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Oligometastasitc disease: Does surgical resection play a role?

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Oligometastasitc disease: Does surgical resection play a role?

Christiane Bruns 1

Affiliations

1 Universitätsklinikum Köln, Köln, Germany

Summary

AI Generated

Surgical resection may play a role in oligometastatic pancreatic cancer if the right patients can be identified, though biological markers to define true oligometastatic disease are currently lacking.

The speaker presented the HOLLYBANK trial, a single-arm feasibility study in which patients with up to five liver metastases receive combination chemotherapy and undergo synchronous resection of the primary tumor and metastases; as stated by the speaker, 107 of a planned 150 patients have been enrolled with a resection rate of 35 percent.
A 10-year retrospective analysis at the speaker's institution examined clinical characteristics including number of metastases, affected organs, CA19-9 levels, and chemotherapy response, finding that patients meeting oligometastatic criteria had higher overall survival than non-oligometastatic patients.
The speaker emphasized that no biological or molecular biomarkers currently exist to distinguish true oligometastatic disease from occult systemic disease, and that current selection relies on clinical features such as limited metastatic burden and response to chemotherapy.
German guidelines recommend that resection of the primary tumor with synchronous oligometastatic disease (fewer than three liver metastases) should be performed only in clinical trials under a multimodal therapy concept.
The speaker stated that potential benefits of resection in selected patients include chemotherapy-free intervals with reduced toxicity, removal of tumor cell mass, and possibly reduced development of resistance, but stressed this must be achieved with low morbidity and mortality.

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Abstract

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Mechanisms & Personalised Medicine Small Intestine & Nutrition Pancreas Surgery

Session

Pancreatic cancer

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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UEG Presentation

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Donor selection with liver disease

Dieter Broering 1

Affiliations

1 King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia

Summary

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Abstract

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Surgery

Session

New developments in liver transplantation

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Patrizia Burra

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UEG Presentation

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GP: When to refer?

Pierluigi Fracasso 1

Affiliations

1 Ospedale Sandro Pertini, Roma, Roma, Italy

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Abstract

Event

UEG Week Berlin 2025

Topics

Oesophagus Primary Care

Session

Spastic oesophagus: Is it curable?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Butt problems

Emma V. Carrington 1

Affiliations

1 University of North Carolina / NCRBSI, London, United Kingdom

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Abstract

Event

UEG Week Berlin 2025

Topics

Colorectal Hepatobiliary Primary Care

Session

Cross-cutting: Management changes in high prevalence problems

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Donor selection with liver disease

Dieter Broering

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D. Nageshwar Reddy

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Patrizia Burra

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UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

RANDOMIZED CONTROLLED TRIAL COMPARING ENDOSCOPIC BALLOON DILATION VERSUS ENDOSCOPIC STRICTUROTOMY FOR SHORT STRICTURES (&LT; 3 CM) RELATED TO CROHN’S DISEASE (THE BEST-CD TRIAL) (NCT05521867)

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RANDOMIZED CONTROLLED TRIAL COMPARING ENDOSCOPIC BALLOON DILATION VERSUS ENDOSCOPIC STRICTUROTOMY FOR SHORT STRICTURES (&LT; 3 CM) RELATED TO CROHN’S DISEASE (THE BEST-CD TRIAL) (NCT05521867)

Partha Pal 1, Kanapuram Pooja 1, Rajesh Gupta 1, Manu Tandan 1, D. Nageshwar Reddy 1

Affiliations

1 Asian Institute of Gastroenterology, Hyderabad, India

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Abstract

Introduction

Although endoscopic balloon dilation (EBD) remains the standard intervention for Crohn’s disease (CD)-associated strictures, its efficacy is limited by high recurrence and surgery rates. Retrospective analyses suggest endoscopic stricturotomy (ES) may offer superior outcomes, particularly in anastomotic strictures. However, no randomized trials have directly compared EBD and ES for short CD-related strictures.

Aims & Methods

This single-center, randomized controlled trial (August 2022–March 2025) enrolled adult CD patients (18–65 years) with symptomatic, predominantly fibrotic or mixed, short strictures (<3 cm), including both de novo and anastomotic types, accessible via standard endoscopy. Patients with multiple (>2) strictures, strictures beyond endoscopic reach, or prior stricturotomy were excluded. Participants were randomized to undergo either EBD or ES. The primary outcome was clinical recurrence at 1 year. Secondary outcomes included re-intervention, surgery, emergency visits, hospitalization, technical success, and adverse events.

Results

Out of 70 randomized patients, 69 were analyzed (EBD: 35; ES: 34). Baseline characteristics were comparable between groups. Technical success was similar (EBD: 91.4%, ES: 94.1%). On time to event analysis, clinical recurrence was significantly lower in the ES group (OR=0.343, 95% CI: 0.134–0.881; p=0.026). Re-intervention rates favored ES (EBD: 25.7%, ES: 8.8%; OR=0.337, 95% CI: 0.131–0.870; p=0.025). Surgery rates were numerically lower with ES (EBD: 11.4%, ES: 5.9%) but not statistically significant (p=0.581). Hospitalization was significantly more frequent in the EBD arm (OR=0.276, 95% CI: 0.091–0.840; p=0.023). ED visits also trended lower with ES, though not statistically significant (p=0.062) (see table). Adverse events occurred in 25.7% of EBD patients (bleeding n=3 [1 hemoclip], pain with admission n=3, micro-perforation n=1, post-procedure pain n=2) and 14.7% of ES patients (bleeding n=3 [1 self-limited, 1 coagrasper, 1 hemoclip], none required transfusion, suspected perforation n=1, mild pain n=1).

Outcome	EBD (n=35)	ES (n=34)	p-value	Odds Ratio (95% CI)
Technical Success (%)	91.4% (32/35)	94.1% (32/34)	0.70	-
Clinical Recurrence (%)	48.6%	23.5%	0.026	0.343 (0.134–0.881)
Re-intervention Rate (%)	25.7%	8.8%	0.025	0.337 (0.131–0.870)
Surgery (%)	11.4%	5.9%	0.581	0.707 (0.207–2.422)
Stricture-related ED Visits (%)	20.0%	11.8%	0.062	0.404 (0.156–1.047)
Stricture-related Hospitalizations (%)	25.7%	8.8%	0.023	0.276 (0.091–0.840)
Any Adverse Event (%)	25.7% (9/35)	14.7% (5/34)	0.45	-

Conclusion

In this interim analysis, ES was associated with significantly lower clinical recurrence, re-intervention, and hospitalization compared to EBD for short CD-related strictures, with similar safety outcomes. These findings support ES as a potentially superior first-line endoscopic strategy over EBD in selected patients with Crohn’s disease strictures. (NCT05521867)

References

Lan N, Shen B. Endoscopic Stricturotomy Versus Balloon Dilation in the Treatment of Anastomotic Strictures in Crohn's Disease. Inflamm Bowel Dis. 2018 Mar 19;24(4):897-907. doi: 10.1093/ibd/izx085. PMID: 29546384.

Event

UEG Week Berlin 2025

Topics

Endoscopy Radiology & Imaging IBD

Submission format

Abstract

Session

Advances in the investigation of the small bowel

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Donor selection with liver disease

Dieter Broering

GP: When to refer?

Pierluigi Fracasso

Butt problems

Emma V. Carrington

RANDOMIZED CONTROLLED TRIAL COMPARING ENDOSCOPIC BALLOON DILATION VERSUS ENDOSCOPIC STRICTUROTOMY FOR SHORT STRICTURES (&LT; 3 CM) RELATED TO CROHN’S DISEASE (THE BEST-CD TRIAL) (NCT05521867)

D. Nageshwar Reddy

Long-term outcome post-LTx in adults

Patrizia Burra

Future trends in diagnosis and management of coeliac disease

Fabiana Zingone

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Long-term outcome post-LTx in adults

Patrizia Burra 1

Affiliations

1 University of Padua-Multivisceral Transplant Unit- Gastroenterology, Padova, Italy

Summary

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Summary is not available for this content yet.

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Abstract

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Surgery

Session

New developments in liver transplantation

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

Donor selection with liver disease

Dieter Broering

GP: When to refer?

Pierluigi Fracasso

Butt problems

Emma V. Carrington

RANDOMIZED CONTROLLED TRIAL COMPARING ENDOSCOPIC BALLOON DILATION VERSUS ENDOSCOPIC STRICTUROTOMY FOR SHORT STRICTURES (&LT; 3 CM) RELATED TO CROHN’S DISEASE (THE BEST-CD TRIAL) (NCT05521867)

D. Nageshwar Reddy

Long-term outcome post-LTx in adults

Patrizia Burra

Future trends in diagnosis and management of coeliac disease

Fabiana Zingone

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Future trends in diagnosis and management of coeliac disease

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Future trends in diagnosis and management of coeliac disease

Fabiana Zingone 1

Affiliations

1 University of Padua, Padua, Italy

Summary

AI Generated

Summary is not available for this content yet.

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Abstract

Event

UEG Week Berlin 2025

Topics

Immunology Small Intestine & Nutrition

Session

Coeliac or non-coeliac enteropathy?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Donor selection with liver disease

Dieter Broering

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Emma V. Carrington

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D. Nageshwar Reddy

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Patrizia Burra

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Fabiana Zingone

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