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Introduction

Adenoma detection rate (ADR) is a robust quality indicator independently associated with the risk of interval colorectal cancer (I-CRC) and death. Nevertheless, reliable adenoma detection requires adequate bowel cleansing since it improves mucosal visualization of the surface of the colorectal mucosa.

Aims & Methods

This post-hoc analysis of a randomised phase-IV clinical trial aims to assess the predictors of polyp detection rate (PDR) and ADR in a population of in and outpatients undergoing split preparation with 1L polyethylene glycol plus ascorbate (1L PEG+ASC) and 4L PEG solution. The ‘OVER’ trial was a phase-IV RCT performed across 10 Italian centers (registration/protocol: EudraCT Number 2018-004543-24). Four hundred seventy-eight patients were randomized 1:1 to receive split-dose 1L PEG+ASC or a split-dose 4-L PEG-based regimen. In this post-hoc analysis, multivariable logistic regression models were designed to assess the presence of variables associated with PDR and ADR. All statistical analyses were performed using SPSS v. 28.0 for Macintosh (SPSS Inc., Chicago, USA).

Results

No differences in PDR (34.1% vs 32.9%, P=0.787), ADR (25.5% vs 23.5%, P=0.632) were found in patients undergoing 1L-PEG+ASC and 4L-PEG, respectively.
At multivariable logistic regression analysis, older age (OR=1.040, 95%CI=1.023-1.057; P<0.001), cleansing success (OR=2.250, 95%CI=1.009-5.020; P=0.048) and higher withdrawal time (OR=1.155, 95%CI=1.079-1.236; P<0.001) were independently associated with PDR.
Besides, older age (OR=1.042, 95%CI=1.021-1.063; P<0.001), shorter intubation time (OR=0.891, 95%CI=0.816-0.972; P=0.010), higher withdrawal time (OR=1.171, 95%CI=1.094-1.253; P<0.001) and 100% consumption of the first dose (OR=8.368, 95%CI=1.025-68.331; P=0.047) were independently associated with ADR (Table 1).
In the subgroup of patients undergoing colonoscopy for screening or surveillance (N=220/478), longer preparation time (OR=1.559, 95%CI=1.161-2.093; P=0.003), and colonoscopy within 5h after the end of preparation (OR=3.119, 95%CI=1.013-9.608; P=0.047) were independently associated with ADR.

Table 1. Univariable and multivariable logistic regression analysis of variable associated with ADR in overall study population.

	Univariable analysis			Multivariable analysis
Variable	No adenoma detected (N=327)	Adenoma detected (N=106)	P value	Odds Ratios (CI-95%)	P value
Age	57.4 ± 15.3	64.8 ± 11.8	<0.001	1.042 (1.021-1.063)	<0.001
Diabetes	290 (88.7%) 37 (11.3%)	86 (81.1%) 20 (18.9%)	0.046	1.035 (0.522-2.051)	0.923
Preparation regimen - Afternoon-morning - Same-day	215 (65.7%) 112 (34.3%)	82 (77.4%) 24 (22.6%)	0.025	1.668 (0.957-2.907)	0.071
Preparation duration	2.8 ± 2.0	3.4 ± 3.0	0.018	1.094 (0.999-1.198)	0.051
Intubation time	8.7 ± 4.1	7.8 ± 2.8	0.043	0.891 (0.816-0.972)	0.010
Withdrawal time	9.2 ± 3.2	11.3 ± 4.6	<0.001	1.171 (1.094-1.253)	<0.001
Compliance with bowel preparation (I dose) - 100% intake of overall volume - <100% intake of overall volume	308 (94.2%) 19 (5.8%)	105 (99.1%) 1 (0.9%)	0.038	8.368 (1.025-68.331)	0.047

Conclusion

In a large RCT bowel preparation type was not associated to PDR and ADR. Cleansing success is independently associated to PDR but not with ADR. Compliance to bowel preparation, timing of colonoscopy and accurate withdrawal are key elements to ensure adequate ADR with potential implications in reducing I-CRC.

Disclosure

Roberto Vassallo received consultation fees from AlfaSigma and Norgine. Marcello Maida and Roberto Di Mitri served as advisory board member and received lecture grants from Norgine. Other authors have no proprietary, financial, professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of this manuscript.

PREDICTORS OF ADENOMA DETECTION RATE IN PATIENTS UNDERGOING SPLIT PREPARATION WITH 1L AND 4L POLYETHYLENE GLYCOL SOLUTION: POST-HOC ANALYSIS OF A RANDOMISED CLINICAL TRIAL

Marcello Fabio Maida 1, Roberto Vassallo 2, Angelo Zullo 3, Ludovica Venezia 4, Luigi Maria Montalbano 5, Roberto Di Mitri 6, Marco Peralta 7, Clara Maria Virgilio 8, Socrate Pallio 9, Dario Pluchino 10, Fabio D'Amore 11, alessio santagati 12, Emanuele Sinagra 13, Pietro Graceffa 2, Giuseppe Nicosia 2, Salvatore Camilleri 1, Gerlando Gibilaro 1, Yasmin Abdelhadi 6, Gabriele Rancatore 7, Giuseppe Scalisi 8, Giuseppinella Melita 9, Antonio Giovanni Magnano 10, Giuseppe Conoscenti 13, Antonio Facciorusso 14

1 S. Elia-Raimondi Hospital, Caltanissetta, Italy

2 Ospedale "Bucchieri la Ferla" Fatebenefratelli, Palermo, Italy

3 Nuovo Regina Margherita Hospital, Rome, Italy

4 AOU Maggiore della Carità, Novara, Italy

5 Cervello-Villa Sofia Hospital, Palermo, Italy

6 ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy

7 AOU Policlinico Paolo Giaccone, Palermo, Italy

8 Nesima-Garibaldi Hospital, Catania, Italy

9 Policlinico di Messina, Messina, Italy

10 AOUP Vittorio Emanuele, Catania, Italy

11 San Vincenzo Hospital, Taormina, Italy

12 G. Fogliani Hospital, Milazzo, Italy

13 Gemelli Giglio Institute-Foundation, Cefalù, Italy

14 University of Foggia, Foggia, Italy

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Standards and Guidelines

Consensus

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INTRODUCTION

Diet is gaining recognition amongst clinicians, researchers, and the inflammatory bowel disease [IBD] community as a potential modifier to change the course of the disease. The role of diet in the management of IBD has evolved beyond adjustment for nutritional needs and is now applied as therapy to influence disease activity and complications. With growing recognition of diet, there is a demand for high-quality dietary research to guide practice and consideration on where to best position diet in the treatment paradigm. This has led to the commissioning of this first European Crohn’s and Colitis Organisation [ECCO] consensus on dietary management of IBD, with the goal of providing evidence-based recommendations to guide clinical practice.

ECCO Consensus on Dietary Management of Inflammatory Bowel Disease

Vaios Svolos

Publisher

European Crohn’s and Colitis Organisation

Guideline

Consensus

Topics

IBD

Citation

Journal of Crohn's and Colitis, 2025

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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ABSTRACT

Importance

The lack of multidisciplinary workflow guidelines and clear definitions and classifications for neoplasms in and around the ampulla of Vater results in inconsistencies affecting patient care and research.

Objective

The PERIPAN international multidisciplinary consensus group aimed to standardize the multidisciplinary diagnostic workflow and achieve consensus on definitions and classifications in order to ensure proper classification and optimal diagnostic assessment and consequently to improve patient care and future research.

Design

An international team of 43 experts (pathologists, surgeons, radiologists, gastroenterologists, oncologists) from 12 countries identified knowledge gaps, reviewed 37061 articles, and proposed recommendations using the Scottish Intercollegiate Guidelines Network methodology (SIGN), including the Delphi methodology and the AGREEII tool for quality assessment and external validation.

Results

The 38 consensus questions and 51 recommendations provide guidance on the following key aspects: I. More specific anatomic criteria for the definition of what qualifies as “ampullary” neoplasms, their distinction from duodenal and common bile duct tumors, and clinicopathologic characteristics of anatomic subsets; II. Avoidance of the confusing term “periampullary” for final classification; III. Refined definitions of intestinal, pancreatobiliary and mixed subtypes, and introduction of rare histologic subtypes; IV. The use and limitations of immunohistochemical and molecular profiling; V. Biopsy acquisition; VI. Clinical information required for accurate pathology assessment of biopsies and ampullectomy specimens; VII. Key items to be included in pathology reports of endoscopic specimens.

Conclusions and Relevance

Recognition of the Brescia PERIPAN guidelines will allow a more accurate classification of true ampullary cancers and their differentiation from other “periampullary” tumors. This will have significant implications for endoscopic interpretation and management, staging, pathologic diagnosis and therapeutic evaluation as well as oncologic treatment of various anatomic and histologic subsets of ampullary tumors. This will enhance the quality of both clinical care and future research in this complex medical field.

The Brescia International Multidisciplinary Consensus Guidelines on the Optimal Pathology Assessment and Multidisciplinary Pathways of Non-Pancreatic Neoplasms in and Around the Ampulla of Vater (PERIPAN)

Mohammad Abu Hilal

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology

Citation

United European Gastroenterology Journal: 1–21.

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Summary

Extrahepatic abdominal surgery in patients with cirrhosis of the liver represents a growing clinical challenge due to the increasing prevalence of chronic liver disease and improved long-term survival of these patients. The presence of cirrhosis significantly increases the risk of perioperative morbidity and mortality following abdominal surgery. Advances in preoperative risk stratification, surgical techniques, and perioperative care have led to better outcomes, yet integration of these improvements into routine clinical practice is needed. These clinical practice guidelines provide comprehensive recommendations for the assessment and perioperative management of patients with cirrhosis undergoing extrahepatic abdominal surgery. An individualised patient-centred risk assessment by a multidisciplinary team including hepatologists, surgeons, anaesthesiologists, and other support teams is essential.

EASL Clinical Practice Guidelines on extrahepatic abdominal surgery in patients with cirrhosis and advanced chronic liver disease

Publisher

European Association for the Study of the Liver

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary Surgery

Citation

Journal of Hepatology; 2025

Published

2025

UEG Podcast Episode

Journal Podcast

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UEGJ Best Paper Award: Work productivity in DGBIs

Åsa Frändemark, Ahsen Ustaoglu, Haluk Tarik Kani

Published

2024

UEG Standards and Guidelines

Clinical Practice Guideline

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Summary

Vascular diseases of the liver include portal vein thrombosis (with or without cirrhosis), portosinusoidal vascular disorder, Budd-Chiari syndrome, sinusoidal obstruction syndrome, non-obstructive sinusoidal dilatation and peliosis, splanchnic artery aneurysms, and hepatic arteriovenous fistulas. Except for portal vein thrombosis in cirrhosis, these are all rare conditions. Since the last Clinical Practice Guidelines were issued by the European Association for the Study of the Liver in 2016, much data has been published on the diagnosis and management – medical and interventional – of patients with vascular liver diseases. Based on a thorough review of the relevant literature, recommendations are provided to address key clinical dilemmas. The document emphasises personalised care, considering individual risk factors and clinical presentation. Multidisciplinary management involving hepatologists, haematologists, pathologists, interventional radiologists and surgeons is essential in this area. Our aim is to provide guidance on the management of patients with vascular liver diseases based on the best available evidence.