Introduction

Environmental pollution is significantly driven by endoscopic waste generation. Previous studies have found a range of 0.5 to 3.0 kg of waste per endoscopic procedure depending on the geographical origin.

Aims & Methods

This study aimed to evaluate endoscopic waste generation in hospitals and offices to assess its healthcare system impact and propose waste reduction strategies. A prospective, multicentre, observational study was conducted over four-week periods in two tertiary hospitals and two gastroenterology offices in Germany in 2023. Waste from 2275 patients in 2889 procedures was collected, sorted, and weighed. Recyclable waste was categorised. National waste generation from gastrointestinal endoscopies in Germany was estimated using insurance data.

Results

The mean quantity of waste generated per procedure was 1119 g (hospitals: 1167 g; offices: 1094 g). Office-based procedures generated significantly less solid waste compared to equivalent hospital-based procedures (EGD: -51%, colonoscopy: -50%, their combination: -47% and sigmoidoscopy: -69%, all p < 0.001). Combining consecutive procedures could reduce waste by up to 39% for EGD and colonoscopy and 33% for EUS and ERCP. Waste from suction bags had an impact of 35% per procedure and could be processed via the sewage system instead of being disposed. Replacing single-use gowns with reusable ones could reduce personal protective equipment waste by 54%. Furthermore, 23% of endoscopic waste was potentially recyclable.
Gastrointestinal endoscopies in Germany generate extrapolated 8024 tonnes of waste, annually, equivalent to the annual waste generation of 18533 German citizens. This resulted in a total of 3924 tonnes of greenhouse gas emissions.
This figure corresponded to approximately 33.7 million kilometres driven by passenger cars or 4242 economy flights from Frankfurt to New York. If this waste was recycled according to the present study results with a recycling share of 23%, the waste could have been reduced by the equivalent annual waste generation of 3616 German citizens and a reduction of 1427 tonnes of greenhouse gas equivalents. This reduction would have been equivalent to about 12.3 million kilometres driven by car or 1542 economy flights from Frankfurt to New York.

Conclusion

The mass of endoscopic waste generated in Germany is comparable with the domestic waste of a small town. Implementing a waste reduction system in endoscopic practices, prioritizing prevention, reduction, reuse, recycling, and recovery, could significantly reduce waste generation.

Disclosure

Nothing to disclose by the authors.

Introduction

Fecal incontinence is a diagnosis represented by recurrent uncontrolled passage of fecal material for at least 3 months. It is relatively common, with an assumed prevalence of up to 7% of the worldwide population. The therapy is challenging and often with insufficient clinical results. It should be specifically tailored to different symptom presentations meaning urge or passive incontinence. One of the relatively and therefore not widely used treatment options for incontinence is local sphincter stimulation which is a safe non or minimally invasive method. This stimulation could be performed in at home setting, so it presents a substantial time and cost-saving option for the patient and for the healthcare system. However, the data published on this topic so far are scarce with heterogeneous studied populations and results with no universally accepted treatment protocol.

Aims & Methods

This study aims to evaluate the effect of local sphincter stimulation on the functional parameters of sphincters and symptoms based on the different phenotypes. This is a retrospective single-center study analysis on patients with fecal incontinence (age> 18 years). The duration of the training was 12 weeks, with training once daily for 6 days a week. The parameters of the home stimulation device were as follows: Frequency: 40 Hz; Impulse Width: 0.2 s; Ramp-up time: 1s; Workout time: 6s; Rest: 15s. Training duration: 20min. During the perceived stimulation patients were instructed to squeeze the sphincter. 3D anorectal manometry was performed according to the IAPWG protocol at the initiation visit and the control visit. Clinical evaluation was performed by self-reporting Wexner’s score for fecal incontinence at both visits.

Results

Twenty-three patients (23) were consecutively screened for eligibility and assigned for the therapy. Three patients (3) did not adhere to the training due to various personal reasons one (1) patient did not tolerate stimulation. Therefore, 19 patients (10 passive, 9 urge) completed the full treatment protocol for 12 weeks and were considered for the final analysis. The total average increase in sphincter rest medium pressure was 22.53%, with significantly higher improvement in the urge group compared to the passive group (46.24% vs. 1.18% respectively). The total average increase in sphincter rest maximum pressure was 25.69%, with significantly higher improvement in the urge group compared to the passive group (46.92% vs. 6.59% respectively). The total average increase in sphincter maximum squeeze pressure was 36.13%, with significantly higher improvement in the urge group compared to the passive group (57.82% vs. 16.61% respectively). The average improvement in Wexner score was 3.1 points, with higher improvement in the urge group compared to the passive group (4.2 points vs. 2.1 points respectively).

Conclusion

The home-administered local anal sphincter stimulation for 12 weeks seems to be an effective treatment option for both types of fecal incontinence and significantly more effective in the urge type. Therefore this could be considered as a cost and time-effective treatment option compared to standard office-based therapy. Although a home stimulation device is simple to use, the ability of the patient to adhere to the protocol should be evaluated during the screening process.
Funding: European Parliament and Council Recovery and Resilience Plan of the Slovak Republic 2021 – 2027, code: 09I03-03-V04-00761

Introduction

Chronic pancreatitis (CP) is a progressive inflammatory disorder that predisposes patients to various complications, including vascular events. Among these, splenic vein thrombosis (SVT) represents a siginficant, but often underdiagnosed complication, with reported prevalence rates varying widely. SVT may lead to sinistral portal hypertension, resulting in gastric varices and, in severe cases, life-threatening gastrointestinal hemorrhage. This systematic review and meta-analysis aims to determine the true pooled prevalence of SVT in CP patients and to evaluate the bleeding rate among those with splenic thrombosis by synthesizing data from studies in which all participants underwent appropriate imaging for SVT detection.

Aims & Methods

An exploratory search was conducted to identify key articles reporting on the prevalence of SVT among CP patients. Four studies were selected based on their provision of relevant, poolable data on prevalence with the use of proper imaging techniques for detecting SVT, encompassing a total of 1,973 patients. A random effects meta‐analysis was performed using SPSS, and a forest plot was genrated to visually represent both individual and overall prevalence estimates. An ongoing PRISMA compliant systematic literature search continues to capture all pertinent studies on this topic.

Results

Analysis of data from the four selected studies (n = 1,973) revealed a pooled SVT prevalence of 12.7% in CP patients. Although individual study estimates varied, likely reflecting differences in study design, CP etiology, and follow-up duration, the overall result indicates that approximately one in eight patients with CP develops SVT.

Conclusion

Our preliminary findings demonstrate that, when appropriate imaging is employed, SVT occurs in approximately 12.7% of chronic pancreatitis cases. These results underscore the clinical importance of SVT, particularly given its association with an increased risk of gastrointestinal hemorrhage. Routine evaluation for SVT in CP patients should be considered, and further research is warranted to elucidate underlying risk factors and to refine management strategies for this potentially life-threatening vascular complication.

Introduction

For patients with Crohn’s disease (CD), endoscopic healing is an important long-term treatment goal per STRIDE-II consensus recommendations.¹ In this post hoc analysis, the relationships between endoscopic healing and long-term clinical outcomes were assessed in risankizumab (RZB)-treated patients with moderate to severe CD who previously failed tumor necrosis factor antagonist therapy from the phase 3 SEQUENCE trial.²

Aims & Methods

This analysis included RZB-treated patients who completed the week 48 visit in Part 1 of SEQUENCE (NCT04524611) and continued to receive RZB maintenance therapy during Part 2 of the trial. Part 2 is an ongoing open-label extension (OLE) wherein patients who received RZB induction and maintenance treatment during Part 1 could continue to receive RZB (subcutaneous 360mg every 8 weeks up to an additional 220 weeks). All patients in this post hoc analysis completed 100 weeks of RZB treatment (48 weeks in Part 1 and 52 weeks in Part 2). The proportion of patients who achieved week 100 (Part 2) clinical outcomes (including CD activity index [CDAI] response and remission, steroid-free CDAI clinical remission, and normalized fecal calprotectin [FCP] levels) were compared based on week 48 achievement of endoscopic response vs not, endoscopic remission vs not, and steroid-free endoscopic remission vs not (endpoint definitions in Table footnote), using chi-square testing. Patients with missing outcomes were imputed as nonresponders. Endoscopies were scored by a central reviewer. Long-term safety assessments for RZB have been reported elsewhere.³

Results

Of the 224 patients included in the analysis, 114 (50.9%), 80 (35.7%), and 80 (35.7%) patients achieved week 48 endoscopic response, endoscopic remission, and steroid-free endoscopic remission, respectively. A significantly greater proportion of patients who achieved week 48 endoscopic response also achieved week 100 CDAI remission and response, steroid-free CDAI clinical remission, and normalized FCP levels compared to patients who did not achieve week 48 endoscopic response (P≤.05 for all comparisons) (Table). Similar results were observed for patients who achieved week 48 endoscopic remission or steroid-free endoscopic remission (P≤.05 for all endpoints except for CDAI clinical response).

Conclusion

Results from this post hoc analysis of data from SEQUENCE demonstrated that achieving week 48 endoscopic outcomes was associated with sustained clinical improvements after 2 years of RZB treatment.

References

1. Turner D, et al. Gastroenterology. 2021 Apr;160(5):1570–83.
2. Peyrin-Biroulet L, et al. N Engl J Med. 2024 Jul 18;391(3):213–23.
3. Peyrin-Biroulet L, et al. J Crohns Colitis. 2025 Jan 22;19(Supplement_1):i1405–7.

Disclosure

Disclosures
Vipul Jairath has received has received consulting/advisory board fees from AbbVie, Alimentiv Inc, Arena Pharmaceuticals, Asahi Kasei Pharma, Asieris, Astra Zeneca, Bristol Myers Squibb, Celltrion, Eli Lilly, Ferring, Flagship Pioneering, Fresenius Kabi, Galapagos, GlaxoSmithKline, Genentech, Gilead, Janssen, Merck, Mylan, Pandion, Pendopharm, Pfizer, Protagonist, Reistone Biopharma, Roche, Sandoz, Second Genome, Takeda, Teva, Topivert, Ventyx, and Vividion; and speaker’s fees from, AbbVie, Ferring, Galapagos, Janssen Pfizer Shire, Takeda, and Fresenius Kabi.
Christopher Ma has received consulting fees from AbbVie, Alimentiv, Amgen, AVIR Pharma Inc, Bristol Myers Squibb, Celltrion, Eli Lilly, Ferring, Fresenius Kabi, Janssen, McKesson, Mylan, Pendopharm, Pfizer, Prometheus Biosciences Inc., Roche, Sanofi, Takeda, Tillotts Pharma; speaker's fees from AbbVie, Amgen, AVIR Pharma Inc, Alimentiv, Bristol Myers Squibb, Eli Lilly, Ferring, Fresenius Kabi, Janssen, Organon, Pendopharm, Pfizer, Sanofi, Takeda, Tillotts Pharma; royalties from Springer Publishing; research support from AbbVie, Ferring, Pfizer.
Peter Bossuyt received financial support for research from AbbVie, Amgen, Celltrion, Mylan, Pfizer, and Takeda; lecture fees from AbbVie, Celltrion, Janssen, Lilly, and Takeda; and advisory board fees from AbbVie, Arena Pharmaceuticals, BMS, Celltrion, Dr Falk, Galapagos, Janssen, Lilly, Pentax, PSI-CRO, Roche, Takeda, and Tetrameros.
Brian G Feagan has served as a consultant or received speaker’s fees from Abbott/AbbVie, ActoGeniX, Akros, Albireo Pharma, Amgen, AstraZeneca, Avaxia Biologics, Avir Pharma, Axcan, Baxter Healthcare, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Calypso Biotech, Celgene, Elan/Biogen, enGene, Ferring Pharmaceuticals, gIcare Pharma, Gilead, Given Imaging, GSK, Ironwood Pharmaceuticals, Janssen Biotech (Centocor), Johnson & Johnson/Janssen, Kyowa Hakko Kirin Co, Lexicon, Lilly, Lycera, Merck, Mesoblast, Millennium, Nektar, Nestlé, Novartis, Novo Nordisk, Pfizer, Prometheus Therapeutics and Diagnostics, Protagonist Therapeutics, Receptos, Roche/Genentech, Salix Pharmaceuticals, Serono, Shire, Sigmoid Pharma, Synergy Pharmaceuticals, Takeda, Teva Pharmaceuticals, TiGenix, Tillotts, UCB, Vertex Pharmaceuticals, VHsquared, Warner Chilcott, Wyeth, Zealand Pharma, and Zyngenia, and has received research support from Abbott/AbbVie, Amgen, AstraZeneca, Bristol Myers Squibb, Janssen Biotech (Centocor), Johnson & Johnson/Janssen, Millennium, Pfizer, Receptos, Roche/Genentech, Sanofi, Santarus, Tillotts, and UCB.
Namita Joshi, Nidhi Shukla, Kristina Kligys, Javier Zambrano, Toni Anschutz, and Brooke Kim are full-time employees/contractor of AbbVie and may own AbbVie stock or options.

Acknowledgments
AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the abstract. All authors had access to relevant data and participated in the drafting, review, and approval of this abstract. No honoraria or payments were made for authorship. AbbVie and authors thank all the trial investigators and the patients who participated in this clinical trial.
Medical writing support was provided by Stephanie Parsons, PhD, an employee of AbbVie. Editorial support was provided by Amy Kuang, an employee of AbbVie.

Introduction

Cholangiocarcinoma (CCa) is a complex neoplasm with poor prognosis, classified as intrahepatic (iCCa), perihilar (pCCa), or distal (dCCa) in the bile duct. Its variable phenotypes pose diagnostic challenges. Digital single-operator cholangioscopy (DSOC) aids diagnosis but has limitations, including suboptimal biopsy sensitivity, lack of a standardized morphology classification, as well as technical issues. Emerging evidence highlights AI’s potential to enhance DSOC diagnostic capacity, but the differential performance according to tumor characteristics, namely its topography, remains unassessed.

Aims & Methods

This study aimed to evaluate an AI algorithm’s effectiveness in detecting iCCa, pCCa, and dCCa. A deep learning model based on a convolutional neural network (CNN) was designed to automatically predict the malignancy status of biliary strictures. The model was built using DSOC images from four international high-volume centers: Centro Hospitalar Universitário de São João (Porto, Portugal), Hospital Universitario Puerta de Hierro Majadahonda (Madrid, Spain), New York University Langone Hospital (New York, USA) and University of Chicago Medicine (Chicago, USA). Images showing strictures due to cholangiocarcinoma or benign conditions were included. The model was trained with a learning rate of 0.0001, a batch size of 32, and a number of epochs of 10, using PyTorch framework. The detection rate of the algorithm was compared for each location category.

Results

A total of 18166 images from 32 patients from 4 centers. A total of 22 patients were male (69%) and the mean age was 63 years (SD: 11 years). Common bile duct (CBD) strictures represented 44% of the total (n=14) while intrahepatic and perihilar accounted for 22% (n=7) and 34% (n=11), respectively. The algorithm’s DR of strictures representing CCa was 91.6% for iCCa, 89.4% for pCCa and 92.4% for dCCa. Pairwise comparisons revealed a significant difference in the DR for iCCa and pCCa (p<0.05) and dCCa and pCCa (p<0.001).

Conclusion

Topographic characteristics of biliary strictures influence the diagnostic performance of DSOC. While AI shows promise in improving the diagnostic capacity of DSOC, its performance is impacted by DSOC technical limitations. To our knowledge, this is the first multicentric and transatlantic algorithm, capable of providing detection and differentiation of morphologic features of biliary strictures. Developing models should address and control for these issues before widespread clinical integration. Additionally, this evidence stresses the importance of keeping a “human on the loop”, providing clinical reasoning to guide the application of AI algorithms.