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THE UK NATIONAL ERCP SURVEY: ADHERENCE TO GUIDANCE AND ACCESS TO ACUTE CARE

Wafaa Ahmed 1, Bettina Kluettgens 2, Caroline Stockman 2, Christina Dobson 3, Beverly Oates 4, Ian Penman 5, Colin J. Rees 3, Linda Sharp 6, Kofi Oppong 7, Simon Everett 1

Affiliations

1 Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom

2 British Society of Gastroenterology, London, United Kingdom

3 Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom

4 Wirral University Teaching Hospital, Merseyside, United Kingdom

5 Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

6 Newcastle University, Newcastle Upon Tyne, United Kingdom

7 Freeman Hospital, Newcastle-upon-Tyne, United Kingdom

Summary

AI Generated

A national survey of 171 UK organisations and 386 ERCP practitioners reveals substantial practice variation in common bile duct stone management and pancreatic stent placement, alongside limited access to out-of-hours procedures and deep sedation or general anaesthesia.

For intermediate-likelihood common bile duct stones, 9% proceed directly to ERCP while 76% request MRCP or EUS first, and 11% arrange same-session EUS with or without ERCP.
After two or more inadvertent guidewire passes into the pancreatic duct, 25% of practitioners always place a pancreatic stent, 51% usually do, 19% rarely do, and 5% never do; in 10% of organisations the standard practice is usually not to insert a stent.
Out-of-hours ERCP (1800-0800) is unavailable most of the time in 63% of organisations, and weekend ERCP is unavailable most of the time in 59%, with one-third relying on unpaid or goodwill arrangements.
Only 26% of organisations have regular weekly access to deep sedation or general anaesthesia lists, while 55% of practitioners report suboptimal patient tolerance with conscious sedation affecting therapeutic intent in the past month and 62% would prefer to perform all ERCPs under deep sedation or general anaesthesia.
Compliance with NICE quality standard for ERCP within 72 hours for common bile duct stones causing jaundice is achieved all or most of the time in 86% of organisations, and within 24 hours for emergency cases in 66%.

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Abstract

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is a high-risk procedure. There are multiple clinical guidelines yet practice varies. As part of an on-going BSG Endoscopy Quality Improvement Programme, we aim to describe current ERCP practice in the UK and benchmark this against published guidelines.

Aims & Methods

An anonymised survey link was emailed to all independent ERCP practitioners in the UK and a further survey was sent to all organisations in the UK in which ERCP is carried out. Multiple reminders and individual contacts were used to maximise response rate. Clinical questions covering a range of scenarios were aligned with published guidelines and quality standards including the UK National Institute for Health and Care Excellence (NICE).

Results

171 organisations providing ERCP were identified with a 100% response rate. 491 ERCP practitioners were identified with 78% (n= 386) response rate. In patients with an intermediate likelihood of common bile duct stones (CBDS), 9% of responders would proceed directly to ERCP, 76% would request MRCP or EUS first and 11% would arrange same session EUS +/- ERCP. In patients with normal anatomy and large or difficult to extract stones, 68% would perform sphincterotomy followed by sphincteroplasty and further attempts at duct clearance at the index procedure. After two or more inadvertent guidewire into the pancreatic duct (PD), 25% of individual practitioners always and 51% usually place a PD stent, whereas 19% rarely and 5% never do. In 10% of organisations standard practice is usually not to insert a PD stent.
NICE quality standard in the management of gallstone disease (QS104) stipulate that adults with CBDS causing jaundice have ERCP within 72 hours of diagnosis; 86% of organisations are compliant with this all or most of the time. In patients who need emergency ERCP for CBDS, 66% of organisations are compliant all or most of the time with having an ERCP within 24 hours (QS104).
In 29% of organisations, access to same-day ERCP 5 days a week was not available all/ most of the time. Out of hours ERCP (1800-0800) was not available all or most of the time in 63%, and over weekends it was not available all or most of the time in 59%.ERCP was available out of hours within the hospital in 33% of organisations during weekdays and 36% over the weekends as an unpaid, ad-hoc or goodwill arrangement.
In 26% of organisations there is regular weekly access to a deep sedation / general anaesthetic (DS/GA) list and 60% have access to a DS/GA list on an ad hoc basis or through referral to a different hospital. 55% of ERCPists were aware of the quality of therapeutic intent of any ERCP procedure being affected by suboptimal patient tolerance with endoscopist administered conscious sedation in the past month and 62% would prefer to perform all ERCPs under DS/ GA.

Conclusion

Despite clear guidance, variation in the management of CBDS and placement of pancreatic stents persists. Access to out-of-hours and weekend ERCP is sparse in the UK, and there is a reliance on goodwill to facilitate these cases. The availability of DS/GA is limited and there is a clear desire for improved access to optimise patient tolerance and ERCP outcomes.

Disclosure

Nothing to disclose

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

More Like This:

ADHERENCE TO ENDOSCOPIC QUALITY INDICATORS IN GREECE

Konstantina D. Paraskeva

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

REAL LIFE ADHERENCE TO INTERNATIONAL GUIDELINES IN BD-IPMN MANAGEMENT. CLINICAL AND COSTS IMPACT OF DIVERGENT STRATEGIES IN BD-IPMN CARE. THE PACMANS STUDY

Edoardo Giovanni Giannini

Image-guided surgery techniques

Mahdi Al-Taher

CANCER IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS – A NATIONWIDE DANISH COHORT STUDY WITH MATCHED CONTROLS

Helle Højen

NANO HYDROGEN AMELIORATES SEVERE ACUTE PANCREATITIS

Jinhang Gao

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ADHERENCE TO ENDOSCOPIC QUALITY INDICATORS IN GREECE

George Axiaris 1, Alexandros Ioannou 2, Konstantina Dimopoulou 3, Margarita Papatheodoridi 4, Xenofon Tsamakidis 5, Panagiotis Baxevanis 2, Georgios Tziatzios 6, Ioannis S Papanikolaou 7, Konstantinos Triantafyllou 8, Spyridon Michopoulos 9, Konstantina D. Paraskeva 10

Affiliations

1 Theageneio Anticancer Hospital of Thessaloniki, Thessaloniki, Greece

2 Alexandra General Hospital, Athens, Greece, Athens, Greece

3 “Hippokration” General Hospital of Athens, Greece, Athens, Greece

4 Medical School, National and Kapodistrian University of Athens, Athens, Greece

5 St. Savvas Cancer Hospital, Athens, Greece

6 General Hospital of Nea Ionia “Konstantopoulio Patision”, Athens, Greece

7 Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece

8 Attikon University General Hospital, Athens, Greece

9 Alexandra Hospital, Athens, Greece

10 Konstantopoulio, Athens, Greece

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Abstract

Introduction

Quality assessment is a priority in the field of gastroenterology. However, limited data are available from Greece regarding adherence to quality standards in gastrointestinal endoscopy.

Aims & Methods

This study aims at assessing the knowledge and compliance of Greek gastroenterologists with established quality standards for upper and lower digestive endoscopy, while exploring factors that may influence compliance.
This prospective study recorded data on the quality of upper and lower digestive endoscopy performed in Greece from October 2024 to January 2025. All members of the Hellenic Society of Gastroenterology (n=668) were invited to participate via an electronic survey. The survey included a questionnaire designed specifically for this study, covering demographic and professional characteristics, as well as quality indicators for gastroscopy and colonoscopy.

Results

A total of 164 gastroenterologists participated (response rate 24.55%), of whom 107(65.24%) were male, and 102(62.2%) working in public or academic hospitals. The duration of gastroscopy was not recorded by 116(70.73%) participants, while 102(62.2%) systematically used photodocumentation. Most participants utilized the Prague and Los Angeles classifications 156(95.12%) and 159(96.95%) respectively. Additionally, 140(85.37%) followed the Seattle protocol, and 158(96.34%) conducted biopsies according to ESGE guidelines for precancerous gastric lesions. However, 83(50.61%) don’t use a registry for patients with Barrett’s esophagus. Complications were systematically recorded after gastroscopy by 103(62.8%) and after colonoscopy by 90(54.88%).
In colonoscopy, 149(90.85%) use the BBPS scale, and 158(96.34%) reported successful cecal intubation. Withdrawal times exceeded six minutes for 151(92.07%) participants. An adenoma detection rate of over 25% was achieved by 117(71.78%), while 103(62.8%) consistently used the Paris classification. Proper polypectomy techniques were employed by 111(67.68%), but 100(60.98%) recommended follow-up intervals shorter than guidelines suggest. Patient experience following gastroscopy and colonoscopy was not recorded by 126(76.83%) and 116(70.73%) participants, respectively. Overall, compliance with quality indicators for upper and lower digestive endoscopy was observed in 87(53.05%) and 75(45.73%) participants, respectively. Multivariate analysis revealed that 5-15 years of experience (p=0.05), the use of video recording (p=0.01) and use of high-resolution endoscopes (p<0.01) were associated with improved compliance with quality indicators of upper endoscopy. Whereas age above 55 (p<0.01), use of high-resolution endoscopes(p<0.01), use of video recording (p=0.02) and attendance of educational seminars relevant with quality in endoscopy (p=0.05) were associated with improved compliance with quality indicators of colonoscopy.

Conclusion

In this study, discrepancies were observed in the compliance of Greek endoscopists with endoscopic quality indicators, highlighting the need for further improvement. The systematic recording of these quality indicators is essential, underlining the important role of scientific societies in this process.

Conference

UEG Week Berlin 2025

Submission format

Abstract

Session

OTHER (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

ADHERENCE TO ENDOSCOPIC QUALITY INDICATORS IN GREECE

Konstantina D. Paraskeva

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

REAL LIFE ADHERENCE TO INTERNATIONAL GUIDELINES IN BD-IPMN MANAGEMENT. CLINICAL AND COSTS IMPACT OF DIVERGENT STRATEGIES IN BD-IPMN CARE. THE PACMANS STUDY

Edoardo Giovanni Giannini

Image-guided surgery techniques

Mahdi Al-Taher

CANCER IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS – A NATIONWIDE DANISH COHORT STUDY WITH MATCHED CONTROLS

Helle Højen

NANO HYDROGEN AMELIORATES SEVERE ACUTE PANCREATITIS

Jinhang Gao

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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)

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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 1, Makiko Kinoshita 12, Yukiko Takayama 13, Yuji Amano 14, Kazuhiro Mizukami 1, Kazunari Murakami 15, Keiji Hanada 3

Affiliations

1 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 National Organization Minamiwakayama Medical Center, Tanabe, Japan

13 Tokyo Women's Medical University, Shinjuku, Japan

14 Urawa GIE clinic group, Urawa, Japan

15 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

More Like This:

ADHERENCE TO ENDOSCOPIC QUALITY INDICATORS IN GREECE

Konstantina D. Paraskeva

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

REAL LIFE ADHERENCE TO INTERNATIONAL GUIDELINES IN BD-IPMN MANAGEMENT. CLINICAL AND COSTS IMPACT OF DIVERGENT STRATEGIES IN BD-IPMN CARE. THE PACMANS STUDY

Edoardo Giovanni Giannini

Image-guided surgery techniques

Mahdi Al-Taher

CANCER IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS – A NATIONWIDE DANISH COHORT STUDY WITH MATCHED CONTROLS

Helle Højen

NANO HYDROGEN AMELIORATES SEVERE ACUTE PANCREATITIS

Jinhang Gao

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REAL LIFE ADHERENCE TO INTERNATIONAL GUIDELINES IN BD-IPMN MANAGEMENT. CLINICAL AND COSTS IMPACT OF DIVERGENT STRATEGIES IN BD-IPMN CARE. THE PACMANS STUDY

Stefano Kayali 1, Elisa Marabotto 2, Simone Dibitetto 3, Stefano Fantasia 1, Alberto Busatto 4, Simone Caprioli 2, Andrea Pierre Luzzi 2, Edoardo Vincenzo Savarino 4, Luigi Andrea Laghi 1, Claudio Giovanni De Angelis 5, Edoardo Giovanni Giannini 2

Affiliations

1 University of Parma, Parma, Italy

2 University of Genoa, Genova, Italy

3 University of Turin, Turin, Italy

4 University of Padua, Padua, Italy

5 ‘San Giovanni Battista’ Hospital, University of Turin, Turin, Italy

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Abstract

Introduction

Over the last two decades, there has been a rise in the diagnosis of Branch Duct Intraductal Papillary Mucinous Neoplasms (BD-IPMN), incidental findings posing potential neoplastic risks. Multiple guidelines, notably the International Association of Pancreatology (IAP)' revised in Fukuoka in 2017, have been suggested to optimize risk management. However, the intricate nature of these guidelines makes adherence challenging, raising uncertainties regarding their application in clinical practice.

Aims & Methods

This study aimed to assess adherence to the 2017 IAP guidelines, identify factors associated with non-compliance, and analyze the impact of divergent strategies on clinical outcomes and costs. Clinical and histopathological data from 2017 to 2023 were retrospectively collected from four tertiary centers in Northern Italy, focusing on patients with suspected BD-IPMN. Multivariate logistic regressions were employed to analyze factors influencing divergent strategies from the IAP guidelines and assess their consequences on clinical outcomes, survival, and costs. Surveillance strategies were considered aggressive if deviating to a narrower surveillance timing or indicating higher-level examinations than recommended by the IAP guidelines. Conservative approach was defined as suggesting extended surveillance timing or indicating lower-level examinations than specified by the IAP.

Results

Of the 333 enrolled patients with a total of 1400 visits and a median follow-up of 4 years, 54% received recommendations deviating from the guidelines, predominantly in an aggressive direction (53.7%). Protective factors for deviation were an Age-adjusted Charlson Comorbidity Index (ACCI) above 4 (OR 0.44, 95% CI 0.33-0.58, p < 0.001) and larger initial IPMN size (OR 0.22, 95% CI 0.17-0.28, p < 0.001), while divergent approach increased by 25% every two years of follow-up (OR 1.25, 95% CI 1.11-1.41, p < 0.001). Conservative divergences, occurring in 25% of cases, were associated with the presence of High-Risk Stigmata (HRS) (OR 5.79, 95% CI 1.82-18.50, p = 0.003) and female gender (OR 1.55, 95% CI 1.25-2.04, p = 0.001). Notably, divergent strategies did not lead to different rates of IPMN-related mortality (2.5% vs 2.4%, p = 1). However, they resulted in increased surveillance costs, escalating from 720 [407-1253] to 878 [664-1181] euros per patient over three years (p = 0.001).

Conclusion

In conclusion, adherence to the IAP guidelines in clinical practice was low, predominantly exhibiting deviations in an aggressive direction. This non-adherence significantly increased costs compared to those projected by following the recommended guidelines.

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

Pancreatic cancer: Clinical and basic science (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

More Like This:

ADHERENCE TO ENDOSCOPIC QUALITY INDICATORS IN GREECE

Konstantina D. Paraskeva

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

REAL LIFE ADHERENCE TO INTERNATIONAL GUIDELINES IN BD-IPMN MANAGEMENT. CLINICAL AND COSTS IMPACT OF DIVERGENT STRATEGIES IN BD-IPMN CARE. THE PACMANS STUDY

Edoardo Giovanni Giannini

Image-guided surgery techniques

Mahdi Al-Taher

CANCER IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS – A NATIONWIDE DANISH COHORT STUDY WITH MATCHED CONTROLS

Helle Højen

NANO HYDROGEN AMELIORATES SEVERE ACUTE PANCREATITIS

Jinhang Gao

UEG Presentation

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Image-guided surgery techniques

Mahdi Al-Taher 1

Affiliations

1 Maastricht UMC, Dubai, United Arab Emirates

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Abstract

Event

UEG Week Copenhagen 2023

Topics

Endoscopy Mechanisms & Personalised Medicine Radiology & Imaging Surgery

Session

Digestive diseases: Help from the machines?

Published

2023

More Like This:

ADHERENCE TO ENDOSCOPIC QUALITY INDICATORS IN GREECE

Konstantina D. Paraskeva

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

REAL LIFE ADHERENCE TO INTERNATIONAL GUIDELINES IN BD-IPMN MANAGEMENT. CLINICAL AND COSTS IMPACT OF DIVERGENT STRATEGIES IN BD-IPMN CARE. THE PACMANS STUDY

Edoardo Giovanni Giannini

Image-guided surgery techniques

Mahdi Al-Taher

CANCER IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS – A NATIONWIDE DANISH COHORT STUDY WITH MATCHED CONTROLS

Helle Højen

NANO HYDROGEN AMELIORATES SEVERE ACUTE PANCREATITIS

Jinhang Gao

UEG Presentation

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

CANCER IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS – A NATIONWIDE DANISH COHORT STUDY WITH MATCHED CONTROLS

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CANCER IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS – A NATIONWIDE DANISH COHORT STUDY WITH MATCHED CONTROLS

John Gásdal Karstensen 1,2, Steffen Bülow 1, Helle Højen 1, Anne Marie Jelsig 3, Niels Jespersen 1, Klaus Kaae Andersen 4, Mads Damsgaard Wewer 1, Johan Burisch 1, Hans Christian Pommergaard 3,2

Affiliations

1 Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

2 University of Copenhagen, Copenhagen, Denmark

3 Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

4 Omicron ApS, Copenhagen, Denmark

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Abstract

Introduction

Familial adenomatous polyposis (FAP) is a hereditary disorder that predisposes patients to colorectal cancer (CRC). Prophylactic colectomy has greatly reduced the risk of CRC. However, new associations between FAP and the risk of other cancers have subsequently emerged. In this study, we aimed to assess the risk of specific primary and secondary cancers among FAP patients in comparison with matched controls.

Aims & Methods

All known FAP patients up until April 2021 were identified in the nationwide Danish Polyposis Register and paired with four unique controls matched by birth year, sex, and zip code. Risk of overall cancers, specific cancer types, and risk of a second primary cancer were assessed and compared with controls.

Results

The analysis included 565 FAP patients and 1,890 controls. The overall risk of cancer was significantly higher for FAP patients than controls (hazard ratio (HR): 4.12, CI 95%, 3.28-5.17, p<0.001). The increased risk was mainly due to CRC (HR: 4.61, CI 95% 2.58-8.22, p<0.001), pancreatic cancer (HR: 6.45, CI 95% 2.02-20.64, p=0.002), and duodenal/small bowel cancer (HR: 14.49, CI 95% 1.76-119.47, p=0.013), while no significant difference was observed for gastric cancer (HR: 3.29, CI 95% 0.53-20.23, p=0.20). Furthermore, the risk of a second primary cancer was significantly higher for FAP patients (HR: 1.89, CI 95% 1.02-3.50, p=0.042). After 15 years, the point estimates for FAP patients and controls were 83.6 % vs. 94.8% being alive without cancer, 7.2% vs. 1.9% developing cancer, and 15.1% vs. 3.4% were deceased, respectively. When extending the period to 30 years, 60.7% vs. 81.1% were alive without cancer, 11.4% vs. 5.6% developed cancer, and 27.9% vs. 13.4% were deceased for FAP patients and controls, respectively. Between 1980 and 2020, the risk of cancer among FAP patients decreased by approximately 50%.

Conclusion

Analyzing national data for Danish polyposis patients and matched controls, we found that although the risk of developing cancer among FAP patients has been reduced by 50% over the last forty years, that risk is still significantly higher than for matched controls. Colorectal, pancreatic, and duodenal/small bowel cancer, as well as development of second primary cancers, are the main contributors to this increased risk. The risk of gastric cancer did not differ between FAP patients and controls. These findings should be included in future surveillance protocols and treatment guidelines for FAP patients.

References

Karstensen JG, Burisch J, Pommergaard HC, et al. Colorectal Cancer in Individuals With Familial Adenomatous Polyposis, Based on Analysis of the Danish Polyposis Registry. Clin Gastroenterol Hepatol 2019;17(11):2294-300 e1.
Monahan KJ, Bradshaw N, Dolwani S, et al. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG). Gut 2020;69(3):411-44.
Karstensen JG, Bulow S, Burisch J, et al. Validation of the Endoscopic Part of the Spigelman Classification for Evaluating Duodenal Adenomatosis in Familial Adenomatous Polyposis: A Prospective Study of Interrater and Intrarater Reliability. Am J Gastroenterol 2022;117(2):343-45.
Monahan KJ, Bradshaw N, Dolwani S, et al. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG). Gut 2020;69(3):411-44.

Disclosure

JGK is a consultant for SNIPR BIOME.

Event

UEG Week Copenhagen 2023

Topics

Colorectal Digestive Oncology Radiology & Imaging

Submission format

Abstract

Session

Lower GI cancer: Screening, follow-up and beyond

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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NANO HYDROGEN AMELIORATES SEVERE ACUTE PANCREATITIS

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NANO HYDROGEN AMELIORATES SEVERE ACUTE PANCREATITIS

Xianhui Zeng 1,2, Xianglei Yuan 1, chong zhao 1, Jinhang Gao 1, Chengwei Tang 1

Affiliations

1 West China Hospital, Sichuan University, Chengdu, China

2 West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China

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Abstract

Introduction

During severe acute pancreatitis (SAP), large amounts of reactive oxygen species (ROS) are produced in the abdominal cavity, which can directly damage abdominal organs and be absorbed into the blood, causing systemic inflammatory response syndrome and multiple organ dysfunction. Molecular hydrogen (H₂) can target to eliminate harmful ROS such as hydroxyl radical^[1]. When severe inflammatory damage occurs in the pancreas, microthrombosis are widely produced, and the antioxidant effect is difficult to be fully exerted if H₂ is administered through circulation.

Aims & Methods

We have developed hydrogen-loaded nanoparticles (nano hydrogen) to bring H₂ into direct contact with the pancreas by intraperitoneal administration, providing a new strategy for the anti-inflammatory treatment of SAP. In this study, we investigated the pathophysiological mechanisms by which nano hydrogen ameliorates SAP.
In vivo, SAP was established by retrograde injection of sodium taurocholate through the rat pancreatic duct. Nano hydrogen (37.5 mg/kg) was injected intraperitoneally in the SAP + nano hydrogen group. The survival rate was calculated. Pathological scoring was performed. Neutrophil and macrophage infiltration, ultrastructural changes of acinar cells and vascular endothelial cells, and microthrombosis of pancreatic tissue were detected. In vitro, intracellular ROS of AR42J cells were measured using hydroxyphenyl fluorescein solution. Human umbilical vein endothelial cells (HUVECs) were stimulated with TNF-α, and nano hydrogen was used for intervention. RNA-seq was performed on rat pancreatic tissue and HUVEC samples. The expression of VCAM-1, ICAM-1 and NF-κB p65 in HUVECs was compared. β-galactosidase staining and markers of cellular senescence such as phosphorylated γ-H₂A.X, p53, p21, and p16 were detected. The opening of the mitochondrial permeability transition pore (MPTP) and mitochondrial membrane potential of HUVECs were assessed.

Results

After intraperitoneal administration of nano hydrogen into SAP rats, the survival rate increased by 66%, and the pathological score of pancreas dramatically decreased (p < 0.01). The neutrophil infiltration was significantly reduced (p < 0.01), and the ultrastructure of acinar cells and vascular endothelial cells was significantly improved. The pancreatic tissue of SAP rats had a large number of microthrombi, which were significantly reduced by nano hydrogen. Pancreatic vascular endothelial cells in SAP rats expressed p21.
Nano hydrogen significantly downregulated the dominant transcriptional events in SAP pancreas, such as leukocyte chemotaxis and migration and oxidative stress, and also significantly reduced the production of ROS in the acinar cells and the expression of VCAM-1, ICAM-1 and phosphorylated p65 after TNF-α stimulation of HUVECs (p < 0.01). RNA-seq analysis of HUVECs indicated that TNF-α induced cellular senescence, confirmed by positive β-galactosidase staining and significantly increased expression of phosphorylated γ-H₂A.X, total p53, phosphorylated p53, p21 (p < 0.05) and p16 (p < 0.01). MPTP opened and mitochondrial membrane potential disappeared in TNF-α-stimulated HUVECs. Nano hydrogen significantly attenuated the abovementioned manifestation.

Conclusion

Nano hydrogen can effectively eliminate ROS brought to the pancreas by neutrophil infiltration and etc., and improve vascular endothelial cell function, thus significantly improving pathological damage such as pancreatic necrosis, which has important translational value for clinical treatment.

References

1. Ohsawa I, Ishikawa M, Takahashi K, et al. Hydrogen acts as a therapeutic antioxidant by selectively reducing cytotoxic oxygen radicals. Nat Med, 2007, 13(6): 688-694.

Event

UEG Week Copenhagen 2023

Topics

Endoscopy Gut Microbiota Hepatobiliary Pancreas

Submission format

Abstract

Session

Burning questions in acute pancreatitis

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Jinhang Gao