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Introduction

Endoscopic submucosal dissection (ESD) has emerged as a promising treatment modality for superficial esophageal squamous cell carcinoma. However, cases with submucosal or lymphovascular invasion are associated with an increased risk of lymph node metastasis and, therefore, require surgery or chemoradiotherapy. To avoid unnecessary treatment, the parameters supporting pre-treatment analysis need to be elucidated. Notably, ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters are associated with prognosis in advanced esophageal squamous cell carcinoma. However, the usefulness of FDG PET/CT in diagnosing superficial esophageal carcinoma remains unclear.

Aims & Methods

This study aimed to investigate the association between FDG PET/CT parameters and histopathological findings, including tumor depth and lymphovascular invasion.
Patients with superficial esophageal cancer who underwent FDG PET/CT scans before undergoing interventions such as ESD or surgery at Nagasaki University Hospital between June 2010 and December 2019 were retrospectively analyzed. Clinicopathological factors, FDG PET/CT parameters, magnifying endoscopy and histopathological findings were examined for correlation with tumor depth or lymphovascular invasion. Patients were classified into two groups according to tumor depth: pT1a (tumor confined to the muscularis mucosa) or pT1b (tumor invading the submucosa). Receiver operating characteristic curve analyses were performed to predict pT1a/pT1b or lymphovascular invasion, and to determine cut-off values for continuous variables. Subsequently, univariate and multivariate analyses were carried out.

Results

Fifty-three patients (27 ESD/26 surgery, median age 68 years old, 36 males, median size 30 mm) were analyzed. Among the FDG PET/CT parameters, standardized uptake value (SUV) max, metabolic tumor volume, and total lesion glycolysis were significantly higher in the pT1b group compared to the pT1a group. Multivariate analysis revealed that SUV max ≥3.472 was the only independent predictor of pT1b (odds ratio [OR] 5.09, 95% confidence interval [CI] 1.22–21.1, p=0.0249, area under the curve [AUC]=0.67, sensitivity 0.500, specificity 0.862). Furthermore, SUV max ≥3.616 was the only independent predictor of lymphovascular invasion (OR 5.11, 95% CI 1.16–22.4, p=0.0304, AUC=0.690, sensitivity 0.533, specificity 0.868).

Conclusion

SUV max may be useful in predicting pT1a/pT1b and lymphovascular invasion. Based on the findings of this study, a SUV max of ≥3.616 may guide clinical decision-making to avoid unnecessary ESD in superficial esophageal squamous cell carcinoma.

References

1) Kitagawa Y, et al. Esophageal cancer practice guidelines 2022 edited by the Japan esophageal society: part 1. Esophagus. 2023 Mar 18:1–30. doi: 10.1007/s10388-023-00993-2. Epub ahead of print. PMID: 36933136; PMCID: PMC10024303.
2) Huang YC, et al. FDG PET using SUVmax for preoperative T-staging of esophageal squamous cell carcinoma with and without neoadjuvant chemoradiotherapy. BMC Med Imaging. 2017 Jan 5;17(1):1. doi: 10.1186/s12880-016-0171-7. PMID: 28056868; PMCID: PMC5217536.
3) Minashi K, et al. Efficacy of Endoscopic Resection and Selective Chemoradiotherapy for Stage I Esophageal Squamous Cell Carcinoma. Gastroenterology. 2019 Aug;157(2):382-390.e3. doi: 10.1053/j.gastro.2019.04.017. Epub 2019 Apr 20. PMID: 31014996.
4) Oyama T, et al. Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology: magnifying endoscopic classification of the Japan Esophageal Society. Esophagus. 2017;14(2):105-112. doi: 10.1007/s10388-016-0527-7. Epub 2016 Apr 6. PMID: 28386209; PMCID: PMC5362661.

18F-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY PARAMETERS ASSOCIATED WITH HISTOLOGICAL OUTCOMES IN SUPERFICIAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Keiichi Hashiguchi 1, Hisaya Tanaka 2, Junya Shiota 2, Taro Akashi 2, Maiko Tabuchi 3, Moto Kitayama 2, Kayoko Matsushima 1, Yuko Akazawa 2, Naoyuki Yamaguchi 4, Kazuhiko Nakao 2

1 Nagasaki University Hospital, Nagasaki, Japan|||Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

2 Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

3 Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan|||Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

4 Nagasaki University Hospital, Nagasaki, Japan

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

Upper GI endoscopy and neoplasia (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Towards a robust and compact deep learning system for primary detection of early Barrett’s neoplasia

Ahsen Ustaoglu 1, Martijn R. Jong 2

1 Early Cancer Institute, University of Cambridge, United Kingdom

2 Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands

Topics

Oesophagus

Published

2023

UEG Online Course

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The diagnosis and treatment of gastro-oesophageal reflux disease (GORD) have been driven by our knowledge of its pathophysiology. From equating GORD with oesophagitis and hiatal hernia to identifying the role of transient lower oesophageal sphincter relaxations, different GORD phenotypes and microscopic features, the pathophysiology is now understood to be multifactorial.

This online course covers the different components that contribute to the pathophysiology of GORD by following the path of the refluxate. The role of the stomach, antireflux barrier, refluxate, clearance mechanisms, mucosa and symptom perception are each considered in turn.

Learning objectives

To understand that the pathophysiology of GORD is multifactorial
To become familiar with each of the individual pathophysiology abnormalities
To realize that patients with different GORD phenotypes may have different underlying pathophysiological mechanisms
To recognize that treatment of GORD should be designed to modify the specific pathophysiology
To appreciate that patients with GORD who have similar symptoms but different pathophysiology mechanisms may need different treatments

Target audience

This course is suitable for gastroenterologists in training, but is also appropriate for physicians and surgeons in other disciplines, as well as nurses, biotechnicians and advanced-years’ medical students who have an interest in gastroenterology.

GORD Pathophysiology - Part 1

Daniel Sifrim, Kornilia Nikaki

Event

GORD Pathophysiology Part 1

Topics

Neurogastroenterology & Motility Oesophagus

Accreditation status

accredited

Duration

1 hour

Published

2018

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Introduction

Malignant distal biliary obstruction is a common complication in the progression of pancreatic tumors. Endoscopic ultrasound (EUS) guided drainage can provide effective biliary drainage when not achieved by endoscopic retrograde cholangiopancreatography (ERCP) and can be performed by hepaticogastrostomy or choledocoduodenostomy (CDD). Gallbladder drainage by cholecystogastrostomy (GBD) has been described in small uncontrolled series and could be effective. The objective of this study was to compare the clinical efficacy of CGD vs CDD in distal biliary tract obstruction (DBTO).

Aims & Methods

This was a retrospective, multicenter study (four tertiary centers) including all consecutive patients with DBTO and jaundice who underwent CDD or GBD with a lumen-apposing metal stent (LAMS). The primary outcome was to compare the clinical success rate defined as a decrease of total bilirubin by 50% in 14 days and/or a decrease in total bilirubin below 51 µmol/L after 30 days. Secondary outcomes were technical success, overall survival, survival without biliary reintervention, immediate (within 24 hours) and delayed (>24 hours) morbidity.

Results

78 patients were included between July 2018 and September 2022, 41 GBD and 37 CDD. The mean age was 71 years, and 82% had pancreatic adenocarcinoma, 55% had metastatic disease at diagnosis, and 45% had duodenal stenosis. Most patients (N=59; 76%) had undergone EUS-guided drainage after ERCP failure. The mean diameter of the main bile duct was significantly smaller in the CGD group (13 mm vs. 18 mm; p=0.001). The total bilirubin mean was 196 µmol/L in the GBD group vs. 241 µmol/L in the CDD group; p=0.149. Clinical success was comparable between the two groups: 88% (36/41 - CGD) vs. 89.2% (33/37 - CDD); p=0.848. There was no difference in overall survival (log-rank p=0.727) or survival without biliary obstruction (log-rank p=0.725) between the two groups. Immediate morbidity was comparable: 7% (3/41 - GBD) vs. 13% (5/37 - CDD); p=0.368. The rate of significant immediate complications tended to be lower in the GBD group (5% (2/41 - CGD) vs. 8% (3/37 - CDD); p=0.093). Delayed morbidity (mainly LAMS obstruction) (>24 hours) was lower in the GBD group 7.3% (3/41 - CGD) vs. 27% (10/37 - CDD); p=0.022. There were no biliary complications after the 26th day in the GBD group. The LAMS dimensions did not have an impact on biliary complications in the CGD group (6x8mm vs. 10x10mm vs. 15x10mm).

Conclusion

Biliary drainage of tumoral obstruction of the distal biliary tract by GBD had comparable clinical efficacy and was associated with reduced delayed morbidity compared to CDD. This type of drainage is feasible, especially when the main bile duct is not dilated enough to consider CDD.

References

Maire F, Hammel P, Ponsot P, Aubert A, O’Toole D, Hentic O, et al. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol. 2006 Apr;101(4):735–42.
van der Merwe SW, van Wanrooij RLJ, Bronswijk M, Everett S, Lakhtakia S, Rimbas M, et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022 Feb;54(2):185–205.
Issa D, Irani S, Law R, Shah S, Bhalla S, Mahadev S, et al. Endoscopic ultrasound-guided gallbladder drainage as a rescue therapy for unresectable malignant biliary obstruction: a multicenter experience. Endoscopy. 2021 Aug;53(8):827–31.

COMPARISON OF EUS-GUIDED CHOLEDOCHODUODENOSTOMY VERSUS EUS-GUIDED GALLBLADDER DRAINAGE IN PATIENTS WITH MALIGNANT DISTAL BILIARY OBSTRUCTION AFTER FAILED ERCP A RETROSPECTIVE MULTICENTER ANALYSIS (GALLBLADEUS STUDY)

Jules Daniel 1, Diane Lorenzo 2, Ludovic Caillo 1, Romain Gerard 3, Eric Assenat 4, Jean-François Bourgaux 1, Antoine Debourdeau 5

1 CHU Nîmes, Montpellier University MUSE, Nîmes, France

2 Hôpital Beaujon, Paris Cité University, Clichy, France

3 CHU Lille, Lille University, Lille, France

4 CHU Montpellier, Montpellier University MUSE, Montpellier, France

5 CHU Nîmes, Montpellier University MUSE, Nîmes, France|||CHU Montpellier, Montpellier University MUSE, Montpellier, France

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

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Introduction

Irritable bowel syndrome (IBS) is a complex multifactorial disorder characterized by recurrent abdominal pain associated with defecation or a change in bowel habits. Patients with IBS often complain of extra-intestinal symptoms resulting in impaired related quality of life. Growing evidence support the hypothesis that intestinal barrier dysfunction has a central role in the pathophysiology of IBS being the interface between the gut lumen and the deeper intestinal layers as well as the brain.

Aims & Methods

The aims of this study were: to characterize the epithelial and vascular barriers; to correlate molecular, morphological and functional aspects of epithelial and vascular barriers with IBS symptoms. 66 healthy subjects (AC) and 223 patients with IBS (112 IBS-D, 58 IBS-C and 53 IBS-M) were enrolled in the study. Rome IV criteria, Bowel disease questionnaire, Short Form 36, Hospital Anxiety Depression Scale were used to phenotype patients. Sugar test was used to evaluate in vivo permeability. The vascular barrier was characterized by using immunohistochemistry, western blot and electron microscopy. Vascular permeability was evaluated by assessing two markers: plasmalemma vesicle–associated protein-1 (PV1) and vascular endothelial cadherin (VEC). A translational model based on Caco-2 cells or HUVEC was used to evaluate permeability changes induced by mediators spontaneously released by mucosal biopsies and to highlight the underlying molecular mechanisms. Correlation analyses have been performed among experimental and clinical data.

Results

Compared to AC, lactulose (P<0.05), sucralose (P<0.01), sucrose (P<0.01) excretion and the L/M ratio (P<0.01) were significantly increased in IBS patients. Soluble mediators released by mucosal biopsies of IBS patients increased Caco-2 permeability compared to AC mediators (P<0.05) via a down-regulation of tight junction gene expression. Blood vessels were significantly increased by 1.5 fold in the colonic mucosa of IBS patients compared to AC (P<0.01). PV1 expression was increased (P<0.01) while VEC expression was decreased in the colonic mucosa of IBS group compared to AC (P<0.05). IBS mucosal mediators increased HUVEC permeability compared to AC mediators. The HUVEC changes associated with IBS samples were mediated by a protease-activated receptor (PAR)2 dependent mechanism resulting in VEC down-regulation. Significant correlations emerged among permeability changes and intestinal, extra-intestinal symptoms and health-related quality of life reported by IBS patients.

Conclusion

Epithelial and vascular barriers are compromised in IBS and are likely involved in symptom development.

Disclosure

Nothing to disclose

INTESTINAL EPITHELIAL AND VASCULAR PERMEABILITY IS INCREASED IN IRRITABLE BOWEL SYNDROME AND CORRELATES WITH SYMPTOMS

Maria Raffaella Barbaro 1, Cesare Cremon 2, Giovanni Marasco 1, Edoardo Vincenzo Savarino 3, Simone Guglielmetti 4, Francesca Bonomini 5, Marta Palombo 5, Antonio Di Sabatino 6, Sabrina Valente 5, Gianandrea Pasquinelli 5, Nathalie Vergnolle 7, Vincenzo Stanghellini 2, Giovanni Barbara 2

1 University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

2 University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

3 University of Padua, Division of Gastroenterology, Padua, Italy

4 Università degli Studi di Milano, Milano, Italy

5 University of Bologna, Bologna, Italy

6 University of Pavia, Pavia, Italy

7 INSERM UMR-1220, Toulouse, France

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

All about disorders of gut-brain interaction (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

Volatile Organic Compounds (VOC’s) are produced in response to endogenous metabolic processes within the body and as a result of functional activation of the trillions of microbes within the gut (exogenous VOC’s). VOC’s pass from the gut lumen into the blood stream and can be detected on exhaled breath. To date, microbiome research has mainly relied on stool collection and analysis which has both spatial and temporal limitations in that stool represents the end of the metabolic process and sampling is mostly constrained to spontaneous bowel movements. Breath can be assessed repeatedly in real time and, following ingestion of carbohydrate probes, samples can be taken during periods when the microbiome is known to be functionally active. In this study we used state of the art collection and detection technology to fully characterise both endogenous and exogenously produced VOC’s in healthy subjects for the first time.

Aims & Methods

In 45 healthy subjects, baseline breath samples were taken after a 24-hour low fermentable diet and overnight fast. Subjects then ingested 10g of lactulose mixed with 200ml water and subsequent breath samples were taken at 45, 90 and 180-mins following ingestion. VOC breath samples were acquired using the Breath Biopsy ® collection system over 10-minutes whilst subjects breathed filtered air and VOC’s were collected onto sorbent tubes which concentrated the compounds for later analysis. Analysis was then performed using Gas Chromatography Mass Spectrometry (GC-MS).
The exhaled breath samples were evaluated in targeted (i.e. absolute amounts of 42 compounds of interest) and untargeted manner (i.e. gathering as many compounds in the sample as possible).

Results

600 distinct VOC’s were detected at baseline and these represent the endogenous healthy human VOCome. Targeted analysis indicated that levels of isoprene, 3-methylthiophene, phenol and propionic acid showed differences in exhaled breath between baseline and post-lactulose challenged individuals (p < 0.05). Moreover, the untargeted analysis identified 14 additional compounds in exhaled breath with significant increases following lactulose ingestion (p-value<0.05). All those compounds were reliably measured only on breath and appeared in at least 85% of individuals.

Conclusion

This study provides the first comparative profile of the entire healthy human VOCome in relation to endogenous and exogenously (microbiome related) VOC’s. We identified several changes in the composition of exhaled breath during functional activation of the microbiome following ingestion of a carbohydrate probe. This fundamental work describes a unique experimental model and provides normative reference ranges that will form the foundation for future novel microbiome, nutritional and gut biomarker research.

Disclosure

A Hobson is a shareholder in the Functional Gut Clinic
S Bloor is an employee of he Functional Gut Clinic
N Nagalingam, A Somlinska, B O'Brien, R Stollard, T Woodland, A Tawfike, M Allsworth and B Boyle are employees of Owlstone Medical

PROFILING THE HEALTHY HUMAN VOCOME – UNIQUE INSIGHTS INTO ENDOGENOUS AND EXOGENOUS (GUT MICROBIAL) METABOLISM VIA DETECTION OF VOLATILE ORGANIC COMPOUNDS ON BREATH.

Anthony Hobson 1, Nabeetha Nagalingam 2, Agnieszka Smolinska 2, Brett O'Brien 2, Rory Stollard 2, Ahmed Tawfike 2, Max Allsworth 2, Billy Boyle 2, Sarah Bloor 1

1 The Functional Gut Clinic, Cambridge, United Kingdom|||Anglia Ruskin University, Chelmsford, United Kingdom

2 Owlstone Medical, Cambridge, United Kingdom

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

H. pylori at interfaces (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

Dietary and lifestyle recommendations are the cornerstones of the treatment of GERD. However, the evidence of the efficacy of those recommendations is lacking. We performed a retrospective analysis of the GISTAR study¹ participants evaluating the symptoms of GERD and dietary and lifestyle parameters developing a tool for predicting GERD symptoms based on the aforementioned criteria.

Aims & Methods

The aim of the study was to analyse the factors pointing to GERD symptoms through the use of data mining and decision tree classifier.
Methods: GERD diagnosis was evaluated using a self-assessment questionnaire ². Dietary, demographic and lifestyle data were collected within the GISTAR study protocol¹. 3340 40-64 year old participants from the GISTAR study were included in the analysis. 1670 of them did not have GERD symptoms. 41 attributes describing demographic, lifestyle, and dietary habits were used for these respondents to induce a decision tree classification model using Orange Data Mining software³.

Results

Fried potatoes including French fries were the most predictive factor of GERD symptoms (65.3% with symptoms; 1516 from 2321), especially for females (82.6%; 1048/1228). This was more pronounced in the group who consumed sweets once per week (87.2%, 950/1090). In males, who consumed fried potatoes, the next most important factor was the consumption of sweets (46.3%, 431/930).
For participants who didn’t consume fried potatoes (14.6%; 147/1008), 1-3 cups of green tea (37.9%; 66/174) and male gender (71.4 % 20/28) were predictors of GERD symptoms.
The accuracy of the decision tree model was: sensitivity (74.8%), precision (75.6%), specificity (75.9%) and AUC (0.841%).

Conclusion

Fried potatoes, female gender and consumption of sweets are the risk factors predicting the diagnosis of GERD. None of the lifestyle factors were displayed as significant.

References

1. Leja M, Park JY, Murillo R, et al. Multicentric randomised study of Helicobacter pylori eradication and pepsinogen testing for prevention of gastric cancer mortality: the GISTAR study. BMJ Open 2017;7:e016999. doi: 10.1136/bmjopen-2017-016999
2. Jones R, Junghard O, Dent J, Vakil N, Halling K, Wernersson B, Lind T. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther. 2009 Nov 15;30(10):1030-8. doi: 10.1111/j.1365-2036.2009.04142.x. Epub 2009 Sep 8. PMID: 19737151.
3. Demsar J, Curk T, Erjavec A, Gorup C, Hocevar T, Milutinovic M, Mozina M, Polajnar M, Toplak M, Staric A, Stajdohar M, Umek L, Zagar L, Zbontar J, Zitnik M, Zupan B (2013) Orange: Data Mining Toolbox in Python, Journal of Machine Learning Research 14(Aug): 2349−2353.

EVALUATION OF THE DECISION TREE CLASSIFICATION MODEL USING DIETARY AND LIFESTYLE FACTORS FOR PREDICTING GERD DIAGNOSIS IN GISTAR STUDY POPULATION

Ilze Birka 1, Raivis Amolins 2, Daiga Santare 1, Marcis Leja 1, Inese Polaka 2

1 University of Latvia, Riga, Latvia

2 Riga Technical University, Riga, Latvia

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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