Introduction

Gastric hyperplastic polyps (GHPs) carry a neoplastic transformation risk of up to 5%, with previous studies indicating an increased risk with larger polyp size. We aimed to evaluate the frequency and risk factors of its malignant transformation in a Portuguese cohort.

Aims & Methods

A multicenter retrospective cohort study was conducted including all patients undergoing endoscopic resection of GHPs ≥10mm from January 2013 to January 2024 in Portuguese tertiary reference centers. Patients with hereditary polyposis syndromes were excluded. Demographic, clinical, endoscopic, and histopathological data were collected.

Results

A total of 782 GHPs from eight centers were evaluated. The median age was 68 years (IQR 60-75), and 58.8% were female. Evidence of advanced gastritis stage (OLGIM≥3) and synchronous gastric neoplasia were present in 57 (10.2%) and 37 (4.7%) cases, respectively. The median lesion size was 15 mm (IQR 12-20), and most presented a polypoid morphology (96.8%). Most GHPs were removed by endoscopic mucosal resection (86.6%), followed by cold snare polypectomy (8.1%) endoscopic submucosal dissection (3.6%), and cold snare EMR (1.7%), achieving en-bloc resection in 677 cases (86.6%). Neoplastic transformation was observed in 33 polyps (4.2%) – 25 (3.2%) low/high-grade dysplasia and 8 (1.0%) adenocarcinoma; the resection was non-curative in 30.3% of cases.
In the multivariate analysis, OLGIM≥3 (OR 4.994, 95%CI 1.036-24.065), lesion size ≥25 mm (OR 7.973, 95%CI 7.973 (1.242-51.180), flat/depressed morphology (OR 9.57, 95%CI 1.096-83.712) and synchronous gastric neoplasia (OR 16.956, 95%CI 2.737-105.045) were independently associated with a higher risk of malignant transformation.

Conclusion

The risk of malignant transformation of GHPs in non-neglectable, with lesion size and morphology and concomitant precancerous gastric conditions/lesions being associated with a higher risk. Nevertheless, the rate of non-curative endoscopic resection is high. The identification of these features may help for optimizing and tailoring the selection of adequate endoscopic resection techniques and surveillance strategies in high-risk patients.

Introduction

Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are chronic conditions with alternating phases of flare-ups and remission. Due to the persistent and often severe course of these diseases, effective treatment significantly improves patients' daily activities and overall functioning. [1] Given the uncertain prognosis and the frequent disease progression despite pharmacotherapy, it is important to explore additional interventions that could support traditional treatments. While physical activity may provide both anti-inflammatory and functional benefits in IBD, data on its efficacy and safety during disease exacerbation remain scarce. [2] This pilot study is the first real-world investigation into the effects of a supervised physical exercise training in patients hospitalized due to IBD flare.

Aims & Methods

This study aimed to evaluate the effects of an individualized, moderate-intensity, supervised physical exercise training on exercise tolerance, inflammation, and fatigue resistance in patients hospitalized due to IBD flare, and to explore baseline factors associated with greater benefit from the intervention. Patients were randomly assigned to an intervention group, receiving individual cycloergometer training during hospitalization, or to a control group without exercise. Both groups were well balanced at baseline, with no significant differences in demographic, clinical, or laboratory parameters. At both admission and discharge, all patients underwent standardized graded exercise tests to establish their exercise tolerance based on the lactate threshold and heart rate/power output response. Furthermore laboratory assessments, and the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) questionnaire were conducted.

Results

A total of 22 patients were included in the study, with 13 patients in the intervention group and 9 patients in the control group. Although FACIT-F scores improved in both groups, the intervention group demonstrated a significantly greater improvement (median change –39 points; IQR –49 to –11; p = 0.014) compared to the control group (median change –25 points; IQR –52 to –6; p = 0.30). Baseline FACIT-F scores were significantly correlated with changes in heart rate response response during exercise: patients with greater baseline fatigue and poorer functional status experienced greater improvement in exercise tolerance (r = –0.62, p = 0.028). Platelet counts remained more stable in the intervention group (median change +10 ×10³/µl; IQR –65 to +45) compared to a significant increase in the control group (median +74 ×10³/µl; IQR +44.5 to +101.75; p = 0.046). In the intervention group, greater reductions in calprotectin were strongly correlated with more favorable heart rate responses during a graded exercise test (r = –0.92, p = 0.009).

Conclusion

Supervised training program during hospitalization for IBD flare was associated with improved fatigue resistance and more favorable inflammatory responses. Patients with worse baseline functioning obtained greater benefit in exercise tolerance. These findings support the feasibility and potential therapeutic role of individualized physical activity in acute IBD care and highlight the need for further investigation in real-world settings.

References

1. Farrell D, Artom M, Czuber-Dochan W, Jelsness-Jørgensen LP, Norton C, Savage E. Interventions for fatigue in inflammatory bowel disease. Cochrane Database Syst Rev. 2020 Apr 16;4(4):CD012005. doi: 10.1002/14651858.CD012005.pub2.
2. Achtenberg M, Cibor D, Zwolińska-Wcisło M. Structured exercise in patients with inflammatory bowel disease: a literature review. Gastroenterology Review/Przegląd Gastroenterologiczny. 2025;20(1):36-40. doi:10.5114/pg.2025.148473.

Disclosure

Magdalena Achtenberg has received lecture fees and/or travel grants from Ferring and Eli Lilly, unrelated to the present work. Tomasz Dziubyna has received travel grants from Fresenius, unrelated to the present work. Małgorzata Zwolińska-Wcisło, Dorota Cibor, Karolina Gazda, Magdalena Wyrzykowska, Piotr Kosieniak, Maria Wiśniewska, Jerzy A. Żołądź, Marcin Grandys and Joanna Majerczak declare no conflict of interest.

Introduction

Colonoscopy is a standard procedure but it is unclear whether a short or long colonoscope is more favorable regarding procedure efficiency and patient comfort. The performance of different colonoscope lengths cannot be objectively compared in live patients due to various limitations. Hence, the choice of colonoscope length is a matter of personal preference or institutional tradition. Preclinical tools to assess scope performance are needed. We evaluated endoscopists’ performance using short vs. long colonoscopes in the Mikoto simulator, enabling objective measurements using pressure and distension sensors within a 3D-printed, calibrated colon model.

Aims & Methods

Aims: i) Performance comparison of short vs. long comparison in the Mikoto simulator, enabling objective measurements using pressure and distension sensors within a 3D-printed, calibrated colon model. ii) First evaluation of this novel simulator.
Delegates at ESGE Days and DGE-BV 2024 were invited to perform two simulation rounds—one with each scope length in a random order —and completed a survey. Main outcome was the performance of different scope lengths as measured by the caecal intubation time and the proprietary “Mikoto score” (a combination of pressure and distension measurements exerted on the model).

Results

Of 281 participants, 252 complete datasets were analyzed (187 ESGE, 65 DGE-BV). The Mikoto-Score was lower with long scopes (74 vs. 77; p=0.01), and caecal intubation time was longer (2:59 vs. 2:38 min; p=0.01). A second round did not improve performance. Mikoto-Scores were unaffected by scope preference or sedation strategy but were lower in users of the two-person technique. Scores correlated with self-assessed skill and colonoscopy experience (r=0.43, r=0.47). The median system-usability score was 77.5 indicating a good evaluation by the examiners and a good usability.

Conclusion

Using the Mikoto simulator, long colonoscopes caused more colonic distension and longer insertion times, potentially impacting patient comfort. Objective simulator data can inform scope selection in clinical practice. The Mikoto simulator reflects endoscopist self-assessed skill and previous experience.

Disclosure

1. Antonelli G, Voiosu AM, Pawlak KM et al. Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2024; 56: 131-150. doi:10.1055/a-2205-2613
2. Lee SH, Lee DJ. Comparison on colonoscopic parameters according to length of adult-colonoscope. Chin Med J (Engl) 2014; 127: 85-91.
3. Obstein KL, Patil VD, Jayender J et al. Evaluation of colonoscopy technical skill levels by use of an objective kinematic-based system. Gastrointest Endosc 2011; 73: 315-321, 321.e311. doi:10.1016/j.gie.2010.09.005
4. Repici A, Badalamenti M, Maselli R et al. Efficacy of Real-Time Computer-Aided Detection of Colorectal Neoplasia in a Randomized Trial. Gastroenterology 2020; 159: 512-520 e517. doi:10.1053/j.gastro.2020.04.062
5. de Groen PC. Advanced systems to assess colonoscopy. Gastrointest Endosc Clin N Am 2010; 20: 699-716. doi:10.1016/j.giec.2010.07.012
6. Fennerty MB, Earnest DL, Hudson PB et al. Physiologic changes during colonoscopy. Gastrointestinal endoscopy 1990; 36: 22-25.
7. Ofori E, Ramai D, John F et al. Occupation-associated health hazards for the gastroenterologist/endoscopist. Ann Gastroenterol 2018; 31: 448-455. doi:10.20524/aog.2018.0265
8. Williams C, Teague R. Colonoscopy. Gut 1973; 14: 990-1003. doi:10.1136/gut.14.12.990
9. Barthel J, Hinojosa T, Shah N. Colonoscope length and procedure efficiency. J Clin Gastroenterol 1995; 21: 30-32. doi:10.1097/00004836-199507000-00008
10. Kim K-M, Lee S-H, Lee D-J et al. A Randomized Controlled Trial of Comparison on Time and Rate of Cecal and Termianl Ileal Intubation according to Adult-Colonoscope Length: Intermediate versus Long. J Korean Med Sci 2014; 29: 98-105.
11. Sakai Y. Technique of colonoscopy. Gastroenterologic endoscopy 1987; 2: 1253-1280.
12. Lee HL, Eun CS, Lee OY et al. Significance of colonoscope length in cecal insertion time. Gastrointestinal Endoscopy 2009; 69: 503-508. doi:https://doi.org/10.1016/j.gie.2008.06.006
13. Kim YG, Kim KJ, Yang DH et al. Intermediate-length colonoscope needs more training duration than long-length colonoscope. Scand J Gastroenterol 2014; 49: 1007-1013. doi:10.3109/00365521.2013.856465
14. Dubow RA, Katon RM, Benner KG et al. Short (35-cm) versus long (60-cm) flexible sigmoidoscopy: a comparison of findings and tolerance in asymptomatic patients screened for colorectal neoplasia. Gastrointest Endosc 1985; 31: 305-308. doi:10.1016/s0016-5107(85)72211-0
15. Stoffel EM, Murphy CC. Epidemiology and Mechanisms of the Increasing Incidence of Colon and Rectal Cancers in Young Adults. Gastroenterology 2020; 158: 341-353. doi:10.1053/j.gastro.2019.07.055
16. Fujii M, Onoyama T, Ikebuchi Y et al. A novel humanoid-robot simulator for colonoscopy. Endoscopy 2020; 53: E291-E292. doi:10.1055/a-1264-6804
17. Ward ST, Mohammed MA, Walt R et al. An analysis of the learning curve to achieve competency at colonoscopy using the JETS database. Gut 2014; 63: 1746. doi:10.1136/gutjnl-2013-305973
18. Siau K, Pelitari S, Green S et al. JAG consensus statements for training and certification in colonoscopy. Frontline Gastroenterol 2023; 14: 201-221. doi:10.1136/flgastro-2022-102260
19. Bundesärztekammer. (Muster-)logbuch-13.4-FA Innere Medizin und Gastroenterologie. In: Bundesärztekammer; 2011:
20. Haycock A, Koch AD, Familiari P et al. Training and transfer of colonoscopy skills: a multinational, randomized, blinded, controlled trial of simulator versus bedside training. Gastrointestinal Endoscopy 2010; 71: 298-307. doi:10.1016/j.gie.2009.07.017
21. Vajpeyi A, Naidu AS, Hawel JD et al. A multi-modal training environment for colonoscopy with pressure feedback. Surgical Endoscopy 2024. doi:10.1007/s00464-024-11442-1
22. Gomez PP, Willis RE, Van Sickle K. Evaluation of two flexible colonoscopy simulators and transfer of skills into clinical practice. J Surg Educ 2015; 72: 220-227. doi:10.1016/j.jsurg.2014.08.010
23. Mu Y, Yang X, Guo F et al. Colonoscopy Training on Virtual-Reality Simulators or Physical Model Simulators: A Randomized Controlled Trial. Journal of Surgical Education 2024; 81: 1339-1345. doi:https://doi.org/10.1016/j.jsurg.2024.07.020
24. Shumaker DA, Zaman A, Katon RM. A randomized controlled trial in a training institution comparing a pediatric variable stiffness colonoscope, a pediatric colonoscope, and an adult colonoscope. Gastrointestinal Endoscopy 2002; 55: 172-179. doi:https://doi.org/10.1067/mge.2002.121189
25. Tribonias G, Bacasis AD, Komeda Y ​