Introduction

Obesity remains a major public health issue in developed countries. While bariatric procedures such as Roux-en-Y gastric bypass (RYGB) are effective, up to 20% of patients experience long-term weight regain. Dilation of the gastrojejunal anastomosis (GJA) may contribute to this, possibly due to faster gastric emptying. Argon plasma coagulation (APC) has been shown to reduce GJA diameter, potentially restoring satiety and promoting weight loss.

Aims & Methods

This study aimed to evaluate APC efficacy in reducing GJA diameter in patients with post-RYGB weight regain and to identify potential predictors of total weight loss (TWL).
A retrospective, single-center study included 36 RYGB patients treated with APC from 2018–2023. The primary outcome was %TWL. Secondary endpoints included reduction in anastomosis diameter (RAD), comorbidities, and adverse events (AEs). Patients were followed at 3, 6, and 12 months and categorized by TWL (≥5%, ≥10%, ≥15%). Responders were defined as those achieving ≥5% TWL at 3 months. Associations between TWL, responders to APC and demographic or clinical variables were analyzed.

Results

Total Weight Loss
Initially, all patients experienced some degree of weight loss after the APC intervention. The mean absolute TWL of 8.3%, 8%, and 8.2% at 3, 6, and 12 months.
Regarding categorical TWL, over 60% achieved ≥5% TWL throughout follow-up (Figure 1), with 61.1% at 3 months, 66.7% at 6 months, and 63.9% at 12 months. Though ≥10% and ≥15% rates were lower. No clinically significant associations were found between pre-treatment patients factors and comorbidities; and subsequent weight loss.
TWL was significantly higher in responders (14.9%, 11.7%, 11.1%) vs. non-responders (Figure 2), but no predictive baseline factors were identified (Table 1).
At 12 months (Figure 3), over 80% maintained ≥5% TWL, and more than 50% reached ≥10% . Though ≥15% was sustained in only 13.9%–16.7%, highlighting obesity’s chronic nature and APC’s limited long-term effect.
Furthermore, at 12 months, mean BMI in responders was significicantly lower (31.7kg/m²), and over a quarter (27.3%) of responders achieved a BMI <30, no longer meeting obesity criteria, which may be considered a significant clinical success.
GJA diameter
Patients presented with notably enlarged GJA diameters, with a mean pre-APC GJA of 26.61 ± 5.41 mm, and 16.4 ± 5.0 mm post-APC (p < 0.001). A small final GJA diameter (<18 mm) was achieved in 72%. The mean RAD was 10.22 ± 6.4 mm, representing a 36.9 ± 19.3% decrease. However, neither RAD nor final GJA diameter were predictive of TWL. These findings align with the hypothesis proposed by some authors, suggesting that patients with persistently larger GJA diameters (>18 mm) may benefit from alternative interventions, such as endoscopic suturing.

Variables	Non-responders: (TWL < 5% at 3m) 14/36 (39%)	Responders: (TWL ≥ 5% at 3m) 22/36 (61%)	p value
BMI before RYGB (kg/m2)	44.5 ± 5	46.2 ± 4.1	0.270
BMI before APC (kg/m2)	36.3 ± 5.2	35.9 ± 5.5	0.824
BMI 1 year post-APC (kg/m2)	34.8 ± 5.1	31.7 ± 4.1	0.049
TWL (%) 3 months	1.4 ± 0.02	14.9 ± 0.07	0.001
TWL (%) 6 months	5.4 ± 0.08	11.7 ± 0.07	0.008
TWL (%) 12 months	3.7 ± 0.08	11.1 ± 0.08	0.009
Baseline GJA diameter (mm)	26.5 ± 5	26.7 ± 5.7	0.923
Final GJA diameter (mm)	15.8 ± 4.8	16.8 ± 5.3	0.577
RAD (%) median (IQR)	-39.3 (-50,-23)	-33.8 (-54.3, -19.2)	0.808

Table 1. Variables in responders an non-responders.

Number of APC sessions, efficacy and safety
The impact of the number of APC sessions on TWL was assessed comparing patients with 1–2 sessions versus those with 3-4. Although other studies have found correlation, in our study, a weak correlation with TWL at 3 months was found with Spearman’s Rho test (ρ = 0.163).
Technical success rate was 100%. Only three mild AEs (8%) were reported: two mild stenosis that required endoscopic dilation and a GJA mild ulcer.

Conclusion

APC is a safe, non-invasive and effective option for managing weight regain after RYGB at least in the short and medium term, in 60% of patients. Despite efforts, no predictors of TWL were identified. Larger studies and a multidisciplinary approach may further improve outcomes.

References

Thompson CC, Slattery J, Bundga ME. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain. Surg Endosc. 2006;20(11):1744-8.
Baretta GA, Alhinho HC, Matias JE. Argon plasma coagulation of gastrojejunal anastomosis for weight regain after gastric bypass. Obes Surg. 2015;25(1):72-9.
Moon, R.C., Texeira, A.F, Neto, M.G. Efficacy of Utilizing Argon Plasma Coagulation for Weight Regain in Roux-en-Y Gastric Bypass Patients: a Multi-center Study. 2018;28(9):2737-44.

Szvarca D, Jirapinyo P. Endoscopic Management of Weight Regain After Bariatric Surgery. Gastrointest Endosc Clin N Am. octubre de 2024;34(4):639-54.

Jirapinyo, P, Moura D, Dong W. Dose response for argon plasma coagulation in the treatment of weight regain after Roux-en-Y gastric bypass. Gastrointest Endosc. 2020;91(5):1078-84.

Lopez-Nava G, Asokkumar R, Rull A, Corbelle F, Beltran L, Bautista I. Bariatric endoscopy procedure type or follow-up: What predicted success at 1 year in 962 obese patients? Endosc Int Open. diciembre de 2019;07(12):E1691-8.

Introduction

Hepatitis E virus (HEV) infection in Europe is predominantly due to zoonotic genotype 3, transmitted via undercooked pork, game or shellfish (1,2). In the Helsinki and Uusimaa Hospital District (HUS), 70 laboratory-confirmed cases occurred from 2020–2024, with a pronounced peak in early 2024 (3). Seroprevalence in high-income countries ranges from ~6 % to > 50 %, increasing with age and swine exposure (1,2). While most infections are asymptomatic or mild, patients with underlying liver diseases may have more severe outcomes. Diagnosis relies on anti-HEV IgM/IgG serology and PCR detection of viral RNA (4).

Aims & Methods

Objective of this study is to investigate the epidemiology of hepatitis E virus (HEV), its clinical manifestations, and factors associated with hospitalization in the Helsinki University Hospital (HUS) area between 2020 and 2024. We conducted a retrospective registry study including all patients diagnosed with hepatitis E in the HUS area from January 2020 to December 2024. Data were collected from the electronic health record system, the laboratory database, and the shared contact-tracing software of the HUS Epidemiology Unit and Uusimaa welfare regions. Variables analyzed comprised demographic data, symptoms at presentation, key laboratory parameters (ALT, bilirubin, C-reactive protein), probable sources of infection, and details of hospitalization episodes.

Results

Study population: 70 patients (median age 58 years [IQR 45–67]; 58.6 % male).
Clinical manifestations: 92.2 % were symptomatic. The most frequent symptoms were fatigue (55.9 %), abdominal pain (47.5 %), nausea (45.8 %), and jaundice (42.6 %).
Laboratory findings: Median peak ALT was 1 153 U/L (IQR 544–1 538); median peak bilirubin 39 μmol/L (IQR 17–79); median peak CRP 22 mg/L (IQR 11–32).
Genotypes: Of 19 genotyped cases, 3c (21.1 %), 3e (21.1 %), and 3f (57.9 %), with genotype 3f predominant.
Infection sources: Cold-smoked sausages (e.g., mettwurst) were implicated in most domestic cases (69.6 % of identified sources), especially during the early 2024 outbreak. Other identified sources were unspecified meat products (6.5 %), berries (6.5 %), contact with wild animals (e.g., hunting, 4.3 %), blood transfusion (4.3 %), pork meat (4.3%), and game meat (4.3%).
Hospitalization: 50.7 % required ≥1 night of inpatient care. Hospitalized patients were older, had higher ALT, bilirubin, and CRP values, and more comorbidities than outpatients.
Predictors of hospital stay: In a multivariable zero-inflated negative binomial model, higher peak CRP was independently associated with longer hospital stay (β = 0.02; p = 0.005).

Conclusion

The early-2024 surge of HEV cases in the HUS area represents an internationally rare, large genotype 3 outbreak. Cold-smoked meat products were identified as the principal transmission route, although infections linked to blood transfusions, consumption of raw berries, and wildlife contact also occurred. Cases were disproportionately concentrated in men over 50 years of age. Among hospitalized patients, peak CRP emerged as the strongest predictor of inpatient care, and both mortality and incidence of hepatic insufficiency were relatively high given high sanitation standards in Finland. Further multicenter, inter-regional studies are needed to establish statistically robust risk factors for severe outcomes and to guide clinical and public health interventions.

References

1. Luo Q, Chen J, Zhang Y, Xu W, Liu Y, Xie C, ym. Viral hepatitis E: Clinical manifestations, treatment, and prevention. Liver Res. maaliskuuta 2024;8(1):11–21.
2. Hartl J, Otto B, Madden RG, Webb G, Woolson KL, Kriston L, ym. Hepatitis E Seroprevalence in Europe: A Meta-Analysis. Viruses. 6. elokuuta 2016;8(8):211.
3. THL. Terveyden ja hyvinvoinnin laitos. 2024 [referenced: 13. lokakuuta 2024]. Hepatiitti E-tapausten esiintyvyys Suomessa – THL. Available: https://thl.fi/aiheet/infektiotaudit-ja-rokotukset/taudit-ja-torjunta/taudit-ja-taudinaiheuttajat-a-o/hepatiitti-e/hepatiitti-e-tapausten-esiintyvyys-suomessa
4. Dalton HR, Kamar N, Baylis SA, Moradpour D, Wedemeyer H, Negro F. EASL Clinical Practice Guidelines on hepatitis E virus infection. J Hepatol. kesäkuuta 2018;68(6):1256–71.

Introduction

Gastric cancer (GC) is the fifth most common malignancy worldwide and the fourth leading cause of cancer death. In Colombia, it ranks third in incidence and first in mortality, with a 5-year survival below 25% in advanced stages. Early detection relies on identifying premalignant lesions. OLGA and OLGIM histological staging systems enable risk stratification. While stages III–IV are known high-risk states, the role of stage II remains unclear. This study focuses on OLGA II to address this gap.

Aims & Methods

This systematic review and meta-analysis, registered on PROSPERO (CRD42024549931), adhered to PRISMA 2020 guidelines. The primary objective was to determine whether OLGA stage II confers a statistically significant risk of GC compared to stages 0–I. Secondary objectives included evaluating risks across all advanced stages (II–IV) and contrasting OLGA versus OLGIM staging.
We searched PubMed, EMBASE, and Cochrane up to 31 May 2024 using terms including "OLGA", "OLGIM", "gastric cancer", and "gastric intraepithelial neoplasia". Inclusion criteria covered cohort, case-control, and cross-sectional studies reporting GC incidence stratified by OLGA/OLGIM stage. Data extraction and quality assessment were performed independently by two reviewers using the Newcastle-Ottawa Scale, with evidence certainty assessed via GRADE. Meta-analytical synthesis used random-effects modelling, and heterogeneity was assessed with I² and Tau² statistics.

Results

Twenty-eight studies met inclusion criteria, comprising 13 cohort, 11 case-control, and 4 cross-sectional studies.

• OLGA II vs 0–I (Cross-sectional studies): A significantly increased GC risk was observed (Z = 3.14; P = 0.002; I² = 65%), suggesting OLGA II as an early but meaningful predictor of malignant transformation.
• OLGA II (Cohort studies): No statistically significant difference was found (P = 0.28; I² = 0%), though sample size was limited.
• OLGIM II: Demonstrated increased risk only in case-control settings (Z = 11.26; P < 0.00001), but not in cohort studies.

Findings for OLGA and OLGIM stages III–IV corroborated existing evidence of elevated risk. However, this is the first meta-analysis to demonstrate a potential oncogenic risk beginning at OLGA stage II, particularly evident in cross-sectional data.
Sensitivity analyses affirmed result consistency, and the certainty of evidence was rated moderate. Subgroup comparisons revealed that OLGA may outperform OLGIM in early risk discrimination.

Table 1. Summary of Gastric Cancer Risk According to OLGA and OLGIM Stages

Staging System	Stage	Study Design	Pooled Risk Estimate	95% CI	Heterogeneity (I²)	Significance (p-value)
OLGA	II vs 0–I	Cross-sectional	OR 2.34	1.36 – 4.02	65%	0.002
OLGA	II vs 0–I	Cohort	RR 1.20	0.85 – 1.69	0%	0.28
OLGA	III–IV vs 0–II	Case-control & Cohort	OR 4.87 / RR 3.12	–	88%	< 0.00001
OLGIM	II vs 0–I	Case-control	OR 1.95	1.52 – 2.50	0%	< 0.00001
OLGIM	II vs 0–I	Cohort	RR 1.10	0.85 – 1.42	0%	0.74
OLGIM	III–IV vs 0–II	Case-control & Cohort	OR 3.89 / RR 2.91	–	82%	< 0.00001

Abbreviations: OR = Odds Ratio; RR = Risk Ratio; CI = Confidence Interval

Conclusion

Our study highlights a pivotal finding: OLGA stage II—previously considered an intermediate state—emerges as a statistically significant risk factor for gastric cancer. These findings suggest that the progression to malignancy may begin earlier than currently recognised. Incorporating OLGA II into surveillance strategies could lead to improved early detection, especially in high-incidence countries. The data support a shift toward broader inclusion criteria for endoscopic follow-up and reinforce the clinical utility of histological staging in GC prevention frameworks.

References

• Yue H, Shan L, Bin L, Shi L. The OLGA and OLGIM staging systems are useful for assessing the gastric cancer risk: a systematic review and meta-analysis. Gastric Cancer. 2018;21(4):579–87. doi:10.1007/s10120-017-0779-4
• Rugge M, Genta RM, Zambon CF, et al. OLGA staging for gastritis: a tutorial. Dig Liver Dis. 2008;40(9):650–8. doi:10.1016/j.dld.2008.02.020
• Rugge M, Meggio A, Pennelli G, et al. Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer: a 5-year prospective study of 1755 patients. Gut. 2019;68(3):477–84. doi:10.1136/gutjnl-2017-315252
• Pimentel-Nunes P, Libânio D, Marcos-Pinto R, et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group, European Society of Pathology, and Sociedade Portuguesa de Endoscopia Digestiva guidelines update 2019. Endoscopy. 2019;51(4):365–88. doi:10.1055/a-0859-0574
• Correa P. Human gastric carcinogenesis: a multistep and multifactorial process—First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res. 1992;52(24):6735–40.

Introduction

Endoscopic drainage is standard of care in malignant biliary obstruction (MBO).

Aims & Methods

The aim of this study was to investigate efficacy of biliary stenting in providing access to systemic chemotherapy. Patients with biliary obstruction (bilirubin >2.5 mg/dl) caused by unresectable biliary or pancreatic cancer were retrospectively analyzed with respect to use of chemotherapy and survival. Laboratory data were analyzed at baseline, 7-10 and 28-35 days following biliary stenting.

Results

Patients with MBO (n=78) were allocated into one of three groups according to bilirubin level [mg/dl] 2.5 – 5.99 (group 1), 6.0 - 15.0 (group 2) and >15 (group 3). On first blood testing mean bilirubin declines from baseline in respective groups were: 1.19 (29.5%), 3.77 (38.5%) and 7.1 (27.3%), and on second measurement 1.61 (40%), 5.69 (58.2%) and 13.0 (50%). Chemotherapy was applied in 28 (35.8%) patients, less frequently in group 3 than in group 1 (31.2% vs 44.0%; p =0.07) and group 2 (vs 38.1%; p =0.06). Mean survival time was 4.8 ±2.8 months and was significantly shorter in group 3 as compared to group 2 (3.8 ±2.0 vs 6.2 ±3.9 months; p =0.02) and to group 1 (vs 5.4 ±2.7 months; p =0.03).

Conclusion

In two-thirds of patients with MBO endoscopic biliary drainage does not grant access to chemotherapy. Use of chemotherapy and survival time are significantly higher in patients with bilirubin level below 15 mg/dl as compared to those with greater bilirubinemia, but in patients with bilirubin level below 6 mg/dl the biliary drainage is minimally effective.

Disclosure

No.

Introduction

The global prevalence of Helicobacter pylori (HP) infection is almost 43% and affects almost 18% of Italians [1, 2]. The literature describes several endoscopic signs detectable during upper-GI endoscopy that may predict HP status [3]; however, in clinical practice, random biopsies according to the Sydney system are still widely used for its determination.

Aims & Methods

The aim of our study is to investigate the role of Regular arrangement of collecting venules (RAC) assessment, during upper-GI endoscopies, for predicting HP status. We conducted a monocentric prospective study including patients who underwent upper-GI endoscopy for any indications from August 2024 to February 2025. Upper-GI endoscopies were performed according to standard of care [4], with high-definition scopes and after adequate cleaning [5]. Exclusion criteria were autoimmune gastritis, antibiotics within the previous 4 weeks, gastric surgery, previous endoscopic submucosal resection, upper-GI neoplasms, age <18 years, severe liver/kidney disease and previous known HP infection. Every procedure was performed by 6 endoscopists trained in recognition of all typical endoscopic signs of healthy stomach or HP infection: RAC, fundic gland polyps, linear streaks, hematin spots and diffuse redness prior to data collection. HP infection was investigated by histological evaluation by bioptic sampling, obtained according to the Sydney criteria.

Results

From 429 enrolled patients, 244 patients were included, according to inclusion criteria (M 124, 50.8%, median age 54.9, IQR 41.9-65.0). The prevalence of H. pylori infection was 15.5% (38/244). The presence of RAC in both greater and lesser curvature was observed in 63.1% (154/244) of cases, gland polyps in 19.6% (48/244), linear streaks in 15.5% (38/244), hematin spots in 15.9% (39/244) and diffuse redness in 9% (22/244). The presence of RAC, gland polyps and diffuse redness were significantly associated with higher prevalence of HP infection (p<0.001). The best performance was obtained from the presence of RAC in both greater and lesser curvature (AUROC 0.808, p<0.001) with a sensitivity (SEN), specificity (SPE), NPV and PPV respectively of 82.7% (64.2-94.1), 78.8% (72.3-84.4), 96,2% (92-98.3) and 40.8% (33.3-48.7). At multivariate analysis it confirmed to be related to HP-negative status (p=0.01, OR 0.04 95%CI: 0.005-0.481). Lastly, the presence of RAC showed a higher performance in males (AUROC 0.836, SEN 86.6% 59.5-98.3, SPE 80.6% 71.4-87.9, NPV 97.1% 90.3-99.2, PPV 44.1% 33.4-55.3) and in young patients (AUROC 0.846, SEN 80% 51.9-95.6, SPE 89.2% 81.1-94.7, NPV 96.2% 90.1-98.6, PPV 56.7% 40.9-71.3). As expected, the presence of RAC required a very short observation time (29.3 ± 11.0 versus 34.7 ± 11.7 seconds; p=0,001).

Conclusion

The presence of RAC in both the greater and lesser curvatures is the most important and reliable indicator of HP-negative status, and the time required for the evaluation is minimal. Our findings may represent a first step toward avoiding unnecessary random biopsies, promoting a more accurate endoscopic examination focused on the careful assessment of the gastric mucosa

References

1. Chen YC, et al. Global Prevalence of Helicobacter pylori Infection and Incidence of Gastric Cancer Between 1980 and 2022. Gastroenterology, 2024
2. Zullo A, et al. Upper Endoscopy in Patients with Extra-Oesophageal Reflux Symptoms: A Multicentre Study. GE Port J Gastroenterol, 2020
3. Seo JY, et al. Predicting Helicobacter pylori infection from endoscopic features. Korean J Intern Med, 2024
4. Bisschops R, et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy, 2016
5. Manfredi G, et al. Premedication with simethicone and N-acetylcysteine for improving mucosal visibility during upper gastrointestinal endoscopy in a Western population. Endosc Int Open, 2021

Introduction

Common bile duct (CBD) stones are one of the most frequent indications for endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic complete sphincterotomy (EST) followed by balloon or basket extraction is widely considered the gold standard technique for the treatment of CBD stones; being successful in more than 90% of cases with approximately 5% overall rate of adverse events [1]. Endoscopic papillary large balloon dilatation (EPLBD) is an effective technique in treating large common bile duct (CBD) stones. However, the efficacy and safety of EPLBD in the setting of periampullary diverticula (PAD) are prospectively lacking.

Aims & Methods

This study aimed to compare the effectiveness and short-term safety of EPLBD after limited sphincterotomy with those of EST for extracting large CBD stones in the setting of PAD prospectively. Forty-eight patients with large CBD stone(s) > 1 cm were recruited. All patients had a PAD. Before the procedure patients were evaluated by history taking, clinical examination full investigations including proper imaging studies. During the procedure, patients were randomized to either group I; patients treated with EPLBD after limited sphincterotomy, and group II; patients treated with EST. CBD clearance was defined as a single procedure (EPLBD vs EST), single session (no repeat ERCP), and non-assisted (no lithotripsy used) stone extraction. After the procedure patients were hospitalized with clinical, laboratory, and imaging assessment.

Results

Table 1: Univariate regression of the parameters affecting stone extraction

PAD: periampullary diverticulum			* significant as P value≤ 0.05
	Odds ratio	95% CI	P value​
The used technique	5.92	1.32 to 25.3	0.009∗
Stone (s) number	0.62	0.17 to 2.25	0.468
Stone (s) diameter (mm)	2.59	0.63 to 10.56	0.187
Type of PAD​	1.32	0.65 to 2.67	0.437

The overall stone extraction rate in the current study was only 77.3% (n=34). The efficacy of stone extraction was significantly higher in the EPLBD (n= 21,87.5%) group compared to EST (n= 13, 54.17%) group (p = 0.011). The procedure-related adverse events were lower in the EPLBD group compared to the EST group. Pancreatitis was significantly higher in the EST (n=14, 58.33%) group than in the EPLBD (n=3, 12.5%) group (p= 0.001). There were no perforations or case fatalities in either group. The predictors of stone extraction were analyzed using univariate regression (Table 1), and it is noticeable that the used technique was the independent predictor of success in stone extraction (Odds Ratio: 5.92, 95% Confidence Interval: 1.38 to 25.30, p-value = 0.009).

Conclusion

The current practice guidelines of the ESGE and ASGE suggest that for large CBD stones, an EST followed by a large balloon dilatation is preferable to EST alone because combining dilatation with EST improves duct clearance and reduces the need for lithotripsy without adding risk. Our results among PAD patients seem to echo this: the EPLBD approach in comparison to EST yielded higher stone clearance on first attempt even without using lithotripsy by the study design. Hence, based on the current study these existing recommendations can be extrapolated to the PAD population based on our study which is one of the first randomized trials in the specific PAD subgroup.

References

1. Zippi M, Traversa G, Pica R, De Felici I, Cassieri C, Marzano C, et al. Efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) performed in patients with Periampullary duodenal diverticula (PAD). Clin Ter. 2014;165(4):e291-4.