Introduction

In recent years, emphasis has been shifted on to understanding the role of N1-methyladenosine (m1A) in tumor progression. While little is known about its regulatory effect on mRNA and its role in metastatic colorectal cancer (CRC).

Aims & Methods

We performed methylated RNA immunoprecipitation sequencing with tumor tissues and tumor-adjacent normal tissues from three CRC patients to determine the profile of m1A methylation in CRC. Expression of Diaphanous-related formin 3 (DIAPH3) and its correlation with clinicopathological characteristics of CRC were evaluated using immunohistochemistry and online datasets. The role of DIAPH3 in the migration and invasion of CRC cells was evaluated by wound healing and transwell assays. Besides, the downstream targets of DIAPH3 were screened by mass spectrometry analysis. By co-transfecting DIAPH3 siRNA and Keratin 19 (KRT19) ectopic plasmid in CRC cells, the role of DIAPH3-KRT19 signaling axis was confirmed.

Results

The mRNA level of DIAHP3 and its m1A modification were increased simultaneously in CRC. Besides, high expression of DIAPH3 in CRC tissues was significantly associated with metastasis, and tended to progress to an advanced stage. After knocking down the expression of DIAPH3, the migration and invasion capabilities of CRC cells suffered notable decline, which can be rescued by overexpressing KRT19. Besides, the degradation of KRT19 might be regulated by DIAPH3 in a proteasome-dependent pathway.

Conclusion

DIAPH3 mRNA was upregulated in CRC cells through m1A methylation. Targeting DIAPH3 results in suppressed migration and invasion of CRC cells, potentially through proteasome-dependent degradation of downstream KRT19.

Introduction

To compare real‐world outcomes of radiofrequency ablation (RFA) for Barrett’s esophagus (BE) in Belgium before (Feb 2008–Jan 2017) and after (Jan 2017–Dec 2023) reimbursement, focusing on efficacy (complete remission of intestinal metaplasia, CR-IM; complete remission of dysplasia, CR-D), safety, baseline histology, and prior endoscopic resection (ER) rates, with statistical testing.

Aims & Methods

Prospective registry of expert Belgian centers.
- Pre-reimbursement: 342 treated, 295 evaluable (≥ 1 y follow-up; ITT efficacy).
- Post-reimbursement: 701 treated, 627 evaluable (≥ 1 y follow-up; ITT efficacy).
Patients in 2024–2025 with < 5 sessions and no CR were censored. Collected: demographics, histology (IM, LGD, HGIN, EAC), ER rate, Prague C/M, RFA sessions, and outcomes. Categorical variables by χ²/Fisher’s exact; continuous by Mann–Whitney U test.

Results

Conclusion

After reimbursement, Belgian centers treated more patients with no statistically significant differences in demographics, baseline histology, BE extent, ER practice, efficacy or safety (all p>0.05). Reimbursement broadened access without compromising RFA outcomes. Continuous surveillance remains essential.​​​​

References

Vliebergh JH, Deprez PH, de Looze D, Ferrante M, Orlent H, Macken E, Christiaens P, Mana F, De Hertogh G, Willekens H, Bisschops R. Efficacy and safety of radiofrequency ablation of Barrett’s esophagus in the absence of reimbursement: a multicenter prospective Belgian registry. Endoscopy. 2019 Apr;51(4):317–325. doi:10.1055/a-0739-7679. Epub 2018 Oct 25

Disclosure

Speaker fee for Medtronic

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most demanding and high-risk endoscopic procedures.
Failures and complications are more common than we realise, they lead to low satisfaction for the patient, high frustration for the endoscopist, higher risks of more instrumentalization in further re-attempts.

Keeping a meticulous updated data logging is fundamental to understand how we perform, what specific factors predict our failures, and identifying areas of improvement, mistakes or learning opportunities.

Aims & Methods

This prospective cohort study was conducted over a 3-year period (September 2020 to January 2024) at a tertiary care centre.
We defined all the adverse events as per ESGE guidelines¹ The 30- mortality was analysed and stratified based on relation to ERCP.
We also identified patients’ factors (Age, sex, frailty, NEWS>4, anticoagulation, antiplatelets, palliative) and technique (First pass cannulation, double wire, precut sphincterotomy, sphincteroplasty). Descriptive statistics, chi-square or t-tests were used to evaluate associations between clinical characteristics and outcomes.

Results

A total of 438 patients underwent ERCP by the single operator during the study period. Procedural success was achieved in 389 cases (88.9%) and in 100% of cases of non-native ampulla. Success rates were lower in malignant cases (80.6%) compared to benign cases (90.05%) with an odds ratio (OR) of 2.21 (CI 1.05–4.63, p = 0.03).
Complications included: Post-ERCP pancreatitis: 12/438 (2.74%) Infections: 4/438 (0.91%) (3 cholangitis, 1 cholecystitis) Perforation: 3/438 (0.68%) and Bleeding: 2/438 (0.45%)
Mortality within 1 month was 17/438 (3.88%) mostly unrelated to the procedure in palliative and frail patients. Procedure-related mortality occurred in 4 cases (0.91%),due to pancreatitis (n=2),perforation (n=1) and sepsis secondary to cholecystitis (n=1).
Of all conscious sedation, only 204 /423 (48.2%) were deemed comfortable. 174/423 (41.1%) had mild discomfort, 32/423 (7.5%) had significant discomfort and 13/423 ( 3.07%) severe or very poor. Female patients demonstrated higher risk of poor tolerance (OR 2.09, CI 1.05–4.18 p = 0.04) but no higher procedural failure.
In difficult cannulation, double-wire succeeded in 19/36(52.8%). When combined with additional techniques after initial failure, success increased to 77.8%. Pre-cut sphincterotomy succeeded only in 13/25( 52%) lower than data published (>75%), thought to be due to learning curve and limited patient tolerance. However, pre-cut helped cannulation in most follow-up ERCPs .
Double wire associated risk of post-ERCP pancreatitis -but exclusively when prophylactic pancreatic duct stent was not placed-OR 3.96 (CI 1.02-15.3) p=0.04. None other AEs were significantly associated with any advanced cannulation techniques.

Conclusion

Overall failure rates and AEs were consistent with published literature. Statistically significant risks of failure included malignant aetiology (OR 2.21) and poor tolerance (OR 2.20). Female sex associated higher intolerance (OR 2.09). Both double-wire and pre-cut sphincterotomy showed failure rates of approximately 50%. Frailty was a significant predictor of 30-day mortality (OR 4.83).

References

1. Dumonceau JM, Kapral C, Aabakken L, Papanikolaou IS, Tringali A, Vanbiervliet G, Beyna T, Dinis-Ribeiro M, Hritz I, Mariani A, Paspatis G, Radaelli F, Lakhtakia S, Veitch AM, van Hooft JE. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020 Feb;52(2):127-149.
2. Banks PA, BollenTL, Dervenis C et al. Classification of acute pancreatitis– 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102–111
3. Enochsson L., Swahn F., Arnelo U., Nilsson M., Löhr M., Persson G. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP. Gastrointest. Endosc. 2010;72:1175–1184.
4. Spadaccini M, Binda C, Fugazza A, Repici A, Tarantino I, Fabbri C, Cugia L, Anderloni A, On Behalf Of The Interventional Endoscopy Amp Ultra Sound I-Eus Group. Informed Consent for Endoscopic Biliary Drainage: Time for a New Paradigm. Medicina (Kaunas). 2022 Feb 22;58(3):331.
5.Chen J, Wan JH, Wu DY, Shu WQ, Xia L, Lu NH. Assessing Quality of Precut Sphincterotomy in Patients With Difficult Biliary Access: An Updated Meta-analysis of Randomized Controlled Trials. J Clin Gastroenterol. 2018 Aug;52(7):573-578

Introduction

Biliary drainage (BD) in patients with distal malignant biliary obstruction (DMBO) implies a higher risk of difficult biliary cannulation (DBC) during endoscopic retrograde cholangiopancreatography (ERCP). When standard techniques, (sphincterotome, and guidewire) fail, the endoscopist may proceed with advanced cannulation techniques, such as the double
guidewire technique, needle-knife precut papillotomy or fistulotomy, and transpancreatic sphincterotomy. Despite the higher risk of adverse events, these advanced strategies can still fail in
up to 15% of cases. In recent times, endoscopic ultrasound-guided biliary drainage (EUS-BD) emerged as a viable alternative in case of DBC due to its favorable profile in terms of both technical success, and safety.

Aims & Methods

Multi-center (4 centers), international (Italy, France), retrospective, propensity score-matched study including patients with DMBO, and common bile duct (CBD) diameter >12mm. DBC cases managed with either advanced cannulation techniques (aERCP group), or direct EUS- guided approach (performed straight away after failure of standard cannulation; EUS-BD group) were considered for the analysis. A 2:1 propensity score-matched analysis was performed balancing age, sex, and CBD diameter to reduce confounding, and ensure comparability between groups. The outcomes of interest were the rates BD failure, clinical success, and adverse events (AEs).

Results

Standard cannulation techniques failed in 524 cases during the study period. Advanced cannulation techniques, and EUS-guided approach were attempted in 472, and 52 cases, respectively. After matching, 76 (aERCP group), and 38 patients (EUS-BD group) were included in the analysis (age: 77.4+10.5 and 76.7+12.6, male: 70.6% vs 71.1%, CBD diameter: 16.5+2.9 and 17.2+3.3, respectively). In aERCP group, also advanced cannulation techniques failed in 17 22.4%) cases, however all these patients were successfully treated by EUS-guided approach as a rescue strategy. No cases of BD failure were reported in EUS-BD group (p<0.05). Clinical success was comparable between the two groups (aERCP:91.2%, vs EUS-BD:94.7%, p=0.46). The 20.6% of patients experienced AEs in the aERCP group (7 cholangitis, 6 pancreatitis, 2 bleeding, 2 other), compared to the 7.9% reported in EUS-BD group (2 cholangitis, 1 pancreatitis, 1 bleeding; p=0.14).

Conclusion

EUS-guided biliary drainage shows higher technical success rate compared to advanced cannulation techniques, with comparable clinical success. Regarding safety, the observed trend of reduced adverse events (AEs) with the EUS-guided approach may require a larger, adequately powered study to confirm statistical significance. In patients with dilated CBD (>12mm).
EUS-BD may be considered an efficient option in case of DBC, possibly minimizing the risk of adverse events.

Clinical Case Summary

Colonoscopy is an essential tool in the diagnosis and management of various gastrointestinal disorders, yet it carries a risk of complications that can complicate patient care. Among these, post-colonoscopy appendicitis represents a rare but critical condition. The interplay between colonoscopy-induced inflammation and pre-existing appendiceal pathology may contribute to this phenomenon. A thorough understanding of the pathophysiology, clinical manifestations, and management strategies associated with post-colonoscopy appendicitis is vital for healthcare professionals to enhance early recognition and optimize patient outcomes.
A sixty-one-year-old female patient underwent esophagogastroduodenoscopy(EGD) and colonoscopy due to recurrent episodes of diffuse, non-radiating mild abdominal pain, as well as for colorectal cancer screening. The procedure was conducted without complications, but the bowel preparation was deemed inadequate (BBPS: 1-2-1). Twenty-four hours later, the patient presented to the emergency department, reporting severe diffuse non-radiating abdominal pain accompanied by multiple episodes of vomiting, nausea, and watery non-bloody diarrhea. Computed tomography of the abdomen was performed showing acute appendicitis. Subsequently, open appendectomy was performed with a course of intravenous antibiotics and patient then discharged home in good physical condition.
In conclusion, this case highlights the potential for post-colonoscopy appendicitis as a rare but significant complication that can arise following gastrointestinal procedures. It underscores the importance of maintaining a high index of suspicion for appendicitis in patients presenting with abdominal symptoms after colonoscopy, facilitating timely diagnosis and treatment.

References

• Ali,Mohammad MD¹; Patel, Jigar MD²; Katz, Douglas MD²; Friedel, David MD³. Post-Colonoscopy Appendicitis: A Rare but Concerning Entity: 1548. American Journal of Gastroenterology 113():p S891, October 2018
• ASGE review of adverse events in colonoscopyKothari, Shivangi T. et al.
  Gastrointestinal Endoscopy, Volume 90, Issue 6, 863 - 876.e3
  

Clinical Case Summary

Background & aim: Gastric ischemia is a rare but often overlooked cause of abdominal pain. We present a case of chronic ischemic gastritis due to severe mesenteric arterial stenosis, highlighting the importance of early recognition and interventional management.
Methods: A 77-year-old female with type 2 diabetes mellitus and dyslipidemia presented with a 1-month history of severe postprandial epigastric pain, progressive in intensity, leading to significant weight loss and liquid diet dependence. She denied vomiting or bowel habit changes. Esophagogastroduodenoscopy(EGD) revealed severe erythematous, edematous mucosa with multiple scattered clean-based ulcers and erosions in the stomach and duodenum. CT angiography demonstrated severe atherosclerotic changes, including near-complete stenosis of the celiac trunk and significant narrowing of the superior mesenteric artery (SMA).
Results: A multidisciplinary team, including surgery and interventional radiology, decided on superior mesenteric angioplasty. The procedure involved abdominal aortogram, selective SMA arteriogram, and angioplasty with placement of two metallic stents, achieving successful revascularization. Post-procedure, the patient was discharged on dual antiplatelet therapy. Follow-up showed complete resolution of symptoms, improved appetite, and weight gain. Repeat EGD revealed significant mucosal healing, confirming the success of revascularization.
Conclusion: Chronic ischemic gastritis is an underdiagnosed entity that should be considered in patients with postprandial abdominal pain and weight loss, especially with vascular risk factors. Early recognition and intervention can lead to significant symptom relief and improved outcomes. This case emphasizes the role of endovascular interventions in managing ischemic gastroduodenopathy.

References

Clinical Gastroenterology and Hepatology 2014;12:246–252
Ribas BM,. Severe ischemic gastritis caused by chronic mesenteric ischemia. J Vasc Bras. 2023;22:e20230002