Introduction

Population-based surveys have demonstrated substantial overlap of DGBI across multiple gastrointestinal (GI) regions and that this overlap is associated with increased health impairment. Comprehensive assessments of this overlap in patients with IBS are lacking, and the link with pathophysiology is not understood. In addition, IBS patients also frequently report overlapping non-GI comorbidities (somatic symptoms disorder , depression and anxiety) .The interaction between overlapping DGBI and non-GI comorbidities in IBS, and the impact of this interaction needs to be further investigated.

Aims & Methods

We included IBS patients with completed ROME II, III or IV questionnaires to assess overlapping DGBI in other anatomical GI regions (esophageal, gastroduodenal, anorectal). Patients completed validated questionnaires to measure the severity of GI (Gastrointestinal Symptom Rating Scale for IBS (GSRS-IBS)) and psychological (Hospital Anxiety and Depression Scale (HADS)) symptoms, IBS-specific quality of life (QOL) (IBS QOL), GI symptom-specific anxiety (Visceral Sensitivity Index (VSI)), and somatic symptoms (Patient Health Questionnaire-15 (PHQ-15) and Symptom Checklist-90 (SCL90)). Overlap of non-GI comorbidites (somatic symptom disorder, depression and anxiety) were assessed using suggested cut-off levels on PHQ, SCL-90 and HADS. Oro-anal transit time (OATT) was measured with radiopaque markers, and rectal sensitivity with balloon distensions using a barostat. GI symptoms following a Lactulose Nutrient Challenge Test (LNCT) were also recorded as a measurement of sensitivity to microbial fermentation and nutrients.

Results

We included 688 patients with IBS (70.5% female, mean age 37.3 ± 12.5 years; IBS-C 29.7 %, IBS-D 34.6 %, IBS-M 24.7%, and IBS-U 11.0%.). Overall, 68.3% of IBS patients had overlapping DGBI in other anatomical GI regions; one region: 39.4%, two regions: 23.3%, three regions: 5.7%. An overlapping esophageal DGBI was seen in 26.2%, a gastroduodenal DGBI in 31.6%, and anorectal DGBI in 38.1%. The prevalence of overlapping somatic symptom disorder in IBS was 53.8%, while depression and anxiety overlap was seen in 32.2% and 50.9% of the IBS patients. A higher number of non-GI comorbidities was associated with a greater number of overlapping DGBI in IBS (p<0.01).
With increasing number of overlapping DGBI diagnoses and non-GI comorbidities in IBS, there was a gradual increase in the severity of GI and psychological symptoms, as well as a gradual decrease in QOL (Table 1). In addition, with increasing number of overlapping diagnoses, a gradual increase in visceral sensitivity (reduction in rectal discomfort threshold and increased discomfort during LNCT) was seen, but no links with abnormal OATT, age or body mass index were noted.

Conclusion

Overlapping DGBI diagnoses and non-GI comorbidities are common among IBS patients. This overlap has an impact on both GI and non-GI symptoms, as well as a link with GI sensitivity. Assessment of overlapping DGBI and non-GI comorbidites seems to be of importance to optimize clinical management in patients with IBS.

Introduction

The safety and efficacy of endoscopic haemostasis in patients with upper gastrointestinal (UGI) bleeding has been widely assessed over the years. However, to date no study addressed the management of UGI bleeding specifically in the setting of patients with surgically altered anatomy.

Aims & Methods

Our study is focused on the evaluation of the endoscopic management of UGI bleeding in these patients with specific concern about the techniques used to achieve haemostasis, the management of technical failure and the rate of adverse events. We conducted a multicentre retrospective- prospective observational study in 13 endoscopy units in Italy. All consecutive patients with UGI bleeding and surgically altered anatomy managed endoscopically were collected from January 2023 to November 2024.

Results

We enrolled 162 patients (73% males) with a mean age of 69 years. 45% of patients had history of oncologic surgery while 20% underwent bariatric surgery. The most common clinical manifestations were melena (59%) followed by hematemesis (22%). At bleeding event patients were taking anticoagulants and antiplatelet in 32% and 16% of cases, respectively. In 43% of cases from 1 to 4 blood units were needed, in 15% more than 4 blood units, while in 42% of patients no transfusions ware required. 42% of endoscopic procedures were performed with anesthesiologist assistance. Bleeding was located at anastomotic site in 70% of cases and ulcer was the most common source of bleeding (54% of patients). The most frequently used treatments were adrenaline combined with TTSC (40 %) and TTSC alone (24%). Haemostatic powder or gel and adrenaline combined with thermal treatment were used only in 6 and 4% of cases respectively while OTSC was used in 1 patient alone after failure of adrenaline combined with TTSC. Bleeding control during endoscopy was achieved in 94% of patients. In 12 patients rebleeding occurred, which was managed with surgery in 2 patients, interventional radiology in 1 case and with new endoscopic treatment in 4 cases. No serious adverse events linked to endoscopy were reported.

Conclusion

Our preliminary results showed that patients with altered anatomy often had severe bleeding requiring a large amount of blood transfusions. The standard endoscopic homeostatic techniques seemed to be effective for the management of bleeding, although a not negligible rate of patients needed additional treatments. However, further data are needed to better assess clinical outcomes in this setting and to better define possible predictive predictors of clinical success and therefore which technique should be preferred to achieve haemostasis.

References

1. S. G. Lim et al., “Endoscopic Approach for Postoperative Complications Following Laparoscopic-Assisted Gastrectomy in Early Gastric Cancer: Literature Review,” Hepatogastroenterology., vol. 59, pp. 1308–1312, 2012.
2. J.-H. Park et al., “Safety and efficacy of post-anastomotic intraoperative endoscopy to avoid early anastomotic complications during gastrectomy for gastric cancer.,” Surg. Endosc., vol. 34, no. 12, pp. 5312–5319, Dec. 2020.
3. K.-H. Kim, M.-C. Kim, G.-J. Jung, J.-S. Jang, and S.-R. Choi, “Endoscopic treatment and risk factors of postoperative anastomotic bleeding after gastrectomy for gastric cancer.,” Int. J. Surg., vol. 10, no. 10, pp. 593–597, 2012.
4. Shen, Y.; Xiao, M.; Weng, J.; Yang, L.; Feng, Y.; Ye, Y.; Zheng, P. Diagnosis and treatment of postoperative bleeding in patients after gastrectomy: A retrospective case series study. J. Gastrointest. Oncol. 2023, 14, 110–118.
5. Wichmann, D.; Fusco, S.; Werner, C.R.; Voesch, S.; Duckworth-Mothes, B.; Schweizer, U.; Stüker, D.; Königsrainer, A.; Thiel, K.; Quante, M. Endoscopic Management for Post-Surgical Complications after Resection of Esophageal Cancer. Cancers 2022, 14, 980.

Introduction

Post-liver transplant (LT) bile leaks (BLs) are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP). While fully covered self-expandable metal stents (fc-SEMSs) have shown promising results, their use is often limited by concerns regarding adverse events (AEs), with limited data comparing their efficacy and safety. Moreover, European guidelines do not clearly endorse their up-front use over plastic stents. To date, no studies have directly compared these two treatments for post-LT BLs.

Aims & Methods

This study aims to compare the safety and efficacy of plastic versus fc-SEMS in treating post-LT BLs.
We conducted a retrospective study in single tertiary endoscopy center, reviewing cases from January 2018 to March 2024. Among 223 ERCPs performed in LT recipients, 30 patients treated with ERCP as first-line therapy for post-LT BLs were included. Patients with biliodigestive anastomosis dehiscence or prior interventions (percutaneous drainage or surgery) were excluded.

Results

Of the 30 patients (96.7% duct-to-duct anastomosis), 14 (46.7%) received plastic stents and 16 (53.3%) received fc-SEMSs. Anastomotic leaks were the predominant type (85.7% in the plastic stent group vs. 87.5% in the fc-SEMS group).Both groups achieved 100% technical and clinical success. No significant differences in AE rates were observed (42.9% for plastic vs. 37.5% for fc-SEMS, p=0.1), and no severe complications occurred. Among the 13 patients in whom biliary strictures (BSs) were reported, 4 cases were de novo strictures, occurring equally in the plastic stent group (n=2) and the fc-SEMS group (n=2). The remaining 9 strictures were present prior to BL treatment (3 in the plastic stent group and 6 in the fc-SEMS group). Resolution of BSs was achieved in 66.7% (4/6) of patients treated with fc-SEMSs, compared to 33.3% (1/3) in the plastic stent group, showing a borderline statistically significant difference (p=0.05), though this was limited by the small sample size. No patient required rescue procedures for persistent BL. A median of 2 ERCP sessions per patient (SD ±1) was needed for complete BL resolution. During a median follow-up of 8 months (IQR 1–27.3), only one recurrence occurred in the plastic stent group, successfully managed with fc-SEMS.

Conclusion

ERCP with either plastic stents or fc-SEMSs effectively treats post-LT BLs, with no significant differences in AEs between the two groups. Given their comparable success and safety, fc-SEMS could be considered not only as a rescue therapy but also as a primary, effective and safe treatment option.

References

1. Moy BT, Birk JW. A Review on the Management of Biliary Complications after Orthotopic Liver Transplantation. J Clin Transl Hepatol. 2019;7(1):61-71
2. Phillips MS, Bonatti H, Sauer BG, et al. Elevated stricture rate following the use of fully covered self-expandable metal biliary stents for biliary leaks following liver transplantation. Endoscopy. 2011;43(6):512-517
3. Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020;52(02):127-149

Introduction

Endoscopic ultrasound (EUS) is an essential tool in the evaluation of lymph nodes (LNs), especially for oncologic staging and guiding therapeutic decisions. Characteristics such as hypoechoic appearance, well-defined borders, round shape, and a size exceeding 10 mm are typically associated with malignancy, offering 80–100% accuracy when observed collectively—though this ideal combination is rare. While EUS-guided tissue acquisition (EUS-TA) contributes to diagnosis, its reliability can be limited.

Aims & Methods

This multicenter study aimed to assess the performance of a novel artificial intelligence (AI) model in predicting LN malignancy based on EUS images.
The study involved EUS images from nine centers across Spain, Portugal, Brazil, the United Kingdom, and the United States. Lesions were annotated as “malignant” or “benign” and outlined using bounding boxes. Final diagnoses were established through positive fine-needle aspiration or biopsy (FNA/FNB), or, when negative, confirmed with a minimum of six months of clinical follow-up. A convolutional neural network (CNN) was created using the YOLO (“You Only Look Once”) architecture, incorporating both detection and classification components. Key performance indicators included detection rate (DR), sensitivity, specificity, overall accuracy, and the area under the curve (AUC).

Results

The model was trained on 59,992 images derived from 82 EUS procedures. The CNN achieved a sensitivity of 98.8% (95% CI: 98.5–99.2%), a specificity of 99.0% (95% CI: 98.3–99.7%), and a precision of 99.0% (95% CI: 98.4–99.7%) in differentiating malignant from benign LNs. The negative predictive value (NPV) was 98.8% (95% CI: 98.4–99.2%) for malignant and 97.0% (95% CI: 95.0–98.9%) for benign nodes. The overall diagnostic accuracy for both malignant and benign findings reached 96.99% (95% CI: 87.8–96.2%).

Conclusion

This is the first study to explore the application of deep learning for LN analysis through EUS imaging. Reliable LN characterization is vital in determining disease stage and informing treatment pathways, with direct implications for patient management. The AI-based model demonstrated strong performance in both detection and classification tasks, highlighting its potential to enhance LN evaluation with EUS and contribute to more individualized, effective care.

Disclosure

No co

Introduction

Spontaneous bacterial peritonitis (SBP) is a well-recognized decompensation that significantly affects the clinical outcome of patients with liver cirrhosis. The aim of this study is to assess the factors associated with short-term mortality in this patient population.

Aims & Methods

We conducted a retrospective study (January 2022 to December 2024) on all cirrhotic patients with SBP, admitted in the Gastroenterology Department of “St. Spiridon” County Clinical Emergency Hospital Iasi, a tertiary referral center. The SBP cases were identified based on elevated ascitic fluid absolute PMN count > 250 cells/mm³, with or without positive ascitic fluid bacterial culture.

Results

Out of the 114 cirrhotic patients diagnosed with SBP for the first time, 39 (34,2%) were female and 75 (65,8%) were male, with a mean age of 57 years. Most patients had advanced liver disease according to the Child-Pugh classification: 98 patients (86%) were classified as Child C, and 16 patients (14%) as Child B. The mean MELD-Na score was 23.3 points. The overall in-hospital mortality rate was 17.5% (20 patients). According to the multivariable analysis, several factors were significantly associated with in-hospital mortality, such as: renal dysfunction (OR 8.4118 [95% CI 2.9190 to 24.2403]; P=0.0001), serum bilirubin higher than 3 mg/dl (OR 4.8571 [95% CI 1.7445 to 13.5216]; P=0.0025), serum sodium lower than 130 mmol/l (OR 4.3750 [95% CI 1.5973 to 11.9833]; P=0.0041), international normalized ration (INR) higher than 2 (OR 4.5222 [95% CI 1.6471 to 12.4161]; P=0.0034).

Conclusion

Renal dysfunction, elevated INR, hyperbilirubinemia, and hyponatremia appear to be significant factors associated with the worsening of prognosis in cirrhotic patients with SBP, influencing in-hospital mortality.

Introduction

Recent studies have revealed that liquid-liquid phase separation (LLPS) plays a critical role in tumorigenesis. Myotilin (MYOT), a key component of actin cross-linking protein complexes, is involved in regulating myofibril assembly and maintaining the structural integrity of Z-discs in muscle cells. Intriguingly, MYOT contains intrinsically disordered regions (IDRs) and has been implicated in the migration of gastric cancer. However, whether MYOT undergoes LLPS and whether this process contributes to gastric cancer progression remains unexplored.

Aims & Methods

We aimed to investigate whether MYOT undergoes LLPS and its potential role in gastric cancer progression.
Differential gene expression analysis was performed on gastric cancer samples from our sequencing data and validated using public databases. The Disprot, Database of Protein Disorder was used to predict the IDRs of MYOT. Fluorescence recovery after photobleaching (FRAP) and cellular immunofluorescence were explored to assess MYOT’s ability to undergo LLPS. Cell proliferation, apoptosis and migration assay were conducted to investigate the potential role of MYOT in gastric cancer. Actin polymerization assays were performed to evaluate the qualitative effects of purified MYOT on actin polymerization.

Results

Differential gene expression analysis revealed that MYOT was significantly downregulated in gastric cancer tissues compared to adjacent normal tissues, a finding further confirmed by RT-qPCR. In the prediction of protein structure, it can be found that MYOT contains extensive IDRs. FRAP analysis demonstrated rapid fluorescence recovery in GFP-MYOT droplets within minutes, suggesting dynamic LLPS behavior. Similarly, purified GFP-MYOT exhibited fusion behaviors, further supporting its capacity for LLPS in vitro. Overexpression of MYOT did not significantly affect gastric cancer cell proliferation or apoptosis, but reduced cell migration. Actin polymerization failed to occur both in the GFP-MYOT and GFP control samples.

Conclusion

Our findings demonstrate that MYOT suppresses gastric cancer cell migration and purified GFP-MYOT does not directly promote on actin polymerization, implicating its potential role as a tumor suppressor. Additionally, MYOT undergoes LLPS both in vitro and in vivo, as evidenced by FRAP. We propose that MYOT may exert its anti-tumor effects through LLPS-mediated mechanisms, offering a novel perspective on its function in gastric cancer progression.