Introduction

Studies have generally highlighted three groups of patients at particular risk of dysphagia: the elderly, those with neurological pathology and the critically ill. Over the last decade, there has been increasing interest in the role of critical illness related dysphagia, however, less is known about the impact of infection and sepsis on unwell patients in hospital. In this study, we aimed to assess the prevalence and factors predicting dysphagia in patients with no prior history of dysphagia, admitted to hospital with infections or sepsis.

Aims & Methods

Participants ≥ 18 years of age admitted to hospital with infections or sepsis caused by pneumonia, urine tract infections or cholecystitis were recruited from an NHS Trust. Researchers, electronic patient record administrators and clinical coding staff screened patient data over 12 months from 01/02/2022 to 01/02/2023. All patients with potentially confounding conditions or pathology, such as previous or ongoing dysphagia, acute head injuries or stroke, were excluded. Those that remained had data extracted from their notes, including age, gender, length of stay (LOS), intensive care unit (ICU) admission status, co-morbidities, type of infection/sepsis, obesity, frailty and mortality. Patient data was then subjected to statistical analysis, including Chi-squared, T-Tests, Logistic regression and Cox regression.

Results

Over the study period, 4475 patients (M: 2031, F: 2444) were admitted with infections (Pneumonia 2465, UTI 1888 and Cholecystitis 401). Of these, 189 (4.2%) developed dysphagia (Pneumonia 6.0%, UTI 3.5%, Cholecystitis 0.8%). Additionally, 865 patients (M: 434, F: 431) were admitted with sepsis (Pneumonia 535, UTI 413 and Cholecystitis 55). Of these, 54 (6.2%) had dysphagia (Pneumonia 9.3%, UTI 3.4%, Cholecystitis 3.6%).
Logistic regression revealed that increasing age, the presence of sepsis, delirium, dementia and Parkinson’s disease (PD) were significantly associated with an increased risk of dysphagia (OR 1.02, 1.74, 1.60, 2.43, 3.88; P 0.002, 0.013, 0.008, <0.001, <0.001). Obesity and female gender were associated with a reduced risk of dysphagia (OR 0.53, 0.65; P 0.006, 0.001). Other comorbidities such as diabetes, chronic obstructive pulmonary disease (COPD), cirrhosis and heart failure were not significantly associated with dysphagia. Additionally, Cox regression revealed that increasing age, sepsis, dysphagia, delirium and frailty all significantly increased LOS (HR 0.99, 0.63, 0.59, 0.67, 0.79; P <0.001, <0.001, <0.001, <0.001, <0.001).

Conclusion

Our study has identified that infection and sepsis-associated dysphagia is a major syndrome, with age being a significant determinant. Additionally, patients with PD, delirium or dementia without previous or existing dysphagia are at high risk of developing dysphagia should they be admitted with infections or sepsis. Our novel findings should increase clinical awareness of infection and sepsis-associated dysphagia in hospitalised patients and prompt greater study of this phenomenon.

References

Sasegbon A, O'Shea L, Hamdy S. Examining the relationship between sepsis and oropharyngeal dysphagia in hospitalised elderly patients: a retrospective cohort study. Frontline Gastroenterol. 2018 Oct;9(4):256-261. doi: 10.1136/flgastro-2018-100994. Epub 2018 Jun 2. PMID: 30245787; PMCID: PMC6145432.

Disclosure

None to disclose

Introduction

Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most frequent adverse event following ERCP, with an incidence of 3–10% in the general population and up to 40% in high-risk patients. Risk factors are commonly classified as patient-related (young age, female sex, suspected sphincter of Oddi dysfunction) or procedure-related (precut sphincterotomy, difficult cannulation, pancreatic duct manipulation). However, the impact of specific therapeutic maneuvers—such as stone extraction techniques and biliary drainage—on PEP risk remains uncertain. In particular, the role of mechanical lithotripsy as an independent risk factor is still poorly defined. Moreover whether the systematic use of prophylaxis has actually reduced PEP incidence over time—particularly in high-risk cases—also remains uncertain.

Aims & Methods

This study aimed to retrospectively assess both patient- and procedure-related risk factors for post-ERCP pancreatitis, with a focus on therapeutic interventions whose impact remains uncertain. Findings were also compared with existing literature to refine individual risk profiles and inform preventive strategies.
We retrospectively analyzed 678 consecutive inpatients (49% male, 51% female; mean age 72.7 ± 13.4 years) admitted to our Gastroenterology Unit treated with ERCP for various indications (e.g., choledocholithiasis, pancreatic cancer, biliary strictures) between January 2020 and December 2024. All procedures were performed by experienced interventional endoscopists. PEP incidence was compared across categorical variables using chi-squared or Fisher’s exact tests (significance threshold p < 0.001). Age was compared using the Mann–Whitney U test. Variables significant in univariate analysis were included in a multivariate logistic regression model.

Results

Thirty-six cases of PEP were identified (5.3%), including 58% mild, 34% moderate, and 8% severe. No procedure-related deaths were reported. Patients with PEP were significantly younger (median age 69 vs 76 years, p = 0.01). Independent risk factors included suspected sphincter of Oddi dysfunction (OR = 7.8, p < 0.001) and mechanical lithotripsy (OR = 4.20; 95% CI: 1.38–12.78; p = 0.007), while biliary stenting was protective (OR = 0.17; 95% CI: 0.04–0.67; p = 0.01). Nasobiliary drainage showed a non-significant trend toward protection (OR = 0.67; p = 0.34), and pancreatic stenting was not significantly associated with reduced risk (p = 0.54). No significant associations were found for stone extraction method, periampullary diverticulum, sphincterotomy, or precut. PEP incidence declined from 6.3% in 2020 to 3.8% in 2024 (p = 0.22), possibly reflecting improved prophylaxis.

Conclusion

Suspected sphincter of Oddi dysfunction and younger age were confirmed as significant PEP risk factors. Mechanical lithotripsy emerged as a high-risk maneuver, while biliary stenting appeared protective. These findings suggest procedure-specific risks should be integrated into individual preventive strategies.

Introduction

Endoscopic biliary sphincterotomy is an effective treatment for common bile duct stones. However, its success can be compromised by the presence of large stones or extensive choledochal lithiasis.
The aim of this study was to evaluate the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in patients with large obstructive stones (>15 mm) and those with one or two stones or choledochal lithiasis, and to identify factors influencing the success of endoscopic drainage and associated complications in the management of large bile duct stones.

Aims & Methods

This was a retrospective, descriptive, and analytical study conducted over a 19-year period, from April 2006 to February 2025, in our department.
A total of 1,011 patients who underwent ERCP for common bile duct stones were included. Choledochal lithiasis was defined as the presence of more than three stones, and a large stone was defined as an obstructive stone larger than 15 mm. Patients were divided into two groups:

• Group I (n = 143): Patients with a single obstructive stone larger than 15 mm.
• Group II (n = 868): Patients with one or two stones or choledochal lithiasis.

Results

Patients with large stones (Group I) represented 14.1% (n = 143) of the cohort, while Group II included 868 patients (85.9%).
The success rate after a single catheterization was 55.2% in Group I compared to 81% in Group II (p < 0.001). Reintervention was required in 14.7% of Group I patients versus 8% in Group II (p = 0.009). Additional procedures were performed in 46.2% of cases in Group I versus 16.1% in Group II.
The overall success rate after reintervention and/or additional procedures was 88.7% in Group I versus 92.5% in Group II (p = 0.125).
Early complication rates were higher in Group I (10.5%) compared to Group II (5.1%), with a statistically significant difference between groups (p = 0.017).
Univariate analysis identified the following factors as significantly decreasing the overall success rate of endoscopic treatment: older age, acute cholangitis, bile duct stricture, and significant bile duct dilation (diameter >15 mm).
Multivariate analysis, adjusted for age, sex, surgical history, acute pancreatitis, acute cholangitis, periampullary diverticulum, bile duct diameter, and bile duct stricture, showed that only acute cholangitis (OR: 0.295; 95% CI: [0.164 – 0.532]; p < 0.001) and bile duct stricture (OR: 0.53; 95% CI: [0.922 – 1.051]; p = 0.001) were independently associated with a decreased overall success rate of endoscopic treatment.

Conclusion

Our study found no statistically significant difference in the effectiveness of endoscopic treatment between patients with large stones and those with simple lithiasis. However, the presence of acute cholangitis and bile duct strictures appears to be associated with a reduced overall success rate of endoscopic management.

Introduction

Managing hypoxemia during procedural sedation, particularly in patients with obesity or obstructive sleep apnea (OSA), remains a significant challenge in clinical practice. This meta-analysis compared the use of positive airway pressure (PAP) with standard oxygenation therapy for patients at increased risk of hypoxemia undergoing gastrointestinal endoscopic procedures.

Aims & Methods

MEDLINE, Embase, and Cochrane databases were searched for randomized controlled studies comparing PAP systems versus standard oxygenation. Odds ratio (OR) was used for binary outcomes and mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI). Further research implications were evaluated by a trial sequential analysis (TSA).

Results

Our meta-analysis included six RCTs comprising 606 patients. Compared with standard oxygenation, PAP systems reduced the rate of hypoxemia (OR 0.21; 95%CI 0.12 to 0.38, p<0.001), and severe hypoxemia (OR 0.15; 95%CI 0.05 to 0.49, p=0.002). Additionally, the PAP group experienced fewer arrhythmic events (p=0.04), required fewer airway maneuvers (p=0.002), and had a reduced total propofol dosage (p=0.04). There was no significant difference between the groups in terms of hypotension events (p=0.39), procedure duration (p=0.62), hypoxemia episode duration (p=0.78), anesthesiologist satisfaction (p=0.44), or endoscopist satisfaction (p=0.79).

Conclusion

Overall, the use of PAP systems appears to be a promising strategy for optimizing sedation and enhancing patient safety during gastrointestinal endoscopic procedures for patients at risk of hypoxemia.

Introduction

Perihilar cholangiocarcinoma (pCCA) is a rare malignancy originating from the bile duct bifurcation which is often diagnosed in an advanced stage. Most patients require endoscopic or percutaneous biliary drainage, as they present themselves with jaundice and/or cholangitis. In most Western countries, only palliative chemotherapy (pCTx) is offered to these patients, positively impacting overall survival and quality of life. Unfortunately, median survival is still poor, with only 10.6 months in patients receiving pCTx, compared to a dismal 4.0 months in patients receiving best supportive care (1). For non-resected pCCA, there is much debate on the optimal technique of biliary drainage, which is often deemed necessary to initiate pCTx. This study aimed to investigate the impact of biliary drainage on pCTx initiation and survival in patients with non-resected pCCA.

Aims & Methods

Individual patient data from all Dutch patients diagnosed with non-resected pCCA between 2015 and 2020 were retrieved from the Netherlands Cancer Registry. Survival data was last updated on 1^st of February 2024. Data was retrieved and de-identified by trained data clerks. The primary outcome was pCTx initiation. Secondary outcome was overall survival. For both the primary and secondary outcome, associations were investigated for several (biliary drainage) factors by multivariable competing risk regression analysis. Initial drainage procedure and initiation of pCTx were treated as time-varying covariates. Sensitivity analysis for pathologically proven pCCA was performed.

Results

A total of 1265 patients (median age of 74 years [IQR: 66-82 years]) were included, of whom 242 patients (19.1%) received pCTx after a median interval of 72 days [IQR 43-110 days] after initial presentation. Patients who underwent biliary drainage did not receive pCTx more often. If performed, drainage at a referral hospital (HR:0.65, 95%CI: 0.42-0.99), ≥3 drainage procedures performed (HR:0.53, 95%CI: 0.32-0.88), and drainage performed ≥14 days after presentation (HR:0.70, 95%CI: 0.49-0.99) were associated with no pCTx. Median overall survival for those who received pCTx and those who did not was 12.8 months [95%CI: 11.7-14.2] and 2.7 months [95%CI: 2.4-3.1]. Receiving of pCTx was associated with improved overall survival (HR:0.61, 95%CI: 0.51-0.73), but biliary drainage was not. If performed, biliary drainage by percutaneous trans-hepatic catheter placement compared to endoscopic plastic stenting (HR:1.27, 95%CI: 1.02-1.57) was associated with diminished survival, and drainage performed ≥14 days after presentation (HR: 0.76, 95% CI: 0.65-0.88) was associated with improved overall survival. Sensitivity analysis for pathologically confirmed pCCA showed similar results.

Conclusion

The need for biliary drainage did not affect the initiation of pCTx. When indicated, biliary drainage should be performed as quick as possible in an academic center to improve the rate of patients receiving pCTx.

References

1. Izquierdo-Sanchez L, Lamarca A, La Casta A, Buettner S, Utpatel K, Klumpen HJ, et al. Cholangiocarcinoma landscape in Europe: Diagnostic, prognostic and therapeutic insights from the ENSCCA Registry. J Hepatol. 2022;76(5):1109-21.

Disclosure

J. de Vos-Geelen has served as a consultant for Amgen, AstraZeneca, MSD, Pierre Fabre, and Servier, and has received institutional research funding from Servier (all outside the submitted work). RPV reports a research grant and consultancy fees from Boston Scientific, research grant from Prion medical, Consultancy fee from Cook Medical, Speakersfee Viatris. N Haj Mohammad has served as a consultant for Merck, BMS, Astra Zeneca, Servier and has received institutional research funding from Servier. M.J. Bruno serves as a consultant and receives support for industry and investigator-initiated studies from Boston Scientific and Cook Medical and receives support for investigator-initiated studies from Pentax Medical, 3 M, Interscope, and Mylan. W.J. Lammers acts as a consultant/lecturer for Mediglobe. The remaining authors declare no conflicts of interests.

Introduction

A new LED endoscopy system featuring advanced noise-reduction technology for enhanced brightness and minimal halation, the EP-8000 with the EC-860ZP colonoscope (Fujifilm), is scheduled to be released.

Aims & Methods

We conducted a multicenter, observational study to evaluate the new system’s potential improvements in image quality compared to a previous system/scope (VP-7000/EC-760ZP). From January 2024 to January 2025, patients undergoing colonoscopy at two institutions were enrolled. Images of the cecum and lesions were captured using white light imaging (WLI), blue light imaging (BLI), and linked color imaging (LCI) under similar conditions about air insufflation, angle, distance, and so on. Participants were divided into three groups: Group 1 (EP-8000+EC-860ZP; 50 cases), Group 2 (EP-8000+EC-760ZP; 50 cases), and Group 3 (VP-7000+EC-760ZP; 50 cases). Cecal images were evaluated for brightness and halation using a four-point scale (1=poor to 4=excellent) by endoscopists and original values by image-analysis software, while lesion images were assessed for brightness, halation, and visibility by endoscopists.

Results

In cecal images, the endoscopists’ scores for WLI in Group 1 were significantly better than in Group 3 for brightness (3.71±0.55 vs. 3.51±0.58, p<0.001) and for halation (3.60±0.51 vs. 3.18±0.59, p<0.001). Similarly, for BLI and LCI, Group 1 achieved higher scores than Group 3 regarding brightness (BLI: 3.15±0.85 vs. 2.23±0.92, p<0.001; LCI: 3.83±0.42 vs. 3.54±0.58, p<0.001) and halation (BLI: 2.99±0.69 vs. 2.71±0.78, p<0.001; LCI: 3.33±0.60 vs. 3.10±0.58, p<0.001). Software analysis confirmed that Group 1 had superior brightness values compared to Group 3 for WLI (122.7±6.6 vs. 110.7±7.7, p<0.001), BLI (99.1±10.9 vs. 69.3±11.5, p<0.001), and LCI (139.4±9.2 vs. 113.1±10.7, p<0.001), as well as lower halation values for WLI (1.34±1.80 vs. 3.35±3.59, p=0.031) and LCI (1.48±0.83 vs. 4.06±3.99, p=0.010). Regarding lesion images, brightness, halation, and visibility for WLI, BLI, and LCI were significantly better in Group 1 than in Group 3.

Conclusion

The new LED system provided marked improvements in brightness, halation, and lesion visibility. The software assessment was consistent with endoscopists assessment objective and can be used for the development and evaluation of new endoscopic systems.

References

Nishizawa T, Toyoshima O, Yoshida S, et al. TXI (Texture and Color Enhancement Imaging) for Serrated Colorectal Lesions. J Clin Med 2021; 11: 119.
Okumura T, Hotta K, Imai K, et al. Efficacy of texture and color enhancement imaging for the visibility and diagnostic accuracy of non-polypoid colorectal lesions. DEN Open 2024; 29; 5: e380.
Antonelli G, Bevivino G, Pecere S, et al. Texture and color enhancement imaging versus high definition white-light endoscopy for detection of colorectal neoplasia: a randomized trial. Endoscopy 2023; 55 :1072-1080.
Yoshida N, Inagaki Y, Inada Y, et al. Additional 30-Second Observation of the Right-Sided Colon for Missed Polyp Detection With Texture and Color Enhancement Imaging Compared with Narrow Band Imaging: A Randomized Trial. Am J Gastroenterol 2024; 119: 539-546.
Aniwan S, Vanduangden K, Kerr SJ, et al. Linked color imaging, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection: a randomized trial. Gastrointest Endosc 2021; 94: 969-977.
Yoshida N, Draganov PV, John S, et al. Comparison of LED and LASER Colonoscopy About Linked Color Imaging and Blue Laser/Light Imaging of Colorectal Tumors in a Multinational Study. Dig Dis Sci 2023; 68: 3943-3952.

Disclosure

Yoshida N and Dohi O received a research grant from Fujifilm Co. Yamamoto H had a consultant relationship with Fujifilm Co. and received honoraria, grants, and royalties from the company. Yano T received a research grant and honoraria from Fujifilm, Japan. The other authors declare no conflicts of interest. Novel endoscopic systems and scopes were lent by Fujifilm Co.