Gastrointestinal Neuroendocrine Tumours

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Neuroendocrine tumours (NETs) develop from enterochromaffin cells, which are located throughout the gastrointestinal tract. Most NETs arise in the gastro-entero-pancreatic tract (GEP-NETs) and they are increasingly found during endoscopic investigation. Although rare, the incidence of NETs is increasing, and prolonged patient survival means that their prevalence is high. Prognosis and treatment options vary according to the size, grade/stage and functionality of the NET, making correct diagnosis and staging key.

In this online course, Dalvinder Mandair, Christos Toumpanakis and Martyn Caplin cover all aspects of gastric NETs, duodenal NETs and rectal NETs—their pathogenesis, investigation, diagnosis, classification, staging, management and prognosis.

Learning objectives

To develop an understanding of the classification of gastric, duodenal and rectal neuroendocrine tumours (NETs)
To recognise the endoscopic features that may indicate the presence of a NET
To learn which investigations are required as part of the diagnostic work-up
To identify the patients that need to be referred to a specialist NET centre

Target audience

This course is suitable for gastroenterologists, nurse endoscopists, upper gastrointestinal surgeons and colorectal surgeons, but is also appropriate for trainees and medical students.

Gastrointestinal Neuroendocrine Tumours

Dalvinder Mandair, Christos Toumpanakis, Martyn E Caplin

Event

Gastrointestinal Neuroendocrine Tumours

Topics

Digestive Oncology

Accreditation status

not accredited

Duration

1 hour

Published

2019

UEG Online Course

accredited

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With the introduction of population-based screening programs in several countries, the proportion of patients diagnosed with early invasive colorectal cancer (T1 CRC) has been vastly increasing. There are several major challenges in clinical management of this patient group, resulting in significant practice variations among physicians.

This online course covers the most relevant aspects of clinical management of T1 CRC patients, and provides an overview of latest insights and current knowledge gaps. To facilitate the learning process, several questions on real-life patient cases have been included in which learners can bring the acquired knowledge directly into practice.

Learning objectives

To understand how to reach a conclusive diagnosis of GORD
To know how to reach a conclusive diagnosis of no GORD
To understand how to deal with an inconclusive diagnosis

Target audience

This course is suitable for gastroenterologists, surgeons, pathologists, nurses and any other healthcare professionals interested in, or actively involved in clinical management of T1 CRC patients.

This course was developed by Alexandra M.J. Langers, Jurjen J. Boonstra, James C.H. Hardwick, Richard (H.) Dang et al. in receipt of an Activity Grant from UEG.

Management of early-invasive (T1) colorectal cancer

Alexandra Langers, Jurjen J. Boonstra, James Hardwick

Event

Management of early-invasive (T1) colorectal cancer

Topics

Digestive Oncology

Accreditation status

accredited

Duration

1 hour

Published

2020

UEG Online Course

accredited

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Gastric polyps are frequently found incidentally during upper gastrointestinal endoscopy. Although gastric polyps are rare and generally produce few symptoms, some have malignant potential and need to be resected.

This online course addresses the various types of gastric polyp and their endoscopic appearance, diagnosis, pathology, malignant potential and treatment.

Learning objectives

To become familiar with the typical endoscopic features of gastric polyps
To gain knowledge of the necessary diagnostic work-up of a gastric polyp
To learn the need for surveillance or treatment for the different types of polyp

Target audience

This course is suitable for gastroenterologists in training, but is also built to serve physicians and surgeons in other disciplines, as well as nurses, bio-technicians and advanced-years’ medical students who have an interest in gastroenterology.

Gastric polyps

Oliver Pech, Pradeep Bhandari, Raf Bisschops

Event

Gastric polyps

Topics

Digestive Oncology

Accreditation status

accredited

Duration

1 hour

Published

2018

UEG Poster

Standard Poster

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Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) remains the procedure with the highest complication rate underscoring the importance of high-quality training. Despite existing guidelines, real-world data regarding training conditions remain limited. This Pan-European survey aims to explore the perceptions surrounding ERCP training.

Aims & Methods

A survey was distributed through the friends of the Young United European Gastroenterologists (UEG) Talent Group network. Inclusion criteria were physicians working in a UEG member state and regularly performing ERCP. Likert-scales as well as single- and multiple-choice questions were utilized.

Results

649 of 1035 respondents from 35 countries were eligible for analysis. 228 were identified as trainees, 225 as trainers, and 196 regularly performed ERCP without being in either category. The mean age was 43 years with 72.0%, 27.6%, and 0.3% identifying as male, female, and non-binary, respectively. 73% of all participants agreed that a structured training regimen is desirable. However, 64% of participants reported not having such a structured program at their institution (71% of trainees and 55% of trainers). Likewise, 80% of participants did not have a mandatory self-assessment before training initiation.
Majority of trainees (73%) and trainers (81%) favored that training should be concentrated within centers meeting certain quality metrics. For this, 64% of all participants indicated that a threshold of 200 annual ERCPs should be used. Using this threshold revealed that 32% of trainees pursued training in centers with <200 annual ERCPs and that a low annual caseload of <50 was more frequent at lower volume centers vs. higher volume centers (86% vs. 63%, respectively). Furthermore, 71% of trainees performed <50 ERCPs/year in stark contrast to 95% of trainers performing >50 ERCPs/year. While 27% of trainees in higher volume centers were female, all trainees in lower volume centers were of female gender.

Conclusion

The first Pan-European survey investigating ERCP training conditions revealed that structured training and concentration of training efforts within European centers meeting specific quality metrics are desirable but exposed the low availability of structured training programs and that around 30% of trainees are practicing at lower volume centers. These data could be interpreted as motivation to further standardize ERCP training conditions and ultimately improve patient care throughout Europe.

BETWEEN VISION AND REALITY: RESULTS FROM A PAN-EUROPEAN SURVEY ON ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY TRAINING CONDITIONS

Karim Hamesch 1, Oscar Cahyadi 2, Stavros Dimitriadis 3, Marcus Hollenbach 4, Pilar Acedo 5, Myriam Ayari 6, Helena Tammela 7, Egle Dieninyte - Misiune 8, Viktor Domislovic 9, Ana Dugic 10, Martin Ďuriček 11, Omar Elshaarawy 12, Anne Fennessy 13, Mark Enrik Geissler 14, Zornitsa Gorcheva 15, Amer Hadi 16, Valon Hamza 17, Ismar Hasukic 18, Henriette Heinrich 19, Iris J. M. Levink 20, Jan Král 21, Lumir Kunovsky 22, Mattias Mandorfer 23, Maria Moris 24, Yana Nikiforova 25, Hassan ouaya 26, Gianluca Pellino 27, Anthea Pisani 28, Odri Qejvani 29, Hasan Sadigov 30, Maciej Salaga 31, Orestis Sidiropoulos 32, Cem Simsek 33, Paula Sousa 34, Milica Stojkovic Lalosevic 35, Katja Tepeš 36, Andrei Mihai Voiosu 37, Lucas Wauters 38, Alberto Zanetto 39, Sophie Schlosser-Hupf 40, Jonas J. Staudacher 41

1 University Hospital Aachen, Aachen, Germany|||University Hospital RWTH Aachen, Aachen, Germany|||Junge Gastroenterologie (JuGa) - German Young Gastroenterology Study Group, Berlin, Germany

2 St. Josef-Hospital, a hospital of the Ruhr-University-Bochum, Essen, Germany|||Junge Gastroenterologie (JuGa) - German Young Gastroenterology Study Group, Berlin, Germany

3 University Hospital Coventry and Warwickshire, Coventry, United Kingdom|||Junge Gastroenterologie (JuGa) - German Young Gastroenterology Study Group, Berlin, Germany

4 Heidelberg University Hospital, Heidelberg, Germany|||Junge Gastroenterologie (JuGa) - German Young Gastroenterology Study Group, Berlin, Germany

5 University College London, London, United Kingdom

6 Internal Security Forces Hospital La Marsa, Tunis, Tunisia

7 East Tallinn Central Hospital, Tallinn, Estonia

8 Vilnius university Santaros Klinikos, Vilnius, Lithuania|||Vilnius university hospital Santara Clinics, Vilnius, Lithuania

9 University Hospital Centre Zagreb, Zagreb, Croatia

10 Heidelberg University Hospital, Department of Medicine IV, Heidelberg, Germany, Heidelberg, Germany|||Karolinska Institute, Stockholm, Sweden|||Junge Gastroenterologie (JuGa) - German Young Gastroenterology Study Group, Berlin, Germany

11 Jessenius Faculty of Medicine, University Hospital in Martin, Martin, Slovakia

12 Royal Liverpool University Hospital, UK, Liverpool, United Kingdom|||National Liver Institute, Menoufia University, Menoufia, Egypt

13 St Vincent's University Hospital, Dublin 14, Ireland

14 Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany|||Junge Gastroenterologie (JuGa) - German Young Gastroenterology Study Group, Berlin, Germany

15 Saint Marina University Hospital, Pleven, Bulgaria

16 Hvidovre University Hospital, Soeborg, Denmark

17 University Clinical Center of Kosova, Prishtine, Kosovo

18 UKC Tuzla, Tuzla, Bosnia and Herzegovina

19 Universitätsspital Basel, Basel, Switzerland

20 Erasmus University Medical Center, Rotterdam, Netherlands

21 Institute for Clinical and Experimental Medicine, Prague, Czechia|||Second Faculty of Medicine, Charles University, Prague, Czechia

22 2nd Department of Internal Medicine – Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine, Palacky University Olomouc, Olomouc, Czechia|||University Hospital Olomouc, Faculty of Medicine and Dentistry, Olomouc, Czechia|||Masa

23 Medical University of Vienna, Vienna, Austria

24 Hospital Universitario Marqués de Valdecilla, Santander, Spain

25 Government Institution “L.T.Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine”, Kharkov, Ukraine

26 tangier faculty of medicine / tangier mohamed VI university hospital, Tangier, Morocco

27 Università degli Studi della Campania "Luigi Vanvitelli", Aversa (CE), Italy|||Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain

28 Mater Dei Hospital, Mosta, Malta

29 University Hospital Center 'Mother Teresa', Tirana, Albania

30 AZERBAIJAN MEDICAL UNIVERSITY, Baku, Azerbaijan

31 Medical University of Lodz, Lodz, Poland

32 417 NIMTS, Cholargos, Greece

33 Hacettepe University, Ankara, Turkey

34 Tondela-Viseu Hospital Center, Viseu, Portugal

35 Clinical center of Serbia, Belgrade, Serbia

36 Diagnostic center Rogaska, Rogaska Slatina, Slovenia

37 Colentina Clinical Hospital Dept. of Gastroenterology, Bucharest, Romania

38 University Hospitals Leuven, Leuven, Belgium

39 Gastroenterology/Multivisceral Transplant Unit, Padua, Italy

40 Universitätsklinikum Regensburg, Regensburg, Germany|||Junge Gastroenterologie (JuGa) - German Young Gastroenterology Study Group, Berlin, Germany

41 Charité Universitätsmedizin Berlin, Berlin, Germany|||Berlin Institute of Health at Charité, Berlin, Germany

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Abstract

Session

Endoscopic techniques (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Poster

Standard Poster

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Introduction

Dysphagia is a common condition with consequences surpassing the physical dimension and extending to the patient’s psychological, personal, and professional life. However, when referring to non-obstructive esophageal dysphagia (NOD) and motility disorders, data is still scarce.

Aims & Methods

Our study consists in a prospective and multicentric evaluation of the severity of dysphagia and its impact on quality of life, that was measured with the Eckardt, EuroQol-5D (TTO and VAS) and PROMIS GI Disrupted Swallowing (PDS) scores, in patients with NOD and underlying motility disorders. We included 373 individuals (250 with NOD and 123 without dysphagia).

Results

Among patients with NOD, 97 had esophagogastric junction (EGJ) outflow disorders on manometry according to Chicago V4.0, 24 spastic motility disorders, 38 hypomotile disorders and 91 normal motility. Compared with non-dysphagic individuals, dysphagic patients had significantly worse scores of both EuroQol-5D and PDS (p-values <0.001).
Among esophageal motility disorders, Eckardt score was significantly different between groups (p-value <0.001) as determined by ANOVA. Specifically, it was significantly higher in EGJ outflow disorders (mean of 5.2), when compared to spastic motility disorders (mean of 3.3) or dysphagic patients with normal motility (mean of 3.2).
With respect to Patient-reported outcomes, PDS score was statistically different between groups (p-value 0.003), being higher in the EGJ outflow disorders (mean T-score of 64.1) when compared to hypomotiity disorders (mean of 60.2) and dysphagic patients with normal motility (mean of 60.3).
Regarding patient-reported quality of life, there were no differences between groups in terms of EuroQol-5D TTO or VAS score (p-value of 0.156 and 0.368, respectively).

Conclusion

Our findings highlights the impact of NOD on the quality-of-life of patients. Although physician and patient reported symptoms’ severity were worse on EGJ outflow disorders, overall quality of life seems equally affected among all esophageal motility profiles.

IMPACT OF NON-OBSTRUCTIVE ESOPHAGEAL DYSPHAGIA ON QUALITY OF LIFE: A PORTUGUESE MULTICENTRIC PROSPECTIVE STUDY

André Mascarenhas 1, Jose Azevedo Rodrigues 2, Raquel R. Mendes 1, Helena Coelho Lima 3, Tiago Guedes 4, Silvia Maria Barrias 4, Mara Costa 5, Paulo Souto 5, João Carlos Silva 6, Joao Paulo Laranjeira Correia 6, Bárbara Morão 7, Joana Revés 7, Carina Leal 8, Rui Tato Marinho 9, Miguel Mascarenhas-Saraiva 3

1 Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal

2 Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal|||Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal

3 ManopH, Porto, Portugal

4 Centro Hospitalar Universitário de Santo António, Porto, Portugal

5 Unidade Local de Saúde de Coimbra, Coimbra, Portugal

6 Unidade Local de Saúde Gaia e Espinho, Vila Nova de Gaia, Portugal

7 Hospital Beatriz Ângelo, Loures, Portugal

8 Unidade Local de Saúde de Leiria, Leiria, Portugal

9 Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal|||Unidade Local de Saúde de Santa Maria, Lisboa, Portugal

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Presentation

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Ergonomics in endoscopy: Take care of your body

Aga Kalbarczyk 1

1 University Hospital, Medical University of Warsaw, Warsaw, Poland

Event

UEG Week Vienna 2024

Topics

Nurses

Session

Management: Increase staff wellbeing

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Poster

Standard Poster

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Introduction

The implementation of colorectal cancer screening programmes has been associated with an increase in the incidence of malignant polyps removed endoscopically. In those without endoscopic cure criteria, surgery can be performed to improve oncological outcomes.

Aims & Methods

Evaluate factors associated with the presence of residual malignant disease in the surgical specimen after endoscopic removal of a malignant polyp without endoscopic cure.
Retrospective, cohort study including patients with a malignant polyp endoscopically removed without endoscopic cure, who underwent surgery. The absence of endoscopic cure was defined as positive vertical resection margins (< 1 mm), poorly differentiated grade, depth of submucosal invasion > 1 mm, presence of lymphatic or vascular invasion, or presence of tumour budding. Patients with a synchronous neoplastic lesion and those with a malignant polyp without complete endoscopic removal were excluded.

Results

Included 74 consecutive patients submitted to surgery after the endoscopic removal of a malignant polyp without endoscopic cure. Most patients were male (62.2%), with a mean age of 64 ± 10 years. Regarding the endoscopic mucosal resection (EMR), 45 polyps were removed in one fragment (60.8%) and the other 29 were submitted to piecemeal EMR (39.2%). In 15 cases, snare tip spray coagulation (STSC) was performed at the margins of mucosal defects after EMR, 6 in normal-appearing margins (8.1%) and 9 in margins suspected of residual adenomatous tissue (12.2%). Considering the post-operative outcomes, 7 patients required surgical re-intervention (9.5%), 1 was admitted in the intensive care unit (1.4%), 1 patient died (1.4%), and 2 patients required re-hospitalization in the following 6 months (2.7%).
The presence of residual malignant disease in the surgical specimen occurred in 9 patients (12.2%), 7 had intramural disease (9.5%) and 2 had nodal metastasis (2.7%). Patients with polyps with a flat component were 5 times more likely to have residual disease in the surgical specimen (p=0.043). The polyp size and its location in the right colon were not associated with the presence of residual disease in the surgical specimen (p=0.140 and p=0.654, respectively). Patients with polyps submitted to piecemeal EMR were 7 times more likely to have residual disease in the surgical specimen (p=0.024), with 2 patients with residual disease after EMR in one fragment (4.4%) and 7 patients with residual disease from the piecemeal EMR group (24.1%). Those in which STSC was performed were also more likely to have residual disease in the surgical specimen (p<0.001). No statistically significant differences were found between the presence of positive margins, lymphatic or vascular invasion or well or moderately differentiated histologic grade, and the presence of residual disease in the surgical specimen (p=1.000, p=0.675 and p=0.686, respectively). Tumour budding was described in 3 patients, none of which had residual disease in the surgical specimen.

Conclusion

A minority of patients had residual malignant disease in the surgical specimen, with a higher risk for those with polyps with a flat component or that were submitted to piecemeal EMR. In fact, with piecemeal EMR almost one quarter of patients had residual disease e less than 5% of those with EMR in one fragment had residual disease in the surgical specimen, highlighting the need for a careful evaluation of the polyp before endoscopic removal and the importance of removal in one fragment, in case of suspected submucosal invasion.

SURGERY AFTER ENDOSCOPIC REMOVAL OF A MALIGNANT POLYP: IS RESIDUAL DISEASE A REAL ISSUE?

Ana Isabel Ferreira 1, Joao Carlos Goncalves 1, Mariana Souto 1, Sofia Xavier 1, Pedro Boal Carvalho 1, Joana Lúcia Teixeira Magalhães Magalhães 1, José Berkeley Cotter 1

1 Hospital Senhora da Oliveira – Guimarães, Guimarães, Portugal|||School of Medicine, University of Minho, Braga, Portugal|||ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal

Conference

UEG Week Vienna 2024

Topics

Colorectal

Submission format

Abstract

Session

LOWER GI (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024