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MULTIDISCIPLINARY APPROACH IN EOSINOPHILIC OESOPHAGITIS CARE: HOW TO IMPROVE DIAGNOSIS AND MANAGEMENT

Irene Spinelli 1, Francesca Fianchi 1, Arianna Aruanno 1, SARA URBANI 1, Francesca Veccia 1, Daniele Ferrarese 1, Daniela Belella 1, Marco Cintoni 1, Gabriele Pulcini 1, Maria Cristina Mele 1, Francesca Mangiola 1, Rosario Landi 1, Eleonora Nucera 1, Gianluca Ianiro 1, Antonio Gasbarrini 1, Annalisa Tortora 1

Affiliations

1 Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

Summary

AI Generated

A retrospective study of 98 eosinophilic esophagitis patients managed by a multidisciplinary team found high prevalence of co-existing conditions and reduced diagnostic delay compared to published literature.

82% of patients had allergic diseases, 52% required nutritional support, and 64% needed psychological support for disease-related issues
Mean time to diagnosis was 2.25 months for the 13 patients evaluated with the multidisciplinary approach from initial presentation, compared to 3 years diagnostic delay reported in literature
43% of patients were referred by members within the multidisciplinary team, which included gastroenterologist, allergist, dietitian, psychologist, and endoscopist
The study included 98 patients (76 males, 22 females) with mean age at diagnosis of 25 years, referred between September 2016 and April 2023
The authors conclude that a multidisciplinary team approach enables shared decision-making and may reduce diagnostic delay in eosinophilic esophagitis management

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Abstract

Introduction

Eosinophilic esophagitis (EoE) is a complex disease that often coexists with different conditions. Given the complexity of this pathology, a multidisciplinary approach, with gastroenterologist, allergist, dietitian, psychologist, and endoscopist may benefit to diagnosis and management of patients, reducing time to diagnosis as well.

Aims & Methods

To evaluate impact of multidisciplinary team in diagnosis and management of eosinophilic esophagitis disease. A retrospective study was conducted to include all patients referred to Fondazione Policlinico Universitario A. Gemelli between September 2016 and April 2023. Prevalence of allergic, nutritional, and psychological disturbs was evaluated. Referral for each patient was reviewed. Diagnostic delay (time interval between first occurrence of EoE symptoms and confirmed diagnosis with endoscopy) was analyzed in patients with suspected eosinophilic esophagitis and diagnosis made in our center, compared to data reported in literature. Publications from 2014 to 2023 were reviewed.

Results

A total of 98 patients, 76 males and 22 females, with a mean age at diagnosis of 25 years, were included in the study. For all patients, each visit was conducted in team with gastroenterologist, allergist, dietitian, and psychologist. 81 patients presented allergic diseases (82 %), 51 patients (52 %) needed nutritional support by a dietitian and 63 patients (64 %) presented psychological implication by the disease to necessitate clinical support. 42 patients (43%) were referred by team members. 13 patients (13%) presented to our center with suspect eosinophilic esophagitis. For these patients, ab initio evaluated with multidisciplinary approach, mean time to diagnosis was 2.25 months. Diagnostic delay reported in literature was 3 years.

Conclusion

Multidisciplinary team is needed to manage patients with eosinophilic esophagitis because its several associated diseases. In fact, most of our patients presented allergic, nutritional, and psychological disturbs. This approach assures more appropriate medical management through shared decision making. Almost half of patients was referred by team members. Thank to awareness of each physician of the team and his early referral, we assisted in a reduction of diagnostic delay in our center compared to data reported in literature.

References

Lenti MV, Savarino E, Mauro A, Penagini R, Racca F, Ghisa M, Laserra G, Merli S, Arsiè E, Longoni V, de Bortoli N, Sostilio A, Marabotto E, Ziola S, Vanoli A, Zingone F, Barberio B, Tolone S, Docimo L, Pellegatta G, Paoletti G, Ribolsi M, Repici A, Klersy C, Di Sabatino A. Diagnostic delay and misdiagnosis in eosinophilic oesophagitis. Dig Liver Dis. 2021 Dec;53(12):1632-1639. doi: 10.1016/j.dld.2021.05.017. Epub 2021 Jun 8. PMID: 34116974
Sauer BG, West A, McGowan EC. Multidisciplinary Eosinophilic Esophagitis Care: A Model for Comprehensive Patient-Centered Care Through Shared Decision Making Between Gastroenterology, Allergy, and Nutrition. Clin Gastroenterol Hepatol. 2021 Nov;19(11):2226-2229. doi: 10.1016/j.cgh.2021.07.025. Epub 2021 Jul 16. PMID: 34280551.
Murray FR, Kreienbuehl AS, Greuter T, Nennstiel S, Safroneeva E, Saner C, Schindler V, Schlag C, Schoepfer AM, Schreiner P, Straumann A, Biedermann L. Diagnostic Delay in Patients With Eosinophilic Esophagitis Has Not Changed Since the First Description 30 Years Ago: Diagnostic Delay in Eosinophilic Esophagitis. Am J Gastroenterol. 2022 Nov 1;117(11):1772-1779. doi: 10.14309/ajg.0000000000001950. Epub 2022 Aug 12. PMID: 35971224.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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NOVEL BIOLOGICAL AND RADIOLOGICAL MARKERS FOR PREDICTING MALIGNANT PROGRESSION IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLAMS: A PROSPECTIVE STUDY

Lorenzo Piemonti

Approaches to improve nutrition and physical activity levels in patients with liver disease

Catarina Lindqvist

Under Pressure with Lina Sopiene

Egle Dieninyte - Misiune

THREE-YEAR ONCOLOGICAL OUTCOMES OF ENDOSCOPIC INTERMUSCULAR DISSECTION FOR SUSPECTED DEEP SUBMUCOSAL INVASIVE RECTAL CANCER

Roel Hompes

RESULTS OF THE ANGH COHORT ON MILD TO SEVERE ACUTE BILIARY PANCREATITIS (CAPABLES): EVALUATING DIFFERENT FEEDING MODALITIES PRIOR TO CHOLECYSTECTOMY

Hend Ayadi

ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Kazuro Chiba

UEG Presentation

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NOVEL BIOLOGICAL AND RADIOLOGICAL MARKERS FOR PREDICTING MALIGNANT PROGRESSION IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLAMS: A PROSPECTIVE STUDY

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NOVEL BIOLOGICAL AND RADIOLOGICAL MARKERS FOR PREDICTING MALIGNANT PROGRESSION IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLAMS: A PROSPECTIVE STUDY

Stefano Crippa 1, Paolo Riccardo Camisa 1, Giulio Belfiori 1, Benedetta Ferrara 1, Diego Palumbo 1, Francesca Aleotti 1, Laura Cerri 1, Gabriele Capurso 2, Marco Schiavo Lena 1, Paolo Giorgio Arcidiacono 3,1, Francesco De Cobelli 1, Massimo Falconi 4, Lorenzo Piemonti 1

Affiliations

1 San Raffaele Scientific Institute/Vita Salute San Raffaele University, Milan, Italy

2 San Raffaele Scientific Institute Irccs, Rome, Italy

3 Ospedale San Raffaele, Milan, Italy

4 Università Vita-Salute San Raffaele, San Raffaele, Italy

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Abstract

Introduction

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are the most frequently identified precursor lesions of pancreatic cancer (PDAC). Only a minority progress towards malignancy, making their identification a critical point in cancer prevention. The available guidelines are imprecise, commonly resulting in over treatment of indolent lesions.

Aims & Methods

The aim of this study (EMI-IPMN, NCT06706700) is to discover novel biological and radiological biomarkers that can distinguish malignant from benign IPMNs. We focused on Endocrine, Metabolic and Inflammatory (EMI) factors, some pathways that are characterized in PDAC but poorly investigated in IPMN progression.
Patients with a presumed diagnosis of IPMN with indication for surgical resection who underwent high-quality magnetic resonance imaging (MRI) and/or computed tomography (CT), were prospectively enrolled. Peripheral blood (PB) and cyst fluid (CF) samples were collected during surgery, and lesions were histologically classified as IPMN with low-grade dysplasia (LGD), high-grade dysplasia (HGD), or invasive cancer (IC). Malignant IPMNs were defined as those with HGD and IC. Cytokine and hormone levels were measured in both fluids using multiplex assays and compared across the diagnostic groups. Continuous variables were converted into categorical variables based on optimal cut-off values, and both univariate and multivariate logistic regression analyses were conducted.

Results

Among the 205 patients enrolled, 133 (58 females, 75 males, median age 69.2) had a histological diagnosis of IPMN: 49 (36.8%) had LGD, 44 (33.1%) HGD and 40 (30.1%) had IC. Analysis of the EMI profile revealed higher concentrations of several markers (IL-8, VEGF, GLP-1, glucagon, and C-peptide) in CF compared to PB. Specific cytokines such as MCP-1 IP-10, TNFα, and IL-8 were significantly elevated in the CF of HGD/IC cases compared to LGD (p=0.05, 0.041, 0.001 and 0.025 respectively). Similarly, IP-10, IL-8, and MDC levels in PB were higher in HGD/IC patients (p=0.006, 0.008 and 0.004 respectively).
Pancreatic fat content, assessed with mDixon Quant Fat Fraction MRI sequences, was notably higher in HGD/IC patients (13.89%) compared to LGD patients (8.38%, p<0.05), and positively correlated with MCP-1 levels in CF.
Among these biological and radiological markers TNFα in the CF demonstrated a substantial diagnostic accuracy for identifying malignant IPMN, with an area under the ROC curve (AUC) of 0.72. In the final multivariable analysis we demonstrate that high TNFα levels in CF and HbA1c were the two independent risk factors for the identification of malignant IPMN (OR 10.8 and 1.11 respectively).

Conclusion

The progression of IPMN to PDAC is associated with a proinflammatory shift in the tumor microenvironment, reflected by local (CF) and systemic (PB) elevations in key cytokines (TNFα, MCP-1, and IL-8) whose involvement in PDAC progression is well established. Elevated hormone levels in CF, along with the strong association between malignant IPMN and HbA1c, underscore the critical role of endocrine alterations in the early stages of pancreatic tumorigenesis. These findings may be harnessed to enable earlier detection of malignant transformation in IPMN. Moreover, the correlation between imaging markers and biological profiles suggests that MRI could serve as non-invasive proxies for underlying pathological changes. Together, these results offer new insights into the pathophysiology of IPMN progression and may imporve diagnostic strategies

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Pancreas

Submission format

Abstract

Session

Prediction and prognosis of pre-malignant and malignant pancreatic lesions

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Egle Dieninyte - Misiune

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Kazuro Chiba

UEG Presentation

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Approaches to improve nutrition and physical activity levels in patients with liver disease

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Approaches to improve nutrition and physical activity levels in patients with liver disease

Kate Hallsworth 1, Catarina Lindqvist 2

Affiliations

1 NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, United Kingdom

2 None, None, Sweden

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Abstract

Event

UEG Week Berlin 2025

Topics

Nurses

Session

Innovative approaches in liver disease management

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Egle Dieninyte - Misiune

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Roel Hompes

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Kazuro Chiba

UEG Podcast Episode

UEG Podcast

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Under Pressure with Lina Sopiene

Egle Dieninyte - Misiune

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Abstract

Topics

Primary Care

Published

2025

More Like This:

NOVEL BIOLOGICAL AND RADIOLOGICAL MARKERS FOR PREDICTING MALIGNANT PROGRESSION IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLAMS: A PROSPECTIVE STUDY

Lorenzo Piemonti

Approaches to improve nutrition and physical activity levels in patients with liver disease

Catarina Lindqvist

Under Pressure with Lina Sopiene

Egle Dieninyte - Misiune

THREE-YEAR ONCOLOGICAL OUTCOMES OF ENDOSCOPIC INTERMUSCULAR DISSECTION FOR SUSPECTED DEEP SUBMUCOSAL INVASIVE RECTAL CANCER

Roel Hompes

RESULTS OF THE ANGH COHORT ON MILD TO SEVERE ACUTE BILIARY PANCREATITIS (CAPABLES): EVALUATING DIFFERENT FEEDING MODALITIES PRIOR TO CHOLECYSTECTOMY

Hend Ayadi

ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Kazuro Chiba

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

THREE-YEAR ONCOLOGICAL OUTCOMES OF ENDOSCOPIC INTERMUSCULAR DISSECTION FOR SUSPECTED DEEP SUBMUCOSAL INVASIVE RECTAL CANCER

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THREE-YEAR ONCOLOGICAL OUTCOMES OF ENDOSCOPIC INTERMUSCULAR DISSECTION FOR SUSPECTED DEEP SUBMUCOSAL INVASIVE RECTAL CANCER

Lisa van der Schee 1, Sander C. Albers 2, Paul Didden 1, Miangela M. Lacle 1, Arantza Farina 2, Milan Richir 1, Martijn Intven 1, Jurriaan Tuynman 2, Roel Hompes 2, Evelien Dekker 2, Frank P. Vleggaar 1, Barbara A.J. Bastiaansen 2, Leon M.G. Moons 1

Affiliations

1 University Medical Center Utrecht, Utrecht, Netherlands

2 Amsterdam University Medical Centers, Amsterdam, Netherlands

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Abstract

Introduction

Endoscopic intermuscular dissection (EID) was recently introduced as a novel resection technique for deep submucosal invasive rectal cancer (D-SMIC)¹. While short-term outcomes are promising, intermediate- and long-term oncological safety has not yet been established. Therefore, we aimed to evaluate the 3-year oncological outcomes of EID for suspected rectal D-SMIC.

Aims & Methods

In this prospective cohort study, data of consecutive patients treated with EID for suspected rectal D-SMIC at two academic hospitals in the Netherlands between 2018 and 2022 were analyzed. Superficial submucosal invasive cancer (S-SMIC) was defined as Sm1 and D-SMIC as Sm2-3. Tumors were considered high-risk if they exhibited at least one of the following histological risk factors: high-grade tumor differentiation (G3), lymphovascular invasion, tumor budding grade 2-3, R1/Rx resection margins (<0.1 mm), or ≥pT2 invasion. Patients with D-SMIC or ≥pT2 invasion who did not undergo further treatment after EID, either due to the absence of additional risk factors or based on patient preference, underwent close surveillance. This surveillance involved biannual MRI and endoscopic scar inspection for 2 years, followed by annual MRI and endoscopy for 3 years. A complete colonoscopy was performed after 1 and 4 years. CEA blood levels were measured every six months for 5 years. Study outcomes included the 3-year locoregional recurrence rate (LRR), 3-year distant recurrence rate (DRR), 3-year salvageable recurrence rate (SRR) and 3-year rectal preservation rate. The 3-year estimates were calculated using the Kaplan-Meier method. Locoregional recurrence was defined as intramural cancer recurrence and/or mesorectal lymph node metastasis, while distant recurrences referred to other cancer recurrences. Salvageable recurrence was defined as cancer recurrence that could be treated with curative intent. Rectal preservation was defined as the absence of completion total mesorectal excision (TME) following EID or cancer recurrence.

Results

EID was initiated in 188 patients (median age 67 years, 33% female, 85% ASA I-II, median lesion size 25 mm) and successfully completed in 177 (94%). Histology showed non-invasive histology in 20 (11%), S-SMIC in 9 (5%), D-SMIC in 94 (53%) and ≥pT2 in 53 (30%) cases. R0 resection rates within these groups were 100%, 100%, 93% and 58%, respectively. Among the 94 D-SMIC cases, 35 (37%) had no histological risk factors other than deep submucosal invasion. Out of the D-SMIC cases, 72/94 (77%) followed a rectal preserving strategy (64/72 close surveillance and 8/72 adjuvant chemoradiotherapy), while 22/94 (23%) underwent completion TME. The median follow-up period within the D-SMIC group was 30 months (IQR 18-48). At three years, the LRR was 5.9% (95%CI 0.0-11.5%) and the DRR was 1.1% (95%CI 0.0-3.4%). The 3-year SRR was 100% (95%CI 100-100%). One patient (1.1%) died of a non-CRC-related cause. Among the subgroup of 35 D-SMIC cases without additional histological risk factors, all of whom underwent close surveillance following EID, no recurrences occurred within the first three years of follow-up. Beyond this period, one locoregional recurrence (2.9%) occurred at 37 months and one distant recurrence (2.9%) at 51 months, both salvageable. Overall, the 3-year rectal preservation rate among all 188 patients who underwent EID for suspected rectal D-SMIC, was 64.6% (95%CI 58.0-71.9%).

Conclusion

EID for suspected rectal D-SMIC resulted in favorable 3-year rectal preservation rates and demonstrated excellent 3-year oncological outcomes for rectal D-SMIC without additional risk factors.

References

1) Moons LMG, Bastiaansen BAJ, Richir MC, Hazen WL, Tuynman J, Elias SG, Schrauwen RWM, Vleggaar FP, Dekker E, Bos P, Fariña Sarasqueta A, Lacle M, Hompes R, Didden P. Endoscopic intermuscular dissection for deep submucosal invasive cancer in the rectum: a new endoscopic approach. Endoscopy. 2022 Oct;54(10):993-998.

Event

UEG Week Vienna 2024

Topics

Colorectal Digestive Oncology

Submission format

Abstract

Session

Local treatment for locally advanced colon cancer: How to improve outcome

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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NOVEL BIOLOGICAL AND RADIOLOGICAL MARKERS FOR PREDICTING MALIGNANT PROGRESSION IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLAMS: A PROSPECTIVE STUDY

Lorenzo Piemonti

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Catarina Lindqvist

Under Pressure with Lina Sopiene

Egle Dieninyte - Misiune

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Roel Hompes

RESULTS OF THE ANGH COHORT ON MILD TO SEVERE ACUTE BILIARY PANCREATITIS (CAPABLES): EVALUATING DIFFERENT FEEDING MODALITIES PRIOR TO CHOLECYSTECTOMY

Hend Ayadi

ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Kazuro Chiba

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

RESULTS OF THE ANGH COHORT ON MILD TO SEVERE ACUTE BILIARY PANCREATITIS (CAPABLES): EVALUATING DIFFERENT FEEDING MODALITIES PRIOR TO CHOLECYSTECTOMY

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RESULTS OF THE ANGH COHORT ON MILD TO SEVERE ACUTE BILIARY PANCREATITIS (CAPABLES): EVALUATING DIFFERENT FEEDING MODALITIES PRIOR TO CHOLECYSTECTOMY

Frederick Moryoussef 1, Charles De Ponthaud 2, Denis Grasset 3, ANDRE JEAN REMY 4, Serge Bellon 5, Pierre Mayer 6, Mathias Vidon 7, Augustin Drouet D'Aubigny 8, Caroline Lemaitre 9, christophe locher 10, Mourad MEDMOUN 11, Florence Skinazi 12, vincent quentin 13, Marie-Pierre Ripault 14, Mehdi Kaassis 15, Clara Yzet 16, Julien Lollivier 17, Guillaume Allard 18, Florent Ehrard 19, Romain Gerard 20, Hend Ayadi 21, Félix Goutorbe 22, Gaelle Boudoux d'Hautefeuille 23, Oana Maria Zaharia 24, Jeremie Albouys 25, Frédéric HELUWAERT 26, Emily Siegel 27, Thomas Grainville 28, Christelle d'Engremont 29, Nicolas Etchepare 30, Cristina Levi 31, Antoine Martin 32, Gabriela Chitic 33, Wasim Al Rafei 34, Oussama Daboussi 35, Adrian Culetto 36, Aymeric Becq 37, Armand Garioud 38, Renato Micelli Lupinacci 39, Enrique Perez 40, Roxana Stan Iuga 41, David Cuen 42, Anthony Caldiero 43, Claire Charpignon 44, Ludovic Caillo 45, Eve Gelsi 46, Sylvie Peschard 47, Julia Travagli 1, Vinciane Rebours 48, gilles macaigne 49

Affiliations

1 CH Poissy-Saint-Germain-En-Laye, Poissy, France

2 Pitie Salpétrière University Hospital, Paris, France

3 CHBA Service de Gastroentérologie, Vannes, France

4 CH Perpignan, Perpignan, France

5 Centre Hospitalier d'Avignon Henri Duffaut, Perpignan, France

6 Hepato-gastroenterology, Strasbourg, France

7 Centre Hospitalier Intercommunal de Creteil, Creteil, France

8 CH Cornouaille, Quimper, France

9 CH Le havre, Le Havre, France

10 CH Meaux, Meaux, France

11 CH Creil, Creil, France

12 CH Delafontaine, Saint Denis, France

13 Y Le Foll, Saint Brieuc, France

14 CH Narbonne, Narbonne, France

15 CH DE CHOLET, Cholet Cedex, France

16 Amiens univerisity hospital, Amiens, France

17 CH Valenciennes, Valenciennes, France

18 CH Aix-en-provence, Aix-en-provence, France

19 CH Lorient, Lorient, France

20 Inserm, Lille, France

21 CH Marne-la-vallée, Marne-la-vallée, France

22 CH Cote basque, Bayonne, France

23 CH Mteropole Savoie, Aix-les-bains, France

24 CH Dunkerque, Dunkerque, France

25 CHU Limoges / University of Limoges, Limoges, France

26 CH Annecy, Annecy, France

27 CH Mulhouse, Mulhouse, France

28 CHU Rennes, Rennes, France

29 Grenoble University Hospital, Grenoble, France

30 CH Valence, Valence, France

31 CH sud-francilien, Corbeilles-en-Essone, France

32 Kremlin Bicetre University Hospital, Kremlin Bicetre, France

33 CH Gonesse, Gonesse, France

34 CH Portes de Provencd, Montelimar, France

35 CH Chartres, Chartes, France

36 University Hospital Le Rangueuil, Toulouse, France

37 Mondor University Hospital, Creteil, France

38 CH Villeneuve-saint-georges, Villeneuve, France

39 Ambroise Paré University Hospital, Boulogne Billancourt, France

40 University Hospital Georges Pompidou, Paris, France

41 CH Dreux, Dreux, France

42 CH Saint-malo, Saint-malo, France

43 Tenon University Hospital, Paris, France

44 Montsouris Institute, Paris, France

45 CHU DE NIMES, Nîmes, France

46 Nice University Hospital, Nice, France

47 CH Meulan, Meulan-les-mureaux, France

48 Hopital Beaujon, Clichy, France

49 CH Montfermeil, Montfermeil, France

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Abstract

Introduction

Therapeutic management of acute biliary pancreatitis (ABP) includes endoscopic sphincterotomy and cholecystectomy. However, the optimal feeding strategy prior to cholecystectomy—early oral intake or exclusive enteral nutrition—remains debated, particularly given the risk of recurrent biliary events (BEs) before surgery, especially when surgery is delayed.

Aims & Methods

The primary objective was to evaluate the likehood of BEs (biliary colic/migration, stone impaction, cholangitis, recurrent acute pancreatitis, and acute cholecystitis) prior to cholecystectomy, comparing feeding methods: oral vs. exclusive enteral nutrition. The secondary objective was to evaluate cholecystectomy rates during the initial hospitalization and the reasons for non-performance. Data were collected during hospitalization, at 3 months, and at 6 months if surgery had not been performed by month 3. BEs and feeding modalities at those times were documented. Analyses included Cox models and Chi-square tests.

Results

From October 2022 to December 2023, 1,172 patients with ABP were prospectively enrolled by 60 French hospitals, with 1,167 included in the final analysis. Sixty patients (5%) were lost to follow-up, and 34 deaths (3%) were reported. Severe ABP was observed in 27.2% (n=317) of patients. After 48–72 hours, oral feeding was resumed in 62% (n=724), enteral feeding in 16% (n=192), and fasting/parenteral feeding in 21% (n=249). During follow-up, 236 BEs occurred in 172 patients, meaning 15.5% experienced at least one event, with a median onset time of 26 days (range: 9–57 days). Specifically, 6% had at least one episode of biliary colic/migration, 2.1% experienced stone impaction, 2.3% developed cholangitis, 6.1% had recurrent AP (9% of which were severe), and 1.6% developed acute cholecystitis.
Univariate analysis identified several factors associated with a higher risk of BE recurrence (p < 0.10): age ≥52 years (p=0.093), obesity (BMI ≥30, p=0.032), ASA score >2 (p=0.097), total bilirubin ≥60 µmol/L (p=0.010), CRP >150 mg/L, diagnostic delay ≥21 days (p=0.009), and prior sphincterotomy (p=0.136). No difference in BE incidence was observed between severe and non-severe ABP (p=0.497) when analyzing the first 172 BEs.
Over the full follow-up period, despite the 87 BEs analyzed and potential biases, there remained no significant association between nutrition type (oral vs. exclusive enteral nutrition ) and the likelihood of BE occurrence (p=0.447).
In patients with non-severe ABP, cholecystectomy was performed during the initial hospitalization in only 33% of cases. The main reasons for non-performance were structural (e.g., lack of availability or surgeon refusal), accounting for 45% of cases.

Conclusion

BEs are frequent and clinically relevant: 15.5% of patients experienced at least one before surgery, with 6% developing recurrent ABP (9% of which were severe). Cholecystectomy remains underutilized; only one-third of patients with non-severe ABP underwent it during their initial stay, often due to modifiable reasons. Neither ABP severity nor nutritional type-oral vs enteral nutrition (despite potential biases, missing data, and ongoing analysis)-appeared to be associated with the occurrence of BEs prior to surgery. Early cholecystectomy, when possible, remains the only reliable strategy for preventing BEs.

Disclosure

This study received a research grant from Fresenius Kabi.

Event

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

From The Lion King to Waterland: A journey through pancreatitis

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

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ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Jun Nakahodo 1,2, Kensuke Hoshi 1,3, Shin-ichiro Horiguchi 1, Yasuji Seyama 1, Hiroko Okinaga 1, Mei Nakamura 1, Tomoaki Sawano 1, Masanao Kurata 1, Kazuro Chiba 1, Hiroki Tabata 1, WATARU UJITA 1, Ryogo Minami 1, Sorano Ichiya 1, T. Kamisawa 1, TOSHIRO IIZUKA 1

Affiliations

1 Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Japan

2 Juntendo University, Bunkyo-Ku, Japan

3 Toho University Omori Medical Center, Ota-ku, Japan

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Abstract

Introduction

Early diagnosis of pancreatic cancer relies on detecting subtle, indirect signs of minute tumors. Endoscopic ultrasonography (EUS) is crucial for this purpose. However, EUS image construction is influenced not only by the density and structure of the target areas but also by the characteristics of the surrounding tissue. Directly correlating preoperative EUS images and precisely aligning the pathological images of the area of interest remains challenging, as comparisons often rely on approximate anatomical regions. To overcome this limitation and to gain a deeper understanding of EUS imaging capabilities at the microscopic level, the present study examined unfixed pancreatic resection specimens using EUS immediately after surgery.

Aims & Methods

The present study aimed to investigate the characteristics and limitations of EUS imaging by directly comparing EUS images with the corresponding pathological sections of resected pancreatic specimens. The samples derived from distal pancreatectomies for pancreatic ductal adenocarcinoma without chemotherapy (pT1b or less in the UICC classification, 8th edition) were obtained between January 2023 and November. Specimens from pancreatoduodenectomies were excluded to enable a precise, one-to-one comparison between the pathological specimens and EUS images. The resected specimens were immersed in saline and examined using a convex-type EUS scope (Olympus UCT260/ME-2, Tokyo, Japan). Areas of interest, including the main tumor site and any abnormal findings, were marked with nylon sutures. HE-stained pathological sections from these marked areas were then directly compared with the corresponding EUS images to evaluate the imaging characteristics of various pathological features.

Results

The present study included four male and three female patients with a mean age of 76.3 years. The tumor location included the pancreatic body (n = 5) and the tail (n = 2). According to the 8th edition of the UICC classification, the pathological T stage was Tis, T1a, and T1b in four, two, and one cases, respectively. The pathological findings of 24 samples were compared with the corresponding EUS images. The rate of detection of the specific pathological features using EUS was 0%, 33%, 64%, 47%, and 60% for PanIN lesions, invasive carcinoma, localized pancreatic atrophy (predominantly fatty), localized pancreatic atrophy (predominantly fibrotic), and pancreatic cysts ≤ 2 mm, respectively. Solitary cysts ≤ 2 mm were often identifiable, while multiple, clustered cysts appeared as faint, hypoechoic areas. Localized pancreatic atrophy with predominant fibrosis appeared as a faint, hypoechoic area, and atrophy with predominantly fatty replacement appeared as a high-intensity area within the parenchyma. However, complete fatty replacement obscured the boundary with surrounding fatty tissue, leading to its appearance as loss of the pancreatic parenchyma.

Conclusion

The present findings demonstrated that despite its high diagnostic accuracy for pancreatic diseases, EUS is limited in its ability to visualize tissue microarchitecture. Understanding the specific imaging features of localized pancreatic atrophy and small pancreatic cysts on EUS is crucial for improving the accuracy of early diagnoses of pancreatic cancer. The insights gained from this one-to-one comparison of the EUS findings and pathological specimens can contribute to enhancing the precision of the diagnosis and facilitate the earlier detection of pancreatic cancer.

Event

UEG Week Berlin 2025

Topics

Endoscopy Hepatobiliary Pancreas

Submission format

Abstract

Session

Textbook knowledge and limits of HPB endoscopy

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

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Lorenzo Piemonti

Approaches to improve nutrition and physical activity levels in patients with liver disease

Catarina Lindqvist

Under Pressure with Lina Sopiene

Egle Dieninyte - Misiune

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Roel Hompes

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Hend Ayadi

ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Kazuro Chiba