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

Endoscopic retrograde cholangiopancreatography (ERCP) poses a risk of patient-to-patient transmission of multidrug-resistant organisms (MDROs) via contaminated duodenoscopes. The prevalence of MDRO carriage in ERCP patients is unknown but crucial for assessing this risk and to determine the impact and choice of targeted infection prevention measures.

Aims & Methods

The aim of this study was to measure MDRO prevalence in ERCP patients across four countries. This observational study included adults undergoing ERCP in the Netherlands, India, Italy, and the United States. Pre-procedural rectal and throat-nose swabs were collected for MDRO detection. Patient- and procedure-related data were systematically collected. Risk factors for MDRO carriage were determined through multivariate logistic regression analysis.

Results

Of 1244 patients, 462 (37.1%) carried an MDRO. Extended-spectrum beta-lactamase-producing Enterobacterales were most common (337/1244, 27.1%), followed by carbapenemase-producing Enterobacterales (94/1244, 7.6%). MDRO prevalence exhibited significant geographical variation, highest in India (83.1%) and lowest in the Netherlands (10.8%), with intermediate rates in Italy (31.6%) and the United States (20.1%). Additionally, MDRO types varied substantially across countries. Pre-procedural MDRO carriage was significantly associated with chronic lung disease (aOR 1.75, 95% CI 1.07–2.86, P = 0.025), congestive heart failure (aOR 2.20, 95% CI 1.33–3.64, P = 0.002), and prior penicillin use (aOR 1.66, 95% CI 1.05–2.63, P = 0.031).

Conclusion

Patients undergoing ERCP have a moderate to high prevalence of MDRO carriage, with significant variation in prevalence, species, and resistance mechanisms across countries. High MDRO prevalence increases the risk of duodenoscope contamination by MDRO and subsequent patient-to-patient transmission via these contaminated endoscopes. Pre-procedural screening could enable targeted infection prevention measures, including enhanced reprocessing or the use of single-use duodenoscopes, to reduce the risk of future duodenoscope-related MDRO outbreaks.

Disclosure

This study was supported by an unrestricted research grant from Boston Scientific and received material support from Copan Italia SpA. The study was investigator-initiated, and neither Boston Scientific nor Copan Italia had any role in the design of the study protocol, data analysis, interpretation of results, or preparation of the abstract.

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

Duodenoscopes have been implicated in patient-to-patient transmission of multidrug-resistant organisms (MDROs). Current gastrointestinal MDRO surveillance relies primarily on rectal screening, yet the duodenum is the primary site of duodenoscope exposure to MDRO. This study evaluated the predictive value of rectal and throat-nose screening for detecting MDROs in duodenal fluid as a marker of duodenoscope contamination risk.

Aims & Methods

The aim of this study was to evaluate the predictive value of rectal and throat-nose screening for detecting MDROs in duodenal fluid as a marker of duodenoscope contamination risk. This study was conducted at two tertiary care centers in India and the Netherlands. Adult patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were included. Rectal swabs, throat-nose swabs, and duodenal aspirates were collected and analyzed for MDROs. The detected MDROs were compared using species identification, antibiotic susceptibility patterns, and whole-genome sequencing.

Results

A total of 512 participants were included: 339 from the Netherlands and 173 from India. Rectal MDRO carriage was observed in 33.8% (173/512), throat-nose carriage in 0.2% (1/512), and duodenal carriage in 22.9% (117/512). Due to the low prevalence of carriage in the nose or throat, only the predictive value efficacy of rectal screening was assessed. Rectal screening showed a sensitivity of 38.5% for genetically related strains in duodenal fluid. For detecting any duodenal MDRO, rectal screening demonstrated a sensitivity of 90.6%, specificity of 83.0%, a positive predictive value (PPV) of 61.3%, and a negative predictive value (NPV) of 96.7%.

Conclusion

Rectal screening is unreliable for detecting strain-specific duodenal MDROs. While effective in identifying non-carriers, it overestimates true duodenal MDRO carriage. Thus, utility of rectal screening in guiding infection prevention strategies for duodenoscope contamination is greater in regions with low MDRO prevalence.

Disclosure

This study was supported by an unrestricted research grant from Boston Scientific and received material support from Copan Italia SpA. The study was investigator-initiated, and neither Boston Scientific nor Copan Italia had any role in the design of the study protocol, data analysis, interpretation of results, or preparation of the abstract.

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

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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.