Introduction

Helicobacter pylori (HP) infection is the most significant environmental factor contributing to gastric carcinogenesis. However, the rising prevalence of antibiotic resistance in HP has become a global concern. Currently, there is limited research on the correlation between HP antibiotic resistance and early gastric cancer (EGC). This study aimed to detect HP resistance genes in EGC patients using qRT-PCR on paraffin-embedded ESD specimens and explore the association between HP resistance and EGC.

Aims & Methods

A total of 150 EGC patients who underwent endoscopic submucosal dissection (ESD) between January 1, 2023, and December 31, 2024, were enrolled. HP resistance genes were detected in post-ESD gastric mucosal paraffin sections. Resistance rates to various antibiotics were compared, and correlations between resistance and clinicopathological features were analyzed.

Results

Among the 150 EGC patients, 28 (18.67%) were HP-positive, with 18 (64.3%, 95% CI: 44.1%–81.4%) showing antibiotic resistance. Levofloxacin had the highest resistance rate (50.0%), followed by clarithromycin (38.9%), tetracycline (11.1%), and amoxicillin (5.6%). No resistance to furazolidone was observed. Multidrug resistance analysis revealed common combinations, including clarithromycin + quinolone (22.2%) and clarithromycin + quinolone + tetracycline (5.6%). No significant correlations were found between resistance and clinicopathological features such as tumor location, size, histologic type, differentiation, depth of invasion, or mucosal status (all *p* > 0.05).

Conclusion

HP antibiotic resistance is prevalent in EGC patients, with high resistance rates to levofloxacin and clarithromycin. However, no significant association was observed between HP resistance and clinicopathological characteristics of EGC. Further studies are needed to elucidate the role of resistant HP strains in gastric carcinogenesis.

References

[1]Yang L, Kartsonaki C, Yao P, de Martel C, Plummer M, Chapman D, Guo Y, Clark S, Walters RG, Chen Y, Pei P, Lv J, Yu C, Jeske R, Waterboer T, Clifford GM, Franceschi S, Peto R, Hill M, Li L, Millwood IY, Chen Z; China Kadoorie Biobank Collaborative Group. The relative and attributable risks of cardia and non-cardia gastric cancer associated with Helicobacter pylori infection in China: a case-cohort study. Lancet Public Health. 2021 Dec;6(12):e888-e896. doi: 10.1016/S2468-2667(21)00164-X.
[2]Lee YC, Chiang TH, Chou CK, Tu YK, Liao WC, Wu MS, Graham DY. Association Between Helicobacter pylori Eradication and Gastric Cancer Incidence: A Systematic Review and Meta-analysis. Gastroenterology. 2016 May;150(5):1113-1124.e5. doi: 10.1053/j.gastro.2016.01.028. Epub 2016 Feb 2.
[3]Dingsdag SA, Hunter N. Metronidazole: an update on metabolism, structure-cytotoxicity and resistance mechanisms. J Antimicrob Chemother. 2018 Feb 1;73(2):265-279. doi: 10.1093/jac/dkx351.
[4]Dingsdag SA, Hunter N. Metronidazole: an update on metabolism, structure-cytotoxicity and resistance mechanisms. J Antimicrob Chemother. 2018 Feb 1;73(2):265-279. doi: 10.1093/jac/dkx351.
[5]Lee SM, Kim N, Kwon YH, Nam RH, Kim JM, Park JY, Lee YS, Lee DH. rdxA, frxA, and efflux pump in metronidazole-resistant Helicobacter pylori: Their relation to clinical outcomes. J Gastroenterol Hepatol. 2018 Mar;33(3):681-688. doi: 10.1111/jgh.13906.

Introduction

Enteroscopy-assisted ERCP (E-ERCP) is used to treat biliary-enteric anastomotic stricture and common bile duct stones after alimentary tract reconstruction. However, anastomotic stricture usually responds poorly to balloon dilation caused by severe fibrosis. Here, we report a novel technique, endoscopic radial incision (ERI) combined with E-ERCP, to treat biliary-enteric anastomotic stricture and common bile duct stones.

Aims & Methods

From October 2023 to November 2024, six patients with biliary-enteric anastomotic stricture and common bile duct stones who responded poorly to balloon dilation received ERI combined with E-ERCP in Zhongshan Hospital, Fudan University. The primary outcomes were relief of biliary-enteric anastomotic stricture and the removal of common bile duct stones. The secondary outcome was the complication rate of the procedure.

Results

The mean age was 48 and 3 patients were male. All 6 patients successfully received ERI combined with E-ERCP. Four patients with anastomotic stricture were incised by Hook knife, while two patients with the Hook knife not reaching the anastomotic area was incised by the top of the snare. After the ERI, the diameters of the biliary-enteric anastomotic stoma enlarged from 3 mm to 10 mm. The mean diameter of common bile duct stones was 8 mm. All the common bile duct stones were removed by basket catheter successfully, confirmed by intraoperative common bile duct radiography and postoperative MRCP. The mean procedure time was 32 minutes and the mean postoperative hospitalization time was 2 days. No intraoperative and postoperative complications occurred.

Conclusion

ERI combined with E-ERCP, as a novel technique, could be an effective and safe method to treat biliary-enteric anastomotic stricture and common bile duct stones after alimentary tract reconstruction.

Introduction

With the global rise in obesity, endoscopic bariatric therapy (EBT) is increasingly adopted as a less invasive alternative to surgery. Among the most commonly used approaches are space-occupying techniques via intragastric balloons (IGB) and restrictive methods like endoscopic gastroplasty (EG).

Aims & Methods

This study aimed to evaluate changes in anthropometric parameters and body composition following EBT, and to identify early predictors of weight loss associated with these procedures. This analysis combined data from two single-center, randomized trials involving obese patients undergoing EBT using either IGB (ClinicalTrials.gov NCT06673550) or EG (ClinicalTrials.gov NCT04854317). The primary outcome was the effect of EBT on body circumferences (arm, waist, hip, calf) and body composition metrics including fat mass (FM), fat-free mass (FFM), and body cell mass (BCM). The secondary outcome focused on identifying predictive factors for weight loss. The 6-month follow-up was chosen for assessment, corresponding to the standard IGB removal timeline.

Results

Between July 2020 and January 2024, 318 obese patients were included: 156 received IGB (mean age 46±14 years; 69.2% female; mean BMI 41.9±9.1 kg/m²; 53.0% with class III obesity), while 162 underwent EG (mean age 46±10 years; 87.5% female; mean BMI 36.6±3.1 kg/m²; 58.3% with class II obesity). Follow-up at 6 months was completed by 93.5% in the IGB group (146/156) and 70.4% in the EG group (114/162). Average total body weight loss (TBWL) was 14.2±7.1% for IGB and 16±6% for EG, with corresponding excess weight loss (EWL) of 30.8±23.3% and 39.7±14.9%, respectively. Both groups showed significant reductions in all body circumferences (p<0.001). FM and FM% decreased markedly (p<0.001), while FFM% (p<0.001) and BCM% (p<0.05) increased. In the EG group, linear regression revealed a significant correlation between phase angle and both TBWL (r=0.327, p<0.05) and EWL (r=0.274, p<0.05), a relationship not observed in the IGB group. This difference may be due to distinct baseline characteristics, particularly BMI, and the differing mechanisms of action between the two EBT modalities.

Conclusion

Both IGB and EG demonstrated effectiveness in promoting weight loss, reducing body measurements, and improving body composition in obese patients. Phase angle may serve as a valuable predictor of weight loss in certain EBT approaches, suggesting its potential role in guiding personalized obesity treatment strategies.

Disclosure

Dr Vadalà di Prampero and Dr Milutin Bulajic are consultants for Apollo Endosurgery, EndoTools Therapeutics and USGI Medical.

Introduction

EndoZip^TM is a fully automated endoscopic suturing device designed to reduce gastric volume for obesity treatment, minimizing the operator-dependence for endoscopic gastroplasty. A recent multicenter clinical trial showed that the device is easy-to-use, safe, and effective for treating class I and II obesity. In this study, we aim to assess the efficacy and safety of EndoZip^TM to facilitate improvement in patients with obesity-related comorbidities.

Aims & Methods

This is the analysis, including the Italian site only, of a prospective, single-arm, open-label, clinical trial including patients with a BMI of 30-42 kg/m² and hypertension and/or type 2 diabetes mellitus (T2DM) who failed non-invasive weight-loss therapies and were deemed suitable for bariatric endoscopy according to the multidisciplinary team.
We report the percentage of total body weight loss (%TBWL), changes in Hb1AC and/or Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), changes in ambulatory blood pressure monitor (ABPM), and/or treatment for hypertension following automatic endoscopic procedure. Incidence of adverse events was also recorded.
Patients’ clinical health conditions were evaluated at 6 and 12 months as compared to baseline and classified as “Improved”, “No change”, or “Worsened”.

Results

Twenty patients (80% female, mean age 51.9±9.8, mean BMI 34.9±3.2 kg/m2) were enrolled at a single tertiary center. Five patients (25%) had both hypertension and T2DM, eleven (55%) had only hypertension, and four (20%) had only T2DM. One patient with hypertension was lost to follow-up.
At 12 months, the mean %TBWL was 11.4% (with SE 1.1%). Among patients with T2DM, improvement was observed in all subjects at 6 months. At 12 months, 5 out of 8 (62.5%) showed an improvement in their diabetes health condition, 2 out of 8 (25%) showed no change, and one patient experienced worsening in HbA1c and HOMA-IR. In the group of patients with hypertension, 7 out of 13 (54%) showed an improvement in ABPM values and/or in their hypertension medication. Meanwhile, 4 out of 13 (31%) experienced no change, and in 2 out of 13 (15%), there was a worsening of their condition. In these two cases, the patients had discontinued an antihypertensive medication. One anticipated severe adverse event, immediate post-procedure bleeding, was reported. The event was effectively managed endoscopically with a single clip and a 2 mL injection of fibrin glue, without the need for blood transfusion. No pathologies were identified in the esophagus, and the sutures in the stomach were found to be intact.

Conclusion

Based on these preliminary results, automatic endoscopic gastroplasty seems to be safe and promising for the treatment of obesity and associated comorbidities such as hypertension and T2DM.

References

Boskoski I, Lopez-Nava G, Ravishankar A, Bove V, Matteo MV, De Siena M, Pontecorvi V, Giannetti G, Iaconelli A, Spada C, Shamah SE. Automatic endoscopic gastroplasty for the treatment of obesity: results from a prospective multicenter study (with video). Gastrointest Endosc. 2025 Apr;101(4):818-827. doi: 10.1016/j.gie.2024.09.026. Epub 2024 Sep 21. PMID: 39307402.

Introduction

Supragastric belching disorder (SBD) is characterized by unconscious air swallowing and its immediate expulsion from the esophagus. Diagnosis is usually made by history and physical examination though supplementary evaluations can be considered. High-resolution esophageal manometry combined with stationary impedance (HRIM) allows confirmation of SBD diagnosis in patients with esophageal symptoms. Better understanding of this condition is needed to increase recognition and guide treatment.
With the aim of characterizing the population diagnosed with SBD using HRIM and its association with other esophageal motility disorders (EMDs) or gastroesophageal reflux disease (GERD), we conducted a descriptive study.

Aims & Methods

We identified patients with SBD diagnosis who underwent HRIM using MMS-Unisensor® solid-state probe with 36 channels coupled with 16 channels of impedance in a tertiary hospital from January 2020 to December 2024. HRIM studies were interpreted according to Chicago classification v3.0 and v4.0. Demographic and clinical characteristics were collected. Data from pH-metry and/or pH-Impedance (pH-IMM) tests were also gathered to assess presence of pathological acid gastroesophageal reflux (GER).

Results

39 patients were included (64% women) with a mean age of 52.7 years. Demographic and clinical characteristics are summarized in Table 1. Some patients developed SBD after esophagogastric surgery (10.4%). One-third of patients had some EMD: ineffective esophageal motility (27%) and esophageal absent contractility (5.4%). 12.9% of patients associated rumination disorder (RD). 25% patients had pathological acid GER in pH-metry and/or pH-IMM. A significant association was observed between the presence of pathological acid GER and symptoms of regurgitation (p=0.02) and vomiting (p=0.05), and between pathological acid GER and EMD finding in HRIM (p=0.05). 94.1% patients had consumed proton pump inhibitors (PPIs) in the previous 6 months, but only 50% showed symptomatic improvement with PPIs therapy. Symptoms improved in 91% of follow-up patients with diaphragmatic breathing exercises and patient education about the pathophysiology of the disorder to motivate active patient participation in their treatment. On average, patients experienced a diagnostic delay of 38.2 months (IQR: 24–54).

Table 1. Demographic and clinical variables from the SGB patients sample

Conclusion

SBD is more common in middle-aged women as other functional gastrointestinal disorders. Association of SBD with RD is notable. Both SBD and RD could be misdiagnosed as PPI-refractory GERD. It is important to study the presence of GERD in order to optimize PPI treatment: in our study, only one quarter of the patients exhibited esophageal acid burden. Most patients improved with non-pharmacological treatment. SBD may be effectively treated with diaphragmatic breathing exercises and training patients for awareness of belching episodes. Diagnostic delay may be due to lack of awareness and limited access to diagnostic tests. Promoting knowledge about pathophysiology, symptoms and complementary tests would reduce diagnostic time and would improve the management of this rare disorder.

References

1. Sergeev I, Velosa M, Mardare R, Yazaki E, Sifrim D. The influence of supragastric belching severity on esophageal acid exposure and motility. Neurogastroenterol Motil. 2023 Apr;35(4):e14520.

2. Davidson K, Sibley H, O'Rourke AK. Supragastric belching and rumination syndrome: diagnosis and management. Curr Opin Otolaryngol Head Neck Surg. 2023;31(6):343-349.
3. Sawada A, Fujiwara Y. Belching disorders and rumination syndrome: A literature review. Digestion. 2024;105(1):18–25.

Disclosure

The authors report no conflicts of interest related to this work.

Introduction

Multiparametric Ultrasound (MP-US) is emerging as a key tool for liver disease assessment and management, offering rapid, non-invasive insights into tissue characteristics, usually accessible only through liver histology^1,2. Steatosis and inflammation, main factors in fibrosis and cirrhosis progression, should be ideally detected and quantified early, aiding in the diagnosis and risk assessment of chronic liver disease (CLD)³. MP-US combines ultrasound wave propagation techniques: Shear Wave Dispersion (SWD) evaluates frequency-dependent changes in wave velocity reflecting inflammation-related viscosity; Shear Wave Elastography (SWE) estimates liver stiffness as indirect marker of fibrosis; Attenuation Ultrasound (USAT) and speed of sound (TSSI) assess hepatic fat content measuring energy loss and sound speed^3,4.

Aims & Methods

The study aimed to assess the accuracy of USAT/TSSI, SWE and SWD measured by a novel MP-US device (Resona A20, Mindray) compared to liver histology to evaluate steatosis, fibrosis and inflammation.
This single-centre observational, prospective study conducted from May to November 2024 included adult patients (≥18 years) with suspected CLD, referred for MP-US evaluation and percutaneous liver biopsy.
Parameters were obtained in a single session by placing a 2–3 cm diameter Region of Interest (ROI) at least 1.5 cm below the liver capsule.
Five valid measurements - defined by a Motion Stability Index (M-STB) of 5 and a high reproducibility (green zone on colorimetric map) - were acquired for each technique, collecting mean, median, interquartile range (IQR), IQR/median, standard deviation (SD) and SD/mean^4,5.
Histology was the reference standard for grading inflammation, fibrosis and steatosis using defined scoring systems.

Results

A total of 78 patients (46 women; mean age 51.6 years) were included in the study: 42 with MASLD, 20 with PSVD or nonspecific cholangiopathies, 9 with AIH and 7 with PBC.
USAT values increased progressively with steatosis severity, showing statistically significant differences across all stages (S0 vs S1, S1 vs S2 and S0 vs S1–3; p < 0.001). ROC curve analysis demonstrated high diagnostic accuracy with an AUC of 0.801 for S0 vs S1, 0.977 for S1 vs S2 and peak performance for S0–1 vs S2–3 (AUC 0.992, sensitivity 100%, specificity 95.1%). Optimal USAT cut-off values to classify mild, moderate and severe steatosis were 0.55, 0.67, and 0.75, respectively.
Conversely, TSSI values decreased with increasing steatosis grade. ROC analysis revealed moderate diagnostic performance of TSSI in distinguishing S0 from S1 (AUC 0.77) and S0–1 from S2–3 (AUC 0.76). A moderate inverse correlation was observed between TSSI and USAT values (ρ = –0.53, p < 0.001).
SWE values increased with fibrosis stage according to the METAVIR scoring system, demonstrating good performance in detecting advanced fibrosis (p = 0.024). However, most patients exhibited either no fibrosis (F0) or mild fibrosis (F1) on liver histology, limiting SWE overall diagnostic performance.
Viscosity values showed a non-significant upward trend with increasing inflammation. Standard liver function tests demonstrated only a weak correlation with histological inflammation. Notably, SWD approached statistical significance in differentiating the presence of at least mild inflammation from no inflammation (A0 vs A123).

Conclusion

MP-US offers valuable non-invasive insights into liver tissue characteristics reflecting histological findings. Further studies are warranted to support the non-invasive assessment of key pathological features, potentially replacing liver biopsy.

References

1. Grgurevic, I., Tjesic Drinkovic, I. & Pinzani, M. Multiparametric ultrasound in liver diseases: an overview for the practising clinician. Postgrad Med J 95, 425–432 (2019).
2. Sumida, Y., Nakajima, A. & Itoh, Y. Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroenterol 20, 475–485 (2014).
3. Garcovich, M. et al. Shear Wave Dispersion in Chronic Liver Disease: From Physical Principles to Clinical Usefulness. Journal of Personalized Medicine 2023, Vol. 13, Page 945 13, 945 (2023).
4. Ferraioli, G. et al. WFUMB Guidelines/Guidance on Liver Multiparametric Ultrasound. Part 2: Guidance on Liver Fat Quantification. Ultrasound Med Biol 50, 1088–1098 (2024).
5. Ferraioli, G. et al. WFUMB Guideline/Guidance on Liver Multiparametric Ultrasound: Part 1. Update to 2018 Guidelines on Liver Ultrasound Elastography. Ultrasound Med Biol 50, 1071–1087 (2024).