Introduction

Esophageal anastomotic stricture is a common complication after esophagogastric anastomosis, primarily characterized by inability to eat or difficulty swallowing.

Aims & Methods

This study aims to compare the efficacy and safety of endoscopy radial incision (ERI) technique versus endoscopic balloon dilation (EBD) in treating refractory esophageal anastomotic strictures. A retrospective analysis was conducted on patients who underwent endoscopic treatment for esophageal anastomotic stricture from January 2020 to June 2024. Based on inclusion and exclusion criteria, data were collected and analyzed, including preoperative stricture duration, preoperative treatment history, pre-and postoperative swallowing difficulty symptoms (Barthe score), improvement in anastomotic diameter, and occurrence of intraoperative and postoperative complications, to assess efficacy and safety.

Results

A total of 109 patients were included in the study, with 46 in the ERI group and 63 in the EBD group. All patients successfully completed the endoscopic procedures. The average operation time for the ERI group was 10.15±5.23 minutes, with an average of 2.26±0.76 incisions made. No adverse events such as bleeding or perforation occurred in either group during or after the procedure. There were no significant differences in preoperative dysphagia score (3.58±0.76 vs. 3.22±0.63) or anastomotic diameters (0.30±0.02 vs. 0.29±0.03) between the two groups. On postoperative 1 week, 3 months, 6 months, and 1 year, the effective symptom relief rates for the ERI group were 100%, 76.1%, 47.8%, and 41.3%, respectively, while the effective symptom relief rates for the EBD group were 100%, 39.7%, 28.6%, and 20.6%.

Conclusion

The ERI technique is a safe and feasible method for treating refractory esophageal anastomotic strictures, with superior efficacy compared to EBD.

Introduction

Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic disorder characterized by recurrent intestinal inflammation and complications. Although there has been significant research on bacterial dysbiosis in IBD, the role of the gut mycobiome has been largely overlooked, especially in surgical tissue samples.

Aims & Methods

We aim to characterize the intestinal mycobiome in surgical resections from IBD patients.
Intestinal fungal communities in surgical resections obtained from 20 UC and 30 CD patients, with non-IBD colonic and ileal resections as controls respectively, were analyzed. Fungal DNA was extracted and the ITS region was amplified and sequenced. This data was processed by Dada2 software. Statistical analyses were performed in R, using Adonis tests for multivariate analysis. Rarefaction curves, richness and diversity indexes were calculated and compared by Wilcoxon. Constrained correspondence analysis (CCA) was used for visualization, and ANCOMBC2 for taxon abundance comparisons. P-values were adjusted using FDR method. Spearman's correlation was applied to correlate mycobiome data with microbiota sequencing. Data were expressed as mean ± SEM and compared using t-tests, one-way ANOVA, or Kruskal-Wallis tests, with significance set at p < 0.05.

Results

Results revealed modest changes in fungal diversity and richness in UC resections compared with control-UC samples. However, CD exhibited significant mycobiome alterations at genus level, including an increased abundance of Malassezia (log2FC=-1.4), specifically Malassezia globosa (log2FC=-9,4) at species level, alongside a reduction in Yarrowia lipolytica (log2FC=8.2) compared to the control-CD samples. Regarding fungal correlations, in surgical samples from UC patients, the majority of the correlations were positive while any negative correlation was statistically significant. On the other hand, CD patients showed few negative and weaker positive correlations. Correlation analyses further suggested complex interkingdom interactions between fungal and bacterial communities. In UC patients, Dothideomycetes unclassified stands out with the majority of significant correlations, whereas in CD patients most of the significant negative correlations found in control-CD disappeared while new significant correlations appeared.
Additionally, mycobiome differences between complicated CD-phenotypes were analysed and Cryptococcus pseudolongus and Cladosporium unclassified were significantly more abundant in B3 samples than in B2, whereas Dothideomycetes unclassified was more abundant in B2 than in B3. Moreover, distinct fungal signatures capable of discriminating between them were identified by analyzing ROC curves and Dothideomycetes unclassified presented an AUC value of 0,823 and Cladosporium unclassified with an AUC of 0,737.

Conclusion

Intestinal mycobiome has been characterized for the first time in surgical resections from both UC and CD patients, observing statistical differences in the genera Malassezia and Yarrowia in CD patients. Additionally, several associations between fungal and bacterial species were identified, highlighting the direct interaction between the bacteriome and mycobiome. Notably, complicated-CD phenotypes exhibit a distinct mycobiome pointing Dothideomycetes unclassified and Cladosporium unclassified as potential discriminators between these phenotypes.

Introduction

With nearly half of Romania’s population living in rural areas (1) with limited imaging access, non-invasive tests for liver steatosis and fibrosis are especially valuable. In such settings, ultraportable devices may offer practical solutions by providing point-of-care (POCUS) liver assesment.

Aims & Methods

The aim of this study was to determine the prevalence of liver steatosis and fibrosis in this population and to assess the concordance between ultrasound and various non-invasive serological and imaging methods within a screening program.
Between 2022 and 2024, Caravans were conducted in 17 villages across Central and North Romania. Participants received blood tests, abdominal ultrasound(US), and ultrasound elastography using ultraportable devices (liver stiffness (LSM) and attenuation coefficient(AT). Steatosis was assessed with the Fatty Liver Index(FLI), Hepatic Steatosis Index(HSI) while fibrosis was evaluated using FIB-4 and the NAFLD Fibrosis Score (NFS) and pairwise agreement between methods was determined by overall percentage agreement, Cohen’s kappa (κ), and concordance within each modality’s defined low- and high-risk groups.

Results

Of the 1,935 individuals screened, 1,721 underwent blood tests and 1,208 underwent ultrasound.62% had a BMI>25 kg/m², with 31.2% overweight,27.3% grade I obesity,11.9% grade II obesity and 8.1% morbid obesity;54.5% had prediabetes, 17.7% diabetes and 78.7% were dyslipidemic.
Steatosis prevalence was 50.8% on ultrasound (mild:30.6%,moderate:11.7%,severe:8.6%) and 26.5% on AT (mild 11.9%, moderate 4.9%, severe 9.7%). High steatosis risk was estimated at 55.1% by FLI, 63.7% by HSI and 86.5% by VAI.
Pairwise concordance for steatosis was moderate for US vs FLI and US vs AT (κ = 0.39 and 0.33).FLI and HSI showed the strongest agreement (k = 0.66; 92.7%match in high-risk). AT showed weak concordance with serological scores. (Table 1).
Advanced liver disease was found in 3.4% by ultrasound. LSM classified 88.4% as<F2 and 4.8% as F3–F4.Low fibrosis risk was found in 61.5% (FIB-4) and 62.5% (NFS) and high risk in 5.4% and 5.85%.
For fibrosis, US vs LSM showed 97.7% concordance (κ = 0.69), US vs FIB-4 93.3% (κ = 0.39)(Table 1).Among intermediate‐risk cases of the serological tests, 4.4% of FIB-4 and 6.7% of NFS had advanced (F3–F4) fibrosis.

Conclusion

FLI and HSI showed strong agreement and among serum scores FLI showed the strongest agreement with ultrasound. LSM aligned most closely with ultrasound, making it the best confirmatory test, while FIB-4, although less sensitive for advanced disease had very good low-risk agreement and therefore would be suiteble for initial screening.

References

1. National Institute of Statistics. Romania in figures-statistical abstract. https://insse.ro/cms/ro/content/rom%C3%A2nia-%C3%AEn-cifre-breviar-statistic-limba-englez%C4%83-4.

Disclosure

The HE-RO-I Project (State-of-the-art colaborativ ROmânia-Islanda în managementul HEpatopatiilor cronice și a complicaţiilor acestora, ciroza hepatică și cancerului hepatic, destinat grupurilor vulnerabile din România, inclusiv Romi) was initiated by a team of physicians from the Gastrointestinal and Hepatology Institute of Cluj-Napoca, in collaboration with Caravana cu Medici – Cluj-Napoca Branch and Landspítali University Hospital in Reykjavik, Iceland, under the coordination of the Romanian Ministry of Health. The project aimed to deliver health education and conduct screening—primarily for liver diseases—among vulnerable populations (including roma people) from remote areas of Central and Northern Romania.
Financed by the Finance Mechanism of European Economic Space 2014-2021.

Introduction

Upper gastrointestinal bleeding (UGIB) remains a major clinical emergency with significant morbidity and mortality despite advances in endoscopic and medical management. While existing risk scores have been widely used, their applicability to specific populations is limited. We aimed to identify mortality-associated risk factors in Colombian patients with UGIB and propose the "Bogotá Score" as a novel stratification tool tailored to our population.

Aims & Methods

We conducted a retrospective case-control study involving 472 patients with UGIB across three Colombian centres during 2023. Twenty-five (5.3%) patients died due to UGIB-related complications. Demographic, clinical, and endoscopic variables were compared using bivariate analysis. Variables significantly associated with mortality were included in a multivariate logistic regression model. A point-based risk score—the Bogotá Score—was derived from independent predictors.

Results

Age ≥70 years, anaemia (OR 7.15; p=0.022), haemoglobin <10 g/dL, Blatchford score >8 (OR 1.18; p=0.003), hospitalisation delay >24h (OR 1.01; p=0.008), and rectorrhagia were associated with increased mortality. Conversely, melena was linked to reduced risk (OR 0.20; p=0.001). These variables were integrated into the Bogotá Score. Patients were stratified into four risk categories: low (0–3), moderate (4–6), high (7–9), and very high (≥10).

Table: Bogotá Score – Risk Stratification Tool

Interpretation:

• 0–3: Low risk

• 4–6: Moderate risk

• 7–9: High risk

• ≥10: Very high risk

Conclusion

The Bogotá Score represents a simple, evidence-based tool for early risk stratification in UGIB. By incorporating context-specific variables, it enhances clinical decision-making in Latin American settings. Early ICU transfer and intensive monitoring for high-risk groups may improve outcomes. Future multicentre validation is warranted.

References

• Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ. 2017;356:i6432. This study evaluates the performance of various risk scoring systems, including the Glasgow-Blatchford Score, in predicting clinical outcomes in UGIB patients. ​BMJWikipedia+7Wikipedia – Die freie Enzyklopädie+7Nature+7

• Zou K, Huang S, Ren W, et al. Development and validation of a dynamic nomogram for predicting in-hospital mortality in patients with gastrointestinal bleeding: a retrospective cohort study in the intensive care unit. Scientific Reports. 2024;14:27940. This research presents a predictive model for in-hospital mortality among patients with gastrointestinal bleeding, emphasizing the importance of tailored risk assessment tools. ​Sage Journals+3Nature+3Nature+3

• In KR, Oh YE, Moon HS, et al. Comparison and validation of several scoring systems for non-variceal upper gastrointestinal bleeding: a retrospective study. Scientific Reports. 2024;14:27940. This study compares and validates multiple scoring systems for non-variceal UGIB, highlighting the need for accurate risk stratification in diverse populations.

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.