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Free for all myUEG account holders. Your access level is set automatically based on your occupation. Medical professionals get full access to all content. If you are a non-medical user, you can only access UEG Week content from congresses you attended.

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Introduction

Colonoscopy is the ‘gold standard’ investigation for assessment of the large bowel allowing diagnosis, biopsies, and therapy to be undertaken. Colonoscopy detects and prevents colorectal cancer through detection and removal of polyps, and is important in the diagnosis and treatment of non-neoplastic conditions. Poor quality colonoscopy is associated with increased rates of interval cancers. High quality colonoscopy cannot occur without good quality bowel preparation. Evidence in the UK show that 22% of failed colonoscopies were due to poor bowel preparation. Apart from the bowel cleansing agent, dietary restriction prior to colonoscopy has been shown to enhance quality of bowel preparation at colonoscopy.

Aims & Methods

We aimed to assess the information received and followed by patients in terms of dietary modification prior to colonoscopy.
A single centre prospective analysis of 60 consecutive patients attending colonoscopy at Chase Farm Hospital in London was undertaken in May 2022. Patients were asked to complete a questionnaire with information gathered about: type of bowel prep undertaken, whether written information about how to take bowel prep was received, whether a telephone consultation explaining dietary restriction prior to procedure happened, whether they followed a low fibre diet and the amount of fluid drunk.

Results

57 patients returned the questionnaire.
Of the 57 patients, 39% patients received written information on dietary restriction. A further 35% of patients received telephone information, 26% of patients receiving both written and verbal information. 56.9% of patients followed the 3 day dietary restriction. The quality of bowel preparation was inadequate (fair and poor by Aronchick scale) in 60% of those who did not follow the low fibre diet compared to 24% when followed. Patients who had seen a clinician in clinic and patients undergoing surveillance procedure were more likely to follow dietary restriction compare to direct access patients.

Conclusion

In this prospective study of clinical practice, we conclude that advice regarding dietary fibre restriction prior to colonoscopy is variable. In clinical practice, there is low compliance of dietary restriction prior to colonoscopy. We find that those who followed a low fibre diet are 40 % more likely to have a favourable bowel preparation compared to those following a high fibre diet. Those that had inadequate bowel prep required a repeat colonoscopy adding to the burden of the already stretched service. We recommend improvements in the implementation of the low residue diet in addition to the guidance of cleansing agents prior to colonoscopy.

POOR ADHERENCE TO DIETARY RESTRICTION IMPACTS QUALITY OF COLONOSCOPY IN CLINICAL PRACTICE

Katrin Nuija 1, Kalpesh Besherdas 1

1 Royal Free London, Enfield, United Kingdom

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 Podcast Episode

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ESGE highlights with Ian Gralnek

Ian Gralnek, Egle Dieninyte - Misiune

Published

2025

UEG Online Course

accredited

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This interactive course explores why optimising polyp detection is central to high-quality colonoscopy and its direct impact on morbidity and mortality. Designed for general gastroenterologists and young endoscopists, the course addresses key quality indicators, bowel preparation, scoping techniques, and the integration of AI for improved detection. Participants will learn to interpret and apply optical diagnosis systems (NICE, WASP, LST-classification, BLINC) and to choose appropriate therapeutic strategies tailored to polyp type and patient context. Surveillance intervals and outcome factors, including family history and syndromes, will be discussed in line with ESGE guidelines. Case-based discussions will focus on communication with patients regarding diagnosis and management. By combining expert testimony, videos, and practical strategies, the course aims to improve participants’ endoscopic practice, ensuring earlier detection, appropriate treatment, and better long-term outcomes.

Target Audience:

Gastroenterologists (in training)
Other physicians and surgeons
Nurses
Medical students

Impact of Polyp Detection in Colonoscopy

Raf Bisschops, Manuele Furnari, Veronique Van der Voort, Pieter Sinonquel

Event

Impact of Polyp Detection in Colonoscopy

Topics

Endoscopy Colorectal

Accreditation status

accredited

Duration

1 hour

Published

2025

UEG Online Course

accredited

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Acute pancreatitis is the most frequent pancreatic disease and the most common reason for emergency room admission for all nonmalignant gastrointestinal diseases. This rapid-onset and painful inflammation of the pancreas is troublesome to manage because it has a diverse and often unpredictable clinical course. Although the inflammation usually subsides, complications can develop, and some patients will progress to chronic pancreatitis.
Learning objectives

The aetiology of acute pancreatitis
The different classification systems for acute pancreatitis
The diagnosis of acute pancreatitis
The therapeutic regimes for acute pancreatitis
Target audience

This course is suitable for gastroenterologists in training, but it is also appropriate for physicians and surgeons in other disciplines, as well as nurses, biotechnicians and advanced-years’ medical students who have an interest in gastroenterology.

Acute pancreatitis

Ali Alexander Aghdassi, Markus M. Lerch

Event

Acute pancreatitis

Topics

Pancreas

Accreditation status

accredited

Duration

1 hour

Published

2020

UEG Presentation

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Pancreatic cancer - a rising problem. Surgical, oncological and endoscopic treatment, screening modalities for early detection

Ioannis S Papanikolaou 1

1 Attikon University Hospital, National and Kapodistrian University of Athens, Medical School., Athens, Greece

Event

UEG Week Berlin 2025

Topics

Nurses

Session

Patient care: Differences matter

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

The polypectomy technique used by endoscopists depends on multiple factors including anticipated histological subtype (eg Paris and Kudo pitt pattern), estimated polyp size and location within the colon. The latest European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend the most suitable methods which minimise risk of post-procedural bleeding and perforation, whilst ensuring cost-effectiveness. ESGE recommends avoiding cold biopsy due to its high rate of incomplete resection. ESGE also recommends cold snare polypectomy for removal of nonpedunculated adenomatous polyps under 10mm and hot snare with or without endoscopic mucosal resection (EMR) for polyps over 10mm. In addition, ESGE recommends cold snare or cold EMR for sessile serrated lesions (SSL) of all sizes, as well as consideration of endoscopic submucosal dissection (ESD) for certain polyps over 20mm.

Aims & Methods

This study aimed to assess the current practice in our institution in terms of polypectomy technique across all polyp sizes and histological subtypes in comparison to the ESGE standards.
A single centre, retrospective analysis of 100 consecutive patients who have had polypectomies done for polyps of any size from April 2024 at a hospital in North London was undertaken. The data was collected using the Medilogic endoscopy reporting tool, and the electronic patients record. The technique used for polypectomy, along with the type of polyp at histology retrieved, was scrutinized and compared with compliance of ESGE guidance on polypectomy technique.

Results

A total of 177 polypectomies from 100 patients were analysed. 121 polypectomies (68%) followed ESGE recommendations and 56 polypectomies (32%) did not. The 56 non-compliant polypectomies used methods including cold biopsy, hot snare with or without EMR for polyps under 10mm and hot EMR for SSLs (see Table).

Polypectomy method compliant with ESGE		Polypectomy method non-compliant with ESGE
Cold snare or cold EMR for all SSL	13	Hot EMR for SSL	4
Cold snare or cold EMR <10mm	79	Cold snare or cold EMR > 10mm	12
Hot EMR >10mm	26	Hot EMR <10mm	12
ESD	3	Hot snare <10mm	3
		Cold biopsy	25
Total in line with ESGE:	121 (68%)	Total not in line with ESGE:	56 (32%)

Conclusion

This study shows poor adherence to the ESGE guidelines in our department with regards to colorectal polypectomies, with only two-thirds of polypectomies adhering to the recommended techniques. A third of polypectomies undertaken were not in line with ESGE recommendations (56/177 – 32%), of these 16/56 (34%) polypectomies involved inappropriate diathermy use which could have led to increased risk of complications such as post-polypectomy bleeding and perforation. A significant number of polyps are removed by the cold biopsy technique (25/177 – 14%) which is not advocated due to a higher risk of local recurrence.
We recommend better dissemination and implementation of the ESGE guidelines to enhance clinical practice with regards to polypectomy techniques.

HOW ARE POLYPS REMOVED IN CLINICAL PRACTICE? A COMPARISON TO ESGE POLYPECTOMY GUIDELINES

Eliana Broder 1, Kalpesh Besherdas 1

1 Royal Free Hospital, London, United Kingdom

Conference

UEG Week Berlin 2025

Topics

Colorectal

Submission format

Abstract

Session

LOWER GI (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Colorectal cancer associated to chronic colitis (CAC) has a different pathogenesis compared to sporadic or familial colorectal cancer (CRC) and represents the major complication of inflammatory bowel disease (IBD). It is now well-established that IL-33 and its receptor, ST2, are important factors in the pathogenesis of IBD. Emerging evidence also suggests its critical role in epithelial proliferation and the potential contribution to inflammation-driven tumorigenesis that can lead to CRC.

Aims & Methods

The aim of our study was to characterize the precise contribution of IL-33/ST2 axis in the azoxymethane (AOM)/dextran sodium sulfate (DSS) model of colitis-associated CRC. C57/BL6 wild-type (WT), Il33^-/-, T1/St2^-/- and Nt5e^-/- mice were given a single dose of AOM (10 mg/kg) followed by two cycles of 3% DSS for 7d in drinking water. Vehicle-treated WT mice served as controls and were sacrificed at the same time points. Another group of WT followed the same protocol and received CD73 inhibitor i.p. treatment or vehicle. Disease Activity Index (DAI), as well as endoscopic, stereomicroscopic and histological evaluations of colons were performed. IHC, immunofluorescence (IF), qPCR, and ELISA were done on full-thickness colons of WT for IL-33 and ST2 localization and identification, as well as mRNA and protein expression, respectively. RNA-Seq was performed on whole tissues from AOM/DSS treated WT, Il33^-/-and T1/St2^-/-. qPCR analysis was done on isolated polyps from WT, Il33^-/-and T1/St2^-/-for Nt5e (CD73) and adenosine pathway targets.

Results

Il33, Ilrl1(ST2L), and Ilrl1(sST2) mRNA transcripts, as well as IL-33 and total ST2 proteins were dramatically elevated in AOM/DSS-treated WT mice vs. controls. IHC and IF of treated WT mice revealed localization of IL-33 to the colonic epithelium and to cells within the polyp LP morphologically consistent with stromal and mast cells. Little to no staining for IL-33 was present in controls. Using IF, IL-33 co-localized with sub-epithelial myofibroblast markers Actin and Vimentin, or with mast cell markers Tryptase and MCPT1. AOM/DSS treatment in Il33^-/- and T1/St2^-/- mice resulted in a significant decreased polyp number and size vs. WT, with colonoscopy revealing the development of protruding lesions with abnormal vascular patterns, suggesting tumorous lesions in WT mice, while all deficient mice showed their absence with a more impressive mucosal inflammation, likely due to reduced epithelial proliferation and repair caused by the deficiency of IL-33 signaling. RNA-Seq identified a significant reduction of Nt5e and adenosine pathway targets in Il33^-/- and T1/St2^-/-vs. WT. qPCR on isolated polyps confirmed this observation. AOM/DSS-treated Nt5e^-/- showed a significant decreased polyp number and size vs. controls. Therapeutic inhibition of CD73 produced similar results.

Conclusion

Our results suggest that the IL-33/ST2 axis promotes tumorigenesis in colitis-associated CRC through the activation of CD73. Further studies are underway to determine mechanisms of action that support these findings.

IL-33 ACTIVATES CD73-EXPRESSING CELLS PROMOTING TUMORIGENESIS DURING COLITIS-ASSOCIATED COLORECTAL CANCER

Loris Riccardo Lopetuso 1, Giuseppe Privitera 2, Luca Di Martino 3, Daniele Corridoni 3, Antonio Gasbarrini 4, Fabio Cominelli 3, Carlo De Salvo 3, Theresa Torres Pizarro 5

1 Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica di Roma, Roma, Italy

2 Università Cattolica del Sacro Cuore, Rome, Italy

3 Case Western Reserve University, Cleveland, United States

4 Fondazione Policlinico Universitario Gemelli IRCCS, Università’ Cattolica, Rome, Italy

5 Case Western Reserve University School of Medicine, Cleveland, United States

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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