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Moving green endoscopy forward: How do I inspire my team? What gets them involved best?

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Moving green endoscopy forward: How do I inspire my team? What gets them involved best?

Anastasia Tsalouka 1

1 University General Hospital Attikon, Athens, Greece

Event

UEG Week Vienna 2024

Topics

Nurses

Session

Sustainability and hygiene: Implementation of new projects

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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WNT11 IS A NOVEL WNT TARGET GENE AND SUPPORTS TUMOR CELL PROLIFERATION IN COLORECTAL CANCER

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Introduction

Mutations of Adenomatous polyposis coli (APC) are among the most frequent molecular aberrations in colorectal cancer (CRC) and result in oncogenic activation of the Wnt signaling pathway. Previous work showed that despite harboring these mutations, CRC cells require the secretion of Wnt ligands (WNTs) for survival. So far, no systematic analysis to assess the expression and function of all WNTs in CRC has been conducted.

Aims & Methods

We sought to systematically assess the expression of all 19 WNTs in different CRC models. This was performed by bioinformatical analysis of publicly available datasets as well as qRT-PCR and Western blot analysis of CRC organoid lines. Among the highly expressed WNTs, we aimed to investigate their molecular regulation as well as specific oncogenic functions. Employing CRISPR/Cas9 gene editing, we modeled frequent oncogenic mutations in CRC cells and human colon organoids to examine their effect on the expression of WNTs. In order to examine the specific oncogenic effects of selected WNTs, we performed shRNA-based gene knockdown in CRC cell lines and organoids. Using colony formation and CellTiter-Glo (CTG) assays, we assessed the viability of CRC cells and organoids, respectively.

Results

Among all WNTs, especially WNT11 is highly expressed in publicly available datasets and a panel of CRC organoids. Furthermore, the expression of WNT11 is correlated to a signature of high Wnt activation in publicly available datasets of CRC tissues. Introduction of APC mutations through CRISPR/Cas9 in CRC cell lines and human colon organoids resulted in upregulation of WNT11. Inhibition of the downstream transcriptional coactivator of Wnt signaling β-Catenin by small molecule inhibitors and siRNA abrogates the expression of WNT11 in CRC cells and organoids. Knockdown of WNT11 impairs the colony formation of CRC cells as well as the viability of CRC organoids in CTG assay.

Conclusion

Our results show that WNT11 is highly expressed in CRC and directly secreted by tumor cells. We show that WNT11 is a target gene of the Wnt pathway, which is upregulated in the context of APC mutations, and that WNT11 supports the proliferation of CRC cells. These results unravel new aspects of the oncogenic effects of APC mutations and identify WNT11 as a potential therapeutical target in APC-mutant CRC. To characterize the oncogenic function of WNT11 in CRC in more detail, further research is needed. The in vivo effects of WNT11 silencing will be addressed in a murine xenograft model.

WNT11 IS A NOVEL WNT TARGET GENE AND SUPPORTS TUMOR CELL PROLIFERATION IN COLORECTAL CANCER

Johannes Werner 1, Kim Elisabeth Boonekamp 1, Julia Josten 1, Matthias Ebert 2, Tianzuo Zhan 2, Michael Boutros 1

1 German Cancer Research Center, Heidelberg, Germany

2 Mannheim University Hospital, Mannheim, Germany

Event

UEG Week Copenhagen 2023

Topics

Colorectal Digestive Oncology Mechanisms & Personalised Medicine Stomach & H. Pylori

Submission format

Abstract

Session

Precision medicine of tomorrow in GI cancer

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

The treatment of symptomatic hemorrhoidal disease (HD) in patients with bleeding disorders (BD) is challenging. This vulnerable group benefits the most from less invasive office-based procedures associated with low bleeding complications, namely polidocanol foam sclerotherapy (PFS).

Aims & Methods

The present study aimed to compare the efficacy and safety of polidocanol foam sclerotherapy (PFS) in the treatment of hemorrhoidal disease (HD) in patients with and without bleeding disorders (BD).
This was a prospective, multicentric, cohort study that enrolled patients with symptomatic internal HD grades I-III with BD (group B) and without BD (group A) following a 18-months period. HD baseline severity was assessed using the Goligher classification, the hemorrhoidal disease bleeding grade (HDBG) and the Sodergren hemorrhoid symptom severity (SHSS) scoring system. Both groups were treated with PFS prepared according to the Tessari´s technique. Patients with congenital BD did not perform prior bleeding prophylaxis and patients with acquired BD due to antithrombotic drugs did not discontinue therapy. The efficacy outcomes included therapeutic success (defined by an improvement of HDBG and SHSS score over baseline) and recurrence of HD (defined by HDBG and SHSS score greater than at the end of the intervention period) during a 12-months follow-up period. The safety outcomes comprised the rate and severity of complications related to PFS.

Results

The study included 228 patients (Group A: 155; Group B: 73). At baseline, the group B presented higher HDBG (p<0.001) and SHSS (p=0.019). The overall therapeutic success rate was 93.4% with an average number of sessions of 1.51±0.74, significantly higher for group B (1.68±0.86 vs 1.43±0.65, p=0.013). A 11.4% complications rate was reported, the majority were mild (96.2%); bleeding complications occurred in 4.8% of the patients. No significant differences were reported between the two groups concerning therapeutic success, recurrence rate, and complications rate.

Conclusion

Patients with BD may present with more symptomatic HD at baseline. Nevertheless, PFS decreased hemorrhoidal bleeding and symptom severity with low incidence of complications in these patients, demonstrating similar effectiveness and safety comparing to patients without BD. Notably, performing PFS did not expose patients with BD to an increased thrombotic risk.

POLIDOCANOL FOAM SCLEROTHERAPY: A BREATH OF FRESH AIR FOR THE TREATMENT OF HEMORRHOIDAL DISEASE IN PATIENTS WITH BLEEDING DISORDERS

Paulo Sergio Salgueiro 1, Andreia Rei 1, Andreia Rei 1, Bruno Rosa 2, Ana Maria Oliveira 3, Tiago Guedes 1, Andreia Rei 1, Paulo Sergio Salgueiro 1

1 Centro Hospitalar Universitário de Santo António, Porto, Portugal

2 Hospital da Senhora da Oliveira, Guimarães, Portugal

3 Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal

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

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Introduction

The current gold standard for diagnosis of Inflammatory bowel disease (IBD) is based on clinical and endoscopic evaluation as well as histologic and radiologic evaluation. However, endoscopic evaluation can be uncomfortable and carry some risks, especially in the pediatric population that requires general anesthesia in order to perform the procedure.

Aims & Methods

Our aim was to investigate whether serum biomarkers can differentiate between pediatric patients with and without IBD. Secondary aims were to determine whether there are biomarkers that can differentiate between Crohn's disease (CD) and Ulcerative colitis (UC), and whether we can predict progression to biologic treatment within one year from diagnosis using these biomarkers.
Pediatric patients undergoing a first diagnostic colonoscopy at British Columbia Children's Hospital (BCCH) between December 2019 and June 2022 were invited to participate in the study. A 2 ml blood sample was taken from each participant at the time of colonoscopy. Demographic and clinical data were collected from each patient. Blood samples were analyzed using the Legendplex^TMflow cytometry kits investigating which included 50 different inflammatory cytokines and chemokines associated with IBD. A prediction model was built via a supervised learning method to determine how well we can predict the different groups.

Results

One hundred pediatric patients participated in the initial study. Five were excluded from the analysis due to uncertain diagnosis. Median age was 13.36 years, 39 were females (41%) and 54 (56.84%) were diagnosed with IBD, with 35 (64.81%) diagnosed with Crohn's disease. On a univariate analysis and Volcano plot 6 biomarkers were found to be strongly associated with the diagnosis of IBD: IL22, IL8, TARC, GROA, MIG, and IL18. The cross-validated AUROC was 0.70. Using SPLS-DA the classification accuracy was improved to 0.84, and MIG was found to be the key biomarker to discriminate between pediatric IBD patients and non-IBD patients.
On a univariate analysis only TSLP was found statistically significant as a predictor of CD, and RANTES and TARC were found as negative predictors for initiating biologic treatment within one year of diagnosis. However, the prediction model did not predict well the subclasses nor progression to biologic treatment.

Conclusion

Using serum biomarkers can predict the diagnosis of Pediatric IBD. MIG was found to be the key biomarker in the prediction model.

MIG (CXCL9) CHEMOKINE IS A KEY BIOMARKER THAT DISCRIMINATES BETWEEN PEDIATRIC IBD PATIENTS AND NON-IBD PATIENTS IN A NOVEL BIOMARKER MODEL

Adi Eindor 1, Kevin Tsai 2, Kevan Jacobson 2

1 Shamir Medical Center, Zeriffin, Israel

2 BC Children's Hospital, Vancouver, Canada

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

Endoscopic ultrasound (EUS) is an important tool for the evaluation of patients with common bile duct (CBD) dilation without obvious identified aetiology after ultrasonography (US), computed tomography (CT) and/or magnetic resonance cholangiopancreatography (MRCP).

Aims & Methods

The aim of this study was to evaluate the diagnostic performance of EUS for CBD dilation in patients with a negative initial study.
Retrospective, unicentric and cohort study including patients who underwent EUS for CBD dilation (diameter ≥7mm if intact anatomy or ≥10mm if prior cholecystectomy) in the absence of obvious pathology on prior imaging, including US, CT and/or MRCP, from January 2016 until June 2022. All EUS procedures were performed with a linear echoendoscope.

Results

Totally, 109 patients were included, 50 patients without symptoms or altered liver biochemistry (45.9%). Among the 41 patients with positive EUS, 33 patients had choledocholithiasis (30.3%), 6 chronic pancreatitis (5.5%) and 2 had ampullary cancer (1.8%). Older age was associated with positive EUS (median 79 vs 71 years, p=0.030). Patients with jaundice, cholelithiasis and altered liver biochemistry were 16.2 (p=0.002), 3.1 (p=0.024) and 2.9 (p=0.009) times more likely to have positive EUS, respectively.
A total of 53 patients underwent MRCP with a negative result (48.6%). In this group, 12 patients had a positive EUS, 10 had choledocholithiasis (18.9%) and 2 had chronic pancreatitis (3.8%). Of those, patients with abdominal pain and jaundice were 15.4 (p<0.001) and 20.0 (p=0.007) times more likely to have positive EUS, respectively. CBD diameter in MRCP was not associated with finding a causative lesion (p=0.473).
Considering only asymptomatic patients without altered liver biochemistry, CBD diameter ≥8.5mm, evaluated by CT, had a sensibility of 100% and specificity of 75% in predicting a positive EUS (AUC 0.734, p=0.048).

Conclusion

EUS is a useful diagnostic method for patients with unexplained CBD dilation, with a higher yield, even in patients with negative MRCP, and especially in patients with older age, symptoms such as abdominal pain and jaundice, cholelithiasis and/or altered liver biochemistry. CBD diameter evaluated by CT had a moderate discriminative ability in predicting a positive EUS in asymptomatic patients without altered liver biochemistry.

ENDOSCOPIC ULTRASOUND IN COMMON BILE DUCT DILATION: A REAL ADVANTAGE

Ana Isabel Ferreira 1, Tiago Lima Capela 1, Vítor Macedo Silva 1, Sofia Xavier 1, Francisca Dias de Castro 1, Joana Lúcia Teixeira Magalhães Magalhães 1, Silvia Leite 1, José Berkeley Cotter 1

1 Hospital Senhora da Oliveira, Guimarães, Guimarães, Portugal|||School of Medicine, University of Minho, Braga, Portugal|||PT Government Associate Laboratory, Braga/Guimarãesport, Portugal

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

Radiofrequency ablation is considered the standard therapy for flat dysplastic BE. Hybrid APC is a newer under evaluation, less expensive technique, but with the need of a special injection device and catheter. Aim of the study: To evaluate the efficacy of a standard APC catheter after submucosal injection for BE ablation.

Aims & Methods

To evaluate the efficacy of a standard APC catheter after submucosal injection for BE ablation. Naïve or after previous treatments patients with BE and low - grade dysplasia (LGD) were prospectively evaluated. Sodium chloride solution 0.9% was injected submucosally with a 23 G needle followed by APC application with a standard catheter (ERBE APC 300, 45Watts) on the created cushion. The same procedure was repeated for most of BE surface to be cauterized, with special attention not to ablate large circumferential areas. Patients were under high dose PPIs. Biopsies were taken according to the Seattle protocol during the follow-up.

Results

31 patients, 28 males (90.3%), 56.7±12.5 years old. Their initial diagnosis was: 19 patients with LGD (61.3%), 7 with high grade dysplasia (22.6%), and 5 with intramucosal cancer (16.1%). Eleven patients (35.5%) had previous endoscopic mucosal resection (EMR) while 7 (22.6%) had received radiofrequency ablation (RFA). Median BE length with LGD at the beginning of APC was 4cm (25th-75th:2-7, min-max:1-10). Median follow-up:10.1(1-108) months. In total 20 (64.5%) patients completely eradicated BE. For the remaining 11 patients APC led to a substantial reduction of BE length [Initial Median: C3M6 (Min: C0M1, Max: C6M8) to a final median: C0M2 (Min:C0M1, Max:C2M5] but the study is ongoing. Initial BE length was correlated to APC sessions needed (r= 0.54, p<0.01) but was not a limiting factor for complete BE eradication. Instead, smoking was an aggravating factor for BE complete eradication (HR=3.12, 95%CI.: 1.2-8.12, p=0.02). No death, hospitalization, severe hemorrhage, or perforation were observed. In 7 patients moderate pain requiring paracetamol, resolved after a few hours of in hospital supervision while 11 patients had mild dysphagia the following days without permanent stenosis.

Conclusion

Conclusions: 1) Standard APC after submucosal injection is safe and tolerable for BE ablation. 2) It may be applied in naïve patients or if other techniques were previously used. 3) Length increases the number of sessions needed but does not seem to be a limiting factor for APC application.

EFFICACY AND SAFETY OF ARGON PLASMA COAGULATION (APC) STANDARD CATHETER USE, AFTER SUBMUCOSAL INJECTION FOR BARRETT’S ESOPHAGUS (BE) ABLATION

Spyridon Michopoulos 1, Alexandros Ioannou 1, George Axiaris 1, Charalambos Koumentakis 1, MAIRI TZAKRI 1, Evgenia Papathanasiou 1, Emmanouil Pantelakis 1, Larisa Vasilieva 1, Georgios Leonidakis 1, Evanthia Zampeli 1, Panagiotis Baxevanis 1, Kalliopi Petraki 2

1 Alexandra Hospital, Athens, Greece

2 Metropolitan Hospital, Faliron, Greece

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

Colorectal neuroendocrine tumors (NETs) and polyps have similar endoscopic manifestations and are easily misidentified. Due to the low incidence of NETs, it is difficult to obtain adequate images to fit deep-learning models. This study introduced a few-shot learning (FSL) model for the ternary classification of NETs and polyps on endoscopic images.

Aims & Methods

Three classes of endoscopic images (56 serrated lesions and polyps [SLPs], 86 traditional adenomas and 53 NETs) were collected from three datasets. First, three images from each class were randomly selected for Support Set (SS), while others for Query Set (QS). Second, ResNet50 V2 was pretrained based on ImageNet and then on esophageal endoscopic images Third, imaging eigenvectors were extracted based on a dual-pretrained model. Fourth, the Euclidean distances to the nine SS images were calculated for each QS image. Finally, a k-nearest neighbor classifier was used for classification based on Euclidean distances. The proposed FSL model was tested in three rounds.

Results

The performance of the FSL model (macro-area under the curve [AUC], 0.731; macro F1-score, 0.674; Matthews Correlation Coefficient [MCC], 0.526; Kappa, 0.523) was better than that of the traditional ResNet50 V2, junior endoscopist, and senior endoscopist. When identifying NETs, the proposed FSL model achieved the highest accuracy 0.823, sensitivity 0.653, precision 0.673 and F1-score 0.659, whereas the senior endoscopist achieved the highest specificity 0.904.

Conclusion

This study presented a FSL method based on transfer learning and metric learning to distinguish between SLPs, adenoma, and NETs on endoscopic images. This suggests that FSL might be an effective method for computer-aided diagnosis of rare diseases.

FEW-SHOT LEARNING FOR CLASSIFICATION OF COLORECTAL NEUROENDOCRINE TUMORS AND POLYPS ON ENDOSCOPIC IMAGES

Shiqi Zhu 1, Jiaxi Lin 1, Lihe Liu 1, Chunfang Xu 1, JINZHOU ZHU 1

1 The First Affiliated Hospital of Soochow University, Suzhou, China

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

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