Introduction

Idiopathic gastroparesis (IG) remains a challenging condition, with few effective therapeutic options available. Despite recent European and international consensuses, some management modalities are still different in the French practice (1).

Aims & Methods

We aimed to develop French recommendations on the diagnosis and management of IG in adults and paediatric patients, highlighting the similarities and differences with recent consensuses. A Delphi process was conducted among a panel of 16 French neurogastroenterology experts, including gastroenterologists and paediatricians. A first list of statements was drafted with a literature summary. After revisions and clarifications, 3 voting rounds were conducted and consensus statements were identified (defined as ≥ 80% agreement).

Results

Consensus was reached for 39 out of 46 statements. Definition and diagnostic modalities were similar to recent guidelines. IG was defined as symptoms associated with delayed gastric emptying (GE), in the absence of a mechanical obstruction. The panel agreed that nausea and vomiting are cardinal symptoms, with postprandial distress symptoms frequently overlapping. Variable presentations according to age were highlighted in paediatric patients.
Delayed GE can be confirmed by either scintigraphy or a GE breath test, using a solid meal, and a 4-hour measurement. Food retention at endoscopy was not considered a diagnostic criterion. Pyloric EndoFlip was not considered a diagnostic or pretherapeutic tool. A blood test and screening for Helicobacter pylori were supported before diagnosing IG.
Regarding the management, like in recent guidelines, the panel supported a first-line therapy using dietary advice and dopamine antagonists (metoclopramide or domperidone). The panel supported the efficacy of intravenous erythromycin, but not oral erythromycin. Agreement on the efficacy of other drugs, including prucalopride, antiemetics, or neuromodulators, was not reached. The use of nutritional support was recommended if deemed necessary for refractory vomiting and malnutrition, with enteral post-pyloric nutrition recommended as the first option.
The consensus supported different strategies for the management of refractory gastroparesis. Stopping opioids, or drugs inducing delayed GE, and the treatment of associated constipation were recommended before considering more invasive procedures. The efficacy of pyloric toxin injection was not agreed upon. Gastric endoscopic pyloromyotomy and gastric electrical stimulation were considered effective therapies for refractory IG. Finally, surgical procedures were not supported.

Conclusion

This consensus shows that the diagnostic modalities for IG are similar in France as compared to international guidelines, but highlights differences in the management of refractory gastroparesis, supporting endoscopic pyloromyotomy or the implantation of gastric electrical stimulation.

References

1. Schol J, Wauters L, Dickman R, Drug V, Mulak A, Serra J, et al. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis. United European Gastroenterol J. 2021 Apr;9(3):287–306.
2. Schol J, Huang IH, Carbone F, Fernandez LMB, Gourcerol G, Ho V, et al. Rome Foundation and international neurogastroenterology and motility societies’ consensus on idiopathic gastroparesis. Lancet Gastroenterol Hepatol. 2025 Jan;10(1):68–81.

Disclosure

HS received lecture fees from Enterra Medical, and Viatris.

Introduction

At the time of treat to target, endoscopic healing is the goal to achieve in ulcerative colitis (UC). Colonoscopy (CO), rectosigmoidoscopy (RS) or rectoscopy can be performed to assess endoscopic healing. The objective of this study was to compare the performance of rectosigmoidoscopy with colonoscopy to predict endoscopic healing (EH) and histological healing.

Aims & Methods

This is a monocentric, prospective cohort of UC patients. All UC patients with a total colonoscopy were included between January 2021 and January 2023. Endoscopic and histological activity were measured using the MAYO endoscopic scores on each colonic segment and the Nancy Score, respectively. The correlation between RS or rectoscopy alone and CO in terms of endoscopic and histological mucosal healing was assessed using Cohen's kappa coefficient.
The study population was calculated according to the following assumptions: (1) absence of rectosigmoidoscopy lesions if absence of total colonoscopy lesions (0%), (2) 10% of lesions not seen in RS, (3) expected difference of 10% between CT and RS. 80 patients had to be included to demonstrate a significant difference in terms of EH between RS and CT with a bilateral alpha risk of 5% and a power of 81%.

Results

80 patients were included. 34 patients were MAYO 0 in RS and CO, 44 were not healed in RS and CO.. The correlation between the two exams was almost perfect with an index к of 0.949 (p=0) for MAYO 0 (2 patients misclassified), and к of 0.945 (p=0) for MAYO 0-1. The correlation between histological healing in RS and CO was almost perfect (к=0.877, p<0.001). Additionally, the correlation between rectoscopy and CT for the evaluation of mucosal healing MAYO 0 and histological healing was almost perfect (к=0.826 (p < 0.001) and к=0.8 (p < 0.001), respectively.

Conclusion

RS is sufficient in UC to assess both endoscopic mucosal healing (whether defined by a Mayo score of 0 or 1) and histological healing. With a false negative rate < 10%, rectoscopy could be a less invasive exam to assess healing in UC.