Introduction

Gastric emptying testing (GET) is used to assess gastric motility, however is non-specific and insensitive for neuromuscular disorders. Gastric Alimetry® is a new medical device combining non-invasive gastric electrophysiological mapping and validated symptom profiling.

Aims & Methods

This study aimed to assess patient-specific phenotyping using Gastric Alimetry with comparison to GET.
Patients with chronic gastroduodenal symptoms underwent simultaneous GET and Gastric Alimetry. Tests comprised a 30-minute baseline, ^99mTC-labelled egg meal, and 4-hour postprandial recording. Results were referenced to normative ranges^1,2. Symptoms were profiled in real-time during testing in the validated Gastric Alimetry App³, phenotyped with rule-based criteria, and compared to long-term symptom questionnaires of Rome IV criteria, Patient Assessment of Upper Gastrointestinal Symptom Severity Index (PAGI-SYM), Gastroparesis Cardinal Symptom Index (GCSI), Patient Assessment of Upper Gastrointestinal Disorders Quality of Life (PAGI-QoL), Patient Health Questionnaire-2 (PHQ-2), and State-Trait Anxiety Inventory-6 (STAI-6). Three Gastric Alimetry symptom profiles were phenotyped: i) continuous (symptoms do not correlate with meal or gastric activity); ii) gastric sensorimotor (symptoms increase within 30 minutes of the meal and decay as gastric activity decreases); and iii) Other (symptoms that do not fit the other two symptom profiles).

Results

75 patients with chronic gastroduodenal symptoms were assessed; 77% female, median age 43, median BMI 24.0. Motility abnormality detection rates were: GET 22.7% (14 delayed, 3 rapid); Gastric Alimetry spectral analysis 33.3% (14 dysrhythmic / low amplitude; 5 high amplitude; 6 abnormal frequency); combined yield 42.7%. In patients with normal spectral analysis, Gastric Alimetry symptom phenotypes included: gastric sensorimotor 17%; continuous 30%; other 53%. The sensorimotor phenotype correlated strongly with gastric amplitude (median r=0.61 vs r=0.08 and r=0.06 respectively; p=0.0002). Abnormal Gastric Alimetry phenotypes showed superior correlations with GCSI, PAGI-SYM, and STAI-6 anxiety scores (p<0.05), while Rome IV Criteria and delayed gastric emptying did not correlate (p>0.05). Delayed gastric emptying was not predictive of specific Gastric Alimetry phenotypes.

Conclusion

Gastric Alimetry generated a higher yield for motility abnormalities than GET in patients with chronic gastroduodenal symptoms. Gastric Alimetry also identified patient-specific symptom phenotypes, showing correlations with health psychology variables not observed with Rome IV and delayed gastric emptying. GET and Gastric Alimetry assess different aspects of gastric function, indicating these tests may have complementary roles.

References

1. Varghese C, Schamberg G, Calder S, et al. Normative values for body surface gastric mapping evaluations of gastric motility using gastric alimetry: Spectral analysis. American Journal of Gastroenterology 2022; Publish Ahead of Print. Epub ahead of print 2022. DOI: 10.14309/ajg.0000000000002077.
2. Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for Gastric Emptying Scintigraphy: A joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Journal of Nuclear Medicine Technology; 36: 44–54.
3. Sebaratnam G, Karulkar N, Calder S, et al. Standardized system and app for continuous patient symptom logging in gastroduodenal disorders: Design, implementation, and validation. Neurogastroenterology & Motility 2022; 34. Epub ahead of print 2022. DOI: 10.1111/nmo.14331.

Disclosure

Greg O'Grady, Armen Gharibans and Peng Du hold intellectual property and grants in gastric electrophysiology and are Directors of University of Auckland spin-out companies (Greg O'Grady: Alimetry, Insides Company; Armen Gharibans: Alimetry; Peng Du: FlexiMap); Stefan Calder, Gabriel Schamberg, Stephen Waite, and Christopher N. Andrews are members of Alimetry. The remaining authors have no relevant conflicts of interest to declare.

Introduction

The prevalence of biliopancreatic malignancies is steadily increasing. Most patients are inoperable due to the typically advanced stage of the disease at the time of diagnosis and require biliary drainage. Despite numerous large-scale studies, the identification of predictive factors for survival in these cancers to improve their prognosis remains a challenge.
The aim of our study was to evaluate the survival of patients who underwent biliary stenting as part of the management of unresectable biliopancreatic malignancies and to assess the factors influencing the survival rate.

Aims & Methods

We conducted an observational cohort study between January 1, 2021, and March 28, 2024. All patients who underwent biliary drainage for obstructive jaundice due to biliopancreatic cancer (pancreatic head adenocarcinoma, peri-hilar cholangiocarcinoma, gallbladder cancer, ampulloma) were included. Contraindications to palliative chemotherapy were poor general condition (ECOG/WHO performance status 3 or more) and hyperbilirubinemia due to inadequate biliary drainage.

Results

82 patients were included in our study. The mean age in our series was 63.4 +/- 12 years. The sex ratio was 1. The median survival was 350 days (95% CI 268 – 514). 49.4% had pancreatic head adenocarcinoma, 30.6% had cholangiocarcinomas, 10% had ampullomas, and 10% had gallbladder cancer.
The median survival for pancreatic head adenocarcinoma was 450 days vs. 562 days for ampullomas, 356 days for cholangiocarcinomas, and 301 days for gallbladder cancer.
The type of cancer did not have a statistically significant difference on median survival (p = 0.95).
15% of patients had failed ERCP and underwent percutaneous biliary drainage. They had a 2.5 times higher risk of death (RR = 2.57, 95% CI 1.26-5.25, p = 0.01). Indeed, the median survival without death in cases of percutaneous drainage was 39 days vs. 375 in cases of successful ERCP (p = 0.007).
65% of patients were able to undergo palliative chemotherapy after stenting. The median survival with chemotherapy was 562 days vs. 30 days for patients who could not initiate it (p < 0.001). The latter had a 10 times higher risk of death in the month following stent placement (RR = 10.7, 95% CI 5.23-21.9, p < 0.001).
In our series, the presence of pancreatic head adenocarcinoma was associated with a higher probability of receiving chemotherapy (p = 0.04). However, it did not have a significant impact on median survival.
In multivariate analysis, only palliative chemotherapy seemed to improve the survival median (p < 0.001), while recurrence of jaundice and stent occlusion were associated with death (p = 0.03).

Conclusion

According to the results of our study, the prognosis of unresectable biliopancreatic cancers is poor but appears to be improved by a successful biliary stenting. Patients in whom biliary stent placement was a bridging procedure that allows chemotherapy seem to have higher survival rates. The generalization of endoscopic ultrasound-guided biliary drainage as an alternative to biliary percutaneous drainage could improve the survival rate in patients with failed ERCP.

Introduction

Non-invasive assessment of liver structure is an invaluable current practice of hepatology.
The rate of obesity is increasing globally. Africa is not an exception as obesity has become quite prevalent in many parts of Africa like Nigeria.
Steatosis (excessive fat in the liver) can be assayed in the liver using a controlled attenuation parameter (CAP) during transient elastography (TE).

Aims & Methods

All patients fasted for at least 3 hours prior to carrying out a Fibroscan. The level of fibrosis was recorded in kPa and the CAP in dB/m. The machine (Fibroscan Expert 630) also recorded the Shear wave speed (SWS) in meters per second. Height and weight were obtained using a Stadiometer and BMI was extrapolated. Biodata was obtained using a questionnaire

Results

One thousand four hundred and nine participants (1,409) were studied. The mean age was 43.84 (sd=14.27) years. About Sixty-five percent (64.84%) were males. The commonest (57.5%) indication for Fibroscan was Chronic Hepatitis B (CHBVI). Alcohol consumption and or suspicions of fatty liver disease made up about Nine percent (8.93%) of the indications. About 48% had higher-than-normal BMI.
About 81% had steatosis stage S0 (<248 dB/m). Nineteen percent had different degrees of steatosis. The largest group was S3 (280dB /m and above) with 9.6 %. Stage S1 (2458-267dB/m) was 5.7%. About 20% had significant fibrosis (14.0kPa and above) via TE measurement.
Age had a weak positive correlation (+0.185) with TE scores while BMI had a weak negative correlation (-0.162) with TE scores. On the other hand, the CAP score was strongly and positively (+0.461) correlated with BMI but negatively (-0.073) with SWS. P=0.001
On multiple regression, only BMI (B =4.09) significantly predicts CAP score by about 4 folds, p=0.0001.

Conclusion

The rate of obesity is increasing among adults in North-central Nigeria. Among this cohort, it’s clear that as BMI increases, the degree (Stage) of steatosis also increases.

Introduction

United European Gastroenterology (UEG) Guideline on IgG4-related digestive disease provides evidence-based recommendations for the diagnosis and management of immunoglobulin G4 (IgG4)-related digestive disease in adults and children. IgG4-related digestive disease can be diagnosed only with a comprehensive work-up that includes histology, organ morphology at imaging, serology, search for other organ involvement, and response to glucocorticoid treatment. Indications for treatment are symptomatic patients with obstructive jaundice, abdominal pain, posterior pancreatic pain, and involvement of extra-pancreatic digestive organs. Treatment with glucocorticoids should be weight-based and initiated at a dose of 0.6–0.8 mg/kg body weight/day orally for 1 month to induce remission and then be tapered within two additional months. Response to initial treatment should be assessed at week 2–4 with clinical, biochemical, and morphological markers.

Aims & Methods

The aim of this study is to evaluate the adherence to diagnostic, therapeutic and management recommendations of the IgG4 guideline across Europe. The invitation to participate in the study was published at My Connect UEG platform. Questions in the survey were related to the organ involvement, diagnosis, treatment and follow up of newly diagnosed patients with IgG4-related digestive diseases in the three-year period (January 2021 - December 2023) after the publication of the guideline in 2020. We have received data from 14 European centers (12 countries).

Results

One hundred ninety-nine patients (76% males) were included in this multicentric study.
IgG4-related digestive disease was diagnosed in 54, 75, and 70 patients during 2021, 2022 and 2023 respectively.
Most of the patients had concomitant pancreatic and biliary tree involvement (46%), followed by pancreatic (34%), biliary tree (19%), esophageal (1.5%) or bowel (0.5%) involvement. Among autoimmune pancreatitis (AIP) patients, 76% received a definite diagnosis.
The combination of CT and MRI was employed in 63% of the patients, whereas 13% received only either CT or MRI.
Endoscopic ultrasound was performed in 56% of the patients.
Pancreatic exocrine and endocrine function at baseline were controlled in 78% and 76% of the patients, respectively.
Most of the patients (72%) received induction treatment with glucocorticoids (GC) according to UEG guidelines, whereas 8%, 7%, and 13% received a different GC scheme, a different drug, or no treatment, respectively.
Eleven patients underwent surgery due to suspected cancer.
Follow up assessment was performed according to guidelines (between 2-4 weeks from treatment start) in 48% of the patients and after 4 weeks in 38% of the patients, but 7% did not receive any follow-up imaging.
Among the 37 patients with biliary tract and liver involvement, 51% underwent MRI and CT, while EUS was used in 43% of the patients.
Treatment and imaging follow up mirrored UEG guidelines in 78% and 57% of the patients, respectively.
Five patients underwent surgery due to suspected cancer.
Three cases of IgG4-RD of the esophagus and one case of IgG4-related bowel disease were detected.

Conclusion

IgG4-related digestive disease was diagnosed in pancreas and the bile duct (concomitant or isolated) in most of the patients. IgG4-related disease in other digestive organs is very rare. Adherence to the European guidelines is high in the context of diagnosis and the first line treatment. Surgery was performed in 8% of all cases due to the suspected cancer. There are still differences across Europe regarding the follow up of patients.

Disclosure

Dr Vujasinovic and Dr Löhr have received lecture fees from Abbott and Viatris.
Dr Ponsioen received research grants from Gilead and Perspectum and consultancy fees from Chemomab and NGM.