Introduction

Metabolic dysfunction-associated Steatotic Liver disease (MASLD) is complicated by various cardiometabolic (CMR) manifestations, and the prognosis is severely burdened by acute cardiovascular events (ACE).
Even though several drugs have been tested to target CMR comorbidities, lifestyle modifications remain the cornerstone intervention. Unfortunately, the dietary-behavioral prescription is constantly limited by poor compliance, with the sociodemographic-determinant factors impacting this remaining undetermined.
Moreover, despite emerging evidence supporting behavioral therapy's relevance, the real long-term benefits of offering motivational support to MASLD individuals represent an unexplored scenario in real life.

Aims & Methods

This study aimed to evaluate the efficacy of multidisciplinary management on clinical outcomes in MASLD, investigating compliance with specialist-tailored indications. We consecutively enrolled individuals presenting MASLD diagnostic criteria (n.286). After recruitment, patients were randomized into three cohorts: subjects (n.72) receiving generic hepatologist-provided advice (“H”); subjects (n.71) also receiving the nutritionists-prescribed individualized intervention (“HN”); patients (n.143) treated with an approach additionally involving cognitive/behavioral-based psychological support (“HNP”). H and HN represented the “standard of care” (n.143), whereas “HNP” constituted the “experimental group” (n.143). At baseline, anthropometric, biochemical, clinical, liver stiffness (LSM), controlled attenuation parameter (CAP), lifestyle habits (including sociodemographic determinants), and body composition values were recorded. Along 24 months, on semestral hepatological, nutritional (H and HN), and psychological (HNP) follow-ups, all parameters were reassessed, the occurrence of ACEs was recorded, and compliance was opportunely evaluated. Three time-study points were considered: baseline (T0), intermediate (i.e., after 18 months – T1), and end of the study (T2).

Results

Intermediate evaluations revealed a significantly higher prevalence of individuals achieving a >10% decrease in body weight (HNP:62.09%; HN:44.9%; H:35.8%; chi-square, HNP vs. HN, p:0.01; HNP vs. H, p:0.0002) after 18 months (T1) in the experimental group. At the end of the observation period (T2), in this setting, a further increase in the proportion of individuals presenting and preserving >10% decrease in body weight was reported (HNP: 72.03%; HN: 46.7%; H: 39.2%, chi-square T1, HNP vs. HN, p:0.02; HNP vs. H, p:0.0001; McNemar T1-T2 HNP vs HN, p:0.001, HNP vs H, p:0.001), as wells as a significant improvement in Homeostatic-model-assessment-for-insulin-resistance (p:0.001), HDL (p < 0.0001), LSM (p:0.007), CAP (p:0.002), and fat-mass (p < 0.0001) was observed (HNP, T0 vs T2).
Relevantly, HNP patients presented a significantly lower risk of ACEs [HR: 0.497, IC (0.236-0.751) 95%, p:0.04)]. Logistic regression analysis (adjusted for sex, age, drug administration, and cardiovascular risk factors) revealed that HNP adherence was significantly associated with lower ACE occurrence (aOR: 0.81; C.I. 95%: 0.55-0.97; p:0.02). Consistently, the loss of compliance rate was significantly lower in HNP (HNP:12.08%; HN:34.7%; H:45.8%; HNP vs HN, HNP vs H, p:0.001). Finally, the analysis of sociodemographic factors revealed large family (i.e., > 3 individuals), dynamic work (i.e., < 2 hours/die dedicated to main meals), and city life as social determinants impacting compliance (OR: 2.11, 1.78, 1.12) (all p < 0.05).

Conclusion

In the era of Precision Medicine, the correct management of MASLD patients should contemplate the integration of standard hepatological-nutritional with psychological support.

References

1. Romeo M, Dallio M, Cipullo M, Coppola A, Mazzarella C, Mammone S, Iadanza G, Napolitano C, Vaia P, Ventriglia L, Federico A. Nutritional and Psychological Support as a Multidisciplinary Coordinated Approach in the Management of Chronic Liver Disease: A Scoping Review. Nutr Rev. 2025 Feb 24:nuaf001. doi: 10.1093/nutrit/nuaf001. Epub ahead of print. PMID: 39992295.
2. Righetti R, Cinque F, Volpe MT, Sebastiani G. Integrating behavioral interventions into a holistic approach to metabolic dysfunction-associated steatotic liver disease. Expert Rev Gastroenterol Hepatol. 2024 Jul;18(7):303-313. doi: 10.1080/17474124.2024.2385487. Epub 2024 Aug 5. PMID: 39075881.
3. European Association for the Study of the Liver (EASL) Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024 Sep;81(3):492-542. doi: 10.1016/j.jhep.2024.04.031. Epub 2024 Jun 7. PMID: 38851997.

Introduction

Colorectal anastomotic dehiscence (CAD) is one of the most severe postoperative complications in colorectal surgery, significantly impacting patient morbidity and mortality. Current risk assessment methods rely on clinical and intraoperative factors, but no real-time predictive tool exists. This study aimed to develop an artificial intelligence model based on intraoperative recording of the anastomosis for CAD prediction.

Aims & Methods

A convolutional neural network (CNN) was trained using a dataset of annotated frames from colorectal surgery videos across three international high-volume centers: IPO Lisboa, Hospital das Clínicas de Ribeirão Preto, São Paulo, Brazil and Royal Liverpool University Hospital. The dataset included a total of 5,356 annotated frames from 25 patients, 2,007 frames classified as CAD-positive and 3,349 as CAD-negative. Four CNN architectures (EfficientNetB0, EfficientNetB7, ResNet50, and MobileNetV2) were tested. Performance was evaluated using sensitivity, specificity, accuracy, and area under the receiver operating characteristic (AUROC) curve. Heatmaps were generated to identify key regions influencing predictions.

Results

The best-performing model achieved an accuracy of 99.55%, AUROC of 99.60%, sensitivity of 99.21%, specificity of 100%, PPV of 100%, and NPV of 98.94%. The model reliably identified CAD-positive frames and provided visual explanations through heatmaps.

Conclusion

To our knowledge, this is the first AI model developed to predict CAD using intraoperative video analysis. Its accuracy suggests the potential to redefine surgical decision-making by providing real-time risk assessment. Further refinement with a larger dataset and diverse surgical techniques could enable intraoperative interventions to prevent CAD before it occurs, marking a paradigm shift in colorectal surgery.

Introduction

The European Union has signalled gastric cancer screening and prevention as a major health priority. The TOGAS consortium (TOwards GAstric cancer Screening in the European Union; togas.lu.lv), funded in response to this call, investigates different strategies for primary and secondary prevention of gastric cancer in Europe. One pilot study aims at determining the yield of having an oesophagogastroduodenoscopy (OGD) on the same day of a colonoscopy for colorectal cancer screening or polyp surveillance.

Aims & Methods

This is the first interim data on n=602 individuals recruited in 8 centres across Europe (France, Germany, Ireland, Latvia, Lithuania, the Netherlands, Portugal, and Spain). Individuals of the age of 50-74 years, attending for screening or surveillance colonoscopy, were invited to participate if they did not have a past diagnosis of gastric preneoplastic conditions requiring surveillance. Standardization of endoscopic procedures was assured by a rigorous protocol including all quality parameters defined by ESGE. This included standards for image documentation and biopsy sampling. Demographics, comorbidities, medication and the previous surgical and family history were recorded. Patients with marked preneoplastic changes (i.e. glandular atrophy or intestinal metaplasia [IM] at OLGA/OLGIM stage 3 or 4, and/or EGGIM score >5) were registered as requiring further endoscopic surveillance. Mann-Whitney U-test was applied for comparison of age between groups and Chi2 test for comparison of categorical variables (significance for p<0.05).

Results

The mean age of participants was 62 years (SD +/- 8.0), with 55.8% being male. Of 245 individuals who underwent an OGD prior to inclusion, 93.1% of these procedures were done >3years before and 60.4% were done at a tertiary centre. We identified 6 (1.0%) malignant/neoplastic lesions, 4 gastric cancers/dysplastic lesions and 2 oesophageal carcinomas. A positive H. pylori status was diagnosed in 34.2%. Endoscopically, a diagnosis of preneoplastic conditions was made in 217 participants (36.0%). Of these, 84 (14.0%) showed gastric atrophy, 45 (7.5%) gastric IM and 75 (12.5%) both conditions combined. Of those with gastric atrophy, this was classified as multifocal in 44 (27.6%) individuals, of those with IM in 45 (37.5%). OLGA stages 3 and 4 were confirmed for 1.9% and 0.8%, OLGIM stages 3 and 4 for 2.3% and 0.4%. Benign ulcers were diagnosed in 28 (4.7%) participants. The majority being gastric ulcers in 19 (3.2%) individuals, duodenal ulcers in 9 (1.5%), and oesophageal ulcers in 2 (0.3%). An additional 13 (2%) participants were diagnosed with Barrett’s oesophagus. It is of note that also 12 (2.0%) colorectal cancers were identified in the cohort. A positive H. pylori status was associated with the need for gastric surveillance (p=0.031).

Conclusion

This interim analysis of the first European pilot study on a combined screening for upper and lower GI tumours shows that this approach is feasible. Regarding the detection of upper GI malignancy and preneoplastic conditions, our findings are in line with previous systematic reviews, but we also demonstrate a reasonable rate of non-malignant findings that are also of relevance when defining the best screening strategy in Europe.

Disclosure

JB: Advisory fee from Flynn Pharma Ltd, Juvise Pharmaceuticals.
MCWS: Research Support from Sysmex, Norgine, Sentinel
OK: Speakers fee, advisory fee from Abbvie, Pfizer, Takeda, Janssen, Shire.