Introduction

Esophageal squamous cell carcinoma (ESCC) often develops the synchronous or metachronous multiple ESCC. Although the Japanese guideline recommended endoscopic examination as surveillance at least once a year after endoscopic resection (ER) of ESCC, the optimal surveillance modality was not specified. In clinical practice, image-enhanced endoscopy (IEE) followed by Lugol chromoendoscopy (LCE) is commonly performed. While LCE reduces the proportion of missed lesion, it has low specificity and causes severe discomfort to the patients, so attempts have been made to omit Lugol's staining. It is unknown what lesions may be missed at this time point by omitting LCE in surveillance after esophageal ER.

Aims & Methods

Thus, this study aimed to clarify clinicopathological characteristics of synchronous or metachronous multiple ESCCs missed by IEE but detected by LCE in surveillance endoscopy after esophageal ER. We retrospectively analyzed the consecutive lesions that fulfilled all of the following inclusion criteria: (1) treated with endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) at our institution between April 2021 and March 2022; (2) newly detected during surveillance endoscopy after ER or during preoperative endoscopy for other ESCC; (3) underwent narrow-band imaging (NBI) or blue laser imaging (BLI) observation followed by LCE observation in the esophagus using a high-definition endoscope at the endoscopic examination of lesion detection; and (4) biopsy-proven or strongly suspected squamous cell carcinoma. Patients with a history of chemotherapy, radiotherapy, or surgery for esophageal cancer were excluded. Lesions were classified into the IEE group (detected by NBI/BLI) and the LCE group (detected only after Lugol staining). The lesion in the IEE group were defined when the lesion was clearly visualized and in focus on the endoscopic images with NBI or BLI, or the endoscopic report described that it was detected with NBI/BLI. We evaluated the features of the lesions in the LCE group by comparing the clinicopathological characteristics between the lesions in the IEE group and LCE group. The endpoints were proportion of　LCE detected lesion and the proportion of target ESCC, defined as ESCC with pathological invasion depth of the muscularis mucosae (pT1a-MM) or deeper and/or positive lymphovascular invasion (LVI) on histological evaluation after ER.

Results

A total of 122 lesions in 96 patients were included. The IEE group comprised 99 lesions (81.1%) in 75 patients, while the LCE group comprised 23 lesions (18.9%) in 21 patients, thus proportion of LCE detected lesion was 18.9%. Most patients (92.7%, 89/96) had grade C of Lugol voiding staining. The median lesion size was 15 mm (range: 4-60 in the IEE group, which was higher than that in the LCE group at 10 mm (5-30). The lesions located on the anterior (23.5%) and left wall (31.3%) tended to be more frequently detected by LCE than those on the right (10.8%) and posterior wall (13.9%). Finally, 26 lesions were treated with EMR and 96 with ESD. The pathological diagnosis was pT1a-MM in 5 lesions and pT1b-SM1 in 2, resulting in the proportion of target ESCC of 5.7% (7/122). By group, the proportions of target ESCC were 7.1% (7/99) in the IEE group and 0% in the LCE group.

Conclusion

The characteristics of missed lesions in IEE observation tended to be small and located on the left or anterior wall of esophagus at surveillance endoscopy. Furthermore, all of these lesions were curatively resected with ER, resulting pT1a-EP/LPM without LVI in the pathological diagnosis.

Introduction

Appropriate knowledge of surface features of colorectal polyps is necessary for their adequate management. Data are limited regarding the diagnostic value of surface pattern-based prediction of histology.

Aims & Methods

This nationwide observational cohort study aimed to compare the optical diagnosis based on Kudo’s pit pattern and the histologic result in case of colorectal polyps endoscopically removed during screening colonoscopies.
Data regarding Kudo’s pit pattern of the lesions (Kudo I-V), and the final histological results were obtained from clinical records of screening colonoscopies which were prospectively collected in the registry of Hungarian National Public Health Institute. The level of agreement was characterized by Cohen’s kappa coefficient. The feasibility of optical diagnostics to differentiate neoplastic and non-neoplastic lesions, as well as to identify submucosally invasive cancer (SMIC) were investigated. The potential effects of polyp size and location (left/right colon), and that of timing of colonoscopy (1st period between 2019 and 2021, and 2nd period between 2022 and 2023) were also evaluated.

Results

A total of 8289 polyps removed during screening colonoscopy were registered in the database between 2019 and 2023, from these 7187 were neoplastic (439 SMIC) and 1102 were non-neoplastic. Out of the 1095 serrated polyps 171 contained dysplasia. Non-neoplastic polyps had Kudo I pattern in 7.7%, Kudo II in 48.1%, Kudo III in 40.9%, Kudo IV in 3.2%, and Kudo V in 0.1% of the cases. Neoplastic lesions without submucosal invasion had Kudo I surface pattern in 2.0%, Kudo II in 7.5%, Kudo III in 71.2%, Kudo IV in 17.4%, and Kudo V in 1.7% of the cases, while in case of SMIC, the surface pattern was Kudo I in 0.2%, Kudo II in 0.7%, Kudo III in 15.7%, Kudo IV in 8.9%, and Kudo V in 74.5% of the cases.
Kudo I-II category showed moderate agreement with non-neoplastic lesions (κ=0.440), irrespective of lesion size and location, and timing of screening colonoscopy. The level of agreement was only slight for serrated lesions (κ=0.168). Kudo V category demonstrated substantial agreement (κ=0.722) with SMIC, irrespective of lesion size, location, and timing. SMICs could be identified based on Kudo V category with 74.5% sensitivity, 98.5% specificity, 73.0% positive and 98.6% negative predictive value.

Conclusion

This is the first real-world data obtained from screening colonoscopies of the Hungarian national colorectal screening program. Optical diagnosis might support the differentiation of neoplastic and non-neoplastic lesions and can be especially helpful in identifying SMICs that might require a different management approach.

Introduction

Sex-based differences have shown to impact ulcerative colitis (UC) treatment outcomes and need to be considered when managing therapy strategies for patients with UC. Etrasimod is an oral, once‑daily (QD), selective sphingosine 1‑phosphate (S1P)_1,4,5 receptor modulator for the treatment of moderately to severely active UC.

Aims & Methods

This pre-defined subgroup analysis reports on efficacy and safety outcomes in male and female patients receiving etrasimod 2 mg QD or placebo in the phase 3 ELEVATE UC 52 (NCT03945188) and ELEVATE UC 12 (NCT03996369) trials. Key efficacy endpoints were assessed in patients with a baseline modified Mayo score 5–9 at Week 12 (data pooled from both trials) and Week 52 (ELEVATE UC 52 only). Safety was assessed in the pooled ELEVATE UC 52 and ELEVATE UC 12 safety population.

Results

In the pooled population, a total of 269 male and 227 female patients received etrasimod; 150 and 97, respectively, received placebo. Significantly more male and female patients receiving etrasimod vs placebo achieved clinical remission (Week 12 – male: percentage difference for etrasimod vs placebo [Δ] 10.7, female: Δ 19.7; Week 52 – male: Δ 21.5, female: Δ 29.1; all p < 0.01), symptomatic remission (Week 12 – male: Δ 21.4, female: Δ 20.6; Week 52 – male: Δ 26.4, female: Δ 22.5; all p < 0.01), endoscopic improvement (Week 12 – male: Δ 12.7, female: Δ 21.2; Week 52 – male: Δ 21.9, female: Δ 32.5; all p < 0.01) and endoscopic improvement-histologic remission (Week 12 – male: Δ 9.9, female: Δ 16.7; Week 52 – male: Δ 14.1, female: Δ 24.1; all p < 0.01; Table). Similar findings were seen for corticosteroid‑free and sustained clinical remission (Table). Similar proportions of treatment‑emergent adverse events (TEAEs; 56.8% and 64.6%), serious TEAEs (4.9% and 5.0%) and TEAEs leading to discontinuations (3.8% and 5.8%) were reported in male and female patients receiving etrasimod and were comparable to those receiving placebo.

Conclusion

Similar findings in male and female patients support the use of etrasimod in both to achieve symptomatic, endoscopic and histologic outcomes.

References

Disclaimer: Pfizer’s generative artificial intelligence tool MAIA was used to assist production of the abstract first draft. Authors reviewed/edited and take responsibility for the content.

Disclosure

JT receives advisory board fees from AbbVie, Lilly, Janssen and Pfizer Inc; research grants from AbbVie and Janssen; and speaker fees from AbbVie, Janssen, Lilly, Takeda and Pfizer Inc.
RB receives advisory board fees from AbbVie, Bristol Myers Squibb, Celltrion, Janssen, Lilly, Takeda and Pfizer Inc; and consultancy/speaker/moderator fees from AbbVie, Bristol Myers Squibb, Celltrion, Ferring, Janssen, Takeda and Pfizer Inc.
AJY receives consultancy fees from AbbVie, Arena, Bristol Myers Squibb, Celltrion, Pfizer Inc and Takeda; and lecture fees from AbbVie and Bristol Myers Squibb.
MG, EK are employees of Pfizer AG and shareholders of Pfizer Inc.
LH is an employee of Pfizer R&D UK Ltd.
ABD is an employee of Pfizer Inc, Philippines.
KW is an employee of Pfizer Canada Inc and shareholder of Pfizer Inc.
IB reports consulting and lecturer fees from AbbVie, Amgen, Biogen, Janssen‐Cilag, Celgene/BMS GmbH, Celltrion, Falk Foundation, Fresenius Kabi, Galapagos, Lilly,Merck, Pharmacosmos, Pfizer, Takeda, and Tillotts.

Introduction

Proton pump inhibitors (PPIs) are extensively prescribed due to the widespread diagnosis of gastro-oesophageal disease (GORD). ^1,2 Overutilisation of PPIs is common, and growing concerns over adverse events, inappropriate prescribing and unnecessary costs ^3,4 are driving exploration into the implementation of holistic management, including deprescription strategies¹.

Aims & Methods

We aimed to quantify healthcare professionals’ (HCPs) preferences on the management of GORD in the UK, and identify attributes perceived as enhancing or detracting from quality of care.
Attributes were derived from qualitative data gathered through 3 focus groups with gastroenterologists, pharmacists and general practitioners (GPs), and interviews with 4 GORD patients.
A discrete-choice experiment (DCE) was developed and administered via online survey (Jan–Apr 2025) to 38 HCPs. Respondents chose between paired hypothetical GORD management scenarios, varying by symptom severity, appointment frequency, treatment approach, information delivery method, and cost. Preferences were modelled using a multinomial conditional logit with effects coding. Marginal rates of substitution (MRS) were calculated to quantify trade-offs.

Results

74% of respondents were pharmacists (n=28) and 26% GPs (n=10). All had managed GORD patients in the past year, and 81% expressed concern over long-term PPI use.
A holistic approach combining PPIs with lifestyle modification was strongly preferred over PPI monotherapy (β=0.4244, p<0.001), representing the most influential driver of care quality. Lifestyle modification alone was also favoured over PPI monotherapy (β=0.1125), though this did not reach statistical significance (p=0.127).
Respondents expressed significant aversion to providing information via pamphlets compared to GP-led counselling (β=–0.1836, p=0.046), while no preference emerged between pharmacist- and GP-led counselling (β=0.0512, p=0.573). Neither appointment burden nor out-of-pocket costs significantly influenced decision-making.
Symptom severity was a notable driver: HCPs selected scenarios involving moderate symptoms over mild (β=0.2353, p=0.005), indicating increased urgency and prioritisation for moderate disease.
Analysis of MRS between attributes suggested that HCPs are willing to accept 4.4 additional appointments to manage moderate symptoms, rather than mild, and nearly 8 additional appointments to deliver combined holistic lifestyle and pharmacological therapy. This highlights a willingness to absorb appointment-related resource demands in favour of more comprehensive, effective care.

Conclusion

Concerns around long-term PPI use support a shift toward active GORD management and PPI deprescribing, with structured follow-up to monitor treatment response.
This interim analysis highlights a clear preference among HCPs for multimodal GORD management, particularly combining lifestyle modification with pharmacological treatment, and reinforces the importance of interactive clinician[BA1] -led patient education, which can promote compliance and improve outcomes. The willingness to accept 4.4 additional appointments reflects the value placed on ongoing monitoring and personalised care. However, this raises the question on the impact this may have on health services, and whether the integration of self-care into multimodal approaches developed with HCPs could be an alternative solution to be investigated. [LH2] These findings highlight the need for a system-wide shift toward guideline-informed, stepped-care models.
A further analysis on patient population preferences is under review.

References

1. Savarino E, Anastasiou F, Labenz J, Hungin APS, Mendive J. Holistic management of symptomatic reflux: rising to the challenge of proton pump inhibitor overuse. Br J Gen Pract. 2022; 72(724):541-544.
2. Hungin APS, Scarpignato C, Keefer L, Corsetti M, Anastasiou F, Muris JWM, Mendive JM, Kahrilas PJ. Review article: rethinking the "ladder" approach to reflux-like symptom management in the era of PPI "resistance" - a multidisciplinary perspective. Aliment Pharmacol Ther. 2022; 55(12):1492-1500.
3. Plehhova K, Wray J, Aluko P, Sutton S, McArdle J, Dawson A, Coyle C, Stevens RM. Prescribing practices for proton pump inhibitors among primary care physicians in England: an evaluation. BJGP Open. 2025.
4. Sosio J, McKee N, [BA1] [LH2] Gold R, Singson A, Boroda K. S579 PPI Stewardship: A Quality Improvement Tool to Improve Long-Term Prescribing Practices. Am J Gastroenterol. 2024; 119(10S): S400.

Disclosure

This study was funded by Reckitt Benckiser Healthcare Ltd.
K. Plehhova, and E. Horvath are employees of Reckitt.