Introduction

MASLD, a metabolic condition that includes cardiovascular risk factors, is associated with increased cardiovascular risk, particularly in cases with advanced fibrosis (1). It is now recognized as the leading cause of liver disease globally, with an estimated prevalence of 25–45% (2). This increase mirrors global trends in obesity, diabetes, and metabolic syndrome. While the majority of MASLD patients are obese—between 51% and 81% have a BMI >30 kg/m² (3)—MASLD also occurs in lean individuals. However, the risk factors in this population remain poorly defined (4). Approximately 19.2% of MASLD patients have a normal BMI (5), and current estimates suggest that about 40% of MASLD patients are obese while 20% are lean (6).There is limited data on adverse outcomes in MASLD patients with BMI <25 kg/m², but some studies have shown that lean MASLD patients may be at even higher risk of all-cause mortality, liver-related death, and cardiovascular disease compared to those with obesity (7).

Aims & Methods

To compare cardiovascular health status using the Life’s Essential 8 score between lean and obese patients with MASLD.

Study Design: Descriptive, observational, cross-sectional, retrospective, and retrolective study.
Population: Patients affiliated with the Centro Médico Nacional 20 de Noviembre ISSSTE who were treated in the gastroenterology department and diagnosed with MASLD between January 2023 and December 2023, regardless of their BMI.
Methods: The analysis will begin by evaluating the distribution of numerical variables and using the Kolmogorov-Smirnov test to assess data normality. Descriptive statistics will be used to summarize demographic and clinical characteristics. Patients will be grouped by BMI (<25 and ≥25 kg/m²) to compare clinical features using appropriate statistical tests (t-test, Mann-Whitney U, or chi-square). Correlations between BMI and clinical scores, including Life’s Essential 8, will be assessed using Pearson or Spearman methods. If applicable, BMI cut-off points linked to higher LE8 scores will also be identified.

Results

A total of 110 MASLD patients were analyzed, with 80% being female and an even split between those with BMI <25 kg/m² and >25 kg/m². The average age was 55.8 years, and the mean BMI was 27.95 kg/m². Diabetes was the most common comorbidity (25.5%), followed by elevated cholesterol (24.5%). Most patients had mild steatosis (67.3%).Life’s Essential 8 scores were higher in lean patients (66.61) than in those with higher BMI (59.33). Lean patients also had more mild steatosis, lower rates of comorbidities, and a greater proportion achieved high cardiovascular health scores (9.1%), unlike the high-BMI group, which had no high scores and more frequent low cardiovascular health (21.8%).Spearman correlation revealed a statistically significant negative correlation between BMI and cardiovascular health score (ρ = −0.425, p < 0.01), suggesting that higher BMI is associated with lower cardiovascular health.

Conclusion

The findings of this study show that, regardless of BMI, lean patients with MASLD exhibit impaired cardiovascular health according to the Life’s Essential 8 score, similar to patients with obesity. This suggests that cardiovascular involvement in MASLD is not solely dependent on body weight. These results highlight the value of LE8 as a useful tool to identify and address cardiovascular risk in all MASLD patients, regardless of body composition. This evidence reinforces the need to continue researching and implementing multidisciplinary approaches to address the growing problem of metabolic liver disease in the population.

References

1. Rinella, M. E., & Sanyal, A. J. (2015). Genetics, diagnostics and therapeutic advances in NAFLD. Nature reviews Gastroenterology & hepatology, 12(2), 65-66.
2. Rinella, M. E. (2015). Nonalcoholic fatty liver disease: a systematic review. Jama, 313(22), 2263-2273.
3. Sookoian, S., & Pirola, C. J. (2017). Systematic review with meta‐analysis: risk factors for non‐alcoholic fatty liver disease suggest a shared altered metabolic and cardiovascular profile between lean and obese patients. Alimentary pharmacology & therapeutics, 46(2), 85-95.
4. Godoy-Matos, A. F., Silva Júnior, W. S., (2020). NAFLD as a continuum: from obesity to metabolic syndrome and diabetes. Diabetology & metabolic syndrome, 12, 1-20.
5. VanWagner, L. B., & Armstrong, M. J. (2018). Lean NAFLD: A not so benign condition?. Hepatology communications, 2(1), 5-8.
6. Ye, Q., Zou, B., Yeo, Y. H., Li, J., Huang, D. Q., Wu, Y., et al. (2020). Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. The lancet Gastroenterology & hepatology, 5(8), 739-752.
7. Zou, B., Yeo, Y. H., Nguyen, V. H., (2020). Prevalence, characteristics and mortality outcomes of obese, nonobese and lean NAFLD in the United States, Journal of internal medicine, 288(1), 139-151.

Introduction

Fecal immunochemical test (FIT), widely used in colorectal cancer screening, has emerged as a potential biomarker of endoscopic activity in inflammatory bowel disease (IBD). Compared to fecal calprotectin, FIT offers greater standardization, automation and availability, with simpler handling and potentially better adherence. Its implementation could streamline non-invasive monitoring, but its diagnostic accuracy in IBD remains unclear. We therefore conducted a systematic review and meta-analysis to evaluate its performance.

Aims & Methods

Selection of studies: assessing the accuracy of FIT to estimate endoscopic activity in IBD patients. Search strategy: electronic bibliographical searches. Data synthesis: meta-analyses of the FIT were performed combining the sensitivity (Se), specificity (Sp), likelihood ratios (LRs), and area under de curve (AUC) values of summary receiver operating characteristic (ROC) curves of the individual studies. Heterogeneity among the studies was assessed by the I-squared (I²) statistic.

Results

Eighteen studies (table 1) met the inclusion criteria: 12 focused on ulcerative colitis (UC), 4 on both UC and Crohn’s disease (CD), and 2 on CD alone. Twelve studies employed the standard cut-off for FIT provided by the manufacturer or used the same cut-off as for colorectal cancer screening (usually considered the common threshold), while 6 studies estimated their optimal cut-off values. When we considered all studies (including 1,812 patients and 2,137 assessments), the accuracy of FIT for the diagnosis of endoscopic activity was (pooled values): Se: 0.66, Sp: 0.83, LR+: 4.96, and LR-: 0.38, respectively, with an AUC of 0.86. Significant heterogeneity was found among the Se (I² 89%) and Sp (I² 86%) of different studies. Most of the available studies were based exclusively on patients with UC (including 1,554 patients and 1,904 assessments), so we performed a subgroup analysis including only this type of IBD, finding a pooled Se, Sp, LR+ and LR- of 0.69, 0.82, 5.35 and 0.31 respectively, with an AUC of 0.88. On the other hand, in patients with CD (327 patients, 302 assessments), the corresponding values were 0.55, 0.85, 3.2 and 0.58, with an AUC of 0.73. ROC curve analysis showed that FIT had a higher diagnostic performance in UC patients.

Conclusion

FIT demonstrates moderate-to-high diagnostic accuracy for detecting endoscopic activity in IBD, particularly in UC. Therefore, FIT may represent a promising non-invasive tool for assessing IBD disease activity. However, significant heterogeneity among studies underscores the need for further research to optimize cut-off values and define the role of FIT in routine IBD monitoring.

Introduction

The ulcers after duodenal endoscopic resection (ER) are exposed to bile and pancreatic juice, therefore delayed perforation and bleeding are major complications. The condition caused by perforation can become serious, requiring surgical treatment and even death.
As a preventive measure, the suture of the ulcer after ER has been reported to be effective. There are two main suture methods: endo clips and laparoscopic suturing.

Aims & Methods

The aim of this retrospective study is to investigate the outcome of Endoscopic submucosal dissection (ESD) and laparoscopic and endoscopic co-operative surgery (D-LECS) for superficial non-ampullary duodenal epithelial tumors (SNADETs). ESD ulcer was sutured with endo clips in ESD group, and with laparoscopic suture in D-LECS group.
One hundred seventy-eight patients with SNADETs who underwent ESD and 41 patients with SNADETs who underwent D-LECS from November 2002 to February 2025 were investigated outcome of procedure. The patient’s characteristics in ESD and D-LECS were as follows. male/female: 124/54 and 27/14, median age: 62 (37-86) and 67 (37-83) years old, location of the tumor (bulbs/2^nd/3rd portion): 15/139/24 and 0/32/9, major macroscopic type (0-I/0-IIa/0-IIb/0-IIc): 5/91/1/81 and 1/32/0/8. Only major macroscopic type was difference significantly between ESD and D-LECS (p=0.001). SM1 was defined as submucosal invasion of less than 500 μm, and SM2 was defined as deeper. R0 was defined as lateral and vertical margin negative, and lymph-vascular involvement negative. DLECS was selected when it was predicted that endo clips suture might be insufficient, or when the scope maneuverability was poor.

Results

1. Median procedure time was 36 (7-245) in ESD and 351 (202-673) minutes in D-LECS, respectively(p<0.001). Median diameter of resected specimen was 17 (8-66) and 38 (17-70) mm(p<0.001). Median diameter of resected specimen and tumor was 10 (2-63) and 27 (14-52) mm(p<0.001). Intramucosal tumor (Vienna classification category 3 to 5.1) /T1bSM (category 5.2): 176/2 and 37/4 (p=0.01).
2. The en bloc resection was 90% (161/178) and 95% (39/41), respectively (p=0.53). R0 resection rate was 85% (151/178) and 88% (36/41) (p=0.62).
3. The rate of complete suture for ESD ulcer was 92% (164/178) in ESD group and 100% in D-LECS group, respectively (p=0.07). The details in D-LECS are as follows: 27% (11/41) of laparoscopic suture alone and 73% (30/41) of laparoscopic and endo clips suture.　
4. Complications: intraoperative perforation was 2% (4/178) and 10% (4/41) (p=0.04). Intraoperative bleeding requiring blood transfusion was 0% and 0%. Delayed perforation was 1% (2/178) and 0% (p=1.00). Delayed bleeding was 2% (4/178) and 0% (p=1.00).
Discussion:
1. The DLECS group treated larger cases and had more intraoperative perforations, but no delayed perforation or bleeding was observed.
2. Laparoscopic suture of the pancreatic side was not possible, but complete suture was achieved in all cases by adding a clip from the luminal side endoscopically.
3. Even after complete suture by ESD, delayed perforation can still occur. Therefore, if abdominal pain occurs, a CT scan should be performed immediately.　And if perforation is suspected, laparoscopic re-suture should be considered immediately.

Conclusion

DLECS for large SNADETs has similar outcome of ESD, and is an effective treatment. DLECS should be considered when complete suture with a clip is predicted to be difficult or when the scope maneuverability was poor.

References

None

Introduction

Sessile serrated lesions with dysplasia (SSLD) are known high-risk polyps due to their potential for rapid progression to colorectal cancer (CRC). As such, timely detection and appropriate treatment are essential. However, due to the fact that SSLDs are relatively rare, evidence regarding their prevalence and characteristics remains limited. This population-based study aims to generate more robust evidence on the prevalence and characteristics of SSLDs.

Aims & Methods

This study analyzed all prospectively collected baseline colonoscopy data from the Dutch CRC screening program between January 2014 and December 2023, linked to the national pathology database (PALGA). The prevalence of sessile serrated lesions (SSL) and SSLD was calculated for two time periods (2014-2018 and 2019-2023), along with the number needed to screen (NNS) and corresponding confidence intervals (CI), stratified by age category (<60, 60-70, >70) and gender. Dysplasia rates (the proportion of SSLD among all SSL diagnoses) were assessed by polyp characteristics- including location, age- and size category- as well as by colonoscopy year to evaluate temporal trends. Multivariate regression using generalized estimating equations (GEE) was performed to examine the influence of age and gender on SSLD prevalence, and to identify polyp-level characteristics associated with dysplasia.

Results

Among 516.193 colonoscopies, 49.953 individuals had at least one SSL, and 5.737 individuals had at least one SSLD. Over the study period, a total 1.033.298 polyps were removed, including 76.771 SSLs and 7.019 SSLDs. Among FIT-positive individuals the overall SSL prevalence 9.68% (9.60-9.76) and the overall SSLD prevalence was 1.11% (1.08-1.14). The NNS for SSLs decreased from 13 in 2014-2018 to 9 in 2019-2023, while the NNS for SSLDs remained stable at 90. At patient level, increasing age was associated with higher SSLD prevalence (OR 1.03 CI95% 1.03-1.04 per year increase). At polyp level, both increasing age and size of SSLs were associated with a higher rate of dysplasia (P<0.001), yet at least 30% of SSLD cases involved polyps <10 mm. Regression analysis combining size and age showed that, compared to SSLs <5mm in individuals aged ≤60 years, the odds of dysplasia were seven times higher in individuals aged >70 years with SSLs ≥25mm (OR 7.01 CI95% 3.81-12.5). Over time, the dysplasia rate among SSLs declined from 17.5% in 2014 to 6.6% in 2023 (table 1).

Table 1: Diagnoses of SSL versus SSL and overall rate of dysplasia over time

Conclusion

This national study demonstrated that the prevalence for SSLs increased over time, while the prevalence of SSLD remained stable. Dysplasia in SSLs was associated with older age and larger polyp size. The observed decline in dysplasia rates over time may reflect challenges in SSLD detection, possibly due to limited classification guidelines compared to SSLs. Further research is needed to support improved recognition of SSLDs by both endoscopists and pathologists.

Disclosure

ED: received honoraria for consultancy from Olympus, Fujifilm, Ambu, InterVenn, Norgine and Exact Sciences. Speakers' fees from Olympus, Norgine, IPSEN/Mayoly, FujiFilm, Steris and Pentax. Endoscopic equipment on loan of FujiFilm
All other authors (NR and JIJ, VA) have nothing to disclose.

Introduction

Balloon-assisted enteroscopy (BAE) is an important diagnostic tool for small bowel evaluation, especially following a positive Video Capsule Endoscopy (VCE) or Cross-Sectional Imaging (CSI). However, the diagnostic yield of BAE in this context remains variable.

Aims & Methods

This retrospective study aimed to evaluate the diagnostic yield of BAE performed following positive imaging. All BAE procedures conducted between 01/2009-12/2024 following a positive CSI (CT or MRI) or VCE within 12 months prior to the procedure were included. Clinical characteristics, procedural indications (polyp/mass, suspected bleeding or inflammation), and imaging modalities were compared between groups. A classification tree analysis explored factors associated with a positive diagnostic yield.

Results

Among 224 BAE procedures, the diagnostic yield was 58.5% (131 positive findings). No significant differences were observed between positive and negative groups regarding sex, age, indication, pre-BAE imaging modality (VCE or CSI), route, or depth of insertion. Classification tree analysis identified bleeding-related indications (e.g. overt bleeding or angioectasias) as the strongest predictor of positive yield (74.5% vs. 50%, p=0.005), particularly with antegrade BAE. However, cross-validation failed to generate a stable model, with a misclassification risk of 41.5% (±3.3), indicating limited predictive accuracy.

Conclusion

In this large retrospective study spanning 15 years, BAE following positive imaging demonstrated a diagnostic yield of nearly 60%. While demographic and procedural factors were not predictive, bleeding-related indications were significantly associated with positive findings, highlighting the importance of clinical context in guiding BAE use. These findings may help optimize patient selection and improve procedural efficacy.

Introduction

As of 2023, 45.33% of Romania’s population resides in rural areas (1), many in remote regions with limited access to healthcare and education.

Aims & Methods

This study aimed to assess the prevalence of viral hepatitis and the prevalence, metabolic characteristics and fibrosis burden of MASLD among Romania’s remote rural population. To our knowledge, this is the first study to assess the health profile of this population, with a focus on liver diseases.
Between 2022 and 2024, medical Caravans were conducted in 17 villages across Central and North Romania. Participants underwent hepatology consultations, laboratory testing (including rapid tests for hepatitis B and C), abdominal ultrasound and non-invasive assessment of steatosis and fibrosis using ultraportable devices. MASLD was defined by the presence of hepatic steatosis on ultrasound and at least one cardiometabolic risk factor (obesity, diabetes or prediabetes, dyslipidemia or hypertension) (2). Fibrosis was staged using liver stiffness measurement(LSM), FIB-4 and NAFLD Fibrosis Score(NFS). Data for this study was colected prospectively on-site.

Results

1,935 individuals were screened, 1,721 had blood tests, 1,692 had rapid tests for hepatitis B and C, and 1,208 underwent ultrasound. The prevalence of hepatitis B was 2.18% and of hepatitis C was 3.19%. MASLD status could be assessed in 1,305 participants, of whom 617 (47.3%) met the diagnostic criteria. MASLD was significantly associated with obesity (OR=5.07, 95%CI[3.93–6.54], p<0.001), diabetes or prediabetes (OR=3.43, 95%CI[2.56–4.61], p<0.001) and dyslipidemia (OR=2.29, 95%IC[1.80–2.91], p<0.001). Most MASLD patients had multiple metabolic risk factors(RF): 17.02% had 1 risk factor, 30.47% had 2, 52.51% had 3 or more.
Median values for liver stiffness(5.2–5.3 kPa) and FIB-4 score(1.14-1.28) showed minimal variation across individual cardiometabolic risk factors. Fibrosis staging methods showed increasing trends of advanced fibrosis with higher cardiometabolic burden, but only the NFS demonstrated statistically significant differences between risk groups(p=0.0025 for 1vs3+, p=0.0012 for 2vs3+).
Advanced fibrosis prevalence among MASLD patients based on different tests was: LSM 6.24% (vs.3.29% in non-MASLD, p=0.001), FIB-4 5.3% ( vs. 6.1%, p=0.144), NFS 7.8% (vs.4.0%, p < .001). Dyslipidemia was associated with the highest prevalence of advanced fibrosis among MASLD patients based on LSM (6.86%) and NFS (8.44%), and diabetes or prediabetes based on FIB-4 (3.56%). Among those with advanced fibrosis,diabetes was present in over 90% of patients across all methods.

Conclusion

There is a substantial burden of preventable and underdiagnosed diseases in Romania’s remote rural communities. The prevalence of hepatitis B and C was at or above national estimates, underscoring the need for expanded screening and vaccination. MASLD affected nearly half of this large rural cohort. The presence of advanced fibrosis and clustering of metabolic risk factors in these underserved populations highlights the need for continued outreach, early detection and integrated liver care strategies.

References

1. National Institute of Statistics. Romania in figures-statistical abstract. https://insse.ro/cms/ro/content/rom%C3%A2nia-%C3%AEn-cifre-breviar-statistic-limba-englez%C4%83-4
2. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024 Sep;81(3):492-542. doi: 10.1016/j.jhep.2024.04.031.

Disclosure

The HE-RO-I Project (State-of-the-art colaborativ ROmânia-Islanda în managementul HEpatopatiilor cronice și a complicaţiilor acestora, ciroza hepatică și cancerului hepatic, destinat grupurilor vulnerabile din România, inclusiv Romi) was initiated by a team of physicians from the Gastrointestinal and Hepatology Institute of Cluj-Napoca, in collaboration with Caravana cu Medici – Cluj-Napoca Branch and Landspítali University Hospital in Reykjavik, Iceland, under the coordination of the Romanian Ministry of Health. The project aimed to deliver health education and conduct screening—primarily for liver diseases—among vulnerable populations (including roma people) from remote areas of Central and Northern Romania.
Financed by the Finance Mechanism of European Economic Space 2014-2021.

Introduction

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver condition globally, closely associated with increased cardiovascular morbidity and mortality. Despite preserved left ventricular ejection fraction (LVEF), patients with NAFLD may exhibit subclinical cardiac dysfunction. Speckle tracking echocardiography (STE) offers sensitive myocardial strain assessment, surpassing conventional LVEF measurements. This systematic review and meta-analysis aimed to evaluate the association between NAFLD and subclinical left ventricular systolic dysfunction using STE-derived strain parameters.

Aims & Methods

A comprehensive literature search was conducted in PubMed, EMBASE, and Scopus. Observational studies assessing NAFLD patients using STE-derived myocardial strain parameters were included. Quality assessment was performed using the Newcastle-Ottawa Scale. Primary outcomes were the mean differences (MD) in global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global apical strain (GAS), and related strain rate indices between NAFLD spectrum patients and controls.

Results

Sixteen studies involving 8,359 participants were included. NAFLD patients exhibited significant reductions in GLS (MD: -2.043; 95% CI: -2.868, -1.218), GAS (MD: -3.706; 95% CI: -4.999, -2.413), and GCS (MD: -1.415; 95% CI: -2.893, 0.064) compared to controls. The reductions were more pronounced in individuals with moderate/severe NAFLD and those with concomitant type 2 diabetes mellitus (GLS MD: -4.385; 95% CI: -5.400, -3.369 in diabetic NAFLD vs. diabetic controls). Subgroup analysis also demonstrated a stepwise impairment in strain parameters from simple steatosis to non-alcoholic steatohepatitis (NASH). Importantly, LVEF remained preserved across all groups, underscoring the subclinical nature of the observed dysfunction.

Conclusion

This meta-analysis confirms the presence of subclinical left ventricular systolic dysfunction in NAFLD patients, detectable via STE despite normal LVEF. Myocardial strain parameters, particularly GLS, offer valuable early indicators of cardiac impairment. Routine integration of STE in NAFLD management may enable timely cardiovascular risk stratification and intervention.