Acta gastro-enterologica Belgica最新文献

Background and study aims: Embedded transpapillary self-expandable metal stents (SEMS) may require extraction over time and standard approaches often fail. In the current study we describe a newly developed approach to refractory embedded SEMS, using balloon dilation-assisted extraction. Our aim was to evaluate the feasibility and outcomes of this novel technique.

Patients and methods: This is an exploratory single-center retrospective analysis of all consecutive patients undergoing endoscopic balloon-assisted stent extraction. Baseline, procedural and follow-up data were collected and analyzed.

Results: Twelve patients with embedded transpapillary SEMS were identified (60.0% female, mean age 70.1 [SD±18.1] years, uncovered SEMS 33.3%) with median dwell time of 457.5 (IQR 175.8-1042) days. Previous extraction attempts were undertaken in the majority of cases (83.3%), including SEMS-in-SEMS placement (41.7%). Using the balloon-assisted stent extraction technique, successful SEMS extraction was achieved in 10 out of 12 cases (83.3%). Adverse events occurred in 3 patients (Grade II [n=2, 16.7%] - Grade III [n=1, 8.3%]). After a median follow-up time of 171 (58-260) days, 1 biliary recurrence occurred for which endoscopic re-evaluation was performed.

Conclusions: Our data suggest that endoscopic balloonassisted stent extraction should be considered for extraction of embedded self-expandable metal stents, as it showed high efficacy without any major procedure-related adverse events, using readily available endoscopic tools.

Background: Functional dyspepsia (FD) is a disorder of gutbrain interaction characterised by epigastric pain, epigastric burning, early satiation or postprandial fullness. Despite its high prevalence, clinicians struggle with the diagnosis and management of these patients.

Methods: A Delphi consensus was conducted by 20 experts from Belgium, and consisted of a literature review, summarising the existing evidence, and a voting process on 119 statements. Grading of recommendations, assessment, development and evaluation criteria were applied to evaluate the quality of evidence. Consensus was defined as > 80 % agreement.

Results: Belgian consensus underlines the multifactorial aetiology of FD. In addition to the cardinal symptoms, bloating and weight loss are also observed in FD. Functional dyspepsia co-exists with other DGBIs, including IBS. Subtyping based on the postprandial nature of symptoms is recommended. Patients should receive a positive diagnosis. Additional testing is not routinely required before initiating therapy, except in the presence of alarm features or treatment-refractory symptoms, and can consist of upper GI endoscopy, abdominal imaging and gastric emptying testing. The consensus refuted the role of carbohydrate malabsorption testing, pyloric impedance planimetry, pH/impedance monitoring, food allergy testing and permeability testing in FD. Explanation and reassurance, also addressing lifestyle factors, represent the cornerstone of the management. Proton Pump Inhibitors are considered the firstline pharmacological treatment. With the exception of specific neuromodulators, the panel did not achieve consensus for other therapeutic options. This consensus recommends against restrictive diets, invasive endoscopic or surgical treatment, parenteral nutrition, antibiotics, spasmolytics and opioids in the management of FD.

Conclusion: A panel of Belgian experts summarised the existing evidence on the aetiology, presentation, diagnosis and treatment of FD with attention to the availability within the Belgian healthcare system. Areas of future research are identified.

Objective: Few studies have explored using ultrasound-guided warm saline enema to treat acute intussusception in children. This article aimed to assess the effect of warm saline enema on acute intussusception in children.

Methods: In this study, we retrospectively analyzed 169 children who underwent ultrasound-guided warm saline enema treatment for pediatric intussusception in 3201 Hospital, Shanxi, China between January 1, 2020, and December 31, 2022.

Results: Out of the 169 children included in the study, 156 were successfully treated, while 13 did not respond to the treatment. The success rate was 92.31%, and the failure rate was 7.69%. The reduction time and hospital stay in 169 children ranged from 9 to 54 minutes and 1 to 25 days, respectively. On average, the reduction process took about 20.84±4.86 minutes, and the hospital stay was around 3.79±2.49 days. Among the 169 children, 3 experienced nausea and vomiting, while none had postoperative diarrhea or intestinal perforation. The overall incidence of complications like nausea and vomiting was 1.78%.

Conclusions: A total of 169 children with intussusception underwent treatment using ultrasound-guided warm saline enema. The reduction time was consistent with the existing literature. Complications were small in these cases, only manifested as nausea and vomiting. These findings also provide valuable evidence for clinical management of these diseases.

Background: Extensive validation of the Q-NRG indirect calorimeter in canopy mode, especially against reference devices, is lacking. The aim of this study was to test its agreement in canopy mode with the Deltratrac II, which has always been considered as the gold standard indirect calorimeter in daily practice.

Methods: Healthy volunteers underwent indirect calorimetry with two consecutive assessments, using Q-NRG and Deltatrac II, both in canopy mode, in a random order, after careful calibrations. Body position, fasting conditions and environment were standardized. Agreement between the two devices was evaluated by paired Student's t test, correlation coefficients, and Bland-Altman plots.

Results: Sixty-one adults (85.2% male, aged 25.7±8.4 y, BMI 23.3±2.9 kg/m2) were included. Measured energy expenditure was similar whether it was measured using Q-NRG or Deltatrac II: 1816±361 kcal/day or 1809±260 kcal/day (p=0.803), respectively. There was a significant positive correlation between the two measures (ρ=0.78, p= <0.01). The Q-NRG slightly overestimated the energy expenditure compared to the Deltatrac II measure: the bias ± limits of agreement was 7 ± 227 kcal/day.

Conclusion: In healthy volunteers breathing spontaneously, the Q-NRG in canopy mode performed similarly to the Deltatrac II for energy expenditure measurement. The present study confirms the previously demonstrated accuracy of the Q-NRG device, and supports its clinical use in canopy mode.

Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over a quarter of the global population, with up to 30% developing Metabolic Dysfunction-Associated Steatohepatitis (MASH), a progressive form that can silently lead to fibrosis, cirrhosis, and liver cancer. Current diagnostic methods, including blood-based scores and imaging, are insufficient for early detection, leading to late-stage diagnoses in most patients. Liver biopsy remains the diagnostic gold standard but is invasive, costly, and prone to high inter- and intra-reader variability, limiting its utility in routine care and clinical trials. Our research highlights myosteatosis-fat infiltration in skeletal muscle-as a potential early, non-invasive marker of MASH. In preclinical models and clinical studies, myosteatosis correlated with the presence of MASH and distinguished it from isolated steatosis. Notably, reductions in myosteatosis following interventions such as bariatric surgery or dietary regimens were associated with histological improvements in MASH, suggesting a potential role in predicting treatment response. In larger cohorts, myosteatosis was identified as a strong predictor of all-cause mortality. In parallel, we utilized a VCAM- 1-targeted molecular imaging technique and demonstrated a high accuracy in detecting inflammation in preclinical MASH models. This technology is now advancing to clinical trials for validation in humans. Taken together, our data support that targeted medical imaging may enable early, non-invasive diagnosis and monitoring of MASH, reducing reliance on liver biopsy and improving patient outcomes.

Pelvic floor multidisciplinary team (MDT) discussion is emerging as a standard part of care for patients with pelvic floor disorders. Although its use is encouraged by guidelines, there is still a lack of solid evidence supporting its benefits. The aim of this study is to evaluate the impact of pelvic floor MDT discussions on the diagnostic approach and treatment of a patient population at Antwerp University Hospital. After reviewing 26 patient cases, the study demonstrated a change in technical investigations in 69% of cases and a change in diagnostics in 85% of cases. These findings indicate that pelvic floor MDT discussions have a significant impact on both the diagnostic and treatment approaches for pelvic floor disorders.

Visceral leishmaniasis (VL) is a severe vector-borne parasiti disease, endemic in various tropical countries but also in the Mediterranean Basin. We report the case of a 64-year-old immunocompetent male, who presented with jaundice, fever, splenomegaly, hyperferritinaemia and cytopenias after a recent trip to Portugal. Clinical and biochemical findings were consistent with the diagnosis of an acute cholestatic hepatitis and haemophagocytic lymphohistiocytosis (HLH), secondary to visceral Leishmania infantum which was later confirmed by bone marrow examination. Despite adequate therapy with liposomal amphotericin B, the disease and HLH relapsed. Retreatment with higher dosing was eventually successful. This case highlights the risk of acquiring VL in southern Europe and its possible unusual presentations, causing diagnostic delay, as well as its complex management that requires appropriate multidisciplinary communication.

Background and study aims: Selective internal radiation therapy (SIRT) has shown good results in unresectable liver metastases from neuroendocrine neoplasms (NELM) with a high disease control rate (DCR) reported. The aims of the study is to assess retrospectively the efficacy and safety of 10y of SIRT for NELM.

Patients and methods: Primary endpoint was objective response rate (ORR) and DCR by RECIST 1.1 at 2, 4 and 12 months (m). Secondary endpoints were overall survival (OS), liver progressionfree survival (liver-PFS), clinical response (NEN-related symptoms improvement) and safety.

Results: 50 consecutive patients with NELM who got SIRT from 2011 to 2021 in one center. The two major NEN primary sites were pancreas (46%) and small intestine (36%). Histological NEN grades were 10%, 46% and 44% for grades 1, 2 and 3 respectively. ORR and DCR were 16% and 80% at 2m, 22% and 92% at 4m and 32% and 82% at 12m. Survival rates at 1 and 2 y were 76% and 72% respectively. Prognostic factors for OS and liver-PFS were NEN histological grade (3 vs 1+2) (hazard ratio (HR) for OS: 4.33 [1.8-10.6], for liver-PFS: 3.91 [1.3-11.4]), and early (2m) DCR (HR for OS: 0.14 [0.1-0.4], for liver-PFS: 0.016 [0.003-0.08]). Clinical response occurred in 7 of the 10 symptomatic patients. One patient died from radioembolization-induced liver disease.

Conclusion: SIRT showed efficacy in NELM pts, with a high DCR and an good safety profile. G1-2 grade and early DCR were associated with a better OS and liver-PFS.

Background: Subcutaneous (SC) infliximab CT-P13 (IFX) has recently been registered for the treatment of moderate-to-severe inflammatory bowel disease (IBD). The SC route is an attractive option for patients. However, many open questions remain on how to safely switch patients from maintenance IV to SC administration.

Objective: to assess switching from IV to SC IFX therapy in IBD patients through clinical and biochemical evaluation.

Methods: Patients in durable remission on eight-weekly (or six-weekly) IV infliximab and therapeutic IFX trough levels were switched to SC therapy every two weeks. All patients were monitored prospectively every 3 months with patient reported outcomes (PRO), labs including IFX concentrations and faecal calprotectin every 6 months for minimum one-year follow up.

Results: 55 patients (21 UC, 34 CD) agreed to switch to SC therapy. The median follow up in CD patients was 15.5 months, respectively 20 months in UC patients. All patients remained in deep remission according to PRO2, CRP and calprotectin. IFX serum concentrations more than tripled 3 months after the switch (18.31 ± 10.53 μg/mL vs. 4.82 ± 3.06 μg/mL at the start) and remained stable during further follow up. Local pain and injection site reactions both transient were reported in 47% and 42% patients respectively but disappeared in > 50% when injecting in the abdomen or when changing pen to syringe.

Conclusion: Switching UC and Crohn patients in clinical remission and adequate trough levels from maintenance IV tot SC infliximab therapy was successful for at least one year. A proportion of patients experienced pain and or injection site reactions.