United European Gastroenterology Journal最新文献

Objectives: Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal condition and ligation-assisted antireflux mucosectomy (ARMS-L) which is a modified ARMS procedure that combines mucosa ligation and endoscopic mucosectomy was evaluated as an effective and safe endoscopic procedure. Moreover, the long-term efficacy of ARMS-L requires further validation.

Methods: This prospective study included 189 patients with proton pump inhibitor (PPI)-dependent and cardioesophageal sphincter-relaxed GERD. Primary endpoint was the treatment efficacy (subjective and objective symptom): the total GERD-HRQL questionnaire score and the rate of PPI discontinuation at the follow-up. Secondary endpoints included improvements in GERD-Q scores, HRM, 24-h pH impedance monitoring, and AFS grade, as objective measures of hiatal disruption.

Results: All patients underwent ARMS-L successfully and the average duration of follow-up are 48 months. 70.3% (133/189) of patients achieved a ≥ 50% improvement in the total GERD-HRQL score. HRM parameters improved significantly, with LES resting pressure increasing from 6.3 to 6.6 mmHg and LES residual pressure from 5.9 to 7.2 mmHg. 24-h pH impedance monitoring showed significant improvement, with the DeMeester score decreasing from 27.23 to 8.63. 70.9% of patients stopped PPIs, and 29.1% used PPIs occasionally. The improvement in the DeMeester score was lower in patients with AFS grade 1 (from 24.13 to 9.74) compared with those with grade 2 (from 27.98 to 7.86) and grade 3 (from 28.86 to 8.90).

Conclusions: ARMS-L reduced GERD symptoms and improved the quality of life for a long time, particularly in PPI-dependent and cardioesophageal sphincter relaxed GERD patients.

Background and aims: Endoscopic size estimation of large colorectal polyps influences treatment decisions and clinical outcomes; however, its precision remains unclear. This study aimed to assess the accuracy of endoscopic size estimation for colorectal lesions ≥ 20 mm utilizing data from an endoscopic submucosal dissection (ESD) cohort.

Methods: This post hoc analysis included only en bloc resected lesions treated by ESD. Patients with neuroendocrine tumors, recurrent lesions, colitis-associated dysplasia, or insufficient data were excluded. Size accuracy was defined as a margin of error < 5 mm. Outcomes included the frequency of size errors ≥ 10 mm and ≥ 20 mm, terminal digit preferences in estimated size, and predictors for lesions estimated endoscopically at 20 mm but pathologically ≥ 25 mm. The reference standard was pathological size.

Results: Among 1889 lesions (1809 patients), 61 lesions (60 patients) were excluded. Finally, 1828 lesions (1749 patients) were evaluated. The accuracy of endoscopic size estimation was 53.4%. Errors ≥ 10 and ≥ 20 mm occurred in 19.1% and 4.5% of lesions, respectively. Endoscopic size estimation showed a strong terminal digit preference for 0 (65.2%) and 5 (30.0%). Among 366 lesions estimated at 20 mm, 97 (26.5%) were pathologically ≥ 25 mm. Polypoid lesions [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.1-6.8] and laterally spreading tumors granular type (OR 2.0, 95% CI: 1.1-3.5) were predictors of underestimation.

Conclusions: Endoscopic size estimation of large colorectal lesions can be inaccurate and influenced by digit bias, underscoring the need for improved measurement techniques (UMIN000010136).

This is an update of the WHO SSI guideline published in 2018, focussing on areas pertinent for gastrointestinal (GI) surgery and hepatobiliary and pancreatic (HBP) surgical procedures. Based on new information and appraisal of current evidence, the following recommendations can be suggested: During skin preparation, we suggest using alcohol-based chlorhexidine for clean, clean-contaminated, and contaminated GI and HBP surgical field preparation in the absence of a mucous membrane (e.g., stoma, genitalia, anus). Preoperatively, we suggest that corticosteroids and anti-TNF medication be discontinued. No recommendations could be made on the following comparisons, given the paucity of high-quality evidence and panel discussion not favouring one intervention over the other based on clinical experience: 2%-3% chlorhexidine gluconate versus aqueous povidone-iodine for surgical field preparation. 4%-5% chlorhexidine gluconate versus aqueous povidone-iodine for surgical field preparation. Aqueous chlorhexidine gluconate versus aqueous povidone-iodine for surgical field preparation Pre-operative dexamethasone in single-dose versus no pre-operative dexamethasone for patients undergoing GI surgery. Discontinuing Vedolizumab preoperatively versus continuing Vedolizumab preoperatively for patients undergoing GI surgery. Discontinuing Ustekinumab preoperatively versus continuing Ustekinumab preoperatively for patients undergoing GI surgery.

Background and aims: The incidence of acute pancreatitis is increasing in the Western world. About 10% of cases are caused by hypertriglyceridemia. Plasmapheresis was shown to reduce serum triglyceride (TG) levels, and current apheresis guidelines recommend its use in severe acute hypertriglyceridemia-induced pancreatitis (HIP). However, data on safety and efficacy are lacking. This study aimed to evaluate the clinical efficacy of plasmapheresis in hypertriglyceridemia-induced pancreatitis.

Methods: This is a retrospective multicenter cohort study of patients hospitalized for an episode of hypertriglyceridemia-induced pancreatitis from January 1, 2012 to December 31, 2022. The predefined composite primary endpoint was in-hospital mortality and organ failure. To reduce allocation bias, we performed propensity score matching.

Results: 245 episodes of hypertriglyceridemia-induced pancreatitis from 13 German centers were included. Of those, 95 episodes were treated with plasmapheresis. After propensity score matching, the final cohort consisted of 60 well-balanced pairs. Plasmapheresis was not associated with a difference in the primary composite outcome, in-hospital mortality, and organ failure (8/60 vs. 5/60; χ²(1) = 0.776; p = 0.378), nor was there any difference in the severity of pancreatitis episodes. It showed only a moderate reduction of serum triglyceride compared to the non-plasmapheresis group, but a significantly longer hospital stay in the plasmapheresis group (12 days; IQR 14 vs. 9 days; IQR 11; U = 1356; Z = -2.46; p = 0.014).

Conclusions: Plasmapheresis in patients with hypertriglyceridemia-induced pancreatitis was not associated with a better clinical outcome compared with conservative treatment in this propensity score-matched retrospective cohort study. Outside clinical studies, this costly and potentially complicative treatment should be considered with caution.

Introduction: Gastroenterology is a dynamic speciality that manages a wide range of gastrointestinal disorders. With the rising burden of gastrointestinal diseases, high-quality and standardised training is essential. United European Gastroenterology (UEG) aims to harmonise gastroenterology training across Europe.

Methods: This multicentre observational study analysed national gastroenterology training curricula from 51 UEG national member societies. Between February and December 2024, curricula were obtained via national societies and online resources. Analysis focussed on five domains: (1) clinical core knowledge, (2) technical and procedural skills, (3) research, (4) non-technical competencies and (5) mentoring and assessment structures.

Results: Median training duration was 60 months (IQR 48-72). Only 7.1% of curricula allowed part-time training; fewer than 17% permitted early sub-specialisation. Clinical core knowledge: All curricula defined core clinical competencies, including hepatology, upper gastrointestinal disorders, pancreatic and IBD care. Technical and procedural skills: Basic endoscopy was universally required, with a median of 300 gastroscopies and 200 colonoscopies. Advanced procedures featured in 70.0% of curricula, with substantial variation.

Research: Research training appeared in 76.2% of curricula, though structure and depth varied. Non-technical competencies: Non-technical competencies were covered in only 11.9%; communication (64.3%), leadership (26.2%), and professionalism (23.8%) were most common. Areas like shared decision-making, interprofessional collaboration, AI, and sustainability were rarely included. Training, mentoring and assessment frameworks: Training centre and trainer requirements were specified in 26.2% and 23.8% of curricula, respectively. One-third included formal mentoring. Competency-based objectives were present in 78.6% and logbooks in 42.9%. Few used structured tools: EPAs (7.1%), DOPS (9.5%) and Mini-CEX (2.4%). Exams were common; 9.5% used the ESEGH. The UEG Blue Book was cited in 24%.

Discussion: Competency-based training is widespread, but structured assessments and non-technical skills are inconsistently addressed. There is a need for minimum training standards and greater curricular alignment across UEG member societies to ensure consistent and high-quality gastroenterology training in Europe.

Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest cancers, with chemotherapy as the mainstay but highly variable efficacy and toxicity. Current regimens, such as FOLFIRINOX and gemcitabine-based combinations, are selected empirically without validated biomarkers to guide choice. Several strategies have been explored to personalize therapy. Patient-derived organoids and molecular classifiers such as PurIST have improved biological understanding but have limited clinical applicability. More recently, predictive transcriptomic signatures have emerged as practical tools. GemPred identifies patients likely to benefit from adjuvant gemcitabine; GemCore, validated in both resected and metastatic tumors, is compatible with small biopsies; and Pancreas-View integrates multiple drug-specific predictors, including for all FOLFIRINOX components and gemcitabine, enhanced by AI. These approaches, retrospectively validated in large cohorts and clinical trials, consistently link predicted sensitivity with improved survival. Beyond regimen selection, signatures enable treatment de-escalation, optimize first-line choices, and identify multidrug-resistant tumors. Ongoing prospective trials will establish their feasibility, supporting transcriptomic profiling as a step toward precision chemotherapy in PDAC.

Introduction: Since the publication of the first European Society for the Study of Coeliac Disease (ESsCD) guidelines in 2019, significant advancements have emerged in the diagnosis of coeliac disease (CeD) in adults. These 2025 guidelines incorporate new evidence to refine diagnostic strategies, aiming for improved accuracy of testing, and enhance overall quality of clinical care.

Methods: A multidisciplinary panel of experts revised the ESsCD guidelines using the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation II) and the GRADE methodology (The Grading of Recommendations Assessment, Development, and Evaluation). Clinical questions were structured using the PICO format, and statements and recommendations were finalised through a Delphi consensus process. Literature quality was assessed using AMSTAR-2 and QUADAS-2 tools.

Results: The updated guidelines are presented in two parts. Part 1 focuses on adult CeD diagnosis, introducing major changes such as a conditional no-biopsy approach for selected adults with high-titre IgA anti-TG2 serology (≥ 10 × ULN). Regarding serology, the use of validated high-performance ELISAs displaying a high diagnostic accuracy is emphasised, while routine use of IgA anti-Endomysium serology is no longer recommended for confirmation. Revised duodenal biopsy protocols now mandate at least four samples from the second part of the duodenum, with bulb biopsies conditionally included. The guidelines provide structured approaches for diagnosing potential CeD, seronegative villous atrophy, and CeD in individuals already on a gluten-free diet. HLA-DQ2/DQ8 typing is recommended for diagnostic clarification in select cases.

Conclusions: The updated 2025 ESsCD guidelines provide a comprehensive framework for the diagnosis of CeD in adults. By integrating evolving diagnostic strategies, minimising over-testing, and patient-centred care approaches, they aim to optimise patient outcomes, quality of life and use of diagnostic resources at the same time.