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Introduction

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder from the atopic disease spectre. Despite being studied for years, the EoE-specific therapy has been approved only recently and includes budesonide orodispersible tablet (1) and IL-4R antagonist, dupilumab (2). Therefore, data on the management of the patients who do not respond to this treatment is scarce. Especially those who were diagnosed long in the past and have undergone different therapeutical approaches remain an understudied group. The aim of this project was to provide information on the treatment courses in a real-world setting over past 10 years.

Aims & Methods

This was a retrospective nation-wide project collecting data on patients with EoE in 7 Austrian centres since January 2014. The last follow-up was marked as of February 2025. Information on patients’ demographics, previous medical history, number of esophageal food impactions and different treatment lines were recorded. Due to the descriptive character of the work, no power analysis was carried out.

Results

In total, 336 patients (30.1% female) were included. Approximately one third of them (119/336) experienced an esophageal food impaction before the diagnosis was made. The most common 1st line therapy was budesonide orodispersible tablet (193/336, 57.4%), followed by proton pump inhibitors (87/336, 25.9%) and food elimination diet (20/336, 6.0%). Two hundred twenty (220/336, 65.5%) patients did not remain on the 1^st line treatment. Forty-four (44/336, 13.1%) subjects required more than 2 therapies and one person received even 7^th line medication. Biologic treatment – dupilumab – was given to forty-one (12.2%) patients. It was the first line treatment in 1 person, the others received it in the further course. These drugs were well-tolerated and 97.6% (40/41) patients remained on it until the last follow-up and reached symptomatic remission. Three patients were diagnosed more than 10 years before they received biologic treatment and 2 of them responded to it. One person discontinued due to side effects. The most common reasons for switch for dupilumab were clinical and/or histological activity (24/41, 58.5%), side effects (10/41, 24.4%) and patients’ preference (2/41, 4.9%).

Conclusion

This is the first study on different therapy courses in patients with EoE in Europe. Due to its retrospective character, no direct conclusions on the superiority of one approach upon another in case of refractoriness are possible.

References

1. Lucendo AJ, Miehlke S, Schlag C, Vieth M, von Arnim U, Molina-Infante J, et al. Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial. Gastroenterology. 2019;157(1):74-86.e15.
2. Hirano I, Dellon ES, Hamilton JD, Collins MH, Peterson K, Chehade M, et al. Efficacy of Dupilumab in a Phase 2 Randomized Trial of Adults With Active Eosinophilic Esophagitis. Gastroenterology. 2020;158(1):111-22.e10.

Disclosure

JP: travel grants from Johnson&Johnson and Tillots Pharma AG
MW: no conflicts of interest
PD: consulting and speakers fees from Falk Pharma, Sanofi, Abbvie, MSD, Takeda, Janssen, Pfizer
KS: support from: Abbvie, Astro Pharma, Takeda, Johnson&Johnson, MSD, Falk Pharma, Galapagos
TH: speaker fee from Falk
MH: no conflicts of interest
LKS: •Past/present Principal investigator für Studien gesponsort durch: SigmaTau, Sanofi , Tigenix und Falk;
•Speaker fee: MSD, AbbVie, Ferring, MerckSerono/Dr Falk, Chiesi, Novartis, Roche, Abbott, Phadia Austria/Thermo Fisher Scientific, CSL-Behring , Janssen-Cilag Pharma, Labors.at GmbH, Vertex, ENML Laborbetriebs GmbH, Johnson&Johnson
•Conference support: Mylan, Abbott, MSD, Gilead, MerckSerono/Dr Falk, Novartis, Pfizer, Janssen-Cilag Pharma, Chiesi, Shire, Abbvie, Takeda, Vertex, Astropharma
•Consultancy for: MSD, Takeda
GN: lecturing fees, consulting fees, and advisory fees from AbbVie, Merck Sharp & Dohme, Takeda, Janssen-Cilag, Pfizer, Gilead, Galapagos, Ferring, Vifor, AstroPharma, Falk, Bristol Myers Squibb, Arena Pharmaceuticals and Amgen
MT: received grant support from Albireo, Alnylam, Cymabay, Falk, Genentech, Gilead, Intercept, MSD, Takeda and UltraGenyx, honoraria for consulting from AbbVie, Albireo, Agomab, Boehringer Ingelheim, BiomX, Chemomab, Dexoligo Therapeutics, Falk, Genfit, Gilead, GSK, Hightide, Intercept, Ipsen, Jannsen, MSD, Novartis, Phenex, Pliant, Regulus, Siemens and Shire, speaker fees from Albireo, Boehringer Ingelheim, Bristol-Myers Squibb, Falk, Gilead, Intercept, Ipsen, Madrigal, Mirum and MSD , as well as travel support from AbbVie, Falk, Gilead, Jannsen and Intercept. He is also co-inventor of patents on the medical use of 24-norursodeoxycholic acid filed by the Medical University of Graz (service inventions).
WS: no conflicts of interest
HS: consulting and speakers fees from Falk Pharma, Sanofi, Medtronic
PS: consulting fees and/or speaker fees from Dr. Falk Pharma, GmbH, Takeda, Regerenon-Sanofi Pharmaceuticals, AbbVie, Janssen-Cilag, Receptos-Celgene-BMS

TREATMENT PATTERNS IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS IN ERA OF BIOLOGICS – A MULTI-CENTRE RETROSPECTIVE STUDY

Jagoda Pokryszka 1, Michael Weitersberger 2, Patrick Dinkhauser 3, Karin Steidl 4, Thomas Horvatits 5, Michael Häfner 6, Lili Kazemi-Shirazi 1, Gottfried Novacek 1, Michael Trauner 1, Wolfgang Sieghart 7, Hansjörg Schlager 8, Philipp Schreiner 9

1 Medical University Vienna, Vienna, Austria

2 Ordensklinikum Linz Elisabethinen, Linz, Austria

3 Klinikum Wels-Grieskirchen, Wels, Austria

4 Krankenhaus Barmherzige Brüder St. Veit, St. Veit an der Glan, Austria

5 Gastromedics, Eisenstadt, Austria

6 Krankenhaus Barmherzige Schwestern, Vienna, Austria

7 Imed 19, Vienna, Austria

8 Medical University of Graz, Graz, Austria

9 Medical University Vienna, Vienna, Austria|||Imed 19, Vienna, Austria

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Therapy update EoE: Conventional treatment and treatment options for children

Jorge Amil Dias 1, Ulrike von Arnim 2

1 Hospital Lusíadas, Porto - Paed. Gastroenterology, Porto, Portugal

2 Otto-Von Guericke University, Madgeburg, Germany

Event

UEG Week Berlin 2025

Session

Therapy update: EoE

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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ENDOSCOPIC ULTRASONOGRAPHY-GUIDED GASTROENTEROSTOMY VERSUS SURGICAL GASTROJEJUNOSTOMY FOR PALLIATION OF MALIGNANT GASTRIC OUTLET OBSTRUCTION (ENDURO)

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Introduction

Gastric outlet obstruction is a common manifestation of advanced gastric, duodenal, and periampullary malignancies, severely affecting quality of life. Endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) may be superior to surgical gastroenterostomy (SGJ) as palliative treatment for this condition, but randomised trials are currently lacking.

Aims & Methods

We performed a multicenter, randomized controlled trial involving palliative patients with a malignant obstruction localized between the pylorus and the distal duodenum, randomizing them 1:1 to either EUS-GE or SGJ. The first co-primary superiority end point was time to solid oral intake. The second co-primary non-inferiority end point was persistent or recurrent obstructive symptoms for which a reintervention was required within six months after treatment. The predefined non-inferiority margin was 20%.

Results

From February 2022 to February 2024, 250 patients were screened in 12 participating hospitals in the Netherlands. Of the 98 enrolled patients, 48 were assigned to EUS-GE and 50 were assigned to SGJ. Median age was 69 versus 70 years and the most prevalent etiology was pancreatic cancer in 58% versus 50% in the EUS-GE group and SGJ group, respectively. Median time to oral intake was significantly shorter in the EUS-GE group compared to the SGJ group: 1 day versus 3 days (hazard ratio, 2.21, 95% CI, 1.43 to 3.42, p=0.0003). In the endoscopic group, 5 patients (10%) experienced persistent or recurrent obstructive symptoms requiring reintervention, compared with 6 patients (12%) in the surgical group (risk difference, 1.6%, upper limit of 90% CI, 8.9%). Clinical success, defined as the ability to tolerate solid oral intake, was higher in the EUS-GE group (96% versus 80%, relative risk, 1.20, 95% CI, 1.03 to 1.39). Median length of hospital stay was shorter in the EUS-GE group (1 day versus 4 days, relative change, 0.46, 95% CI, 0.20 to 0.78). Serious adverse events, defined as Clavien-Dindo ≥3B, were observed in 8% of patients in the EUS-GE group and in 12% of patients in the SGJ group (relative risk, 0.69, 95% CI, 0.21 to 2.31). Median survival was 91 days after EUS-GE (95% CI, 74 to 140) and 74 days (95% CI, 46 to 110) after SGJ. Thirty-day mortality was 13% in the EUS-GE group and 26% in the SGJ group (relative risk, 0.48, 95% CI, 0.20 to 1.14). In the first three months following the procedure, quality of life was not different between the two treatments.

Conclusion

This trial showed that EUS-GE, compared to SGJ, is superior in terms of time to solid oral intake and non-inferior with regards to the rate of persistent or recurrent obstructive symptoms requiring reintervention. Based on these results, EUS-GE should be the preferred palliative treatment for malignant gastric outlet obstruction.

Disclosure

Yorick L. van de Pavert, Janine B. Kastelijn, Marc G. Besselink, Dieke C. Booij, Jurjen J. Boonstra, Judith Boot, Olivier R.C. Busch, Wouter J.M. Derksen, Bas Groot Koerkamp, Akin Inderson, Wim J. Lammers, Daan J. Lips, J. Sven D. Mieog, I. Quintus Molenaar, Alexander A.F.A. Veenhof, Niels G. Venneman, Robert C. Verdonk, Paco M.J. Welsing, Thomas R. de Wijkerslooth, and Hjalmar C. van Santvoort report no conflicts of interest.
Freek Daams is proctor for Intuitive, received educational grants from Medtronic, and received speaker’s fees from Johnson & Johnson and Medtronic.
Paul Fockens is consultant for Cook Endoscopy and Olympus.
Rogier P. Voermans reports research grants from Boston Scientific and Prion Medical, performed as a consultant for Boston Scientific and Cook Medical, and received speaker’s fees from Mylan and Zambon.
Roy L.J. van Wanrooij is a consultant for Boston Scientific.
Marco J. Bruno is a consultant for Boston Scientific, Cook Medical, and Pentax Medical; received support for industry-initiated studies from Boston Scientific and Cook Medical; and received support for investigator-initiated studies from Boston Scientific, Cook Medical, Pentax Medical, Mylan, Interscope, and ChiRhoStim.
Jeanin E. van Hooft received lecture fees from Cook Medical, Boston Scientific, Medtronic, and Abbvie, is an independent observer for Olympus, and is the current secretary general of the federation United European Gastroenterology (UEG).
Leon M.G. Moons is a consultant for Boston Scientific.
Frank P. Vleggaar is a consultant for Boston Scientific.

ENDOSCOPIC ULTRASONOGRAPHY-GUIDED GASTROENTEROSTOMY VERSUS SURGICAL GASTROJEJUNOSTOMY FOR PALLIATION OF MALIGNANT GASTRIC OUTLET OBSTRUCTION (ENDURO)

Yorick van de Pavert 1, Janine Kastelijn 1, Marc G. Besselink 2, Dieke C. Booij 3, Jurjen J. Boonstra 4, Judith Boot 1, Marco J. Bruno 3, Olivier R.C. Busch 2, Freek Daams 5, Wouter J.M. Derksen 6, Paul Fockens 7, Bas Groot Koerkamp 8, Jeroen Hagendoorn 9, Jeanin van Hooft 4, Akin Inderson 4, Willem Lammers 3, Daan J. Lips 10, Sven Mieog 4, I. Quintus Molenaar 9, Alexander A.F.A. Veenhof 11, Niels G. Venneman 10, Robert C. Verdonk 12, Rogier P. Voermans 2, Roy LJ van Wanrooij 13, Paco M.J. Welsing 1, Thomas de Wijkerslooth 11, Leon M.G. Moons 1, Hjalmar C. van Santvoort 14, Frank P. Vleggaar 1

1 UMC Utrecht, Utrecht, Netherlands

2 Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands|||Cancer Center Amsterdam, Amsterdam, Netherlands

3 Erasmus University Medical Center, Rotterdam, Netherlands

4 Leiden University Medical Center, Leiden, Netherlands

5 Amsterdam UMC, Location Vrije Universiteit, Amsterdam, Netherlands|||Cancer Center Amsterdam, Amsterdam, Netherlands

6 St. Antonius Hospital, Nieuwegein, Netherlands|||UMC Utrecht, Utrecht, Netherlands

7 Cancer Center Amsterdam, Amsterdam, Netherlands|||Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands

8 Erasmus University Medical Center Cancer Institute, Rotterdam, Netherlands

9 UMC Utrecht, Utrecht, Netherlands|||St. Antonius Hospital, Nieuwegein, Netherlands

10 Medisch Spectrum Twente, Enschede, Netherlands

11 Netherlands Cancer Institute, Amsterdam, Netherlands

12 St. Antonius Hospital, Nieuwegein, Netherlands

13 Cancer Center Amsterdam, Amsterdam, Netherlands|||Amsterdam UMC, Location Vrije Universiteit, Amsterdam, Netherlands

14 University Medical Center Utrecht, Utrecht, Netherlands|||St. Antonius Hospital, Nieuwegein, Netherlands

Event

UEG Week Berlin 2025

Topics

Immunology Oesophagus

Submission format

Abstract

Session

Opening Plenary

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Introduction: Immunotherapy in digestive cancers - Where are we heading?

Christoph Roderburg 1

1 University Hospital of Düsseldorf, Düsseldorf, Germany

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Digestive Oncology Immunology Mechanisms & Personalised Medicine

Session

Immunotherapy in digestive cancers: Where are we heading?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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I do underwater resection

Michael John Bourke 1

1 Westmead Hospital Sydney, Westmead, Australia

Event

UEG Week Berlin 2025

Topics

Endoscopy Nurses

Session

Large controversies for large polyps

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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PEGOZAFERMIN DEMONSTRATED ROBUST HISTOLOGICAL IMPROVEMENT AND BENEFIT IN HEPATIC AND METABOLIC BIOMARKERS: RESULTS FROM A 48-WEEK MULTI-CENTER, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED PHASE 2B TRIAL (ENLIVEN)

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Introduction

Metabolic dysfunction-associated steatohepatitis (MASH) is often associated with metabolic disorders such as obesity, metabolic syndrome, and/or diabetes. FGF21 analogs are promising therapies for MASH due to their direct anti-fibrotic effects as well as additional hepatic and extrahepatic benefits. Pegozafermin (PGZ), an FGF21 analog, was evaluated for safety and efficacy in a Phase 2b trial (ENLIVEN) with either weekly (QW) or every two-week (Q2W) dosing versus matching placebo in MASH patients with biopsy-proven F2/F3 fibrosis. Primary histology endpoints and non-invasive tests (NITs) were assessed at week 24, followed by additional NIT evaluation at the end of a 24-week blinded extension for a total of 48 weeks.

Aims & Methods

Patients were randomized to PGZ 15mg QW, 30mg QW, or 44mg Q2W or placebo for 24 weeks (histology-based primary endpoints). During the 24-week extension, most patients continued their assigned treatment with the exception of a subset of placebo patients who were re-randomized to receive PGZ 30mg QW. The full analysis set includes F2/F3 patients with NAFLD activity score (NAS) ≥4 at baseline (n=192).

Results

At 24-weeks, PGZ 30mg QW or 44mg Q2W led to statistically significant and clinical meaningful improvement in both primary histological endpoints (one stage of fibrosis improvement without worsening of MASH and MASH resolution without worsening of fibrosis) compared to placebo. Non-invasive testing at weeks 24 and 48 demonstrated that PGZ treatment was associated with robust and sustained reductions in liver fat content (MRI-PDFF), biomarkers of fibrosis (VCTE, ELF, PRO-C3) and liver injury (ALT, AST). PGZ also improved metabolic parameters such as lipids and HbA1c at both 24 and 48 weeks. PGZ was generally safe and well tolerated with the most common treatment emergent adverse events (TEAEs) being mild/moderate nausea and diarrhea. No deaths occurred; six early terminations for TEAEs including one drug-related serious AE occurred.

Conclusion

At 24 weeks, treatment with PGZ in MASH patients with F2/F3 fibrosis led to significant fibrosis regression and MASH resolution, which was corroborated by improvement across a variety of non-invasive tests including liver fat, inflammation, fibrosis, and metabolic markers. Benefits on NITs were sustained over the full 48-weeks of the study, with favorable safety and tolerability. PGZ is the first therapy to achieve fibrosis regression and MASH resolution with a Q2W dosing regimen. Phase 3 studies in noncirrhotic (ENLIGHTEN-Fibrosis) and cirrhotic (ENLIGHTEN-cirrhosis) patients are currently underway to confirm these results.

Disclosure

Jörn Schattenberg: Consultant: Akero, Alentis Therapeutics, Astra Zeneca, 89Bio, Boehringer Ingelheim, GSK, Ipsen, Inventiva Pharma, Madrigal, MSD, Northsea Therapeutics, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Siemens Healthineers; Speaker: Gilead Sciences, Advanz, Echosens, MedPublico GmbH; Grants: Boehringer Ingelheim, Siemens Healthcare GmbH; Stock Options: AGED diagnostics, Hepta Bio
Arun J Sanyal: Consulting: Genefit, Gilead, Malinckrodt, Pfizer, Salix, Boehringer Ingelheim, Novartis, Bristol Meyers Squibb, Merck, Hemoshear, Lilly, Novo Nordisk, Terns, Albireo, Jannsen, Poxel, 89bio, Siemens, AstraZeneca, NGM Bio, Amgen, Regeneron, Genentech, Alnylam, Roche, Madrigal, Inventiva, Covance, Prosciento, HistoIndex, PathAI; Grants: Gilead, Malinckrodt, Boehringer Ingelheim, Novartis, Bristol Meyers Squibb, Merck, Lilly, Novo Nordisk, Fractyl, Madrigal, Inventiva; Stock holder: Exhalenz, GenFit, Hemoshear, Durect, Indalo, NorthSea, Tiziana, Rivus
Naim Alkhouri: Research funding: 89Bio, AbbVie/Allergan, Akero, Better Therapeutics, Boehringer Ingelheim, Bristol-Myers Squibb, Corcept, DSM, Galectin, Genentech, Genfit, Gilead, Hepagene, Healio, Intercept, Inventiva, Ionis, Madrigal, Merck, NGM, Noom, NorthSea, Novo Nordisk, Perspectum, Pfizer, Poxel, Viking, and Zydus; Speaker bureau: AbbVie/Allergan, Alexion, Echosens, Eisai, Exelixis, Gilead, Intercept, Perspectum, Salix, and Theratechnologies; Consultant: 89Bio, AbbVie/Allergan, Echosens, Fibronostics, Gilead, Intercept, Madrigal, Novo Nordisk, Perspectum, Pfizer, and Zydus.
Rohit Loomba: Consultant: Aardvark Therapeutics, Altimmune, Anylam/Regeneron, Amgen, Arrowhead Pharmaceuticals, AstraZeneca, Boston Pharmaceuticals, Bristol-Meyers Squibb, CohBar, Eli Lilly, Galmed, Gilead, Glympse Bio, Hightide, Inipharma, Intercept, Inventiva, Ionis, Janssen Inc., Madrigal, Metacrine, Inc., NGM Biopharmaceuticals, Novartis, Novo Nordisk, Merck, Pfizer, Sagimet, Theratechnologies, 89bio, Terns Pharmaceuticals and Viking Therapeutics; Grants: Arrowhead Pharmacetuicals, AstraZeneca, Boegringer-Ingelheim, Bristol-Meyers Squibb, Eli Lilly, Galectin Therapeutics, Galmeed Pharmaceuticals, Gilead, Hanmi, Intercept, Inventiva, Ionis, Janssen, Madrigal Pharmaceuticals, Merck, NGM Biopharmaceuticals, Novo Nordisk, Pfizer, Sonic Incytes and Terns Pharmaceuticals; Stockholder: Co-founder LipoNexus, Inc
Mildred D Gottwald, Shibao Feng, Germaine D Agollah, Cynthia L Hartsfield, Hank Mansbach, Maya Margalit: 89bio employee and stock holder

PEGOZAFERMIN DEMONSTRATED ROBUST HISTOLOGICAL IMPROVEMENT AND BENEFIT IN HEPATIC AND METABOLIC BIOMARKERS: RESULTS FROM A 48-WEEK MULTI-CENTER, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED PHASE 2B TRIAL (ENLIVEN)

Jörn Schattenberg 1, Arun J Sanyal 2, Naim Alkhouri 3, Mildred D. Gottwald 4, Shibao Feng 4, Germaine D. Agollah 4, Cynthia L Hartsfield 4, Hank Mansbach 4, Maya Margalit 5, Rohit Loomba 6

1 Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany

2 Virginia Commonwealth University School of Medicine, Richmond, United States

3 Arizona Liver Health, Phoenix, United States

4 89bio, San Francisco, United States

5 89bio, Rehovot, Israel

6 University of California San Diego MASLD Research Center, San Diego, United States

Event

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

Lifestyle management and therapy in MASLD

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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COMPARING TRIPLE RECTAL ULTRASOUND IMAGING TECHNOLOGY IN PREDICTING RECTAL HISTOENDOSCOPIC REMISSION IN ULCERATIVE COLITIS (THE TRINITY STUDY): TRANS ABDOMINAL, TRANS-PERINEAL AND ENDOSCOPIC ULTRASOUND (NCT06717906)

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Introduction

While trans-perineal ultrasound (TPUS) is promising, its accuracy compared to trans-abdominal ultrasound (TAS) and endoscopic ultrasound (EUS) in predicting rectal histoendoscopic activity in ulcerative colitis (UC) is unclear.

Aims & Methods

We aimed to evaluate the reliability of TPUS in predicting rectal histoendoscopic activity in UC using EUS as the reference standard. This prospective study included adult UC patients who underwent TAS and TPUS, followed by EUS. Rectal total wall thickness (TWT) and vascularity (Modified Limberg Score, MLS) were measured on all modalities. Additionally, mucosal thickness (MT) and submucosal thickness (SMT) were assessed on EUS. Receiver operating characteristic (ROC) analysis was performed to determine the area under the curve (AUC) for predicting endoscopic activity (Ulcerative Colitis Endoscopic Index of Severity, UCEIS >1) and histologic activity (Nancy Index >1).

Results

A total of 142 UC patients (33.8% female, median age 40 years, BMI 22.5 kg/m²) were included. Disease extent was proctitis (12%), proctosigmoiditis (58%), and extensive colitis (30%). The median SCCAI score was 3 (range: 0-8). Most patients were on 5-ASA (90.8%), azathioprine (31%), and tofacitinib (10.6%).
The median rectal length visualized on TPUS was 3.9 cm (2.4-6.3 cm). Endoscopic remission (UCEIS ≤1) was observed in 49.3% of patients, and histologic remission (NHI ≤1) in 38.7%.
For endoscopic activity, EUS had the highest accuracy, with MT >0.95 mm (AUC: 0.96, sensitivity: 98.6%, specificity: 87%) and MLS >1 (AUC: 0.95, sensitivity: 81.7%, specificity: 94%). TPUS had moderate accuracy(TWT >5.4 mm, AUC: 0.73), while TAS performed poorly (TWT >5.8 mm, AUC: 0.63).
For histologic remission, EUS vascularity (MLS >1) was most predictive (AUC: 0.91, sensitivity: 66.3%, specificity: 98.1%), followed by rectal TWT ≥4 mm (AUC: 0.83) and MT ≥0.95 mm (AUC: 0.86). Among non-EUS techniques, TPUS (TWT ≥6.1 mm, AUC: 0.66) showed moderate accuracy, while TAS was the least predictive (AUC: 0.62).
The Milan Ultrasound Criteria (MUC) demonstrated highest accuracy for endoscopic remission with EUS MUC ≥8 (AUC: 0.94), followed by TPUS (AUC: 0.78) and TAS (AUC: 0.67). For histologic remission, EUS MUC >7 had the highest accuracy (AUC: 0.87), followed by TPUS (MUC ≥9.7, AUC: 0.70) and TAS (AUC: 0.64) (Table 1). BMI-based comparisons showed no significant differences in MUC scores.

Measure	Sensitivity	Specificity	AUC	p-value	95% CI
	Endoscopic Activity
TAS (MUC) (≥8.5)	67.6%	60.9%	0.67	<0.001	0.59-0.76
TPUS (MUC) (≥8)	86%	62.3%	0.78	<0.001	0.70-0.86
EUS (MUC) (≥8)	81.7%	81.2%	0.94	<0.001	0.85-0.95
	Histologic activity
TAS (MUC) (>8.6)	62.8%	66%	0.64	0.005	0.54-0.74
TPUS (MUC) (≥9.7)	59.3%	79.6%	0.70	<0.001	0.61-0.79
EUS (MUC) (>7)	83.7%	81.5%	0.87	<0.001	0.81-0.93

Correlation analysis showed a strong correlation between TPUS and EUS TWT (r=0.371, p<0.001). TPUS and TAS had moderate correlation (r=0.309, p<0.001), while TAS and EUS showed weaker correlation (r=0.264, p=0.002 for average TWT, r=0.234, p=0.005 for lower rectal TWT). MUC scores correlated best between EUS and TPUS (r=0.425, p<0.001).

Conclusion

While EUS remains the most accurate, TPUS shows moderate accuracy for assessing rectal inflammation in UC. However, TPUS is limited to the lower rectum and needs further validation for better reproducibility. Standardized cutoffs and integration into routine UC monitoring could enhance non-invasive assessment, reducing endoscopy reliance and improving patient management.(NCT06717906).

References

1. Sagami S, Kobayashi T, Aihara K, Umeda M, Morikubo H, Matsubayashi M, Kiyohara H, Nakano M, Ohbu M, Hibi T. Transperineal ultrasound predicts endoscopic and histological healing in ulcerative colitis. Aliment Pharmacol Ther. 2020;51(12):1373-1383. [10.1111/apt.15767]
2. Sagami S, Kobayashi T, Aihara K, Umeda M, Odajima K, Morikubo H, Asonuma K, Miyatani Y, Fukuda T, Matsubayashi M, Kiyohara H, Nakano M, Hibi T. Early improvement in bowel wall thickness on transperineal ultrasonography predicts treatment success in active ulcerative colitis. Aliment Pharmacol Ther. 2022;55(10):1320-1329. [10.1111/apt.16817]

COMPARING TRIPLE RECTAL ULTRASOUND IMAGING TECHNOLOGY IN PREDICTING RECTAL HISTOENDOSCOPIC REMISSION IN ULCERATIVE COLITIS (THE TRINITY STUDY): TRANS ABDOMINAL, TRANS-PERINEAL AND ENDOSCOPIC ULTRASOUND (NCT06717906)

Partha Pal 1, Mohammad Abdul Mateen 1, Anuradha Sekaran 1, Kanapuram Pooja 1, Arzeena Kaleemuddin 1, Thanmayee Rangineni 1, Jahangeer Basha 1, Rajesh Gupta 1, Manu Tandan 1, Sundeep Lakhtakia 1, D. Nageshwar Reddy 1

1 Asian Institute of Gastroenterology, Hyderabad, India

Event

UEG Week Berlin 2025

Topics

IBD Radiology & Imaging

Submission format

Abstract

Session

Monitoring IBD by imaging

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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