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Introduction

Obesity awareness has recently increased following its pandemic evolution. Besides nutritional and lifestyle modifications and pharmacological therapy, many other therapeutic strategies have been evaluated, with fluid-filled intragastric balloon (FF-IB) being the most prevalent. There is still no consensus around which is the best filling volume for FF-IB, that is usually filled according to the physician’s expertise, with the purpose to tailor the filling on patient’s BMI and stomach shape. This study aimed to find out any differences in terms of outcomes of different FF-IB’s filling volume.

Aims & Methods

This was a single-center, observational prospective study of obese patients undergoing FF-IB (Medsil, Orbera) for 6 months, with a random filling volume of 500, 600, or 700 ml of saline and Methylene Blue (fig.1). The outcomes were evaluation of early post-procedural complications (pain, nausea and/or vomiting in the first 24 hours), percentage of early removal for intolerance, percentage of Total Body Weight Loss (TBWL%) and percentage of Excess Weight Loss (EWL%) at 6 months follow-up, quality of Life (QoL, measured by EQ-5D test) at 1, 3, and 6 months follow-up and modifications of blood tests and blood pressure at 6 months.

Results

Between July 2020 and May 2023, 180 obese patients (41.7±9.02 kg/m2, 46.2±14 years, 70% female, 53% obesity class III, Fatty Liver Disease as the main comorbidity; other baseline characteristics in table 1) underwent a FF-IB placement, that was removed after 180±12 days. Pain was the most frequent complication in the first 24 hours, being encountered in 77.5 % of patients, while nausea and/or vomiting were detected in 50.7 % of cases; no differences were observed among the three groups with different filling volume (pain p=0.180, nausea p=0.718, and vomiting p=0.480). Early removal was detected at a mean time of 75±43 days in 19 patients (10.6 %), with no differences among the 3 groups (p=0.870). At 6 months follow-up the mean TBWL% was 14.6±7.14, EWL% was 30.8±23.30, with no differences among the three groups (p=0.882 and p=0.733, respectively). QoL at 1, 3, and 6 months follow-up significantly improved from the baseline in each time frame (p<0.001) and this improvement was the same among the three groups (p=0.819, p=0.822, p=0.849). Mean levels of cholesterol, triglycerides, low-density lipoprotein, and HbA1c, as well as systolic and diastolic blood pressure, were significantly improved at 6 months after FF-IB placement (P<0.05), and no differences among the three groups of filling volume were detected.

Conclusion

An IB’s filling volume of 500, 600, or 700 ml seems to give the same outcomes in terms of post- procedural complications, percentage of early removal, TBWL%, EWL%, QoL, and improvement of blood tests and blood pressure, regardless of the baseline characteristics of patients.

Disclosure

FLUID-FILLED INTRAGASTRIC BALLOON’S FILLING VOLUME AT 500, 600, OR 700 ML: WHICH IS THE MAGIC NUMBER?

Salvatore Francesco Vadalà di Prampero 1, Ica Bassu 2, Valentina Cosseddu 2, Alessandro Zuddas 2, Katarina Jankovic 3, Federica Di Maio 2, Paola Bazzu 2, Jessica Formichetti 2, Chiara Rocchi 2, Marco Massidda 2, Simona Masia 2, Giacomo Faleschini 4, Nikola Panic 5, Gabriella Manzoni 2, Guido Costamagna 1, Milutin Bulajic 1

1 Isola Tiberina - Gemelli Isola Hospital, Rome, Italy

2 Mater Olbia Hospital, Olbia, Italy

3 Clinic for Gastroenterohepatology, University Clinical Centre of Serbia, Belgrade, Serbia

4 Spital STS, Thun, Switzerland

5 CHC Dr Dragisa Misovic-Dedinje, Belgrade, Serbia

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

The varied spectrum of malnutrition (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Standards and Guidelines

New

Clinical Practice Guideline

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ABSTRACT

Introduction

Since the publication of the first European Society for the Study of Coeliac Disease (ESsCD) guidelines in 2019, substantial advances have been made in understanding the management and complex disease courses of coeliac disease (CeD) in adults. These 2025 updated guidelines aim to integrate new evidence, refine management strategies, and promote a personalised and multidisciplinary approach to care.

Methods

The ESsCD convened a multidisciplinary panel of experts to revise the 2019 guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework. Evidence was appraised and graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Statements and recommendations were draughted within working groups and finalised through a structured Delphi consensus process.

Results

The updated guidelines are presented in two parts. Part 1, which has already been published, addresses the diagnostic approach to CeD in adults, whereas Part 2 focuses on disease management, structured follow-up, and the evaluation and treatment of persistent symptoms despite a gluten-free diet or refractory disease. New or expanded sections include guidance on the safe inclusion of oats, use of low-FODMAP diets in patients with persistent symptoms, management of exocrine pancreatic insufficiency, recognition of functional asplenia and related vaccination recommendations, and stratified bone-health screening. The guidelines also discuss nutritional and psychosocial support, digital models of care, and structured transition from paediatric to adult services. Updated therapeutic strategies for refractory CeD are provided, including immunosuppressive and novel pharmacologic options.

Conclusions

These updated guidelines offer a comprehensive, evidence-based framework for the management and follow-up of adults with CeD. By integrating recent scientific advances with pragmatic, patient-centred recommendations, they seek to optimise clinical outcomes, quality of life, and long-term health in individuals with CeD.

European Society for the Study of Coeliac Disease (ESsCD) 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 2: Management, Follow-Up, and Complex Disease Courses

Abdulbaqi Al-Toma

Guideline

Clinical Practice Guideline

Topics

Immunology Small Intestine & Nutrition

Citation

United European Gastroenterology Journal, 2026

Published

2026

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

This joint ASGE-ESGE guideline provides an evidence-based summary and recommendations regarding the role of endoscopic bariatric and metabolic therapies (EBMTs) in the management of obesity. The document was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. It evaluates the efficacy and safety of EBMT devices and procedures that currently have CE mark or FDA-clearance/approval, or that had been approved within five years of document development. The guideline suggests the use of EBMTs plus lifestyle modification in patients with a BMI of ≥30 kg/m², or with a BMI of 27.0–29.9 kg/m² with at least 1 obesity-related comorbidity. Furthermore, it suggests the utilization of intragastric balloons and devices for endoscopic gastric remodeling (EGR) in conjunction with lifestyle modification for this patient population.

American Society for Gastrointestinal Endoscopy–European Society of Gastrointestinal Endoscopy guideline on primary endoscopic bariatric and metabolic therapies for adults with obesity

Pichamol Jirapinyo, Alia Hadefi

Publisher

European Society of Gastrointestinal Endoscopy

Guideline

Clinical Practice Guideline

Topics

Endoscopy Stomach & H. Pylori

Citation

Endoscopy 2024; 56(06): 437-456

Published

2024

UEG Standards and Guidelines

Consensus

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Highlights

Across European cancer centres, imaging protocols show considerable heterogeneity.

This European collaboration conducted a consensus finding survey on mCRC imaging.

An imaging protocol scorecard is provided to facilitate implementation in trials.

Abstract

Background

Treatment monitoring in metastatic colorectal cancer (mCRC) relies on imaging to evaluate the tumour burden. Response Evaluation Criteria in Solid Tumors provide a framework on reporting and interpretation of imaging findings yet offer no guidance on a standardised imaging protocol tailored to patients with mCRC. Imaging protocol heterogeneity remains a challenge for the reproducibility of conventional imaging end-points and is an obstacle for research on novel imaging end-points.

Patients and methods

Acknowledging the recently highlighted potential of radiomics and artificial intelligence tools as decision support for patient care in mCRC, a multidisciplinary, international and expert panel of imaging specialists was formed to find consensus on mCRC imaging protocols using the Delphi method.

Results

Under the guidance of the European Organisation for Research and Treatment of Cancer (EORTC) Imaging and Gastrointestinal Tract Cancer Groups, the European Society of Oncologic Imaging (ESOI) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), the EORTC-ESOI-ESGAR core imaging protocol was identified.

Conclusion

This consensus protocol attempts to promote standardisation and to diminish variations in patient preparation, scan acquisition and scan reconstruction. We anticipate that this standardisation will increase reproducibility of radiomics and artificial intelligence studies and serve as a catalyst for future research on imaging end-points. For ongoing and future mCRC trials, we encourage principal investigators to support the dissemination of these imaging standards across recruiting centres.

Keywords

Colorectal cancer
Imaging
Computed tomography
Positron emission tomography
Standardisation
Radiomics
Artificial intelligence

Imaging standardisation in metastatic colorectal cancer: A joint EORTC-ESOI-ESGAR expert consensus recommendation

Marcus Unterrainer, Christophe Deroose

Publisher

European Society of Gastrointestinal and Abdominal Radiology

Guideline

Consensus

Topics

Digestive Oncology Radiology & Imaging Colorectal

Citation

European Journal of Cancer, Volume 176, 2022, Pages 193-206

Published

2022

UEG Standards and Guidelines

Clinical Practice Guideline

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Summary

Transjugular intrahepatic portosystemic shunt (TIPS) placement is a well-established procedure for managing complications of portal hypertension. In recent years, the field of TIPS has seen rapid advances, particularly in technical approaches, prognostic modelling, and an expanding range of indications. The aim of these EASL guidelines is to comprehensively address all aspects of TIPS in patients with cirrhosis. Other related topics, such as the use of TIPS in surgical settings and in vascular liver disorders, are covered in separate dedicated clinical practice guidelines.

EASL Clinical Practice Guidelines on TIPS

Publisher

European Association for the Study of the Liver

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary

Citation

Journal of Hepatology, Volume 83, Issue 1, 177 - 210

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Summary

Autoimmune hepatitis (AIH) is a chronic liver disease of unknown aetiology which may affect any patient irrespective of age, sex, or ethnicity. At baseline, the clinical spectrum of the disease varies largely from asymptomatic cases to acute liver failure with massive hepatocyte necrosis. The aim of these EASL guidelines is to provide updated guidance on the diagnosis and management of AIH both in adults and children. Updated guidance on the management of patients with variants and specific forms of AIH is also provided, as is detailed guidance on the management of AIH-associated cirrhosis, including surveillance for portal hypertension and hepatocellular carcinoma, as well as liver transplantation in decompensated cirrhosis.

Keywords

Autoimmune hepatitis; Autoantibodies; Variant syndromes; Immunosuppression; Azathioprine; Mycophenolate mofetil

EASL Clinical Practice Guidelines on the management of autoimmune hepatitis

Publisher

European Association for the Study of the Liver

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary

Citation

Journal of Hepatology, Volume 83, Issue 2, 453 - 501

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Background: Evidence and practice recommendations on the use of transanal total mesorectal excision (TaTME) for rectal cancer are conflicting.

Objective: We aimed to summarize best evidence and develop a rapid guideline using transparent, trustworthy, and standardized methodology.

Methods: We developed a rapid guideline in accordance with GRADE, G-I-N, and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of four general surgeons practicing colorectal surgery, a radiologist with expertise in rectal cancer, a radiation oncologist, a pathologist, and a patient representative. We conducted a systematic review and the results of evidence synthesis by means of meta-analyses were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus.

Results: This rapid guideline provides a weak recommendation for the use of TaTME over laparoscopic or robotic TME for low rectal cancer when expertise is available. Furthermore, it details evidence gaps to be addressed by future research and discusses policy considerations. The guideline, with recommendations, evidence summaries, and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494.

Conclusions: This rapid guideline provides evidence-informed trustworthy recommendations on the use of TaTME for rectal cancer.

Keywords: Rectal cancer · TaTME · Transanal TME · Clinical practice guideline · GRADE · EAES

Additional resource: https://app.magicapp.org/#/guideline/LGm87E

UEG and EAES rapid guideline: Systematic review, meta-analysis, GRADE assessment and evidence-informed European recommendations on TaTME for rectal cancer

Marco Milone

Publisher

European Association for Endoscopic Surgery and other interventional techniques

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology Surgery

Citation

Surgical Endoscopy volume 36, pages2221–2232 (2022)

Published

2021

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