Introduction

The functional lumen imaging probe (FLIP) relies on the principle of impedance planimetry that enables direct measurement of intraluminal cross-sectional areas, allowing the assessment of intraluminal diameters, lumen geometric profiles, and wall biomechanical properties. Electrical impedance refers to the opposition to alternating current presented by the combined effect of resistance and reactance in a closed circuit. Planimetrics is the study of plane measurements, including distances and areas. Since the early 2000s, impedance planimetry has been introduced into clinical practice, allowing principally assessment of any sphincter function / dysfunction. In humans, the functional lumen imaging probe is applied mostly to diseases of the oesophagus (achalasia, dysphagia, gastro-oesophageal junction outflow obstruction, eosinophilic oesophagitis, gastro-oesophageal reflux disease), pyloric distensibility (gastroparesis), and ano-rectal disorders (faecal incontinence). The physiology of the gastrointestinal tract of pigs is similar to that of humans, and therefore porcine experimental models are suitable for various endoscopic and preclinical studies.

Aims & Methods

Aims: The aim of our pilot project was to introduce this method to assess function of the lower oesophageal sphincter and pyloric muscle in experimental pigs.
Methods: All measurements were accomplished in one session under general anaesthesia in six adult female pigs (mean weight 34.2 ± 3.6 kg). EndoFLIP 1.0 System with EndoFLIP catheters (length of measuring zone 80 mm; 16 paired impedance planimetry sensors; filling volumes: 20, 30 and 40 mL). Five major parameters were evaluated for each filling volume: balloon pressure (mm Hg), estimated diameter (mm), cross-sectional area (mm²), distensibility defined as cross-sectional area divided by balloon distending pressure (mm²/mm Hg), and zone compliance defined as the change in volume over a 2-cm long segment spanning five electrodes, centred around the gastro-oesophageal junction or pylorus (mm³/mm Hg).

Results

In total, 180 particular readings were successfully accomplished, see Table 1. Most of the measured values were nearing lower average figures for the lower oesophageal sphincter and upper average figures for the pylorus in healthy humans. The porcine pyloric sphincter is composed of the torus pyloricus. It serves as a sturdy "gatekeeper" between the stomach and D1 duodenum, thus explaining higher pyloric readings. There was a clear trend for increasing values of CSA, diameter, and balloon pressure with increased filling balloon volumes. However, the sphincter distensibility did not change with increasing filling volumes either for the lower oesophageal sphincter or pylorus.

Table 1
Endoscopic functional luminal imaging probe panometry of the lower oesophageal sphincter and pylorus in six experimental pigs

Conclusion

Endoscopic functional luminal planimetry in experimental pigs is feasible, both for the lower oesophageal sphincter and the pylorus. This is an important starting point for future experimental endoscopic trials and pharmacology studies.

Introduction

The management of obesity is often complicated by associated comorbidities such as type 2 diabetes, hypertension and hyperlipidaemia—all of which contribute to significant polypharmacy. High pill burden is linked to reduced adherence, increased healthcare costs, and lower quality of life. While Endoscopic Sleeve Gastroplasty (ESG) has been established as a minimally invasive intervention for weight loss, its impact on medication use remains underexplored. This study aims to evaluate changes in medication burden following ESG in a real-world cohort, with a focus on the potential for pharmacological de-escalation alongside weight loss.

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 change in medication burden, defined as the total number of prescribed medications at baseline, 6 months, and 12 months following ESG. Data on medication count were collected from electronic medical records, including all chronic medications prescribed for obesity-related comorbidities.

Results

At baseline, 17.8% of patients were on one or more oral anti-diabetic medications, 2.6% were on insulin, 30.9% were taking antihypertensives, and 22% were on lipid-lowering therapy. At 6 months post-ESG, the proportion of patients on anti-diabetic medications decreased to 15.2%, and insulin use dropped slightly to 2.1%. Anti-hypertensive use declined to 20.8%, and lipid-lowering therapy was reduced to 17.1%. By 12 months, further reductions were observed: 12.7% of patients remained on anti-diabetic medications, only 1.4% were on insulin, and use of anti-hypertensives and lipid-lowering agents fell to 20.8% and 18.8%, respectively.
The total number of medications per patient decreased significantly over time. At baseline, patients were on an average of 1.36 medications targeting diabetes, hypertension, and hyperlipidemia. This declined to 0.61 medications at 6 months and 0.59 at 12 months, corresponding to mean reductions of 0.75 (95% CI: 0.42–1.07, p < 0.001) and 0.77 (95% CI: 0.46–1.08, p < 0.001), respectively. These reductions were consistent across all major cardiometabolic drug classes.

Conclusion

In addition to driving meaningful weight loss, ESG contributes to a measurable reduction in medication burden for obesity-related comorbidities. These findings support the broader role of ESG in promoting pharmacologic de-escalation, potentially improving long-term adherence and quality of life in patients with obesity.

Disclosure

NIL

Introduction

Previous studies have shown that appendectomy protects against the development of Ulcerative Colitis (UC), but the reason for this is not yet known. The risk of Crohn´s disease (CD) and Microscopic Colitis (MC) after appendectomy has been studied to a lesser extent. In Finland, the correlation between appendectomy and inflammatory bowel disease (IBD) has not been previously studied.

Aims & Methods

We aim to investigate the risk of developing IBD after appendectomy in the Hospital district of Helsinki and Uusimaa, Finland. In this cohort study the patient material consisted of data from the Hospital district of Helsinki and Uusimaa’s patient database from 2005-2020. The analysis included 8,969 patients, who underwent appendectomy, and 20,582 non-appendectomy controls matched by age and sex. The risk of IBD after appendectomy was analyzed by calculating the incidence-rate ratios (IRRs).

Results

In this study, we did not find a significant inverse correlation between appendectomy and UC (IRR 0.88, 95 % CI 0.31-2.15). However, we did find a significantly increased risk of both CD (IRR 7.04, 95 % CI 1.56-53.16) and MC (IRR 3.15, 95 % CI 1.16-8.97) after appendectomy. The increased risk of CD after appendectomy remained significant when the reason for appendectomy was defined as appendicitis and mesenteric lymphadenitis, but did not remain significant for other reasons.

Conclusion

The increased risk of Crohn’s disease and Microscopic Colitis after appendectomy suggests that appendectomy as a treatment should be carefully considered if acute appendicitis is suspected. Alternative treatment for uncomplicated appendicitis may include antibiotics or symptomatic treatment.

Introduction

Gastroparesis (GP) is a chronic motility disorder characterized by recurrent upper gastrointestinal (GI) symptoms, namely early satiety, nausea and vomiting, in the absence of a mechanical obstruction. Functional Lumen Imaging Probe (FLIP) is a potential game-changer in anatomical sphincter assessment. Recently, wide prospective trials[1] and a randomized sham-controlled study[2] implemented FLIP to predict response of pyloric-targeted treatments. This has prompted the need for a comprehensive analysis of available FLIP data in GP.

Aims & Methods

The aim of this systematic review was to investigate FLIP role in GP. Meta analysis of normative values and treatment comparative outcomes was also performed. A systematic search was performed until May 2024 on 4 major databases (Pubmed-MEDLINE, Embase, Web of Science, Cochrane). Studies on post-oncological/bariatric surgery gastroparesis were excluded. Pooled baseline mean of FLIP metrics and mean differences (MDs) pre vs post-treatment were calculated. In addition to estimate clinically meaningful normative values for GP, upper-limit reference ranges were estimated by pooled standard deviations (SDs) implementing the formula pooled mean ± 1.96 × pooled SD. Random effects meta-analysis with Knapp-Hartung correction for 95% confidence intervals (CIs) adjustment and I² statistics with subgroup analysis to address heterogeneity were performed.

Results

Twenty studies (N= 805 patients) were included. The majority focused on treatment response, particularly pyloromyotomy. The most assessed FLIP metrics were distensibility index (DI) and cross-sectional area (CSA). Three studies (on 7 total) reported a positive correlation between DI and CSA with specific symptoms (dyspepsia spectrum and nausea/vomiting) and their severity at baseline. Ten studies (on 15 total) studies showed an association between FLIP parameters with clinical response. Pooled mean DI ranged from 7.5 to 8.9 mm²/mmHg and CSA from 85.5 to 195.6 mm² at baseline. Minimum diameter (Dmin) ranged between 10.6 and 16.5 mm while Pressure (P) between 14.8 and 34.5 mmHg (table 1.). Upper-limit normative values for GP ranged from 173-317 mm² for CSA, 17-27 mm for Dmin, 32-64 mmHg for P (between 30-50 mL of fill volumes), while for DI at 50mL the reference limit attested at 21.5 mm²/mmHg. Comparing pre-and post-treatment response, MD of 2.5 mm²/mmHg (I² 24%) for DI at 50 mL, 46.7 mm² (I² 47%) and 68.8 mm² (I² 0%) for CSA at 40 and 50 mL respectively, were statistically significant.

Table 1. FLIP metrics pooled mean values at different fill volumes at baseline in gastroparesis patients

Conclusion

This is the first systematic effort in gathering evidence on FLIP in gastroparesis. CSA and DI significantly changed after pylorus-targeted treatments. Normative values displayed substantial heterogeneity and wide CIs. The cut-off of 10 mm²/mmHg for DI seems feasible to categorize patients to be addressed to pylorus-targeted treatments. Further studies to calculate prediction ability of this cut-off are warranted.

References

1. Jacques J, Pagnon L, Hure F, Legros R, Crepin S, Fauchais A-L, et al. Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function. Endoscopy. 2019;51(1):40-9.
2. Martinek J, Hustak R, Mares J, Vackova Z, Spicak J, Kieslichova E, et al. Endoscopic pyloromyotomy for the treatment of severe and refractory gastroparesis: a pilot, randomised, sham-controlled trial. Gut. 2022;71(11):2170-8.

Disclosure

E.V. received speaker and/or consulting fees from Sanofi/Regeneron, Falk Pharma, Apollo Therapeutics, and Aurora Biofarma. AJB received research funding from BMS, Sanofi/Regeneron, SST, and Dr. Falk Pharma and received speaker and/or consulting fees from Uniquity, Laborie, Medtronic, BMS, Dr. Falk Pharma, Calypso Biotech, Eupraxia, Aqilion, Alimentiv, Sanofi/Regeneron, Uniquity, Reckitt, AlfaSigma and AstraZeneca. All other authors did not have any disclosures.

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