Introduction

Transient elastography (TE) by Fibroscan® is a widespread method for non-invasive evaluation of liver stiffness measurement (LSM). Point-shear wave elastography (pSWE) is an alternative non-invasive method for this type of assessment. Transient elastography is also able to evaluate hepatic steatosis by the function Controlled Attenuation Parameter (CAP).

Aims & Methods

We aimed to compare the results of TE and pSWE for fibrosis assessment in patients with non-alcoholic steatohepatitis (NASH), stratified by the degree of steatosis.
​Consecutive patients with established diagnosis of NASH attending our Gaastroenterology Unit underwent liver stiffness measurement (LSM) by both TE and pSWE. Liver steatosis was measured by CAP and the severity was graded into S0-S3. At least 10 measurements were performed and results were expressed as median with interquartile range. Statistical analysis was conducted by Pearson’s test for correlation and linear regression. Bland-Altman graphs with bias and ROC curves with estimation of sensitivity, specificity, and area under the curve (AUC) were drawn.

Results

Seventy-seven patients were recruited (17 females, 60 males, aging 54.1 ± 13.9). The overall correlation between TE and pSWE was moderate (r=0,63, p < 0.001). Linear regression showed a “b” coefficient of 0.99 ± 0.033. The Bland-Altman plot found a bias of -0,52 and only six valued exceeded the 95% CI limits. When considering patients with mild steatosis (S1), we found a strong correlation (r=0.81, 95% CI 0.39-0.95, p=0.003). The highest correlation between TE and pSWE was recorded for S2 subjects: r=0.90 (95% CI, 0.64-0.98, p<0.001). The correlation was low in S3 patients (r=0.42, 95% CI, 0.09-0.67, p=0.001). A cut-off of 11.15 kPa of pSWE had sensitivity=87,50 % and specificity=97,10% to detect relevant fibrosis, with an AUC=0.98 compared to TE.

Conclusion

pSWE and TE showed comparable LSM in NASH. A good concordance was observed in patients with mild or moderate liver steatosis, while in S3 patients we observed a weaker agreement between the two techniques.

Introduction

Liver elastography is one of the basic diagnostic tools in hepatology practice. The most widely used and most studied tool in the world is transient elastography (Fibroscan), however, this system is unevenly available in Slovakia. Shear-wave elastography is a more accessible method because it is built into standard ultrasound systems. However, the problem of shear-wave elastography remains the interpretation of its results, since the threshold values for significant fibrosis (SF) and advanced fibrosis (AF) are unique for each system.

Aims & Methods

To compare the results of transient elastography (TE) and point shear-wave elastography (pSWE) in a cohort of patients examined simultaneously with both systems and to determine the clinical benefit of pSWE in practice.
We examined all indicated patients over a 15-month period using both TE and pSWE (Hitachi Arietta V70). We recorded liver stiffness values in kPa, and baseline demographic and laboratory parameters. We used TE as the gold standard, with a threshold of >10 kPa for SF and >15 kPa for AF. We evaluated the accuracy of pSWE in predicting the detection of SF and AF. We used three models: the first one containing only pSWE values, and two logit models using pSWE together with common demographic and laboratory parameters. We identified the area under the curve (AUROC) and threshold values for each model and evaluated the probability of SF and AF according to these values.

Results

We examined 500 patients with a median age of 60 (IQR 48-69), male/female 214/286, with a SF rate of 30.8% and AF of 18.4%. The stiffness values according to TE and pSWE showed a highly significant correlation (rho=0.593, P<0.001). We found the accuracy of pSWE alone in predicting SF (AUROC=0.812), and AF (AUROC=0.839) with threshold values of SF>6.34 and AF>8.45 kPa. For values of pSWE<6.34, 6.34-8.45, and >8.45 kPa, the probability of SF was 11.1, 40.9, and 65.4% and AF was 5.0, 14.77, and 48.9%. We created two probability models (for P, range 0 to 1): ASTEL1 (N=369) that included pSWE, GGT, and platelets (AUROC SF=0.856, AUROC AF=0.908), and ASTEL2 (N=467) using pSWE, age, sex, AST/ALT, GGT (AUROC SF=0.857, AUROC AF=0.901). We set a threshold of P<0.33 to exclude SF and P>0.66 to confirm AF. At P<0.33, P=0.33-0.66, and P>0.66, SF was present in 15.6, 62, and 94.2% (ASTEL1) and 13.92, 50.7, and 86.8% (ASTEL2). At P<0.33, P=0.33-0.66 and P>0.66, AF was present in 5.6, 30, and 79.7% (ASTEL1) and in 4.4, 28, 73.68% (ASTEL2).

Conclusion

pSWE alone has an excellent negative predictive value (<6.34 kPa, 88.9-95%) in the diagnosis of SF and AF. Higher accuracy of positive prediction of SF (86.8-94.2%) and AF (73.7-79.7%) can be achieved by using one of two probability models (for P>0.66) combining SWE values with common demographic and laboratory parameters.

Introduction

PEUGIC (Post-Endoscopy Upper Gastrointestinal Cancer) is defined as carcinoma in the upper gastrointestinal (GI) tract which was preceded by negative upper endoscopy in the last 3 years. According to current knowledge, the rate of PEUGIC is an important parameter of quality and should not exceed 10 %. The aim of this study was to evaluate the occurrence and risk factors of PEUGIC at non-university hospital in Frydek-Mistek (Czech Republic) between 2013 and 2023.

Aims & Methods

This is a retrospective analysis of the patients diagnosed with upper GI cancer from January 2013 to December 2023. The data analyzed included family history of upper GI cancer, indications of the examination, therapy, tumor location and histological type. Risk factors for PEUGIC were calculated using the Chi-squared test and Fisher's exact test, with p <0,05 considered significant.

Results

During the study period, a total of 22727 gastroscopies were performed in total, and 122 patients were diagnosed with upper GI cancer (88 men and 34 women), including 35 esophageal tumors, 80 gastric tumors, and 7 duodenal tumors. Family history of upper GI tumor was reported in 10 patients. PEUGIC was identified in 12 patients (9,84%, 9 men and 3 women, mean age 69,25 years), including 6 in the esophagus, 5 in the stomach, and 1 in the duodenum. Two patients had early detection as part of adequate surveillance (Barrett's esophagus, post-polypectomy). Thus, we can evaluate 10 patients as true PEUGIC (8,20%). The rate of PEUGIC was 17,14 % (6/35) in the esophagus, 6,25 % (5/80) in the stomach, and 14,3 % (1/7) in the duodenum. Tumor location (for esophagus p=0,086, for stomach p=0,065, for duodenum p=0,525), histology (for adenocarcinoma p=0,332, for spinocelular cancer p=0,402, for neuroendocrine tumor p=0,25), male gender (p=0,815), or family history of upper GI tumor (p=0,335) were not statistically significant risk factors for detecting PEUGIC.

Conclusion

The overall rate of PEUGIC at our institution over the 11-year study period was 9,86 %, without early detected lesions as part of adequate surveillance, it was 8,20 %. Early detection of PEUGIC, which indicate poorer endoscopy quality, need to be distinguished from early detection of carcinoma within adequate surveillance.

Introduction

The prevalence of functional dyspepsia (FD) and gastroparesis in diabetic patients remains unknown. A high prevalence of gastroparesis has been reported in diabetic patients reaching up to 5%.¹ However, recent consensus specified the symptom pattern for gastroparesis, with nausea and/or vomiting as predominant symptoms, now defined as “gastroparesis-like symptoms” (GPLS).² The global prevalence of GPLS has been estimated to reach only 1.2% in diabetic patients, but type 1 and type 2 diabetes were not assessed separately.²

Aims & Methods

We aimed to assess the prevalence and burden of FD and GPLS in primary care patients with diabetes, comparing patients with type 1 and type 2 diabetes. An online survey was addressed to diabetic patients through general practitioners and diabetic patient associations. The survey included the Rome IV questionnaire and the Patient Assessment of Gastro-Intestinal Disorders-Symptom Severity Index (PAGI-SYM) for upper gastro-intestinal symptoms. Anxiety, depression, somatization, and quality of life were also assessed by specific questionnaires (Generalized Anxiety Disorder GAD-7, Patient Health Questionnaire PHQ-9, PHQ-15, and PAGI-QoL questionnaires respectively).

Results

A total of 216 patients completed the questionnaires, among which 146 had type 1 diabetes, and 68 had type 2 diabetes, (2 patients did not know their type of diabetes). The median age of the population was 56 (50-61) years old, with 134 female patients (61.8%). The prevalence of FD was 13.0% with no difference between the 2 groups. The prevalence of GPLS reached 4.2% and was significantly higher in patients with type 2 diabetes (8.9% vs 2.1%; p=0.03). The burden of upper gastro-intestinal symptoms and their impact on quality of life was higher in type 2 diabetes patients with higher PAGI-SYM and PAGI-QoL scores while anxiety and somatization were not different between type 1 and type 2 diabetes patients (see Table). Overall, patients with GPLS had higher anxiety (9 vs 3; p=0.003), depression (12 vs 3; p=0.001) and somatization scores (16 vs 6; p<0.001) than patients without. Compared to patients with FD without GPLS, GPLS patients had numerically higher but not statistically different scores for symptom severity (51 vs 28; p=0.46), anxiety (9 vs 7; p=0.29), depression (12 vs 7; p=0.07), somatization (16 vs 11.5; p=0.16) and quality of life scores (52 vs 24; p=0.16).

Conclusion

This study confirms that the prevalence of GPLS seems to be higher in diabetic patients compared to available population data, especially in patients with type 2 diabetes. The impact of the symptoms was similar to the impact of FD in this population. Further studies are required to assess the prevalence of delayed gastric emptying in diabetic type 1 and 2 patients with GPLS.

References

1. Choung RS, Locke GR, Schleck CD, et al. Risk of Gastroparesis in Subjects with Type 1 and 2 Diabetes in the General Population. Am J Gastroenterol 2012;107:82-88.
2. Huang I-H, Schol J, Khatun R, et al. Worldwide prevalence and burden of gastroparesis-like symptoms as defined by the United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis. United European Gastroenterol J 2022;10:888-897.