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Summary: The ultimate guide to colorectal cancer staging surgery adjuvant treatment

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Summary: The ultimate guide to colorectal cancer staging surgery adjuvant treatment

Ana-Maria Bucalau 1

1 Erasme University Hospital, Brussels, Belgium

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Colorectal Digestive Oncology Surgery

Session

The ultimate guide to colorectal cancer staging surgery adjuvant treatment

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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TRANSFORMING RADIATION PROCTOPATHY MANAGEMENT: REAL-WORLD EVIDENCE ON PURASTAT FROM A UK TEACHING HOSPITAL

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Introduction

Radiation proctopathy (RP) is a common late complication of pelvic radiotherapy, affecting up to 20% of patients treated for pelvic malignancies. It manifests as rectal bleeding, anaemia, urgency, and diarrhoea, significantly reducing quality of life. Argon Plasma Coagulation (APC) remains the standard endoscopic therapy but has notable limitations, including high recurrence rates, the need for multiple sessions, and risks such as ulceration and perforation.
PuraStat, a synthetic self-assembling peptide hydrogel, offers an innovative alternative by creating a transparent matrix that promotes haemostasis and mucosal healing without thermal injury. While small series have shown benefit, robust real-world evidence is lacking.

Aims & Methods

We assessed real-world outcomes of PuraStat in RP at a UK tertiary centre (2023–2024). Consecutive patients with chronic radiation-induced rectal bleeding were included and treated by a single endoscopist. Patients were stratified into two cohorts:
1. De novo PuraStat – no prior APC (n=50)
2. APC→PuraStat – persistent or recurrent symptoms despite APC (n=50)
PuraStat was applied during flexible sigmoidoscopy, either as monotherapy or following APC. The primary outcome was resolution or improvement of rectal bleeding. Secondary outcomes included the number of repeat endoscopic interventions within 6 months and treatment-related adverse events.

Results

A total of 100 patients were included (median age: 74 years, range 64–85; 52% male). Most had prostate or gynaecological cancer treated with pelvic radiotherapy.
- De novo PuraStat (n=50): All achieved symptomatic relief, with marked bleeding reduction and endoscopic improvement. Follow-up sigmoidoscopy showed mucosal healing or mild residual proctitis in 92%. Mean repeat sessions: 1.3 (range 0–3) over 6 months.
- APC→PuraStat (n=50): These patients had undergone a median of 3 APC sessions with limited success. PuraStat led to complete symptom control in all cases, reducing the need for frequent interventions (mean: 1.5 sessions over 6 months).
No adverse events (e.g., perforation, infection, severe pain) were reported in either group. Patients with severe radiation-associated vascular ectasia (RAVE) and refractory bleeding demonstrated excellent response to PuraStat.

Conclusion

This large real-world series demonstrates that PuraStat is a safe, effective, and well-tolerated therapy for radiation proctopathy, whether used as first-line treatment or following APC failure. It provided rapid and sustained bleeding control, significantly reduced the need for repeat endoscopic interventions, and promoted mucosal healing without the risks associated with thermal therapies. Importantly, PuraStat showed consistent efficacy even in patients with severe radiation-associated vascular ectasia (RAVE) and those refractory to conventional modalities, highlighting its role as both a frontline and salvage option. These findings position PuraStat as a valuable addition to the therapeutic armamentarium for radiation-induced rectal bleeding. Larger prospective, multicentre studies and cost-effectiveness analyses are warranted to validate these results and define its optimal place in treatment algorithms.

Table 1: Treatment Outcomes by Group

Group	n	Symptom Relief	Mean Repeat Sessions
De novo PuraStat	50	100%	1.3
APC→PuraStat	50	100%	1.5

References

1- White K, Henson CC. Endoscopically delivered PuraStat for the treatment of severe haemorrhagic radiation proctopathy: Service evaluation of a new endoscopic treatment for a challenging condition. Frontline Gastroenterol. 2021;12(1):37–42. doi:10.1136/flgastro-2020-101735
2-Van de Wetering FT, Verleye L, Andreyev HJN, Maher J, Vlayen J, Pieters BR, et al. Non-surgical interventions for late rectal problems (proctopathy) of radiotherapy in people who have received radiotherapy to the pelvis. Cochrane Database Syst Rev. 2016;(4):CD003455. doi:10.1002/14651858.CD003455.pub2
3-Andreyev HJN, Davidson SE, Gillespie C, Allum WH, Swarbrick E. Practice guidance on the management of acute and chronic gastrointestinal problems arising as result of treatment for cancer. Gut. 2012;61:179–192. doi:10.1136/gutjnl-2011-300563
4-Dahiya DS, Kichloo A, Tuma F, Albosta M, Wani F. Radiation proctitis and management strategies. Clin Endosc. 2022;55(1):22–32. doi:10.5946/ce.2020.288
5-Rustagi T, Mashimo H. Endoscopic management of chronic radiation proctopathy. World J Gastroenterol. 2011;17(41):4554–4562. doi:10.3748/wjg.v17.i41.4554
6-Lenz L, Rohr R, Nakao F, Libera E, Ferrari A. Chronic radiation proctopathy: A practical review of endoscopic treatment. World J Gastrointest Surg. 2016;8(2):151–158. doi:10.4240/wjgs.v8.i2.151

TRANSFORMING RADIATION PROCTOPATHY MANAGEMENT: REAL-WORLD EVIDENCE ON PURASTAT FROM A UK TEACHING HOSPITAL

MUHAMMAD HUSNAIN KHIZAR 1, Sergio Coda 1, Vinoth Nadesalingam Vinoth Nadesalingam 1

1 Barking, Havering And Redbridge University Hospitals NHS Trust, London, United Kingdom

Event

UEG Week Berlin 2025

Topics

Colorectal Digestive Oncology Endoscopy Histopathology

Submission format

Late-Breaking Abstract

Session

Colorectal ESD: The better way?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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RIBOSOMAL PROTEIN RPS8 PROMOTES HEPATOCELLULAR CARCINOMA METASTASIS VIA UPREGULATING ISG15 TO STABILIZE NEUTROPHIL EXTRACELLULAR TRAP RECEPTOR CCDC25

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Introduction

Liver cancer ranks as the sixth most common malignant tumor worldwide and the third leading cause of cancer-related deaths. Hepatocellular carcinoma (HCC), accounting for approximately 90% of primary liver cancers, is among the most lethal malignancies, with a mortality-to-incidence ratio as high as 0.92. Metastasis remains a pivotal determinant of HCC patient prognosis and therapeutic efficacy, making in-depth exploration of its underlying mechanisms a critical foundation for improving clinical outcomes. Ribosomes, composed of ribosomal RNA (rRNA) and ribosomal proteins (RPs), are central to protein synthesis. Emerging evidence highlights that ribosomal heterogeneity influences tumor biology through differentially regulating protein translation. However, the specific mechanisms by which ribosomal proteins contribute to HCC metastasis remain poorly characterized, underscoring a significant gap in oncological research.

Aims & Methods

We performed a screen for ribosomal genes associated with survival in HCC patients using multiple databases through a comprehensively bioinformatics analysis. We estimated the correlation between RPS8 expression and clinicopathological features of patients in HCC. We explored the biological function of RPS8 in HCC cells via lentiviral in vitro. We further assessed the tumorigenicity of RPS8 using both subcutaneous tumor formation in nude mouse and orthotopic liver tumorigenesis in NCG mouse. multi-omics were applied for exploring the mechanism of RPS8 in HCC.

Results

Comprehensive pathological evaluation of HCC clinical specimens revealed overexpression of RPS8 in tumor tissues, which exhibited significant associations with higher tumor stage, poorly differentiated histology , microvascular invasion,and reduced overall survival.Functional studies demonstrated that knockdown of RPS8 suppressed proliferation, migration, and invasion in HCC cell lines . Overexpression of RPS8 could enhance the malignant behavior of HCC cells. Moreover, RPS8 depletion reduced subcutaneous tumor volume and orthotopic liver tumor metastasis to lungs. Mechanistically, proteomic analysis and RIP-seq revealed interferon-stimulated gene 15 (ISG15) exhibited the most significant downregulation at the protein level upon RPS8 knockdown and RPS8 directly binds to ISG15 mRNA. GO and KEGG analysis indicate that RPS8 promotes HCC invasion and metastasis by modulating cell motility and migration. Among the top five differentially expressed proteins, CCDC25, a neutrophil extracellular trap (NET) repceptor, exhibited the most significant downregulation upon RPS8 knockdown. ISG15 can bind with target proteins to form ISGlation, thus preventing the ubiquitinlation. Bioinformatic predictions have identified six potential ubiquitination modification sites in CCDC25. Additionally, molecular docking analyses suggest the presence of potential ubiquitination modification sites within the binding interface between ISG15 and CCDC25. We then performed CCDC25 overexpression in RPS8-knockdown HCC cells and CCDC25 knockout in RPS8-overexpressing HCC cells. Downregulation or upregulation of CCDC25 partially reversed the oncogenic effects of RPS8 respectively, supporting CCDC25 as a critical downstream mediator of RPS8-driven HCC progression. Finally, we found that NETs from HCC patients could promote in vivo metastasis of control cells, but showed less efficacy in RPS8-knockdown cells.

Conclusion

Ribosomal protein RPS8 promotes HCC metastasis through upregulating ISG15 to stabilize NETs receptor CCDC25 protein. These findings provide a promising therapeutic strategy targeting .

References

1.Kang J, Brajanovski N, Chan KT et al. Ribosomal proteins and human diseases: molecular mechanisms and targeted therapy. Signal Transduction and Targeted Therapy 2021; 6.
2. Larionova TD, Bastola S, Aksinina TE et al. Alternative RNA splicing modulates ribosomal composition and determines the spatial phenotype of glioblastoma cells. Nature Cell Biology 2022; 24:1541-1557.
3.Kang JA, Kim YJ, Jeon YJ. The diverse repertoire of ISG15: more intricate than initially thought. Experimental & Molecular Medicine 2022; 54:1779-1792.
4.Yang L, Liu Q, Zhang X et al. DNA of neutrophil extracellular traps promotes cancer metastasis via CCDC25. Nature 2020; 583:133-138.
5.Zhan X, Wu R, Kong XH et al. Elevated neutrophil extracellular traps by HBV‐mediated S100A9‐TLR4/RAGE‐ROS cascade facilitate the growth and metastasis of hepatocellular carcinoma. Cancer Communications 2022; 43:225-245.

RIBOSOMAL PROTEIN RPS8 PROMOTES HEPATOCELLULAR CARCINOMA METASTASIS VIA UPREGULATING ISG15 TO STABILIZE NEUTROPHIL EXTRACELLULAR TRAP RECEPTOR CCDC25

Qin Tang 1, Xueyin Chen 1, Yongjun Zhu 1, Jian Gao 1, Song He 1, Zhihang Zhou 1

1 The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Immunology Mechanisms & Personalised Medicine

Submission format

Abstract

Session

Bench to bedside and beyond frontiers in HCC

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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SAFETY AND EFFICACY OF EXTENDED SURVEILLANCE INTERVALS FOLLOWING COLORECTAL ESD: AN INTERNATIONAL MULTICENTER STUDY

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Introduction

Post-ESD surveillance guidelines remain heterogeneous, with many centers favoring early surveillance colonoscopy (SC) despite low recurrence rates after curative resection. This study aimed to evaluate the safety and outcomes of delayed SC after R0 colorectal ESD for benign lesions and to identify risk factors for metachronous advanced neoplasia.

Aims & Methods

We retrospectively analyzed 1,097 patients who underwent colorectal ESD between 2013 and 2021. Clinical, procedural, and histological characteristics were recorded. Among 778 patients with available surveillance data, outcomes were compared between those who had early SC (<12 months) and those with delayed SC (>24 months). Rates of recurrence, advanced neoplasia, and colorectal cancer were assessed. Risk factors for metachronous advanced neoplasia were evaluated via univariate and multivariate analysis.

Results

Mean patient age was 74.3 ± 10.8 years; 54.1% were male. En bloc and R0 resection rates were 95.8% and 83.3%, respectively. Among patients with surveillance data, 82.6% underwent early SC, and 17.4% had late-only SC. The rate of advanced adenoma at first SC was low and comparable between early and late groups (3.9% vs. 6.7%, p = 0.167). The overall rate of metachronous advanced adenoma was 6.5%, with no significant difference between early and late strategies (6.1% vs. 8.9%, p = 0.25). All four colorectal cancers were detected in the early group; none occurred in the late-only group. Recurrence on the ESD scar was rare (1.5% overall), and no late recurrences occurred after a normal SC1. The only significant predictor of metachronous advanced neoplasia was the number of synchronous lesions at index colonoscopy (OR 1.16, 95% CI 1.07–1.27; p < 0.01).

Conclusion

Delayed surveillance colonoscopy 3 years after R0 colorectal ESD for benign lesions appears safe and effective in selected patients. The multiplicity of synchronous lesions could guide risk stratification. These findings support extending SC intervals after curative ESD, with potential to reduce unnecessary procedures.

References

Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ, et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy. juin 2022;54(6):591‑622.
Dai M, Xiao X, Guo CLT, Lui RN, Yip HC, Chu S, et al. The Long‐Term Risk of Metachronous Advanced Adenoma Recurrence After Endoscopic Submucosal Dissection for Colorectal Neoplasia: A Propensity‐Score Matched Longitudinal Cohort With 5‐Year Follow‐Up. United Eur Gastroenterol J. 21 déc 2024;13(2):210‑9.
Yoshida N, Naito Y, Siah KTH, Murakami T, Ogiso K, Hirose R, et al. High incidence of metachronous advanced adenoma and cancer after endoscopic resection of colon polyps ≥20 mm in size. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. mars 2016;28(2):194‑202.

SAFETY AND EFFICACY OF EXTENDED SURVEILLANCE INTERVALS FOLLOWING COLORECTAL ESD: AN INTERNATIONAL MULTICENTER STUDY

Paul Brouzeng 1, Jérémie Jacques 2, Jeremie Albouys 3, Paul Carrier 2, Romain Legros 1, Hugo Lepetit 4, Sophie GEYL 1, Ludovico Alfarone 5, Abdulraman Qatomah 6, Cesare Hassan 7, Daryl Ramai 6, Hiroyki Aihaiara 6

1 CHU Limoges, Limoges, France

2 CHU Limoges - Hepato-Gastro-Enterology, CHU Limoges; Limoges/FR, Limoges, France

3 CHU Limoges / University of Limoges, Limoges, France

4 CHU Limoges France, Limoges, France

5 Milan, Milan, Italy

6 Brigham and Women's Hospital, Boston, United States

7 Humanitas University, Pieve Emanuele MI, Italy

Event

UEG Week Berlin 2025

Topics

Colorectal Digestive Oncology Endoscopy Histopathology

Submission format

Late-Breaking Abstract

Session

Colorectal ESD: The better way?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Rheumatic diseases affecting the liver

Emanuel della Torre 1

1 San Raffaele University, San Raffaele, Italy

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Hepatobiliary Immunology

Session

Autoimmune disease of liver and bile ducts

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Integrative care of gastric cancer: From endoscopic therapies to surgery and chemo/raditherapy

David G. Graham 1, Bas P.L. Wijnhoven 2

1 University College London Hospital, London, United Kingdom

2 Erasmus MC Rotterdam Dept. of Surgery, Rotterdam, Netherlands

Event

UEG Postgraduate Teaching Programme Berlin 2025

Session

From risk to recovery: A postgraduate dive into gastric cancer care

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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A PROSPECTIVE STUDY COMPARING ULTRA-LOW VOLUME BOWEL PREPARATIONS FOR CAPSULE COLONOSCOPY AND PAN-INTESTINAL CAPSULE ENDOSCOPY: EFFICACY OF 1L POLYETHYLENE GLYCOL PLUS ASCORBIC ACID VS. SODIUM PICOSSULFATE WITH MAGNESIUM CITRATE

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Introduction

Capsule colonoscopy and Pan-intestinal Capsule Endoscopy (PCE) are well-established diagnostic procedures. However, the optimal bowel preparation regimen remains undefined, with pooled adequate cleansing rates reaching only 72.5%¹. While ultra-low volume preparations (≤1L) have demonstrated efficacy in conventional colonoscopy², their effectiveness in capsule-based modalities has yet to be determined.

Aims & Methods

In this prospective, randomized, researcher-blind, single center trial, we compared the efficacy of two ultra-low volume bowel preparation regimens, 1L Polyethylene Glycol Plus Ascorbic Acid (PEG-Asc) and 1L Sodium Picossulfate with Magnesium Citrate (SPMC). Patients referred for capsule-based procedures were randomized in a 1:1 ratio to receive either PEG-Asc or SPMC. The primary endpoints were the rates of complete examinations, adequate bowel preparation, and excellent right colon cleansing.

Results

A total of 117 patients were included, referred for capsule colonoscopy due to incomplete colonoscopy (76.1%) or for PCE to assess luminal inflammation (17.9%) or anemia (6%). Overall, 61.5% were female, with a mean age of 61.3 ± 16 years. The complete examination rate was 71.8%, with no significant difference between groups (PEG-Asc 72.9% vs. SPMC 70.7%; p = 0.792). Adequate bowel preparation was achieved in 62.4% of cases, which was significantly more frequent in the PEG-Asc group (72.9%) compared to SPMC (51.7%; p = 0.018). Among complete procedures, excellent right colon cleansing was observed more often with PEG-Asc (34.1%) than with SPMC (7.3%; p = 0.003).

Conclusion

The completion and adequate preparation rates remain suboptimal in the capsule colonoscopy and PCE procedures. In this study, both ultra-low volume purgative solutions demonstrated comparable efficacy in achieving complete examinations, but the PEG-Asc resulted in significantly better overall preparation quality and superior right colon cleansing compared to SPMC. These findings suggest that PEG-Asc may be the preferred ultra-low volume regimen for optimizing bowel visualization in capsule-based examinations.

References

1. Rosa, B., Donato, H., Cúrdia Gonçalves, T., Sousa-Pinto, B. & Cotter, J. What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis. Dig. Dis. Sci. 68, 4418–4431 (2023).
2. Arieira, C. et al. Bowel cleansing efficacy for colonoscopy: prospective, randomized comparative study of same-day dosing with 1-L and 2-L PEG + ascorbate. Endosc. Int. Open 09, E1602–E1610 (2021).

A PROSPECTIVE STUDY COMPARING ULTRA-LOW VOLUME BOWEL PREPARATIONS FOR CAPSULE COLONOSCOPY AND PAN-INTESTINAL CAPSULE ENDOSCOPY: EFFICACY OF 1L POLYETHYLENE GLYCOL PLUS ASCORBIC ACID VS. SODIUM PICOSSULFATE WITH MAGNESIUM CITRATE

Joao Carlos Goncalves 1, Ines Marques 1, Mariana Souto 1, Ana Isabel Ferreira 1, Joana Lúcia Teixeira Magalhães Magalhães 1, Bruno Rosa 1, José Berkeley Cotter 1

1 Unidade Local de Saúde do Alto Ave, Guimarães, Portugal|||Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal

Event

UEG Week Berlin 2025

Topics

Endoscopy Radiology & Imaging Colorectal

Submission format

Abstract

Session

Advances in the investigation of the small bowel

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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