Introduction

The majority of non-pedunculated colorectal lesions can be curatively resected by standard polypectomy or endoscopic mucosal resection (EMR). However, EMR carries a higher risk of bleeding, which remains one of the most common complications of the procedure¹.

Aims & Methods

We aimed to assess the incidence of intra-procedural bleeding (IPB) and post-polypectomy bleeding (PPB) following EMR of non-pedunculated colorectal lesions and to identify potential risk factors.
A retrospective single-center cohort study was conducted, including all consecutive patients who underwent EMR at a non-tertiary hospital between January 2020 and September 2023. Demographic data, clinical characteristics, lesion features, and procedural variables were collected. Risk factors for IPB and PPB were evaluated using logistic regression analysis.

Results

302 patients (61% male; mean age: 68.9 ± 9.3 years) with a total of 410 colorectal lesions underwent EMR. The mean lesion size was 20.9 ± 10.5mm, with over half (51%) exceeding 20mm, and the majority (57%) were located in the right colon. En bloc resection was achieved in 47% of cases. Regarding morphology, 58% (n=238) were classified as Paris 0-IIa and 30% (n=122) as lateral spread tumors.
IPB and PPB occurred in 8.3% and 3.9% of procedures, respectively, with none being clinically significant. Of these, 38% required endoscopic therapy with snare tip soft coagulation or clip placement. Although right colon location showed a higher incidence of IBP and PPB, these differences were not statistically significant (p=0.356 and p=0.569, respectively).
Larger lesions were associated with a higher incidence of IBP (p<0.05), with size >20mm harboring the highest rate (p=0.039. OR 2.159. IC 1.023-4.554). Higher SMSA (p=0.001) and SERT (p<0.005) scores were also associated with an increased incidence of IPB. Multivariate logistic regression analysis identified size as an independent risk factor for IPB (p=0.015).
Patients medicated with antiplatelet (p<0.05. OR: 7.924. IC 2.415-25.996) and anticoagulant (p<0.05. OR 10.697. IC 3.366-33.994) drugs exhibited higher rates of PPB, accounting for 69% of cases. Larger lesions were also associated with a higher incidence of PPB, though not statistically significant (p=0.337). Prophylactic soft coagulation of visible scar vessels was associated with a reduced risk of PPB (p=0.013. OR 2.420. IC 1.233-9.484). Mechanical prophylaxis with clip placement, performed in 19% of cases (71% in the right colon), did not reduce the risk of PPB (p=0.992). Multivariate logistic regression analysis confirmed anticoagulation as an independent risk factor for IPB (p=0.028).

Conclusion

Lesion size, SMSA and SERT scores were associated with a higher risk of IPB. Patients on antiplatelet and anticoagulant drugs are at higher risk of PPB. Prophylactic endoscopic coagulation of nonbleeding visible vessels within the mucosal defect reduced the risk of PPB and may be a viable strategy to decrease PPB in patients taking anticoagulants.

References

1 – Ferlitsch M et al. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2024. Endoscopy. 2024 Jul;56(7):516-545. doi: 10.1055/a-2304-3219.

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

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

Ingestible sensors hold the promise to revolutionize the monitoring of gastrointestinal diseases, including inflammatory bowel disease (IBD). These miniature electronic capsules could provide a minimally-invasive, cost-effective, and patient-friendly alternative to traditional endoscopic procedures, with the promise of greatly enhancing disease tracking and management.

Aims & Methods

To enable real-time, minimally-invasive monitoring of gut health, we developed the Gastrointestinal Smart Module (GISMO), a highly miniaturized ingestible sensor (3 times smaller than video capsules) that measures redox balance, pH, and temperature throughout the GI tract.
Redox balance plays a key role in regulating the intestinal barrier and mediating interactions among the host, immune system, and gut microbiota. In conditions like IBD, gastrointestinal cancers, and irritable bowel syndrome (IBS), disruptions in immune response and shifts in the gut microbiome can destabilize the balance of oxidants and antioxidants^1,2. This imbalance leads to oxidative stress, detectable through altered redox signals.
After validation in both lab and pre-clinical models, the GISMO system was tested in healthy participants.

Results

In this first-in-human trial, 66 sensors were administered to 15 healthy participants. The GISMO system demonstrated feasibility, safety, and ease of use. Participants reported ease in swallowing the sensors and expressed willingness to ingest multiple capsules. No device-related adverse events occurred throughout the study. GISMO is the first device capable of measuring in vivo redox balance, providing high-resolution data every 20 seconds. The data revealed consistent profiles from an oxidative environment in the stomach to a strongly reducing environment in the colon. This group of self-reported healthy volunteers exhibited low inter- and intra-subject variability, providing a reliable baseline for future comparative studies in patient populations.

Conclusion

This trial marks the first in vivo measurement of redox balance along the human gut, paving the way for new insights into the role of redox balance in maintaining gut homeostasis, inflammation, and the gut microbiome. The ability to conduct frequent and simple monitoring could revolutionize the way gastrointestinal diseases are tracked and managed.

References

1. Campbell, E. L. & Colgan, S. P. Control and dysregulation of redox signalling in the gastrointestinal tract. Nat Rev Gastroenterol Hepatol 16, 106–120 (2019).
2. Bourgonje, A. R. et al. Oxidative Stress and Redox-Modulating Therapeutics in Inflammatory Bowel Disease. Trends Mol Med 26, 1034–1046 (2020).

Disclosure

AE, FL, NVH, RA have filed a patent application on sensing in the gastrointestinal tract with the European (EP4197437A1) and U.S. (US20230190178A1) patent office. FL, AE, and RS have filed a patent application on measuring and localizing inflammation in the gut (application no. EP 24217111.4) with the European patent office. TTo, IDCM, AE, FL have filed a patent application on localization of an ingestible device (application no. EP24222150.5).

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.