UEG Week 2025: Relive the Highlights

From groundbreaking research to expert debate — experience it all again on demand. Recordings and posters now available on gutflix.eu

Explore your recommendations now!

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Poster

Standard Poster

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

Free for all myUEG account holders. Your access level is set automatically based on your occupation. Medical professionals get full access to all content. If you are a non-medical user, you can only access UEG Week content from congresses you attended.

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

Introduction

Distal malignant biliary obstruction (DMBO) is a serious diagnosis that often results in significant morbidity and mortality due to development of obstructive jaundice and related complications. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been described as a salvage therapy for patients with DMBO following unsuccessful ERCP and/or EUS-guided biliary drainage [1,2]. EUS-GBD leverages the proximity of the gallbladder to the gastrointestinal lumen to establish a new passage for biliary drainage, which offers a viable and potentially safer alternative to current EUS-BD techniques, particularly when the gallbladder is distended [3]. There is a paucity of data reporting on the outcomes of EUS-GBD for this indication, limited by small cohorts and single-centre design. We report a multi-centre study of outcomes for EUS-GBD performed for DMBO in non-surgical candidates.

Aims & Methods

A review of a prospectively collected database of 28 EUS-GBD cases was performed between 2017 and 2024 at two referral centres in New Zealand. At both centres, patients were consented for biliary drainage via ERCP, EUS-BD, and/or EUS-GBD prior to sedation so that drainage could be achieved in a single anaesthetic session. Ethics approval was provided at participating centres before commencement. Included participants were adults diagnosed with DMBO who had unsuccessful ERCP and/or EUS-BD, and a patent hepatocystic junction. A transduodenal approach was universal, using electrocautery-enhanced lumen apposing metal stents (LAMS), and propofol-assisted anaesthesia. Technical success (TS), clinical success (CS), length of hospital stay (LOS), adverse events (AEs), reinterventions, and survival were recorded. CS was defined by improvement in biochemistry and symptoms within 72 hours. AEs were categorised into serious and non-serious events. Re-interventions were categorised into early (<7 days) or delayed (≥7 days) procedures. Follow up duration was from time of intervention until patient death.

Results

Mean age was 74 years with 32.1% females. Pancreatic cancer was the most common diagnosis. Mean Charlson comorbidity index was 9.8 ± 1.4 and mean ASA physical status classification was 3.9 ± 0.5. The 10mm LAMS was most commonly used (78.6%), with co-axial plastic stent placement performed in 25%. TS and CS was achieved in all cases. Pre-procedure bilirubin improved from mean 126 ± 115 umol/L to 63 ± 49 umol/L at 72 hours. There were no intra-procedural complications and no early reinterventions recorded. Mean LOS was 3 ± 3 days. There were 9 non-serious AEs, all infective in aetiology and treated with antibiotics. 5 serious AEs were recorded (cholangitis (n=1), recurrent obstruction (n=3) and LAMS obstruction (n=1)) and only these cases required reintervention. These were treated with ERCP (n=1), percutanous drainage (n=3), and stent removal (n=1) respectively. No repeat procedure was required in 23/28 (82.1%) patients. Median cohort survival was 135 days.

Conclusion

EUS-GBD offers excellent TS and CS as a salvage therapy for DMBO in the second or third-line setting. Furthermore, it is safe with a favourable AE profile, short LOS and low rate of reintervention. This is particularly important in this cohort of patients with advanced malignancy. EUS-GBD offers a durable therapy and can be used as destination platform for other DMBO therapeutics. We have also demonstrated feasibility of sequential deployment within the same interventional session as ERCP and EUS-BD procedures creating a streamlined process for limiting cumulative anaesthetic exposures.

References

1. Imai, H., et al., EUS-guided gallbladder drainage for rescue treatment of malignant distal biliary obstruction after unsuccessful ERCP. Gastrointestinal endoscopy, 2016. 84(1): p. 147-151.
2. Debourdeau, A., et al., Effectiveness of endoscopic ultrasound (EUS)‐guided choledochoduodenostomy vs. EUS‐guided gallbladder drainage for jaundice in patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography: Retrospective, multicenter study (GALLBLADEUS Study). Digestive Endoscopy, 2024.
3. Kamal, F., et al., Efficacy and safety of EUS-guided gallbladder drainage for rescue treatment of malignant biliary obstruction: A systematic review and meta-analysis. Endoscopic ultrasound, 2023. 12(1): p. 8-15.

EUS-GUIDED GALLBLADDER DRAINAGE FOR DISTAL MALIGNANT BILIARY OBSTRUCTION IN PATIENTS WITH UNSUCCESSFUL ERCP AND EUS-GUIDED BILIARY DRAINAGE

Michael Chieng 1, Jerry Chin 2, Rees Cameron 3, Estella Johns 3, Frank Weilert 2

1 Waikato Hospital - Health New Zealand, Hamilton, New Zealand|||University of Copenhagen, Copenhagen, Denmark

2 Waikato Hospital - Health New Zealand, Hamilton, New Zealand

3 Wellington Hospital Dept. of Gastroenterology, Wellington, New Zealand

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

Difficult biliary cannulation (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Podcast Episode

New

UEG Podcast

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

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

Nutrition in coeliac disease for a clinician with Cristian Costas

Pradeep Mundre

Topics

Small Intestine & Nutrition

Published

2026

UEG Presentation

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

ONE-YEAR CHANGES IN ALT AND LSM, BUT NOT IN CAP, PREDICT LONG-TERM LIVER OUTCOMES IN PATIENTS WITH MASLD

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

Introduction

The availability of new drugs for the treatment of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) underlines the need of early predictors of response to such therapies. This study evaluated the impact of 1-year changes in liver stiffness measurement by Vibration-Controlled Transient Elastography (LSM by VCTE), controlled attenuation parameters (CAP), and serum alanine aminotransferase (ALT) on liver outcomes in patients with MASLD.

Aims & Methods

A large multicenter cohort of MASLD patients with LSM≥8kPa and prospective follow-up was enrolled. Liver-related events (LRE), including hepatocellular carcinoma (HCC) and liver decompensation (LD), were evaluated during follow-up. LSM, CAP, and ALT were assessed at baseline and at 1-year follow-up. Cumulative incidence functions and cause-specific Cox regression analyses were performed to correlate 1-year reduction in LSM, CAP, and ALT with the risk of developing LRE, LD and HCC.

Results

In 2443 patients with MASLD and LSM≥8kPa, a 1-year reduction in ALT of 17 IU/L (HR 0.62; 95% CI 0.41-0.95; p=0.02) and a 20% reduction in LSM (HR 0.44; 95% CI 0.29-0.67; p<0.001) were both independently associated with a lower risk of LRE. Similarly, in 1412 patients with MASLD and LSM≥10kPa, a 1-year reduction in ALT of at least 17 IU/L (HR 0.62; 95% CI 0.39-0.98; p=0.04) and a 20% reduction in LSM (HR 0.42; 95% CI 0.27-0.66; p<0.001) were independently associated with a decreased risk of LRE. Comparable results were observed when considering LD separately, but not for HCC. One-year changes in CAP did not predict liver outcomes. When combining 1-year reduction in ALT of 17 IU/L and a 1-year 20% reduction in LSM, the 5-year probabilities of LRE ranged from 2.1% in the best profile to 5% in the worst profile in patients with LSM≥8kPa, and from 3.3% to 8.1% in those with LSM≥10kPa.

Conclusion

One-year reductions in ALT of 17 IU/L and in LSM by 20%, but not changes in CAP, reduce long-term liver outcomes in patients with MASLD, providing suggestion on monitoring therapy effectiveness.

ONE-YEAR CHANGES IN ALT AND LSM, BUT NOT IN CAP, PREDICT LONG-TERM LIVER OUTCOMES IN PATIENTS WITH MASLD

Grazia Pennisi 1, Giuseppe Infantino 2, Gabriele Di Maria 2, Emmanuel Tsochatzis 3, Elisabetta Bugianesi 4, Masato Yoneda 5, Ming-Hua Zheng 6, Hannes Hagström 7, Jérôme Boursier 8, Jose Luis Calleja 9, George Boon-Bee Goh 10, Wah-Kheong Chan 11, Rocio Gallego-Durán 12, Arun J Sanyal 13, Victor De Ledinghen 14, Philip Newsome 15, Jian-Gao Fan 16, Laurent Castera 17, Michelle Lai 18, Céline Fournier-Poizat 14, Grace Lai-Hung Wong 5, Angelo Armandi 19, Atsushi Nakajima 20, Wen-Yue Liu 6, Ying Shang 21, Marc de Saint-Loup 22, Elba Llop 23, Kevin Kim Jun Teh 24, Carmen Lara-Romero 25, Amon Asgharpour 26, Sara Mahgoub 15, Mandy Sau-Wai Chan 27, Manuel Romero-Gomez 28, Huapeng Lin 29, Seung Up Kim 30, Terry Cheuk-Fung Yip 5, Adele Tulone 2, Che To Jimmy Lai 5, Boyu Yang 5, Hye-Won Lee 31, Abraham Aregay Desta 32, Giacinta Ciancimino 2, Marco Enea 2, Calogero Camma 33, Vincent Wai Sun Wong 5, Salvatore Petta 34

1 Policlinico Paolo Giaccone, Palermo, Italy

2 University of Palermo, Palermo, Italy

3 UCL Institute of Liver and Digestive Health, London, United Kingdom

4 AOU Città della Salute e della Scienza University of Torino, Torino, Italy, Torino, Italy

5 University of Hong Kong, Hong Kong, China

6 Wenzhou Medical University, Wenzhou, China

7 Department of Upper GI Diseases, Karolinska university hospital Huddinge, Stockholm, Sweden

8 Centre Hospitalier Universitaire, Angers, France

9 University of Madrid, Madrid, Spain

10 University of Singapore, Singapore, Malaysia

11 University of Malaya, Kuala Lumpur, Malaysia

12 University of Seville, Seville, Spain

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

14 Echosense, Paris, France

15 University of Birmingham, Birmingham, United Kingdom

16 Shanghai Jiaotong University School of Medicine, Shanghai, China

17 Hôpital Beaujon - Service d’Hépatologie, Hôpital Beaujon; Clichy/FR, Clichy, France

18 Harvard Medical School, Boston, United States

19 University of Turin, Torino, Italy

20 Yokohama City University Hosp. Dept. of Gastroenterology, Yokohama, Japan

21 Karolinska Institutet, Stockholm, Sweden

22 Angers University, Angers, France

23 Gastroenterology, Hospital Puerta de Hierro, Madrid, Spain, Madrid, Spain

24 Changi General Hospital, Singhealth, Singapore, Singapore

25 Punta Europa Hospital, Algeciras, Spain

26 VCU School of Medicine, Richmond, United States

27 Echosens, Paris, France

28 Valme University Hospital University of Seville, Sevilla, Spain

29 University of Shanghai, Shanghai, China

30 Yonsei University College of Medicine, Seoul, Korea, Republic of

31 Yonsei University College Dept. of Internal Medicine, Seoul, Korea, Republic of

32 University of Florence, Florence, Italy

33 UOC Gastroenterologia Ed Epatologia, Palermo, Italy

34 University of Palermo Italy 48.37, Palermo, Italy

Event

UEG Week Berlin 2025

Topics

Hepatobiliary IBD Mechanisms & Personalised Medicine

Submission format

Abstract

Session

Predicting and understanding early stages of advanced liver disease

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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

DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

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

Introduction

Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease affecting the biliary epithelium, leading to bile duct strictures and eventually cirrhosis. Liver fibrosis is a well-established predictor of disease outcome in PSC. The Enhanced Liver Fibrosis (ELF) test, which combines three direct serum markers—hyaluronic acid (HA), tissue inhibitor of metalloproteinases-1 (TIMP-1), and amino-terminal pro-peptide of type III pro-collagen (PIIINP)—has been shown to correlate with the Ishak staging of liver histology in PSC. Both the ELF score and its individual components demonstrate moderate diagnostic accuracy in distinguishing advanced fibrosis (AUROC 0.73–0.78) and cirrhosis (AUROC 0.73–0.81) [1].
However, liver fibrosis and cirrhosis in PSC develop as secondary consequences of bile duct strictures and therefore represent late-stage indicators of disease progression. We have previously shown that biliary levels of calprotectin and interleukin-8 (IL-8) can help identify patients at higher risk of developing bile duct strictures. Moreover, our findings indicated that commonly used liver function tests, particularly plasma alkaline phosphatase (P-ALP), lack both sensitivity and specificity for effectively monitoring PSC progression [2].

Aims & Methods

To study: 1) the association of ELF with ERC-score, 2) the predictive value of ELF for bile duct disease progressio assessed by ≥2 increase in ERC score or need for dilatation, 3) the role of ELF-test to predict the overall disease outcome.
We included patients from Helsinki PSC-registry with ELF determined at least once, and ≥2 ERC examinations. End of f/u was 31.12.23. ERC -score was determined as described earlier [3]. ELF ≥9.8 was used as a marker for advanced liver fibrosis.

Results

In total, we included 397 patients. Demographics, laboratory results, and outcomes stratified by ELF levels, are presented in the table. Increase of ERC-score did not differ between groups, but the score at baseline associated with ELF-test (p<0.001). Progression of PSC assessed by increase of ERC score≥2 or dilatation did not correlated with ELF-levels (p=0.11), but ln[P-hyaluronic acid] showed close association with progression of bile duct changes (p<0.001). The probability for LTx increased in a linear way with the increase of ELF-level. (<0.001).

Variables	ELF ≤9.8 N=310	ELF 9.8-11.2 N=62	ELF ≥11.3 N=25	p for linearity
Person years. [Median (IQR) of person years]	2181 [5.6(3.5,11.8)]	414 [5.6(3.5,11.8)]	82 [2.5(1.3,3.8)]	-
PSC duration, mean (SD), years	6.9(5.8)	8.8(6.0)	11.2(8.1)	<0.001
AOM, mean (SD)	1.39(0.46)	1.83(0.56)	2.49(0.67)	<0.001
P-ALP, U/l, median (IQR)	94(74,135)	168(107,250)	317(203,438)	<0.001
P-Bil, µmol/l, median (IQR)	11(8,17)	13(9,18)	29(17,48)	<0.001
Biliary calprotectin, mg/l, median (IQR)	1.3(0.2,15.8)	13.4(0.9,71.0)	22.4(9.1,133.0)	<0.001
Increase of ERC score ≥2, n(%)*	35(11)	9(15)	4(16)	0.35
Increase of ERC score≥2 or dilatation, n(%)*	142(46)	40(65)	20(80)	<0.001
CCA, HCC, GBCA, Death, LTx (Incidence (95% CI), [no])**	15(10 to 21), [32]	60(39 to 89), [25]	220(30 to 347), [18]	<0.001

* Adjusted linearity for age, sex, PSC duration, intra-and extrahepatic disease,and ERC-score at baseline
** per 1000 pyrs. Adjusted for age, sex, PSC duration, intra-and extrahepatic disease.
Abbreviations: AOM, Amsterdam-Oxford model; CCA, cholangiocarcinoma, GB-CA, gallbladder carcinoma; LTx, liver transplantation.

Conclusion

The ELF test correlates with the severity of bile duct disease and the risk of liver transplantation, but it is not suitable for assessing the progression of bile duct changes based on sequential ERC examinations. The role of hyaluronic acid as a surrogate marker of bile duct changes deserves further studies.

References

[1] Thorburn DT et al. Hepatology Communications 2024;8(7):e0467, [2] Färkkilä M et al. JHEP Rep. 2024 Jul 2;6(10):101161, [3] Boyd S, et al. Endoscopy. 2016;48:432-9.