Introduction

Colonoscopy is the gold standard investigation in the lower gastrointestinal tract. However, 75% of patients can experience pain or discomfort with moderate sedation. The application of robotic technology promises to advance and overcome difficulties faced including better utilisation of rooms for advanced procedures and to achieve a complete colonoscopy in patients where pain and technical challenges inhibit progression.

Aims & Methods

This pilot study, the first at a UK NHS Hospital between January 2023 to April 2025 with an expert endoscopist performing the robotic colonoscopy with the Endotics system. This is a disposable soft robot which employs expand and contract movement to self-propel along the bowel. Patients with failed previous standard colonoscopy along with index diagnostic procedures deemed potentially difficult were recruited. Procedures were performed outside the endoscopy unit similar to an outpatient clinical room.

Results

112 patients were recruited (50M:62F), mean-age 56.3 years over 27 months. The commonest indications for robotic colonoscopy were rectal bleeding (36.9%), failed standard colonoscopy (22.6%) and change in bowel habit (17.2%). 23 patients had failed previous standard colonoscopy with 16 patients achieving completion with subsequent robotic colonoscopy (70% improvement). Average caecal intubation time 36.63 minutes with average total procedure time 48.74 minutes.

Conclusion

Robotic colonoscopy provides a safe and effective method in improving comfort and completion-rates, including previously failed colonoscopy. Direct visualisation, biopsy and polypectomy is still possible with robotic colonoscopy. This study has demonstrated a viable alternative to conventional colonoscopy. With no sedation it allows procedures to be conducted outside the traditional endoscopy unit such as outpatients. The study highlights a learning curve to reduce caecal intubation time. The study is expanding with further endoscopists being trained in robotic endoscopy with a view to expand the service available to patients.

Introduction

Lynch syndrome is a hereditary cancer predisposition syndrome associated with a significantly increased risk of colorectal cancer (CRC). Despite regular colonoscopic surveillance, patients remain at considerable risk of developing CRC. Surgical resection has long been the cornerstone of curative treatment, but it often comes with substantial morbidity. Endoscopic en-bloc resection techniques such as endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (eFTR) may offer effective, organ-sparing alternatives for early invasive cancers, but data on their safety and oncological outcomes in Lynch syndrome patients are lacking.

Aims & Methods

We conducted a multicenter, multinational retrospective case series including Lynch syndrome patients with confirmed pathogenic variants in MLH1, MSH2, MSH6, PMS2, or EPCAM deletions who underwent endoscopic en-bloc resection for malignant colorectal lesions between 2010 and 2024. Clinical, procedural, histological, and follow-up data were collected from medical records. The primary outcome was the rate of curative endoscopic resection, defined as radical resection without the need for surgery and no locoregional recurrence or distant metastasis at 6 months. Secondary outcomes included locoregional recurrence or distant metastasis at 24 and 60 months, along with the number of additional resections performed.

Results

A total of 38 patients (mean age 61.3 ± 15 years, 50% female) underwent 17 ESDs, 19 eFTRs, 1 endoscopic intermuscular dissection (EID), and 1 hybrid procedure (Combined ESD + eFTR). The R0 resection rate was 89% (34/38). Thirteen (34%) patients underwent additional surgery, with 12 cases due to T1CRC with high risk features (including all 4 cases with R1 resection) and 1 case due to perforation. In 25 patients (66%), curative treatment was achieved through endoscopic resection alone. Of these, 18 completed at least 6-months of follow-up, all of whom were disease-free. At 24 months, endoscopy was performed in nine patients, all of whom remained disease-free. Two patients completed 60-months of follow-up with no recurrences.

Conclusion

This is the first and largest case series of patients with Lynch syndrome treated with en bloc endoscopic resection. In 7 out of 10 patients, curative treatment was achieved through endoscopic resection alone without exposing patients to the morbidity of oncological surgery. These findings suggest that ESD and eFTR are safe and could serve as minimally invasive alternatives to surgery for selected patients, warranting further prospective evaluation.

Introduction

A well-established association exists between dietary fibre intake and overall health, with fibre recognised as a therapeutic intervention for a number of gastrointestinal disorders, including irritable bowel syndrome and chronic constipation.^1,2 A diet rich in dietary fibre is endorsed by guidance from United European Gastroenterology and the European Society of Clinical Nutrition and Metabolism, however only 9% of the UK population consumes the recommended amount of 30g/day of fibre.^3-5
Providing patients with clear and specific dietary recommendations is likely to enhance compliance, leading to improved health outcomes.⁶ While doctors often provide generalised advice to patients to increase their fibre intake, little is known about their specific or detailed knowledge of fibre-rich foods and the methods they use to counsel patients on dietary modifications.

Aims & Methods

This study aimed to assess how well doctors identified food as high fibre sources, their confidence in providing fibre-related advice, and how frequently they engage in such discussions.
A cross-sectional survey targeting hospital doctors in the UK was conducted via a questionnaire in April 2025 using the Qualtrics platform. The survey captured demographic data, clinical practices, knowledge, and confidence levels in fibre-related counselling. All responses were anonymous. Participants were asked to rate the amount of dietary fibre in a representative selection of 8 foods from different food categories. Food was classified as high fibre (≥6g/100g), medium fibre (3-5g/100g), and low/no fibre food (<3g/100g). All nutritional information was obtained from the British Nutrition Foundation.⁷

Results

Seventy-one responses were collected, 1 was incomplete, leaving 70 for analysis. Most doctors worked in either gastrointestinal surgery (46%) or internal medical (41%) specialties. The largest group of respondents stated that they were required to provide dietary advice to patients at least each week (49%).
Many respondents could not identify that high fibre food sources such as bran flakes (49%) and wholemeal toast (56%) had more than 6g/100g of fibre. Some respondents also wrongly classified low/no fibre food to be high fibre sources (apple [30%], banana [29%], and salads [40%]). No respondent was able to correctly identify the correct fibre category for all 8 foods.
Sixty percent of respondents stated a lack of confidence in providing dietary advice regarding fibre intake to patients and 61% did not feel confident in altering a patient’s daily fibre intake based on their clinical condition.

Conclusion

Many doctors cannot accurately categorise food which are high, medium and low/no fibre food sources. Most doctors do not feel confident in providing fibre advice to patients. This is likely to impact patient understanding and successful adherence to fibre rich diets. Easily accessible resources and dedicated teaching on fibre intake should be provided to doctors in allied specialties as this has the potential to improve patient care.

References

1. Barber TM, Kabisch S, Pfeiffer AFH, Weickert MO. The Health Benefits of Dietary Fibre. Nutrients [Internet]. 2020 Oct 21;12(10):3209. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7589116/
2. Yang J. Effect of dietary fiber on constipation: A meta-analysis. World Journal of Gastroenterology [Internet]. 2012;18(48):7378. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544045/
3. Food and Drink Federation . Action on Fibre [Internet]. The Food & Drink Federation. 2022 [cited 2025 Apr 25]. Available from: https://www.fdf.org.uk/fdf/our-work/our-campaigns/action-on-fibre/
4. Hooper B, Spiro A, Stanner S. 30 g of Fibre a day: an Achievable recommendation? Nutrition Bulletin [Internet]. 2015 May 19;40(2):118–29. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/nbu.12141
5. Gressier M, Frost G. Minor Changes in Fibre Intake in the UK Population between 2008/2009 and 2016/2017. European Journal of Clinical Nutrition [Internet]. 2021 May 13;76(2). Available from: https://www.nature.com/articles/s41430-021-00933-2
6. McKeown NM, Fahey GC, Slavin J, van der Kamp JW. Fibre Intake for Optimal health: How Can Healthcare Professionals Support People to Reach Dietary recommendations? BMJ [Internet]. 2022 Jul 20;378:e054370. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9298262/
7. BRITISH NUTRITION FOUNDATION. Fibre - Nutrition Information - British Nutrition Foundation [Internet]. British Nutrition Foundation. 2023. Available from: https://www.nutrition.org.uk/nutritional-information/fibre/

Introduction

Gastric cancer (GC) ranks as the sixth most common cancer globally and is the fifth leading cause of cancer-related mortality. Previous studies have shown that the five-year survival rate for early-stage GC exceeds 90%. Gastroscopy is the gold standard for GC diagnosis, but its invasive nature and high cost limit its clinical application. Non-invasive tests have been reported in GC prediction, yet current biomarkers fall short in sensitivity or specificity, particularly for early GC prediction, leading to misdiagnosis and potential delays in GC treatment, which may reduce patient survival rates. Multi-omics biomarker panels significantly enhance diagnostic efficacy through multidimensional information complementarity, compared to single-omics or individual biomarkers. Therefore, developing non-invasive multi-omics biomarker combinations holds great promise for enhancing GC diagnostic accuracy and increasing the likelihood of early diagnosis and treatment.

Aims & Methods

This study utilized mass spectrometry-based proteomics and metabolomics to comprehensively analyze the peripheral blood components of non-gastric cancer (NGC, including patients with chronic superficial gastritis and precancerous lesions such as atrophic gastritis, intestinal metaplasia, and dysplasia) and gastric cancer (GC, including patients with well-defined staging from stage IA (T1N0M0) to advanced stages). We employed machine learning algorithms to develop a multi-omics biomarker combination capable of identifying GC and enabling early GC diagnosis.The studies involving humans were approved by the Medical Research Ethics Committee of Peking University Third Hospital.

Results

Through differential analysis of plasma proteins and metabolites in GC (n=53) and NGC (n=41) (FDR<0.05, log2FC>1), we identified 333 upregulated proteins and 570 upregulated metabolites. LASSO regression further narrowed down the candidates to 10 proteins (10-P) and 10 metabolites (10-M) as potential biomarkers. Subsequently, we constructed gastric cancer prediction models using random forest algorithms. In the validation set (n=27), the 10-P Model achieved a prediction accuracy of 0.85 (AUC: 0.91, sensitivity 0.83, specificity 0.86), while the 10-M Model had a prediction accuracy of 0.77 (AUC: 0.82, sensitivity 0.83, specificity 0.77). The Multi-Omics Integrated Model (MOIM), built via machine learning-based Voting Classifier, reached a prediction accuracy of 0.92 (AUC: 0.96, sensitivity 0.91, specificity 0.93), surpassing the former two models. For stage IA GC (n=22) prediction, MOIM's accuracy was 0.93, higher than the 10-P Model's 0.86 and the 10-M Model's 0.79. Finally, we streamlined the model to include only 7 proteins and 3 metabolites, forming the Simplified Multi-Omics Integrated Model (sMOIM), which achieved accuracies of 0.91 for GC and 0.92 for stage IA GC.

Conclusion

The selected plasma protein and metabolite biomarker combination enables highly accurate prediction of GC, especially early-stage GC. Moreover, the multi-omics integrated analysis achieves superior accuracy, sensitivity, and specificity compared to single-omics prediction, suggesting its potential as an effective strategy for the precise early diagnosis of gastric cancer.

Introduction

Proton pump inhibitors (PPIs) are commonly prescribed for acid-related disorders, yet concerns about overuse and long-term adverse effects persist. Physicians, due to their medical knowledge and unrestricted access to medications, may demonstrate unique self-medication behaviors. This study aimed to assess the prevalence, indications, self-prescribing habits, and awareness of PPI-related risks among physicians.

Aims & Methods

A cross-sectional online survey was administered to 442 physicians across different healthcare levels. The anonymous questionnaire collected data on demographics, frequency and indications for PPI use, self-medication practices, knowledge of adverse effects, and deprescribing behavior. Descriptive and comparative statistical analyses were conducted.

Results

Of the respondents, 60.8% reported occasional PPI use, and 52.0% admitted to self-medicating without prior medical consultation. The most common indications were gastroesophageal reflux disease (GERD) and dyspepsia. Preventive use (e.g., before fatty meals or alcohol) was rare, reported by only 6.1%. Although awareness of potential side effects was high, just 2.0% had discontinued or reduced PPI use due to adverse effects.

Conclusion

Self-medication and occasional PPI use are prevalent among physicians, despite a high level of awareness regarding potential harms. These findings underscore the need for targeted educational efforts and clearer deprescribing guidelines to promote more rational PPI use in the medical community.

Disclosure

The authors declare no conflicts of interest related to this study.

Introduction

Timely endoscopy in upper gastrointestinal bleeding (UGIB) is crucial. However, the ideal timing, particularly in relation to hemodynamic status, remains a matter of debate. Despite advances in diagnostic techniques and endoscopic treatments, its mortality rate has not declined significantly over the years.

Aims & Methods

We aimed to assess clinical practice patterns and determine how the timing of endoscopy is influenced by the patient's hemodynamic status. We conducted an international online survey between April 2023 and November 2023 among physicians managing patients with UGIB. REDCap was used for data collection. We assessed clinicians' opinions on the optimal timing of endoscopy (within 2, 6, 12, 24, or >24 hours) for variceal (VUGIB) and non-variceal (NVUGIB) bleeding under three hemodynamic conditions: stable, unstable responding and not responding to hemodynamic resuscitation. Additionally, we asked how they defined hemodynamic instability. The primary analysis summarized responses as proportions. Secondary analyses explored variations in responses by clinical experience, practice setting, and annual UGIB case volume.

Results

A total of 533 clinicians from 50 countries completed the survey. Of the respondents, 291 (54.6%) worked in university-based hospitals, 361 (67.7%) managed over 100 UGIB cases annually, and 236 (44.3%) had more than 10 years of experience. For NVUGIB, the majority recommended endoscopy within 24 hours for stable patients (229, 43.1%), within 6 hours for unstable responders (161, 30.2%), and within 2 hours for unstable non-responders (254, 47.8%). For VUGIB, the most common recommendations were endoscopy within 12 hours for stable patients (155, 29.1%), within 6 hours for unstable responders (201, 37.7%), and within 2 hours for unstable non-responders (319, 60%). More experienced physicians, those working in university-based hospitals, and those managing high UGIB patient volumes tend to favor earlier endoscopy. The most commonly chosen definition for hemodynamic instability, selected by 345 (64.7%) was systolic blood pressure <100 mmHg and heart rate >100 bpm or syncope or orthostatic hypotension or signs of organ hypoperfusion, selected by 345 (64.7%) of the respondents. Statistical variability was significant across all analyses (p<0.0001). Younger clinicians were more likely to adhere to guideline recommendations.

Conclusion

We found that the more hemodynamically unstable the patients are, the earlier gastroenterologists tend to recommend performing endoscopy for UGIB. Clinical experience, hospital type, and annual patient number significantly influenced the preferred timing of endoscopy in UGIB. There was considerable variability among respondents’ answers. This study highlights opportunities to improve consistency in clinical practice and identifies potential areas for further research.

Introduction

Tofacitinib (TOFA) is an oral Janus kinase Inhibitor for the treatment of ulcerative colitis (UC). We aimed to prospectively assess the real-world effectiveness and safety of TOFA in patients with moderate-to-severe UC, using a stringent criteria for clinical benefit.

Aims & Methods

TOFAST study is a prospective, multicenter, observational study including patients initiating TOFA from 39 French centers (Dec 2020 – Jun 2023). This interim analysis reports one-year effectiveness and safety. The primary endpoint was clinical benefit at one-year, defined as PRO-2 remission [rectal bleeding subscore (RBS) of 0 and stool frequency subscore (SFS) of ≤1], regardless of TOFA discontinuation. Patients with colectomy, death, treatment with another biologic/JAKi/immunosuppressant or corticosteroids (CS) in the last 3 months were considered non-responders. Secondary endpoints included clinical remission, clinical response, change in daily PRO-2 scores during the first 14 days, the median time to relief, and safety. Clinical remission was defined as Partial Mayo Score (PMS) ≤2 with no subscore >1, clinical response as a decrease in PMS ≥ 3 points and ≥30% from inclusion with a concomitant decrease in RBS ≥ 1 point (absolute subscore of 0 or 1). Patient’s symptomatic relief was reported as the time in days from initiation of TOFA to improvement of their symptoms. Missing data were imputed as non-responders.

Results

150 and 146 patients were included in the safety and effectiveness analysis, respectively, with a median exposure duration of 7.4 [Q1; Q3: 2.9; 12.0] months. In the effectiveness population, mean (± SD) age was 36.9 ±13.6 years, median disease duration was 6.0 years [Q1; Q3: 2.6; 11.2], 47.2% of patients had pancolitis, and the mean total Mayo Score was 7.8 ±2.3. 94.5% of patients had previously received at least one TNF-inhibitor, 62.3% vedolizumab and 32.2% ustekinumab. 27.4% of patients received at least 3 biologics. All patients initiated TOFA at 10 mg b.i.d, in combination with 5-ASA and CS for 19.9% and 33.6% of patients, respectively.
At one-year clinical benefit was achieved by 38/146 (26.0%) patients, and 66/146 (45.2%) of patients were still treated with TOFA. 30.1% and 30.8% of patients achieved clinical remission and clinical response, respectively. For the 94 (64.4%) patients who reported symptomatic improvement the median time to relief was 7 days [Q1; Q3: 4.0; 14.0]. Among the 102 patients who completed their daily PRO-2 subscores during the first 14 days, 36 (35.3%) and 55 (53.9%) normalized their SFS and RBS, respectively by day 14.
89.3% of patients reported at least one adverse event (AE) and 23.3% reported at least one serious AE. Twenty-two (14.7%) infections, 3 cases of herpes zoster, 2 cases of cancers (one non-invasive low-grade urothelial carcinoma and one colon adenocarcinoma) as well as one death (considered not related to the treatment) were reported. No major cardiovascular or venous thromboembolic event were observed.

Conclusion

In this large prospective real-world cohort of refractory UC patients, one-year clinical benefit was achieved in 26% using a stringent PRO-2 endpoint. Nearly one third were in clinical remission. Rapid symptomatic relief within 14 days and a manageable safety profile reinforce the role of TOFA as a therapeutic option in difficult-to-treat UC.

Disclosure

This study has been sponsored by Pfizer. A Bouzidi and Y Brault are employees and shareholders of Pfizer.