Introduction

Multiparametric Ultrasound (MP-US) is emerging as a key tool for liver disease assessment and management, offering rapid, non-invasive insights into tissue characteristics, usually accessible only through liver histology^1,2. Steatosis and inflammation, main factors in fibrosis and cirrhosis progression, should be ideally detected and quantified early, aiding in the diagnosis and risk assessment of chronic liver disease (CLD)³. MP-US combines ultrasound wave propagation techniques: Shear Wave Dispersion (SWD) evaluates frequency-dependent changes in wave velocity reflecting inflammation-related viscosity; Shear Wave Elastography (SWE) estimates liver stiffness as indirect marker of fibrosis; Attenuation Ultrasound (USAT) and speed of sound (TSSI) assess hepatic fat content measuring energy loss and sound speed^3,4.

Aims & Methods

The study aimed to assess the accuracy of USAT/TSSI, SWE and SWD measured by a novel MP-US device (Resona A20, Mindray) compared to liver histology to evaluate steatosis, fibrosis and inflammation.
This single-centre observational, prospective study conducted from May to November 2024 included adult patients (≥18 years) with suspected CLD, referred for MP-US evaluation and percutaneous liver biopsy.
Parameters were obtained in a single session by placing a 2–3 cm diameter Region of Interest (ROI) at least 1.5 cm below the liver capsule.
Five valid measurements - defined by a Motion Stability Index (M-STB) of 5 and a high reproducibility (green zone on colorimetric map) - were acquired for each technique, collecting mean, median, interquartile range (IQR), IQR/median, standard deviation (SD) and SD/mean^4,5.
Histology was the reference standard for grading inflammation, fibrosis and steatosis using defined scoring systems.

Results

A total of 78 patients (46 women; mean age 51.6 years) were included in the study: 42 with MASLD, 20 with PSVD or nonspecific cholangiopathies, 9 with AIH and 7 with PBC.
USAT values increased progressively with steatosis severity, showing statistically significant differences across all stages (S0 vs S1, S1 vs S2 and S0 vs S1–3; p < 0.001). ROC curve analysis demonstrated high diagnostic accuracy with an AUC of 0.801 for S0 vs S1, 0.977 for S1 vs S2 and peak performance for S0–1 vs S2–3 (AUC 0.992, sensitivity 100%, specificity 95.1%). Optimal USAT cut-off values to classify mild, moderate and severe steatosis were 0.55, 0.67, and 0.75, respectively.
Conversely, TSSI values decreased with increasing steatosis grade. ROC analysis revealed moderate diagnostic performance of TSSI in distinguishing S0 from S1 (AUC 0.77) and S0–1 from S2–3 (AUC 0.76). A moderate inverse correlation was observed between TSSI and USAT values (ρ = –0.53, p < 0.001).
SWE values increased with fibrosis stage according to the METAVIR scoring system, demonstrating good performance in detecting advanced fibrosis (p = 0.024). However, most patients exhibited either no fibrosis (F0) or mild fibrosis (F1) on liver histology, limiting SWE overall diagnostic performance.
Viscosity values showed a non-significant upward trend with increasing inflammation. Standard liver function tests demonstrated only a weak correlation with histological inflammation. Notably, SWD approached statistical significance in differentiating the presence of at least mild inflammation from no inflammation (A0 vs A123).

Conclusion

MP-US offers valuable non-invasive insights into liver tissue characteristics reflecting histological findings. Further studies are warranted to support the non-invasive assessment of key pathological features, potentially replacing liver biopsy.

References

1. Grgurevic, I., Tjesic Drinkovic, I. & Pinzani, M. Multiparametric ultrasound in liver diseases: an overview for the practising clinician. Postgrad Med J 95, 425–432 (2019).
2. Sumida, Y., Nakajima, A. & Itoh, Y. Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroenterol 20, 475–485 (2014).
3. Garcovich, M. et al. Shear Wave Dispersion in Chronic Liver Disease: From Physical Principles to Clinical Usefulness. Journal of Personalized Medicine 2023, Vol. 13, Page 945 13, 945 (2023).
4. Ferraioli, G. et al. WFUMB Guidelines/Guidance on Liver Multiparametric Ultrasound. Part 2: Guidance on Liver Fat Quantification. Ultrasound Med Biol 50, 1088–1098 (2024).
5. Ferraioli, G. et al. WFUMB Guideline/Guidance on Liver Multiparametric Ultrasound: Part 1. Update to 2018 Guidelines on Liver Ultrasound Elastography. Ultrasound Med Biol 50, 1071–1087 (2024).

Introduction

Gastric cancer is a major cause of cancer-related mortality, and early detection improves outcomes. However, organized gastric cancer screening programs are largely absent in Europe, and vulnerable groups often have low awareness of preventive services. Roma communities face pronounced health disparities and barriers to healthcare, including social exclusion and low literacy, which may limit their use of preventive services [1].

Aims & Methods

We aimed to explore the knowledge, attitudes, and preferences regarding gastric cancer screening among Roma adults with low health literacy in Cluj-Napoca, Romania, to inform culturally tailored outreach strategies, as part of the TOGAS project. Approximately 40 Roma adults (18–72 years) were recruited via community centers for three focus groups (two urban, one rural) in Cluj-Napoca. All participants first attended a brief educational session on digestive health and gastric cancer to ensure baseline understanding. Guided by trained moderators, groups discussed their awareness of gastric cancer and perceptions of screening methods (endoscopy, blood tests, stool tests). All discussions were audio-recorded, transcribed, and thematically analyzed.

Results

Baseline awareness of gastric cancer screening was minimal. Most participants had never heard of any screening test or program for gastric cancer, indicating a major knowledge gap. Nevertheless, after receiving information, many expressed interest in screening for early detection. A prominent theme was communication preferences: nearly all participants preferred to receive health information via mobile phone or social media (e.g., messaging) and also through traditional channels like primary care providers. Overall, participants were open to screening if it was offered conveniently and respectfully.

Conclusion

Outreach is needed to improve engagement in cancer prevention among underserved populations. The lack of awareness in this Roma community echoes reports of poor knowledge of cancer prevention in other Roma groups and signals the need for targeted health promotion to reduce inequalities. As European health authorities consider implementing gastric cancer screening, input from vulnerable communities will be vital for equitable uptake.

References

1. Leja M. Where are we with gastric cancer screening in Europe in 2024? Gut. 2024 Nov 11;73(12):2074-2082.

Introduction

Optical diagnosis (OD) with a “resect and discard” strategy involves diagnosing diminutive polyps with high confidence, photodocumenting and resecting these without sending to histology. This greener, more efficient and cost-effective process underwent a comprehensive evaluation in the DISCARD3 study which showed, in a single screening centre, this meets the threshold for implementation and is feasible and safe with a quality assurance (QA) process in place. The NHS Bowel Cancer Screening Programme (NHSBCSP) in England approved implementation in 2023. Early learning from translating this research into a population based programme is presented.

Aims & Methods

All 506 screening colonoscopists in England have been invited to undertake accreditation in OD. Part 1 of the process involves attendance at a training day including a pre- and post-training test where 120 polyps are optically diagnosed. Pass criteria is ≥85% accuracy for high confidence optical diagnoses and overall ≥50% high confidence calls. Part 2 involves supervised OD at each endoscopists’ base hospital of 20 consecutive high confidence, optical polyp diagnoses with assessment of photodocumentation quality and diagnostic accuracy. To pass part 2 photodocumentation quality is required to be adequate in ≥90% of cases using the “3C photo quality score” and diagnosis accuracy ≥85%. Once achieved, individuals are fully accredited to perform OD with a resect and discard strategy for screening cases and must undertake re-accreditation with online assessment of a further 120 polyp images every 2 years to demonstrate competency. Those accredited are supported by “Optical Diagnosis Champions” at each screening centre who monitor performance and support QA. Once in place “Optical Diagnosis Champions” will support those becoming accredited in OD.

Results

65 screening colonoscopists attended part 1 of the accreditation in March 2024. 85% (55/65) passed the post-test on the first attempt with a further 7 individuals passing on repeat attempts. Overall 62/65 (95%) have completed part 1. Of these, 55/62 (89%) have successfully completed part 2 and are fully accredited.
As of 31 March 2025, 9618 polyps have been resected and discarded with a cost saving equivalent to £355866 (assuming a cost of £37 per polyp). An estimated 3206 hours of histopathology time has been saved (assuming 20 minutes per polyp).
Further training days have been held in September 2024, February 2025 and March 2025 increasing the total number of screening participants to over half of all screeners in England (310/506). The results from these will be reported in due course.

Conclusion

The NHSBSCP is the first population based screening programme in the world to implement OD with a resect and discard strategy. Quality assurance and monitoring is ongoing. In this early stage there have already been cost and time savings for the NHS which are expected to increase substantially once roll out completes in 2027.

References

Ahmad A et al. Implementation of optical diagnosis with a “resect and discard” strategy in clinical practice: DISCARD3 study. Gastrointestinal Endoscopy 2022; 96(6): 1021-1032.e2.

Disclosure

BPS has done consultancy and speaker work for Olympus. There are no other relevant current conflicts of interest to declare.

Introduction

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive and effective treatment for obesity. However, concerns remain regarding gastric mucosal folding and the resulting reduced visibility of the gastric lining. To address these limitations, we developed a novel peroral endoscopic myo-neurotomy (POEM-N) technique (1), adapted from peroral endoscopic myotomy (POEM), as a weight-loss procedure. Although promising, the original POEM-N was time-consuming. This study aims to evaluate the safety and efficacy of a revised POEM-N (R-POEM-N) technique using a submucosal approach as a less invasive bariatric option in a porcine model.

Aims & Methods

Twelve pigs were assigned to either the R-POEM-N group (n = 8) or a sham endoscopic control group (n = 4). Myo-neurotomy was performed at four gastric sites in the R-POEM-N group: two on the greater curvature of the gastric body and two in the antrum. All pigs were fed a hypercaloric diet (twice the standard weight-based intake) and monitored for eight weeks post-procedure. The primary outcome was the proportional change in body weight at 8 weeks, calculated as the ratio of weight change to baseline weight. Secondary outcomes included food intake, changes in serum glucolipid levels, and assessments of safety and procedural duration.

Results

R-POEM-N was successfully completed in all pigs without major adverse events. The mean procedure time was 171.3 ± 3.0 minutes. At 8 weeks, the proportional change in body weight was significantly lower in the R-POEM-N group compared to controls (P = 0.017). Food intake was also significantly reduced in the R-POEM-N group (P < 0.05). No significant differences were observed in serum glucolipid levels between groups.

Conclusion

R-POEM-N effectively limited weight gain in a porcine model and demonstrated a favorable safety profile. These findings suggest that R-POEM-N may serve as a promising, minimally invasive bariatric intervention.

References

(1) Hamada K, Yamasaki Y, Takaki A, et al. Gastric peroral endoscopic myo-neurotomy as less-invasive bariatric surgery in porcine models: an experimental study. iGIE. 2024; 3: 358–65 doi: 10.1016/j.igie.2024.06.002.

Introduction

Recent insights in polyp molecular biology have suggested that hyperplastic polyps (HP) are closely related to sessile serrated lesions (SSL). Their hallmark serrated crypts closely resemble those found in SSL. Furthermore, similar to SSL, specific subtypes of HP can harbor BRAFV600E-mutations. These findings, amongst others, have raised the hypothesis that some HP may have an intrinsic malignant potential through the serrated neoplasia pathway. However, in everyday clinical practice, no routine HP subdifferentiation is performed. Therefore, we aimed to develop a deep learning algorithm to classify molecular subclasses of HP, namely microvesicular hyperplastic polyps (MVHP) and goblet cell-rich hyperplastic polyps (GCHP), based on their endoscopic features.

Aims & Methods

In this single-center trial 238 hyperplastic polyps from 159 patients were retrospectively selected. All polyps had high quality endoscopic video in white light endoscopy and virtual chromoendoscopy (i-scan) using Pentax EC38-i20c and EC34-i10 endoscopes. All histological slides were reviewed by an expert pathologist, updating diagnoses to MVHP, GCHP or mixed HP. We selected the polyps without mixed constitution for development of a deep learning algorithm. These polyps were randomly split into 70% for training, 10% for validation and 20% for testing. Sequences of still images of the polyps were manually annotated and subsequently used to train a deep learning algorithm, with dataset imbalance addressed by randomly oversampling the MVHP.

Results

The 238 HPs were reclassified as 152 GCHP, 59 MVHP and 27 mixed HPs after expert histological review. We subsequently trained a convolutional neural network on the 211 HPs without mixed constitution. This resulted in a model with an AUC of 0.817, corresponding to a sensitivity of 80.0% for predicting MVHP and 78.4% for predicting GCHP. However, due to the low prevalence of MVHP (28%) the positive predictive value for MVHP is only 33.3%, whilst the positive predictive value for GCHP is 96.7%.

Conclusion

We successfully developed a deep learning algorithm capable of differentiating between molecular subclasses of hyperplastic polyps (MVHP vs GCHP) based on their endoscopic features. This model demonstrated a robust AUC of 81.7% with a sensitivity of 80.0% and 78.4% for predicting MVHP and GCHP respectively. However, the low prevalence of MVHP (28%) limited its positive predictive value (33.3%) for predicting MVHP. Despite these challenges, this pilot study serves as a proof of concept that artificial intelligence is capable of predicting hyperplastic polyp subclasses based on endoscopic appearance. Furthermore, it highlights the potential of artificial intelligence to enhance the diagnostic precision, which could contribute to more tailored surveillance and management strategies in the future.

Disclosure

The authors declare no conflicts of interest.

Introduction

Chronic viral hepatitis is among the principal public health problems and a leading cause of morbidity and mortality. The advent of direct-acting antiviral agents (DAAs) impressively changed the management of chronic Hepatitis C virus (HCV) infection. In parallel, WHO's global hepatitis strategy aims to reduce new hepatitis infections by 90% and deaths by 65% from 2016 to 2030 and to identify undiagnosed individuals with chronic hepatitis infection before clinical progression. Currently, a free screening for HCV infection is offered in Italy to subjects born between 1969 and 1989 and also to subjects under the care of addiction services (SerD) and those in detention. In line with national screening plans, the Tuscany Region activated free screening among these subjects.

Aims & Methods

This study aimed to define the prevalence of chronic HCV infection in patients over 55, specifically those not included in free HCV screening programs, aligning with global, regional, and national plans for HCV elimination. Additionally, the study provides a linkage to the care of those infected, evaluates the hepatitis B virus (HBV) prevalence in a subgroup of patients, and describes the clinical features of this study population. Patients born before 1969 hospitalized to the Internal Medicine and Gastroenterology Divisions at Santa Maria alle Scotte Hospital in Siena prospectively underwent screening for HCV antibodies. The gastroenterology cohort was evaluated for HBV infection. All enrolled patients were assessed for comorbidities, treatment and transaminase levels (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]).

Results

A total of 207 subjects, of whom 169 resided in Siena, were divided into three cohorts based on the department where they were admitted and underwent HCV screening. Patients present a high prevalence of comorbidities (88.4%), among them common were cardiovascular diseases (68.1%), cancer (35.3%), liver and hepatobiliary diseases (28%), and diabetes (22.2%). In the entire study population, 15.5% of patients received immunomodulating drugs. Overall, 63 patients (30.4%) showed the presence of elevated transaminase levels, 8 patients (3.9%) were anti-HCV positive, and 2 were HCV RNA positive (0.9%). Of 96 patients in the gastroenterology cohort, 9 (9.4%) had HBV infection, of whom 8.4% had HBsAg-negative infection.

Conclusion

An active HCV infection prevalence of 0.9% was found in hospitalized patients (> 55 years old). A substantial proportion of people in the gastroenterology cohort residing in South-Eastern Tuscany carried occult HBV infection (8.4%). The increase in transaminase levels can be linked to the combined presence of liver and hepatobiliary diseases and the administration of immunomodulatory drugs. This study confirms that an opportunistic screening can contribute to identifying the submerged people affected by viral hepatitis.

References

1. World Health Organization. Global health sector strategy on viral hepatitis 2016–2021. Accessed June 2016. http://apps.who.int/iris/bitstream/10665/246177/1/WHO-HIV-2016.06-eng.pdf
2. Ministero della Salute. DECRETO 14 Maggio 2021. Esecuzione dello Screening Nazionale per L’eliminazione del Virus dell’HCV. (21A04075) (GU Serie Generale n.162 del 08-07-2021). https://www.gazzettaufficiale.it/eli/id/2021/07/08/21A04075/sg (accessed on 8 July 2021).
3. REGIONE TOSCANA. Avvio di un Programma di Screening Gratuito per Prevenire, Eliminare ed Eradicare il Virus Dell’epatite C, in Attuazione Dell’art. 25-Sexies del D.L.n. 162/2019. http://www301.regione.toscana.it/bancadati/atti/Contenuto.xml?id=5355950&nomeFile=Delibera_n.1538_del_27-12-2022 (accessed on 31 December 2022)

Disclosure

Prof. Brillanti reports grants and personal fees from Gilead Sciences.

Introduction

Endoscopic depth diagnosis is essential for the treatment decision of Barrett's esophageal adenocarcinoma (BEA). However, it is sometimes difficult to diagnose due to the anatomy of the esophagogastric junction, such as the difficulty of luminal distension. For inconclusive cT1a or cT1b lesions, we introduced staging ESD, allowing for histologic diagnosis for depth invasion. However, the clinical feasibility and significance of staging ESD remain unclear.

Aims & Methods

In this study, we evaluated the performance of endoscopic depth diagnosis of cT1 BEA and the appropriate treatment strategy.
This study included cT1N0M0 BEA treated with ESD or surgery from January 2015 to June 2024. The cases with poorly differentiated component on target biopsy were excluded. Endoscopic depth diagnosis was based on macroscopic appearance (such as the following findings suggestive of cT1b: polypoid, mixed macroscopic type, thickness, hardness, severe redness, and ulceration). EUS was added at the discretion of the endoscopist. We made the treatment decision based on our multidisciplinary conference, and the final diagnosis was classified as conclusive cT1a or cT1b, and inconclusive cT1a or cT1b. We performed ESD for conclusive cT1a, and surgery for conclusive cT1b. And we performed staging ESD for inconclusive cT1a or cT1b. Curative resection was defined as pT1a with R0 resection, and without lymphovascular invasion or poorly differentiated component.

Results

This study included 54 lesions in 52 patients. The median age was 66 years (43-92). There were 42 male patients. Siewert type [type I/type II] were 12 and 42, respectively. Background Barrett’s esophagus [SSBE/LSBE] were 36 and 16, respectively. The median size was 20mm (5-50). Major macroscopic appearances [0-I/0-IIa/0-IIb/0-IIc] were 11, 19, 1, and 23, respectively. Histology on targeted biopsy [tub1/tub2] were 41, 13, respectively. 39 lesions were diagnosed by white light endoscopy alone, and 15 lesions were comprehensively diagnosed by additional EUS. 41 lesions were diagnosed as cT1a and 13 lesions were diagnosed as cT1b. ESD and surgery were performed for 47 and 7 lesions, respectively. Pathologic depths [T1a/T1b/T2] were 42, 11, and 1, respectively. The sensitivity, specificity, and positive predictive value of endoscopic diagnosis of T1b were 25.0%, 76.2%, and 23.1%, respectively. 10 of 54 (18.5%) T1a lesions were overdiagnosed. Staging ESD was performed for 20 lesions, and all of them achieved en bloc resection without adverse events. R0 resection was achieved in 13 of 14 (92.9%) cT1a and 5 of 6 (83.3%) cT1b, respectively. Curative resection was achieved in 8 of 14 (57.1%) cT1a and 4 of 6 (60.0%) cT1b, respectively. 3 of 54 (5.6%) T1a were diagnosed as conclusive cT1b, and underwent surgery, leading to overtreatment.

Conclusion

The diagnostic performance of endoscopic depth diagnosis is insufficient, leading to overdiagnosis. Staging ESD for inconclusive cT1 BEA is technically feasible and can be an option to avoid overtreatment.