UEG Week 2025: Relive the Highlights

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Introduction

The adherence of doctors and patients to published colorectal post-polypectomy surveillance guidelines varies greatly, and patient follow-up is critical but time-consuming.

Aims & Methods

Aims: We aimed to develop an automatic surveillance (AS) system to accurately identify post-polypectomy patients, assign surveillance intervals for different risks of patients and proactively follow up with patients on time.
Methods: The endoscopic and pathological reports from 47,544 patients from three hospitals were used to develop AS system based on natural language processing. The performance of AS system was fully evaluated in internal and external tests according to five different guidelines worldwide and compared with that of doctors. Furthermore, a multi-reader-multi-case (MRMC) trial was conducted to evaluate the effect of AS system on improving doctors’ guideline adherence and efficiency, and a prospective trial was performed to evaluate the success rate for automatically informing patients and its effect on reducing the burden of nurses.

Results

In internal, external 1, and external 2 tests, the system reached an overall accuracy of 99.73%, 99.54%, and 99.77% for identifying different types of patients, respectively; and achieved an overall accuracy of ≥99.45%, ≥98.89%, and ≥98.56% for stratifying patients' risk levels and assigning surveillance intervals according to five guidelines. The system greatly increased the accuracy of doctors (98.67% vs. 78.10%, p=0.043) in MRMC trial. In a prospective trial, AS system successfully informed 93·18% of patients, and significantly reduced the follow-up time cost (127.4s vs. 14.02s per patient).

Conclusion

This system has great potential to improve doctors' adherence to guidelines while relieving the workload of doctors and nurses.

Disclosure

The authors declare no conflict of interest.

THE DEVELOPMENT AND CLINICAL EVALUATION OF A NATURAL LANGUAGE PROCESSING-BASED AUTOMATIC SURVEILLANCE SYSTEM FOR COLORECTAL POST-POLYPECTOMY PATIENTS

CONGHUI SHI 1, Lianlian Wu 1, Jia Li 1, Honggang Yu 1

1 Renmin Hospital of Wuhan University, Wuhan, China

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 Standards and Guidelines

Position Paper

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Abstract

Objectives

Jejunal tube feeding (JTF) is increasingly becoming the standard of care for children in whom gastric tube feeding is insufficient to achieve caloric needs. Given a lack of a systematic approach to the care of JTF in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimize its utility and safety.

Methods

A group of members of the Gastroenterology and Nutrition Committees of the European Society of Paediatric Gastroenterology Hepatology and Nutrition and of invited experts in the field was formed in September 2016 to produce this clinical guide. Seventeen clinical questions treating indications and contraindications, investigations before placement, techniques of placement, suitable feeds and feeding regimen, weaning from JTF, complications, long-term care, and ethical considerations were addressed.

A systematic literature search was performed from 1982 to November 2018 using PubMed, the MEDLINE, and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.

During a consensus meeting, all recommendations were discussed and finalized. In the absence of evidence from randomized controlled trials, recommendations reflect the expert opinion of the authors.

Results

A total of 33 recommendations were voted on using the nominal voting technique.

Conclusions

JTF is a safe and effective means of enteral feeding when gastric feeding is insufficient to meet caloric needs or is not possible. The decision to place a jejunal tube has to be made by close cooperation of a multidisciplinary team providing active follow-up and care.

The Use of Jejunal Tube Feeding in Children

Ilse Broekaert

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Position Paper

Topics

Paediatrics Small Intestine & Nutrition

Citation

Journal of Pediatric Gastroenterology and Nutrition, 69: 239-258

Published

2019

UEG Standards and Guidelines

Consensus

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Abstract

Background
Medical advances have dramatically improved the long-term prognosis of children and adolescents with once-fatal hepatobiliary diseases. However, there is no generally accepted optimal pathway of care for the transition from paediatric care to the adult health system.

Aim
The purpose of this position paper is to propose a transition process for young people with paediatric onset hepatobiliary diseases from child-centred to adult-centred healthcare services.

Methods
Seventeen ESPGHAN/EASL physicians from 13 countries (Austria, Belgium, France, Germany, Hungary, Italy, the Netherlands, Norway, Poland, Spain, Sweden, Switzerland, and United Kingdom) formulated and answered questions after examining the currently published literature on transition from childhood to adulthood. PubMed and Google Scholar were systematically searched between 1980 and January 2018. Quality of evidence was assessed by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) system. Expert opinions were used to support recommendations whenever the evidence was graded weak. All authors voted on each recommendation, using the nominal voting technique.

Results
We reviewed the literature regarding the optimal timing for the initiation of the transition process and the transfer of the patient to adult services, principal documents, transition multi-professional team components, main barriers, and goals of the general transition process. A transition plan based on available evidence was agreed focusing on the individual young people's readiness and on coordinated teamwork, with transition monitoring continuing until the first year of adult services.

We further agreed on selected features of transitioning processes inherent to the most frequent paediatric-onset hepatobiliary diseases. The discussion highlights specific clinical issues that will probably present to adult gastrointestinal specialists and that should be considered, according to published evidence, in the long-term tracking of patients.

Conclusions
Transfer of medical care of individuals with paediatric onset hepatobiliary chronic diseases to adult facilities is a complex task requiring multiple involvements of patients and both paediatric and adult care providers.

Keywords: children; hepatobiliary disease; transition; young adults; young people

The Health Care Transition of Youth With Liver Disease Into the Adult Health System: Position Paper From ESPGHAN and EASL

Pietro Vajro, Björn Fischler, Patrizia Burra, Dominique Debray, Antal Dezsofi, Salvatore Guercio Nuzio, Nedim Hadzic, Loreto Hierro, Jörg Jahnel, Thierry Lamireau, Patrick McKiernan, Valérie McLin, Valerio Nobili, Piotr Socha, Françoise Smets, Ulrich Baumann, Henk Jan Verkade

Publishers

European Society for Paediatric Gastroenterology, Hepatology and Nutrition, European Association for the Study of the Liver

Guideline

Consensus

Topics

Hepatobiliary Paediatrics

Citation

Journal of Pediatric Gastroenterology and Nutrition, 66: 976-990

Published

2018

UEG Presentation

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GP: First line diagnosis and treatment

Juan Mendive 1

1 European Society for Primary Care Gastroenterology (ESPCG), Sant Adrià de Besòs ( Barcelona), Spain

Event

UEG Week Berlin 2025

Topics

Neurogastroenterology & Motility Primary Care

Session

Therapy update: Dyspepsia

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Gastro-oesophageal reflux disease diagnosis and how to avoid them

Sabine Roman 1

1 Hôpital Edouard Herriot, Lyon, France

Event

UEG Week Berlin 2025

Topics

Endoscopy Nurses Small Intestine & Nutrition Oesophagus Surgery

Session

Mistakes in…: Upper GI

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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LONG-TERM PROTON PUMP INHIBITOR USE AND RISK OF GASTRIC NEUROENDOCRINE NEOPLASMS IN A POPULATION-BASED STUDY FROM THE FIVE NORDIC COUNTRIES

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Introduction

Hypergastrinemia, caused by chronic atrophic gastritis or Helicobacter pylori (H. pylori) associated pangastritis, is associated with an increased risk of non-cardia gastric cancer. Recent studies have also found an increased risk of gastric cancer in long-term proton pump inhibitor (PPI) users. Patients with chronic atrophic gastritis also have an increased risk of neuroendocrine neoplasms (NEN) due to hypergastrinemia. However, whether long-term PPI use increases the risk of gastric NEN has not been assessed in the general population.

Aims & Methods

The aim of the present study was to assess the risk of gastric NEN among long-term PPI users in a multinational population-based study from the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden). The study was based on the Nordic Gastric and Esophageal Tumor Study (NordGETS), which is a population-based multinational sex, age, calendar year, and country matched case-control study including all adults (≥18 years of age) with a diagnosis of gastric or esophageal tumor in the Nordic countries. In the present study, the cases were incident gastric NEN identified in the cancer registries and the exposure was long-term use of PPI categorised into three equal-sized groups (tertiles) of defined daily doses (DDDs) from the medication registries of the Nordic countries between 1996 and 2020. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for chronic atrophic gastritis, NEN in the duodenum or pancreas, and H. pylori infection identified in the patient registries and medication registries.

Results

In total, 1,790 gastric NEN case patients were compared to 17,897 control participants. After a one-year run-in period, the median follow-up was 11.8 years. The risk of incident gastric NEN increased in PPI users compared to non-users in a dose-dependent manner. The adjusted OR for incident gastric NEN was 1.83 (95% CI 1.56 to 2.15) in the highest tertile of PPI use (>385 DDDs, entire drug history) compared to no PPI use (Table). The risk was higher in the younger age group (<65 years) than the older age group (≥65 years) and the estimates were consistent when excluding individuals with chronic atrophic gastritis, other NENs, and H. pylori.

Table Risk of gastric neuroendocrine neoplasms (NEN) by proton pump inhibitor (PPI) exposure defined by tertiles of defined daily doses (DDD) for the entire drug history between 1996 and 2020.
PPI (DDD)*	Crude odds ratio (95% confidence interval)**	Adjusted odds ratio (95% confidence interval)***
None	1.00 (reference)	1.00 (reference)
Tertile 1	1.46 (1.25-1.70)	1.34 (1.14-1.58)
Tertile 2	1.54 (1.30-1.81)	1.37 (1.15-1.64)
Tertile 3	1.92 (1.65-2.24)	1.83 (1.56-2.15)
* Tertiles: 1 ≤56 DDDs; 2 >56-385 DDDs; 3 >385 DDDs. Matched for sex, age, calendar year, and country. * Matched for sex, age, calendar year, and country, and adjusted for chronic atrophic gastritis, NEN in duodenum or pancreas, and H. pylori.

Conclusion

In this population-based study from the five Nordic countries the risk of gastric NEN was increased in PPI users compared to non-users of PPI in a seemingly dose-dependent manner. The risk was higher in younger age groups of PPI users compared to older age groups.

Disclosure

No conflicts of interest

LONG-TERM PROTON PUMP INHIBITOR USE AND RISK OF GASTRIC NEUROENDOCRINE NEOPLASMS IN A POPULATION-BASED STUDY FROM THE FIVE NORDIC COUNTRIES

Eivind Ness-Jensen 1, Giola Santoni 2, Cecilia Radkiewicz 2, My von Euler-Chelpin 3, Joonas H. Kauppila 4, Helgi Birgisson 5, Reidar Fossmark 6, Jesper Lagergren 7

1 NTNU, Norwegian University of Science and Technology, Levanger, Norway|||Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway

2 Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden

3 University of Copenhagen, Copenhagen, Denmark

4 University of Oulu and Oulu University Hospital, Oulu, Finland|||Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden

5 Icelandic Cancer Registry, Reykjavík, Iceland

6 NTNU, Norwegian University of Science and Technology, Trondheim, Norway|||Oslo University Hospital, Oslo, Norway

7 King's College London and Guy’s and St Thomas Foundation Trust, London, United Kingdom|||Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Endoscopy Oesophagus

Submission format

Abstract

Session

From prediction to detection in upper GI

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Poster

Standard Poster

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Introduction

Barrett’s oeosphagus (BO) is the precursor to oesophageal adenocarcinoma (OAC), a malignancy with a poor overall prognosis. Endoscopic surveillance of patients with BO aims to detect dysplasia and OAC to improve long-term outcomes. However, the majority of patients with BO do not progress to cancer.^1,2 It is therefore important to establish the relevant clinical risk factors for malignant progression in this cohort to enable risk stratification and facilitate a personalised approach to management. While obesity is an independent risk factor for both BO and OAC,^3-5 the role of obesity in the malignant progression of BO is unclear. We undertook a systematic review and dose-response meta-analysis to estimate the association between obesity and malignant progression in patients with BO.

Aims & Methods

We searched MEDLINE and EMBASE databases via the OVID interface to December 2023. Studies which reported the effect of body mass index (BMI) on the progression of BO (no dysplasia or low-grade dysplasia[LGD] at baseline) to HGD or OAC were included. Two-stage dose-response meta-analysis was performed to estimate the association between BMI and malignant progression. Study quality was appraised using a modified Newcastle-Ottawa scale. The review was registered on PROSPERO (CRD42017051046).

Results

Twenty studies reported data on 38565 patients in total, of whom 1684 patients were diagnosed with HGD/OAC/OC. Each 5kg/m²increase in BMI was associated with a 4% increase in malignant progression to HGD or OAC (unadjusted OR 1.04; 95% CI 1.00 to 1.07; p<0.001; I² 57.2%). The association remained consistent after adjusting for potential confounders (adjusted OR 1.06; 95% CI 1.02 to 1.10;p<0.001; I² 0%). Nineteen studies were considered moderate to high quality.

Conclusion

Our meta-analysis suggests that obesity as measured by BMI is associated with malignant progression of BO with a dose-response relationship. The findings from our study are consistent with mechanistic evidence for the role of obesity in the pathogenesis of OAC. Future risk prediction models could incorporate measures of obesity to potentially improve risk stratification in patients with BO. Weight loss might reduce the risk of malignant progression in patients with BO.

References

1. Bhat S, Coleman HG, Yousef F, et al. Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study. J Natl Cancer Inst 2011;103:1049-57.
2. Hvid-Jensen F, Pedersen L, Drewes AM, et al. Incidence of adenocarcinoma among patients with Barrett's esophagus. N Engl J Med 2011;365:1375-83.
3. Kubo A, Cook MB, Shaheen NJ, et al. Sex-specific associations between body mass index, waist circumference and the risk of Barrett's oesophagus: a pooled analysis from the international BEACON consortium. Gut 2013;62:1684-91.
4. Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008;371:569-78.
5. Corley DA, Kubo A, Zhao W. Abdominal obesity and the risk of esophageal and gastric cardia carcinomas. Cancer Epidemiol Biomarkers Prev 2008;17:352-8

THE ASSOCIATION BETWEEN OBESITY AND MALIGNANT PROGRESSION OF BARRETT’S OESOPHAGUS: A SYSTEMATIC REVIEW AND DOSE-RESPONSE META-ANALYSIS

Mie Thu Ko 1, Tom Thomas 2, Emily Holden 1, Ian Beales 3, Leo Alexandre 4

1 University Of East Anglia, Norwich, United Kingdom

2 Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom

3 Norfolk & Norwich University Hospital, Norwich, United Kingdom

4 Norfolk and Norwich University Hospital, Norwich, United Kingdom

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

Barrett's oesophagus (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Week 2025: Relive the Highlights

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