Introduction

With the increasing westernization of lifestyles, there has been a significant rise in obesity, leading to a growing interest in metabolic syndrome and insulin resistance. Identifying indicators of insulin resistance through endoscopic findings could be valuable in assessing a patient's systemic metabolic status. Thus, we conducted a retrospective study to explore the association between endoscopic findings and insulin resistance.

Aims & Methods

We retrospectively investigated the patients who underwent screening endoscopy at Bundang Jesaeng General Hospital between February and June 2023. We excluded patients who were not tested for insulin resistance. Insulin resistance was defined using Homeostatic Model Assessment for Insulin Resistance (HOMR_IR), with a value above 1.9. We also assessed the Helicobacter pylori (H. pylori) status using rapid urease test, and history of previous eradication into current infection, non-infection, and past infection. To ensure balanced variables between the two groups, we performed propensity score matching (1:2 ratio) based on age and H. pylori status. Multivariate analysis was performed to investigate the association between the endoscopic features and insulin resistance.

Results

Following propensity score matching, we selected 210 patients with insulin resistance and 420 patients without insulin resistance were selected. In baseline characteristics, age and H. pylori status were balanced between the two groups. Prior to propensity score matching, endoscopic findings including erosive esophagitis, RAC (regular arrangement of collecting venules), atrophy, and diffuse redness appeared to be significant associated with insulin resistance. However, after matching, only erosive esophagitis remained significantly associated with insulin resistance. Furthermore, the severity of erosive esophagitis showed positive correlation with the degree of insulin resistance, as indicated by increased HOMA_IR. Multivariate analysis demonstrated that erosive esophagitis (OR 1.81, p = 0.010) significantly raised the risk of insulin resistance while RAC was associated with a lower risk of insulin resistance (OR 0.68, p = 0.032).

Conclusion

Our study showed an obvious correlation between insulin resistance and erosive esophagitis, as well as RAC among the endoscopic findings. Moreover, we observed a proportional relationship between the severity of erosive esophagitis and the degree of insulin resistance. Multivariate analysis showed that erosive esophagitis and RAC were significantly associated with the insulin resistance. These findings suggest that individuals with erosive esophagitis and without RAC should undergo metabolic evaluation to assess their insulin resistance status. Further research is warranted to explore the underlying mechanisms and potential implications of these associations.

Introduction

Non-variceal upper gastrointestinal bleeding can usually be controlled endoscopically; however, if endoscopic hemostasis fails, it can pose a life-threatening risk. Trans-arterial embolization is a less invasive, safe, and effective rescue therapy that can serve as an alternative to surgery. Identifying factors influencing rebleeding after trans-arterial embolization in advance could lead to more efficient and safer patient management. Therefore, we aim to investigate these factors.

Aims & Methods

We retrospectively investigated 167 patients treated with TAE between January 2008 and June 2023. All patients underwent emergent endoscopy prior to TAE. Re-bleeding was defined as the presence of melena, hematemesis, or hematochezia with a fall in hemoglobin levels (> 0.8 g/dl) or shock after TAE. The primary outcomes was 30-day re-bleeding rate.

Results

Total of 104 patients with non-variceal upper gastrointestinal bleeding were selected. Re-bleeding within a month after TAE was noted in 24 patients (23.1%). Patients with re-bleeding had significantly higher rates of thrombocytopenia (50.0% vs. 15.0%, p= 0.001) and coagulopathy (20.8% vs. 5.0%, p= 0.045) than those without re-bleeding. Additionally, 7-day mortality (16.7% vs. 2.5%, p=0.035), AIMS65 score (2.0 vs. 1.0, p=0.029), and ABC score (7.0 vs. 4.0, p=0.002) were significantly elevated in patients with re-bleeding. A multivariate logistic analysis showed thrombocytopenia (odds ratio: 5.44, 95% confidence interval: 1.84–16.92, p= 0.002) and an ABC score ≥ 6 (odds ratio: 2.87, 95% confidence interval: 1.02–8.66, p= 0.005) significantly increased the risk of re-bleeding after TAE.

Conclusion

TAE could be an effective and safe treatment for non-variceal upper gastrointestinal bleeding. However, thrombocytopenia and elevated ABC scores might be associated with a higher 30-day rebleeding rate after TAE. Therefore, patients with these risk factors should be carefully monitored and managed.

Introduction

Erosive esophagitis (EE) is a clinically significant manifestation of gastroesophageal reflux disease (GERD), characterized by endoscopically visible mucosal breaks due to chronic gastric acid exposure. EE increases the risk of complications such as Barrett’s esophagus and esophageal adenocarcinoma. Although esophagogastroduodenoscopy (EGD) remains the diagnostic gold standard, it is invasive and often requires sedation. Wired magnetic-assisted capsule endoscopy (MACE) is a novel, minimally invasive technique using a magnetically navigable capsule tethered via a soft wire, enabling upper gastrointestinal tract examination. However, its diagnostic value for EE remains underexplored.

Aims & Methods

From February 2021 to November 2024, 85 patients underwent wired MACE followed by EGD within six hours at National Taiwan University Hospital. Indications included acute upper gastrointestinal bleeding (n=30), esophageal varices screening (n=33), and pre-bariatric surgery assessment (n=22). Diagnostic accuracy of wired MACE for EE was assessed using EGD as the reference. Patient-reported discomfort (0–10 scale) and acceptance (0–5 scale) were compared between the two modalities.

Results

The mean age was 57.8 years (SD 15.2; range 23–83), with 62.4% male. EGD was performed without sedation in 92.9% of cases. Wired MACE showed a sensitivity of 86.4% (95% CI: 76.2–97.0%), specificity of 82.9% (95% CI: 71.4–94.0%), PPV of 84.4%, NPV of 85.0%, and overall accuracy of 84.7%. Agreement with EGD was substantial (κ = 0.69). MACE was associated with lower mean discomfort scores (1.9 vs. 5.5, p < 0.0001) and higher acceptance scores (4.2 vs. 2.3, p < 0.01), indicating superior tolerability.

Conclusion

Wired MACE demonstrated high diagnostic accuracy and substantial agreement with EGD in detecting EE. Its significantly lower discomfort and higher patient acceptance support its potential as a less invasive, better-tolerated diagnostic alternative to conventional endoscopy.

References

Sharma, P., et al., The Diagnostic Accuracy of Esophageal Capsule Endoscopy in Patients With Gastroesophageal Reflux Disease and Barrett's Esophagus: A Blinded, Prospective Study. Official journal of the American College of Gastroenterology | ACG, 2008. 103(3): p. 525-532.
Lien, G.S., et al., Feasibility and safety of a novel magnetic-assisted capsule endoscope system in a preliminary examination for upper gastrointestinal tract. Surg Endosc, 2018. 32(4): p. 1937-1944.

Introduction

The eosinophilic esophagitis (EoE) endoscopic reference score (EREFS) is the validated scoring system for endoscopic findings of EoE. EREFS findings are currently scored cumulatively and correlate modestly with histological disease activity (HDA), symptoms, and adaptive behaviors. However, inflammatory and fibrotic findings may reflect different aspects of EoE, but this has never been evaluated.

Aims & Methods

We investigated the correlation of EREFS inflammatory and fibrotic subscores with HDA, symptoms and adaptive behaviors. In three tertiary referral centres for EoE, consecutive adults (>18 years) undergoing upper endoscopy for suspected or follow up EoE were prospectively enrolled. EREFS was scored as follows: edema 0-1; rings 0-3; exudates 0-2; furrows 0-2; stricture 0-1. The EREFS inflammatory sub-score (EREFS-i) combined the scores of edema, exudates and furrows. The EREFS fibrotic sub-score (EREFS-f) combined the scores of moderate-severe rings (score ≥2) and stricture. Subsequently, at least six esophageal biopsies were collected to assess HDA based on peak eosinophil count/high-power field (PEC/HPF) (active EoE PEC ≥15/HPF; EoE in remission: PEC<15/HPF). Symptoms were assessed using the dysphagia symptoms questionnaire (DSQ). Adaptive behaviors were assessed using the Pisa EoE Adaptation Questionnaire v1.0 (PiEAQ) [reference 1]. Clinical characteristics were recorded. Kruskal-Wallis Rank Sum Test and Pearson’s Chi-squared were used for comparisons. ROC curve analysis was used to calculate the diagnostic accuracy (AUC). Spearman’s test and linear regression models were used to assess relationships between variables. Significance threshold was p<0.05.

Results

121 patients were included. 58% had active EoE, 42% were in histological remission. Baseline clinical data are reported in Table 1. The EREFS total score had modest AUC for predicting HDA (0.68) and did not show significant correlation with DSQ and PiEAQ. In contrast, EREFS-i had AUC of 0.73, with 88.2% sensitivity and 51.4% specificity for predicting HDA, being significantly more accurate compared to the EREFS-f (p<0.001; Figure 1). There was a significant correlation between EREFS-i and PEC/HPF with Spearman’s Rho=0.5 (p<0.001), with linear regression showing that an increase of 1 point of any inflammatory feature corresponded to an increase of 12 eosinophils/HPF (p<0.0001). In contrast, EREFS-f correlated significantly with the use of adaptive behaviors assessed with PiEAQ [Spearman’s Rho of 0.6 (p<0.001); Figure 2], with linear regression showing that an increase of 1 point of any fibrotic feature corresponded to an increase of one adaptive behavior (p=0.001). EREFS, EREFS-i, and EREFS-f had nonsignificant negative correlation with DSQ (p>0.05 for all).

Conclusion

We confirmed that, while total EREFS provides a global assessment of endoscopic disease severity, it lacks correlation with histological and clinical disease activity. However, we demonstrated that EREFS-i correlates significantly with PEC and predicts PEC/HPF and that EREFS-f correlates significantly with the use of adaptive behaviors assessed with PiEAQ, which represent known clinical markers of disease activity. Neither EREFS-i nor EREFS-f correlated significantly with DSQ. In conclusion, we showed that, compared to the total EREFS, EREFS sub-scores improve the correlation between endoscopy findings with histology and clinical disease activity markers. Applied to clinical practice, our results represent another step towards precision medicine in the setting of EoE.

References

[reference 1] Visaggi P, Del Corso G, Solinas I, Ovidi F, Adamo G, Dulmin I, Baiano Svizzero F, Bellini M, Savarino EV, de Bortoli N. Adaptive Behaviors, Esophageal Anxiety, and Hypervigilance Modify the Association Between Dysphagia Perception and Histological Disease Activity in Eosinophilic Esophagitis. Am J Gastroenterol. 2024 Dec 30. doi: 10.14309/ajg.0000000000003272. Epub ahead of print. PMID: 39787341.

Disclosure

Speaker or consultancy for Apogee Therapeutics, Dr Falk Pharma, Malesci, JB Pharmaceuticals, Sanofi

Introduction

When esophageal cancer is diagnosed at an advanced stage, it requires a highly invasive treatment, and its prognosis is poor. Although the number of endoscopic examinations has been increasing globally, esophageal cancer is still difficult to diagnose at an early stage. The rapidly increasing number of endoscopic examinations performed over a short period might influence diagnostic performance. Accessing the association between calendar month and esophageal cancer detection rates might improve policy and guide institutional support.

Aims & Methods

We aimed to evaluate the association between the increased number of examinations over a certain period and esophageal cancer detection rates (EDR) among a large population in the Korean National Cancer Screening Program (KNCSP). We performed a retrospective population-based study using the KNCSP database for gastric cancer between 2015 and 2019. We included 28,032,590 Koreans aged ≥40 years. We assessed monthly EDR and performed a negative binomial regression model and least square mean evaluation to evaluate the association between the screening month and EDR.

Results

In total, 28,032,590 subjects underwent upper endoscopy, according to KNCSP. The monthly number of subjects who underwent examinations was the highest in December (n=4,819,606, 17.2%). EDR tended to decrease towards the end of the year, and EDR was the lowest in December 2015 – 2019 (0.06 – 0.08). In the multivariable logistic model, the association of calendar month with detected cancer remained after adjusting for other confounding factors (December 2015: odds ratio, 0.58; 95% CI, 0.43 – 0.79; P < .001; 2016: odds ratio, 0.51; 95%CI, 0.38 – 0.67; P < .001). The age group adjusted the calendar month, and the predicted detection rate significantly decreased at the end of the year compared with the beginning of the year in 2015, 2016, and 2017 respectively.

Conclusion

In the KNCSP, the workload of endoscopists increased excessively, with an increasing number of examinations towards the end of the year, as demonstrated by decreased EDR during this period.

Introduction

Pharmacologic therapy is a key component of obesity management, either as standalone treatment or in conjunction with procedural interventions. The role of weight loss medications in the peri-ESG period remains unclear, with questions surrounding whether ESG reduces the need for pharmacotherapy or serves as a platform for combination therapy. Limited data exist on how prescribing patterns evolve before and after ESG in real-world settings. This study aims to evaluate the use of anti-obesity medications before and after ESG, focusing on patterns of pharmacologic initiation and its relationship to weight loss outcomes.

Aims & Methods

We conducted a retrospective review of 236 patients who underwent ESG at Singapore General Hospital between November 2020 and December 2025. All procedures were performed by a single experienced endoscopist using a U-shaped suturing pattern. For this analysis, we examined the use of anti-obesity medications before and after the ESG. Medications included GLP-1 receptor agonists, sympathomimetic agents, lipase inhibitors, and combination therapies. The primary outcome was the proportion of patients receiving pharmacotherapy across timepoints and its association with total body weight loss (%TBWL).

Results

Among the 236 ESG patients, 21.6% had previously used anti-obesity medications, most commonly GLP-1 receptor agonists or phentermine. This group consistently achieved the lowest total body weight loss (%TBWL) across all follow-up points. Compared to medication-naïve patients, their mean %TBWL was significantly lower at 6 months (9.9% vs 17.2%, p = 0.015), 12 months (7.8% vs 13.8%, p = 0.026), and 24 months (4.3% vs 10.6%, p = 0.003). These findings underscore the complexity of obesity care, as even patients exposed to multiple treatment modalities may continue to experience suboptimal outcomes.
After ESG, 37.7% of patients were initiated on pharmacotherapy, most commonly semaglutide (n = 66), including 38 on subcutaneous and 28 on oral formulations, with estimated mean doses of 1.63 mg/week and 13.2 mg/day, respectively. Phentermine and liraglutide were used in 13.9% and 3.0% of patients. Patients who received medications only after ESG had lower %TBWL at 6 months compared to those never on medications (14.0% vs 18.8%, p = 0.027), but outcomes were similar by 12 and 24 months. This suggests that pharmacotherapy may help support suboptimal early responders and mitigate longer-term differences.

Conclusion

Anti-obesity medications, particularly semaglutide, are commonly introduced after ESG to support patients with suboptimal early weight loss. While those requiring pharmacotherapy initially experienced less %TBWL, outcomes equalized by 12 months, suggesting a role for adjunctive treatment in slower responders. Patients who had previously used weight loss medications consistently achieved poorer outcomes, highlighting the challenges of obesity management even with multimodal therapy. These findings underscore the importance of individualized treatment strategies and the complementary role of pharmacotherapy alongside ESG in real-world practice.

Disclosure

​NIL