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PRELIMINARY RESULTS OF A RETROSPECTIVE STUDY OF OVER 20 YEARS OF ROUTINELY TRANSNASAL PERCUTANEOUS ENDOSCOPY GASTROSTOMY PLACEMENT: SAFETY AND FEASIBILITY

Giuseppina Vincoli 1, Alessandra Zannella 1, Alessandro Gigliozzi 1, Marzia Fioravante 1, Sandro Boschetto 1, Donatella Serva 1, Fausto Barberani 1, Mauro Tosoni 1, Maurizio Giovannone 1

Affiliations

1 San Camillo de Lellis Hospital, Rieti, Italy

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Abstract

Introduction

Since the report of Shaker in 1994, transnasal esophagogastroduodenoscopy (T-EGDS) has been reported worldwide as one technique to facilitate comfortable procedures avoiding sedation. From 1996 in our Centre, we routinely use this technique in all the patients for diagnostic and selected operative EGDS. This approach is also suitable for the placement of percutaneous endoscopy gastrostomy (PEG) but in the published papers it has been performed only when conventional upper gastrointestinal endoscopy was unusable (dysphagic patients with neurological disease or with stenosis and/or occlusion of the mouth or pharynx). On the contrary, since 2000 we have routinely used the transnasal approach for all patients requiring PEG, reserving the oral technique when the transnasal access route is impossible.

Aims & Methods

We performed a retrospective analysis of all patients who underwent PEG placement between January 2000 and March 2023 in the Unit of Gastroenterology of San Camillo De Lellis Hospital, Rieti, Italy, in order to demonstrate the feasibility and safety of T-PEG placement in routine practice. We used ultrathin gastroscope through a nostril after assessment and lubrification, and the pull technique was used for tube placement.

Results

PEG placement was required for 256 consecutive patients (male 49.4%; female 51.6%), the average age was 79 years, within a range from 26 to 104 years. Transnasal approach was used in 162 patients (nasal group: 63.3%) while oral approach was used in 94 (oral group: 36.7%). The failure of transnasal approach was related to impossibility of nasal intubation due to narrow nasal passages or to inability to transilluminate the stomach. In these cases we needed transoral route. 14 patients underwent transoral PEG placement due to unavailability of transnasal gastroscope. The duration of the procedures was similar in both approaches (12 ±3 minutes oral vs 13±4 minutes nasal).
The most common indications for PEG insertion were neurologic disorders (n=132, 51.6 %), cerebrovascular accident (n=73, 28.5 %), esophageal cancer or head and neck cancer (n=18, 7 %), other pathologies (n=33, 12.9 %). 167 procedures were performed without sedation: 77.8 % ( n= 130) in the nasal group and only 22.1% (n=37) in the oral group. Outpatient regimen PEG placement was also significantly higher in trans nasal group (79 % vs 58 % oral group). We registered 3 major complications, 1 in oral group and 2 in nasal group (one necessitated surgery). No procedure-related death was registered. There were no unplanned re-admissions of outpatients discharged from the gastroenterology unit for procedure-related complications.

Conclusion

The more than twenty years’ experience of our center demonstrates that the transnasal approach is safety, feasible and could be routinely used in daily endoscopic practice for PEG placement. The minimally invasive technique therefore reserves sedation to a few selected cases to reduce costs, improve logistic organization and avoid anesthesia related complications.

References

Campo R, Montserrat A, Brullet E. Transnasal gastroscopy compared to conventional gastroscopy: a randomized study of feasibility, safety, and tolerance. Endoscopy. 1998 Jun;30(5):448-52.
Schuldt AL, Kirsten H, Tuennemann J, Heindl M, van Bommel F, Feisthammel J, Hollenbach M, Hoffmeister A. Necessity of transnasal gastroscopy in routine diagnostics: a patient-centred requirement analysis. BMJ Open Gastroenterol. 2019 Apr 14;6(1):e000264.
Dumortier J, Lapalus MG, Pereira A, Lagarrigue JP, Chavaillon A, Ponchon T. Unsedated transnasal PEG placement. Gastrointest Endosc. 2004 Jan;59(1):54-7.
Dumortier J, Napoleon B, Hedelius F, Pellissier PE, Leprince E, Pujol B, Ponchon T. Unsedated transnasal EGD in daily practice: results with 1100 consecutive patients. Gastrointest Endosc. 2003 Feb;57(2):198-204
Preiss C, Charton JP, Schumacher B, Neuhaus H. A randomized trial of unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) versus peroral small-caliber EGD versus conventional EGD. Endoscopy. 2003 Aug;35(8):641-6.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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PANCREATIC MORPHOLOGICAL AND ENDOCRINE CHANGES FOLLOWING ACUTE PANCREATITIS: PRELIMINARY RESULTS FROM THE GOULASH PLUS STUDY

Peter Hegyi

ULTRASOUND ASSESSMENT OF QUADRICEPS MUSCLE THICKNESS AS A PROGNOSTIC TOOL IN ADVANCED CHRONIC LIVER DISEASE: A PROSPECTIVE STUDY

Bruno Manuel Santos Peixe

Panel discussion: Pancreatic and small bowel neuroendocrine tumours

TEXTBOOK OUTCOMES OF EUS-GUIDED HEPATICOGASTROSTOMY ACCORDING TO INDICATION AND PRESENTING ANATOMY: A PROSPECTIVE COHORT STUDY

Paolo Giorgio Arcidiacono

DETERMINANTS OF NEOPLASIA YIELD AT THE FIRST SURVEILLANCE COLONOSCOPY: THE IMPACT OF ENDOSCOPIST'S ADR

Carlo Senore

RECURRENCE AFTER R0 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR HIGH-RISK T1 COLORECTAL CANCER: TUMOR LOCATION OUTWEIGHS HISTOLOGICAL RISK FACTORS

Jérémie Jacques

UEG Presentation

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PANCREATIC MORPHOLOGICAL AND ENDOCRINE CHANGES FOLLOWING ACUTE PANCREATITIS: PRELIMINARY RESULTS FROM THE GOULASH PLUS STUDY

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PANCREATIC MORPHOLOGICAL AND ENDOCRINE CHANGES FOLLOWING ACUTE PANCREATITIS: PRELIMINARY RESULTS FROM THE GOULASH PLUS STUDY

Alexandra Mikó 1,2, Noémi Gede 1, Nelli Farkas 1, Vivien Vass 1, Dalma Dobszai 3,4, Áron Vincze 2, Patrícia Sarlós 2, Nándor Faluhelyi 1, Ferenc Izbéki 5, László Gajdán 6, Dorottya Tarján 4, Mónika Lipp 4, Balint Eross 4, Andrea Szentesi 2,4, Peter Hegyi 2,4,7

Affiliations

1 University of Pécs, Medical School, Pécs, Hungary

2 University of Pécs, Pécs, Hungary

3 University of Pécs Medical School, Pécs, Hungary

4 Semmelweis University, Budapest, Hungary

5 Saint George University Hospital, Szekesfehervar, Hungary

6 Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary

7 University of Szeged, Szeged, Hungary

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Abstract

Introduction

Acute pancreatitis (AP) may lead to recurrent AP (RAP), chronic pancreatitis (CP), and diabetes mellitus (DM).

Aims & Methods

We aimed to assess progression from AP to RAP, CP, and prediabetes or diabetes after AP. GOULASH-PLUS is a multicentre observational follow-up study assessing pancreatic morphology and endocrine function at baseline and annually. Patients were classified by morphology (single AP, RAP, early CP, CP) and endocrine status (normal, prediabetes, diabetes).

Results

The four-year follow-up data of the first 360 patients were analyzed in this ongoing study:
Morphology status: By the end of the fourth year of the follow-up, the proportion of patients with RAP, ECP and CP morphology status has more than doubled (55.1% CI: 47.48-62.49% vs. 25.3% CI: 21.09-30.04% at baseline). Among patients with a single AP at baseline (n=269), progression to RAP, ECP or CP affected 35.1% by the fourth year. The morphological status progression was the highest in the first two years (21.2%).
Endocrine status: The proportion of diabetic patients nearly doubled by the first year and tripled by the fourth-year follow-up visit (from 13.6% CI:10.44-17.53% to 25.8% CI:21.33-30.84% and 39.2% CI:31.70-47.24%, respectively). Among patients with a single AP at baseline, the proportion of prediabetes and DM together has increased from 41.5% (CI:35.76-47.48%) at baseline to 74.2% (CI:64.89-81.74%) at the fourth year. During the four-year follow-up, the progression of the endocrine status was the highest in the first two years (30.4%; 21.2%).

Conclusion

The high incidence of late complications within two years supports guideline-recommended targeted follow-up after AP.

Event

UEG Week Barcelona 2026

Topics

IBD Pancreas Gut Microbiota Endoscopy Digestive Oncology Colorectal

Submission format

Abstract

Session

Hot topics in clinical GI research

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Peter Hegyi

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Bruno Manuel Santos Peixe

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TEXTBOOK OUTCOMES OF EUS-GUIDED HEPATICOGASTROSTOMY ACCORDING TO INDICATION AND PRESENTING ANATOMY: A PROSPECTIVE COHORT STUDY

Paolo Giorgio Arcidiacono

DETERMINANTS OF NEOPLASIA YIELD AT THE FIRST SURVEILLANCE COLONOSCOPY: THE IMPACT OF ENDOSCOPIST'S ADR

Carlo Senore

RECURRENCE AFTER R0 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR HIGH-RISK T1 COLORECTAL CANCER: TUMOR LOCATION OUTWEIGHS HISTOLOGICAL RISK FACTORS

Jérémie Jacques

UEG Presentation

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ULTRASOUND ASSESSMENT OF QUADRICEPS MUSCLE THICKNESS AS A PROGNOSTIC TOOL IN ADVANCED CHRONIC LIVER DISEASE: A PROSPECTIVE STUDY

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ULTRASOUND ASSESSMENT OF QUADRICEPS MUSCLE THICKNESS AS A PROGNOSTIC TOOL IN ADVANCED CHRONIC LIVER DISEASE: A PROSPECTIVE STUDY

Margarida Portugal 1, Marta Eusébio 1, Isabel Malta Carvalho 1, Catarina Aguieiras 1, Marta Filipe da Silva Lobo Ferreira 1, Bruno Manuel Santos Peixe 1

Affiliations

1 ULS Algarve, Faro, Portugal

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Abstract

Introduction

Advanced chronic liver disease (ACLD) is characterized by a hypercatabolic state leading to progressive muscle loss and sarcopenia, affecting up to 40% of patients. Sarcopenia is associated with increased mortality, higher risk of hepatic decompensation, and worse clinical outcomes. Although computed tomography is the gold standard for muscle mass assessment, its use is limited by cost, radiation exposure, and accessibility. Muscle ultrasound has emerged as a simple, non-invasive bedside alternative. Advanced chronic liver disease (ACLD) is characterized by a hypercatabolic state leading to progressive muscle loss and sarcopenia, affecting up to 40% of patients. Sarcopenia is associated with increased mortality, higher risk of hepatic decompensation, and worse clinical outcomes. Although computed tomography is the gold standard for muscle mass assessment, its use is limited by cost, radiation exposure, and accessibility. Muscle ultrasound has emerged as a simple, non-invasive bedside alternative.

Aims & Methods

This study aimed to evaluate the prognostic value of quadriceps muscle ultrasound in patients with ACLD, focusing on hepatic decompensation and 6-month mortality.
We conducted a prospective, single-center observational study including 55 consecutive hospitalized patients with ACLD in 2024. Muscle ultrasound was performed within 48 hours of admission using a 7.5–10 MHz linear probe, with patients in the supine position. Quadriceps thickness was measured at two-thirds of the distance between the anterior superior iliac spine and the patella. Three measurements per limb were obtained, and the mean value was normalized to height (thickness/height ratio). Primary outcomes were hepatic decompensation and 6-month mortality.

Results

Patients were predominantly male (85.5%), with a mean age of 60 years; alcohol-related liver disease was the leading etiology (69%). Median MELD-Na was 20, and most patients were Child-Pugh C. The mean thickness/height ratio was 7.22 ± 2.11 cm/m. During follow-up, 34.5% developed hepatic decompensation and 38.2% died.
ROC analysis demonstrated good discrimination for hepatic decompensation (AUC = 0.698; p = 0.02) and moderate discrimination for mortality (AUC = 0.638; p = 0.04). Optimal cut-offs were 7.95 cm/m and 7.0 cm/m, respectively. Patients with lower thickness/height ratio had a markedly increased risk of hepatic decompensation (OR ≈ 9; p = 0.01) and mortality (OR ≈ 5; p = 0.03). Kaplan–Meier analysis revealed significantly earlier decompensation and reduced survival in patients with lower muscle thickness (log-rank p < 0.05 for both outcomes).

Conclusion

Quadriceps muscle ultrasound is a simple, rapid, and reproducible bedside tool for assessing muscle mass in ACLD. The thickness/height ratio demonstrated significant prognostic value, with lower values associated with increased risk and earlier occurrence of hepatic decompensation and mortality. These findings support the integration of muscle ultrasound into routine clinical assessment of ACLD patients. Limitations include small sample size, single-center design, and lack of functional muscle assessment.

References

Dasarathy S, Merli M. Sarcopenia from mechanism to diagnosis and treatment in liver disease. J Hepatol. 2016 Dec;65(6):1232-1244.;
Ooi PH, Hager A, et al. Sarcopenia in Chronic Liver Disease: Impact on Outcomes. Liver Transpl. 2019 Sep;25(9):1422-1438.;
Tandon P, Low G, et al. A Model to Identify Sarcopenia in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2016 Oct;14(10):1473-1480.e3.;
Mahmoud H, Kamal H, El-Liethy N, et al. Value of ultrasound in grading the severity of sarcopenia in patients with hepatic cirrhosis. Egypt J Radiol Nucl Med. 2021;52:295.;
Flagiello V, et al. Ultrasound-Defined Sarcopenia Independently Predicts Acute Decompensation in Advanced Chronic Liver Disease. Dig Liver Dis. 2021;56(Suppl 1):S71-S72.;
Gödiker J, Schwind L, Jacob T, Böhling N, Reinartz Groba SN, Kimmann M, et al. Assessment of sarcopenia and outcome with ultrasound-based measurements in patients with liver cirrhosis. Liver Int. 2021.

Event

UEG Week Barcelona 2026

Topics

Mechanisms & Personalised Medicine Radiology & Imaging Hepatobiliary

Submission format

Abstract

Session

Liver cirrhosis: A cirrhotic conundrum - Diagnosis and evaluation

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Peter Hegyi

ULTRASOUND ASSESSMENT OF QUADRICEPS MUSCLE THICKNESS AS A PROGNOSTIC TOOL IN ADVANCED CHRONIC LIVER DISEASE: A PROSPECTIVE STUDY

Bruno Manuel Santos Peixe

Panel discussion: Pancreatic and small bowel neuroendocrine tumours

TEXTBOOK OUTCOMES OF EUS-GUIDED HEPATICOGASTROSTOMY ACCORDING TO INDICATION AND PRESENTING ANATOMY: A PROSPECTIVE COHORT STUDY

Paolo Giorgio Arcidiacono

DETERMINANTS OF NEOPLASIA YIELD AT THE FIRST SURVEILLANCE COLONOSCOPY: THE IMPACT OF ENDOSCOPIST'S ADR

Carlo Senore

RECURRENCE AFTER R0 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR HIGH-RISK T1 COLORECTAL CANCER: TUMOR LOCATION OUTWEIGHS HISTOLOGICAL RISK FACTORS

Jérémie Jacques

UEG Presentation

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Panel discussion: Pancreatic and small bowel neuroendocrine tumours

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Panel discussion: Pancreatic and small bowel neuroendocrine tumours

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Small Intestine & Nutrition Pancreas Digestive Oncology

Session

Pancreatic and small bowel neuroendocrine tumours

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

PANCREATIC MORPHOLOGICAL AND ENDOCRINE CHANGES FOLLOWING ACUTE PANCREATITIS: PRELIMINARY RESULTS FROM THE GOULASH PLUS STUDY

Peter Hegyi

ULTRASOUND ASSESSMENT OF QUADRICEPS MUSCLE THICKNESS AS A PROGNOSTIC TOOL IN ADVANCED CHRONIC LIVER DISEASE: A PROSPECTIVE STUDY

Bruno Manuel Santos Peixe

Panel discussion: Pancreatic and small bowel neuroendocrine tumours

TEXTBOOK OUTCOMES OF EUS-GUIDED HEPATICOGASTROSTOMY ACCORDING TO INDICATION AND PRESENTING ANATOMY: A PROSPECTIVE COHORT STUDY

Paolo Giorgio Arcidiacono

DETERMINANTS OF NEOPLASIA YIELD AT THE FIRST SURVEILLANCE COLONOSCOPY: THE IMPACT OF ENDOSCOPIST'S ADR

Carlo Senore

RECURRENCE AFTER R0 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR HIGH-RISK T1 COLORECTAL CANCER: TUMOR LOCATION OUTWEIGHS HISTOLOGICAL RISK FACTORS

Jérémie Jacques

UEG Presentation

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TEXTBOOK OUTCOMES OF EUS-GUIDED HEPATICOGASTROSTOMY ACCORDING TO INDICATION AND PRESENTING ANATOMY: A PROSPECTIVE COHORT STUDY

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TEXTBOOK OUTCOMES OF EUS-GUIDED HEPATICOGASTROSTOMY ACCORDING TO INDICATION AND PRESENTING ANATOMY: A PROSPECTIVE COHORT STUDY

Giuseppe Vanella 1,2, Rosa Claudia Stasio 1,3, Rukaia Barà 1,2, Giuseppe Marzocca 1,2, Diego Palumbo 2,1, Francesco Frigo 1,3, Andrea Casadei-Gardini 2,1, Francesco De Cobelli 2,1, Michele Reni 2,1, Massimo Falconi 2,1, Paolo Giorgio Arcidiacono 1,2

Affiliations

1 IRCCS San Raffaele Scientific Institute, Milan, Italy

2 Vita-Salute San Raffaele University, Milan, Italy

3 University of Turin, Turin, Italy

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Abstract

Introduction

Endoscopic Ultrasound-Guided HepaticoGastrostomy (EUS-HGS) has emerged as a valuable complement to retrograde biliary drainage. However current evidence is focused on technical success and constrained by small sample sizes, retrospective design, heterogeneous techniques and indications.

Aims & Methods

Single center prospective study conducted between April-2021 and October-2025. All consecutive patients undergoing EUS-HGS with a dedicated partially covered metal stent (Giobor, Taewoong) for a malignant indication were enrolled in a prospective registry of Therapeutic EUS (PROTECT; ClinicalTrials.gov NCT04813055) with prospective scheduled bimonthly assessment of outcomes. 30-days Net Clinical Benefit (NCB30) was defined as Clinical Success (CS) without recurrent biliary obstruction (RBO) or 30-days mortality, while Textbook Outcome (TBO30) was defined as NCB30 plus no 30-days procedure-related adverse events (AEs).

Results

83 patients were included (median age 67 [60-74], female 61.4%, pancreatic adenocarcinoma 50.6%, cholangiocarcinoma 20.5%, metastatic diseases 78.3%, ascites 41%).
Indication for EUS-HGS were: 1) distal malignant biliary obstruction (MBO) with duodenal invasion (43.4%); 2) drainage completion of hilar MBO (39.8%); 3) surgically-altered anatomy (16.9%).
Technical success and CS rate were 95.2% and 70.9% respectively. AEs were registered in 43.4% of patients (mild/moderate 19.5%, severe/fatal 25.6%) and were deemed procedure-related in 28.4%. 30-days mortality was 21.8% (cancer-related in 83%). After a median follow-up of 63 [32-113] days, RBO was registered in 6.8%.
NCB30 and TBO30 were 54.2% and 45.8% respectively. Best Supportive Care (BSC) was advised in 60.9% of patients.
CS was significantly lower when the stenosis was hilar versus distal/anastomotic (p=0.001). Accordingly, the NCB30 was significantly lower when EUS-HGS drained only one segment versus the left hemiliver versus the whole liver (36.4% versus 45.5% versus 73.5%, p=0.02). Since the AEs were also higher in patients undergoing partial versus complete liver drainage (p=0.001), the TBO30 was accordingly different, being 9.1% versus 39.4% and 67.6% respectively (p=0.002) as well as advice for BSC (p=0.0008).

Conclusion

Despite excellent technical success, only ≈50% of patients experience a net clinical benefit or a textbook outcome after EUS-HGS, whilst the rest receive a recommendation for BSC. Outcomes are deeply influenced by the level of the stenosis and actual liver drainage, claiming for personalized imaging-guided patients’ selection.

Event

UEG Week Barcelona 2026

Topics

Radiology & Imaging Hepatobiliary Endoscopy

Submission format

Abstract

Session

Endoscopy: Taming the biliary tree

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

PANCREATIC MORPHOLOGICAL AND ENDOCRINE CHANGES FOLLOWING ACUTE PANCREATITIS: PRELIMINARY RESULTS FROM THE GOULASH PLUS STUDY

Peter Hegyi

ULTRASOUND ASSESSMENT OF QUADRICEPS MUSCLE THICKNESS AS A PROGNOSTIC TOOL IN ADVANCED CHRONIC LIVER DISEASE: A PROSPECTIVE STUDY

Bruno Manuel Santos Peixe

Panel discussion: Pancreatic and small bowel neuroendocrine tumours

TEXTBOOK OUTCOMES OF EUS-GUIDED HEPATICOGASTROSTOMY ACCORDING TO INDICATION AND PRESENTING ANATOMY: A PROSPECTIVE COHORT STUDY

Paolo Giorgio Arcidiacono

DETERMINANTS OF NEOPLASIA YIELD AT THE FIRST SURVEILLANCE COLONOSCOPY: THE IMPACT OF ENDOSCOPIST'S ADR

Carlo Senore

RECURRENCE AFTER R0 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR HIGH-RISK T1 COLORECTAL CANCER: TUMOR LOCATION OUTWEIGHS HISTOLOGICAL RISK FACTORS

Jérémie Jacques

UEG Presentation

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DETERMINANTS OF NEOPLASIA YIELD AT THE FIRST SURVEILLANCE COLONOSCOPY: THE IMPACT OF ENDOSCOPIST'S ADR

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DETERMINANTS OF NEOPLASIA YIELD AT THE FIRST SURVEILLANCE COLONOSCOPY: THE IMPACT OF ENDOSCOPIST'S ADR

Stefano Rousset 1,2, Gianluigi Ferrante 1, Marco Silvani 1, Marco Calcagno 1, Cristiano Piccinelli 1, Annalisa Castella 3, Dario Mazzucco 4, Arrigo Arrigoni 5, Fabiana Venezia 6, Lorenzo Marcello Orione 7, Vittoria Grammatico 8, Paola Cassoni 9, Maria Caterina Maconi 10, Cesare Hassan 11, Carlo Senore 1

Affiliations

1 University Hospital Città della Salute e della Scienza, Torino, Italy

2 School of Specialization in Statistics and Biometry, University of Turin, Torino, Italy

3 ASL TO3 Piedmont, Collegno (To), Italy

4 Ospedale di Rivoli, Rivoli (To), Italy

5 IRCCS Candiolo, Candiolo (To), Italy

6 ASL TO4 Piedmont, Chivasso (To), Italy

7 ASL CN1 Piedmont, Cuneo, Italy

8 ASL TO5 Piedmont, Chieri (To), Italy

9 University of Turin, Torino, Italy

10 ASL AL Piedmont, Alessandria, Italy

11 Humanitas University, Pieve Emanuele MI, Italy

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Abstract

Introduction

Previous studies showed an inverse association with interval CRC (PCCRC) and the adenoma detection rate (ADR) of the endoscopist performing the colonoscopy (TC) following a positive FIT result (FIT+ index TC). While an inverse association between the characteristics of the index lesion and the risk of neoplasia at surveillance TC has been documented, there is limited evidence about the impact of endoscopist's ADR on this key intermediate outcome.

Aims & Methods

Aims: To analyse the relative weight of patient-, procedure-, and provider-level determinants of advanced adenoma (AAd) and CRC detection rate (DR) at the first surveillance TC.
Methods: Population: cohort of FIT+ screenees, within the Piedmont region screening program, who performed FIT between 2004 and 2022 and were referred to 3-year surveillance, following the excision of high-risk (HR) adenomas (> 2 adenomas or 1 tubular adenoma >9 mm or 1 adenoma with villous component > 20%, or with high-grade dysplasia). The ADR of the endoscopist performing the FIT+ index TC was measured as the proportion of TCs with at least one adenoma, out of the total number of TCs performed within the program between 2004 and 2022. ADR was categorized according to an approximation of the quintile distribution (≤39.9%; 40% - 44.9%, 45% - 49.9%; 50% - 54.9%, ≥55%). Operators who had performed < 100 TCs were excluded. Primary outcome: AAd DR; secondary outcome CRC DR. The association between explanatory variables and outcomes was assessed using multilevel logistic regression models with random intercepts for endoscopists.

Results

Out of 47,245 FIT-positive screenees undergoing TC, 14,423 (31%) were detected with HR adenomas, 11,100 (77%) were referred to 3-year surveillance and 8,063 of them (73%) underwent a surveillance TC. After excluding subjects with missing information about the endoscopist, inadequate preparation, or incomplete exam, 6909 HR patients (median age 65 years, 63% male) examined by 163 operators were included in the analysis: 936 were detected with an AAd (13.5%) and 31 with a CRC (0.4%). In multilevel models, older age (65-70 years: OR=1.18; 95% CI: 1.02–1.36), male sex (OR=1.63; 95% CI: 1.39–1.91), proximal polyp location (OR=2.08; 95% CI: 1.70-2.55 ), and suboptimal quality of bowel preparation at index TC (OR 1.29; 95% CI: 1.11–1.50) were associated with increased AAd risk at surveillance TC, while the AAd DR at surveillance TC showed a decreasing trend with increasing ADR of the endoscopist performing the FIT+ index TC, reaching a plateau for ADR ≥50% (OR=0.67; 95% CI: 0.50-0.89).

AAd risk at surveillance TC by endoscopist’s ADR at index FIT+ TC Adjusted by sex, age, polyp size, interval between index and surveillance TC, polyp location, quality of preparation of index TC
	OR*	95% CI
ADR ≤39.9	1.00	-
ADR 40-44.9	0.86	0.66 - 1.12
ADR 45-49.9	0.73	0.55 - 0.96
ADR 50-54.9	0.67	0.50 - 0.89
ADR ≥55	0.65	0.47 - 0.89

Conclusion

Endoscopist's competence (measured using ADR metrics) is affecting not only the PCCRC risk, but also the DR of neoplasia at the surveillance TC. These findings suggest that a substantial proportion of the observed risk of AN recurrence following excision of AAds might be attributable to the miss rate of lesions associated with low ADR at the index TC. Consistent with previous studies, we observed a plateau for the protective effect of ADR above 45%. Endoscopist' ADR should be regularly monitored, to optimize surveillance strategies among FIT+ screenees and it might be considered among the criteria for defining the surveillance interval following HR adenoma detection.

References

M. F. Kaminski et al., ‘Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative’, United Eur. Gastroenterol. J., vol. 5, no. 3, pp. 309–334, 2017.
E. Dekker, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842–851’, pp. 842–851
N. D. Pilonis et al., ‘Adenoma Detection Rates by Physicians and Subsequent Colorectal Cancer Risk.’, Jama, vol. 333, no. 5, pp. 400–407, 2024.
M. Zorzi et al., ‘Adenoma Detection Rate and Colorectal Cancer Risk in Fecal Immunochemical Test Screening Programs’, Ann. Intern. Med., vol. 176, no. 3, pp. 303–310, 2023.

Disclosure

No COI to disclose

Event

UEG Week Barcelona 2026

Topics

Colorectal Endoscopy Digestive Oncology

Submission format

Abstract

Session

Beyond colonoscopy: Improvements to come!

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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RECURRENCE AFTER R0 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR HIGH-RISK T1 COLORECTAL CANCER: TUMOR LOCATION OUTWEIGHS HISTOLOGICAL RISK FACTORS

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RECURRENCE AFTER R0 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR HIGH-RISK T1 COLORECTAL CANCER: TUMOR LOCATION OUTWEIGHS HISTOLOGICAL RISK FACTORS

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RECURRENCE AFTER R0 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR HIGH-RISK T1 COLORECTAL CANCER: TUMOR LOCATION OUTWEIGHS HISTOLOGICAL RISK FACTORS

Charles Maugé 1, Ramziath Mama K Karim 1, Giulio Calabrese 2, Mathieu Pioche 3, Alessandro Repici 4, Timothee Wallenhorst 5, Cesare Hassan 6, Marion SCHAEFER 7, Roberta Maselli 8, Arthur Berger 9, Arnaldo Amato 10, Bertrand Brieau 11, Francesco Pugliese 12, Yann Le Baleur 13, Federico Barbaro 14, Edouard Chabrun 15, Andrea Anderloni 16, Geoffroy Vanbiervliet 17, Laura Rovedatti 18, Philippe Leclercq 19, Bianca Maria Quarto Colosso 20, Thibault Degand 21, Mariachiara Campanale 22, Maximilien Barret 23, Stefano Angeletti 24, Gabriel Rahmi 25, Maurizio Spandre 26, DOUMBE MANDENGUE Paul 27, Carlo Fabbri 28, Vincent Lepilliez 29, Giulia Gibiino 30, Geoffrey Icardo 31, Alessandro Gubbiotti 32, François Tocquer 33, Paolo Cecinato 34, Damien Felot 7, Giuseppe Grande 35, Gerard Laura 3, Gianluca Andrisani 36, Francesco Vito Mandarino 37, Ludovico Alfarone 38, Sandro Sferrazza 39, Jérémie Jacques 40

Affiliations

1 University of Limoges, Limoges, France

2 University of Naples Federico II, Naples, Italy

3 Hospices Civils de Lyon, Lyon, France

4 Ist. Clinico Humanitas Rozzano Dept. of Gastroenterology, Milano, Italy

5 CHU Pontchaillou, Rennes, France

6 Humanitas University, Pieve Emanuele MI, Italy

7 Centre Hospitalier Régional Universitaire de Nancy, Nancy, France

8 Sofar, Roma, Italy

9 CHU Bordeaux, Bordeaux, France

10 Gastroenterology Unit, Ospedale Valduce, Como, Italy, Como, Italy

11 CHU Nantes, Nantes, France

12 Milan, Milan, Italy

13 Saint Jospeh, Paris, France

14 Gemelli Hospital, Roma, Italy

15 CHU Angers, Angers, France

16 Fondazione IRCCS San Matteo Pavia, Pavia, Italy

17 CHU, Hôpital L´Archet 2 Gastroentérologie - Gastroenterology, CHU, Hôpital L´Archet 2 Gastroentérolo, Nice, France

18 Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

19 UZ Leuven, Liège, Belgium

20 Bari, Bari, Italy

21 CHU de Dijon, Dijon Cedex, France

22 Ospedale Galliera, Genova, Italy

23 Cochin Hospital, Paris, France

24 Roma, Roma, Italy

25 Hôpital Européen Georges Pompidou Dept. de Gastroenterologie, Paris, France

26 Turini, Turini, Italy

27 Saint Joseph, Paris, France

28 AUSL Romagna, Forlì-Cesena Gastroenterology, Bologna, Italy

29 Lyon Mermoz, Lyon, France

30 AUSL Romagna, Bologna, Italy

31 CHU Limoges Dupuytren 1, Limoges, France

32 Padoue, Padoue, Italy

33 Bordeaux, Bordeaux, France

34 Policlinico S Orsola Malpighi, Reggio Emilia, Italy

35 AOU Modena, Modena, Italy

36 Complesso Integrato Columbus, Catholic University, Rome, Italy

37 Milano, Milan, Italy

38 Milano, Milano, Italy

39 Palerme, Palerme, Italy

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

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Abstract

Introduction

Management of T1 colorectal cancer after endoscopic resection is currently guided by histological predictors of lymph node metastasis, a surrogate endpoint. However, data on clinically meaningful outcomes such as recurrence remain scarce, particularly in Western populations. We aimed to evaluate recurrence after R0 endoscopic submucosal dissection (ESD) of a T1 colorectal cancer with pejorative criteria (non curative) and identify its determinants, with a specific focus on tumor location.

Aims & Methods

We conducted a retrospective multicenter cohort study nested within a prospective ESD database, including 490 patients with T1 colorectal cancer treated by R0 resection but with non curative resection criteria (depth of invasion > 1000 microns, Lymphovascular invasion, high grade budding, poor differentiation, perineural invasion). The primary endpoint was oncological recurrence (local, locoregional, or distant). Cumulative incidence was estimated using competing risk analysis, and predictors were assessed using Fine and Gray models.
Given the low prevalence but strong effect of perineural invasion, a sensitivity analysis excluding these patients was performed to ensure that this dominant feature did not mask associations with other variables.

Results

After a median follow-up of 29 months, 30 patients (6.3%) developed recurrence. The cumulative incidence was 10.7%, while cancer-specific mortality remained very low (1.9%).
Before accounting for competing risk of death, recurrence was markedly higher in rectal lesions (10.4%) than in colonic lesions (1.8%). Recurrence patterns also differed: rectal cancers were mainly associated with locoregional recurrence (60%), whereas all recurrences in colonic lesions were distant (100%).
In multivariable analysis, tumor location (colon vs rectum: sHR 0.40, 95% CI 0.19–0.86; p=0.02) and perineural invasion (sHR 9.51, 95% CI 2.81–32.24; p=0.001) were independently associated with recurrence. In contrast, classical histological criteria—including lymphovascular invasion (sHR 1.15; p=0.74)—were not predictive.
Importantly, treatment strategy (surgery vs surveillance) had no impact on recurrence (sHR 1.52, 95% CI 0.69–3.33; p=0.29).
In sensitivity analysis excluding perineural invasion, recurrence remained low (8.4%), and tumor location remained the only independent predictor (sHR 0.22, 95% CI 0.07–0.64; p=0.006), while all histological variables were non-significant.

Conclusion

In this large Western cohort nested within a prospective ESD database, recurrence after R0 resection of high-risk T1 colorectal cancer was uncommon and cancer-specific mortality was rare. Recurrence risk was strongly dependent on tumor location, being markedly higher in rectal than in colonic lesions.
Tumor location and perineural invasion—rather than classical histological criteria—were the main determinants of recurrence. Notably, surgery did not reduce recurrence risk in this study, questioning its systematic use based on histological risk alone.
These findings support a shift toward outcome-driven, individualized management strategies integrating tumor location, biological markers, and competing risk of death.

Event

UEG Week Barcelona 2026

Topics

Digestive Oncology Endoscopy Colorectal

Submission format

Abstract

Session

Endoscopic resection: Cut, cure, prevent

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

PANCREATIC MORPHOLOGICAL AND ENDOCRINE CHANGES FOLLOWING ACUTE PANCREATITIS: PRELIMINARY RESULTS FROM THE GOULASH PLUS STUDY

Peter Hegyi

ULTRASOUND ASSESSMENT OF QUADRICEPS MUSCLE THICKNESS AS A PROGNOSTIC TOOL IN ADVANCED CHRONIC LIVER DISEASE: A PROSPECTIVE STUDY

Bruno Manuel Santos Peixe

Panel discussion: Pancreatic and small bowel neuroendocrine tumours

TEXTBOOK OUTCOMES OF EUS-GUIDED HEPATICOGASTROSTOMY ACCORDING TO INDICATION AND PRESENTING ANATOMY: A PROSPECTIVE COHORT STUDY

Paolo Giorgio Arcidiacono

DETERMINANTS OF NEOPLASIA YIELD AT THE FIRST SURVEILLANCE COLONOSCOPY: THE IMPACT OF ENDOSCOPIST'S ADR

Carlo Senore

RECURRENCE AFTER R0 ENDOSCOPIC SUBMUCOSAL DISSECTION FOR HIGH-RISK T1 COLORECTAL CANCER: TUMOR LOCATION OUTWEIGHS HISTOLOGICAL RISK FACTORS

Jérémie Jacques