Introduction

Intubation of the terminal ileum (TI) is the gold standard for completion of colonoscopy.
Our aim was to assess if this objective was achieved in our centre between endoscopists using various bowel preparations.
Poly ethylene glycol 4000 Vs Magnesium sulphate combined with potassium and sodium sulphates were the two commonly used bowel preparations. Magnesium containing preparations must be used with caution and avoided in patients with renal insufficiency, cardiac disease or pre-existing electrolyte abnormality and patients on diuretic therapy.
The Boston Bowel Preparation Scale was developed to limit inter-observer variability in the rating of bowel preparation quality, while preserving the ability to distinguish various degrees of bowel cleanliness and is mainly designed for adults. There is no dedicated bowel preparation score available for paediatric colonoscopies, BBPS is being used for critical comparison in our prospective cohort.

Aims & Methods

Objectives: To compare the intubation rate of TI between two endoscopists with quality of bowel preparation of colonoscopies in a tertiary health care centre and to assess the quality of bowel preparation of individual colonoscopies performed vis-a-vis, Boston bowel preparation scale as a prospective study over a period of 1 year.
Material and methods: A prospective study in a tertiary referral centre in children who underwent colonoscopies, aged 1 month to 17 years over a period of 1 year.
All children whose parents consented were included in the study. Results were collated using Microsoft Excel ™.A total of 135 cases were enrolled during our study period.

Results

1. TI intubation rate in PEG-4000 + bisacodyl based laxative formula is 87%
2. TI intubation rate in Magnesium/sodium/potassium based saline laxative formula is 79%
3. No side effects were encountered/ observed in either of the cohort.

Conclusion

In our study albeit the fact that our endoscopist chose different bowel preparations based on their anecdotal evidence based experience, we found that the bowel preparation was adequate.
There was no standardised paediatric bowel preparation globally and we note that every hospital or department or clinician have devised their own bowel preparation based either on personal experience or current available scientific literature.
We also note that we do not have a BBPS for paediatrics which will of immense value for research evaluation and revalidation of bowel preps.

References

1. Hien PT, Thoi VH, Ha NT, Kalach N. Efficacy of Two Regimens for Colon Cleansing Using Polyethylene Glycol 4000: A Randomized Open Label Trial. Indian Pediatr. 2021 Dec 15;58(12):1119-1123. Epub 2021 May 28.
2. Goodman and Gilman’s The pharmacological basis of therapeutics., 13^th edition
3. Mamula, Petar, and Noor Nema. “Bowel Preparation for Pediatric Colonoscopy.” Frontiers in pediatrics vol. 9 705624. 1 Sep. 2021
4. Barraclough H, Gillett P, Basude D, et al OC68 A multicentre assessment of adequacy of bowel preparation for paediatric ileocolonoscopy using the Boston bowel preparation scale (BBPS) Frontline Gastroenterology 2023;14:A42.

Introduction

Helicobacter pylori (Hp) infection is one of the major causes of gastric cancer and represents a significant global public health challenge. In Japan, where the incidence of gastric cancer is high, reducing the risk through the eradication of Hp is deemed crucial. While enhancing awareness about Hp is thought to encourage testing and contribute to treatment, there is a lack of evaluation regarding the Japanese population's awareness of Hp.

Aims & Methods

In this cross-sectional study, we aim to assess baseline knowledge and attitude tuwards Hp among Japanese population. Participants were recruited through an online survey platform (Macromill, Inc), with ages ranging from 20 to 69, reflecting the age demographic composition of Japan equally across genders. Referencing the existing surveys on Hp^1-3, we assessed knowledge on five key aspects related to Hp: risk of infection (scored out of 7), diseases caused by Hp (scored out of 7), methods of testing (scored out of 5), benefits and side effects of Hp eradication (scored out of 8), and knowledge of gastric cancer prevention (scored out of 10). Attributes of participants, socioeconomic factors, and health literacy (HLS-14)⁴ were also evaluated to study their correlation with knowledge about Hp.

Results

A total of 3,095 individuals participated. Of these, 56.3% reported having some knowledge about Hp. 865 participants (28.0%) had undergone Hp testing, 354 (11.4%) confirmed Hp infection, and 283 (9.1%) had received treatment for Hp. About 55.6% (1,722 participants) consider that the treatment for Hp posed a significant financial burden. The average correct response rate across all knowledge items was 45.6% (SD: 19.0%). The individual correct response rates were 57.3% for risk of Hp infection, 50.9% for diseases caused by Hp, 24.5% for methods of testing, 45.6% for benefits and side effects of Hp eradication, and 44.4% for knowledge of gastric cancer prevention. Higher scores were significantly associated with having an income over 4 million yen, a family history of Hp, personal Hp testing history, Hp treatment history, and higher health literacy. Over 80% of respondents acknowledged that understanding the relationship between Hp and stomach symptoms, recognizing Hp as a gastric cancer risk, and knowing that Hp eradication reduces future gastric cancer risk influenced their decision on the need for eradication. Similarly, the same proportion reported that believing that the harshness of the treatment exceeds the current symptoms and the high costs of testing and treatment influenced their decisions for eradication.

Conclusion

The level of understanding of Hp among the Japanese population is moderate and influenced by income level, health literacy, and personal experience with the Hp infection. Many consider testing and treatment burdensome. Enhancing correct understanding of Hp could potentially increase testing and treatment rates, contributing to the future reduction of gastric cancer in Japan.

References

1. Kimberly S Bailey, et al., Helicobacter pylori treatment knowledge, access and barriers: a cross-sectional study. Helicobacter 2023;28(2):e12954.
2. You Wu, et al., Awareness and attitudes regarding Helicobacter pylori infection in Chinese physicians and public population: A national cross-sectional survey.Helicobacter 2020;25(4):e12705
3. Thomas Zheng Jie Teng, et al., Helicobacter pylori knowledge and perception among multi-ethnic Asians.Helicobacter 2021;26(3):e12794.
4. Machi Suka, et al.,The 14-item health literacy scale for Japanese adults (HLS-14). Environ Health Prev Med. 2013;18(5):407-15.

Introduction

Endoscopic ultrasound-guided fine needles biopsy (EUS-FNB) is nowadays considered mandatory for the assessment of solid pancreatic lesions (SPLs) in the neoadjuvant era. Even if most recent guidelines suggest that not less than 3 passes are sufficient to obtain adequate histological characterization, the right number of needle passes with the newest generation of FNB needles remains a topic of debate. In our study we aim to evaluate if less than 3 passes are enough to ensure high rates of confirmed histological diagnosis with the newest generation of FNB cutting needles.

Aims & Methods

Consecutive patients with SPLs requiring tissue sampling through EUS-FNB were enrolled in our study between October 2022 and March 2023. Tissue sampling was performed by the same expert endoscopist through a new 22G needle with asymmetric three-prong tip with the slow-pull technique and fanning when possible. The number of needle passes was determined by the macroscopic onsite evaluation (MOSE), and samples, coming from different passes, were divided into different test tubes. Our endpoints were diagnostic accuracy, positive core procurement yield and sample quality considering each test tube separetely.

Results

53 lesions (of which 75% pancreatic ductal adenocarcinoma) were sampled with an average size of 31 mm (SD=12mm). Sampling was performed with 2 or 3 passes, according to MOSE. Regarding the first needle pass, diagnostic accuracy was 97% (51 confirmed histological diagnosis) which reached 98% considering the second needle pass. Sample adequacy reached approximately 99%. Positive core procurement and tissue quality were >95% in all test tubes. No major adverse events were detected.

Conclusion

In patients with SPLs, the newest generation of histology needles for EUS-FNB could ensure a high diagnostic accuracy with only one needle pass, becoming extremely relevant in terms of time-saving, cost-effectiveness and safety, especially in high volume centers. Due to the limited number of patients additional data are needed.

Introduction

Axial spondyloarthritis (axSpA), characterised by chronic inflammation of the sacroiliac joints (SIJs) and spine, is a common extraintestinal manifestation in Inflammatory Bowel Disease (IBD). It is associated with poor outcomes and a substantial impact on quality of life. Thus, early detection is important to optimally tailor treatment and suppress the inflammation in all disease domains. However, the prevalence and pattern of axial involvement have not been described in early IBD.

Aims & Methods

We aimed to describe the prevalence and distribution of axial symptoms, clinical findings and MRI-determined inflammatory and structural lesions in the spine and SIJs of patients with newly diagnosed IBD. Patients with newly diagnosed IBD from a prospective population-based inception cohort were consecutively included. Structured rheumatological interview collecting data on peripheral and axial symptoms and clinical evaluation were performed. MRI assessment for spine and SIJ inflammation and structural lesions was based on validated and widely applied scoring systems [1,2]. Further, an expert assessment of the MRIs as +/- indicative of axSpA applying standardized definitions was performed [3,4].

Results

Of 110 included patients (mean age 42 years, 40% male, 40 with Crohn’s disease (CD), 70 with ulcerative colitis (UC)), 74 had active IBD. At the time of evaluation, 4 patients received treatment with systemic glucocorticoid and one received TNF-inhibitor. Nine patients were HLA-B27 positive. None were previously diagnosed with SpA.
Back and/or buttock pain was reported by 48(44.9%) patients and inflammatory back pain by 10(9.1%). In 23(21.5%) patients the pain could not be better explained by competing conditions (for example degenerative disc disease, nerve root compression, osteoporosis or fibromyalgia) according to the assessing rheumatologist. The axial symptoms were accompanied by peripheral joint and/or entheseal symptoms in 30(62.5 %) patients and 33(68.8%) had tender and/or swollen joints and/or entheses.
According to the MRI expert, MRIs of 17(16.7%) patients were indicative of axSpA (spine and SIJs evaluated together), while 11(10.8%) of the spine-MRIs and 13(12.7%) of the SIJ-MRIs were indicative of axSpA. Only 10 of the 17 patients with typical axSpA MRI findings had axial symptoms. There was no difference in symptoms or MRI findings between patients with UC and CD, or between patients with active and inactive IBD.
Spine bone marrow oedema (BME) in ≥1 slice was present in 30(30.3%) patients. SIJ BME in ≥1 slice was found in 27(26.5%) patients, erosion was present in 24(23.5%) patients, fat lesions in 12(11.8%) and ankylosis in 3(2.9%). The definition of positive MRI for sacroiliitis was fulfilled in 12 (11.8%) patients of whom six had axial symptoms. The Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA were met in 11 cases.

Conclusion

One out of six patients with newly diagnosed IBD had findings indicative of axSpA on spine and SIJs MRI. Since only ̴60% of these patients were symptomatic, we conclude that axSpA may be an underdiagnosed early-occurring condition among IBD patients. Our results indicate a low threshold for performing MRI of the spine and SIJs and a need for multidisciplinary collaboration to ensure early detection of axial involvement to enable an optimal therapeutic strategy and prevent future structural damage and disability.

References

1. Maksymowych et al., Art Rheum, 2005, 53(5) and 53(4)
2. Maksymowych et al., Journal of rheum, 2014
3. Lambert et al., Ann Rheum Dis 2016
4. Maksymowych et al., Rheumatology 2021

Introduction

Current guidelines advise esophagectomy for submucosal esophageal adenocarcinoma (T1b EAC). However, data from retrospective studies suggest that endoscopic follow-up (FU) may be a valid alternative in patients without signs of lymph node metastases (LNM) at baseline. In this international multicenter, prospective cohort study (NCT03222635), we aim to evaluate the safety of a watchful waiting strategy with regular endoscopic FU in patients treated endoscopically for T1b EAC.

Aims & Methods

This ongoing prospective study is conducted in 19 hospitals in Europe and Australia, and aims to include 141 patients with 5-year FU. After radical endoscopic resection of T1b EAC, patients are re-staged with endoscopic ultrasound (EUS) and CT/PET. In the absence of LNM or distant metastases (N0M0), and upon consent for endoscopic FU, patients are included and undergo strict endoscopic FU with gastroscopy and EUS every 3 months during year 1 and 2, every 6 months during year 3 and 4, and at year 5. CT/PET is repeated after 1 year. We divided our cohort into two groups: ‘high-risk’ (submucosal invasion ≥500um, a/o poorly/undifferentiated tumor (G3-4), a/o lymphovascular invasion (LVI+)) and ‘low-risk’ if no high risk features are present. Primary outcome parameters are 5-year disease specific survival and overall survival; secondary outcome parameters are rate of LNM and local recurrence.

Results

Since July 2017, 134 patients (112 men, median age 69 ±10 years) were included with a median FU of 22 (IQR 11-35) months: 87 high-risk and 47 low-risk patients. 6 patients (4% [95%CI 0.2-8.8]) were diagnosed with LNM (table 1) after median FU of 8 (IQR 5-16) months. Of these 6 patients, 2/6 were referred for neoadjuvant chemo(radio)therapy with esophagectomy (ypT0N1M0, ypT0N0M0), 1/6 underwent esophagectomy only (pT0N2M0), 3/6 underwent a selective surgical resection of the tumor-positive LN.
7 patients (5% [95%CI 0.8-9.6] were diagnosed with an intra-luminal tumor recurrence not eligible for endoscopic re-treatment after median FU of 7 (IQR 6-15) months. 5 had initial ESD and 2 cap-based EMR. Of these 7 patients, 2/7 underwent esophagectomy (pT1bN0M0, pTisN0M0), 1/7 had neoadjuvant chemoradiotherapy and esophagectomy (ypT1aN0M0), 3/7 underwent (chemo)radiotherapy only, of which 1 patient eventually died as result of stenosing EAC, 1/7 refused additional treatment. No distant metastases were diagnosed during FU in both cohorts. Five patients died during FU of a cause unrelated to EAC. Five patients discontinued FU due to old age. Two patients were lost to FU.

Conclusion

The preliminary analysis from our ongoing prospective study suggest that in patients with radically removed high- or low-risk T1b EAC, without LNM at baseline, a strict endoscopic follow-up protocol is feasible and the window for curative therapy remains open for those patients who develop LNM (4%) or a local intra-luminal recurrence (5%) during FU. Most patients demonstrate uneventful FU.

Disclosure

No conflict of interests.