United European Gastroenterology Journal最新文献

Background: The fecal immunochemical test (FIT) is widely implemented as a first-line tool in organized colorectal cancer (CRC) screening programs, including Italy. Following a positive FIT, colonoscopy is recommended. Computer-aided detection (CADe) systems have the potential to enhance adenoma detection, particularly in FIT-positive populations where identifying advanced adenomas is critical for cancer prevention. This study evaluated the diagnostic performance of CADe-assisted colonoscopy versus standard colonoscopy (SC) in a FIT-based screening cohort.

Methods: In this multicenter, randomized controlled trial, patients with a positive FIT result were randomized to undergo either CADe-assisted or standard colonoscopy. The primary endpoint was the advanced adenoma detection rate (AADR). Secondary endpoints included overall adenoma detection rate (ADR), adenomas per colonoscopy (APC), and mean withdrawal time (WT).

Results: Of 1077 patients enrolled, 68 were excluded due to inadequate bowel preparation, leaving 1009 patients for analysis (CADe: n = 506; SC: n = 503). AADR was comparable between the groups (21.3% vs. 20.5%, p = 0.794). However, CADe significantly improved ADR (67.6% vs. 59.8%, p = 0.012) and APC (1.82 ± 2.12 vs. 1.34 ± 1.81, p < 0.001). Mean WT was longer in the CADe group (17.10 ± 8.28 min vs. 16.13 ± 8.28 min, p = 0.016).

Conclusions: In a FIT-based organized CRC screening setting, CADe did not enhance detection of AADR with a modest increase in withdrawal time. NCT04441580.

Background: Microscopic colitis (MC), comprising lymphocytic colitis (LC) and collagenous colitis (CC), is an inflammatory bowel disease with increasing incidence. MC etiopathogenesis remains unknown; however, altered colonic epithelial integrity may underlie uncontrolled luminal antigen passage, triggering immuno-inflammatory responses.

Objective: The aim of this study was to further define the involvement of the colonic epithelium in MC.

Methods: A paired transcriptomic and proteomic analysis followed by epithelial ultrastructural examination was performed on colonic biopsies from LC and CC patients, and from irritable bowel syndrome with a predominance of diarrhoea (IBS-D) and healthy subjects (H) as control groups. The impact of budesonide therapy on the epithelial structure was also evaluated in CC.

Results: MC patients exhibited decreased expression of inter-microvilli adhesion and actin-bundling proteins, accompanied by increased expression of actin-membrane connection proteins compared to both control groups. Distinct molecular differentiated CC and LC, which translated into differential ultrastructure abnormalities. The colonic microvilli in CC patients were shorter in length and fewer in number, with partial restoration following budesonide treatment, whereas LC showed a reduction solely in microvilli number. A negative correlation was found between daily stool frequency and SPATN1 and ATP8B1 protein levels in CC patients.

Conclusions: Molecular dysregulation and aberrant ultrastructure of the colonic brush border feature the colonic epithelium in LC and CC. These previously undescribed findings provide new perspectives for further defining MC pathogenesis and identifying biomarkers for diagnosis, prognosis and treatment of this debilitating and prevalent disease.

Background: Prophylactic complete closure of mucosal defects after resection of gastrointestinal lesions is key to reducing delayed bleeding, but complete closure for large defects can be challenging with conventional through-the-scope clips (TTSC). The introduction of a TTSC with anchor prongs offers ability to approximate margins of larger defects.

Objective: The study objective was to evaluate prophylactic complete closure after polypectomy, endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD) in large (≥ 20 mm) nonpedunculated colorectal lesions (LNPCLs).

Methods: We conducted a multicenter, single-arm prospective cohort study of the TTSC with anchor prongs for prophylactic closure after EMR/polypectomy or ESD for LNPCLs. Patients were followed for 30 days after the index procedure. The primary outcome was the rate of complete closure of the defect. Other outcomes were the rate of delayed (postprocedural) bleeding, and rate of serious adverse events (SAEs).

Results: One hundred five eligible patients were enrolled. Ninety-nine (94.3%) defects had complete closure, with rates of 93.0% (80/86) for EMR/polypectomy and 100.0% (19/19) for ESD procedures. Delayed bleeding occurred in 2 (1.9%) patients by 30 days after the index procedure. Eight (7.6%) patients had ≥ 1 SAE, including bleeding (2 patients), perforation (1), microperforation (1), aspiration (1), nausea (1), and post-polypectomy syndrome (1).

Conclusion: Prophylactic use of the TTSC with anchor prongs achieved a 94% rate of complete defect closure after EMR/polypectomy or ESD for LNPCLs. The rate of delayed bleeding after closure in this cohort was 1.9%. A prospective RCT is ongoing to further evaluate the clinical outcomes of a TTSC with anchor prongs used for prophylactic closure.

Trial registration: ClinicalTrials.gov number, NCT05653843.

Background: While tumor necrosis factor (TNF) inhibitors can induce paradoxical reactions, sarcoidosis-like disease has hardly been reported so far. This study aimed to describe the epidemiological, diagnostic and therapeutic features of TNF inhibitor-induced sarcoidosis-like lesions in patients with inflammatory bowel disease.

Methods: We conducted a case series across 59 institutions affiliated with the Groupe d'Etude Therapeutique des Affections Inflammatoires du Tube Digestif. Diagnosis of TNF inhibitor-induced sarcoidosis was based on typical clinical and radiological signs, histological evidence of non-necrotizing granuloma, exclusion of alternative diagnoses, and a timeline consistent with drug exposure. A pharmacovigilance expert reviewed each case to confirm drug causality.

Results: We identified 14 cases of sarcoidosis-like lesions, including 9 patients with Crohn's disease, 4 ulcerative colitis, and 1 with unclassified inflammatory bowel disease. The implicated medications were infliximab (8), adalimumab (5), and golimumab (1), predominantly in first-time biotherapy users (71%). The median time from treatment initiation to sarcoidosis diagnosis was 27.5 months (range 3-91). Common clinical manifestations included dyspnea (71%), coughing (50%) and fever (50%). Ten patients discontinued TNF inhibitor therapy and started oral steroids, leading to complete symptom resolution in seven cases and improvement in two. Median time from steroid initiation to clinical remission of sarcoidosis was 84 days (range 11-134). After a median follow-up of 40 months, while no relapses occurred in 13 patients, one showed persistent sarcoidosis activity.

Conclusions: TNF inhibitor-induced sarcoidosis should be considered in inflammatory bowel disease patients with chronic respiratory symptoms or fever after exclusion of mycobacterial infection. Management involves discontinuation of TNF inhibitors and a course of steroids.

Background and study aims: Motorized spiral enteroscopy (MSE) was introduced as a major advancement in small-bowel enteroscopy, enabling higher complete enteroscopy rates with shorter procedure times. However, after a fatal adverse event (AE) involving severe esophageal injury, the device was withdrawn from the market in July 2023. This raised questions about whether earlier safety signals were missed.

Methods: We conducted a systematic review and meta-analysis comparing MSE with balloon-based enteroscopy (double-balloon [DBE] and single-balloon enteroscopy [SBE], analyzed together). Outcomes included overall AEs, serious AEs (SAEs), and data collection quality. Results from the German PowerSpiral Registry were included, comprising 647 MSE procedures in 523 patients (January 2020-July 2023) before registry closure following device withdrawal.

Results: Thirteen MSE studies (including the registry) and 55 DBE/SBE studies were analyzed, totaling 12,559 enteroscopies (2024 MSE; 10,535 DBE/SBE). MSE showed significantly higher rates of AEs (10.8% vs. 1.6%) and SAEs (1.5% vs. 0.4%). Procedure-related SAEs were also more frequent with MSE (1.1% vs. 0.3%). Esophageal injury (0.10% vs. 0.009%) and intestinal perforation (0.5% vs. 0.1%) occurred more often with MSE, whereas acute pancreatitis (0.05% vs. 0.27%) and esophageal perforation (0% vs. 0.02%) were more common with DBE/SBE. AE reporting for MSE was detailed, but structured follow-up and reliable case tracking were inconsistent.

Conclusions: MSE was associated with higher AE and SAE rates than balloon enteroscopy. These findings highlight the need for cautious adoption, rigorous safety monitoring, and more robust AE reporting when introducing innovative endoscopic technologies.

Study registration: The prospective and retrospective cohort studies were registered in the German Registry of Clinical Studies (DRKS), namely DRKS00026990 and DRKS00028571.

Background: Chronic delta hepatitis represents a major health burden. Until recently, pegylated interferon-alfa-2a (PEG-IFNα) therapy was the only treatment option for patients infected with hepatitis D virus (HDV). The aim of this study was to evaluate 10-year long-term clinical and virological outcomes after 96 weeks of treatment with PEG-IFNα with or without tenofovir disoproxil fumarate (TDF).

Methods: We conducted a retrospective follow-up study of the Hep-Net-International-Delta-Hepatitis-Intervention-Study 2 (HIDIT-II trial). Patients had received 96 weeks of treatment with either PEG-IFNα-2a plus TDF or PEG-IFNα-2a alone. Patients were included if they had completed the 96-week treatment period and had at least one follow-up visit (PEG-IFNα-2a + TDF; n = 51, PEG-IFNα-2a alone; n = 56).

Results: Patients who received PEG-IFNα-2a + TDF were younger (37 vs. 42 years) and no significant differences were observed in other baseline characteristics between the two treatment arms. A total of 26 patients (24%) developed one or more liver-related endpoints after a mean time of 8.4 years. The incidence of endpoints was significantly lower in the combination group (14% vs. 34%, p = 0.02). The development of liver-related endpoints was also associated with non-response to therapy (HDV RNA and HBsAg), elevated HBV DNA at week 72, and baseline age, cirrhosis, platelets, INR, AST, GGT, bilirubin and albumin according to the Cox regression model.

Conclusions: The long-term follow-up of this large randomised clinical trial demonstrates that combination therapy with TDF and virological response to PEG-IFNα-2a (undetectable HDV RNA and HBsAg loss) were associated with better clinical outcomes.

Trial registration: NCT00932971, EudraCT 2008-005560-13.

United European Gastroenterology (UEG) has launched an initiative to promote physician well-being and prevent burnout. This current concept article is based on a survey of the National Societies Forum and National Societies Committee, a meta-analysis by Shiha et al., and a scoping review of evidence-based interventions. It identifies key systemic and individual drivers of burnout, outlines its consequences, and presents strategies for intervention-recognising that physician burnout threatens individual health, patient safety, and the sustainability of health care systems. Burnout in gastroenterology is driven by demanding workloads, complex procedures, and increasing administrative tasks. Addressing physician well-being must be viewed as a systemic challenge requiring coordinated efforts from individuals, hospitals, and scientific societies. National and specialist GI societies are pivotal. They must implement initiatives and advocate for systemic change through education, policy advocacy, and sustainable work design. Acknowledgement of burnout is a start. Progress requires commitment to well-being and continuing research.