Introduction

Fecal microbiota transplantation (FMT) is an established treatment for Clostridium difficile infection (CDI) and is increasingly explored for other conditions such as inflammatory bowel disease (IBD), autism spectrum disorder (ASD), and metabolic syndromes. Various FMT delivery methods exist, including colonoscopy, enema, nasogastric tube, and oral capsules, with colonoscopy often preferred for its high success rates. This study aimed to assess the safety profile of FMT administered via colonoscopy in pediatric patients.

Aims & Methods

Fecal microbiota transplantation (FMT) has been established as an effective treatment for Clostridium difficile infection (CDI) and is being increasingly explored for other conditions, including inflammatory bowel disease (IBD), autism spectrum disorder (ASD), and metabolic disorders. Various administration routes exist, with colonoscopy often preferred for its efficacy. This study aims to assess the safety profile of FMT via colonoscopy in pediatric patients since data in pediatric population is scarce.
We conducted a retrospective, single-center study at Vilnius University Hospital Santaros Klinikos, reviewing all pediatric FMT procedures performed between 2017 and 2024. Patient data, including demographic information, clinical indications, and post-procedure outcomes, were collected from medical records. All procedures adhered to institutional safety protocols.

Results

A total of 108 FMT procedures were performed on 73 pediatric patients (52 male, 21 female), with a median age of 8.8 years (range: 2.7–17.8 years). The primary indications for FMT included ASD - as part of an ongoing biomedical research (n=84, 77.8%), CDI (n=11, 10.2%), IBD (n=7, 6.5%), and other conditions (n=6, 5.6%). Among CDI cases, 81.8% were associated with underlying IBD. No complications related to anesthesia or the colonoscopy procedure were observed, and no serious adverse events occurred. Mild, self-limiting adverse events, such as transient diarrhea and abdominal discomfort, were reported in 10 cases (9.3%). One patient (0.9%) experienced fever and pharyngitis three days post-procedure, though this was deemed unrelated to FMT.

Conclusion

Our findings suggest that FMT via colonoscopy is a well-tolerated and safe procedure in pediatric patients, with no significant complications and only occasional mild, transient adverse effects. These results support the continued use of FMT as a safe therapeutic option in pediatric care.

Clinical Case Summary

An 80-year-old woman with a history of right ovarian cancer, treated with total hysterectomy and bilateral salpingo-oophorectomy followed by adjuvant radiotherapy in 1984, presented with tenesmus and rectal bleeding. She had long-standing radiation-induced enteritis. Colonoscopy revealed a 50mm ulcerated neoplasm in the distal rectum. Histopathological analysis confirmed a low-grade rectal adenocarcinoma with loss of nuclear expression of the mismatch repair proteins MSH2 and MSH6. Staging with thoracoabdominal CT and pelvic MRI showed a distal rectal adenocarcinoma invading the vagina and levator ani muscle (cT4), cN0, with a suspicious left inguinal lymph node (possible cM1). Given her prior exposure to pelvic radiotherapy and the presence of chronic radiation-induced injury, a multidisciplinary team, after discussion with the patient and her family, decided to initiate off-label neoadjuvant treatment with dostarlimab for six months, completing a total of eight cycles. Six weeks after completion of immunotherapy, flexible sigmoidoscopy demonstrated a clinical near-complete response (near-cCR) and pelvic MRI showed radiologic complete response (rCR), with no evidence of residual tumor or lymphadenopathy. A new flexible sigmoidoscopy is scheduled in four weeks. If cCR is confirmed, the patient will enter a Watch and Wait surveillance program. Traditionally, rectal cancer treatment has relied on a combination of chemoradiotherapy and surgery, resulting in pathologic complete response in up to 25% of patients, but frequently associated with complications and treatment-related toxicity. Recent studies have demonstrated promising results with immune checkpoint inhibitors, particularly dostarlimab as single agent, an antiprogrammed cell death protein 1 monoclonal antibody. In recent studies so far, this agent was remarkably effective in mismatch repair–deficient, locally advanced rectal cancer, showing high rates of cCR and prolonged overall survival.

References

Andrea Cercek et al, A Phase Two, Single-Arm, Open-Label Study With Dostarlimab Monotherapy in Participants With Untreated Stage II/III dMMR/MSI-H Locally Advanced Rectal Cancer (AZUR-1), Clinical Colorectal Cancer

A. Cercek, M. Lumish, J. Sinopoli, J. Weiss, J. Shia, M. Lamendola-Essel, I.H. El Dika, N. Segal, M. Shcherba, R. Sugarman, Z. Stadler, R. Yaeger, J.J. Smith, B. Rousseau, G. Argiles, M. Patel, A. Desai, L.B. Saltz, M. Widmar, K. Iyer, J. Zhang, N. Gianino, C. Crane, P.B. Romesser, E.P. Pappou, P. Paty, J. Garcia-Aguilar, M. Gonen, M. Gollub, M.R. Weiser, K.A. Schalper, L.A. Diaz Jr. PD-1 BLockade in Mismatch Repair-deficient, Locally Advanced Rectal Cancer

Introduction

PEG is a procedure designed to provide prolonged nutritional access for patients who present an intact and/or functional gastrointestinal, but with difficulty or inability to swallow. In pediatric oncology services, PEG is most frequently indicated for children with central nervous system (CNS) tumors and head and neck cancers. While it is well established in clinical practice as an effective and safe method for obtaining enteral access, few studies specifically address the performance of PEG in children with cancer.

Aims & Methods

The main objective of this study is to describe demographic aspects, underlying pathologies, complications, and outcomes of patients who underwent PEG due to cancer. The present study consists in a retrospective cohort of PEG procedures performed in children with any neoplastic diseases that justified a PEG insertion, during the period of October 2000 and January 2018 at the Digestive Endoscopy Unit of the Cancer Hospital I of the Brazilian National Cancer Institute (INCA). Data collection included demographic and pathology baseline information, as well as details regarding post-PEG follow-up and complications. Data extraction was conducted with Excel with further descriptive analyses.

Results

During the study period, a total of 97 children who underwent PEG were included in the study. The mean age was 10.1 years (range: 0.5 to 18.9 years), and fifty-six children (57.7%) were male. The underlying oncological pathologies included 69 cases (71.1%) of neurological tumors, 23 cases (23.7%) of head and neck tumors, 4 cases (4.1%) of hematological malignancies and 1 case of adrenal cortex carcinoma (1%). Fifty-eight patients (59.7%) experienced complications, including granulation tissue formation in 25 cases (25.7%), stoma infection in 6 (8.1%), local pain in 21 (21.6%), bleeding in 3 (3.1%), accidental tube dislodgement in 4 (4.1%), and gastrocolocutaneous fistula in 2 (2.0%). The mean duration of tube placement was 22.1 weeks (range: 0.4 to 483 weeks). At the end of the study, 62 patients had died from their oncological disease (63.9%), 15 patients continued using the tube (15.4%), and 20 patients had the tube removed after completing treatment (20.6%). No cases were lost to follow-up.

Conclusion

PEG is a safe and effective procedure for providing prolonged enteral nutritional access in children with neoplastic disease. Complications are generally classified as minor, and typically do not require invasive treatments.

References

1. Pedersen AM, Kok K, Petersen G, Nielsen OH, Michaelsen KF, Schmiegelow K. Percutaneous endoscopic gastrostomy in children with cancer. Acta Paediatr 1999; 88 (8): 849-52.
2. Skolin I, Hernell O, Larsson MV, Wahlgren C, Wahlin YB. Percutaneous endoscopic gastrostomy in children with malignant disease. J Pediatr Oncol Nurs 2002; 19 (5): 154-63.
3. Gassas A, Kennedy J, Green G, Connolly B, Cohen J, Dag-Ellams U, Kulkarni A, Bouffet E. Risk of ventriculoperitoneal shunt infections due to gastrostomy feeding tube insertion in pediatric patients with brain tumors. Pediatr Neurosurg 2006; 42 (2): 95-9.
4. Parbhoo DM, Tiedemann K, Catto-Smith AG. Clinical outcome after percutaneous endoscopic gastrostomy in children with malignancies. Pediatr Blood Cancer 2011; 56 (7): 1146-8.
5. Schmitt F, Caldari D, Corradini N, Gicquel P, Lutz P, Leclair MD, Podevin G. Tolerance and efficacy of preventive gastrostomy feeding in pediatric oncology. Pediatr Blood Cancer 2012; 59 (5): 874-80.
6. Kaur S, Ceballos C, Bao R, Pittman N, Benkov K. Percutaneous endoscopic gastrostomy tubes in pediatric bone marrow transplant patients. J Pediatr Gastroenterol Nutr 2013; 56 (3): 300-3.

Introduction

Gastric adenocarcinoma (GAC) is the the sixth most common cancer worldwide. It is estimated that 54% of cases are preventable; yet, its prognosis remains poor, with 1-year and 5-year survival rates being just 48% and 22%, respectively. GastroPanel (Biohit Oyj; Helsinki, Finland) is an ELISA kit that measures pepsinogen I (PGI); pepsinogen II (PGII); gastrin-17 (G-17); and Helicobacter pylori IgG antibodies (Hp IgG). PGI and the PGI/PGII ratio correlate inversely with the severity of chronic atrophic gastritis (AG). Proximal open patterns (O1–O3) of Kimura and Takemoto classification of atrophic gastritis are associated with higher risk of developing gastric neoplasm. The aim of this study was to assess GastroPanel performance in the identification of moderate to severe AG in dyspepsia.

Aims & Methods

In this UK, single-centre, prospective diagnostic accuracy study, 324 patients [56.8% (n=184) female; median age 57 years (range 39–92 years)] were recruited for gastroscopy with biopsy and histology according to the updated Sydney System (USS). Blood (plasma) samples were collected for GastroPanel analysis. Paired samples were obtained from 268 patients [56.3% (n=151) female; median age=57 (range 39–92 years)]. Patients with type 2 diabetes were enrolled in a separate group. GastroPanel results were interpreted using the GastroSoft app (Biohit) for all patients.

Results

Overall agreement between GastroPanel and the USS classification was 90% (95% CI=86.7 to 93.8%), with a weighted kappa (κw) of 0.828 (95% CI=0.781 to 0.865). In receiver operating characteristics (ROC) curve analysis, using moderate/severe atrophic gastritis of the corpus (AGC2+) as the endpoint, AUC=0.840 (95% CI 0.630 to 1.000) and 0.960 (95% CI 0.907 to 1.000) for PGI and the PGI/PGII ratio, respectively.

Conclusion

GastroPanel is a reliable dyspepsia triage test distinguishing patients who can be safely treated conservatively from those with moderate to severe proximal (corpus) atrophic gastritis at high risk of developing GAC. A new proposed clinical pathway for dyspepsia might include the GastroPanel.

Disclosure

No conflict of interest to disclose