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Introduction

Colonic diverticular bleeding (CDB) is the most common cause of acute lower gastrointestinal bleeding (ALGIB) and often requires blood transfusion. There are several studies regarding the use of restrictive blood transfusion for acute upper gastrointestinal bleeding, but there is only one previous study regarding the use of restrictive blood transfusion for ALGIB [1]. Therefore, the efficacy of restrictive blood transfusion for CDB remains unclear.

Aims & Methods

This study sought to elucidate the association between the restrictive blood transfusion strategy and the clinical outcomes in patients with CDB. We retrospectively analyzed 475 patients who were urgently hospitalized for CBD and received blood transfusions at two facilities between November 2013 and December 2021. Transfusion strategy was defined as the restrictive group when patients received transfusion for hemoglobin (Hb) ≤ 7 g/dl, and the liberal group when patients received for Hb > 7 g/dl. The hemoglobin cut-off value for restrictive blood transfusion was determined based on a prior randomized clinical trial regarding UGIB [2]. Rebleeding within 30-days, mortality within 30-days, and composite outcome within 30-days were evaluated. The composite outcome comprised the following endpoints: rebleeding, need for surgery or IVR for hemostasis, and mortality within 30 days. We also investigated medical costs during hospitalization. Logistic regression analysis was performed to calculate the odds ratios (OR) with 95% confidence interval (CI) to analyze associations between restrictive transfusion strategy and outcomes.

Results

Of 475 patients, 184 (38.7%) (124 males, 60 females, mean age 76.5±11.5 years) patients received blood transfusion. The mean hemoglobin levels at the time of transfusion in the restrictive and liberal groups were 6.3±0.6 g/dl and 8.2±1.2 g/dl, In the restrictive and liberal group, rebleeding within 30-days was 53.9% and 45.3% (P = 0.24), the mortality within 30-days was 1.1% and 0% (P = 0.30), the composite outcome within 30-days was 56.1% and 52.6% (P = 0.63), respectively. After adjusting for potential confounders, multivariate analysis revealed that restrictive transfusion strategy not associated with decreased rebleeding risk within 30-days, (P = 0.42 ; odds ratio [OR], 1.3), whereas endoscopic hemostasis significantly associated with decreased rebleeding risk (P < 0.01 ; OR 0.2). There was no statistically significant difference in total medical costs between the two groups (P = 0.68).

Conclusion

There were no statistically significant differences in rebleeding within 30-days, mortality within 30-days, and compositeoutcome within 30-days between the restrictive and liberal blood transfusion strategies. Restrictive blood transfusion may be a reasonable therapeutic strategy for patients with CDB, except for patients in which shock status cannot be withdrawn. However, further evidence is needed to advocated the efficacy of restrictive transfusion strategies for lower gastrointestinal bleeding.

References

[1] Kherad O, Restellini S, Martel M, Sey M, Murphy MF, Oakland K, et al. Outcomes following restrictive or free red blood cell transfusion in patients with lower gastrointestinal bleeding. Aliment Pharmacol Ther. 2019 Apr;49(7):919–25.
[2] Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013 Jan;368(1):11–21.

TRANSFUSION STRATEGIES FOR PATIENTS WITH COLONIC DIVERTICULAR BLEEDING

Takumi Komatsu 1, Yoshinori Sato 2, Tadateru Maehata 2, Yusuke Nakamoto 2, Masaki Kato 2, Hirofumi Kiyokawa 2, Hiroshi Yasuda 2, Yoshihito Yoshida 3, Yuichiro Kuroki 3, Nobuyuki Matsumoto 3, Keisuke Tateishi 2

1 St.Marianna University School of Medicine, Kawasakishi, Japan|||St. Marianna University School of Medicine, Yokohama Seibu Hospital, Yokohamashi, Japan

2 St.Marianna University School of Medicine, Kawasakishi, Japan

3 St. Marianna University School of Medicine, Yokohama Seibu Hospital, Yokohamashi, Japan

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Podcast Episode

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Best of UEG Week - Nursing with Mary Phillips and Leigh Donnelly

Mary Phillips, Leigh Donnelly

Topics

Primary Care

Published

2025

UEG Podcast Episode

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Best of UEG Week - HPB with Carolin Schneider

Topics

Hepatobiliary Pancreas

Published

2025

UEG Podcast Episode

Journal Podcast

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UEG Journal Best Paper Award 2022 - Combining biologics and small molecules in IBD

Katarzyna Pawlak 1, Laurent Goessens 2

1 Department Gastroenterology, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland

2 Centre Hospitalier de Mouscron, Belgium

Topics

IBD

Published

2022

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Introduction

The incidence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) are notably higher in individuals diagnosed with type 2 diabetes mellitus (T2DM). However, studies evaluating the progression of MASLD in patients with T2DM and normal serum aminotransferase (ALT) levels are limited.

Aims & Methods

This 5-year prospective cohort study aimed to evaluate the progression of MASLD in T2DM patients with normal ALT. People with type 2 diabetes who had MASLD (defined by controlled attenuation parameter (CAP) >250 dB/min) and ALT levels that stayed normal (defined by ALT ≤40 IU/L for at least two occasions spanning at least six months) at Rajavithi Hospital, Bangkok, from November 2016 to 2017 were included. We excluded patients with viral hepatitis and alcohol consumption exceeding moderate levels. Transient elastography (TE) and CAP measurements were performed at baseline and ≥5 years of follow-up. The cutoffs to define significant and advanced fibrosis were TE >8 kPa and TE >12 kPa, respectively. All patients were instructed to reduce their weight and abstain from herbal remedies; medications for comorbidities were prescribed without limitations, subject to the physician's assessment. (most patients were under endocrinologist care.)

Results

The study included 84 patients, 57% of whom were female and had a mean age of 58.5 years. Of these, 62% were obese, with a mean BMI of 28.6 kg/m2. At baseline, the median TE was 6.92±3.35 kPa; 57 (68%) had no significant fibrosis, 22 (26%) had significant fibrosis, and 5 (6%) had advanced fibrosis, and after a 5-year follow-up, the median TE was 6.54±3.57 kPa; 69 (82%) had no significant fibrosis, 15 (18%) had significant fibrosis, and 2 (2%) had advanced fibrosis. During the follow-up, fibrosis decreased in 45 (54%), remained stable in 6 (7%), and increased in 33 (39%) patients, while a small proportion of patients experienced changes in the stages of fibrosis: 1.2% progressed from significant to advanced fibrosis; 17.4% regressed from advanced to significant fibrosis or transitioned from significant to no fibrosis; 12.8% remained stable with significant and advanced fibrosis; and the majority (66.3%) remained without significant fibrosis. A significant factor associated with fibrosis progression was alcohol consumption (p=0.013), while the use of angiotensin receptor blockers (p=0.042) was associated with fibrosis regression. Significant factors associated with steatosis progression included high baseline BMI (p=0.013), an increase in BMI ≥ 5% (p=0.04), high fasting plasma glucose, and LDL cholesterol levels, while a decrease in BMI ≥ 5% (p=0.002) the use of calcium channel blockers (p=0.038) and coffee consumption >3 cups per day (p=0.031) were associated with steatosis regression. ALT elevation during the follow-up occurred in a small proportion of patients, and it was not significantly associated with fibrosis or steatosis progression.

Conclusion

The majority of MASLD patients with T2DM and normal ALT maintained a relatively stable liver disease during 5 years of follow-up. Obesity, weight gain, alcohol consumption, and inadequate metabolic control were all associated with the progression of MASLD, whereas weight loss, coffee consumption, angiotensin receptor blockers, and calcium channel blockers were all associated with the improvement of MASLD.

Disclosure

I have nothing to disclose

PROGRESSION OF METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS AND NORMAL SERUM AMINOTRANSFERASE LEVELS: A 5-YEAR PROSPECTIVE COHORT

Wongagsorn Euateerasarun 1, Chalermrat Bunchorntavakul 1

1 Rajavithi Hospital, Bangkok, Thailand

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Abstract

Session

LIVER (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Introduction

Capsule endoscopy (CE) is commonly used as the initial exam in situations of suspected mid-gastrointestinal bleeding, after normal upper and lower endoscopy. Although the assessment of the small bowel is the primary focus of CE, detection of upstream or downstream vascular lesions may also be clinically significant. This study aimed to develop and test a Convolutional Neural Network (CNN)-based model for panendoscopic automatic detection of vascular lesions during CE.

Aims & Methods

A multicentric retrospective study was conducted, based on 1022 CE exams. We used a total of 35655 frames, from seven types of CE devices (PillCam Colon 1, PillCam Crohn's, PillCam SB1, PillCam SB3, OMOM HD, Olympus, Mirocam), of which 11091 were considered to have vascular lesions (angiectasia or varices) after triple validation. We divided data into a training and a validation set, the latter being used to evaluate the model’s performance. At time of division, all frames from a given patient were assigned to the same dataset. Our primary outcome measures were sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) and an area under the precision-recall curve (AUC-PR).

Results

A total of 35655 frames were used, with 11091 including vascular lesions. The validation data set contained 2433 frames with normal mucosa and 933 vascular lesions.
Sensitivity and specificity were 86.4% and 98.3%, respectively. PPV was 95.2%, while the NPV was 95.0%. Overall accuracy was 95.0%. The AUC-PR value was 0.96. The CNN processed 115 frames per second.

Conclusion

The study presents promising results for the application of AI deep learning models in panendoscopic automatic detection of vascular lesions in various gastrointestinal topographies. The methodological details, including the patient-split design and the use of frames from different types of CE devices, suggest that the model could be effectively used in routine clinical practice independently of the device brand. This study highlights the potential of panendoscopic evaluation of all gastrointestinal tract and the need for further research in this area. Overall, the high diagnostic performance of this CNN in multibrand devices addresses an important issue of technological interoperability, allowing it to be replicated in multiple technological settings. However, the study has some limitations, including a small number of frames and a retrospective design, which may introduce selection bias, therefore prospective and multicentric studies are needed before introducing this deep learning model into clinical practice. This is the first proof-of concept AI deep learning model developed for panendoscopic automatic detection of vascular lesions during CE.

References

Triester, S.L., et al., A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol, 2005. 100(11): p. 2407-18.
Liao, Z., et al., Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc, 2010. 71(2): p. 280-6.
Rondonotti, E., et al., Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy, 2018. 50(4): p. 423-446.
Ribeiro, T.F.-U.I.C.H., Colon capsule endoscopy and artificial intelligence: a perfect match por panendoscopy, in Artificial Intelligence in Capsule Endoscopy, C.H. Mascarenhas M, Macedo G, Editor. 2023, Academic Press.
Tsuboi, A., et al., Artificial intelligence using a convolutional neural network for automatic detection of small-bowel angioectasia in capsule endoscopy images. Dig Endosc, 2020. 32(3): p. 382-390.
Saurin, J.C., et al., Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy. Endoscopy, 2003. 35(7): p. 576-84.
Mascarenhas, M., et al., Deep learning and colon capsule endoscopy: automatic detection of blood and colonic mucosal lesions using a convolutional neural network. Endosc Int Open, 2022. 10(2): p. E171-e177

DEEP LEARNING AND CAPSULE ENDOSCOPY: AUTOMATIC MULTI-BRAND PANENDOSCOPIC DETECTION OF VASCULAR LESIONS

Pedro Cardoso 1, Miguel Mascarenhas-Saraiva 1, Miguel Martins 1, Tiago Ribeiro 1, João Afonso 1, Francisco Mendes 1, Ana Patrícia Andrade 1, Hélder Cardoso 1, Miguel Mascarenhas-Saraiva 2, João Ferreira 3, Guilherme Macedo 1

1 São João University Hospital, Porto, Portugal|||WGO Gastroenterology and Hepatology Training Center, Porto, Portugal|||Faculty of Medicine of the University of Porto, Porto, Portugal

2 ManopH, Instituto CUF, Porto, Portugal

3 Faculty of Engineering of the University of Porto, Porto, Portugal|||DIGESTAID - Digestive Artificial Intelligence Development, Porto, Portugal

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

Upper GI and small bowel endoscopy (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Online Course

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Acute pancreatitis is the most frequent pancreatic disease and the most common reason for emergency room admission for all nonmalignant gastrointestinal diseases. This rapid-onset and painful inflammation of the pancreas is troublesome to manage because it has a diverse and often unpredictable clinical course. Although the inflammation usually subsides, complications can develop, and some patients will progress to chronic pancreatitis.
Learning objectives

The aetiology of acute pancreatitis
The different classification systems for acute pancreatitis
The diagnosis of acute pancreatitis
The therapeutic regimes for acute pancreatitis
Target audience

This course is suitable for gastroenterologists in training, but it is also appropriate for physicians and surgeons in other disciplines, as well as nurses, biotechnicians and advanced-years’ medical students who have an interest in gastroenterology.

Acute pancreatitis

Ali Alexander Aghdassi, Markus M. Lerch

Event

Acute pancreatitis

Topics

Pancreas

Accreditation status

accredited

Duration

1 hour

Published

2020

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