Acta gastro-enterologica Belgica最新文献

Background and study aims: Pediatric data on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prophylaxis remains limited. This study evaluated the effectiveness and safety of combined rectal indomethacin and lactated Ringer's (LR) as prophylaxis for PEP in children undergoing ERCP.

Patients and methods: We retrospectively reviewed all pediatric ERCPs performed at a single tertiary center (2012- 2025). The study group consisted of procedures performed after 2021, when a standardized prophylaxis protocol (100 mg rectal indomethacin before ERCP plus LR at 2.5 L·m-2, started 2 hours before and continued 6 hours after) was implemented. Procedures performed before 2021 served as the control group. Primary and secondary endpoints were the development of PEP and cholangitis, respectively. Analyses considered American Society for Gastrointestinal Endoscopy (ASGE) procedural complexity, stent placement/type, and naive papilla status.

Results: Seventy-five children underwent 95 ERCPs (prophylaxis group: 23 patients/38 procedures; control group: 55 patients/65 procedures). Baseline demographic and procedural characteristics were similar between the prophylaxis and control groups. Post-ERCP pancreatitis developed in 13.2% of procedures in the prophylaxis group and 13.8% in the control group (RD -0.7%; 95% CI -18.5 to 19.9; p = 1.000). Cholangitis developed in 5.3% of procedures in the prophylaxis group and 7.7% in the control group (RD -2.4%; 95% CI -15.3 to 14.0; p = 1.000). Adjustment for stent type did not meaningfully alter the associations between prophylaxis and outcomes. All PEP cases were mild to moderate. No treatment-related adverse events-including indomethacin-associated gastrointestinal or renal complications, or fluid-overload events-were observed in either group.

Conclusions: Combined rectal indomethacin plus LR was feasible and well tolerated in pediatric ERCP but did not significantly reduce PEP or cholangitis. These findings highlight the need for larger, multicenter pediatric trials to define optimal prophylaxis.

We report a rare drugs adverse effect of a GLP1-RA, presenting as severe gastric stasis, eosinophilic duodenitis, and high bowel obstruction. The patient, treated with oral semaglutide for type 2 diabetes and obesity, developed progressive upper gastrointestinal symptoms culminating in faecal vomiting. Endoscopic and histological findings revealed marked eosinophilic infiltration of the duodenum. To our knowledge, this is the first reported case linking semaglutide to eosinophil-driven duodenitis causing mechanical obstruction. As the use of GLP1-RAs expands, clinicians should be aware of rare but potentially serious gastrointestinal adverse effects, particularly in patients with risk factors for impaired motility. Early recognition of symptoms and consideration of underlying eosinophilic gastrointestinal disease are essential for timely diagnosis and management.

Irritable bowel syndrome with constipation (IBS-C) is a common subtype of functional bowel disorder associated with substantial symptom burden and reduced quality of life. Management typically begins with dietary and lifestyle modification, laxatives, and antispasmodics; however, many patients experience inadequate relief, underscoring the need for more effective therapies.

Linaclotide, a synthetic guanylin analog, is an established treatment for IBS-C. By activating guanylate cyclase-C (GCC) receptors on intestinal epithelial cells, it promotes intestinal fluid secretion, accelerates transit, and alleviates visceral hypersensitivity. Randomized controlled trials have demonstrated its efficacy and favorable safety profile, with mild-to-moderate diarrhea and abdominal pain being the most common adverse events. Because clinical trial populations may not fully reflect real-world patient diversity, real-world evidence (RWE) provides valuable complementary data. This review summarizes current RWE on linaclotide in IBS-C, integrating findings from multiple studies to present a comprehensive view of its effectiveness and safety in routine clinical practice.

This case discusses a 76-year-old female patient with a large mass at the major papilla of Vater, initially suspected to be an ampullary adenoma. The lesion, identified during an upper endoscopy for anemia and fatigue, showed chronic inflammation but no malignancy. The patient's medical history included breast cancer and a partial distal pancreatectomy for an intraductal papillary mucinous neoplasm. Further imaging and biopsies did not confirm malignancy or adenoma but suggested actinomycosis. Actinomycosis, caused by Actinomyces species, presents challenges due to its rarity, slow progression, and difficulty in diagnosis. It can mimic malignancies, especially occurs following surgery, and requires long-term antibiotic therapy. We present the first documented case of actinomycosis involving the ampulla of Vater and emphasize the importance of considering actinomycosis in the differential diagnosis of ampullary masses, particularly in postsurgical patients with granulomatous tissue.

Background and study aims: Peptide receptor radionuclide therapy (PRRT) has been reimbursed in Belgium since 2022. Post marketing monitoring of efficacy in Belgian context has not yet been performed. This study aimed to evaluate the efficacy and safety of PRRT in patients with progressive metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

Patients and methods: Our retrospective analysis included GEP-NET patients who received at least one cycle of [¹⁷⁷Lu] Lu-DOTA-TATE at Institute Jules Bordet (Brussels, Belgium) between 2013 and 2023. Treatment response was assessed according to RECIST 1.1 (Response Evaluation Criteria in Solid Tumors). Progression free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier analysis. Treatment safety profiles were reported descriptively.

Results: Following initial PRRT (PRRT-1), in 110 patients with progressive metastatic GEP-NETs (grades 1-3), median PFS was 22.5 months (95% CI: 19.7-29), and median OS was 42.3 months (95% CI: 34.3-55). RECIST 1.1 responses were complete response in 1%, partial response in 21.6%, stable disease in 60.8%, and progression in 16.7% of patients. Median time of follow-up post PRRT-1 was 26.4 months (range: 0.8 - 106.4). Grade 3-4 anemia, leukopenia, lymphopenia and thrombocytopenia occurred in 1.9%, 2.8%, 50.5% and 2.8% of patients, respectively. Two patients (1.8%) developed myelodysplastic syndrome. Grade 3 or 4 renal toxicity was observed in two patients who had impaired renal function prior to PRRT.

Conclusion: Post-marketing analysis in an ENETS Center of Excellence confirmed that the efficacy and safety of PRRT in GEPNETs are consistent with phase 3 trial data.

Acute ischemic colitis associated with the use of neuroleptic agents is a rare but potentially life-threatening condition, and its true incidence is likely underestimated. The exact pathophysiological mechanisms underlying this complication remain poorly understood. Sigmoidoscopy or colonoscopy is considered the gold standard for diagnosis, although various imaging modalities can also aid in the diagnostic process. Preventive measures primarily involve the management of constipation and the reduction of risk factors. In cases of suspected neuroleptic-induced ischemic colitis, prompt adjustments in medication-either through dose reduction or substitution with alternative antipsychotics-should be considered. This article presents two cases of ischemic colitis caused by neuroleptic treatment, emphasizing the critical importance of early diagnosis and timely intervention.

Background and aim of the study: Cardiopulmonary complications, malnutrition, frailty and minimal hepatic encephalopathy are underrecognized complications of cirrhosis with a major impact on mortality and morbidity. The aim of this study is to investigate a new locally introduced care pathway with standardized screening for these complications and its impact on patients care and hospital financing.

Patients and methods: We performed a single center retrospective study of 40 patients hospitalized with cirrhosis who participated in the care pathway between April 2023 and June 2024. Electronic medical records were evaluated for screened complications and financial outcomes were calculated within our population, consecutively with and without this care pathway. Long term data regarding survival and referral were collected in June 2025.

Results: Hepatopulmonary syndrome was diagnosed in 14.7% of the patients. Frailty was present in 57.7% of the patients and malnutrition in 45%. Minimal hepatic encephalopathy was established in 17.5% of the patients. The median justified hospital days were significantly higher with the care pathway compared to without [8.4 (6.0-10.8) vs 6.2( 4.9-8.6) p<0.01 ( Z=-3.43)]. In 15 (37.5%) patients, the care pathway added a higher financial reimbursement for the hospital compared to when the care pathway would not have been performed.

Conclusions: This study emphasizes the importance of systematic screening and education of these complications. Due to systematical screening these underrecognized complications get identified earlier. Performing this care pathway did significantly and positively impact the number of justified hospital days and financial reimbursement for the hospital.

Background: STRIDE II guidelines highlight the importance of closely monitoring patients with inflammatory bowel disease (IBD) to assess therapy effectiveness and predict or manage flares. However, with a growing patient population, the outpatient clinic capacity is strained, and many patients, especially those in longterm remission, may not require frequent in-person visits. This study aims to assess the interest for optimizing resources through remote monitoring for patients with IBD in a high-volume referral centre.

Methods: An anonymous survey was conducted in 281 adult IBD patients, either untreated or on stable subcutaneous or oral maintenance therapy for more than one year. We assessed interest in a remote monitoring program and insights into their preferences for its implementation as well as eventual cost and time savings.

Results: Of the 281 patients (52% female, 67% Crohn's disease, 32% ulcerative colitis, 1% IBD type unclassified), 76% expressed interest in reducing their outpatient visits in favour of remote monitoring. Of note, 79% of these 214 patients were willing to attend outpatient clinic visits every two years. However, patients emphasized the importance of personal contact in establishing a trustworthy and safe remote monitoring system. Additionally, the study identified cost and time savings for patients, as a visit to the outpatient visit took a median (interquartile range) of 3 (2-4) hours.

Conclusion: Remote monitoring is a promising program for IBD patients in stable remission, offering potential financial and time savings for employers, patients, and society. However, further research is required to evaluate the safety and feasibility of this approach.

Background and study aims: Since 2019, pancreatic surgery in Belgium has been centralised to high-volume centres to improve care quality and reduce postoperative morbidity and mortality. All patients who are potential surgical candidates are discussed preoperatively at a centralised multidisciplinary board (MCCC = Multidisciplinair Consult Complexe Chirurgie). Typically, patients with a (possible) malignancy have already been evaluated by a multidisciplinary tumour board (MDT) in the referring hospital. This study aimed to assess the impact of the MCCC on the diagnosis of solid and cystic pancreatic lesions and to analyse referral patterns.

Patients and methods: This single-centre, non-interventional retrospective study included 217 patients with a newly diagnosed pancreatic lesion, discussed at the MCCC of Ghent University Hospital between July 1, 2019, and December 31, 2021. The influence of the MCCC on the diagnosis of pancreatic lesions was analysed.

Results: Among 217 patients (median age 65 years; 50% male), the most frequent diagnoses were pancreatic adenocarcinoma (n=99; 45,6%), IPMN (12%) and pancreatitis (7%). The MCCC altered the initial diagnostic assessment in 18,4% of cases. Among benign referrals, 20% (5/25) were ultimately found malignant, likely altering treatment. None of the 166 patients referred with a malignant diagnosis were reclassified as benign. During the first three years after centralisation, referral quality remained unchanged, with 12% unspecified lesions annually.

Summary: Centralisation may over time affect referral quality as expertise concentrates. Initial diagnosis and staging still occur in referring hospitals and are first discussed locally. This early analysis shows stable referral appropriateness after centralisation. Ongoing monitoring is needed to evaluate longterm effects of centralisation on diagnostic quality and early detection.

Intraperitoneal focal fat infarction (IFFI) encompasses a group of rare conditions that are clinically and radiologically similar, arising from focal fatty tissue necrosis. These entities often mimic other acute abdominal conditions such as acute appendicitis or cholecystitis. We present the case of a 65-year-old female with progressive abdominal pain, ultimately diagnosed with IFFI using contrast-enhanced computed tomography (CT). Omental infarction (OI) was the leading diagnosis, though a definitive distinction from epiploic appendagitis (EA) could not be made on imaging. Conservative management with anti-inflammatory medication, analgesia, and low-molecular-weight heparins (LMWH) proved effective, resulting in complete resolution within five days. This case highlights the diagnostic value of CT-imaging in differentiating IFFI from other causes of acute abdomen, thereby avoiding unnecessary surgical interventions. The aetiology of OI will be discussed, along with a detailed focus on management strategies that may also apply to other causes of IFFI.