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Introduction

Targeted oral therapies offer advanced therapy options with convenient administration and different mechanism of actions to existing biologic therapies to treat ulcerative colitis (UC). The objective of this study was to assess the evolution of Janus Kinase inhibitor (JAKi) usage in UC patients, highlighting any nuances in treating different patient types.

Aims & Methods

A multi-centre online medical chart review study of patients with UC was conducted between Jul – Sep 2019, 2021, and 2022 among UK, FR, DE, IT & ES gastroenterologists practicing across hospital and private practices. Physicians were screened for practice duration and patient volume. Charts of patients prescribed with JAKis were included in the analysis.

Results

The total number of sampled gastroenterologists recruited in this survey and collective total of reported UC patients treated with JAKi therapy are
- Q3 2019: 206 gastroenterologists reporting 127 patients
- Q3 2021: 203 gastroenterologists reporting 87 patients
- Q3 2022: 206 gastroenterologists reporting 100 patients
Looking at reported JAKi-receiving UC patient characteristics, the mean age became progressively younger over time (2019: 40yrs, 2021: 38yrs, 2022: 36yrs) and the proportion of JAKi patients recorded as male also increased between 2019 to 2021 (2019: 65%, 2021: 62%, 2022: 75%). Reported JAKi patients recorded without any additional comorbidities also increased in proportion of the sample from 2019 (2019: 39%, 2021: 58%, 2022: 65%).
The mean recorded calprotectin level of reported JAKi-receiving UC patients increased over time (calprotectin mean – 2019: 204, 2021: 250, 2022: 341). When analysing reasons that prompted sampled gastroenterologists to choose JAKis for the UC patients, ‘rapid symptomatic control’ and ‘pain reduction’ were the most frequently cited reasons for every time point.

Table 1: Cited reasons for JAKi usage in reported UC patients (% patients)

Timepoint	Q3 2019	Q3 2021	Q3 2022
% cited with 'rapid symptomatic control'	22.0%	28.7%	36.0%
% cited with 'pain reduction'	7.1%	10.3%	13.0%
% cited with 'can be used as monotherapy'	37.8%	43.7%	26.0%

‘Can be used as monotherapy’ was cited less as a reason for choosing JAKi in 2022 vs 2019. This aligns with reported JAKi monotherapy usage decreased over the same timeframe (% reported patients receiving JAKi as monotherapy – 2019: 76%, 2021: 72%, 2022: 55%), whilst reported JAKi combination usage with 5-ASA increased (% reported patients receiving JAKi as combination with 5-ASA – 2019: 8%, 2021: 16%, 2022: 30%).

Conclusion

In this study cohort, there is evidence of evolving nuances in JAKi usage among gastroenterologists in their UC patients over time. This may be partly influenced by clinical data release and regulatory influences over this timescale. Further investigation using comparator cohort is warranted.

ASSESSING THE EVOLVING NUANCES OF JAK INHIBITOR PRESCRIPTION IN ULCERATIVE COLITIS (UC) PATIENTS

MamTing Thoo 1, Penny Robinson 2, Denise Baldock 2

1 Ipsos, Kuala Lumpur, Malaysia

2 Ipsos, London, United Kingdom

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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How to define the hot spots?

Marjolijn Duijvestein 1

1 Radboudumc, Nijmegen, Netherlands

Event

UEG Week Berlin 2025

Topics

Endoscopy Nurses

Session

Is your GI-practice sustainable?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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BEYOND ENDOSCOPY: EVALUATING NON-INVASIVE TOOLS FOR MONITORING POSTOPERATIVE CROHN'S DISEASE RECURRENCE

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Introduction

Post-operative recurrence (POR) affects a substantial proportion of Crohn's disease (CD) patients following intestinal resection. While ileocolonoscopy remains the gold standard for detecting recurrence, its invasive nature and patient burden have spurred interest in non-invasive monitoring approaches. This study evaluates the performance of faecal calprotectin (FC) and cross-sectional imaging at different timepoints in predicting endoscopic recurrence in postoperative CD patients.

Aims & Methods

In this multicenter retrospective cohort of 895 CD patients who underwent ileocecal resection, we analyzed the diagnostic accuracy of FC measurements at 3, 6-12, and 18-24 months postoperatively for predicting endoscopic recurrence (Rutgeerts score ≥i2 or SES-CD ≥3). Additionally, we assessed the concordance between intestinal ultrasound (IUS) and magnetic resonance imagings (MRI) and endoscopic findings at both 6-12- and 18-24-months using kappa statistics.

Results

FC demonstrated modest discriminatory ability at 3 months (AUC 0.642, 95% CI: 0.530-0.753) and 6-12 months (AUC 0.653, 95% CI: 0.593-0.713), with improved performance at 18-24 months (AUC 0.676, 95% CI: 0.608-0.744). The optimal cutoff values for FC (47.5 μg/g at 3 and 6-12 months; 80.0 μg/g at 18-24 months) were substantially lower than standard thresholds (150-250 μg/g) used in non-operated patients.
At 6-12 months, radiological and endoscopic assessments showed moderate agreement (κ=0.426, p<0.001) with 63.2% concordance. At 18-24 months, IUS demonstrated superior agreement with endoscopic findings (κ=0.531, p<0.001; sensitivity 83.8%, specificity 72.7%) compared to MRI (κ=0.324, p<0.001). Notably, radiological remission at 18-24 months was identified as a significant protective factor against surgical recurrence (OR 0.356, 95% CI: 0.179-0.705, p=0.003).

Table I: Concordance between endoscopic and radiologic findings (IUS and MRI) for inflammation and remission at 18–24 months post-ileocecal resection. Abbreviations: IUS: Intestinal ultrasound, MRI: Magnetic resonance imaging.

Comparison	n	κ	Strength of Agreement	p-value	Condition	Endoscopic Activity	Endoscopic Remission
Endoscopic Remission 18–24m vs. IUS 18–24m	123	0.531	Moderate	<0.001	Active Inflammation	60	7
					Remission	21	35
					Total	81	42
Endoscopic Remission 18–24m vs. MRI 18–24m	140	0.324	Fair	<0.001	Active Inflammation	64	17
					Remission	28	31
					Total	92	48

Conclusion

Non-invasive monitoring with FC shows promise in postoperative CD surveillance, though diagnostic thresholds differ substantially from those established for non-operated patients. IUS demonstrates superior concordance with endoscopic findings compared to MRI, particularly at later timepoints. The protective role of radiological remission against surgical recurrence highlights the importance of transmural healing. Combining FC with radiological assessment, especially IUS, may provide a comprehensive, patient-friendly approach to monitoring postoperative CD, potentially reducing the need for invasive procedures in selected patients but further studies are needed in this direction.

BEYOND ENDOSCOPY: EVALUATING NON-INVASIVE TOOLS FOR MONITORING POSTOPERATIVE CROHN'S DISEASE RECURRENCE

Luisa Bertin 1, Benedetta Masoni 2, Silvia Ferretti 2, Alessandro Armuzzi 2, Cristina Bezzio 2, Miriana Zanconato 1, Gianluca Semprucci 1, Davide Giuseppe Ribaldone 3, Adele Capello 3, Giorgia Bodini 4, Francesco Calabrese 4, ANDREA PASTA 4, Linda Ceccarelli 5, Francesco Costa 5, Lorenzo Bertani 6, Marco Marino 7, Luca Navarria 7, Gianluca Benevento 8, Renato Sablich 8, Marta Ascolani 9, Michele Campigotto 9, Andrea Buda 10, Gaia Riguccio 10, Nicoletta Merlini 11, Elisabetta Dal Pont 12, Daniele Canova 13, Fabiana Zingone 1, Edoardo Vincenzo Savarino 1

1 University of Padova, Padova, Italy

2 IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

3 University of Turin, Turin, Italy

4 Policlinico San Martino, Genova, Italy

5 AOU Pisa, Pisa, Italy

6 University of Pisa, Pisa, Italy

7 Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy

8 Ospedale S.Maria degli Angeli, Pordenone, Italy

9 Ospedale Ca'Foncello, Treviso, Italy

10 Ospedale di Santa Maria del Prato di Feltre, Feltre, Italy

11 Ospedale Vittorio Emanuele III, Montecchio, Italy

12 Ospedale San Martino di Belluno, Belluno, Italy

13 San Bortolo Hospital, Vicenza, Italy

Event

UEG Week Berlin 2025

Topics

IBD

Submission format

Abstract

Session

Predicting clinical outcomes in IBD

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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ENDOSCOPIC CLOSURE OF A RECTAL FISTULA USING AMPLATZER™ CARDIAC SEPTAL DEFECT OCCLUDER

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Introduction

Cardiac septal ocludder device is an off-label device for closure of gastrointestinal fistulas and should be considered for chronic refractory fistulas to conventional endoscopic treatments.

Aims & Methods

We describe the off-label use of a cardiac septal defect occluder (CSDO, Amplatzer™, Abbott) for endoscopic closure of a lower gastrointestinal tract fistula between the rectum and post-cystectomy surgical site.

Results

An 84-year-old male with medical history of T1 bladder cancer underwent radical cystectomy complicated with surgical site abscess. Abdominal CT revealed free gas in surgical site and a rectum wall defect suggestive of fistula. Despite conservative treatment, patient persisted with penial and anal discharge. Patient was referred for endoscopic closure. Colonoscopy showed a 6mm fistulous tract between the cystectomy surgical site and the rectum wall. Two initial closure attempts with 12/6 over-the-scope clips (OTSC) after margin epithelial ablation were tried (second attempt with combined placement of a detachable snare below the OTSC), each 3 months apart. Despite initial technical and clinical success, fistula recurred after spontaneous detachment of OTSCs. Endoscopic
internal drainage with a double pigtail stent was also tried, however, fistula persisted after distal spontaneous migration 2 months later. Considering fistula persistence, patient was proposed for closure with a CSDO. After fluoroscopic characterization of the defect (surgical site: 20x25mm, fistulous tract length: 4mm: fistula orifice diameter: 3mm), a 16/4/12mm Amplatzer™ CSDO was chosen. After placement of a 0.035’AmplatzerTM guidewire from the rectum into the surgical site, guided by a 5.4-Fr angiography catheter, a delivery sheath was then advanced into the surgical site over the guidewire. After mounting the CSDO on the loading device, it was advanced inside the delivery sheath, and correctly deployed with the proximal flange in the surgical site and distal flange in the rectum. Patient remains well, without clinical recurrence.

Conclusion

To date, only 4 cases of lower gastrointestinal fistulas closure with CSDO, all rectovaginal fistulas, have been reported. To the best of our knowledge, this is the first case of endoscopic closure of a fistula between rectum and surgical site.

ENDOSCOPIC CLOSURE OF A RECTAL FISTULA USING AMPLATZER™ CARDIAC SEPTAL DEFECT OCCLUDER

Renato Medas 1, Eduardo Rodrigues-Pinto 1, João Afonso 1, João Carlos Silva 1, Pedro Pereira 1, Guilherme Macedo 1

1 Centro Hospitalar e Universitário de São João, Porto, Portugal

Event

UEG Week Copenhagen 2023

Topics

Colorectal Digestive Oncology Endoscopy

Submission format

Video Case

Session

Video Case Session

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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When should we change a treatment?

Tim Raine 1

1 Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom

Event

UEG Week Copenhagen 2023

Topics

Colorectal Digestive Oncology IBD Surgery

Session

Ways to personalise treatment in ulcerative colitis

Published

2023

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Introduction

In the southwest Netherlands, hospitals collaborate to provide high quality, uniform care for inflammatory bowel disease (IBD). To achieve this, a care pathway (CP) was implemented for treating IBD with biologics and small molecules (1). The CP consists of protocols addressing different stages in IBD treatment, such as initiation and switching of therapy, frequency and type of follow-up. This study assessed the adherence to the CP and identified barriers and facilitators to its implementation.

Aims & Methods

A mixed-methods study was conducted. Quantitative data was used to evaluate the adherence to different protocols of the CP and was collected retrospectively from electronic health records (EHRs) from December 2020 until March 2023. Surveys and semi-structured interviews were used to identify barriers and facilitators, using the Extended Normalisation Theory. Surveys were sent to all healthcare providers and interviews were conducted with gastroenterologists, IBD-nurses, healthcare assistants, and IT-personnel.

Results

A total of 299 patients were included. Adherence to the CP regarding the documentation of travel plans and vaccination status improved after implementing the CP (15% pre-implementation vs. 33% post-implementation), as well as written communication with general practitioners (31% vs. 83%) and body weight registration (12% vs. 50%). Among patients switching medication, 25% had a repeated screening for HIV, tuberculosis, and hepatitis B and C documented if prior tests were over a year old. Post-implementation, scheduling outpatient visits were more closely aligned with CP recommendations across CP protocols (57% vs. 100%), as did blood test ordering (10% vs. 44%). Disease activity scoring with validated questionnaires remained low (7% vs. 21%).  Adherence to registering medication adherence, current smoking status, and side effects during annual outpatient visits remained low (18% vs. 40%).
Of 85 surveys, 42 were completed, and 11 interviews were conducted. Facilitators were improving collaboration between healthcare providers and the potential to standardise care. Barriers included the complexity of the use in EHRs, difficulty for healthcare providers to change their current routine, and the heterogeneity of IBD.

Conclusion

A CP for the treatment of IBD with biologics and small molecules has been implemented to improve IBD care, however, adherence appears to be challenging, partially contributed to the difficulty healthcare providers experience in changing their behaviour. The gradual improvement indicates that increased familiarity with the CP may enhance adoption. Discrepancies between performed and documented tasks in EHRs may also contribute to lower adherence rates, which could be improved by audit and feedback sessions.

References

1. van Linschoten R, van Leeuwen N, Nieboer D, Birnie E, Scherpenzeel M, Verweij KE, et al. Value-based care pathway for inflammatory bowel disease: a protocol for the multicentre longitudinal non-randomised parallel cluster IBD Value study with baseline period. (2044-6055 (Electronic))

Disclosure

Drs. Visser received speaker fees from Lilly outside the submitted work. Prof. Dr. van der Woude reports grants from Pfizer and Janssen and personal fees from AbbVie and Celltrion outside the submitted work. Dr. van Noord reports personal fees from Janssen, Takeda, and Falk outside the submitted work. Dr. West reports personal fees from AbbVie, Janssen, and Pfizer outside the submitted work.

ADHERENCE TO A CARE PATHWAY FOR INFLAMMATORY BOWEL DISEASE IN THE SOUTHWEST REGION OF THE NETHERLANDS: RESULTS OF THE MULTICENTRE COHORT STUDY IBD VALUE

Elyke H. Visser 1, S. Allers 2, Reinier van Linschoten 3, Alexander Bodelier 4, Claire Fitzpatrick 5, Vincent de Jonge 6, Hestia Vermeulen 7, Evelyne Verweij 8, Sanne van der Wiel 9, Danielle van der Horst 10, C. Janneke van der Woude 11, Desiree Leemreis- van Noord 12, Rachel West 13

1 Franciscus Hospital, Rotterdam, Netherlands|||Erasmus Medical Centre, Rotterdam, Netherlands

2 Erasmus University Rotterdam, Rotterdam, Netherlands

3 Erasmus Medical Centre, Rotterdam, Netherlands

4 Amphia Hospital, Breda, Netherlands

5 IJsselland Ziekenhuis, Capelle aan den IJssel, Netherlands

6 Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands

7 Ikazia Ziekenhuis, Rotterdam, Netherlands

8 Maasstad Hospital, Rotterdam, Netherlands

9 Reinier de Graaf Gasthuis, Delft, Netherlands

10 Crohn & Colitis NL, Woerden, Netherlands

11 Erasmus Medical Centre, Rotterdam, Netherlands|||Radboud University, Nijmegen, Netherlands

12 Erasmus Medical Centre, Rotterdam, Netherlands|||Franciscus Hospital, Rotterdam, Netherlands

13 Franciscus Hospital, Rotterdam, Netherlands

Conference

UEG Week Berlin 2025

Topics

IBD

Submission format

Abstract

Session

IBD (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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DOMAIN-SPECIFIC PRETRAINING OF DEEP LEARNING SYSTEMS IN GASTROINTESTINAL ENDOSCOPY IMPROVES PERFORMANCE OVER CURRENT STATE-OF-THE-ART PRETRAINING METHODS

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Introduction

For training deep learning algorithms in medical imaging, application-specific data is often scarce. Deep learning systems are therefore generally pretrained on large publicly available labeled data sets of general imagery, unrelated to the envisioned application, to have the algorithm learn basic features from these widely available data followed by refinement training on the generally scarce application-specific images. Pretraining might be more effective if the images for pretraining resemble the envisioned application, i.e., domain-specific pretraining.

Aims & Methods

We investigated if pretraining on general endoscopic imagery results in a better performance of five existing AI systems with an application in gastro-intestinal endoscopy, compared to current state-of-the art pretraining approaches (i.e., supervised pretraining with ImageNet and semi-weakly supervised pretraining with the Billion-scale data set). Our group has created an endoscopy-specific dataset called GastroNet for pretraining deep learning systems in endoscopy. GastroNet consists of 5,084,494 endoscopic images retrospectively collected between 2012 and 2020 in seven Dutch hospitals. We created four pretrained models: one using GastroNet and three using ImageNet and/or the Billion-scale data set. The pretraining method was either supervised, self-supervised, or semi-weakly supervised. The pretrained models were subsequently trained towards five independent, commonly used applications in GI endoscopy, using their original application-specific datasets. Outcome parameters were: 1) classification and/or localization performance of the five trained applications; 2) change in performance when the number of available application-specific training data was reduced, to investigate a possible difference in performance drop for the different pretrained models.

Results

Overall, the domain-specific pretrained model resulted in a statistically superior performance for the five different GI applications. More detailed results are presented in Table 1. The superiority was also reflected in a smaller drop in performance when the number of application-specific training data were reduced artificially.

Table 1. Overview of performance of the five different application-specific data sets using four different pretrained models. Cells highlighted in green represent the highest scoring pretrained model per application-specific data set.

Data set	Metric	ImageNet Supervised model	GastroNet model	ImageNet Self-supervised model	Billion-scale model
GRAIDS	AUC	99%	100%	98%	99%
Kvasir	Dice	64%	82%	59%	78%
GIANA	Accuracy	92%	94%	71%	93%
Barrett’s neoplasia	AUC	91%	97%	84%	94%
Colonic polyps	AUC	88%	91%	84%	89%

Conclusion

Domain-specific pretraining, using unlabeled general endoscopic images, is superior to current state-of-the-art pretraining approaches for developing deep learning algorithms in GI endoscopy. It also allows more effective use of the generally scarce application-specific endoscopy images. These findings might cause a paradigm shift in the development of AI systems in endoscopy.

DOMAIN-SPECIFIC PRETRAINING OF DEEP LEARNING SYSTEMS IN GASTROINTESTINAL ENDOSCOPY IMPROVES PERFORMANCE OVER CURRENT STATE-OF-THE-ART PRETRAINING METHODS

Kiki Fockens 1, Tim Boers 2, Jelmer Jukema 1, Martijn R. Jong 1, Joost van der Putten 2, Maarten Struyvenberg 1, Roos E. Pouw 1, Lucas Duits 1, Bas L.A.M. Weusten 3, Lorenza Alvarez Herrero 3, Martin Houben 4, Wouter B. Nagengast 5, Jessie Westerhof 5, Alaa Alkhalaf 6, Rosalie C. Mallant-Hent 7, Pieter Scholten 8, Krish Ragunath 9, Stefan Seewald 10, Peter Elbe 11, Francisco Baldaque-Silva 11, Maximilien Barret 12, Jacobo Ortiz-Fernández-Sordo 13, Guiomar Moral 13, Oliver Pech 14, Torsten Beyna 15, Fons van der Sommen 2, Peter de With 2, Jeroen de Groof 1, Jacques J. Bergman 1

1 Amsterdam UMC, Amsterdam, Netherlands

2 Eindhoven University of Technology, Eindhoven, Netherlands

3 St Antonius Hospital, Nieuwegein, Netherlands

4 Haga Teaching Hospital, The Hague, Netherlands

5 UMCG, Groningen, Netherlands

6 Isala, Zwolle, Netherlands

7 Flevoziekenhuis, Almere, Netherlands

8 OLVG Amsterdam, Amsterdam, Netherlands

9 Queens Medical Centre Campus Nottingham University Hospitals, Nottingham, United Kingdom

10 GastroZentrum Hirslanden, Zurich, Switzerland

11 Karolinska Institute, Stockholm, Sweden

12 Cochin Hospital, Paris, France

13 Nottingham University Hospitals, Gastroenterology, Nottingham, United Kingdom

14 Krankenhaus Barmherzige Brüder Klinik für Gastroenterologie und Interventionelle Endoskopie - Klinik, Regensburg, Germany

15 Evangel. Krankenhaus Düsseldorf, Düsseldorf, Germany

Event

UEG Week Copenhagen 2023

Topics

Education & Training Endoscopy

Submission format

Abstract

Session

Training and life of a young gastroenterologist

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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