Introduction

The LiverRisk score has been developed as blood-based tool to estimate liver stiffness measurement (LSM) in the general population (i.e., in subjects without known chronic liver disease (CLD), and thus, detect compensated advanced chronic liver disease (cACLD; LSM ≥10kPa) and stratify their risk of liver-related events. Notably, its utility in other settings is unclear as a one-size-fits-all blood-based test. We aimed to evaluate its diagnostic/prognostic performance in patients referred to specialized hepatology outpatient clinics (i.e., tertiary care).

Aims & Methods

Subjects with known/suspected CLD at first LSM (cohort-I, n=5897) or first referral & LSM (cohort-II, n=1558) were retrospectively included. Calibration/agreement of the LiverRisk score with LSM was assessed as well as its diagnostic accuracy for LSM-defined cACLD compared to FIB-4/APRI. Finally, its predictive performance for hepatic decompensation was evaluated.

Results

In cohort-I/II, mean age was 48.3/51.8years, 44.2%/44.7% were female, predominant etiologies were viral hepatitis (51.8%)/MASLD (63.7%), median LSM was 6.9 [5.1-10.9]/ 5.8 [4.5-8.8]kPa, and 1690 (28.7%)/ 322 (20.7%) had cACLD.
Despite a moderate correlation (Pearson’s r: 0.325/0.422), the LiverRisk score systematically underestimated LSM (mean difference according to the Bland-Altman-method: -2.9/-1.8 points≙kPa). Variation of observed differences was considerable (95%CI of agreement: 39.4 and 35.2 points≙kPa), and showed a clear pattern towards larger disagreement at higher values with lower LiverRisk score than LSM.
The diagnostic accuracy of the LiverRisk for cACLD (AUROC: 0.757 [95%CI: 0.744-0.770]/ 0.790 [95%CI: 0.762-0.819]) was comparable to FIB-4 (0.769/0.813) and APRI (0.747/0.765). The cut-off of 10points≙kPa yielded an overall accuracy of 74.2%/81.2%, high specificity (91.9/93.4%), but low negative predictive value (76.6/84.5%) with false-negative results in 20.0%/13.5% in cohort-I/II, respectively.
In cohort-I, 208 (3.5%) patients developed hepatic decompensation (median follow-up: 4.7years). The LiverRisk score showed a reasonable accuracy for predicting hepatic decompensation within 2 years (AUROC: 0.817); however, it was inferior to LSM (0.891, p<0.001) and FIB-4 (0.912, p<0.001). The strata of LiverRisk score (and of LSM/FIB-4) discriminated patient groups of distinct risks for hepatic decompensation.

Conclusion

While being a major step forward for screening subjects without known liver disease in primary care, the LiverRisk score was not superior (vs. FIB-4) for diagnosis of cACLD or (vs. FIB-4/LSM) for prediction of hepatic decompensation in a tertiary care setting, i.e., in cohorts with a higher pre-test probability of cACLD. Notably, FIB-4 even outperformed the LiverRisk score in terms of prognostic utility.

Introduction

Functional diseases of the gastrointestinal tract are a common diagnosis, with the most common manifestations being functional dyspepsia and IBS. The pathophysiological mechanisms and etiology of this group of diseases are not fully understood, but stress is believed to play a key role.

Aims & Methods

This study aims to evaluate the effectiveness of a low-histamine diet in patients with irritable bowel syndrome. Patients who meet the ROME IV criteria were included in the study. The study included 120 patients, divided into three groups: low- histamine diet, FODMAP diet and mediterranian diet.Questionnaires were used to assess stress levels PSS-4, anxiety GAD-7, severity of IBS - IBS Severity Score, and quality of life. The questionnaires were completed three times: both at the beginning of the study, immediately after the end of the 4-week diet, and one month after the end of the diet therapy.

Results

The low-histamine diet led to a statistically significant improvement in IBS symptoms compared to baseline. These findings suggest that the dietary intervention had a positive therapeutic effect ( low- histamine diet : t = 9.6181, p-value < 0.001, low FODMAP diet Z = 22, p-value < 0.001, mediterannian diet Z =119, p-value < 0.001).

Conclusion

Dietary therapy plays a key role in the management of IBS. The low-histamine diet shows promising results and may serve as a viable alternative to the FODMAP diet.

Disclosure

The study was launched after receiving approval from the Research Ethics Committee (REC) at the Medical University "Prof. Dr. Paraskev Stoyanov" – Varna, protocol 111/ 20.01.2022y.Data were processed and analyzed using appropriate statistical methods chosen according to the nature of the variables and research questions. The analysis includes:

• Evaluation of the statistical significance of the main and interactions between the factors (Repeated Measures with Wicolxon and Paired t-test).
• Regression analysis to assess relationships between dependent and independent variables. As well as using heteroskedasticity-robust standard error estimates (HC3) to ensure accuracy of regression analysis results.

Clinical Case Summary

Materials and methods: 24-year-old man with an episode of nausea, anorexia and loss of 4-5 kg in a week, which resolved spontaneously without drugs. During the episode had hyperchromic urine, yellowing of skin and eyes.After 1 month small increase of serum transaminases x 1.5. Regular bowel function. No clinical signs. US regular. Anti-HbsAg and HCV-Ab negative. After another month he had highly increase of serum transaminases with AST x 27 and ALT x50 GGT x3, Total bilirubin 2.85. Negative ANA, AMA, LKM, IgA anti TTG, anti EBV, anti CMV, alpha1 anti trypsian slight increase. He performed a new serum analysis with increase of anti-TTG IgA. He subsequently performed genetics for celiac disease and confirmed homozygous DQ2.Performs EGDS for suspected celiac disease which documents nodularity in bulb and DII scalloping. Histological examination shows Marsh 3B.After 150 g gluten daily intake had IgA anti TTG x 4. A diagnosis of celiac disease is made and he started GFD with serum transaminases x 2After 2 months with good adherence to GFD has AST x20 and ALT x 50. He denies alcohol abuse.Negative hemochromatosis mutations. Stable weight, Regular bowel function. We perform liver biopsy. The histological examination documents Histological Activity index acc. Knodell modified by Ishak: 7 Grading.
Results: Diagnosis is moderately active chronic autoimmune hepatitis.Therapy is started with prednisone 40 mg daily. With AST x10 and ALT x 20After 15 days of therapy AST x 5 and ALT x9, therefore values halving and normal bilirubin. Currently under follow-up in our Hospital
Conclusions: Although the history is still unknown and the histological exam is compatible but not certain, the good response to steroid therapy is a positive factor that proves the correctness of the diagnosis. This diagnostic difficulty leads us to always evaluate the autoimmune cause in a young patient without risk factors with a small increase in transaminases.

References

University of Salerno

Introduction

In contrast to mucosal T1 rectal cancers with an R0 rate of up to 92% at centers, R0 resection may drop to 30% in case of deep sm infiltration due to thermal artefacts at the basal resection margin. TME often follows as completion surgery. Deep sm infiltration as isolated risk factor excluding L+, V+, G3 and Bd2-3 seems associated with a low risk of LN metastases of only 2.6%. Endoscopic Intermuscular Dissection (EID) is a new flexible endoscopic dissection technique with separation of the circumferential and longitudinal muscular layer. EID ideally provides a specimen incl. the entire submucosa and inner circumferential mp layer. 12 sequential EIDs were compared to 53 historical rectal ESDs with HGIEN or rectal cancer as hp. result.

Aims & Methods

Lesions with biopsy proven ADC or HGIEN of the rectum without endoscopic, EUS or clinical signs of deep local infiltration. 2 pat. included after neo-adjuvant RT/Ch th. 24 and 26 mo before with complete response and refusing definitive surgery. Both with local flat polyps (SSA (1) hyperplastic polyp / LGIEN adenoma (2). Endoscopy, EUS, MRI, CT and rectal digital examination without suspicion of local malignant infiltration. Pts were offered to prospectively undergo EID after extensive informed consent within a prospective protocol. All procedures were carried out under gen. anesthesia by an exp. interv. endoscopist with >1000 ESDs. Results of EID were compared to a historical collective of 53 cases with rectal ESD and a histological result of rectal cancer or HGIEN (08-2018 to 12-2021).

Results

From 11-2023 to 09-2024, 12 EIDs were carried out in 12 pts (6 f/ 6 m; mean 63 y; 34-83y). 09/12 lower rectum, 1/12 middle, 1/12 lower and middle, 1/12 upper rectum. 'En bloc' resection rate was 100%, R0 resection rate 89% for neoplasia / HGIEN. Histopathology: 3x ADC G2, 6x HGIEN, 3x LGIEN including both cases with neodajuvant RT/Ch. R0 resection was achieved in 2 of the 3 ADCs. Both with deep sm infiltration without any other risk factors. Tumor board: close clin. & imaging FU. In the 3rd ADC: TU infiltration of inner muscular layer (T2). Pat. underwent uneventful TME 10 d after EID. Clinical FU in all others. Length of hosp. stay 7.1 days. No serious major complications. All pts. closely followed with uneventful FU.
In the historical ESD group R0 resection was achieved in 100% of the HGIEN cases (45/45) but only in 3/8 lesions (37.5%) of cases with adenocarcinoma.

Conclusion

EID seems a new perspective for the endosc. resection of T1 rectal cancers and suspicious polyps in the rectum. More experience and a comparison to surgical local procedures (TAMIS etc.) is necessary for the final assessment of EID as new promising endoscopic technique.

References

Introduction

Gastric outlet obstruction (GOO) is a debilitating condition commonly caused by malignant or benign diseases, impairing gastric emptying and nutritional status. While surgical gastrojejunostomy (SGJ) has traditionally been the standard palliative approach, endoscopic ultrasound-guided gastrojejunostomy (EUSGJ) has recently emerged as a minimally invasive alternative. This systematic review and meta-analysis aimed to compare the efficacy and safety of EUSGJ versus SGJ for the management of GOO.

Aims & Methods

A systematic search of PubMed, Embase, Medline, and Cochrane Library was conducted to identify studies directly comparing EUSGJ and SGJ in adult patients with GOO. Nine retrospective studies comprising 1,086 patients (654 EUSGJ; 432 SGJ) were included. Primary outcomes included technical and clinical success, length of hospital stay (LOS), operative time, and overall complication rates. Secondary outcomes included infection, ileus, hemorrhage, perforation, and re-intervention. Meta-analyses were performed using fixed or random effects models depending on data heterogeneity.

Results

EUSGJ was significantly superior to SGJ in terms of technical success (OR = 0.16; 95% CI: 0.05–0.45; p = 0.0006), shorter operative time (MD = –96.89 minutes; 95% CI: –146.16 to –47.61; p < 0.00001), reduced postoperative LOS (MD = –4.79 days; 95% CI: –6.52 to –3.06; p < 0.0001), lower overall complication rates (OR = 0.24; 95% CI: 0.17–0.33; p < 0.00001), reduced postoperative ileus (OR = 0.07; 95% CI: 0.02–0.17; p < 0.00001), and fewer infections (OR = 0.17; 95% CI: 0.08–0.37; p < 0.00001). No statistically significant differences were found regarding clinical success, re-intervention, hemorrhage, or perforation.

Conclusion

EUSGJ demonstrates superior procedural outcomes and safety profiles compared to SGJ in the management of GOO and represents a valuable tool in expert hands. However, further prospective studies and randomized trials are necessary to validate these findings, assess long-term outcomes, and define its role within individualized patient care and clinical guidelines.

Disclosure

No conflict of interest