UEG Week 2025: Relive the Highlights

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UEG Podcast Episode

UEG Podcast

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Innovation - A journey from idea to product

Pradeep Mundre 1, Alexander Meining 2

1 Bradford Teaching Hospitals NHS trust, Leeds, United Kingdom

2 University of Würzburg, Germany

Published

2023

UEG Podcast Episode

Journal Podcast

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The impact of COVID-19 pandemic in Gastroenterology: focus on IBD

Katarzyna Pawlak 1, Fernando Magro 2, Candida Abreu 2

1 Department Gastroenterology, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland

2 Hospital de São João, Porto, Portugal

Topics

IBD

Published

2021

UEG Standards and Guidelines

Position Paper

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Abstract

Objectives

Jejunal tube feeding (JTF) is increasingly becoming the standard of care for children in whom gastric tube feeding is insufficient to achieve caloric needs. Given a lack of a systematic approach to the care of JTF in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimize its utility and safety.

Methods

A group of members of the Gastroenterology and Nutrition Committees of the European Society of Paediatric Gastroenterology Hepatology and Nutrition and of invited experts in the field was formed in September 2016 to produce this clinical guide. Seventeen clinical questions treating indications and contraindications, investigations before placement, techniques of placement, suitable feeds and feeding regimen, weaning from JTF, complications, long-term care, and ethical considerations were addressed.

A systematic literature search was performed from 1982 to November 2018 using PubMed, the MEDLINE, and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.

During a consensus meeting, all recommendations were discussed and finalized. In the absence of evidence from randomized controlled trials, recommendations reflect the expert opinion of the authors.

Results

A total of 33 recommendations were voted on using the nominal voting technique.

Conclusions

JTF is a safe and effective means of enteral feeding when gastric feeding is insufficient to meet caloric needs or is not possible. The decision to place a jejunal tube has to be made by close cooperation of a multidisciplinary team providing active follow-up and care.

The Use of Jejunal Tube Feeding in Children

Ilse Broekaert

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Position Paper

Topics

Paediatrics Small Intestine & Nutrition

Citation

Journal of Pediatric Gastroenterology and Nutrition, 69: 239-258

Published

2019

UEG Podcast Episode

UEG Podcast

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Oesophageal cancer with Massimiliano di Pietro (Part 1)

Massimiliano di Pietro, Pradeep Mundre

Topics

Digestive Oncology Endoscopy Oesophagus

Published

2025

UEG Poster

Standard Poster

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Introduction

Barrett’s oeosphagus (BO) is the precursor to oesophageal adenocarcinoma (OAC), a malignancy with a poor overall prognosis. Endoscopic surveillance of patients with BO aims to detect dysplasia and OAC to improve long-term outcomes. However, the majority of patients with BO do not progress to cancer.^1,2 It is therefore important to establish the relevant clinical risk factors for malignant progression in this cohort to enable risk stratification and facilitate a personalised approach to management. While obesity is an independent risk factor for both BO and OAC,^3-5 the role of obesity in the malignant progression of BO is unclear. We undertook a systematic review and dose-response meta-analysis to estimate the association between obesity and malignant progression in patients with BO.

Aims & Methods

We searched MEDLINE and EMBASE databases via the OVID interface to December 2023. Studies which reported the effect of body mass index (BMI) on the progression of BO (no dysplasia or low-grade dysplasia[LGD] at baseline) to HGD or OAC were included. Two-stage dose-response meta-analysis was performed to estimate the association between BMI and malignant progression. Study quality was appraised using a modified Newcastle-Ottawa scale. The review was registered on PROSPERO (CRD42017051046).

Results

Twenty studies reported data on 38565 patients in total, of whom 1684 patients were diagnosed with HGD/OAC/OC. Each 5kg/m²increase in BMI was associated with a 4% increase in malignant progression to HGD or OAC (unadjusted OR 1.04; 95% CI 1.00 to 1.07; p<0.001; I² 57.2%). The association remained consistent after adjusting for potential confounders (adjusted OR 1.06; 95% CI 1.02 to 1.10;p<0.001; I² 0%). Nineteen studies were considered moderate to high quality.

Conclusion

Our meta-analysis suggests that obesity as measured by BMI is associated with malignant progression of BO with a dose-response relationship. The findings from our study are consistent with mechanistic evidence for the role of obesity in the pathogenesis of OAC. Future risk prediction models could incorporate measures of obesity to potentially improve risk stratification in patients with BO. Weight loss might reduce the risk of malignant progression in patients with BO.

References

1. Bhat S, Coleman HG, Yousef F, et al. Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study. J Natl Cancer Inst 2011;103:1049-57.
2. Hvid-Jensen F, Pedersen L, Drewes AM, et al. Incidence of adenocarcinoma among patients with Barrett's esophagus. N Engl J Med 2011;365:1375-83.
3. Kubo A, Cook MB, Shaheen NJ, et al. Sex-specific associations between body mass index, waist circumference and the risk of Barrett's oesophagus: a pooled analysis from the international BEACON consortium. Gut 2013;62:1684-91.
4. Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008;371:569-78.
5. Corley DA, Kubo A, Zhao W. Abdominal obesity and the risk of esophageal and gastric cardia carcinomas. Cancer Epidemiol Biomarkers Prev 2008;17:352-8

THE ASSOCIATION BETWEEN OBESITY AND MALIGNANT PROGRESSION OF BARRETT’S OESOPHAGUS: A SYSTEMATIC REVIEW AND DOSE-RESPONSE META-ANALYSIS

Mie Thu Ko 1, Tom Thomas 2, Emily Holden 1, Ian Beales 3, Leo Alexandre 4

1 University Of East Anglia, Norwich, United Kingdom

2 Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom

3 Norfolk & Norwich University Hospital, Norwich, United Kingdom

4 Norfolk and Norwich University Hospital, Norwich, United Kingdom

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

Barrett's oesophagus (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Poster

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Introduction

The adherence of doctors and patients to published colorectal post-polypectomy surveillance guidelines varies greatly, and patient follow-up is critical but time-consuming.

Aims & Methods

Aims: We aimed to develop an automatic surveillance (AS) system to accurately identify post-polypectomy patients, assign surveillance intervals for different risks of patients and proactively follow up with patients on time.
Methods: The endoscopic and pathological reports from 47,544 patients from three hospitals were used to develop AS system based on natural language processing. The performance of AS system was fully evaluated in internal and external tests according to five different guidelines worldwide and compared with that of doctors. Furthermore, a multi-reader-multi-case (MRMC) trial was conducted to evaluate the effect of AS system on improving doctors’ guideline adherence and efficiency, and a prospective trial was performed to evaluate the success rate for automatically informing patients and its effect on reducing the burden of nurses.

Results

In internal, external 1, and external 2 tests, the system reached an overall accuracy of 99.73%, 99.54%, and 99.77% for identifying different types of patients, respectively; and achieved an overall accuracy of ≥99.45%, ≥98.89%, and ≥98.56% for stratifying patients' risk levels and assigning surveillance intervals according to five guidelines. The system greatly increased the accuracy of doctors (98.67% vs. 78.10%, p=0.043) in MRMC trial. In a prospective trial, AS system successfully informed 93·18% of patients, and significantly reduced the follow-up time cost (127.4s vs. 14.02s per patient).

Conclusion

This system has great potential to improve doctors' adherence to guidelines while relieving the workload of doctors and nurses.

Disclosure

The authors declare no conflict of interest.

THE DEVELOPMENT AND CLINICAL EVALUATION OF A NATURAL LANGUAGE PROCESSING-BASED AUTOMATIC SURVEILLANCE SYSTEM FOR COLORECTAL POST-POLYPECTOMY PATIENTS

CONGHUI SHI 1, Lianlian Wu 1, Jia Li 1, Honggang Yu 1

1 Renmin Hospital of Wuhan University, Wuhan, China

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

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 Week 2025: Relive the Highlights

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