Introduction

The protocol of the clinical trial OLGA (Operative Link for Gastritis Assessment) proposed in 2005 (M.Rugge & R. Genta, 2005) has become widely used in clinical practice as the method of unified assessment of the progression of atrophic gastritis and the risk of developing stomach cancer.
The protocol involves obtaining 5 fragments of the gastric mucosa: 2 fragments from the antrum, 2 fragments from the oxyntic part and 1 fragment from the incisura angularis. It was believed that the mucosa in this region, being in fact a transition zone between the location of the pyloric and oxyntic glands of the stomach, may be the place with the most pronounced probability of developing atrophic and dysplastic processes.
The purpose of this study was to establish the significance of histological changes in the gastric mucosa in the region of the incisura angularis to assess the degree of inflammation activity and the stage of atrophic gastritis.

Aims & Methods

1146 patients (916 women and 230 men) with clinical manifestations of chronic gastritis aged 20 to 84 years were examined. Most patients were represented in the age group from 50 to 70 years (54.6%). Biopsy material was obtained during endoscopic examination in accordance with the OLGA protocol. Histological assessment of the degree of inflammation activity and the stage of atrophy was carried out according to the standard OLGA protocol. Then the same samples were evaluated without taking into account histological changes in the incisura angularis.

Results

During histological examination more frequently (73.2%) was detected the mild severity of inflammation in gastric mucosa (grade II according to the OLGA system). This score practically did not change if the biopsy from the incisura angularis was not tested. Severe stages of gastric mucosa atrophy (stages III and IV according to the OLGA system) were detected in 465 patients (40.58%). If changes in the incisura angularis were not taken into account, then severe stages of atrophy (III and IV) were detected in 460 patients (40.1%). In total, changes in the assessment of the stage of atrophy occurred in 53 patients (4.62%), and more often this was observed in patients with stages I and II of atrophy. Only in 8 patients stage IV of atrophy was changed to III, and in 3 patients stage III was changed to stage II. Thus the stage of atrophy was changed in less than 0,5% of patients in groups with severe atrophy if the samples from the incisura angularis were excluded from the examination.

Conclusion

Evaluation of the histological changes in the gastric mucosa from the incisura angularis does not significantly affect the assessment of the grade and stage of chronic gastritis according to the OLGA system.

References

Rugge M, Genta RM. Staging and grading of chronic gastritis. Human Pathology (2005) 36, 228– 233

Disclosure

This study was conducted within the healthcare research project “Epidemiological study of Helicobacter pylori infection prevalence in Moscow” funded by Autonomous non-profit organization "Moscow Center for Innovative Technologies in Healthcare" administered by the Moscow Healthcare Department. Grant No. 0903-1/22.

Introduction

Endoscopic radical excision in the rectum may offer a curative, organ-preserving strategy, potentially reducing the need for surgery and its associated morbidity and mortality.¹ The muscle-retracting sign (MRS) detected using the pocket-detection method (PDM) has shown moderate to high diagnostic accuracy for real-time submucosal invasion (SMI) depth assessment in rectal lesions.² This study evaluated the technical and clinical outcomes of a structured algorithm combining PDM and MRS for real-time invasion depth assessment with endoscopic resection of rectal lesions.

Aims & Methods

We prospectively included consecutive patients with rectal lesions at risk of SMI at a tertiary care centre between September 2023 and March 2025. We excluded lesions with nodal metastases on radiological staging and subepithelial lesions. A management algorithm was applied, incorporating PDM for MRS status evaluation and invasion assessment, followed by endoscopic resection based on MRS status, lesion size, and location: endoscopic submucosal dissection (ESD; MRS-, all locations), endoscopic intermuscular dissection (EID; MRS+ or severe fibrosis, distal rectum), knife-assisted full-thickness resection (kFTR; MRS+ or severe fibrosis, any size, proximal extraperitoneal rectum), or device-assisted full-thickness resection (FTRD; MRS+ or severe fibrosis, ≤15 mm, intraperitoneal rectum). Primary outcomes were technical success, en-bloc and R0 resection and adverse events.

Results

37 rectal lesions were included (mean patient age 68.8 years [SD 10.1]; 56.8% male). The median lesion size was 30 mm (IQR 20–40), mostly located in the distal rectum (23/37; 62.2%), and distributed as anterior (n = 12), lateral (n = 11), and posterior (n = 14). 5 lesions (13.5%) were classified as JNET 2b, 15 (40.5%) as JNET 3.
Among MRS-negative lesions (23/37; 62.2%), 22 underwent ESD, and 1 underwent EID for submucosal fibrosis. In MRS-positive lesions (14/37; 37.8%), the selected treatments included EID in 7, kFTR in 6, and FTRD in 1.
Technical success of PDM and endoscopic resection was achieved in 36/37 cases (97.3%). En-bloc resection was achieved in 36/37 (97.3%) cases, and R0 resection in 34/36 (94.4 %). Pathology revealed deeply invasive (>pT1sm1) adenocarcinoma in 14/37 (37.8%), with 83.8% diagnostic accuracy of PDM + MRS. Curative resection was achieved in 26/37 cases (70.3%). Adverse events occurred in 4/37 patients (10.8%), including delayed bleeding in 3 (8.1%) and pneumonia in 1 (2.7%). No delayed perforation occurred. The median length of hospital stay was 1 day (IQR 1-1).
Rectal preservation was achieved in 34/37 patients (91.9%), with a median follow-up of 8.8 months (IQR 5.3-10.8). We observed no loco-regional recurrences, distant metastases, or deaths. Surgery was performed for technical failure in one case (kFTR aborted due to massive invasion, pT2N0 adenocarcinoma) and for non-curative resections in 2 cases (one with pT0N1 and another with pT0N0 in surgical specimens).

Conclusion

The PRIME endoscopic algorithm demonstrated high technical success, en-bloc and R0 resection rates for rectal lesions at risk of SMI. This minimally invasive approach allowed rectal preservation in the majority of patients with a low rate of complications, making it a promising alternative to surgery for such lesions.

References

1. Argenziano, M.E.*, Sorge, A.*, Hoorens, A., Montori, M., Poortmans, P.J., Smeets, S., Tornai, T., Debels, L.K., Desomer, L. and Tate, D.J. (2025), Knife-assisted full-thickness resection guided by the pocket-detection method for posterior deeply invasive rectal cancer: A novel endoscopic approach (with video). DEN Open, 5: e70116. https://doi.org/10.1002/deo2.70116
2. Argenziano, M E*; Sorge, A*; Montori, M; Poortmans, P J; Tornai, T; Smeets, S; Al-Dury, S; Debels, L; Desomer, L; Tate, D J Accuracy of the Muscle Retraction Sign for determining deep Submucosal Invasion During Endoscopic Resection of Rectal Lesions. Endoscopy 2025; 57(S02): 14 - 14 DOI: 10.1055/s-0045-1805114

Introduction

Inflammatory bowel disease is a chronic, relapsing condition influenced by genetic, microbial, and environmental factors. This study evaluated the therapeutic potential of multi-strain probiotics in mitigating the severity of experimentally induced colitis in rats, focusing on clinical outcomes, histopathological changes, inflammatory markers, and microbiota changes.

Aims & Methods

Thirty six-week-old male Sprague-Dawley rats were randomly assigned to three groups: Control, Acute Colitis (AC), and Probiotic Treatment (RP; receiving Lactobacillus rhamnosus and Lactobacillus paracasei). Probiotics were administered orally once daily, beginning three days prior to colitis induction with rectal DNBS and continued for seven days post-induction. On day eight, colon tissues and blood samples were collected for histological and biochemical analysis, and fecal samples were analyzed to assess gut microbiota composition.

Results

The AC group showed significantly elevated TNF-α levels compared to the Control and RP groups (p < 0.001), while probiotic treatment significantly reduced TNF-α levels compared to the AC group (p = 0.002, p < 0.001, respectively). Although the RP group demonstrated increased IL-10 levels and decreased MDA levels, these changes were not statistically significant. Histopathological analysis revealed a lower median Ameho’s score in the RP group compared to the AC group, though without statistical significance.

Microbiota analysis showed no significant differences in alpha diversity across groups. However, beta diversity significantly differed in the AC group compared to Control, and after probiotic treatment, the RP group’s beta diversity showed a partial shift toward the Control group. Distinct microbial species characterized each group: Akkermansia spp. and Parasutterella spp. were predominant in distinguishing the Control group from others; Romboutsia spp. and Turicibacter spp. differentiated the AC group; and Roseburia spp. and Anaerotruncus spp. were the key species distinguishing the RP group from the others.

Conclusion

Multi-strain probiotics reduced TNF-α levels and modulated gut microbiota composition in DNBS-induced colitis. Although changes in IL-10, MDA, and histopathology were not statistically significant, trends favored the probiotic group. Microbial analysis revealed distinct species profiles across groups, with partial restoration of beta diversity and enrichment of beneficial taxa like Roseburia spp. in the probiotic group. These findings support the potential of probiotics as a therapeutic adjunct in IBD, highlighting the need for further studies to confirm efficacy and explore underlying mechanisms.

Introduction

Despite the availability of clinical guidelines, a wide range of alternative Helicobacter pylori (H. pylori) eradication regimens continue to be used in routine clinical practice. Data on the frequency and effectiveness of these less frequently prescribed regimens remain limited.

Aims & Methods

Aim: To evaluate the prescription patterns and effectiveness of less frequently prescribed eradication regimens within the European Registry on Helicobacter pylori Management (Hp-EuReg).
Methods: International, multicentre, prospective, non-interventional registry on the management of H. pylori infection, ongoing since 2013. For this analysis, treatment regimens prescribed in fewer than 5% of all cases were classified as 'less frequently prescribed'. Additionally, therapies not previously categorized in the registry database were also included. Treatment effectiveness was assessed using modified intention-to-treat (mITT) and per-protocol (PP) analyses.

Results

Overall, 260 less frequently prescribed regimens were identified, representing 5.5% of all recorded prescriptions (82,510). A total of 2,853 (63%) of these regimens were used as first-line therapy. Among these less frequently prescribed regimens, the most frequently used first-line treatments encompassed bismuth-containing quadruple therapy with PPI–clarithromycin–metronidazole–bismuth (20%), followed by non-bismuth hybrid quadruple therapy with clarithromycin–amoxicillin–metronidazole (9.5%), and dual therapy with PPI–amoxicillin (8.6%). In second-line, the most common regimens were triple therapies, such as the PPI–amoxicillin–moxifloxacin (16%), PPI–clarithromycin–levofloxacin (11%), and PPI–metronidazole–levofloxacin (9.5%). In third-line, the most frequently used regimes were bismuth-based quadruple regimens including PPI–metronidazole–doxycycline–bismuth (27%), followed by triple therapies with PPI–clarithromycin–levofloxacin (6.8%) and PPI–amoxicillin–moxifloxacin (5.6%). In the fourth-line, the most frequent prescriptions were: bismuth-based quadruple therapies including PPI–amoxicillin–rifabutin–bismuth (30%) and PPI–metronidazole–doxycycline–bismuth (11%). Finally, the fifth treatment-line accounted for some less common treatments, such as the dual therapy with PPI–amoxicillin (19%) and the triple therapy with PPI–amoxicillin–bismuth (18%). Effectiveness and frequency of use in first-, second- and third-line of treatment are described in Table 1. Antibiotic-free regimens such as the combination of a PPI with a probiotic —generally Lactobacillus bulgaricus or Lactobacillus reuteri—were prescribed as alternative therapeutic approaches in 104 cases (2.3%), achieving 74% mITT and 76% PP overall effectiveness.
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Conclusion

Among the various less frequently used H. pylori eradication regimens, only a few (such as the PPI-clarithromycin-metronidazole-bismuth regimen and the hybrid regimen including clarithromycin–amoxicillin–metronidazole) achieved first-line eradication rates above 90%. In subsequent treatment lines, effectiveness was highly variable and often suboptimal. These findings highlight the importance of evidence-based treatment selection to optimize treatment outcomes.

Disclosure

Conflict of interest statement
Olga P. Nyssen has served as a speaker or has received research funding from Allergan, Mayoly Spindler, Richen, Biocodex and Juvisé.
Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé, Biocodex.
The remaining authors declare no conflicts of interest.