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Very early onset colitis

Dror Shouval 1

1 Sheba Medical Center, Ramat Gan, Israel

Event

UEG Week Copenhagen 2023

Topics

IBD Immunology Mechanisms & Personalised Medicine Paediatrics

Session

Non-IBD related colitis

Published

2023

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Total neoadjuvant treatment: The way forward?

Wytze Lameris 1

1 Amsterdam UMC, Amsterdam, Netherlands

Event

UEG Week Berlin 2025

Topics

Colorectal Digestive Oncology Mechanisms & Personalised Medicine

Session

Catching up with every day's practise in colorectal cancer treatment

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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This is the dilemma: Capsule endoscopy and radiology

Andrea Laghi 1, Cristiano Spada 2

1 Sapienza - University of Rome, Rome, Italy

2 Catholic University Rome - Digestive Endoscopy unit, Catholic University Rome; Rome/IT, Rome, Italy

Event

UEG Postgraduate Teaching Programme Berlin 2025

Session

Into the depths! Guiding minimally-invasive management of small-bowel pathology

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Complex IBD patient (Complete Session)

Event

UEG Week Copenhagen 2023

Topics

IBD Primary Care

Session

Complex IBD patient

Published

2023

UEG Poster

Standard Poster

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Introduction

Despite robust quality indicators such as adenoma detection rate (ADR) in patients without IBD, such indicators for quality in colonoscopy are so far lacking in IBD. The European Society of Gastrointestinal Endoscopy currently recommends a dysplasia detection rate (DDR) of >8%, but evidence base for this is limited.

Aims & Methods

To examine whether existing quality indicators such ADR correlate with endoscopists’ IBD specific quality indicators such as dysplasia detection rate (DDR) and dysplastic lesions per colonoscopy (DPC). Data from consecutive colonoscopies performed by gastroenterologists across 11 tertiary IBD centres were collected, selected if at least 150 non-IBD colonoscopies and 40 IBD-surveillance colonoscopies were performed over a 5-year period. Non-IBD colonoscopies were for patients aged ≥50y, and IBD-colonoscopies for patients meeting national and international criteria for eligibility for dysplasia surveillance. Colonoscopies were excluded if the patient had known dysplasia, a known or suspected familial CRC syndrome, previous colonic resection or severe inflammation in Crohn’s or UC. Correlation between endoscopists’ ADR, adenomas per colonoscopy (APC) in non-IBD colonoscopies with their DDR and DPC in IBD colonoscopies. Secondarily, detection of sessile serrated lesions (SSLs) in patients with and without IBD were analysed.

Results

21 endoscopists (Table 1) met inclusion criteria, who performed 3207 non-IBD colonoscopies and 902 IBD (515 ulcerative colitis [UC] and 387 Crohn’s disease [CD]) colonoscopies. Of the non-IBD colonoscopies, patients’ median age was 65 (IQR 58-73) years, with 1556 (49%) female. Of the IBD-colonoscopies, patients’ median age was 48 (IQR 36-59) years, with 412 (45.7%) female, median disease duration of 14 (IQR 10-21) years. Chromoendoscopy was used in 234 (26%) of IBD colonoscopies. Nontargeted segmental biopsies were performed in 854 IBD colonoscopies, of which 12 (1.42%) detected dysplasia. No cancers were detected in all 902 IBD surveillance colonoscopies.
Key quality indicators for endoscopists are outlined in table 1. ADR correlated with both DDR (Pearson r = 0.44, p = 0.047) and DPC (r = 0.51, p = 0.018). Of the 17 endoscopists with ADR ≥35%, 13 (76%) endoscopists had DDR of ≥ 8%, 6 (35%) had DDR ≥ 12%, and 9 (53%) had a DPC rate of ≥ 0.15. Sessile serrated lesion detection rate (SSLDR) and SSL per colonoscopy (SSLPC) were strongly correlated in both IBD and non IBD endoscopies.

Table 1. Characteristics of 21 endoscopists included for study

Experience as endoscopist, n (%)	< 10 years	7 (33)
	≥ 10 years	14 (67)
Subspecialty, n (%)	IBD	17 (81)
	Advanced endoscopy	1 (5)
	Dual IBD/advanced endoscopy	1 (5)
	General	2 (10)
ADR, median, range (%)		44 (25-68)
APC, median, range		0.83 (0.42-1.9)
DDR, median, range (%)		10 (0-23)
DPC, median, range		0.13 (0-0.30)

Conclusion

Individual endoscopists’ ADRs in patients without IBD correlate with their DPC and DDR in patients with IBD. Further studies are required to assess whether these indicators are correlated with post-colonoscopy colorectal cancer in patients with IBD.

Disclosure

No conflicts of interest to disclose

DETECTION OF DYSPLASTIC LESIONS IN PATIENTS WITH IBD IS CORRELATED WITH ENDOSCOPISTS’ ADENOMA DETECTION RATE IN PATIENTS WITHOUT IBD: DEVELOPMENT OF QUALITY INDICATORS FOR IBD ENDOSCOPY

Daniel Saitta 1, Gloria Sepe 2, Unknown Unknown 3, Akhilesh Swaminathan 3, Anna Mitchell 3, Peter de Cruz 4, Ethan Tan 4, Abhinav Vasudevan 5, Myo Jin Tang 5, Grace Feng 5, Krishnal Dutt 5, Lena Thin 6, Zhi Tan 6, Melissa Chew 2, Mani Suleiman 2, Andrew Metz 7, Gareth Walker 8, Cathal McGowan 8, David Edwards 8, Nazneen Irani 9, James Chen 9, Linda Yang 10, Alexandra Louey 10, Craig Haifer 11, Judit Rueda i Collell 12, Thomas Skinner 12, Elizabeth Chow 13, Angus Ferguson 13, Mayur Garg 2

1 Launceston General Hospital, Launceston, Australia

2 Northern Health, Epping, Melbourne, Australia

3 Alfred Health, Melbourne, Australia

4 Austin Health, Heidelberg, Australia

5 Eastern Health, Box Hill, Australia

6 Fiona Stanley Hospital, Perth, Australia

7 Royal Melbourne Hospital, Melbourne, Australia

8 Royal Brisbane and Women's Hospital, Herston, Australia

9 Sir Charles Gairdner Hospital, South Perth, Australia

10 St Vincent's Hospital, Fitzroy, Australia

11 St Vincent's Hospital Sydney, Sydney, Australia|||University of New South Wales, Sydney, Australia

12 St Vincent's Hospital Sydney, Sydney, Australia

13 Western Health, Footscray, Australia

Conference

UEG Week Berlin 2025

Topics

IBD

Submission format

Abstract

Session

Scoping IBD (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Poster

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Introduction

While three JAK inhibitors are now available in Ulcerative Colitis (UC), no direct comparison exists between these drugs making difficult the hierarchization of these therapeutic options.

Aims & Methods

We performed a systematic review and network meta-analysis to compare the short and long-term efficacy of the three available JAK inhibitors (JAKi) (Tofacitinib/TOFA, filgotinib/FILGO, upadacitinib/UPA) in patients with moderat-to-severe UC.
We performed a systematic review and network meta-analysis (PRISMAguidelines) of randomized controlled trials (including post-hoc analyses) conducted in adults, evaluating the efficacy of JAKi in moderate-to-severe UC.
The outcome mesures were 1) steroid-free clinical remission (CFREM) after induction therapy (partial Mayo score ≤ 2), 2) CFREM with endoscopic improvement (endoscopic Mayo score ≤ 1) after induction therapy, 3) CFREM at one year among induction-responders, 4) CFREM at one year among patients in clinical remission after induction.
The network meta-analysis was carried out according to a random effects model. The results are presented as relative risk (RR) with 95% confidence interval. The risk of bias of the studies was assessed according to the Cochrane risk-of-bias tool for randomized trials and overall statistical heterogeneity between studies was assessed using τ .
The SUCRA ranking method (surface under the cumulative ranking) was used to rank the treatments.

Results

Nine studies were included in this network meta-analysis, including a total of 2015 patients.
TOFA 10mg bid, FILGO 200 mg qd and UPA 45mg qd were more effective than placebo to induce CFREM and CFREM with endoscopic improvement. Side-by-side comparisons between JAKi found a higher efficacy of UPA 45 mg qd versus FILGO 200 mg qd (RR=0.22[0.10; 0.45]) for induction but no other significant difference between JAKi. SUCRA ranking hierarchizes induction therapies as following : UPA 45 mg qd (0.99), TOFA 10mg bid (0.75), FILGO 200 mg qd (0.27) and placebo (0.01).
Among induction-responders, all JAKi maintenance regimen (TOFA 10mg bid, TOFA 5mg, bid, FILGO 200mg qd, FILGO 100 mg qd, UPA 30 mg qd, UPA 15 mg qd) were more effective than placebo to achieve CFREM at one year with the following SUCRA ranking : UPA 30mg qd (0.85), TOFA 10mg bid (0.80), FILGO 200 mg qd (0.64), TOFA 5mg bid (0.56), UPA 15 mg (0.44), and placebo (0.01).
Among patients in CFREM after induction phase, all JAKi maintenance regimen (TOFA 10mg bid, TOFA 5mg, bid, FILGO 200mg qd, FILGO 100 mg qd, UPA 30 mg qd, UPA 15 mg qd) were more effective than placebo to achieve CFREM at one year with a different ranking (SUCRA) : TOFA 10 mg bid (0.84), FILGO 200 mg bid (0.74), TOFA (5mg bid) (0 .66), UPA 30mg qd (0.63), UPA 15 mg (0.44) and placebo (0.09).

Conclusion

While this network meta-analysis confirms the efficacy of JAKi to induce and maintain CFREM in moderate-to-severe UC, UPA seems to be the most effective JAKi to induce and maintain CFREM. However, once CFREM achieved after induction, continuing the same dose than during induction such as TOFA (10mg bid) or FILGO 200 mg seems to be more effective than reducing the dose (UPA 30 mg or UPA 15 mg) to maintain remission highlighting the dose-efficacy relationship of JAKi.

Disclosure

Consulting fees from: Abbvie, Amgen, Arena, Biocon, Biogen, Celltrion Healthcare, CTMA, Ferring, Galapagos/AlfaSigma, GutyCare/Resilience Janssen, Lilly, MSD, Nexbiome, Pfizer, Roche, Sandoz, Takeda et Tillotts
Lecture fees from: Abbvie, Amgen, Biogen, Celltrion Healthcare Galapagos/AlfaSigma, Ferring, Janssen, Lilly, Mayoli-Spindler, MSD, Nordic Pharma, Norgine, Pfizer, Roche, Takeda, Tillotts and Vifor Pharma
Research grants/fundings from: Abbvie, Celltrion Healthcare, Janssen, Lessaffre, Lilly, Pfizer, Sandoz and Takeda