Introduction

Recent research has highlighted significant health risks associated with pregnancy among female surgeons in USA. They reported increased risks of infertility and pregnancy complications among female surgeons, attributed to work schedules and delayed childbearing due to professional demands (1).

Aims & Methods

This joint study by the Young Gastroenterology (JUGA) and Surgical Working Group of Young Surgeons (CAJC) of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) and the German Society for General and Visceral Surgery (DGAV) focuses on the prevalence and factors of major pregnancy complications among female visceral medicine doctors in Germany and compares their experiences with a non-doctor control group from lawyers and teachers. Utilizing an anonymous online survey, responses from 352 doctors detailing 757 pregnancies and 92 non-doctors with 172 pregnancies were collected and analyzed. Generalized Linear Mixed Models (GLMM) were employed to assess risk factors linked with pregnancy complications, with particular attention to work conditions and use of assisted reproductive technologies.

Results

The study revealed no differences in maternal age at first live birth, number of births as well as the overall frequency and number of pregnancy complications between female visceral medicine doctors and non-doctors. However, visceral medicine doctors experienced higher rates of pregnancy loss (23.1% vs. 13.7%, p = 0.008) and intrauterine growth restriction (3.0% vs. 0.0%; p = 0.025). Work hours, especially close to end of pregnancy and during nights and weekends, were significantly longer for doctors (p ≤ 0.001) and associated with pregnancy complications. Additionally, a higher proportion of doctors expected pregnancy to have more impact on their career compared to non-doctors (90.3% vs. 70.1%; p = 0.001), with both groups commonly aligning family planning with career goals.

Conclusion

These results reveal significant differences in pregnancy-related complications, with a higher prevalence among medical professionals, likely influenced by working hours and times. Further analysis is warranted to better understand the underlying factors contributing to these disparities and to inform targeted interventions.

References

1. Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of Infertility and Pregnancy Complications in US Female Surgeons. JAMA Surg. 2021;156(10):905–915. doi:10.1001/jamasurg.2021.3301

Introduction

Rectal sensory function plays a critical role in normal bowel function. For example, rectal hypersensitivity is associated with Irritable Bowel Syndrome (IBS), whereas rectal hyposensitivity is linked to constipation.
The International Anorectal Physiology Working Group (IAPWG) (1) has established a standardised investigation protocol for anorectal physiological function. According to this protocol, the rectal sensory function is evaluated by simple balloon distension using an elastic balloon during a standard high-resolution anorectal manometry investigation (HRAM). However, the gold standard for rectal sensory assessment is the rectal barostat investigation, as described by the European COST action GENIEUR group (2).
The correlation between these two methods is largely unknown. The two methods use different balloons (elastic vs. non-elastic balloons, different size and shape). Moreover, the barostat is pressure-controlled whereas the HRAM is volume-controlled. For this reason, assessment of the level of agreement is not feasible.

Aims & Methods

We assessed the correlation between rectal sensory testing with the HRAM and rectal barostat investigations for each sensory threshold, in a group of healthy volunteers.
Twenty-six healthy volunteers (mean age 42 years, 50% females) were recruited and investigated using both HRAM according to the IAPWG protocol and rectal barostat using the GENIEUR protocol on the same day.
Sensory thresholds for first sensation (FS), first urge (FU), intense urge (IU) and maximum tolerable volume (MTV) were recorded for both methods.
Spearman’s rank correlation coefficient was used for analysis, since it does not assume normal distribution.

Results

Median values, along with the 1^st and 3^rd quartile are presented in Table 1.
There were statistically significant positive correlations between the sensory thresholds for first urge, intense urge and maximum tolerable volume. However, the correlation coefficients were generally weak, with only MTV showing a correlation coefficient above 0.5.

Table 1. Quartiles of the four sensory thresholds used and Spearman’s correlation factor between HRAM and barostat based investigations.

	First sensation		First urge		Intense urge		MTV
Quartiles	HRAM	B	HRAM	B	HRAM	B	HRAM	B
1st	12.00	43.00	60.25	91.75	86.25	155.00	116.75	189.25
2nd	27.50	76.00	79.00	142.50	111.50	210.00	175.50	230.50
3rd	48.75	108.00	96.00	177.00	164.50	259.50	224.75	319.00
Spearman’s rho	.151		.433		.400		.573
p	.460		.026		.043		.002

Conclusion

There is a weak correlation between the two methods, suggesting that HRAM balloon distension and barostat cannot be used interchangeably with respect to rectal sensory testing. Standardisation of rectal sensory testing is warranted to improve the accuracy and reliability.

References

(1). Carrington E. et al. The international anorectal physiology working group (IAPWG) recommendations: Standardized testing protocol and the London classification for disorders of anorectal function. Neurogastroenterology & Motility. 2020;32: e13679.
(2). https://genieur.eu/Downloads/PhenotypingTool/SOP_Rectal_barostat.pdf

Introduction

Endoscopic ultrasound-guided biliary drainage (EUS-BD) is reported to be useful as an alternative treatment for patients who are unable to undergo transpapillary bile duct drainage. EUS-hepaticogastrostomy (HGS), which involves a transgastric approach to the left intrahepatic bile duct, has been suggested as the first-line approach for EUS-BD because of a lower risk of bile leakage in patients with dilated intrahepatic bile ducts. However, there are few reports comparing the effectiveness and safety of EUS-BD procedures between EUS-HGS and EUS-HGS with antegrade stenting (EUS-AS+HGS).

Aims & Methods

Therefore, we compared the efficacy and safety of EUS-AS+HGS and EUS-HGS as drainage methods in EUS-BD. From April 2017 to December 2020, we retrospectively evaluated patients who underwent EUS-AS+HGS or EUS-HGS in our hospital for unresectable malignant biliary obstruction for which transpapillary biliary drainage had failed. We compared the time to recurrence of biliary obstruction (TRBO), overall survival, technical success rate, clinical success rate, adverse event rate, reintervention rate, and length of hospital stay between each procedure.

Results

A total of 68 patients, 22 in the EUS-AS+HGS group and 46 in the EUS-HGS group, were included in the study. In the EUS-HGS group, 38 patients underwent HGS only, while EUS-AS+HGS was attempted in another 8 patients who ultimately underwent EUS-HGS because of unsuccessful guidewire penetration. In the EUS-AS+HGS group, the TRBO was significantly longer, and the re-intervention rate significantly lower than in the EUS-HGS group (both p=0.03). However, there were no significant differences in technical success rate, overall survival, clinical success rate, adverse event rate, and length of hospital stay.

Conclusion

EUS-AS+HGS was superior to EUS-HGS regarding the length of biliary patency and re-intervention rate in patients with unresectable malignant biliary obstruction. The results suggest that EUS-AS+HGS is the preferred treatment when guidewire penetration of the biliary stricture is possible.

Introduction

The sex differences in the incidence of gastric cancer have been well known. However, uncertainty still exists in terms of prognosis of GC. For example, the US SEER data reports a significantly better prognosis in females than in males, but the prognosis is better in males than in females in Korean Central Cancer Registry data. Roles of molecular markers and gut microbiota as new prognostic factor are emerging recently, but few studies seem to try to reveal sex differences.

Aims & Methods

In this background, we aimed to analyze the differences in GC characteristics according to sex in Korean patients, mainly focused on survival. This was a single-center retrospective study. A total of fifteen thousand patients diagnosed with GC at the Seoul National University Bundang Hospital between 2003 and 2023 were included. Clinicopathological characteristics, histologic types, survival rates with age- and stage-stratification, and associated risk factors were analyzed. Information related to death was cross-verified using medical record review and data from the National Statistical Office.

Results

The ratio of males and females was about 2:1, and there was no differences in stage between sexes. Female patients were significantly younger than males, had more gastric body cancers and tumors with diffuse type or poorly differentiated histology. Females underwent less endoscopic treatment and more surgery, and tumors with microsatellite instability was more common in females, while mutation of p53 was less common. In histological types according to Lauren classification, diffuse type histology was more common in younger patients in both males and females. The proportion of intestinal type GC increased with age, but the proportion increased rapidly in males while increased gradually in females. In Cox multivariate regression analysis for GC-related death, older age, proximal tumor location, diffuse type histology and advanced tumor stage were risk factors. In terms of survival, overall and GC-specific survival did not show significant differences between sexes in the analysis of the total population. However, sex differences in survival reversed with age, that younger females under 50 showed survival disadvantages, but the survival became similar in 50s, and older females over 60 showed survival advantages in both overall and GC-specific survival. Furthermore, in the stratification analysis according to the stage, there were no significant differences in stages I to III. But, stage IV female patients showed significant survival disadvantages. In subgroup analysis of stage IV patients, the differences between males and females in median survival were two months, and female patients were significantly younger and had a higher proportion of diffuse type GC than male patients, which shows aggressive feature and is related to poorer survival.

		Total (N=1,924) (%)	Male (n=1,282) (%)	Female (n=642) (%)	p
Median survival (mo)		10	11	9	0.022
Age (mean±SD)		61.59±14.25	62.41±13.23	59.96±15.97	0.001
Age (in diffuse type patients, mean±SD)		54.55±14.71	56.43±14.29	52.26±14.91	0.001
Lauren classification	Intestinal	554 (48.0)	438 (56.7)	116 (30.4)	<0.001
	Diffuse	574 (49.7)	315 (40.7)	259 (68.0)
	Mixed / Indeterminate	26 (2.3)	20 (2.6)	6 (1.6)

Conclusion

Significant differences in survival between sexes were observed with stratification analysis, although sex itself was not an independent prognostic factor. These age-dependent changes are thought to suggest the effect of sex hormones. These differences should be considered in clinical practice and later research in terms of tailored medicine.

Introduction

Fecal microbiota transplantation (FMT) is a highly effective treatment for recurrent Clostridioides difficile infection (CDI), but its safety is jeopardized by the potential risk of transmitting microbial pathogens. Stool biobanks have established to provide both a widespread and equitable access to FMT and high safety, quality, and traceable workflows. To guarantee the safety of each donor stool batch, international guidelines recommend either a quarantine or a direct stool testing with a rapid molecular assay for gut pathogens. While reports of the quarantine-based approach are emerging, data on the direct testing-based approach are still limited

Aims & Methods

Our aim is to report outcomes of a donor screening program for FMT including a direct stool testing-based approach based on a rapid molecular assay for gut pathogens.We prospectively evaluated all candidates enrolled in our FMT donor program since the introduction of a direct stool testing with a rapid molecular assay for gut pathogens, in 2019. Following international guidelines, donor screening consisted of a five-step framework, including: 1) collection of clinical history; 2) blood and stool testing; 3) a further questionnaire the day of each donation; 4) nasopharyngeal swab and stool RT-PCR assay for SARS-CoV-2 the day of each donation (after March 2020); 5) a direct stool testing with a rapid molecular assay for gut pathogens and cultures for MDRO evaluation. Specifically, the RT-PCR Allplex™ Gastrointestinal Panel Assay (Seegene, Korea) was used for a comprehensive identification of common gastrointestinal pathogens. The QIAamp Fast DNA Stool Mini Kit (QIAGEN, Hilden, Germany) was used for nucleic acid extraction. We evaluated rates of donations per year, rates and reasons of candidates’ exclusion at each step of the donor screening, as well as the rate of unsuitable fecal donations and the intestinal pathogens that caused their rejection. Finally, we recorded the number of total fecal aliquots provided by eligible donors, and related safety outcomes at 12 weeks after their use within FMT.

Results

From January 2019 to December 2022, 227 candidates were assessed for eligibility. Of them, 122 were excluded at different steps of the screening process. Finally, we enrolled 69 eligible donors (37 females, 53,6%; mean age 37, 30% of the total pool). Thirty-seven fecal aliquots were collected in 2019 (13 donors), 39 in 2020 (20 donors); 51 in 2021 (24 donors), and 104 in 2022 (43 donors). Overall, we collected 231 fecal donations, of which 136 (58.8%) were considered eligible and stored at -80°C for FMT. Eight donations were discarded for insufficient amount of feces (<50 g - 3%), and 87 (37.6%) for positivity to intestinal pathogens, including Enteropathogenic E. coli (EPEC) (n=31 samples – 13.4%), ESBL (extended-spectrum beta-lactamase) E. coli (n=15 samples, 6.5%), Blastocystis hominis (n=17 samples, 7.3%).Notably, we found a seasonal variation among pathogen positivity, as most pathogens were observed in Autumn (from September to December: n=48/87, 55.8%).All donations have been used, and no serious adverse events or infections have been observed at 12 weeks after FMT.

Conclusion

Our screening of donor feces based on direct stool testing guarantees high safety of FMT, although with high rates of donor exclusion, with the need of a well-established framework to guarantee a continuous availability of eligible donors to avoid shortages of fecal aliquots.

Disclosure

G.I. has received personal fees for acting as speaker for Biocodex, Danone, Sofar, Malesci, Metagenics and Tillotts Pharma, and for acting as consultant and/or advisor for Ferring Therapeutics, Giuliani, Malesci and Tillotts Pharma. A.G. reports personal fees for consultancy from Eisai Srl, 3PSolutions, Real Time Meeting, Fondazione Istituto Danone, SinergieSrl, Board MRGE and Sanofi SpA personal fees for acting as a speaker for Takeda SpA, AbbVie and Sandoz SpA and personal fees for acting on advisory boards for VSL3 and Eisai. G.C. has received personal fees for acting as advisor for Ferring Therapeutics. All other authors have no conflicts of interest to disclose.

Introduction

Acute severe colitis (ASC) is an important cause of morbidity and mortality in Ulcerative Colitis (UC), requiring hospitalisation and, frequently, colectomy. Intravenous corticosteroids (CS) remain the first-line medical treatment. Approximately 40% of episodes of ASC do not respond to this treatment and require rescue therapy with ciclosporin (CIC) or infliximab (IFX)¹. In the past decades, these treatments and protocol-driven management algorithms led to reduced mortality and colectomy rates. A simple clinical scoring system (the Admission Model for the Intensification of Therapy in Acute Severe Colitis (ADMIT-ASC))³, based on CRP, albumin, and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score, was recently developed to predict the steroid response on admission.

Aims & Methods

We aimed to retrospectively assess the steroid non-response during admission with ASC and the usefulness of the new prognostic clinical index ADMIT-ASC at admission to predict steroid response in a Belgian tertiary center. All patients admitted with ASC between 1^st January 2015 and 1^st April 2023 were identified from our inflammatory bowel disease database at Erasme University Hospital. Inclusion criteria were ASC patients admitted at the hospital, standard treatment with at least 3 days of intravenous CS and endoscopy evaluation upon admission. ASC was defined according to modified Truelove and Witts’ criteria as ≥6 bloody stools/day with one or more markers of systemic disturbance (tachycardia >90 beats/min, temperature >37.8°C, haemoglobin <105 g/L or CRP >30 mg/L). Steroid non-response was defined as the need for medical rescue therapy (CIC of IFX) or colectomy during the admission. ADMIT-ASC index consists of four points: CRP ≥100 mg/L (1 point), albumin ≤25 g/L (1 point) and UCEIS score ≥4 (1 point) or ≥7 (2 points).

Results

Table I Admission Demographics data (n= 84)	Steroid response (n=49)	Steroid non-response (n=35)	P value
Median disease duration (years) (IQR)	3.6 (0.3-0.9)	2.1 (0.8-5.5)	0.5
Montreal Classification	E1 : 5/49 (10%) E2 : 20/49 (41%) E3 : 24/49 (49%)	E1 : 0/35 E2 : 12/35 (34%) E3 : 23/35 (66%)	0.084
5-ASA, n (%)	22 (45%)	10 (29%)	0.13
Methotrexate or thiopurine, n (%)	6 (12%)	9 (26%)	0.11
Infliximab, n (%)	4 (8.2%)	8 (23%)	0.058
Vedolizumab, n (%)	7 (14%)	5 (14%)	>0.9
Tofacitinib, n (%)	2 (4.1%)	2 (5.7%)	>0.9
Readmission, n (%)	12 (24%)	10 (29%)	0.7
5-ASA, 5-aminosalicylate P values from Wilcoxon rank-sum test or Fisher’s exact test.

Out of 127 patients admitted with UC and treated with intravenous CS during three days, 84 (45% male, median age of 31 years old) were included in the study. Admission demographics and clinical characteristics are described in Table 1.
For 17 patients (20%), the admission was their index presentation of UC. Response to CS was seen in 49 patients (58%). Thirty-three patients (39%) received medical rescue therapy (17/33 IFX and 16/33 CIC). Colectomy rate during admission was 13% after a median duration of 18 days (IQR: 16-54). Admission C reactive protein (CRP) (p=0.036), albumin (p=0.026) and UCEIS scores (p=0.022) were significantly associated with steroid non-response. Patients scoring 0, 1, 2, 3 and 4 had steroid response rates of 90%,75%, 55%, 19% and 0%, respectively. Scoring of ≥3 was 75% (95% CI, 0.43 to 0.95) predictive of steroid failure (OR 5.08, 95%, CI 1.38 to 24.5).

Conclusion

In this tertiary referral cohort study, we confirmed that the ADMIT-ASC index is a simple clinical tool that can be used on the day of admission to predict steroid non-response in ASC with a threshold of ≥3 to identify patients who are unlikely to respond to intravenous CS and enabling timely treatment escalation or surgery.

References

1. Travis S, Satsangi J, Lémann M. Predicting the need for colectomy in severe ulcerativecolitis: a critical appraisal of clinical parameters and currently available biomarkers. Gut 2011;60:3–9.
2. Travis SP, Farrant JM, Ricketts C, et al. Predicting outcome in severe ulcerative colitis.Gut 1996;38:905–10.
3. Adams A, Gupta V, Mohsen W, et al. Gut 2023;72:433–442.

Disclosure

VB has not disclosure.
CDT has not disclosure.
CM has not disclosure.
AC has received lecture fees from Galapagos, Abbvie, Janssen, celltrion, Pfizer, Takeda.
DF has received lecture fees from Abbvie, Astrazeneca, Dr.Falk Pharma, Ferring, Janssen, Mundipharma, MSD, Pfizer, Takeda, Amgen, and advisory board fees from Abbvie, Janssen,Takeda, Celltrion, Amgen.
CL has received consultancy fees from Janssen, Abbvie, Takeda and Galapago and speaker fees from Sandoz, Janssen, Abbvie

Introduction

Pancreatic duct (PD) stones frequently occur in chronic calcifying pancreatitis (CCP) and are a main factor contributing to pain onset and exacerbation as well as impaired quality of life (QOL). In these patients endoscopic intervention with removal of obstructing pancreatic duct (PD) calculi and regaining pancreatic duct drainage should be performed. In this regard, digital single operator video pancreatoscopy (d-SOVP) is still under investigation for the treatment of PD stones but seems to be an emerging alternative to standard endoscopic procedures with reported success rates between 43%-100%, based on small retrospective studies. However, while reported short term success rates seem very promising, there is still poor evidence for long-term clinical success and benefit for patients` quality of life.

Aims & Methods

Aims: To investigate the role of d-SOVP guided PD-stone lithotripsy in patients with CCP on clinical success and QOL in a long-term follow-up (FU).
Methods: Patients with CCP undergoing d-SOVP (SpyGlass DS) guided lithotripsy of PD stones with initial technical and clinical success were recruited in this retrospective analysis. Persistence of technical success (ductal clearance) and clinical success (defined as pain reduction >50 % in numerical rating scale (NRS)) as well as postinterventional QOL were evaluated by database analysis and a systematic questionnaire (based on SF-12) regarding pain intensity and incidence, painkiller intake and impact on QOL every 6 months obtained in the respective outpatient clinic. Data are presented as mean±SD.

Results

A total of 32 patients was evaluated during long-term FU of 40.8±8.3 months (range 32 – 57 months). 81% of patients (26/32) reported a significant and lasting decrease in pain and symptom burden with mean decrease of NRS from 6.1±0.55 (preinterventionally) to 1.6±0.35 at last reported visit of FU, p<0.01. In 4 patients (12.5%) subsequent pancreatic duct stenting was required due to persistent PD strictures, no recurrent intraductal stones were observed. 3 patients (9.4%) reported persistent pain, with 2 of these being eligible for partial pancreatectomy. QOL criteria significantly improved in 81% of patients defined by major improvements of their general health status and everyday life performance. Two patients were lost to follow-up, 3 patients (9.4%) died during follow up.

Conclusion

D-SOVP guided lithotripsy is safe and effective, achieving high rates of initial technical and clinical success rates as defined by complete ductal clearance and QOL. Beneficial effects on symptom control and QOL persist in the majority of CCP patients after approximately 41 months of FU. Therefore, we suggest d-SOVP to become the intervention of choice in these complex patients. Nevertheless, further prospective trials are warranted to prove these results.

Disclosure

Mark Ellrichmann, Horst Neuhaus, Torsten Beyna and Christian Gerges received lecture from Boston Scientific.