Young Investigator's Award Finals

YIA-01

Piezo1-mediated lactate metabolism in intestinal vascular endothelial cell is involved in macrophage activation in IBD

Chang Liang and Yan Zhang

Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China

APDWF and JGHFoundation Young Investigator's Awards, November 23, 2024, 5:10 PM - 6:30 PM.

Objectives: In IBD patients, elevated mesenteric blood flow alters mechanical forces in intestinal vascular endothelial cells (VECs). These cells sense changes via the mechanosensitive ion channel Piezo1, converting mechanical stimuli into inflammatory signals and inducing inflammation. VECs also secrete lactate, contributing to inflammation. The role of Piezo1 in regulating intestinal vascular lactate metabolism in IBD remains unclear.

Materials and Methods: Single-cell sequencing was performed on colon tissues from IBD patients and healthy controls to investigate Piezo1 expression and lactate metabolism. Endothelial cell-specific Piezo1 knockout (Piezo1iΔEC/iΔEC) mice were generated and subjected to DSS-induced colitis. Inflammation severity, lactate levels in endothelial cells and plasma, and macrophage polarization were measured. HIF-1α-MCT signaling was explored.

Results: Piezo1 expression was significantly higher in the colonic mucosa of active IBD patients and DSS-induced colitis mice compared to controls. Single-cell sequencing showed Piezo1 enrichment in intestinal VECs in active IBD. Piezo1iΔEC/iΔEC mice with DSS-induced colitis showed reduced IL-6, TNF-α, IL-1β levels, decreased M1 macrophage activation, and lower lactate levels compared to controls. Piezo1 knockdown inhibited HIF-1α and MCT expression in VECs.

YIA-02

Prevalence and endoscopic characteristics of dyspepsia in Japanese adults: insights from a cancer screening initiative

Suguo Suzuki¹, Takeshi Kanno^1,2, Tomoyuki Koike¹, Takashi Chiba³, Kiyotaka Asanuma³, Katsuaki Kato³, Yutaka Hatayama¹, Yohei Ogata¹, Masahiro Saito¹, Xiaoyi Jin¹, Waku Hatta¹, Kamane Uno¹, Akira Imatani¹ and Atsushi Masamune¹

¹Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan; ²R and D Division of Career Education for Medical Professionals, Medical Education Center, Jichi Medical University, Shimotsuke, Japan; ³Miyagi Cancer Society, Sendai, Japan

APDWF and JGHFoundation Young Investigator's Awards, November 23, 2024, 5:10 PM - 6:30 PM.

Objectives: Dyspepsia is a significant social issue due to its negative impact on quality of life, with substantial cases showing no findings on upper gastrointestinal endoscopy (EGD). Recent Japanese epidemiologic reports on dyspepsia in the general population are limited. This study aimed to clarify the prevalence of dyspepsia and EGD findings in the Japanese population.

Materials and methods: Participants in the public gastric cancer EGD screening program in Sendai, a city with a population of approximately 1.08 million, targeting residents ≥50 years from April 2019 and March 2021, were enrolled. Data included symptoms (heartburn, upper abdominal pain, and bloating), EGD findings, sex, age, and history of Helicobacter pylori eradication. Dyspepsia was defined as upper abdominal pain and/or bloating.

Results: A total of 23,250 individuals (9,562 men and 13,688 women) with a median age of 70 years were enrolled. Heartburn and dyspepsia were reported in 20.7% and 28.0% of them repectively. Multiple logistic regression analysis revealed factors associated with dyspepsia: female (OR 1.82, 95% CI: 1.71–1.94); age <70 years (OR 1.09, 95% CI: 1.02–1.15); after H. pylori eradication (OR 1.10, 95% CI: 1.03–1.18); erosive esophagitis (OR 1.30, 95% CI: 1.15–1.48); gastric ulcer (OR 1.56, 95% CI: 1.01–2.43); and duodenal ulcer (OR 2.57, 95% CI: 1.23–5.39). The proportion of individuals without EGD findings showed no significant difference regardless of dyspepsia status, 29.3% and 27.9%.

YIA-03

Double-blinded placebo-controlled randomized trial evaluating non-enteric coated enzymes effect on pain in chronic pancreatitis

Misbah Unnisa, Abdul Rasheed, Rajesh Goud, VV Chandana, Manohar Reddy, Jahangeer Basha, Chandan Palle, Shagufta Farheen, Manu Tandan and D. Nageshwar Reddy and Rupjyoti Talukdar

Asian Institute Of Gastroenterology (AIG) Hospitals, Hyderabad, India

APDWF and JGHFoundation Young Investigator's Awards, November 23, 2024, 5:10 PM - 6:30 PM.

Objectives: Even though earlier meta-analyses did not show pain reduction with pancreatic enzyme supplementation, subgroup analysis with non-enteric coated preparations did document benefit. In this study, we assessed the effect of non-enteric coated pancreatic enzyme preparation on pain in CP (NCT05042284).

Materials and Methods: Patients with CP (per Mayo Clinic criteria) with chronic pain were enrolled. The primary outcome was a change in pain scores (VAS 0–10) at 12-weeks. Secondary outcomes were changes in number of painful days, analgesic requirements, hospitalizations, patient's global impression of change (PGIC), and quality-of-life. Weekly pain data were collated. Repeated measures, linear and mixed-effects models were used to analyze the primary outcome. Analysis was intention-to-treat.

Results: 107 out of 256 screened patients fulfilled enrolment criteria and were randomized into placebo(n = 53) and high protease(30,000 U) containing non-enteric coated enzyme preparation(n = 54) groups. 76(71%) patients were male and the baseline characteristics matched in both groups. At the end of 3 months, the calculated mean difference of VAS pain score between placebo and enzyme group was 0.38 (−0.94 to 1.69)[P = 0.58] indicating no significant difference. The mean number of analgesics in placebo and enzyme group were 3.9 ± 5.2 and 10.8 ± 24.4; hospitalizations in both the groups were 0.2 ± 0.9 and 0.1 ± 0.9 days respectively, the differences being non-significant. The difference in changes in the number of painful days, global health status, quality of life, PGIC and adverse effects were also non-significant.

YIA-04

Texture and color enhancement imaging improves colonic adenoma detection: a multicentre randomized controlled trial

Edward Young^1,2, Arvind Rajagopalan¹, Derrick Tee^1,2, Dharshan Sathananthan^1,2, Sophie Hoile^1,2 and Rajvinder Singh^1,2

¹Lyell McEwin Hospital, Northern Adelaide Local Health Network, Adelaide, Australia; ²Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia

APDWF and JGHFoundation Young Investigator's Awards, November 23, 2024, 5:10 PM - 6:30 PM.

Objectives: Despite participation in population bowel cancer screening programs, patients continue to develop preventable interval colorectal cancers due to missed polyps at prior colonoscopy. Texture and color enhancement imaging (TXI) is a new advanced mucosal imaging technology, seeking to improve lesion identification without compromising the familiar color spectrum. This study aimed to compare TXI to high-definition white light imaging (WLI) for adenoma detection during colonoscopy.

Materials and Methods: This randomized controlled trial was performed in two tertiary hospitals, with patients over the age of 18 referred for colonoscopy eligible for inclusion in the study. 324 patients were included in the final analysis, with 163 randomized to examination using TXI and 161 to WLI. After colonoscope insertion to the caecum, the assigned imaging was used for the entirety of mucosal inspection time. Only polyps that were resected and confirmed histologically were included in the analysis.

Results: Overall adenoma detection rate was higher with TXI versus WLI (54.6% versus 40.99%, P = 0.01). The mean number of adenomas per colonoscopy was also higher with TXI than WLI (1.71 versus 0.94, P < 0.01). TXI increased the number of flat (0.58 versus 0.24, P < 0.01) and right-sided (1.13 versus 0.73, P = 0.03) adenomas detected per colonoscopy. Multivariable analysis demonstrated an odds ratio of 2.42 (95% CI 1.5–4.0) for adenoma detection with TXI compared to WLI.

Conclusion: TXI improves adenoma detection during colonoscopy, particularly for flat and right-sided adenomas that have historically been difficult to detect.

YIA-05

Plasma proteomic profiles predict future NAFLD in healthy adults

Shiyi Yu^1,2,3,4, Chun Ling Chen^1,2, Weihong Sha^1,2 and Hao Chen^1,2

¹Department of Gastroenterology, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, China; ²The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; ³HKUMed Laboratory of Cellular Therapeutics, the University of Hong Kong, Hong Kong, SAR, China; ⁴Faculty of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China

APDWF and JGHFoundation Young Investigator's Awards, November 23, 2024, 5:10 PM - 6:30 PM.

Objective: To identify plasma protein biomarkers associated with the onset of non-alcoholic fatty liver disease (NAFLD) and evaluate their predictive power.

Method: We analyzed proteomics data from 52,952 NAFLD-free adults in the UK Biobank over 16.6 years, identifying 782 incident cases. Using Cox proportional hazards regression models, we explored associations between 1,463 plasma proteins and incident NAFLD, adjusting for multiple covariates and applying Bonferroni correction. Significant proteins were further evaluated using LGBM/Cox predictive models, employing sequential forward selection for optimal AUC performance, and SHAP plots to illustrate contributions. Tenfold cross-validation assessed the model's predictive power and robustness.

Results: Among 2,737 plasma proteins, GGT1, FUOM, ACY1, CDHR2, and KRT18 were consistently associated with incident NAFLD and ranked highly in protein importance. Combining GGT1 with demographic data yielded excellent predictive accuracy for NAFLD (AUC = 0.870). Notably, GGT1 and FUOM showed high specificity for dementia prediction, with individuals having higher GGT1 levels being 3.8 times more likely to develop dementia. GGT1, FUOM, ACY1, CDHR2, and KRT18 began changing at least 15 years before NAFLD diagnosis, showing an upward trend.

YIA-06

Optimal positions in Thoracoscopic Esophagectomy: a network meta-analysis of intraoperative and postoperative outcomes

Citra Aryanti^1,2, Edwin Nugroho Njoto³ and Made Mulyawan²

¹Digestive Surgery Training Program, Department Of Surgery, Hasanuddin University, Makassar, Indonesia; ²Division of Digestive Surgery, Department of Surgery, Udayana University, Denpasar, Indonesia; ³Faculty of Medicine and Health, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia

APDWF and JGHFoundation Young Investigator's Awards, November 23, 2024, 5:10 PM - 6:30 PM.

Objective: The robust advantages that thoracoscopic esophageal dissection offers patients have led to its increasing popularity. The patient's positioning is as important as the surgeon's technical proficiency to maximize surgical access and patient safety during these difficult procedures. This study aimed to compare the intraoperative and postoperative outcomes of thoracoscopic esophagectomy performed in three positions: prone, semi-prone, and lateral decubitus.

Methods: A study compared intraoperative and postoperative outcomes in thoracoscopic esophagectomy using different positions. Medline, Scopus, and Cochrane were searched for relevant studies. Intraoperative outcomes included procedure duration, blood loss, lymph node harvest, R0 resection, and conversion rate. Postoperative outcomes included hospital stay, anastomosis leakage, nerve palsy, and pulmonary complications. Statistical analyses were conducted using BUGSnet 1.1.0 in R Studio, and results were displayed using a league table and forest plot.

Results: A quantitative analysis of 19 studies involving 11,715 participants found that the prone position in thoracoscopic esophagectomy resulted in shorter operation time, less blood loss, more harvested lymph nodes, shorter hospital stay, and higher R0 resection rate. However, it had a higher conversion rate to open thoracotomy and increased risk of laryngeal recurrent nerve injury compared to the semi-prone position. The semi-prone position had the lowest risk of anastomosis leakage, pulmonary complications, and laryngeal recurrent nerve injury. The lateral decubitus position did not show any advantages in terms of outcomes.