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Microbiological surveillance: What has to be changed?

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Microbiological surveillance: What has to be changed?

Lionel Pineau 1

1 Biotech-Germande, Marseille, France

Event

UEG Week Copenhagen 2023

Topics

Endoscopy Nurses Standards & Guidelines

Session

Hygiene and infection control

Published

2023

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Video Case: Post surgical leak and fistula

Seung-Hun Chon 1

1 University Hospital of Cologne, Cologne, Germany

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Endoscopy Surgery

Session

Houston we have a problem! GI bleeding and endoscopic therapy of endoscopic and surgical complications

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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This is the dilemma: Capsule endoscopy and radiology

Andrea Laghi 1, Cristiano Spada 2

1 Sapienza - University of Rome, Rome, Italy

2 Catholic University Rome - Digestive Endoscopy unit, Catholic University Rome; Rome/IT, Rome, Italy

Event

UEG Postgraduate Teaching Programme Berlin 2025

Session

Into the depths! Guiding minimally-invasive management of small-bowel pathology

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Poster

Standard Poster

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Introduction

Intragastric balloon (IGB) is a minimally invasive intervention used for obese patients who do not achieve adequate weight loss with standard medical therapy (SMT), which includes lifestyle interventions with or without pharmacological treatment. It is also an option for individuals who do not meet the criteria for bariatric surgery or choose not to undergo it. Despite its growing use, there is little data on the short and long-term effectiveness of IGB compared to SMT in randomized controlled trials (RCTs).

Aims & Methods

This systematic review and meta-analysis aimed to compare the efficacy of IGB therapy for at least six months versus SMT in the treatment of obesity, assessing outcomes at 6, 9, and 12 months. A comprehensive literature search was conducted in the MEDLINE, EMBASE, and Cochrane Library databases. The primary outcome was the percentage of excess weight loss (%EWL), while secondary outcomes included absolute weight loss (AWL), percentage of total weight loss (%TWL), and body mass index reduction (BMIR). We calculated mean differences (MD) with 95% confidence intervals (CI) for continuous outcomes. Meta-regression was performed using baseline body mass index (BMI) as a covariate, and subgroup analyses were conducted based on IGB type, baseline BMI, and pharmacological therapy in the SMT group.

Results

A total of 15 RCTs, including 1,961 patients, were included. Compared to SMT, IGB therapy resulted in significantly greater %EWL at 6 months (MD 16.80%; 95% CI [9.22%; 24.38%]), 9 months (MD 14.36%; 95% CI [7.67%; 21.04%]), and 12 months (MD 13.10%; 95% CI [10.43%; 15.77%]). IGB was also superior in AWL, %TWL, and BMIR across all time points (Table 1). Subgroup analyses revealed that results remained consistent regardless of pharmacological therapy use in the SMT group (p=0.77). The Orbera balloon showed superior %TWL at 6 months (p<0.01) and AWL at 6 months (test for subgroup differences with p=0.01), while the Spatz3 balloon demonstrated better %TWL at 9 months (p<0.01). Studies with a baseline BMI >40 kg/m² had significantly greater %TWL at 6 months (p=0.04) and AWL at 6 months (p<0.01) than those with BMI ≤40 kg/m². Meta-regression analysis indicated that higher baseline BMI was associated with greater AWL and BMIR at 6 months.

Conclusion

IGB therapy was significantly more effective than SMT, even when pharmacological therapy was included, leading to superior weight loss outcomes at 6, 9, and 12 months.

Table 1. Summary of findings.

Outcome	Single-arm analysis, mean (95% CI)		Two-arm analysis, Mean difference (95%CI)
Outcome	IGB group	SMT group	Two-arm analysis, Mean difference (95%CI)
%EWL 6 months	30.37 (23.25, 37.48)	13.07 (8.17, 17.98)	16.80 (9.22, 24.38)
%EWL 9 months	28.31 (7.93, 48.68)	12.09 (-0.82, 25.01)	14.36 (7.67, 21.04)
%EWL 12 months	34.51 (32.40, 36.62)	20.62 (16.61, 24.62)	13.10 (10.43, 15.77)
%TBWL 9 months	13.11 (9.80, 16.41)	3.78 (2.72, 4.83)	7.66 (3.34, 11.98)
%TBWL 12 months	9.70 (6.13, 13.27)	4.63 (1.84, 7.42)	5.33 (4.16, 6.50)
AWL 9 months, kg	13.14 (8.82, 17.45)	4.37 (2.91, 5.83)	8.65 (4.93, 12.37)
AWL 12 months, kg	10.175 (4.61, 15.73)	5.38 (1.97, 8.78)	4.87 (1.87, 7.88)
BMI loss 12 months, kg/m²	4.85 (2.01, 7.69)	2.61 (1.24, 3.98)	2.27 (0.80, 3.74)

AWL, absolute weight loss; BMI, body mass index; CI, confidence interval; IGB, intragastric balloon; MD, mean difference; RCTs, randomized controlled trials; SMT, standard medical treatment; %EWL, percentage of excess weight loss; %TBWL, percentage of total body weight loss.

References

1- Abu Dayyeh, Barham K, et al. Lancet. 2021.

2- Chan, Daniel L., et al. Obesity Surgery. 2021.

3- Coffin, B, et al. Obes Surg. 2017.

4- Courcoulas, et al. Int Journal of Obesity. 2017.

5- Farina, Maria Grazia, et al. Obes Surg. 2012.

6- Fuller, et al. Obes Bio and Int Physiology. 2013.

7- Gómez, V, et al. Obesity. 2016.

8- Hollenbach, M, et al. Digestion. 2024.

9- Kashani, et al. SN Comp Clinical Med. 2022.

10- Konopko-Zubrzycka, et al. J Clin Endoc Metab. 2009.

11- Lee, YM, et al. Gastrointest Endosc. 2012.

12- Mohammed, et al. Trends Med Res. 2014.

13- Ponce, J, et al. Surg Obes Relat Dis. 2015.

14- Sullivan, S, et al. Surg Obes Relat Dis. 2018.

15- Vicente, M, et al. Surgical Endoscopy. 2020.

INTRAGASTRIC BALLOON FOR OBESITY TREATMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

João Pedro Schmitt 1, Gabriel Amaral 1, Gilmara Meine 1, Lucas Monteiro Delgado 2

1 Feevale University, Novo Hamburgo, Brazil

2 Federal University of Minas Gerais, Belo Horizonte, Brazil

Conference

UEG Week Berlin 2025

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

Obesity (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Long-term outcomes of endoscopic resection

Seiichiro Abe 1

1 National Cancer Center Hospital, Tokyo, Japan

Event

UEG Week Copenhagen 2023

Topics

Digestive Oncology Endoscopy Stomach & H. Pylori Surgery

Session

Gastric cancer: Timing is key

Published

2023

UEG Presentation

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THE SPECTRUM OF MICROORGANISMS IS ASSOCIATED WITH THE OUTCOMES OF ENDOSONOGRAPHY-GUIDED THERAPY FOR INFECTED PANCREATIC FLUID COLLECTIONS

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Introduction

Previous studies have demonstrated that infected pancreatic fluid collections are associated with worse clinical outcomes¹.

Aims & Methods

In light of the global rise in antibiotic resistance, this study investigates the impact of the spectrum of infecting microorganisms on the effectiveness of endosonography (EUS)-guided drainage for these conditions. Data on EUS-guided drainage of pancreatic fluid collections performed between 2018 and 2022 at three endoscopy units of Charité Berlin, regardless of the etiology, were reviewed and analyzed. The primary- endpoints were the duration of hospital stay and clinical success of the therapeutic EUS, defined as (1) the resolution of the collection to <50% within 1-3 months as observed in follow-up imaging and (2) clinical improvement. The secondary endpoints were the duration of ICU stay, mortality, and the total number of required interventions to achieve treatment success, including the initial intervention, removal and replacement of stents, and additional procedures, e.g., necrosectomy or therapy of complications during 12 months follow-up. The infection of the fluid collection was diagnosed based on microbiological evidence obtained from EUS-guided fine needle aspiration or positive blood culture, after excluding other sources of infection, along with clinical presentation and elevated inflammatory markers. The microorganisms were categorized based on microscopic appearance, Gram staining, and the number of germs in a collection. Patients with sterile necrotic collections undergoing the same therapeutic modality were used as a control group to compare the outcomes.

Results

A total of 102 patients (71.6% male, mean age 55.9±13.9 years) were included in the final analysis. In 91 of the 102 cases (89.2%), double pigtail plastic stents were utilized (46.1% were multiple), and in 38 (37.3%) patients, a transmural endoscopic necrosectomy was performed. In 29.5% of cases, penicillin; 18.2%, carbapenems; 13.6%, cephalosporins; 6.8%, metronidazole; 6.8%, vancomycin; and 18.2%, other antibiotics were administered. Compared to the control group, Gram-positive germs were associated with a significantly longer hospital stay (32 vs. 21 days, p < 0.001 ) and a greater need for ICU services (49 vs. 2 days, p < 0.001). Endoscopic therapy was less successful for Candida glabrata infections compared to those caused by Candida albicans (45.5% vs. 85.4%). While both were associated with a significantly prolonged hospital stay, infections with Enterococcus faecium (including 4 cases of vancomycin-resistant Enterococcus faecium, VRE) resulted in significantly higher mortality (29.4% vs. 4.5%, p < 0.05), and infections with Enterococcus faecalis were associated with significantly worse clinical outcomes as defined by the resolution of the collection in follow-up assessments (33.3% vs. 88%, p < 0.05). These correlations remained significant in the multivariate regression analysis, with Enterococcus faecium showing an odds ratio (OR) of 8.1 (95% CI: 1.4–47.4) for higher mortality.

	Number (%)	Hospital (days)	ICU (days)	Interventions (n)	Resolution (%)	Outcome (%)	Mortality (%)
Non-infected (control) Infected	44 (43.1) 58(56.9)	21 (1-71) 23 (1-243)*	2 (1-60) 15 (1-186)*	3 (1-8) 5 (2-21)*	100 (14.3-100) 81.4 (22.5-100)	88 75.8	4.5 12.1
Gram-positive Gram-negative Mixed infections	42 (41.2) 22 (21.6) 39 (38.2)	32 (1-243)** 29.5 (7-243)* 27.5 (1-243)*	49 (2-186)** 49 (1-107)* 49 (1-143)*	5 (2-21)* 5 (2-11)* 5 (2-21)*	70.8 (22.5-100) 100 (32.3-100) 81.2 (22.5-100)	69.6 76.9 73.9	14.3 13.6 12.8
*Enterococcus faecium* *Enterococcus faecalis* *Candida albicans* *Candida glabrata* *Streptococcus spp.* *Klebsiella pneumoniae* *Escherichia coli* Others	17 (16.7) 6 (5.9) 18 (17.6) 7 (6.9) 13 (12.7) 8 (7.8) 5 (4.9) 22 (21.6)	34 (6-210) 93 (62-210) 20 (4-205) 34 (6-169) 10 (1-28)* 26 (12-107) 35 (7-107) 47.5 (9-243)**	36 (3-186)* 61.5 (7-92)* 9 (1-143) 16 (7-74)* 9 42 (9-92) 59 (1-92) 16 (2-143)*	6 (2-21) 8 (3-12)* 3.5 (2-11) 6.5 (2-20) 5 (3-5)* 3 (2-6) 6 5.5 (2-21)*	83.5 (22.5-100) 60.0 (32.3-69.2)* 85.4 (32.3-100) 45.5 (22.5-83.8)* 78.9 (63.0-100) 100 (32.3-100) 100 (32.3-100) 79.2 (32.3-100)	62.5 33.3* 76.9 50 100 80 75 76.9	29.4* 16.7 5.9 28.6 0 12.5 0 13.6
Compared to non-infected: p <0.05, *p<0.001

Conclusion

The type of infecting organism significantly impacts clinical outcomes in patients undergoing EUS-guided drainage for infected peripancreatic fluid collections. Enterococcus faecalis and faecium infections were associated with poorer clinical outcomes, highlighting the need for targeted therapeutic strategies.

References

1. Werge M, Novovic S, Schmidt PN, Gluud LL. Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis. Pancreatology. 2016 Sep-Oct;16(5):698-707.