Introduction

This study aims to compare the clinical efficacy and application value between a novel magnetic marker-assisted intraoperative real-time navigation system and conventional carbon nanoparticle labeling for precise tumor localization in intestinal resection procedures.

Aims & Methods

A prospective randomized controlled trial enrolled 120 patients with histologically confirmed early intestinal neoplasms undergoing laparoscopic resection at our institution from September 2021 to September 2024. Participants were stratified into three cohorts: Group A (magnetic marker navigation system, n=40), Group B (carbon nanoparticle labeling, n=40), and Group C (unmarked controls, n=40). Preoperative endoscopic procedures in Group A involved trans-mucosal implantation of three ferromagnetic markers in inverted triangular configuration at 1 cm intervals from both oral and anal tumor margins 24-48 hours prior to surgery. Intraoperative localization utilized dual-modality guidance combining endoscopic light source visualization with magnetic sensor detection to delineate resection boundaries.

Results

Both Groups A and B achieved 100% accuracy in tumor margin delineation with R0 resection rates, while Group C demonstrated 17.5% margin positivity (7/40) requiring intraoperative frozen section-guided re-excision. The novel magnetic navigation system (Group A) significantly reduced lesion localization time compared to conventional methods [(0.45 ± 0.56 vs 5.42 ± 2.28 minutes, P < 0.001)]. Both experimental groups exhibited superior operative efficiency versus controls, with total procedure durations reduced by 32.6% (Group A) and 28.4% (Group B) respectively (P < 0.01).

Conclusion

The proprietary magnetic marker-assisted real-time navigation system demonstrates significant advantages in localization precision and operative efficiency for laparoscopic intestinal tumor resection, representing a technically superior alternative to traditional localization methods.

Introduction

In pediatric patients, gastrostomy tubes are not always permanent. Sometimes these tubes are removed after the patient can tolerate sufficient oral nutrition and have spontaneous closure. The site becomes a gastrocutaneous fistula (GCF) when persistent leakage occurs for more than one month. Although surgical repair is generally successful for GCF, endoscopic approaches with an over-the-scope clip (OTS clip) are less invasive and have a lot of benefits, such as less postoperative pain and shorter procedure time.

Aims & Methods

Aim: This study aimed to determine the efficacy and safety of therapy with OTS clips combined with fibrin glue for closure GCF in the pediatric population.
Methods: All the procedures were performed under general anesthesia. To cauterize the GCF tract we used argon plasma coagulation, cytology brush or electric scalpel. After scarifying the tract, fibrinogen and thrombin solutions were injected through the skin into the fistulous tract. After that, the GCF was closed with an OTS clip Padlock system. One month and 6 months after postclosure, the patient returned for a follow-up visit and an X-ray.

Results

A total of 10 children were selected for this study. 2 were excluded because the OTS clip didn’t pass through the oropharynx, and one was ruled out for having peptic esophagitis. Therefore, a total of 7 patients were included. Gastrostomy tubes were in place for more than 6 months in all patients.
Patients mean age was 7 years old. The youngest patient was 2 years old and the smallest one weighed 13 kg. The GCF tract was scarified with argon plasma coagulation in 2 patients, cytology brush in 3, and electric scalpel in 3 patients. All the fistulas were closed with fibrin glue and OTS Padlock system. All the patients were sent home 4 hours after the procedure.
In one case the clip spontaneously fell off 2 months after the procedure and the patient underwent a second successful endocliping procedure. A follow-up X-ray performed six months after the procedure confirmed that the clip didn’t fall off in 6 patients (85.7%).
There were no endoscopic or anesthetic complications. There were no reports of disabling pain after the procedure.
A total of five (71.4%) patients had definitive GCF closure in the 6-month follow-up. One patient had a recurrence of closed fistula (14.3%) after a respiratory infection, and another one had the gastric wall closed but the skin was still open.

Conclusion

Our study has shown that the OTS clip combined with fibrin glue are safe and effective in closing GCF in children. The current size of the clip limits its use in small children because it is difficult to navigate through the oropharynx. This combined technique is a potential alternative to standard surgery, with fewer complications, less postoperative pain, and shorter procedure time. Further studies are necessary with more patients.

References

1. Bustamante Bm Bhat s Menoza-Ladd A. Endoscopic closure of chronic trachea-esophageal fistula with an over-the-scope-clip suturing technique. Endoscopy 2018: 50:E155-156.
2. Chandrasekar VT, Desai M, Aziz M et al. Efficacy and safety of over-the-scope-clips for gastrointestinal bleeding: a systematic review and mate-analysis. Endoscopy 2019: 51(10): 941-9.
3. Klinger GM, Cardona AH. Endoscopic closure of tracheoesophageal fistula for tuberculosis with an over-the-scope-clip. Rev Esp Enferm Dig 2018: 110(9): 594-6.
4. Khotay T.H., Haber G., Sonpal N. et al. The over-the-scope clip system – a novel technique for gastrocutaneous fistula closure: The first North American experience. Can J Gastroenterol 2012; 26(4): 193-5.
   

Introduction

Serology plays a key role in the evaluation of celiac disease (CD).

Aims & Methods

We assessed the analytical performance for the detection of CD autoantibodies, compared with routine laboratory methods, of MosaiQ AiPlex^® CD microarray (AiPlex CD. AliveDx, Switzerland) a CE-marked, novel, single-use, multiplexed microarray immunoassay, used with its fully automated proprietary system. The valuated device features the simultaneous, semi-quantitative measurement of both IgA and IgG anti-tissue transglutaminase (tTG) and IgA and IgG anti-deamidated gliadin peptide (DGP) antibodies, as well as a qualitative measurement of total IgA in human serum; however, for this study, the comparison was limited to tTG IgA and tTG IgG as no samples characterized for DGP IgA nor for DGP IgG were available. Banked, de-identified serum samples characterized as reactive or non-reactive for tTG IgA and tTG IgG as per routine methods were tested with the evaluated device. Routine methods included EliA™ Celikey^® IgA (Phadia AB, Sweden), EliA™ Celikey^® IgG (Phadia AB, Sweden), QUANTA^® Flash h-tTG IgA (Inova Diagnostics, USA), QUANTA^® Flash h-tTG IgG (Inova Diagnostics, USA), Anti-Tissue-Transglutaminase IgA (ORGENTEC Diagnostika GmbH, Germany), Anti-Tissue-Transglutaminase IgG (ORGENTEC Diagnostika GmbH, Germany) and QUANTA Lite^® R h-tTG IgA ELISA (Inova Diagnostics, USA). Positive percent agreement (PPA), negative percent agreement (NPA) for individual analytes were calculated as were overall positive and percent agreements.

Results

The evaluated device identified 43 out of 45 samples characterized as reactive for tTG IgA per routine methods and 79 out of 81 samples characterized as non-reactive, for a PPA of 96% (95% CI: 84.8, 99.4) and an NPA of 98% (95% CI: 91.3, 99.7). Likewise, it identified 14 out of 18 samples characterized as reactive for tTG IgG per routine methods and 79 out of 85 samples characterized as non-reactive, for a PPA of 78% (95% CI: 52.3, 93.5) and an NPA of 93% (95% CI: 85.2, 97.3). Overall positive and negative percent agreement were 90% (95% CI: 80.4, 96.4) and 95% (95% CI: 90.7, 97.9), respectively (Table 1).

Conclusion

In the present study, the evaluated multiplexed microarray immunoassay showed high concordance with routine methods for the detection of tTG IgA and tTG IgG. This device may be considered a suitable alternative method for the serological assessment of patients under clinical suspicion of CD and has the potential to help simplifying the laboratory evaluation of this condition by simultaneously and automatically analyzing IgA and IgG isotypes of key CD markers.

Disclosure

This study was funded by AliveDx Suisse SA, Eysins, Switzerland. Gerber Gomez ​and Christian Fischer are AliveDx employees.

Introduction

Despite significant advances in the management of non-variceal upper gastrointestinal bleeding (NVUGIB), the optimal timing of endoscopy remains a subject of debate. Current guidelines recommend performing endoscopy within 24 hours of presentation, yet the impact of this strategy in different risk stratifications is not fully elucidated.
This study aimed to evaluate the influence of early endoscopy (≤24 hours) on clinical outcomes in NVUGIB patients, with particular focus on risk stratification using the Glasgow-Blatchford Score (GBS).

Aims & Methods

This retrospective, single-center cohort study included consecutive adult patients who underwent upper gastrointestinal endoscopy for suspected NVUGIB over a four-year period. Demographic, clinical, biochemical, endoscopic, and outcome data were collected and analyzed.
Patients were stratified based on GBS into low-risk (GBS <12) and high-risk (GBS ≥12) categories. The primary outcome was 30-day mortality. Secondary outcomes included need for endoscopic hemostasis and blood transfusion

Results

A total of 298 patients were included (mean age: 65.3 ± 17.1 years; 57% male), of whom 55% were classified as high-risk. Endoscopy was performed within 24 hours in 62.1% of cases.
In low-risk patients, early endoscopy was significantly associated with:

• Higher rate of endoscopic therapy (p = 0.003)
• Lower 30-day mortality (p = 0.03)
• Reduced need for blood transfusion (p = 0.03)

Patients in the low-risk group who underwent delayed endoscopy (>24 hours) were significantly older (70.8 ± 15.2 vs. 63.5 ± 16.7; p = 0.01), had more comorbidities (Charlson Comorbidity Index: 4.0 ± 2.1 vs. 3.1 ± 2.5; p = 0.02), lower baseline hemoglobin (10.1 ± 3.1 vs. 11.3 ± 2.8; p = 0.03), and were more frequently admitted during weekends or holidays (27 vs. 0; p < 0.001).
In contrast, in high-risk patients, no statistically significant differences in outcomes were observed between early and delayed endoscopy.

Conclusion

Our findings suggest that performing upper endoscopy within 24 hours is associated with improved clinical outcomes, specifically reduced mortality and transfusion requirements, in low-risk NVUGIB patients. Early intervention appears especially beneficial in older patients with multiple comorbidities and initial anemia. These data support prioritizing early endoscopic evaluation in selected lower-risk patients as part of optimized UGIB management pathways.

References

 Sung JJY, Chiu PWY, Chan FKL, Lau JYW, Goh KL, Ho LH, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding. Gut. 2018;67(10):1757–68.
 Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations. Ann Intern Med. 2019;171(11):805–22.
 Lau JYW, Yu Y, Tang RSY, Chan HCH, Yip HC, Chan SM, et al. Timing of endoscopy for acute upper gastrointestinal bleeding. N Engl J Med. 2020;382(14):1299–308.

Introduction

Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic disorder characterized by recurrent intestinal inflammation and complications. Although there has been significant research on bacterial dysbiosis in IBD, the role of the gut mycobiome has been largely overlooked, especially in surgical tissue samples.

Aims & Methods

We aim to characterize the intestinal mycobiome in surgical resections from IBD patients.
Intestinal fungal communities in surgical resections obtained from 20 UC and 30 CD patients, with non-IBD colonic and ileal resections as controls respectively, were analyzed. Fungal DNA was extracted and the ITS region was amplified and sequenced. This data was processed by Dada2 software. Statistical analyses were performed in R, using Adonis tests for multivariate analysis. Rarefaction curves, richness and diversity indexes were calculated and compared by Wilcoxon. Constrained correspondence analysis (CCA) was used for visualization, and ANCOMBC2 for taxon abundance comparisons. P-values were adjusted using FDR method. Spearman's correlation was applied to correlate mycobiome data with microbiota sequencing. Data were expressed as mean ± SEM and compared using t-tests, one-way ANOVA, or Kruskal-Wallis tests, with significance set at p < 0.05.

Results

Results revealed modest changes in fungal diversity and richness in UC resections compared with control-UC samples. However, CD exhibited significant mycobiome alterations at genus level, including an increased abundance of Malassezia (log2FC=-1.4), specifically Malassezia globosa (log2FC=-9,4) at species level, alongside a reduction in Yarrowia lipolytica (log2FC=8.2) compared to the control-CD samples. Regarding fungal correlations, in surgical samples from UC patients, the majority of the correlations were positive while any negative correlation was statistically significant. On the other hand, CD patients showed few negative and weaker positive correlations. Correlation analyses further suggested complex interkingdom interactions between fungal and bacterial communities. In UC patients, Dothideomycetes unclassified stands out with the majority of significant correlations, whereas in CD patients most of the significant negative correlations found in control-CD disappeared while new significant correlations appeared.
Additionally, mycobiome differences between complicated CD-phenotypes were analysed and Cryptococcus pseudolongus and Cladosporium unclassified were significantly more abundant in B3 samples than in B2, whereas Dothideomycetes unclassified was more abundant in B2 than in B3. Moreover, distinct fungal signatures capable of discriminating between them were identified by analyzing ROC curves and Dothideomycetes unclassified presented an AUC value of 0,823 and Cladosporium unclassified with an AUC of 0,737.

Conclusion

Intestinal mycobiome has been characterized for the first time in surgical resections from both UC and CD patients, observing statistical differences in the genera Malassezia and Yarrowia in CD patients. Additionally, several associations between fungal and bacterial species were identified, highlighting the direct interaction between the bacteriome and mycobiome. Notably, complicated-CD phenotypes exhibit a distinct mycobiome pointing Dothideomycetes unclassified and Cladosporium unclassified as potential discriminators between these phenotypes.

Introduction

With nearly half of Romania’s population living in rural areas (1) with limited imaging access, non-invasive tests for liver steatosis and fibrosis are especially valuable. In such settings, ultraportable devices may offer practical solutions by providing point-of-care (POCUS) liver assesment.

Aims & Methods

The aim of this study was to determine the prevalence of liver steatosis and fibrosis in this population and to assess the concordance between ultrasound and various non-invasive serological and imaging methods within a screening program.
Between 2022 and 2024, Caravans were conducted in 17 villages across Central and North Romania. Participants received blood tests, abdominal ultrasound(US), and ultrasound elastography using ultraportable devices (liver stiffness (LSM) and attenuation coefficient(AT). Steatosis was assessed with the Fatty Liver Index(FLI), Hepatic Steatosis Index(HSI) while fibrosis was evaluated using FIB-4 and the NAFLD Fibrosis Score (NFS) and pairwise agreement between methods was determined by overall percentage agreement, Cohen’s kappa (κ), and concordance within each modality’s defined low- and high-risk groups.

Results

Of the 1,935 individuals screened, 1,721 underwent blood tests and 1,208 underwent ultrasound.62% had a BMI>25 kg/m², with 31.2% overweight,27.3% grade I obesity,11.9% grade II obesity and 8.1% morbid obesity;54.5% had prediabetes, 17.7% diabetes and 78.7% were dyslipidemic.
Steatosis prevalence was 50.8% on ultrasound (mild:30.6%,moderate:11.7%,severe:8.6%) and 26.5% on AT (mild 11.9%, moderate 4.9%, severe 9.7%). High steatosis risk was estimated at 55.1% by FLI, 63.7% by HSI and 86.5% by VAI.
Pairwise concordance for steatosis was moderate for US vs FLI and US vs AT (κ = 0.39 and 0.33).FLI and HSI showed the strongest agreement (k = 0.66; 92.7%match in high-risk). AT showed weak concordance with serological scores. (Table 1).
Advanced liver disease was found in 3.4% by ultrasound. LSM classified 88.4% as<F2 and 4.8% as F3–F4.Low fibrosis risk was found in 61.5% (FIB-4) and 62.5% (NFS) and high risk in 5.4% and 5.85%.
For fibrosis, US vs LSM showed 97.7% concordance (κ = 0.69), US vs FIB-4 93.3% (κ = 0.39)(Table 1).Among intermediate‐risk cases of the serological tests, 4.4% of FIB-4 and 6.7% of NFS had advanced (F3–F4) fibrosis.

Conclusion

FLI and HSI showed strong agreement and among serum scores FLI showed the strongest agreement with ultrasound. LSM aligned most closely with ultrasound, making it the best confirmatory test, while FIB-4, although less sensitive for advanced disease had very good low-risk agreement and therefore would be suiteble for initial screening.

References

1. National Institute of Statistics. Romania in figures-statistical abstract. https://insse.ro/cms/ro/content/rom%C3%A2nia-%C3%AEn-cifre-breviar-statistic-limba-englez%C4%83-4.

Disclosure

The HE-RO-I Project (State-of-the-art colaborativ ROmânia-Islanda în managementul HEpatopatiilor cronice și a complicaţiilor acestora, ciroza hepatică și cancerului hepatic, destinat grupurilor vulnerabile din România, inclusiv Romi) was initiated by a team of physicians from the Gastrointestinal and Hepatology Institute of Cluj-Napoca, in collaboration with Caravana cu Medici – Cluj-Napoca Branch and Landspítali University Hospital in Reykjavik, Iceland, under the coordination of the Romanian Ministry of Health. The project aimed to deliver health education and conduct screening—primarily for liver diseases—among vulnerable populations (including roma people) from remote areas of Central and Northern Romania.
Financed by the Finance Mechanism of European Economic Space 2014-2021.

Introduction

Upper gastrointestinal bleeding (UGIB) remains a major clinical emergency with significant morbidity and mortality despite advances in endoscopic and medical management. While existing risk scores have been widely used, their applicability to specific populations is limited. We aimed to identify mortality-associated risk factors in Colombian patients with UGIB and propose the "Bogotá Score" as a novel stratification tool tailored to our population.

Aims & Methods

We conducted a retrospective case-control study involving 472 patients with UGIB across three Colombian centres during 2023. Twenty-five (5.3%) patients died due to UGIB-related complications. Demographic, clinical, and endoscopic variables were compared using bivariate analysis. Variables significantly associated with mortality were included in a multivariate logistic regression model. A point-based risk score—the Bogotá Score—was derived from independent predictors.

Results

Age ≥70 years, anaemia (OR 7.15; p=0.022), haemoglobin <10 g/dL, Blatchford score >8 (OR 1.18; p=0.003), hospitalisation delay >24h (OR 1.01; p=0.008), and rectorrhagia were associated with increased mortality. Conversely, melena was linked to reduced risk (OR 0.20; p=0.001). These variables were integrated into the Bogotá Score. Patients were stratified into four risk categories: low (0–3), moderate (4–6), high (7–9), and very high (≥10).

Table: Bogotá Score – Risk Stratification Tool

Interpretation:

• 0–3: Low risk

• 4–6: Moderate risk

• 7–9: High risk

• ≥10: Very high risk

Conclusion

The Bogotá Score represents a simple, evidence-based tool for early risk stratification in UGIB. By incorporating context-specific variables, it enhances clinical decision-making in Latin American settings. Early ICU transfer and intensive monitoring for high-risk groups may improve outcomes. Future multicentre validation is warranted.

References

• Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. This study evaluates the performance of various risk scoring systems, including the Glasgow-Blatchford Score, in predicting clinical outcomes in UGIB patients. ​BMJWikipedia+7Wikipedia – Die freie Enzyklopädie+7Nature+7

• Zou K, Huang S, Ren W, et al. Development and validation of a dynamic nomogram for predicting in-hospital mortality in patients with gastrointestinal bleeding: a retrospective cohort study in the intensive care unit. Scientific Reports. 2024;14:27940. This research presents a predictive model for in-hospital mortality among patients with gastrointestinal bleeding, emphasizing the importance of tailored risk assessment tools. ​Sage Journals+3Nature+3Nature+3

• In KR, Oh YE, Moon HS, et al. Comparison and validation of several scoring systems for non-variceal upper gastrointestinal bleeding: a retrospective study. Scientific Reports. 2024;14:27940. This study compares and validates multiple scoring systems for non-variceal UGIB, highlighting the need for accurate risk stratification in diverse populations.