BMJ Open Gastroenterology最新文献

{"title":"Building a gastroenterology fellowship programme in Rwanda: a model of international partnerships and sustainable capacity building.","authors":"Hanna Aberra, Kulwinder S Dua, Dirk J Van Leeuwen, Florence Masaisa, Gamal Salah, Vincent Dusabejambo, Eric Rutaganda, Kara Neil, Janvier Murayire, Emile Sebera, Augustin Sendegeya, Innocent Dadamessi, Zerihun Abebe, Menelas Nkeshimana, Frederick Makrauer, Timothy Walker, Steve Bensen, Berhane Redae","doi":"10.1136/bmjgast-2026-002310","DOIUrl":"10.1136/bmjgast-2026-002310","url":null,"abstract":"","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Escalating anti-tumour necrosis factor exposure with reductions in surgical resection rates in paediatric inflammatory bowel disease: an 18-year real-world population-based cohort study.","authors":"Zachary Green, Myrna Nicholas, Stephanie Vuijk, Mike Stanton, Christopher Bakewell, Tracy Coelho, Akshay Batra, Nadeem A Afzal, Sarah Ennis, Robert Mark Beattie, James Ashton","doi":"10.1136/bmjgast-2026-002344","DOIUrl":"10.1136/bmjgast-2026-002344","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the relationship between anti-tumour necrosis factor (TNF) use and surgical resection rates in a regional paediatric inflammatory bowel disease (IBD) cohort.</p><p><strong>Methods: </strong>This retrospective cohort study used prospectively maintained electronic data from a regional UK paediatric gastroenterology centre (2007-2024). Included were individuals with modified Porto IBD diagnosis, aged ≤17 years. Annual prevalent IBD population was estimated using incident diagnoses and transition to adult services. Abdominal surgery rates (strictureplasty, resection, primary stoma) and anti-TNF administration were collected and prevalence calculated. Three anti-TNF epochs, defined by the European Crohn's and Colitis Organisation/European Society of Paediatric Gastroenterology, Hepatology and Nutrition guidelines in 2014 and 2020, were compared: Epoch-1 (2007-2013; <20% anti-TNF), Epoch-2 (2014-2020; 20%-50%) and Epoch-3 (2021-2024; >50%). Kaplan-Meier analysis with log-rank testing compared surgery-free survival between early and later anti-TNF treatment groups.</p><p><strong>Results: </strong>One thousand five hundred and thirty-eight children were included (915 Crohn's disease (CD), 529 ulcerative colitis (UC) and 94 IBD-unclassified). Median age at diagnosis was 13.3 years, and the prevalent population increased (253-597 patients). Anti-TNF-treated prevalence rose across epochs (5.9%, 31.9%, 61.1%; p<0.001). Resection rates declined 3.93%, 1.57% and 1.09% (Epoch 1-3) (p=0.003). Rates did not significantly decrease from Epoch 2 to 3 (p=0.217). CD surgery significantly decreased (4.9%, 1.7%, 1.5%, p=0.006); trends in UC rates did not reach significance (1.89%, 1.55%, 0.56%, p=0.314). Time to anti-TNF from diagnosis decreased (1.2, 0.8 and 0.26 years, p=0.008). Early vs later anti-TNF initiation was not associated with surgery-free survival.</p><p><strong>Conclusion: </strong>We report a significant increase in anti-TNF prevalence, with earlier deployment. Surgical resection rates have declined and plateaued; reflecting reduced CD surgery. Future research should focus on optimised anti-TNF and second-line biologic deployment to move beyond current levels of surgery.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13295801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and effectiveness of the Colovac anastomosis protection device compared with diverting ileostomy after low anterior resection: protocol for an international, multicentre, prospective, non-randomised comparative study (SAFE-3).","authors":"Clément Pastier, Patricia Sylla, Sang W Lee, Antonino Spinelli, Niels Komen, John Marks, Joseph Martz, Rebecca Rhee, Justin Maykel, Jorge Marcet, Quentin Denost, Karen Zaghiyan, Jennifer S Davids, Nivedh Paluvoi, David Hiller, Elisabeth C McLemore, Leon Maggiori, Andre D'hoore, Mehraneh D Jafari, Vitaliy Poylin, Christopher Jerome Buzas, Jean-Jaques Tuech, Jérémie H Lefèvre","doi":"10.1136/bmjgast-2025-002235","DOIUrl":"10.1136/bmjgast-2025-002235","url":null,"abstract":"<p><strong>Introduction: </strong>Diverting loop ileostomy (DLI) after low anterior resection for rectal cancer reduces the clinical consequences of anastomotic leakage but is associated with significant morbidity, impaired quality of life and the need for a second operation for stoma closure. Temporary intraluminal bypass devices have been developed to protect the anastomosis while avoiding DLI. However, high-quality prospective data comparing such devices with standard DLI remain limited. This study aims to evaluate the safety and effectiveness of the Colovac device compared with DLI.</p><p><strong>Methods and analysis: </strong>SafeHeal Studies (SAFE-3), consisting of SafeHeal Standard of Care (Diverting Ileostomy) study (SH-SOC23) and SafeHeal Colovac Anastomosis Protection Device Evaluation Pivotal Study (SAFE-3CV), is an international, multicentre, prospective, non-randomised comparative study comprising two sequential cohorts: SH-SOC23 (standard-of-care diverting ileostomy control) and SAFE-3CV (Colovac anastomosis protection device). A total of 233 patients will be enrolled (SAFE-3CV n=108-120; SH-SOC23 n=132) across 25 centres in 4 countries. The primary endpoints are the rate of major complications at 9 months for safety and stoma avoidance at day 10 for effectiveness. Secondary outcomes include overall postoperative morbidity, stoma-related complications, reoperation rates, length of stay and stoma avoidance. Sample size calculation is based on non-inferiority assumptions. Data will be analysed using intention-to-treat principles, with propensity score adjustment to account for baseline differences between cohorts. Comparative analyses will include logistic regression and sensitivity analyses.</p><p><strong>Ethics and dissemination: </strong>The study was approved by ethics committees at the country level or at individual sites as per individual country requirements. An independent safety monitoring committee regularly reviews adverse events and safety data throughout the study. Results will be disseminated through peer-reviewed publications and presentations at international meetings.</p><p><strong>Trial registration numbers: </strong>SH-SOC23: NCT06152276 and SAFE-3CV: NCT07116668.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary preoperative assessment for colorectal surgery: new insights and developments.","authors":"Joyce Ong, Michael Wylie, Malcolm G Dunlop, Nicholas T Ventham","doi":"10.1136/bmjgast-2025-002127","DOIUrl":"10.1136/bmjgast-2025-002127","url":null,"abstract":"<p><p>Preoperative assessment is a critical step for every patient undergoing major colorectal surgery. Increasingly, major colorectal resection is being safely performed in older and multimorbid patients. Many established tenets of preoperative assessment-careful history and examination and selected laboratory investigations-have remained unchanged for decades. However, there is an increasing focus on the importance of this step in the pathway as a key opportunity to intervene and improve patient outcomes following surgery. Patients are increasingly complex, necessitating a multidisciplinary approach involving a range of specialists to help identify and optimise modifiable risk factors and manage comorbidities. Modern approaches use risk stratification scores to better communicate risk, nutritional and frailty assessments, intravenous iron therapy, antibiotic plus bowel cleansing regimens and the use of biomarkers. Preoperative patient education and prehabilitation approaches are being harnessed to better prepare patients for surgery. Comprehensive assessment and optimisation before surgery can improve surgical outcomes and contribute to safer perioperative care.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term classification stability and treatment patterns of inflammatory bowel disease unclassified: a longitudinal observational study.","authors":"Mario Andrea Latorre, Michael Rennie, Konstantina Rosiou, Marco Vincenzo Lenti, Christian Philipp Selinger","doi":"10.1136/bmjgast-2026-002339","DOIUrl":"10.1136/bmjgast-2026-002339","url":null,"abstract":"<p><strong>Objective: </strong>In patients presenting with inflammatory bowel disease (IBD), it may not be possible to diagnose ulcerative colitis (UC) or Crohn's disease (CD) and a classification of IBD Unclassified (IBD-U) is applied. We aim to describe the long-term natural history and treatment patterns in IBD-U.</p><p><strong>Methods: </strong>This analysis was based on the Leeds IBD Steroid Study, a large retrospective study conducted at Leeds Teaching Hospitals (a UK-based tertiary IBD unit) that included all adult patients with an established diagnosis of IBD who had contact with the service between January 2016 and December 2017 and where access to primary care records were linked to hospital electronic records. Patients with IBD-U were analysed retrospectively. Baseline demographics and treatment patterns of patients with IBD-U were compared with UC and CD. Longitudinal follow-up occurred until 2025 to determine stability of IBD-U diagnosis.</p><p><strong>Results: </strong>Of 153 patients with IBD-U, 52% were male; the mean age was 46.6 years, and the mean disease duration was 13.1 years. Patients with IBD-U were less likely to receive mesalazine (85%) compared with UC (92%, p=0.0058) but more likely than patients with CD (44%, p<0.0001). Biologics were more often used for IBD-U (21%) than UC (9.5%, p<0.0001) but less often than CD (51%, p<0.0001). Steroid use and use of healthcare resources were higher in IBD-U than in UC and CD. 12 patients (7.8%) were reclassified as UC, 6 patients (3.9%) were reclassified as CD and 135 patients (88.2%) remained classified as IBD-U at the end of follow-up.</p><p><strong>Conclusion: </strong>IBD-U remains largely a stable diagnosis over long-term follow-up. Patients with IBD-U exhibit distinct therapeutic patterns and increased healthcare utilisation compared with UC and CD. These findings underscore the clinical relevance of IBD-U as a persistent phenotype and highlight the need to optimise treatment decisions and reduce the burden associated with diagnostic uncertainty.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of advanced combination therapies for treating inflammatory bowel disease in adults: a systematic review and meta-analysis.","authors":"Shellie Radford, Daniel Arruda Navarro Albuquerque, Zara Najeeb, Debangsh Agarwal, Anoop John, Morris Gordon, Vassiliki Sinopoulou, Gordon Moran","doi":"10.1136/bmjgast-2026-002307","DOIUrl":"10.1136/bmjgast-2026-002307","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically synthesise available evidence on the safety of advanced combination therapy (ACT) in adults with inflammatory bowel disease (IBD), with secondary exploratory evaluation of efficacy outcomes.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>Searches of Embase (via Ovid), MEDLINE and PubMed were initially undertaken on 9 May 2025 and updated on 8 April 2026. Additional studies were identified through hand-searching and reference list screening. Eligible publications were restricted to those published between 1 January 2015 and 31 March 2026.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials as well as observational and descriptive studies. Conference abstracts, reviews, editorials and commentaries were excluded. Inclusion was restricted to publications in English.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently screened studies, extracted data and assessed risk of bias using Joanna Briggs Institute tools and Cochrane RoB-1. Pooled proportions of total adverse events (TAEs), serious adverse events (SAEs) and treatment discontinuations were calculated using random-effects meta-analysis. Subgroup analyses were conducted by drug class. Where meta-analysis was not appropriate, findings were narratively synthesised.</p><p><strong>Results: </strong>Fifty-two studies (n=2022 participants) were included. The most frequent combinations were anti-TNFa plus integrin inhibitors and interleukin (IL) 23 plus integrin inhibitors. Pooled analyses demonstrated low rates of SAEs (eg, anti-TNFa plus integrin inhibitors: 2.7%, 95% CI 0.22% to 6.86%) and discontinuations (6.38%, 95% CI 2.36% to 11.58%), although heterogeneity was substantial and certainty of evidence was very low, with some analyses based on small sample sizes.</p><p><strong>Conclusion: </strong>ACT may be associated with low rates of SAEs in selected patients with refractory IBD; however, the evidence is limited by small sample sizes, heterogeneity and predominantly observational designs. Robust conclusions regarding safety and efficacy cannot be made due to very low GRADE certainty.</p><p><strong>Prospero registration number: </strong>CRD420251025883.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of non-cancer comorbidities and mortality in chronic pancreatitis: a retrospective cohort study.","authors":"Shauntelle Quammie, Adil Rashid, Rahul Munyal, Edward S Nicholson, Christopher Clarke, Suresh V Venkatachalapathy, Colin John Crooks, Guruprasad P Aithal, Aloysious D Aravinthan","doi":"10.1136/bmjgast-2025-002194","DOIUrl":"10.1136/bmjgast-2025-002194","url":null,"abstract":"<p><strong>Objective: </strong>Chronic pancreatitis (CP) is a progressive fibro-inflammatory disease associated with increased comorbidity and mortality. This study aimed to characterise the natural history of CP by assessing comorbidity prevalence and mortality in a CP cohort.</p><p><strong>Methods: </strong>A retrospective cohort study was performed at Nottingham University Hospitals NHS Trust, including patients diagnosed with CP between 1 January 2006 and 31 December 2014. Participants were followed up until 31 May 2023. Comorbidity prevalence was compared with national data from England in 2022 to calculate standardised prevalence ratios (SPRs). Similarly, standardised mortality ratios (SMRs) were also evaluated.</p><p><strong>Results: </strong>Of the 1003 patients with CP, 678 who resided within the Greater Nottingham area were included in the study cohort. The overall median follow-up was 5.7 years (IQR 1.2-10.6). Compared with the general population, patients with CP had significantly elevated SPRs for heart failure (3.0; 95% CI 2.3 to 3.8), diabetes mellitus (2.4; 95% CI 2.1 to 2.7), ischaemic heart disease (2.4; 95% CI 2.0 to 2.8), atrial fibrillation (1.9; 95% CI 1.5 to 2.3) and cerebrovascular disease (1.4; 95% CI 1.0 to 1.8). The cumulative incidence at 20 years of diabetes mellitus, chronic liver disease and chronic kidney disease was 12%, 11% and 11%, respectively. During follow-up, 495 patients (73%) died, with median survival of 5.7 years (95% CI 4.8 to 6.4). The overall SMR of patients with CP was significantly increased (2.3; 95% CI 2.1 to 2.6; p<0.0001) compared with the general population. Leading causes of death were malignancy (27%), infections (22%) and cardiovascular disease (6.9%).</p><p><strong>Conclusion: </strong>CP is associated with increased risk of multiple comorbidities and elevated mortality as compared with the general population. Enhanced surveillance and early intervention strategies may help prevent or delay the onset of these associated conditions.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of serrated lesion detection using different indicators: a single-centre, community-based, retrospective cohort study.","authors":"Bernard Denis, Vigueneche Catinat, Laurianne Plastaras, Izabella Amaritei, Marion Bolliet, Mathilde Clavel, Rémi Darrius, Paul Montet, Sebastian Vuola, Leslie Simomia Mbowen, Karima Hammas","doi":"10.1136/bmjgast-2026-002254","DOIUrl":"10.1136/bmjgast-2026-002254","url":null,"abstract":"<p><strong>Objective: </strong>There are inverse associations between both the adenoma detection rate (ADR) and the serrated lesion detection rate (SLDR) and the risk of postcolonoscopy colorectal cancer. We aimed to evaluate the SLDRs of community endoscopists and to define the most relevant quality indicator for this.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on adults undergoing colonoscopy from January 2023 to June 2024 at a community hospital. ADR, sessile, proximal, large, clinically relevant and advanced SLDRs were assessed.</p><p><strong>Results: </strong>Overall, 1871 colonoscopies were evaluated, performed by 11 endoscopists. The overall ADR, sessile and proximal SLDR were respectively 27.0% (95% CI 24.6% to 29.8%), 7.0% (95% CI 5.5% to 8.4%) and 8.9% (95% CI 7.4% to 10.3%). A third of endoscopists had suboptimal SLDRs. The correlation between ADR and sessile SLDR was moderate and non-significant (r=0.57, p=0.07) but was excellent between sessile and proximal SLDR (r=0.93, p<0.001). Based on the regression line, a sessile SLDR of 6% corresponded to a proximal SLDR of 7.8% (95% CI 6.5% to 9.1%). In multivariate analysis, proximal SLDR was significantly associated with mean withdrawal time (OR 2.50 (95% CI 1.44 to 4.32 for >11 min vs <9 min)).</p><p><strong>Conclusion: </strong>The performance observed in this community setting was suboptimal for the detection of serrated lesions. A mean withdrawal time >11 min was associated with a doubling of ADR and proximal SLDR compared with <9 min. In routine practice, the sessile and proximal SLDRs seem to be similar for assessing the detection of serrated lesions and should become major quality indicators for colonoscopy.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of multivariable prognostic machine learning models to identify patients at risk for inadequate bowel preparation when undergoing colonoscopy: a prospective, multicentre study.","authors":"Christoph Schramm, Carolin Hehn, Harald Curth, Ingo Scheller, Jan-Hinnerk Weingaertner, Matthias Christian Reichert, Philipp Kasper, Dilan Bozal, Gabriel Allo, Markus Casper, Thomas Adams, Leonie Jochheim, Amos Zeller, Gilbert Rahe, Joerg Zeeh, Christoph Neumann-Haefelin, Frank Lammert, Hartmut Schmidt, Christoph M Friedrich, Martin Buerger","doi":"10.1136/bmjgast-2025-002238","DOIUrl":"10.1136/bmjgast-2025-002238","url":null,"abstract":"<p><strong>Objective: </strong>Inadequate bowel preparation impairs the accuracy of colonoscopy and increases the burden on patients and healthcare systems. Consequently, the quality of bowel preparation is an important quality indicator. We aim to develop and validate multivariable prognostic models for the identification of patients at risk of inadequate bowel preparation using machine learning (ML).</p><p><strong>Methods: </strong>Demographic and clinical data from consecutive patients ≥18 years of age who underwent colonoscopy at six centres in Germany were prospectively collected. Adequate bowel preparation was defined as Boston Bowel Preparation Scale ≥6 with a value ≥2 in each colonic segment. We used statistical and ML methods to build prognostic models and to compare them to published models.</p><p><strong>Results: </strong>Overall, we analysed 2652 patients, including 699 (26.4%) inpatient procedures. The mean patient age was 57.6 years (SD 16 years), and 48.9% were women. In 1401 (52.8%) patients, the indication was screening or surveillance, and 1035 (39%) patients had a first-time colonoscopy. The rate of inadequate bowel preparation was 16%. Sensitivities, specificities and areas under the curve of predictive models obtained by generalised boosting models, Ranger, support vector machine (radial), CatBoost and Net Regularised Generalised Linear Models were 0.51-0.86, 0.52-0.83 and 0.71-0.74, respectively. They were only marginally superior to a logistic regression model. All models had high negative predictive values >0.9 for inadequate bowel preparation. To detect one patient with inadequate bowel preparation, 8-10 patients need to be evaluated.</p><p><strong>Conclusions: </strong>Predictive models to identify patients at risk for inadequate bowel preparation obtained by ML showed comparable results compared with a logistic regression model.</p><p><strong>Trial registration number: </strong>DRKS00018878.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of the AGATE hybrid score for pre-endoscopic risk stratification in acute upper gastrointestinal bleeding: a single-centre, retrospective cohort study.","authors":"Yavuz Özden, Ömer Yüzügülen, Ferhat Omurca","doi":"10.1136/bmjgast-2025-002217","DOIUrl":"10.1136/bmjgast-2025-002217","url":null,"abstract":"<p><strong>Objective: </strong>To compare five established pre-endoscopic risk scores in acute upper gastrointestinal bleeding (AUGIB) and to derive a hybrid score (Acute Gastrointestinal Bleeding ABC-GBS Triage Evaluation (AGATE)) integrating mortality prediction and triage utility.</p><p><strong>Methods: </strong>We conducted a single-centre retrospective cohort study at Kayseri City Hospital, Kayseri, Türkiye, including 5000 consecutive adults with endoscopically confirmed AUGIB (January 2020-January 2025). The primary outcome was 30-day mortality; secondary outcomes were therapeutic intervention and 30-day rebleeding. Age-Blood tests-Comorbidities (ABC), Mental status-ASA class-Pulse-Albumin-Systolic blood pressure-Haemoglobin (MAP(ASH)), Haematemesis-Heart rate-Haemoglobin-Blood pressure-Blood urea nitrogen, Glasgow-Blatchford score (GBS) and Albumin, INR, Mental status, Systolic blood pressure, Age ≥65 were calculated at presentation. AGATE was derived using multivariable logistic regression for the composite end point (mortality or intervention) and internally validated with 1000 bootstrap resamples.</p><p><strong>Results: </strong>Mortality was 9.2% (460/5000), intervention was required in 71.0% (3550/5000) and rebleeding occurred in 14.5% (725/5000). For mortality, ABC (area under the receiver operating characteristic curve (AUROC) 0.83, 95% CI 0.80 to 0.86) and MAP(ASH) (AUROC 0.81, 95% CI 0.78 to 0.84) demonstrated the highest discrimination; for intervention, GBS (AUROC 0.78, 95% CI 0.74 to 0.82) and MAP(ASH) (AUROC 0.77, 95% CI 0.73 to 0.80) demonstrated the highest discrimination. AGATE achieved AUROCs of 0.85 (95% CI 0.82 to 0.87) for mortality and 0.80 (95% CI 0.77 to 0.82) for intervention. For the composite end point, AGATE outperformed GBS (AUROC 0.86, 95% CI 0.83 to 0.88 vs 0.77 95% CI 0.74 to 0.80; p<0.001), with an optimism-corrected AUROC of 0.843. Using a low-risk cut-off (≤5), AGATE classified 38% (1900/5000) as low risk (0.3% mortality, 4.0% intervention), compared with 15% (750/5000) for GBS ≤1.</p><p><strong>Conclusion: </strong>AGATE provides balanced pre-endoscopic triage by integrating predictors from ABC and GBS, expanding the low-risk group while maintaining very low short-term mortality. Prospective external validation in independent multicentre settings is required.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}