Introduction

Cold polypectomy, including cold forceps polypectomy (CFP) and cold snare polypectomy (CSP), is safe and effective in treating colorectal polyps. Its role in upper gastrointestinal (UGI) lesions has not yet been well established and validated.

Aims & Methods

To evaluate the efficacy and safety of cold polypectomy for UGI lesions resection.
Retrospective cohort study including 350 consecutive cold endoscopic polypectomies conducted in a public and private endoscopy unit, between January/2021 and December/2022. CSP was performed using a dedicated cold snare. A 30-day phone survey was carried out to evaluate post-polypectomy adverse events. Univariate and multivariate analyses were performed to evaluate the efficacy and safety of CFP and CSP using the SPSS software v28.

Results

Overall, 350 lesions in 296 patients were removed by cold polypectomy (CFP-148 lesions; CSP-202 lesions), mainly gastric (82.6%). Their mean size was 2.68±0.78mm (range 2-6mm) and 5.64±2.12mm (range 3-15mm) for CFP and CSP, respectively (p<0.01). Fundic gland (47.4%) and hyperplastic (33.1%) polyps were the most common histological diagnosis. While the complete endoscopic resection rate was 100% in both groups, the en-bloc resection rate was superior for CSP (CFP 85.8% vs. CSP 99.0%; p<0.01). At histological analysis, the complete (R0) resection rate was also higher for CSP (CFP 93.6% vs. CSP 98.0%; p=0.041). Immediate bleeding, endoscopically treated, was observed exclusively for CSP (CFP 0% vs. CSP 1.0%; p=0.225). No other adverse events were observed, namely delayed bleeding or perforation. After univariate analysis, duodenal lesions (OR 12.857; 95%CI [1.025-161.257]; p=0.048), CFP (OR 3.350; 95%CI [0.987-11.369]; p=0.052), and piecemeal resection (OR 101.333; 95%CI [623.411-438.607]; p<0.001) were associated with higher nonassessable (Rx) resection rate. At multivariate logistic regression, only piecemeal resection was associated with a higher Rx resection rate (OR 168.657; 95%CI [17.982-1581.849]; p<0.001). Considering lesions sized ≤6mm, corresponding to 291 lesions from 256 patients (CFP-148 lesions; CSP-143 lesions), the en-bloc resection rate (CFP 85.8% vs. CSP 98.6%; p<0.001) and the R0 resection rate (CFP 93.6% vs. CSP 97.9%; p=0.081) were also superior for CSP. No adverse events were reported in this subanalysis.

Conclusion

Cold polypectomy is effective and safe for the resection of UGI lesions, with CSP being more effective than CFP, regardless of lesion size. Piecemeal resection is an independent factor associated with the Rx resection rate.

Introduction

Faecal incontinence (FI) is prevalent, being associated with a high biopsychosocial burden and considerable health costs. The pathophysiology of FI is varied and often multifactorial, representing a diagnostic and therapeutic challenge. Anorectal manometry is the first recommended diagnostic method, although its utility is debatable due to overlapping findings between healthy individuals and patients.

Aims & Methods

The aim of this study is to establish a relationship between FI clinical presentation, manometric findings, and imaging.
We prospectively included all patients undergoing high-resolution anorectal manometry, according to the London protocol, at a tertiary centre, who agreed to respond to a questionnaire to characterize their FI, between August 2021 and March 2023. Clinical records were consulted, in order to access demographic data and past imaging reports. Statistical analysis was performed using IBM SPSS Statistics version 26®.

Results

Forty-seven patients were included with a mean age of 63.5±11.6 years, 87.2% women, of whom 73.2% had an obstetric history. Depressive/anxious symptoms were described in 59.6%, previous perineal surgery in 38.3%, and concomitant urinary incontinence in 40.0%. Mean FI duration was 5.4±5.2 years, with 51.1% reporting daily complaints and a bowel movement median of 2.0 (IQR 3.0). Males tended to have more bowel movements than females (3.5 (IQR 5.0) vs 2.0 (IQR 2.0); p-value 0.03). FI for flatus and faeces was present in 57.4%, for faeces alone in 34.0%, and for flatus alone in 8.5%. Urgency FI was verified in 37.0%, passive FI in 37.0%, and mixed FI in 26.1%. Mean Wexner score was 10±5. Rectal examination revealed hypotonicity in 15.9%. Mean resting pressure on anorectal manometry was 55.9±22.5 mmHg, dyssynergy was identified in 16.7% and altered balloon expulsion in 19.5%. The mean value of first sensation, first urge to defecate, and maximum tolerated volume were within the normal range. Imaging was performed in 19 patients (40.4%), with external anal sphincter injury in 15.8% and internal sphincter injury in 10.5%. Mean thickness of the internal anal sphincter (IAS) was 2.3±1.0 cm. Patients with hypotonicity in rectal examination had lower anal resting pressure (35.7±16.0 mmHg vs 60.3±22.4 mmHg; p-value 0.09) and lower IAS thickness (1.6±0.8 mm vs 2.6±0.9 mm; p-value 0.07), although not statistically significant. Patients with depressive/anxious symptoms showed lower maximum incremental pressure (56.6±34.0 mmHg vs 81.2±46.2 mmHg; p-value 0.045), as well as females when compared to males (60.0±34.9 mmHg vs 108.7±53.2 mmHg; p-value 0.005). No other statistically significant results were found, especially correlating clinical findings with manometry or imaging.

Conclusion

Our study showed, as previously replicated, that clinical, manometric and imaging findings have low correlation in the assessment of FI, reflecting its pathophysiological complexity.

Introduction

The first international guideline for managing preneoplastic conditions of the stomach (MAPS I) was published in 2012, followed by an update (MAPS II) in 2019. As adherence to these guidelines remains uncertain, we evaluated adherence by comparing the management of preneoplastic gastric conditions before and after the introduction of MAPS I and II in selected European centers.

Aims & Methods

Patient data were retrieved from nine endoscopy units in seven European countries during three periods: pre-MAPS I (2010/2011), post-MAPS I (2017/2018), and post-MAPS II (2022/2023). Screening and dyspepsia-related endoscopies were included. Data on endoscopy, histopathology, Helicobacter pylori (H. pylori) treatment, and surveillance were collected using a standardized form. Adherence to nine MAPS recommendations was assessed, with improvement defined as a ≥10% increase in guideline-concordant management.

Results

A total of 2,426 patients were included. Most centers (57%) improved in at least seven of the nine recommendations over time. Virtal Chromoendoscopy use improved in six centers, with four reporting its use in >50% of cases. All centers improved in performing biopsies from the antrum and corpus, five conducted random biopsies in nearly all patients, and four performed these plus an incisura biopsy in >90% of cases. Endoscopic scores for patient stratification were rarely used, while five centers improved in histological scoring or intestinal metaplasia subtyping. H. pylori treatment recommendation remained high (71%-100%), and endoscopic surveillance adherence improved in four of seven centers

Conclusion

Adherence to MAPS guidelines improved in most centers. However, gaps in virtual chromoendoscopy, targeted biopsies, and endoscopic/histopathological scoring remain, potentially affecting surveillance recommendations. This underscores the need for a more tailored approach to enhance implementation.

References

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Introduction

Portal hypertension (PH) is a significant complication of advanced chronic liver disease (ACLD), often leading to acute variceal bleeding (VB), a life-threatening emergency. Preemptive transjugular intrahepatic portosystemic shunt (pTIPS) has become a critical intervention in managing PH-related complications, specifically in reducing the risk of re-bleeding. The hepatic venous pressure gradient (HVPG) is the gold standard for assessing PH severity, but its invasive nature necessitates the exploration of non-invasive alternatives.

Aims & Methods

This study aimed to investigate the role of spleen stiffness, measured through shear-wave elastography (SWE), as a non-invasive predictor of PH severity and its correlation with HVPG in ACLD patients undergoing pTIPS after acute VB. We conducted a prospective study correlating spleen stiffness, measured by shear-wave elastography (SWE), with HVPG in ACLD patients (Child-Pugh class C<14 or B>7 with active bleeding) undergoing pTIPS placement following acute VB. Eleven patients with pre- and post-TIPS spleen stiffness measurements were included.

Results

Spleen stiffness was positively correlated with both pre-TIPS HVPG (Spearman's coefficient r=0.527; p=0.145) and post-TIPS HVPG (r=0.719; p<0.05). Furthermore, spleen stiffness significantly decreased after p-TIPS placement (pre-pTIPS: 36.42 [IQR 6.06] vs. post-pTIPS: 28.94 [IQR 7.80]; p<0.05), while the decrease in liver stiffness measurement was not statistically significant.

Conclusion

The results of this prospective study indicate that spleen stiffness, as measured by SWE, offers a valuable non-invasive method for assessing portal hypertension severity in patients with ACLD. We found a positive correlation between spleen stiffness and both pre- and post-TIPS HVPG. Additionally, significant reductions in spleen stiffness post-TIPS suggest that this metric can serve as a useful tool for monitoring patient response to pTIPS and potentially predicting outcomes. These findings highlight the importance of incorporating spleen stiffness measurement into the clinical management of patients with PH undergoing pTIPS, providing clinicians with an additional tool for assessing treatment efficacy and guiding patient care. Further research with larger cohorts is recommended to confirm these results and establish spleen stiffness as a reliable non-invasive alternative for PH assessment.