Introduction

Management of poscholecystectomy complications has been variably discussed. Various options exist but the recent trend has been towards the endoscopic retrograde approach favoring a simultaneous diagnostic and therapeutic potential.

Aims & Methods

Objetive: A single institution retrospective analysis of 203 with bile duct injuries (BDI) after laparoscopic cholecystectomy (LC). We studied the various endoscopic modalities to evaluate the efficacy of the approach.
Patients and Methods: From January 2005 to January 2025, a retrospective analysis was conducted of 5528 patients referred to the endoscopy department. During this period, 434 were referred after related BDI. These 434 (7,8%) are BDI. 231(53,2%) after open cholecystectomy and 203 (46,8%) after LC, formed the basis for this study. 154 (75,8%) were female and 49 (24,2%) were male, with an average age of 49,1years (range,13-88 years). The clinical presentation of the BDI: jaundice 134 (66,0%); pain 47 (23,1%); fever 79 (38,9%); persistent drainage 75 (36,9%); pruritus 74 (36,4%) and acute biliary pancreatitis 18 (8,8%). ERCP was used in all cases.

Results

There were 103 patients with stricture (26 total transaction and 77 partial) and 64 (31,6%) patients with leaks and 36 (17,7%) had a combination of leaks and stricture. Endoscopic diagnosis was feasible in all cases. Subsequently, 170 (83, 7% ) patients were considered for endotherapy and endoscopic treatment was interrupted in 17 patients, required surgical intervention, success healing was shown in 90% There 64 biliary fistulae: 40 of the cystic stump, 20 of the common hepatic and 2 of the right hepatic and 2 of the left hepatic; 36 (17,7%) biliary fistulae with stenosis (9 complete transaction and 27 partial transaction) and 103 stenosis (26 total transaction and 77 partial). The 35 total transaction required surgical treatment; however two were treated by endoscopies. There was success in the endoscopic treatment of biliary fistulae, which 64 esphincterotomy transpapilar (ETP) and four stents. 27 patients with biliary fistulae with stenosis were 6 ETP; 11 ETP with stents; 8 ETP, dilatation, stents and two ETP with dilatation and two patients need the surgical treatment. 71/77 (92,2%) patients with stenosis could be treated: 34 ETP, stents; 36 ETP, dilatation, stents; and 3 ETP, dilatation. Complications occurred in 6 (3, 5%), perforation (n = 1), mild pancreatites (n=3), and cholangitis (n=2) and 17 patients failed endoscopic treatment.

Conclusion

The ERCP in biliary complications of LC is feasible and with good results. It firms as coadjuvant treatment of the definitive surgery and in some situations being the method close for the definitive treatment.

Disclosure

No Conflict of Interest

Introduction

The coexistence of HBV and hepatic steatosis is frequent, but its impact on the progression of liver disease remains poorly characterized and much debated.

Aims & Methods

We aim by this study to determine the prevalence, associated factors, consequences of this association and response to treatment.
A retrospective analysis was conducted over 20 years from 2005 to 2025 on a single-center cohort of 124 patients with chronic HBV, of whom 16.1% (n=20) had steatosis (confirmed by imaging). Demographic, virological, metabolic and histological (fibrosis stage) characteristics were compared between the groups with and without steatosis. And statistical tests (Chi², Mann-Whitney, logistic regression) were used.
For the comparison, we defined:
- Group A: combining steatosis and HBV
- Group B: HBV without steatosis.

Results

The prevalence of steatosis in patients with HBV in our series was 16.1%, with a mean age of 52.1 years higher than that of patients with HBV without steatosis, (45.8 years), with a p-value of 0.02. Furthermore, in our work there was a clear female predominance, with a sex ratio of 3 F/H in group A vs 0.9F/H in group B with a p-value of 0.04.
In the history of our patients, we found that 30% of patients had high blood pressure in group A compared with 18% in group B, 10% had diabetes in group A compared with 8% in the other group, and there was no significant difference in smoking habits (15% compared with 12%). Statistical regression did not find any significant correlation in those signs. On the other hand, in the case of dyslipidemia, there was a slight predominance of group A (15% vs. 10%) with a p-value of 0.045.
The analysis of hepatic test didn’t show any big difference between results of GGT, PAL and ASAT but for ALAT there was a higher in patients with steatosis with a median of 62 vs 52,1 and a p-value of 0,02.
Our study also found no difference in serological results: 95% of patients with steatosis were Hbs Ag positive, with the presence of Hbc Ab in all patients at the time of diagnosis. These results were not very different from those of patients without steatosis (Hbs Ag positive in 96.8% and Hbc Ab positive in all patients). Only 10% of patients had a positive Hbe Ag in group A vs 7.2% in group B. The median viral load before treatment was 1870 UI/ml vs 2450 UI/ml with no real difference noted between the 2 groups, confirmed by statistical regression which found a p=0.82 value.
Our study found no real impact on liver disease, showing no worsening of fibrosis (30% F≥2 with steatosis vs 25% without, p=0.62*).
After analysis using the association Chi² test, our study found similar virological responses under treatment (83% in group A vs 78% in group B, p=0.75*).

Conclusion

In this cohort, steatosis in HBV patients (16.1%) was associated with age and female sex. Hepatic test showed a higher ALAT fold among patient with steatosis. However, higher viral load or more severe fibrosis was not demonstrated. Steatosis in HBV does not appear to have a negative influence on the course of the disease. These results suggest that the management of HBV with steatosis should primarily target virological control, without requiring any specific therapeutic adaptation.

Disclosure

no conflict of interest

Introduction

Obesity is a global health challenge associated with significant morbidity, mortality, and economic burden. Endoscopic Sleeve Gastroplasty (ESG) has emerged as a safe, incisionless, and minimally invasive alternative to bariatric surgery for patients with obesity who are either unwilling or unsuitable for surgical options. While ESG has demonstrated promising short-term results in terms of weight loss and metabolic improvement, there remains a paucity of data on long-term outcomes, particularly beyond one year. This study aims to evaluate the long-term efficacy of ESG in a large Asian cohort, focusing on total body weight loss (TBWL) as the primary outcome, with body mass index (BMI) change and absolute weight loss as secondary outcomes.

Aims & Methods

We conducted a retrospective review of 236 patients who underwent ESG at Singapore General Hospital between November 2020 and December 2025. All procedures were performed by a single experienced endoscopist using a U-shaped suturing pattern. The primary outcome was the percentage of total body weight loss (%TBWL) at 6, 12, and 24 months post-procedure.

Results

The cohort consisted predominantly of female patients (69%), with the majority being of Chinese ethnicity (42.8%). The mean age at baseline was 41.4 years (SD ± 10.6), and the mean baseline BMI was 35.0 kg/m² (SD ± 6.1). All ESG procedures were technically successful, with an average of five sutures placed per patient and a mean procedure time of 75 minutes (SD ± 17). No major complications were reported, and the average hospital stay was one day.
Follow-up data were available for 114 patients at 6 months, 86 at 12 months, and 41 at 24 months. The mean percentage total body weight loss was 15.9% (SD ± 10.5) at 6 months, 12.7% (SD ± 7.8) at 12 months, and 9.9% (SD ± 7.8) at 24 months, reflecting a sustained reduction in weight over time. As secondary outcomes, BMI decreased significantly from baseline by a mean of 6.0 kg/m² (SD ± 5.3) at 6 months, 4.2 kg/m² (SD ± 5.7) at 12 months, and 3.5 kg/m² (SD ± 5.7) at 24 months (all p < 0.001). These were accompanied by corresponding mean weight losses of 16.8 kg (SD ± 17.1), 12.1 kg (SD ± 8.6), and 9.6 kg (SD ± 9.0) at the respective timepoints, all statistically significant (p < 0.001).

Conclusion

ESG is a safe and effective endoscopic intervention for weight loss, with sustained and clinically meaningful reductions in total body weight, BMI, and absolute weight observed up to two years post-procedure. These real-world data from a large tertiary Asian centre support the long-term utility of ESG as a viable non-surgical option for obesity management.

Disclosure

​Nil

Introduction

Impedance planimetry (EndoFLIP®) is an emerging tool in the assessment of esophageal motility, with its role in daily clinical practice gradually being defined. In contrast to high-resolution manometry (HRM), EndoFLIP® is generally well tolerated and can be performed during the same endoscopic session, allowing for a dynamic and functional evaluation of the esophagogastric junction and the esophagus. However, its applicability within the diagnostic algorithm for dysphagia remains insufficiently established.

Aims & Methods

A retrospective single-center observational study was conducted on EndoFLIP® procedures performed between September 2019 and December 2024 in patients whose primary symptom was dysphagia. Variables assessed included prior performance of HRM, diagnoses established by both HRM and EndoFLIP®, and therapeutic decisions made based on EndoFLIP® findings. All procedures were performed under general anesthesia.

Results

A total of 106 EndoFLIP® procedures were performed, with a median age of 59 years and 50.9% male. The median initial Eckardt score was 3 (maximum 12). 78.3% of patients presented pathological findings on EndoFLIP®, and in two-thirds (n=77), these findings led to a change in the therapeutic approach, implemented in the same endoscopic procedure in 22 cases. Half of the patients (n=49) had not previously undergone MAR due to: intolerance (n=23); assessment of distensibility plateau in eosinophilic esophagitis (n=11); optimization of initial endoscopy with simultaneous EndoFLIP® (n=6); assessment of treated achalasia and/or post-surgical status (n=3). In these patients, the majority had diagnostic findings on EndoFLIP® (78.8%), with the most frequent being achalasia (n=12). Of the patients who underwent MAR, nearly one-third (n=16) had inconclusive results. In only one case did the EndoFLIP® not show any abnormalities, while the remaining cases were diagnosed with achalasia (n=4), OJEG (n=4), and absence of contractility (n=3). When evaluating suspected OJEG (n=14) in MAR, only three were confirmed on EndoFLIP®, while the others were reclassified as normal study (n=8), achalasia (n=2), and absence of contractility (n=1).

Conclusion

This study highlights the need for a paradigm shift, advocating for the routine use of EndoFLIP® in the assessment of dysphagia in various contexts, including initial screening of motor disorders during index endoscopy, post-surgical evaluations, and a more accurate assessment of the esophagogastric junction (EGJ) and esophageal caliber in specific pathologies. EndoFLIP® allows for faster diagnoses, reduces the need for additional testing, and potentially enables earlier therapeutic planning, sometimes within a single session.

Introduction

Avoidant Restrictive Food Intake Disorder (ARFID) is increasingly recognized within the paediatric population and specialist clinics. However, there is sparse data on the prevalence and burden of ARFID within the adult general population. We addressed this issue.

Aims & Methods

A population-based Internet survey with pre-defined demographic quotas was conducted across the UK and USA in 2023. The survey collected data on demographics, body mass index (BMI), ARFID (using the nine-item ARFID screening tool, NIAS), disorders of gut-brain interaction (using the Rome IV diagnostic questionnaire), PHQ-15 somatic symptoms, PHQ-4 anxiety and depression, PROMIS-10 quality of life, and healthcare utilisation.

Results

In total, 4002 adults (mean age 47 [range 18-91] years and 50% females) completed the survey. Overall, 26.0% (n=1035) screened positive for ARFID, with similar results between the UK (23.0%) and USA (29.0%). The prevalence of positive ARFID screens by NIAS subscale were 15.3% for poor appetite, 13.9% for picky eating, and 6.2% for fear of aversive consequences. In all, 18.2% had a single ARFID domain, 5.7% had two domains and 1.9% had all three domains.
ARFID was more common in females than males (29.6% vs. 22.1%, OR 1.5), and highest amongst people aged 18-39 years (31.6%), followed by those aged 40-64 years (25.0%), and lowest in those 65 years and over (16.1%); p<0.001.
Individuals with ARFID - compared to those without ARFID - had a significantly higher prevalence of disorders of gut-brain interaction (51% vs. 37.5%, OR 2.2), including irritable bowel syndrome (11.8% vs. 4.0%, OR 3.2) and functional dyspepsia (25.8% vs. 7.0%, OR 4.6). They were significantly more likely to be underweight (BMI<18.5; 7.0% vs. 1.5%), experience greater somatic symptoms and mood disturbances, reduced mental and physical quality of life, and increased healthcare utilization (i.e. medication use and doctor visits). An increase in the number of ARFID domains was associated with greater general health impairment; p<0.001.

Conclusion

Elevated ARFID symptoms are common within the adult general population, affecting 1-in-4 people, and associated with substantial health burden. Increased awareness of ARFID will aid clinical service provision and future research on how to best manage this patient group.

Disclosure

Nil

Introduction

Small intestinal bacterial overgrowth (SIBO) is characterized by the presence of excessive gram-negative aerobic and anaerobic colonic bacteria in the small intestine^1,2, leading to increased carbohydrate fermentation and gas production. Symptomatology frequently overlaps with other gastrointestinal disorders³. This study aimed to identify factors associated with test positivity and improve patient selection for diagnostic evaluation.

Aims & Methods

Retrospective, unicentric study. A cohort of 34 patients underwent glucose hydrogen and methane breath testing for SIBO. Demographic, clinical, laboratory data and test results were analyzed.

Results

The cohort included 21 females (61.8%) and 13 males (38.2%), with a mean age of 46.5 ± 15.9 years. Chronic diarrhea was the leading indication for testing (82.4%), followed by abdominal pain (8.8%). Tests results were positive in 4 cases (11.8%). Positive patients had a higher mean age (56.0 ± 10.8 vs. 46.1 ± 15.8 years, p = 0.236) and a comparable gender distribution. Among positive patients, diarrhea was reported in 100% of cases, followed by abdominal distension (75%) and abdominal pain (50%). Folic acid levels were higher in the positive group (11.65 vs. 6.54 ng/mL, p = 0.074), while fecal calprotectin levels were significantly elevated (480 vs. 44.26 µg/g, p = 0.027). Altered small intestine anatomy due to prior surgical interventions was strongly associated with test positivity (p = 0.012), while systemic disorders affecting gastrointestinal motility showed a non-significant trend (p=0.136). Proton pump inhibitor use was not associated with test positivity (p = 1.0). Rifaximin treatment led to symptom improvement in all positive cases, but with no significant difference compared to negative patients (p = 0.444).

Conclusion

Elevated serum folate and fecal calprotectin levels may serve as indicators of underlying SIBO in the appropriate setting. Altered small intestine anatomy was strongly associated with test positivity, and could indicate SIBO under adequate intestinal transit time. These findings highlight the need for larger studies to refine patient selection and improve diagnostic strategies.

References

1. UpToDate. Small intestinal bacterial overgrowth: Etiology and pathogenesis. Available at: https://www.uptodate.com/contents/small-intestinal-bacterial-overgrowth-etiology-and-pathogenesis. Accessed January 19, 2025.
2. Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Am J Gastroenterol. 2020;115(2):165-178. doi:10.14309/ajg.0000000000000501.
3. Sachdev AH, Pimentel M. Antibiotics for irritable bowel syndrome: Rationale and current evidence. Curr Gastroenterol Rep. 2012;14:439–45.