Introduction

Non-invasive assessment of liver structure is an invaluable current practice of hepatology.
The rate of obesity is increasing globally. Africa is not an exception as obesity has become quite prevalent in many parts of Africa like Nigeria.
Steatosis (excessive fat in the liver) can be assayed in the liver using a controlled attenuation parameter (CAP) during transient elastography (TE).

Aims & Methods

All patients fasted for at least 3 hours prior to carrying out a Fibroscan. The level of fibrosis was recorded in kPa and the CAP in dB/m. The machine (Fibroscan Expert 630) also recorded the Shear wave speed (SWS) in meters per second. Height and weight were obtained using a Stadiometer and BMI was extrapolated. Biodata was obtained using a questionnaire

Results

One thousand four hundred and nine participants (1,409) were studied. The mean age was 43.84 (sd=14.27) years. About Sixty-five percent (64.84%) were males. The commonest (57.5%) indication for Fibroscan was Chronic Hepatitis B (CHBVI). Alcohol consumption and or suspicions of fatty liver disease made up about Nine percent (8.93%) of the indications. About 48% had higher-than-normal BMI.
About 81% had steatosis stage S0 (<248 dB/m). Nineteen percent had different degrees of steatosis. The largest group was S3 (280dB /m and above) with 9.6 %. Stage S1 (2458-267dB/m) was 5.7%. About 20% had significant fibrosis (14.0kPa and above) via TE measurement.
Age had a weak positive correlation (+0.185) with TE scores while BMI had a weak negative correlation (-0.162) with TE scores. On the other hand, the CAP score was strongly and positively (+0.461) correlated with BMI but negatively (-0.073) with SWS. P=0.001
On multiple regression, only BMI (B =4.09) significantly predicts CAP score by about 4 folds, p=0.0001.

Conclusion

The rate of obesity is increasing among adults in North-central Nigeria. Among this cohort, it’s clear that as BMI increases, the degree (Stage) of steatosis also increases.

Introduction

The prevalence of biliopancreatic malignancies is steadily increasing. Most patients are inoperable due to the typically advanced stage of the disease at the time of diagnosis and require biliary drainage. Despite numerous large-scale studies, the identification of predictive factors for survival in these cancers to improve their prognosis remains a challenge.
The aim of our study was to evaluate the survival of patients who underwent biliary stenting as part of the management of unresectable biliopancreatic malignancies and to assess the factors influencing the survival rate.

Aims & Methods

We conducted an observational cohort study between January 1, 2021, and March 28, 2024. All patients who underwent biliary drainage for obstructive jaundice due to biliopancreatic cancer (pancreatic head adenocarcinoma, peri-hilar cholangiocarcinoma, gallbladder cancer, ampulloma) were included. Contraindications to palliative chemotherapy were poor general condition (ECOG/WHO performance status 3 or more) and hyperbilirubinemia due to inadequate biliary drainage.

Results

82 patients were included in our study. The mean age in our series was 63.4 +/- 12 years. The sex ratio was 1. The median survival was 350 days (95% CI 268 – 514). 49.4% had pancreatic head adenocarcinoma, 30.6% had cholangiocarcinomas, 10% had ampullomas, and 10% had gallbladder cancer.
The median survival for pancreatic head adenocarcinoma was 450 days vs. 562 days for ampullomas, 356 days for cholangiocarcinomas, and 301 days for gallbladder cancer.
The type of cancer did not have a statistically significant difference on median survival (p = 0.95).
15% of patients had failed ERCP and underwent percutaneous biliary drainage. They had a 2.5 times higher risk of death (RR = 2.57, 95% CI 1.26-5.25, p = 0.01). Indeed, the median survival without death in cases of percutaneous drainage was 39 days vs. 375 in cases of successful ERCP (p = 0.007).
65% of patients were able to undergo palliative chemotherapy after stenting. The median survival with chemotherapy was 562 days vs. 30 days for patients who could not initiate it (p < 0.001). The latter had a 10 times higher risk of death in the month following stent placement (RR = 10.7, 95% CI 5.23-21.9, p < 0.001).
In our series, the presence of pancreatic head adenocarcinoma was associated with a higher probability of receiving chemotherapy (p = 0.04). However, it did not have a significant impact on median survival.
In multivariate analysis, only palliative chemotherapy seemed to improve the survival median (p < 0.001), while recurrence of jaundice and stent occlusion were associated with death (p = 0.03).

Conclusion

According to the results of our study, the prognosis of unresectable biliopancreatic cancers is poor but appears to be improved by a successful biliary stenting. Patients in whom biliary stent placement was a bridging procedure that allows chemotherapy seem to have higher survival rates. The generalization of endoscopic ultrasound-guided biliary drainage as an alternative to biliary percutaneous drainage could improve the survival rate in patients with failed ERCP.

Introduction

Bowel sound analysis holds promise as a non-invasive, cost-effective alternative to conventional diagnostic methods. However, standardized recording and interpretation methods are lacking. Our study aims to address this gap by investigating the correlations between bowel sounds and clinical/endoscopic data in patients.

Aims & Methods

We conducted a single-center, observational, cross-sectional study at the Mongi Slim Hospital's Gastroenterology Department. The study included patients scheduled for colonoscopy who had followed a residue-free diet for at least three days and ingested a bowel prep the day before the examination. We collected the patients' medical and surgical history, their digestive complaints, and performed a bariatric assessment. Bowel sounds were then recorded for 5 minutes using a modified version of the Littman® CORE Digital stethoscope and were then analyzed using AI programs to extract acoustic features. Afterwards, these features were compared with clinical and endoscopic data to establish correlations.

Results

We included 95 patients in our study (mean age = 56.32 years, sex ratio M/F = 1.02). Colonoscopy was performed in 83 patients (87.37%) and was total in 62 patients (74.70%). At least one endoscopic anomaly was present in 47 patients (54.63%). The most common finding was polyps in 27 patients, representing 57.45% of patients with an endoscopic anomaly. We labeled 33,837 bowel sounds from the 95 recordings of the included patients, with an average of 356.18 bowel sound labels per recording. The mean ratio of bowel sound duration to recording duration was 22.75%, corresponding to 68 seconds of bowel sounds out of the 5 minutes recorded.
In the analytical study, we found that gender was correlated with the RMS and Envelope features, with p-values of 0.021 and 0.032, respectively, suggesting that men tend to have an increased overall amplitude of the signal, while women exhibit a greater variability of amplitude over time. Difficulty passing gas was also correlated with RMS and Envelope with p-values of 0.039 and 0.032, respectively, implying that patients having trouble passing gas produce sounds with lower average amplitude and increased variability over the course of the signal. Difficulty passing gas was also correlated with Spectral Contrast with a p-value of 0.036. This means that in these patients, the spectral energy is evenly distributed across frequencies and there are no major frequency variations over the course of the signal. The presence of an endoscopic anomaly was also correlated with RMS and Envelope with p-values of 0.027 and 0.024, respectively, suggesting that in the presence of an endoscopic anomaly, the average amplitude of the signal would be lower, and the amplitude of the sounds would be more variable over the course of the signal. We also found that the presence of polyp(s) was correlated with RMS and Envelope with p-values of 0.041 and 0.042, respectively, indicating that in the presence of polyp(s), the average signal amplitude is lower, and the amplitude of the sounds is more variable over the course of the signal.

Conclusion

Although conducted under experimental conditions, since we used a controlled diet and bowel prep, this study demonstrated promising correlation between bowel sounds and both clinical data and endoscopic findings in patients, particularly the amplitude of bowel sounds and its variations over time. Further studies are needed to verify these correlations under more real-life conditions.

References

- Wang N, Testa A, Marshall BJ. Development of a bowel sound detector adapted to demonstrate the effect of food intake. Biomed Eng OnLine. 4 janv 2022;21(1):1.
- Inderjeeth AJ, Webberley KM, Muir J, Marshall BJ. The potential of computerised analysis of bowel sounds for diagnosis of gastrointestinal conditions: a systematic review. Syst Rev. déc 2018;7(1):124.
- Nowak JK, Nowak R, Radzikowski K, Grulkowski I, Walkowiak J. Automated Bowel Sound Analysis: An Overview. Sensors. janv 2021;21(16):5294.
- Redij R, Kaur A, Muddaloor P, Sethi AK, Aedma K, Rajagopal A, et al. Practicing Digital Gastroenterology through Phonoenterography Leveraging Artificial Intelligence: Future Perspectives Using Microwave Systems. Sensors. janv 2023;23(4):2302.
- Yoshino H, Abe Y, Yoshino T, Ohsato K. Clinical application of spectral analysis of bowel sounds in intestinal obstruction. Dis Colon Rectum. sept 1990;33(9):753.
- Craine BL, Silpa M, O’Toole CJ. Computerized Auscultation Applied to Irritable Bowel Syndrome. Dig Dis Sci. 1 sept 1999;44(9):1887‑92.

Disclosure

This study was conducted along with DigeHealth, a swiss start-up working on developing a non invasive monitoring system for bowel disorders.

Introduction

Intraductal papillary mucinous neoplasms (IPMN) have a potential to evolve into pancreatic adenocarcinomas. While main-duct IPMN (MD-IPMN), involving the main pancreatic duct (MPD), are less common than side-branch IPMN (SB-IPMN) or mixed-type IPMN (mixed-IPMN), their malignant transformation potential is far greater. Current guidelines refer to worrisome radiological features and high-risk stigmata of IPMN in dictating recommended management strategies, whether surgical resection, endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) or long-term radiological follow-up. However, controversy exists between different guidelines in terms of recommended follow up duration.

Aims & Methods

To assess the utility of radiological follow up of MD-IPMN and mixed-IPMN, including prevalence of worrisome radiological findings and their correlation to development of progression or pancreatic adenocarcinoma.
​Eighty-four patients with MD-IPMN or mixed-IPMN who underwent at least one magnetic resonance cholangiopancreatography (MRCP) at our medical center were included. Clinical and laboratory data were obtained retrospectively from their medical records, and imaging tests were revised. A cross-sectional analysis was aimed to point clinical and laboratory parameters associated with development of pancreatic adenocarcinomas. A retrospective cohort study was performed on 44 patients of the study population, who had at least six months of follow up (mean follow up time 26.51±18.75 months), trying to point factors correlating with worrisome radiological features.

Results

Nine cases of pancreatic adenocarcinoma were recorded in the cohort (10.7%). These were diagnosed in 7 patients at presentation, whereas 2 patients developed them during follow up period. Factors associated with cyst progression greater than 5 mm during follow up were alanine aminotransferase (ALT) levels (p=0.007), maximal cyst size (p=0.02), MPD diameter (p=0.01) and the presence of jaundice (p=0.04) or a sense of abdominal fullness (p=0.008). The cross-sectional analysis indicated that pancreatic adenocarcinoma was associated with complaints of nausea (p=0.01), as well as elevation of aspartate aminotransferase (AST) (p=0.05), gamma glutamyl transpeptidase (GGT) (p=0.01) and alkaline phosphatase (ALP) (p=0.01).

Conclusion

This study demonstrates the association between clinical findings and elevated liver enzymes and the risk of IPMN malignant transformation. Although further studies are needed, these data may aid in risk stratifying patients when determining the duration and mode of follow up for IPMN.

Introduction

In recent years, evidence shows that long non-coding RNAs (lncRNAs) are key regulators of gene transcription and play important roles in the pathogenesis of inflammatory bowel diseases. LncRNAs are involved in the regulation of intestinal epithelial cell apoptosis, cell-cell interactions, and enhancing inflammation, among others. Biological therapies, which are considered the most potent for disease control, only benefit one-third of patients. For this reason, a deeper understanding of the mechanisms by which biological drugs elicit their effect on intestinal mucosal is needed. Hence, we aimed to unravel the ex vivo modulator effect of infliximab on the lncRNAs expression in intestinal biopsies from patients with Crohn´s Disease (CD).

Aims & Methods

We performed an unbiased transcriptomic analysis of intestinal biopsies from the ileum and colon from 30 patients [active CD = 10, quiescent CD = 10, healthy controls (HC) = 10] to identify lncRNA differentially expressed in the setting of infliximab modulation. Endoscopic biopsies were cultured with or without infliximab and the transcriptome was determined by Illumina gene expression array. We used different databases (Ensembl Biomart, RNAcentral and ToppGene) to search for non-annotated lncRNA information and data on the location (cellular component), biological process and molecular function of differentially expressed lncRNAs.

Results

Transcriptomic results revealed a widespread dysregulation of lncRNAs in ileum biopsies from patients with active CD, quiescent CD and HC compared to the colon at baseline and after infliximab culture. These differentially expressed lncRNAs were enriched in such pathways as proliferation, apoptosis, migration, inflammatory response of fibroblasts, response to wounding, posttranscriptional regulation of inflammatory genes and activation of the mitogen-activated protein kinase signaling pathways. Regarding the effect of infliximab according to intestinal location, presence of disease and activity, no significant lncRNAs were identified in the different study comparatives.

Conclusion

We have characterized the basal transcriptomic landscape of lncRNAs in patients with CD (active and quiescent) and HC both in ileum and left colon. However, we have not found differential lncRNA expression due to the effect of infliximab, suggesting that the location (ileum or colon) is more relevant when analyzing differences in lncRNA expression in the intestinal tissue.

Introduction

Cancer is the second leading cause of death globally. Colon cancer is the fifth most prevalent type of cancer. Screening, particularly colonoscopy, reduces incidence by 40% and mortality by 50%. The process of bowel preparation before a colonoscopy is complex and requires the patient’s compliance. Enhanced education using a smartphone application has been shown to improve bowel preparation quality. However, heterogeneity was observed among the studies.

Aims & Methods

AIMS: To determine if providing instructions through an application enhances bowel preparation quality in Thai patients undergoing elective colonoscopy.

METHODS: From July 2022 to January 2024, a prospective, endoscopist-blinded, randomized, controlled trial was conducted. Consecutive patients aged > 18 years old who had convenient access to the Line application were randomly assigned in a 1:1 ratio to be educated via the smartphone application (APP group) or the standard education (control group). All patients received the same purgative regimen. The primary outcome was the Boston Bowel Preparation Scales (BBPS). Secondary outcomes included adenoma detection and cecal intubation rates, cecal intubation time, withdrawal time, and patient satisfaction.

Results

The trial aims to recruit 488 patients. A total of 272 patients (APP group, n = 131; control group, n =141) were preliminary analyzed. The mean age was 61.5 years old, and 29% were male. The mean BBPS was comparable between the APP and control groups (8.30 ± 0.99 vs 8.51 ± 1.19, P = 0.173). Both groups achieved adequate bowel preparation (BBPS>6) in 99.2% of cases. All secondary outcomes corresponded with the primary outcome. In the subgroup analysis among the elderly, levels of education, income, and waiting times for colonoscopies, BBPS was not impacted by the providing methods. No adverse events related to education were observed.

Conclusion

Both standard and enhanced education using the smartphone application resulted in excellent bowel preparation. Eligible patients included in this study might influence this outcome. However, using the smartphone application was well-received and could potentially replace standard education for bowel preparation.

References

1. Virani S, Bilheem S, Chansaard W, Chitapanarux I, Daoprasert K, Khuanchana S, et al. National and Subnational Population-Based Incidence of Cancer in Thailand: Assessing Cancers with the Highest Burdens. Cancers. 2017;9(8):108.

2. May FP, Shaukat A. State of the Science on Quality Indicators for Colonoscopy and How to Achieve Them. Official journal of the American College of Gastroenterology | ACG. 2020;115(8):1183-90.

3. Desai M, Nutalapati V, Bansal A, Buckles D, Bonino J, Olyaee M, et al. Use of smartphone applications to improve quality of bowel preparation for colonoscopy: a systematic review and meta-analysis. Endosc Int Open. 2019;7(2):E216-E24.

Introduction

Gastroenterology (GE) is a medical discipline that studies all diseases of the digestive system. It comprises several areas of study and offers a large variety of sub-specializations: proctology, interventional endoscopy or even digestive oncology. The decisive elements in the choice of this specialty vary among interns. The aim of our study is to determine the various factors influencing the choice of gastroenterology as a specialty among medical interns.

Aims & Methods

This is a cross-sectional, multicentric, survey-type study, conducted from September 1 to 30, 2023, involving 7 national medical faculties. All medical interns, regardless of sex or age, participated in our study.
An electronic survey with 29 items was created using Google Forms®. It was divided into two parts: the first part contained 13 questions on socio-demographic characteristics and exposure to GE during the academic curriculum, while the second part concerned the factors motivating the choice or not of GE as a specialty.
A statistical analysis using the Fisher’s exact test was performed. P values of <0.05 were considered statistically significant. Data were analyzed using Jamovi (Version 2.3).

Results

A total of 329 responses were collected: the majority were women 208 (63.2) with a F/M sex ratio of 1.7 and a median age of 27 [25; 28] years. The majority had already completed a GE rotation during their training course n=205 (62.3), of which 90 (44.1) had found it "satisfactory". More than half of the participants n= 178 (54.1) had already considered GE as a future specialty, and this choice was mostly made during GE lectures given in medical school n= 66 (36.9). Among those who had never considered GE, the main reasons were lack of interest in the specialty, the fact that it is a medical specialty, lack of information about GE, potential remuneration, and dissatisfaction with GE rotation during the training course (59.2%, 28.9%, 13.9%, 10.4% and 10% respectively).
Among those who finally opted for GE, the majority were women (70.2% vs. 29.8%, p=0.004). Satisfaction with the GE rotation during the training course had an impact on the final choice: "satisfactory" vs. "mediocre" (43.8% vs. 6.3% p=0.009).
Multivariate analysis showed that early interest in fields such as endoscopy (OR= 4.46, CI95%: 1.44-13.78, p=0.009) or proctology (OR= 4.26, CI95%: 1.01-18.01, p=0.05) increased the chance of choosing GE.

Conclusion

This study showed that there is a gender disparity in the choice of GE as a specialty. The fact that it is a medical discipline may lead men to choose another path. Our study also highlighted the importance of GE training courses during the medical curriculum to motivate interns to join our specialty, as well as the need to spotlight certain areas such as endoscopy or proctology.