Introduction

Previous research has shown that categorizing high-confidence (HC) diagnoses as those reached within 3 s without hesitation notably enhanced the optical diagnostic accuracy for colorectal polyps. This study aimed to assess the efficacy of a new computer-aided diagnosis (CADx) system integrated with the 3-second rule in the optical diagnosis of colorectal polyps among endoscopists with different levels of experience.

Aims & Methods

In this multicenter ex vivo study, 35 endoscopists evaluated 100 polyps (51 adenomas, 39 hyperplastic polyps, and 10 sessile serrated lesions) using narrow-band imaging video clips on an online platform. The assessments comprised two phases: individual endoscopist diagnosis and CADx-assisted diagnosis. HC assignments followed the 3-second rule in both phases. Performance metrics assessed included HC accuracy, HC rate, and adherence to the Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) and Simple Optical Diagnosis Accuracy (SODA) thresholds.

Results

HC diagnostic accuracy improved from 78.3% (95% CI: 76.6–80.0) to 89.8% (95% CI: 88.6–90.9) with CADx assistance (p < 0.001). The proportion of HC predictions increased from 64.2% to 75.4% with the CADx assistance (p < 0.001). Novice endoscopists notably showed a significant improvement in HC accuracy with CADx assistance (74.1% vs. 88.8%; p < 0.001). The CADx-assisted diagnoses nearly met the SODA standards and PIVI thresholds when combined with the 3-second rule.

Conclusion

Integrating CADx with the 3-second rule significantly improved the optical diagnostic performance for colorectal polyps, particularly among endoscopists lacking systematic training.

Disclosure

Jung Ho Bae has a financial interest in Ainex Corporation, while Soonwhan Kang and Jinbae Park are employed by Ainex Corporation. The authors disclose no conflicts of interest.

Introduction

Hypertriglyceridemia (HTG) is an underdiagnosed etiology of acute pancreatitis (AP), traditionally reported in 1–7% of cases. However, emerging evidence suggests that its true prevalence may be significantly higher. Prompt identification and effective management of HTG-induced AP are essential, yet standardized treatment approaches remain limited. This study aimed to assess the prevalence of HTG-induced AP and evaluate insulin infusion as a first-line therapeutic strategy.

Aims & Methods

We retrospectively analyzed 200 adult patients admitted with AP at [Hospital Name] between January 2023 and December 2024. Patients with serum triglyceride levels ≥11.3 mmol/L (≥1000 mg/dL) and no other identifiable causes of AP (e.g., gallstones, alcohol use) were included. Demographic data, comorbidities, treatment modalities, and outcomes were reviewed. A favorable response to insulin therapy was defined as a ≥50% reduction in serum triglyceride levels within 72 hours. Statistical analysis was performed using SPSS; p<0.05 was considered statistically significant.

Results

HTG was identified as the primary cause of AP in 40 out of 200 patients (20%). Among these, 60% had type 2 diabetes mellitus, 50% were obese (BMI ≥30 kg/m²), and 35% reported regular alcohol use. All patients were initiated on insulin infusion. Thirty-four patients (85%) responded favorably, while six (15%) required plasmapheresis. The mean hospital stay was significantly shorter in the insulin-only group compared to those requiring plasmapheresis (5 vs. 8 days, p<0.01), with a lower complication rate as well (10% vs. 25%, p<0.05). No in-hospital mortality occurred.

Conclusion

HTG-induced AP may be substantially more prevalent than previously recognized. Routine triglyceride screening should be considered in AP cases with no obvious cause. Insulin infusion is a safe, effective, and widely accessible first-line therapy that may reduce complications and length of hospital stay. These findings support early metabolic assessment and proactive risk factor management to improve clinical outcomes.

Introduction

Non-invasive elastography techniques have become essential for evaluating hepatic fibrosis and portal hypertension. Although liver stiffness is routinely assessed, spleen stiffness has gained recognition as an emerging marker of portal hypertension. Its application in the intensive care unit (ICU), particularly among patients with chronic liver disease and acute-on-chronic liver failure (ACLF), remains underexplored. This study investigates the utility of Acoustic Radiation Force Impulse (ARFI) imaging for spleen stiffness assessment in ICU patients, focusing on its prognostic relevance and feasibility in a high-acuity setting.

Aims & Methods

We conducted a prospective observational study enrolling 44 ICU patients with established chronic liver disease, with or without ACLF. Spleen stiffness was measured serially using ARFI elastography every 2–4 days during the ICU stay. Clinical data—including liver and renal function parameters, respiratory support settings, and outcome variables—were collected concurrently. The primary aim was to assess the feasibility of serial spleen stiffness measurement in this cohort, identify influencing clinical variables, and explore associations with clinical outcomes.

Results

Spleen stiffness assessment via ARFI was successfully performed in all included patients. Higher spleen stiffness values were significantly associated with renal replacement therapy (p < 0.001) and the need for invasive mechanical ventilation (p < 0.001). An inverse relationship was observed between airway pressures during ventilation and spleen stiffness values (p = 0.017), suggesting potential interplay between mechanical factors and elastographic findings. Spleen stiffness did not correlate with patient age, BMI, or vasopressor requirement. Over time, spleen stiffness showed dynamic changes corresponding to clinical progression or improvement, supporting its potential as a non-invasive surrogate of disease trajectory.

Conclusion

Our findings demonstrate that spleen stiffness measurement via ARFI elastography is both feasible and clinically informative in the intensive care setting for patients with liver cirrhosis. Beyond reflecting portal hypertension, spleen stiffness appears to integrate aspects of hepatic and extrahepatic dysfunction, correlating with organ failure and clinical deterioration. These results underscore its potential as a non-invasive, bedside-accessible biomarker to support dynamic risk stratification and individualized decision-making in critical care hepatology.

Introduction

The most common reason for non-attendance for a colonoscopy procedure by patients is fear and anxiety over pain and discomfort with up to 89% of cases. This can then lead to lack of engagement and loss to follow-up potentially worsening cancer detection rates.
Solutions such as increased sedation and state-of-the-art equipment are not always available options for patients and endoscopy units. The role of inexpensive interventions which can significantly improve patient experience and improvement of quality metrics is desirable. This study examines the effect of music and task distraction on pain and discomfort during colonoscopy with assessment of patients’ real-time physiological parameters. This interval study reports on the first cohort of patients recruited to gain initial insight into the ongoing multi-centre study.

Aims & Methods

A three-arm observational study was conducted between September 2023 and March 2024 at Imperial College Healthcare Trust (UK) with ethical approval. Seven expert endoscopists were recruited. Suitable patients were identified from a selection criterion and consented. They were fitted with a vest containing the medical device which recorded their physiological parameters in real-time continuously. They were randomised to one of three arms: A-standard colonoscopy, B-colonoscopy with music or C-colonoscopy with smartphone task distraction. Colonoscopy was performed as normal with further information gathered on difficulty, technique and subjective opinions of the patient. Statistical analysis was applied to data with generalised estimated equations and Anova modelling.

Results

60 patients (32M:28F. Mean age 47.4); 20 from each arm were recruited. Observational data of mean heart rate (mHR) reported for Arm A 84.9 (SD 23.51, p <0.008), Arm B 107.3 (SD 37.95, p<0.015) and Arm C 80.54 (SD 27.14, p<0.878). Anova variance reported Arm A 0.81, Arm B 0.03 and Arm C <0.00)
Observational date of mean respiratory rate (mRR) reported for Arm A 13.7 (SD 6.14, p<0.017), Arm B 13.2 (SD 5.87, p<.015) and Arm C 13.2 (SD 6.18, p<0.038). Anova variance reported Arm A 1.42, Arm B 0.71 and Arm C 1.02).
All patients reported satisfaction with their intervention, and all would recommend undertaking the same intervention again. Further analysis on effect of sedation, technique and difficulty of procedure is ongoing.

Conclusion

It has been demonstrated that music and task distraction with smartphone, both can significantly improve objective measures of pain and discomfort for patients undertaking a colonoscopy. It provides a practical, inexpensive and implementable option to improve patient experience, engagement and follow up. The results from this interval study will be built upon with the complete data recruitment target of 500 patients. This has been completed as on March 2025 and is undergoing full data analysis.

Introduction

To reduce mortality risks in patients with metabolic dysfunction-associated steatohepatitis (MASH) it is critical to have a better disease understanding in real-world populations. Limitations of past studies were small sample size, point in time of data collection, being single center, biopsy based, or broad focus on steatotic liver disease.

Aims & Methods

This study investigates mortality rates, causes of death, and the role of socio-demographic risk factors and biomarkers that could be associated with mortality in a large real-world MASH population.
Retrospective cohort study (2016-2021 years) using Optum Market Clarity (linked claims and electronic health records, EHRs) from the United States. MASH was defined by the first ICD10 diagnosis code (K75.81 Nonalcoholic steatohepatitis) recorded during the study period, presence of AST, ALT and platelets tests carried out 3 months prior/after diagnosis, and absence of diseases prior/at diagnosis, such as alcoholic/chronic liver diseases. Risk factors included age, sex, race, region, comorbidities, FIB-4 fibrosis score and routinely collected biomarkers such as LDL cholesterol, Triglycerides, eGFR, and HbA1c. The associations between risk factors and mortality were estimated using multivariate survival models. To contextualize findings, crude mortality rates were calculated in the subgroup of MASH patients with BMI ≥ 25 and type 2 diabetes (T2D) and in a group of patients in Optum with BMI ≥ 25 who did not report any liver diseases or T2D.

Results

18,710 MASH patients (mean age 44 years, 54% female, 80% white, 95% with BMI ≥ 25, 52% with T2D) had been followed-up (FU) for 6.5 years after diagnosis (mean FU = 3 years): 1465 patients died (70% from cardiovascular disease (CVD) and 17% from liver-related causes). The mortality rate was 25 per 1000 persons-year (py). African Americans (vs white) and South residents (vs North-East) had higher all-cause mortality rates [Hazard ratios (HRs) of 1.33 and 1.45 respectively]. A decrease in eGFR of 10 mL/min/1.73m² and having 3 or more comorbidities (vs none) were also associated with increased mortality (HRs of 1.21 and 1.93 respectively). The mortality rate was 31 per 1000 py in MASH with BMI ≥ 25 and T2D (5 times higher than those with BMI ≥ 25 without liver diseases/diabetes).

Conclusion

CVD risk reduction in patients with MASH will be crucial to improve outcomes. Mortality rates are especially high in MASH patients who are overweight/obese and living with T2D. In addition, racial differences in MASH mortality were observed: African Americans and South residents were at increased risk; this may be due to less access to health care. Also, the eGFR-mortality association signaled that kidney and renal disease prevention is important. This is the largest and most comprehensive study on MASH mortality using claims and EHRs.

Disclosure

Originally presented at International Liver Congress 2024, organized by the European Association for the Study of the Liver (EASL)

Introduction

The prevalence of obesity in inflammatory bowel disease (IBD) has risen, with 15–40% of adults classified as obese and an additional 20–40% as overweight ¹. Poor dietary habits and sedentary lifestyles contribute to overweight and sarcopenia, potentially worsening IBD-related disability.

Aims & Methods

This cross-sectional study aimed to evaluate the relationships between nutritional status, adherence to the Mediterranean diet, sarcopenia and disability in IBD patients. Patients with IBD attending the outpatient clinic or infusion unit of an academic tertiary center between 2023 and 2024 were consecutively enrolled. Bioelectrical impedance analysis (BIA) was used to estimate the fat-free mass index (FFMI), a recognized measure of skeletal muscle mass. Physical function was assessed via gait speed (time to walk 6 meters), and handgrip strength (HGS) measured using a Jamar dynamometer. Sarcopenia was diagnosed based on FFMI, HGS, and walking speed. Disability was evaluated using the IBD-Disk questionnaire, with scores ≥40 indicating moderate-to-severe disability. Adherence to the Mediterranean diet was assessed using the Medi-Lite score, with scores <9 reflecting low adherence. Demographic, clinical, and disease related data were collected.

Results

A total of 95 IBD patients (58% with Crohn’s disease, CD), 57.8% female, with a median age of 42 years (IQR 26-58) were included. Clinical activity ,measured with the Harvey-Bradshaw index (HBI), had a median score of 6 (IQR 4–7) for CD, while the median pMayo score for ulcerative colitis (UC) was 4 (IQR 2–6).
The median BMI was 23.60 (IQR 21-27). Overweight prevalence was 43.2% (41/95). Low adherence to the Mediterranean diet was significantly more frequent in overweight patients compared to nonoverweight patients (p<0.001). Overweight was also associated with increased age (p < 0.001). Sarcopenia prevalence was 7% (7/95) and was more common in non-overweight patients than in overweight patients (p = 0.002). The median BMI among sarcopenic patients was 20.6 (18.5–25.3). The mean IBD-Disk score was 41 ± 23.2, with 46.3% of patients reporting moderate-to-severe disability. Overweight patients were more likely to experience moderate-to-severe disability compared to non-overweight patients [27 (65.9%) vs. 23 (42.6%), p =0.02]. No significant association was found between sarcopenia and moderate-to-severe disability (p = 0.44).

Conclusion

Overweight is associated with low adherence to the Mediterranean diet and increased disability in IBD patients. Targeted interventions to improve adherence to the Mediterranean diet and manage overweight could potentially reduce disability in IBD patients.

References

1. Singh S et al, Nat Rev Gastro Hepatol. 2017 February ; 14(2): 110–121 10.1038/nrgastro.2016.181

Introduction

Transport is a major contributor to the environmental impact of endoscopic procedures, including therapeutic ones like Endoscopic Submucosal Dissection (ESD). An ESD generates 73.2 kg CO₂e, with nearly half attributed to travel, notably for face-to-face consultations with endoscopists or anesthesiologists. Alternatives like virtual or local off-site consultations may reduce this burden. This study aimed to assess whether different consultation types affect ESD outcomes and to estimate the environmental benefit of using non-traditional formats.

Aims & Methods

We analyzed ESD procedures recorded from January to September 2024 in the FECCO prospective national database, which included details on consultation types and transport modes. Clinical parameters (age, ASA score, ESD effectiveness: success, en bloc, R0, curative; and safety: perforation, delayed bleeding, surgery for adverse events) and logistical data (consultation number/type, travel distance and mode) were collected. The main endpoint was the comparison of ESD outcomes and environmental impact based on the type of consultation. Three consultation types were compared: face-to-face in the distant resection center (FFD), face-to-face locally (FFL), and remote virtual (VR). Environmental data were derived from the RESECT post hoc study.

Results

Among 1809 ESDs, 1458 patients had FFD endoscopic consultations (85.4%), while 249 had VR (14.6%). Of 1747 patients with anesthesiology data, 1348 had FFD (77.2%), 359 FFL (20.5%), 36 VR (2.1%), and 4 had no consultation. Mean round-trip distances were 34 km for FFL and 175 km for FFD. Combined consultations accounted for 325,500 km and 65 tons CO₂e (36 kg/patient). Only 7/1481 (0.5%) used public transport. Since the procedure is performed exclusively in expert centers, it accounts for an additional 316,575 km of travel and 63 tons of CO₂e emissions (34.8 kg CO₂e per patient). No differences were found between FFD and VR groups in lesion size, location, CONECCT class, patient age, anticoagulant/antiplatelet use. ASA score was slightly lower in VR (2.12 vs 2.24, p=0.04). En bloc resection was 96.6% vs 96.0% (p=0.57), R0 resection 89.4% vs 92.7% (p=0.19). Perforation occurred in 7.6% vs 8.4% (p=0.76), surgery for adverse events in 1.22% vs 1% (p=0.99), and delayed bleeding in 5.9% vs 2% (p=0.04). ESD duration and resection speed were similar (60 min/36.4 mm²/min FFD vs 61 min/38 mm²/min VR, p>0.2).

Conclusion

ESD outcomes after teleconsultation are comparable to those following face-to-face consultation. Despite this, only 12% used teleconsultation, though it could save 36 kg CO₂e per patient. Optimizing care pathways to promote remote consultations could significantly reduce the environmental footprint of ESD.