Introduction

Autoimmune hepatitis (AIH) is a rare chronic liver disease. Assessment of Health-Related Quality of Life (HRQoL) in this field has emerged as a novel method to evaluate the well-being of patients and their therapeutic management. The aim of this study was to evaluate the health-related quality of life in patients with autoimmune hepatitis by comparing it to that of patients with chronic hepatitis C and healthy subjects.

Aims & Methods

We conducted a single centre study enrolling patients followed in our department for AIH between 2010 and 2023. Thirty patients followed for hepatitis C in our center et forty healthy subjects were selected as a control group. We assessed health related quality of life in these patients using the chronic liver disease questionnaire which is a specific tool used in liver disease to appreciate the HRQoL. Patients with decompensed cirrhosis were excluded.

Results

A total of 100 patients were enrolled: 30 patients with AIH, 30 patients with chronic hepatitis C and 40 healthy subjects. The median age was 51 (50-, 64- and 45-year-old respectively in AIH, chronic hepatitis C and healthy subjects) and the sex-ratio was 0,4. The overall Chronic Liver Disease Questionnaire scores (82 vs. 190, P<0.001), the worry domain (8 vs 30, P<0.001), the systemic symptom domain (14 vs 35, P<0.001) and the fatigue domain (10 vs 25, P<0.005) were significantly inferior in patients with autoimmune hepatitis compared to healthy subjects. Similarly, these scores were significantly worst in AIH patients compared to hepatitis c patients: overall Chronic Liver Disease Questionnaire scores (82 vs. 138, P < 0.001), the worry domain (8 vs 30, P<0.001), the systemic symptoms domain (14 vs 35, P<0.001) and the fatigue domain (10 vs 25, P<0.001). In AIH patients, the univariate analysis showed that cirrhosis was associated with lower overall score (99 vs 145, P<0.01) and lower score on the worry domain (7 vs 27, P<0.002) and the use of prednisolone was associated with lower scores on the worry domain (7 vs 8, P<0.05).

Conclusion

Patients with autoimmune hepatitis show a significant impairment of health-related quality of life compared to hepatitis c patients and healthy subjects. Therefore, focusing on the quality of life in these patients is important in order to provide an optimum medical care.

Introduction

Symptomatic luminal stricture in Crohn’s Disease (CD) occurs in up to 20% of patients at the diagnosis and in more than 50% during their lifetime. A considerable percentage of patients often require further surgery for post-operative CD recurrence, with a consequent increased burden of short bowel syndrome. In this scenario, combining biological therapy with endoscopic balloon dilation (EBD) could potentially reduce this risk.

Aims & Methods

Our study aimed to evaluate the efficacy of EBD combined with biologic therapy in symptomatic gastrointestinal strictures in CD patients. We conducted a retrospective study including consecutive CD patients who underwent EBD for low gastrointestinal strictures from December 2015 until November 2022 at our tertiary IBD Center. Subsequent subocclusive/occlusive episodes, the need for steroids, and surgery due to CD stenosis were evaluated during a follow-up period of 6, 12 months, and 24 months.

Results

A total of 52 patients treated with EBD with an overall number of 55 strictures were included. The mean age was 46,8 (18-77) years. The median of disease duration was 9 (0-42) years. Among the total of 55 studied strictures: 14 (25%) in patients with active smoking, 21 (38%) with increased CRP values at the time of dilation, 43 (78%) had evidence of moderate or severe endoscopic disease activity with ulcerative lesions at stricture site. Anastomotic strictures accounted for 26 (47%) of all 55 strictures. The remaining 29 (53%) were de novo stricture: 8 (15%) ileal, 11 (20%) at ileocecal valve, 4 (7%) colonic, and 6 (11%) anal . Forty-two patients (76%) were under biologic therapy at the time of EBD and 2 (4%) started after EBD. EBD technical success was reported in 60% of the procedures, and no adverse events were recorded. After 6 months from EBD, at univariate analysis, increased CRP at the time of dilation resulted in a risk factor for the need for steroids (OR 14,63, IC 2,690 to 71,50; p-value = 0,0006, Table 2). Concomitant biological therapy, active smoke, and the presence of ulcerative lesions did not show a significant correlation with considered outcomes. After 12 and 24 months from EBD, concomitant biological therapy resulted in being a protective factor for surgery (OR 0,06; IC 0,005 to 0,502; p-value=0,0047), while subocclusive and occlusive events were less frequent in anastomotic strictures than ileal stenosis (OR 0,07; IC 0,005 to 0,651; p-value=0,0152).

Conclusion

In patients with CD undergoing EBD for intestinal CD stricture, concomitant biological therapy reduces the risk of surgery for CD stenosis recurrence. Further prospective and controlled studies are underway to confirm these observations.

Disclosure

Antonio Gasbarrini reports personal fees for consultancy for Eisai S.r.l., 3PSolutions, Real Time Meeting, Fondazione Istituto Danone, Sinergie S.r.l. Board MRGE, and Sanofi S.p.A, personal fees for acting as a speaker for Takeda S.p.A, AbbVie, and Sandoz S.p.A, and personal fees for acting on advisory boards
for VSL3 and Eisai. Daniela Pugliese received speaker fees from AbbVie, MSD, Takeda and Janssen, Pfizer; advisory board fees from Pfizer. Franco Scaldaferri i: advisory board for Abbvie, Janssen, MSD, Sanofi and Takeda; All the other authors have no conflict of interest to declare

Introduction

Endoscopic interventions in children require specialized training and expertise due to unique anatomy and physiology challenges. Pancreaticobiliary endoscopies represent highlighted procedures in this population due to the often-unusual indications and the inherent high risk of complications.

Aims & Methods

The current work demonstrates our experience in pancreaticobiliary endoscopy in the pediatric population. We retrospectively analyzed data on all patients <18 years old who underwent endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS) from 2021 to the present days at our department. We collected demographical data, indications, procedural findings, interventions, and complications.

Results

Overall, 19 ERCPs and 7 EUS procedures were performed on 24 children with regular endoscopes. 15 were males, and the mean age was 10.7 years (±4.7). Indications for ERCP included bile duct stones, benign stricture, pancreatic divisum and disconnected duct syndrome. Successful intervention was carried out in 18 cases, while there was one case of unsuccessful deep pancreatic duct cannulation due to abnormality of the duct. There was one case of perforation (Stapfer II), which was effectively managed endoscopically by placing a fully covered self-expanding metallic stent. 1 case of mild post-ERCP acute pancreatitis occurred following ERCP. EUS was performed for chronic pancreatitis, pancreatic cystic neoplasia, acute necrotizing pancreatitis, biliary compression and polycystic pancreas. 3 tissue acquisitions were done and one EUS-guided transluminal drainage was established. There were no complications.

Conclusion

To our knowledge, this is the most comprehensive domestic dataset of pancreaticobiliary endoscopies in children. Our findings imply that ERCP and EUS are effective diagnostic and treatment modalities in pediatric patients with acceptable safety profiles.

Introduction

We conducted a multicenter, randomized, comparative study (MARVELOUS trial) of EPLBD without additional EST (EPLBD alone) versus EST at 19 institutions in Japan and reported the usefulness and safety of EPLBD alone for removing large common bile duct stones (Kogure H, et al. Endoscopy 2020; 52: 736-744). Long-term follow-up was conducted after stone treatment, and in this study, we compared the long-term outcomes of EPLBD alone and EST.

Aims & Methods

Of 161 patients who participated in the MARVELOUS trial and had complete stone removal (82 in the EPLBD alone group and 79 in the EST group), those who could be followed up for more than 30 days were included in the study. Long-term biliary events (recurrent bile duct stones, acalculous cholangitis, cholecystitis, and biliary tract cancer) in the EPLBD alone and EST groups were compared.

Results

The analysis included 59 cases in the EPLBD alone group and 62 cases in the EST group. There were no differences in background factors (age, sex, number and size of stones, diameter of the common bile duct, gallbladder status, and presence of periampullary diverticulum) between the two groups, except for age (77.8 vs. 81.7 years, P=0.01). The median follow-up periods were 44.4 months in the EPLBD alone group and 35.1 months in the EST group, and there were no significant differences in the incidence of long-term biliary events (15.3% vs. 22.6%). There were no significant differences in the incidence of recurrent bile duct stones (8.5% vs. 12.9%), acalculous cholangitis (5.1% vs. 3.2%), cholecystitis (5.1% vs. 12.5%), and biliary tract cancer (0% vs. 1.6%) between the two groups. Although the cumulative recurrence rates of stones (1/3/5 years) were 3.8%/8.3%/8.3% in the EPLBD alone group and 5.4%/18.3%/18.3% in the EST group, and the cumulative incidence rates of long-term biliary events (1/3/5 years) were 7.6%/12.1%/18.8% in the EPLBD alone group and 13.7%/24.6%/27.6% in the EST group, there was no statistically significant difference. No significant factors related to recurrent bile duct stones were extracted by univariate and multivariate analyses.

Conclusion

EPLBD without EST tends to have better long-term outcomes than EST and may be an option for the treatment of large bile duct stones.

Clinical Case Summary

Introduction: Typical complications of pancreatitis include the development of pseudocysts, obstruction of the bile duct or duodenum, and thrombosis of the splenic veins. Furthermore, pancreatitis can often lead to ascites or pleural effusions. Despite these known complications, detection of hemodynamic relevant pancreatogenic pericardial effusion is rare.
Case report: We present the case of an 81-year-old patient admitted to the emergency department with symptoms including shortness of breath, arterial hypotension, abdominal pain, dizziness, and chills. Additionally, the patient has been experiencing chronic abdominal pain since being diagnosed with acute pancreatitis four years ago. Anamnesis confirmed chronic alcohol consumption. Laboratory parameters showed increased serologcal inflammatory markers and lipase levels. Further diagnostic evaluation by computed tomography (CT) revealed characteristic findings of chronic pancreatitis, including perihepatic and perigastric abscess formations. Moreover, a circular pericardial effusion and bilateral pleural effusions were also detected. Due to the patient's hemodynamic and respiratory instability, endotracheal intubation was performed in the intensive care unit. Due to escalating indications of pericardial tamponade with arterial hypotension, tachycardia, and desaturation, emergency pericardial drainage and bilateral pleural drainage were performed immediately. Two percutaneous drains were inserted to address the intra-abdominal abscesses. Following the intervention, hemodynamic and respiratory stabilization allowed for extubation. The patient could be discharged from the hospital one month later.
Conclusion: The emergence of pericardial tamponade as a complication of pancreatitis is exceptionally rare and poses a potentially life-threatening scenario. Therefore, our case underscores the importance of excluding pericardial effusion in patients with pancreatitis using echocardiography or other radiological methods.

Introduction

Effective colorectal cancer prevention relies on the quality of screening colonoscopy examinations. Cecal withdrawal time is significantly associated with adenoma detection rate (ADR), which is an established quality indicator for screening colonoscopy. Therefore, we introduced a real-time cecal withdrawal timer (CWT) that alerts the physician of the elapsed time since cecal intubation.

Aims & Methods

An observational, retrospective, single-center study to evaluate CWT in screening colonoscopy tests. The CWT is activated by a vocal command when the physician achieves cecal intubation. Following activation, the elapsed time is audio-announced every minute until the end of the procedure. The ADR of colonoscopies with and without the CWT was evaluated following CWT implementation from January 2023 to February 2024. Moreover, the ADR of the entire department in this period was compared with the year before.

Results

Of 1,557 colonoscopies between January 2023 and February 2024, 908 (58.3%) were performed with the CWT with a median withdrawal time of 8.75 (IQR: 6.9-12.0) minutes. During this period, the CWT usage was greater than 50% in 11 out of 14 months. Considering only months with CWT usage over 50%, the ADR of colonoscopies with CWT was 28.3% compared to 19.2% in those without (p<0.001). Among physicians who performed at least 20 tests with and 20 tests without the CWT, 6 out of 8 demonstrated improved ADR with the cecal timer. Notably, the 2 physicians who did not improve ADR had baseline ADR exceeding 30%. The overall ADR of the department between January 2023 and February 2024 was 25.5%, compared to 26.2% in 2022 (p=0.704).

Conclusion

Initial findings of the CWT program suggest its potential in enhancing screening colonoscopy quality indicators, although long-term prospective follow-up is warranted.

Disclosure

Nothing to declare