Introduction

Segmental colitis associated with diverticulosis (SCAD) is an increasingly recognized clinical and pathological disorder, characterized by a chronic inflammatory response involving the inter-diverticular mucosa of a colonic segment, sparing the rectum and the right colon. However, its prevalence and outcome in the setting of colorectal cancer (CRC) screening is unknown.

Aims & Methods

Aims: to assess the prevalence of SCAD in the setting of a CRC screening program and to evaluate the differences in terms of oncological outcomes between SCAD and "simple" diverticulosis. We performed a retrospective analysis from a prospectively-maintained database including all subjects undergoing first screening colonoscopy according to regional CRC program from 2019 to 2022. Patients with incomplete colonoscopy, inadequate bowel preparation or known diagnosis of SCAD or CRC were excluded. Endoscopic signs of SCAD were registered as “crescentic fold disease”, “mild-to-moderate UC-like”, “Crohn’s disease-like” and “Severe UC-like”. The number of adenomas (ADR) and cancers was also recorded. Statistical analysis included chi-square, Student’s t-test and odds ratio (OR) with 95% confidence interval (CI) when indicated.

Results

a total of 1518 patients were included (males 51.8%, mean age 63.48±6.39). Adenomas were detected in 638 patients (ADR 42%), while CRC was diagnosed in 86 cases (5.7%). Diverticulosis was described in 570/1518 patients (37.5%), while SCAD was endoscopically diagnosed in 69 patients (4.5%). Among them, 48 (69.6%) presented a crescentic fold disease, 14 (20.3%) a mild-to-moderate UC-like pattern, 6 (8.7%) a CD-like pattern and 1 (1.4%) had a severe UC-like pattern. When SCAD patients were compared to subjects with simple diverticulosis (501 patients), we found no differences in terms of gender (males 55.1% vs 50.7%, p=0.46) or age (63.86±6.45 vs 64.45±6.38, p=0.47). Interestingly, the use of anticoagulant/antiplatelet (28.9% vs 30.1%, p=0.79), anti-hypertensive (46.4% vs 48.1%, p=0.89) or anti-hyperglycemic drugs (36.2% vs 41.1%, p=0.52) had no effect on SCAD onset as compared with patients with diverticulosis. However, patients with SCAD had significant lower rate of adenomas (ADR 31.9% vs 47.3%, p=0.018, OR 0.52, 95%CI 0.31-0.89), and lower –but not significant– rate of CRC (1.4% vs 6.2%, p=0.14, OR 0.22, 95%CI 0.02-1.66). Most patients were successfully treated with 5-ASA and none needed surgery for SCAD.

Conclusion

SCAD can be diagnosed in about 5% of population undergoing screening colonoscopy and in about 12% of those with diverticulosis. SCAD seems to be associated with a reduced rate of adenomas or CRC as compared with diverticulosis.

Introduction

Intestinal ultrasound (IUS), in particular bowel wall thickness (BWT), is accurate in determining endoscopic disease activity in ulcerative colitis (UC). Reduction of BWT six weeks into advanced anti-inflammatory treatment predicted endoscopic response and clinical remission. Filgotinib is a preferential JAK1-inhibitor effective in UC. Currently, there is no data on IUS-kinetics or early prediction of treatment response with filgotinib.

Aims & Methods

In this study, we aimed to identify early IUS predictors of treatment response to filgotinib in patients with moderate to severe UC. This prospective observational study included UC patients with active endoscopic disease (i.e. endoscopic MAYO score (EMS) ≥2) starting with filgotinib. Clinical scores (UCEIS, Lichtiger), biochemical parameters and IUS parameters of the sigmoid were assessed at baseline, after 4 weeks (W4) and at the time of the second endoscopy (between W8 and W23). Endoscopic remission (i.e. EMS=0), endoscopic response (i.e. decrease in EMS ≥1 compared to baseline) and clinical remission (SCCAI ≤2 or Lichtiger score ≤3) were assessed. IUS response (i.e. defined as a reduction in BWT of >25% or >2.0 mm, or >1.0 mm and one colour Doppler signal) was assessed at week 4. All normally distributed data were reported in mean ± standard deviation [SD] and non-normally distributed in median and interquartile range [IQR]. Mann–Whitney U tests were used to compare continuous non-parametric variables, chi square tests for dichotomous variables.

Results

A total of 20 patients were included. 13 patients underwent second endoscopy, 2 refused a follow-up endoscopy and 5 patients were still in follow-up. At baseline, 9 patients (9/20, 45%) had received ≥2 biologicals, 16 patients (16/20, 80%) had previous anti-TNF exposure, and no patients were exposed to other JAK-inhibitors. 8 patients (8/20, 40%) had severe endoscopic disease at baseline (i.e. EMS=3). 5 patients (5/13, 38%) were endoscopic responders at W8-23, and no patient reached endoscopic remission. BWT was significantly lower in the sigmoid colon from W4 onwards for patients reaching endoscopic response (Table 1). Decrease in BWT compared to baseline was statistically greater in endoscopic responders from W4 onwards (Table 1). IUS response was seen at W4 in 6 patients, of which 5 were endoscopic responders (83%, p=0.002). Decrease in BWT from W4 onwards was statistically greater in patients reaching clinical remission at W8-23 (-45% (-55% to -36.6%) vs -9% (-25% to +8%), p=0.014).

Conclusion

On IUS, UC patients treated with filgotinib have significantly lower BWT from week 4 onwards compared to baseline, which could predict endoscopic response.

Disclosure

MP received speakers fees from Janssen and Tillotts
CT received speakers fees from Tillotts
FV received speaker or honoraria fees from AbbVie, Janssen and Tillotts
ML received consultancy/lecturefees from Abbvie, Bristol Myers Squibb , Eli Lilly, Galapagos, Janssen-Cilag, Johnson & Johnson, Medtronic, Pfizer, Takeda and Tillotts.
RG Received speakers fee from Janssen and Tillotts
GD has served as a consultant and/or received speaker’s fees from AbbVie, Alimentiv, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion Healthcare, Cytoki Pharma, Eli Lilly, Ferring, Galapagos, Glaxo SmithKline, Gossamer Bio, Immunic, InDex Pharmaceuticals, Janssen, Johnson & Johnson, Kaleido, Pfizer, Progenity, Prometheus Biosciences, Prometheus Laboratories, Protagonist Therapeutics, Takeda, Tillotts, Ventyx Biosciences.
KG has received grants from Pfizer Inc, Celltrion and Galapagos; consultancy fees from AbbVie, Arena Pharmaceuticals, Galapagos, Gilead, Immunic Therapeutics, Janssen Pharmaceuticals, Novartis, Pfizer Inc., Samsung Bioepis and Takeda and speaker’s honoraria from Abbvie, Celltrion, Ferring, Janssen Pharmaceuticals, Novartis, Pfizer Inc, Samsung Bioepis, Takeda and Tillotts.

Introduction

A successful colonoscopy requires ideal stool preparation, yet the percentage of insufficient bowel preparation is still very high. Frequently, the patients use website information on colonoscopy preparation. Conversely, the daily activity of the hospital staff consists of spending time with patients, communicating with them and giving answers to a high number of questions coming from patients regarding the preparation for the procedure or the exam itself. Hence, the idea to adopt a rapid and intuitive patient-oriented digital service to respond to their needs, the virtual assistant Eric.

Aims & Methods

Endo-Chat is an automated online communication platform, powered by AI (Artificial Intelligence) with the use of the Natural Language Processing and Deep Learning technologies, that answers procedure-related questions in real-time. The engine is named ERIC, stands for "Endoscopy Robot for Intelligent Chat" and is an intelligent chatbot, capable of answering autonomously to most of the doubts of a patient who is supposed to undergo an endoscopic examination.

Results

Since the introduction of the conversational artificial intelligence system at the Policlinico Gemelli starting from 24^th of January 2022 to the 16^th of March 2023, Eric has been able to autonomously manage 94% of the questions sent by patients, thus forwarding only the remaining 6% (of the requests) to specialized human operators.
We calculated that in the pre-pilot phase, a large part of the daily activity of nurses was dedicated to communicating with patients, around 40 hours per week, while in the post-pilot phase, the time spent for communication was significantly reduced to 15 hours per week. According to OECD Health Statistics 2022, the average annual salary of a European nurse is 35,300 euros, with an annual hypothetical saving of 22,062 euros, comparable to a part-time contract.
Also, the number of cancelled procedures for poor patient preparation has fallen from 22 to 7 per week, considering a volume of 200 procedures per week.
Regarding patient's experience, users can leave voluntary feedback on their virtual assistant experience directly on the ERIC website, evaluating the quality of the service. Patient service evaluations were enthusiastic till now, as 63% rated the service as excellent.

Conclusion

In our observational pilot study, the first in Europe to our knowledge, we assessed the benefits measurement for patients and Hospital staff. Starting from these preliminary interesting results, we can speculate that the introduction of Endo-Chat in high-volume endoscopy service is feasible and useful not only for patients but also for hospital staff.

Disclosure

The authors declare no conflict of interest

Introduction

Many individuals rapidly regain excess weight once they stop dieting. This phenomenon, which is commonly called yoyo-dieting, is a pattern of losing weight and then regaining it, placing individuals at greater risk for metabolic complications and obesity. There is some evidence that yoyo-dieting-induced obesity causes long-term alterations in the gut microbiome composition. There is also increasing evidence suggesting that diets high in resistant starch (RS) may positively improve gut health and metabolism.

Aims & Methods

This study aimed to investigate how yoyo-dieting affects gut health and whether supplementation with resistant starch could be a promising and effective weight management strategy.
Male and female C57BL/6 mice (n=48/sex, n=8/group) were allocated to six different diets for 20 weeks [control, high-fat (HFD), yoyo-diet (HFD interspaced with control every 5 weeks), control with RS, HFD with RS, and yoyo-diet with RS]. Metabolic measurements were performed, including body weight, glucose and insulin tolerance tests, adipose tissue, and organ weight. Liver and intestines were collected for structural changes assessed by histology. Epithelial barrier integrity was assessed in Ussing chambers. Faecal samples were collected for microbial profiling using 16S ribosomal RNA sequencing.

Results

Male mice fed a HFD with RS had significantly lower weight gain, liver mass, adipose tissue, and insulin tolerance compared to mice fed a HFD alone, while no significant differences were observed in females. No significant differences in glucose tolerance and intestinal permeability were observed across all diets and between sexes. Male mice had significantly higher alpha diversity and a different microbiota profile compared to female mice. Mice fed diets supplemented with RS had significantly lower alpha diversity and a different microbiota profile compared to mice fed without RS. Male and female mice have different microbiota profiles. Mice fed a HFD with RS have a similar microbiota profile to mice fed the control diet with RS. After changing diets (switching from diets high in fat to the control diet – yoyo groups), no change in microbiome profile was observed in female mice previously fed HFD with RS, while male mice previously fed a HFD supplemented with RS had a similar microbiome profile to control mice.

Conclusion

Different microbiome signatures and metabolic measurements were observed in male and female mice. In male mice consuming a HFD, RS lowered weight gain and shifted the microbiota profile to one similar to mice fed a control diet with RS. In males consuming a HFD diet interspaced with the control diet (yoyo-diet), RS shifted the microbiota profile of mice to a similar signature seen in control animals. No significant differences were observed in females.

Disclosure

No conflict of interest

Introduction

Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle has a high diagnostic accuracy and enables physicians to obtain sufficient pathological samples compared to standard needles ^1-2. However, no conclusion has been reached regarding the best combination of the number of passes and the number of to-and-fro movements (TAFs) in EUS-FNB. Although adverse events associated with EUS-FNB are rare, serious bleeding and tumor dissemination can occur ³.

Aims & Methods

Fewer passes and TAFs may help prevent these adverse events. Therefore, we conducted a prospective study to examine the diagnostic performance of a single pass with five TAFs in EUS-FNB. This single-center prospective observational study was conducted at a tertiary institution. From April 1, 2021, to August 31, 2022, 56 patients were enrolled. Three passes were performed using a 22-gauge Franseen needle (TopGain^R; Medicos Hirata, Tokyo, Japan) during the EUS-FNB. The number of TAFs were 5 in the first passes (5-TAF group) and 15 in the second and third passes (15-TAF group), respectively. Each TAF was performed with a suction technique using a 20-mL negative pressure syringe. The primary endpoint was the accuracy of the first pass, and the secondary endpoint was a qualitative comparison of the specimens between the 5-TAF and 15-TAF groups. All patients were followed up for more than 6 months. Qualitative evaluation was performed as follows: the adequate sample score ranged from 0 to 5, and the contamination and bloodiness scores ranged from 0 to 3.

Results

A total of 56 patients were enrolled in this study. Of them, data from 53 patients were analyzed. Three patients were excluded: two patients had an insufficient number of passes due to bleeding during the procedure, and one patient could not be punctured due to difficulty in identifying the lesion. The patient characteristics were as follows: median age, 73 years (range, 48–92 years), number of male patients, 28 (52.8%). The final diagnoses were malignant disease in 42 patients and benign disease in 11. The accuracy rate was 86.7% (95% confidence interval: CI, 74.7–94.5%) in the 5-TAF group, 81.1% (95% CI, 72.4–88.1%) in the 15-TAF group; the total accuracy rate in the 5-TAF and 15-TAF groups was 89.3%. There was no significant difference in the accuracy rate between 2 groups. The adequacy scores (average [standard deviation]) of the 5-TAF and 15-TAF groups were 4 [1.45] and 3.39 [1.81], respectively. The rates of adequacy scores ≥3 in the 5-TAF and 15-TAF groups were 84.9% and 72.6%, respectively (p=0.09). The contamination scores of the 5-TAF and 15-TAF groups were 1.57 [1.01] and 1.91 [1.06], respectively. The rates of contamination scores ≤1 in the 5-TAF and 15-TAF groups were 51.9% and 34.6%, respectively (p<0.05). The bloodiness scores of the 5-TAF and 15-TAF groups were 0.57 [0.64] and 0.86 [0.79], respectively. The rates of bloodiness score ≤1 in the 5-TAF and 15-TAF groups were 92.3%, and 75.0%, respectively (p<0.05). For each score, the 5-TAF group had a higher value than the 15-TAF group.

Conclusion

In the EUS-FNB with a Franseen needle, a single pass with five TAFs showed the possibility of obtaining a clinically acceptable accuracy rate and high-quality specimens.

References

1) Ishigaki K, Nakai Y, Oyama H et al. Endoscopic Ultrasound-Guided Tissue Acquisition by 22-Gauge Franseen and Standard Needles for Solid Pancreatic Lesions. Gut and Liver, 2020; 14(6): 817-825.
2) Li Z, Liu W, Xu X et al. A Meta-Analysis Comparing Endoscopic Ultrasound-guided Fine-needle Aspiration With Endoscopic Ultrasound-guided Fine-needle Biopsy. J Clin Gastroenterol 2022; 56(8): 668-678.
3) Mizuide M, Ryozawa S, Fujita A, et al. Complications of endoscopic ultrasound-guided fine needle aspiration: a narrative review. Diagnostics (Basel). 2020; 10: 964.

Disclosure

The authors have no conflicts of interest directly relevant to the content of this article.

Clinical Case Summary

Extra intestinal digestive involvement of tuberculosis (TB) remains a rare entity, even in endemic countries.3 cases of extra intestinal digestive TB in immunocompetent patients are reported.
Case 1: A 50-year-old man was admitted for exploration of weight loss and weakness, with chronic abdominal pain. A computed tomography (CT) scan of the abdomen showed multiple hypodense hepatics and splenic nodules; an ultrasound-guided percutaneous liver biopsy was performed. The patient was diagnosed to have primary hepatosplenic TB. Images:
1:CT scan:multiple lesions in the liver and spleen
2:Liver tissue showing granulomatos reaction)
Case 2: A 24-year-old woman,admitted for exploration of chronic epigastralgia.Abdominal and pelvic CT scan and pancreaticobiliary Magnetic Resonance Imaging (MRI)showed a mass at the isthmus and tail of the pancreas associated with adenopathies.The endoscopic ultrasound (EUS)showed a cystic lesion at the pancreatic corporal-caudal junction. Given the strong suspicion of a pseudo papillary and solid tumor of the pancreas,a caudal splenopancreatectomy was decided. Intraoperatively, exploration revealed,whitish pinhead-sized lesions disseminated over the entire pancreatic parenchyma,suggesting pancreatic TB.An anatomopathological examination of an adenopathy confirmed the diagnosis of TB. Images:
1:MRI showing a mixed lesion in the pancreas
2:EUS image showing the heterogeneous lesion of the pancreas)
Case 3: a 28-year-old man, was admitted for exploration of abdominal pain with fever and weight loss.The physical examination found an abdominal tenderness and hepatomegaly.Hepatic nodular lesions were revealed on CT and MRI.The diagnosis of hepatic tuberculosis was confirmed after anatomopathological analysis of the biopsies of the hepatic nodules obtained during laparoscopy. images:
1: Abdominal CT scan:multiple hypodense hepatic lesions
2: A hepatic MRI:a dysmorphic liver,with heterogeneous lesions)