Introduction

Gastrointestinal stromal tumors (GIST) are the most common malignant subepithelial lesions (SELs) found in the gastrointestinal tract. Due to GIST’s notable features including vascularity and deep location, endoscopic ultrasound (EUS) is the first-line diagnostic approach. Three models, color-doppler EUS, power-doppler EUS, and e-FLOW EUS, are useful for real-time vascularity detection; however, they are not effective for fine and slow flow vessel detection. Therefore, contrast enhanced EUS (CE-EUS) is proposed as a first-line approach. Nevertheless, the use of contrast may be detrimental, thus limited to some patients. To avoid contrast-related adverse events, a novel diagnostic method known as detective flow imaging endoscopic ultrasonography (DFI-EUS) has emerged.

Aims & Methods

To evaluate the utility of DFI-EUS in the diagnosis and differentiation of gastrointestinal SELs (GIST and leiomyomas) in comparison to CE-EUS.
A single-center, prospective, diagnostic study was conducted between December/2022 and October/2023 at IECED, Ecuador. The study protocol was approved by the Institutional Review Board and was conducted in accordance with the Declaration of Helsinki. Patients ≥18 years old with a suspected diagnosis of gastrointestinal SELs were enrolled for EUS vascularity assessment. Patients with contraindication for contrast agent administration, any clinical condition rendering EUS-DFI or CE-EUS unfeasible, pregnant and nursing were excluded. First, SELs’ assessment was performed by two expert endosonographers (blinded to patient’s clinical information) using DFI-EUS, followed by a CE-EUS examination (using Sulphur hexafluoride contrast agent) for diagnostic confirmation. The identification rate along with diagnostic accuracy of DFI-EUS and CE-EUS based on histopathological confirmation was the primary endpoint. The type of vascularization (microvascular/microvascular) along with endosonographic appearance (hyper/hypovascular) were also recorded.

Results

A total of 24 patients were included, comprising 54.2% females. The examined lesions consisted of 70.8% GIST and 29.1% leiomyoma. Predominantly, lesions were found in the stomach (91.7%) and within the muscularis propria layer (91.7%). All GIST were hypoechoic and mainly heterogeneous, larger than leiomyoma in size (>2 cm; p < 0.001). Tortuous vessels were significantly identified in GIST (p 0.045). Both CE-EUS (94.1%; p 0.003) and DFI-EUS (94.1%; p< 0.001) successfully detected GIST (Table 1). The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of DFI-EUS was comparable with CE-EUS with rates of 94.12% vs 94.12, 100% vs 99.64%, 100% vs 99.85% and 87.5% vs 99.64%, respectively (Table 2). A strong inter-rater agreement between CE-EUS vs DFI-EUS was detected with a kappa of 0.903 (p<.001).

Conclusion

DFI-EUS proves to be a reliable diagnostic tool, exhibiting high diagnostic accuracy, comparable to that of CE-EUS in the differentiation of GIST and SELs in the gastrointestinal tract. Larger multicenter studies are necessary to position this alternative for SELs' differentiation in clinical practice.

References

1. Yamashita Y, Ashida R, Tamura T, Shimokawa T, Yamazaki H, Kawaji Y, Tamura T, Hatamaru K, Itonaga M, Kitano M. Novel Technique of Endoscopic Ultrasonography for the Differential Diagnosis of Gallbladder Lesions and Intraductal Papillary Mucinous Neoplasms: A Single-Center Prospective Study. Diagnostics (Basel). 2023 Jun 21;13(13):2132. doi: 10.3390/diagnostics13132132. PMID: 37443527; PMCID: PMC10341113.
2. Yamashita Y, Yoshikawa T, Yamazaki H, Kawaji Y, et al. A Novel Endoscopic Ultrasonography Imaging Technique for Depicting Microcirculation in Pancreatobiliary Lesions without the Need for Contrast-Enhancement: A Prospective Exploratory Study. Diagnostics (Basel). 2021 Oct 30;11(11):2018. doi: 10.3390/diagnostics11112018. PMID: 34829364; PMCID: PMC8621279.
3. Casali PG, Blay JY, Abecassis N, Bajpai J, et al; ESMO Guidelines Committee, EURACAN and GENTURIS. Electronic address: clinicalguidelines@esmo.org. Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2022 Jan;33(1):20-33. doi: 10.1016/j.annonc.2021.09.005. Epub 2021 Sep 21. No abstract available. PubMed ID: 34560242

Disclosure

Carlos Robles-Medranda is a key opinion leader and consultant for Pentax Medical, Steris, Medtronic, Motus, Micro-tech, G-Tech Medical Supply, CREO Medical, EndoSound, and mdconsgroup.
The other authors declare no conflict of interest.

Introduction

Self-expandable metallic stents (SEMS) are commonly used to relive malignant gastric outlet obstruction (GOO). However, SEMS with high radial force can occurs tissue proliferation caused by mechanical injury. To overcome these problems, drug-eluting stents using antiproliferative drugs have been developed. Specially, everolimus have demonstrated efficacy in reducing restenosis rates in arteries, but their potential application in the gastrointestinal tract remains unexplored. Additionally, recent studies have reported that stents with thinner struts have a reduced risk of clinical restenosis compared to stents with thicker struts. However, the application of everolimus-coated laser-cut stents, which offer robust antiproliferative properties, has not yet been investigated or established in the gastrointestinal tract.

Aims & Methods

This study aims to investigate the efficacy and safety of everolimus-coated laser-cut SEMS in suppressing stent-induced tissue hyperplasia in a rat gastric outlet model.
Everolimus-coated laser-cut SEMS were prepared using ultrasonic spray technology, and the characteristics of the SEMS before and after coating process were evaluated. Twelve male rats were randomly divided into two groups: control (laser-cut SEMS, n = 6) and everolimus (everolimus-coated laser-cut SEMS, n = 6). The effectiveness of everolimus-coated laser-cut SEMS were assessed by comparing results of fluoroscopy, endoscopy, and histopathological analyses.

Results

Everolimus were uniformly coated onto the surface of the laser-cut SEMS and approximately 80% of everolimus was slowly released for a week. Stent placement was successful in all rats. Stent-induced tissue hyperplasia variables were significantly lower in the everolimus group compared to the control group (all p < 0.05). The luminal diameter was significantly larger in the everolimus group than in the control group (p < 0.05). The degrees of α-SMA-, Ki-67-, and BrdU-positive deposition were significantly lower in the everolimus group (p < 0.001), while the degree of TUNEL-positive deposition was significantly higher than in the control group (p < 0.001).

Conclusion

Everolimus-coated laser-cut SEMS effectively suppressed stent-induced tissue hyperplasia in a rat gastric outlet model. Local treatment with everolimu via laser-cut SEMS was safe and effective to maintain the stent patency and has therapeutic potential in the prevention of restenosis after stent placement in the gastrointestinal tract.

Disclosure

No disclosure

Introduction

T1 colorectal cancer can be managed either by surgery or interventional endoscopy. High-risk features after endoscopic resection (G3, submucosal invasion >1000 µm, lympho-vascular invasion, tumour budding+, or R1 resection) increase the risk of lymphnode metastasis (10-15%), often requiring additional surgery. However, the benefits of surgery versus endoscopic resection alone remain unclear, particularly in elderly or frail patients.

Aims & Methods

The aim of the study is to assess recurrence rate and overall survival in patients underwent surgery, endoscopy or both. Secondary endpoints is to evaluate incidence of adverse events and length of hospital stay
All consecutive patients diagnosed with T1 colorectal cancer from 2018 to 2024 in our institution were enrolled in this retrospective study. We divided this cohort in 3 groups: endoscopic resection plus surgery (ER-S), upfront surgery (SR), or endoscopic resection alone (ER). Demographics data, mortality, cancer recurrence rate, disease free survival and AEs were recorded.

Results

One-hundred and thirty-three patients were enrolled in the study: 34 (72 years±10) in the SR group, 65 (65 years±11) in the ER-S group and 34 (77 years±11) in ER, respectively.
Lesions were similar (p-value 0.30) for dimension: 31±15 mm (ER) vs 23±12 mm (ER-S) vs 30±13 mm (ER) such as follow-up (23 vs 24 vs 21 months) for the three groups (p-value 0.428). Hospital stay after the procedure was significantly lower in the ER group (1 day median) vs SR (median 9 days;p-value 0.0001) and ER-S group (7 days median;p-value 0.003). Cumulative 30 days adverse events were higher in the SR group (62%; p-value 0.0001) and in the ER-S group (22%; p-value 0.001) compared to ER alone (12%). During the study period, no endoscopic/radiological recurrence occurred in the SR group whereas 1 patient in the ER-S group and 2 in the ER group showed recurrence non suitable for further treatments.
Five patients in SR group died after a median of 18 months (1 for early surgical complication); 2 died in the ER-S group after a median of 34 months and 3 died in the ER group after a median of 24 months (1 for rectal cancer progression) (p-value 0.365).
Overall survival was comparable among the three groups with no significant difference (p-value 0.718) with a median of 40 months (SR), 28 (ER-S) and 26 (ER) months.

Conclusion

Endoscopic resection alone appears to be a reasonable option for high-risk T1 CRC patients, especially those with increased surgical risk due to low rate of recurrence, low adverse events and a comparable overall survival in short-mid term.

References

1. Quénéhervé, L.; Pioche, M.; Jacques, J. Curative Criteria for Endoscopic Treatment of Colorectal Cancer. Best Pract. Res. Clin. Gastroenterol. 2024, 101883, doi:10.1016/j.bpg.2024.101883.
2. Chen, Y.; Jing, W.; Chen, M.; Wang, Z.; Wu, J.; Yang, J.; Yang, L.; Deng, K. Long-Term Outcomes of Local Resection versus Surgical Resection for High-Risk T1 Colorectal Cancer: A Systematic Review and Meta-Analysis. Gastrointest. Endosc. 2023, 97, 1016-1030.e14, doi:10.1016/j.gie.2023.02.027.
3. Spadaccini M, Bourke MJ, Maselli R, et al. Clinical outcome of non-curative endoscopic submucosal dissection for early colorectal cancer. Gut. Published online January 20, 2022. doi:10.1136/gutjnl-2020-323897
4. Corre, F.; Albouys, J.; Tran, V.-T.; Lepilliez, V.; Ratone, J.-P.; Coron, E.; Lambin, T.; Rahmi, G.; Karsenti, D.; Canard, J.-M.; et al. Impact of Surgery after Endoscopically Resected High-Risk T1 Colorectal Cancer: Results of an Emulated Target Trial. Gastrointest. Endosc. 2023, S0016-5107(23)02933-4, doi:10.1016/j.gie.2023.09.027.
5. UICC. TNM. Classification of malignant tumours. eighth ed. Wiley; 2016. p. 272

Disclosure

Giuseppe Grande is consultant for Olympus, Boston Scientific, ERBE, Fujifilm

Introduction

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder from the atopic disease spectre. Despite being studied for years, the EoE-specific therapy has been approved only recently and includes budesonide orodispersible tablet (1) and IL-4R antagonist, dupilumab (2). Therefore, data on the management of the patients who do not respond to this treatment is scarce. Especially those who were diagnosed long in the past and have undergone different therapeutical approaches remain an understudied group. The aim of this project was to provide information on the treatment courses in a real-world setting over past 10 years.

Aims & Methods

This was a retrospective nation-wide project collecting data on patients with EoE in 7 Austrian centres since January 2014. The last follow-up was marked as of February 2025. Information on patients’ demographics, previous medical history, number of esophageal food impactions and different treatment lines were recorded. Due to the descriptive character of the work, no power analysis was carried out.

Results

In total, 336 patients (30.1% female) were included. Approximately one third of them (119/336) experienced an esophageal food impaction before the diagnosis was made. The most common 1st line therapy was budesonide orodispersible tablet (193/336, 57.4%), followed by proton pump inhibitors (87/336, 25.9%) and food elimination diet (20/336, 6.0%). Two hundred twenty (220/336, 65.5%) patients did not remain on the 1^st line treatment. Forty-four (44/336, 13.1%) subjects required more than 2 therapies and one person received even 7^th line medication. Biologic treatment – dupilumab – was given to forty-one (12.2%) patients. It was the first line treatment in 1 person, the others received it in the further course. These drugs were well-tolerated and 97.6% (40/41) patients remained on it until the last follow-up and reached symptomatic remission. Three patients were diagnosed more than 10 years before they received biologic treatment and 2 of them responded to it. One person discontinued due to side effects. The most common reasons for switch for dupilumab were clinical and/or histological activity (24/41, 58.5%), side effects (10/41, 24.4%) and patients’ preference (2/41, 4.9%).

Conclusion

This is the first study on different therapy courses in patients with EoE in Europe. Due to its retrospective character, no direct conclusions on the superiority of one approach upon another in case of refractoriness are possible.

References

1. Lucendo AJ, Miehlke S, Schlag C, Vieth M, von Arnim U, Molina-Infante J, et al. Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial. Gastroenterology. 2019;157(1):74-86.e15.
2. Hirano I, Dellon ES, Hamilton JD, Collins MH, Peterson K, Chehade M, et al. Efficacy of Dupilumab in a Phase 2 Randomized Trial of Adults With Active Eosinophilic Esophagitis. Gastroenterology. 2020;158(1):111-22.e10.

Disclosure

JP: travel grants from Johnson&Johnson and Tillots Pharma AG
MW: no conflicts of interest
PD: consulting and speakers fees from Falk Pharma, Sanofi, Abbvie, MSD, Takeda, Janssen, Pfizer
KS: support from: Abbvie, Astro Pharma, Takeda, Johnson&Johnson, MSD, Falk Pharma, Galapagos
TH: speaker fee from Falk
MH: no conflicts of interest
LKS: •Past/present Principal investigator für Studien gesponsort durch: SigmaTau, Sanofi , Tigenix und Falk;
•Speaker fee: MSD, AbbVie, Ferring, MerckSerono/Dr Falk, Chiesi, Novartis, Roche, Abbott, Phadia Austria/Thermo Fisher Scientific, CSL-Behring , Janssen-Cilag Pharma, Labors.at GmbH, Vertex, ENML Laborbetriebs GmbH, Johnson&Johnson
•Conference support: Mylan, Abbott, MSD, Gilead, MerckSerono/Dr Falk, Novartis, Pfizer, Janssen-Cilag Pharma, Chiesi, Shire, Abbvie, Takeda, Vertex, Astropharma
•Consultancy for: MSD, Takeda
GN: lecturing fees, consulting fees, and advisory fees from AbbVie, Merck Sharp & Dohme, Takeda, Janssen-Cilag, Pfizer, Gilead, Galapagos, Ferring, Vifor, AstroPharma, Falk, Bristol Myers Squibb, Arena Pharmaceuticals and Amgen
MT: received grant support from Albireo, Alnylam, Cymabay, Falk, Genentech, Gilead, Intercept, MSD, Takeda and UltraGenyx, honoraria for consulting from AbbVie, Albireo, Agomab, Boehringer Ingelheim, BiomX, Chemomab, Dexoligo Therapeutics, Falk, Genfit, Gilead, GSK, Hightide, Intercept, Ipsen, Jannsen, MSD, Novartis, Phenex, Pliant, Regulus, Siemens and Shire, speaker fees from Albireo, Boehringer Ingelheim, Bristol-Myers Squibb, Falk, Gilead, Intercept, Ipsen, Madrigal, Mirum and MSD , as well as travel support from AbbVie, Falk, Gilead, Jannsen and Intercept. He is also co-inventor of patents on the medical use of 24-norursodeoxycholic acid filed by the Medical University of Graz (service inventions).
WS: no conflicts of interest
HS: consulting and speakers fees from Falk Pharma, Sanofi, Medtronic
PS: consulting fees and/or speaker fees from Dr. Falk Pharma, GmbH, Takeda, Regerenon-Sanofi Pharmaceuticals, AbbVie, Janssen-Cilag, Receptos-Celgene-BMS