Introduction

Endoscopic resection (ER) is curative for Barrett’s oesophagus-related early-stage oesophageal adenocarcinoma (EAC) without high-risk features, such as lymphovascular invasion (LVI), positive margins (R1), and deep submucosal invasion (T1bsm2-3). Piecemeal endoscopic mucosal resection (pEMR), often used for lesions larger than 15mm, prevents assessment of lateral margins and therefore complicates precise risk estimation for residual EAC at the first post-ER endoscopy. Thus, we investigated alternative clinical factors that could potentially be used to assess the risk for residual and recurrent EAC post-ER.

Aims & Methods

We performed a longitudinal cohort study of patients who underwent ER between 2006-2023. Inclusion criteria were: T1a or well/moderately differentiated T1bsm1 EAC; LVI-, and R0 resection. ER was categorised as pEMR (n=105) or en-bloc ER (n=22 en-bloc EMR, n=9 endoscopic submucosal dissection). The primary outcome was residual EAC at first post-ER endoscopy. Secondary outcomes were residual HGD at first post-ER endoscopy, recurrence of EAC and HGD at any post-ER endoscopy, and remission of EAC, HGD and intestinal metaplasia (IM) at latest endoscopy. Multivariate logistic regression, receiver operating characteristics, chi-squared, and Kaplan Meier analyses were performed to investigate possible associated risk factors.

Results

The cumulative incidence of recurrence of HGD was higher post-pEMR compared to en-bloc ER (HR = 2.43, 95% CI: 1.1-5.36; p=0.021), with residual EAC at first post-ER endoscopy accounting for 35% of such post-pEMR recurrence. The percentage of pEMR specimens with EAC was an independent risk factor for residual EAC at first post-pEMR endoscopy (p=0.013, Table 1). A 53.5% cut-off of involved pEMR specimens was identified as the optimal threshold for residual EAC prediction (specificity=0.68, sensitivity=0.67, AUC=0.66). Indeed, rate of residual (p=0.013) and recurrent (p=0.00041) EAC were higher when EAC involvement was >50%.However, rates of remission of EAC (p=0.13), HGD (p=0.20) and IM (p=0.81) were unaffected by high EAC burden.

Conclusion

High burden of cancer in pEMR specimens correlates with increased risk of residual and recurrent EAC at post-pEMR endoscopy. Post-pEMR site check is recommended prior to endoscopic ablation, particularly in patients where more than 50% of pEMR specimens show EAC, where repeat ER should be performed in cases of flat subtle lesions. This will ensure eradication of any focus of residual disease and high success rates for treatment of early EAC using endotherapy.

Introduction

Congenital hepatic fibrosis (CHF) is a rare autosomal recessive disease derived from biliary dysgenesis secondary to ductal plate malformation; it often coexists with Caroli’s disease, von Meyenburg complexes, autosomal dominant polycystic kidney disease (ADPKD), and autosomal recessive polycystic kidney disease (ARPKD). Congenital hepatic fibrosis (CHF) and Caroli syndrome has varied clinical presentations with or without renal involvement.

Aims & Methods

Our study aimed to describe the clinical manifestations and natural history of children with CHF and Caroli with or without renal involvement. Retrospective data from January 2022 to January 2024 was collected and analyzed.

Results

Twenty-three children (Caroli=7, CHF=16) were enrolled male predominance (76%) was noted. Consanguinity was noted in 76% and 23% had affected siblings. Median age at initial presentation was two years and abdominal distension was the most common presentation (47.6%) followed by variceal bleeding (23.8%), cholangitis (14.2%), incidental diagnosis (9.5%) and pancytopenia (4.76%). Median age at presentation and diagnosis was later with variceal bleeding at 5.6 years compared with children with abdominal distension who presented at 18 months respectively (p=0.0001). Renal involvement was present in 76% of the children. Autosomal Recessive Polycystic Kidney Disease (ARPKD) was the most common renal manifestation noted. Of them, 18% had developed Chronic Kidney Disease (CKD). All Caroli cases (100%) had renal involvement. There was no statistical difference in the age of presentation of CHF with or without renal involvement (p=0.5998). Growth faltering was noted in 52% of children. Statistical analysis revealed no significant difference in the likelihood of developing portal hypertension among children with either congenital hepatic fibrosis (CHF) or Caroli disease, regardless of renal involvement. Portal hypertension was seen in 76%. Only one child had variceal bleeding on follow up.

Conclusion

Abdominal distension, organomegaly, variceal bleeding, and cholangitis are frequently observed clinical manifestations in both congenital hepatic fibrosis (CHF) and Caroli disease. Interestingly, while renal involvement is more prevalent in Caroli disease compared to CHF, there doesn't appear to be a direct correlation between renal involvement and the severity of hepatic manifestations or growth faltering in affected children. This underscores the complexity of these conditions and the need for tailored management approaches that address both hepatic and renal complications.

References

1. Srinath, Arvind, and Benjamin L Shneider. “Congenital hepatic fibrosis and autosomal recessive polycystic kidney disease.” Journal of pediatric gastroenterology and nutrition vol. 54,5 (2012): 580-7. doi:10.1097/MPG.0b013e31824711b7
2. Gunay-Aygun M, Font-Montgomery E, Lukose L, Tuchman Gerstein M, Piwnica-Worms K, Choyke P, Daryanani KT, Turkbey B, Fischer R, Bernardini I, Sincan M, Zhao X, Sandler NG, Roque A, Douek DC, Graf J, Huizing M, Bryant JC, Mohan P, Gahl WA, Heller T. Characteristics of congenital hepatic fibrosis in a large cohort of patients with autosomal recessive polycystic kidney disease. Gastroenterology. 2013 Jan;144(1):112-121.e2. doi: 10.1053/j.gastro.2012.09.056. Epub 2012 Oct 3. PMID: 23041322; PMCID: PMC4162098.

Introduction

Aims & Methods

Results

Conclusion

Disclosure

Introduction

In Hungary, the population-based colorectal carcinoma (CRC) screening programme was introduced at the end of 2018, shortly before the start of the COVID-19 pandemic.

Aims & Methods

The aim of our retrospective cohort study was to evaluate the impact of two presumably opposing causal factors, COVID-19 pandemic and population-based screening, on the incidence and clinical characteristics of CRC. All patients with newly diagnosed CRC from 2014 to 2023 were included and categorized into pre-pandemic (confirmed between 2014-2019), pandemic (confirmed in 2020-2021) and post-pandemic (confirmed in 2022-2023) groups. The extended pre-pandemic period was required to assess the impact of the screening programme, further dividing it into screening-affected (2015, 2016, and 2019) and unaffected (2014, 2017, 2018) subgroups.

Results

A total of 2803 patients were diagnosed with CRC during the study period. The annual number of CRC cases was significantly lower in the pandemic subgroup compared to the pre-pandemic screened and post-pandemic subgroups (254/year, 295/year and 295/year, p=0.009). In addition, in the pandemic subgroup, the incidence rates of CRCs detected at localized stage were significantly lower compared to the other three groups (36.61%, 50.85%, 46.35% and 49.49%, p<0.001). Statistically significant difference in the rate of T1 tumors was only observed between the pandemic and the post-pandemic subgroups (7.09% and 12.20%, p=0.026). In the pandemic period, the annual number of colonoscopies decreased by 64.31% compared to the pre-pandemic period overall, however, the post-pandemic period (n=4574) saw a modest 8.70% increase relative to the pre-pandemic period, offering only partial compensation for the shortage experienced during the pandemic. Furthermore, the annual number of colonoscopies in the extended pre-pandemic subgroup with screening was higher by 20.06% compared to the pre-pandemic subgroup without screening (4591 examinations/year vs 3824 examinations/year) and it was almost the same as the post-pandemic subgroup (4574 examinations/year). Substantially fewer examinations were required to detect a CRC in the pandemic group compared to the pre-pandemic overall and post-pandemic groups (10.67, 15.56, 13.97 and 15.50 examinations, respectively), but within the extended pre-pandemic group, there was no relevant difference between the two subgroups in the mean number of colonoscopies required to detect a CRC (15.56 vs. 13.97).

Conclusion

Our study confirmed the negative impact of COVID-19 pandemic on the CRC epidemiology. The newly introduced population-based CRC screening has only been able to partially compensate this negative effect during pandemic period, however, was moderately compensated by during the pandemic period, but in the post-pandemic period it caused a favorable change in the clinical features of CRC. Our study demonstrates both the effectiveness of the screening programme and that by introducing non-invasive pre-screening of patients (e.g. iFOBT) in a pandemic situation, it can reduce its negative public health impact.

Introduction

The Crohn’s Disease Activity Index (CDAI) is a widely used research tool used to quantify CD patient’ symptoms, evaluate the severity of CD and to determine treatment outcomes.^​

Aims & Methods

The objective of this study was to assess any nuances in treating CD patients with active disease (CDAI score >150), who have remained on the same advanced therapy (biologics/ novel oral molecules) for more than 6 months. The Ipsos CD Therapy Monitor, a multi-centre online medical chart review study of patients with CD was conducted between July – September 2023 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 advanced therapy were included in the analysis.

Results

208 sampled physicians collectively reported 373 CD patients who were recorded as being on the same advanced therapy for more than 6 months. 286 reported patients were deemed in remission (CDAI score ≤ 150) and 87 patients recorded with active disease (CDAI score >150). Looking at reported CD patient co-morbidities, metabolic conditions were more common in patients with active disease vs those in remission (24% vs 19%)

When looking at extra-intestinal manifestations (EIMs) between the two patient groups, patients with active disease were more likely to experience EIMs vs those in remission.

Table 1: EIMs in reported CD patients (% patients)

Conclusion

Comparisons in this study cohort highlighted that active disease in CD patients, as determined by the CDAI score, is associated with a higher number of patient co-morbidities and a greater likelihood of extra-intestinal manifestations; this indicates a more severe or complicated disease burden. As additional development products with new mechanisms of action become available in gastroenterology, non-TNF therapy usage may grow over time to provide more holistic and individualised treatment strategies for CD patients. Further investigation using comparator cohort is warranted.

References

[1] Use of the Crohn’s disease activity index in clinical trials of biological agents, Hugh James Freeman https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725371/

Disclosure

No

Introduction

Radiation therapy as part of neoadjuvant treatment for rectal cancer aims to improve local disease control with increased response rates and the possibility of sphincter preservation. The addition of the "watch and wait" (W&W) strategy has increased the efficacy and safety associated with neoadjuvant radiotherapy. Despite the use of low doses (between 40-50.4 Gy), most studies report complete pathological response rates of 10-27%. However, there is still a lack of studies with higher doses to evaluate effectiveness in terms of clinical and pathological response, versus the toxicity associated with increased radiation dose.

Aims & Methods

The aim was to evaluate the efficacy and tolerance of neoadjuvant therapy for potentially resectable rectal cancer with higher radiation doses.
A retrospective observational preliminary study included 41 individuals with potentially resectable rectal cancer (T2-T4, N0-1, M0), treated with capecitabine (825mg/m2 every 12 hours, 5 days a week) and 25 sessions of 54 Gy + 50 Gy to pelvic lymph nodes, considering patients on W&W. Partial response was defined as downstaging of at least 1 level in T and/or N. Complete clinical response was defined as reevaluation by MRI, endoscopy with biopsies, and digital rectal examination without evidence of residual disease. Short- and long-term complications of increased radiation dose were also evaluated.

Results

Out of 41 individuals with potentially resectable disease observed during the study, downstaging was observed in 78% (n=32), with 29% (n=12) showing complete response (clinical and/or pathological). Of the patients with complete clinical response (n=12), 8 underwent total mesorectal excision due to unpassable stenosis affecting adequate visualization of the rectal mucosa (n=1), presence of rectal ulcer with negative biopsies (n=6), and concurrent ulcerative colitis (n=1). All these patients showed complete pathological response. Four patients entered the W&W protocol, 3 of them with residual ulcer and negative biopsies, without recurrence at present (4 years follow-up). Radiation therapy complications were observed in 7% (n=3) of patients, respectively due to rectal stenosis, radiation proctitis, and radiation cystitis.

Conclusion

Our study found higher rates of downstaging and complete response compared to most studies under similar conditions and with lower radiotherapy doses, with a relatively low frequency of adverse effects.

References

Anter, A., Eladawei, G., & Mosbah, M. (2013). Preoperative capecitabine and pelvic radiation in locally advanced rectal cancer: preliminary results (Mansoura experience). Translational Gastrointestinal Cancer, 2(3), 112-117.
Korkolis, D. P., Boskos, C. S., Plataniotis, G. D., Gontikakis, E., Karaitianos, I. J., Avgerinos, K., Katopodi, A., Xinopoulos, D., Dimitroulopoulos, D., Beroukas, K., & Vassilopoulos, P. P. (2007). Pre-operative chemoradiotherapy with oral capecitabine in locally advanced, resectable rectal cancer. Anticancer research, 27(1B), 541–545.
A. De Paoli, et al. (2006). Capecitabine in combination with preoperative radiation therapy in locally advanced, resectable, rectal cancer: a multicentric phase II study, Annals of Oncology, Volume 17, Issue 2, Pages 246-251,

Introduction

The early-stage pancreatic cancer (e-PC; stage I/II) detection rate is very low at approximately 25%. The role of general physician is very important for e-PC detection.

Aims & Methods

The aim of this study was to evaluate the effectiveness of the check score sheet used clinical findings to detect e-PC in gastroenterology clinic.
Patients of clinic with a score of ≥ 2 points on clinical findings were enrolled: symptoms of abdominal pain/back pain and/or body weight loss (1 point), high amylase, lipase and/or trypsin (1 point), high carbohydrate antigen 19-9 (CA19-9) (1 point), new-onset or worsened diabetes (2 point), family history of pancreatic cancer (2 points) and ultrasonography (US) findings including direct (e.g., a solid pancreatic tumor) and/or indirect findings (e.g., dilatation of a pancreatic diameter of ≥ 2 mm and/or cystic lesions) (2 points). Abdominal CT and/or EUS (Endoscopic ultrasonography) were performed for all these enrolled patients, and we evaluated about pancreatic disease and pancreatic cancer detection rates of this check score sheet.

Results

Between July 2017 and March 2024, 621 patients (mean age 67.6 years, female 391 [63%]), were enrolled in clinic. The 458 pancreatic cystic disease (IPMN and SCN) cases (73.7%), the 28 chronic pancreatitis disease cases (4.5%), the 18 PC patients (2.9%) and the 10 pancreatic solid disease (SPN and NEM) (1.6%) were detected by abdominal CT and/or EUS. The 6 patients with e-PC were detected. The mean clinical finding score of the PC group (3.2 ± 1.4) was significantly higher than that of the overall non-PC group (2.2 ± 0.6) ( p < 0.05). US findings were significantly more frequent in the PC group than in the non-PC group ( p <0.05). Although the sensitivity of direct findings by US was 42.3%, that of indirect-findings was 91.7% in the PC group.

Conclusion

Many pancreatic diseases, which may have potential of pancreatic cancer in future, were detected by this simple check score of ≥ 2 points on clinical findings. And in clinic pancreatic cancers were detected efficiently. Indirect findings by US may play an important role in improving the e-PC detection rate.