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COLD SNARE VERSUS HOT SNARE ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLORECTAL ADENOMAS AND SERRATED LESIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

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COLD SNARE VERSUS HOT SNARE ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLORECTAL ADENOMAS AND SERRATED LESIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Federico IV Peralta 1, Enrik John Aguila 2, Nikko Theodore Raymundo 1, Hugo Uchima 3, Sunil Gupta 4

Affiliations

1 St. Luke's Medical Center - Global City, Taguig, Philippines

2 St. Luke's Medical Center - Global City, Taguig, Philippines|||Ospital ng Maynila Medical Center, Manila, Philippines

3 Hospital Germans Trias i Pujol, Barcelona, Spain|||Teknon Medical Center, Barcelona, Spain

4 Westmead Hospital, Sydney, Australia, Ermington, Australia

Summary

AI Generated

Meta-analysis of 2898 large colorectal polyps shows cold snare EMR offers superior safety with lower bleeding and perforation risk but higher recurrence for adenomas, while recurrence rates for serrated lesions are comparable between cold and hot techniques.

Cold snare EMR was associated with significantly higher polyp recurrence overall (RR 1.91) and for adenomatous lesions ≥20mm (RR 1.79), but recurrence for serrated lesions did not differ significantly between cold and hot techniques (RR 1.49, 95% CI 0.66–3.33).
Cold snare EMR demonstrated significantly lower risks of intraprocedural bleeding (RR 0.66), delayed bleeding (RR 0.39), perforation (RR 0.22), and post-polypectomy syndrome (RR 0.58), all with no heterogeneity.
Technical success rates were comparable between cold and hot snare EMR (OR 0.46, 95% CI 0.13–1.64).
The authors recommend hot snare EMR when minimising recurrence is a priority for adenomas, while cold snare EMR should be the technique of choice for non-dysplastic serrated lesions and for frail patients, those with comorbidities, or those on anticoagulation therapy.
The analysis pooled seven studies (four RCTs and three observational studies) comprising 1029 cold snare and 1869 hot snare procedures, with technique choice recommended to be individualized based on lesion characteristics, patient factors, and operator expertise.

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Abstract

Introduction

Endoscopic mucosal resection (EMR) is a minimally invasive technique for removing large non-pedunculated colorectal polyps (LNPCP), traditionally using hot snare EMR (H-EMR) with electrocautery. While effective, H-EMR poses risks including delayed bleeding and thermal injury, which cold snare EMR (C-EMR) may reduce by avoiding electrocautery. With emerging evidence in support of C-EMR, this systematic review and meta-analysis compares its safety and effectiveness compared to H-EMR for LNPCP.

Aims & Methods

The objective of this systematic review and meta-analysis is to compare the safety and effectiveness of C-EMR versus H-EMR for adenomas and serrated lesions ≥15mm. Relevant studies were identified through systematic searches of the PubMed, Medline, Cochrane, and Google Scholar databases through March 2025. Quality assessment was conducted using the Cochrane Risk of Bias (RoB2) tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for retrospective studies. A random-effects meta-analysis was performed to generate pooled odds ratio (OR) and risk ratios (RR) with 95% confidence intervals. Subgroup analyses were conducted to explore potential sources of heterogeneity, if present.

Results

Seven studies, including four RCTs and three non-randomized comparative studies, were included in the analysis, with a pooled sample of 2898 LNPCP (1029 C-EMR and 1869 H-EMR). Technical success rates were comparable between C-EMR and H-EMR (OR 0.46, 95% CI [0.13–1.64]; I² = 19%). However, C-EMR was associated with significantly lower risks of intraprocedural bleeding (RR 0.66), delayed bleeding (RR 0.39), perforation (RR 0.22), and post-polypectomy syndrome (RR 0.58), all with I² = 0%. Conversely, C-EMR was linked to a significantly higher risk of polyp recurrence (RR 1.91, 95% CI [1.29–2.81]; I² = 53%). Subgroup analyses confirmed this increased recurrence in RCTs (RR 2.01). Specifically, for large adenomatous lesions ≥20mm, recurrence was significantly higher with C-EMR compared to H-EMR (RR 1.79, 95% CI [1.40-2.30]; I²= 0%), whereas no significant difference was observed between techniques for serrated lesions (RR 1.49, 95% CI [0.66–3.33]; I² = 34%). Regarding safety, subgroup analysis of large adenomatous lesions–including two studies exclusively evaluating this group–revealed higher rates of delayed bleeding (RR 0.24) and perforation (RR 0.51) in the H-EMR group. In contrast, for serrated lesions, van Hattem et al.–the only study exclusively evaluating this subtype–reported no adverse events with C-EMR, whereas delayed bleeding and perforation occurred in 5.1% and 0.8% of cases, respectively, in the H-EMR group.

Conclusion

Both C-EMR and H-EMR are effective for resecting LNPCP. For adenomas, H-EMR demonstrates lower recurrence rates but carries higher risks of bleeding and perforation. If recurrence is a concern, H-EMR is preferred; however, C-EMR, which offers superior safety, may be a better option for frail patients, those with comorbidities or on anticoagulation therapy. Comparatively, for serrated lesions, recurrence rates are similar between the two techniques, but C-EMR is safer and should be the technique of choice. The decision should be individualized, taking into account lesion characteristics, patient factors, and operator expertise to ensure an optimal balance between procedural safety and long-term outcomes.

References

Nogales O, Carbonell-Blanco C, Pina SM, et al. Cold snare endoscopic mucosal resection versus standard hot technique for large flat non-pedunculated colonic lesions: Results of the CS-EMR 2019 randomized controlled trial. Endoscopy, 2025.
O'Sullivan T, Cronin O, van Hattem WA, et al. Cold versus hot snare endoscopic mucosal resection for large (≥15 mm) flat non-pedunculated colorectal polyps: A randomized controlled trial. Gut, 2024
Steinbrück I, Ebigbo A, Kuellmer A, et al. Cold versus hot snare endoscopic resection of large nonpedunculated colorectal polyps: Randomized controlled German CHRONICLE trial. Gastroenterology, 2024
Pohl H, Rex D, Barber J, et al. Cold snare endoscopic resection for large colon polyps – a randomized trial. Gastrointestinal Endoscopy, 2024.
Ladna M, King WW, Ijaz Z, et al. Cold versus hot endoscopic mucosal resection of large (>20 mm) colonic polyps: A single-center retrospective study. Gastrointestinal Endoscopy, 2024.
Rashid M, Swartz A, Alomari M, et al. Cold vs. hot EMR for large colon polyps (≥20 mm): Analysis of effectiveness, safety, and cost-benefit. Gastrointestinal Endoscopy, 2023.
van Hattem WA, Shahidi N, Vosko S, et al. Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods. Gut, 2021

Event

UEG Week Berlin 2025

Topics

Colorectal Digestive Oncology Endoscopy

Submission format

Abstract

Session

It's all about the right technique: Colorectal lesions

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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IMPROVED ENDOSCOPIC VISIBILITY WITH GEL VERSUS WATER IMMERSION DURING COLORECTAL UNDERWATER EMR: A RANDOMIZED CROSSOVER TRIAL

Motoyuki Otsuka

THE CAUSES OF POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER DURING SURVEILLANCE ENDOSCOPY: RESULTS FROM THE ENGLISH NATIONAL ROOT CAUSE ANALYSIS PROJECT

Nigel Trudgill

IMPACT OF TIMING OF PREMEDICATION ON MUCOSAL VISIBILITY DURING ENDOSCOPY-A RANDOMIZED CONTROLLED TRIAL

D. Nageshwar Reddy

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Keiji Hanada

UEG Presentation

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IMPROVED ENDOSCOPIC VISIBILITY WITH GEL VERSUS WATER IMMERSION DURING COLORECTAL UNDERWATER EMR: A RANDOMIZED CROSSOVER TRIAL

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IMPROVED ENDOSCOPIC VISIBILITY WITH GEL VERSUS WATER IMMERSION DURING COLORECTAL UNDERWATER EMR: A RANDOMIZED CROSSOVER TRIAL

Junki Toyosawa 1, Yasushi Yamasaki 1, Hidetaka Mizushima 1, Mikako Ishiguro 1, Takashi Yamamoto 1, Yuki Aoyama 1, Keiko Takeuchi 1, Toshihiro Inokuchi 1, Hideaki Kinugasa 1, Masahiro Takahara 1, Sakiko Hiraoka 1, Motoyuki Otsuka 1

Affiliations

1 Okayama University Hospital, Okayama, Japan

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Abstract

Introduction

Underwater endoscopic mucosal resection (UEMR) has been increasingly utilized due to its clinical benefits. However, in patients with poor bowel preparation, UEMR is limited by impaired endoscopic visualization due to luminal turbidity. Viscoclear®, a gel designed to secure endoscopic fields, has been available in Japan since 2020 and has demonstrated a 92.2% effectiveness rate in improving visibility during bleeding or inadequate bowel prep. While its usefulness during UEMR has been anticipated, clinical evidence remains limited. We conducted an image analysis study to evaluate the visibility enhancement effect of gel immersion compared to underwater.

Aims & Methods

This study was a prospective randomized crossover trial to compare the endoscopic visibility of colorectal adenomatous lesions (6-20 mm) between under-water and under-gel observation. Each lesion was observed alternately in both settings using white light imaging (WLI), blue laser imaging (BLI), and linked color imaging (LCI). Color difference (ΔE) between tumor and adjacent non-tumor areas was calculated using the Lab color space in Photoshop (Adobe Systems Inc.) to evaluate lesion margins. Based on preliminary retrospective data from our institution, a sample size of 72 was calculated (power: 0.8, one-sided α: 0.05). (jRCTs062220033)

Results

Between July 2022 and May 2024, 72 lesions were enrolled. Median tumor size was 8 mm (range: 6–18 mm). Histopathology revealed 65 adenomas (90.3%), 2 cancers (2.6%), 3 traditional serrated adenomas (4.1%), and 2 hyperplastic polyps (2.8%). Boston Bowel Preparation Scale Segment Scores (BBPS-SS) were 3 in 50 cases, 2 in 21 cases, and 1 in 1 case.
Median ΔE values in the underwater group were 10.0 (WLI), 15.7 (BLI), and 11.7 (LCI), while those in the under-gel group were 12.4 (WLI), 21.1 (BLI), and 13.1 (LCI). ΔE was significantly higher in the under-gel group than the underwater group under WLI and BLI (p = 0.01 and p < 0.01, respectively).
In subgroup analysis by BBPS-SS, under-gel observation showed significantly higher ΔE in WLI and BLI when BBPS-SS ≤2 (p = 0.03 and p < 0.01, respectively). No significant differences were seen when BBPS-SS was 3.

Conclusion

Under-gel observation improved the visibility of lesion margins under WLI and BLI compared to underwater observation, particularly in patients with suboptimal bowel preparation. Gel immersion endoscopy may therefore be a useful adjunct in difficult visualization conditions during colorectal UEMR.

Event

UEG Week Berlin 2025

Topics

Colorectal Endoscopy Surgery

Submission format

Abstract

Session

Improving decision-making in colorectal lesions

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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IMPROVED ENDOSCOPIC VISIBILITY WITH GEL VERSUS WATER IMMERSION DURING COLORECTAL UNDERWATER EMR: A RANDOMIZED CROSSOVER TRIAL

Motoyuki Otsuka

THE CAUSES OF POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER DURING SURVEILLANCE ENDOSCOPY: RESULTS FROM THE ENGLISH NATIONAL ROOT CAUSE ANALYSIS PROJECT

Nigel Trudgill

IMPACT OF TIMING OF PREMEDICATION ON MUCOSAL VISIBILITY DURING ENDOSCOPY-A RANDOMIZED CONTROLLED TRIAL

D. Nageshwar Reddy

Tailoring surveillance on patient's risk: Less is more

Roos E. Pouw

GLP-1 agonist beyond diabtes and obesity

Jörn Schattenberg

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Keiji Hanada

UEG Presentation

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THE CAUSES OF POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER DURING SURVEILLANCE ENDOSCOPY: RESULTS FROM THE ENGLISH NATIONAL ROOT CAUSE ANALYSIS PROJECT

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THE CAUSES OF POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER DURING SURVEILLANCE ENDOSCOPY: RESULTS FROM THE ENGLISH NATIONAL ROOT CAUSE ANALYSIS PROJECT

Amar Srinivasa 1, Rebeca Fiadeiro 2, Karen Clements 2, Tameera Rahman 2, Shilpi Goel 2, Tim Gentry 2, Nicholas E Burr 3, Matthew Banks 4, Anjan Dhar 5, Chris Healey 6, Mimi McCord 7, Dipankar Mukherjee 8, warren chapman 9, Roland Valori 10, Nigel Trudgill 11

Affiliations

1 Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom

2 Health Data Insight CIC, Cambridge, United Kingdom

3 Leeds Institute for Biomedical and Clinical Sciences, Leeds, United Kingdom

4 University College London Hospital NHS Trust (UCLH), London, United Kingdom

5 Darlington Memorial & Bishop Auckland Hospitals, Darlington, United Kingdom

6 Airedale Nhs foundation trust, Airdale, United Kingdom

7 Heartburn Cancer UK, Basingstoke, United Kingdom

8 Barking, Havering And Redbridge University Hospitals NHS Trust, Romford, United Kingdom

9 University Hospitals NHS Foundation Trust, Birmingham, United Kingdom

10 Gloucestershire NHS Foundation Trust - Medicine, Gloucestershire NHS Foundation Trust; Cheltenham/GB, Cheltenham, United Kingdom

11 Sandwell & West Birmingham Hospitals NHS Trust, West Bromwich, United Kingdom

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Abstract

Introduction

Post endoscopy upper gastrointestinal cancers (PEUGIC) are often missed opportunities to diagnose earlier or even prevent cancer. PEUGIC in patients undergoing surveillance for pre-malignant conditions are a potentially important surveillance quality indicator. A national process for identifying all PEUGIC in the English National Health Service and performing root cause analysis was developed.

Aims & Methods

Potential PEUGIC between 2017 and 2023 occurring 3-36 months after an index endoscopy which did not result in a cancer diagnosis were identified from National Cancer Registration Dataset and Hospital Episode Statistics held by the National Cancer Registration and Analysis Service. Data from local root cause analysis were uploaded onto a secure portal for national analysis. Only PEUGIC following surveillance endoscopy were included in this analysis. Logistic regression analysis was used to identify associations.

Results

3151 potential PEUGIC were examined by local reviewers in 144 English hospitals. 635 (20%) were excluded and data were available for 2516 PEUGIC. 618 PEUGIC (24.6%) were undergoing surveillance for: Barrett’s oesophagus (83%); chronic atrophic gastritis (7%) or other conditions (10%). PEUGIC sites were oesophagus 85%, stomach 13% and duodenum 1%. 5% of PEUGIC were not related to the pre-malignant condition under surveillance.
Table 1 summarises the PEUGIC root cause analysis results based on the World Endoscopy Organisation categorisation. Inadequate endoscopy or decision making occurred in 30% of PEUGIC (categories B/D) and was associated with patient harm OR 2.61 (95% CI 1.74 -3.92).
Seattle biopsy protocol compliance was only 58% in Barrett’s surveillance PEUGIC. Additional focal or cancer associated lesions were present at index endoscopy in the PEUGIC segment in 23%.
Oesophageal and gastric PEUGIC often presented with stage 2 cancers or greater (48% and 43% respectively). 45.2% of oesophageal and 47.0% of gastric PEUGIC were considered at least possibly avoidable. Treatment was adversely affected with palliative treatment in 22% of oesophageal and 30% of gastric PEUGIC. 6% led to premature death.
Endoscopy practices associated with stage ≥2 cancer were: sedation without opioids OR 1.75 (95% CI 1.03-2.97); lack of image enhancement OR 1.78 (95% CI 1.18-2.70) and lack of dedicated surveillance sessions OR 2.08 (95% CI 1.46-2.98).

Table 1 Root causes of all surveillance PEUGIC

PEUGIC categorisation	Completed cases
A: Lesion detected, adequate assessment and decision making but PEUGIC occurred	378 (61%)
B: Lesion detected, inadequate assessment and decision making	158 (26%)
C: Possible missed lesion, endoscopy and decision making adequate	56 (9%)
D: Possible missed lesion, endoscopy and decision making inadequate	24 (4%)

Conclusion

Inadequate assessment or decision making was noted in 30% of surveillance PEUGIC, which adversely affected treatment in 20% of oesophageal and 30% of gastric PEUGIC. 48% of oesophageal and 43% of gastric PEUGIC patients presented with stage 2 cancer or greater suggesting potential failures of surveillance. Optimal sedation practice, image enhancement and dedicated surveillance sessions were associated with stage 1 PEUGIC and better outcomes.

Event

UEG Week Berlin 2025

Topics

Endoscopy Oesophagus

Submission format

Abstract

Session

Endoscopic resection in the upper GI tract

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

IMPROVED ENDOSCOPIC VISIBILITY WITH GEL VERSUS WATER IMMERSION DURING COLORECTAL UNDERWATER EMR: A RANDOMIZED CROSSOVER TRIAL

Motoyuki Otsuka

THE CAUSES OF POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER DURING SURVEILLANCE ENDOSCOPY: RESULTS FROM THE ENGLISH NATIONAL ROOT CAUSE ANALYSIS PROJECT

Nigel Trudgill

IMPACT OF TIMING OF PREMEDICATION ON MUCOSAL VISIBILITY DURING ENDOSCOPY-A RANDOMIZED CONTROLLED TRIAL

D. Nageshwar Reddy

Tailoring surveillance on patient's risk: Less is more

Roos E. Pouw

GLP-1 agonist beyond diabtes and obesity

Jörn Schattenberg

A JAPANESE NATIONWIDE PROSPECTIVE OBSERVATIONAL STUDY ON EARLY PANCREATIC CANCER SCREENING IN HOSPITAL OUTPATIENTS USING A COMPREHENSIVE SCORING SYSTEM COMPARED WITH WESTERN SCREENING METHODS (EPSS-1)

Keiji Hanada

UEG Presentation

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IMPACT OF TIMING OF PREMEDICATION ON MUCOSAL VISIBILITY DURING ENDOSCOPY-A RANDOMIZED CONTROLLED TRIAL

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IMPACT OF TIMING OF PREMEDICATION ON MUCOSAL VISIBILITY DURING ENDOSCOPY-A RANDOMIZED CONTROLLED TRIAL

Zaheer Nabi 1, MARAGONI RAJESH GOUD 2, Preeti Sudha 1, D. Nageshwar Reddy 1

Affiliations

1 Asian Institute of Gastroenterology, Hyderabad, India

2 Asian Institute of gastroenterology,Hyderabad, Hyderabad, India

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Abstract

Introduction

Gastric mucosal visibility is essential for high-quality upper gastrointestinal (GI) endoscopy. While simethicone and N-acetylcysteine (NAC) have been shown to improve mucosal visibility, the optimal time interval between preparation and endoscopy remains undefined.

Aims & Methods

This randomized controlled trial evaluated the effect of timing on mucosal visibility and explored the upper limit beyond which visibility begins to decline.
In this single-center, randomized controlled trial, adult patients undergoing elective upper GI endoscopy were randomized into four groups: placebo, simethicone + NAC with endoscopy performed after 10–20 minutes, 20–30 minutes, and >30 minutes. The primary outcome was the proportion of patients achieving adequate gastric mucosal visibility (GMV), defined as a score of <7 on a validated visibility scale. A pre-specified subgroup analysis of the >30 minute group was performed by stratifying patients into 20-minute intervals (31–50, 51–70, and 71–90 minutes) to assess the durability of mucosal clarity over time.

Results

Comparison	Adequate gastric mucosal visibility (%)	P
10–20 min vs 20–30 min	27% vs 62%	0.001
10–20 min vs >30 min	27% vs 67%	0.001
10–20 min vs Placebo	27% vs 2.6%	0.001
20–30 min vs >30 min	62% vs 67%	0.174
20–30 min vs Placebo	62% vs 2.6%	0.001

1,140 patients (median age 42years, 63.2% males) were included in the study. Adequate GMV was significantly higher in all preparation groups compared to placebo (p < 0.001). The 20–30 minute and >30 minute groups demonstrated the highest rates of adequate visibility (61.5% and 73.5%, respectively), both significantly superior to the 10–20 minute group (26.9%) and placebo (2.6%). In the >30 minute subgroup analysis, the 31–50 minute interval demonstrated the highest adequacy (73.5%). The 51–70 minute group showed moderate adequacy (52.1%), which was not significantly different from the 20–30 minute group (p = 0.207). However, the 71–90 minute group had reduced adequacy (43.8%) and did not differ significantly from the 10–20 minute group (p = 0.145). No adverse events were reported across study arms.

Conclusion

Endoscopy performed between 20 and 50 minutes after mucosal preparation yields optimal gastric mucosal visibility. A decline in visibility beyond 50 minutes suggests a practical upper limit for endoscopy timing following preparation. These findings support structured, time-sensitive scheduling following mucosal cleansing to enhance procedural quality.

Disclosure

None

Event

UEG Week Berlin 2025

Topics

Endoscopy Oesophagus

Submission format

Abstract

Session

Randomised controlled trials in upper GI endoscopy

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

IMPROVED ENDOSCOPIC VISIBILITY WITH GEL VERSUS WATER IMMERSION DURING COLORECTAL UNDERWATER EMR: A RANDOMIZED CROSSOVER TRIAL

Motoyuki Otsuka

THE CAUSES OF POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER DURING SURVEILLANCE ENDOSCOPY: RESULTS FROM THE ENGLISH NATIONAL ROOT CAUSE ANALYSIS PROJECT

Nigel Trudgill

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D. Nageshwar Reddy

Tailoring surveillance on patient's risk: Less is more

Roos E. Pouw

GLP-1 agonist beyond diabtes and obesity

Jörn Schattenberg

A JAPANESE NATIONWIDE PROSPECTIVE OBSERVATIONAL STUDY ON EARLY PANCREATIC CANCER SCREENING IN HOSPITAL OUTPATIENTS USING A COMPREHENSIVE SCORING SYSTEM COMPARED WITH WESTERN SCREENING METHODS (EPSS-1)

Keiji Hanada

UEG Presentation

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

Tailoring surveillance on patient's risk: Less is more

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Tailoring surveillance on patient's risk: Less is more

Roos E. Pouw 1

Affiliations

1 Amsterdam UMC, Amsterdam, Netherlands

Summary

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Abstract

Event

UEG Week Berlin 2025

Topics

Endoscopy Oesophagus

Session

Barrett's oesophagus: Are we getting there?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

IMPROVED ENDOSCOPIC VISIBILITY WITH GEL VERSUS WATER IMMERSION DURING COLORECTAL UNDERWATER EMR: A RANDOMIZED CROSSOVER TRIAL

Motoyuki Otsuka

THE CAUSES OF POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER DURING SURVEILLANCE ENDOSCOPY: RESULTS FROM THE ENGLISH NATIONAL ROOT CAUSE ANALYSIS PROJECT

Nigel Trudgill

IMPACT OF TIMING OF PREMEDICATION ON MUCOSAL VISIBILITY DURING ENDOSCOPY-A RANDOMIZED CONTROLLED TRIAL

D. Nageshwar Reddy

Tailoring surveillance on patient's risk: Less is more

Roos E. Pouw

GLP-1 agonist beyond diabtes and obesity

Jörn Schattenberg

A JAPANESE NATIONWIDE PROSPECTIVE OBSERVATIONAL STUDY ON EARLY PANCREATIC CANCER SCREENING IN HOSPITAL OUTPATIENTS USING A COMPREHENSIVE SCORING SYSTEM COMPARED WITH WESTERN SCREENING METHODS (EPSS-1)

Keiji Hanada

UEG Presentation

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GLP-1 agonist beyond diabtes and obesity

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GLP-1 agonist beyond diabtes and obesity

Jörn Schattenberg 1

Affiliations

1 Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany

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Abstract

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Mechanisms & Personalised Medicine

Session

Therapy update: MASH and metabolic disorders

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

IMPROVED ENDOSCOPIC VISIBILITY WITH GEL VERSUS WATER IMMERSION DURING COLORECTAL UNDERWATER EMR: A RANDOMIZED CROSSOVER TRIAL

Motoyuki Otsuka

THE CAUSES OF POST ENDOSCOPY UPPER GASTROINTESTINAL CANCER DURING SURVEILLANCE ENDOSCOPY: RESULTS FROM THE ENGLISH NATIONAL ROOT CAUSE ANALYSIS PROJECT

Nigel Trudgill

IMPACT OF TIMING OF PREMEDICATION ON MUCOSAL VISIBILITY DURING ENDOSCOPY-A RANDOMIZED CONTROLLED TRIAL

D. Nageshwar Reddy

Tailoring surveillance on patient's risk: Less is more

Roos E. Pouw

GLP-1 agonist beyond diabtes and obesity

Jörn Schattenberg

A JAPANESE NATIONWIDE PROSPECTIVE OBSERVATIONAL STUDY ON EARLY PANCREATIC CANCER SCREENING IN HOSPITAL OUTPATIENTS USING A COMPREHENSIVE SCORING SYSTEM COMPARED WITH WESTERN SCREENING METHODS (EPSS-1)

Keiji Hanada

UEG Presentation

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

A JAPANESE NATIONWIDE PROSPECTIVE OBSERVATIONAL STUDY ON EARLY PANCREATIC CANCER SCREENING IN HOSPITAL OUTPATIENTS USING A COMPREHENSIVE SCORING SYSTEM COMPARED WITH WESTERN SCREENING METHODS (EPSS-1)

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

A JAPANESE NATIONWIDE PROSPECTIVE OBSERVATIONAL STUDY ON EARLY PANCREATIC CANCER SCREENING IN HOSPITAL OUTPATIENTS USING A COMPREHENSIVE SCORING SYSTEM COMPARED WITH WESTERN SCREENING METHODS (EPSS-1)

Ryota Sagami 1, Kentaro Yamao 2, Akinori Shimizu 3, Hidefumi Nishikiori 4, Koji Yoshida 5, Mamoru Takenaka 6, Akihiro Yoshida 6, HAJIME IMAI 7, Katsunori Sekine 8, Masatoshi Murakami 9, Nao Fujimori 9, Rintaro Nagayama 10, Toshiharu Ueki 10, Jun Nakahodo 11, Kazuhisa Okamoto 12, Makiko Kinoshita 13, Yukiko Takayama 14, Yuji Amano 15, Kazuhiro Mizukami 12, Kazunari Murakami 16, Keiji Hanada 3

Affiliations

1 Faculty of Medicine, Oita University, Yufu, Japan|||Faculty of Medicine, Oita University, Yufu, Japan

2 Nagoya University, Nagoya, Japan

3 Onomichi General Hospital, Onomichi, Japan

4 Oita San-ai Medical Center, Oita, Japan

5 Faculty of Medicine, Kawasaki Medical University, Kurashiki, Japan

6 Kinki University, Osaka sayama, Japan

7 Okanami General Hospital, Iga, Japan

8 National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan

9 Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

10 Fukuoka University Chikushi Hospital, Fukuoka, Japan

11 Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome H, Tokyo, Japan

12 Faculty of Medicine, Oita University, Yufu, Japan

13 National Organization Minamiwakayama Medical Center, Tanabe, Japan

14 Tokyo Women's Medical University, Shinjuku, Japan

15 Urawa GIE clinic group, Urawa, Japan

16 Oita University Dept. of Gastroenterology, Yuhu, Japan

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Abstract

Introduction

Pancreatic cancer (PC) has one of the poorest prognoses among malignancies. Early detection, particularly of stage 0 or stage 1 disease, is crucial to improving survival outcomes. However, conventional screening strategies based solely on family history or symptoms—as commonly practiced in Western countries—have shown limited sensitivity for early-stage PC. In Japan, more comprehensive approaches are being developed.

Aims & Methods

Low-grade relevant (LGR) factor	High-grade relevant (HGR) factor
・sporadic family history ・diabetes mellitus ・diabetes mellitus worsening ・stomach/back symptoms ・weight loss ・elevated serum pancreatic enzyme ・heavy alcohol consumption ・smoking history ・obesity	・familial PC ・hereditary PC syndrome/pancreatitis ・new-onset diabetes mellitus ・jaundice ・elevated serum tumor biomarkers ・chronic pancreatitis ・pancreatic cyst ・main pancreatic duct dilation
Score positive; 3 points or more	Score positive; 1 point or more

This nationwide, multicenter prospective study aimed to evaluate the utility of a novel scoring system for early PC detection among hospital outpatients. From August 2019 to May 2024, all outpatients presenting with symptoms, risk factors, subtle imaging abnormalities of the pancreas, or requesting pancreatobiliary screening at the Department of Gastroenterology in hospitals participating in the Early Pancreatic Cancer Screening Study (EPSS) were considered for inclusion. Consecutive patients who had no pancreatic tumors suspected by any imaging modalities were examined, no prior history of endoscopic ultrasound (EUS) examination for pancreatic disease, and/or no referrals from other hospitals specifically for PC diagnosis were prospectively enrolled. The system comprised low- and high-grade relevant (LGR/HGR) factors referring to both risk factors and diagnostic indicators, including symptoms and subtle imaging abnormalities associated with PC. Patients were classified as score-positive if they had ≥3 LGR or ≥1 HGR factor(s). Diagnostic yield for stage 0/1 and all-stage PC was compared between score-positive and score-negative groups. Diagnostic performance was also evaluated against previous large-scale Japanese data and Western screening methods based on family/genetic risk or symptoms. The sample size was determined based on a previous large-scale PC screening study in Japan.

Results

Of 3,287 patients, 2,531 were score-positive and 756 were score-negative. PC was diagnosed in 283 patients (8.6%), including 67 with stage 0/1 disease. The detection rate of stage 0/1 PC was significantly higher in score-positive than in score-negative patients (2.6% vs. 0.7%, P=.001). Compared to a previous Japanese study (0.78%), this study showed a significantly higher detection rate (P<.001). The sensitivity of the scoring system for stage 0/1 PC was 93.1%, significantly outperforming Western-style approaches (12.5% for family/genetic risk and 50.0% for symptom-based screening; both P<.001), while maintaining comparable accuracy. Even combining family/genetic risk and symptoms, sensitivity remained lower than that of the scoring system (56.9%, P<.001). For all-stage PC, both the accuracy and sensitivity of the diagnosis based on the scoring system were significantly higher than those based on family/genetic risk, symptom, or the combination of symptom and family/genetic risk (P = .030, .004, .002 for accuracy; and all P <.001 for sensitivity, respectively). Among the 283 PC cases, 23.7% were stage 0/1, 15.9% were ≤10 mm, and 45.6% underwent surgical resection. Multivariate logistic analysis identified older age, worsening diabetes, and MPD dilation as significant independent predictors of stage 0/1 PC.

Conclusion

The scoring system demonstrated superior sensitivity and comparable accuracy to traditional screening strategies for detecting early-stage PC. Its use in outpatient settings may facilitate earlier diagnosis and intervention, thereby improving resectability and prognosis.

References

Klein AP. Pancreatic cancer epidemiology: understanding the role of lifestyle and inherited risk factors. Nat Rev Gastroenterol Hepatol 2021;18:493-502.
Hanada K, Okazaki A, Hirano N, et al. Diagnostic strategies for early pancreatic cancer. J Gastroenterol 2015;50:147-54.
Sagami R, Hayasaka K, Ujihara T, et al. Role of EUS combined with a newly modified scoring system to detect pancreatic high-grade precancerous lesions. Endosc Ultrasound 2022.

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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