Introduction

Impedance planimetry (EndoFLIP®) is an emerging tool in the assessment of esophageal motility, with its role in daily clinical practice gradually being defined. In contrast to high-resolution manometry (HRM), EndoFLIP® is generally well tolerated and can be performed during the same endoscopic session, allowing for a dynamic and functional evaluation of the esophagogastric junction and the esophagus. However, its applicability within the diagnostic algorithm for dysphagia remains insufficiently established.

Aims & Methods

A retrospective single-center observational study was conducted on EndoFLIP® procedures performed between September 2019 and December 2024 in patients whose primary symptom was dysphagia. Variables assessed included prior performance of HRM, diagnoses established by both HRM and EndoFLIP®, and therapeutic decisions made based on EndoFLIP® findings. All procedures were performed under general anesthesia.

Results

A total of 106 EndoFLIP® procedures were performed, with a median age of 59 years and 50.9% male. The median initial Eckardt score was 3 (maximum 12). 78.3% of patients presented pathological findings on EndoFLIP®, and in two-thirds (n=77), these findings led to a change in the therapeutic approach, implemented in the same endoscopic procedure in 22 cases. Half of the patients (n=49) had not previously undergone MAR due to: intolerance (n=23); assessment of distensibility plateau in eosinophilic esophagitis (n=11); optimization of initial endoscopy with simultaneous EndoFLIP® (n=6); assessment of treated achalasia and/or post-surgical status (n=3). In these patients, the majority had diagnostic findings on EndoFLIP® (78.8%), with the most frequent being achalasia (n=12). Of the patients who underwent MAR, nearly one-third (n=16) had inconclusive results. In only one case did the EndoFLIP® not show any abnormalities, while the remaining cases were diagnosed with achalasia (n=4), OJEG (n=4), and absence of contractility (n=3). When evaluating suspected OJEG (n=14) in MAR, only three were confirmed on EndoFLIP®, while the others were reclassified as normal study (n=8), achalasia (n=2), and absence of contractility (n=1).

Conclusion

This study highlights the need for a paradigm shift, advocating for the routine use of EndoFLIP® in the assessment of dysphagia in various contexts, including initial screening of motor disorders during index endoscopy, post-surgical evaluations, and a more accurate assessment of the esophagogastric junction (EGJ) and esophageal caliber in specific pathologies. EndoFLIP® allows for faster diagnoses, reduces the need for additional testing, and potentially enables earlier therapeutic planning, sometimes within a single session.

Introduction

The coexistence of HBV and hepatic steatosis is frequent, but its impact on the progression of liver disease remains poorly characterized and much debated.

Aims & Methods

We aim by this study to determine the prevalence, associated factors, consequences of this association and response to treatment.
A retrospective analysis was conducted over 20 years from 2005 to 2025 on a single-center cohort of 124 patients with chronic HBV, of whom 16.1% (n=20) had steatosis (confirmed by imaging). Demographic, virological, metabolic and histological (fibrosis stage) characteristics were compared between the groups with and without steatosis. And statistical tests (Chi², Mann-Whitney, logistic regression) were used.
For the comparison, we defined:
- Group A: combining steatosis and HBV
- Group B: HBV without steatosis.

Results

The prevalence of steatosis in patients with HBV in our series was 16.1%, with a mean age of 52.1 years higher than that of patients with HBV without steatosis, (45.8 years), with a p-value of 0.02. Furthermore, in our work there was a clear female predominance, with a sex ratio of 3 F/H in group A vs 0.9F/H in group B with a p-value of 0.04.
In the history of our patients, we found that 30% of patients had high blood pressure in group A compared with 18% in group B, 10% had diabetes in group A compared with 8% in the other group, and there was no significant difference in smoking habits (15% compared with 12%). Statistical regression did not find any significant correlation in those signs. On the other hand, in the case of dyslipidemia, there was a slight predominance of group A (15% vs. 10%) with a p-value of 0.045.
The analysis of hepatic test didn’t show any big difference between results of GGT, PAL and ASAT but for ALAT there was a higher in patients with steatosis with a median of 62 vs 52,1 and a p-value of 0,02.
Our study also found no difference in serological results: 95% of patients with steatosis were Hbs Ag positive, with the presence of Hbc Ab in all patients at the time of diagnosis. These results were not very different from those of patients without steatosis (Hbs Ag positive in 96.8% and Hbc Ab positive in all patients). Only 10% of patients had a positive Hbe Ag in group A vs 7.2% in group B. The median viral load before treatment was 1870 UI/ml vs 2450 UI/ml with no real difference noted between the 2 groups, confirmed by statistical regression which found a p=0.82 value.
Our study found no real impact on liver disease, showing no worsening of fibrosis (30% F≥2 with steatosis vs 25% without, p=0.62*).
After analysis using the association Chi² test, our study found similar virological responses under treatment (83% in group A vs 78% in group B, p=0.75*).

Conclusion

In this cohort, steatosis in HBV patients (16.1%) was associated with age and female sex. Hepatic test showed a higher ALAT fold among patient with steatosis. However, higher viral load or more severe fibrosis was not demonstrated. Steatosis in HBV does not appear to have a negative influence on the course of the disease. These results suggest that the management of HBV with steatosis should primarily target virological control, without requiring any specific therapeutic adaptation.

Disclosure

no conflict of interest

Introduction

Obesity is a global health challenge associated with significant morbidity, mortality, and economic burden. Endoscopic Sleeve Gastroplasty (ESG) has emerged as a safe, incisionless, and minimally invasive alternative to bariatric surgery for patients with obesity who are either unwilling or unsuitable for surgical options. While ESG has demonstrated promising short-term results in terms of weight loss and metabolic improvement, there remains a paucity of data on long-term outcomes, particularly beyond one year. This study aims to evaluate the long-term efficacy of ESG in a large Asian cohort, focusing on total body weight loss (TBWL) as the primary outcome, with body mass index (BMI) change and absolute weight loss as secondary outcomes.

Aims & Methods

We conducted a retrospective review of 236 patients who underwent ESG at Singapore General Hospital between November 2020 and December 2025. All procedures were performed by a single experienced endoscopist using a U-shaped suturing pattern. The primary outcome was the percentage of total body weight loss (%TBWL) at 6, 12, and 24 months post-procedure.

Results

The cohort consisted predominantly of female patients (69%), with the majority being of Chinese ethnicity (42.8%). The mean age at baseline was 41.4 years (SD ± 10.6), and the mean baseline BMI was 35.0 kg/m² (SD ± 6.1). All ESG procedures were technically successful, with an average of five sutures placed per patient and a mean procedure time of 75 minutes (SD ± 17). No major complications were reported, and the average hospital stay was one day.
Follow-up data were available for 114 patients at 6 months, 86 at 12 months, and 41 at 24 months. The mean percentage total body weight loss was 15.9% (SD ± 10.5) at 6 months, 12.7% (SD ± 7.8) at 12 months, and 9.9% (SD ± 7.8) at 24 months, reflecting a sustained reduction in weight over time. As secondary outcomes, BMI decreased significantly from baseline by a mean of 6.0 kg/m² (SD ± 5.3) at 6 months, 4.2 kg/m² (SD ± 5.7) at 12 months, and 3.5 kg/m² (SD ± 5.7) at 24 months (all p < 0.001). These were accompanied by corresponding mean weight losses of 16.8 kg (SD ± 17.1), 12.1 kg (SD ± 8.6), and 9.6 kg (SD ± 9.0) at the respective timepoints, all statistically significant (p < 0.001).

Conclusion

ESG is a safe and effective endoscopic intervention for weight loss, with sustained and clinically meaningful reductions in total body weight, BMI, and absolute weight observed up to two years post-procedure. These real-world data from a large tertiary Asian centre support the long-term utility of ESG as a viable non-surgical option for obesity management.

Disclosure

​Nil