Introduction

Background: Worldwide, gastric cancer (GC) is the fourth cause of death for neoplastic pathology and the fifth for incidence (1). To reduce GC mortality, a strategy is to timely diagnose preneoplastic lesions, especially in patients with significant risk factors. Since in 1^st degree relatives was found an up to 2.5 times increased risk for GC (2), recent guidelines suggest an esophagogastroduodenoscopy (EGDS) screening in patients who have a 1^st degree relative for GC (3). However, if the EGDS shows the absence of atrophy or intestinal metaplasia, no further EGDS is currently recommended. Otherwise, if precancerous conditions are diagnosed, European guidelines, MAPS II, suggest repeating EGDS shortening the interval (4).

Aims & Methods

The purpose of this cross-sectional study was to determine the endoscopic and histological findings and the prevalence of preneoplastic and neoplastic conditions in patients undergoing EGDS for 1^st degree relative for GC.
In this cross-sectional study, patients who underwent an EGDS with biopsies according to the updated Sydney system protocol, due to 1^st degree GC relative indication from January 2008 to September 2022, were included. The preneoplastic conditions were staged with OLGA and OLGIM systems. Exclusion criteria were patients with previous gastric surgery and patients with an incomplete biopsy sampling.

Results

Overall, 330 patients were considered [64% F; 56 (20-87) years]. Twenty patients were excluded from the study due to an incomplete biopsy sampling, thus 310 patients were finally included. The mere indication of 1^stdegree relative for GC was found in 55.7% of patients, whilst 18% also had anemia, 32% gastrointestinal symptoms, 11% performed EGDS for Hp eradication control, 1% for previous gastric dysplasia and 8% for other conditions. Histological examination identified 2 (0.6%) intestinal type gastric cancers and 2 (0.6%) low-grade dysplasia (none of these patients had previous dysplasia). Regarding precancerous conditions, 11 % were OLGA I-II, 0.3% OLGA III-IV whilst 10% were OLGIM I-II and 0.3% were OLGIM III-IV. Hp infection was found in 25.5% of patients. Furthermore, in 2.25% of cases, corpus-restricted atrophic gastritis was diagnosed.

Conclusion

Our study support the role of EGDS with biopsies in patients with 1^st degree relative for GC as 2 neoplastic lesions and 2 low-grade dysplasia were found in patients with low stages of OLGA/OLGIM, and 10% of patients would have required follow-up according to European guidelines.

References

1. Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 71(3), 209-249.
2. Yaghoobi, M., McNabb-Baltar, J., Bijarchi, R., & Hunt, R. H. (2017). What is the quantitative risk of gastric cancer in the first-degree relatives of patients? A meta-analysis. World journal of gastroenterology, 23(13), 2435.
3. Banks, M., Graham, D., Jansen, M., Gotoda, T., Coda, S., Di Pietro, M., ... & Dinis-Ribeiro, M. (2019). British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut, 68(9), 1545-1575.
4. Pimentel-Nunes, P., Libânio, D., Marcos-Pinto, R., Areia, M., Leja, M., Esposito, G., ... & Dinis-Ribeiro, M. (2019). Management of epithelial precancerous conditions and lesions in the stomach (maps II): European Society of gastrointestinal endoscopy (ESGE), European Helicobacter and microbiota Study Group (EHMSG), European Society of pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy, 51(04), 365-388.

Introduction

Lynch syndrome (LS) is associated with an increased risk of upper gastrointestinal (GI) cancers. While upper GI surveillance is recommended in several guidelines, there remains international variability and ongoing debate regarding its implementation, timing, and extent. This study evaluated the incidence of gastric (GC), duodenal (DC), and jejunal cancers (JC) in LS patients using data from the German Consortium for Familial Intestinal Cancer (GCFIC). In addition, the diagnostic yield of esophagogastroduodenoscopy (EGD) and push enteroscopy (PE), performed at a tertiary care center, was retrospectively analyzed.

Aims & Methods

A total of 960 endoscopic procedures (494 EGD, 466 PE) were retrospectively analyzed in 349 LS patients documented at a tertiary care center. Push enteroscopy (PE) was performed using a colonoscope to allow deeper insertion into the small intestine, enabling inspection of the proximal jejunum. Clinically relevant findings included intestinal metaplasia, Barrett’s esophagus, adenomas, and carcinomas. These findings were systematically compared between EGD and PE to evaluate diagnostic yield. The GCFIC database was evaluated to determine cancer incidence by genotype.

Results

In the GCFIC cohort (n=2859), the majority of GC (2.2%), DC (2.1%), and JC (1.9%) occurred in high-risk pathogenic variant carriers (PGV) (MLH1, MSH2, EPCAM). However, a small proportion of cancers was also observed in low-risk PGV carriers: GC in two MSH6 carriers, DC in five patients with MSH6 or PMS2, and JC in seven low-risk carriers (MSH6: 3, PMS2: 4). In the NZET cohort, 22% of procedures and 50 % of patients revealed relevant findings. Gastric adenomas were found in 3.7%, gastric cancer in 1.1%, and intestinal metaplasia in 28% of patients. Duodenal adenomas were found in 3.7% and cancer in 0.9%. Jejunal neoplasia was detected exclusively by PE (adenomas 1.7%, cancer 0.6%).

Conclusion

Upper gastrointestinal surveillance is essential in patients with Lynch syndrome. Push enteroscopy (PE) provides diagnostic value beyond conventional esophagogastroduodenoscopy (EGD), particularly in detecting jejunal neoplasia, and should be considered in high-risk surveillance protocols.

Disclosure

Robert Hüneburg was funded by Deutsche Krebshilfe (DECADE), and Wilhelm-Sander-Stiftung.
Jacob Nattermann was funded by Wilhelm-Sander-Stiftung.

Introduction

Despite the availability of various image-enhanced endoscopy (IEE) techniques, direct comparisons of their performance in detecting lower gastrointestinal lesions are scare.

Aims & Methods

This systematic review and network meta-analysis aims to compare the diagnostic performance of different IEE modalities on detection of colorectal lesions. We conducted a systematic search of PubMed, EMBASE, and Web of Science for randomized controlled trials (RCTs) published up to January 1, 2025, which compared the diagnostic accuracy of various IEE in detecting colorectal lesions. The primary outcomes were rate-based metrics including polyp (PDR), adenoma (ADR), advanced adenoma (AADR), and serrated lesion detection rate (SLDR). Additionally, count-based measures were compared, including mean polyp per patient (MPP) and mean adenoma per patient (MAP). Narrow-band imaging (NBI) techniques were classified into two categories: old generation (e.g., EVIS LUCERA Spectrum or EXERA II) and new generation (e.g., EVIS EXERA III or LUCERA ELITE). To rank the performance of each modality, we employed the Surface Under the Cumulative Ranking curve (SUCRA). For binary outcomes, odds ratios (ORs) were calculated; and for continuous outcomes, mean differences (Δ) were determined with all results reported alongside their respective 95% confidence intervals (CIs).

Results

Conclusion

This network meta-analysis demonstrates that TXI, new-generation NBI, LCI, and CE all exhibit better performance than WLI in detecting colorectal lesions. TXI demonstrated consistent efficacy in both polyp and adenoma detection. The new-generation NBI and LCI showed significant advantages in terms of lesion yield per patient. However, the diagnostic benefit of IEE for serrated lesions remains uncertain due to insufficient evidence. Additional head-to-head studies are necessary to further confirm these findings.

Introduction

Recent advances in large language models, such as GPT-4.0 and GPT-4.5, have increased the accessibility of artificial intelligence (AI) in clinical settings. However, its role in decision-making remains unclear.

Aims & Methods

This study compares the appropriateness of esophagogastroduodenoscopy (EGD) prescriptions across ten clinical scenarios, as evaluated by gastroenterology specialists, residents, general practitioners, and five AI systems (ChatGPT-4.0, ChatGPT-4.5, Gemini, Claude, and OpenEvidence), using ESGE and ASGE guidelines as the reference standard. A cross-sectional survey was developed using 10 real-world clinical vignettes in gastroenterology, each with three response options: appropriate, inappropriate, or uncertain. The vignettes were developed based on real-world clinical practices by three expert gastroenterologists, and then reviewed by the authors.The final questionnaire was hosted on Google Forms and simultaneously distributed—without prior notice—to gastroenterology specialists, residents, and general practitioners across Italy to minimize external influence. The same clinical scenarios were then submitted to five AI systems (ChatGPT-4.0, ChatGPT-4.5, Gemini, Claude, and OpenEvidence) using the same multiple-choice format. AI responses were collected on April 22, 2025.

Results

A total of 122 healthcare professionals participated in the study (61% male; mean age 39.7 ± 13.6), including 41 gastroenterology specialists, 31 residents, and 50 general practitioners. Most participants were from northern Italy (76%), with additional representation from central (14%) and southern regions (10%), covering a total of 10 regions. The majority had less than 5 years of clinical experience (66%) and were employed in public hospitals (49%). Only 30% reported prior use of AI in clinical practice. All respondents considered the clinical scenarios realistic.
The average accuracy rate was highest among gastroenterologists (65.6% ± 11.6) and residents (64.8% ± 10.0), compared to general practitioners (56.8% ± 11.0), with statistically significant differences (p < 0.001 and p < 0.005, respectively).
Among AI systems, OpenEvidence and Gemini outperformed all human groups (80% and 80%, p < 0.001), while ChatGPT-4.0 (70%) and Claude (60%) showed comparable performance to clinicians. Notably, ChatGPT-4.5 (50%) underperformed relative to all human categories.

Conclusion

This study highlights significant variability in the appropriateness of upper GI endoscopy prescriptions among different medical professionals, with gastroenterologists performing better than general practitioners. Emerging AI models, particularly OpenEvidence and GEMINI, demonstrated promising performance in clinical decision-making, outperforming all human groups in certain scenarios. These AI systems could serve as valuable tools to support gastroenterologists and other healthcare professionals, enhancing adherence to evidence-based practices and facilitating more direct consultation of clinical guidelines. Further research is needed to explore the integration of AI into clinical workflows and its potential to refine decision-making in gastroenterology.

References

1) Chang PW, Amini MM, Davis RO, et al. ChatGPT4 Outperforms Endoscopists for Determination of Postcolonoscopy Rescreening and Surveillance Recommendations. Clin Gastroenterol Hepatol. 2024 Sep;22(9):1917-1925.e17. doi: 10.1016/j.cgh.2024.04.022. Epub 2024 May 9. PMID: 38729387.
2) Maida M, Celsa C, Lau LHS, et al. The Application of Large Language Models in Gastroenterology: A Review of the Literature. Cancers (Basel). 2024 Sep 28;16(19):3328. doi: 10.3390/cancers16193328. PMID: 39409948; PMCID: PMC11475222.

Introduction

Endoscopic submucosal dissection (ESD) is being increasingly adopted worldwide for the treatment of colorectal neoplastic lesions. However, its role in patients with inflammatory bowel disease (IBD) remains debatable, particularly due to the increased risk of submucosal fibrosis from chronic inflammation, which can theoretically impact the clinical outcomes of this technique. This study aimed to assess the efficacy and safety of ESD for colorectal neoplastic lesions in IBD patients, comparing Asian and Western settings.

Aims & Methods

A systematic review was conducted by searching MEDLINE and Web of Science until January 2025, in accordance to MOOSE guidelines. We included primary studies reporting ESD performance in IBD patients. We performed random-effects meta-analysis for several outcomes, including en-bloc, R0, and curative resection rates, frequency of adverse events (post-procedural bleeding and perforation), local recurrence and need for additional surgery after ESD. Certainty of evidence was assessed using GRADE.

Results

We included 20 studies (565 patients and 732 lesions). The meta-analytical frequencies of en-bloc, R0, and curative resection rates were 95.7% (95%CI=93.5-97.9%; I²=60.1%), 84.6% (95%CI=79.4-90.1%; I²=68.9%), and 83.9% (95%CI=76.3-92.4%; I²=75.9%), respectively. Bleeding and perforation occurred in 7.0% (95%CI=4.4-11.2%; I²=16.9%) and 7.9% (95%CI=5.3-11.9%; I²=2.4%) of cases, respectively. Local recurrence frequency was 5.3% (95%CI=3.5-7.9%; I²=0%). The meta-analytical need for additional surgery was 13.3% (95%CI=9.5-18.1%; I²=42.5%). No differences were found between Asian and Western studies for any outcome. The certainty of evidence was considered "low" in 4 outcomes and "very low" in the remaining outcomes.

Conclusion

ESD appears feasible and safe for treating IBD-associated colorectal neoplasias. Similar results were observed between Asian and Western studies.