Introduction

Spontaneous bacterial peritonitis (SBP) is a frequent complication in cirrhotic patients, representing also a marker of disease progression in such patients. The aim of this study is to evaluate the outcome of further decompensation in patients with liver cirrhosis who develop SBP.

Aims & Methods

We conducted a retrospective study (January 2022 to April 2024) on all cirrhotic patients with SBP admitted in the Gastroenterology Department of “St. Spiridon” County Clinical Emergency Hospital Iasi, a tertiary referral center. The SBP cases were identified based on elevated ascitic fluid absolute PMN count > 250 cells/mm³, with or without positive ascitic fluid bacterial culture.

Results

Among 114 cirrhotic patients with a first SBP episode, 39 (34.2%) were female and 75 (65.8%) were male, with a mean age of 57 years. Most had advanced liver disease: 98 patients (86%) were Child C, and 16 patients (14%) were Child B, with a mean MELD-Na score of 23.3. In-hospital mortality rate was 17.5% (20 patients). Patients who died or were lost to follow-up period of 12 months (22 patients; 19.3%) were excluded. For the remaining 72 patients, further decompensation was defined as refractory ascites, recurrent SBP, hepato-renal syndrome-acute kidney injury (HRS-AKI), hepatic encephalopathy (HE), or variceal bleeding. During follow-up period, 46 patients (63.9%) experienced further decompensation: HE (16 patients; 34.8%), SBP (9 patients; 19.6%), HRS-AKI (8 patients; 17.4%), ascites (7 patients; 15.2%), and variceal bleeding (6 patients; 13%). Mean time until the occurrence of further decompensation was 79.2 days. In-hospital mortality rate among these patients was 63% (29 cases). The hazard ratio for mortality in those with further decompensation was 2.14, indicating a 2.14-fold increased risk of in-hospital death compared to those with only one SBP episode.

Conclusion

These results reinforce the crucial impact of further decompensation on short-term mortality in cirrhotic patients with SBP.

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is widely used for biliary diseases, yet safety data in transplant recipients remain scarce.

Aims & Methods

This study aimed to evaluate short-term survival and ERCP-related complications in transplant patients. We conducted a retrospective cohort study using the TriNetX database (December 2020–December 2024). Patients diagnosed with acute cholangitis who underwent ERCP were included. Transplant recipients were matched 1:1 with non-transplant controls without active cancer using propensity score matching. Outcomes assessed included survival (Kaplan-Meier analysis) and ERCP-related complications such as post-ERCP pancreatitis (PEP), sepsis, perforation, retroperitoneal abscess, liver abscess, blood transfusion, and emergency department visits.

Results

Before matching, 2,209 transplant recipients and 41,202 non-transplant controls met the inclusion criteria. After propensity score matching, 1,710 matched pairs were analyzed. Survival rates were comparable between transplant and non-transplant groups. Transplant recipients had significantly lower rates of PEP (HR: 0.591, 95% CI: 0.371–0.943, p=0.0254) and emergency department visits (HR: 0.667, 95% CI: 0.498–0.893, p=0.0061). Rates of other complications were not significantly different: sepsis (HR: 1.183, 95% CI: 0.799–1.754, p=0.4005), retroperitoneal abscess (HR: 1.514, 95% CI: 0.587–3.906, p=0.3468), liver abscess (HR: 1.377, 95% CI: 0.826–2.293, p=0.2176), perforation (HR: 2.088, 95% CI: 0.793–5.493, p=0.1272), and blood transfusions (HR: 1.642, 95% CI: 1.255–2.147, p=0.0003). Subgroup analysis of liver transplant patients showed lower PEP rates (HR: 0.592, 95% CI: 0.347–1.009, p=0.0510), but higher risks of retroperitoneal abscess (HR: 3.499, 95% CI: 0.976–12.544, p=0.0402), liver abscess (HR: 2.682, 95% CI: 1.303–5.521, p=0.0053), and blood transfusions (HR: 1.797, 95% CI: 1.282–2.518, p=0.0005).

Conclusion

ERCP appears safe in transplant recipients, demonstrating comparable short-term survival and overall complication rates to non-transplant patients. However, careful monitoring for post-ERCP bleeding and infections is particularly warranted in liver transplant recipients.

References

1. O'Connor HJ, Vickers CR, Buckels JA, McMaster P, Neuberger JM, West RJ, Elias E. Role of endoscopic retrograde cholangiopancreatography after orthotopic liver transplantation. Gut. 1991 Apr;32(4):419-23. doi: 10.1136/gut.32.4.419. PMID: 2026341; PMCID: PMC1379083.
2. Predictors of Early Repeat Endoscopic Retrograde Cholangiopancreatography After Liver Transplantation by Organ Donor TypeSinha, Jasmine et al. Techniques and Innovations in Gastrointestinal Endoscopy, Volume 24, Issue 2, 159 - 166

Introduction

Studies report that almost 50% of Large Non-Pedunculated Colorectal Polyps (LNPCP) have been subjected to heavy manipulation in form of prior attempts at resection or extensive biopsy sampling prior to referral to an expert centre. This significantly impacts several critical outcomes of endoscopic resection (ER). However, understanding of standardised classifications of LNPCP, endoscopic diagnosis and indications for ER has increased in general endoscopy practice which may have improved decision making prior to referral. We aimed to compare trends in patterns of prior injudicious manipulation and the significance of biopsy sampling over sequential time periods in a large cohort of patients referred to a tertiary referral centre for ER.

Aims & Methods

Referral documentation, including clinic and referral letters, endoscopy reports, and histopathology result, were reviewed for evidence of prior resection attempts or biopsy sampling. Data included the number of biopsy samples taken and corresponding histological results. Patients referred between January 2011 and August 2024 were categorised into five time periods. Heavy manipulation was defined as either a prior resection attempt or ≥6 biopsy samples. Analyses included comparisons of resection attempts, heavy manipulation, biopsy sampling, and the detection of high-grade dysplasia on biopsies (as a marker of improved lesion assessment and targeted sampling). Trends in practice changes were assessed using the Chi-square test for trend.

Results

1407 LNPCP were treated by ER. There was a significant trend toward fewer prior failed attempts at resection over sequential time periods with 30% in Period 1 and only 11% in Period 5 (p<0.001); fewer LNPCP subjected to heavy manipulation with 61% in Period 1 and 27% in Period 5 (p<0.001) and fewer LNPCP with prior biopsy sampling with 77% in Period 1 and 47% in Period 5 (p<0.001). However, there was no trend found for an improvement in biopsy sampling yields of HGD with 18% in Period 1 and 25% in Period 5 (p=0.1).

Conclusion

In a large cohort of ER of LNPCP, this study demonstrates a significant reduction over time in failed resection attempts, heavy manipulation, and biopsy sampling of LNPCP before referral to a tertiary centre for endoscopic resection (ER). This suggests an improvement in endoscopic lesion assessment and decision making by general endoscopists. However, heavy manipulation remains a significant problem. Although fewer LNPCP are biopsied prior to referral, the yield of significant findings did not change, suggesting biopsies are not effectively targeted, and highlighting the need for further improvements in lesion assessment.

Introduction

EUS-hepatico-gastrostomy(HGS) has become indispensable procedure in case of inaccessible cases due to malignant invasion to the duodenum etc. , failed ERCP cases, and failed cases after single balloon assisted ERCP(SBE-ERCP) in surgical altered anatomy.

Aims & Methods

From January, 2016 to April, 2024, we have performed EUS-HGS in 131(Male:79, Female 52, averaged age: 72) cases. The indication of EUS-BD was inaccessible to the duodenal papilla due to malignant invasion or failed cases of ERCP in cases of normal anatomy. In cases without duodenal invasion and intrahepatic bile duct dilatation, we perform EUS-CDS and we perform EUS-BD rendezvous in cases of accessible normal anatomy. And we performed EUS-HGS in remained cases. In surgical anatomy cases, we firstly perform SBE-ERCP, EUS-HGS were performed after failed SBE-ERCP. We have investigated the safety and usefulness of HGS.

Results

The subjects were consisted of malignant diseases (pancreatic cancer: 61(46.6%), biliary cancer: 20(15.3%), and others 35(26.7%) and benign disease (stenosis of bilio-jejunum anastomosis 7(5.3%), bile duct stone7(5.3%), primary sclerosing cholangitis 1(0.8%)). The reason for EUS-HGS were consisted of duodenal invasion 84 (64.1%) cases, inaccessible 21(16%), failed deep canulation 20(15.3%), others 6(4.6%). And normal anatomy cases were 90 (68.7%) and surgical anatomy 41(31.3%). Technical and clinical success was 128(97.7%) and 116(88.5%). The median procedure duration was 36 minutes (range 11-109). The used needle was 19 guage: 113(86.3%) and 22 guage: 18(13.7%). The puncturing branch was B3: 95(72.5%), B2: 35(26.7%), and B1: 1(0.8%). The averaged size of punctured branch was 5.0mm (range2.0-13.0). The dilation method was bougie: 97(74%), balloon: 21(16%), electrocautery: 6(4.6%), drill dilator: 5(3.8%), and not dilate: 2(1.5%). The used stent was plastic stent (PS): 105(80.2%) and covered metallic stent (CMS): 24(18.3%). The stent patency was PS: 120 days and CMS: 226 days (p=0.13). The early complication was peritonitis: 10(7.6%), bacteremia: 5(3.8%), cholangitis: 4(3.1%), bleeding: 2(1.5%), and migration: 3(2.3%). The multivariate analysis revealed only longer procedure duration (more than 36 min.) corelated to early complication(p=0.01).

Conclusion

EUS-HGS is safe and effective and essential for inaccessible cases, failed cases after ERCP and SBE-ERCP. And longer procedure duration corelated with early complication.

Introduction

Faecal microbial markers are emerging as valuable non-invasive tools for colorectal cancer (CRC) screening in average-risk populations. However, their utility in Lynch Syndrome (LS) carriers—a high-risk hereditary condition characterized by unique genetic and physiological features—remains largely unexplored.

Aims & Methods

This study investigates whether LS carriers exhibit distinct faecal microbial signatures compared to average-risk individuals, aiming to assess the potential of microbial markers to inform LS-specific surveillance strategies.
Faecal samples were collected from LS carriers undergoing routine surveillance colonoscopy and from participants in the Catalonia CRC screening program prior to screening colonoscopy. Quantitative PCR (qPCR) was employed to quantify selected bacterial markers: F. prausnitzii (FPRA), its phylogroups I (PHGI) and II (PHGII), P. stomatis (PTST), B. fragilis (BCTF), B. thetaiotaomicron (BCTT), B46 (best BLAST match: S. variable), G. morbillorum (GMLL), B48 (best BLAST match: Ruminococcus, Roseburia, and Coprococcus), E. coli (ECO), and Eubacteria (EUB) as total bacterial load. Participants from both cohorts were categorized by colonoscopy findings into normal colonoscopy (NC), non-advanced lesions (NAL), and advanced lesions (AL, including advanced adenomas and CRC). Statistical comparisons included t-tests and multivariate analysis of variance (MANOVA) following isometric log-ratio (ILR) transformation.

Results

LS carriers demonstrated significantly distinct faecal bacterial profiles relative to average-risk individuals, independent of lesion presence. Across the full cohort, LS carriers showed increased abundances of PTST (p<0.001), BCTT (p<0.001), B46 (p<0.001), and ECO (p<0.001), along with reduced levels of PHGI (p=0.017) and B48 (p=0.030).
In individuals with NC, LS carriers exhibited higher abundances of PTST (p<0.001), BCTT (p=0.010), B46 (p=0.025), ECO (p=0.017), and PHGI (p=0.041). Among those with NAL, LS carriers again presented higher abundances of BCTT (p=0.015), B46 (p<0.001), FPRA (p=0.012), ECO (p=0.043), and PHGI (p=0.024). In AL cases, LS carriers displayed a marked reduction in the abundance of BCTF (p<0.001) and an increase in the abundance of BCTT (p=0.043).
MANOVA analysis revealed significant differences in overall bacterial panel composition between LS carriers and average-risk individuals at each lesion stage (NC: p<0.001; NAL: p<0.001; AL: p=0.009).

Conclusion

LS carriers harbour a consistently distinct faecal bacterial profile compared to average-risk individuals, with differential abundance patterns evident across all stages of colorectal lesion development. These results highlight the importance of identifying and validating LS-specific bacterial markers, rather than extrapolating from average-risk cohorts, to enhance surveillance and early detection strategies tailored to this high-risk population.

Disclosure

S. Taboada-López, M. Malagón, L. Oliver, M. Serra-Pagès and S. Ramió-Pujol are employees of GoodGut.