Introduction

The real-world utilization of video capsule endoscopy (VCE) still remains poorly understood, particularly among patients with celiac disease (CeD). Current guidelines recommend utilizing VCE as a management tool for patients with CeD, such as for the follow-up and monitoring of the disease, rather than for diagnostic purposes. This study aimed to obtain an improved understanding of the patterns of VCE utilization in a US healthcare database.

Aims & Methods

This retrospective observational study was conducted using data collected from the US MarketScan^® Commercial and Medicare Supplemental claims database from 2002 to 2023. Patients were grouped into two cohorts: all patients with ≥ 1 VCE procedure code (cohort 1) and those with ≥ 1 VCE procedure code who were subsequently diagnosed with CeD (cohort 2). CeD diagnosis and indications for VCE were identified by ≥ 1 inpatient or ≥ 2 outpatient International Classification of Diseases (ICD)-9/-10 medical diagnostic codes. Demographic and clinical characteristics, patterns and indications for VCE utilization, and provider type were summarized using descriptive statistics.

Results

Of the 229,941 patients who had ≥ 1 procedure code for VCE (cohort 1), 4,996 were diagnosed with CeD (cohort 2) from 2002 to 2023. During this period, the frequency of VCE use peaked between 2008 and 2014, and was similar between patients from cohort 1 and cohort 2, with proportions ranging from 7.3% to 9.1% in cohort 1, and from 8.1% to 9.7% in cohort 2. The mean age (standard deviation) at first VCE procedure date was 55.0 (17.7) years in cohort 1 and 47.9 (17.3) years in cohort 2, and there were more females than males in both cohorts (59.1% vs 40.9% in cohort 1 and 69.7% vs 30.3% in cohort 2, respectively). VCE use was notably greater in those aged 18–49 years with CeD than in those of the same age in the overall population. Most VCE procedures were performed by gastroenterologists in both cohorts of patients (72.7% in cohort 1 and 73.9% in cohort 2). The most common indication for VCE use in cohort 1 was unspecified anemia, reported in over half of the patients. Abdominal pain with unspecified location and fatigue/other malaise were the most common indications for VCE use among patients in cohort 2 and were reported in over half of these patients. Among the VCE indications reported in both cohorts, the most common were abdominal pain with unspecified location (51.5% in cohort 1 and 62.0% in cohort 2), followed by fatigue/other malaise (47.2% in cohort 1 and 52.7% in cohort 2).

Conclusion

Findings from this study suggest that VCE may have a role among patients with CeD beyond the current clinical guideline recommendations, although use has decreased in recent years in both patients with CeD and the general population.

Disclosure

MA, NC, VG, DAL, SM, RS, and ST are employees of Takeda Development Center Americas, Inc. and receive stock or stock options. SL and DSM have nothing to disclose.

Introduction

Metabolic disfunction-associated Liver Disease (MASLD) and Metabolic disfunction-Associated Steatohepatitis (MASH) are conditions that are significantly influences by lifestyle factors. Actual problem today is the significant spread of MASLD among people of socially active age, high costs for diagnosis and treatment, and a decrease in the quality of life and work capacity of such patients.

Aims & Methods

The aim of the research is to study the dynamics of indicators of the functional state of the liver, the lipid spectrum of the blood, to evaluate the cardiovascular risk according to the SCORE-2 scale under the influence of complex pathogenetic treatment of the identified disorders in patients with steatohepatitis associated with metabolic dysfunction in combination with obesity. 46 outpatients with a diagnosis MASH were examined: 29 (63.1 %) men and 17 (36.9 %) women aged 32-55 years. There were patients divided into two groups. The first (main) group with a diagnosis MASH were 19 (41.3 %) people who received atorvastatini: 20 mg per day, 90 days. The second group (comparison) – 27 (58.7%) of patients who were prescribed ursodeoxycholic acid preparations in combination with atorvastatini: 250 mg (15 mg/kg of body weight) for 90 days. The healthy group consisted of 12 people of the appropriate age. The anthropometric criterion of obesity was the Quetelet index (BMI = body weight (kg)/height (m²)). Phenotypic variant of obesity was determined by the ratio of waist circumference / hip circumference (WC/HC). Visceral obesity was observed in all examined patients. Among the patients of the main group, there were 9 (47.4 %) people with type I obesity degree (BMI = 32.6 ± 2.2 kg/m2), 6 (31.5 %) – II degree (BMI = 35.8 ± 3.6 kg/m2), and 4 (21.1 %) – III degree (BMI = 40.0 ± 2.1kg/m2), in the comparison group – 17 (62.9 %), 6 (22.3 %) and 4, respectively (14.8 %). This indicated that the patients had an abdominal type obesity. For assessment biochemical indicators of the functional state of the disease were studied using unified methods (general level bilirubin and its fractions (direct and indirect), activity of serum aminotransferases ALT and AST, alkaline phosphatase (AP), total cholesterol (CHD) content in serum blood, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), very-low-density lipoprotein cholesterol (VLDL), triglycerides.

Results

In most patients suffering from MASH there was found a reliable increase of the direct bilirubin level in the blood, of the activity of alanine aminotransferase (ALT, ALT) and alkaline phosphatase (ALP), and of the blood lipid spectrum (p<0,05). According to the body mass index (BMI) most of the examined patients had visceral obesity. After the course of the combined therapy there were marked the positive dynamics in biochemical indices of the blood (p < 0,05): decrease of the direct bilirubin level, aminotransferase (ALT, ALT), blood phosphatase. The indices of blood lipid spectrum approached to the normal indexes (p < 0,05).

Conclusion

the addition of ursodeoxycholic acid to statin therapy results in a statistically significant reduction in overall cardiovascular risk, as measured by SCORE-2, compared with atorvastatin monotherapy. All patients were recommended to continue the course treatment - a combination of atorvastatini and ursodeoxycholic acid for 2-3 months. This indicates the almost complete recovery of the liver functional activity and achievement of the consistent biochemical of MASH.

References

1. Harrison SA, Ruane PJ, Freilich BL, et al. Efruxifermin in non-alcoholic steatohepatitis: a randomized, double-blind, placebo-controlled, phase 2a trial. Nat Med. 2021;27(7):1262-71. https://doi.org/10.1038/s41591-021-01425-3
2. Powell EE, Wong VW, Rinella, M. Non-alcoholic fatty liver disease. Lancet. 2021;397:2212-24. https://doi.org/10.1016/ S0140-6736(20)32511-3
3. Prins GH, Rios-Morales M, Gerding A, Reijngoud DJ, Olinga P, Bakker BM. The effects of butyrate on induced metabolic-associated fatty liver disease in precision-cut liver slices. Nutrients. 2021;13:4203. https://doi.org/10.3390/nu13124203
4. Alkhouri N, Herring R, Kabler H, et al. Safety and efficacy of combination therapy with semaglutide, cilofexor and frsocostat in patients with non-alcoholic steatohepatitis: a randomised, open-label phase II trial. J Hepatol. 2022;77(3):607-18. https://doi.org/10.1016/j.jhep.2022.04.003
5. Younossi ZM, Rinella ME, Sanyal AJ, et al. From NAFLD to MAFLD: implications of a premature change in terminology. Hepatology. 2021;73 (3):1194-8. doi: 10.1002/hep.31420. Epub 2021 Feb 6. PMID: 32544255. https://doi.org/10.1002/hep.31420

Clinical Case Summary

Introduction: Eating disorders are often overlooked in the management of inflammatory bowel disease (IBD), despite their potential to aggravate malnutrition and reduce treatment effectiveness.
Aims & Methods: This case report aims to raise awareness of the possible coexistence of binge eating disorder (BED) and IBD. A female Crohn’s disease patient with persistent malnutrition and therapeutic resistance disclosed binge eating behavior and was referred for psychiatric care.
Results: Despite clinical remission with infliximab, the patient maintained a BMI of 13.8. After BED diagnosis and psychiatric intervention, her BMI increased to 16.6 with notable emotional improvement.
Conclusion: BED can mimic or worsen IBD complications. Screening for eating disorders and implementing multidisciplinary care—including mental health support—are crucial to optimize outcomes.

References

1) Inflammatory Bowel Disease and Eating Disorders: A systematized review of comorbidity
L Ilzarbe et al. J Psychosom Res. 2017 Nov.
2)Celiac Disease and Inflammatory Bowel Disease Are Associated With Increased Risk of Eating Disorders: An Ontario Health Administrative Database Study
Lakshmimathy Subramanian et al. Clin Transl Gastroenterol. 2024.
3)Shared genetic influences between eating disorders and gastrointestinal disease in a large, population-based sample of adult women and men
Laura A Pascoe et al. Psychol Med. 2024 Apr.
4) Prevalence and Characteristics of Avoidant/Restrictive Food Intake Disorder in Adult Neurogastroenterology Patients
Helen Burton Murray et al. Clin Gastroenterol Hepatol. 2020 Aug.

Introduction

According to the British Society of Gastroenterology (BSG) guidelines on sedation in gastrointestinal endoscopy (2023), minimal to moderate sedation is typically sufficient for level 1/2 endoscopic retrograde cholangiopancreatography (ERCP). However, deep sedation is not routinely available in many centres, potentially affecting patient comfort and procedure completion. This study investigated factors associated with incomplete ERCP procedures, with a particular focus on patient intolerance.

Aims & Methods

A retrospective review of all ERCP’s performed over six months at our tertiary centre was conducted. Data collected included demographics, indication, ERCP grade, sedation used, cannulation rate and completion of procedure (eg complete duct clearance). Achieving the primary therapeutic or diagnostic goal served as the primary outcome. Univariate and multivariable analyses were used to evaluate factors contributing to incomplete procedures.

Results

475 ERCP’s were analysed (median age 67 years; range 18–92; 49.5% female). Successful cannulation was achieved in 458 of 475 procedures (96.4%). Among the 55/475 (11.6%) incomplete ERCPs, 32 (6.7% of all procedures) were abandoned due to patient discomfort—manifested as pain, restlessness, and inability to tolerate the procedure. Univariate analysis showed significantly higher opiate doses (63.8 mg vs. 56.3 mg, p=0.015) and higher midazolam doses (5.0 mg vs. 4.0 mg, p=0.0003) in incomplete procedures. No significant differences were observed for age, sex, inpatient status, ERCP grade, or use of general anaesthesia. Multivariable analysis revealed no independent risk factors for incompletion. Other contributing factors included prolonged procedures (e.g., EUS prior to ERCP) and challenging anatomy.

Conclusion

Patient discomfort emerged as the primary driver of incomplete ERCPs, highlighting the importance of optimizing sedation strategies and ensuring adequate anaesthetic support. Higher opiate and midazolam doses correlated with incomplete procedures suggesting that deeper sedation may have allowed completion. More detailed research including data from a combination of tertiary and non-tertiary centres is needed to refine sedation practices in line with current BSG guidelines.

Introduction

Musculoskeletal disorders (MSDs) are the leading cause of occupational disease and represent a major public health concern. Endoscopy plays a central role in hepatogastroenterology, and its practice is associated with a high prevalence of MSDs, ranging from 40% to 90% among endoscopists. The increasing complexity of endoscopic procedures may further exacerbate musculoskeletal strain on practitioners. However, few studies have been conducted on this topic, and most rely on observational and self-reported data, limiting their level of evidence. Quantitative studies assessing the impact of digestive endoscopy, particularly endoscopic retrograde cholangiopancreatography (ERCP), on MSD risk under real working conditions remain scarce.

Aims & Methods

To obtain objective and reliable data, we used the KIMEA tool, which analyzes an operator’s movements by generating a digital twin based on data collected through a depth camera and wrist-mounted sensors. This system allows for an objective assessment of musculoskeletal strain by estimating MSD risk using the Rapid Upper Limb Assessment (RULA) method. Our study was conducted on two experienced endoscopists performing a total of 10 ERCP procedures.

Results

Motion analysis revealed an average global RULA score of 4.2, indicating a moderate risk of MSDs. Musculoskeletal strain was predominantly observed in the forearms, particularly in the wrists, which remained in constrained postures for more than 50% of the procedure time. The musculoskeletal load was asymmetrical, with greater strain on the left side. These findings were consistent across all 10 procedures.

Conclusion

Discussion: This study confirms the significant musculoskeletal strain on the upper limbs during ERCP procedures. Our findings align with existing literature. The KIMEA tool appears to be a suitable method for analyzing movements in digestive endoscopy and represents a methodological advancement for the objective evaluation of musculoskeletal strain in this field.
Conclusion: Motion analysis using the KIMEA tool provides objective evidence that ERCP practice poses a risk for MSD development. Further studies with larger sample sizes are needed to strengthen the level of evidence, assess the impact of factors such as age, experience, gender, and procedure type, and promote the integration of ergonomic measures into endoscopic practice to reduce MSD risk.

Introduction

Advanced colorectal neoplasia (ACN) has a high potential for malignancy, and its early detection and removal can effectively reduce the incidence and mortality of colorectal cancer (CRC). A predictive model to estimate the risk of ACN could help direct patients and providers to improve screening efficiency.

Aims & Methods

We aimed to develop a comprehensive risk prediction model specifically for ACN.
A retrospective cross-sectional study was conducted on patients who underwent endoscopy at the Affiliated Wuxi People's Hospital of Nanjing Medical University from January 1, 2021, to December 31, 2023. The researchers collected clinical data, including histopathological results, demographic information, lifestyle features, and medical history. Univariate and multivariable analyses were used to derive a risk prediction model based on the training cohort of the sample, and points were assigned to each variable to create a risk score. Scores with comparable risks were grouped into different risk categories. The model and its scores were tested using the validation cohort.

Results

Among the 2054 participants in the training cohort [mean age, 60 (52, 68) years; 1022 (50.0%) female], the prevalence of ACN was 271 (13.3%). The eight-variable model (sex, age, diabetes, family history of CRC in a first-degree relative, history of colonoscopy history, smoking, gastric histopathological results, and Helicobacter pylori infection history) resulted in two risk categories, with an area under the receiver operating characteristic curve (AUC) of 0.710 (95% CI: 0.679-0.742). In the validation cohort of 495 participants with an ACN prevalence of 62 (12.5%), model performance was comparable (AUC=0.715, 95% CI: 0.649-0.781). The ACN risk was 6.9% and 23.9% in the low- and high-risk groups, respectively, and 14 and 4 participants needed to be screened in the low- and high-risk groups, respectively. Further analysis revealed that three other prediction methods, including the Asia-Pacific Colorectal Screening (APCS) score [0.622 (0.556-0.688), p=0.049], the APCS score-revised edition [0.589 (0.524-0.653), p=0.007], and the colorectal tumor prediction score [0.570 (0.504-0.636), p=0.002], displayed significantly lower AUCs than our prediction ACN model.

Conclusion

The developed and validated prediction model performed well in identifying individuals with ACN at high risk in asymptomatic Chinese populations. Colonoscopy examinations in these patients were necessary, as they not only facilitated early detection of ACN but also enabled timely intervention to prevent CRC.

Introduction

Endoscopic papillectomy (EP) is indicated for papillary adenoma that do not extend into the pancreatic bile duct. There are cases in which en bloc resection or curative resection is expected to be difficult with conventional EP. For such cases, we introduced hybrid EP, in which snaring is performed after peri-lesion incision using a dedicated ESD knife.

Aims & Methods

A total of 13 cases who underwent hybrid EP between 2022 and 2024 were identified from our prospectively maintained database. Hybrid EP involved a circumferential incision with partial submucosal dissection, and subsequent snare resection of ampullary tumors, which was performed by two endoscopists with expertise in ESD or endoscopic retrograde cholangiopancreatography. Demographic data and clinicopathological outcomes were retrospectively evaluated.

Results

En bloc resection was achieved by hybrid EP in all 13cases, with the median procedure time of 118 (range: 65-170) minutes. The median diameters of the resected specimens and tumors were 25 and 15 mm, respectively. All lateral margins were clear, whereas vertical margin was uncertain in one (7.6%), resulting in the complete resection rate of 92.4%. Postoperative bleeding developed in two (15.3%). No tumor recurrence was observed even in that case with uncertain vertical margin, after a median follow-up of 244 (range, 97-678) days.

Conclusion

Hybrid EP is an useful technique for duodenal papillary tumors that are difficult to resect en bloc or curatively by conventional EP.
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