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SAFETY AND EFFICACY OF EXTENDED SURVEILLANCE INTERVALS FOLLOWING COLORECTAL ESD: AN INTERNATIONAL MULTICENTER STUDY

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Introduction

Post-ESD surveillance guidelines remain heterogeneous, with many centers favoring early surveillance colonoscopy (SC) despite low recurrence rates after curative resection. This study aimed to evaluate the safety and outcomes of delayed SC after R0 colorectal ESD for benign lesions and to identify risk factors for metachronous advanced neoplasia.

Aims & Methods

We retrospectively analyzed 1,097 patients who underwent colorectal ESD between 2013 and 2021. Clinical, procedural, and histological characteristics were recorded. Among 778 patients with available surveillance data, outcomes were compared between those who had early SC (<12 months) and those with delayed SC (>24 months). Rates of recurrence, advanced neoplasia, and colorectal cancer were assessed. Risk factors for metachronous advanced neoplasia were evaluated via univariate and multivariate analysis.

Results

Mean patient age was 74.3 ± 10.8 years; 54.1% were male. En bloc and R0 resection rates were 95.8% and 83.3%, respectively. Among patients with surveillance data, 82.6% underwent early SC, and 17.4% had late-only SC. The rate of advanced adenoma at first SC was low and comparable between early and late groups (3.9% vs. 6.7%, p = 0.167). The overall rate of metachronous advanced adenoma was 6.5%, with no significant difference between early and late strategies (6.1% vs. 8.9%, p = 0.25). All four colorectal cancers were detected in the early group; none occurred in the late-only group. Recurrence on the ESD scar was rare (1.5% overall), and no late recurrences occurred after a normal SC1. The only significant predictor of metachronous advanced neoplasia was the number of synchronous lesions at index colonoscopy (OR 1.16, 95% CI 1.07–1.27; p < 0.01).

Conclusion

Delayed surveillance colonoscopy 3 years after R0 colorectal ESD for benign lesions appears safe and effective in selected patients. The multiplicity of synchronous lesions could guide risk stratification. These findings support extending SC intervals after curative ESD, with potential to reduce unnecessary procedures.

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. juin 2022;54(6):591‑622.
Dai M, Xiao X, Guo CLT, Lui RN, Yip HC, Chu S, et al. The Long‐Term Risk of Metachronous Advanced Adenoma Recurrence After Endoscopic Submucosal Dissection for Colorectal Neoplasia: A Propensity‐Score Matched Longitudinal Cohort With 5‐Year Follow‐Up. United Eur Gastroenterol J. 21 déc 2024;13(2):210‑9.
Yoshida N, Naito Y, Siah KTH, Murakami T, Ogiso K, Hirose R, et al. High incidence of metachronous advanced adenoma and cancer after endoscopic resection of colon polyps ≥20 mm in size. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. mars 2016;28(2):194‑202.

SAFETY AND EFFICACY OF EXTENDED SURVEILLANCE INTERVALS FOLLOWING COLORECTAL ESD: AN INTERNATIONAL MULTICENTER STUDY

Paul Brouzeng 1, Jérémie Jacques 2, Jeremie Albouys 3, Paul Carrier 2, Romain Legros 1, Hugo Lepetit 4, Sophie GEYL 1, Ludovico Alfarone 5, Abdulraman Qatomah 6, Cesare Hassan 7, Daryl Ramai 6, Hiroyki Aihaiara 6

1 CHU Limoges, Limoges, France

2 CHU Limoges - Hepato-Gastro-Enterology, CHU Limoges; Limoges/FR, Limoges, France

3 CHU Limoges / University of Limoges, Limoges, France

4 CHU Limoges France, Limoges, France

5 Milan, Milan, Italy

6 Brigham and Women's Hospital, Boston, United States

7 Humanitas University, Pieve Emanuele MI, Italy

Event

UEG Week Berlin 2025

Topics

Colorectal Digestive Oncology Endoscopy Histopathology

Submission format

Late-Breaking Abstract

Session

Colorectal ESD: The better way?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Treatment of patients with ingestion of caustic substances

Aga Charitini 1, Nikolaos Samarentsis 1

1 None, None, Greece

Event

UEG Week Berlin 2025

Topics

Nurses

Session

Endoscopic techniques: Emergency and difficult situations

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Integrative care of gastric cancer: From endoscopic therapies to surgery and chemo/raditherapy

David G. Graham 1, Bas P.L. Wijnhoven 2

1 University College London Hospital, London, United Kingdom

2 Erasmus MC Rotterdam Dept. of Surgery, Rotterdam, Netherlands

Event

UEG Postgraduate Teaching Programme Berlin 2025

Session

From risk to recovery: A postgraduate dive into gastric cancer care

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Will molecular targeted therapies become the new gold-standard in PC

Nisar Peter Malek 1

1 Medical University Hospital Tuebingen, Tübingen, Germany

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Mechanisms & Personalised Medicine Small Intestine & Nutrition Pancreas Surgery

Session

Pancreatic cancer

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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GUT MYCOBIOME SIGNATURES PREDICT NEOADJUVANT IMMUNOCHEMOTHERAPY RESPONSE IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A MACHINE LEARNING APPROACH WITH EXPERIMENTAL VALIDATION

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Introduction

Esophageal squamous cell carcinoma (ESCC) is associated with poor prognosis despite advances in neoadjuvant immunochemotherapy (NICT). With highly variable treatment responses, identifying reliable predictive biomarkers remains crucial. While gut microbiome influences on immunotherapy efficacy are increasingly recognized, the specific role of the fungal microbiome (mycobiome) in NICT outcomes for ESCC remains unexplored, representing a significant gap in developing personalized treatment strategies.

Aims & Methods

This study aimed to characterize gut mycobiome signatures in ESCC patients and develop fungal biomarker-based predictive models for NICT response. We conducted ITS2 sequencing on 136 fecal samples collected from 68 ESCC patients (pre- and post-NICT) and 19 healthy controls (HC). Patients were stratified as responders (R, n=26) or non-responders (NR, n=42) based on tumor regression grade (TRG) scores. We performed comprehensive analyses of mycobiome diversity, composition, co-occurrence networks, and functional pathways across groups. The Boruta algorithm was employed for feature selection to identify fungal biomarkers, followed by multilayer perceptron (MLP) machine learning with five-fold cross-validation to develop predictive models. Additionally, ESCC xenograft models were established to investigate gut mycobiome-immune interactions through fecal microbiota transplantation (FMT) and targeted fungal manipulation experiments.

Results

ESCC patients demonstrated significant mycobiome dysbiosis compared to healthy controls, characterized by reduced fungal alpha diversity and distinct beta diversity patterns. At baseline, ESCC patients showed enrichment of Rhodotorula minuta, Actinomucor elegans, and several Candida species. Responders exhibited significantly higher baseline fungal diversity than non-responders, with enrichment of Meyerozyma, Candida boidinii, Trichosporon dermatis, and Cryptococcus species, whereas non-responders showed predominance of Saccharomyces, Nakaseomyces, and pathogenic Candida species (C. glabrata, C. parapsilosis, C. albicans). Responders also displayed more complex, stable fungal co-occurrence networks with higher density and clustering coefficients. Post-NICT, both groups showed partial recovery of mycobiome diversity, with significant increases in beneficial fungal taxa. Functional pathway analysis revealed distinct metabolic profiles between responders and non-responders. Using the Boruta algorithm, we identified 23 genus-level and 22 species-level fungal biomarkers that demonstrated high predictive value. The MLP model based on genus-level markers achieved AUCs of 90.2% (training) and 91.9% (test), while the species-level model showed comparable performance. In animal experiments, mice receiving R-FMT exhibited reduced tumor growth and enhanced CD8+ T cell infiltration compared to NR-FMT recipients. Notably, Candida boidinii supplementation synergized with anti-PD-1 therapy, while Saccharomyces depletion enhanced treatment sensitivity.

Conclusion

Our findings establish the gut mycobiome as a powerful predictor of NICT response in ESCC, with machine learning models achieving >90% accuracy using fungal biomarkers. Experimental validation not only confirms mechanistic links between specific fungi and antitumor immunity but also demonstrates that targeted mycobiome modulation can enhance immunotherapy efficacy. This dual approach of prediction and intervention offers a novel framework for precision oncology in ESCC, potentially transforming clinical decision-making and treatment outcomes in this challenging malignancy.

References

1. Li J, Xu J, Zheng Y, et al. Esophageal cancer: Epidemiology, risk factors and screening. Chin J Cancer Res. 2021; 33(5): 535-547.
2. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012; 366(22): 2074-2084.
3. Schroeder W, Ghadimi M, Schloesser H, et al. Long-Term Outcome After Histopathological Complete Response with and Without Nodal Metastases Following Multimodal Treatment of Esophageal Cancer. Ann Surg Oncol. 2022.
4. Rosner S, Liu C, Forde PM, Hu C. Association of Pathologic Complete Response and Long-Term Survival Outcomes Among Patients Treated With Neoadjuvant Chemotherapy or Chemoradiotherapy for NSCLC: A Meta-Analysis. JTO Clin Res Rep. 2022; 3(9): 100384.
5. Coker OO, Nakatsu G, Dai RZ, et al. Enteric fungal microbiota dysbiosis and ecological alterations in colorectal cancer. Gut. 2019; 68(4): 654-662.
6. Dohlman AB, Klug J, Mesko M, et al. A pan-cancer mycobiome analysis reveals fungal involvement in gastrointestinal and lung tumors. Cell. 2022; 185(20): 3807-3822.
7. Wurster S, Albert ND, Kontoyiannis DP. Candida auris Bloodstream Infection Induces Upregulation of the PD-1/PD-L1 Immune Checkpoint Pathway in an Immunocompetent Mouse Model. Msphere. 2022; 7(2): e81721.

GUT MYCOBIOME SIGNATURES PREDICT NEOADJUVANT IMMUNOCHEMOTHERAPY RESPONSE IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A MACHINE LEARNING APPROACH WITH EXPERIMENTAL VALIDATION

le liu 1, Liping Liang 2, Shijie Mai 3

1 Zhujiang Hospital, Southern Medical University, Guangzhou, China

2 Guangzhou First People's Hospital, Guangzhou, China

3 Nanfang Hospital, Southern Medical University, Guangzhou, China

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Gut Microbiota Immunology Mechanisms & Personalised Medicine Oesophagus

Submission format

Abstract

Session

Oncobiome

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Surgical navigation

Suzanne S. Gisbertz 1

1 Amsterdam UMC, Amsterdam, Netherlands

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Endoscopy Nurses Oesophagus Surgery

Session

What's new in early oesophageal cancer in 2025?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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A PROSPECTIVE STUDY COMPARING ULTRA-LOW VOLUME BOWEL PREPARATIONS FOR CAPSULE COLONOSCOPY AND PAN-INTESTINAL CAPSULE ENDOSCOPY: EFFICACY OF 1L POLYETHYLENE GLYCOL PLUS ASCORBIC ACID VS. SODIUM PICOSSULFATE WITH MAGNESIUM CITRATE

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Introduction

Capsule colonoscopy and Pan-intestinal Capsule Endoscopy (PCE) are well-established diagnostic procedures. However, the optimal bowel preparation regimen remains undefined, with pooled adequate cleansing rates reaching only 72.5%¹. While ultra-low volume preparations (≤1L) have demonstrated efficacy in conventional colonoscopy², their effectiveness in capsule-based modalities has yet to be determined.

Aims & Methods

In this prospective, randomized, researcher-blind, single center trial, we compared the efficacy of two ultra-low volume bowel preparation regimens, 1L Polyethylene Glycol Plus Ascorbic Acid (PEG-Asc) and 1L Sodium Picossulfate with Magnesium Citrate (SPMC). Patients referred for capsule-based procedures were randomized in a 1:1 ratio to receive either PEG-Asc or SPMC. The primary endpoints were the rates of complete examinations, adequate bowel preparation, and excellent right colon cleansing.

Results

A total of 117 patients were included, referred for capsule colonoscopy due to incomplete colonoscopy (76.1%) or for PCE to assess luminal inflammation (17.9%) or anemia (6%). Overall, 61.5% were female, with a mean age of 61.3 ± 16 years. The complete examination rate was 71.8%, with no significant difference between groups (PEG-Asc 72.9% vs. SPMC 70.7%; p = 0.792). Adequate bowel preparation was achieved in 62.4% of cases, which was significantly more frequent in the PEG-Asc group (72.9%) compared to SPMC (51.7%; p = 0.018). Among complete procedures, excellent right colon cleansing was observed more often with PEG-Asc (34.1%) than with SPMC (7.3%; p = 0.003).

Conclusion

The completion and adequate preparation rates remain suboptimal in the capsule colonoscopy and PCE procedures. In this study, both ultra-low volume purgative solutions demonstrated comparable efficacy in achieving complete examinations, but the PEG-Asc resulted in significantly better overall preparation quality and superior right colon cleansing compared to SPMC. These findings suggest that PEG-Asc may be the preferred ultra-low volume regimen for optimizing bowel visualization in capsule-based examinations.

References

1. Rosa, B., Donato, H., Cúrdia Gonçalves, T., Sousa-Pinto, B. & Cotter, J. What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis. Dig. Dis. Sci. 68, 4418–4431 (2023).
2. Arieira, C. et al. Bowel cleansing efficacy for colonoscopy: prospective, randomized comparative study of same-day dosing with 1-L and 2-L PEG + ascorbate. Endosc. Int. Open 09, E1602–E1610 (2021).

A PROSPECTIVE STUDY COMPARING ULTRA-LOW VOLUME BOWEL PREPARATIONS FOR CAPSULE COLONOSCOPY AND PAN-INTESTINAL CAPSULE ENDOSCOPY: EFFICACY OF 1L POLYETHYLENE GLYCOL PLUS ASCORBIC ACID VS. SODIUM PICOSSULFATE WITH MAGNESIUM CITRATE

Joao Carlos Goncalves 1, Ines Marques 1, Mariana Souto 1, Ana Isabel Ferreira 1, Joana Lúcia Teixeira Magalhães Magalhães 1, Bruno Rosa 1, José Berkeley Cotter 1

1 Unidade Local de Saúde do Alto Ave, Guimarães, Portugal|||Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal

Event

UEG Week Berlin 2025

Topics

Endoscopy Radiology & Imaging Colorectal

Submission format

Abstract

Session

Advances in the investigation of the small bowel

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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