Introduction

Patients with acute severe ulcerative colitis (ASUC) have a lifetime risk of an acute flare requiring hospital stay. The diagnosis of acute severe ulcerative colitis is based on Truelove and Witts criteria and the treatment by intravenous steroids showed improved clinical remission and reduced mortality. However, some patients respond poorly to systemic steroids and need a medical treatment by of anti TNF agents or a surgical treatment by colectomy. The aim of our work is to study the ACE score as a predictive factor of surgery in acute severe ulcerative colitis.

Aims & Methods

We conducted a retrospective study on the Hepato gastro enterology department in IBN Rochd University Hospital of CASABLANCA, including all the admissions of patients with acute severe ulcerative colitis between 2016 and 2023. Demographic (sex, age, smoking habits ,age of the diagnosis, prior episodes of severe ulcerative colitis, extent of the disease according to Montreal classification, maintenance medication prior to hospital admission) , clinical (lichtiger score at admission and 3 days after IV steroid, laboratory (albumin, CRP) at day 1 and day 3 during hospital stay and endoscopic (Mayo score and UCEIS) characteristics of the patients were collected from medical records. The primary outcome was to calculate the ACE score and determine the association between a high score and a major risk of surgery. The score ACE was calculated following this formula: albumin≤30 g/L{score=1}+ CRP ≥50 mg/L{score=1} + increased endoscopic severity {score=1} predicting 78.1% of no responders .

Results

97 patients were included in the study. The median age was 28 years with interquartile range (IQ) [15, 64]. The sex ratio was 1. 22,7% had a history of smoking. For 53 patients, acute severe ulcerative colitis was inaugural. At day1, the median C-reactive protein (CRP) was 84 mg/dl and the mean of albumin level was 29.9+/-6.28. The evolution at day 5 was marked by the persistence of a high Lichtiger score in 21 patients. 10 were treated with anti TNF alpha and 11 underwent colectomy. Younger age (<20 years) and inaugural acute severe ulcerative colitis was significantly associated with a higher risk of colectomy (p=0.019; p=0.001). Elevated C-reactive protein (>45) at day 3 (p=0.004), decreased albumin level (<30g/L) (p=0.02) and positive oxford criteria (p<0.01) was also significantly associated with colectomy risk. The ACE (Albumin, CRP, Endoscopic) score was calculated in our patients, and a higher score of 3 was significantly associated to a major risk of colectomy.

Conclusion

Multiple biomarkers have been used to predict a non-response to steroids in the situation of acute severe ulcerative colitis. The most used is Travis score at day 3. The ACE score has been used recently in many studies , and confirm its ability to predict non responders to first line medical therapy. Further research and validation of these scoring systems are warranted to enhance their accuracy and reliability in predicting the need for a second line therapy or surgery.

References

1. Dinesen LC, Walsh AJ, Protic MN, Heap G, Cummings F, Warren BF, et al. The pattern and outcome of acute severe colitis. J Crohns Colitis. oct 2010;4(4):431‑7.

Introduction

Many studies, mostly conducted on pediatric patients, suggested that oxidative stress as well as several micro-RNAs (miRNAs) may play an important role in coeliac disease (CeD) pathogenesis. However, the interplay between oxidative stress and miRNAs regulatory functions in CeD remains to be clarified.

Aims & Methods

This pilot study was conducted to evaluate the role of miRNAs and oxidative stress in adult CeD patients and to analyze their potential interactions.
A total of 51 subjects were retrospectively included in the study: n=12 CeD patients at the time of diagnostic upper GI endoscopy (CeD-dia); n=18 CeD patients after at least one year on a gluten-free diet (CeD-fu); n=5 patients with complicated CeD (CeD-compl); n=10 control patients undergoing upper GI endoscopy for other diseases (CP); n=6 healthy controls (HC). In these subjects, a blood sample and duodenal biopsies were collected. Based on a literature search, several miRNAs involved in the pathogenesis of CeD and with a known relationship with oxidative stress (miR-155, miR-200, miR-125, miR-192, miR-21, miR-451, miR-146 and miR-1226) were quantified with qRT-PCR in plasma. Oxidative stress was evaluated through the measurement of the levels of 8-OHdG adduct in the DNA extracted from the duodenal tissue and from peripheral blood using High Performance Liquid Chromatography with Electrochemical Detection (HPLC-EC).

Results

Among the evaluated miRNAs, miR-451, miR-146 and miR-155 were differentially expressed between groups. In particular, compared to HC, CeD-dia and CeD-fu groups have significantly lower levels of miR-451 (p=0.01 and p=0.006, respectively). The expression of miR-146 in CeD-dia was significantly higher compared to CeD-fu patients (p=0.03), while HC demonstrated lower levels compared to both CeD-dia and CeD-fu (p=0.03 and p=0.01, respectively). A trend toward lower levels of miR-155 was shown in HC compared to CeD-dia (p=0.05) and CeD-fu (p=0.06). The blood level of 8-OHdG were significantly higher in CeD-dia and CeD-fu patients compared to CP (p=0.05 and p=0.001, respectively). No correlations were demonstrated between tissue 8-OHdG levels and miRNAs. By contrast, blood 8-OHdG levels were positively correlated with miR-155 in CeD-compl (r=0.9, p=0.04) and with miR-200 in CeD-fu (r=0.68, p=0.02), while negatively correlated with miR-1226 in CeD-fu (r=-0.62, p=0.04).

Conclusion

miRNAs and the oxidative stress have a role in the pathogenesis of CeD. In this pilot study, we showed that a crosstalk between these two may exist, in particular during follow-up and in complicated CeD. Whether oxidative stress is able to up- or downregulate some miRNAs or, conversely, whether miRNAs expression is capable to modulate the response to oxidative stress in CeD patients should be evaluated in future larger studies.

Introduction

Previous studies showed that adhering to high-quality screening colonoscopy leads to markedly decreased incidence and mortality of colorectal cancer. However, more is needed to know about the impact of the duration of participation on quality parameters.

Aims & Methods

This study aims to evaluate the relationship between the duration of endoscopists' participation within the Austrian quality assurance program for screening colonoscopy and their quality parameters. A generalized linear mixed model, adjusted for sex and age, was utilized to evaluate the effect of the time elapsed since participation on quality parameters, such as adenoma detection rate (ADR), advanced adenoma detection rate (AADR) and carcinoma detection rate (CDR).

Results

392 endoscopists provided data from 326,445 screening colonoscopies from 2007 to 2022. Results showed that each year of participation in the quality assurance initiative led to a 1.02% increase in ADR (95% CI [1.004-1.034], p-value = 0.013) as well as a 1.17% increase in CDR (95% CI [1.107-1.245], p-value <0.001) adjusted for patients' age and sex. The advanced adenoma detection rate increased by 1.00% each year of participation (95% CI [0.983-1.023], p-value = 0.762).

Conclusion

The participation of endoscopists in the quality assurance initiative was associated with a significant increase in ADR and CDR for each year of participation. However, the increase in AADR was not statistically significant.

Introduction

Cold snare polypectomy (CSP) has become popular as a safe and simple treatment for small colonic lesions. According to the Japanese guidelines, CSP is indicated for adenomas <10 mm with no suspicion of carcinoma [1]. Occasionally, colorectal carcinoma is diagnosed after resection, and there is no consensus on the treatment of such lesions [2-4].

Aims & Methods

This single-center retrospective study aimed to investigate the long-term prognosis of Japanese patients with pathologically diagnosed colorectal carcinoma after resection by CSP. Patients who underwent CSP for small colonic lesions at our hospital in 2013–2022 and were histopathologically diagnosed with colorectal carcinoma were included in this study. We examined the local residual or recurrence rate, scar detection rate, and recurrence-free survival rate in patients who underwent at least one colonoscopy after CSP.

Results

Out of 12,935 lesions (6,082 cases) that were resected using CSP during the study period, 81 lesions (0.63%; 81 cases) were histologically diagnosed as colorectal carcinoma (mean age, 69.7 years; male patients, 69% [56/81]). Histologically, all tumours were well-differentiated adenocarcinomas. Negative lateral and vertical margins of the resected specimens were 47% (38/81) and 72% (58/81), respectively. Of these 81 cases, 47 (58%) were followed up at least once by colonoscopy. The breakdown of cases that were not followed up endoscopically is as follows: concurrent advanced cancer (n=15), advanced age (n=7), dropout (n=7), and others (n=5). Endoscopic evidence of residual disease or recurrence was found in 1/47 patients (2%), and the remaining 46 patients had a median colonoscopic follow-up of 425 days (interquartile range, 192.5–1078.5 days) with no endoscopic evidence of local recurrence. In 51% (24/47) of cases, post-polypectomy scars could be identified. In one case where local residual carcinoma was confirmed, a retrospective review of the CSP revealed incomplete resection at the time of treatment. Abdominal CT performed immediately after CSP showed coincidental peritoneal dissemination, and the patient died 177 days after diagnosis. In 46 patients with no endoscopic evidence of local recurrence, the median observation period was 921 days (interquartile range, 475–1654.5 days), with six cases of death from causes other than colorectal cancer, and the others were alive without recurrence.

Conclusion

The frequency of residual disease or recurrence of colorectal carcinoma treated by CSP was low, and the long-term prognosis was favourable once the absence of residual lesions was confirmed endoscopically.

References

1. Uraoka T, Takizawa K, Tanaka S et al. Guidelines for Colorectal Cold Polypectomy (supplement to "Guidelines for Colorectal Endoscopic Submucosal Dissection/Endoscopic Mucosal Resection"). Dig Endosc 2022; 34: 668-675.
2. Yoshii S, Hayashi Y, Nakamura T et al. Endoscopic features and clinical course of colorectal carcinoma resected by cold snare polypectomy. J Gastroenterol Hepatol 2023, in press
3. Inoki K, Takamaru H, Furuhashi H et al. Management of colorectal high-grade dysplasia or cancer resected by cold snare polypectomy: a multicenter exploratory study. J Gastroenterol 2023, in press
4. Yoshida N, Fukumoto K, Hasegawa D et al. Recurrence rate and lesions characteristics after cold snare polypectomy of high-grade dysplasia and T1 lesions: A multicenter analysis. J Gastroenterol Hepatol 2021; 36: 3337-3344.

Introduction

Pancreatic fluid collections (PFCs) resulting from acute pancreatitis (AP) that are persistently symptomatic can be associated with infections and mass effect.

Aims & Methods

Aim: The aim of the study was to evaluate the clinical characteristics and natural history of PFCs in AP.
Methods: In this study, we recruited a total of 378 patients includes 253 (66.93%) prospective hospitalized patients and 125 (33.06%) retrospective patients who had presented with documented AP at the Pancreas Clinic. In this abstract, we present prospective data. Patients underwent a thorough demographic and clinical history. We also recorded data on PFC morphology, presence of venous thrombosis, the need for interventions and outcomes of PFCs at baseline and each follow-up visit. Continuous data were expressed in median with interquartile range (IQR) and categorical data as proportions.

Results

A total of 253 prospective hospitalized patients were included with median (interquartile range, IQR) age in years of 34.56 (27–43) and a higher prevalence of males 217 (81.5%) than females 36 (14.2%) were observed. The most common etiology was idiopathic 71 (28.1%) followed by alcohol 70 (27.7%), alcohol with smoking 5 (2.0%) and cholelithiasis 37 (14.6%). Most patients had moderately severe and severe AP were 214 (84.6%) and 39 (15.4%) respectively with the index episode observed in 175 (69.2%), recurrent in 75 (29.6%) and acute on chronic in 3 (1.2%). The most common type of fluid collection was acute necrotic collection 230 (90.9%) followed by walled-off necrosis 20 (7.9%), pseudocyst 4 (6.2%) and acute peripancreatic fluid collection 3 (1.2%).
In terms of fluid collection, During the first three months, the volume and maximum size were 83.60 (26.3–383.20) cubic centimeters (cc) and 8.90 (5.47–12.42) diameter, respectively. Venous thrombosis was the most common complication in 172 (68%) patients and was observed in the retropancreatic splenic vein in 38 (15.2%). 18 (14.4%) patients required interventions in the first 3 months, while 14 (11.2%) in the next 3 months. Venous thrombosis developed in 15 (5.9%) additional patients during the next 3 months. The most common intervention was EUS-guided cystogastrostomy (CG) with SEMS or plastic placement in 49 (19.6%) in the first 3 months, followed by PCD alone in 29 (11.5%), PCD followed by EUS drainage in 16 (6.4%), and combined procedures in 15 (6%). Complete resolution was observed in 52 (20.6%) patients among those who did not undergo intervention within the first three months, while a reduction and increase in size were seen in 60 (23.7%) and 65 (25.7%) patients respectively. Among the patients who did not undergo intervention between third and sixth months, complete resolution was observed in 72 (28.5%) patients, while a decrease and increase in size were seen in 31 (12.3%) and 26 (10.3%) patients respectively. Among the patients who underwent interventions during the first and next 3 months, PFC relapse and increase in size were observed in 8.90 (5.47–12.42) and 4.4 (0.0–10.9) of the patients who underwent interventions in the first and following three months, respectively. The mortality rate was observed in 21 (8.4%) patients.

Conclusion

75% of PFCs undergo spontaneous resolution within 6 months, while most relapses and venous thrombosis occur within the first 3 months. These findings highlight the importance of closely monitoring patients during the early stages of PFC development, as this period may present a heightened risk for complications that require medical intervention.

References

1. Manrai M, Kochhar R, Gupta V, Yadav TD, Dhaka N, Kalra N, Sinha SK, Khandelwal N. Outcome of Acute Pancreatic and Peripancreatic Collections Occurring in Patients With Acute Pancreatitis. Ann Surg. 2018 Feb;267(2):357-363. doi: 10.1097/SLA.0000000000002065. PMID: 27805963.

Disclosure

None

Introduction

Several studies have shown that a low quality of colonoscopy reduces its effect in preventing colorectal cancer (CRC), but it is not clear to which extent a low-quality colonoscopy is still effective compared to no colonoscopy. We aimed to compare the 13-year risk of developing CRC between persons with I) a high-quality screening colonoscopy, II) a low-quality screening colonoscopy and III) without a screening colonoscopy.

Aims & Methods

Using observational data from a German claims database (GePaRD; 20% population coverage) we emulated a target trial with three arms: High-quality screening colonoscopy (highQualSC) vs. low-quality screening colonoscopy (lowQualSC) vs. no screening colonoscopy (noSC) at baseline. The quality of baseline colonoscopy was categorized based on the polyp detection rate of the examining physician. We included persons at average CRC risk aged 55–69 years and without a colonoscopy, polypectomy or fecal occult blood test before baseline. We estimated adjusted cumulative CRC incidence over 13 years of follow-up.

Results

Overall, we included 142,960 persons in the highQualSC arm, 62,338 persons in the lowQualSC arm and 124,040 persons in the noSC arm. The adjusted 13-year risk of any CRC was 1.77% in the highQualSC arm, 2.09% in the lowQualSC arm and 2.74% in the noSC arm. Compared to the noSC arm, the adjusted relative risk (aRR) was 0.76 (95% CI: 0.70-0.84) in the lowQualSC arm and 0.65 (95% CI: 0.60-0.69) in the highQualSC arm.

Conclusion

Our study demonstrated that the effect of screening colonoscopy in preventing CRC is substantially lower in persons with a low-quality as compared to a high-quality screening colonoscopy. However, it also showed that attending a low-quality screening colonoscopy still markedly reduces the risk of CRC compared to no screening colonoscopy.

Introduction

Mortality of acute mesenteric ischemia (AMI) is closely correlated with the development and extent of irreversible transmural intestinal necrosis (ITIN). In this context, the surgical assessment of small bowel viability is difficult, subjective (visual) and invasive. In order to better identify high-risk patients justifying an immediate surgical evaluation, the non-invasive Clichy score was developped in 2017 (Nuzzo et al. Am J Gastroenterol 2017). The aim of this study was to evaluate the diagnostic performance of this score.

Aims & Methods

The development cohort included 67 patients with AMI admitted to our center between 2009 and 2015, with a Clichy score including 3 independent factors (organ failure, elevation of plasma lactate > 2 mmol/L, and intestinal dilation on CT scan > 25mm; area under the ROC curve [AUROC] = 0.94 [95% confidence interval: 0.87–1.00]). The present validation study prospectively included patients admitted to our center for AMI between 2016 and 2018. The presence of ITIN was defined histologically as previously published. The diagnostic performance of the score was assessed by AUROC in the total cohort, and in the AMI subgroups of arterial and venous origin.

Results

52 patients (mean age 65, 37% women) were included. Arterial and venous occlusion induced AMI occurred in 65% and 35% of cases, respectively. ITIN was confirmed in 14 patients (27%). Organ failure, elevation of plasma lactate > 2 mmol/L, and intestinal dilatation > 25 mm was observed in 17 (33%), 15 (29%) and 12 ( 23%) of patients, respectively. The AUROC for the diagnosis of ITIN by the Clichy socre was 0.90 (95% CI = 0.81 – 0.98). In the presence of 0, 1, 2 and 3 factors, the risk of ITIN was 0%, 14%, 55% and 75%, respectively (Figure). In subgroup analyses, the AUROC for the diagnosis of ITIN was 0.96 (0.89 – 1.00) in arterial AMI, and 0.77 (0.53 – 0.85) in venous AMI. In arterial AMI, the risk of ITIN was respectively 0%, 13%, 67% and 100% in the presence of 0, 1, 2 and 3 factors. In venous AMI, the risk of ITIN was respectively 0%, 17%, 50% and 50% in the presence of 0, 1, 2 and 3 factors. The negative predictive value (NPV) of a score of 0 was 100% in both types of AMI. The positive predictive value (PPV) of a score of 3 was 100% in arterial AMI, and 50% in venous AMI.

Conclusion

This prospective study is the first which validates a non invasive diagnostic score of ITIN in the setting of AMI. The diagnostic performance of the score was satisfactory, especially in AMI of arterial origin. These results suggest that these factors should prompt laparotomy consideration if present. In the subgroup of venous AMI, further studies seem necessary to identify other risk factors.

Disclosure

MSD Avenir grant