Introduction

Acetic acid chromoendoscopy (AAC) is frequently used in Barrett esophagus (BE) surveillance endoscopies. AAC is believed to be useful as a ‘red flag’ technique, thereby improving the overall neoplasia detection and the diagnostic yield of targeted biopsies. Accurate targeted neoplasia detection with AAC therefore holds the promise of abandoning random four-quadrant biopsies at 2cm intervals of the BE segment. Although some data exist on the use of AAC in expert centers, the added value in a non-dysplastic surveillance population in routine clinical practice is currently unclear.

Aims & Methods

A prospective stepped wedge cluster randomized trial was conducted in 18 Dutch community hospitals. BE patients undergoing surveillance endoscopies were eligible, while those with known or previously treated dysplasia were excluded. Participating hospitals shifted from usual care (no AAC; control group) to the incorporation of AAC (AAC; intervention group) in randomized order. Endoscopists were trained in the use and assessment of AAC immediately prior to its implementation. In both study groups, targeted biopsies were obtained in the presence of visible lesions before the acquisition of random four-quadrant biopsies. Primary endpoint was the overall neoplasia detection rate, defined as the percentage of patients with low-grade dysplasia (LGD), high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in both targeted and random biopsies, confirmed by an experienced GI pathologist. Secondary endpoint was the neoplasia detection rate of targeted biopsies. Data were analyzed using an as-treated approach, employing mixed effects regression analyses with a random intercept per hospital and correction for calendar time and BE length.

Results

We included 2,267 patients (1570 males; mean age 66) between June 2020 and November 2023. A total of 1,438/2,267 (63%) patients were allocated to usual care and 829/2,267 (37%) to AAC. In patients allocated to AAC, AAC was applied in 679/829 patients (82%). Overall, 163/2,267 patients (7.2%) were diagnosed with neoplasia, which encompassed LGD in 111/2,267 patients (4.9%), HGD in 30/2,267 patients (1.3%), and EAC in 22/2,267 patients (1.0%). The use of AAC did not result in a significantly higher overall neoplasia detection rate (7.4% with AAC [50/679 patients] versus 7.1% without AAC [113/1,588 patients]; OR 0.97; 95% CI 0.65-1.44). Visible lesions were detected in 95/679 (14.0%) patients receiving AAC versus 101/1,588 (6.4%) patients receiving usual care (p<0.001), yet the targeted neoplasia detection rate was not significantly higher (2.1% [14/679 patients] versus 1.8% [29/1,588 patients]; OR 1.05; 95% CI 0.49-2.24). Neoplasia was detected by random four-quadrant biopsies in the majority of patients: 39/50 patients (78%) receiving AAC and 81/113 patients (72%) receiving usual care.

Conclusion

The use of AAC does not improve the overall or targeted neoplasia detection rate in BE patients undergoing endoscopic surveillance in routine clinical practice. Endoscopic surveillance with AAC-guided targeted biopsies cannot replace the random biopsy protocol.

Disclosure

Pentax Medical, C2 Therapeutics

Introduction

Arterial hypertension (AI) is a key contributor to cardiovascular risk, particularly in individuals with metabolic syndrome (MS). Emerging evidence implicates gut dysbiosis in the pathophysiology of AI¹.

Aims & Methods

This study aimed to characterize the gut microbiota (GM) profile associated with AI in MS patients. We performed 16S rRNA gene sequencing on fecal samples from 94 MS patients. Participants underwent comprehensive clinical and biochemical evaluation. Patients were stratified based on individual MS criteria: waist circumference, HDL-cholesterol, fasting glycemia, AI, and triglyceride levels. GM diversity and composition were analyzed across these subgroups.

Results

Stratification by AI status revealed significant differences in both α- and β-diversity of the GM, unlike other MS components. AI was associated with distinct microbial signatures, including 35 differentially abundant taxa, among which 25 were at the genus level. Patients without AI exhibited higher levels of Actinobacteriota (notably Clavibacter) and the Bacillales_A order (Rummeliibacillus genus). Conversely, patients with AI showed increased abundance of genera such as CAG-485, Ruminococcus_F, Aphodomorpha, Brochothrix, Psychrobacter, Lentilactobacillus, and Negativibacillus. Notably, the genus Enterocloster was significantly reduced in hypertensive individuals.

Conclusion

Enterocloster species are involved in the synthesis of Microbially Conjugated Bile Acids (MCBAs)², a novel class of bile acids formed in the gut via conjugation with glycine, tyrosine, and phenylalanine. Given the inverse relationship between conjugated bile acids and systolic blood pressure, the decreased abundance of Enterocloster in AI patients suggests a potential mechanistic link. These findings position Enterocloster and MCBA pathways as promising biomarkers and therapeutic targets in AI. Ongoing studies aim to validate these associations in an independent cohort.

References

1. The gut microbiome and hypertension. Joanne A. O’Donnell, et al., Nature Reviews Nephrology (2023)
2. Global Chemical Impact of the Microbiome Includes Novel Bile Acid Conjugations. Robert Quinn et al. (2020)

Introduction

Burnout Syndrome is a subject that has been studied for several decades. Despite the fact that is a well-known topic and that more and more people are suffering from it, the bibliography shows that there are no great changes in it and as a consequence, there are still great deficiencies in the prevention of this syndrome today.
In 1981, Maslach and Jackson defined Burnout as a syndrome that occurs when there is inadequate coping with chronic stress, i.e., as a consequence of continuous work stress, negative attitudes and feelings appear both in the professional role itself and towards colleagues, and this makes the person suffering from it emotionally exhausted.
Burnout syndrome is now considered a public health problem because of the number and severity of the consequences for the physical and psychological integrity of workers. According to the International Council of Nurses, professionals who suffer higher levels of work and personal stress are 30% more likely to suffer accidents in their workplace. This means that on the one hand the person suffering from work-related stress and/or burnout syndrome has a series of complications of varying degrees of severity and on the other hand the organisation has to bear the costs involved (e.g. sick leave).

Results & Findings

Observational, descriptive and cross-sectional study, carried out in March 2025 on the nursing staff of our Digestive Endoscopy Unit. A survey was distributed with a section for the analysis of socio-demographic data and another presenting the Maslach Burnout Inventory (MBI) questionnaire.
Descriptive statistical analysis was performed using frequency and association tables.
All questionnaires received were analysed and no exclusion criteria were established. Total sample was 30 professionals, 18 nurses (60%) and 12 TCAES (40%).

Summary & Discussion

Proffesionals with presence and/or tendency to suffer burnout is characterised by being a professional of nursing on a temporary contract, female, aged 31-45 years and who have been working in our Endoscopy Unit from 5 to 10 years.
It is worth emphasising that there is a significant percentage of professionals who suffer from a high level of emotional exhaustion (63,3%)
Excessive workload (73,3%) and high-pressure job (52,6%), as well as poor workplace relationships (73,7%) are the main precursors highlighted by professionals for the appearance of burn out.

Conclusion

These data show that this is a latent problem and it is therefore necessary to take measures, both of an organisational nature and to intervene in the
nursing staff.

References

Maslach C, Schaufeli WB, Leiter M. 2001. Job burnout. Annual Review of Psychology. 52, 397-422.Gordon, S. 2005.
ICN (13 January 2021). Mass Trauma Experienced by the Global Nursing Workforce. [Internet] 2021 [Access 30/03/2025] Available at: https://www.icn.ch/sites/default/files/inline-files/ICN%20COVID19%20update%20report%20FINAL.pdf
Nursing against the odds: How health care cost cutting, media stereotypes, and medical hubris undermine nurses and patient care. Ithaca, NY: ILR Press (Cornell University Press).
Baiget, D, Chapela, R, López-Pérez, A, Milà, A. Síndrome de burnout entre el personal de enfermería del Servicio de Endoscopia Digestiva del HUVH. Enferm Endosc Dig. [Internet] 2016 [Access 30/03/2025];3(2): 30-37. Available at: http://aeeed.com/documentos/publicos/revista/octubre2016/Enferm%20Endosc %20Dig.%202016;3(2)30-37.pdf