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Pharyngeal local anaesthesia for oesophago-gastro-duodenoscopy: A quality improvement study with enhanced patient tolerance and reduced risk of airborne infection

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Pharyngeal local anaesthesia for oesophago-gastro-duodenoscopy: A quality improvement study with enhanced patient tolerance and reduced risk of airborne infection

Esther Killan 1

1 NORTHUMBRIA HEALTHCARE TRUST, New Castle, United Kingdom

Event

UEG Week Copenhagen 2023

Topics

Colorectal Endoscopy Nurses Oesophagus Pancreas

Session

Free papers II: Patient care and assistance

Published

2023

UEG Presentation

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SAFETY AND EFFICACY OF EXTENDED SURVEILLANCE INTERVALS FOLLOWING COLORECTAL ESD: AN INTERNATIONAL MULTICENTER STUDY

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Introduction

Post-ESD surveillance guidelines remain heterogeneous, with many centers favoring early surveillance colonoscopy (SC) despite low recurrence rates after curative resection. This study aimed to evaluate the safety and outcomes of delayed SC after R0 colorectal ESD for benign lesions and to identify risk factors for metachronous advanced neoplasia.

Aims & Methods

We retrospectively analyzed 1,097 patients who underwent colorectal ESD between 2013 and 2021. Clinical, procedural, and histological characteristics were recorded. Among 778 patients with available surveillance data, outcomes were compared between those who had early SC (<12 months) and those with delayed SC (>24 months). Rates of recurrence, advanced neoplasia, and colorectal cancer were assessed. Risk factors for metachronous advanced neoplasia were evaluated via univariate and multivariate analysis.

Results

Mean patient age was 74.3 ± 10.8 years; 54.1% were male. En bloc and R0 resection rates were 95.8% and 83.3%, respectively. Among patients with surveillance data, 82.6% underwent early SC, and 17.4% had late-only SC. The rate of advanced adenoma at first SC was low and comparable between early and late groups (3.9% vs. 6.7%, p = 0.167). The overall rate of metachronous advanced adenoma was 6.5%, with no significant difference between early and late strategies (6.1% vs. 8.9%, p = 0.25). All four colorectal cancers were detected in the early group; none occurred in the late-only group. Recurrence on the ESD scar was rare (1.5% overall), and no late recurrences occurred after a normal SC1. The only significant predictor of metachronous advanced neoplasia was the number of synchronous lesions at index colonoscopy (OR 1.16, 95% CI 1.07–1.27; p < 0.01).

Conclusion

Delayed surveillance colonoscopy 3 years after R0 colorectal ESD for benign lesions appears safe and effective in selected patients. The multiplicity of synchronous lesions could guide risk stratification. These findings support extending SC intervals after curative ESD, with potential to reduce unnecessary procedures.

References

Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ, et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy. juin 2022;54(6):591‑622.
Dai M, Xiao X, Guo CLT, Lui RN, Yip HC, Chu S, et al. The Long‐Term Risk of Metachronous Advanced Adenoma Recurrence After Endoscopic Submucosal Dissection for Colorectal Neoplasia: A Propensity‐Score Matched Longitudinal Cohort With 5‐Year Follow‐Up. United Eur Gastroenterol J. 21 déc 2024;13(2):210‑9.
Yoshida N, Naito Y, Siah KTH, Murakami T, Ogiso K, Hirose R, et al. High incidence of metachronous advanced adenoma and cancer after endoscopic resection of colon polyps ≥20 mm in size. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. mars 2016;28(2):194‑202.

SAFETY AND EFFICACY OF EXTENDED SURVEILLANCE INTERVALS FOLLOWING COLORECTAL ESD: AN INTERNATIONAL MULTICENTER STUDY

Paul Brouzeng 1, Jérémie Jacques 2, Jeremie Albouys 3, Paul Carrier 2, Romain Legros 1, Hugo Lepetit 4, Sophie GEYL 1, Ludovico Alfarone 5, Abdulraman Qatomah 6, Cesare Hassan 7, Daryl Ramai 6, Hiroyki Aihaiara 6

1 CHU Limoges, Limoges, France

2 CHU Limoges - Hepato-Gastro-Enterology, CHU Limoges; Limoges/FR, Limoges, France

3 CHU Limoges / University of Limoges, Limoges, France

4 CHU Limoges France, Limoges, France

5 Milan, Milan, Italy

6 Brigham and Women's Hospital, Boston, United States

7 Humanitas University, Pieve Emanuele MI, Italy

Event

UEG Week Berlin 2025

Topics

Colorectal Digestive Oncology Endoscopy Histopathology

Submission format

Late-Breaking Abstract

Session

Colorectal ESD: The better way?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Integrative care of gastric cancer: From endoscopic therapies to surgery and chemo/raditherapy

David G. Graham 1, Bas P.L. Wijnhoven 2

1 University College London Hospital, London, United Kingdom

2 Erasmus MC Rotterdam Dept. of Surgery, Rotterdam, Netherlands

Event

UEG Postgraduate Teaching Programme Berlin 2025

Session

From risk to recovery: A postgraduate dive into gastric cancer care

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Summary: The ultimate guide to colorectal cancer staging surgery adjuvant treatment

Ana-Maria Bucalau 1

1 Erasme University Hospital, Brussels, Belgium

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Colorectal Digestive Oncology Surgery

Session

The ultimate guide to colorectal cancer staging surgery adjuvant treatment

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Optimal medical and surgical treatment: When, where, who?

Alessandro Armuzzi 1, Christianne Johanna Buskens 2

1 IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

2 Academic Medical Center, Amsterdam, Netherlands

Event

UEG Week Copenhagen 2023

Topics

Education & Training IBD Standards & Guidelines Surgery

Session

New insights in perianal Crohn's disease

Published

2023

UEG Presentation

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Conclusion Mistakes in … : Lower GI

Henriette Heinrich 1

1 Stadtspital Triemli, Zürich, Switzerland

Event

UEG Week Berlin 2025

Topics

Colorectal Endoscopy IBD Nurses

Session

Mistakes in…: Lower GI

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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GUT MYCOBIOME SIGNATURES PREDICT NEOADJUVANT IMMUNOCHEMOTHERAPY RESPONSE IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A MACHINE LEARNING APPROACH WITH EXPERIMENTAL VALIDATION

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Introduction

Esophageal squamous cell carcinoma (ESCC) is associated with poor prognosis despite advances in neoadjuvant immunochemotherapy (NICT). With highly variable treatment responses, identifying reliable predictive biomarkers remains crucial. While gut microbiome influences on immunotherapy efficacy are increasingly recognized, the specific role of the fungal microbiome (mycobiome) in NICT outcomes for ESCC remains unexplored, representing a significant gap in developing personalized treatment strategies.

Aims & Methods

This study aimed to characterize gut mycobiome signatures in ESCC patients and develop fungal biomarker-based predictive models for NICT response. We conducted ITS2 sequencing on 136 fecal samples collected from 68 ESCC patients (pre- and post-NICT) and 19 healthy controls (HC). Patients were stratified as responders (R, n=26) or non-responders (NR, n=42) based on tumor regression grade (TRG) scores. We performed comprehensive analyses of mycobiome diversity, composition, co-occurrence networks, and functional pathways across groups. The Boruta algorithm was employed for feature selection to identify fungal biomarkers, followed by multilayer perceptron (MLP) machine learning with five-fold cross-validation to develop predictive models. Additionally, ESCC xenograft models were established to investigate gut mycobiome-immune interactions through fecal microbiota transplantation (FMT) and targeted fungal manipulation experiments.

Results

ESCC patients demonstrated significant mycobiome dysbiosis compared to healthy controls, characterized by reduced fungal alpha diversity and distinct beta diversity patterns. At baseline, ESCC patients showed enrichment of Rhodotorula minuta, Actinomucor elegans, and several Candida species. Responders exhibited significantly higher baseline fungal diversity than non-responders, with enrichment of Meyerozyma, Candida boidinii, Trichosporon dermatis, and Cryptococcus species, whereas non-responders showed predominance of Saccharomyces, Nakaseomyces, and pathogenic Candida species (C. glabrata, C. parapsilosis, C. albicans). Responders also displayed more complex, stable fungal co-occurrence networks with higher density and clustering coefficients. Post-NICT, both groups showed partial recovery of mycobiome diversity, with significant increases in beneficial fungal taxa. Functional pathway analysis revealed distinct metabolic profiles between responders and non-responders. Using the Boruta algorithm, we identified 23 genus-level and 22 species-level fungal biomarkers that demonstrated high predictive value. The MLP model based on genus-level markers achieved AUCs of 90.2% (training) and 91.9% (test), while the species-level model showed comparable performance. In animal experiments, mice receiving R-FMT exhibited reduced tumor growth and enhanced CD8+ T cell infiltration compared to NR-FMT recipients. Notably, Candida boidinii supplementation synergized with anti-PD-1 therapy, while Saccharomyces depletion enhanced treatment sensitivity.

Conclusion

Our findings establish the gut mycobiome as a powerful predictor of NICT response in ESCC, with machine learning models achieving >90% accuracy using fungal biomarkers. Experimental validation not only confirms mechanistic links between specific fungi and antitumor immunity but also demonstrates that targeted mycobiome modulation can enhance immunotherapy efficacy. This dual approach of prediction and intervention offers a novel framework for precision oncology in ESCC, potentially transforming clinical decision-making and treatment outcomes in this challenging malignancy.

References

1. Li J, Xu J, Zheng Y, et al. Esophageal cancer: Epidemiology, risk factors and screening. Chin J Cancer Res. 2021; 33(5): 535-547.
2. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012; 366(22): 2074-2084.
3. Schroeder W, Ghadimi M, Schloesser H, et al. Long-Term Outcome After Histopathological Complete Response with and Without Nodal Metastases Following Multimodal Treatment of Esophageal Cancer. Ann Surg Oncol. 2022.
4. Rosner S, Liu C, Forde PM, Hu C. Association of Pathologic Complete Response and Long-Term Survival Outcomes Among Patients Treated With Neoadjuvant Chemotherapy or Chemoradiotherapy for NSCLC: A Meta-Analysis. JTO Clin Res Rep. 2022; 3(9): 100384.
5. Coker OO, Nakatsu G, Dai RZ, et al. Enteric fungal microbiota dysbiosis and ecological alterations in colorectal cancer. Gut. 2019; 68(4): 654-662.
6. Dohlman AB, Klug J, Mesko M, et al. A pan-cancer mycobiome analysis reveals fungal involvement in gastrointestinal and lung tumors. Cell. 2022; 185(20): 3807-3822.
7. Wurster S, Albert ND, Kontoyiannis DP. Candida auris Bloodstream Infection Induces Upregulation of the PD-1/PD-L1 Immune Checkpoint Pathway in an Immunocompetent Mouse Model. Msphere. 2022; 7(2): e81721.