint removal of obstacles to implementation. So, it is necessary to continue work on increasing the response rate to achieve better long-term effects.

References

Carbotti G, Danica MN. van den Berg, Andre L. Carvalho, Carlo Senore, Eveline AM. Heijnsdijk, Harry J. de Koning, Iris Lansdorp-Vogelaar. Developments in the roll-out and performance of CRC screening in Europe. Best Practice & Research Clinical Gastroenterology 2026; 80:102043,ISSN 1521-6918, https://doi.org/10.1016/j.bpg.2025.102043.102043.

Conference

UEG Week Barcelona 2026

Topics

Colorectal

Submission format

Abstract

Session

LOWER GI (EXCLUDING IBD) (Posters)

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

FAMILIAL COLORECTAL CANCER HISTORY IS ASSOCIATED WITH A DISTINCT IMMUNE–GENOMIC PHENOTYPE IN MICROSATELLITE-STABLE RECTAL CANCER: A PROSPECTIVE MULTICENTRE COHORT STUDY

Marco Scarpa

Imaging is the only technique to study small bowel motility

Jaap Stoker

CLINICAL COURSE OF BLOWN-OUT MYOTOMY AFTER PERORAL ENDOSCOPIC MYOTOMY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

Yuzo Kodama

NATIONAL COLORECTAL CANCER SCREENING PROGRAM IN REPUBLIC CROATIA

Miroslava Katicic

Panel discussion: Cross-cutting: Diagnostic - invasive or not invasive

UNDERWATER VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL NEOPLASIA: A MULTICENTER, RANDOMISED CONTROLLED TRIAL

Francesco Di Matteo

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Panel discussion: Cross-cutting: Diagnostic - invasive or not invasive

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Panel discussion: Cross-cutting: Diagnostic - invasive or not invasive

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Abstract

Event

UEG Week Barcelona 2026

Topics

Hepatobiliary Primary Care Neurogastroenterology & Motility Endoscopy

Session

Cross-cutting: Diagnostic - invasive or not invasive

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

FAMILIAL COLORECTAL CANCER HISTORY IS ASSOCIATED WITH A DISTINCT IMMUNE–GENOMIC PHENOTYPE IN MICROSATELLITE-STABLE RECTAL CANCER: A PROSPECTIVE MULTICENTRE COHORT STUDY

Marco Scarpa

Imaging is the only technique to study small bowel motility

Jaap Stoker

CLINICAL COURSE OF BLOWN-OUT MYOTOMY AFTER PERORAL ENDOSCOPIC MYOTOMY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

Yuzo Kodama

NATIONAL COLORECTAL CANCER SCREENING PROGRAM IN REPUBLIC CROATIA

Miroslava Katicic

Panel discussion: Cross-cutting: Diagnostic - invasive or not invasive

UNDERWATER VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL NEOPLASIA: A MULTICENTER, RANDOMISED CONTROLLED TRIAL

Francesco Di Matteo

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

UNDERWATER VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL NEOPLASIA: A MULTICENTER, RANDOMISED CONTROLLED TRIAL

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UNDERWATER VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL NEOPLASIA: A MULTICENTER, RANDOMISED CONTROLLED TRIAL

Gianluca Andrisani 1, Giulio Antonelli 2, Sandro Sferrazza 3, Federico Barbaro 4, Silvia Pecere 4, Francesco Pugliese 5, Mattia Corradi 6, Luigi Giovanni Papparella 7, Cesare Hassan 8, Mattia Brigida 9, Giulio Calabrese 3, Arianna Andreozzi 10, Antonio Facciorusso 11, Guido Costamagna 12, Michele Cicala 13, Francesco Di Matteo 14

Affiliations

1 Campus Biomedico Roma, Rome, Italy

2 Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli (N.O.C.), Roma, Italy

3 Gastroenterology and Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy

4 Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training, Roma, Italy

5 ASST NIGUARDA, Milano, Italy

6 Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy

7 Digestive Endoscopy, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy

8 Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Pieve Emanuele MI, Italy

9 Department of Experimental Medicine, Università del Salento, Palermo, Italy

10 Digestive Endoscopy Unit, University Campus Bio-Medico, Rome, Italy

11 Department of Experimental Medicine, Università del Salento, Lecce, Italy

12 Digestive Endoscopy, Ospedale Isola Tiberina - Gemelli Isola, Roma, Italy

13 Università Campus Bio Medico, Roma, Italy

14 Digestive Endoscopy Unit, University Campus Bio-Medico, Roma, Italy

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Abstract

Introduction

Underwater endoscopic submucosal dissection (UESD) has been proposed as a technical modification of conventional gas-assisted ESD (GESD) to improve operative field stability and procedural efficiency during colorectal ESD. However, comparative evidence remains limited, particularly in Western practice.

Aims & Methods

We conducted a prospective, multicentre, open-label, randomised controlled trial across five Italian tertiary referral centres between December 2024 and December 2025. Adult patients referred for colorectal ESD were randomly assigned 1:1 to UESD or GESD. The trial was designed as a non-inferiority study for en bloc resection with a prespecified margin of 10%. Secondary endpoints included R0 resection, procedural time, dissection speed, smoke interference, intraprocedural bleeding, use of hemostatic forceps, and post-procedural adverse events.

Results

Overall, 295 patients were randomised and 286 completed the assigned procedure (143 per arm). En-bloc resection was achieved in 142/143 lesions (99.3%) in both groups, with an absolute risk difference of 0.0% (95% CI −3.2-3.2), supporting non-inferiority of UESD. R0 resection rates were similar (95.1% vs 95.8%). Compared with GESD, UESD was associated with shorter procedural time (median 59.0 vs 70.0 min), faster dissection speed (27.0 vs 21.4 mm²/min), less smoke interference (8.4% vs 48.3%), less intraprocedural bleeding (19.6% vs 35.0%), and lower use of hemostatic forceps (44.8% vs 61.5%). Adjusted analyses confirmed these findings.

Conclusion

In this first multicentre randomised trial of UESD, and the first European randomised comparison of underwater versus gas-assisted colorectal ESD, UESD was non-inferior to GESD for en bloc resection while improving key procedural outcomes.

References

Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ, et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy. 2022;54(6):591–622. doi:10.1055/a-1811-7025.
Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27:417–434. doi: 10.1111/den.12456.
Fuccio L, Hassan C, Ponchon T, Mandolesi D, Farioli A, Cucchetti A, et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc. 2017;86:74–86.e17. doi: 10.1016/j.gie.2017.02.024.
Singh RR , Nanavati J, Gopakumar H, Kumta NA. Colorectal endoscopic submucosal dissection in the West: A systematic review and meta-analysis. Endosc Int Open. 2023 Nov 27;11(11):E1082-E1091. doi: 10.1055/a-2181-5929.
Matsumoto A, Tanaka S, Oba S, Kanao H, Oka S, Yoshihara M, et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol. 2010;45:1329–1337. doi: 10.3109/00365521.2010.495416.

Disclosure

The authors have no conflict of interest related to the manuscript.

Event

UEG Week Barcelona 2026

Topics

Digestive Oncology Endoscopy Colorectal

Submission format

Abstract

Session

Endoscopic resection: Cut, cure, prevent

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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