Oral Presentations

OP-01-01

Innovations in diagnosing indeterminate biliary strictures: Pilot comparison of the specs tool and peroral cholangioscopy

James Emmanuel and Raman A/L Muthukaruppan

Queen Elizabeth Hospital, Kota Kinabalu, Malaysia

Oral Presentation 1, APDW Theatre 1, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objective: This study evaluates the diagnostic capabilities of a new tool, Stent Pusher- guided Endobiliary Forceps (SPECS) in assessing indeterminate biliary strictures.

Procedure (Material): SPECS procedure utilises a 10F sized stent pusher, advanced over a guidewire. Once pusher is correctly positioned with confirmation by fluoroscopy, contrast is injected via the pusher to redelineate the stricture followed by biopsies that are performed using a paediatric biopsy forceps.

Methods: 6 patients with indeterminate biliary strictures underwent evaluation and biopsy using ERCP and POCS followed by a tandem SPECS procedure. Key metrics evaluated included and the technical and clinical success, size of tissue samples, procedure length, and complications.

Results: Technical success for both procedures were 100%. SPECS demonstrated higher diagnostic accuracy compared to POCS 4/6 (66.7%) vs 2/6 (33.3%). Average size of tissue samples (mm) obtained with SPECS were comparable to those with POCS ( median 5.5 vs 4.0 ; p = 0.285). Procedure length (minutes) was shorter with SPECS (median 9.6 vs 14.6 ; p = 0.005). There were no complications reported for both methods.

Discussion: While both modalities have strengths, SPECS which allows contrast instillation, shows advantages in diagnostic accuracy, tissue adequacy and procedure duration. Although our study did not measure cost, accessories used in SPECS are generally more cost-effective. Additionally, SPECS addresses technical challenges and complications seen with free-handed cannulation with biopsy forceps.

Conclusion: Our study highlights SPECS as an effective alternative to POCS for biliary strictures; further research is needed to confirm findings and assess cost-effectiveness in larger populations.

OP-01-02

Differences in peroral cholangioscopic findings between primary sclerosing cholangitis and other bile duct diseases

Taito Fukuma, Toshio Fujisawa and Hiroyuki Isayama

Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan

Oral Presentation 1, APDW Theatre 1, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objective: To evaluate the utility of peroral cholangioscopy (POCS) in distinguishing primary sclerosing cholangitis (PSC) from cholangiocarcinoma by comparing POCS findings among PSC, cholangiocarcinoma, and intrahepatic stones.

Methods: We analyzed POCS findings from patients with PSC, cholangiocarcinoma, and intrahepatic stones from February 2018 to February 2023. Findings were classified as Active (mucosal erythema, ulcers, white exudate, irregular surface), Chronic (traverse scarring, round scarring, pseudodiverticula, stenosis), and Tumorous (tortuous vessels, dilated vessels, fragility, mass formation). The presence of shallow clustered depressions (punched-out lesions: POL) was also assessed. Findings were graded on a 0-4 scale and compared among disease groups.

Results: The study included 22 PSC cases, 25 cholangiocarcinoma cases, and 19 intrahepatic stone cases. Traverse scarring, round scarring, and POL were significantly more frequent in the PSC group (p < 0.001). Irregular surface, dilated vessels, tortuous vessels, fragility, and mass formation were significantly more frequent in the cholangiocarcinoma group (p < 0.001). Pseudodiverticula appeared only in the PSC group. Grade 3 traverse scarring was exclusive to PSC. POL was observed in 91% of PSC cases, and dilated vessels in 88% of cholangiocarcinoma cases.

Discussion: POL is highly sensitive for PSC diagnosis, while pseudodiverticula is highly specific. Traverse scarring is also significant for diagnosing PSC. Distinguishing PSC-associated cholangiocarcinoma from PSC alone is challenging, but irregular surfaces and tumorous findings can aid in differentiation. Dilated vessels are highly sensitive and specific for cholangiocarcinoma diagnosis. Further studies are needed for validation.

OP-01-03

Cholangioscopic and radiologic features of hepatobiliary tuberculosis – An initial single center experience

Leah Anne Legaspi and Evan Ong

Metropolitan Medical Center, Manila, Philippines

Oral Presentation 1, APDW Theatre 1, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: Hepatobiliary tuberculosis (HBTB) is the closest differentials of cholangiocarcinoma. Treatment and prognosis differ hence definitive diagnosis is vital. We aim to describe the cholangioscopic and radiologic features of HBTB.

Materials and Methods: Among patients referred to our center for direct cholangioscopy due to hilar strictures, we collected 7 cases positive for TB GeneXpert. The cholangiograms were characterized on site of involvement, stenosis type, and central ductal communication. The cholangioscopic criteria includes: mucosal coarsening, presence of scars, ulceration, nodules, villous growths, abnormal vessels, and stenosis shape. All cases underwent direct intraductal biopsies for histopathology and TB GeneXpert.

Results: All patients presented with obstructive jaundice. Preliminary imaging studies showed hilar stricture in all. Hepatic calcifications were observed in 5/7 patients. Cholangiograms showed communicating intrahepatic ducts in 4/7, separate right and left ducts in 2/7. Stenosis was smooth tapering in 5/7 with total hilar cut off in 2/7. Direct cholangioscopy showed presence of mucosal coarsening and granularity around the stenosis in all. Other findings include small ulcers, nodularities, scars, fibrous bands, villous projections, abnormal or oozing vessels and presence of lithiasis. The narrowing was slit-like in 4/7 resulting from extraductal bulges. All biopsies were positive for TB GeneXpert and histopathology showed acute and chronic inflammation without malignancy.

Conclusion: Cholangioscopy is useful to differentiate HBTB from cholangiocarcinoma. Direct visualization using the different mucosal features plus a Positive TB GeneXpert rules out malignancy and establishes the diagnosis of HBTB.

OP-01-04

Endoscopic classification of benign neoplasms of the major duodenal papilla

Yury Starkov and Ayubkhan Vagapov and Seda Dzhantukhanova and Rodion Zamolodchikov

Vishnevsky National Medical Research Center for Surgery, Moscow, Russian Federation

Oral Presentation 1, APDW Theatre 1, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: To select the optimal method of treatment of patients with neoplasms major duodenal papilla (MDP), endoscopic typing of neoplasms is necessary, which provides for an accurate topical characterization of the tumor, taking into account the size, growth, and spread to the walls of the duodenum, the terminal sections of the CBD and MPD.

Materials and Methods: From the year 2000 to 2022, 149 patients were diagnoses and treated with MDP tumors in our Center. A total of 134 endoscopic procedures were performed with morphology report confirming the presence of MDP adenomas in 126 cases

Results: Based on the analysis of endoscopic and EUS pictures of 149 patients, we developed an endoscopic classification of MDP neoplasms. In this classification, we have identified 4 types of MDP neoplasms (Table 1) depending on their size, growth patterns, and spread to the walls of the duodenum and the terminal section of the CBD and MPD

Conclusion: The endoscopic classification presented by us makes it possible to categorize MDP tumors depending on the characteristics of growth as well as their topographical and anatomical attributes. This classification allows for standardized criteria by choosing the optimal selection of surgical resection of these tumors. The implementation of this classification into clinical practice allows us based on preoperative endoscopic examination of patients, to select the optimal volume of endoscopic excision of MDP tumors with the most saving resection within healthy tissue and minimizing the risk for postoperative complications

OP-01-05

The value of JNET classification in predicting colorectal polyp histology at Tam Anh Hospital, Vietnam

Le Bich Ngoc Dang

Tam Anh Hospital, Ho Chi Minh City, Vietnam

Oral Presentation 1, APDW Theatre 1, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: To determine the histopathological predictive value of JNET classification with narrow band imaging (NBI), dual focus magnifiying (M-DF) endoscopy.

Materials and methods: Observational, cross-sectional study was conducted, involving a sample of 401 patients with 456 polyps from November 1, 2023 to January 31, 2024 at Tam Anh Hospital, Ho Chi Minh City. The Olympus EVIX X1 CV-1500 system having NBI (Narrow Banding Imaging) with dual focus magnification mode and CF-EZ1500DL Colonoscope were used to evaluate polyps according to the JNET classification. Data were analyzed by SPSS 25.0 software.

Results: 87% of polyps were detected at age ≥40, of which the age of 40-50 accounted for 21,9%. The rate of JNET 1, JNET 2A, JNET 2B, JNET 3 were 12.1%; 85.5%; 1.5%; 0.9% respectively. The sensitivity and specificity of JNET classification were 80% and 98.3% for JNET 1; 98.1% and 75.6% for JNET 2A; 45.5% and 99.5% for JNET 2B; 66.7% and 100% for JNET 3. The specificity in distinguishing malignant neoplasia (including high-grade adenomas and invasive cancers) and benign neoplasia (including low-grade adenomas); in distinguishing deeply invasive cancer from the remaining types of neoplasia were all 100%.

Conclusions: NBI based JNET classification with Dual-focal magnification has high value in predicting the histology of colorectal polyps, thereby, it could help the endoscopists to have the right attitude for management of the polyps without waiting for the histology results, saving the costs, time, effort, and limiting the unnecessary surgeries. Therefore, the JNET classification should be widely and routinely used in Vietnam.

OP-01-06

Strategies for selective resection of SSL in JNET type 1 lesions

Daizen Hirata, Mineo Iwatate, Wataru Sano and Yasushi Sano

Sano Hospital, Kobe, Japan

Oral Presentation 1, APDW Theatre 1, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Aims: We previously conducted a multicenter prospective study to differentiate SSLs among JNET type 1 lesions ≥6 mm and concluded JNET type 1 lesions ≥6 mm were recommended to be resected. On the other hand, selective resection of SSLs can reduce medical costs and procedure-related accidents. We aimed to explore strategies for the selective resection in JNET type 1 lesions.

Methods: This study included all detected JNET type 1 lesions ≥6 mm. Twenty expert endoscopists diagnosed SSLs and HPs, noting eight characteristic findings of SSLs after conventional and magnifying NBI observation. Across four institutions, 4,397 patients were recruited, and 217 JNET type 1 lesions from 162 patients were analyzed. The sensitivity, specificity, and accuracy of endoscopic diagnoses of SSLs were 79.8%, 59.1%, and 71.4%, respectively. As secondary analysis, we extracted the characteristics of misdiagnosed SSLs, proposed two strategies, and evaluated its diagnostic performance.

Results: The misdiagnosed SSLs were more common in the right colon. Therefore, two strategies focusing on lesion location and findings were proposed. Plan A was selective resection performed only in left colon, and plan B was selective resection of lesions with characteristic findings. Simulation of these plans showed that Plan A had a sensitivity of 93.0%, accuracy of 71.9%, and negative predictive value of 80.0%; Plan B increased sensitivity to 95.3% but decreased specificity 20.5% and accuracy 65.0%.

Conclusions: For selective resection of JNET type 1 lesions ≥6 mm, selective resection performed only in the left colon only is recommended.

OP-01-07

Updated incidence and mortality of colon cancer in chinese: A time-trend analysis

Junjie Huang, Sze Chai Chan, Chenwen Zhong, Yat Ching Fung and Martin Wong

The Chinese University Of Hong Kong, Sha Tin, Hong Kong

Oral Presentation 1, APDW Theatre 1, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Background and Aims: This study aims to provide a comprehensive analysis of colon cancer’s disease burden, incidence trend, and mortality trend by sex and age group.

Methodology: The Hong Kong Cancer Registry was accessed to retrieve the number of new cases and deaths. The age-standardized rates (ASR) of colon cancer were calculated. Joinpoint regression was conducted to evaluate the Annual Average Percentage Change (AAPC) of the incidence and mortality of colon cancer.

Results: In Hong Kong, there were 3,189 (ASR=18.1) newly reported colon cancer cases in 2020. Males reported a higher incidence than females (ASR=21.4 vs 15.0 in females). The incidence of the older population aged over 50 was also higher than the younger population (ASR= 79.1 vs 2.7 in the young population). 1,542 colon cancer-related deaths were reported (ASR=7.5) in 2020. Likewise, the reported mortality was higher among males (ASR=9.1 vs 6.0 in females) and the older population (ASR= 34.7 vs 0.6 in the young population). The overall mortality trend of colon cancer decreased significantly (AAPC: -1.2, 95% CI: -1.9, -0.6, p=0.002), particularly among the older population (AAPC: -1.2, 95% CI: -1.9, 0.5, p=0.004), males (AAPC: -1.3, 95% CI: -1.8, -0.8, p<0.001) and females (AAPC: -1.3, 95% CI: -2.3, -0.2, p=0.019) decreased significantly, while no significant changes were observed for the overall and the subgroups’ incidence.

Conclusion: An overall decreasing trend was observed in the mortality of colon cancer, while the incidence trend was stable. Intensive lifestyle modification might be important for the reduction of colon cancer incidence.

OP-01-08

Early and advanced PCCRC in a single GI center in Japan

Mineo Iwatate and Daizen Hirata and Yasushi Sano

Sano Hospital, Kobe, Japan

Oral Presentation 1, APDW Theatre 1, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: Post-colonoscopy colorectal cancer (PCCRC) is a key quality indicator for colonoscopy. However, the difference in PCCRC between the early and advanced stages has not been well studied. To address this gap in the literature, we conducted a retrospective study to evaluate the prevalence and characteristics of PCCRC classified into early and advanced stages in a single GI center in Japan.

Materials and Methods: The medical records of consecutive adult patients with CRC between 2010 and 2020 at Sano Hospital in Japan were retrospectively examined. PCCRC is defined as CRC detected within 36 months of the initial colonoscopy. The characteristics of early and advanced PCCRC were analyzed, including lesion size, macroscopic type, location, and the experience of endoscopists (expert: colonoscopy experience greater than 10 years) at the initial endoscopy.

The results are presented below.

Results: Of 996 CRCs detected during the study period, 19 were diagnosed as PCCRC. The proportion of PCCRC was 1.9% (19/996). Table 1 shows the characteristics of 19 PCCRCs. For PCCRC at an early stage, around 80% of them are LST-NG or IIa+IIc, which are easy to miss due to their subtle appearance. For PCCRC at an advanced stage, 82% of them are located at the blind portion such as SDJ, RSJ, and cecum. Experts performed the initial colonoscopy in almost all PCCRC cases (94%).

OP-01-09

Value of endoscopic tumor grade valuation in rectal neuroendocrine tumors based on vascular pattern

Ye Zheng and Rui Ji

Qilu Hospital, Shandong University, Jinan, China

Oral Presentation 1, APDW Theatre 1, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: The clinical utility of applying endoscopic vascular patterns in rectal neuroendocrine tumor (NET) remains unknown. The aims of this study were to develop a system for utilizing vascular patterns for tumor grade and determine its predictive value and underlying mechanism in rectal NET.

Materials and Methods: We retrospectively included patients diagnosed as well-differentiated rectal NET between March 2015 and July 2022. The entire dataset was randomly divided into evaluation and validation sets. In the evaluation set, three endoscopists and two pathologists reviewed the endoscopic images of 110 lesions; the relationship between endoscopic tumor features and tumor grade was then explored using a multivariable regression model. Based on the endoscopic vessel characteristics, vascular patterns were established and classified into V1 and V2 types. In the validation set, 47 lesions were used to assess the diagnostic performance of the vascular patterns. Angiogenesis-associated markers were also measured using immunohistochemistry.

Results: Multivariate analysis demonstrated good association between tumor grade and vascular pattern (13.65 odds ratio; 95% confidence interval, 2.06–90.58). Vascular patterns exhibited almost perfect intra- and inter-observer agreement (kappa=0.957). The sensitivity and positive predictive value of V1 for predicting Grade 1 were 89.3% and 97.9%, respectively. Immunohistochemical analysis revealed significantly higher microvessel density for V2 than for V1. However, expression of angiogenesis-related factors was negative.

Conclusions: Vascular patterns can help accurately identify tumor grade, which is of considerable value for guiding endoscopists in the determination of lesions suitable for endoscopic resection.

OP-02-01

Gastric microbial changes derived from fifaximin treatment might have an alleviating effect on cirrhosis

Ye Fang, Yifei Liu, Yingjie Ai, Xiaoquan Huang and Shiyao Chen

Zhongshan Hospital, Fudan University, Shanghai, China

Oral Presentation 2, APDW Theatre 2, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: Effect and application of rifaximin, a non-absorbable antibiotic, on hepatic encephalopathy prevention is widely accepted but remains unclear on liver fibrosis. Previous study put emphasis on intestinal flora but gastric microbiota lacks investigation. We aimed to evaluate rifaximin’s impact on gastric flora and downstream effect on liver fibrosis.

Materials and Methods: Intraperitoneal injection of TAA was used for cirrhosis induction. At the eighth week, mice were performed sterilization and randomly divided into two groups for intragastric administration: control (CTRL) and rifaximin (RFXM) group with processed gastric lavage fluids from patients in the corresponding group, every two days and last for two weeks. Liver fibrosis, inflammation and gastrointestinal flora were then estimated.

Results: To validate the impact of gastric flora alteration derived from rifaximin on cirrhosis, we performed gastric lavage intervention and microbe transplantation on cirrhotic mice. HE and Masson staining showed declining hepatic collagen in the RFXM group as Ishak score and collagen volume fraction significantly decrease after microbe transplantation with gastric lavage of rifaximin-treated patients. Liver fibrosis markers including α-SMA, collagen I, collagen III, Tgf-β, Timp-1, and Mmp2 were significantly decreased in RFXM, which also suggested improvement of fibrosis. We also evaluated inflammatory factors and found that there was no difference in TNF-α, IL-2 and IL-6 between two groups while IL-8 likewise evidently declined. Change of gastric microbiota was also verified and multiple taxa exhibited alteration including Pasteurellaceae, Sphingomonadaceae, Alistipes, Rhizobium, Veillonella etc.

OP-02-02

Comparison of prognostic value of sarcopenia and MELD score in patients with cirrhosis of liver

Shivam Gupta

Kalinga Institute Of Medical Sciences, Bhubaneswar, India

Oral Presentation 2, APDW Theatre 2, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: This study aims to compare prognostic value of sarcopenia and MELD score in assessing 28 days and 3 months mortality in patients with cirrhosis of liver and estimate prevalence of sarcopenia in different etiologies of cirrhosis of liver.

Methods: All consecutive gastroenterology OPD and IPD patients ≥ 18 years of age and diagnosed with cirrhosis of liver were prospectively enrolled. Sarcopenia assessment was done as per AWGS 2019 consensus algorithm. In order to determine normal transverse psoas muscle thickness (TPMT) and hand grip strength (HGS) cut-off values for our population (labelled as Indian criteria), 100 subjects (50 males and 50 females) were also prospectively enrolled.

Results: After applying exclusion criteria, 271 patients were enrolled and divided into two groups where 221 patients (81.54%) were sarcopenic and 50 (19.46%) were non-sarcopenic. Significant male preponderance (7.18:1) and a significantly lower mean BMI [22.25±3.58 kg/m2] was noted in the sarcopenic group. Prevalence of sarcopenia was seen to be significantly more in patients with alcohol related liver disease followed by NAFLD. When sarcopenia and MELD score were compared for 28 days and 3 months mortality, significantly higher mortality was seen in patients with sarcopenia than those without sarcopenia at MELD <15.

Conclusions: Our prospective study concludes that at MELD score <15, sarcopenia is better predictor of 3 months mortality than MELD score.

OP-02-03

Ammonia levels vs Child-Pugh scores in predicting mortality among cirrhotic patients: a single-center retrospective cohort

Emily Grace Honorio

Chong Hua Hospital, Cebu, Philippines

Oral Presentation 2, APDW Theatre 2, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Background & Objectives: The Child-Pugh scoring system is used globally to predict mortality among cirrhotic patients. The utility of serum ammonia levels has been widely debated. Although its levels do not correlate with the severity of hepatic encephalopathy, its ability to predict mortality among cirrhotic patients is an area still to be investigated. This study aimed to determine the diagnostic accuracy of ammonia levels versus Child-Pugh scores in predicting mortality among adult cirrhotic patients.

Methodology: After IRB approval, a 4-year retrospective chart review of cirrhotic patients admitted from January 2020 to December 2023 was done; noting the level of ammonia on admission and the Child Pugh score. Comparison was done using Chi-square test and independent t-test for categorical and continuous variables, respectively. Final analysis was done using Jamovi 2.4.7, an R-based open-source statistical computing software to to test the sensitivity of serum ammonia and to find the area under the curve (AUC). All p-values <.05 were considered significant.

Results: Among the 273 records, 192 (70.3%) had shown results of serum ammonia as part of the admission work up. The area under the curve (AUC) was found to be 0.722 (95% CI=0.648-0.796) and is statistically significant (p.<0001). With a cutoff value of 57mcg/dL, ammonia level has a sensitivity of 76.6% and specificity of 59.4% in predicting mortality among cirrhotic patients.

Conclusion: Serum ammonia levels in patients with cirrhosis, despite its negative connotation on hepatic encephalopathy, is a good predictor of mortality comparable with the validated Child Pugh scoring system.

OP-02-04

The association of Child-Turcotte-Pugh’s score with grading esophageal varices in decompensated liver cirrhosis patients

Qayyum Irfan¹, Susanto Hendra Kusuma^2,3, Fardah Akil^2,3, Muhammad Luthfi Parewangi^2,3, Nu'man AS Daud^2,3, Rini R Bachtiar^2,3 and Amelia Rifai^2,3

¹Internal Medicine Specialist Program, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; ²Division of Gastroenterology-Hepatology, Departement of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; ³Centre of Gastroentererology-Hepatology HAM Akil, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Oral Presentation 2, APDW Theatre 2, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: The severity of chronic liver disease can be assessed by several non invasive methods, one of them includes scoring system like Child Turcotte Pugh (CTP) classification, which can predicts the risk of variceal bleeding and has been used as a prognostic tool in patients of liver cirrhosis. The objective of this study was to find association of grade of esophageal varices with CTP class in patients of decompensated liver cirrhosis.

Materials and methods: This was a cross sectional descriptive study in Gastro Center RSUP Wahidin Sudirohusodo, Makassar between January 2024 to June 2024. A total 107 patients were included in the study who were diagnosed as cirrhosis according to AASLD consensus 2024. Patients were classified into CTP class A, B and C. Upper Gastrointestinal endoscopy was performed and endoscopic grading of esophageal varices were correlated with CTP class and the data were recorded and analyzed using chi-square test.

Result: This study involved 107 subjects, with CTP Class A 41 subjects (38.3%), CTP Class B 43 subjects (40.2%) and CTP Class C 23 subjects (21.5%). The degree of varices consisted of small grade 41 subjects (47.6%) and large grade 56 subjects (52.3%). A relationship was found between the CTP Score and the degree of varices with p-value 0.025.

OP-02-05

Metabolic risk factors and adverse outcomes in decompensated alcoholic cirrhosis: A comparative analysis

KK Rashid, Ann Mary George, Akhil N.V, Yamuna R Pillai, Srijaya S Sreesh and Krishnadas Devadas

Government Medical College, Thiruvananthapuram, Thiruvananthapuram, India

Oral Presentation 2, APDW Theatre 2, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: This study compares adverse outcomes in patients with decompensated alcoholic cirrhosis, with and without metabolic risk factors (Met RF) such as diabetes mellitus (DM), hypertension (HTN), dyslipidemia (DLP), and obesity/overweight.

Materials and Methods: In this prospective observational study, 210 inpatients with decompensated alcoholic cirrhosis were monitored for one year. Patients were divided into 105 with Met RF and 105 without (No Met RF). Outcomes included decompensations, hospitalizations, infections, sepsis, acute kidney injury (AKI), disease severity (CHILD status, Child Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) scores), and mortality at 30 days, 90 days, and one year.

Results: The mean age was similar between Met RF (54.04 years) and No Met RF (53.9 years) groups (p=0.95). All participants were male. The Met RF group had lower mean daily alcohol consumption (101.9 g/day vs. 122.24 g/day, p=0.007) and higher CAGE and AUDIT-C scores in No Met RF (p<0.05). Metabolic syndrome (MetS) was present in 35.2% of Met RF. In the Met RF group, 68.6% had DM, 57.1% obesity, 28.6% HTN, 23.8% overweight, and 4.8% had DLP. CHILD C cirrhosis was seen in 77.14% of Met RF and 82.9% of No Met RF. Met RF had higher CRP, urea, creatinine, and potassium (p<0.05). During the 1-year follow-up, Met RF showed increased hospitalizations, decompensations, infections, sepsis, SIRS, and AKI (p<0.05). MELD scores (p<0.02) and mortality were higher in Met RF, with significant 30-day mortality (p=0.017).

Conclusion: Met RF significantly increased morbidity, short-term mortality, and disease severity in decompensated alcoholic cirrhosis.

OP-02-06

Cross-cultural adaptation and validation of the Malay Adult cirrhosiS Knowledge Questionnaire (ASK-QM)

Hak Keith Leung¹, Sanjiv Mahadeva¹, Ruveena Bahavani Rajaram¹, Haniza Omar² and Pauline Siew Mei Lai^3,4

¹Department of Medicine, University Of Malaya, Kuala Lumpur, Malaysia; ²Selayang Hospital, Selayang, Malaysia; ³Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia; ⁴School of Medical and Life Sciences, Sunway University, Sunway City, Malaysia

Oral Presentation 2, APDW Theatre 2, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: Cirrhosis is common in Malaysia, but no questionnaire in the local language (Malay) has been developed to assess patients’ knowledge of this disease. This study aimed to adapt and validate the Malay Adult cirrhosiS Knowledge Questionnaire (ASK-QM).

Materials and Methods: ASK-QM was translated according to international guidelines and validated in two liver cirrhosis with or without decompensation, aged ≥18 years, who could understand Malay at baseline and a fortnight later.

Results: 121 out of 132 patients with cirrhosis agreed to participate (response rate=91.7%). The overall median score of the ASK-QM was 54.5 [38.6-68.2] and the difficulty factor was 0.5 (range: 0.1-0.8 for each domain). Confirmatory factor analysis showed a good model fit with results of Comparative fit index (CFI) ranging from 0.836 to 1.000, whilst, the Tucker–Lewis index (TLI) ranged from 0.690 to 1.004 across all four domains. The root mean square error of approximation (RMSEA) value was reported from 0.000 to 0.100. For standardized root mean squared residual (SRMR) was from 0.008 to 0.015. Patients with tertiary education scored higher compared to those without (63.6 [45.5-77.3] vs 52.3 [36.4-63.6], p<0.05). The overall Kuder-Richardson (KR) coefficient was 0.761 indicating adequate internal consistency. Test-retest among 82 out of 121 patients (response rate=67.7%) demonstrated adequate reliability with eighteen out of 22 items having Wilcoxon signed-rank test values that were statistically not significant, p>0.005.

Conclusion: The ASK-QM was found to be a valid and reliable questionnaire for evaluating knowledge of liver cirrhosis amongst Malay-speaking adults.

OP-02-07

DOACs are associated with lower bleeding risk than warfarin in patients with cirrhosis

Yichong Jiang^1,2,3, Lilian Yan Liang^1,2,3, Terry Cheuk-Fung Yip^1,2,3, Jimmy Che-To Lai^1,2,3, Vincent Wai-Sun Wong^1,2,3 and Grace Lai-Hung Wong^1,2,3

¹Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong; ²Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong, Hong Kong; ³Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong

Oral Presentation 2, APDW Theatre 2, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Background: Patients with cirrhosis often have indications for anticoagulation. In recent years, DOACs have become the preferred anticoagulant in many clinical contexts, but their safety in cirrhosis remains unclear. This study aimed to compare the risk of bleeding in patients with cirrhosis who received warfarin and DOACs.

Method: This territory-wide, retrospective cohort study included patients with cirrhosis diagnosed in Hong Kong between 2000 and 2020. Warfarin and DOAC users were defined as those prescribed these medications for 4 weeks or more. Bleeding events, e.g., gastrointestinal bleeding and intracranial hemorrhage, were identified based on ICD-9-CM diagnosis codes.

Results: Of 31,542 patients with cirrhosis, 1,360 received warfarin (mean age 67.4±13.1 years), and 495 received DOACs (mean age 74.1±11.0 years). At a median follow-up of 1.5 (IQR 0.2-4.3) years, 291/1855 (15.7%) patients developed bleeding, with 137 gastrointestinal bleeding and 64 intracranial hemorrhage. The 3-year cumulative incidence of bleeding was 24.8% and 16.6% in warfarin and DOACs users, respectively (p<0.001; Figure 1A). Lower baseline hemoglobin (adjusted hazard ratio[aHR] 0.81, 95% CI 0.76-0.87, p<0.001), higher baseline MELD score (aHR 1.07, 95% CI 1.02-1.13, p=0.009) and warfarin use (DOACs vs warfarin; aHR 0.70, 95% CI 0.51-0.95, p=0.023) were associated with more bleeding in the multivariable Cox model. Patients with baseline hemoglobin ≤10g/dL had a higher risk of bleeding in both warfarin (p<0.001) and DOAC (p=0.007) users (Figures 1B-1C).

OP-02-08

Identification of subphenotypes of septic patients with liver cirrhosis

Jiaxi Lin and Jinzhou Zhu

Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China

Oral Presentation 2, APDW Theatre 2, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Background and Aims: Septic patients with liver cirrhosis exhibits considerable heterogeneity. The objective of current study was to identify subphenotypes of liver cirrhosis with sepsis among intensive care unit (ICU) patients.

Methods: A retrospective study was performed based on the Medical Information Mart for Intensive Care (MIMIC-IV 2.0) database. Using unsupervised clustering, we identified distinctive subphenotypes based on 37 clinical variables obtained on admission. Primary outcomes were 28-day mortality. Cox regression was applied to quantify the risk associated with each subphenotype concerning clinical outcomes. A machine learning (ML) prediction model was developed and made available online, capable of identifying these subphenotypes from fundamental clinical variables.

Results: Our study enrolled a total of 1087 septic patients with liver cirrhosis, revealing two unique subphenotypes via k-means clustering algorithm. Subphenotype 1 was assigned to 719 patients (66%) and subphenotype 2 to 368 patients (34%). The subphenotype 2 was characterized by higher levels of hepatic injury, higher SOFA scores (average SOFA scores were 12.5), and worse clinical outcomes (28-day mortality, 49%). Subphenotype 2 showed significantly increased risk of 28-day mortality compared to Subphenotype 1 (hazard ratio [HR] = 2.14 [95%CI 1.69 – 2.71], p < 0.001). The ML model integrated seven variables could predict subphenotypes accurately.

Conclusion: This study differentiated and stratified subphenotypes among septic patients with liver cirrhosis, laying a foundation for more personalized therapeutic strategies. The predictive ML model developed has the potential to bolster clinical decision-making pertaining to these patients within the ICU setting.

OP-02-09

Evolving trends in liver cirrhosis in Pakistan (2002-2022): Causes and future predictions

Om Parkash, Abhishek Lal, Mushyada Ali, Safia Awan and Zainab Samad

Aga Khan University, Karachi, Pakistan

Oral Presentation 2, APDW Theatre 2, Exhibition Hall, November 22, 2024, 10:30 AM - 11:50 AM

Objective: This cross-sectional study was conducted to review the pattern of cirrhosis from years 2008 to 2021.

Methods: Data regarding primary index cases with associated diagnoses was obtained from Health Information Management Systems (HIMS) at the Aga Khan University Hospital, Karachi, Pakistan. Data was collected using the International Classification of Diseases (ICD) codes 9th and 10th version.

Results: This study included total of 10,394 patients between years 2008 to 2021.Significant changing patterns have been observed over the study period and these patterns include age onset of cirrhosis (p-value <0.001), change in aetiology (p-value <0.001), and gender difference for HBV (p-value= 0.65). Prevalence of cirrhosis fluctuated around 20%, with no significant changes from 2008 to 2021 (p-value= 0.06). Primary etiologies of Cirrhosis presented significant changes over years, with HCV being most common. However, prevalence of HCV decreased from 60.2% in 2008 to 41% in 2021. Conversely, prevalence of non-b and non-c liver diseases showed increased prevalence from 16.8% to 28.8%. Mortality rates of patients over the years remained relatively stable. There were notable gender differences where males had higher cases of HBV infection as compared to females (15.1%, 5.4%). However, high cases of non-b and non-c cases were in higher proportions in females in comparison to males (26.6%, 20%).

Conclusions: Evolving patterns in the age of onset, aetiology, and gender disparities in cirrhosis emphasize the dynamic nature of this disease. These findings call for updated public health strategies and personalized treatment approaches to address changing demographics and causative factors of cirrhosis.

OP-03-01

The Correlation between refractory functional dyspepsia, stress levels and autonomic nervous system balance

Apriliana Adhyaksari¹, Triyanta Yuli Pramana², Ratih Arianita³, Aritantri Darmayani² and Didik Prasetyo²

¹Subspecialist Program Division of Gastroenterohepatology Internal Medicine Department, Faculty of Medicine Sebelas Maret University Dr. Moewardi Hospital, Surakarta, Surakarta, Indonesia; ²Division of Gastroenterohepatology Internal Medicine Department, Faculty of Medicine Sebelas Maret University Dr. Moewardi Hospital, Surakarta, Surakarta, Indonesia; ³Division of Psychosomatic and Palliative Medic Internal Medicine Department, Faculty of Medicine Sebelas Maret University Dr. Moewardi Hospital, Surakarta, Surakarta, Indonesia

Oral Presentation 3, Uluwatu 1, November 22, 2024, 10:30 AM - 11:50 AM

Introduction: Functional dyspepsia (FD) is one of the FGIDs that can cause chronic symptoms and is associated with heterogeneous disorders. One of which is linked to an imbalance of the autonomic nervous system (ANS) and also well known that psychosocial comorbidity is considered to play an important role. This study aims to investigate the correlation between stress levels, ANS changes, and the severity level of FD.

Materials and Methods: A total of 25 FD. Dyspepsia score, psychosocial comorbidities and the changes in ANS were recorded in one-time meeting.This study was cross-sectional design. All basic characteristics data are expressed as median values.

Results: This study revealed that the severity level of FD correlates with PSS-10 (total score p<0,001), which indicates patients with FD have increased psychosocial stressors.We found that patients with FD tend to have a decreased parasympathetic activity (LF/HF mean 2,16±2,91) but have no statistical correlation (SDNN p=0,993 and LF/HF p=0,954).On the other hand, psychosocial stressors correlate with the ANS changes (p=0,017), indicating that parasympathetic dysfunction may caused by psychosocial comorbidities.

Discussion and Conclusion: ANS is rarely assessed in treating GI disorders. In this study, the level of SDNN based on the average age, was relatively lower compared to the SDNN reference (the mean SDNN at age 30s is 41). LF/HF ratio in this study also revealed a higher number.These findings indicate that reduced parasympathetic activity and psychosocial comorbidities have a strong correlation with these changes. Therefore, further studies are necessary to establish the causal factors of the observed parasympathetic dysfunction in FD.

OP-03-02

Endoscopic findings in patients with different breakfast timings & their short leed score

Kiran Bajaj and Shahid Karim

Liaquat nation hospital Karachi, Karachi, Pakistan

Oral Presentation 3, Uluwatu 1, November 22, 2024, 10:30 AM - 11:50 AM

Background: Breakfast, as the first meal of the day, varies considerably over time among people of even same culture and country. Specially in urban people it has changed over time, in terms of content & timing. Missing meals specially breakfast might make you feel unhealthy and low in performance.

Objective: To see endoscopic changes in patients with different breakfast timings and their short Leeds dyspepsia score, visiting outpatient clinics in a tertiary care hospital.

Methods: This cross-sectional study was performed in outpatient clinics of Gastroenterology Department in Liaquat National Hospital, Karachi after acquiring formal permission from Hospital Ethics. Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) was used to identify severity of dyspepsia and Gastroscopy was performed in symptomatic patients to see endoscopic findings.

Results: Total 400 patients were enrolled in study with mean age of 43±15.8 years and majority were males (53%). Average breakfast time was 9.0am±1.8hr (it ranges from 5:30am to 11.45am). frequency of esophagitis (50%), moderate to severe gastritis (38.7% & 65.4% respectively) and duodenitis (69.9%) were higher in patients having breakfast after 9-10 am. Frequency of dyspeptic symptoms was 86.5%, 75.3%, 45.3% and 42% for indigestion, heartburn, nausea and regurgitation respectively. Mean SF Leeds score was 14±5.6. Regression analysis showed that there was increase of 2.03 units in SF Leeds score with one-unit increase in breakfast timing.

Conclusion: Study found significant relationship of breakfast timing with endoscopic severity of inflammation in Gut and increase SF Leeds score, particularly in those patients having breakfast after 10:00 O’ clock in morning.

OP-03-03

Functional luminal imaging probe (FLIP) characteristics of achalasia - the first Asian experience

Chiu Leung Jacky Ho¹, Tin Long Marc Wong¹, Hon Chi Yip² and Che Yuen Justin Wu¹

¹Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong; ²Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong

Oral Presentation 3, Uluwatu 1, November 22, 2024, 10:30 AM - 11:50 AM

Objective: Endoluminal functional imaging probe (FLIP) is a promising tool in diagnosing esophageal disorders, but no data exists on its use in the Asian population. Our objective is to define the FLIP characteristics of Asian achalasia patients.

Materials and Method: We retrospectively reviewed achalasia patients with high-resolution manometry (HRM) and FLIP performed from 2020-2024 at Prince of Wales Hospital, Hong Kong. Patients with prior endoscopic or surgical treatment were excluded. HRM was analyzed using the Chicago 4.0 classification. FLIP results were reviewed for contractility response (CR) and esophagogastric junction (EGJ) opening (based on EGJ distensibility index [EGJ-DI] and maximal EGJ diameter). Subgroup analysis was conducted for type I and type II achalasia.

Results: Twenty-five achalasia patients (mean age 47.3, 52% male, 96% Chinese) were included. The primary indication for FLIP was pre-operative assessment (72%). The mean EGJ-DI was 1.89 ± 1.15. The commonest CR pattern was absent contractility (60%). Eight (32%) and 5 (20%) patients had EGJ-DI >2 and >2.8 respectively. None had both normal EGJ opening and CR. Type II patients (52%) had significantly higher LES basal pressure than type I (25.93 ± 16.26 vs 19.22 ± 9.68, p = 0.03), but they were not different in other baseline characteristics, HRM metrics and FLIP findings.

Conclusion: Our achalasia cohort showed FLIP characteristics similar to Western data, with no significant differences between type I and type II patients. However, the existing EGJ-DI cutoff is not sensitive for Asian achalasia patients. Further studies are needed to define FLIP normality in Asians.

OP-03-04

Development of an electronic patient-reported outcome (ePRO) web system for functional gastrointestinal disorders (FGID)

Mamoru Ito, Masao Yoshioka, Ryoichi Harada, Daisuke Kawai, Keita Harada, Shyuhei Ishiyama, Akiko Fujiwara, Junichiro Nasu and Junji Shiode

Okayama Saiseikai General Hospital, Okayama, Japan

Oral Presentation 3, Uluwatu 1, November 22, 2024, 10:30 AM - 11:50 AM

Background: In the treatment of FGID , improving quality of life (QOL) and subjective symptoms are the primary treatment goals. Despite the importance of developing treatment strategies based on patient-reported outcomes (PRO) in FGID care, there are few reports of real-time use of ePRO in daily clinical practice.

Objective: The goal was to develop an ePRO system that is easy to use in daily FGID clinical practice.

Materials and Methods: An ePRO system was developed that allows FGID patients to select and respond PRO questionnaires according to their clinical situation. It was designed to enable real-time quantification of QOL.

Results: The ePRO system was constructed using open-source software such as CentOS, Apache, and PostgreSQL. The system comprises a web server and database management system on a virtual private server (VPS) with Linux as the platform. The system was constructed with a web server and database management system as middleware, and it includes three web applications. In clinical settings, tablet devices are used to access the server for data input and viewing. Previous data can be retrieved from the database and shared as color graphs showing score trends.

Conclusion: While the importance of Shared Decision Making (SDM) is widely recognized, it often requires considerable time. The ePRO web system we developed can be utilized in clinical practice and track each patient's PRO. The system, sharing PRO trends with patients, could be a valuable tool for facilitating SDM within the limited time available in clinical practice.

OP-03-05

Association between Duodenal eosinophil count and functional dyspepsia- a case-control study

Imteaz Mahbub¹, ANM Saifullah², M Masudur Rahman¹ and Md Golam Kibria¹

¹Sheikh Russel National Gastroliver Institute & Hospital, Dhaka, Bangladesh; ²Sheikh Sayera Khatun Medical College and Hospital, Gopalgonj, Bangladesh

Oral Presentation 3, Uluwatu 1, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: Functional dyspepsia (FD) is one of the common gastrointestinal disorders where immune activation by eosinophils is hypothesized to be an important mechanism behind the pathogenesis. This study aimed to evaluate the association of duodenal eosinophil count with FD.

Materials and Methods: This case-control study was conducted in the gastroenterology department, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh. Endoscopic biopsy was taken from the second part of the duodenum of 46 FD cases and 40 controls. Eosinophil counting was done by a pathologist and expressed per HPF. Eosinophil count >21/HPF was considered as the cut-off value for high eosinophil count.

Results: Forty-six adult FD patients diagnosed by Rome-III criteria were taken as cases. Forty patients attending for endoscopy with different indications with normal features were taken as controls. The mean age was (40.34± 16.22) and (40.15± 13.96) in FD patients and controls (P = 0.997). Among 46 females- 25 were FD and 21 were controls; among 40 males- 21 were FD and 19 were controls respectively (P = 0.863). The mean eosinophil count of the second part of Duodenum in FD patients (23.98±7.98) was higher than controls (15.63±5.94) (P <0.001). A total of 32 FD patients (69.6%) had >21/HPF eosinophil while 7 patients (17.5%) had >21/HPF eosinophil (P <0.001).

Conclusions: Eosinophil count of duodenum was significantly higher in FD patients than controls and 9.74 times more likely to be associated with it.

OP-03-06

Mycobacterium peregrinum: A novel candidate for gastric pathogen in Indonesian dyspeptic patients

Muhammad Miftahussurur^1,2 and Ricky Indra Alfaray^2,3

¹Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Mediicine, Universitas Airlangga, Surabaya, Indonesia; ²Helicobcter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia; ³Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan

Oral Presentation 3, Uluwatu 1, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: Despite Helicobacter pylori being commonly linked to gastritis, the high prevalence of gastritis in Indonesia contrasts with the low incidence of H. pylori infection. This suggests other bacteria may contribute to gastric diseases in the region. Our study aimed to investigate a specific bacterium isolated from Indonesian gastritis patients that grew on selective H. pylori plates.

Materials and Methods: We isolated this bacterium from several gastritis patients using H. pylori selective plates and identified the species through 16S rRNA analysis. The pathogenic potential was assessed through various biochemical tests and infection assays using the AGS cell line. We extracted and sequenced the DNA using both short and long-read sequencing technologies, followed by hybrid assembly with Trycycler to achieve high-quality whole genome sequencing. The genome was then analyzed for virulence factors.

Results: The bacterial species identified was Mycobacterium peregrinum, found in the corpus, antrum, and duodenum of gastritis patients. Biochemical tests essential for survival and pathogenicity in the stomach, including urease, oxidase, and catalase tests, were positive. M. peregrinum induced a hummingbird-like appearance in AGS cells, mimicking the outcome of H. pylori infection. Genome analysis revealed several virulence factors potentially responsible for inflammation and continuation of this bacterium in the infected cells.

Conclusion: Our study suggests that M. peregrinum may be a potential candidate that contribute to the high rates of gastritis in Indonesia, despite the low prevalence of H. pylori infection. This finding highlights the need for further investigation into non-H. pylori bacterial involvement in gastric diseases.

OP-03-07

Additional role of transabdominal ultrasonography on esophagogastroduodenoscopy for uninvestigated dyspepsia; a prospective study

Sapol Thepwiwatjit, Piyaporn Apisarnthanarak and Supot Pongprosobchai

Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

Oral Presentation 3, Uluwatu 1, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: Esophagogastroduodenoscopy (EGD) is a mainstay investigation of dyspepsia. Transabdominal ultrasonography (US) was widely used among general practitioners, but the benefit was unclear. We aimed to evaluate the diagnostic yield of EGD plus US in the investigation of dyspeptic patient indicating for EGD.

Materials and Methods: All patients with dyspepsia indicating for EGD were enrolled. EGD plus US were performed. Lesions detected from EGD and US were recorded and classified according to the possibility to be an etiology of dyspepsia.

Results: Overall, 263 patients were enrolled. The mean age (SD) was 59 (12) years and 79% were female. Common EGD findings in order were non-erosive gastritis (66%), erosive gastritis (17%), and normal EGD (10%). Twenty-two percent were considered significant lesions, but no gastroesophageal cancer was detected. H. pylori was present in 27%. Common US findings were fatty liver (46%), normal US (27%), and gallstone (10%). Eight percent showed lesions which required further work up e.g. focal liver lesion and pancreatic cyst, but all were finally insignificant. No HPB cancer was detected.

Conclusion: The diagnostic yield of EGD in dyspeptic patient indicating for endoscopy was low. Additional US did not augment the diagnosis yield from EGD.

OP-03-08

Perceptions and approach of Indian practitioners towards high risk of gastrointestinal complications: Questionnaire-based physician study

Pooja Vaidya, Dattatray Pawar and Akhilesh Sharma

Alkem Laboratories Limited, Mumbai, India

Oral Presentation 3, Uluwatu 1, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: Gastroprotection is often neglected by physicians in patients at increased risk of GI complications such as erosions, ulcers and bleeding which can be detrimental to patient’s health. This study was conducted to assess perceptions, approach, and clinical practice of physicians towards gastroprotection in such patients.

Materials and Methods: This cross-sectional, observational, questionnaire-based study was conducted by interviewing physicians attending a national conference from all across India. Questionnaire comprised of 10 multiple-choice and open-ended type questions. Descriptive statistics were used to assess responses.

Results: Overall 672 physicians participated including consulting physicians (80%, 539), general physicians (14%, 91), and other specialties including cardiology, pulmonology, diabetology, etc. (6%, 42). About 94.7% physicians believed some patients under their care are at high risk of GI complications. In clinical practice, such patients are encountered frequently (several times a month) by 41% physicians, and very frequently (almost daily) by 10%. Common risk factors identified were increasing age (50%), smoking (50%), H. pylori infection (39%), concomitant medications (NSAIDs, steroids, etc.; 33%), diabetes (31%), and hypertension (26%). Overall, 93.3% physicians prescribed gastroprotective agent, typically for 1-3 months. Pantoprazole was preferred (52%) agent, followed by ranitidine and famotidine (20%), omeprazole (11%), esomeprazole (9%), and rabeprazole (8%). Challenges in managing high-risk patients included lack of awareness among physicians, non-compliance, polypharmacy, and failure to identify high-risk patients.

Conclusion: Identification and management of risk factors for gastrointestinal complications can significantly improve patient outcomes. Increasing physician awareness and implementing clear guidelines for high-risk patients is crucial.

OP-03-09

HUC-MSC-derived exosomes delivery of miR-337-3p targets HKDC1 in treating gastric precancerous lesions

Qianqian Xu, Mingyue Liu and Hongwei Xu

Department of Gastroenterology, Shandong Provincial Hospital, Shandong, China

Oral Presentation 3, Uluwatu 1, November 22, 2024, 10:30 AM - 11:50 AM

Objectives: To validate human umbilical cord mesenchymal stem cell-derived exosomes (MSC-Exo) in reversing gastric precancerous lesions (GPL) and explore its regulation of hexokinase domain containing 1 (HKDC1).

Materials and Methods: MSC-Exo were isolated by ultracentrifugation and co-cultured with N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-induced GPL cells (MC). Apoptosis was assessed by flow cytometry, autophagosomes by immunofluorescence, and HKDC1, EMT, apoptosis, and autophagy markers by Western blot. MiR-337-3p, predicted to target HKDC1, was validated using qRT-PCR and dual-luciferase reporter assays. MC were transfected with miR-337-3p mimics/inhibitors to examine its impact on HKDC1. HUC-MSCs transfected with miR-337-3p inhibitors provided exosomes (inhibitor-Exo) for further analysis. MC was co-cultured with inhibitor-Exo to assess miR-337-3p effects on HKDC1 and related markers. BALB/c mice GPL models induced with N-methyl-N′-nitrosourea (MNU) were treated with MSC-Exo, inhibitor-Exo, controls, or saline to evaluate therapeutic effects and HKDC1 regulation.

Results: Exosomes internalized by MC reduced HKDC1, apoptosis, and EMT while increasing autophagy. Dual-luciferase assays confirmed miR-337-3p binding to HKDC1 mRNA 3' UTR. MSC-Exo upregulated miR-337-3p in MC, reducing HKDC1, whereas inhibition of miR-337-3p reversed these effects. Co-cultured with inhibitor-Exo reduced miR-337-3p, upregulated HKDC1, and mitigated MSC-Exo effects on EMT, apoptosis, and autophagy in MC. MSC-Exo administered via tail vein reduced HKDC1 and reversed GPL in mice, while miR-337-3p inhibition compromised therapeutic efficacy.

Conclusion: HUC-MSCs deliver miR-337-3p via exosomes targeting HKDC1 mRNA 3' UTR, playing a crucial role in reversing gastric precancerous lesions.

OP-04-01

The success rate of ERCP in obstructive jaundice cases: A one-year preliminary study in Malang

Mochamad Fachrureza, Syifa Mustika, Supriono Supriono and Bogi Pratomo

RSSA, Malang, Indonesia

Oral Presentation 4, APDW Theatre 1, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: ERCP has an important place in identification and treatment of obstructive jaundice. The most common therapeutic ERCP are extracting stone and stenting. This is a preliminary study to evaluate the success rate of therapeutic ERCP in Saiful Anwar General Hospital over 1-year experience.

Methods: We conducted a retrospective study based on medical record of patients who had undergone ERCP in Saiful Anwar General Hospital from March 2023 until March 2024. Univariate and multivariate analysis was performed to evaluate predictors of ERCP failure.

Results: The study included 17 patients with obstructive jaundice who had undergone ERCP. The etiology varied from bile duct stone (76.5%), malignancies of biliary obstruction (17.6%), CBD stricture (5.9%). The success rate of ERCP was 82.4%. The complication post-ERCP was 29.5% (pancreatitis 11.8%, hypoalbuminemia 11.8% and septic shock 5.9%), 30-day morbidity was 17.6% and 6-month morbidity was 5.9%. At multivariate analysis, cholangitis and CBD stricture were related to higher extraction stone failure with OR 25.44 (95% CI 2.15±87.33) and mass was related to higher stent failure with OR 32.61 (95% CI 6.37±121.47).

Conclusion: The success rate of extracting stone and stenting is acceptable for ERCP in the management of obstructive jaundice. Despite of its associated complication, ERCP is a reliable method in treating obstructive jaundice.

Key words: ERCP, extracting stone, obstructive jaundice, stenting, success rate

OP-04-02

Efficacy of nomogram for prediction of treatment-related adverse events for peripancreatic fluid collections: Wonderful-study group

Toshio Fujisawa¹, Sho Takahashi¹, Tsuyoshi Hamada², Mamoru Takenaka³, Atsuhiro Masuda⁴, Hideyuki Shiomi⁵, Takuji Iwashita⁶, Hiroyuki Isayama¹, Ichiro Yasuda⁷ and Yosuke Nakai⁸

¹Graduate School of Medicine, Juntendo University, Tokyo, Tokyo, Japan; ²Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; ³Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan; ⁴Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan; ⁵Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan; ⁶First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan; ⁷Third Department of Internal Medicine, University of Toyama, Toyama, Japan; ⁸Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan

Oral Presentation 4, APDW Theatre 1, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Endoscopic drainage for peripancreatic fluid collection (PFC) is effective, but the incidence of treatment-related adverse events (tAEs) is high. An Italian group proposed a nomogram that predicts tAEs based on four items of main pancreatic duct injury, abnormal vessels, the need for a multigate technique, and the need for percutaneous drainage (Digestive Endoscopy 2022;34:1459). We examined the validity of this nomogram using a Japanese multicenter cohort of the WONDERFUL study group.

Materials and Methods: Validation of the nomogram was performed using our cohort of 441 PFCs at 11 Japanese centers. The association between the nomogram score and the incidence of tAEs was statistically analyzed using the Cochrane-Armitage trend test.

Results: The cohort consisted of 339 (77%) males, and 245 (55%) WONs. LAMSs were placed in 96 (22%) cases and 114 cases underwent endoscopic necrosectomy (26%). Technical and clinical success rates were 97.3% and 87.5%, respectively. A total of 59 (13.4%) tAEs and 7 (1.6%) treatment-related mortality were observed. According to the nomogram score, when the subjects were classified into 5 grades of 0 -10, 11 -85, 86 -140, 141 -180, and 180 or more, tAEs rates were 11%, 13%, 30%, 30%, and 22%, respectively. The higher the number of scores, the higher the tAEs rate (Ptrend < 0.001), and especially, the tAEs rate was high over 85 points.

Conclusion: Predicting the incidence of tAEs using a nomogram is useful also in the Japanese cohort.

OP-04-03

Diagnostic yield of peroral cholangioscopy-guided biopsy compared to conventional method for suspected malignant biliary stricture

Hiroki Kawanaka, Banri Ogino, Jun Sakamoto, Toshiki Entani, Nobuhiko Hayashi and Ichiro Yasuda

Third Department of Internal Medicine, University of Toyama, Toyama, Toyama, Japan

Oral Presentation 4, APDW Theatre 1, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objective: This study aimed to evaluate the diagnostic yields of peroral cholangioscopy-guided targeted biopsy (POCS-B) compared to fluoroscopy-guided endoscopic transpapillary forceps biopsy (ERCP-B).

Methods: This single-center retrospective study included patients who underwent POCS-B and ERCP-B in the same session between September 2018 and June 2024. The primary endpoint was the diagnostic sensitivity for malignancy.

Results: A total of 78 cases were included. The final diagnosis was 77 malignant cases and 1 benign case. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of POCS-B were 67.5, 100, 100, 3.8, 67.9%, and those of ERCP-B were 67.5, 100, 100, 3.8, 67.9%, respectively. When combined POCS-B with ERCP-B, the sensitivity increased to 76.9%, but there was no significant difference (P value=0.189). Diagnostic sensitivity of POCS-B was significantly lower in cases with previous biliary stenting compared to primary pathological sampling (56.8% vs 82.4%, P value=0.0267). The site of stricture and the presence of cholangitis before biopsy did not affect diagnostic sensitivity.

Conclusion: There was no significant difference in diagnostic performance between POCS-B and ERCP-B. However, combining both methods improved the diagnostic sensitivity. In addition, the diagnostic sensitivity was considered improved before biliary drainage.

OP-04-04

Investigation of the effect of standard lactated Ringer‘s solution in preventing post ERCP pancreatitis

Tetsuhisa Ko¹, Arata Sakai¹, Ryota Nakano², Masahiro Tsujimae¹, Takashi Kobayashi¹, Atsuhiro Masuda¹ and Yuzo Kodama¹

¹Kobe University, Kobe City, Japan; ²Hyogo Medical University, Nishinomiya City, Japan

Oral Presentation 4, APDW Theatre 1, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: To prevent post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), massive infusions of lactated Ringer’s solution (LR) are recommended. However, massive infusions may lead to fluid overload. There is no evidence that LR is superior to other intravenous fluids at standard dosages. This study aimed to compare the incidence and severity of PEP between LR and sodium-poor solution (SP) at standard dosages.

Methods: This was a retrospective observational study. In our clinical protocol, SP was administered pre and post ERCP before January 2019, and LR was administered after January 2019. We evaluated 1181 cases that underwent ERCP from June 2017 to June 2020. The primary endpoint was the incidence of PEP. The secondary endpoints were the severity of PEP, C-reactive protein (CRP) levels, and systemic inflammatory response syndrome (SIRS) levels at 24 and 48 hours post-ERCP.

Results: 514 patients were administered SP, and 667 were administered LR pre and post ERCP. PEP developed in 29 and 32 patients, respectively (p=0.55). Pancreatography (OR 2.91, 95%CI 1.63-5.22; p<0.001), rectal NSAIDs administration (OR4.99, 95%CI 1.58-15.75; p=0.006), history of ERCP (OR0.20, 95%CI 0.10-0.37; p<0.001), and history of PEP (OR5.58, 95%CI 1.83-17.08; p=0.003) were associated with PEP, but the type of infusion solution was not associated (p=0.62). Severe PEP developed in 2 and 3 cases (p=0.74). Among PEP cases, CRP levels and SIRS levels at 24 and 48 hours show no significant difference.

Conclusions: The effect of standard dosage of LR in preventing PEP was not proven.

OP-04-05

Real-time notification of colonoscopic optical diagnosis dose not affect patient's anxiety and depression after polypectomy

Chen Ya Kuo¹, Kai Shun Liang¹, Fu Jen Li¹, Yu Tsung Chen¹, Yu Tse Chiu¹, Chi Yang Chang¹ and Han Mo Chiu²

¹Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan; ²Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Oral Presentation 4, APDW Theatre 1, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: To examine whether real-time notification of colonoscopic optical diagnosis of resected polyps affects patient anxiety and depression levels before the availability of histological diagnosis.

Materials and Methods: This single-center, open-label, prospective, parallel randomized controlled trial enrolled outpatients aged 40 to 79 who received sedated colonoscopy and polypectomy. After colonoscopy, patients were randomized into the "ordinary care group (OC)" (information provided at the next scheduled clinic visit) or the "real-time notification group (RTN)" (information provided immediately after colonoscopy). Anxiety and depression levels were measured using the Taiwan version of the Hospital Anxiety and Depression Scale (HADS) before the next clinic visit for histological results. The differences between the two groups were compared.

Results: Of the 523 patients, 265 were assigned to the ordinary care group (5 withdrew) and 258 to the real-time notification group (2 withdrew). Baseline characteristics were similar between groups. Anxiety and depression scores before receiving histological results were similar in both groups (anxiety score: OC 1.37 vs. RTN 1.30, p=0.326; depression score: 1.18 vs. RTN 1.00, p=0.825). Multivariable analysis showed that younger age and higher baseline anxiety scores were associated with higher anxiety scores after colonoscopy; higher baseline depression scores were associated with higher depression scores after colonoscopy.

Conclusion: Real-time notification of colonoscopic optical diagnosis of resected polyps did not affect anxiety or depression levels before the availability of histological diagnosis. Younger age and higher baseline anxiety levels are associated with higher anxiety levels after colonoscopy.

OP-04-06

Evaluating the efficacy of argon plasma coagulation for chronic radiation proctitis with bleeding predominant form

Huong La Dieu

Bach Mai Hospital, Hanoi, Viet Nam

Oral Presentation 4, APDW Theatre 1, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Clinical and paraclinical findings of chronic radiation proctitis patients who received argon plasma coagulation and evaluating the efficacy of this technique.

Subjects and Methods: A cross – sectional descriptive study. We enrolled all the patients who had proctitis after receiving radiotherapy to treat pelvic cancer and were treated with the Argon Plasma Coagulation method at the Gastroenterology and Hepatology Center, Bach Mai Hospital from September 2018 to October 2023.

Results: We enrolled 64 patients after 5 years. The mean age of the patients was 62,7±10,7 years (32 – 85 years old), the disease occurred predominantly in women (90,6%). The time for symptoms to appear after radiotherapy were 3 years with a rate of 93,7%. All patients were admitted to the hospital because rectal bleeding, the rate of patients requiring blood transfusion was 39,1%. The mean Zinicola score was 3,5±1,1 (2-5), Wacher score ≥ 3 accounts for 65,7%. There were no significant differences between Zinicola score, Wacher score and the grade of anemia. The procedure was successful in 100% of cases. The recurrence rate after 6 months was 32.8% and after 12 months was 34,4%. There were no significant differences between Zinicola score and the rate of recurrence after 12 months. The common side effects were abdominal pain 20%, ulcer 15,4%, and stenosis 6,2%.

Conclusion: Chronic radiation proctitis usually occurs within 3 years after receiving radiotherapy. APC is the safe and effective endoscopic hemostasis treatment. The most side effects were abdominal pain, ulcer, stenosis.

OP-04-07

Prospective evaluation of artificial intelligence-assisted monitoring of effective withdrawal time on adenoma detection rate.

Thomas Ka Luen Lui, Carla Pui Mei Lam, Vivian Wai Man Tsui, Elvis Wai Pun To, Loey Lung Yi Mak, Michael Kwan Lung Ko, Kevin Sze Hang Liu and Wai Keung Leung

Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong

Oral Presentation 4, APDW Theatre 1, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Effective withdrawal time (EWT) is a novel artificial intelligence (AI)-derived colonoscopy quality metric, which measures the actual duration of clear images obtained during scope withdrawal from cecum to rectum. We have previously demonstrated the superiority of EWT to standard withdrawal time (SWT) on adenoma detection rate (ADR) in a retrospective study. This prospective study determines the association between EWT and colonic lesion detection rates

Material and Methods: Patients were recruited in our hospital from Nov 2023 to Feb 2024. The AI derived (AI) real time effective mucosal examination monitor system (EndoScreen QC) was initiated during scope withdrawal, starting from cecum to anus and endoscopists who were blinded to the output of the system. The primary outcome was the correlation between EWT and ADR, which was determined by the Pearson correlation coefficient (r); and compared with SWT. Other outcomes included correlation between EWT and polyp detection rate (PDR) or serrated lesion detection rate (SDR).

Results: In the prospective analysis, 185 colonoscopies performed by 9 endoscopists were analyzed (Table 1). The correlation between EWT and ADR was significantly higher (r=0.98, 95%CI: 0.96-1.00) than between SWT (r=0.80, 95%CI: 0.53-0.98, p<0.01). For PDR, the correlation with EWT was also significantly higher than SWT (r=0.97, 95%CI: 0.95-1.00 vs r=0.73, 95%CI: 0.30-0.98, p=0.02). However, there was no significant difference between EWT and SWT on SDR [r=0.92, 95%CI: 0.72-1.00 vs r=0.93, 95%CI: 0.86-0.98, p=0.89]. (Table 1)

Conclusion: The novel AI-derived EWT demonstrated better correlation with ADR and PDR than SWT in this prospective study.

OP-04-08

Magnifying endoscopic observation helps for the diagnosis of cancer portion involving sessile serrated lesions (SSLs)

Takahiro Ishitsuka¹, Kenzo Hara³, Shoichi Saito³, Manabu Takamatsu² and Hiroshi Kawachi²

¹Department of Lower GI, Cancer Institute Hospital of JFCR, Tokyo, Japan; ²Department of Pathology, Cancer Institute Hospital of JFCR, Tokyo, Japan; ³Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan

Oral Presentation 4, APDW Theatre 1, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: In this study, we retrospectively evaluated the efficacy of endoscopic diagnosis using magnifying endoscopy for early colorectal cancer originating from sessile serrated lesions (SSLs).

Materials and Methods: Between February 2016 and September 2022, 45 cases with 48 lesions resected endoscopically or surgically were analyzed. Parameters studied included: lesion location, macroscopic type, site of cancer area within the whole lesion, JNET and pit pattern.

Results: 85.4% of lesions were located in the right-side colon. Histologically, intramucosal cancer (pTis, corresponding SSLD according to the WHO classification) accounted for 31 lesions, slight submucosal invasive cancer (pT1a) for 7 lesions, and deep submucosal invasive cancer (pT1b) for 10 lesions. The predominant macroscopic type was the protruded type, observed in 85.4% (41/48) of cases. The site of cancer area was predominantly at the lesion edge in 60-70% of pTis and pT1a lesions, whereas in pT1b lesions, they were centrally located within the lesion. Among pTis lesions, JNET type 2A and type 2B were mainly observed in 35% and 45% respectively, and pit pattern III or IV was noted in 58%. In pT1a lesions, JNET type 2B and type 3 were observed in 43% and 29%, respectively, pit pattern Vi low and Vi high were 51.7% and 28.6%, respectively. In pT1b lesions, JNET type 2B and type 3 were observed in 90% and 10%, respectively, and pit pattern Vi low, Vi high and Vn were in 20%, 60% and 20%, respectively.

Conclusion: Magnifying endoscopic observation is considered a valuable modality for treatment assessment.

OP-04-09

Adenoma detection rate of the updated computer-aided detection system based on lesion size

Naoki Sugimura, Daizen Hirata, Mineo Iwatate, Santa Hattori, Mikio Fujita, Wataru Sano and Yasushi Sano

Gastrointestinal center, Sano Hospital, Kobe, Japan

Oral Presentation 4, APDW Theatre 1, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: EndoBRAIN-EYE is a computer-aided detection (CADe) system that has been updated multiple times. Previously, we conducted a prospective study to investigate the detection performance of the updated CADe, version 1.2.3., compared with the previous version 1.2.0. Our study revealed that the positive predictive value was increased from 17% to 43%. However, the adenoma detection rate (ADR) of the updated CADe compared with endoscopists was not yet known. Therefore, a secondary analysis was conducted to investigate the ADR of the updated CADe based on lesion size.

Materials and Methods: This is a single-center retrospective observational study. Data from 100 patients enrolled in the study using the updated CADe were compared with data from patients who underwent colonoscopy without the updated CADe at our hospital during the same period. The ADR was investigated, with lesion size divided into three categories (≦5mm, 6-9mm, ≧10mm).

Results: A total of 650 patients who underwent colonoscopy at our hospital from January to April 2023 were analyzed, with 100 patients using the updated CADe and 550 patients examined only by endoscopists. There were no significant differences in patient backgrounds such as sex ratio, age, and indication. The ADRs were 50% for the updated CADe and 44% for endoscopists. The ADR of the updated CADe vs. endoscopists in each lesion size category were as follows: 45% vs. 38% for lesions ≤5mm, 16% vs. 12% for lesions 6-9mm, and 5% vs. 5% for lesions ≥10mm.

Conclusion: The updated EndoBRAIN-EYE could detect smaller lesions better than endoscopists.

OP-04-10

Underwater endoscopic mucosal resection for medium-sized flat polyps of large intestine: A randomized controlled trial

Chenghai Yang

Shenzhen Hospital, Southern Medical University, Shenzhen, China

Oral Presentation 4, APDW Theatre 1, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Background: Underwater endoscopic mucosal resection(UEMR) has shown positive effect in the treatment of polyps, but the comparison of UEMR and conventional endoscopic mucosal resection(CEMR) in the treatment of medium-sized flat polyps in the large intestine is unknown.

Objectives: To compare the clinical efficacy and safety of UEMR and CEMR in the treatment of medium-sized flat polyps of large intestine.

Methods: From December 2022 to February 2024, 200 patients with medium-sized (10 mm ≤ diameter ≤ 20 mm) colorectal flat polyps were randomly divided into UEMR group and CEMR group with 100 cases in each group. The resection rates, tolerance and complications of the two groups were evaluated.

Results: The R0 resection rate (73.3% vs. 56.3%, P = 0.011) and the En bloc resection rate (91.1% vs. 80.6%, P = 0.032) of the UEMR group were significantly higher than those of the CEMR group; The mean abdominal pain score of UEMR group was significantly lower than that of the CEMR [(3.2 ± 1.9) vs. (4.1 ± 2.1), P = 0.006]; The intraoperative bleeding rate of the UEMR group was 4.0% (4/99), and that of the CEMR group was 6.1% (6/99), and there was no significant difference between the two groups (P = 0.516). There was no delayed bleeding and perforation in both groups.

Conclusion: UEMR was effective in the treatment of medium-sized flat polyps of large intestine with few complications, and tolerance of patients was good, which is worthy of clinical promotion.

OP-05-01

Factors Related to Health-Related Quality-of-Life of Cirrhosis Patients in Cipto-Mangunkusumo Hospital Jakarta: a Preliminary Study

Ignatius Bima Prasetya^1,2, Ryan Herardi², Ahmad Yusran² and Chyntia OM Jasirwan³

¹Faculty of Medicine, Universitas Pelita Harapan, Kota Tangerang, Indonesia; ²Fellow of Gastroenterohepatology Department of Internal Medicine Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia; ³Division of Hepatology Department of Internal Medicine Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia

Oral Presentation 5, APDW Theatre 2, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Quality of life (QoL) is an often-overlooked domain in cirrhosis. We aim to evaluate factors related to QoL among cirrhosis patients using the Indonesian version of Chronic Liver Disease Questionnaire (CLDQ).

Materials and Methods: Data were collected from cirrhosis patients attending the Hepatology-Outpatient-Clinic in RSCM from May 27th to June 4th 2024. Consenting patients were asked to fill the CLDQ. Data regarding age, gender, Child-Pugh category, etiology, and onset of cirrhosis were collected from medical records.

Results: A total of 52 patients were sampled. Mean age of the samples was 57.31-year-old, most were below 60-year-old (55.8%) and male (61.5%). Most patients were in Child-Pugh A category (42 patients-80.8%), followed by Child-Pugh B (8 patients-15.4%) and C (2 patients-3.8%). The most common etiology was hepatitis B (73.1%), followed by hepatitis C (21.2%) and non-B-non-C hepatitis (5.8%). Cirrhosis onset was equal, with 25% patients diagnosed in <1 year, 38.5% in the last 1-5 years, and 36.5% in >5 years. Median total CLDQ score of all participant was 6.10 (2.90-7.00). Child-Pugh category was the only variable with significant association with QoL (p 0.013). Median CLDQ of patients with Child-Pugh A was the highest (6.21), followed by B (5.49) and C (4.75). Further breakdown of the CLDQ components showed that significant difference was noted between medians of the Child-Pugh categories in the abdominal and emotion domains but not in other domains.

Conclusion: Child-Pugh category is associated with quality of life in cirrhosis, especially in the abdominal and emotion domains.

OP-05-02

Characteristics and determinant survival of spontaneous bacterial peritonitis in liver cirrhotic patients

Ayu Sekarani Damana Putri^1,3, Supriono Supriono², Syifa Mustika^1,2, Bogi Pratomo^1,2, Gede Nanda Utama¹ and Chrisandi Yusuf Rizqiansyah¹

¹Internal Medicine Department, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; ²Gastroentero-Hepatology Division, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; ³Faculty of Medicine, Universitas Tadulako, Palu, Indonesia

Oral Presentation 5, APDW Theatre 2, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Spontaneous bacterial peritonitis (SBP) is a life-threatening infection in advanced cirrhosis patients with a 40% mortality rate. This study aims to identify the most robust predictors of mortality in cirrhotic patients with SBP.

Materials and Methods: This prospective cohort study involved 94 cirrhosis patients with SBP treated at Saiful Anwar Hospital Malang from October 2020 to December 2023. Clinical data, including age, sex, etiology, laboratory results, fluid ascites analysis, and cultures, were obtained. The primary outcome was 30-day mortality, with secondary outcomes including length of hospital stay. The statistical analyses included Mann-Whitney, multivariate logistic regression, and the receiver operating characteristic (ROC) curve to evaluate the prognostic accuracy.

Results: The mean age of the study participants was observed to be 56.28±9.52 years. 81.8% were males. 73.3% had hepatitis B, 13.3% had hepatitis C viral infection, 6.38% had a history of alcohol consumption, and 7.1% had other etiologies. The mortality rate in hospitality was 60.8%. Significant predictors of mortality included NLR (AUC 0.732, RR 1.155), acute kidney injury (AUC 0.770, RR 4.035), and MELD-Na (AUC 0.85, RR 19.19). Age, CRP, procalcitonin, and cirrhosis etiology were not significantly associated with mortality. The MELD-Na score demonstrated good prognostic accuracy, with specificity of 89.6% and sensitivity of 68.9%.

Conclusion: NLR, AKI, and MELD-Na scores are reliable prognostic tools for predicting mortality outcomes in patients with SBP, emphasizing the importance of enhanced monitoring and early intervention. Its high AUC value demonstrates its strong predictive accuracy.

OP-05-03

Evaluation of Neutrophil-To-Lymphocyte ratio and Lymphocyte-to-Monocyte ratio for predictions of prognosis of liver cirrhosis patients

Mohammad Mahatabur Rahman

Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh

Oral Presentation 5, APDW Theatre 2, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: To evaluate the neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) for the prediction of prognosis of liver cirrhosis patients.

Material and Methods: This Cross-sectional analytical study was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2020 to December 2020. Total 40 compensated cases and 40 decompensated cases were included and information regarding clinical profile, laboratory parameters was collected. LMR, NLR, MELD score and CP score were calculated both groups. Correlation between LMR, NLR and CP/MELD score were established and cut-off values of LMR and NLR were obtained.

Results: The mean value of NLR was significantly higher in decompensated cirrhosis patients than that of compensated ones and LMR was significantly higher in compensated cirrhosis patients(p<0.001). NLR had a significant strong positive correlation with CPS scores (r=0.774, p<0.05) whereas LMR had a significant negative correlation with CPS scores (r = -0.732, p<0.05). At a cut-off value ≥5.61, NLR had 80% sensitivity and specificity & LMR had 64% sensitivity & 79% specificity, cut-off value was found ≤ 2.45. A cut-off value of MELD score ≥ 26.5 was 100% sensitive but 80% specific in the prediction of death among patients with cirrhosis. Those parameters were capable of presaging the early prognosis of liver cirrhosis patients. Of them, NLR was found most precise.

Conclusion: Hematological parameters like NLR and NLR would provide prognosticative for patients with liver cirrhosis. Present study evidenced that NLR is the vital predictor for the prognosis of liver cirrhosis patients.

OP-05-04

Effect of bone marrow mesenchymal stem cells on long-term survival of patients with liver cirrhosis

Mengfan Ruan¹, Yuhang Yin^1,2, Wen Ning^1,3, Beilei Zhang^1,3, Hao Lin¹, Xiaodong Shao¹, Xiaoxi Wang¹, Xiaozhong Guo¹ and Xingshun Qi^1,2,3

¹General Hospital of Northern Theater Command (Teaching Hospital of Jinzhou Medical University), Shenyang, China; ²Postgraduate College, China Medical University, Shenyang, China; ³Postgraduate College, Dalian Medical University, Dalian, China

Oral Presentation 5, APDW Theatre 2, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Bone marrow mesenchymal stem cells (BMSCs) therapy should be effective for improvement of liver function and short-term outcome in patients with cirrhosis, but few studies have explored the long-term prognosis of cirrhotic patients treated with BMSCs.

Materials and Methods: In this retrospective study, 260 patients with liver cirrhosis were included, of whom 130 were treated with transhepatic arterial transplantation of BMSCs. Effect of BMSCs on death was explored by Cox regression analysis, as well as competing risk analysis, where liver transplantation was a competing event. Hazard ratio (HR) and sub-distribution HR (sHR) were calculated. Subgroup analyses were performed based on the age, sex, Child-Pugh class, and model for end-stage liver disease (MELD) score.

Results: The median follow-up duration was 5.27 years. Adjusted by age, sex, and Child-Pugh score. Multivariate Cox regression (HR=0.707, P=0.020) and competing risk analyses (sHR=0.709, P=0.026) demonstrated that BMSCs were independently associated with a lower risk of death in cirrhotic patients in the overall analysis. Univariate Cox regression analyses demonstrated that BMSCs were significantly associated with a decreased risk of death in the subgroup analyses of age ≤50 years (HR=0.533, P=0.016), male patients (HR=0.626, P=0.010), Child-Pugh class B (HR=0.638, P=0.026), and MELD score of >12 (HR=0.483, P=0.002), but not age >50 years (HR=0.740, P=0.097), female patients (HR=0.699, P=0.170), Child-Pugh class A (HR=0.728, P=0.309), Child-Pugh class C (HR=0.746, P=0.369), or MELD score of ≤12 (HR=0.720, P=0.096).

Conclusion: BMSCs can significantly improve the long-term prognosis of patients with cirrhosis.

OP-05-05

Intestinal decontamination with rifaximin ameliorates liver fibrosis by attenuating LSEC dysfunction

Tingting Su¹ and Sanchuan Lai²

¹First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; ²Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

Oral Presentation 5, APDW Theatre 2, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objective: The gut microbiome plays an important part in the development and progression of liver disease. Liver sinusoidal endothelial cells (LSECs), as the first barrier in liver to encounter blood from portal circulation, are probably affected by gut-derived microbiota and their byproduct. we hypothesis that gut dysbiosis in liver disease may aggravate LSEC dysfunction, which further promote liver fibrosis and portal hypertension.

Materials and Methods: Liver cirrhosis was induced by carbon tetrachloride (CCl4 ) injection or bile duct ligation (BDL). The non-absorbable antibiotic rifaximin was used to treat the cirrhotic mice to see the effect of gut microbiota changes on LSEC dysfunction and liver fibrosis. The primary LSECs were isolated from mice. The 16S rRNA sequencing was performed to reveal the gut microbiota changes in cirrhotic mice and the effect of rifaximin on it.

Results: Rifaximin attenuated liver fibrosis and LSEC dysfunction in CCl4 and BDL mice. liver fibrosis induced remarkable change in gut microbiome and rifaximin further modified it. The probiotics like Lactobacillus murinus and Bifdobacterium pseudolongum were decreased in cirrhotic mice ,while re-induced by rifaximin. CCl4 and BDL mices showed elevated LPS in serum compared with control. And Rifaximin treatment decreased serum LPS level. LPS treatment induces LSEC dysfunction by inhibiting eNOS mRNA expression. And TLR4 inhibitor attenuated LPS-induced LSEC dysfunction.

Conclusion: Gut dysbiosis caused gut barrier dysfunction and induced more LPS into portal system, which aggravating LSEC dysfunction, thus promoting liver fibrosis and increasing portal pressure. Intestinal decontamination with rifaximin ameliorated liver fibrosis and portal hypertension.

OP-05-06

Does cirrhosis status influence medication pattern and glycemic control in patients with type 2 diabetes?

Mary Yue Wang^1,2, Sherlot Juan Juan^1,2, Grace Lai-Hung Wong^1,2, Vincent Wai-Sun Wong^1,2 and Terry Cheuk-Fung Yip^1,2

¹Medical Data Analytic Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; ²State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China

Oral Presentation 5, APDW Theatre 2, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: We aimed to compare secular trends of glycemic control and anti-diabetic medication use in patients with type 2 diabetes mellitus (T2DM), with and without cirrhosis.

Materials and Methods: We identified patients retrospectively from 2000-2023 and excluded patients aged <18 years at T2DM diagnosis, or with type 1 diabetes. Percentage of patients who achieved time-weighted average hemoglobin A1c (HbA1c) <7% and used different anti-diabetic medications were compared in five consecutive periods (2000-2004, 2005-2009, 2010-2014, 2015-2019, and 2020-2023).

Results: Of 1,206,233 patients with T2DM from 2000-2023, 63,200 (5.2%) had cirrhosis, of whom 28.5% had decompensated cirrhosis. Proportion of patients achieving HbA1c <7% increased regardless of cirrhosis (Figures 1A-1B), with the greatest improvement in patients with compensated cirrhosis (from 47.9% to 77.7%) (Figure 1C). Compared to those without cirrhosis, fewer patients with cirrhosis used oral medications (e.g., metformin use 61.0% vs 35.3% in 2020-2023, p<0.001), but insulin was used more often (35.1% vs 20.2% in 2020-2023, p<0.001). Insulin was more commonly used among patients with decompensated cirrhosis than those with compensated cirrhosis (46.4% vs 32.2% in 2020-2023, p<0.001) (Figures 1C-1D). The use of dipeptidyl peptidase-4 inhibitors, sodium-glucose co-transporter-2 inhibitors and glucagon-like-peptide 1 receptor agonists increased over years in all groups.

OP-05-07

Bleeding risk for early anticoagulation after ECI in cirrhosis patients with GV and PVT

Huishan Wang, Ye Fang, Sitao Ye, Xinghuan Li, Xiaoquan Huang, Jian Wang, Lili Ma and Shiyao Chen

Zhongshan Hoipital, Fudan University, Shanghai, China

Oral Presentation 5, APDW Theatre 2, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objective: Patients with gastric varices (GV) and portal vein thrombosis (PVT) in liver cirrhosis have a dual contradiction between bleeding and thrombus anticoagulation. This study aims to explore the correlation between anticoagulation treatment and postoperative bleeding events in liver cirrhosis patients with gastric varices and portal vein thrombosis, and further investigate the influencing factors of postoperative bleeding.

Methods: Patients diagnosed with PVT and treated with endoscopic cyanoacrylate injection (ECI) from January 2023 to December 2023 at Zhongshan Hospital affiliated with Fudan University due to GV bleeding were included. Collect clinical data of patients and divide them into anticoagulant group and non-anticoagulant group based on whether anticoagulant treatment is performed after surgery; Follow up observation for 6 weeks to evaluate re-bleeding of patients.

Result: A total of 160 patients were included, of which 65 patients received anticoagulation 48 hours after ECI, and 95 patients did not. There was no statistically significant difference (p>0.05) between the two groups in terms of gender, etiology of liver cirrhosis, dosage of cyanoacrylate and sclerosing agents, and Child Pugh grading. Kaplan-Meier survival analysis showed that there was no statistically significant difference in bleeding rates between the two groups within 6 weeks after surgery (1.54% vs 1.05%, p=0.795).COX regression analysis indicated that the large amount of cyanoacrylate used was a risk factor for bleeding within 6 weeks (HR=5.862, p=0.015)after ECI.

OP-05-08

Frailty in Children with Chronic Liver Disease: Prevalence and Impact on Outcomes

Deepika Yadav and Vikrant Sood and Rajeev Khanna and Seema Alam and Bikrant Bihari Lal and Jaya Benjamin and Rakesh Kumar and Sukriti Baweja

Department of Pediatric Hepatology, Institution Of Liver And Biliary Sciences, India

Oral Presentation 5, APDW Theatre 2, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Frailty has been defined as a phenotypic representation of impaired muscle contractile function and is a well-known complication of chronic liver disease. There is only limited available pediatric literature in this regard with no studies in the Indian population. The current study was thus aimed to estimate the prevalence of frailty and analyze predictive factors and its association with long-term outcomes in children with liver disease.

Methods: Children (5-18 years of age) with cirrhotic liver disease (CLD) and non-cirrhotic portal hypertension (NCPH) were prospectively enrolled. The frailty assessment was done by the 5 classic ‘Fried Frailty Criteria’. Children were followed for 12 months to assess the long-term outcomes.

Results: The study included 170 children [CLD (n = 149; compensated CLD/CCLD, n =109 and decompensated CLD/DCLD, n =40) and NCPH (n=21)]. The overall prevalence of frailty was 48% [40 % in CCLD, 80 % in DCLD & 33 % in NCPH group (p < 0.05)]. Among the patients with CLD, 76 (51%) were identified as frail. Frail children had significantly higher risk of decompensation and poorer hepatic synthetic functions, and its presence at baseline predicted future risk of decompensation, infectious complications, need for readmissions, and poor outcome (death) (p< 0.05).

OP-05-09

Impact of peptic ulcer bleeding on the outcomes of cirrhotic patients with acute gastrointestinal bleeding

Yuhang Yin^1,2, Fanpu Ji³, Fernando Gomes Romeiro⁴, Mingyu Sun⁵, Qiang Zhu⁶, Dapeng Ma⁷, Shanshan Yuan⁸, Yingli He⁹, Xiaofeng Liu¹⁰, Cyriac Abby Philips¹¹, Nahum Méndez-Sánchez¹², Metin Basaranoglu¹³, Kanokwan Pinyopornpanish¹⁴, Yiling Li¹⁵, Yunhai Wu¹⁶, Yu Chen¹⁷, Ling Yang¹⁸, Lichun Shao¹⁹, Andrea Mancuso²⁰, Frank Tacke²¹, Su Lin²², Bimin Li²³, Lei Liu^24,25 and Xingshun Qi^1,2

¹General Hospital of Northern Theater Command, Shenyang, China; ²Postgraduate College, China Medical University, Postgraduate College, China Medical University, Shenyang, China; ³Department of Infectious Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China; ⁴Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil; ⁵Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; ⁶Department of Gastroenterology, Shandong Provincial Hospital, Jinan, China; ⁷Department of Critical Care Medicine, The Sixth People’s Hospital of Dalian, Dalian, China; ⁸Department of Gastroenterology, Xi’an Central Hospital, Xi’an, China; ⁹Department of Infectious Diseases, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China; ¹⁰Department of Gastroenterology, The 960th Hospital of Chinese PLA, Jinan, Shandong; ¹¹Department of Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Kerala, India; ¹²Medica Sur Clinic, National Autonomous University of Mexico, Mexico, Mexico; ¹³Gastroenterology and Hepatology, Bezmialem Vakif University, Istanbul, Turkey; ¹⁴Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; ¹⁵Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang, China; ¹⁶Department of Critical Care Medicine, The Sixth People’s Hospital of Shenyang, Shenyang, China; ¹⁷Difficult and Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China; ¹⁸Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; ¹⁹Department of Gastroenterology, Air Force Hospital of Northern Theater Command, Shenyang, China; ²⁰Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico-Di Cristina-Benfratelli, Palermo, Italy; ²¹Department of Hepatology & Gastroenterology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Berlin, Germany; ²²Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; ²³Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China; ²⁴Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, China; ²⁵State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China

Oral Presentation 5, APDW Theatre 2, Exhibition Hall, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Peptic ulcer is the most common source of non-variceal bleeding. However, it remains controversial whether the outcomes of cirrhotic patients with peptic ulcer bleeding differ from those with variceal bleeding.

Methods: Cirrhotic patients with acute gastrointestinal bleeding (AGIB) who underwent endoscopy and had an identifiable source of bleeding were retrospectively screened from an international multicenter cohort. In-hospital mortality and 5-day failure to control bleeding were compared between peptic ulcer bleeding and variceal bleeding groups. Logistic regression analyses were performed to explore the impact of peptic ulcer bleeding on in-hospital death and 5-day failure to control bleeding. Odd ratios (ORs) were calculated. Propensity score matching (PSM) analysis was performed by matching age, gender, Child-Pugh score, and model for end-stage liver disease score.

Results: Overall, 1535 patients were included, of whom 73 (4.7%) had peptic ulcer bleeding. Peptic ulcer bleeding group had a significantly higher in-hospital mortality (11.0% vs. 2.8%, P=0.001) than variceal bleeding group, but the rate of 5-day failure to control bleeding was statistically similar between them (6.8% vs. 4.7%, P=0.389). Multivariate logistic regression analyses showed that peptic ulcer bleeding was not independently associated with in-hospital death (OR=2.169, P=0.126) or 5-day failure to control bleeding (OR=1.230, P=0.680). PSM analyses demonstrated that both in-hospital mortality (9.7% vs. 6.3%, P=0.376) and rate of 5-day failure to control bleeding (6.9% vs. 5.4%, P=0.787) were not significantly different between the two groups.

Conclusions: The impact of peptic ulcer bleeding on the in-hospital outcomes of cirrhotic patients is similar to that of variceal bleeding.

OP-06-01

Knowledge, attitude and experience on colorectal cancer screening among healthcare workers in a tertiary hospital

Caratao Isabelo IV and Enjel Gabriel and Karen Batoctoy

Vicente Sotto Memorial Medical Center, Cebu, Philippines

Oral Presentation 6, Uluwatu 1, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: This study assessed the knowledge, attitudes, and experiences of healthcare workers, including doctors, nurses, aides, and technologists, regarding colorectal cancer (CRC) screening. It explored their current understanding, attitudes towards screening, and whether these attitudes were influenced by past experiences or peer testimonies. The findings provide baseline data and highlight the need for educational initiatives to improve CRC screening awareness and compliance.

Materials and Methods: A cross-sectional survey assessed 319 healthcare workers in a tertiary care and medical training hospital. Using stratified random sampling, participants from various departments were selected. Data was collected through a web-based questionnaire and analyzed using Jamovi software, with results presented as frequencies and means, and significance determined by Chi-square tests (p<0.05).

Results: Most participants were under 40 years old and predominantly male. Knowledge levels varied significantly between medical and non-medical staff (p < .001). Many were unaware of screening guidelines, though most recognized colonoscopy as the recommended test. The majority valued screening but had concerns about cost, discomfort, and invasiveness. Experiences with CRC patients and procedures varied, with many having indirect or no personal experience. Willingness to undergo screening was not significantly influenced by smoking or alcohol consumption.

OP-06-02

Harnessing gut microbiome biomarkers to predict neoadjuvant immunochemotherapy outcomes in esophageal cancer

Le Liu¹, Liping Liang² and Shijie Mai³

¹Shenzhen hospital, Southern Medical University, Shenzhen, China; ²Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; ³Nanfang hospital, Southern Medical University, Guangzhou, China

Oral Presentation 6, Uluwatu 1, November 22, 2024, 12:50 PM - 2:10 PM

Background: The gut microbiome's influence on antitumor treatments such as chemotherapy is increasingly recognized, yet, the empirical research focusing on its predictive capacity for responses to neoadjuvant immunochemotherapy (NICT) in esophageal squamous cell carcinoma (ESCC) is limited.

Method: We analyzed 136 fecal samples from 68 ESCC patients, both pre- and post-NICT therapy, alongside 19 samples from healthy controls using microbiome sequencing. Patients were categorized as either responders or nonresponders to NICT therapy based on clinical evaluations. A machine learning classifier, LightGBM, was developed to predict therapy responses, utilizing baseline microbial biomarkers from 54 patients and tested in a separate cohort of 14 patients.

Results: Significant shifts in the microbiome composition were noted, including a reduction in ESCC-associated pathogens and increases in Limosilactobacillus, Lacticaseibacilus, and Staphylococcus post-NICT therapy. Notably, distinct microbiota profiles were observed at baseline between responders and nonresponders. Butyrate-producing bacteria such as Faecalibacterium, Eubacterium_eligens_group were predominantly found in responders, while Veillonella, Campylobacter were more common in nonresponders. We then divided our patient cohort into training and test sets at a 4:1 ratio and utilized the XGBOOST-RFE algorithm to identify seven key microbial biomarkers. A predictive model was developed using LightGBM, which achieved an AUROC of 86.8% in the training set, 76.8% in the validation set, and 76.5% in the testing set.

Conclusions: Our findings underscore the gut microbiome as a novel source of biomarkers for predicting NICT responses in ESCC, highlighting its potential to advance the integration of microbiome profiling into clinical practice for modulating cancer treatment responses.

OP-06-03

Endoscopic construction of an anti-reflux mucosal barrier for the treatment of GERD

Jiaoyang Lu and Xiuli Zuo and Yanqing Li and Xuefeng Lu

Qilu Hospital, Jinan, China

Oral Presentation 6, Uluwatu 1, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Based on the porcine natural antireflux mechanism, we developed a novel endoscopic procedure to build an antireflux mucosal flap to block acid reflux and treat GERD.

Materials and Methods: The antireflux mucosal valvuloplasty (ARMV) procedure is performed by releasing and reconstructing three-fourths of the circumference of cardiac mucosa at the lesser curvature side into a double-layer mucosal flap. The mucosal flap works together with cardiac scarring to block reflux. We retrospectively reviewed 30 patients who underwent ARMV from 2019 to 2021. Subjective and objective data evaluating GERD were collected before and after ARMV.

Results: All 30 ARMV procedures were performed successfully, with a mean operation time of 72.6 ± 20.3 minutes. One patient had postoperative bleeding that required endoscopic hemostasis. The mean follow-up time was 28.9 ± 13.9 months. Twenty-five of 30 patients (83.3%) and 23 of 26 patients (88.5%) reported discontinuation or reduction in proton pump inhibitor therapy 3 months and 1 year after ARMV, respectively. GERD questionnaire and GERD Health-Related Quality of Life questionnaire scores improved significantly from 14.0 ± 2.6 and 48.7 ± 15.0, respectively, before ARMV to 7.7 ± 2.5 and 10.2 ± 5.9, respectively, 12 months after ARMV (P < .0001 in both comparisons).

OP-06-04

Incidence and progression to neoplasm in Barrett's esophagus from a large population-based study in Iceland

Ken Namikawa^1,2, Magnús Konráðsson¹, Melkorka Sverrisdóttir³, Helgi Sigmundsson¹, Jón Jónasson^3,4 and Einar Björnsson^1,3

¹Department of Internal Medicine, Division of Gastroenterology, Landspítali University Hospital, Reykjavik, Iceland; ²Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; ³Faculty of Medicine, University of Iceland, Reykjavik, Iceland; ⁴Department of Pathology, Landspítali University Hospital, Reykjavik, Iceland

Oral Presentation 6, Uluwatu 1, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Barrett’s esophagus (BE) is the known precursor to esophageal adenocarcinoma (EAC), however varing progression rate sto neoplasm have been reported. The aims of the study were to evaluate the prevalence of BE and neoplasms in BE, and progression to those in a large population.

Materials and Methods: This was a retrospective study and patients from 10 institutions who were identified through a database of 2 centralized pathology laboratory. Demographics and relevant clinicopathological features were obtained from medical records of patients with a pathologically confirmed BE by presence of intestinal metaplasia between 1990 and 2022.

Results: A total of 945 patients were identified with BE: 647 men (68.5%); median age at diagnosis of 63 years (IQR 53-73). At the time of BE diagnosis, 12.6% had a presence of neoplasm (57 LGD, 15 HGD, and 47 EAC). Among 826 BE patients without neoplasm at the time of BE diagnosis, the cumulative incidence of neoplasm was 5.0% (23 LGD, 7 HGD, and 11 EAC) with median observation-period of 5 years (IQR: 4-9). In total, 160 cases of neoplasm (65.8% in long-segment, 34.2% in short-segment BE) were diagnosed in this BE cohort; 74.4% at time of BE diagnosis; and 25.6% without dysplasia at diagnosis progressed to neoplasm during follow-up.

OP-06-05

The change of esophageal transit scintigraphy in patient with achalasia after peroral endoscopic myotomy

Hyojin Park and Young Hoon Youn

Gangnam Severance Hospital, Seoul, South Korea

Oral Presentation 6, Uluwatu 1, November 22, 2024, 12:50 PM - 2:10 PM

Background/Aims: The esophageal transit scintigraphy (ETS) is a nuclear medicine imaging that can be used for people who have problems in esophageal transit. In particular, changes in esophageal motor function can be evaluated non-invasively before and after the treatment in patients who underwent peroral endoscopic myotomy(POEM) in patients with achalasia. The purpose of this study was to compare the change of several parameters of esophageal transit and manometric profiles who underwent POEM in achalasia patients.

Methods: We collected 30 patients with achalasia who underwent high-resolution manometry and ETS before and after POEM.

Results: All patients achieved clinical treatment success (Eckardt score < 3). The esophageal transit [T1/2(min)] was significantly improved after POEM (p< 0.05). The esophagus emptying, 10 seconds after isotope ingestion significantly improved (p< 0.05). As a result of analyzing the change in time to peak on the time-radioactivity curve, it decreased statistically in middle esophagus. The distal contractile integral and body amplitude was positively correlated to esophageal transits.

Conclusion: Patients with achalasia who received POEM showed improvement in esophageal transit as well as manometric profiles. Considering the time to peak of the radiation curve, it can be seen that improvement in retention of middle portion affects esophageal transit and improvement of symptoms in patients who have undergone POEM.

OP-06-06

GERD Prevalence in India: Insights from a Nationwide Population-Based Study

Dattatray Pawar and Pooja Vaidya and Akhilesh Sharma

Medical Affairs Head, Medical Department, Alkem Laboratories Ltd, Mumbai, India

Oral Presentation 6, Uluwatu 1, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Globally, gastroesophageal reflux disease (GERD) significantly affects the health and quality of life of millions. However, community-based data on GERD prevalence in India is limited. To address this, we conducted a large-scale, population-based study to determine the prevalence of GERD in Indian population.

Materials and Methods: The Frequency Scale for the Symptoms of GERD (FSSG) was utilized to diagnose GERD in adults aged ≥18 years. A cut off score of 8 indicated probable diagnosis of GERD. Geographical distribution, age, gender, and BMI of participants with and without GERD were analyzed using descriptive statistics.

Results: Of 32,100 participants, 24,387 (76.0%) were identified with probable GERD. Geographically, GERD prevalence was highest in North (25.41%) and West (23.50%) zones, compared to South (12.50%) and East (14.07%) zones. Prevalence was similar among males (75.82%) and females (76.25%). Incidence of GERD was highest among middle-aged participants (30-59 years), peaking at 40-49 years (27.03%). Participants with GERD had higher mean BMI (26.48±3.74) than those without GERD (24.34±2.95; p<0.0001). Obese participants had significantly higher incidence (76.35%) compared to normal (11.89%) and overweight (11.76%) individuals. On univariate analysis, participants with BMI≥28 had almost three times the odds of experiencing GERD symptoms compared to those with a BMI of 20–22.99 (OR 2.7, p<0.0001).

Conclusion: This large-scale study highlights significant prevalence of GERD in India, particularly among middle-aged individuals with a higher BMI and in certain geographical regions. This emphasize the importance of targeted public health strategies to manage and reduce the burden of GERD, particularly in high-risk populations.

OP-06-07

The Effect of xerostomia on esophageal motility

Nanicha Siriwong¹, Panyavee Pitisuttithum², Pakkapon Rattanachaisit², Jarongkorn Sirimongkolkasem², Tanisa Patcharatrakul¹ and Sutep Gonlachanvit¹

¹Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; ²Center of Excellence in Neurogastroenterology and Motility, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Oral Presentation 6, Uluwatu 1, November 22, 2024, 12:50 PM - 2:10 PM

The role of saliva in modulating esophageal contraction remains unclear. Our study aims to investigate the effect of xerostomia on esophageal motility.

Methods: Patients experiencing chronic idiopathic ENT symptoms with negative pH test results underwent measurement of saliva flow rate and high-resolution esophageal manometry (HRM) (Medtronic Inc., MN, USA). Xerostomia was defined as either an unstimulated salivary flow rate ≤0.1 mL/min or a stimulated flow rate ≤0.5 mL/min with 2% citric acid. Patients with xerostomia were matched 1:1 with normal salivary flow patients based on age and gender. The HRM protocol included ten upright wet swallows with an additional five of 5 dry swallows and was analyzed according to the standard Chicago classification.

Results: Forty patients were enrolled. Clinical characteristics and manometry diagnosis were similar between xerostomia and normal salivary flow groups. During dry swallows, xerostomia group showed a higher prevalence of rapid contractions, a lower proportion of normal esophageal peristalsis, shorter distal latency (DL) and faster contractile front velocity (CFV) compared with the normal salivary flow group. However, xerostomia did not affect lower esophageal integrated relaxation pressure and distal contractile integral. During wet swallows, there was no effect of xerostomia on esophageal contraction and other metrics. We performed a linear mixed model to evaluate the effects of xerostomia on esophageal motility and found that DL and CFV were affected by xerostomia during dry swallows, after adjusting for age, gender, BMI, and swallowing sequence.

OP-06-08

Characteristics of Gastric Cardiac Adenocarcinoma at the Zone of Esophagogastric Junction

Shunsuke Ueda¹, Masao Yoshida¹, Yoichi Yamamoto¹, Noboru Kawata¹, Tadakazu Shimoda² and Hiroyuki Ono¹

¹Division of Endoscopy, Shizuoka cancer center, Nagaizumi, Japan; ²Department of Pathology, Shizuoka Cancer Center, Nagaizumi, Japan

Oral Presentation 6, Uluwatu 1, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: Esophagogastric junction (EGJ) cancer is classified based on the location of the tumor epicenter. This classification encompasses gastric cardiac adenocarcinoma (GCA) without extension to the EGJ, which is considered a common gastric cancer. This study aims to elucidate the characteristics of T1 adenocarcinoma in the zone of EGJ (defined as Jz, within ±2cm of the EGJ).

Materials and Methods: We retrospectively reviewed records of patients who underwent endoscopic resection (ER) or surgery for T1 adenocarcinoma with the tumor epicenter within the Jz between January 2010 and December 2023. Exclusion criteria were recurrence, post-chemotherapy status, and long-segment Barrett esophagus. We compared two groups: Group G, GCA without extension to the EGJ, and Group E, lesions localized in the esophagus or extending across the EGJ.

Results: Among 271 lesions included, 220 were treated by ER and 51 by surgery. Group G consisted of 99 lesions, while Group E included 172 lesions. Group G included older patients (G vs E, 74 vs 69 years, P <0.001) and had a higher Helicobacter pylori infection rate (65.7% vs 30.2%, P <0.001). There were no significant differences in macroscopic type and tumor size between the groups. Group E exhibited a higher incidence of submucosal invasive carcinoma (27.3% vs 44.8%, P = 0.004) and a tendency towards increased lymphovascular invasion (13.1% vs 22.1%, P = 0.077).

Conclusion: GCA without extension to the EGJ is characterized by an association with Helicobacter pylori infection and a lower frequency of submucosal invasion.

OP-06-09

The Mechanism of MT1 Regulation of Copper Metabolism in the Pathogenesis of Achalasia

Lu Wang and Xin Chen

Tianjin Medical University, Tianjin, China

Oral Presentation 6, Uluwatu 1, November 22, 2024, 12:50 PM - 2:10 PM

Objectives: To explore the regulatory role of Metallothionein 1 (MT1) in copper metabolism and neuronal cells, and to further investigate the mechanism by which MT1 alleviates neuronal injury in achalasia (AC) through its effects on copper metabolism.

Materials and Methods: Bioinformatics analysis to identify key molecules and pathways. In vitro experiments were carried out on enteric neuronal cells, while in vivo experiments utilized a mouse model of AC induced by BAC denervation.

Results: 1. Sequencing data from GSE201699 and LES revealed significant enrichment of differentially expressed genes related to copper metabolism. MT1M showing notable differential expression (Figure 1).

2. IHC: In LES tissues, the expression of MT1M and cuproptosis-related proteins were significantly lower in the AC group compared to the normal control group, consistent with RT-qPCR results. (Figure 2-3).

3. In Vitro Experiments: Culturing primary enteric neuronal cells from mice and transfecting them with si-MT1M resulted in low MT1M expression and reduced cell viability as indicated. Further validation is planned with Elesclomol-CuCl2 to assess MT1M's regulation of cuproptosis.

4. In the mouse AC model constructed via BAC denervation, intraperitoneal injection of recombinant MT1M protein significantly improved body weight, food intake, and esophageal motility in the MT1M intervention group compared to the AC model group.

OP-06-10

Global burden of gastroesophageal reflux disease in 204 countries and territories from 1990 to 2021

Claire Chenwen Zhong¹, Xingxin Gu², Suwen Shi³, Xiangyi Meng⁴, Junjie Hang⁵, Jianli Lin⁶, Yu Li⁷ and Junjie Huang⁸

¹The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR999077, China; ²Department of Physics, Boston University, Boston, Massachusetts, 02215, USA; ³College of Professional Studies, Northeastern University, Boston, Massachusetts, 02115, USA; ⁴Department of Chemistry, Boston University, Boston, Massachusetts, 02215, USA; ⁵Department of Physics and Astronomy, Northwestern University, Evanston, Illinois, 60208, USA; ⁶Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong, 518000, China; ⁷Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100080, China; ⁸Department of Computer Science and Engineering, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, 999077, China

Oral Presentation 6, Uluwatu 1, November 22, 2024, 12:50 PM - 2:10 PM

Background: Gastroesophageal reflux disease(GERD) is a persistent and widespread condition affecting the upper digestive system, characterized by symptoms such as regurgitation, heartburn, and chest pain. This study aimed to assess the global burden of GERD across 204 countries and territories from 1990 to 2021.

Methods: Data on GERD were obtained from Global Burden of Disease 2021, covering 204 countries and territories. Annual case numbers and age-standardized rates were analyzed to assess the incidence and disability-adjusted life-years(DALYs) of GERD. Trends in incidence rates and DALYs were evaluated using total percentage changes.

Results: In 2021, global GERD incidence was estimated at approximately 324 million cases(95% uncertainty interval[UI]:288-359 million), resulting in 6.3 million DALYs(95% UI:3.1-11.2 million). India had the highest number of cases(76.3 million), followed by China(32.3 million), and the US(16.0 million). For DALYs, Brazil ranked third instead of the US. From 1990 to 2021, the global age-standardized incidence rate(ASIR) and age-standardized DALYs rate(ASDR) increased by 4% and 3%, respectively. There was a period from 2000 to 2010 when ASIR and ASDR decreased by 1%, followed by a sharp increase of 5% from 2010 to 2021. In 2021, Korea had the lowest ASIR, while Norway had the lowest ASDR. Throughout 1990-2021, females consistently had higher GERD incidence, DALYs, and age-standardized rates than males.

Conclusions: GERD represents a significant public health challenge due to its increasing incidence and DALYs. Understanding global and regional epidemiological trends is essential for policymakers and stakeholders to develop effective prevention and treatment strategies to alleviate the burden of GERD.

OP-07-01

The usefulness of combined antegrade stenting in endoscopic ultrasound-guided hepaticogastrostomy for malignant distal biliary obstruction

Fumisato Kozakai

Sendai City Medical Center, Sendai, Miyagi, Japan

Oral Presentation 7, APDW Theatre 1, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: The usefulness of combined antegrade stenting during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) for malignant distal biliary obstruction (MDBO) has been recently highlighted. This study aimed to compare the outcomes of EUS-HGS with antegrade stenting (EUS-HGAS) and EUS-HGS alone for MDBO.

Materials and Methods: Patients who underwent EUS-HGAS or HGS for MDBO between January 2013 and June 2024 were included in this study. Time to recurrent biliary obstruction (TRBO), overall survival (OS), and adverse events (AEs) for each group were retrospectively evaluated.

Results: Seventy-six patients (32 in the HGAS group and 44 in the HGS group) were analyzed. There was no statistical difference in prior biliary drainage and HGS stent type between the groups (p = .086, p = .789). A history of biliary metallic stenting for MDBO was more common for the HGS group (6% vs. 39%, p = .001). The median TRBO was significantly longer for the HGAS group (367 vs. 85 days, p = .007), whereas OS showed no significant difference (160 vs. 198 days, p = .229). Regarding AEs, acute pancreatitis was more frequent for the HGAS group (16% vs. 0%, p = .011). Multivariable analysis using the Cox hazards model showed that the absence of combined antegrade stenting as an independent risk factor for RBO (p = .045, hazard ratio: 2.55, 95% confidence interval: 1.02–6.38).

Conclusions: Combined antegrade stenting for MDBO can prolong TRBO. However, further accumulation of cases is required to establish strategies considering the possibly frequent adverse events.

OP-07-02

Short single-balloon enteroscope-assisted ercp for patients with surgically altered anatomy: Retrospective cohort study

Aniruddha Pratap Haripal Singh, Siddhant Agrawal, Hardik Rughwani, Mohan Ramchandani, Sundeep Lakhtakia, Rakesh Kalapala, Zaheer Nabi, Mona Aggarwal, Shujaath ASIF, Pradev Inavolu, G V Rao and Duvuur Nageshwar Reddy

AIG Hospitals, Hyderabad, India

Oral Presentation 7, APDW Theatre 1, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Aims: Performing ERCP in patients with surgically altered anatomy presents significant challenges. The advent of the short single-balloon enteroscope has revolutionized the technique for these patients. This study aims to evaluate the demographics, efficacy, safety, and adverse events associated with enteroscopic ERCP in this specific population.

Methods: All patients with altered anatomy who underwent ERCP from March 2019 to October 2023 were included. Adverse events were recorded. All patients were followed up for a maximum of 3 months.

Results: In this study, 63 patients (58% male, aged 12-80 years) underwent a total of 100 procedures. The success rates for enteroscopy, diagnostic, therapeutic, and overall procedures were 95%, 94.7%, 97.7%, and 88%, respectively. The primary reasons for procedural failure were the inability to reach the anastomotic site and unsuccessful biliary cannulation. The most prevalent diagnosis was biliary calculi (intrahepatic, common bile duct, and hepaticojejunostomy site calculi) observed in 38.1% of cases, followed by anastomotic site stricture in 19% of cases. Seven patients with large biliary calculi required biliary lithotripsy followed by ERCP for biliary clearance. Six patients with significant anastomotic site calculi underwent fragmentation using a polypectomy snare. Adverse events occurred in 6.8% of patients, including two serious adverse events: one necessitating surgical intervention and the other requiring endoscopic closure of an afferent limb perforation.

OP-07-03

Risks of post-biliary sphincterotomy bleeding with warfarin and direct oral anticoagulants: a population-based cohort study

Vincent Wh Lo^1,2, Terry CF Yip^2,3, Louis HS Lau^1,3, Grace LH Wong^1,2,3, Vincent WS Wong^1,2,3 and Raymond SY Tang^1,2

¹Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; ²Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, SAR; ³Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, SAR

Oral Presentation 7, APDW Theatre 1, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: We aimed to identify risk factors associated with delayed post-sphincterotomy bleeding, and to evaluate the post-sphincterotomy bleeding and thromboembolic risks among DOAC and warfarin users.

Materials and Methods: We performed a territory-wide retrospective cohort study involving patients from 2012 to 2021. Adults underwent endoscopic biliary sphincterotomy on a native papilla were identified. The incidence and risk factors for delayed post-sphincterotomy bleeding were evaluated in the entire cohort and in the subgroup of patients on oral anticoagulants. One-to-one propensity score (PS) matching model was developed for warfarin and DOAC comparison. The primary outcome was delayed post-sphincterotomy bleeding, defined as bleeding requiring endoscopic haemostasis within 30 days. Secondary outcomes were 30-day blood transfusion requirement and new thromboembolic event.

Results: 33423 patients were included for analysis. Warfarin (adjusted hazard ratio [aHR] 3.66, p<0.001) and DOAC users (aHR 3.16, p<0.001) had increased risks of post-sphincterotomy bleeding. Other independent risk factors included aspirin or heparin use, pre-cut sphincterotomy and periprocedural bleeding. Within the subgroup of patients receiving oral anticoagulants, heparin bridging therapy (aHR 5.01, p<0.001) was the only independent risk factor for bleeding. After PS-matching analysis, DOAC users had a similar bleeding risk compared to warfarin users (aHR 1.00, p=0.99). Blood transfusion requirement and new onset thromboembolism were similar between the two groups.

Conclusion: Warfarin and DOAC increase the risk of delayed post-sphincterotomy bleeding, although the risk appears similar in both groups. Heparin bridging therapy further increases this risk. Careful patient selection for heparin bridging therapy is therefore vital in patients undergoing biliary sphincterotomy.

OP-07-04

Efficiency of novel plastic stent with polytetrafluoroethylene-lined lumen in unresectable malignant distal biliary obstructions

Toji Murabayashi, Shinya Sugimoto and Akira Kamei

Department of Gastroentelorogy, Ise Red Cross Hospital, Ise, Japan

Oral Presentation 7, APDW Theatre 1, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: A novel plastic stent with an inner polytetrafluoroethylene layer (REGULUS Biliary Tube Stent System, Japan Lifeline Co. Ltd., Tokyo, Japan) that could impede sludge adhesion within the stent lumen, became commercially available in Japan in 2022. This study aimed to evaluate the superiority of the novel plastic stent over conventional stents for treating unresectable malignant distal biliary obstruction (UMDBO).

Materials and Methods: Using a prospectively maintained database, 26 consecutive patients, without any history of drainage, who received REGULUS placement for UMDBO between January 2023 and June 2024 (REGULUS group) and 25 consecutive patients who received conventional polyethylene plastic stent placement (conventional [control] group), between April 2020 and December 2022, just before the introduction of REGULUS, were enrolled in this study. Patients with transient drainage, stent diameters larger than 8.5-Fr, or etiologies other than pancreatobiliary malignancy were excluded. The main outcome measure was the time to recurrent biliary obstruction (TRBO).

Results: Both groups had 100% technical success rates; clinical success rates in the REGULUS and conventional groups were 96% (25/26) and 100% (25/25), respectively (p = 1.0). Kaplan–Meier analysis showed a median (95% confidence interval) TRBO of 67 (33–168) and 87 (61–108) days in the REGULUS and conventional groups, respectively (p = 0.915).

Conclusion: Regarding TRBO, the present study demonstrated no advantage of the novel plastic stent over the conventional plastic stent for UMDBO.

OP-07-05

Efficacy of new uncovered self-expandable metallic stent (YABUSAME) for malignant hilar biliary obstruction

Akihisa Ohno¹, Nao Fujimori¹, Kotaro Takeshita^2,3, Susumu Hijioka², Kenji Ikezawa⁴, Takeshi Ogura⁵, Masaki Kuwatani⁶, Shinpei Doi⁷, Masato Endo⁸, Saburo Matsubara⁹, Reiko Yamada¹⁰, Hirosato Mashima¹¹, Mikinori Kataoka¹², Ryoji Takada⁴, Atsushi Okuda⁵, Nobuhiro Katsukura⁷, Hirosumi Suzuki⁸, Takamistu Tanaka¹⁰, Masanari Sekine¹¹, Hidetoshi Kitamura¹² and Takuji Okusaka²

¹Kyushu University, Fukuoka, Japan; ²National Cancer Center Hospital, Chuo, Japan; ³Tane General Hospital, Osaka, Japan; ⁴Osaka International Cancer Institute, Osaka, Japan; ⁵Osaka Medical and Pharmaceutical University, Takatsuki, Japan; ⁶Hokkaido University Hospital, Sapporo, Japan; ⁷Teikyo University Mizonokuchi Hospital, Kawasaki, Japan; ⁸University of Tsukuba, Tsukuba, Japan; ⁹Saitama Medical University, Saitama, Japan; ¹⁰Mie University, Tsu, Japan; ¹¹Jichi Medical University Saitama Medical Center, Saitama, Japan; ¹²Mita Hospital, International University of Health and Welfare, Minato, Japan

Oral Presentation 7, APDW Theatre 1, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: In a recent year, a variety of self-expandable metallic stents (SEMS) for biliary stricture have been launched. The optimal SEMS for malignant hilar biliary obstruction (MHBO) is not established. We evaluated the efficacy of new uncovered laser-cut SEMS (YABUSAME) for MHBO in Japan.

Materials and Methods: We conducted a multicenter, prospective, and single-arm study in Japanese 11 hospitals from March 2021 to December 2021. The primary endpoint was the rate of patients with no recurrent biliary obstruction at 6 months (6M non-RBO rate).

Result: The overall enrolled patients was 45 and 42 patients underwent the placement of YABUSAME for MHBO. Median age is 69. The most common diseases and Bismuth type were cholangiocarcinoma (28.9%) and IV (35.6%), respectively. Twenty-seven patients (60.0%) underwent the previous biliary drainage. Bilateral drainage was frequently performed (72.1%). Drainage methods were partial stent-in-stent, side-by-side, and unilateral in 28 (65.1%), 3 (7.0%), and 12 (27.9%) patients, respectively. The rates of technical success, clinical success, and adverse event were 93.2% (41/45), 79.1% (34/45), and 4.4% (2/45), respectively. 6M non-RBO rate was 55.3% (29.5-75.0). Median time to RBO and overall survival (OS) was 231 and 125 days.

Conclusion: This multicenter prospective study showed the efficacy of YABUSAME for MHBO, but not as much as expected, which may be influenced by the high rate of patients with previous biliary drainage, unilateral placement, and short OS.

OP-07-06

Evaluating initial results of endoscopic intervention in treating biliary tract complications post liver transplantation

Quang Pham Minh Ngoc, Tung Nguyen Lam, Thang Duong Minh, Ky Thai Doan, Thanh Tran Van and Tuan Nguyen Anh

108 Military Central Hospital, Ha Noi, Viet Nam

Oral Presentation 7, APDW Theatre 1, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Aims: Determining the initial results of endoscopic intervention for managing biliary complications post-liver transplantation at 108 Military Central Hospital.

Methods: The study encompasses patients experiencing biliary complications after liver transplantation at 108 Hospital from September 2019 to June 2023. The research methodology involves a combined retrospective and prospective study with a cross-sectional descriptive approach.

Results: From September 2019 to June 2023, 183 patients received liver transplants at 108 Hospital, most of them from living donors. The incidence of biliary complications post-liver transplantation in our hospital is 20.76% (38/183 patients), with biliary stricture constituting 84.2%. All patients are prioritized for endoscopic intervention, and the success rate of ERCP is 92.1% in the first intervention. The predominant method employed is stricture dilation combined with placing biliary plastic stents, accounting for 68.6%. The total number of ERCP interventions per patient ranged from a minimum of 1 to a maximum of 7. Most patients received multiple stents during their latest intervention (68.6%). Patients responded positively to the intervention, evidenced by reduced symptoms (jaundice, fever, abdominal pain) and improved biochemical markers (GOT, GPT, GGT, ALP). The post-intervention complication rate was 20.0%, with most cases manageable through internal medicine, except for one intervention-related fatality.

Conclusions: ERCP should be chosen as the first-line intervention for patients with post-liver transplantation biliary complications due to its minimally invasive nature, ease of deployment, high success rates, and favourable patient responsiveness. Implementing a rational strategy alongside vigilant monitoring is essential to optimize outcomes in these cases.

OP-07-07

Microbiological assessment, antibiotic sensitivity and resistance pattern from biliary stents in metropolitan medical center

Rolando Rabot Jr and Evan Ong

Metropolitan Medical Center, Manila City, Philippines

Oral Presentation 7, APDW Theatre 1, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: This study aims to determine the prevalence of pathogens and antimicrobial resistance profiles in patients with biliary stents to aid the clinician in their choice of antibiotics.

Method: A total of 49 plastic biliary stents extracted via ERCP were analyzed between September 2022 and September 2023. Stent samples were taken under a strict protocol and immediately sent to the microbiological laboratory for culturing. Pathogens were cultured and identified according to standard protocols.

Results: Pathogens were cultured from the extracted stents in 93.88% (46/49) of samples. The majority of the indications were of benign pathology 85.71% (42/49). Monomicrobial growth was more common at 55% (27/49). However, polymicrobial growth is more frequently isolated in patients with acute cholangitis. The most frequently isolated were gram-negative bacteria including Escherichia coli 55% (27/49) and Klebsiella pneumoniae 26% (13/49). Multi-drug resistant bacteria were also isolated, Extended-Spectrum Beta-Lactamase (ESBL), Escherichia coli 12.2% (6/49) and Klebsiella pneumoniae 6.52% (3/49), as well as fungi such as Candida sp 6.12% (3/49). There was highest resistance to ampicillin 79.59% (39/49). On the other hand, highest susceptibility rate was found in Ceftazidime 63% (31/49).

Conclusion: E. coli, K. pneumoniae, and their multi-drug resistant forms are the most frequently associated organisms in plastic biliary stents in this study. Fluoroquinolones and Cephalosporins showed a high resistance rate and may not be adequate for the treatment of cholangitis and other biliary diseases, especially with the emergence of multi-drug resistant bacteria.

OP-07-08

Risk factor analysis for stent migration of fully covered SEMS for malignant distal biliary obstruction

Arata Sakai¹, Atsuhiro Masuda¹, Takaaki Eguchi², Keisuke Furumatsu^2,3, Takao Iemoto⁴, Shiei Yoshida⁵, Yoshihiro Okabe⁶, Kodai Yamanaka⁷, Ikuya Miki⁸, Saori Kakuyama⁹, Yosuke Yagi¹⁰, Daisuke Shirasaka¹¹, Shinya Kohashi¹, Takashi Kobayashi¹, Hideyuki Shiomi^1,12 and Yuzo Kodama¹

¹Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; ²Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan; ³Department of Gastroenterology, Akashi Medical Center, Akashi, Japan; ⁴Department of Gastroenterology, Kita-harima Medical Center, Ono, Japan; ⁵Department of Gastroenterology, Kobe Medical Center, Kobe, Japan; ⁶Department of Gastroenterology, Kakogawa Central City Hospital, Kakogawa, Japan; ⁷Division of Gastroenterology, Konan Medical Center, Kobe, Japan; ⁸Department of Gastroenterology, Hyogo Cancer Center, Akashi, Japan; ⁹Department of Gastroenterology, Takatsuki General Hospital, Takatsuki, Japan; ¹⁰Department of Internal Medicine, Shiso Municipal Hospital, Japan; ¹¹Department of Gastroenterology, Kobe Red Cross Hospital, Kobe, Japan; ¹²Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Japan

Oral Presentation 7, APDW Theatre 1, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: This study aimed to assess the clinical performance of a novel fully covered metal stent for unresectable malignant distal biliary obstruction (MDBO) and clarify the risk factor for stent migration.

Materials and Methods: This was a multicenter, single-arm, prospective study. The primary outcome was the non-obstruction rate at 6 months. The secondary outcomes were overall survival (OS), recurrent biliary obstruction (RBO), time to RBO (TRBO), technical success, clinical success, and adverse events.

Results: A total of 73 patients were enrolled in the study. The non-obstruction rate at 6 months was 61%. The median OS was 233 days, median TRBO was 216 days, technical success was 100%, clinical success was 97%, RBO occurred in 49%, and adverse events occurred in 21% of cases. The length of bile duct stenosis < 2.2 cm was the only significant risk factor for stent migration.

Conclusion: The non-obstruction rate of a novel fully covered SEMS for MDBO is comparable to that reported earlier, but shorter than what was expected. The short length of bile duct stenosis is a significant risk factor for stent migration.

OP-07-09

Long-term outcomes of fully covered metal stent versus multiple plastic stents for hepaticojejunostomy anastomotic stricture

Tatsuya Sato, Naminatsu Takahara and Mitsuhiro Fujishiro

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan

Oral Presentation 7, APDW Theatre 1, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: We aimed to compare the long-term outcomes of a fully-covered self-expandable metal stent (FCSEMS) versus multiple plastic stents (MPS) for hepaticojejunostomy anastomotic strictures (HJAS).

Material and Methods: Patients who underwent stent placement for HJAS using a short-type double balloon-assisted endoscope between June 2008 and September 2022 were retrospectively studied. MPS placement was conducted until 2017 (MPS group) when FCSEMS placement was introduced in our clinical practice (FCSEMS group). Stent exchange was scheduled every three months until stricture resolution. Patients were followed up at an outpatient clinic at least 12 months after stent removal. The primary outcome of this study was the stent-free rate at 12 months after stent removal.

Results: Between the MPS group (n = 34) and FCSEMS group (n = 53), patient characteristics were not significantly different except for the rate of refractory cases (MPS 8.8% vs. FCSEMS 58.5%, P < 0.001). Technical success (94.1% vs. 100%, P = 0.15) and early adverse events (7.6% vs. 3.8%, P = 0.283) were not different. The rate of stricture resolution was significantly higher in the FCSEMS group (52.9% vs. 96.2%, P < 0.001) with a shorter median indwelling time (188 days [IQR, 103-453] vs. 92 days [IQR, 90-98], P = 0.002). The stent-free rate 12 months after stricture resolution was significantly higher in the FCSEMS group (41.2% vs. 75.5%, P < 0.001), while the cumulative recurrence rate was not different (P = 0.697).

Conclusion: The stent-free rate at 12 months was significantly higher in the FCSEMS group.

OP-08-01

Effectiveness of solanum procumbens combined with tenofovir disoproxil fumarate in treatment of chronic hepatitis B

Le Thi Thu Hien², Le Quoc Tuan¹, Dinh Cong Tiep¹, Dinh Cong Dang¹ and Phuong Linh Ha¹

¹Cam Khe 103 Clinic, Phu Tho, Viet Nam; ²Thai Nguyen University of Medicine and PharmacyLuong Ngoc Quyen, Vietnam

Oral Presentation 8, APDW Theatre 2, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Aims: Evaluating the effectiveness of Solanum procumbens (SP) combined with Tenofovir disoproxil fumarate (TDF) in the treatment of hepatitis B virus (HBV).

Methods: Study on a randomized controlled clinical trial in 150 HBeAg-positive patients with chronic hepatitis B at Cam Khe Clinic from May 2019 to November 2023, who divided into 3 groups treated with: SP 300mg combined with TDF 300mg group, TDF 300mg group and SP 300mg group.

The percentages of ALT concentration response when using hard capsules containing SP combined with TDF after 6, 12, 18 months of SP-TDF group were higher than TDF group and SP group (p<0.01).

Response to reducing HBV DNA concentration higher than 3 log copies/ml when using hard capsules containing SP combined with TDF were higher than in the TDF group (p<0.01). The rates of response to reduce HBV DNA below the detection threshold in the SP -TDF group after 6, 12, 18 months were higher than TDF group (p<0.01).

Response to HBeAg loss when using hard capsules containing SP combined with TDF group after 6, 12, 18 months were higher than TDF group(p<0.01).

The rate of Anti-HBe appearance response in the SP-TDF group after 6, 12, 18 months were higher than TDF group and SP group (p<0.01).

Response to loss of HBeAg and simultaneous appearance of anti-HBe in the SP combined with TDF group after 6,12, 18 months were higher than TDF group (p<0.01).

Conclusions: The combination of SP and TDF is more effective than TDF group in the treatment of HBV.

OP-08-02

Effect of transarterial chemoembolization (TACE) on health related quality of life in patients with hepatocellular carcinoma

Susan George, Arjun Haridas, Jesse Jacob and Krishnadas Devadas

Government Medical College, Kerala, Thiruvananthapuram, India

Oral Presentation 8, APDW Theatre 2, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: Health-Related Quality of Life (HRQoL) is as crucial as the length of survival for patients receiving palliation. The change in HRQoL in patients with HCC before and after TACE along with the clinical and biochemical factors which can predict it were evaluated.

Materials and Methods: 45 enrolled patients were followed up for 3months. HRQoL and baseline characteristics were assessed using EORTC HCC specific questionnaire at baseline, 2 weeks and 3 months. Tumor response was assessed at 6 weeks by mRECIST criteria.

Results: Before TACE, the most impacted Functional scale aspects were global health status (51.7%) and physical functioning (68.7%). The commonest symptoms were fatigue (46.4 ± 29.2%), insomnia (32.6 ± 36.6%) and abdominal pain (32.2 ± 30.9%). Financial constraints were a significant concern for 63% patients.

The average percentage of pre-interventional global health status did not show significant change at 2 weeks (51.7% Vs 50.0%, p = 0.613), but there was notable improvement at 3 months (51.7% Vs 66.7%, p <0.001). Functional scales showed reduction at 2 weeks and improvement at 3 months. High AFP and CRP, low albumin, increase in MELD and CTP scores were found to have negative impact on change in global health status at 3 months.

Conclusion: Effective symptom management, along with implementation of coping strategies to improve functionality are crucial when caring for patients who have undergone TACE, particularly during the first two weeks post-procedure, without which, a decrease in quality of life may prompt patients to halt treatment.

Keywords: HRQOL, HCC, TACE

OP-08-03

Alcohol consumption increases risk of hepatocellular carcinoma in patients with chronic hepatitis B-related decompensated cirrhosis

Vicki Wing-ki Hui^1,2, Zeyuan Yang^3,4, Jimmy Che-To Lai^1,2, Ramsey Cheung^3,4, Terry Cheuk-Fung Yip^1,2, Vincent Wai-Sun Wong^1,2, Grace Lai-Hung Wong^1,2 and Robert Wong^3,4

¹Medical Data Analytics Centre (MDAC), Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; ²Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong, Hong Kong; ³Gastroenterology and Hepatology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA; ⁴Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA

Oral Presentation 8, APDW Theatre 2, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Long-term antiviral therapy effectively reduces hepatic decompensation and HCC in CHB-related cirrhosis. However, patients with excessive alcohol use are typically excluded from clinical trials. This study assesses the impact of alcohol consumption on risk of incident HCC in treated patients with CHB-related decompensated cirrhosis.

Patients with HCC-free CHB-related decompensated cirrhosis were identified. Alcohol consumption was identified using a combination of ICD-9/10 codes or alcohol intake based on previously validated algorithms. Fine-Gray model was used to adjust for competing risk of death and liver transplantation. The follow-up period was 5 years. Patients with follow-up duration of less than 3 months were excluded.

We identified 1,132 patients with CHB-related decompensated cirrhosis (mean age 64 years, 65% male), among whom 396 (35%) reported alcohol consumption. Their MELD and Child-Pugh [IQR] scores were 12.3 ± 4.5 and 8 [8,8] respectively (Alcohol group: MELD 12.1 ± 5; Child-Pugh 8[8,8]; No alcohol group: MELD 12.0 ± 4.5, Child-Pugh 8[8,8]). Ascites was the most common decompensating event (785 cases, 69%). The 5-year cumulative incidence [95% CI] of HCC were 18.2% [12.9%, 23.1%] and 32.4% [23.8%, 40.1%] in patients in the no alcohol group and those with alcohol consumption (p<0.001) (Figure 1). After adjusting for age, sex, total bilirubin, and alpha fetoprotein, alcohol consumption increased the risk of HCC (adjusted subdistribution hazard ratio: 1.398; [95% CI]: [1.001, 1.953]; p = 0.05).

Alcohol consumption significantly increases risk of HCC in patients with CHB-related decompensated cirrhosis on potent antiviral therapy, though larger sample sizes are warranted for conclusive findings.

OP-08-04

Phospho-Smad3L as potential predictive biomarker for hepatocellular carcinoma development in patients with alcohol-related liver disease

Panuwat Promsorn¹, Takashi Yamaguchi¹, Shinji Shimoda¹, Katsunori Yoshida¹, Kanehiko Suwa¹, Kazunori Aoi¹, Toshiro Fukui¹, Hisashi Kosaka², Hideyuki Mastushima², Kosuke Matsui², Masaki Kaibori² and Makoto Naganuma¹

¹Department of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Japan; ²Department of Surgery, Kansai Medical University, Hirakata, Japan

Oral Presentation 8, APDW Theatre 2, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Objective: Alcohol-associated hepatocellular carcinoma (A-HCC) is often diagnosed late due to inadequate screening in patients with alcohol-related liver disease (ALD). While liver fibrosis is a known risk factor, some ALD patients develop HCC without cirrhosis. Transforming growth factor (TGF)-β signaling is implicated in hepatic fibrogenesis and carcinogenesis. Tumor necrosis factor (TNF)-α, a key factor in ALD progression, activates c-Jun N-terminal kinase (JNK), leading to phosphorylation of Smad3 at its linker region (pSmad3L), which is associated with tumorigenesis. This study aims to determine whether Smad3 phosphorylation patterns can predict HCC risk in ALD patients, regardless of fibrosis.

Materials and Methods: We conducted immunohistochemical analysis of pSmad3L signaling in liver samples from 18 ALD patients, both with and without HCC, categorized by the severity of fibrosis (mild or severe). Sixteen patients with chronic hepatitis C (HCV) were included as controls. Image analysis software (HALO™) quantified pSmad3 staining intensity.

Results: In HCV-infected control, severe fibrosis was associated with a higher percentage of strong pSmad3L compared to mild fibrosis (32.75% vs. 11.30%, p = 0.0472). Conversely, mild fibrosis patients showed higher strong pSmad3C compared to severe fibrosis (45.90% vs. 5.55%, p = 0.0107). A-HCC patients exhibited significantly higher strong pSmad3L than the ALD group in both mild (44.62% vs. 4.31%, p = 0.0122) and severe fibrosis (69.73% vs. 35.03%, p = 0.0369).

Conclusion: Smad3 phosphorylation patterns could be a valuable biomarker for assessing HCC risk in ALD patients. Specifically, elevated pSmad3L staining indicate an increased risk of HCC development, independent of liver fibrosis status.

OP-08-05

SARC-HLT score-A bedside tool for assessing sarcopenia and predicting survival in patients with Hepatocellular carcinoma

S Sreekumar, N V Akhil, A Shanid, Krishnadas Devadas and Srijaya Sreesh

Government Medical College, Thiruvananthapuram, Thiruvananthapuram, India

Oral Presentation 8, APDW Theatre 2, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: Sarcopenia is recognized as a significant prognostic factor in hepatocellular carcinoma(HCC). We aimed to derive a bedside score for assessing sarcopenia and evaluate its prognostic significance in HCC.

Materials and Methods: Prospective observational study of 106 cirrhosis patients with HCC. Relevant investigations and CECT abdomen were taken at 0,6 and 12 months. Skeletal muscle area at L3 vertebra and skeletal muscle index were calculated. Patients were treated according to BCLC staging and monitored for survival, treatment response, and adverse events.

Results: 66 patients(62.3%) had sarcopenia. On regression analysis, hand grip strength(HGS), triceps skin fold thickness(TSFT), and liver frailty index(LFI) were found to be independent predictors of sarcopenia(p< 0.005),and the Beta coefficient was multiplied to LFI, HGS and TSFT and the sum of values were obtained and termed as SARC-HLT score( LFI* 2.735–HGS*0.279 – TSFT*0.823). This score had an AUROC of 0.937 and, at a cutoff of <-6.7, has a sensitivity of 93.9% and specificity of 75% in predicting sarcopenia. Mortality was higher in the sarcopenic group(median overall-survival(OS) of 7 months p<0.001). The non-sarcopenic group had a higher progression-free survival (PFS)(p< 0.01). Multivariate Cox-proportional hazard models identified advanced CHILD status(HR-5.9,p <0.001) and albumin (HR-0.18,p -0.001 ) as independent predictors of shorter OS . Adverse events were common in the sarcopenic group(p< 0.001) in the first 6 months leading to treatment discontinuation.

Conclusions: Sarcopenia has excellent predictive value for OS, PFS, and early adverse events. The SARC-HLT score is a simple bedside tool with good sensitivity for early identification of sarcopenia.

OP-08-06

Predictors of response to atezolizumab plus bevacizumab in patients with hepatocellular carcinoma,a multicentre Indian study

Satender Pal Singh¹, Karan Kumar², Vinod Arora¹, Anand Kulkarni³, Ashok Chowdhury¹, Alisha Chaubal⁴, Sahaj Rathi⁵, Samir Shah⁴, Sunil Taneja⁵, Ashish Kumar⁶, Ajay Duseja⁵, P.N. Rao³, Vivek Saraswat² and Shiv Kumar Sarin¹

¹Institute of liver and biliary Sciences, New Delhi, India; ²Mahatama Gandhi Hospital, Jaipur, India; ³Asian Institute of gastroenterology, Hyderabad, India; ⁴Global Hospitals, Mumbai, India; ⁵Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India; ⁶Sir Ganga Ram Hospital, New Delhi, India

Oral Presentation 8, APDW Theatre 2, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: An approved treatment for people with advanced HCC is immunotherapy with atezolizumab and bevacizumab. With lack of data from India, we conducted the largest multicentre study to evaluate the efficacy and safety of atezolizumab and bevacizumab in patients with advanced unresectable HCC.

Material and Methods: We included the data collected from 6 centres across India, from January 2021 till December 2023. Total of 250 patients were screened, 160 patients were included in study. Patients who received <3 injections were excluded. Objectives were to study overall survival, progression free survival, objective response rate and adverse effects.

Results: Mean age of included patients was 61.9±11.7 years, 88% male. 55% had NASH as etiology, 16.3% hepatitis C, 18.8% hepatitis B, rest were alcohol and cryptogenic etiology. Mean MELD score was 12.05±4.46, ALBI score was 2.04±0.57 and CTP score was 6.43±1.29. The median overall survival was 10(95%CI:6.1-15.6) months. The median progression free survival was 8 (95%CI:5.1-14.7) months. 11(6.9%) achieved complete response, 28(17.5%) achieved partial response, 33(20.6%) had stable disease, 88(55%) had progressive disease. On multivariate analysis, CRP>1 [p-0.007,OR 95%CI-3.57(1.41-8.99)], PIVKA2 > 400 [p-0.019, OR95%CI-3.12(1.21-8.08)] and diabetes [p-0.042,OR95%CI-4.13(1.97-8.42)] were associated with non-response to atezolizumab and bevacizumab injection. 53% patients developed any grade of adverse effect, 20% develop grade 3/4 adverse event amounting to stoppage of therapy.

Conclusion: In patients with unresectable hepatocellular carcinoma, atezolizumab combined with bevacizumab resulted in better overall and progression free survival in patients with better liver functions. CRP>1, PIVKA2>400 and presence of diabetes predicts non-response to atezolizumab and bevacizumab injections.

OP-08-07

Microtubule-associated protein tau (MAPT) is a prognostic marker and tumor-promoting protein in hepatocellular carcinoma

Bo Wang¹, Na Huang², Yongqiang Xiong¹, Jun Li² and Shu Zhang^1,3

¹Department of Geriatric General Surgery, The Second Affiliated hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; ²National & Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, The Second Affiliated hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; ³Experimental Teaching Center for Clinical Skills, The Second Affiliated hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China

Oral Presentation 8, APDW Theatre 2, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Background: The MAPT encodes the microtubule-associated protein tau, which stabilizes microtubules. While crucial in neurodegenerative diseases like Alzheimer's, MAPT's role in hepatocellular carcinoma(HCC) remains understudied.

Methods: We used TCGA database to compare MAPT expression in HCC and adjacent tissues, assessing gene mutations and methylation levels. Kaplan-Meier analysis evaluated MAPT's prognostic value and its correlation with clinicopathological features. Gene enrichment and immune infiltration analyses explored potential mechanisms. In vitro, qRT-PCR and Western blot assessed MAPT expression and function in HCC cell lines.

Results: Bioinformatics showed significant up-regulation of MAPT mRNA and protein in HCC (P < 0.001), linked to gene amplification, lower promoter methylation, and P53 mutation. Kaplan-Meier analysis revealed that low MAPT expression correlates with better prognosis (P < 0.05) and is associated with age, gender, etiology, disease stage, and vascular invasion (P < 0.05). Enrichment analysis indicated MAPT's involvement in apoptosis, chemokine signaling, NF-kappa B signaling, PD-L1/PD-1 checkpoint, and PPAR signaling pathways. Immune infiltration analysis showed positive correlations between MAPT expression and CD4+ T cell, macrophage, and neutrophil levels (P < 0.001). Western blot and qRT-PCR confirmed MAPT upregulation in HepG2 and BEL-7402 cell lines (P < 0.001). Knockdown of MAPT inhibited the proliferation, migration and invasion in HCC cells and also allowed the cells to undergo G0/G1 phase arrest and increased apoptosis.

Conclusion: High MAPT expression in HCC is associated with poor prognosis, likely due to its roles in immune infiltration, cell proliferation, migration, invasion, and apoptosis. MAPT is a potential prognostic marker and therapeutic target for HCC.

OP-08-08

Correlation between altered cellular energetics and developmental stage dysregulation of NK cells in hepatocellular carcinoma

Pushpa Yadav, Anupma Kumari, Prabhjyoti Pahwa, Aesha Rehan, Viniyendra Pamecha, Shiv K. Sarin and Nirupma Trehanpati

Institute of Liver And Biliary Sciences, New Delhi, India

Oral Presentation 8, APDW Theatre 2, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Background: Functional NK cells are crucial components of the tumor microenvironment (TME) in HCC. The significant knowledge gap regarding their metabolic alterations prompted us to investigate the correlation between cellular energetics and developmental stage dysregulation of NK cells in HCC.

Material and Methods: We studied 27 patients with end-stage liver disease (12 HCC and 15 CLD). Cirrhosis and HCC were induced in B6C3F1 mice using DEN and CCL4. Gp.I (control) and Gp.II received 1X PBS, while Gp.III and Gp.IV were administered single dose of DEN (1mg/kg i.p.) at 2 weeks old. From 8-30 weeks, Gp.I and Gp.III received olive oil, and Gp.II and Gp.IV received CCL4 (0.2ml/kg, twice/week). High-dimensional flow-cytometry was used to analyze PBMCs and LILs from both human and mice tissues.

Results: In animal model, TME showed elevated total (p=0.0492) and immature (CD11b-veCD27-ve, p=0.007) NK cells. Similarly, patient LILs showed increased frequency of immature(CD56++CD16-, p=ns) NK and diminished expression of maturation marker, CD57 on mature (CD56+CD16+, p=0.0012)NK cells.

Immature NK cell subsets (CD11b-veCD27-ve, p=0.0176) in mice and CD56++CD16-ve(p=0.0123) in humans with HCC showed decreased expression of hexokinase-2 compared to their cirrhotic controls. Increased ROS production was observed in CD56++CD16-ve NK cell subset(p=0.0038) of HCC patients when compared to CLD.

Conclusion: Our results indicate metabolic reprogramming of NK cells and perturbation of their developmental stages in HCC. Decreased frequency of mature NK cells, coupled with reduced HK2 and heightened ROS production suggests mitochondrial depolarization. These metabolic alterations may contribute to the dysregulation of NK cell developmental stages in HCC.

OP-08-09

High expression of OGT are correlated with poor prognosis and defective immune-infiltration in hepatocellular carcinoma

Bo Wang¹, Yongqiang Xiong¹, Na Huang², Jun Li² and Shu Zhang^1,3

¹Department of Geriatric General Surgery, The Second Affiliated hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; ²National & Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; ³Experimental Teaching Center for Clinical Skills, The Second Affiliated hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China

Oral Presentation 8, APDW Theatre 2, Exhibition Hall, November 22, 2024, 2:30 PM - 3:50 PM

Background: O-linked β-N-acetylglucosamine (O-GlcNAc) glycosylation, a post-translational modification catalyzed by O-GlcNAc transferase (OGT), is implicated in various human diseases. However, research on OGT in hepatocellular carcinoma (HCC) is limited.

Methods: We analyzed OGT expression using UALCAN and HPA databases. Expression differences were validated through RT-PCR, Western blotting, and Immunohistochemistry. Prognostic value and correlation with clinical features were assessed via Kaplan-Meier analysis. Genetic variations and methylation levels were explored using COSMIC and UALCAN. The relationship with aerobic glycolysis and immune infiltration was examined using TIMER, alongside gene enrichment and drug sensitivity analyses.

Results: OGT mRNA and protein were significantly upregulated in HCC, confirmed across multiple cell lines by RT-PCR. Kaplan-Meier analysis revealed better prognosis in patients with low OGT expression. OGT levels correlated with gender, weight, histological grade, and P53 status. Over-expression correlated with increased DNA copy number and lower promoter methylation, especially with P53 mutations. Immune infiltration analysis showed positive correlations with B cells, CD8+ T cells, CD4+ T cells, macrophages, and neutrophils, and with key glycolysis kinases. Enrichment analysis linked OGT to RNA/DNA metabolism, apoptosis, mTOR, and Notch signaling.

Conclusion: OGT upregulation in HCC indicates poor prognosis, particularly with P53 involvement. It regulates aerobic glycolysis, immune infiltration, and apoptosis, suggesting OGT as a potential biomarker for HCC diagnosis, treatment, and prognosis.

OP-09-01

Sodium-glucose cotransporter-2 inhibitors associated with lower colorectal cancer risk than aspirin in diabetic metformin users

Ka Shing Cheung^1,2, Xianhua Mao^1,2, Jing-Tong Tan¹, Wai Keung Leung¹ and Wai-Kay Seto^1,2

¹The University of Hong Kong, Hong Kong, Hong Kong; ²The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

Oral Presentation 9, Uluwatu 1, November 22, 2024, 2:30 PM - 3:50 PM

Background: Aspirin and metformin are recommended as chemopreventive agents against colorectal cancer (CRC) development as per American Gastroenterological Association. We aimed to compare effectiveness of aspirin and sodium-glucose co-transporter 2 inhibitors (SGLT-2i) on CRC prevention in type 2 diabetes (T2D) metformin users.

Methods: All metformin users aged 18-69 years between 2015 and 2021 were identified from territory-wide electronic healthcare database in Hong Kong. Index date was date of first metformin prescription, and a 6-month entry period was applied to assess aspirin and SGLT-2i use. Primary outcome was CRC and secondary outcomes included CRC-related mortality and colonic adenoma (any, non-advanced, and advanced). Covariates included age, sex, body mass index, smoking, alcohol use, dyslipidemia, hypertension, hemoglobin A1c, T2D duration, cardiovascular diseases, other anti-diabetic medications, non-aspirin non-steroidal anti-inflammatory drugs, statins, and colonoscopy. We applied multivariable Cox regression models to calculate adjusted hazard ratios (aHRs) of outcomes with SGLT-2i.

Results: Among 62,869 T2D metformin users (mean [SD] age:59.8 [+/-7.7] years; 61.4% male), 32,320 (51.4%) was aspirin(+)/SGLT-2i(-) group, 21,405 (34.0%) aspirin(-)/SGLT-2i(+) group, and 9,144 (14.5%) aspirin(+)/SGLT-2i(+) group. During a mean follow-up of 4.6 (+/-2.4) years, there were 500 (0.8%) incident CRC and 87 (0.1%) CRC-related deaths. Compared with SGLT-2i(-)/aspirin(+), SGLT-2i(+)/aspirin(-) and SGLT-2i(+)/aspirin(+) were associated with lower CRC risk (aHR:0.54;95%CI:0.39-0.75; and aHR:0.53;95%CI:0.37-0.76, respectively). Use of SGLT-2i with or without aspirin was associated with lower risk of CRC-related mortality (aHR:0.65;95%CI:0.48-0.90), any adenoma (aHR:0.69;95%CI:0.61-0.79), non-advanced adenoma (aHR:0.71;95%CI:0.62-0.81), and advanced adenoma (aHR:0.57;95%CI:0.41-0.78).

Conclusion: SGLT-2i, irrespective of aspirin, was associated with lower CRC risk than aspirin, among T2D metformin users.

OP-09-02

Precise Notch-targeted therapeutic in colorectal cancer by Notch1 attenuation via tumor microenvironment-responsive cascade DNA therapy

Dake Chu

Xian Jiaotong University, Xi'an, China

Oral Presentation 9, Uluwatu 1, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: The Notch signaling is a key molecular pathway that regulates cell fate and development. Aberrant Notch signaling can lead to carcinogenesis and progression of malignant tumors. However, current therapies targeting Notch pathway lack specificity and induce high toxicity.

Materials and Methods: In this report, a tumor microenvironment-responsive and injectable hydrogel is designed to load plasmid DNA complexes as a cascade gene delivery system to achieve precise Notch-targeted gene therapy of colorectal cancer (CRC). The hydrogels are prepared through cross-linking between phenylboric acid groups containing poly(oligo(ethylene glycol)methacrylate) (POEGMA) and epigallocatechin gallate (EGCG), used to load the complexes between plasmid DNA encoding short hairpin RNAs of Notch1 (shNotch1) and fluorinated polyamidoamine (PAMAM-F) (PAMAM-F/shNotch1).

Results: In response to low pH and H2O2 in tumor microenvironment, the hydrogel can be dissociated and release the complexes for precise delivery of shNotch1 into tumor cells and inhibit Notch1 activity to suppress malignant biological behaviors of CRC. In the subcutaneous tumor model of CRC, PAMAM-F/shNotch1-loaded hydrogels can accurately attenuate Notch1 activity and significantly inhibit tumor growth without affecting Notch signal in adjacent normal tissues.

Conclusion: Therefore, this therapeutic system can precisely inhibit Notch1 signal in CRC with high responsiveness and low toxicity, providing a promising Notch-targeted gene therapeutic for human malignancy.

OP-09-03

Mediterranean diet adherence is associated with reduced cancer and improved cancer survivorship in older adults

Daniel Clayton-Chubb^1,2, Jessica Fitzpatrick^1,2, Nicole Vaughan¹, Robyn Woods², Alice Owen², William Kemp^1,2, Ammar Majeed^1,2, John McNeil², Andrew Chan³ and Stuart Roberts^1,2

¹Alfred Health, Melbourne, Australia; ²Monash University, Melbourne, Australia; ³Massachusetts General Hospital, Boston, USA

Oral Presentation 9, Uluwatu 1, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: While a Mediterranean diet (MD) is commonly recommended, its role in reducing cancer risk and improving cancer survivorship is understudied in older adults. As such, we aimed to determine whether MD-like dietary intake was associated with incident cancer, incident GI cancer, and survivorship in older Australian adults.

Materials and Methods: In this post hoc analysis of the ASPREE trial and ALSOP sub-study, MD-Score (MDS) was developed via extensive food-frequency questionnaire (FFQ) of 12-months of self-reported dietary patterns, giving a potential MDS of 0 to 18. Participants with a recent pre-FFQ cancer diagnosis were excluded. GI cancer included colorectal/gastric/gastro-oesophageal/liver/pancreatic. MDS was analysed in quartiles.

Results: 12,394 participants (median 76.8 years) completed the FFQ while living outside residential care. 573 were excluded due to missing data/recent cancer diagnosis. The remaining 11,831 had a mean MDS of 11.1 (±2.0) and were followed for median 5.8 (IQR 4.6-6.5) years; 13.8% (1,629) developed cancer (344 [2.9% overall] GI cancers). Higher MDS was associated with reduced cancer (Q4 vs Q1 HR 0.71 [95% CI 0.62-0.81]) and GI cancer (Q4 vs Q1 HR 0.70 [95% CI 0.51-0.95]) (Figure 1). Fully adjusted results remained significant for all cancer (Q1 vs Q4 aHR 0.85 [95% CI 0.74-0.99]) but not GI cancer (Q1 vs Q4 aHR 0.82 [95% CI 0.60-1.13]). Higher MDS was associated with reduced all-cause mortality (Q4 vs Q1 aHR 0.73 [95% CI 0.56-0.96]) in those who developed cancer.

Conclusion: In community-dwelling older adults, better MD adherence reduces the risk of all cancers and improves cancer survivorship.

OP-09-04

Accuracy of fusobacterium nucleatum, bacteroides fragilis, and their combination in predicting colorectal cancer occurrence

Nikko Darnindro^1,2, Murdani Abdullah², Ninik Sukartini³ and Cleopas Martin Rumende⁴

¹Fatmawati General Hospital, Jakarta Timur, Indonesia; ²Gastroenterology, Pancreaticobilier, and Digestive Endoscopy Division, Internal Medicine Department, CiptoMangunkusumo Hospital, Jakarta, Indonesia; ³Clinical Patology Department, CiptoMangunkusumo Hospital, Jakarta, Indonesia; ⁴Pulmonology and Critical Care Medicine Division, Internal Medicine Department, CiptoMangunkusumo Hospital, Jakarta, Indonesia

Oral Presentation 9, Uluwatu 1, November 22, 2024, 2:30 PM - 3:50 PM

Backgrounds: The study aimed to assess the diagnostic accuracy of Fusobacterium nucleatum, Bacteroides fragilis, and their combination for predicting the occurrence of colorectal cancer (CRC).

Methods: A cross sectional study with total of 59 participants were included. The examination of microbiota involved the utilization of 16s rRNA sequencing. Subsequent bioinformatics analysis was conducted utilizing the wf-metagenomics pipeline offered by EPI2Me-Labs, a platform developed by Oxford Nanopore Technologies. Diagnostic accuracy was assessed by area under the curve (AUC) of receiver operating characteristic (ROC) curve.

Results: Among the 59 subjects, 35 patients were diagnosed with colorectal cancer (CRC) and 24 patients non-CRC. The median levels of Fusobacterium nucleatum and Bacteroides fragilis were notably higher in CRC patients compared to non-CRC patients (Fusobacterium nucleatum: 0.07 vs. 0, p = 0.003; Bacteroides fragilis: 0.69 vs. 0.032, p = 0.002). The AUC for predicting CRC was 0.727 (95% CI: 0.600 – 0.853) for Fusobacterium nucleatum, while Bacteroides fragilis was marginally higher at 0.735 (95% CI: 0.607 – 0.862). The combination of Fusobacterium nucleatum and Bacteroides fragilis has the highest AUC 0.786 (CI 95%: 0.671 – 0.900) compared to Fusobacterium nucleatum and Bacteroides fragilis alone. With the cut off Fusobacterium nucleatum ≥ 0.0117 and Bacteroides fragils ≥0.0836 offers sensitivity 82.8%, specificity 50%, PPV 70.7%, and NPV 66.7%.

Conclusion: These findings underscore the potential utility of Fusobacterium nucleatum and Bacteroides fragilis, individually and in combination, as predictive markers for colorectal cancer.

Keyword: Fusobacterium nucleatum, Bacteroides fragilis, diagnostic, colorectal cancer

OP-09-05

Integrated multi-omic analysis identifies metabolic changes associated with disease progression in sessile serrated lesion tumorigenesis

Junyuan Deng¹, Ruolan Li¹, Yi Lu² and Feng Liu¹

¹Endoscopic Center, Shanghai Tenth Hospital, Tongji University, Shanghai, China; ²School of medicine, Tongji University, Shanghai, China

Oral Presentation 9, Uluwatu 1, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: Sessile serrated lesion is a colorectal premalignant lesion and comprises of 30% CRC. There still lacks a clear understanding of the metabolic change in different progressing stage of serrated pathway. Based on this, we performed transcriptomic analysis and metabolic sequencing in Chinese SSL samples.

Materials and Methods: We collected 30 fresh samples (10 normal colon mucosa, 4 hyperplastic polyps (HP), 16 sessile serrated lesions (SSL)) from 20 patients underwent endoscopic surgery. BRAF V600E mutation was measured through sanger sequencing. Ki67 and microsatellite instability markers (MLH1, MSH2, MSH6 and PMS6) were evaluated through immunohistochemistry. RNA transcriptomic sequencing and paired GC-MS study were performed to detect the gene expression and metabolite concentration. Data analysis was performed by R software.

Results: Positive BRAF V600E mutation was detected in 12 of 16 (75%) SSL compared with HP and the normal mucosa (P<0.001). Ki67 level was significantly increased in SSL samples than HP samples (10.2% vs. 5.4%, P=0.0492). All HP and SSL samples were microsatellite stable. Increased TCA cycle and citric acid was found in HP samples. Enriched glycolysis, cholesterol synthesis and lipid biosynthesis pathways were found in SSL samples. Amino acids (glutamine, serine, lysine, proline), lactate and fatty acids were increased in SSL samples.

Conclusion: The energy status was stable in HP samples. SSL had a higher metabolic and proliferative level than the normal tissue. Altered amino acids and fatty acid biosynthesis in SSL indicates the huge demand of biological substrate. Our result strongly implies the metabolic change is associated with SSL tumorigenesis.

OP-09-06

The Efficacy and safety of chemotherapy in mucinous colorectal adenocarcinoma patients: A systematic review

Andree Kurniawan^1,2, Angeline Tancherla³, Fernanda Dharmaraja³, Felix Wijovi³, Ignatius Bima Prasetya^1,4, Dimas Priantono², Chandra Sari², Devi Astri Rivera Amelia², Deden Djatnika², Muhammad Arman Nasution², Nugraheny Prasasti Purlikasari², Beta Agustia Wisman², Farieda Ariyanti², Yohana Sitompul² and Lidya Juniarti Silalahi²

¹Internal Medine. Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia; ²Hematology and medical oncology trainee, Faculty of medicine, Universitas Indonesia; Dr Cipto Mangunkusumo hospital Jakarta, Jakarta, Indonesia; ³Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia; ⁴Gastroenterology Hepatology trainee, Faculty of medicine, Universitas Indonesia; Dr Cipto Mangunkusumo hospital Jakarta, Jakarta, Indonesia

Oral Presentation 9, Uluwatu 1, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: To evaluate the current data regarding the efficacy and safety of chemotherapy in patients with mucinous colorectal adenocarcinoma.

Materials and Methods: Data were collected from PubMed, PMC, and Science Direct, using combinations of keywords related to mucinous colorectal adenocarcinoma and chemotherapy. The included studies had investigated about the efficacy and safety of chemotherapy in mucinous colorectal adenocarcinoma patients. Observational studies (cohort) and clinical trial studies were included. The references from previous systematic review were also evaluated. The searching and extracting process were underwent by minimal 2 authors. The quality of each included study was assessed using the Newcastle-Ottawa Scale (NOS) or JADAD scale.

Results: A total of 12 studies consisting of 68,914 mucinous adenocarcinoma patients were included. There were 8 studies with good quality and 4 studies with moderate quality based on the NOS assessment. The chemotherapy regimens varied among the included studies. The studies varied between the location of colon either left or right. Most of included studies have reported survival benefit of chemotherapy in colorectal mucinous adenocarcinoma patients, especially stage II or stage III. Other studies showed no improvement of survival who receiving chemotherapy. disease. Mostly the side effects were still tolerated.

Conclusion: There is lack of good evidence regarding the chemotherapy regiment in mucinous colorectal adenocarcinoma patients. Existing evidence on the efficacy of chemotherapy is mixed. There were heterogeneity between studies. Further research is needed to better understand the optimal chemotherapy regimens and patient selection for this colorectal cancer subtype.

OP-09-07

Cumulative incidence of second primary cancers in a large cohort of long-term gastric cancer survivors

Xianchun Gao, Weili Han, Jun Yu, Yang He, Abudurousuli Reyila and Yongzhan Nie

Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China

Oral Presentation 9, Uluwatu 1, November 22, 2024, 2:30 PM - 3:50 PM

Background: A new primary cancer is a serious late effect of a pre-existing gastric cancer diagnosis. We investigated the incidence of second primary cancers (SPCs) in a prospective cohort of long-term gastric cancer survivors.

Methods: Patients who were newly diagnosed with gastric cancer from 2008 to 2020 and alive 1 year after diagnosis were recruited from a large multicenter cohort database. Follow-up was from date of first cancer diagnosis and lasted up to dead, ending on January 31, 2024. Cohort information on SPC was obtained by clinic visit, telephone interview yearly, and medical records of other hospitals. Furthermore, risk factors for SPC development were analyzed by Cox proportional hazards models.

Results: 10,376 adults were included in our study (8001 [77.1%] male individuals; median age at diagnosis 58.3 years. Over a median (IQR) follow-up of 5.9 (3.4-9.3) years, 173 patients (1.7%) developed a SPC. Lung cancer was the most common of SPCs (41 patients); the others include the carcinomas of the colorectal (37), esophageal (22), prostate (11), and other types of malignancies (62). The cumulative incidence of SPC increased over time from 1.0% (95% CI, 0.9%-1.1%) 5 years after diagnosis to 4.1% (95% CI, 3.7%-4.5%) 10 years after diagnosis. Multivariate analysis showed that age ≥65 years (HR 1.89, [95% CI, 1.34-2.66]) and smoking (HR 1.82, 1.25-2.66) were independent risk factors.

Conclusions: Patients with gastric cancer are at high risk of developing SPCs, and in particular, lung, colorectal, and esophageal cancers. Close surveillance of patients over a longer period should be considered.

OP-09-08

Factors associated with colorectal adenoma in the young: A single-center case control study

Ronell Lee and Jose Tan

Chinese General Hospital And Medical Center, Manila, Philippines

Oral Presentation 9, Uluwatu 1, November 22, 2024, 2:30 PM - 3:50 PM

Background: Colorectal adenomas are recognized precursors to colorectal cancer, and their early detection and removal are crucial in cancer prevention. The incidence of colorectal adenomas among younger populations (under 45 years) appears to be increasing, raising concerns about identifying risk factors specific to this demographic. Understanding these factors is essential to develop targeted screening and prevention strategies.

Methods: This single-center case-control study will include adult patients aged 45 years or younger who underwent colonoscopy at the Chinese General Hospital and Medical Center from January 1, 2024, to July 31, 2024. Cases are defined as patients with histopathologically confirmed colorectal adenomas, while controls are patients whose colonoscopy results did not indicate adenomas. The study will examine factors such as age, gender, body mass index (BMI), alcohol and cigarette consumption, and family history of colorectal cancer.

Results: The study aims to identify significant differences in these factors between the case and control groups, contributing to a better understanding of the epidemiology of colorectal adenomas in young patients.

Conclusion: By identifying key risk factors, this research seeks to enhance screening protocols and preventive measures for colorectal adenomas in younger populations, ultimately aiding in the reduction of colorectal cancer incidence.

OP-09-09

Mendelian randomization study of the relationship between gut microbiota and risk of gastroenteropancreatic neuroendocrine neoplasms

Shuang Ma

Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China

Oral Presentation 9, Uluwatu 1, November 22, 2024, 2:30 PM - 3:50 PM

Objectives: Increasing evidence suggests that the gut microbiota plays a significant role in the development and progression of tumors. However, there is limited evidence regarding the interaction between gut microbiota and gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs). Therefore, we conducted Mendelian randomization (MR) analysis to explore the association between gut microbiota and GEP-NENs.

Materials and Methods: A two-sample Mendelian randomization (MR) analysis was conducted to assess the potential causal effect of gut microbiota on the risk of GEP-NENs. Summary-level data for gut microbiota and GEP-NENs were obtained from the genome-wide association study (GWAS) of the MiBioGen and FinnGen Consortium, respectively. The inverse-variance weighted (IVW) method was employed as the primary approach. Additionally, multiple sensitivity analyses were carried out to verify the robustness of the results.

Results: MR analysis provided compelling evidence of causal relationships between genetically predicted gut microbiota and the risk of rectal neuroendocrine tumors. These causal associations were particularly pronounced within taxa of the genera Bacteroides (OR: 3.46, 95% CI: 1.49−8.02, q = 0.004), Firmicutes (OR: 1.78, 95% CI: 1.18−2.68, q = 0.006), and Actinobacteria (OR: 1.1, 95% CI: 1.17−3.09, q = 0.01). Further sensitivity analyses supported the robustness of the study findings.

Conclusion: The findings suggest a potential genetic susceptibility between specific gut microbiota and the risk of rectal neuroendocrine tumors. This provides new directions and strategies for personalized prevention and management of rectal neuroendocrine tumors based on gut microbiota.

OP-10-01

Novel drainage technique for hilar cholangiocarcinoma: Usefulness of the SPLAC method

Akihiro Yoshida and Mamoru Takenaka and Atsuhiro Masuda and Hideyuki Shiomi and Masatoshi Kudo

Kindai University, osaka-sayama, Japan

Oral Presentation 10, APDW Theatre 1, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Background: Although there have been many reports of the usefulness of Inside Stent (IS) for drainage treatment of hilar cholangiocarcinoma, there are many cases of hilar bile duct cancer in which the existing length does not fit well because of long stenosis length or a peripheral neck. For such cases, the required length is measured in real-time, and the ENBD tubing is cut to that length to create a dedicated PS with the optimal length for each case (stent placement with length adjustment according to the case: SPLAC). In this multi-center retrospective study, we compared the usefulness of SPLAC with Normal PS and IS for hilar cholangiocarcinoma.

Patients and Methods: The 145 patients (43 SPLAC/34 IS/68 Norma) underwent biliary drainage using PS for hilar cholangiocarcinoma between January 1, 2017, and April 30, 2022, at three domestic institutions were enrolled. The success rate, clinical improvement rate (post-treatment T-Bil <1.3 or >50% improvement from the highest preoperative value), duration of stent patency, and complication rate were compared.

Results: The success rate of each procedure was 100%, while the clinical improvement rate was SPLAC 100% (43/43), IS 91.2% (31/34), and Normal 89.7% (61/68). The stent patency (days, mean/IQR) was SPLAC 168.1 (36-219), IS 148.3 (148.3), and Normal 102.3 (21-104) (P = 0.03). The complication rates were SPLAC 0% (0/43), IS 2.9% (1/34), and Normal 17.7% (12/68) (P < 0.01).

OP-10-02

Factors contributing to the development of post-ERCP pancreatitis in pancreatic duct guidewire cannulation

Kotaro Takeshita, Kento Hisamatsu, Yuma Fujita and Satoshi Asai

Tane General Hospital, Osaka, Japan

Oral Presentation 10, APDW Theatre 1, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: The pancreatic guidewire method (PGW) is useful for the cannulation of naïve papilla, which is difficult for deep bile cannulation. On the other hand, the PGW has been reported as a risk factor for post-ERCP pancreatitis (PEP). Therefore, we investigated factors contributing to PEP from cases in which the PGW method was performed at our institution.

Materials and Methods: All cases of naïve papilla in which deep bile duct cannulation was attempted at our institution from April 2017 to May 2023 were included.

Results: Of the 2037 patients who underwent ERCP, we analyzed 956 accessible naïve papilla. The mean age was 78 (±14) years, 56.0% were male, 71.9% had stones, 20.5% had malignant biliary stricture, and 7.6% had other conditions. Of those, 4.4% had reconstructed gastrointestinal tract. Overall, the median time for bile cannulation was 2 (IQR, 1-9) minutes, with a 96.3% success rate. 243 patients (25.4%) underwent PGW. The rate of PEP and hyperamylasemia (HA) was 6.5% and 7.8%, respectively.

In the PGW group, 22 (9.1%) patients had PEP, and 20 (8.2%) had HA. Factors contributing to PEP in the PGW were analyzed, the significant factors were no cholangitis and two or more guidewire insertion into the pancreatic duct. Although multivariate analysis was performed, there were no significant independent factors.

Conclusion: The risk of PEP in PGW may be increased by twice or more guidewire insertion into the pancreatic duct. Therefore, once a guidewire is inserted into the pancreatic duct, early transition to PGW should be considered.

OP-10-03

Gastric endoscopic submucosal dissection using continuous low-pressure saline perfusion

Kazuaki Akahoshi, Yuji Ino, Hisashi Fukuda, Takashi Ueno, Hiroki Hayashi, Yoshie Nomoto, Haruo Takahashi and Hironori Yamamoto

Department of Medicine, Division of Gastroenterology, Jichi Medical University, shimotsuke, Japan

Oral Presentation 10, APDW Theatre 1, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: Saline-immersion endoscopy facilitates gastric Endoscopic Submucosal Dissection (ESD) by improving visualization and utilizing buoyancy to lift lesions. However, saline mixed with blood and bubbles from the incision can obscure the view, necessitating frequent suction or water jet adjustments. Large saline volumes may also risk aspiration pneumonia and hypernatremia.

Materials and Methods: To address these issues, we employed continuous low-pressure saline perfusion. A nasogastric tube is inserted and secured with a clip. The assistant keeps the water jet pedal depressed and uses the jet continuously at low pressure while the operator performs ESD. Due to the continuous use of the jet, the inside of the hood is under positive pressure, and dirty water and bubbles are washed out, allowing ESD a good field of view. Moreover, the operator does not need to operate the water jet pedal and can concentrate on pedaling the high-frequency device. Excess fluid and gas are continuously drained through the nasogastric tube, reducing the need for suctioning and minimizing risks. Forty-four patients who underwent gastric ESD by this method between February and July 2024 were evaluated for saline recovery rate, chest x-rays and blood test on the day of admission and the day after ESD, and the presence of complications.

Results: The median saline recovery rate was 93%. There were no cases of aspiration pneumonia, hypernatremia, or exacerbation of heart failure.

Conclusion: The continuous low-pressure saline perfusion method is a simple and effective approach that enhances the ease and safety of gastric ESD.

OP-10-04

Efficacy of endoscopic hand suturing for mucosal defect closure after gastric endoscopic submucosal dissection

Yuri Imura¹, Teppei Akimoto², Motoki Sasaki², Shoma Murata¹, Daisuke Minezaki², Anna Tojo¹, Hinako Sakurai¹, Kentaro Iwata¹, Kurato Miyazaki¹, Teppei Masunaga², Mari Mizutani², Michiko Nishikawa², Yusaku Takatori², Shintaro Kawasaki³, Tomohisa Sujino³, Hideomi Tomida², Noriko Matsuura², Atsushi Nakayama², Kaoru Takabayashi³, Takanori Kanai¹, Motohiko Kato³ and Naohisa Yahagi²

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; ²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan; ³Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan

Oral Presentation 10, APDW Theatre 1, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: Endoscope hand suturing (EHS) is a closure technique that sutures mucosal defects after ESD. We investigated the efficacy of EHS after gastric ESD.

Materials and Methods: This is a retrospective observational study. We identified 106 lesions in 106 patients who were taking antithrombotic agents, had <3cm gastric neoplasms and underwent ESD between January 2017 and April 2024, excluding cases of remnant stomach and cases in which two or more lesions were resected in one time. Of these, those who underwent ESD and defect closure with EHS were allocated in the sutured group, and those who underwent ESD alone without closure were allocated in the non-sutured group. The clinical characteristics and incidence of delayed bleeding were compared between the two groups. To assess the risk of delayed bleeding of each patient, risk categories based on the BEST-J score were used.

Results: 18 lesions in 18 patients in the sutured group and 88 lesions in 88 patients in the non-sutured group; mean age and delayed bleeding risk (low risk/intermediate risk/high risk/very high risk) in the sutured and non-sutured groups were 75:77 years (p=0.33) and 1/5/11/1:25/19/36/8 (p=0.17), respectively. The mean lesion size, location (U/M/L), and circumference (Gre/Less/Ant/Post) were 14 mm:15 mm (p=0.69), 2/10/6:21/27/40 (p=0.12), and 5/7/3/3:11/39/19/19 (p=0.18) in the sutured and non-sutured groups, respectively. The incidence of delayed bleeding in the sutured group and non-sutured group were 0% and 17% (p=0.049), respectively.

Conclusion: EHS may prevent delayed bleeding after gastric ESD in patients taking antithrombotic agents.

OP-10-05

Comparison between Endoscopic full-thickness resection and laparoscopic-endoscopic corroborated surgery for gastric submucosal tumors

Tsukasa Ishida¹, Izuku Otsubo², Masaru Takimoto¹, Hiroyuki Hashimoto, Taro Tanaka¹, Koki Matsuoka¹ and Takatoshi Nakashima¹ and Satoki Shichijyo³ and Noriya Uedo

¹Department of Gastroenterology, Akashi Medical Center, Akashi, Japan; ²Department of Surgery, Akashi Medical Center, Akashi, Japan; ³Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

Oral Presentation 10, APDW Theatre 1, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: In recent years, there has been a growing interest in minimally invasive treatments for gastric submucosal tumors (SMTs). Laparoscopic endoscopic cooperative surgery (LECS) has been developed in Japan for minimally invasive therapy, while endoscopic full-thickness resection (EFTR) has been applied as advanced medical care in approved centers in Japan. This study was a retrospective comparative analysis of the characteristics and outcomes of EFTR with those of LECS.

Materials and Methods: A total of ten patients underwent EFTR and seven patients underwent LECS for SMTs between April 2020 and June 2024 at our institution.

Results: The mean preoperative size as determined by endoscopic ultrasound was not significantly different between the two groups (EFTR 19mm vs LECS 30mm). The majority of intraluminal growing lesions were indicated for EFTR and LECS (80% vs. 100%). The complete resection rate was 100% for both groups. The mean procedure time and maximum CRP level were not significantly different between the two groups (79 minutes vs. 120 minutes, 7.7 mg/dL vs. 8.3 mg/dL). The EFTR group exhibited a significantly shorter postoperative hospital stay than the LECS group (5 days vs 9 days). The pathological results were 94% GIST, with only one case of IgG4-related lesion. The pathological complete resection rate was not significantly different between the two groups (66.7% vs 71.4%).

Conclusions: It is conceivable that EFTR for less than 30mm may be technically feasible, safe, and cost-effective, despite the limitations of a single-center and retrospective study.

OP-10-06

Efficacy and technical feasibility of a novel endoscopic hand-suturing technique for gastric mucosal defects

Yosuke Minoda, Yusuke Suzuki, Masafumi Wada, Yoshitaka Hata, Yoshimasa Tanaka, Haruei ogino and Eikichi Ihara

Kyushu University, Fukuoka, Japan

Oral Presentation 10, APDW Theatre 1, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: In Japan, the innovative endoscopic hand-suturing technique (EHS) for repairing gastric mucosal defects was made feasible in 2022 with a dedicated device named "Sutuart" (Olympus, Tokyo, Japan). This technique involves directly suturing wounds within the gastric lumen using surgical thread and needle. Despite its novelty, the clinical usefulness of this technique has not yet to be fully established. The study aimed to evaluate the efficacy of EHS and identify challenging areas for suturing.

Materials and Method: A retrospective study conducted from November 2022 to June 2024 analyzed 20 cases in which EHS was applied to gastric mucosal defects, excluding one case where the procedure could not be initiated due to esophageal motility disorders. The study assessed the success rate of EHS, the integrity of the sutures, and the complication rate.

Results: Lesions were located in the upper (2 cases), middle (9 cases), M-L junction (6 cases), and lower (3 cases) regions of the stomach. The overall success rate for complete suturing was 90% (18/20), with a success rate of 66% (4/6) for lesions at the M-L junction. The average operative time was 56 minutes, with larger ulcers requiring more time. The suture retention rate was 60% (9/15) in cases re-evaluated approximately five days later. Partial suture separation occurred in 6 cases, primarily around the edges of ulcers. No complications were observed.

Conclusion: Lesions spanning the M-L junction showed a lower technique success rate. Frequent partial separations at ulcer edges indicate a need for targeted improvements in this technique.

OP-10-07

Clinical utility of a MANTIS clips for defect closure after colorectal endoscopic submucosal dissection

Mikio Muraoka, Mayo Tanabe, Naoyuki Uragami, Rei Miyake, Hatsuka Nakamura, Tomoaki Kakazu, Yumi Kishi, Daijiro Shiomi and Haruhiro Inoue

Showa University Koto Toyosu Hospital, Tokyo, 日本

Oral Presentation 10, APDW Theatre 1, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: The MANTIS Clip (Boston Scientific) is a novel anchor pronged clip designed to enhance tissue grasping and facilitate the closure of defects in the gastrointestinal tract. This study evaluates the feasibility and effectiveness of the MANTIS Clip for closing mucosal defects following colorectal endoscopic submucosal dissection (C-ESD).

Materials and Methods: A retrospective single-center study was conducted on patients who underwent C-ESD with MANTIS Clip closure from May 2023 to April 2024. The primary outcome measured was the complete closure success rate. Secondary outcomes included defect size, sustained closure rate, closure time, number of clips used, adverse events, and hospital stay duration.

Results: The MANTIS Clip was used in 52 cases. The complete closure rate was 98.1% (51/52), with a sustained closure rate of 96.1% (49/51). The median closed defect size was 32 mm, with the largest being 62 mm. The median closure time was 8 minutes. Typically, one MANTIS Clip per defect was used, with only one lesion requiring two clips. The median number of additional clips used was seven. Adverse events included one case of bleeding (1.9%) and one case of post-ESD coagulation syndrome (1.9%), both managed without extending hospital stays. The median CRP level on the first day post-ESD was 0.35 mg/dl, and the median hospital stay was 5 days.

Conclusions: The MANTIS Clip is effective and practical for mucosal defect closure post-C-ESD, demonstrating high success and sustained closure rates with minimal complications. Future multi-center randomized trials are needed to further assess its efficacy and safety.

OP-10-08

Removal of superficial large duodenal laterally spreading tumors involving the papilla with endoscopic submucosal dissection

Zhang Qide

Jiangsu Province Hospital of Chinese Medicine, Nanjing, China

Oral Presentation 10, APDW Theatre 1, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Aims: ESD is rarely reported to treat superficial large duodenal laterally spreading tumors involving the papilla(L-LSTs-p). The aim of this study was to evaluate the therapeutic outcomes, complications and technique learning points in small sample size.

Methods: A retrospective single-center study was conducted from October 2022 to February 2023.Five patients who underwent ESD for superficial L-LSTs-p (the short diameter of the lesion ≥3cm) were enrolled.

Results: The age range of patients was from 49 to 73 years (median age 61.4 years) and the male-to-female ratio was 4:1.The lesions involved the main papilla and accessory papilla were 4 cases and 1 case, respectively. The operation time range of ESD was 35-120 mins (median 62 mins) and the hospital stays of patients was 6-12 days (median 7.8 days). Procedure-related complications occurred in 4 patients, including delayed bleeding in 2 cases (40%), mild hyperamylasemia in 4 cases (80%).No intra/post-procedural perforation and postoperative pancreatitis occurred. A pancreatic stent and a three-lumen gastric feeding tube were placed immediately after ESD in 4 patients involved the main papilla and in 5 patients, respectively. No one was implanted the biliary stent. Histological results of resected specimens were carcinoma in situ in 3 cases, adenocarcinoma in 1 case, TSA in 1 case. En bloc resection was in five patients (100%) and curative resection was in four patients (80%).The overall endoscopic success rate of ESD was 100%.

Conclusions: ESD appears to be an effective and safe treatment for superficial L-LSTs-p, and may be considered as an alternative to surgery.

OP-10-09

Significance of Closure with the New Clipping Device MANTIS after Gastric Endoscopic Submucosal Dissection

Takeshi Shimizu, Taku Yamagata, Tomohiro Shimada, Hiroki Sato, Yuta Shibuya and Kei Ito

Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan

Oral Presentation 10, APDW Theatre 1, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: This study retrospectively examined the rates of hemostatic procedures required during second-look endoscopy (SLE) the day after gastric endoscopic submucosal dissection (ESD) and the rates of delayed bleeding (requiring endoscopic hemostasis within 28 days post-ESD) between groups with and without mucosal defect closure using the new clipping device MANTIS (Boston Scientific).

Materials and Methods: We analyzed 216 cases of gastric ESD performed on a single lesion at our institution from January 2023 to February 2024. Forty cases involving mucosal defect closure with MANTIS were categorized into Group A, and remaining 176 cases were placed into Group B. Propensity score matching (caliper 0.2) based on mucosal defect length, antiplatelet agent use, and anticoagulant use was performed for all cases. There were no significant differences in median age (75.0 vs. 75.5 years), male percentage (80.0%), antiplatelet agents (27.5% vs. 25.0%), anticoagulant use (7.5% vs 5.0%), location (U/M/L) (12.5%/12.5%/75.0% vs 20.0%/15.0%/65.0%), median tumor size (12 mm), histological type (38/2 differentiated/undifferentiated), and median mucosal defect length (32[25–40] mm vs 32[25–39] mm) between Groups A and B.

Results: Hemostatic procedures required on the day after ESD were 17.5% (7/40) for Group A vs 37.5% (15/40) for Group B (Fisher’s exact test p = 0.078). Delayed bleeding occurred in 0% (0/40) of Group A vs 7.5% (3/40) of Group B (Fisher’s exact test p = 0.24).

Conclusion: Mucosal defect closure with MANTIS after ESD tended to reduce the rate of hemostatic procedures required during SLE and the rate of delayed bleeding.

OP-11-01

Serological immune response to hepatitis B accelerated vaccination regimen in people who inject drugs

Harshita Katiyar¹, Nalinikanta Rajkumar², Ajay Kumar Mishra¹, Lokeshwar Khumukcham³, Dhabali Thangjam⁴, Giten Khwairakpam⁵, Rajani Singh¹ and Amit Goel¹

¹Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; ²Community Network for Empowerment (CoNE), India; ³Jawaharlal Nehru Institute of Medical Sciences, India; ⁴Babina Diagnostics, India; ⁵TREAT Asia/amfAR Thailand, Bangkok, Thailand

Oral Presentation 11, APDW Theatre 2, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objective: Standard regimen of hepatitis B vaccination, i.e., three doses at 0, 1, and 6 months, is 90-95% effective. To improve their compliance, ‘people who inject drugs’ (PWID) may be vaccinated with an accelerated regimen, i.e., three doses on day 0, 7, and 21. We compared the seroprotection achieved with standard or accelerated regimens.

Material and Methods: PWID were voluntarily vaccinated with standard or accelerated regimens. A 5ml blood specimens was collected, from those who had completed vaccination ≥3 months ago, to measure anti-HBs titers. Vaccine response was defined as appearance of detectable anti-HBs titer and titer ≥10 mIU/mL was considered seroprotected. Numerical and categorical data are expressed as median (interquartile range) and percentage (proportion) and compared using non-parametric tests.

Results: Included 567 PWID (all men), vaccinated with accelerated (n=356; 62.8%) or standard (n=211; 37.2%) regimens. Age was comparable (p=0.99) in accelerated (29 [24-38.5] years) and standard (29 [24-37] years) groups. Anti-HBs titer were estimation after 487 (422-625) days in accelerated groups and 176 (105-211) days in standard group (p<0.001). Seroconversion was achieved in 91.9% and 99.5% of accelerated and standard groups, respectively (p<0.001). Among those who developed anti-HBs, significantly larger proportion (p<0.001) in standard group (99.5%) were seroprotected than accelerated group (92.1%). Anti-HBs titer in standard group (2404 [412-12450]) was significantly higher than 247 (57-1250) mIU/mL in accelerated group (p<0.001).

OP-11-02

Virologic outcome of peginterferon for HBeAg-positive chronic hepatitis B – a long-term follow-up, entecavir-matched study

Jimmy Che-To Lai^1,2,3,4, Vincent Wai-Sun Wong^1,2,3, Vicki Wing-Ki Hui^1,2,3, Yee-Kit Tse^1,2,3, Terry Cheuk-Fung Yip^1,2,3, Henry Lik-Yuen Chan^2,5 and Grace Lai-Hung Wong^1,2,3

¹Medical Data Analytics Centre, The Chinese University Of Hong Kong, Hong Kong, Hong Kong; ²Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong; ³Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong; ⁴Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong; ⁵Union Hospital, Hong Kong, Hong Kong

Oral Presentation 11, APDW Theatre 2, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: We aimed to study the long term virologic outcomes of patients with HBeAg-positive chronic hepatitis B (CHB) who received peginterferon alfa-2b, compared to entecavir-treated patients.

Materials and Methods: HBeAg-positive CHB patients who received peginterferon alfa-2b 1.5 μg/kg/week for 32 weeks and lamivudine 100mg/day for 52 or 104 weeks in years 2000-2004 from two randomized controlled trials were followed and compared with those receiving entecavir treatment by 1:5 matching with age, sex, platelet count, serum alanine transaminase level and cirrhosis status. The virologic responses were analysed.

Results: 85 patients in peginterferon group were followed for a mean of 19.7 ± 3.8 years, compared to 9.8 ± 3.8 years in 425 patients in entecavir group. 50 (48.8%) patients in the peginterferon group received oral antiviral retreatment at a mean of 8.0 years. Ten patients (11.8%) in the peginterferon group achieved HBsAg seroclearance (8 before retreatment; 2 after retreatment), compared to 12 patients (2.8%) in the entecavir group. The cumulative incidences of HBsAg seroclearance were 1.2% and 0.5% at 5 years, 3.6% and 3.2% at 10 years, and 8.6% and 4.7% at 15 years, respectively. (p=0.199) (Fig. 1A). For HBeAg seroconversion, the cumulative incidences were 80.0% and 28.5% at 5 years, 87.3% and 36.6% at 10 years, and 88.5% and 36.6% at 15 years, for peginterferon and entecavir groups, respectively (p<0.001) (Fig. 1B).

Conclusion: Peginterferon treatment is associated with more HBeAg serocconversion and numerically higher HBsAg seroclearance over time compared with entecavir treatment in patients with CHB and positive HBeAg.

OP-11-03

Patterns of testing and seroprevalence of hepatitis B in a tertiary hospital

Litya Nagaretnam, Lau Su Yin, Imran Sidek and Priyadarsini Appalaramoo

Universiti Putra Malaysia, Negeri Sembilan, Malaysia

Oral Presentation 11, APDW Theatre 2, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Introduction: Viral hepatitis B (HBV) remains a significant public health concern despite universal infant vaccination implemented in 1989. This study assesses HBV seroprevalence and screening patterns in Hospital Sultan Abdul Aziz Shah (HSAAS).

Methodology: A retrospective, cross-sectional observational study was conducted, analyzing HBsAg tests performed between December 2023 and May 2024. Data was extracted from electronic medical records and analyzed using descriptive statistics.

Results: Of 437 HBsAg tests performed, 14 were positive (seroprevalence 3.2%). The mean screening age was 57 years. The medical department requested most tests (60.5%). Primary indications were routine screening (75.7%), abnormal liver enzymes (21.6%), and chronic liver disease workup (2.7%). Among positive cases, males (64.3%) predominated, with equal prevalence between Malay and Chinese ethnicities. Only 50% of positive cases were referred to gastroenterology.

Discussion: The 3.2% seroprevalence is lower than reported national prevalence in many Asian countries, possibly reflecting effective vaccination programs or indicating a need for more targeted screening approaches. Malay and Chinese ethnicity has equal prevalence among positive cases. Routine screening yielded the majority of positive cases, but abnormal liver enzymes were also a significant indicator. Two neonates tested positive during prolonged jaundice workup, likely false positives due to recent vaccination.

Conclusion: This study highlights the need for a comprehensive review of current screening strategies, focusing on cost-effectiveness and targeted screening of high-risk groups. Initiatives should optimize referrals for positive cases and enhance interdepartmental collaboration in HBV screening and management.

OP-11-04

Indirect biomarkers are superior in detecting liver fibrosis and cirrhosis in chronic hepatitis B patients

Muhammad Palar Wijaya, Muhammad Begawan Bestari, Dolvy Girawan, Nenny Agustanti and Eka Surya Nugraha

Gastroenterohepatology Divison, Internal Medicine Department, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia

Oral Presentation 11, APDW Theatre 2, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: The study aimed to analyze the diagnostic accuracy of Procollagen-III N-terminal peptide (PIIINP) as a direct and Gamma-glutamyl transpeptidase-to-platelet ratio (GPR), Red cell distribution width-to-platelet ratio (RPR), Albumin-bilirubin score (ALBI), Neutrophil-albumin ratio (NAR) as indirect noninvasive liver fibrosis biomarkers.

Materials and Methods: This is a cross-sectional study with retrospective data collection from Hasan Sadikin General Hospital's Chronic Hepatitis B Registry. All patients were not obese, had no hepatitis C, autoimmune liver disease, HIV, diabetes, or other organ disease, and had no history of alcohol use. Patients who had complete data were included in this study. PIIINP was measured from the stored blood. GPR, RPR, ALBI, NAR, and PIIINP were evaluated in assessing liver fibrosis (>7 kPa) and cirrhosis (>12.5 kPa) as the criteria for treatment in CHB patients. ROC analysis followed by crosstabulation was used to assess the diagnostic accuracy.

Results: 123 patients (69 with fibrosis, 33 with cirrhosis) were used for indirect biomarker analysis, and 88 patients (52 with fibrosis, 23 with cirrhosis) for PIIINP analysis. In diagnosing liver fibrosis, the AUC of GPR, RPR, ALBI, NAR, and PIIINP were 0.82, 0.74, 0.72, 0.39, and 0.61. In diagnosing liver cirrhosis, the AUC of GPR, RPR, ALBI, NAR, and PIIINP were 0.86, 0.81, 0.74, 0.4, and 0.7.

Conclusion: GPR had the best diagnostic accuracy, especially in diagnosing liver cirrhosis. The direct biomarker (PIIINP) still could not meet the need or even replace the role of indirect liver fibrosis biomarkers and was only acceptable for diagnosing liver cirrhosis.

OP-11-05

Mechanism study of shugan jianpi xiaozhi formula in the treatment of methotrexate-induced liver injury

Yongqiang Xiong and Shu Zhang

Department of Geriatric General Surgery, The Second Affiliated Hospital of Xi 'an Jiaotong University, Xi'an, China

Oral Presentation 11, APDW Theatre 2, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

OP-11-06

Neutophile gelatinese-associated lipocalin as a diagnostic tool for renal dysfunction in liver transplant patient: Meta-analysis

Ni Kadek Saras Dwi Guna

Faculty of Medicine, Udayana University, Bali, Indonesia, Badung, Indonesia

Oral Presentation 11, APDW Theatre 2, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: Neutrophil Gelatinase-Associated Lipocalin (NGAL) has emerged as a promising biomarker for the early detection of renal dysfunction. This systematic review and meta-analysis aims to evaluate the diagnostic accuracy of NGAL for renal dysfunction in liver transplant patients.

Materials and Methods: Systematic searches were conducted on ScienceDirect, PubMed, and Cochrane databases for cohort studies assessing NGAL as a diagnostic tool up to June 2024. Diagnostic accuracy of NGAL was evaluated using the summary receiver-operating characteristics (sROC) curve. The analyses further assessed age, BMI, baseline serum creatinine, and Model for End-stage Liver Disease (MELD) score between patients with and without renal dysfunction.

Results: The meta-analysis included 13 cohort studies comprising 1363 participants. Age (MD: 1.32; 95% CI: -1.19 – 3.83; p=0.30) and baseline serum creatinine (MD: -0.80; 95% CI: -9.61 – 8.00; p=0.86) were found to be similar in both groups. Both BMI (MD: 1.86; 95% CI: 0.61 – 3.10; p<0.001) and MELD score (MD: 2.07; 95% CI: 0.97 – 3.16; p<0.001) were higher in the renal dysfunction group. The area under the curve (AUC) for NGAL was 0.83 [0.79–0.86], with a sensitivity of 0.72 [0.61–0.81] and specificity of 0.80 [0.74–0.85], underscoring its notable diagnostic value.

Conclusion: The results indicate that the NGAL biomarker is significant for the early detection of renal dysfunction in liver transplant patients. Its implementation in clinical practice could facilitate timely intervention and improve patient outcomes.

OP-11-07

Identifying FOXO1 as a therapeutic target for post-transplant recurrence in hepatocellular carcinoma

Chao Wang and Xiao Xu

Zhejiang Univercity, Hangzhou, China

Oral Presentation 11, APDW Theatre 2, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Background and Objective: Hepatocellular carcinoma (HCC) is a prevalent and highly lethal cancer in China. Despite liver transplantation being the most effective treatment, tumor recurrence remains a significant issue. Identifying precise diagnostic and therapeutic targets for post-transplant recurrence is essential for improving HCC outcomes. This study investigates the clinical association between FOXO1 expression and liver transplant outcomes in HCC patients and explores the therapeutic potential of an esterase-responsive cationic liposome-coated nanocomplex targeting the liver.

Methods: A tissue microarray from HCC liver transplant patients (n = 259) was analyzed to determine the correlation between FOXO1 expression and clinical parameters. An esterase-responsive cationic liposome-coated nanocomplex carrying FOXO1 was constructed and tested in vivo to assess its impact on post-transplant tumor recurrence.

Results: Low FOXO1 expression was associated with significantly shorter tumor-free (P = 0.010) and overall survival (P = 0.019) in transplant recipients. In animal experiments, hepatic ischemia-reperfusion injury (IRI) induced changes in key inflammatory (TNF-α, IL-6) and oxidative stress proteins (Nrf-2, HO-1), promoting tumor growth. Treatment with the FOXO1 nanocomplex reduced tumor size and alleviated IRI, as evidenced by decreased ALT and AST levels, reduced inflammation, and increased oxidative stress protein expression.

Conclusion: Low FOXO1 expression is a risk factor for post-transplant recurrence of HCC. FOXO1 mitigates IRI-induced oxidative stress and inflammation, inhibiting HCC progression. This provides a new strategy for diagnosing and treating post-transplant tumor recurrence in HCC patients.

OP-11-08

Gallstone disease is associated with liver fibrosis in patients with Metabolic dysfunction-associated steatotic liver disease

S Shabnam and S Mohammed Ajmal and Susan George and S Srijaya and Krishnadas Devadas

Government Medical College, Thiruvananthapuram, Thiruvananthapuram, India

Oral Presentation 11, APDW Theatre 2, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: Metabolic dysfunction-associated steatotic liver disease(MASLD), with its direct impact on hepatic cholesterol synthesis and strong associations with metabolic risk factors, could increase the risk of cholelithiasis. We aimed to estimate the proportion of gallstone disease(GD) in MASLD patients and compare various risk factors in those with and without gallstones.

Materials and Methods: Cross-sectional study of 861 consecutive patients with MASLD. Relevant blood investigations and imaging studies were obtained. Vibration-controlled transient elastography(VCTE) was used to assess Liver stiffness measurement(LSM) and fibrosis grades. Univariate and multivariate analyses were performed to identify factors with significant associations.

Results: 44.1%(380) were females. 27.3% had systemic hypertension(SHTN), 14.5% hypothyroidism, 38.4% dyslipidemia,41.1% type 2 diabetes mellitus(T2DM),13.6% impaired fasting glucose,72.2% insulin resistance,84.7% abdominal obesity, 77% obesity(BMI ≥ 25), 47.7% had metabolic syndrome(MS). Liver stiffness measurement (LSM) showed that 17.7%, 21.6% and 11.8% had significant advanced fibrosis and cirrhosis, respectively. 7.2% (62) had GD. They had higher proportion of females(67.7%), age≥50years(53.2%), T2DM(61.3%), abdominal obesity(93.5%), metabolic syndrome(64.5%), obesity(85.5%), insulin resistance(83.9%), higher LSM and higher AST/ALT ratio(aspartate transaminase/alanine transaminase).In univariate analysis factors associated with GD were age ≥ 50 years[OR-2.46(CI 1.46-4.15,p=0.001)], female sex[OR-2.86(CI 1.67-5.06,p<0.001)], T2DM[OR-2.90(CI-1.72-5.00,p<0.001),] significant fibrosis[OR-2.71(CI-1.55-4.94, p=0.001)] and MS[OR-2.10(CI-1.24-3.65,p=0.007)]. In multivariate analysis, independent associations were found with female gender[OR-2.97(CI 1.68-5.42,p<0.001)], T2DM[OR-2.03 (CI-1.10-3.80, p=0.025)] and significant fibrosis[OR-2.61(CI- 1.47-4.82,p=0.001)].

Conclusion: The proportion of GD in MASLD was higher than the general population. The presence of GD in patients with MASLD may point towards a severe form of liver disease that needs to be assessed diligently.

OP-11-09

Correlation between Fibroscan and Laboratory Tests for Assessing Liver Fibrosis in NAFLD Patients in Bangladesh

Md Yasir Arafat

Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh

Oral Presentation 11, APDW Theatre 2, Exhibition Hall, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: Given the easier availability of laboratory tests like the Fibrosis-4 index (FIB-4), aspartate to platelet ratio (APRI), and aspartate transaminase to alanine transaminase ratio (AST/ALT) compared to liver Fibroscan in Bangladesh, we aim to compare these laboratory tests with Fibroscan for fibrosis staging in non-alcoholic fatty liver disease (NAFLD) patients.

Materials and Methods: This prospective cross-sectional study included 101 NAFLD patients from December 2023 to May 2024 at Sheikh Russel Gastroliver Institute and Hospital, Dhaka, Bangladesh. Two groups were made based on Fibroscan results of non-significant fibrosis (F0-F1, kPa ≤7.5) and significant fibrosis (F2-F4, kPa >7.5). The correlation between the laboratory test and Fibroscan was tested using Spearman's correlation coefficient.

Results: Of 101 NAFLD patients analyzed, 76(75.2%) were males and the mean age was 43±11.3 years. The mean BMI was 27.3 kg/m². Of those, 44.6% had dyslipidemia, 19.8% diabetes, and 13.9% hypertension. Non-significant fibrosis (kPa ≤7.5) was found in 68(67.3%) patients and significant fibrosis (kPa >7.5) in 33(32.7%) patients. FIB-4, APRI, and AST/ALT ratio correlated significantly with fibrosis scores (r=0.488,p<0.0001; r=0.537,p<0.0001; r=0.308,p=0.002, respectively). Areas under the receiver operating characteristic (AUROCs) curves for FIB-4, APRI, and AST/ALT for significant fibrosis were 0.793(p<0.0001), 0.772(p<0.0001), and 0.682 (p=0.003), respectively (Figure 1).

OP-12-01

Time trends in the incidence and mortality of small bowel malignant tumors

Jung Rock Moon¹, Ji Sung Lee² and Seong Ran Jeon³

¹Department of Internal Medicine, Inje University Ilsanpaik Hospital, Seoul, South Korea; ²Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; ³Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea

Oral Presentation 12, Uluwatu 1, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: Small bowel malignancies are rare but highly lethal. However, there is a lack of large-scale clinical research data on the epidemiology. This study aims to investigates the trends in incidence, mortality, and treatment patterns of small bowel malignancies in South Korea using the National Health Insurance Service (NHIS) data.

Methods: We conducted a comprehensive analysis of NHIS claims data from 2005 to 2022 to identify new cases of small bowel malignancies (ICD-10 code, C17). Our analysis encompassed demographic variables, comorbidity profiles utilizing the Charlson Comorbidity Index (CCI), and regional distributions. Treatment modalities, such as surgery and chemotherapy, were evaluated, alongside the frequency and types of diagnostic tests. Survival analysis and factors influencing prognosis were evaluated using Kaplan-Meier curves and Cox proportional hazards models.

Results: Between 2005 and 2022, 20,395 newly diagnosed patients were included. The incidence of small bowel malignant tumors has shown an increasing trend over time, with the 60–69-year age group exhibiting the highest incidence (mean age 63.5±13.7). The 5-year survival rate was 47.7%, showing a consistent annual increase. Factors associated with a poorer prognosis in patients diagnosed with small bowel malignant tumors between 2005 and 2022 include age ≥65 years, male gender, CCI score of ≥2, and lower economic status (≤20th percentile or medical aid).

OP-12-02

The effect of the special education of patients on improving the compliance of gastroscopy screening

Yu Peng and Xiaowei Liu

Xiangya Hospital, Central South University, Changsha, China

Oral Presentation 12, Uluwatu 1, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: To evaluate the effect of the education of patients with specific diseases based on internet and telephone follow-up on improving the compliance of gastroscopy screening in high risk population of gastric cancer.

Materials and Methods: A total of 366 patients were selected from April 2023 to October 2023 who were randomly divided into intervention group and control group. Basic information of the subjects was collected, and both groups received conventional science education related to gastric cancer. In addition, the intervention group also received specialized patient education through wechat and telephone which provided by the research group. During the 3-month and 6-month follow-up, the participants' participation in gastroscopy screening was observed.

Results: A total of 324 patients completed the follow-up study, including 167 in the intervention group and 157 in the control group. There was no significant difference in baseline data between the two groups (p>0.05). The compliance of gastroscopy screening at 3 months and 6 months in the intervention group was higher than that in the control group(p<0.05). The 3-month intervention effect showed that the education of patients with specific diseases based on internet and telephone follow-up was an independent factor affecting the acceptance of gastroscopy screening in high-risk groups (RR=3.748,95%CI= 2.418-6.742; P<0.05). The 6-month intervention effect showed the same independent factor affecting the acceptance of gastroscopy screening (RR=3.615,95%CI= 2.374-6.239; P<0.05).

Conclusion: The education of patients with specific diseases based on internet and telephone follow-up can improve the screening rate of gastroscopy in high-risk groups of gastric cancer.

OP-12-03

Development and validation of an individualized nomogram to identify undifferentiated-predominately mixed-type early gastric cancer

Linlin Shao

Beijing Friendship Hospital, Capital Medical University, Beijing, China

Oral Presentation 12, Uluwatu 1, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: The aim of this study was to established a novel nomogram based on endoscopic and clinicopathological features to predict UM EGCs.

Materials and Methods: This retrospective study included 680 EGCs who underwent endoscopic submucosal dissection (ESD) from two cohorts in China, among which 596 patients were enrolled into the training set while the other were assigned to the validation set. They were divided into differentiated early gastric cancers (D EGCs) and UM EGCs, of which the clinicopathological and endoscopic features were all analyzed using logistic regression model. A nomogram was also developed and evaluated.

Results and Conclusion: Twenty candidate predictors were included in the analysis, and the results showed atrophic gastritis (odds ratio [OR]: 0.14, 95% confidence interval [CI]: 0.03,0.61), IIb (OR: 7.56, 95% CI: 1.83-31.28), IIc (OR: 4.59, 95% CI: 2.33-24.77), faded lesion (OR: 10.79, 95% CI: 2.80-41.58), horizontal location of greater curvature (OR: 3.82, 95% CI: 1.33-10.96) and anterior wall (OR: 3.26, 95% CI: 1.20-8.85), xanthoma (OR: 0.09, 95% CI: 0.01-0.95) and H. pylori eradicated history (OR: 0.19, 95% CI: 0.07-0.52) were independent predictors of UM EGCs in multivariable regression model. UM EGCs are more susceptible to metachronous cancer (OR: 8.84, 95% CI: 1.60-48.78). A nomogram of these factors demonstrated good discriminative ability with an area under curve value of 0.84 [95% CI: 0.79-0.89] in the training set and 0.82 [95% CI :0.65-0.99] in the external validation set.

OP-12-04

Autophagy and sex differences in gastric inflammation and microbiota

Isidora Simovic¹, Karla Vinasco¹, Khean-Lee Goh², Kwon Ming Fock³, Nadeem Kaakoush⁴ and Natalia Castano Rodriguez¹

¹School of Biotechnology and Biomolecular Sciences, UNSW Sydney, Sydney, Australia; ²Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia; ³Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore City, Singapore; ⁴School of Biomedical Sciences, UNSW Sydney, Sydney, Australia

Oral Presentation 12, Uluwatu 1, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: Autophagy carries critical roles in mediating innate immunity, inflammation, and tumour suppression. Anti-microbial autophagy can be directed towards pathogens including Helicobacter pylori, the leading cause of gastric cancer (GC). Previously, we showed a germline mutation that leads to defective autophagy, ATG16L1 rs2241880, significantly increases the risk of H. pylori infection and carcinogenesis. We now aimed at investigating the underlying biological mechanisms contributing to rs2241880-related GC pathophysiology.

Materials and Methods: Gastric microbiota surveying (16S rRNA) was performed on a Han Chinese population (10 GC, 136 controls). In vitro modelling utilized CRISPR/Cas9 to generate rs2241880 knock-in AGS cells which were challenged with H. pylori GC26 to evaluate inflammatory, autophagic and lysosomal activity.

Results: We observed opposing sex specific rs2241880 influence on microbiota diversity; in females, richness was negatively associated with rs2241880 carriage (p: 0.002), while conversely, in males, we observed no effect on richness but a positive association with both evenness (p: 0.01) and Shannon’s index (p: 0.01). In males, rs2241880 was associated with enrichment of Capnocytophaga (p: 0.02). In females, rs2241880 was associated with enrichment of both Rothia (p: 0.0003) and Lautropia (p: 0.0008). rs2241880-carrying gastric epithelial cells exhibited reduced autophagic and lysosomal activity during acute H. pylori infection. An aberrant inflammatory response was observed with exacerbated IL-8 but reduced TNF-α and IFN-β production.

Conclusion: Gastric microbiota surveying revealed sex specific rs2241880 phenotypes influencing diversity and taxon enrichment. rs2241880 carriage elicited an abnormal inflammatory response coupled with disrupted autophagic and lysosomal activity to H. pylori infection in gastric epithelial cells.

OP-12-05

Aspirin was associated with lower pancreatic cancer and cancer-related mortality risk in diabetes mellitus patients

Jing Tong Tan¹, Xianhua Mao^1,2, Ho Ming Cheng¹, Wai-Kay Seto^1,2, Wai K Leung¹ and Ka-Shing Cheung^1,2

¹Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China; ²Department of Medicine, The University of Hong Kong-Shenzhen Hospital, China

Oral Presentation 12, Uluwatu 1, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: Patients with diabetes mellitus have a higher pancreatic cancer (PC) risk. While aspirin has chemopreventive effects on digestive cancers, the potential effect on PC development among DM patients is unclear.

Materials and Methods: This retrospective cohort study identified newly diagnosed type 2 diabetes mellitus (T2DM) adult patients in Hong Kong between 2001 and 2015 from a territory-wide electronic healthcare database. Exclusion criteria were prior history of PC, pancreatic neuroendocrine tumor, metastatic tumor or metastatic renal cell carcinoma, pancreatic cyst, IgG4 disease, or pancreatectomy. The primary outcome was PC, and secondary outcomes were PC-related and all-cause mortality. Aspirin use was treated as time-varying variable (≥180 days use/year) to address immortal-time bias, and multivariable Cox regression model was employed to derive the adjusted hazards ratio (aHR). Propensity-score (PS) matched cohort was used as secondary analysis.

Results: Among 343,966 newly diagnosed T2DM patients (median follow-up 10.5 years; interquartile range 7.7-14.5 years), 1,326 (0.39%) developed PC. There were 57,940 (16.8%) deaths from any cause, and 787 (0.2%) deaths from PC. Aspirin use was associated with lower PC risk in both time-dependent (aHR:0.58; 95%CI:0.49-0.68) and PS matching analysis (aHR:0.57; 95%CI:0.45-0.73) (Table 1). A significant inverse relationship was observed with increasing dose, duration and frequency of aspirin use (Ptrend <0.001). Aspirin was also associated with a lower risk of PC-related mortality (aHR:0.43; 95% CI:0.34-0.53) and all-cause mortality (aHR:0.78; 95% CI:0.75-0.80).

OP-12-06

Hereditary Adenoma Polyposis Coli Colon Cancer prediction using APC-RNA-Quantitative Gene-expression, and the correlation with non-modifiable-factor

Tjahjadi Robert Tedjasaputra¹, Shirly Elisa Tedjasaputra², Mochammad Hatta³, Nasrum Massi³, Rosdiana Natzir³, Agussalim Bukhari³, Marcellus Simadibrata⁴ and Andreas Setiadarma²

¹Tarakan General Hospital / Medical Faculty University of Indonesia, Jakarta, Indonesia; ²Tarakan General Hospital Jakarta. Christian University of Krida Wacana Jakarta, Jakarta, Pusat, Indonesia; ³Medical Faculty University of Hesanuddin, Makassar, Indonesia; ⁴Medical Faculty University of Indonesia, Jakarta, Indonesia

Oral Presentation 12, Uluwatu 1, November 22, 2024, 3:50 PM - 5:10 PM

Background: Hereditary polyposis colon cancer, is a dominantly inherited syndrome of colorectal cancer(CRC), with heightened risk for younger population. Previous studies link its susceptibility to the DNA sequence polymorphism along with pedigree analysis fail in term of applicability.

Aim: To determine a clear cut-off of APC gene expression for CRC heredity grouping factor, also aims to examine the association of risk factors to the CRC heredity.

Methods: The cross-sectional study observed 71 respondents (40 CRCs & 39 controls-subject) from May 2018-December 2020 in determining the CRC hereditary status through APC-mRNA expression using reverse-transcription-polymerase-chain-reaction and the disease’s risk factors. Data were analyzed through Chi-Square, Fischer-exact, T-test, Mann-Whitney, and Multiple logistics.

Results: There are significant differences of APC between CRC 12,156.50 (5,848-15,035) and control group 13,261.74 ± 670.55.

There are significant differences of APC within CRC group among tissue and blood; yet, negative for significance between groups. Through the blood gene expression fifth-percentile, the hereditary CRC cut-off is 12,195 fc, dividing 40 CRC respondents(50 %) was hereditary CRC. Significant risk factors include age, family history, and staging. Nonetheless, after multivariate control, family history is just a confounder. The study develops a probability equation with area under the curve 79,4 %.

Conclusion: Numerous factors have significant relations to heredity of CRC patients. However, true important factors are staging and age, while family history and others are confounders. The definite cut-off point for heredity CRC based on mRNA-APC expression was 12,195 fc.

OP-12-07

Long-term Low-Dose Aspirin Better Reduces Gastrointestinal Cancer Risk: 20-year Longitudinal-Cohort Study of 1,506,525 HongKong Residents

Kelvin KF Tsoi^1,2, Amy SM Lam¹, Ziyu Hao¹, Karen KL Yiu², Stephen L Chan³, Francis KL Chan⁴ and Joseph JY Sung⁵

¹JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; ²Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China; ³Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; ⁴Department of Medicines and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; ⁵Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore

Oral Presentation 12, Uluwatu 1, November 22, 2024, 3:50 PM - 5:10 PM

Objective: Evidence showed aspirin reduces the risk of gastrointestinal(GI) cancers, but most were limited follow-up duration from Western countries. The current study aims to investigate the long-term chemoprotective effect of low-dose aspirin on GI cancers using a 20-year territory-wide electronic health record in Hong Kong.

Method: Between 2000 and 2019, aspirin users were matched with non-aspirin users on a 1:2 age-and-sex matched ratio. Subjects with cancer history, cancer incidence or death within 6 months of enrolment were excluded. The Fine-Grey model with propensity score weighting was used for survival analysis, and a sub-distribution hazard ratio(SHR) used to measure the chemoprotective effect.

Result: A total of 538,147 aspirin users and 968,378 non-users were included, with a mean age of 64.8 years, 9,543,399 person-years of follow-up, and 90% of users with 80mg aspirin. A total of 40,322 cases of GI cancer(2.7%) were recorded. Low-dose aspirin use was associated with a 22% risk reduction in GI cancers(SHR 0.78, 95% CI 0.76-0.80). Gastrointestinal and liver cancers are among those with significant reduction in risk: colorectal cancer (SHR 0.78), liver cancer (SHR 0.67), stomach cancer (SHR 0.79), and pancreatic cancer (SHR 0.85). Duration of usage of aspirin correlates with magnitude of reduced risk of GI cancers (< 5 years of use: SHR 0.91; ≥ 10 years of use: SHR 0.37).

OP-12-08

The impact of metformin to the overall survival of diabetic colorectal cancer patients: Updated meta-analysis

Vidi Prasetyo Utomo¹, Bogi Pratomo Wibowo² and Supriono² and Syifa Mustika

¹Internal Medicine Department, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; ²Gastroenterohepatology Division, Internal Medicine Department, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia

Oral Presentation 12, Uluwatu 1, November 22, 2024, 3:50 PM - 5:10 PM

Objectives: One of the most prevalent cancers worldwide, colorectal cancer continues to be the second largest cause of cancer-related mortality. Colorectal cancer patients with diabetes have a worse overall survival (OS) rate than those without the disease. The current findings about the impact of metformin on the survival rate of diabetic colorectal cancer patients are still controversial. Therefore, we conducted a meta-analysis to explore whether metformin might be relevant to the overall survival of colorectal cancer patients with type 2 diabetes mellitus.

Materials and Methods: We searched literature of studies across databases including Pubmed, EMBASE, ProQuest, and Cochrane Library. The results of all studies were published around the last decade and quality assessment was performed using the Newcastle-Ottawa Scale. Odds ratio (OR) and 95% confidence interval (CI) for each study were calculated and analyzed using the random-effects model. Heterogeneity and publication bias were evaluated as well.

Results: A total of 16 cohort studies were included in this meta-analysis. Metformin use was linked to a higher overall survival rate for patients with diabetic colorectal cancer across all studies (OR, 1.72; 95% CI, 1.5–1.97). The subgroup analysis also revealed that the beneficial effects of metformin were consistent across age groups and geographic regions.

Conclusion: The use of metformin is significantly associated with improved OS in diabetic colorectal cancer patients.

OP-12-09

Combination of artificial intelligence-based endoscopy and methylation panels for early stage of gastric cancer

Yoshiyuki Watanabe¹, Hiroyuki Yamamoto², Ritsuko Oikawa³, Seiji Futagami⁴, Muhammad Miftahussurur⁵, Kok-Ann Gwee⁶, Tomohiro Tada⁷ and Keisuke Tateishi³

¹Department of Internal Medicine, Kawasaki Rinko General Hospital, Kawasaki City, Japan; ²Department of Bioinformatics, St. Marianna University Graduate School of Medicine, Kawasaki City, Japan; ³Division of Gastroenterology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki City, Japan; ⁴Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, Bunkyo-ku, Japan; ⁵Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Indonesia; ⁶Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and The Gastroenterology Group, Gleneagles Hospital, Singapore City, Singapore; ⁷Tada Tomohiro Institute of Gastroenterology and Proctology, Japan

Oral Presentation 12, Uluwatu 1, November 22, 2024, 3:50 PM - 5:10 PM

Background: Esophagogastroduodenoscopy (EGD) and biopsy-based pathological evaluation are needed to diagnose early gastric cancer (EGC). However, since biopsy is only a topical procedure, we have been focusing on DNA methylation using gastric wash fluid as a molecular marker for gastric cancer. In addition, we have decided to conduct a comparative examination with the recently emerged and highly regarded artificial intelligence (AI)-based EGD.

Methods: Gastric wash fluid was collected before and after endoscopic submucosal dissection (ESD) for EGC cases, and changes in four DNA methylation panels related to EGC (MINT25, SOX17, miR34, BARHL2) were evaluated. In addition, a total of 4 kinds of endoscopic images (white light images (WL), narrow band images (NBI), magnify endoscopic images (Mag), and indigo carmine staining images (Indigo)) were evaluated for AI-based EGD diagnosis.

Results: DNA methylation of the 49 cases tended to decrease after treatment in 4 genes, but this was not significant (MINT25: 3.67+6.11%, p=0.662, SOX17: 9.82+3.83%, p=0.992, miR34: 7.06+4.33%, p=0.575, BARHL2: 12.39+7.02, p=0.066). On the other hand, in AI-based endoscopy, the AI score of tumor lesions was high in images under all four conditions (WL: 77.08+7.35, NBI: 73.13+6.71, Mag: 69.54+8.24, Indigo: 70.64+9.17); Scar lesions after ESD showed a significant decrease in AI score and high AUC (WL60.40+1.32, p<0.0001, AUC0.999).

Conclusion: AI-based EGD have a potential modality for EGC diagnosis.

OP-13-01

The feasibility of endoscopic submucosal dissection for the duodenal tumors including papilla (ESDIP)

Yusaku Takatori¹, Naohisa Yahagi¹, Motoki Sasaki¹, Yuri Imura³, Shoma Murata³, Tsubasa Sato³, Daisuke Minezaki¹, Takaoki Hayakawa³, Yuki Nakajima³, Haruka Okada³, Hinako Sakurai³, Anna Tojo³, Kentaro Iwata¹, Kurato Miyazaki¹, Atsuto Kayashima⁴, Teppei Masunaga¹, Mari Mizutani², Teppei Akimoto¹, Takashi Seino³, Shintaro Kawasaki², Masayasu Horibe³, Seichiro Fukuhara⁴, Noriko Matsuura¹, Tomohisa Sujino², Atsushi Nakayama¹, Kaoru Takabayashi², Eisuke Iwasaki³ and Motohiko Kato²

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan; ²Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan; ³Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; ⁴Department of gastroenterology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan

Oral Presentation 13, APDW Theatre 1, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: Endoscopic papillectomy (EP) is a low-invasive treatment for the duodenal tumors including papilla. However, the indication of EP has the limit in size, and also local recurrence have been issues. Here, we developed endoscopic submucosal dissection (ESD) technique for he duodenal tumors including papilla (ESDIP: ESD including papilla) to overcome the problems. The aim of this study is to evaluate the feasibility of ESDIP.

Methods: This was a retrospectives study from a single tertiary care hospital. We included the patients who underwent ESDIP in our institution from August 2010 to January 2024 in the present study. We evaluated characteristics of patients and lesions, clinical results of ESDIP and ERCP as prevention for delayed adverse events, and pathological findings.

Results: Fifty-four patients were included in this study. The mean lesion size was 39mm. The third-quarter cases revealed less than half-circumferential lesion, and the one case was full- circumferential lesion. Resection was accomplished in 96% (n=52) cases, and also en bloc resection rate was 96%. Of the cases in accomplished resection, 98% patients were intubated pancreaticobiliary drainage tube by ERCP to prevent adverse event. Intraprocedural perforation occurred in 8 cases. Delayed bleeding occurred in 10 cases. Delayed perforation was only one case. The incidence of PEP was revealed 25%.

Conclusion: ESDIP may feasible for the duodenal tumors including papilla, and had a potential alternative option to avoid pancreaticoduodenectomy.

OP-13-02

Characteristics of multiple esophageal squamous cell carcinomas detected in the surveillance after endoscopic resection

Yoshio Toshiyuki¹, Ryo Shimizu¹, Kazunori Hijikata¹, Akiyoshi Ishiyama¹, Shoichi Yoshimizu¹, Yusuke Horiuchi¹, Toshiaki Hirasawa¹, Hiroshi Kawachi² and Junko Fujisaki¹

¹Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan; ²Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan

Oral Presentation 13, APDW Theatre 1, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Background and study aim: Endoscopic resection (ER) of esophageal squamous cell carcinoma (ESCC) is an organ-preserving treatment, however, heterochronic carcinomas are often encountered. Most patients are treated using ER, however, for some this is inadequate and requires additional treatment. We sought to identify the characteristics and frequency of lesions at high-risk of metastasis during surveillance based on Lugol-voiding lesion (LVL) grading and esophagogastroduodenoscopy (EGD) intervals.

Methods: Of the 1,301 patients who underwent ER, 956 underwent surveillance EGD at our hospital for at least 1 year (median, 59 months). We analyzed identified multiple ESCCs using univariate and multivariate analysis, to reveal the characteristic of high-metastasis-risk lesions, which was defined ESCC with submucosal or lymphovascular invasion.

Results: In the 956 patients, 444 multiple ESCCs were identified in 216 patients and the cumulative incidence of multiple ESCCs was 15.4% and 22.9% at 3 and 5 years, respectively, while for high-risk lesions it was 1.0% and 1.8%. In a multivariate analysis, being female (odds ratio (OR):6.71, 95% confidence interval (CI):2.07–21.8), lesions located in the cervical/upper thoracic esophagus (OR:5.53, 95% CI:1.82–16.8), and the presence of submucosal tumor (SMT)-like marginal elevation (OR:86.5, 95% CI:12.0–626) were risk factors for high-metastasis-risk lesions. No significant differences in the frequency of high-risk lesions were found based on LVL grade at any EGD intervals.

Conclusions: During endoscopic surveillance, attention should be given to the cervical/upper thoracic esophagus and lesions with SMT-like marginal elevation. The frequency of high-metastasis-risk lesions were not different by LVL grade or EGD intervals.

OP-13-03

Factors affecting difficulties in esophageal ESD

Mika Tsunomiya, Toshiyuki Yoshio, Akiyoshi Ishiyama and Takuji Gotoda

Cancer Institute Hospital, Ariake Koutou-ku, Tokyo, Japan

Oral Presentation 13, APDW Theatre 1, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Background: Esophageal ESD can be challenging on variety of factors. There are only a few studies in a large number of cases.

Objective: To clarify the factors that cause difficulties in esophageal ESD.

Materials and Method: We retrospectively studied 1165 consecutive patients who underwent ESD for a single esophageal squamous cell carcinoma from 2017 to 2023 at our hospital. Difficulty of ESD was defined as meeting any of the following criteria: (1) treatment time≧120 minutes, (2) intraoperative perforation, or (3) failure of en-bloc resection with negative vertical margin. Patients were divided into difficult-to-treat and non-difficult-to- treat groups, and various clinical factors were investigated.

Results: Of 1165 patients who underwent ESD, 111 were in the difficult-to-treat group. The significant risk factors in univariate analysis were “lesions on post treatment scar” (p=0.037), “currently drinking patients” (p=0.02), “circumference of 1/2-2/3 or >2/3” (p<0.0001), “SB knife (vs dual knife)” (p<0.0001), and “lesion length >30mm” (p<0.0001). Multivariate analysis showed that the difficult-to-treat group had factors of "currently drinking patients" (OR: 1.91, 95%CI: 1.02-3.55, p=0.035), "circumference of 1/2-2/3 " (OR: 3.10, 95%CI: 1.70-5.64, p<0.001), "circumference over 2/3" (OR: 10.9, 95%CI: 5.29-22.50, p<0.001), "SB knife" (OR: 5.51, 95%CI: 3.15-9.62, p<0.001), "lesion length >30mm" (OR: 5.10, 95%CI: 2.83-9.20, p<0.001), " experience cases <30 cases" (OR 1.91, 95%CI: 1.18-3.17, p<0.001), “lesions on post treatment scar” (OR 3.00, 95%CI: 1.56-5.79, p=0.001), and “location in junctional zone” (OR: 5.25, 95%CI: 1.45-18.9, p=0.014).

Conclusion: We clarified factors affecting difficulties in esophageal ESD and this may help in deciding endoscopists to perform.

OP-13-04

Comprehensive analysis of nutritional parameters in patients with idiopathic achalasia: A prospective study in India

Praveen Reddy Vasepalli, Zaheer Nabi, Manu Tandon and Nageshwar Reddy

Asian Institute of Gastroenterology, Hyderabad, India

Oral Presentation 13, APDW Theatre 1, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Background and Aim: Achalasia cardia, a primary motility disorder of the esophagus, poses significant malnutrition risks. This study aims to comprehensively assess the nutritional status in untreated achalasia patients, contrasting it with functional gastrointestinal disorders (FGIDs) cases and impact of per-oral endoscopic myotomy (POEM) on nutrition at 1-year.

Methods: We conducted a prospective study including consecutive achalasia cases from December-2021 to April-2022 at a tertiary care centre. Biochemical parameters, anthropometry, subjective global assessment (SGA), and malnutrition universal screening tool were used for nutritional assessment. Cases diagnosed with FGIDs served as controls.

Results: 118 cases (41.2±13.9years, 61% males) with achalasia and 200 controls (43.4±11.9years, 69% males) were included in the study. Subtypes of achalasia included type I (16.9%), II (76.3%) and III (6.8%). Overall, 38.1% and 6.8% cases were moderately and severely malnourished, respectively. As compared to controls, cases with achalasia had lower pre-albumin (19.4 vs 25.2; p=0.001), serum calcium (p=0.012), vitamin D (p=0.001), serum iron (p=0.001), triceps fold thickness (p=0.002) and hand grip strength (p=0.001). On univariate analysis, type I achalasia, body mass index, % weight loss, lower esophageal sphincter pressures and Eckardt scores were predictors of malnourishment (SGA). On multivariate analysis, type of achalasia, mid arm circumference and low body mass index were significant predictors of malnourishment in cases with achalasia. There was significant improvement in the nutritional status after POEM at 1-year follow-up.

Conclusion: Achalasia patients demonstrate a notably higher risk of malnutrition compared to individuals with FGIDs. Nutritional status significantly improves after POEM.

OP-13-05

Clinical efficacy of snare tip precutting endoscopic mucosal resection in 15-20mm non-pedunculated colorectal neoplasms

Geun Hyuk Choi¹, Yunho Jung¹, Seong Woo Choi¹, Seong-Jung Kim², Chang Kyo Oh³ and Tae-Geun Gweon⁴

¹Department of Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, South Korea; ²Department of Internal Medicine, College of Medicine Chosun University, Gwangju, South Korea; ³Department of Internal Medicine, Hallym University Gangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea; ⁴Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea

Oral Presentation 13, APDW Theatre 1, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: The optimal endoscopic resection technique for non-pedunculated colorectal neoplasms 15-20mm in size remained unclear. This study aimed to evaluate the efficacy of snare tip precutting EMR(STP-EMR) compared to conventional EMR(C-EMR) for these lesions.

Materials and Methods: Prospective randomized comparative study recruited 126 patients with 128 colorectal neoplasms of 15-20mm in size and randomly assigned them in a 1:1 ratio to undergo STP-EMR or C-EMR at four university hospitals from June 2022 to November 2023. The primary outcomes were en bloc resection rate(EBR) and complete resection rate(CRR), determined by pathologists.

Results: 128 eligible colorectal neoplasms were successfully resected using C-EMR(n=65) and STP-EMR(n=63). The overall mean lesion size, EBR, and CRR were 17.2±1.9mm, 78.9%(101/128), and 67.1%(86/128), respectively. The EBR(87.3% vs 70.8%, P=0.022) and CRR(76.2% vs 58.5%, P=0.033) were significantly higher in the STP-EMR group compared with the C-EMR group. The mean total procedure time was significantly longer in the STP-EMR group(8.1±2.5 vs 5.0±3.9, P<0.001). There were no significant differences in the post-procedural bleeding rate, perforation rate, and hospital stays between the two groups.

Univariate analysis revealed that the resection method(STP-EMR vs. C-EMR) was the sole significant factor associated with both EBR(P=0.022) and CRR(P=0.033). Pathologic findings and polyp type also significantly influenced CRR. In the multiple logistic regression analysis, the resection method remained the only significant factor of both EBR(OR 3.53, 95%[CI] 1.33-9.34; P=0.011) and CRR(OR 3.03, 95%[CI] 1.29-7.07, P=0.011).

Conclusion: STP-EMR seems to significantly improve en bloc and complete resection for non-pedunculated colorectal neoplasms of 15-20mm, despite a longer procedure time.

OP-13-06

Seven cases of pre-incision clip traction (PICT) using the multiple-ring thread traction (MRTT)

Yuma Fujita¹, Eisuke Nakao¹, Kento Hisamatsu¹, Kotaro Takeshita¹, Satoshi Asai¹ and Masato Shinzato²

¹Tane General Hospital, Osaka City, 550-0025, Japan; ²Okinawa Prefectural Miyako Hospital, Japan

Oral Presentation 13, APDW Theatre 1, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: Although gastric endoscopic submucosal dissection (G-ESD) is widely accepted, it requires a high level of skills to perform safely. In particular, the process of creating a mucosal flap is technically demanding. Recently, PICT and MRTT have been reported as devices to overcome this problem in colon ESD. Here, we present a new method that combines PICT and MRTT for G-ESD.

Material and Methods: PICT with MRTT was performed as follows: A semi-circumferential mucosal incision on the oral side was made. Subsequently, a threaded clip with MRTT was applied to the anal side and pulled to the opposite side of the gastric mucosa. After the mucosal incision was performed at the anal side of the clip, the submucosal layer was immediately opened widely due to the traction, followed by submucosal dissection as usual. We investigated 7 gastric neoplasm cases treated by PICT with MRTT from March 2024 to June 2024.

Results: The median age was 76 (range 60-86) years, 57% were male, 6 cases were early gastric cancer, 1 case was NET G1. The median size of the lesions was 12 (range, 10-20) mm. The median procedure time was 122 (range 43-146) minutes. The en bloc resection rate was 100%, and no intraoperative and postoperative perforation were experienced.

Conclusion: PICT with MRTT could be a safe and effective method for G-ESD.

OP-13-07

Efficacy of ESD using combination of small-caliber-tip hood, and water pressure for appendiceal orifice lesions

Hiroyuki Hashimoto, Tukasa Ishida, Masaru Takimoto, Taro Tnaka, Koki Matsuoka and Takatoshi Nakashima

Akashi Medical Center, Akashi, Japan

Oral Presentation 13, APDW Theatre 1, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: The technical challenge of endoscopic submucosal dissection (ESD) for lesions of the entire covered appendiceal orifice was significant. The feasibility of duodenal ESD was demonstrated by the water pressure method (WPM). Furthermore, ESD using a small-caliber tip (4mm diameter) hood (CH) was considered an effective method for treating fibrotic and appendiceal orifice lesions due to the ability to visualize the narrow lumen with greater precision. A retrospective analysis was conducted on cases that utilized the treatment using WPM with CH.

Materials and Methods: A total of five ESD cases of the entire covering of the appendiceal orifice for lesions were performed at our institution between April 2022 and June 2024. Three cases underwent clip-band traction (CBT), while two cases underwent WPM with CH. The characteristics and treatment outcomes of both groups were subjected to analysis.

Results: The mean size of the lesions was not significantly different between the two groups (CBT 33mm vs. WPM with CH 25mm). The mean procedure time was 106 minutes for CBT and 66 minutes for WPM, respectively. In all cases, en bloc resection was achieved. Two cases of CBT exhibited perforation, which were treated conservatively with clip closure. Furthermore, one case of CBT exhibited an unclear pathological horizontal margin. Fortunately, no recurrence was observed at the one-year follow-up colonoscopy.

Conclusions: It is conceivable that WPM with CH for lesions of the entire covered appendiceal orifice may be technically feasible and safe, despite the limitations of a single center and retrospective study.

OP-13-08

Feasibility and efficacy of ‘Clip with line pulley securing’(CLiPS) technique for closure after colorectal ESD

Darshan Parekh¹, Yohei Minato², Kohei Ono², Yuki Kano², Yoshiaki Kimoto², Nao Takeuchi², Hiroshi Yamazaki², Shinya Nagae², Koichi Furuta² and Ken Ohata²

¹Mumbai Institute Of Gastroenterology, Mumbai, India; ²NTT Medical Center Tokyo, Tokyo, Japan

Oral Presentation 13, APDW Theatre 1, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: Endoscopic closure techniques are a necessary, and constantly evolving area of research to prevent and manage complications of endoscopic submucosal dissection (ESD). Many techniques have recently been reported in literature, however no standardized guidelines exist. We recently developed an easily applicable and economical Clip with Line Pulley Securing (CLiPS) technique for approximating large defects with a single channel endoscope and its successful use in stomach and cecum. This study aims to report the safety and efficacy of this technique for closure of large colorectal defects post ESD.

Materials and Methods: This study retrospectively evaluated 53 patients who underwent closure using CLiPS technique post colorectal ESD. CLiPS technique involves deployment of a clip with nylon line on the distal edge of the ulcer. The line is fixed on the proximal edge with another clip and the edges are approximated using external counter traction. An endoloop is deployed to fix the line, thereby creating a pulley system. The line is cut and final closure is completed with conventional clips. The primary outcomes were complete closure rate and adverse events. The secondary outcomes were closure time and defect size.

Results: Complete closure was achieved in 94.3%(50/53) of cases. The mean defect size was 48.2±18.8 mm and median closure time was 14(5-58) minutes. There was one case each of delayed bleeding and perforation which were managed by endoscopic clipping.

OP-13-09

Prophylactic clip closure in preventing delayed bleeding after colorectal endoscopic submucosal dissection on anticoagulants

Kazunori Takada¹, Naohisa Yoshida², Yoshikazu Hayashi³, Daichi Togo⁴, Shiro Oka⁵, Shusei Fukunaga⁶, Yoshinori Morita⁷, Takemasa Hayashi⁸, Kazuhiro Kozuka⁹, Yosuke Tsuji¹⁰, Takashi Murakami¹¹, Takeshi Yamamura¹², Yoriaki Komeda¹³, Yoji Takeuchi¹⁴, Kensuke Shinmura¹⁵, Hiroko Fukuda¹⁶, Shinji Yoshii¹⁷, Shoko Ono¹⁸, Shinichi Katsuki¹⁹, Kazumasa Kawashima²⁰, Daiki Nemoto²¹, Hiroyuki Yamamoto²², Yutaka Saito²³, Naoto Tamai²⁴, Aya Tamura²⁵, Yuki Itoi²⁶, Shigetsugu Tsuji²⁷, Yoshikazu Inagaki²⁸, Yutaka Inada²⁹, Koichi Soga³⁰, Daisuke Hasegawa³¹, Takaaki Murakami³², Hiroyuk Yoriki³³, Kohei Fukumoto³⁴, Takayuki Motoyoshi³⁵, Yasuki Nakatani³⁶, Yasushi Sano³⁷, Mikitaka Iguchi³⁸, Shigehiko Fujii³⁹, Hiromitsu Ban⁴⁰, Keita Harada⁴¹, Koichi Okamoto⁴², Hitoshi Nishiyama⁴³, Fumisato Sasaki⁴⁴, Kazuhiro Mizukami⁴⁵, Takashi Shono⁴⁶, Ryo Shimoda⁴⁷, Tadashi Miike⁴⁸ and Naoyuki Yamaguchi⁴⁹

¹Shizuoka Cancer Center, Shizuoka, Japan; ²Kyoto Prefectural University of Medicine, Kyoto, Japan; ³Jichi Medical University, Tochigi, Japan; ⁴Sendai Kousei Hospital, Miyagi, Japan; ⁵Hiroshima University Hospital, Hiroshima, Japan; ⁶Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan; ⁷Kobe University International Clinical Cancer Research Center, Hyogo, Japan; ⁸Showa University Northern Yokohama Hospital, Yokohama, Japan; ⁹Faculty of Medicine, Kagawa University, Kagawa, Japan; ¹⁰The University of Tokyo, Tokyo, Japan; ¹¹Juntendo University, Tokyo, Japan; ¹²Nagoya University Graduate School of Medicine, Nagoya, Japan; ¹³Kindai University, Osaka, Japan; ¹⁴Osaka International Cancer Institute, Osaka, Japan; ¹⁵National Cancer Center Hospital East, Kashiwa, Japan; ¹⁶Sasebo City General Hospital, Nagasaki, Japan; ¹⁷Sapporo Medical University, Hokkaido, Japan; ¹⁸Hokkaido University Hospital, Hokkaido, Japan; ¹⁹Otaru Ekisaikai Hospital, Hokkaido, Japan; ²⁰Fukushima Medical University School of Medicine, Fukushima, Japan; ²¹Fukushima Medical University Aizu Medical Center, Fukushima, Japan; ²²The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; ²³National Cancer Center Hospital, Tokyo, Japan; ²⁴The Jikei University School of Medicine, Tokyo, Japan; ²⁵Nihon University School of Medicine, Nihon University, Tokyo, Japan; ²⁶Gunma University Graduate School of Medicine, Gunma, Japan; ²⁷Ishikawa Prefectural Central Hospital, Ishikawa, Japan; ²⁸Nishizin Hospital, Kyoto, Japan; ²⁹Kyoto First Red Cross Hospital, Kyoto, Japan; ³⁰Omihachiman Community Medical Center, Shiga, Japan; ³¹Ayabe City Hospital, Kyoto, Japan; ³²Aiseikai Yamashina Hospital, Kyoto, Japan; ³³Otsu City Hospital, Shiga, Japan; ³⁴Nara City Hospital, Nara, Japan; ³⁵Kyoto City Hospital, Kyoto, Japan; ³⁶Japanese Red Cross Wakayama Medical Center, Wakayama, Japan; ³⁷Sano Hospital, Hyogo, Japan; ³⁸Wakayama Medical University, Wakayama, Japan; ³⁹Kyoto Katsura Hospital, Kyoto, Japan; ⁴⁰Omi Medical Center, Shiga, Japan; ⁴¹Okayama University, Okayama, Japan; ⁴²Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan; ⁴³Nagasaki Medical Center, Nagasaki, Japan; ⁴⁴Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; ⁴⁵Oita University, Oita, Japan; ⁴⁶Kumamoto Central Hospital, Kumamoto, Japan; ⁴⁷Saga University Hospital, Saga, Japan; ⁴⁸University of Miyazaki, Miyazaki, Japan; ⁴⁹Nagasaki University Hospital, Nagasaki, Japan

Oral Presentation 13, APDW Theatre 1, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: Prophylactic clip closure after colorectal endoscopic submucosal dissection (ESD) among patients on anticoagulants is of uncertain effectiveness in reducing delayed bleeding (DB) risk. We aimed to assess the effect of prophylactic clip closure in preventing DB after colorectal ESD among patients on anticoagulants.

Materials and Methods: We used the ABCD-J study database, a large-scale multicenter study analyzing cases of DB among 34,455 colorectal ESD cases from 47 Japanese institutions between 2012 and 2021. DB rates among the non-complete closure and complete closure groups were compared using propensity score matching in patients on direct oral anticoagulants (DOAC) and warfarin.

Results: Overall, 1478 cases receiving colorectal ESD on anticoagulants were examined. After propensity score matching, the complete and non-complete closure groups included 215 and 84 patients on DOACs and warfarin, respectively. The complete closure group showed a significantly lower DB rate in patients receiving DOACs (10.7% vs. 5.1%, P = 0.048) and warfarin (16.7% vs. 6.0%, P = 0.049). Additionally, complete closure significantly reduced the risk of DB among patients taking DOACs for right-sided lesions (absolute risk difference: 7.4%, P = 0.028), whereas no risk reduction was observed for left-sided (absolute risk difference: 3.0%, P = 0.605) or rectal lesions (absolute risk difference: 0%, P = 1.0). A similar trend was observed among patients on warfarin.

Conclusion: Prophylactic clip closure after colorectal ESD significantly reduces the DB rate in patients receiving anticoagulants. In patients on anticoagulants, prophylactic clip closure can be routinely performed after ESD, particularly for right-sided lesions.

OP-14-01

Exploring liver-specific arginase-1 in the context of non alcoholic fatty liver disease progression.

Abhishak Gupta and Puja Sakhuja

Artemis Hospitals and Ilbs New Delhi, DELHI, India

Oral Presentation 14, APDW Theatre 2, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Background: Non-alcoholic steatohepatitis (NASH), a severe form of non-alcoholic fatty liver disease (NAFLD), can progress to cirrhosis and hepatocellular carcinoma. Due to the absence of definitive diagnostic markers, liver biopsy remains essential. Arginase-1 (Arg-1), a liver-specific enzyme catalyzing arginine conversion, has shown significant expression in high-fat diet-induced rat models. We propose Arg-1 as a potential diagnostic tool in routine pathology to distinguish hepatocyte pathologies. Our study aims to quantify early Arg-1 expression in NAFLD development, highlighting its diagnostic potential.

Methods: Using real-time-PCR and immunohistochemistry, we investigated the quantitative expression of Arg-1 in the characterized NAFLD patient biopsies different from F0-F4 (N=3-5 in each stage).

Results: In comparison to F0, the relative gene expression of Arg-1 significantly increased in the progressive stages of F2-F3 (P<0.001). There was no discernible change between F3 and F4 (p < 0.08). Immunohistochemistry (IHC) revealed elevated Arg-1 expression positively correlated with severity (p < 0.01) in NASH patients. The percentage area of stained cells showing Arg-1 positivity was significantly higher between F0 and F4 (p<0.001). A significant positive trend was observed from stage F1 to F3 (p < 0.01). Our findings suggest that elevated Arg-1 expression in liver disease patients may play a role in the development of liver fibrosis and dysfunction.

Conclusions: Therefore, we conclude that hepatic Arg-1 expression can serve as a pathological marker to monitor NAFLD progression. Our findings may pave the way for cutting-edge treatment strategies aimed at slowing the progression of liver disease in NAFLD patients.

OP-14-02

Vitamin D and NAFLD: Is there an association? a cross-sectional study among UAE population

Wala Hamed, Heba Abualas, Mahmoud Kiblawi, Omar Khaddam and Ahmad Alrifai

SSMC, Abu Dhabi, United Arab Emirates

Oral Presentation 14, APDW Theatre 2, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objective: The primary objective of this study is to investigate the correlation between serum vitamin D levels and the prevalence and severity of non-alcoholic fatty liver disease (NAFLD) in adult patients. By analyzing vitamin D concentrations and assessing liver health through imaging and biomarkers, this study aims to determine whether vitamin D deficiency is associated with an increased risk or progression of NAFLD. The findings could provide insights into potential preventative or therapeutic roles of vitamin D in the management of NAFLD.

Materials and Methods: Data was collected from 444 patients diagnosed with NAFLD at a tertiary care center in Abu Dhabi between 2018 and 2020. Patient demographics, medical history, and laboratory results, including vitamin D levels, were analyzed. NAFLD severity was assessed using fibrosis scores and liver ultrasound results.

Results: Out of the 444 patients, 60.6% were female and 60.1% were nationals. The median age was 47 years. Vitamin D levels were available for 191 patients, with a median level of 47.1 ng/mL. Among those, 12.6% had vitamin D levels below 30 ng/mL. Patients with advanced fibrosis (F3-F4) had a higher prevalence of vitamin D deficiency compared to those with mild fibrosis (F0-F2).

Conclusions: This study indicates a significant association between low vitamin D levels and increased severity of NAFLD. These findings support the hypothesis that vitamin D deficiency may contribute to the progression of NAFLD. Further research is needed to explore the potential benefits of vitamin D supplementation in managing NAFLD.

OP-14-03

CTRP1, a linker for glycogen and lipid metabolism ameliorates fatty liver diseases

Sora Han

Sookmyung Women's University, Seoul, South Korea

Oral Presentation 14, APDW Theatre 2, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: CTRP1, an adiponectin paralog, enhances glucose and fatty acid utilization, thus ameliorating systemic hyperglycemia and insulin resistance. We previously observed that global overexpression of CTRP1 in mice increased hepatic glycogen content. The mechanism through which CTRP1 controls hepatic glycogen remains unknown, prompting an investigation into the metabolic functions of CTRP1 in the liver concerning T2DM and fatty liver.

Materials and Methods: Functions of CTRP1 in the liver were studied using inducible CTRP1 conditional KO mice, primary hepatocytes, and adenovirus. Circulating CTRP1 levels were analyzed to assess the clinical association of CTRP1 with fatty liver diseases.

Results: CTRP1 is a novel downstream target of ChREBP, controlling glycogen synthesis and lipid accumulation in the liver, thus ameliorating fatty liver and systemic insulin resistance. CTRP1 enhances hepatic glycogen levels by increasing insulin-dependent glycogenic activity and the protein stability of glycogen synthase 2. Additionally, CTRP1 decreases the protein maturation of the lipogenic transcription factor Srebp1, suppressing de novo lipogenesis. CTRP1 KO mice with hepatic glycogen depletion and fatty liver exhibit insulin resistance and impaired glucose tolerance on a high-carbohydrate diet, mimicking clinical symptoms of pre-T2DM. Notably, circulating CTRP1 levels significantly correlate with the progression from hepatitis to cirrhosis in patients with T2DM, indicating the dual role of CTRP1 in regulating hepatic glycogen and lipid balance in both physiological and pathophysiological processes of hepatogenous diabetes.

Conclusion: CTRP1 could be a potential molecular link between hepatic glycogen and lipid balance and the development of systemic insulin resistance and T2DM.

OP-14-04

Utilizing Artificial Intelligence for assessing of fatty liver in ultrasound images

Jirakorn Jamrasnarodom

Faculty Of Medicine, Chulalongkorn University, Bangkok, Thailand

Oral Presentation 14, APDW Theatre 2, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: Assessing hepatic steatosis, addressing the increasing prevalence of non-alcoholic fatty liver disease (NAFLD) and its associated risks, including hepatocellular carcinoma (HCC), is a crucial step for identifying at-risk patient. With limitations of other non-invasive tests, the primary aim of this study was to develop and evaluate a Controlled Attenuation Parameter (CAP) reader model for assessing hepatic steatosis from liver ultrasonographic images.

Materials and Methods: We utilized liver ultrasonographic images and CAP scores collected from patients at King Chulalongkorn Memorial Hospital, Thailand, from 2017 to 2023. After screening, 1065 images from 352 patients were included. A deep learning model was developed, integrating YOLOv8 classification, Principal Component Analysis (PCA), and Lasso regression to predict CAP scores from ultrasonographic images. The dataset was divided into training (80%), validation (10%), and testing (10%) sets. Model performance was evaluated using R² and mean squared error (MSE).

Results: The CAP reader model achieved an overall R² value of 0.55 and a mean squared error of 1004.07. Subgroup analysis indicated the right intercostal view provided the best performance, with an R² value of 0.74 and an MSE of 637.99. The poor model’s performance in the healthy, mild steatosis groups with negative R² values might be due to the low number of healthy samples.

Conclusion: The CAP reader model shows promise for non-invasive liver fat assessment, especially with the right intercostal view, potentially reducing the need for invasive procedures. Further validation is needed to improve accuracy and generalizability.

OP-14-05

Multisystem health comorbidity networks of metabolic dysfunction-associated steatotic liver disease

Fangyuan Jiang^1,2, Lijuan Wang^2,3, Haochao Ying¹, Jing Sun², Jianhui Zhao², Ying Lu², Zilong Bian², Jie Chen², Aiping Fang⁴, Xuehong Zhang⁴, Susanna C. Larsson^5,6, Christos S. Mantzoros^7,8, Weilin Wang¹, Shuai Yuan⁵, Yuan Ding¹ and Xue Li²

¹Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; ²School of Public Health, Zhejiang University School of Medicine, Hangzhou, China; ³Centre for Global Health, Usher Institute, the University of Edinburgh, Edinburgh, UK; ⁴Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; ⁵Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; ⁶Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden; ⁷Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; ⁸Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA

Oral Presentation 14, APDW Theatre 2, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: The global burden of metabolic dysfunction-associated steatotic liver disease (MASLD) is growing, but its subsequent health consequences have not been thoroughly examined. We performed phenome-wide Mendelian randomization and disease-trajectory analyses to comprehensively assess the health outcomes of MASLD.

Materials and Methods: Phenome-wide association study was conducted to map the associations of MASLD with 948 unique clinical outcomes among 361,021 European in UK Biobank. Disease-trajectory and comorbidity analyses were applied to visualize the sequential patterns of multiple comorbidities related to the occurrence of MASLD. The associations jointly verified by observational and polygenic phenome-wide analyses were further replicated by two-sample Mendelian randomization analysis using data from the FinnGen study and international consortia.

Results: The observational and polygenic phenome-wide association study revealed the associations of MASLD with 96 intrahepatic and extrahepatic diseases, including circulatory, metabolic, genitourinary, neurological, gastrointestinal and hematologic diseases. Sequential patterns of MASLD-related extrahepatic comorbidities were primarily found in circulatory, metabolic, and inflammatory diseases. Mendelian randomization analyses supported the causal associations between MASLD and the risk of several intrahepatic disorders, metabolic diseases, cardio-cerebro-vascular disease and ascites, but found no associations with neurological diseases.

Conclusion: This study elucidated multisystem comorbidities and health consequences of MASLD, contributing to development of combination interventions targeting distinct pathways for the health promotion among MASLD patients.

OP-14-06

Geniposidic acid alleviates metabolic dysfunction-associated steatohepatitis-fibrotic progression to hepatocellular carcinoma by inhibiting senescence-associated secretory phenotype

Gao Jingwen and Chunfang Xu and Jinzhou Zhu

First Affiliated Hospital Of Soochow University, Suzhou, China

Oral Presentation 14, APDW Theatre 2, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver disease worldwide and a leading cause of liver cirrhosis and hepatocellular carcinoma (HCC). Geniposidic acid is a natural compound derived from the traditional Chinese medicine. Despite its antioxidant, anti-inflammatory, and hepatoprotective properties, the specific effects of Geniposidic acid on MASLD remain unclear. This study aims to fill this knowledge gap by exploring the potential therapeutic benefits and underlying mechanisms of Geniposidic acid in the treatment of MASLD.

Materials and Methods: To identify potential targets of Geniposidic acid, we conducted a predictive analysis using four different traditional Chinese medicine databases, namely ITCM, TargetNet, SEA, Super PRED and SwissTarget. Subsequently, the target analysis of Geniposidic acid was integrated with MASLD disease genes and transcriptomic data, and a data mining approach was employed to establish significant associations. To validate the pharmacological effects of Geniposidic acid comprehensively, animal models and cell models were constructed for in vivo and in vitro experiments, respectively.

Results: Geniposidic acid, binding to the cytokines secreted from senescent hepatic stellate cells, such as plasminogen activator inhibitor-1 (PAI-1) and interleukin 8 (IL-8), participates in mediating the p53 signaling pathway and epithelial-mesenchymal transition (EMT) progression. In a high-fat diet-induced severe metabolic dysfunction-associated steatohepatitis (MASH) mouse model, treatment with Geniposidic acid resulted in a reduction in liver nodules and decreased tumor markers.

Conclusion: Geniposidic acid alleviated MASH-fibrotic progression to HCC by inhibiting senescence-associated secretory phenotype and EMT signaling pathway. Geniposidic acid may be considered as a potential candidate for treating MASH.

OP-14-07

Disruption of tight junction molecules and their impact on fibrosis progression in NAFLD patients

Wit Thun Kwa¹, Zi Xuan Zhang¹, Lei Zhou¹, Halisah Nur¹, Wai Mun Loo², Eunice Xiang Xuan Tan², Mark Dhinesh Muthiah^1,2, Yock Young Dan^1,2 and Jonathan Wei Jie Lee^1,2,3

¹Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; ²Division of Gastroenterology and Hepatology, National University Health System, Singapore; ³iHealthTech, National University of Singapore, Singapore

Oral Presentation 14, APDW Theatre 2, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objective: Increased gut permeability (“leaky gut”) is manifested commonly in non-alcoholic fatty liver disease (NAFLD) patients. This pilot study aims to assess the impact of disruption of tight junction molecules on disease progression in NAFLD patients’ fibrosis status.

Methods: We collected 26 tissue samples from the terminal ileum during a colonoscopy at the National University Hospital. Liver fibrosis was assessed using a fibro-scan and subclassified into the control group (n=11), F0-F1 (Early Fibrosis Stage) (n=4), F2-F3 (Moderate Fibrosis Stage) (n=4) and F4 (Advanced Fibrosis Stage) (n=7). qPCR was performed for four tight junction markers (OCLN, F11R, TJP1, and CDH1) and Beta-Actin as the reference gene. Data were analyzed using ΔΔCt methods to determine relative gene expression. The p values are calculated based on the student’s t-test.

Results: The expression level of tight junction markers in NAFLD varied across fibrosis stages. OCLN and F11R were significantly upregulated in early (p < 0.05) and moderate (p < 0.01) fibrosis stages. F11R showed a slight increase in the advanced fibrosis stage (p < 0.05). TJP1 was significantly upregulated only in the moderate fibrosis stage (p < 0.01). No significant changes were observed for OCLN and TJP1 in the advanced fibrosis stage. CDH1 expression was consistently higher across all fibrosis stages (p < 0.001, p < 0.01 and p < 0.05 respectively). (Fig.1)

Conclusion: Our findings demonstrated that tight junction components and cell adhesion properties are dynamically regulated during NAFLD’s early to moderate fibrosis progression, suggesting a compensatory mechanism to maintain barrier integrity.

OP-14-08

Association between NAFLD and Low-Calorie Sweeteners: A bidirectional mendelian randomization study

Sanchuan Lai¹ and Tingting Su²

¹The Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China; ²The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China

Oral Presentation 14, APDW Theatre 2, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: Low-calorie sweeteners (LCS) serve to replace added sugars in beverages and foods. Studies suggested LCS may lead to obesity and other metabolic syndrome, while the association between LCS use and NAFLD was not well defined.

Materials and Methods: We performed a two-sample Mendelian randomization (MR) analysis using SNPs associated with LCSs (including Erythritol, Mannitol and Arabitol) intake in a published genome-wide association study (GWAS) as genetic instruments and summary-level data from published GWAS of NAFLD in the FinnGen (408613 cases) study. Random-effects inverse variance weighted (IVW) was the main analysis method, and MR Egger, weighted median, simple mode, and weighted mode were used as supplementary methods. We examined heterogeneity and horizontal pleiotropy, and examined whether the analysis results were influenced by a single SNP.

Results: Random-effects IVW results showed that Arabitol (p = 0.3580, OR 95% confidence interval [CI] = 1.15 [0.86-1.54]), Erythritol (p = 0.7856, OR 95% CI = 1.01 [0.93-1.10]) and Mannitol (p = 0.8361, OR 95% CI = 1.03 [0.77-1.37]) have no genetic causal relationship with NAFLD.

Conclusion: The present study suggested that LCS (Erythritol, Mannitol and Arabitol) use had no causal relationship with NAFLD at the genetic level.

OP-14-09

SEC62 promotes mitochondrial dysfunction by inhibiting ATAD3B and leads to hepatic apoptosis in non-alcoholic steatohepatitis

Jie Liang and Junchao Lin

Xijing Hospital, Xi'an, China

Oral Presentation 14, APDW Theatre 2, Exhibition Hall, November 22, 2024, 5:10 PM - 6:30 PM

Background & Aims: SEC62 is a pre-protein translocation factor mainly known for the ER unfold proteins cleaning in a manner of ER-phage, as part of autophagy. The causal mechanism of autophagy underlying NASH is not fully elucidated. We aim to investigate the role of SEC62 in the progression of NASH.

Methods: Gene-chip analysis were performed to identify the altered genes in NASH patients’ livers, and clinical samples were used to verify the relationship between SEC62 expression and the hepatic steatosis and injury. SEC62 gene manipulated cell and mouse model were used to evaluate hepatic mitochondrial homeostasis, steatosis, inflammation, and apoptosis. Ch-IP, Co-IP, and proteome analysis were performed to identify the up/down stream molecular mechanisms for SEC62.

Results: SEC62 expression is induced in the liver of animal models and patients with NASH. SEC62-suppressed in vitro and in vivo models ameliorates mitochondrial dysfunction and mitochondria-mediated apoptosis. SEC62-overexpressed in vitro and in vivo models showed the opposite trend. By interacting with ATAD3B, SEC62 improves hepatic inflammation, ROS accumulation, and mitochondrial dysfunction. Hepatic knockdown of SEC62 disturbs mitochondrial functions and aggravate hepatic steatosis.

Conclusions: Collectively, these findings indicate that SEC62 combines with ATAD3B and suppresses intracellular ROS cleaning, playing an essential role in mitochondrial homeostasis and the pathogenesis of steatohepatitis.

OP-15-01

Topographical profiling of helicobacter pyloric pathogenic pathways: Semi-quantified analysis of gastric inflammation and premalignant changes

Tzu-chan Hong^1,3, Chen-Tu Wu², Yih-Leong Chang², Yen-Lin Huang², Yu-Ting Chen², Chan-Yi Lin³, Jyh-Ming Liou^1,3 and Ming-Shiang Wu³

¹Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan; ²Department of Pathology, National Taiwan University Cancer Center, Taipei, Taiwan; ³Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Oral Presentation 15, Uluwatu 1, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: Previous studies of H. pylori infection and Correa sequence focused on the severity of pre-malignant lesions. However, the interactions between all histopathologies within this sequence remain underexplored. We aims to utilize topographical profiling of updated Sydney mapping protocol to semi-quantify these relationships and enhance understanding of the pathological progression.

Materials and Methods: This retrospective cohort study included patients undergoing routine endoscopic and pathology evaluations using the updated Sydney protocol at National Taiwan University Cancer Center from April 2022 to August 2023. Data analysis involved K-means clustering, Multiple Correspondence Analysis, Spearman correlation, and Structural Equation Modeling.

Results: Our study analyzed 406 patients, revealing three distinct histopathological subtypes: chronic gastritis, inflammatory, and premalignant. Age adjusted correlation analyses showed strong correlations between H. pylori levels and both acute and chronic inflammation in the antrum. Chronic inflammation correlated weakly with atrophic gastritis, and atrophic gastritis correlated weakly with intestinal metaplasia. Interestingly, in the gastric body, atrophic gastritis and intestinal metaplasia exhibited a stronger correlation. We further constructed a two layered correlation network of antrum and body connected through inflammations but not premalignant lesions. To further highlight the strength of each pathway in the Correa sequence, categorical structural equation modeling delineated the causal relationships and their magnitudes, tracing the progression from infection all the way to intestinal metaplasia.

Conclusion: This study provides the first comprehensive spatial analysis of H. pylori-induced gastric pathology, revealing distinct interrelationships. The topographical profiling offers valuable insights into the progression of gastric lesions, potentially guiding future precision screening and intervention.

OP-15-02

Tegoprazan-based vs. vonoprazan-based triple therapy for Helicobacter pylori eradication: a randomized, double-blind, active-controlled pilot study

Jae Yong Park¹, Il Ju Choi², Gwang Ha Kim³, Soo Jin Hong⁴, Sung Kwan Shin⁵, Seong Woo Jeon⁶ and Jae Gyu Kim¹

¹Division of Gastroenterology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea; ²Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea; ³Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea; ⁴Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University School of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea; ⁵Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; ⁶Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea

Oral Presentation 15, Uluwatu 1, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: This study aimed to evaluate the efficacy and safety of tegoprazan triple therapy compared to vonoprazan triple therapy for H. pylori eradication.

Methods: In a randomized, double-blind, active-controlled, multicenter pilot study, treatment-naïve adults with H. pylori infection were randomized 1:1:1 to receive tegoprazan 50 mg (TAC 1), tegoprazan 100 mg (TAC 2), or vonoprazan 20 mg (VAC), each administered orally with amoxicillin 1000 mg and clarithromycin 500 mg twice daily for 10 days. The primary outcome was the eradication rate, analyzed in both the per protocol set (PPS) and the full analysis set (FAS).

Results: A total of 102 subjects were randomized, with 97 completing the study. Efficacy was analyzed in the FAS (99 subjects) and PPS (92 subjects). H. pylori eradication rates for TAC 1, TAC 2, and VAC were 66.67% (20/30), 86.67% (26/30), and 87.50% (28/32) in the PPS, and 60.61% (20/33), 78.79% (26/33), and 84.85% (28/33) in the FAS, respectively. There was no great difference between TAC 2 and VAC groups: -0.83% (PPS) and -6.06% (FAS). However, TAC 1 showed lower eradication rates compared to VAC: -20.83% (PPS) and -24.24% (FAS). The safety profile was favorable with no concerning adverse events related to study drugs.

Conclusion: Tegoprazan 100 mg showed comparable H. pylori eradication rates to vonoprazan 20 mg when used as triple therapy, with a favorable safety profile. This study suggests tegoprazan 100 mg could be an optimal dose for H. pylori eradication. Further research with larger sample sizes is needed to confirm these findings.

OP-15-03

Antibiotic Resistance in Helicobacter pylori: Current Trends in Korea

Sang Un Kim, Jeonghwa Lee and Seong Woo Jeon

Division of Gastroenterology, Department Of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea

Oral Presentation 15, Uluwatu 1, November 22, 2024, 5:10 PM - 6:30 PM

Background/Aims: The eradication of H. pylori is crucial for the treatment of associated gastrointestinal diseases. However, the increasing prevalence of antibiotic resistance in H. pylori strains has become significant challenge in clinical practice. This study aims to determine recent antibiotic resistance and treatment success rates for H. pylori in Korea and compare these findings with previous data to understand resistance trends.

Methods: This multi-center prospective cohort study was conducted between September 2022 and February 2024. Patients aged 20 and above but under 80 years old, suspected of having active H. pylori infection based on endoscopic findings. The tissue samples collected from patients through endoscopy were cultured along with the rapid urease test.

Results: The research was conducted in a total of 5 hospitals in Korea, with a total of 83 patients participating. MIC testing was conducted on samples from the patients who were successful in eradication therapy to determine the resistance rates. For amoxicillin, resistance was observed in 6 patients (10%); for clarithromycin, 20 patients (34%); for metronidazole, 29 patients (50%); for tetracycline, 4 patients (7%); and for levofloxacin, 23 patients (40%). Compared to a 2011 Korean study, clarithromycin resistance has increased, while tetracycline resistance has decreased. Metronidazole resistance remains stable. Research on amoxicillin resistance is limited. Levofloxacin resistance rates continue to rise.

Conclusion: Antibiotic resistance in H. pylori is a growing global problem that compromises the effectiveness of eradication therapies. Tailored treatment based on antibiotic susceptibility testing is needed to address this challenge effectively.

OP-15-04

Tegoprazan-Amoxicillin Dual Therapy for Helicobacter pylori Eradication: A Prospective, Randomized, Multicenter Study

Xueyan Lin^1,2,3, Xueping Huang^1,2,3, Shiyun Lu^1,2,3, Yijuan Liu⁴, Feng Qiu⁵, Jie Pan⁶ and Zhihui Lin^1,2,3

¹Department of Gastroenterology and Hepatology, Fujian Provincial Hospital, Fuzhou, China; ²The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China; ³Fuzhou University Affiliated Provincial Hospital, Fuzhou, China; ⁴The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; ⁵Fujian Provincial Geriatric Hospital, Fuzhou, China; ⁶Pingtan Comprehensive Experimental Zone Hospital, Fuzhou, China

Oral Presentation 15, Uluwatu 1, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: We aim to evaluate the efficacy and safety of Tegoprazan-Amoxicillin (TA) dual therapy for Helicobacter pylori (H.pylori) eradication.

Materials and Methods: This prospective, randomized, open-label, multicenter study was conducted at four centers in Fujian, China. H.pylori-infective patients were randomised 1:1:1 to receive one of the following treatments: bismuth quadruple therapy (BQT, esomeprazole 20 mg twice daily + potassium bismuth citrate 240 mg twice daily + amoxicillin 1 g twice daily + clarithromycin 500 mg twice daily), Tegoprazan-Amoxicillin dual therapies (TA-qd, tegoprazan 50 mg once daily + amoxicillin 1 g thrice daily; TA-bid, tegoprazan 50 mg twice daily + amoxicillin 1 g thrice daily) for 14 days.

Results: A total of 321 patients were enrolled. The eradication rates in the BQT, TA-qd, and TA-bid group were: 85.05%(91/107)、84.11%(90/107)、84.11%(90/107)in intention-to-treat analysis(ITT) (BQT vs TA-qd, difference -0.93%, 95%CI -10.61% to 8.74% ; non-inferiority p=0.033; BQT vs TA-bid, difference -0.93%, 95%CI -10.61% to 8.74% ; non-inferiority p=0.033);85.05%(91/107)、85.71%(90/105)、88.25%(90/102)in modified intention-to-treat analysis(mITT) (BQT vs TA-qd, difference 0.67%, 95%CI -8.84% to 10.18% ; non-inferiority p=0.014; BQT vs TA-bid, difference 3.19%, 95%CI -6.02% to 12.3% ; non-inferiority p=0.002) ; 90.81%(89/98)、90.81%(89/98)、93.62%(88/94)in per-protocol analysis(PP) (BQT vs TA-qd, difference 0.00%, 95%CI -8.09% to 8.09% ; non-inferiority p=0.008; BQT vs TA-bid, difference 2.80%, 95%CI -4.76% to 10.36% ; non-inferiority p<0.001). The incidence of adverse reactions in both TA groups was significantly lower than in BQT group (15.15%, 12.37%, 25.00%, respectively; p=0.049). Two weeks of TA therapy altered gut microbiota diversity and composition, but that recovered four weeks after therapy.

OP-15-05

Asia-Pacific survey on the medical treatment of Helicobacter pylori

Koji Otani¹, Dao Viet Hang², Rapat Pittayanon³, Henry Liu⁴, Kee Huat Chuah⁵, John Hsiang⁶, Ning Zhang⁷, Akira Higashimori¹ and Yasuhiro Fujiwara¹

¹Osaka Metropolitan University, Osaka, Japan; ²Hanoi Medical University, Hanoi, Vietnam; ³King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand; ⁴Queen Elizabeth Hospital, Kowloon, Hong Kong, China; ⁵University of Malaya, Kuala Lumpur, Malaysia; ⁶Mount Elizabeth Medical Centre, Mount Elizabeth, Singapore; ⁷The first affiliated hospital of Sun Yat-sen University, Guangzhou, China

Oral Presentation 15, Uluwatu 1, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: The incidence and mortality rates of gastric cancer (GC) remain high due to Helicobacter pylori infection in Asia, and the importance of primary and secondary prevention of GC has been recognized. We aimed to clarify the opinions, consensus, and current issues about H. pylori infection among clinicians in Asia-Pacific region.

Methods: This was an international questionnaire-based internet survey created by the upper gastrointestinal (GI) focus group of the Young Asia Pacific Association of Gastroenterology (APAGE).

Results: The questionnaire was distributed to 98 participants, all whom consented and completed the questionnaire. It was suggested that the prevalence of H. pylori is decreasing across Asia in all age groups by the widespread of eradication therapy. The most common first-line eradication regimen was proton pump inhibitor (PPI), amoxicillin (AMPC) 2,000 mg, and clarithromycin 1,000 mg (48.0%) for 14 days (70.4%), and the most common second-line eradication regimen was PPI, AMPC 2,000 mg, and levofloxacin 500 mg (21.4%) for 14 days (67.3%). It was considered that eradication therapy should be performed for all asymptomatic currently H. pylori-infected adults and minors (age ≤ 17) in 81.6% and 64.3% of respondents. The 82.7% of respondents considered that GC screening by upper GI endoscopy is useful for secondary prevention of GC.

Conclusion: The situation of eradication therapy for H. pylori was different depending on the country and region of Asian countries until now. However, as the need for eradication therapy has been recognized, it seems that the consensus is being obtained between clinicians at the present.

OP-15-06

Overlap of Disorders of Gut-Brain Interactions (DGBI): Frequency, Somatization, Quality of life and Psychological Impact

Shahana Parvin, Karzan Dey Sarker, Rashedul Hasan, Mohammad Iqbal Hossain, Md. Golam Kibria and M Masudur Rahman

Sheikh Russel National Gastroliver Institute And Hospital, Dhaka, Bangladesh

Oral Presentation 15, Uluwatu 1, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: The frequency of overlap of disorders of gut-brain interactions (DGBI) and their effect on health impairment is largely unknown. The aims of this study were to determine the frequency, somatization, quality of life and psychological impact of DGBI and their overlap.

Materials and methods: Consecutive DGBI patients based on ROME lV diagnostic criteria attending at Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh were interviewed using validated Bengali ROME lV questionnaire, PHQ-15, PROMIS-10 and PHQ-4 questionnaire.

Results: Of 2,227 patients, 595 (26.72%) had DGBI [(mean age 34.81 ± 1.11 years; male 399 (67.1%)]. Functional esophageal, gastroduodenal, bowel disorders and anorectal disorders were present in 154 (25.9%), 359 (60.3%), 566 (95.1%) and 17 (2.9%), respectively. Most common DGBI were functional dyspepsia 267 (44.9%) followed by irritable bowel syndrome 174 (29.2%), functional constipation, 151 (25.4%) and functional diarrhea 131 (22.0%). One, two and three or more anatomical regions were involved in 199 (33.4%), 295 (49.6%), 101 (17%) patients. More than one anatomical regions were involved in 396(66.6%) patients. On average, each DGBI patient had 1.84 anatomical regions involvement. The overlapping of DGBI was associated with increased somatization (p = 0.03), worse global physical health (p = 0.019) and more depression state (p = 0.047); (Table 1).

OP-15-07

Deciphering Cancer Evolution through Genomic Profiling of Patient-Derived Xenograft together with primary Gallbladder Cancer

Vipin Yadav¹, Ragini Kilambi¹, V Nagarajan², Manju Kashyap³, Manoj Kumar Kashyap³, Archana Rastogi¹, Deepti Sharma¹, Nirupma Trehanpati¹, Namita Sharma¹ and Gayatri Ramakrishna¹

¹Institute of Liver and Biliary Sciences, Delhi, New Delhi, India; ²National Institute of Immunology, Delhi, New Delhi, India; ³Amity University Haryana, Haryana, India

Oral Presentation 15, Uluwatu 1, November 22, 2024, 5:10 PM - 6:30 PM

Objective: Gallbladder cancer has poor prognosis and is challenging to treat due to late diagnosis. We established patient-derived xenograft (PDX) model of gallbladder cancer to predict clinical outcomes.

Methods: 65-year-old woman underwent cholecystectomy for gallbladder tumor, followed by chemotherapy and second surgery for metastasis to abdominal wall. PDX model was developed from secondary tumor in NOD-SCID mice and characterized using immunohistochemistry. Primary, metastatic and PDX-derived tumors were sequenced for targeted cancer gene panel using next-generation sequencing. Putative functional somatic variants were identified using GATK pipeline.

Results: The secondary gallbladder cancer tumor injected into NOD-SCID mice developed 1cm tumor within 5 months. The PDX tumor was immunopositive for human Muc1 and CK17 markers. Genomic landscape of primary, secondary and PDX-derived tumors revealed the presence of oncogenic mutations in K-Ras(G12V). Additionally, primary tumor exhibited oncogenic mutations, including ALK, PDGFRA, ROS1, MET and BRAF, which decreased significantly in secondary tumor post-chemotherapy. The secondary tumor in abdominal wall showed increased mutation frequency of K-Ras and LRP1B, along with novel mutations in ELF3 and Kit. PDX tumor exhibited new mutations in IDH1 and BAP1, alongside high frequencies of ARID1A, ARID2, ALK, LRP1B, KIT, MET, and MAP2K1 variants, which mark significant evolution from primary and secondary human tumors.

Conclusion: The established gallbladder cancer PDX model showed original primary tumor mutations, with K-Ras as primary driver oncogene while ELF3 drives secondary metastasis. PDX generated tumor showed novel variants in IDH1 and BAP1 genes. The sequential landscape of the primary, metastatic and PDX-derived tumors revealed their evolutionary trajectory.

OP-15-08

Application of APC-specific ACMG/AMP criteria leads to resolution of VUS in ClinVar and LOVD databases

Xiaoyu Sherry Yin^1,2,3, Marcy Richardson⁴, Andreas Laner⁵, Xuemei Shi⁶, Elisabet Ognedal⁷, Valeria Vasta⁸, Thomas v O Hansen^9,10, Marta Pineda^11,12,13, Deborah Ritter^14,15, Johan de Dunnen¹⁶, Emadeldin Hassanin^17,18, Wencong Lyman Lin¹⁹, Ester Borras²⁰, Karl Krahn²¹, Margareta Nordling^22,23, Alexandra Martins²⁴, Khalid Mahmood²⁵, Emily Nadeau²⁶, Victoria Beshay²⁷, Carli Tops¹⁶, Maurizio Genuardi²⁸, Tina Pesaran⁴, Ian M Frayling^29,30,31, Gabriel Capellá^11,12,13, Andrew Latchford²⁹, Sean V Tavtigian^32,33, Carlo Maj^17,34, Sharon E. Plon^14,15, Marc S Greenblatt²⁶, Finlay A Macrae^1,2, Isabel Spier^3,11,35 and Stefan Aretz^3,11,35

¹Department of Colorectal Medicine and Genetics, Royal Melbourne Hospital, Melbourne, Australia; ²Department of Medicine, University of Melbourne, Parkville, Australia; ³Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany; ⁴Ambry Genetics, Aliso Viejo, USA; ⁵Medical Genetics Center Munich, Germany; ⁶Greenwood Genetic Center, Greenwood, USA; ⁷Western Norway Familial Cancer Center, Haukeland University Hospital, Norway; ⁸Northwest Genomics Center, Department of Genome Sciences, University of Washington, USA; ⁹Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; ¹⁰Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; ¹¹European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS) – Project ID No 739547; ¹²Hereditary Cancer Program, Catalan Institute of Oncology – ONCOBELL, IDIBELL, Barcelona, Spain; ¹³Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, Spain; ¹⁴Baylor College of Medicine, Houston, USA; ¹⁵Texas Children's Cancer Center, Texas Children’s Hospital, Houston, USA; ¹⁶Departments of Human Genetics & Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands; ¹⁷Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Germany; ¹⁸Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Luxembourg; ¹⁹St Vincents Hospital Melbourne, East Melbourne, Australia; ²⁰Invitae Corporation, San Francisco, USA; ²¹GeneDx, Gaithersburg, USA; ²²Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; ²³Department of Clinical Genetics, Linköping University Hospital, Linköping, Sweden; ²⁴Université de Rouen Normandie, Inserm, France; ²⁵Colorectal Oncogenomics Group, Department of Clinical Pathology, University of Melbourne, Melbourne, Australia; ²⁶Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, USA; ²⁷Peter MacCallum Cancer Centre, Melbourne, Australia; ²⁸Fondazione Policlinico Universitario A. Gemelli IRCCS, and Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy; ²⁹Polyposis Registry, St Mark’s Hospital, London, UK; ³⁰Inherited Tumour Syndromes Research Group, Institute of Cancer & Genetics, Cardiff University, Cardiff, UK; ³¹National Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland, ³²Department of Surgery and Cancer, Imperial College, London, UK; ³²Huntsman Cancer Institute, University of Utah, Salt Lake City, USA; ³³Department of Oncological Sciences, School of Medicine, University of Utah, Salt Lake City, USA; ³⁴Centre for Human Genetics, University of Marburg, Germany; ³⁵National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Germany

Oral Presentation 15, Uluwatu 1, November 22, 2024, 5:10 PM - 6:30 PM

Background: Pathogenic constitutional APC variants underlie familial adenomatous polyposis, the most common hereditary gastrointestinal polyposis syndrome. To improve variant classification and resolve variants of uncertain significance (VUS), APC-specific ACMG/AMP variant classification criteria were developed by the ClinGen-InSiGHT Hereditary Colorectal Cancer/Polyposis Variant Curation Expert Panel (VCEP).

Methods: A streamlined algorithm using the APC-specific criteria was developed and applied to assess all APC variants in ClinVar and the InSiGHT international reference APC LOVD variant database.

Results: A total of 10,228 unique APC variants were analysed. Among the ClinVar and LOVD variants with an initial classification of (Likely) Benign or (Likely) Pathogenic, 94% and 96% remained in their original categories, respectively. In contrast, 40% of all VUS were reclassified as B/LB and 1% as P/LP. The total number of VUS was reduced from 6,142 (60%) to 3,866 (37.8%), with 41% of previous VUS being re-classified into clinically relevant pathogenicity classes. In 24 out of 37 promising APC variants that remained VUS, a data mining-driven work-up allowed their reclassification as (Likely) Pathogenic.

Conclusions: The application of APC-specific criteria substantially reduced the number of VUS in ClinVar and LOVD. The study also demonstrated the feasibility of a systematic approach to variant classification in large datasets, which might serve as a generalisable model for other gene-/disease-specific variant interpretation initiatives. It also allowed for the prioritization of VUS that will benefit from in-depth evidence collection. This subset of APC variants was approved by the VCEP and made publicly available through ClinVar and LOVD for widespread clinical use.

OP-15-09

FMT is less effective in UC patients with depression, anxiety, insomnia or poor psychological resilience

Guanzhou Zhou^1,2, Xiaolei Liu³, Ronghuan Jiang³, Hong Guo³, Yunsheng Yang^2,4 and Lihua Peng²

¹School of Medicine, Nankai University, Tianjin, China; ²Microbiota Laboratory, Clinical Division of Microbiota, Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Beijing, China; ³Department of Medical Psychology, The First Medical Center of Chinese PLA General Hospital, Beijing, China; ⁴National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China

Oral Presentation 15, Uluwatu 1, November 22, 2024, 5:10 PM - 6:30 PM

Objectives: Fecal microbiota transplantation (FMT) exhibited potential for remission induction in patients with ulcerative colitis (UC) while with uncertain efficacy. Those patients also suffered from abnormal psychological condition like depression and anxiety, which affected FMT efficacy. Therefore, we conducted a series of questionnaires about mental health in patients receiving FMT for UC to predict its effectiveness.

Materials and Methods: Patients with active UC were enrolled in this study. Before the first FMT, four questionnaires were conducted and their cut-off values were based on their individual criterion. It included Patient Health Questionnaire depression scale (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Insomnia Severity Index (ISI-7) and Connor-Davidson Resilience Scale (CD-RISC-25). The abnormal scores were defined as ≥5, ≥4, >7 and <70 individually.

Results: All sixty-one patients with active UC received at least once FMT therapy. The mean Mayo score decrease from 7.95±2.15 to 5.18±2.69 (P<0.001).

Patients with abnormal PHQ-9, ISI-7 and CD-RISC-25 scores decreased less in the Mayo assessment than patients with normal scores (1.885±2.142 vs. 3.457±2.571, P=0.014; 1.467±2.066 vs. 3.371±2.636, P=0.017; 3.600±3.043 vs. 1.550±2.188, P=0.027) (Figure1).

Additionally, we performed a logistic regression analysis to identify predictors of FMT efficacy. The abnormal scores on PHQ-9, GAD-7, ISI-7 and CD-RISC-25 indicated a poor response to FMT therapy. The regression model showed a 76.19% of specificity and 64.29% of sensitivity with 0.806 of AUC.

Conclusion: Patients with abnormal PHQ-9, GAD-7, ISI-7 and CD-RISC-25 scores benefited less from the FMT treatment and those abnormal scores were promising predictors of poor response to FMT.

OP-15-10

Saffron enhanced clinical and immune response in UC patients: A multisite clinical trial study

Hassan Ashktorab¹, Holen Maeker², Hassan Salman Roghani³, Roham Salmanroghani⁴, Farshad Aduli¹, Angesom Kibreab¹ and Adeyinka Laiyemo¹ and Reza Oskrochi and Yusuf Ashktorab and Amr Amin and Amel Ahmed and Hassan Brim

¹Howard University, Washington, United States; ²Stanford University, Stanford, United States; ³Sadoghi University, Yazd, Iran; ⁴The University of Kansas, Kansas, USA; ⁵National Hepatology and Tropical Medicine Institute, Cairo, Egypt; ⁶University of Sharjah, Sharjah, UAE; ⁷American University of Middle East, Kuwait, Kuwait

Oral Presentation 15, Uluwatu 1, November 22, 2024, 5:10 PM - 6:30 PM

Background: Current immunosuppressive UC treatments can have severe side effects, prompting the search for alternative therapies. Dietary interventions have gained attention as adjuvant treatments for UC. Saffron, a spice from the Crocus sativus flower, has shown anti-inflammatory effects in preclinical IBD models.

Aim: This study aims to assess the clinical and laboratory responses of patients with mild to moderate UC to saffron supplementation alongside conventional treatment.

Methods: This clinical trial took place across three sites: Howard University Hospital (USA), Sadoughi Hospital (Iran), and Egypt University Hospital (Egypt). At USA, three UC patients received 50 mg of saffron twice daily for 8 weeks (two cycles). Inflammatory markers, stool calprotectin, and cytokines were measured. Similar trials were conducted in Iran (30 UC patients) and Egypt (20 UC patients). Laboratory markers such as hemoglobin, platelets, CRP, ESR, and fecal calprotectin were recorded, along with clinical scores like SCCAI, partial Mayo score, and Hamilton Anxiety Scale (HAM-A). Univariate analysis compared post-treatment outcomes to baseline. Saffron and placebo capsules were provided by Sina Pajoohan Salamat Corp. (Mashhad, Iran).

Results: In USA patients, saffron reduced pro-inflammatory cytokines, increased anti-inflammatory markers, and significantly lowered fecal calprotectin. The Yazd study showed significant improvement in depression, disease severity, and inflammation, particularly with high-dose saffron. In Egypt, 50% of saffron-treated patients showed improved quality of life and reduced inflammation markers. No adverse events were reported.

Conclusion: Saffron appears to be a promising adjuvant therapy for UC, improving clinical outcomes and reducing inflammation without adverse effects, potentially reducing dependence on immunosuppressants.

OP-16-01

Intra-cystic Antibiotic Instillation with Hydrogen Peroxide during Necrosectomy in Patients with Infected Walled-off Pancreatic Necrosis

Prasanta Debnath and Rahul Samanta and Pradeepta K Sethy

Medica Superspeciality Hospital, Kolkata, Kolkata, India

Oral Presentation 16, APDW Theatre 1, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Infected walled-off pancreatic necrosis (WOPN) is associated with a high rate of complications and mortality (20%–30%). Though endoscopic drainage remains the standard of care, the role of direct antibiotic instillation during endoscopic necrosectomy remains doubtful.

Materials and Methods: This is a single-center, open-label, randomized trial. Patients with suspected or confirmed infected pancreatic necrotic collection were selected for the study. Patients were randomized into 2 treatment groups- i) Instillation of Gentamycin + Hydrogen peroxide (H2O2) - Group A ii) Instillation of H2O2 only - Group B. Number and type of intervention, mortality and morbidity (length of stay in hospital and ICU) and complications were compared.

Results: A total of 23 patients were enrolled - 12 patients in group A and 11 in group B. The median number of necrosectomy sessions in groups A and B are 2 (1-3), and 2 (1-4) (p=NS). Median length of hospital and ICU stay post drainage were 12 and 3 in Group A and 18 and 5 in B respectively, (p<0.05, both). The mortality and complication rates in both groups were comparable.

Conclusion: Direct intra-cystic antibiotic instillation along with H2O2 doesn't reduce the number of necrosectomy sessions but has been shown to reduce the length of hospital and ICU stay in patients with infected walled-off pancreatic necrosis.

OP-16-02

Usefulness of Detective Flow Imaging in Differentiating Small (≤20 mm) Gallbladder Polypoid Lesions

Akito Furuta^1,2, Shunsuke Omoto³, Michihito Kono^1,2, Taro Inoue¹ and Wataru Ono¹

¹Department of Gastroenterology, Kobe Tokushukai Hospital, Hyogo/Kobe, Japan; ²Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada/Osaka, Japan; ³Department of Gastroenterology, Kindai University Hospital, Osaka-sayama/Osaka, Japan

Oral Presentation 16, APDW Theatre 1, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Detective Flow Imaging (DFI), a next-generation color Doppler technique, is an advanced endoscopic ultrasound modality that enables detailed visualization of intratumoral vessels. This study aimed to evaluate the usefulness of DFI in the assessment of small (≤20 mm) gallbladder polypoid lesions compared to contrast-enhanced computed tomography (CE-CT).

Materials and Methods: A retrospective analysis was conducted on 8 cases of gallbladder polypoid lesions ≤20 mm that underwent CE-CT, endoscopic ultrasound with DFI, and subsequent surgery for final pathological diagnosis between September 2021 and July 2024. DFI findings were evaluated based on the number of vessel branches from the base of the polypoid lesion (linear vessels: single branch; dendritic vessels: two or more branches) and vascular abnormalities (tortuous or variable caliber). These findings were compared with CT results.

Results: The mean age of patients was 61 years (range: 35-73 years), and the median lesion diameter was 12.8 mm (range: 10-19 mm). Pathological diagnoses included 5 cases of high-grade Intracystic Papillary Neoplasms (ICPN) and 3 cases of cholesterol polyps. CE-CT showed homogeneous enhancement in all cases, failing to differentiate between ICPN and cholesterol polyps. DFI findings revealed dendritic vessels with tortuous or variable calibers in all ICPN cases, while cholesterol polyps exhibited only linear vessels without abnormal branching or morphological changes.

Conclusion: DFI proves to be a more effective tool than CE-CT for differentiating small (≤20 mm) gallbladder polypoid lesions, offering superior visualization of vascular morphology.

OP-16-03

Comparison of diagnostic yield between pancreatic and liver tissues in EUS-FNAB

Chan Min Jung¹, See Young Lee¹, Sung Il Jang¹, Eui Ju Kim² and Jae Hee Cho¹

¹Gangnam Severance Hospital, Seoul, South Korea; ²Gil Medical Center, Incheon, South Korea

Oral Presentation 16, APDW Theatre 1, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Pancreatic cancer can often metastasize to the liver, leading to a high prevalence of suspected pancreatic cancer patients with liver lesions. Typically, histological confirmation is obtained through EUS-FNAB. In this procedure, there are instances where we obtain pancreatic tissue first and then additionally puncture for liver tissue. This study aims to ascertain whether the diagnostic yield is adequately satisfactory in such cases.

Materials and Methods: We retrospectively analyzed patients who underwent EUS-FNAB for solid liver lesions between November 2014 and September 2023. This study compared obtaining pancreatic tissue several times before obtaining liver tissue with obtaining liver tissue from the beginning.

Results: The data was classified into the Simultaneous group and the Liver-only group, and then analyzed further based on the number of passes within the Simultaneous group. Upon the first pass, an accuracy of 92.6%, sensitivity of 92.3%, and specificity of 100% were observed. For passes 2 and 3, all metrics demonstrated a diagnostic yield of 100%. In contrast, within the Liver-only group, accuracy, sensitivity, and specificity were determined to be 84%, 86.4%, and 66.7%, respectively.

Conclusion: This study confirmed that the diagnostic yield of the Simultaneous group, obtaining pancreatic tissue and liver tissue simultaneously, is not inferior compared to obtaining only liver tissue through EUS-FNAB when comparing diagnostic yields.

OP-16-04

“S. KAREEM-TRAP-score” for EUS-FNB guided malignant tissue output: Comparison of “Diagnostic-metrics” for pancreatic/non-pancreatic solid lesions

Shahid Karim and Shanil Kadir

Gastroenterology, Department of Liaquat National Hospital & Medical College, Karachi, Pakistan

Oral Presentation 16, APDW Theatre 1, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objective: To develop a scoring-tool based on key-factors that influence higher positive outcomes for EUS-FNB-TA, by using accepted diagnostic metrics such as ROC-curve, sensitivity/ specificity/ predictive values in both pancreatic/non-pancreatic biopsies.

Materials & Methods: Retrospective study, conducted in the gastroenterology-department at Liaquat-National-Hospital, Karachi, Pakistan. Electronic-Medical-Record (EMR) of consecutive pancreatic/non-pancreatic EUS-FNB were collected from January2019-July2024 after obtaining institutional approval, excluding incomplete procedures. S.KAREEM-TRAP-score was developed using four parameters: Tissue size (T: 1 if >4 mm, 0 if <4 mm), ROSE (R: 1 if positive, 0 if negative), Age (A: 1 if ≥60 years, 0 if <60 years), and Needle passes (P: 1 if >2 passes, 0 if ≤2 passes), with a scoring range of 0-4. "S.KAREEM" represents the author’s initials (S=Shaahid, K=Kareem). SPSS-version-25 for data-analysis. Diagnostic metrics for pancreatic/ non-pancreatic biopsies were calculated, including Sensitivity/ specificity/ predictive values with a threshold score of 3. ROC-curves/ AUC-values to assess the S.KAKEEM-TRAP-Score’s predictive performance for malignancy.

Results: 154 EUS-FNB were analysed (102/154, 66.2% malignant). Median age was 60 years (IQR: 48-67), male predominance (62.3%). Pancreatic biopsies constituted 58.4% of the cases. Overall, Malignancies were identified in 79.5% of patients aged ≥60 years, 77.8% of those with >2 needle passes, 88.8% of cases with a tissue core size >4 mm, and 94.1% of ROSE-positive cases. Median S.KAREEM-TRAP-Score was 3 (IQR: 2-4). Comparative analysis of pancreatic/ non-pancreatic biopsies/tissue is shown in Table 1.

Conclusion: The S.KAREEM-TRAP-Score may be a valuable tool for predicting higher positive outcomes in EUS-FNB-TA for both pancreatic/ non-pancreatic solid-lesions.

OP-16-05

Utility of macroscopic on-site evaluation (MOSE) in predicting yield of endoscopic ultrasound (EUS) guided biopsy

Raja Taha Yaseen Khan

Sindh Institute of Urology and Transplantation, Karachi, Pakistan

Oral Presentation 16, APDW Theatre 1, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objective: This study aimed to document the etiology, morphology, and utility of macroscopic on-site evaluation (MOSE) in predicting the good yield of endoscopic ultrasound (EUS)-guided biopsy.

Materials and Methods: Patients with solid pancreatic lesions (SPLs) referred for EUS-guided biopsy were included. The etiology, morphology, and results of EUS-guided biopsy were recorded. Due to the unavailability of rapid on-site evaluation (ROSE), MOSE was performed by the endoscopist. MOSE was deemed satisfactory if at least one tissue core of at least 1 inch was obtained. Biopsy specimens were considered of good yield if sufficient for diagnosis. Factors predicting good yield biopsy (GYB) were identified.

Results: Of the 176 patients, 111 (63.1%) were males, with a mean age of 53.8 (±12.6) years. Good yield biopsies (GYB) were obtained in 144 cases (81.8%), including 97 (67.4%) neoplastic and 47 (32.6%) non-neoplastic SPLs. Factors predicting GYB included SPL size >15mm, use of fine-needle biopsy (FNB) needles, ≥2 passes, and satisfactory MOSE on univariate analysis; FNB use, and satisfactory MOSE were significant on multivariate analysis. Satisfactory MOSE had a high sensitivity (85.4%), positive predictive value (95.35%), and diagnostic accuracy (84.7%).

Conclusion: The most common neoplastic SPLs are PDA and NET, while MFCP and AIP are the predominant non-neoplastic SPLs. PDAs tend to occur in the pancreatic head and older patients, whereas NETs are more common in younger patients and the pancreatic body. A good biopsy yield is likely with the use of FNB needles and satisfactory MOSE.

OP-16-06

Novel-cost-effective EUS coiling and glue technique for the management of large gastric varices:A long-term study

Shivam Khare¹, Anil Arora¹ and Jijo Varghese²

¹Sir Ganga Ram Hospital, Delhi, India; ²N S Hospital, Kollam, India

Oral Presentation 16, APDW Theatre 1, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objective: Our aims to find out the efficacy of EUS coiling+glue injection. Moreover in our study after putting Coil under EUS guidance, Direct endoscopic glue injection is done with a 21G sclerotherapy needle. Since the EUS needle was not used for the glue injection it can be reused for an additional upto three cases for deployment of the EUS coil hence reducing the cost of the whole procedure. In short,our study aims to find a cost-effective method of EUS coiling+glue injection in a cohort of the Indian population.

Material and Methods: Retrospective review of prospectively collected data on EUS coiling+glue injection over a period spanning from July 2017 to December 2023 from the Department of Gastroenterology Sir Ganga Ram Hospital New Delhi.

Results: A total of 103patients were taken up for the study. 74patients were Males and 29 were females. The mean follow-up duration of the study population was 34.2 months±21 months. 4 out of 103patients in our study population had rebleeding but the cause of rebleeding turned out to be non variceal causes. Regarding the intraprocedural and post-procedural adverse events 1 out of 103patients in our study population had abdominal pain and fever which responded to oral analgesics and antipyretics, there was no active bleeding from the puncture site or systemic embolization. Technical success was 100% in our study.

Conclusion: Direct endoscopic injection of glue following EUS coiling with a 21G sclerotherapy needle can significantly reduce the cost of the procedure without any risk of infection and gives sustainable long-term beneficial effects.

OP-16-07

Duodenal ESD using EG-840TP with a dedicated conical cap (a prototype small-caliber-tip transparent hood)

Takashi Ueno, Hisashi Fukuda, Hiroki Hayashi, Yoshie Nomoto, Haruo Takahashi, Yuji Ino and Hironori Yamamoto

Jichi Medical University, Japan

Oral Presentation 16, APDW Theatre 1, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Duodenal endoscopic submucosal dissection (ESD) requires advanced endoscopic techniques because of limited endoscopic maneuverability and thin submucosal layer. We introduced the pocket-creation method (PCM) of duodenal ESD to overcome difficulties. The EG-840TP (Fujifilm Co, Tokyo, Japan) was developed for endoscopic treatment as a relatively thin endoscope that has an outer diameter of only 7.9mm but an accessory channel diameter of 3.2mm. It also has a down angle function up to 160 degrees. A dedicated conical cap (a prototype small-caliber-tip transparent hood) is transparent with a 4-mm tip diameter that can be used in ESD. The aim of this study was to evaluate the safety and usefulness of ESD using EG-840TP with the dedicated conical cap for duodenal ESD.

Materials and Methods: We performed ESD with PCM of 13 non-ampullary duodenal lesions using EG-840TP and of 30 lesions using EG-580RD, EG-L580RD7 and EG-840T from June 2016 to May 2024. We retrospectively reviewed the results, comparing EG-840TP with conventional scope. After propensity score matching based on these matching factors of size, location and gross type. We matched 10 patients in the EG-840TP group to 10 patients in the conventional scope group.

Results: Dissection time was faster in the EG-840TP than the conventional scope (61.5 min [25%,75% 44.8,84.8] vs. 123.5 min [25%,75% 83,154.8]; P = 0.02). Regarding the other outcomes, there were no significant differences in the complete resection rate, after bleeding, and perforation between the two groups.

Conclusion: The EG-840TP with the dedicated conical cap may be suitable for duodenal ESD.

OP-16-08

Endoscopic Versus Laparoscopic Resection for Gastrointestinal Stromal Tumors of Esophagogastric Junction: A Propensity-Score-Matched Case-Control Study

Saif Ullah, Shanshan Zhu and Xin-Guang Cao

The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

Oral Presentation 16, APDW Theatre 1, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objective: This study aims to investigate the optimal treatment approach for gastrointestinal stromal tumors (GISTs) located at the esophagogastric junction (EGJ-GIST).

Methods: This retrospective study includes 43 patients who underwent endoscopic resection (ER) and 42 patients who underwent laparoscopic resection (LR) for EGJ-GIST measuring 2 to 5 cm at the First Affiliated Hospital of Zhengzhou University between December 2013 and November 2023. Propensity score matching (1:1) was employed to mitigate confounding factors such as age, sex, tumor size, mitotic count, and risk grade. Tumor outcomes were then compared between the ER and LR groups, each comprising 20 patients.

Results: The ER group exhibited significantly shorter postoperative nil per os (NPO) time (3.0 (3.0, 4.0) vs. 6.0 (4.8, 8.0), P<0.001) and postoperative hospitalization time (6.0 (5.0, 8.0) vs. 9.0 (7.0, 12.0), P<0.001) compared to the LR group. Furthermore, the long-term adverse event rate was significantly lower in the ER group than in the LR group (9.3% vs. 50%, P<0.001). These differences remained statistically significant following propensity score matching. Throughout the follow-up period, neither group experienced recurrence or distant metastasis (Figure).

Conclusion: Endoscopic resection emerges as a promising therapeutic modality for EGJ-GISTs measuring 2 to 5 cm. In comparison to LR, ER offers the advantages of reduced trauma, potential preservation of the anatomical integrity of the EGJ, and notable enhancement of long-term quality of life for patients.

Keywords: Gastrointestinal Stromal Tumors; Esophagogastric Junction tumors; Endoscopic Resection; Laparoscopic Resection.

OP-16-09

Comparative study of Endoscopic Treatment Outcomes for Esophagogastric Junction and Esophageal Cancers

Masao Yoshida, Shunsuke Ueda, Yoichi Yamamoto, Noboru Kawata and Hiroyuki Ono

Shizuoka Cancer Center, Nagaizumi, Japan

Oral Presentation 16, APDW Theatre 1, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Despite the esophagogastric junction (EGJ) being located at the lower end of the esophagus, differences in endoscopic treatment outcomes for EGJ cancer compared to esophageal cancer have not been fully examined. This study aims to evaluate the short-term outcomes of endoscopic treatment for adenocarcinoma in the EGJ (defined within ±2cm of the EGJ).

Materials and Methods: Between 2010 and 2023, 145 EGJ cancers excluding lesions entirely below the EGJ, were treated by ESD (EGJ group). As a control (ESO group), 290 lesions from 1098 thoracic esophageal cancers treated by ESD from 2010 to 2022, matched 1:2 with the EGJ group using propensity scores based on antithrombotic agent use, tumor size, and circumference. Post-procedural bleeding was defined as cases requiring hemostasis or blood transfusion.

Results: There were no significant differences in age (EGJ group: 68.9 years vs. ESO group: 69.6 years), male ratio (81.4% vs. 86.6%), antithrombotic agent use (13.8% vs. 18.6%), tumor size (15.7 mm vs. 15.3 mm), and tumor circumference (≤74%/75%-100%: 94.4%/5.6% vs. 94.5%/5.5%). No intraoperative perforations occurred, and delayed perforation was 0.7% in both groups. Procedure time was longer for the EGJ group (58.5 minutes vs. 35.8 minutes, p<0.001), and post-procedural bleeding was higher (7.6% vs. 0.3%, p<0.001) in the EGJ group. Post-resection steroid use was 15.9% vs. 17.6%, with postoperative stricture rates at 8.3% in both, showing no significant differences.

Conclusion: ESD for EGJ cancers required a longer procedure time and exhibited a higher frequency of post-procedural bleeding compared to esophageal cancers, demanding distinct clinical approaches.

OP-16-10

Analysis of delayed bleeding after colorectal ESD focused on the risk of antithrombotic medications

Xinhan Zhang^1,2, Shoko Ono¹, Shuichi Miyamoto¹ and Naoya Sakamoto¹

¹Hokkaido University Hospital, Sapporo, Japan; ²National Hospital Organization Hokkaido Medical Center, Sapporo, Japan

Oral Presentation 16, APDW Theatre 1, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: For patients undergoing antithrombotic treatment who will receive gastroenterological endoscopic submucosal dissection (ESD) with a high risk of bleeding, new findings concerning antithrombotic therapy withdrawal was added in the Japanese guideline in 2017. In this study, we analyzed the situation of delayed bleeding after colorectal ESD since the change in guideline.

Materials and Methods: Colorectal ESD cases performed at our institution from July 2017 to April 2022 were included and analyzed retrospectively. Patient factors (antithrombotic medication, etc.), lesion factors (tumor length, etc.), and treatment factors (endoscopist, etc.) were investigated from medical records. Patients will continue warfarin treatment where INR falls within the therapeutic range, or have DOAC (direct oral anticoagulants) discontinuation on the day of ESD. Delayed bleeding was defined as postoperative hematochezia which was confirmed from the post ESD ulcer.

Results: A total of 322 colorectal ESD cases were analyzed and delayed bleeding was observed in 20 patients. Comparison of the bleeding and non-bleeding groups, significant difference was observed whether the patients receiving antithrombotic treatment, while there was no statistical difference about lesion factors or treatment factors. Bleeding was more common among those taking multiple antithrombotic medications and those using anticoagulants, while single antiplatelet agent did not increase the risk of bleeding. Although patients using anticoagulants showed more bleeding, no bleeding occurred in those taking DOAC therapy.

Conclusion: Patients using multiple antithrombotic medications or anticoagulants will have higher risk of delayed bleeding in colorectal ESD, but DOAC withdrawal on the day of procedure according to guideline was acceptable.

OP-17-01

The Pancreaticogastrostomy and Pancreatiojejunostomy Outcomes in Pancreaticoduodenectomy: An Umbrella Review of Meta-Analysis from RCTs

Citra Aryanti^1,3, Erwin Syarifuddin², Julianus Aboyaman Uwuratuw², M Ihwan Kusuma², Ronald Erasio Lusikooy², Ibrahim Labeda², Warsinggih Warsinggih², Samuel Sampetoding² and Murny Abdul Rauf²

¹Digestive Surgery Training Program, Department Of Surgery, Hasanuddin University, Makassar, South Sulawesi, Indonesia; ²Division of Digestive Surgery, Department of Surgery, Hasanuddin University, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Sulawesi Selatan, Indonesia; ³Division of Digestive Surgery, Department of Surgery, Udayana University, Denpasar, Indonesia

Oral Presentation 17, APDW Theatre 2, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objective: This umbrella review synthesizes meta-analyses comparing pancreaticojejunostomy and pancreaticogastrostomy for pancreatic reconstruction after pancreaticoduodenectomy, evaluating differential risks of complications like fistula, hemorrhage, and delayed gastric emptying.

Materials and Methods: This rigorous umbrella review synthesizes meta-analyses of RCTs to meticulously evaluate differential risks of 7 key complications between pancreaticogastrostomy and pancreaticojejunostomy for pancreatic reconstruction after pancreaticoduodenectomy, employing advanced meta-analysis in R to inform evidence-based decision-making.

Results: Overall, 20 meta-analyses of RCT that compared outcomes 11.113 subjects in PG group and 11.244 in PJ group in PD were further analyzed in umbrella review in this study. In the cumulative evidences in our umbrella review, the complications of POPF, biliary fistula, and ascites incidence were shown to be significantly lower in PG than PJ group (eOR 0.635; 95%CI 0.584-0.692; p<0,001; I2 27%; eOR 0.484; 95%CI 0.373-0.628; p<0,001; I2 0%; eOR 0.554; 95%CI 0.49-0.627; p<0,001; I2 0%, respectively). Contrary, postoperative hemorrhage and delayed gastric emptying incidence were shown to be significantly higher in PG than PJ group (eOR 1.444; 95%CI 1.269-1.644; p<0,001; I2 0%; eOR 1.113; 95%CI 1.012-1.225; p=0.028; I2 0%, respectively). No significant difference of reoperation and mortality rate were shown between PG and PJ group.

Conclusions: Pancreaticogastrostomy had lower incidence of POPG, biliary fistula, and ascites incidence than pancreaticojejunostomy in PD surgery. However, the hemorrhage and delayed gastric emptying incidence were higher. No significant difference of reoperation and mortality rate were shown.

OP-17-02

The effect of anticoagulation therapy on the surgical outcomes of minimally invasive major digestive surgery

Kei Harada

Kokura Memoriai Hospital, Kitakyushu, Fukuoka, Japan

Oral Presentation 17, APDW Theatre 2, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: The objective of this study is to assess the effect of perioperative anticoagulation therapy (ACT) on the surgical outcomes of minimally invasive major digestive surgery.

Materials and Methods: A total of consecutive 1290 patients undergoing elective minimally invasive (laparoscopic/robotic) major digestive surgery (esophagogastric/colorectal resection for malignancy) between 2014 and 2023 were enrolled. The patients were divided into three groups: patients without receiving anticoagulation therapy (non-ACT, n=1076), patients receiving direct oral anticoagulants (DOAC, n=144), and patients receiving warfarin (WF, n=70). Outcome variables were compared between the groups and the risk factors of postoperative bleeding complications were assessed using logistic multivariate analysis.

Results: The overall rate of thromboembolic complication was 0.5%, and the operative mortality was zero in the whole cohort. The incidences of postoperative bleeding in the non-ACT, DOAC, and WF groups were 1.0%, 6.9% and 11.4%, respectively (P<0.001). Among 8 DOAC-received patients with postoperative gastrointestinal bleeding, 75% of cases occurred on postoperative day 5 or later. Multivariate analysis showed DOAC (odds ratio=5.420, P<0.001) and perioperative heparinization (odds ratio=3.770, P=0.0479) were significant risk factors for major postoperative bleeding.

Conclusion: Although minimally invasive major digestive surgery can be safely performed in patients receiving ACT, attention should be paid for the occurrence of delayed gastrointestinal bleeding especially in the DOAC-received patients. Patients treated with DOAC or perioperative heparinization still represent a challenging group in the present cohort, and need to be carefully managed.

OP-17-03

Incidence and pattern of colorectal cancer in Sri Lanka from 2001-2019

Umesh Jayarajah, Jesuthasan Mithushan and Sanjeewa Seneviratne

Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

Oral Presentation 17, APDW Theatre 2, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: The incidence of colorectal cancer (CRC) has been increasing in Asian countries. Describing the trends in the incidence of CRC is necessary to plan cancer care. This study aims to analyse trends in CRC incidence in Sri Lanka.

Materials and methods: The trends in the incidence of CRC were calculated using the published data from the Sri Lanka Cancer Registry for the period from 2001-2019. The trends in the WHO age-standardised incidence rates were presented using the Joinpoint regression analysis.

Results: A total of 26,316 CRC were diagnosed over the 19-year study period, with an equal gender distribution. The mean age of males and females was 60.7 and 59.6 years, respectively (overall mean age:60.2 years). The incidence of CRC was highest in the 70–74 age group overall (45.4 per 100,000 population). The WHO age-standardised incidence of CRC was observed from 2.9 to 11.9 per 100,000 in 2001–2017 (p<0.05 for trend), followed by a decreasing trend to 11.2 per 100,000 in 2019 with an estimated annual percentage change (EAPC) of 9.1 for the rising trend.

Conclusion: Similar to neighbouring Asian countries, a significant increase in the CRC incidence was observed in Sri Lanka. A rising incidence of CRC is likely due to the combination of better reporting and a true increase in incidence. Future studies focusing on trends in tumour stage and mortality will help to identify the cause for the rising incidence. Given the rising trend, community-based screening policies for CRC should be considered.

OP-17-05

Surgical techniques to prevent empty pelvis syndrome following pelvic exenteration: narrative review on current evidence

Chamila Lakmal Munsinghe Arachchige¹, Bawantha Gamage² and Deepaka Weerasekara²

¹Colombo South Teaching Hospital, Colombo, Sri Lanka; ²Faculty of Medicine, University of Sri Jayawardenepura, Colombo, Sri Lanka

Oral Presentation 17, APDW Theatre 2, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Empty pelvic syndrome (EPS) is a complication following pelvic exenteration, causing significant morbidity with a prevalence of up to 40%. This review explores current literature on preventive techniques.

A systemic search was performed in Medline and Embase using ‘Empty pelvic syndrome and preventive strategies or surgical techniques’ as key words

Of 31 studies 20 were included. 8 methods were identified including four native tissue use; [omentoplasty, muco-cutaneous flaps(MCF), using bladder peritoneum to cover the pelvis, basement membrane biological products (BMBP)] and 4 Prosthetic materials;[obstetric (Bakri) balloon, breast prosthesis, artificial mesh, multiple folly catheters]. Ventral rectus-abdominis (VRM) flaps were the commonest of flaps, but were reported with higher local complication rates (15-30%). The largest series focused on Bakri balloon (76 patients) had shown a 9.6% reduction in EPS (13.3% total) after 3 months of follow up, though statistically insignificant. Though breast prosthesis (53 patients) reported 37% complications none had bowel obstruction or Entero-cutaneous fistula(ECF). Bio-degradable mesh reconstruction (36 patients) reported 36% complications, predominantly pelvic collections, while 2 developed ECF, no perineal hernia or wound complications reported after median follow up of 9 months. No randomized controlled trials (RCTs) or large series were found. Limited data were available for BMBP, bladder peritoneum, and Foley catheter use, with no follow-ups.

Bakri balloons, breast prostheses, and mesh reconstruction were common approaches with some improvement of EPS, but all lack robust data. There was no satisfactory data to decide on best methods. Further studies are needed to identify the optimal preventive strategy with long-term outcomes.

OP-17-07

Determining factors associated with lymph node yield in colorectal cancer

Pasindu Nanayakkara¹, Gayana Mahendra² and Janaki Hewavisenthi²

¹Postgraduate Institute of Medicine, University Of Colombo, Sri Lanka; ²Department of Pathology, Faculty of Medicine, University of Kelaniya, Sri Lanka

Oral Presentation 17, APDW Theatre 2, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: This study aims to analyze the association between Lymph node yield (LNY) and factors related to tumour and patient characteristics in a cohort of Sri Lankan patients.

Materials and Methods: 165 reports from the Department of Pathology, Faculty of Medicine, University of Kelaniya were analyzed. The associations between LNY, (treated as a continuous variable) and age, bowel length, and tumor size (all treated as continuous variables) along with sex, differentiation, lymphovascular invasion (LVI), T-classification (treated as categorical variables with two categories), and N-classification, and tumour location (treated as categorical variables with more than two categories) were examined. The Spearman's correlation, Mann-Whitney test, and Kruskal-Wallis test were used as appropriate.

Results: 98/165 (59.4%) were females. The median age was 64 years (IQR: 53-71). 87/165 (52.72%) and 52/165 (31.51%) were left and right colon tumours respectively. The mean LNY was 21(median 19) (right colon-24 and left colon–19). The results of the Spearman's rank correlation are as follows; age (p=0.0166,

Spearman’s rho(r) = -0.1862), bowel length (p=5.265e-07, r =0.3787), and tumor size (p=0.0160, r =0.1872). The results of the Mann-Whitney U test are as follows; sex (p=0.8590), differentiation (p=0.6613), LVI (p=0.5609), T-classification (p=0.0976). The results of the Kruskal-Wallis test are as follows; N-classification (p=0.9252), tumour location (p=0.0365)

Conclusion: There was a significant association between LNY and younger age, longer bowel length, right-sided location, larger tumor size. However, Sex, tumour differentiation, T-Stage and N-stage did not show a significant association. Consider these factors alongside international guidelines for minimum lymph node retrieval in CRC.

OP-17-08

Growth and Complications in Children receiving Home Parenteral Nutrition: Korean Pediatric Intestinal Failure Network

Sun Woo Park¹, Yeji Kim¹, Jeong Eun Ahn^1,2, Lia Kim^1,2, Homin Huh^1,2, Kyung Jae Lee^1,2, Jin Soo Moon^1,2, Dayoung Ko³, Hyun-Young Kim^3,4, Eun Joo Lee⁵, Kyeng Hee Kwon⁶, Jong Woo Hahn⁷, Hye Ran Yang⁷, Yu Bin Kim⁸, Seo-Hee Kim⁹, Jeana Hong¹⁰, Yeoun Joo Lee¹¹, So-Hyun Nam¹², Ki Soo Kang¹³ and Jae Sung Ko^1,2

¹Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, South Korea; ²Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea; ³Department of Pediatric Surgery, Seoul National University Children’s Hospital, Seoul, South Korea; ⁴Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea; ⁵Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea; ⁶Department of Pharmacy, Graduate school of Dongguk University, Gyeonggi–do, South Korea; ⁷Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea; ⁸Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea; ⁹Department of Pediatrics, Chonnam National University Children's Hospital, Gwangju, South Korea; ¹⁰Department of Pediatrics, Kangwon National University College of Medicine, Chuncheon, South Korea; ¹¹Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of Medicine, Yangsan, South Korea; ¹²Division of Pediatric Surgery, Department of Surgery, Department of Surgery, Inje University Busan Paik Hospital, Busan, South Korea; ¹³Department of Pediatrics, Jeju National University Hospital, Jeju, South Korea

Oral Presentation 17, APDW Theatre 2, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Parenteral nutrition (PN) is essential for children with intestinal failure, offering life-saving support. This study aimed to investigate the clinical characteristics of children with intestinal failure receiving home parenteral nutrition (HPN).

Materials and Methods: From April 2023 to June 2024, nation-wide multicenter cohort study was conducted in 16 tertiary hospitals in Korea. We enrolled patients started HPN under 21 years of age. Clinical characteristics such as underlying etiology, age, anthropometry, laboratory data, history of catheter related blood stream infection (CRBSI) and intestinal failure associated liver disease (IFALD) at the enrollment and 6 months of follow up were analyzed.

Results: Fifty-one patients were enrolled in this study; mean age was 10.6 years and 23 were males. Mean level of height and weight Z- score were -2.4 and -2.4. Etiologies of intestinal failure were chronic intestinal pseudo-obstruction (n=26), short bowel syndrome (n=20), congenital diarrhea and enteropathy (n=4), and others. Mean age of starting PN and HPN were 3.5 years (birth - 18.6 years) and 5.3 years (6 months - 20 years). At the enrollment, complication rates were follows: CRBSI (74.5%), IFALD (45.1%) and central venous catheter thrombosis (21.6%). Mean levels of hemoglobin and alanine aminotransferase were 11.3 g/dL and 43.3 IU/L. During 6 months follow up, 7 of 46 patients were newly diagnosed as CLABSI and IFALD.

Conclusions: This is the first nationwide study of pediatric intestinal failure in Korea. Chronic intestinal pseudo-obstruction was the most common cause of pediatric intestinal failure and growth failure, CRBSI were common.

OP-17-09

Initial experience with Magnetic Sphincter Augmentation in an Asian population – a pilot study

Ching Tang, Ian Yu-Hong Wong and Simon Ying-Kit Law

Queen Mary Hospital, The University Of Hong Kong, Hong Kong, Hong Kong

Oral Presentation 17, APDW Theatre 2, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Magnetic sphincter augmentation(MSA) is an established alternative to fundoplication for treatment of gastroesophageal reflux disease(GERD). This is the first study to review the safety and effectiveness of MSA in an Asian population.

Materials and Methods: Patients with conclusive GERD and a normal esophageal body motility who received MSA between 2019-2024 were prospectively included. Outcomes were compared to a cohort of patients who underwent fundoplication. Pre- and postoperative questionnaires evaluated patient-reported outcomes in the MSA group.

Results: 16 patients who underwent MSA were analysed. 37.5% had Los Angeles B or above esophagitis, 75% had hiatus hernia, and median acid exposure time was 9.7%. Compared to a cohort of 70 patients who underwent fundoplication, the MSA group had a higher preoperative BMI(26.5 vs 24.9, p=0.041), but a shorter hospital stays(1 vs 3days, p<0.001). Technical success was achieved in all patients in the MSA group. One patient had recurrence of hiatus hernia in the MSA group. At 6 months, dysphagia rate was 43.8% in the MSA group, and 3 patients required dilatation. More patients in the MSA group were able to stop or reduce PPI use(93.8% vs 72.8%, p=0.250), and postoperative basal and residual LES pressure were significantly higher (22.3 vs 17.2mmHg, p=0.037; 13.2 vs 7.9mmHg, p=0.041). Patient-reported satisfactory symptom control improved significantly from 12.5% preoperatively to 81.3% at 6months postoperatively in the MSA group.

Conclusion: MSA demonstrated safety and efficacy comparable to fundoplication in the treatment of GERD in an Asian population, with shorter hospital stays and higher PPI cessation rates.

OP-17-10

Standardized techniques for robotic posterior segmentectomy for liver lesions

Yusuke Uemoto and Takahisa Fujikawa

Kokura Memorial Hospital, Kitakyushu, Japan

Oral Presentation 17, APDW Theatre 2, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Robotic liver resection (RLR) is becoming accepted as a minimally invasive liver resection. Posterior segmentectomy (PS) is a challenging procedure, and there are few reports of standardized techniques in RLR. We report on the standardized RLR-PS procedure at our institution.

Materials and Methods: RLR was performed using da Vinci Xi surgical system. The patients were in left semilateral jack-knife position. After mobilized the right lobe, the intrahepatic Glissonean approach was performed to expose the Glissonean pedicle of posterior segment (P-seg). It was ligated and indocyanine green was administered intravenously. P-seg was visualized under the Firefly imaging system by the negative staining method. Along the demarcation line, the liver surface was incised. The saline-linked cautery scissors method was used to transect the liver parenchyma at the border between the color-coated and non-color-coated areas. A precise removal of the ischemic P-seg was accomplished.

Results: Between September 2021 and March 2024, RLR-PS has been performed on seven patients, including 4 hepatocellular carcinomas, 2 colorectal liver metastasis, and 1 intrahepatic cholangiocarcinoma. The median operative time was 552 minutes (356-680), blood loss was 21mL (5-400). There were no cases of conversion, and none required perioperative blood transfusion. Only one case of posthepatectomy liver failure grade A was observed, but there were no complications of Clavien-Dindo classification grade 3 or higher. The length of stay was 8 days (7-9). The postoperative outcomes were similar to laparoscopic liver resection-PS at our institution (Table).

Conclusion: It was suggested our standardized RLR-PS was a safe and feasible surgery.

OP-17-12

Epacadostat overcomes cetuximab resistance in colorectal cancer by targeting IDO-mediated tryptophan metabolism

Yimin Zhou¹, Qiongyan Tao¹, Genwen Chen² and Jianyong Sun¹

¹Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China; ²Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China

Oral Presentation 17, APDW Theatre 2, Exhibition Hall, November 23, 2024, 8:30 AM - 9:50 AM

Mutations in RAS/RAF genes resulting in cetuximab resistance have limited its clinical application in colorectal cancer (CRC) patients. The mechanism of this resistance remains unclear.

RNA sequencing on CRC patients with or without cetuximab resistance. The levels of IDO1 and IDO2 were determined by qPCR, Western Blot and IHC. H&E staining was used to detect pathological sections of tumor tissues. The levels of tryptophan and kynurenine were detected by ELISA. KEGG pathway analysis was employed in cetuximab-resistant CRC tissues. Luciferase reporter assays were used to detect transcriptional activity. siRNA was designed to knock down the corresponding target. The effect of tryptophan metabolites and the IDO inhibitor in the TME was measured by flow cytometry.

RNA sequencing revealed activation of tryptophan pathway and elevation of IDO1 and IDO2 in cetuximab-resistant CRC patients. In vitro, in vivo, and clinical specimens confirmed the upregulation of IDO1, IDO2 and the Kyn/Trp ratio. Furthermore, the combination of cetuximab and epacadostat showed a stronger antitumor effect in vitro and in vivo. KEGG pathway analysis revealed the activation of the IFN-γ pathway. Luciferase reporter assays confirmed the transcriptional activity of IDO1 following cetuximab treatment. Silencing IFN-γ suppressed the upregulation induced by cetuximab. Moreover, we observed that the combination reduced the concentration of the tryptophan metabolite kynurenine, promoted the infiltration of CD8+ T lymphocytes, and enhanced the M1 macrophages polarization within the tumor microenvironment.

Our results supported that epacadostat could sensitize cetuximab-resistant CRC to cetuximab, resulting in remarkable therapeutic efficacy which was realted to tryptophan metabolism and TME.

OP-18-01

Explainable deep learning artificial intelligence for classifying and interpreting ulcerative colitis severity in colonoscopy images

Femmy Nurul Akbar^1,2, Mellisa Irawan³, Nayottama Putra Suherman³, Pramudita Satria Palar³, Nur Rahadiani², Murdani Abdullah² and Ari Fahrial Syam²

¹Faculty of Medicine Universitas Islam Negeri Syarif Hidayatullah Jakarta, Tangerang, Selatan, Indonesia; ²Faculty of Medicine University of Indonesia, Jakarta, Indonesia; ³Faculty of Mechanical and Aerospace Engineering Institut Teknologi Bandung, Bandung, Jakarta

Oral Presentation 18, Uluwatu 1, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Colonoscopy is essential for diagnosing inflammatory bowel diseases (IBD), such as ulcerative colitis (UC). However, diagnosis can be challenging due to variability experience and competency among endoscopists, also the subjective nature of assessments. Recent advancements in deep learning (DL) have shown promise in automating the analysis of colonoscopy images, potentially providing more objective assessments. This study aims to develop a DL model for classifying UC severity from colonoscopy images and to improve visual interpretation through explainability deep learning (XDL).

Materials and Methods: This study used the HyperKvasir dataset, the largest multi-class images collection, which includes 840 UC images, categorized by Mayo Endoscopic Scores (MES) into inactive/mild and moderate/severe classes. A convolutional neural network (CNN) with DenseNet121 architecture was deployed for classification. Grad-CAM and SmoothGrad explainability DL was utilized to improve the interpretability of the DL model.

Results: The DenseNet121 model classified mild to severe UC by achieving an F1 score of 0.9156, an accuracy of 88.2%, and a sensitivity of 93.4%. GradCAM and SmoothGrad performed well in some images in severe UC, that was characterized by excessive blood and ulcers. Meanwhile, mild UC still lacked distinctive features, making interpretation more challenging. However, GradCAM correctly highlights the region with blood, while SmoothGrad identifying the erythema regions.

Conclusion: The DenseNet121 model effectively classified UC severity, and the use of explainability DL methods like Grad-CAM and SmoothGrad can improve the interpretation and characterization of the colonoscopy images. Hence, these results enhanced the ability of endoscopists in distinguishing between mild and severe UC.

OP-18-02

Evaluation of Serum Leucine-Rich α2-Glycoprotein Levels in Racial Differences

Yasuhiro Aoki^1,2, Yohei Mikami¹ and Takanori Kanai¹

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; ²Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

Oral Presentation 18, Uluwatu 1, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Serum leucine-rich α2-glycoprotein (LRG) serves as a biomarker for assessing disease activity in inflammatory bowel disease (IBD). The objective of this study was to identify factors associated with LRG and assess the applicability of LRG in monitoring disease activity among non-Japanese individuals.

Materials and Methods: A retrospective study was conducted on all IBD patients with serum LRG levels measured at our hospital from July 2020 to November 2023. We analyzed the correlation between LRG and various parameters and evaluated LRG, clinical activity, and endoscopic severity in non-Japanese patients.

Results: A total of 12,006 serum LRG measurements were analyzed in 1,791 ulcerative colitis patients, 747 Crohn’s disease patients, and 22 other patients. Among them, 2,500 were Japanese, 26 were Asian, and 32 were non-Asian patients. The analysis of LRG and various blood tests across all races revealed LRG correlated relatively strongly with CRP (r=0.65) and Alb (r=-0.56). There is no significant correlation between LRG levels and the results of liver function, renal function tests, or age. In non-Japanese patients, LRG was significantly lower in the group achieving endoscopic and clinical remission compared to the non-remission group. The area under the curve for LRG in predicting clinical and endoscopic remission in non-Japanese patients was 0.690 (95% CI=0.586-0.779) and 0.737 (95% CI=0.594-0.843), respectively, higher than that of CRP and Alb.

Conclusion: LRG shows a correlation with CRP and Alb. It may serve as a valuable biomarker across racial differences.

OP-18-03

Ultrasonographic assessment of response in hospitalized patients with acute severe ulcerative colitis

Umang Arora, Devasenathipathy Kandasamy, Mahak Verma, Divya Madan, Mukesh Singh, Himanshu Narang, Manjeet Goyal, Malambo Mubunnu, Rajesh Panwar, Nihar Ranjan Dash, Ankur Goyal, Raju Sharma, Vineet Ahuja and Saurabh Kedia

All India Institute of Medical Sciences, New Delhi, India

Oral Presentation 18, Uluwatu 1, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Patients admitted with acute severe ulcerative colitis (ASUC) respond well in two-third cases but monitoring and early detection of non-response is of prime importance to avoid colectomy or mortality. This study evaluates the utility of ultrasonography (USG) in prognostication and decision-making for ASUC patients undergoing standardized treatment protocols. USG offers a non-invasive approach to assess bowel wall thickening and vascularity, pivotal indicators of disease activity.

Materials and Methods: This prospective study enrolled 45 ASUC patients undergoing intravenous steroid therapy, with additional randomization to receive tofacitinib or placebo. USG examinations were conducted at baseline and after 5 days, evaluating bowel wall thickness and vascularity using established criteria. Clinical responses were assessed using the Lichtiger index, with subsequent management guided by response status.

Results: Most patients (>80%) exhibited baseline bowel wall thickening, predominantly in the sigmoid and descending colon. Significant reduction in wall thickness was observed in responders (p<0.05), whereas non-responders showed persistent thickening or worsening. There was correlation between thickening in different segments of the bowel, but no correlation of bowel wall thickening with levels of CRP and albumin, or endoscopic severity. Doppler assessments revealed comparable vascularity between responders and non-responders at baseline and follow-up. Ancillary findings such as pericolic fat thickening and free fluid correlated with clinical outcomes, highlighting their potential prognostic relevance.

Conclusion: Serial USG monitoring provides actionable insights into disease activity and response to therapy in ASUC. Future research should focus on integrating USG with existing predictive models to refine treatment algorithms in this patient population.

OP-18-04

Succinate aggravates OVA-induced intestinal inflammation probably via succinate receptor 1 in the cecum.

Ms Kana Ayaki¹, Yoshikiyo Okada¹, Atsushi Torihata², Tomoaki Horiuchi¹, Kazuki Horiuchi³, Yuta Yoshidome¹, Hiroyuki Tahara¹, Akira Tomioka¹, Hiroyuki Nishimura¹, Kazuyuki Narimatsu⁴, Masaaki Higashiyama¹, Shunsuke Komoto⁴, Kengo Tomita¹ and Ryota Hokari¹

¹National Defense Medical College, Tokorozawa, Japan; ²Aeromedical Laboratory, Iruma, Japan; ³JSDF Iruma Hospital, Iruma, Japan; ⁴National Defense Medical College Hospital, Tokorozawa, Japan

Oral Presentation 18, Uluwatu 1, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Succinate has recently been reported to play an important role in many types of inflammation in various organs via succinate receptors. To clarify the role of succinate in intestinal inflammation, we analyzed the data obtained from OVA-induced diarrhea mouse models.

Material and Method: Mice received an intra-peritoneal injection of OVA with alum twice two weeks apart. The mice then underwent challenge tests with 10 mg OVA in PBS by gavage. One hour before every challenge test, the mice received 2.5% disodium succinate by gavage. Tissue samples and feces were collected from the intestines. The mRNA levels of cytokines and mast cell proteases (Mcpt-1 and Mcpt-4) were determined by QT-PCR. The number of mast cells was measured using toluidine blue staining. Short chain fatty acids from the blood and cecum contents were analyzed by liquid chromatography-mass spectrometry (LC/MS).

Results: Administration of succinate to OVA treatment significantly increased both the severity and occurrence of diarrhea. Pathological studies revealed an increased number of mast cells in the cecum in the OVA-treated groups. The mRNA expression levels of IL-4, IL-13, Mcpt-1, and Mcpt-4 were significantly increased in the cecum of the OVA models, but the mRNA expression of TNF-α or IL-17A did not change. Succinate administration increased the concentrations of succinate, acetate, and propionate in the cecum.

Conclusion: The administration of succinate in OVA-induced diarrheal mouse models may augment intestinal inflammation by increasing the mRNA expression levels of type2 immune cytokines and mast cell proteases (Mcpt-1 and Mcpt-4).

OP-18-05

Real-World Outcomes of First-Line Biologics in Fistulizing vs. Non-Fistulizing Crohn's Disease: An Indian Patient Cohort

Dhanush Mekala, Nalini Raghunathan, Rajendra Patel, Pardhu Bharath Neelam, Sadhana Valluri, Vaishnavi Kaza and Rupa Banerjee

AIG Hospitals, Hyderabad, India

Oral Presentation 18, Uluwatu 1, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: Biologics have revolutionized treatment options for IBD. However, practice patterns in a real-world scenario from resource-limited countries is limited. In regions where affordability and accessibility are significant issues, the optimal use of biologics requires careful evaluation to ensure effective and cost-efficient care.

Methods: Prospectively collected data of consecutive Crohn`s Disease patients treated with first line biologics from a large tertiary care centre was analysed. Demographic,clinical characteristics, disease behaviour, location was recorded. Biologics included Infliximab(IFX), Adalimumab (ADA), Vedolizumab(VDZ), and Ustekinumab(UST).Response status was evaluated using SES-CD score. Logistic Regression was performed on Jamovi(V2.3.28)

Results: 436 patients (60%male,23.3%fistulizing,76.7%non-fistulizing) were analysed. There was significant difference in response rates for patients with fistulas, 65/102 (63.73%) compared to non-fistulizing 281/334 (84.13%) with OR2.9(95%CI 1.5-5.0). IFX was the first line biologic for 73 fistulizing CD patients, of which 52 (71.2%) responded; while 183/211 (86.7%) non-fistulizing CD had responded. ADA was the first line biologic for 35 fistulizing CD patients, of which 10(40%) responded; and 45/64 (70.3%) responders in non-fistulizing CD. No fistulizing CD patients were administered VDZ. For non-fistulizing, VDZ 44/50(88%) responded. UST was given to 3 fistulizing and 9 non-fistulizing of which response rates were 66 and 90% responded respectively. Univariate analysis among anti-TNF patients, had shown response was significantly associated with younger patients compared to elderly and with steroid dependency(Table1).

Conclusion: Fistulizing CD seem to be more severe with significantly lower response rates to first line biologic therapy compared to non-fistulizing phenotype. Overall Infliximab continues to be more effective in fistulizing CD compared to Adalimumab.

OP-18-06

Dietary antioxidant capacity, genetic susceptibility and polymorphism, and risk of Crohn’s disease and ulcerative colitis

Jie Chen¹, Lintao Dan^1,2, Shuai Yuan³, Tian Fu¹, Jiangwei Sun³, Wolk Alicja³, Ludvigsson Jonas^3,4,5, Xue Li², Xiaoyan Wang¹ and Larsson Susanna³

¹The Third Xiangya Hospital of Central South University, Changsha, China; ²School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; ³Karolinska Institutet, Stockholm, Sweden; ⁴Örebro University Hospital, Örebro, Sweden; ⁵Columbia University Medical Center, New York, USA

Oral Presentation 18, Uluwatu 1, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: To investigate the association between dietary total antioxidant capacity (TAC) and incident inflammatory bowel disease (IBD), and the joint effect of genetic susceptibility and polymorphism in the risk of IBD.

Materials and Methods: We conducted a prospective cohort study including 186,195 IBD-free participants from the UK Biobank. We calculated dietary TAC using the oxygen radical absorbance capacity method based on repeated online 24-hour dietary recalls. Crohn’s disease (CD) and ulcerative colitis (UC) were identified via National Institutes of Health in the UK. Genetic susceptibility for IBD was assessed by a polygenic risk score. Cox proportional hazard models were applied to estimate multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).

Results: During a median follow-up of 11.6 years, we identified 396 CD and 809 UC incident cases. Individuals with the highest quintile of dietary TAC had a lower risk of CD (aHR 0.66, 95% CI 0.49-0.90) but not UC (aHR 0.85, 95% CI 0.69-1.06) compared with the lowest group. We observed interactions between TAC and genetic susceptibility at both multiplicative (P-interaction=0.007/0.063 for CD/UC) and additive (both synergy index>1) scales. Additionally, a polymorphism of the endogenous antioxidant enzyme gene SOD2 (rs4880) modified the dietary TAC-UC association (P-interaction=0.039).

Conclusion: This study suggests that diet with high TAC may prevent the development of IBD, particularly in individuals at higher genetic risk and mutation carriers of rs4880 in SOD2. Our findings highlight the importance of diet-genetic interaction in the precise prevention strategies of IBD.

OP-18-07

Oral highly-virulent pathogenic isolates aggravated colitis through oral-gut axis

Jingyi Chen, Congyi Yang, Yalan Xu, Yuzhen Zhao, Jushan Wu, Yulan Liu and Ning Chen

Peking University People's Hospital, Beijing, China

Oral Presentation 18, Uluwatu 1, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: We isolated potential oral pathogens from IBD patients saliva and analyzed their virulence differences, hoping to elucidate the mechanism of different disease patterns in IBD patients.

Materials and Methods: We isolate Streptococcus mutans (S.m) strains from the saliva of ulcerative colitis (UC) patients and explore the pathogenicity of S.m isolates through a series of experiments and sequencing technology.

Results: After over 1 year follow-up, we found that patients with poor disease state had higher proportion of S.m in saliva (58.6% vs 34.6%). 31 S.m strains were isolated from UC patients and 9 strains with greater pro-inflammatory effects and barrier disruption ability were obtained based on Caco-2 cells experiments. Subsequent animal experiments suggested that pro-inflammatory strains exacerbated intestinal inflammation, disrupted intestinal barrier, increased innate and adaptive immune cells, while non-pro-inflammatory strains didn’t induce above effects. The pro-inflammatory effect of S.m isolates on DSS mice disappeared after depleting gut microbiome by antibiotics. 16S rRNA sequencing suggest that S.m significantly affect gut microbiome composition. Additionally, there were 73 differential metabolites between the pro- and non-pro-inflammatory groups, which was associated with inflammatory pathways. Comparing genomic sequences of pro- and non-pro-inflammatory strains, we identified differentially expressed virulence genes RtxB. The expression of RtxB in intestinal mucosa of UC patients (especially UC patients with poor disease state) was higher than healthy controls.

Conclusion: This study found for the first time that the pro-inflammatory effects of S.m isolates are different, which may be related to the expression difference of virulence gene RtxB.

OP-18-08

Efficacy and safety of potassium competitive acid blocker for helicobacter pylori infection: A network meta-analysis

Adam Prabata¹, Diski Saisa², Raihan Fikri Ali Akbar², Nabiel Muhammad Haykal^2,3 and Omar Mukhtar Syarif^2,3

¹Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; ²Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; ³Faculty of Medical Science, Newcastle University, United Kingdom

Oral Presentation 18, Uluwatu 1, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: To compare the efficacy and safety of potassium competitive acid blockers (PCAB) to proton pump inhibitors (PPI) therapy in treating Helicobacter pylori infection.

Materials and Methods: A systematic literature search on randomized-controlled trial (RCT) conducted using PubMed, Cochrane Library, and EMBASE databases using the keywords "PCAB", “Potassium-Competitive Active Blocker”, “peptic ulcer” and "Helicobacter pylori". The risk of bias was assessed with Cochrane Risk of Bias 2 (RoB 2). Outcomes were eradication of H.pylori based on intention-to-treat (ITT), abdominal pain, diarrhea, nausea, and anorexia.

Results: Twenty eight RCTs including 8422 participants were analyzed. Compared to 14 days of PPI-based quadruple therapy, a 14-day 40 mg/day Vonoprazan-based triple regimen (14d-VPZ40 Triple) was the best in H. pylori eradication (Risk Ratio [RR] 1.11; 95% CI 1.03–1.20). However, for adverse events, including diarrhea, abdominal pain, and nausea, there were no significant effects in PCAB-based therapy in comparison to PPI-based therapy.

Conclusion: Vonoprazan-based regimens are more effective than PPI-based regimens in eradicating H. pylori. With the highest eradication rates, the 14d-VPZ40 Triple regimen might be the best option for eliminating H. pylori. Nevertheless, conclusions on the drug safety cannot be determined due to non-significant effects based on the analysis.

OP-18-09

Parental Helicobacter pylori Knowledge and Health Literacy are Associated with Positive Attitudes Towards Child's Screening

Hiroaki Saito^1,2, Chihiro Matumoto¹, Taiga Uchiyama¹, Yoshika Saito³, Yoshitaka Nishikawa^4,5, Masaharu Tsubokura¹ and Yasuhiro Mizuno⁶

¹Fukushima Medical University School of Medicine, Fukushima, Japan; ²Department of Internal Medicine, Soma Central Hospital, Soma, Japan; ³Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan; ⁴Health Informatics, Kyoto University, Kyoto, Japan; ⁵Hirata Central Hospital, Japan; ⁶Ma-ru Clinic Yokosuka, Yokosuka, Japan

Oral Presentation 18, Uluwatu 1, November 23, 2024, 8:30 AM - 9:50 AM

Objectives: In several regions with a high incidence of gastric cancer, including Japan, population-level screening for Helicobacter pylori (Hp) is offered not only to adults but also to adolescents. This study identifies factors associated with parents' opinions about Hp screening for their children.

Materials and Methods: This cross-sectional study surveyed Japanese parents about their knowledge of Hp and health literacy, examining the association with their opinions on their children's participation in Hp screening. Parents were recruited through an online survey platform and asked about their knowledge of Hp, including infection risks, related diseases, testing, and benefits and side effects of Hp eradication. Health literacy was assessed using the 14-item health literacy scale. Logistic regression analysis, adjusted for age, gender, and socioeconomic factors, was used to analyze the association between these scores and positive opinions about Hp screening for their children.

Results: Of 602 participants, 207 (34.4%) reported having been tested for Hp themselves. The mean correct response rate for Hp knowledge was 48.9% (SD: 17.8%). 77 (12.8%) indicated that there was Hp screening program for children in their area. 422 (70.1%) were positive about having their children tested for Hp. Knowledge of Hp (aOR 1.10, 95% CI: 1.07-1.14) and health literacy (aOR 1.08, 95% CI: 1.05-1.11) scores were significantly associated with positive responses to Hp testing for children.

Conclusion: Many parents were positive about Hp screening for their children, associated with their knowledge of Hp and health literacy. Promoting Hp understanding among parents is important for widespread screening.

OP-18-10

Association of H. pylori Genotype and the Clinical Outcomes among Adult Patients who underwent Esophagogastroduodenoscopy

Jan Axel Yusi and Edgardo Bondoc

St. Luke's Medical Center Quezon City, Quezon City, Philippines

Oral Presentation 18, Uluwatu 1, November 23, 2024, 8:30 AM - 9:50 AM

This study aims to determine the different H. pylori genotypes present among infected individuals and its relationship with the different outcomes such as histologic changes, treatment response, and antibiotic sensitivity.

Methods: This is an analytical cross sectional study that included subjects who had undergone gastroscopy from the year 2017 to 2019 and whose data are recorded in a registry. Aside from gastroscopy, these subjects had undergone histopathology, genotype identification, antibiotic sensitivity testing and test for H. pylori eradication.

Results: A total of 110 subjects were included in this study. 43% were cagA positive. Fifty-two percent(n=48/92) were vacA positive with s1a/m2 as the major subunit present(31%). Forty-one percent of the subjects have moderate inflammation and 23% have intestinal metaplasia. Fifty-three subjects have data on treatment response with 87% cure rate. Of the 54 patients with data on antibiotic sensitivity, 48%, 57%, 4%, and 22% have resistance to Metronidazole, Levofloxacin, Tetracycline, and Clarithromycin, respectively. No resistance to Amoxicillin was observed. Positive cagA was associated with intestinal metaplasia and moderate inflammation(p=0.001). Positive vacA was also associated with moderate inflammation(p=0.001). An association is seen with both gene negative and mild inflammation, vacA alone and moderate inflammation, and to cagA plus vacA combination and intestinal metaplasia(p=0.008). No association was seen between different genotypes, and treatment response and antibiotic sensitivity.

Conclusion: Either cagA or vacA gene positivity can lead to a more active and more severe inflammation compared when both are absent. Both cagA and vacA positivity is also associated with the development of intestinal metaplasia.

OP-19-01

Post Corrosive Esophageal Strictures: 2 Years Experience of Endoscopic dilatation

Than Than Aye, Than Than Aye, Tin Moe Wai and Lin Htet Oo

Yangon General Hospital, Yangon, Myanmar

Oral Presentation 19, APDW Theatre 1, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: To assess the responsiveness of dilatation of post-corrosive esophageal stricture.

Materials and Methods: This is the prospective analytic study of outcome of patients with post-corrosive esophageal stricture at the GI department of Yangon General Hospital from January 2022 to December 2023.

Results: A total of 20 patients with ages ranged between 19 to 67 years, male (55%) and females (45%) were included in this study. The cause of caustic material (mainly alkali for toilet cleaning) ingestion was mainly accidental ( 65%) and suicidal was 35%. As regard to the location of the stricture, 7 patients (35%) showed upper-third stricture, 6 (30%) were mid-third, 2 (10%) were lower-third and 5 (25%) had multiple strictures and 45% of patients were simple and whereas 55% had complex stricture. Pylorus involvement causing gastric outlet obstruction was observed in five patients. Dilatation was scheduled every two weeks. Target dilatation diameter of 14 to 16 mm was achieved in 12 patients (60%) after mean dilatation sessions of 10.4 times. However, more than 50% were refactory to dilatation after 6 months requiring regular dilatation over 2 years. Four patients got triamcinolone injection because of refractory stricture. Only 4 patients (20%) developed complications, deep mucosal tear (1), major bleeding (1) and two were complicated with perforation. All complications were successfully managed endoscopically.

Conclusions: Endoscopic treatment of post-corrosive esophageal stricture has a good short term result and low rate of complications. However, some patients still require regular dilatation despite achieving maximum diameter.

OP-19-02

Clinical usefulness of small-bowel capsule endoscopy with panoramic imaging

Ryoichi Harada, Mamoru Ito, Daisuke Kawai, Keita Harada, Syuuhei Isiyama, Akiko Fujiwara, Junichirou Nasu, Masao Yoshioka and Shiode Jyunzi

Dept of Gastroenterology, Okayama Saiseikai General Hospital, Okayama, Japan

Oral Presentation 19, APDW Theatre 1, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Background: The conventional small bowel capsule endoscopy (SBCE) required wearing a portable receiver, which imposed limitations on daily life. CapsoCam Plus®(CapsoCam) with panoramic imaging, uses an onboard storage system that eliminates the need for external receiver equipment, also eliminating the risks associated with radio frequency signals.

Aims & Methods: We aimed to evaluate the usefulness of CapsoCam in Japanese patients by clarifying the utility and issues of CapsoCam who underwent CapsoCam endoscopy at Okayama Saiseikai General Hospital(September 2022~July 2024). The extracted data include: basic demographics, indication, medical history based on Omiya index: 1, preoperative drug, gastric transit time, small bowel transit time, duodenal papilla detection rate,capsule finding based on Saulin P classification. 2, adverse events, capsule recovery rates.

Results: This study included 19 patients, 9(47.3%) were male. Median age was 69.0 (range: 17–91) years. Most common indication was gastrointestinal bleeding (63.1%). Two patients(10.5%) had cardiac pace maker. The entire small intestine was observed in 17 (89.4%). One patients’ capsule remained in the stomach during the whole recording time, one the other patient’s capsule remained in the esophagus. Median small bowel transit times were 314.4 minutes. The duodenal papilla detection rate was 73.7%.4 patients had a history of SB3 use. One patient (5.3%) used SB3 6 months after using CapsoCam.No patient missed capsule retrieval. All patients preferred CansoCam over SB3. No adverse events occurred.

OP-19-03

Assessing the clinical effectiveness and safety of peroral endoscopic myotomy for esophageal achalasia

Nam Nguyen Thanh and Long Nguyen Cong

Bach Mai Hospital, Hanoi, Vietnam

Oral Presentation 19, APDW Theatre 1, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Background: Our aim is to elucidate the technical considerations, effectiveness, and safety of peroral endoscopic myotomy (POEM) in Vietnam, as this novel minimally invasive treatment for esophageal achalasia gains increasing popularity worldwide due to its proven efficacy and safety.

Methods: A study was undertaken involving consecutive achalasia patients who underwent peroral endoscopic myotomy (POEM) from July 2021 to June 2023 at Bach Mai Hospital. Prior to POEM, all patients underwent a thorough assessment, including symptom questionnaires, esophagogastroduodenoscopy, timed barium esophagogram (TBE), and high-resolution manometry (HRM). Follow-up assessments were performed three months, six months, and twelve months after POEM. The study compared procedural variables, adverse events, and clinical outcomes, specifically focusing on achieving an Eckardt score ≤3 and assessing TBE and HRM findings and GERD after POEM.

Results: A total of 30 patients were analyzed (17 men; mean age 47.7 years [range: 21-78]; type I/II/III: 9/19/2). The mean duration of the POEM procedure was 82.5 ± 39.5 minutes, with a significantly longer duration observed in patients with prior Heller surgery or sigmoid-type achalasia. The overall clinical success rate post-POEM was 93.3%. Approximately 50% of patients experienced adverse events during the procedure, mostly mild, and none necessitated further endoscopic or surgical intervention. After 1 year, 20.0% (n = 6) had reflux symptoms, gastroscopy showed that 30.0% (n = 9) had endoscopic evidence of esophagitis and most were well controlled with proton pump inhibitors.

Conclusion: POEM proves highly effective and safe for Vietnamese achalasia patients, regardless of achalasia subtype or prior treatment history

OP-19-04

Evaluating microvascular flow signals in pancreatic tumors with detective flow imaging in endoscopic ultrasonography

Shunsuke Omoto, Mamoru Takenaka and Masatoshi Kudo

Gastroenterology And Hepatology, Kindai University Faculty Of Medicine, Osakasayama, Japan

Oral Presentation 19, APDW Theatre 1, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: Detective flow imaging (DFI) is a novel imaging modality of endoscopic ultrasound (EUS) developed for detecting fine vessels without using ultrasound contrast agents. This study aimed to evaluate the diagnostic value of DFI in differentiating pancreatic tumors.

Materials and Methods: This retrospective study included 35 patients with pancreatic tumors who underwent EUS with DFI at a tertiary referral center from April 2019 to July 2022. Tumor vascularity was classified as “poor,” “moderate,” or “rich” based on blood flow intensity, while vessel patterns were classified as “regular,” “irregular,” or “peritumoral.” Two blinded, experienced endosonographers independently evaluated these characteristics. The study assessed interobserver agreement and the diagnostic ability of DFI in EUS for differentiating pancreatic carcinoma from other pancreatic tumors.

Results: The cohort comprised 23 cases of pancreatic adenocarcinoma, 5 cases of inflammatory pseudotumor, and 7 cases of pancreatic neuroendocrine neoplasm. Final diagnoses were established by surgical pathology in 8 patients, EUS-guided fine-needle aspiration in 26 patients, and a clinical follow-up in a patient. For the diagnosis of pancreatic carcinoma, inter-observer agreement by experts for DFI findings ranged from 0.83 to 1.0. Multivariate logistic regression analysis identified poor vascularity on DFI (odds ratio [OR] 17.8; 95% CI 1.42-222; P=0.03) and peritumoral in vessel pattern (OR 13.9; 95% CI 1.02-190; P=0.05) as independent predictors of pancreatic carcinoma.

Conclusion: DFI in EUS demonstrates potential as a valuable tool for differentiating pancreatic carcinomas from other pancreatic tumors without using contrast agents.

OP-19-05

Benefits of EUS before ERCP in the diagnosis and treatment of pancreatic biliary obstruction

Hien Pham Nhu

Hue Central Hospital, Hue city, Vietnam

Oral Presentation 19, APDW Theatre 1, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: 1. Describe the characteristic ò EUS findings in biliary and pancreatic obstruction. 2. Evaluate the benefits of EUS prior to ERCP.

Materials and Methods: A cross sectional study on 86 patients with suspected pancreatic biliary obstruction and had ERCP indications, who underwent prior EUS at Hue Central Hospital from February 2022 to February 2023.

Results: 86 patients, male (45.3%) and female (54.7%), mostly over 60 years old (62.8%).

EUS findings: The majority of pancreaticobiliary pathology was common bile duct (CBD) stones (48.8%). EUS visualized the entire CBD in 97.7% of cases. The most common shape of distal CBD narrowing due to tumor compression was abrupt cutoff (48%). CBD stone size >10mm was found in 40.5% of cases. Pancreatic duct stones were found in 80% of cases, with mobile stones in 80% and stone size >5mm in 40%. The majority of tumors were at stage T3 (56%).

Treatment outcomes: 26.7% of patients did not undergo ERCP after EUS. Biliary stent placement was performed in 36%. ERCP complexity: level 2 (53.9%), level 3 (31.7%), level 4 (1.6%). Overall ERCP success rate was 93.7%.

Conclusion: Performing diagnostic EUS prior to ERCP is crucial for classifying diseases for ERCP and avoiding complications. It help increase confidence for endoscopists, prediction of complex situations, preparation of appropriate equipment and improve patient outcomes:

OP-19-06

Real circumstances of endoscopic ultrasound-guided fine needle aspiration/biopsy for pancreatic ductal adenocarcinoma ≤ 10 mm

Ryota Sagami¹, Jun Nakahodo², Ryuki Minami³, Kentaro Yamao⁴, Akihiko Yoshida⁵, Yoshifumi Azuma¹, Yasuhisa Hiroshima¹, Hidefumi Nishikiori⁶, Mamoru Takenaka⁵, Kazuhiro Mizukami¹ and Kazunari Murakami¹

¹Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Japan; ²Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Bunkyoku, Japan; ³Department of Gastroenterology, Tenri Hospital, Tenri, Japan; ⁴Department of Gastroenterology, Faculty of Medicine, Nagoya University, Nagoya, Japan; ⁵Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Sayama, Japan; ⁶Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan

Oral Presentation 19, APDW Theatre 1, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: The diagnostic ability of endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNAB) for pancreatic ductal adenocarcinoma (PDAC) ≤10 mm in diameter is relatively low. We aimed to clarify the actual circumstances.

Materials and Methods: Attempted EUS-FNAB procedures for patients with EUS-confirmed pancreatic tumors ≤10 mm were retrospectively analyzed. The technical success of EUS-FNAB was defined as the possible needle puncture with adequate specimens for cyto-histological assessment. The primary endpoint was the diagnostic ability of EUS-FNAB for PDAC ≤10 mm. The diagnostic ability of EUS-FNAB-cytological, histological, or both evaluations was compared using AUC analysis.

Results: Among the 4,959 patients diagnosed with pancreatic tumors of all sizes who underwent attempted EUS-FNAB, EUS-FNAB procedures were attempted for 271 patients with pancreatic tumors ≤10 mm. PDAC was diagnosed in 31.7% of patients. Overall, 80.8% of the patients with pancreatic tumors (median lesion size of 8 mm) achieved technically successful EUS-FNAB. The reasons for technical failure were the inability to puncture due to anatomical inaccessibility (3.3%), unclear visibility for a puncture (5.2%), and inadequate specimen retrieval for cyto-histological analysis (10.7%). In patients who achieved EUS-FNAB technical success, the sensitivity, specificity, and accuracy of EUS-FNAB cyto-histological examination were 82.3%, 94.9%, and 91.3%, respectively. EUS-FNAB cyto-histological examination had a higher diagnostic ability than cytological examination alone or histological examination alone (P=0.002, and <0.001, respectively). However, cytological examination alone had a higher diagnostic ability than EUS-FNAB histological examination alone (P=0.034).

Conclusion: The diagnostic ability of EUS-FNAB for PDAC≤10 mm was relatively low. Cytological and histological evaluation is both needed.

OP-19-07

Gene expression analysis for pancreatic cyst diagnosis: evaluating cystic fluid and plasma

Sabina Seyfedinova, Olga Freylikhman, Ivan Danilov, Olga Kalinina and Evgeniy Solonitsyn

Almazov National Medical Research Centre, Saint Petersburg, Russian Federation

Oral Presentation 19, APDW Theatre 1, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Pancreatic cysts pose diagnostic challenges due to their varying potential for malignancy. Accurate differentiation is crucial for appropriate management. This study explores differential gene expression analysis in cystic fluid and plasma as a diagnostic tool. By assessing specific genetic markers, we aim to improve the precision of pancreatic cyst diagnosis and to evaluate the potential of non-invasive diagnostic methods.

The study analyzed 16 EUS-FNA fresh frozen fluid samples from pancreatic cysts and 15 corresponding blood samples from the same patients. This included 7 mucinous cystic neoplasms (MCN, IPMN) (6 in blood samples), 3 serous cystic neoplasms, and 6 pseudocysts. Differential expression of 17 genes was assessed in cystic fluid and plasma (Table 1). RT-PCR was conducted using specific primers and the qPCRmix-HS SYBR reaction mixture (Eurogene, Russia), with the beta-actin gene as a reference. Relative expression was determined using the 2^-(ΔΔCt) algorithm.

Significant differences in expression for mucinous cysts compared to serous cysts and pseudocysts were identified for 7 out of 17 genes. Additionally, 2 genes exhibited significant expression differences in the serous cyst group compared to the other groups (Table 1). However, the sample size does not allow for definitive conclusions. Despite very significant differences for some genes, the expression levels of any gene did not differ significantly among the three groups in plasma.

Differential gene expression analysis in cystic fluid shows promise for distinguishing pancreatic cyst types. Nevertheless, plasma samples did not demonstrate the required diagnostic potential. Larger sample sizes are needed to confirm these findings.

OP-19-08

Role of endoscopic ultrasound in tumor staging and tissue diagnosis of hilar strictures/cholangiocarcinomas-Prospective observational study

Sri Atchuta Satya Maharshi Tummalapalli

Asian Institute Of Gastroenterology, Hyderabad, India

Oral Presentation 19, APDW Theatre 1, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: The aim of this study is to compare the role of endoscopic ultrasound (EUS) in tumor staging, particularly nodal staging, to cross-sectional imaging, and tissue diagnosis in Hilar cholangiocarcinoma to ERCP-brush cytology.

Materials and Methods: This is a prospective observational study done in a single tertiary care hospital from November 2019 to August 2021 and included patients who underwent EUS in obstructive jaundice due to hilar cholangiocarcinoma after being diagnosed on cross-sectional imaging and were followed for 6 months.

Results: A total of 54 patients were enrolled in this study,mean age of 55 years of which 75.9 % were males.EUS detected Lymph nodes in 38 patients (70.3 %) whereas CECT/MRCP lymph nodes were detected in only 21 patients (38.9 %) and EUS has detected significantly more lymph nodes when compared to CECT/MRCP (p-0.002) and was more accurate in regional Nodal staging.Overall, EUS has diagnosed more malignancy in 24 patients (60 %) when compared to ERCP brush cytology only in 13 patients (27.7 %) (p-0.002).EUS-FNA detected malignancy in approximately 44.1 % of patients with Negative ERCP Brush cytology. After 6 months of follow-up, overall survival was observed in 25 patients (46.3%), 9 patients (16.7%) had lost follow-up, and 20 patients died (30 %) with mean days from diagnosis of 51.2 days.

Conclusion: Endoscopic ultrasound has a more significant and superior role in regional nodal staging than cross-sectional imaging and ERCP-brush cytology.

OP-20-01

Incidence of pancreatic exocrine insufficiency following episode of acute pancreatitis: A prospective Observational Study

Neha Berry and Wajeer Ahmed and Amrish Sahney and Manav Wadhawan and Ajay Kumar

Dept of Gastroenterology, BLK-MAX hospital New Delhi, New Delhi, India

Oral Presentation 20, APDW Theatre 2, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: Patients of Acute pancreatitis (AP) may develop local and systemic complications including endocrine and exocrine insufficiency (PEI), which may persist beyond hospital admission. This study explores incidence of PEI following an episode of AP and at 6 months follow up.

Materials and Methods: Between December 2019 to June 2021, among 120 AP patients presenting to BLK MAX hospital, 90 were included in the study as per inclusion criteria and classified into mild, moderately severe or severe pancreatitis as per revised Atlanta classification. Fecal elastase and fecal sudan stain was performed at the time of discharge (in mild pancreatitis) or after restarting feeding (moderately severe or severe pancreatitis) and at follow up time of 6 months. PEI was diagnosed if fecal elastase was <200ug/g or a positive sudan stain.

Results: Of 90 patients of AP included, 48 (53.3%) developed PEI at index admission. 33.9% with mild, 76% with moderate and 91.6% with severe AP developed PEI. These were followed for 6 months. 39 patients were included in final analysis. None among those with mild, 23.5% with moderate and all with severe pancreatitis had persistent PEI at follow up. Severity of pancreatitis correlated with PEI at follow up (p<0.001). Seven patients with necrotizing pancreatitis persisted with PEI on follow as compared to only one without necrosis (p< 0.001). Seven patients with local complications persisted with PEI as compared to 1 patient without any local complications (p<0.001).

Results: PEI after AP correlated with severity of pancreatitis, degree of necrosis and local complications.

OP-20-02

Formalised frailty assessment in a cohort of patients over 65 years referred for surveillance colonoscopy

Natasha Koloski^1,2, Kate Virgo², Amanda Whaley², Naomi Moy², Ayesha Shah^1,2, Teressa Hansen², John Pickering³, Crystal La Rue³, Ruth Hubbard¹, Natasha Reid¹, Michael Jones⁴ and Gerald Holtmann^1,2

¹University of Queensland, Brisbane, Australia; ²Princess Alexandra Hospital, Woolloongabba, Australia; ³Evidn, Australia; ⁴Macquarie University, Sydney, Australia

Oral Presentation 20, APDW Theatre 2, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: Frailty is a common clinical syndrome in older adults that may carry an increased risk for poor health outcomes including falls, hospitalisation, and mortality. Having a colonoscopy can be associated with potential adverse outcomes in frail patients. However, frailty is not routinely assessed when patients are referred for a surveillance colonoscopy. It is unknown if formalised frailty assessment and routine clinical assessment are suitable to avoid or reduce low-value care.

Materials and Methods: We conducted a prospective randomised controlled study where patients received during their consultation with the Gastroenterologist either a) a personalised (tailored) approach that included standardised assessment of frailty and structured information provided to the consumers and their next of kin if appropriate or b) current standard of care with patient assessment and individualised informed consent. The primary outcome measure was the proportion of patients referred who did not undergo surveillance colonoscopy.

Results: 127 patients participated in the trial (minimum age 65 years – maximum 87 years, 39.4% female). Of these 67 patients were randomised to the frailty assessment intervention and 60 received standard care. There was no significant difference between those who decided not to receive a colonoscopy in the intervention (11.9%; 95%CI 5.3% - 22.2%) versus standard care group (10%; 95%CI 3.8%-20.5%), P=0.72.

Conclusion: Formalised frailty assessment reduced the conversion rate from referral to colonoscopy but the effect was not statistically significant. This suggests that routine clinical practice in regards to surveillance colonoscopy can be effective in minimising low-value care.

OP-20-03

Compliance with gluten free diet in patients of celiac disease: a systematic review and meta-analysis

Shubham Mehta¹, Ashish Chauhan², Dwarakanathan Vignesh³, Samagra Agarwal¹, Ankit Aggarwal¹, Bodhisattya Roy Chaudhari¹, Vineet Ahuja¹ and Govind K. Makharia¹

¹All India Institute of Medical Sciences, New Delhi, India; ²Indira Gandhi Medical College, Shimla, India; ³E.S.I.C Medical College and Hospital, Chennai, India

Oral Presentation 20, APDW Theatre 2, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Background: Strict and lifelong gluten-free diet (GFD) is the gold standard of care for patients with celiac disease (CeD). Many patients with CeD have inadvertent gluten consumption despite being on GFD. Assessment of compliance to GFD must be done using objective methods such as celiac dietary adherence test (CDAT), BIAGI score, standardised dietitian evaluation (SDE) or simpler methods as self-reported GFD compliance.

Methods: We performed a systematic review and meta-analysis to estimate the pooled compliance of GFD (CDAT, BIAGI or SDE) in CeD patients after at least 1 year of initiating GFD. Electronic reference databases were searched from 1st January 1990 to 31st May 2024. Total 43 studies including 20,832 subjects were short listed for pooling the estimates by objective assessment methods. The pooled effect size (95%CI) was calculated using a random effect model.

Results: Most of the studies had low risk of bias. No publication bias was found. The pooled estimate for the proportion of participants compliant to GFD was found to be 68% (95% CI – 63% - 73%, I2 = 98%) Studies using BIAGI’s method for assessment reported higher GFD compliance which was comparable to pooled prevalence of self-reported compliance. We also conducted meta regression using mean age of participants, proportion of male participants and assessment method as independent variables. However, none of the co-variates were significant.

Conclusions: About one-third of CeD patients are not compliant to GFD. More research is needed to characterise those individuals likely to be non-compliant for better care in these patients.

OP-20-04

Traditional Asian Diet Benefits on Gut Microbiome, Stool and Urine Metabolomes in Healthy Asian Women

Nur-Fazimah Sahran^1,2, Lee Yeong Yeh¹, Chong Chun Wie^3,4, Intan Hakimah Ismail⁵, Fahisham Taib², Hoo Pek Sung², Uma Devi Palinasamy³, Usha Sundralingam³, Cindy Shuan Ju Teh⁶, Khong Zhi Xian⁶, Qasim Ayub⁷, Maryam Azlan¹, Shariza Abdul Razak¹, Tengku Ahmad Damitri Al-Astani Tengku Din², Siti Nur Haidar Hazlan², Nurzulaikha Mahd Ablah⁸, Vincent Tee², Nashrulhaq Tagiling² and Emad El-Omar⁹

¹School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia; ²School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia; ³School of Pharmacy, Jeffrey Cheah School of Medicine and Health Sciences Monash University Malaysia, Subang Jaya, Malaysia; ⁴MUM Microbiome Research Centre, Monash University Malaysia, Subang Jaya, Malaysia; ⁵Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia; ⁶Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Wilayah Persekutuan, Malaysia; ⁷School of Science, Monash University Malaysia, Subang Jaya, Malaysia; ⁸Faculty of Data Science and Computing, Universiti Malaysia Kelantan, Kota Bharu, Malaysia; ⁹Microbiome Research Centre, St George & Sutherland Clinical Campuses, School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia

Oral Presentation 20, APDW Theatre 2, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: To examine the efficacy of Traditional Asian Diet (TAD) vs. controls on gut microbiome, stool and urine metabolomes among healthy Asian women.

Materials and Methods: An open-label four-week randomized controlled trial was conducted among healthy women who were randomly assigned into two groups: the TAD group (n=10), and the control group (habitual diet), (n=11). The outcomes measured at baseline, week-2 and week-4 included: dietary intake, stool microbiota (16S rRNA; Illumina Miseq), targeted stool metabolites (butyrate, propionate and acetate; gas chromatography-mass spectra), and urine metabolites profiling with nuclear magnetic resonance spectroscopy. A per-protocol analysis (n=20) was conducted within and between groups, significant p-value <0.05.

Results: Compared to the control group, the TAD group recorded a significantly higher intake of fiber (p<0.001) and lower dietary fat (p<0.05). Significant enrichment of Parabacteroides merdae in TAD and a high abundance of Bacteroides uniformis in the control group were observed. Individuals with baseline levels of Prevotella copri showed enrichment of this bacterium with TAD but not in the control group. Stool butyrate levels remained higher in the TAD group for individuals with baseline levels of Prevotella copri compared to those without this bacterium at baseline, as well as the control group. Separately, a reduction in urine metabolites including creatinine, dimethylamine, and phenethylamine was detected in the TAD compared to the control group.

Conclusion: TAD has demonstrated benefits compared to the control diet, including enrichment of beneficial microbiota, butyrate and reducing harmful metabolites.

OP-20-05

Epidemiology, Predictors and Treatment Outcome of Achalasia in a Multi-ethnic Asian Population with Non-obstructive Dysphagia

Ram Prasad Sinnanaidu, Nabilah Izham, Jun Xin Lim, Qing Yuan Loo, Ban Hong Ang, Naveen Ramasami, Wei Jin Wong, Shiaw Hooi Ho, Sanjiv Mahadeva, Yeong Yeh Lee and Kee Huat Chuah

University of Malaya, Kuala Lumpur, Malaysia

Oral Presentation 20, APDW Theatre 2, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Introduction: Epidemiological data and predictors of achalasia among Asians presenting with non-obstructive dysphagia are scarce, hence our aims in the current study.

Methods: This was a retrospective cohort study of consecutive multi-ethnic Asian patients with non-obstructive dysphagia who underwent oesophageal high resolution manometry in Universiti Malaya Medical Centre (Petaling Jaya) and Hospital Universiti Sains Malaysia (Kota Bharu). Oesophageal motility disorders including achalasia were diagnosed using the Chicago Classification v3.0. Prevalence, incidence, predictor factors (multivariate analysis) and treatment outcome were determined with p<0.05 as significant.

Results: A total of 231 patients were included (mean age 53 years, females 53.2%). Prevalence of achalasia was 25% and estimated incidence was 0.46 per 100,000 people. Prevalence of subtypes of achalasia was 8.7% Type 1, 13.4% Type 2, and 2.2% Type 3 respectively. Other motility disorders are shown in Table 1. Younger age (OR 0.94, 95% CI: 0.90-0.99, p=0.009) and BMI <18.5 kg/m² (OR 18.42, 95% CI: 1.39-244.48, p=0.027) were predictors of achalasia. 63.6% underwent peroral endoscopic myomectomy (POEM) and 15.2% had pneumatic dilation. A positive symptom outcome was observed in patients who underwent POEM, ranging from 76.2% at 3 months to 75% at 2 years.

Conclusion: Achalasia is prevalent in Asians with non-obstructive dysphagia. A younger age and being underweight are predictive factors for achalasia. POEM is the most common intervention with a positive symptom outcome.

OP-20-06

Colorectal cancer screening participation and outcomes in an Australian cohort aged 40-49 years

Erin Symonds¹, Geraldine Laven-Law², Charles Cock¹, Molla Wassie², Maddison Dix² and Graeme Young²

¹Flinders Medical Centre, Bedford Park, Australia; ²Flinders University, Bedford Park, Australia

Oral Presentation 20, APDW Theatre 2, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: With the rising incidence of colorectal cancer (CRC) in people under 50y, there may be benefits in starting CRC screening earlier, however, it is unclear what the participation will be with faecal immunochemical tests (FIT) in younger ages, or what subsequent colonoscopy findings will be. This study compared FIT participation in people aged 40-49y to older age groups, and determined positivity rates and yields at colonoscopy.

Materials and Methods: Data was analysed from a surveillance colonoscopy program (2011-2019) that provides FITs as an interval screening modality. Individuals were provided two-sample FITs (Eiken Chemical Company, Japan) between colonoscopies. Colonoscopy outcomes after positive FITs were assessed for advanced neoplasia. Statistical analyses were with Chi-square tests and logistic regression.

Results: FITs were provided to n=15,726, including 1,424 aged 40-49y (51.7% female), 4,662 aged 50-59y (49.8% female) and 9,640 aged 60-74y (47.4% female). Participation and FIT positivity were lowest for ages 40-49y compared to older ages (Table, p<0.01). In older ages, participation was more likely in females and associated with previous FIT completion, while in the 40-49y group, participation was associated with a higher socioeconomic status and with previous FIT completion (Table, p<0.05). Yield of advanced neoplasia after positive FIT (n=750) was similar across ages, with a positive predictive value of 10.0% for 40-49y, 10.1% for 50-59y, and 12.7% for 60-74y (p>0.05).

Conclusion: FIT participation and positivity are lowest in 40-49y, but yield of advanced neoplasia is comparable with older ages. Appropriate education is needed to support CRC screening engagement in younger individuals.

OP-20-07

Daily Diet and Nutritional Risk Factors for Gastric Atrophy Using a Food Questionnaire in Japan

Ayaka Takasu^1,2, Takuji Gotoda², Sho Suzuki³, Chika Kusano⁴, Chiho Goto⁵, Hideki Ishikawa⁶ and Hirofumi Kogure¹

¹Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan; ²Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan; ³Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan; ⁴Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan; ⁵Department of Health and Nutrition, Nagoya Bunri University, Aichi, Japan; ⁶Department of Molecular-Targeting Prevention, Kyoto Prefectural University of Medicine, Osaka, Japan

Oral Presentation 20, APDW Theatre 2, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: The nutritional factors contributing to gastric atrophy (GA) are not fully understood. This study evaluates the impact of nutrients on GA using a self-administered food frequency questionnaire (FFQ).

Materials and Methods: This was a post hoc analysis of a prospective trial evaluating gastric cancer screening modalities in participants aged 30 to 74 years in Japan from June 2011 to March 2013. All participants completed an FFQ upon enrollment. Daily nutrient intake was calculated from the FFQ. Risk factors for GA were analyzed using logistic regression.

Results: The analysis included 1,147 participants (median age: 62 years; 50.7% men), among whom 493 (43.0%) had GA. In bivariate analysis, higher intake of sodium (odds ratio [OR], 1.47; 95% CI, 1.15 to 1.90; p=0.003), saturated fatty acid (OR, 1.40; 95% CI, 1.03 to 1.89; p=0.030), iron (OR, 1.06; 95% CI, 1.01 to 1.11; p=0.024), protein (OR, 1.01; 95% CI, 1.00 to 1.02; p=0.008), higher age (OR, 1.92; 95% CI, 1.49 to 2.48; p<0.001), positivity for H. pylori IgG antibody (OR, 9.16; 95% CI, 6.86 to 12.22; p<0.001), and history of H. pylori eradication (OR, 2.08; 95% CI, 1.60 to 2.70; p<0.001) were positively associated with GA. Multivariate analysis revealed higher sodium intake (OR, 1.44; 95% CI, 1.01 to 2.04; p=0.043), higher age (OR, 2.02; 95% CI, 1.49 to 2.75; p<0.001), and positivity for H. pylori IgG antibody (OR, 9.03; 95% CI, 6.65 to 12.26; p<0.001) were positively associated with GA.

Conclusions: The study using the FFQ revealed that daily high sodium intake is associated with GA.

OP-20-08

Intestinal Trefoil Factor Plays Critical Roles in Innate Protection and Recovery From, Clostridium Difficile Colitis

Hao Tang¹, Yan Li², Basmah Alhassann², Jimmie Nguyen², Tie Wang², Justin MacDonald², Jiaming Qian¹ and Paul Beck²

¹Peking Union Medical College Hospital, Beijing, China; ²University of Calgary, Calgary, Canada

Oral Presentation 20, APDW Theatre 2, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: Little is known of the mechanisms involved in innate protection and recovery from Clostridium Difficile Colitis. Intestinal Trefoil Factor (ITF) has both protective and restorative roles in the gut. We hypothesized that ITF protects and against C. Difficile induced injury.

Methods: C. Difficile colitis was induced in wild type and ITF-/- mice via intrarectal administration of C. Difficile toxin. In vitro models of toxin exposure, organoids and fresh human colonic biopsies were assessed. C. Difficile injury was assessed via histology, cytokine/chemokine profiles, epithelial proliferation/apoptosis balance.

Results: Intrarectal C. Difficile toxin resulted in acute goblet cell depletion and marked reduction in ITF, but it increased during resolution phase. Although ITF-/- mice had similar histological damage as WT mice at 4h post toxin exposure, they had marked impairment in recovery from colitis (significantly higher cytokine/chemokine levels and histological scores at 48h and 72h post toxin exposure vs. WT). Loss of ITF also resulted in increased epithelial apoptosis, impaired proliferation and a close to 10 fold increased incidence in Pseudomembranous Colitis. Supplementation of recombinant ITF protected WT mice from toxin-induced injury and enhanced recovery. In vitro studies showed that recombinant ITF decreased C. Difficile toxin induced cell death in organoids, promoted cell proliferation, enhanced cell migration and altered cell cycle dynamics (enhancing cell survival) following toxin exposure. Furthermore, recombinant ITF also decreased toxin induced cell death in organoids.

Conclusions: We show that ITF plays important roles in the innate protection against C. Difficile colitis, and is critical in mucosal healing following colitis.

OP-20-09

Global Impact of Low Intake of Fruits and Vegetables: A GBD-based Systematic Analysis

Xiang Xu^1,2, Pengguang Yan¹ and Jingnan Li¹

¹Peking Union Medical College Hospital, China; ²Peking Union Medical College, China

Oral Presentation 20, APDW Theatre 2, Exhibition Hall, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: To estimate the global mortality and disability-adjusted life years (DALYs) attributable to diets low in fruits and vegetables from 1990 to 2021.

Materials and Methods: The 2021 Global Burden of Disease (GBD) study framework and analytical strategies were used to analyze global mortality and DALYs attributable to diets low in fruits and vegetables by geography, age, sex, disease attribution, and sociodemographic index (SDI).

Results: In 2021, the global average intake of fruits and vegetables was 122 g/day and 213 g/day, respectively, far below the optimal intake range (fruits: 340-350 g/day, vegetables: 306-372 g/day). 1.7 million and 0.9 million deaths, 43.8 million and 20.7 million DALYs were attributable to low fruit and vegetable intake. From 1990 to 2021, the global age-standardized rate (ASR) of death due to insufficient intake of fruits and vegetables decreased by 35% and 45%. Sub-Saharan central Africa had the highest ASR of death due to inadequate fruit and vegetable intake (51 per 100,000; 62 per 100,000). Cardiovascular diseases account for nearly 70% of causes of relevant deaths and DALYs. In addition, HDI and SDI were negatively correlated with ASR of deaths.

Conclusion: Global fruit and vegetable intake remains far below the recommended levels. Despite decreases in ASR of deaths and DALYs due to insufficient diet, the total numbers of corresponding deaths and DALYs continue to rise. Considering the inequity, relevant public health policies should prioritize the underdeveloped regions.

OP-21-01

A Multi-Module System for Differential Diagnosis of Crohn's Disease and Intestinal Tuberculosis Based on Metaformer

Xuejie Chen¹, Angran Zhu¹, Yuxing Zhang², Lian Zhao¹, Jie Chen¹ and Xiaoyan Wang¹

¹Third Xiangya Hospital of Central South University, Changsha, China; ²School of Computer Science and Engineering, Southeast University, Nanjing, China

Oral Presentation 21, Uluwatu 1, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: Distinguishing Crohn's disease (CD) from intestinal tuberculosis (ITB) using endoscopy is challenging, especially for junior physicians or those in underdeveloped countries. Accurate differentiation is crucial for treatment and patient management. This study aims to develop a multimodal AI-assisted diagnostic model combining clinical data and colonoscopy images to distinguish between CD and ITB.

Materials and Methods: Patients diagnosed with CD or ITB at Xiangya Third Hospital of Central South University and Hunan Chest Hospital from January 1, 2005, to August 1, 2023, were included. An external validation set was obtained from Zhuzhou Central Hospital. Data collection included clinical text information and colonoscopy images per patient. A MetaFormer algorithm-based multimodality model was constructed for differential diagnosis, evaluated using internal and external validation sets. Performance was measured using accuracy, sensitivity, specificity, and F1 score, compared to endoscopist performance levels.

Results: The study analyzed 408 patients in the internal dataset (311 with CD, 97 with ITB) and 85 in the external validation set (62 with CD, 23 with ITB). The multimodal algorithm outperformed single-data-type approaches. In the internal dataset, the integrated model showed 91.25% accuracy, 96.72% sensitivity, and 73.68% specificity, reducing misdiagnosis rates. External validation confirmed the model's robustness, with 91.76% accuracy, 95.16% sensitivity, and 82.61% specificity. The F1 score was 0.944. The model improved junior endoscopists' diagnostic accuracy to levels comparable with experts (83.17% vs. 85.15%), enhancing diagnostic consistency.

Conclusion: The MetaFormer-based multimodal predictive model for CD and ITB demonstrates high discriminatory power, offering an accurate diagnostic tool to enhance clinical decision-making.

OP-21-02

Kushenol A modulates gut microbiota and repairs mucin sulfation modification disorder to alleviate ulcerative colitis

Hongsuo Chen and Hailong Cao

Tianjin Medical University, Tianjin, China

Oral Presentation 21, Uluwatu 1, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: Sulfation is a conjugation reaction essential for numerous biochemical and cellular functions in mammals. The 3’-phosphoadenosine 5’-phosphosulfate (PAPS) synthase 2 (PAPSS2) is the key enzyme to generate PAPS, which is the universal sulfonate donor for sulfation reactions. High throughput screening of small molecule compounds revealed Kushenol A(KA) may serve as a potential therapeutic target related to PAPSS2. The study aims to investigate the impact of KA on mucin sulfation modification and its mechanisms in inflammatory bowel disease (IBD).

Materials and Methods: Gene-Expression Omnibus (GEO) datasets, Single-cell RNA sequencing (scRNA-seq) were conducted to characterize the expression level of PAPSS2 and Slc35b3 in IBD patients and in different cells types. The dextran sodium sulfate (DSS)-induced colitis model and vitro experiments were used to investigated of the mechanisms of KA regulation on mucin sulfation. Transcriptomic, 16S rRNA, and metabolomic sequencing were conducted.

Results: GEO datasets and scRNA-seq showed the expression of PAPSS2 and Slc35b3 were reduced in IBD patients and increased in intestinal goblet cells. KA significantly mitigated colonic inflammation and facilitated the synthesis of sulphated mucin in colitis mice. RNA sequencing indicated the sulfur metabolism signal pathway was significantly enriched after KA treatment. 16sRNA and metabolomics showed KA manipulated gut microbiota and metabolites to improved mucin sulfation modification, thereby suppressing inflammation.

Conclusion: We have uncovered the important role of PAPSS2-mediated sulfation in colitis. These findings revealed a novel natural compound, namely KA, may hold promise as a therapeutic approach for mitigating colonic inflammation and improving disease outcomes in patients with IBD.

OP-21-03

Oral administration of Sophora Flavescens-derived exosomes-like nanovesicles carrying CX5461 ameliorates DSS-induced colitis in mice

Dongling Dai

Shenzhen Children’s Hospital, Shenzhen, China

Oral Presentation 21, Uluwatu 1, November 23, 2024, 10:10 AM - 11:30 AM

Introduction: CX5461 has been shown to alleviate autoimmune disease, immunological rejection, and macrophage-mediated vascular inflammation, while the therapeutic role of CX5461 in ulcerative colitis (UC) remains unclear. The objective of this study is to investigate the therapeutic effect of SFELNVs@CX5461 on DSS-induced colitis and its possible molecular mechanism.

Methods: The preparation of SFELNVs@CX5461 were electroporated. We conducted the experiments using SFELNV, CX5461 and SFELNVs@CX5461 respectively. Proliferation and apoptosis of RAW264.7 cells were detected by flow cytometry according to the kits. C57BL/6 mice were induced by 3% DSS to establish the colitis model. Then, mice models were orally administrated with SFELNVs@CX5461 (n=5, 80mg/kg) and SFELNVs (n=5, 80mg/kg) for 5 days. The body weight, consistency of stool, and rectal bleeding were measured each day. Finally, after sacrificing the mice, colons and main organs were obtained for the qPCR, HE, and IHC.

Results: Cellular uptake has shown that SFELNVs were targeted uptake by macrophages. Oral SFELNVs@CX5461 exhibited good safety and stability, as well as inflammation-targeting ability in the gastrointestinal tract of DSS-induced colitis mice. In vivo, Oral administration of SFELNVs and CX5461 could relieve mice colitis. More importantly, combined SFELNVs and CX5461 enhanced the treatment efficacy of mice colitis by inhibiting pro-inflammatory factors (TNF-α, IL-1β, and IL-6) expression and promoting M2 macrophage infiltration. Furthermore, SFELNVs promoted M2 polarization by miR4371c using miRNA sequencing.

Conclusions: In summary, SFELNVs@CX5461 represents a therapeutic strategy to UC with excellent biocompatibility due to the ability to enhance anti-inflammatory effects in vitro and in vivo to alleviate UC.

OP-21-04

Correlation between severity of inflammatory bowel disease based on endoscopy examination results and clinical manifestations

Sahrial Fauzi¹, Amelia Rifai^2,3, Muhammad Luthfi Parewangi^2,3, Fardah Akil^2,3, Nu'man AS Daud^2,3, Rini Rachmawarni Bachtiar^2,3 and Susanto Hendra Kusuma^2,3

¹Internal Medicine Specialist Program, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; ²Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; ³Centre of Gastroenterology-Hepatology HAM Akil, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia

Oral Presentation 21, Uluwatu 1, November 23, 2024, 10:10 AM - 11:30 AM

Objective: Inflammatory bowel disease (IBD) is a persistent inflammatory condition that affects both the large and small intestines, encompassing two primary types: crohn's disease and ulcerative colitis. This condition manifests with complaints of bloody diarrhea, fever, weight loss, and abdominal pain. Clinical improvement is indicated by a significant decreased of clinical manifestations, while significant decrease in inflammation and ulceration of the colon and rectum indicates a mucosal healing. The aims of this study to determine the correlation between severity of IBD based on the endoscopic examination results with clinical manifestations.

Material and Methods: This retrospective study was conducted with a cross-sectional approach. The study population was patients with IBD who had undergone gastrointestinal endoscopic examination at Wahidin Sudirohusodo Hospital in 2021 until 2022. The severity of IBD patient was determined by UCEIS and mayo score from the results of the endoscopic examination. Analysis of the study were using chi-square, with significant results if p-value <0.05 is obtained.

Results: This study involved 165 subjects, man 57.5% and women 42.4%, average age 55 years old, type of IBD is ulcerative colitis, with the most common location in rectosigmoid. Clinical manifestations were constipation in 27 (16.3%) subjects, bloody defecation in 71 (43%) subjects, abdominal pain in 44 (26.6%) subjects, diarrhea 23 (13.9%) subjects. There is significant correlation between severity of IBD with bloody defecation (p-value 0.019), diarrhea (p-value 0.001) and constipation (p-value 0.003)

Conclusion: Severity of IBD have a significant correlation with bloody defecation, diarrhea, and constipation.

OP-21-05

A dietitian-led IBD clinic model is effective and efficient, with high patient satisfaction

Sarah Melton, Miles Sparrow, Kate Norton, Alex Boussioutas and Jessica Fitzpatrick

Alfred Health, Melbourne, Australia

Oral Presentation 21, Uluwatu 1, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: Dietary management plays a critical role in the management of IBD, yet many patients lack access to specialised dietetic care. This audit describes the evaluation and impact of a pilot dietitian-led IBD clinic model in a tertiary IBD centre.

Materials and Methods: A dietitian-led IBD clinic (0.4 dietetic EFT) was established and piloted for 6 months. Redcap surveys were used to measure patient satisfaction with dietetic care. Descriptive statistics were used to describe data.

Results: A total of 165 appointments were conducted in 6 months. Reasons for referral are presented in Figure 1. Median time from referral to assessment was 1 day for urgent priority (within 7 days) patients (n=19), 3.5 days for high (within 14 days) priority patients (n=6), 21 days for moderate (within 30 days) priority patients (n=33) and 25.5 days for low (within 90 days) priority patients (n=6). Eight patients (11%) were escalated to the gastroenterologist due to suspected worsening disease activity, or other clinical concerns. Patient engagement was high, with 90% of scheduled appointments attended. Patient satisfaction (15% survey response rate) was overwhelmingly high with 100% of patients reporting that the dietitian informed them adequately about nutrition and IBD, allowed for regular consultation and felt that they were always taken seriously.

Conclusion: The dietitian-led IBD clinic model demonstrated effective specialised nutritional care within a multidisciplinary framework for IBD management. This approach led to dietetic assessment and intervention within desired and best practice timeframes (particularly for urgent and high priority patients), high patient engagement and satisfaction.

OP-21-06

Frequency and spectrum of infections in patients with acute severe ulcerative colitis and in remission

Ujjala Ghoshal¹, Vinod Kumar Dixit², Uday C Ghoshal³, Nitesh Bassi² and Tuhina Bannerjee⁴

¹Department of Microbiology, All India Institute of Medical Sciences, Kalyani, Kolkata, India; ²Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India; ³Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India; ⁴Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

Oral Presentation 21, Uluwatu 1, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: To study the frequency of gastrointestinal infections in patients with acute attack of Ulcerative Colitis and those in remission.

Materials & Methods: Consecutive patients with acute severe UC (ASUC) and those in remission were evaluated for GI infections by stool microscopy, culture and cytomegalovirus (CMV) was studied in rectal biopsy by real-time PCR (RT-PCR), histology and serum IgM anti-CMV antibody. Demographic, clinical and laboratory parameters were recorded. Severity of UC was assessed using standard criteria.

Results: Of 158 patients with UC (age 35.2 ± 13.0 y, 90 [57%] male; 108 ASUC, 50 in remission), 79 had CMV infection (53 by RT-PCR only [≥250 copies], one by inclusion body only, 25 by both). 91/158 (57.6%) had GI infections. The spectrum of infection included CMV alone (60, 38%), Clostridium difficile (1, 0.6%), C. parvum (6, 3.8%), roundworm (2, 1.3%), hookworm (1, 0.6%), E. histolytica (1, 0.6%), Giardia (1, 0.6%), CMV with C. parvum (11, 7%), CMV with C. difficile (2, 1.3%), CMV with isospora (2, 1.3%), CMV with roundworm (1, 0.6%), CMV with hookworm (1, 0.6%), CMV with E. histolytica (2, 1.3%), and C. difficile with C. parvum (1, 0.6%). Infections due to CMV (70/108 vs. 9/50; p<0.00001) and GI infections (75/108 vs. 16/50; p<0.00001) were commoner among patients with ASUC than those in remission.

Conclusion: GI infection including that due to CMV is common in patients with UC, particularly those with ASUC.

OP-21-07

Prevalence of sarcopenia and its determinants in Crohn’s disease - A prospective single centre cohort analysis

Arjun R Guptha, Mathew Philip, Prakash Zacharias and Shibi Mathew

Lisie Institute of Gastroenterology Hepatology and Transplantation, Lisie Hospital, Kochi, India

Oral Presentation 21, Uluwatu 1, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: Sarcopenia is a frequently overlooked association of Crohn’s disease (CD). Only a few studies have investigated the prevalence of sarcopenia in CD in India. In this study, we evaluated the prevalence and factors influencing sarcopenia in Crohn’s disease.

Materials and Methods: We conducted a single centre prospective observational cross section study on CD patients who were evaluated at our tertiary care centre. Patients who presented to the IBD clinic during the study period were enrolled and evaluated for sarcopenia. Hand grip dynamometry with Bioelectrical impedance assay (BIA) were used to determine sarcopenia. Impact of disease phenotype, disease severity, sociodemographic features and laboratory parameters on the prevalence of sarcopenia were analysed.

Results: A total of 110 patients (male: 64.5%; mean age:31.6 years) were included and 66 patients (60%) were diagnosed with sarcopenia. Younger age, early age of onset, anaemia and low Body mass index (BMI) correlated with presence of sarcopenia (P<0.05). Diagnostic accuracy of hand grip strength alone in diagnosing sarcopenia was 83% (Positive predictive value: 78%). Subgroup analysis was done on patients who had additional computed tomography (CT) within 3 months of BIA measurement. BIA showed a diagnostic accuracy of 96% in determining low skeletal muscle index (SMI) as compared to CT. There was no statistical significance with disease phenotype, duration or severity (CDAI score) of the disease.

Conclusions: Higher prevalence of sarcopenia was noted in patient with Crohn’s disease in our population. Younger age, early age on onset, anaemia , C-reactive protein, BMI correlated with presence of sarcopenia.

OP-21-08

Explainable machine learning uncovers a model on inflammation and ustekinumab in patients with Crohn's disease

Junbo Xiao and Yi Han and Xiaowei Liu

Xiangya Hospital of Central South University, Changsha, Hunan Province, China

Oral Presentation 21, Uluwatu 1, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: The use of ustekinumab (UST) has made significant strides in the treatment of Crohn's disease (CD). However, patients' responses varied in recent years, calling for a UST-related model to predict patient outcomes.

Materials and Methods: Three datasets, GSE112366, GSE100833, and GSE134809 were downloaded for analysis. Significant modules and genes associated with CD, inflammation and UST were identified via WGCNA. To clarify the molecular mechanisms involved, GSEA and GSVA were conducted. LASSO, random forests, and SVM-RFE were conducted to develop an optimal model for UST response prediction, whose performance was evaluated by a nomogram and receiver operator curve (ROC).

Results: In total, 28 hub genes were identified, predominantly involved in neutrophil chemotaxis and the IL−17 signaling pathway. Furthermore, dendritic cells and neutrophil infiltration significantly differed between the UST and placebo groups. Also, we examined single-cell data to analyze hub gene expression in subtypes of immune cells and intestinal epithelial cells. Three machine learning approaches were used to discover the following nine genes for the UST response prediction model: WARS, PILRA, STC1, CD274, IL6, FCGR3B, DEFB4A, S100A9 and LILRA1. To measure UST response, a nomogram was established with an area under the curve of 0.752.

Conclusion: Bioinformatics techniques were used to construct a predictive model for CD patients' UST response. New insight into CD pathogenesis and treatment may be gained from the uncovered immune infiltration and signaling pathways.

OP-21-09

Biologics for the Prevention of Postoperative Crohn’s Disease Recurrence: A Retrospective Cohort Study in China

Wang Hongqin, Juan Wei and Fangyu Wang

School of Medicine, Southeast University, Nanjing, China

Oral Presentation 21, Uluwatu 1, November 23, 2024, 10:10 AM - 11:30 AM

Objectives: Postoperative occurrence (POR) in Crohn’s disease (CD) following enterectomy is a major concern. Studies assessing biologics for prophylactic treatment are limited. The aim of this study was to evaluate the efficacy of biologics.

Materials and Methods: Patients diagnosed with CD administered enterectomy and biologics (vedolizumab, ustekinumab and infliximab) at a tertiary care center between March 2021 and August 2023. Clinical POR was defined as a CDAI >150 and a CDAI increase of 100. Endoscopic POR was considered with a Rutgeerts score ≥i2. Both uni- and multivariate cox regression analyses were used to assess risk factors for POR.

Results: After a follow-up of 10.00 (IQR: 5.00-15.00) months, clinical POR was detected in 18 out of 62 (29.0%) patients, including 5/17 (29.4%) in the vedolizumab group, 4/28 (14.3%) in the ustekinumab group and 9/17 (52.9%) in the infliximab group. Cases administered ustekinumab were less likely to relapse than those treated with infliximab (p=0.021). Totally 8 out of 32 patients had endoscopic POR after a follow-up of 6.75±2.951 months. Exposure to immunosuppressants (HR=4.005, 95%CI 1.253-12.804; p=0.019) and extensive lesions (HR=3.145, 95%CI 1.042-9.494; p=0.042) were risk factors for clinical POR.

Conclusion: This study demonstrated biologics (vedolizumab, ustekinumab and infliximab) could effectively prevent POR. Ustekinumab shows a better preventive efficacy than infliximab. Patients administered immunosuppressants or with extensive lesions are more likely to show clinical POR.

OP-22-01

The effectiveness of endoscopic surveillance after oesophagectomy for oesophageal squamous cell carcinoma

Hok Kan, Duncan Cheng, Steven Tsang, Claudia Wong, KK Chan, Betty Law, Fion Chan, Simon Law and Ian Wong

Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong

Oral Presentation 22, APDW Theatre 1, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

This study aims to assess the effectiveness of surveillance oesophagogastroduodenoscopy (OGD) in detecting local recurrences (LR) and head and neck second primary neoplasms (H&N SPNs), and their associated survival outcomes.

A retrospective cohort study was conducted on patients who underwent oesophagectomy between January 2011 and January 2021. Data on demographics, relapse status, and endoscopy procedures were collected from electronic records. The OGDs were categorised as asymptomatic (aOGD) and symptomatic OGDs. The effectiveness was evaluated based on the number of scopes needed to detect LR and H&N SPNs, and the subsequent treatment received.

Between January 2011 and February 2024, 985 OGDs were performed for 268 patients with 513 categorised as aOGD and 472 as symptomatic OGDs. Of the 122 recurrences, 28 were LR. Two asymptomatic LR were identified using aOGDs, but only one was eligible for curative treatment. This patient had the longest post-recurrence survival (PRS) of 10 years. The majority of LR (89.3%) were discovered within two years. Among the patients with palliative treatment, the median PRS was 3.3 months. Seventeen patients had H&N SPN detected, with nine identified through aOGD. All H&N SPNs were detected at an early stage (pT0–1) and were eligible for radical treatment. On average, 256.5 aOGDs were required to find one LR, while 57 aOGDs were needed to detect one H&N SPN.

Conclusion: Asymptomatic OGD (aOGD) was suboptimal in detecting local recurrence but showed promise in detecting early-stage H&N SPN. Future endoscopic examinations should focus more on detecting H&N SPN, potentially improving efficiency and cost-effectiveness.

OP-22-02

The efficacy of Draid-Endo (all-in-one artificial intelligence integrated system) to detect upper gastrointestinal tract lesions

Viet Hang Dao and Duc Tran and Hoang Nguyen and Giap Duong and Kien Dao and Binh Nguyen and Hoa Lam and Trang Nguyen and Tung Nguyen and Steven Truong and Long Dao

Hanoi Medical University, Hanoi, Viet Nam; Institute of Gastroenterology and Hepatology, Hanoi, Viet Nam

Oral Presentation 22, APDW Theatre 1, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: The study aims to evaluate the efficacy of DrAid-Endo (all-in-one artificial intelligence integrated system) in anatomical landmarks identification and lesions detection for upper gastrointestinal (UGI) tract.

Methods: A randomized clinical trial was conducted in patients performed UGI endoscopy. The intervention group will have assistance from DrAid-Endo in real-time to identify 10 anatomical landmarks and detect 5 lesions (erosive esophagitis (EE), gastritis, duodenal ulcer (DU), esophageal cancer (EC), and gastric cancer (GC)) while performing the endoscopy. Dr-Aid Endo was developed from a dataset of 59.866 UGI endoscopy images (46,524 without lesions, 13,342 with the 5 lesions).

Results: The study recruited 120 patients with 50% in each group. The median age was 46.6 years. 34.2% were males, 71,7% had UGI symptoms. The proportions of patients with EE, gastritis, DU, EC, and GC were 45%, 98,3%, 13,3%, 1,7%, and 0,8%, respectively. There were no differences in endoscopists’ detection of the two groups. In the intervention group, the accuracies of AI in identifying anatomical landmarks ranged 83.3-100%. 2/3 malignant cases were identified accurately, the missing case is early esophageal cancer. The highest sensitivities were observed in DU (100%) and EE (85,1%), while the highest F1 score was EE (0.91) and gastritis (0.47). The false positive cases were mostly blur/reflections (43.8%) and blood-stained areas (27.4%), mainly in the duodenal bulb (45.2%) and antrum (30.1%).

Conclusion: In clinical settings, DrAid-Endo showed high accuracy in detecting anatomical landmarks of the UGI tract, high sensitivity in duodenal ulcer and erosive esophagitis.

OP-22-03

Throat pain immediately post upper endoscopy: a prospective cohort study on predictive factors

Gillie Anne Domingo, Jose Maria Gonzalez and Gerardo Pedregosa

Makati Medical Center, Makati City, Philippines

Oral Presentation 22, APDW Theatre 1, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Significance: Throat pain following upper endoscopy is a common complaint, with reported incidence rates ranging from 9 to 12.8%. Despite its minor nature, 2.5% of patients seek medical consultation post endoscopy. This study aims to explore the incidence, risk factors, and throat pain severity immediately post procedure, which are crucial for enhancing patient experience and future compliance.

Methods: This study is a single-center prospective cohort which involved adult patients 18 years and above that underwent upper endoscopy. Patients provided post-procedure throat pain severity ratings using a visual analogue scale.

Results: Among the 896 patients included in the study, 35 (4%) reported throat pain post endoscopy. This group had mostly moderate throat pain (51.4%) with more females (80% vs 58.4%, p = 0.011) and higher frequency of coughing during endoscopy (40% s 16.49%, p < 0.001). On multivariate analysis, independent risk-factors for post endoscopy throat pain were female gender (aOR 3.48, CI 1.46 – 8.26) and coughing (aOR 3.23, CI 1.55 – 6.75).

Conclusion: Female gender and coughing are significant predictors for throat pain. The study recommends further exploration of alternative risk factors to comprehensively understand and address post- endoscopy throat pain. These findings contribute to refining practices for improved patient experience and future procedural compliance.

OP-22-04

Peroral pancreatoscopy with biopsy helps diagnose IPMN tumor extent in the main pancreatic duct.

Toshiki Entani, Banri Ogino, Jun Sakamoto, Hiroki Kawanaka and Nobuhiko Hayashi and Ichiro Yasuda

Third Department of Internal Medicine, University of Toyama, Toyama, Japan

Oral Presentation 22, APDW Theatre 1, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Background: Accurate diagnosis of the tumor extent in the main pancreatic duct (MPD) is important for determining the surgical method and resection line in the main duct type (MD-) and mixed type (MX-) intraductal papillary mucinous neoplasm (IPMN). Peroral pancreatoscopy (POPS) may play a valuable role in diagnosing it.

Aim: This study aimed to evaluate the utility of POPS with mapping biopsy in diagnosing the horizontal tumor extent in the MPD of MD- and MX-IPMN.

Methods: We retrospectively reviewed data from patients who underwent POPS and finally underwent surgical resection between July 2018 and October 2023 at our institution. Preoperative image findings and biopsy results were compared retrospectively with postoperative pathological findings.

Results: A total of 33 cases (22 males and 11 females with a median age of 74 years) were included in this study. They were classified as MD-IPMN in 10 patients and MX-IPMN in 23 patients for the preoperative images. The accuracy for detecting tumor extent in the MPD was 48% (16/33) for CT, 54% (18/33) for MRI, 75% (25/33) for EUS, 88% (29/33) for POPS, and 96% (32/33) for POPS with mapping biopsy. There were no POPS-related adverse events during the procedure. Mild pancreatitis occurred in 2 cases, and hyperamylasemia was noted in 5 cases after the procedure.

Conclusion: POPS with mapping biopsy demonstrated high performance in diagnosing the tumor extent in the MPD and is useful for determining the surgical method and resection line of MD-/MX-IPMN.

OP-22-05

A novel convolutional neural network for real-time diagnosis of early gastric cancer under endoscopy

Xueping Huang^1,2, Qianen He³, Liqian Qiu³, Hong Lin^1,2, Aiping Lin^1,2, Zhipeng Huang⁴, Baihe Wu⁵ and Qiuzhao Chen⁶

¹Fujian Provincial Hospital, Fuzhou, China; ²Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China; ³School of Physics and Information Engineering, Fuzhou University, Fuzhou, China; ⁴First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China; ⁵The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China; ⁶Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China

Oral Presentation 22, APDW Theatre 1, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objective: Accurate detection and localisation of early gastric cancer (EGC) lesions is crucial for improving patients’ survival. Existing deep learning-based EGC lesion segmentation methods can improve diagnostic efficiency, but are parameter-heavy and computationally intensive, and therefore unsuitable for practical real-time endoscopy. We aim to tackle this problem.

Materials and Methods: A novel lightweight segmentation network was developed for highly efficient segmentation of EGC lesions. We compared the segmentation performance of this method with the state-of-the-art ones on a dataset of 3,620 white light images of EGC from four different hospitals. To put this method into practice, a PyQt5-based intelligent processing platform was proposed to demonstrate its potential for clinically-assisted diagnosis.

Results: Our study showed that the processing speed of the new method can reach 55.2 frames per second, the segmentation IoU 69.96%, and Dice 82.32%. The developed platform successfully realize the proposed network and can assist EGC diagnosis.

Conclusion: Our method outperformed others in terms of balancing accuracy and efficiency. We offers a promising clinical application for the real-time diagnosis of EGC.

OP-22-06

Esophagogastric sharp foreign bodies can be removed safety by endoscope with a condom-type urinary catheter.

Ayako Kubota, Tatuki Higashi, Ryuya Suzuki, Asuto Nagai, Mituri Tanida, Atsuki Maeda, Yuriko Shigehisa, Shougo Yano, Rikiya Daike, Takehiro Iwasaki, Michiyo Okazaki and Kunihisa Uchita

Kochi Red Cross Hospital, Kochi, Japan

Oral Presentation 22, APDW Theatre 1, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Background: A very sharp foreign body in upper GI tract is difficult to remove by endoscopy. It sometimes occurs severe complications such as esophageal perforations. Clasp dentures are popular and particularly challenging to be removed because they have very sharp metallic claws. We have been utilizing condom-type urinary catheters which attached to the tip of endoscope to remove foreign body. In this report, we examined the safety and usefulness of this method for removal of clasp dentures.

Methods: From May 2021 to May 2024, 17 cases of endoscopic foreign body were removed using condom catheter at Kochi red cross hospital. 5 of these cases were clasp dentures were classified as Group A. As a historical control, we classified 6 clasp denture cases which had been removed without condom catheter from April 2018 and April 2021 as Group B. We compared that the time required for foreign body removal, successful and complication rate in both Group A and Group B respectively. All cases were performed after obtaining adequate informed consent under the Ethics Committee approval.

Results: The average procedure time in Group A and Group B was 33 minutes and 69 minutes respectively. Though all cases could be removed without any complications in Group A, 60% of cases experienced complications such as pharyngeal lacerations or perforations, and one case couldn’t be removed due to piriform recess perforation in Group B

Conclusion: The condom catheter is very useful to take out very sharp foreign bodies such as clasp-retained denture by endoscope.

OP-22-07

Utilization of computed tomography-scan as guide for patients with relative contraindications to PEG tube insertion

Laurence Laurel, Regina Dimaculangan, Marvin Basco, Rafael Mendoza, Federico Peralta IV and Jasmin Gondayao

St. Luke's Medical Center- Global City, Taguig, Philippines

Oral Presentation 22, APDW Theatre 1, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Background: Percutaneous endoscopic gastrostomy (PEG) provides essential nutritional support for patients with functional gastrointestinal tracts but impaired swallowing. PEG insertion can be challenging in patients with anatomical complications. This study evaluates the outcomes of CT-guided PEG insertion in a tertiary hospital of a developing nation.

Methods: We conducted a retrospective case series of seven patients undergoing CT-guided PEG insertion from January 2021 to December 2023. Patients had relative contraindications for standard PEG insertion, including previous abdominal surgeries and anatomical abnormalities. Low-dose CT scans guided the trocar and PEG tube placement, ensuring precise anatomical orientation and minimizing complications. Data were collected on demographics, PEG indications, procedural success, complications, and follow-up outcomes.

Results: The cohort included five males and two females, with a mean age of 82 years. PEG indications were neurological disorders (5 patients) and cancer cachexia (2 patients). Relative contraindications included failure to transilluminate (71%) and postoperative anatomical difficulty (29%). The CT-guided PEG insertion success rate was 86%, with no major complications reported. Minor complications occurred in four patients (57%), including two peristomal infections, one buried bumper syndrome, and one case of tumoral bleeding; all resolved with conservative management. Three-month follow-up showed all patients maintained adequate nutritional status without further complications.

Conclusion: CT-guided PEG insertion is a viable and safe alternative for patients with relative contraindications to standard PEG techniques. This study demonstrates its feasibility and effectiveness in a tertiary hospital in a developing nation, highlighting its potential to improve outcomes in challenging cases.

OP-22-08

Endoscopic features of gastric intestinal metaplasia using a novel texture and color enhancement imaging (TXI)

Lai Ying Leung, Siew Fung Victor Hau, Chi Ying Jacquelyn Fok, Ka Kei Stephen Ng, Hon Chi Yip, Shannon Melissa Chan, Kwok Wai Enders Ng and Wai Yan Philip Chiu

Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong

Oral Presentation 22, APDW Theatre 1, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: Gastric intestinal metaplasia (GIM) is a well-known precursor lesion for gastric cancer. Light blue crest (LBC) and white opaque substance (WOS) were identified as sensitive markers for GIM under Narrow Band Imaging magnification endoscopy (NBI-ME). Recently, a novel imaging modality with texture and color enhancement imaging (TXI) provides brighter and high contrast images. In this study, we aim to investigate the endoscopic features of GIM using TXI mode in a prospective manner.

Materials and Methods: Consecutive patients undergoing OGD using the novel imaging system (EVIS X-1, Olympus Medical Corporations) with TXI mode were recruited. Photo documentation was performed with white light imaging (WLI), NBI and TXI. Endoscopic target areas of GIM and non-GIM were identified based on the presence of LBC sign and WOS under magnified NBI mode. Morphology and color were assessed under TXI mode. Biopsies were taken at the corresponding site for histological confirmation.

Results: From June 2020 to April 2024, 139 patients with 170 target areas were recruited. The mean age was 65.71+/-9.81 years, with male predominance (82:57). 4.32% and 38.84% had active and history of Helicobacter Pylori infection. Presence of either an elevated lesion or magenta color under non-magnified TXI mode correlated with histological evidence of GIM with sensitivity of 98.08% (95%CI: 96.01-100%), specificity of 77.27% (95%CI: 70.97-83.57%), positive predictive value of 87.18% (95%CI: 82.15-92.21%), negative predictive value of 96.23% (95%CI: 93.36%-99.09%), and accuracy of 90% (95%CI: 85.49-94.51%).

Conclusion: A magenta colored elevated lesion under TXI mode could be a characteristic finding of GIM.

OP-22-09

Outpatient CSP for small duodenal tumors with sedation using remimazolam

Kurato Miyazaki, Atsushi Nakayama, Yuri Imura, Shouma Murata, Daisuke Minezaki, Kentaro Iwata, Hinako Sakurai, Anna Tojo, Teppei Masunaga, Mari Mizutani, Motoki Sasaki, Michiko Nishikawa, Yusaku Takatori, Teppei Akimoto, Tomohisa Sujino, Shintaro Kawasaki, Hideomi Tomida, Noriko Matsuura, Kaoru Takabayashi, Takanori Kanai, Naohisa Yahagi and Motohiko Kato

Keio University Hospital, Tokyo, Japan

Oral Presentation 22, APDW Theatre 1, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: Remimazolam, which is a novel ultrashort-acting benzodiazepine, has several characteristics, which causes less circulatory depression, has a very short half-life, and can be antagonized by flumazenil. Focusing on these characteristics, we introduced remimazolam in outpatient cold snare polypectomy (CSP) for small duodenal tumors, which is performed as a day surgery at our hospital. Although a few reports already showed the usefulness of remimazolam in screening endoscopy, we thought it might be also useful in outpatient procedure, which could be performed in very short time. We will report the efficacy and safety of remimazolam in outpatient CSP, along with its treatment outcomes.

Materials and Methods: From December 2023 to April 2024, 20 consecutive patients who underwent outpatient CSP for duodenal tumors were included. We sedated patients with remimazolam and measured the time taken to recover from sedation. The day after the procedure, we phoned the patients to deny the delayed adverse events and evaluated their satisfaction with sedation on a five-point scale as well as the operator's satisfaction with sedation.

Results: 70% of patients were male and median age was 63. The median total dose of remimazolam during the procedure was 4mg and the median recovery time was 36 minutes, no intraprocedural and delayed adverse events occurred, and the median patients’ and operators’ satisfaction with sedation was five.

Conclusions: Operators could perform CSP without stress and patients could be received the procedures with very high satisfaction. Remimazolam might be effective and safe sadation in day surgery for small duodenal tumors.

OP-22-10

Long term efficacy of surveillance of esophageal cancer using Narrow-Band Imaging

Yasuaki Nagami¹, Masaki Ominami², Shusei Fukunaga², Taishi Sakai⁵, Masafumi Yamamura³ and Hiroaki Minamino⁴

¹Osaka Social Medical Center Hospital, Osaka City, Japan; ²Osaka Metropolitan University Graduate School of Medicine, Osaka City, Japan; ³Ishikiriseiki Hospital, Osak, Japan; ⁴Baba Memorial Hospital, Osak, Japan; ⁵Ohno Memorial Hospital, Osaka, Japan

Oral Presentation 22, APDW Theatre 1, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: Narrow Band Imaging (NBI) allows the detection of early-stage esophageal squamous cell carcinoma (ESCC) with less discomfort compared to iodine staining. However, NBI's sensitivity is reportedly lower, and long-term surveillance results are lacking. This prospective single-arm study aimed to determine if NBI surveillance effectively detects early-stage ESCC over an extended period.

Materials: Eligible patients underwent endoscopic resection for ESCC diagnosed within T1a-LPM (curative resection). Exclusion criteria included stricture, history of esophagectomy or chemoradiotherapy, and poor prognosis. Patients underwent NBI surveillance endoscopy every 6 months, and new lesions were treated. The primary outcome was the 5-year successful surveillance rate, defined as 1 – (patients with metachronous recurrence of non-curative lesions beyond T1a-LPM / all patients). Results were compared to a historical control group using iodine staining.

Results: From 2014 to 2018, 94 out of 96 enrolled patients were analyzed. The historical control group included 151 patients treated between 2006 and 2014. Median ages were 71 in the NBI group and 69 in the iodine group. The 5-year metachronous rates were 13.5% (NBI) and 28.6% (iodine). The 5-year successful surveillance rate was 98.8% (95% CI; 91.8-99.8) in the NBI group and 96.4% (95% CI; 91.5-98.5) in the historical control group. The intergroup difference was 2.4% (95% CI; -6.7 to 8.3), with the lower limit of the 95% CI falling below the non-inferiority margin of -5.0%.

Conclusions: NBI surveillance effectively detects early-stage ESCC in the long term. However, non-inferiority to iodine staining was not demonstrated, likely due to the small sample size.

OP-22-11

Intra-tumour 32P implantation with chemotherapy improved survival of pancreatic cancer: a propensity-score weighted landmark analysis

Amanda Lim^1,2, Darshan Nitchingham¹, Jana Bednarz^2,3, Madison Bills⁴, Laxmi Lanka⁵, Berry Allen⁶, Alvin Tan⁶, William Hsieh⁴, Benjamin Crouch⁴, Joshua Zobel¹, John-Edwin Thomson⁷, Euling Neo⁷, Romina Safaeian¹, Edmund Tse^1,2, Christopher Rayner^1,2, Andrew Ruszkiewicz^2,8,9, Jayden Wong¹⁰, Nimit Singhal¹¹, Dylan Bartholomeusz^1,4, Frank Weilert¹² and Nam Nguyen^1,2

¹Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia; ²The University of Adelaide, Adelaide, Australia; ³SAHMRI Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide, Australia; ⁴Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia; ⁵Department of Radiology, Waikato Hospital, Hamilton, New Zealand; ⁶Department of Nuclear Medicine, Waikato Hospital, Hamilton, New Zealand; ⁷Department of Hepatobiliary Surgery, Royal Adelaide Hospital, Adelaide, Australia; ⁸Surgical Pathology, SA Pathology, Adelaide, Australia; ⁹Centre of Cancer Biology, University of South Australia, Adelaide, Australia; ¹⁰Department of Oncology, Waikato Hospital, Hamilton, New Zealand; ¹¹Department of Oncology, Royal Adelaide Hospital, Adelaide, Australia; ¹²Department of Gastroenterology, Waikato Hospital, Hamilton, New Zealand

Oral Presentation 22, APDW Theatre 1, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: The addition of phophorus-32 (32P) microparticle (OncoSil) intra-tumoural implantation to standard chemotherapy has revealed encouraging results for patients with locally advanced pancreatic cancer (LAPC). This study aimed to compare the outcomes of patient who were treated with FOLFIRINOX alone versus FOLFIRINOX with 32P implantation.

Materials and Methods: A retrospective comparison with landmark analysis and propensity score weighting analysis of LAPC patients who were treated with FOLFIRINOX alone versus FOLFIRINOX with 32P implantation was performed. Landmark analysis was used to address immortal time bias. PSWA was applied to reduce the impact of selection bias. The primary outcome was overall survival at 24 months after first-line treatment initiation, with treatment effect expressed as restricted mean survival time (RMST).

Results: 101 patients with LAPC were included in the landmark, propensity-score weighted analyses (35 OncoSil/chemotherapy, 66 chemotherapy alone). Compared to chemotherapy alone group, the tumour size at 6 months was 12.8mm smaller (95% CI 4.69-20.9, p=0.002) with patients with combination therapy. The probability of downstaging was also 22.3% higher (95% CI 5.12%, 39.5%, p=0.03) in patients with combination therapy. The RMST was 112 days longer for patients with OncoSil/chemotherapy (459 days, 95%CI 393-536) compared to chemotherapy only (347 days, 95% CI 308-392, P<0.0001).

Conclusion: This is the first comparative study between combined chemotherapy and 32P microparticles implantation against standard therapy for patients with LAPC, showing better survival, disease control and downstaging. These findings warrant further evaluation with a larger randomized trial.

OP-23-01

Unexpected intrahepatic cholangiocarcinoma after cholecystectomy and removal of choledocholithiasis

Kezia Christy¹ and Alma Wijaya²

¹General Surgery Department, Padjajaran Univeristy, Bandung, Indonesia; ²Digestive Surgery Division, General Surgery Department, Padjadjaran University, Bandung, Indonesia

Oral Presentation 23, APDW Theatre 2, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Introduction: Etiology of intrahepatic cholangiocarcinoma is not clear. Some studies reported that distal bile duct stones have a correlating with development of the extra-hepatic and intrahepatic cholangiocarcinoma. Some studies also showed cholecystectomy could decrease the risk of cholangiocarcinoma development. We present a case of a 37-y.o- male with intrahepatic cholangiocarcinoma after cholecystectomy and common bile duct exploration due to choledocholithiasis 1 year ago.

Case Description: A 37-year-old male with a history of cholecystectomy and bile duct exploration due to choledocholithiasis one year ago, came to the emergency room due to yellowish all over his body since three months ago. Physical examination found a subfebrile temperature and icteric sclera. MRCP showed intrahepatic mass with extra and intrahepatic bile duct dilatation. Laboratory showed an increase of total, direct, and indirect bilirubin (22.368; 17.018; 5.350 mg/dL), a slight increase in AST (56 U/L) with normal ALT (44 U/L). We also found elevated tumor markers CEA 15.9 ng/mL and CA 19-9 >1200 U/mL, but normal AFP (<2.00 ng/mL). Therefore, we performed PTBD and improvement in his jaundice.

Discussion: Some studies showed choledocholithiasis and cholecystolithiasis were risk factors for development of intrahepatic cholangiocarcinoma, and cholecystectomy could decrease the risk of cholangiocarcinoma development. The mechanism was still unclear but cholestasis, changes in bile composition, relevant metabolic syndromes and reflux of the bile in choledocholithiasis may result in chronic inflammation of the intrahepatic bile duct epithelium.

Conclusion: Bile duct stone including choledocholithiasis should be considered as possible bile duct obstruction due to malignancies including intrahepatic cholangiocarcinoma.

OP-23-02

Multiple Plastic Stent in Refractory Pancreatic Duct Stricture in Chronic Pancreatitis: Response and Recurrence

Pritam Das and Samir Mohindra and S Rakesh Kumar and Dhruv Thakur and Gourav Borah and Naganath K Wodeyar and Kartik Balankhe and Prathap Reddy

KGMU, Lucknow, India

Oral Presentation 23, APDW Theatre 2, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Introduction: Refractory Pancreatic Duct stricture is defined as symptomatic dominant stricture that persists or relapse after 1year of pancreatic stent placement. The aim of this study is to evaluate the efficacy, safety, and long-term outcomes of multiple plastic stents in refractory PD Stricture.

Patients and Methods: This study includes retrospective analysis of prospectively maintained data records, kept in a single tertiary centre from Jan 2017 to September 2022. All chronic pancreatitis with dominant stricture refractory to endotherapy were included in this study.

Results: The mean duration of multiple stent deployment was 13.6 ± 11.6 months with mean number of sessions being 3.1 ± 2.5. Endoscopic Response to therapy was seen in 27 (90%) patients. The mean stent free follow up period was 38.6 ± 19.1 months. Recurrence of stricture was documented in 5 (18.5%) patients. The mean stent-free duration was 33.6 ± 20.9 months. Repeated endotherapy had successful outcomes in 4 (14.81%).

In case of patients with chronic alcohol consumption, the mean duration of endotherapy was 11.92 ± 6.25 months. The mean duration of multiple stent deployment was 10.7 ± 12.0 months, with mean number of sessions being 2.3 ± 2.3. Successful therapeutic response was seen in 11 (84.61 %) patients.

Discussion: In our study, endoscopic therapeutic response was seen in 90 % patients. In our patient group, gradual progressive multiple stenting was done. Alcohol consumption has been associated with more fibrotic strictures. The successful endoscopic response, mean number of sessions, stricture recurrence was similar to the overall patient group.

OP-23-03

Role and mechanism of Myonectin in severe acute pancreatitis: a skeletal muscle-pancreas crosstalk

Xiaowu Dong¹, Weiwei Luo¹, Yaodong Wang¹, Qingtian Zhu¹, Chenchen Yuan¹, Weiming Xiao¹, Weijuan Gong¹, Guotao Lu¹, Xiaolei Shi¹ and Jin Li²

¹Yangzhou University, Yangzhou, China; ²Shanxi Medical University, Taiyuan, China

Oral Presentation 23, APDW Theatre 2, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: Severe acute pancreatitis (SAP) is associated with high mortality rates and diverse complications, notably skeletal muscle atrophy, which significantly worsens its prognosis. Despite its clinical importance, the mechanistic understanding of the interplay between skeletal muscle and the pancreas in SAP is currently limited. Our study aims to elucidate this "organ crosstalk" and its potential implications.

Materials and Methods: We induced an SAP mouse model by pancreatic duct ligation (PDL) and assessed pancreatic necrosis, skeletal muscle atrophy, and Myonectin expression levels. Recombinant Myonectin protein was administered both in vivo and in vitro to evaluate its impact on acinar cell necrosis. Mechanistic insights were derived from RNA-seq data analysis and experimental validation. Serum samples from patients with AP and healthy controls were collected to examine the relationship between serum Myonectin levels and disease severity.

Results: The mouse model displayed severe pancreatic necrosis, skeletal muscle atrophy, and elevated Myonectin levels, with Myonectin administration exacerbating disease severity. We identified iron accumulation-induced ferroptosis as a significant pathway contributing to Myonectin-mediated acinar cell necrosis. Thirty healthy controls and fifty-two AP patients of varying severity were included in the serum samples and clinical data analysis. Analysis of the serum samples revealed significantly higher Myonectin levels in AP patients, showing correlation with disease severity (R=0.28, P=0.041).

Conclusion: Our results emphasize the crucial role of Myonectin in SAP progression and its potential as a prognostic marker for disease severity in AP patients. This study enhances our understanding of SAP pathophysiology and identifies potential therapeutic targets for intervention.

OP-23-04

Systemic Inflammatory Response Index for Predicting Acute Pancreatitis Severity in a Vietnamese Setting

Thong Duy Vo, and Yen Hoang Thi Dao and Tien Manh Huynh and Phat Tan Ho and Duy Thanh Tran

University Medical Center, Ho Chi Minh, Viet Nam

Oral Presentation 23, APDW Theatre 2, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: This study aims to evaluate the prognostic value of the Systemic Inflammatory Response Index (SIRI) in predicting severe acute pancreatitis (SAP) among patients in Vietnam.

Materials and Methods: This prospective, cross-sectional study included 207 patients diagnosed with acute pancreatitis (AP) at a tertiary hospital in Ho Chi Minh City from May to September 2023. Patients were stratified into non-severe and severe AP groups based on clinical criteria. The SIRI was calculated using the formula: neutrophil × monocyte / lymphocyte. The discriminative ability of SIRI was analyzed using multivariate logistic regression and receiver operating characteristic (ROC) curves, and its performance was compared with the BISAP score.

Results: Out of 207 patients, 78.7% were classified as having non-severe AP, while 21.3% were classified as SAP. The median SIRI was significantly higher in the severe group (12.0) compared to the non-severe group (4.9) (p < 0.001). Multivariate analysis identified SIRI (OR = 1.623, p = 0.001) as an independent predictor of SAP. ROC curve analysis revealed that a SIRI cut-off of 7.82 had an area under the curve (AUC) of 0.737. Combining SIRI with the BISAP score improved the predictive performance (AUC = 0.820) and sensitivity (90.91%) for SAP (p < 0.001).

Conclusion: SIRI, especially when combined with the BISAP score, shows significant potential as a prognostic tool for predicting the severity of acute pancreatitis in the Vietnamese clinical setting. The integration of SIRI into routine clinical practice can enhance early risk stratification and optimize patient management strategies.

OP-23-05

Current Status of Liquid-Based CGP Testing in Pancreatic Cancer: A Study Using C-CAT Data

Kazunaga Ishigaki¹, Yurie Tokito², Go Endo², Naminatsu Takahara² and Mitsuhiro Fujishiro¹

¹Department of Clinical Oncology, The University of Tokyo Hospital, Tokyo, Japan; ²Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Oral Presentation 23, APDW Theatre 2, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objective: In August 2021, liquid-based comprehensive genomic profiling (CGP) testing using blood samples received insurance approval in Japan, allowing testing even when sufficient tissue samples for CGP testing are not available. This study aimed to evaluate the performance of liquid-based CGP (L-CGP) testing for unresectable pancreatic cancer (PC).

Methods: We analyzed 1440 cases of unresectable PC registered in the C-CAT database, which underwent L-CGP testing from November 2020 to March 2023. Clinical backgrounds and the presence of mutations in the big four genes, including KRAS, were investigated.

Results: Among the 1440 cases, 786 were male (55%), and the median age (range) was 67 (27-89) years. Distant metastases were found in 1233 cases (86%), with liver metastases in 575 cases (40%), lung metastases in 314 cases (22%), and peritoneal dissemination in 178 cases (12%). Mutations in KRAS, TP53, CDKN2A, and SMAD4 were found in 675 (47%), 743 (52%), 174 (12%), and 102 (7%) cases, respectively. Multivariate analysis of the presence of KRAS mutations showed that KRAS mutations were more likely to be detected in cases with PS 1 or higher (odds ratio: OR 1.45, P<0.01), adenocarcinoma (OR 1.52, P<0.01), distant metastasis (OR 1.96, P<0.01), and liver metastasis (OR 3.27, P<0.01), whereas KRAS mutations were less likely to be detected in cases with peritoneal dissemination (OR 0.50, P<0.01). Submission of CGP testing before regimen change was not identified as a significant factor.

Conclusion: The current L-CGP testing has limitations, and further improvements in detection sensitivity are necessary.

OP-23-06

Clinico-demographic Characteristics, Pain Severity, Complications and Pancreatic Morphology in Different Pain Patterns in Chronic Pancreatitis

Mohammad Shohidul Islam¹, Masudur Rahman¹, Abu Sayeed Mustafa¹, Mir Jakib Hossain¹, Mahmud Hasan¹, Golam Kibria¹ and Rupjyoti Talukdar²

¹Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh; ²Asian Institute of Gastroentrology, Hyderabad, India

Oral Presentation 23, APDW Theatre 2, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: To study on different pain patterns and their comparisons in respect to clinico-demographic characteristics, morphological changes and complications in Chronic Pancreatitis(CP).

Methods: Consecutive patients with CP (fulfilling M-ANNHEIM criteria) attending at Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh were classified for pain patterns. Patients with continuous or intermittent pain were compared for demography, risk factors, clinical characteristics, complications and morphological changes in imaging.

Results: Of 301 patients were included [mean age 33.45±13.28 years; male 176(58.5%)], abdominal pain was present in 281/301(93.4%) patients. History of alcohol intake and smoking were present in 5(2%) and 54(21%) patients. Diabetes mellitus, steatorrhea and jaundice were present in 97 (38%), 77(30%) and 9(3.6%) patients, respectively. Median duration from onset of pain to diagnosis of CP was 607 days (range 0-1400 days). Data on pain patterns were available in 253/301(84.1%) patients. Most frequent pattern of pain was intermittent pain attacks without pain between them (71.5%) followed by persistent pain with pain attack (23.7%), persistent pain with slight fluctuation (2.8%) and pain attack with pain between them (2%) [figure 1]. Continuous type of pain was present in 72(28.5%) patients and 181(71.5%) had intermittent pain. There was no statistically significant difference in demographics, risk factors, pain severity, rate of complications and morphology on imaging between continuous and intermittent pain-groups (P<0.05 significant).

Conclusion: The predominant pain-pattern in CP is intermittent type. There are no differences in demography, clinical characteristics, risk factors, frequency of complications and morphological appearance between intermittent and continuous pain-groups among patients with CP.

OP-23-07

The effect of cholecystectomy on lipid profile

Young Hun Jeon and Hoonsub So

Ulsan University Hospital, Ulsan, South Korea

Oral Presentation 23, APDW Theatre 2, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Background: Cholecystectomy, the surgical removal of the gallbladder, is a widely accepted treatment for gallstone diseases. The main function of the gallbladder is to concentrate and store bile for lipid digestion and aid in cholesterol excretion from the liver. However, the impact of gallbladder removal on lipid profiles has shown inconsistent results in previous studies. This study aims to compare lipid profiles before and after cholecystectomy using data from medical check-ups.

Materials and Methods: A retrospective study was conducted by reviewing medical check-up data from Ulsan University Hospital between January 2009 and March 2020. Participants' demographic information, medical history, clinical measurements, laboratory tests, and lipid profiles were collected. Lipid profiles were compared pre- and post-cholecystectomy using paired t-tests and generalized estimating equations. Propensity score matching was used to compare the cholecystectomy group and non-cholecystectomy group to minimize confounding factors.

Results: A total of 612 cholecystectomy patients were included, and 2:1 propensity matching was done, resulting in 1,054 matched controls from an initial pool of 32,296 controls. Total cholesterol (TC) and triglycerides (TG) decreased significantly in the cholecystectomy group compared to the non-cholecystectomy group.

Conclusion: Cholecystectomy may be associated with changes in lipid profiles, particularly in reducing TC and TG levels. These changes could potentially affect cardiovascular risk in individuals undergoing cholecystectomy.

OP-23-08

Early feeding in Post-endoscopic retrograde cholangiopancreatography pancreatitis: a randomized controlled trial

Jung Hyun Jo¹, Jae Min Lee², Dong Kee Jang³, Jung Wan Choe⁴, Sung Yong Han⁵, Young Hoon Choi⁶, Eui Joo Kim⁷, Min Kyu Jung⁸ and Sang Hyub Lee⁹

¹Yonsei University College of Medicine, Seoul, South Korea; ²Gyeongsang National University College of Medicine, Changwon, South Korea; ³Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea; ⁴Korea University Ansan Hospital, South Korea; ⁵Pusan National University Hospital, Busan, South Korea; ⁶Samsung Medical Center, Seoul, South Korea; ⁷Gil Medical Center, Incheon, South Korea; ⁸Kyungpook National University, Daegu, South Korea; ⁹Seoul National University Hospital, Seoul, South Korea

Oral Presentation 23, APDW Theatre 2, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Background: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a frequent complication affecting 5–10% of ERCP patients. While early oral refeeding (ERF) has shown promising results in acute pancreatitis (AP), its impact on PEP remains unexplored. Thus, our study assesses the safety and efficacy of ERF versus delayed refeeding (DRF) in mild PEP patients.

Methods: In this multicenter trial, eligible patients were randomly assigned in a 1:1 ratio to ERF or DRF groups. ERF began 24 hours after PEP diagnosis, while DRF started after normal bowel sounds and reduced pain. The diet progressed from sips of water to soft food, considering tolerance. Refeeding paused if pain reached ≥5 points or if intake was refused due to pain. Resumption required normal amylase/lipase levels, pain relief, and restored bowel movement. Discharge criteria included patient well-being >24 hours post-diet. Primary outcome included PEP hospitalization duration; secondary outcomes included severe AP, readmission rate (<30 days), and PEP-related mortality/morbidity rates.

Results: Between February 2021 and December 2022, 80 patients (40 in each ERF and DRF group) were enrolled in 9 referral centers. Baseline characteristics and procedural parameters showed no significant differences between groups. Initial PEP severity was similar. During refeeding, four ERF and three DRF patients had refeeding interruptions. ERF significantly reduced PEP hospitalization duration compared to DRF (2.9±1.6 vs. 3.8±2.0 days, p=0.032). Rates of severe AP, readmission (<30 days), and mortality/morbidity related to PEP were similar between groups.

Conclusion: Early oral refeeding significantly reduced PEP patients’ hospital stays and did not increase PEP-related safety issues.

OP-23-09

Alterations in Bile Microbiome Associated with Endoscopic Biliary Stenting

Atsuto Kayashima^1,2, Eisuke Iwasaki², Seiichiro Fukuhara^1,2, Tomohisa Sujino², Kentaro Miyamoto², Takaoki Hayakawa², Haruka Okada², Yuki Nakajima², Shintaro Kawasaki², Masayasu Horibe² and Takanori Kanai²

¹Department of Gastroenterology and Hepatology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; ²Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan

Oral Presentation 23, APDW Theatre 2, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: Traditionally, bile was considered sterile, but recent studies have shown a diverse microbiome in healthy bile. The causative bacteria in acute cholangitis differ with the presence of biliary stents, but the reasons remain unclear. We hypothesized that the presence of biliary stents causes constant changes in the bile microbiome.

Materials and Methods: We prospectively studied naive papilla patients requiring endoscopic retrograde cholangiopancreatography for mainly papillectomy (n=25, control group) and patients after endoscopic biliary stenting for stent exchange or removal (n=10, EBS group). All patients had no acute cholangitis and bile were collected via endoscopic retrograde cholangiopancreatography without prophylactic antibiotics. Bile samples were profiled using 16S rRNA sequencing (V3-V4).

Results: Metagenomics analysis revealed biliary dysbiosis with biliary stents. The EBS group showed significantly lower alpha diversity (Pielou's evenness, p=0.0486) compared to the control group. There was significant difference in beta diversity between two groups (Unweighted Unifrac, p=0.001). Analysis of composition of microbiomes revealed a higher proportion of Enterococcus in the EBS group.

Conclusion: It was suggested that endoscopic biliary stenting may be accompanied by changes in the bile duct microbiome, particularly characterized by an increase in Enterococcus spp. This finding underscores the importance of considering microbial shifts when evaluating patients with biliary stents, as these changes could have implications for the management and treatment of biliary infections.

OP-23-10

One-third of patients with idiopathic recurrent acute pancreatitis develop chronic pancreatitis on long-term follow-up

Gauri Kumbhar, Reuben Thomas Kurien and Sudipta Dhar Chowdhury

Christian Medical College, Vellore, India

Oral Presentation 23, APDW Theatre 2, Exhibition Hall, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: Idiopathic Recurrent Acute Pancreatitis (RAP) is defined as ≥2 episodes of AP without a specific cause. Data on long-term outcomes of patients having IRAP is limited. This study aimed to analyse the long-term outcomes of patients with IRAP.

Materials and Methods: In this prospective study, 48 patients with IRAP with minimum follow up of 6 months were included. Baseline data regarding demographic variables, symptoms, medication details were noted. On 3-6 monthly follow-up, history of symptoms, other relevant investigations and a cross-sectional imaging(CT abdomen or MRCP) or Endoscopic Ultrasound was performed at an interval of 1-2 years to look for features of CP, if the initial CT scan was normal.

Results: 48 patients with IRAP were included of which 36(75%) were males. The mean number of episodes per year was 3.2(1.4). The median duration of follow up was 4.5(IQR 1-6)years. During follow-up, 17(35.4%) patients developed imaging features suggestive of chronic pancreatitis. 19(39.6%) had pancreatic exocrine insufficiency while 7(14.6%) had pancreatic endocrine insufficiency. 21(43.8%) patients complained of ongoing pancreatic pain(type A) with a mean Izbicki pain score of 37.3(10.2). 19(39.6%) were on regular pain medications, 20(41.7%) were prescribed pancreatic enzyme replacement therapy, and 9(18.6) were on regular antioxidants. Univariate logistic regression analysis demonstrated that the duration of follow-up (OR=1.36, 95%CI:1.06-1.74,p=0.01) and the annual frequency of acute episodes (OR=2.24, 95%CI:1.22-4.11,p=0.01) significantly predicted the progression to chronic pancreatitis.

Conclusion: Around one-third of the patients with IRAP progressed to develop chronic pancreatitis and its development was predicted by the duration of follow-up and annual frequency of episodes.

OP-24-01

Cytomegalovirus infection and relapse in patients having idiopathic ulcerative colitis under remission: A prospective study

Ajay Kumar Jain¹, Vikas Raikwar¹, Suchita Jain², Shohini Sircar¹, Priyanka Bhagat³, Nanda Hemwani⁴ and Satish Phatak³

¹Dept of Gastroenterology, Indore, India; ²Dept of Radiodiagnosis & Imaging, Indore, India; ³Dept of Pathology, Indore, India; ⁴Dept of Microbiology, Indore, India

Oral Presentation 24, Uluwatu 1, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: To study the prevalence of CMV infection in patients of UC presenting with relapse and the effect of oral antiviral drugs on the disease course in these patients.

Methods: The study subjects were diagnosed patients of ulcerative colitis with recent-onset symptoms suggestive of relapse. Relapse was defined as more than six stools per day mixed with blood and mucus and a UCEIS score of more than four on Sigmoidoscopy. Exclusion criteria were patients with solid organ transplantation or biological therapy. All patients positive for CMV infection were treated with valganciclovir for 21 days. Post-treatment, all were reassessed every eight weeks.

Results: A total of 90 diagnosed UC patients came for follow-up during the study period. Out of which, 47 had relapse of symptoms. 14 out of these 47 patients with relapse, (29.7%) had CMV infection proven by RT PCR for CMV on tissue samples taken from the rectum. All patients with CMV infection responded to oral valganciclovir, given in two doses for 21 days. All patients showed improvement with two to three well-formed stools without mucus or blood at the end of therapy. They maintained their remission on their initial maintenance therapy at the end of 8 and 16 weeks. None of the patients with relapse treated with valganciclovir required steroids or any add-on immune-modulatory drugs.

Conclusions: 1. This study highlights that CMV infection may be a significant cause of relapse. 2. Treatment with oral antiviral therapy in this group leads to effective disease control with remission.

OP-24-02

Linking microbial genes to mucosal metabolites uncovers host-microbial interactions during drug therapy for ulcerative colitis

Lingjuan Jiang and Hong Yang

Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

Oral Presentation 24, Uluwatu 1, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: The severity of Ulcerative colitis (UC) is contingent upon the state of the colon mucosa, and patients with UC display varying clinical reactions to drugs. Recent research has identified a connection between gut microbiota and ulcerative colitis. However, the specific microbial genes and metabolites associated with mucosal remission of the disease are unclear.

Materials and Methods: We established an approach to link disease-associated microbes to host mucosal metabolites by integrating multi-omics. Participants included healthy controls and individuals with UC, the responding group (UCR) and the ineffective group (UCA) in drug treatment. The identified differential metabolite associated with disease activity was subsequently assessed in a dextran sulfate sodium (DSS)-induced colitis mouse model to evaluate its impact, followed by further in vitro cell experiments to elucidate the underlying mechanisms.

Results: The levels of secondary bile acids were found to have a significant negative association with intestinal inflammation in drug treatment. Integrated analysis of metagenomics and metabolomics revealed that host mucosal bile acid metabolites were negatively associated with the bile acid synthesis-related genes cbh in microbial genomes. Administration of the secondary bile acid ameliorated mucosal inflammation in a mouse model of colitis, reducing the proportion of Th17 and pathogenic Th17 cells. This secondary bile acid acts as an immunomodulatory metabolite, suppressing the glycolysis in Th17-polarizing T cells and affecting cellular metabolic reprogramming to inhibit Th17 cell differentiation.

Conclusion: These findings suggest that microbiomes contributes to disease-associated metabolite changes, underscoring the importance of these interactions in disease pathology and treatment.

OP-24-03

Impact of Early Aggressive Treatment on Long-term Patterns of Biochemical Markers in Inflammatory Bowel Disease

Yu Kyung Jun¹, Yonghoon Choi¹, Cheol Min Shin¹, Young Soo Park¹, Nayoung Kim¹, Dong Ho Lee¹, Soyeon Ahn² and Hyuk Yoon¹

¹Seoul National University Bundang Hospital, Seongnam-si, South Korea; ²Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, South Korea

Oral Presentation 24, Uluwatu 1, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: This study aimed to classify the long-term disease course of patients with inflammatory bowel disease (IBD) based on biochemical markers and to evaluate clinical factors associated with different disease courses.

Materials and Methods: A total of 891 patients with IBD (ulcerative colitis [UC]: 635, Crohn’s disease [CD]: 256) were enrolled. Distinct trajectories of C-reactive protein (CRP) and fecal calprotectin (FCP) following IBD diagnosis were identified using a latent class mixed model. Multinomial logistic regression was employed to evaluate the relationship between different trajectories and clinical variables.

Results: The model optimally grouped patients with IBD into three trajectories. Group 1 achieved and maintained biochemical remission soon after IBD diagnosis. Group 2 took longer to reach biochemical remission. Group 3 had difficulty achieving biochemical remission for 5 years. In CD, early initiation (within 6 months after diagnosis) of immunomodulators (IMs) was associated with higher odds of being in Group 1 in the CRP latent class analysis, and early initiation of advanced therapy increased the likelihood of being in Group 1 in the FCP latent class analysis. For UC, CRP latent classes showed no significant clinical associations. However, in FCP latent classes for UC, a younger age at diagnosis and early initiation of IMs were associated with higher odds of being in Group 2 or 3, while current smoking increased the likelihood of being in Group 1.

Conclusion: Early aggressive treatment in CD patients was associated with better long-term control of biochemical markers, but this association was not in UC patients.

OP-24-04

Stricturing phenotype predisposes to small bowel and colorectal malignancy in Crohns disease

Kiran Kanjamala, Prakash Zacharias, Shibi Mathew, Hasim Ahamed, Remya Pai, Anwin Kurian, Swaran Kumar and Mathew Philip

Hepatology and Transplantation (LIGHT), Lisie Institute of Gastroenterology, Kochi, India

Oral Presentation 24, Uluwatu 1, November 23, 2024, 12:30 PM - 1:50 PM

Background: Carcinogenesis is a major complication in patients with inflammatory bowel disease (IBD).We report the data of Crohn’s disease(CD)related intestinal malignancy and its risk factors from our IBD cohort.

Methods: This study was a longitudinal cohort analysis of prospectively maintained database of 1416 CD patients diagnosed or under follow up from January 1st2013 to December 31st2023.

Results: 1416 patients were included(13037.9 person-years of follow up with mean age at diagnosis 27.62±11.8years,64.1% males,disease duration:9.2±6.7 years).Disease location was L1– 276(19.5%),L2– 225(15.9%),L3-754(53.2%) and isolated L4(11.4%). Most common disease phenotype was B1-1031(73.7%),B2-261(17.7%), B3-71(5%) and B2B3-53(3.7%).Eighteen(1.27%) developed intestinal malignancy in a mean duration of 15.9±10.3 years.Mean age at diagnosis of malignancy was 46.7±14.2 years.While the cumulative risk of developing malignancy was 0.32%, 1.42% and 5.92 % in the first, second and beyond the second decade of disease onset respectively, it was 1.41%, 3.56 % and 11.1% in stricturing disease.The sites of malignancy in descending order were colorectal malignancy10/18, carcinoma jejunum4/18, anal canal carcinoma 3/18 and carcinoma ileum1/18. Four (22.5%) of the above had malignancy at index presentation.Luminal bowel malignancy was only seen in stricturing disease(100%) while anal canal carcinoma was seen in chronic fistulising disease with anal canal stricture.On multivariate regression analysis, disease duration (odds ratio(OR)-1.099,p <0.001), increasing age of onset of disease(OR-1.058,p=0.004),stricturing phenotype(OR-3.04,p <0.001) and active smoking (OR-6.113, p=0.037) were associated with higher risk of malignancy.

Conclusion: The prevalence rate of intestinal malignancy was 1.27 % in our CD cohort.The risk of intestinal malignancy increased with duration of disease,increasing age of onset of disease,stricturing phenotype and active smoking.

OP-24-05

Comparison of gut microbiota in patients with Intestinal Tuberculosis and Crohn’s disease

Ajith C Kuriakose¹, Dilip Abraham², A J Joseph³, Ebby George Simon³, Sudipta Dhar Chowdhury³, Reuben Thomas Kurien³ and Amit Kumar Dutta³

¹Dept of Gastroenterology, MOSC Medical College Hospital, Kolenchery, India; ²Wellcome Trust Research Laboratory, G I Sciences, Christian Medial College, Vellore, India; ³Department of Gastroenterology, Christian Medical College, Vellore, India

Oral Presentation 24, Uluwatu 1, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: There is increasing evidence of microbial dysbiosis in Crohn’s disease(CD), however studies on microbial dysbiosis in Intestinal Tuberculosis(ITB) are lacking. We aimed to study and compare gut microbiota profile in patients with ITB and CD.

Materials and Methods: A total of 49 mucosal samples(inflammed site) were collected from patients with ITB (n=25), CD (n=24) during colonoscopy and then, 16S rRNA gene sequencing was performed using Illumina MiSeq platform. The QIIME2(Quantitative Insights into Microbial Ecology) bioinformatics pipeline was used for performing the microbiome analysis.

Results: Alpha diversity analysis revealed that Shannon(p=0.05) and Faith phylogenetic diversity(p=0.04) indices were significantly reduced in ITB. Beta diversity metrics including the Bray–Curtis and weighted UniFrac showed that samples of ITB clustered separately from those of CD.

On assessing relative abundance at phylum level, firmicutes and bacteroidota were significantly reduced in ITB. At genus level, suterella, subdoligranulum, lachnospiraceae, howardella, faecalibacterium, enhydrobacter, anaerobacillus were significantly reduced in ITB.

Genus level information was used to construct a random forest classifier model and the testing result showed that it was able to differentiate patients with ITB from CD with AUC = 71.43%.

PICRUSt was used to infer the metagenome functional content.The functional changes in ITB microbiomes included significantly decreased representation of level 2 pathways such as cell structure, carbohydrate, polyamine, nucleotide biosynthesis.

Conclusion: Through this study, we demonstrate key differences in gut microbial profile between ITB and CD. Additional studies are needed to validate the potential capability of gut microbiota for the differentiation between ITB and CD.

OP-24-06

Gut microbiota metabolite indole-3-acetic acid maintains intestinal epithelial homeostasis through mucin sulfation

Mengfan Li and Yiyun Ding and Jingge Wei and Yue Dong and Jingyi Wang and Hailong Cao

Tianjin Medical University General Hospital, Tianjin, China

Oral Presentation 24, Uluwatu 1, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: The global incidence and prevalence of inflammatory bowel disease (IBD) are gradually increasing. A high-fat diet (HFD) is known to disrupt intestinal homeostasis and aggravate IBD, yet the underlying mechanisms remain largely undefined.

Materials and Methods: A dietary survey examined the correlation between dietary fat intake and IBD severity. Supplement mice with HFD and analyze changes in tryptophan metabolism in feces. Idole-3-acetic acid (IAA) was supplemented to colitis mouse models and the colitis severity was assessed. RNA-seq was performed and HID-AB staining and the lectin MALII staining were employed to assess the intestinal sulfated mucin levels. The Ahr-/- mice and Cut&Tag assay were used to explore the mechanisms of IAA regulation on mucin sulfation.

Results: A positive correlation between dietary fat intake and disease severity in both IBD patients and murine colitis models is observed. HFD induces a significant decrease in IAA and lead to intestinal barrier damage. Furthermore, IAA supplementation enhances the intestinal mucin sulfation and effectively alleviates colitis. Mechanistically, IAA upregulates key molecules involved in mucin sulfation, including 3’-phosphoadenosine 5’-phosphosulfate synthase 2 (Papss2) and solute carrier family 35 member B3 (Slc35b3) via AHR. Oral administration of L. reuteri, which can produce IAA, contributes to protecting against colitis and promoting mucin sulfation, while the modified L. reuteri strain (LactobacillusΔiaaM) lacking the ability to produce IAA fails to exhibit such effects.

Conclusion: IAA enhances intestinal mucin sulfation through the AHR-Papss2-Slc35b3 pathway, contributing to the protection of intestinal homeostasis.

OP-24-07

Investigating regulatory patterns of immune microenvironment in ulcerative colitis

Shizhe Li, Xiaotong Wang, Junbo Xiao and Xiaowei Liu

Xiangya Hospital of Central South University, Changsha, China

Oral Presentation 24, Uluwatu 1, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: Ulcerative colitis (UC) is unclear in its pathogenesis, but cumulative evidence suggests that abnormal immune cell infiltration contributes to its emergence. Thus, this study aims to define UC's immune microenvironment regulation patterns.

Materials and Methods: Analyzing UC datasets GSE48958 and GSE73661 revealed differentially expressed genes (DEGs). ssGSEA, LASSO regression, and WGCNA algorithms were used to evaluate immune state in UC patients. Furthermore, we employed three machine learning algorithms to identify the optimal feature genes. Leveraging the AUCell algorithm alongside correlation analysis in scRNA sequencing data from GSE125527 was used. Finally, characteristic genes were verified through in vitro experiments.

Results: It was determined that UC is connected to immunological microenvironment changes. And WGCNA revealed 161 potential immune genes, with the intersection of the DEGs and genes from the ImmPort and InnateDB databases yielding 38 hub genes. Following machine learning algorithms, six genes (S100A11, TRIM22, NRG4, MIR21, LEAP2 and VLDLR) differed in immunological microenvironment and therapeutic treatment responses of UC patients. Among them, S100A11 had the best diagnostic performance with an AUC of 0.983. Combining immunohistochemistry, double-fluorescence colocalization and scRNA sequencing data, S100A11 was highly expressed on proinflammatory macrophages in patients with UC and DSS models, which was associated with activation of the NF-kB pathway. Moreover, LPS stimulation of THP-1 and RAW264.7 cells resulted in an increase in S100A11 expression, which was inhibited by JSH-23, an inhibitor of the NF-kB pathway.

Conclusion: Six immune microenvironment-related genes have been identified in UC, which may provide in silico insights into diagnosis and treatment.

OP-24-08

Liver sinusoidal endothelial cells prevent colitis-induced liver injury by inhibiting the activation of liver macrophages

Yiken Lin, Yang Zhang and Yulan Liu

Peking University People's Hospital, Beijing, China

Oral Presentation 24, Uluwatu 1, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: The liver sinusoidal endothelial cell (LSEC) is regarded as the hepatic barrier in the gut-liver axis. However, the exact function and mechanism of LSEC in preventing colitis-induced liver injury is unclear.

Materials and Methods: We conducted three mice models: acute DSS colitis group (DSS group), monocrotaline (MCT)-induced liver injury group (MCT group), and DSS+MCT group. The clodronate liposome (CLP) was used to deplete liver macrophages. LSEC and bone marrow derived macrophages (BMDM) were isolated and LSEC conditioned medium (LSEC-CM) was collected.

Results: The DSS colitis group did not cause significant liver injury and LSEC disruption independently but significantly exacerbated the pre-existing MCT-induced liver injury. Flow cytometry analysis showed that the proportion of MoMф was significantly increased while the proportion of Kupffer cells was decreased in both the DSS group and DSS+MCT group. Interestingly, there was no significant difference in the proportion of either Kupffer cells or MoMф between the DSS group and the DSS+MCT group. However, after we depleted liver macrophages, DSS colitis no longer exacerbated the pre-existing liver injury. In vitro, 10ng/ml LPS, a similar concentration in the portal vein of the DSS group, induced significant proinflammatory activation of BMDM. LSEC-CM significantly suppressed the proinflammatory activation of BMDM and shifted the balance of macrophage populations toward an anti-inflammatory phenotype.

Conclusion: DSS colitis induces the infiltration of MoMф in the liver, when LSEC is healthy, LSEC could inhibit the proinflammatory activation of MoMф which prevents the liver injury caused by gut pathogens.

OP-24-09

Clinical Features and Quality of Life of Crohn's Disease Patients at a Center in Vietnam

Ms Yen Lo

Bach Mai Hospital, Hanoi, Viet Nam

Oral Presentation 24, Uluwatu 1, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: To investigate the clinical characteristics and quality of life of patients with Crohn's disease.

Materials and Methods: This is a cross-sectional description of 143 patients with Crohn's disease from January 2022 to June 2024. Patients diagnosed and undergoing routine management for at least one year were interviewed using the Crohn's and Ulcerative Colitis Questionnaire-8 (CUCQ-8) to describe their quality of life.

Results: The age range was between 16 and 74, average age of 35.3. The male-to-female ratio was 1.4 to 1. The average age at which patients were diagnosed was 31.9, and 4.3% were diagnosed first. The initial therapy had 5.6% of patients receiving 5-ASA, 63.6% receiving corticosteroids combined with azathioprine, and 26.6% receiving biological drugs. After a follow-up of 12 months, 18.2% of patients had to upgrade therapy, of which 23 patients switched to biological drugs. The average score of 65 patients interviewed using CUCQ-8 was 6.7 ± 5.1. Quality of life scores were higher in the subjects without a history of intestinal resection and receiving biological drug treatment. A strong positive correlation was found between Crohn's Disease Activity Index (CDAI) scores and CUCQ-8 scores (r=0.834, p<0.05), indicating worse disease severity linked to poorer QoL.

Conclusion: CD patients receiving inpatient care often have severe symptoms and require treatment with biological agents. QoL of Crohn's patients is related to symptoms and treatment with biological drugs.

Keywords: Crohn's disease, CUCQ-8, quality of life

OP-24-10

Childhood obesity and risk of inflammatory bowel disease in adulthood: A Mendelian randomization study

Zhe Luan and Jing Wang and Yi Chen and Zhizhuang Zhao and Hanwen Zhang and Junling Wu and Shufang Wang and Gang Sun

Department of Gastroenterology and Hepatology, First Medical Center of PLA General Hospital, Beijing, 中国

Oral Presentation 24, Uluwatu 1, November 23, 2024, 12:30 PM - 1:50 PM

Objectives: It is well-known that childhood obesity is associated with various adult gastrointestinal diseases, inflammatory bowel disease (IBD) being no exception. However, previous epidemiological observational studies, while reporting a correlation between the two, have left the question of a causal relationship inconclusive.

Materials and Methods: This study aims to use a two-sample Mendelian randomization (MR) analysis to assess the causal relationship between childhood obesity and IBD as well as its subtypes (ulcerative colitis [UC] and Crohn's disease [CD]). Data on childhood obesity, IBD, and its subtypes (UC and CD) were sourced from IEU OpenGWAS (https://gwas.mrcieu.ac.uk/datasets/ieu-a-1096/) and IIBDGC (https://www.ibdgenetics.org/). The data were analyzed using the inverse variance weighted (IVW), MR-Egger, weighted median, simple mode, and weighted mode methods.

Results: The MR analysis indicates no causal relationship between childhood obesity and IBD or its subtypes (UC and CD). The consistency of the results across the IVW, MR-Egger, weighted median, simple mode, and weighted mode methods suggests the reliability of the findings.

Conclusion: We found that childhood obesity is not causally related to IBD or its subtypes. This differs from prior studies. The observed discrepancies may be due to common biological or environmental confounding factors.

OP-25-01

Atypical Nutcracker’s Syndrome in Polycystic Liver Disease: A Case Report

Salahuddin Andam and Stephen Wong

UST Hospital, Manila, Philippines

Oral Presentation 25, APDW Theatre 1, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Introduction: The formation of esophago-gastric varices is a rare complication of polycystic liver disease (PLD) where the multiplicity of cysts leads to pseudo-cirrhosis and portal hypertension. However, these cysts may also lead to extrinsic vascular compression, wherein the nutcracker syndrome (NCS) is one of the rarest. We report an unusual case of a PLD patient who presented with bleeding gastric varices due to NCS.

Case Description: A 67-year-old female with innumerable large hepatic cysts due to PLD presented with a 3-day history of melena. An esophagogastroduodenoscopy revealed a large isolated gastric fundal varix with stigmata of recent bleeding. A total of 1.5 ml. of cyanoacrylate was injected with hemostasis adequately achieved. The patient was sent home with carvedilol. However, patient had recurrence of melena after 1 month. Repeat esophagogastroduodenoscopy showed the same findings with no diminution of the size of the varices. Repeat 2.5 ml. cyanoacrylate injection was successfully performed. A triphasic computed tomography scan of the abdomen showed a non-dilated portal vein but with extrinsic compression of the left renal vein by the superior mesenteric artery, caused by downward pressure from the cysts, leading to the formation of a gastro-renal shunt and gastric varices. A multidisciplinary conference was convened where a comprehensive strategy involving the placement of coils with subsequent balloon-occluded retrograde transvenous obliteration was offered to the patient.

Conclusion: The rare coexistence of PLD and NCS presents substantial challenges in diagnosis and management. An effective multidisciplinary collaboration underscores the significance of a comprehensive approach when addressing this condition.

OP-25-02

ANN-CAGIB score for predicting in-hospital mortality of cirrhotic patients with acute gastrointestinal bleeding

Zhaohui Bai and Su Lin and Mingyu Sun and Shanshan Yuan and Mariana Marcondes and Dapeng Ma and Qiang Zhu and Yiling Li and Yingli He and Cyriac Philips and Xiaofeng Liu and Kanokwan Pinyopornpanish and Lichun Shao and Nahum Méndez-Sánchez and Metin Basaranoglu and Yunhai Wu and Yu Chen and Ling Yang and Andrea Mancuso and Frank Tacke and Bimin Li and Lei Liu and Fanpu Ji and Xingshun Qi

General Hospital of Northern Theater Command, Shenyang, China

Oral Presentation 25, APDW Theatre 1, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Background/Aims: Acute gastrointestinal bleeding (AGIB) is a common and potentially lethal condition among patients with cirrhosis. CAGIB score has been proposed to predict the risk of in-hospital death in such patients, but its performance requires external validation and further improvement.

Methods: In this prospective study conducted at 23 medical centers from eight countries, 2467 cirrhotic patients with AGIB were included, of whom 1233 and 1234 were randomly assigned to the training and validation cohorts, respectively. By using an artificial neural network (ANN) model, ANN-CAGIB score was established based on the components of CAGIB score. Its predictive performance was evaluated by area under curve (AUC) and compared with those of CAGIB, Child-Pugh, model for end-stage liver disease (MELD)-Na, and MELD 3.0 scores. Gray zone approach was employed to stratify the risk of death based on the ANN-CAGIB score.

Results: In the training cohort, the mean Child-Pugh, MELD-Na, and MELD 3.0 scores were 7.76, 14.09, and 14.39, respectively. The AUC of CAGIB score (AUC=0.789) was not significantly different from that of Child-Pugh (AUC=0.804, P=0.569), MELD-Na (AUC=0.817, P=0.234), or MELD 3.0 (AUC=0.822, P=0.132). Among them, the ANN-CAGIB score had the highest AUC (AUC=0.894). Patients were further divided into low- (ANN-CAGIB score: <0.024), moderate- (ANN-CAGIB score: 0.024-0.063), and high-risk (ANN-CAGIB score: >0.063) groups with a mortality of 0.79%, 3.25%, and 23.50%, respectively. Statistical results were retained in the validation cohort.

Conclusions: ANN-CAGIB score has an excellent predictive performance for in-hospital death in cirrhotic patients with AGIB.

OP-25-03

Correlation Between The Severity Level of Esophageal Varices in Cirrhosis Patients with Anxiety and Depression

Alfan Fathoni

Universitas Brawijaya, Malang, Indonesia

Oral Presentation 25, APDW Theatre 1, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Background: Liver cirrhosis is the final stage of liver damage caused by various diseases and conditions such as chronic alcohol consumption and hepatitis infections. This disease can lead to mental and psychological health problems. Reports on the relationship between the severity of esophageal varices in cirrhosis patients with anxiety and depression in Indonesia are still limited. Therefore, this study aimed to investigate the correlation between the severity of esophageal varices in cirrhosis patients experiencing upper gastrointestinal bleeding with anxiety and depression.

Method: This study was conducted on inpatients at Dr. Saiful Anwar General Hospital in Malang who were diagnosed with liver cirrhosis and experienced upper gastrointestinal bleeding over six months using the consecutive sampling method. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was performed using Chi-Square with a significance level of p-value <0.05.

Results: Among 53 respondents, 10 respondents were normal, 38 respondents experienced anxiety symptoms, and 5 respondents experienced depression symptoms. Based on the chi-square correlation analysis, the relationship between the severity of esophageal varices in cirrhosis patients experiencing upper gastrointestinal bleeding with anxiety and depression was not significant (p=0.366) with a fragile correlation category.

Conclusion: There is no correlation between the severity of esophageal varices in cirrhosis patients experiencing upper gastrointestinal bleeding with anxiety and depression at Dr. Saiful Anwar General Hospital Malang.

Keywords: Anxiety, Depression, Liver Cirrhosis, Upper Gastrointestinal Bleeding.

OP-25-04

Oral versus Intravenous Proton Pump Inhibitor Therapy After Endoscopic Intervention For Upper Gastrointestinal Bleeding

Sarah Logan, Jonty Morreau and Rajan Patel

Christchurch Hospital, Christchurch, New Zealand

Oral Presentation 25, APDW Theatre 1, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: Upper Gastrointestinal bleeding (UGIB) is a common emergency presentation, usually due to peptic ulcer disease (PUD). Gold-standard therapy includes 72 hours of intravenous (IV) proton pump inhibitor (PPI) following endoscopic intervention. A growing body of evidence suggests high dose oral PPI may be equivalent. We aimed to investigate whether high dose oral PPI may be non-inferior to IV PPI therapy after endoscopic intervention.

Materials and Methods: A retrospective review of patients undergoing endoscopic intervention for UGIB identified through coding between December 2022 and February 2023. Patients with varices were excluded. Prescription of oral or IV PPI after endoscopy was recorded. Baseline characteristics collected included demographics, time of onset to scope, time from admission to scope, haemoglobin drop, Glasgow Blatchford Score, PPI administration route, Forrest characterisation and endoscopic therapy used. Outcomes measured included readmission within 30 days, unplanned re-scope, re-bleed, surgery and mortality.

Results: Of 228 endoscopic procedures, 21 patients underwent endoscopic intervention for PUD. Mean age 70.3 years with 5 (23.8%) patients female. 5 (23.8%) patients received oral PPI only following endoscopy and 16 (76.2%) received intravenous PPI. In patients managed with IV PPI, 4 patients required further intervention, or died. No patients that received oral PPI were readmitted within 30 days, had unplanned re-scope, re-bleed, surgery or died.

Conclusion: High dose oral PPI is not associated with poorer outcomes when compared to 72 hours of IV PPI in this small cohort. While further evidence is required, this may support earlier discharge of patients following endoscopic intervention for UGIB.

OP-25-05

Aberrant Right Subclavian Artery-Esophageal Fistula Presenting as Gastrointestinal Bleeding: A Case Report

Elisa Francesca Mendoza, Jonard Co, Ronell Lee and Justin Ryan Tan

Chinese General Hospital And Medical Center, Manila, Philippines

Oral Presentation 25, APDW Theatre 1, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Background: Aberrant right subclavian artery (ARSA) is a rare congenital anomaly of the aortic arch, occurring in 0.2 to 2.5% of the population. Typically asymptomatic, ARSA can present with compressive symptoms such as dysphagia, dyspnea and rarely, upper gastrointestinal bleeding from esophageal erosions. Prolonged placement of a nasogastric tube (NGT) can lead to pressure necrosis and formation of an ARSA-esophageal fistula, a potentially life-threatening complication that may present with gastrointestinal bleeding.

Case Report: A 94-year-old female with tracheostomy and NGT presented with bloody tracheal secretions, melena, and bloody NGT output. Imaging revealed an ARSA intimately related to the trachea and esophagus. Esophagogastroduodenoscopy showed a linear ulcer with indurated borders, and a non-bleeding, pulsating vessel seen 18 centimeters from the incisors. Initial treatment with hemospray was attempted but led to subsequent hematemesis and tracheostomy bleeding, requiring vasopressors for hemodynamic stability. Repeat EGD showed persistent bleeding despite hemoclipping attempts, confirmed by CT angiography, showing contrast extravasation into the esophagus from an ARSA. Successful management involved insertion of a covered stent, which effectively controlled bleeding. Follow-up EGD two weeks later showed healing of the ulcer with a visible, non-bleeding vessel.

Discussion: Endoscopic placement of a Sengstaken-Blakemore tube can temporarily control bleeding from an ARSA-esophageal fistula. Surgical options like open repair, thoracic endovascular aortic repair, and hybrid procedures with covered stents are available. Endovascular techniques such as balloon angioplasty and stenting offer alternative approaches. This case highlights the effective use of a covered vascular stent to control bleeding from an ARSA-esophageal fistula.

OP-25-06

Rising Incidence of Upper Gastrointestinal Bleeding: Five-Year Observational Study at Dr. Saiful Anwar Hospital Malang

Amaranto Ongko and Fernando Hasudungan and Hana Nadya and Mochamad Fachrureza and Syifa Mustika and Supriono and Bogi Pratomo

Oral Presentation 25, APDW Theatre 1, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Objective: Upper gastrointestinal bleeding (UGIB) is a serious medical condition characterized by bleeding in the upper parts of the digestive system, which include the esophagus, stomach, and duodenum. In Malang, Indonesia, managing UGIB poses significant challenges to healthcare providers due to its varied causes and potential complications. This study aims to enlighten the prevalence and trends of UGIB in Malang.

Materials and Methods: This descriptive observational study used a cross-sectional design, analyzing the medical records of patients who underwent endoscopy at Dr. Saiful Anwar General Hospital in Malang. We used total sampling for this study, and data analysis was carried out using SPSS version 22.

Results: The study revealed a sharp increase in UGIB cases from 2019 to 2023, with the number of incidents rising from 28 in 2019 to 383 in 2023. Most patients were male 62% and the majority fell within the 30-60 years age group 70%. Non-variceal cases were the most common 58%. When it came to cirrhosis status, 40% of patients were non-cirrhotic, 33% had an unknown status, and 27% had cirrhosis. Regarding hepatitis, 24% of patients had hepatitis B, 9% had hepatitis C, and 67% had no history of hepatitis.

Conclusion: This study highlights a significant increase in UGIB cases primarily due to non-variceal causes. These findings emphasize the need for targeted preventive measures and improved management strategies for UGIB.

Keywords: Upper gastrointestinal bleeding, hepatitis B, cirrhosis, endoscopy, epidemiology

OP-25-07

Correlation Between Anxiety and Depression with Morbidity and Mortality in Patients with Variceal Bleeding

Syifa Mustika, Agnes Seto, Fakhri Baridwan and Vidia Purnama Sari

Brawijaya University, Malang, Indonesia

Oral Presentation 25, APDW Theatre 1, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Background: Variceal bleeding is a critical complication of chronic liver disease, particularly in patients with liver cirrhosis. It leads to significant blood loss and associated with high morbidity and mortality rates. Anxiety and depression are common psychological conditions in individuals with chronic diseases, including those with variceal bleeding. These conditions also influence morbidity and mortality. However, limited reports discuss the correlation between anxiety and depression and outcomes in patients with variceal bleeding. This study aims to understand the correlation between anxiety and depression and outcomes in patients with variceal bleeding.

Method: This study involved patients with variceal bleeding admitted to Dr. Saiful Anwar General Hospital in Malang over six months. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) Score. Clinical parameters measured included Child-Pugh Score, length of hospital stay, and mortality. Statistical analysis was performed using SPSS Software with the Chi-Square test at a significance level of p-value <0.05.

Results: Among 53 respondents, 72% had anxiety, 9% had depression, and 19% had neither. Our study revealed that anxiety and depression were associated with a longer length of stay compared to those without depression (p=0.0001). Our study also revealed that anxiety and depression were associated with an increased risk of mortality compared to those without these conditions (p=0.0001).

Conclusion: There is a correlation between anxiety and depression and both the length of stay and mortality in patients with variceal bleeding.

OP-25-08

Multivariate analysis for better predictors for diagnosis of varices in liver cirrhosis patients

Ankit Vats

ARMY HOSPITAL R&R, New Delhi, India

Oral Presentation 25, APDW Theatre 1, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Background: Esophageal varices are a common complication in Chronic liver disease.

Methods: A prospective observational study was conducted on liver cirrhotic patients in a tertiary care center. A total of 80 patients diagnosed with liver cirrhosis, were included after consideration of inclusion and exclusion criteria. Esophageal varices were examined in all the patients after proper investigation through abdominal ultrasound with a measurement of spleen diameter (SD), an upper

gastrointestinal endoscopy, and thorough laboratory examinations.

Univariate and multivariate logistic regression analysis was conducted . The performance was assessed by ROC curve with cutoff value and specificity and sensitivity analysis.

Result: Univariate analysis revealed that in 80 cirrhotic patients the mean age was 54.1 ± 10.7 years with a male and female ratio of 3.4:1. Esophageal varices were detected in 52.5% of the study population, out of which 26% were found to be grade IV. The major etiologies were alcohol intake (58.7%), NASH, AIH,

Hepatitis B, Hepatitis C, and Wilson disease. Platelet count was observed to be lower (129666 mm 3 ) in cases with varices than in non-variceal cases. PC/ SD ratio was less than equal to 10000 and was significantly related to varices and PC/ PVD ratio was also directly related to varices. Ratio of PC/SD with a cut-off value of less than equal to 1000 predicted in 73.8 % of varices.

Conclusion: Platelet count (PC), spleen length (SD), portal vein diameter (PVD) and PC/SD ratio parameters are reported to be a better predictor markers for patients with varices.

OP-25-09

The TNF-α-TNFR1 signaling axis regulates neutrophil release NETs to aggravate acute pancreatitis

Pan Zheng, Nianshuang Li and Yin Zhu

The first Affiliated Hospital of Nanchang University, Nanchang, China

Oral Presentation 25, APDW Theatre 1, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: TNF-α is a significant molecule that induces and aggravates inflammation in acute pancreatitis. This study primarily explores the role and mechanism of the TNF-α—TNFR1 signaling axis in AP.

Material and Methods: The AP mouse model was established using cerulein and arginine. Serum levels of amylase, lipase, and cell-free DNA (CfDNA) were examined. Immunohistochemistry was used to detect the expression of TNF-α, TNFR1, MPO, and F4/80. Immunofluorescence was utilized to detect expression markers of neutrophil, MPO, and NETs marker CitH3. The influence of the TNF-α—TNFR1 inhibitor was performed to observe the severity of AP. After knocking out TNFR1 in mice, we observed its impact on mouse AP, with other testing as previously described.

Results: We found a significant increase in TNF-α and TNFR1 expression in the cerulein and arginine-induced AP mouse model. After administering the TNF-α—TNFR1 signaling axis inhibitor, AP markedly alleviated, predominantly evidenced by reduced recruitment of inflammatory cells and decreased acinar cell necrosis. Further research revealed that the reduction in inflammation mainly resulted from decreased neutrophil recruitment in AP and the impact on their NETs release, leading to a drop in serum CfDNA levels. After knocking out TNFR1, the inflammation in murine AP significantly reduced, along with a decrease in the recruitment of neutrophils and their release of NETs.

Conclusion: During the progression of AP, the TNF-α—TNFR1 axis promotes inflammation development in AP, accelerates neutrophil recruitment, and enhances the release of NETs by neutrophils, thereby exacerbating inflammation.

OP-26-01

Comparison of adequacy of EUS guided liver biopsy with percutaneous liver biopsy in live porcine model

Vishnu Abhishek Raju

Kauvery Hospital, Radial Road, Chennai, India

Oral Presentation 26, APDW Theatre 2, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Background: Aim of this pilot study is to establish the non inferiority of EUS guided liver biopsy samples in comparison with paired,percutaneously obtained samples in live animal model.

Methodology: The study was done in animal lab, PSGIMR India. 4Yorkshire pigs were used in this pilot study, administered GA. Percutaneous liver biopsy don, 3 samples obtained in each pig. Subsequently, linear echo endoscope used left lobe subjected to core biopsy. CPT compared between various EUS needles and PC samples by ANOVA. Adequacy of liver biopsy sample is defined by minimum of 6 complete portal tracts in each sample.

Results: The average number of portal tracts/complete portal tracts (CPT) obtained by Percutaneous biopsy (PC),19 G F, 20 G, 22 G and 19 G R were 11.25/8.5, 13/8.25, 7.25/3.25, 3.5/0 and 4/2 respectively. The aggregated total sample length (TSL) were 1.625 cm (PC), 0.9 cm (19 G F), 0.85cm (20 G B), 0.8 cm (22 G F), 0.55 cm (19 G FNA). Specimen TSL and number of CPT was better in EUS guided biopsy done with heparin wet suction technique in 19 G F and 20 G B needles. Better TSL did not correlate with greater CPT (p 0.39)

Conclusion: The EUS guided liver biopsy samples met adequacy criteria in 75 % of the cases. Use of Heparin wet suction technique yielded better specimen in EUS guided biopsies. 19 G Franseen tip needle obtained better samples. Adequate Complete Portal Tract (CPT) was independent of the total sample length.

OP-26-02

Haoqin Qingdan decoction alleviates cholestatic liver disease by inhibiting SRC/PI3K/AKT signaling pathway

Suriguge Bao, Man Liu, Yingxi Su and Lu Zhou

Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China

Oral Presentation 26, APDW Theatre 2, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Purpose: Haoqin Qingdan decoction(HQD)is a famous classical prescription for treating Jaundice in traditional Chinese medicine (TCM). Our study aims to reveal the pharmacological mechanism of HQD in the treatment of Cholestatic liver disease(CLD)through Network pharmacology(NP) and experimental validation.

Methods: Mdr2-deficient mice and 3, 5-diethoxycarboncyl-1, 4-dihydrocollidine (DDC)-fed mice were used as CLD animal models. HQD therapy was divided into low-dose (10.8g/kg), medium-dose (21.6g/kg), and high-dose (43.2g/kg) groups. Then, the pathological changes were assessed using hematoxylin and eosin staining, total bile acid levels, liver enzymes and related cytokines were measured. Meanwhile, NP was used to determine the potential molecular regulation mechanism of HQD in the treatment of CLD, which were then experimentally validated.

Results: In vivo experiments indicated that the medium-dose HQD treatment significantly reduced total bile acid level in the liver, improved inflammation, liver fibrosis,and weight loss. The NP results showed that HQD had 200 cross-targets with CLD, and KEGG enrichment analysis indicated that the Bile secration and SRC/PI3K/AKT pathway could be an important of HQD in the treatment of CLD. These findings were corroborated by quantitative PCR and Western blotting analysis in mouse liver.

Conclusion: These findings suggest that HQD may serve as a promising therapeutic approach for CLD by inhibiting SRC/PI3K/AKT signaling pathway.

OP-26-03

How generative artificial intelligence can assist physicians with diagnosis of liver lesions in computed tomography

Pushpanjali Gupta^1,2,3, Chun-Ying Wu^1,2,3,4,5, Che-Lun Hung^1,2, Yao-Chun Hsu^6,7, Yuan-Chia Chu^8,9, Chia-Sheng Chu^10,11, Teng-Yu Lee^12,13 and Sulagna Mohapatra^2,13

¹Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan; ²Health Innovation Center, National Yang Ming Chiao Tung University, Taipei, Taiwan; ³Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; ⁴Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan; ⁵Department of Public Health, China Medical University, Taipei, Taiwan; ⁶Division of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan; ⁷School of Medicine, I-Shou University, Kaohsiung, Taiwan; ⁸Information Management Office & Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan; ⁹Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; ¹⁰Division of Gastroenterology and Hepatology, Taipei City Hospital Yang Ming Branch, Taipei, Taiwan; ¹¹Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; ¹²Division of Gastroenterology & Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan; ¹³School of Medicine, Chung Shan Medical University, Taichung, Taiwan

Oral Presentation 26, APDW Theatre 2, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: Development of a deep learning-based localization and classification (DLLC) system for Focal Liver Lesions (FLLs) in CT scans that could assist physicians in more robust clinical decision-making.

Materials and Methods: We conducted a retrospective study with 1,589 patients with 17,335 slices and 3,195 FLLs collected from January 2004 to December 2020. The training set included 1272 patients (male: 776, mean age 62 ± 10.9), and the test set included 317 patients (male: 228, mean age 57 ± 11.8). The images were annotated, and the DLLC system was developed using generative adversarial networks to augment the data. A comparative analysis was performed for the DLLC system versus physicians using external data.

Results: Our DLLC system demonstrated mean average precision at 0.81 for localization. The system's overall accuracy for multiclass classification was 0.97 (95% CI: 0.95, 0.99). Considering FLLs ≤ 3cm, the system achieved an accuracy of 0.83 (95% CI: 0.68, 0.98), and for size>3cm, the accuracy was 0.87 (95% CI: 0.77, 0.97) for localization. Furthermore, during classification, the accuracy was 0.95 (95% CI: 0.92, 0.98) for FLLs ≤ 3cm and 0.97 (95% CI: 0.94, 1.00) for FLLs >3cm. When externally validated, the system achieved an accuracy of 85% for localization in the Medical Segmentation Decathlon (MSD) dataset and 95% and 98% accuracies for localization and classification, respectively, in The Cancer Imaging Archive (TCIA) dataset.

Conclusion: The DLLC system, developed with only arterial and venous phase images, can effectively assist inexperienced radiologists and hepatologists in diagnosing FLLs.

OP-26-04

Automated Machine Learning Models for Nonalcoholic Fatty Liver Disease Assessed by Controlled Attenuation Parameter

Lihe Liu

Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

Oral Presentation 26, APDW Theatre 2, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: This study aims to assess the efficacy of automated machine learning (AutoML) in the identification of NAFLD using a population-based cross-sectional database.

Materials and Methods: All data, including laboratory examinations, anthropometric measurements, and demographic variables, were obtained from the National Health and Nutrition Examination Survey (NHANES). NAFLD was defined by controlled attenuation parameter (CAP) in liver transient ultrasound elastography. The least absolute shrinkage and selection operator (LASSO) regression analysis was employed for feature selection. Six algorithms were utilized on the H2O-automated machine learning platform. The models were evaluated by area under receiver operating characteristic curves (AUC) and interpreted by the calibration curve, the decision curve analysis, variable importance plot, SHapley Additive exPlanation plot, partial dependence plots, and local interpretable model agnostic explanation plot.

Results: A total of 4,177 participants (non-NAFLD 3,167 vs. NAFLD 1,010) were included to develop and validate the AutoML models. These models were all superior to existing scoring systems such as FLI, LAP, HSI, NAFLD index, ZJU index, FSI, and FLD index. The model developed by XGBoost performed better than other models in AutoML, achieving an AUC of 0.859, an accuracy of 0.795, a sensitivity of 0.773, and a specificity of 0.802 on the validation set.

Conclusion: We developed an XGBoost model to better evaluate the presence of NAFLD. Based on the XGBoost model, we created an R Shiny web-based application named Shiny NAFLD (http://39.101.122.171:3838/App2/). This application demonstrates the potential of AutoML in clinical research and practice, offering a promising tool for the real-world identification of NAFLD.

OP-26-05

Factors associated with alleviation of liver function abnormalities by pemafibrate

Akio Moriya¹, Yoshiaki Iwasaki² and Masaharu Ando¹

¹Mitoyo General Hospital, Kanonji, Japan; ²Okayama University, Okayama, Japan

Oral Presentation 26, APDW Theatre 2, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: Pemafibrate selectively activates peroxisome proliferator-activated receptor alpha and lowers serum triglyceride levels via upregulation of genes related to beta-oxidation. We aimed to characterize patients who would benefit from pemafibrate for their liver function abnormality.

Materials and Methods: We analyzed 22 patients with alanine aminotransferase (ALT) > 30 U/L at baseline among those who were initiated pemafibrate for the treatment of hypertriglyceridemia. We performed the logistic regression analysis to examine the relation of each item of demographical and laboratory data to the ALT decrease to 80% or less of the baseline 12 weeks after the initiation of treatment.

Results: Steatotic liver disease was observed in 19 patients out of 22 (86%) at baseline. Median ALT levels decreased from 50 U/L to 38 U/L. A decrease in the ALT level to 80% or less was observed in 11 patients (50%). The logistic regression analysis demonstrated that alkaline phosphatase (ALP) and high-density lipoprotein (HDL) were independent factors for ALT reduction (p = 0.0494 and p = 0.0486, respectively). The receiver operating characteristics analysis indicated the cutoff values as 89 U/L (area under the curve = 0.913) for ALP and 47 mg/dL (0.860) for HDL. ALT decreases to 80% or less was observed in 7 patients out of 7 (100%) when both ALP and HDL exceeded the cutoff, whereas 1 out of 10 (10%) when none of them exceeded the cutoff, respectively

Conclusion: ALP and HDL values may be useful as predictors of ALT reduction after pemafibrate administration.

OP-26-06

A comparison of the NAFLD and MAFLD diagnostic criteria among adult Filipinos

Kathleen Kaye Singidas, Karen Batoctoy and Lou Angelique Limquiaco

Vicente Sotto Memorial Medical Center, Cebu, Philippines

Oral Presentation 26, APDW Theatre 2, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Background and Aims: The understanding of fatty liver disease (FLD) has recently evolved from Nonalcoholic fatty liver disease (NAFLD) to Metabolic dysfunction-associated fatty liver disease (MAFLD). This study compares the incidence, clinical profiles, and diagnostic accuracy in detecting significant fibrosis of NAFLD and MAFLD criteria, aiming to assess their real-world applicability.

Method: A descriptive cross-sectional study was conducted involving 63 adult patients. Sociodemographic and clinical profiles were determined. The diagnostic capabilities of NAFLD and MAFLD criteria in identifying significant fibrosis (F2 or higher) were measured using transient elastography. Predictors for significant fibrosis were determined using binary logistic regression.

Result: FLD is more prevalent among Filipino males in their fourth decade of life. Of the patients, 87.30% met MAFLD criteria, while 49.21% fulfilled NAFLD criteria, with a 46.03% overlap and 9.52% not meeting either. MAFLD exhibited a higher male predominance, elevated liver enzymes, and a higher prevalence of significant fibrosis (32.73% vs 16.13%) compared to NAFLD. MAFLD demonstrated superior sensitivity (94.74% vs 25.32%), positive predictive value (32.73% vs 15.15%), negative predictive value (87.50% vs 53%), and diagnostic accuracy (39.68% vs 33.33%) for the detection of significant fibrosis. Additionally, BMI was the only predictor of significant fibrosis (OR=2.11; 95% CI 1.16-3.84; P=0.015). Each 1-point increase in BMI raises the likelihood of significant fibrosis by about 2.1 times.

Conclusion: In this population, MAFLD serves as a more comprehensive and inclusive criterion than NAFLD, providing enhanced diagnostic accuracy for significant fibrosis, thereby emphasizing its practicality and efficiency in real-world clinical settings.

OP-26-07

Incomplete overlap between lean metabolic dysfunction-associated steatotic liver disease and lean nonalcoholic fatty liver disease

Sherlot Song^1,2, Terry Cheuk-Fung Yip^1,2, Grace Lai-Hung Wong^1,2 and Vincent Wai-Sun Wong^1,2

¹Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, HK, 香港; ²State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, HK, 香港

Oral Presentation 26, APDW Theatre 2, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: Recent studies suggested that the definitions of metabolic dysfunction-associated steatotic liver disease (MASLD) and previously nonalcoholic fatty liver disease (NAFLD) identified a largely overlapped patient population. However, patients with hepatic steatosis and normal body mass index (BMI) need to fulfill at least one additional cardiometabolic factor (CMRF) to receive MASLD diagnosis. We assessed whether this additional requirement affects the agreement between the two definitions in lean patients.

Materials and Methods: We included three NAFLD cohorts from Hong Kong: 461 patients with biopsy-proven NAFLD from 2006-2024, 272 individuals randomly selected from community who had magnetic resonance spectroscopy (MRS)-proven NAFLD from 2008-2010, and 11,610 patients with NAFLD diagnosis from Clinical Data Analysis and Reporting System (CDARS) from 2000-2021.

Results: 461, 266, and 11,588 patients in three cohorts fulfilled the MASLD definition respectively. Among lean patients (BMI<23 kg/m2) in the 3 NAFLD cohorts, no patient in the biopsy cohort, 9.0% (6/67) patients in the MRS cohort, and 1.7% (22/1292) patients in CDARS cohort did not meet MASLD criteria and classified as cryptogenic SLD. Compared to overweight/obese MASLD, patients with lean MASLD consistently had fewer CMRFs across 3 cohorts. However, the distribution of Fibrosis-4 (FIB-4) index did not differ significantly between lean and overweight/obese MASLD patients within each cohort (Figure).

Conclusion: The discrepancy between NAFLD and MASLD is more evident among lean patients from general population compared to hospital settings. Although presenting a lower metabolic burden, lean patients with MASLD demonstrated a FIB-4 level similar to overweight/obese patients with MASLD, warranting clinical attention.

OP-26-08

Stigma Surrounding the Nomenclature of Nonalcoholic Fatty Liver Disease Among People Aged 14-18

Jaden Wei

CUHK, Hong Kong, Hong Kong

Oral Presentation 26, APDW Theatre 2, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: To investigate the stigma surrounding the nomenclature of nonalcoholic fatty liver disease (NAFLD) among people aged 14-18.

Materials and Methods: A survey was completed among participants aged 14 to 18 in Hong Kong. The survey contained 10 questions surrounding the participant's view of the terms NAFLD and MASLD.

Results: The survey was completed by 52 participants, 38.5% of all participants thought the term “fatty” would be stigmatizing to patients, while 42.3% thought the term was somewhat stigmatizing. This feeling was more popular among those aged 15 and 18 (66.67% thought it was stigmatizing). More participants believed that “steatotic liver disease” or “liver steatosis” would be a better fit, with 62.7% of total participants saying that it was not stigmatizing. This was more common in 15 and 18-year-olds (83.3% and 66.67%), and less common among 17-year-olds (45.45%). The term “metabolic dysfunction-associated steatotic liver disease” (MALSD) was also believed to be not stigmatizing, with 71.2% of participants believing that it was not stigmatizing. This attitude was more prevalent among 14-year-olds (83.33%) while only 33.33% of 18-year-olds believed this term was not stigmatizing. Overall, 51.9% of respondents felt that a name adjustment from “fatty liver disease” would reduce the stigma surrounding the diagnosis.

Conclusion: An overall majority of respondents believed that “nonalcoholic fatty liver disease” was stigmatizing, while “metabolic dysfunction-associated steatotic liver disease” and “liver steatosis” were not stigmatizing. However, the views varied among different age groups.

OP-26-09

Impact of alanine aminotransferase (ALT) trajectory on liver-related event risk in type 2 diabetes (T2D)

Terry Cheuk-Fung Yip^1,2,3, Sherlot Juan Song^1,2, Mary Yue Wang^1,2, Mandy Sze-Man Lai^1,2, Grace Lai-Hung Wong^1,2,3, Jimmy Che-To Lai^1,2,3 and Vincent Wai-Sun Wong^1,2,3

¹Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong; ²Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong; ³Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong

Oral Presentation 26, APDW Theatre 2, Exhibition Hall, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: We examined whether ALT level and trajectory impact the risk of liver-related complications including hepatic decompensation, hepatocellular carcinoma, and liver-related death in T2D.

Materials and Methods: A territory-wide retrospective cohort of adult patients with T2D from 2000-2016 was identified in Hong Kong. Patients with type 1 diabetes, chronic viral hepatitis, excessive alcohol use, or liver-related complications or follow-up <5 years were excluded. Unsupervised partitional clustering identified trajectories using different distance measures with prototyping functions including dynamic time warping (DTW) with DTW barycenter averaging (DBA), triangular global alignment kernel with DBA, and shape-based distance with shape extraction. Patients were followed from T2D diagnosis to liver-related complications, last follow-up, or 15 years; non-liver-related death was a competing event.

Results: Of 379,268 patients with T2D (mean age 62±13 years, 51.5% females, 1.1% cirrhosis, HbA1c 7.8±2.0%, ALT 22[16-33] U/L), 4,482 (1.2%) developed liver-related complications at a median (IQR) follow-up of 12.2(8.8-15.0) years. DTW-DBA revealed 3 ALT trajectories in the first 5 years after T2D diagnosis: stable (n=143,733[37.9%]), mild increasing (n=89,209[23.5%]), and decreasing (n=146,326[38.6%])(Figure). Compared to the stable trend, patients with decreasing ALT (adjusted cause-specific hazard ratio 0.984, 95% CI 0.972-0.997, p=0.017) had a reduced risk of developing liver-related complications, while those with mild increasing ALT (1.006[0.990-1.023]) was not associated with a higher risk. Higher ALT (1.013[1.004-1.022]), higher HbA1c, older age, male sex, and cirrhosis were associated with an increased risk of liver-related complications.

Conclusion: Lower ALT levels and decreasing ALT over time are associated with a lower risk of liver-related complications in T2D.

OP-27-01

Role of faecal calprotectin to differentiate between treatment-naive intestinal tuberculosis and Crohn’s disease

Sayan Malakar, Umair Shamsul Hoda, Srikanth Kothalkar, Vishwas Kapoor, Gaurav Jyoti Borah, Gaurav Pandey, Piyush Mishra and Uday C Ghoshal

Sanjay Gandhi Postgraduate Institute Of Medical Sciences, Lucknow, India

Oral Presentation 27, Uluwatu 1, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: We aimed to evaluate the role of baseline FC to differentiate treatment-naïve patients with CD and ITB.

Methods: All patients presenting at our luminal gastroenterology unit with clinical features suggestive of ITB or CD were evaluated with baseline FC, ileo-colonoscopy and radiological imaging. Patients received anti-tubercular therapy (ATT) or treatment for CD after the complete evaluation. Baseline FC was compared among patients who achieved complete clinical and endoscopic resolution after six months of therapy.

Results: A total of 231 patients were evaluated for suspected CD or ITB. After evaluation 47 patients were started on ATT and 126 patients received treatment for CD. After six months of therapy, 36 patients in the TB group and 34 patients in the CD had a complete clinical, endoscopic and radiological resolution, and they were included in the final analysis. Baseline, FC was significantly higher in patients with CD than in ITB (744.22 ±755.97 ug/ grams of stool vs 309.18 ±332.83; p=0.003). With a cut-off level of 326 ug/g (normal <50 ug/g), FC had a 67% sensitivity and specificity of 73.5% to diagnose patients with CD [AUROC 0.75; 95% CI 0.635-0.864)]. A composite score including FC > 350 ug/g, duration of disease >18 months and absence of abdominal lymphadenopathy was devised which ranges from 0-7. A score ≥ 4 had a better sensitivity (94%) and specificity (89%) [AUROC 0.963 (95% CI 0.92-1.0)] to diagnose CD as compared to FC alone.

Conclusion: FC helps to differentiate between CD and ITB.

OP-27-02

Importance of Rectal over Colon status in Ulcerative Colitis Remission

Kei Nishioka¹, Haruei Ogino³, Takatoshi Chinen², Yusuke Kimura², Mitsuru Esaki², Xiaopeng Bai², Yosuke Minoda², Yoshimasa Tanaka², Masafumi Wada², Yoshitaka Hata² and Eikichi Ihara²

¹Department of Gastroenterology, Fukuokaken Saiseikai Futsukaichi Hospital, Chikushino, Japan; ²Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ³Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Oral Presentation 27, Uluwatu 1, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: Ulcerative colitis (UC) is a refractory inflammatory disease affecting the rectum to the colon, with pivotal involvement of the rectal environment in relapse initiation. This study aimed to examine the differences in gene expression between the rectum and colon and to identify relapse factors.

Materials and Methods: Study 1: RNA sequencing was performed for biopsies of colon and rectum from active UC, remission UC, and control groups. Study 2: Mucosal impedances (MI) values reflecting mucosal barrier function, and mRNA expressions of tight junctions and inflammatory cytokines were examined in 32 remission UC patients and 22 controls. Relapse occurrence was prospectively monitored.

Results: In Study 1, a comprehensive genetic analysis using RNA-seq revealed distinct gene profiles in the rectum and sigmoid colon of patients with remission UC. The rectum of these patients exhibited enriched immune response and apical junction phenotype, with persistent upregulation of CLDN2 gene expression.

In Study 2, even in remission UC, MI values in the rectum, but not in the sigmoid colon, were significantly decreased, where rectal MI values were negatively correlated with CLDN2, IL1B and IL6.

Conclusion: Rectal status in remission UC differs from that of the colon, with microinflammation and impaired mucosal barrier function, associated with upregulation of CLDN2, playing a role in relapse.

OP-27-03

Predictive Factors For Endoscopic And Histological Remission After Various Advanced Therapies In Ulcerative Colitis

Jung Hyun Noh¹, Yu Kyung Jun^1,2, Yonghoon Choi¹, Cheol Min Shin^1,2, Young Soo Park¹, Nayoung Kim^1,2, Dong Ho Lee^1,2 and Hyuk Yoon^1,2

¹Seoul National University Bundang Hospital, Bundang, South Korea; ²Seoul National University, Seoul, South Korea

Oral Presentation 27, Uluwatu 1, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: The study aimed to compare endoscopic remission (ER) and histologic remission (HR) rates of various advanced therapies (AT) in patients with ulcerative colitis (UC) and identify factors affecting ER and HR.

Materials and Method: Patients with moderate to severe UC starting AT were evaluated for ER (Mayo endoscopic subscore ≤ 1) and HR (Robarts Histopathology Index ≤ 3) at the end of the induction phase. A multinomial logistic regression model assessed clinical factors affecting ER and HR.

Results: In 214 UC patients, 254 ATs were analyzed. The ER rate was 39.0% (TNF-α inhibitors: 21%, ustekinumab: 33%, tofacitinib: 48%, vedolizumab: 53%). The rate of HR among patients who achieved ER was 41.6%, meaning 16% of the total patients reached HR (TNF-α inhibitors: 5%, ustekinumab: 6%, tofacitinib: 9%, vedolizumab: 23%). In multivariable analysis, compared to TNF-α inhibitors, tofacitinib (OR [odds ratio] 6.055, p < 0.001) and vedolizumab (OR 3.372, p < 0.001) were more effective in achieving ER. Male gender (OR 0.521, p = 0.034), patients previously exposed to ATs (OR 0.368, p = 0.003), concomitant use of steroids (OR 0.447, p = 0.008), and severe endoscopic findings before ATs (OR 0.447, p = 0.015) were associated with a lower rate of ER. Vedolizumab (OR 4.071, p = 0.002) and older age (OR 0.376, p = 0.020) were associated with higher and lower rates of HR, respectively.

Conclusion: Among various ATs, vedolizumab was most effective for both ER and HR at the induction phase in patients with moderate to severe UC.

OP-27-04

Comparing accuracy of cross-sectional imaging techniques and small intestinal contrast ultrasonography in Crohn’s disease(cactus-cd trial)

Partha Pal, Mohammed Abdul Mateen, Kanapuram Pooja, Uday Kumar Marri, Rajesh Gupta, Manu Tandan and D Nageshwar Reddy

Asian Institute Of Gastroenterology, Hyderabad, India

Oral Presentation 27, Uluwatu 1, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: Magnetic resonance/computed tomography enterography (MRE/CTE) are established for assessing small bowel (SB) Crohn’s disease (CD) with superior accuracy compared to intestinal ultrasound (IUS). However, the role of small intestinal contrast ultrasound (SICUS) in monitoring CD activity needs further exploration.

Methods: This study evaluated SICUS in comparison to CTE/MRE for monitoring known SB CD activity. Patients (age18-75) with established SB CD underwent SICUS prior to CTE (n=75)/MRE (n=39). Accuracy of SICUS for detecting SB disease presence, extent, maximum bowel wall thickness (BWT), length of involvement, and complications (strictures, fistulas), and its impact on management were assessed against MRE/CTE.

Results: A total of 140 patients (median age 35 years,58.6% male) were included. SICUS showed sensitivity/specificity of 94.6%/100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 58.8%, and accuracy of 95% for detecting SB disease. For disease extent, SICUS had sensitivity/specificity of 88.4%/90.9%, PPV 99.1%, NPV 40%, and accuracy 88.6%. Sensitivity/specificity for detecting strictures were 79% (62.9% with IUS alone)/98.7%, PPV 98%, NPV 85.5%, and accuracy 90%; for fistulas, 85.7%/99.2%, PPV 85.7%, NPV 99.2%, and accuracy 98.6% (Figure1A). SICUS correlated strongly with cross-sectional imaging for BWT (Spearman’s R=0.68, p<0.001) and length of involvement (R=0.851, p<0.001)(Figure1B-C). Missed lesions were primarily in proximal and mid SB. Overall, management changed in 14.3% (n=20) after CTE/MRE.

Conclusion: SICUS accurately identifies SB CD activity, extent, and complications, with limited impact on management decisions compared to cross-sectional imaging. It is particularly beneficial for detecting SB strictures. Cross-sectional imaging remains valuable for proximal and mid SB involvement. (Clinicaltrials.gov: NCT06125678).

OP-27-05

The Effect of Diet and Nutrients on Prognosis of Ulcerative Colitis – a Prospective Study

Gechong Ruan¹, Yujia Zhang¹, Rongrong Li², Ke Zeng³ and Hong Yang¹

¹Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China; ²Department of Clinical Nutrition, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China; ³Department of Information Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Oral Presentation 27, Uluwatu 1, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: This study aims to collect dietary information from Ulcerative colitis (UC) patients through a prospective dietary diary on electronic platform and analyze its relationship with short-term prognosis.

Materials and Methods: This prospective study included 108 UC patients at Peking Union Medical College Hospital from December 2023 to March 2024. Baseline characteristics were obtained through medical record and electronic questionnaires. The patients recorded diet at least three times every two weeks on platform within six weeks. A Dietary Inflammation Index (DII) score was performed. Short term clinical outcomes were evaluated based on the PRO-2 score. Then, 54 patients were included in further intervention studies, receiving guidance on a specific modified anti-inflammatory diet plan or a general dietary education.

Results: A total of 64 UC patients (35 in remission and 29 in active phase) were included. During the 6-week follow-up, higher DII score was associated with an increased risk of short-term adverse outcomes (OR=5.686, p=0.006). The "healthy mode" led to a trend of higher carbohydrates and fiber intake, and the pattern score was significantly correlated with DII score (p<0.05). After six weeks of controlled intervention, the DII score decreased by 1.31 (p=0.019) in the intervention group and 1.14 (p=0.007) in the control group. Dietary intervention demonstrated a significant protective effect on short-term adverse outcomes (OR=0.022, p=0.026).

Conclusion: Diet and nutrient patterns are closely related to the short-term prognosis of UC patients. Management and feedback based on electronic platforms and personalized anti-inflammatory diet interventions may be potential solutions to improve clinical conditions.

OP-27-07

To assess disease perception in patients with IBD presenting in tertiary care hospital in Karachi

Aisha Saleem, Lubna Kamani and Kiran Bajaj

Liaquat National Hospital, Karachi, Pakistan

Oral Presentation 27, Uluwatu 1, November 23, 2024, 2:10 PM - 3:40 PM

Objective: To assess disease perception in IBD patients to improve their clinical outcomes.

Material and Methods: This cross-sectional study was done in all in & outpatients aged 18+ years with IBD for > 6months, presenting in GI Department at Liaquat National hospital, Karachi. IPQ-R (illness perception questionnaire) was used to assess illness perception. Data was analyzed using SPSS version 21.

Results: 29 patients have been studied till now, average age 37.4 ± 14 years. More than half of patients were female (57.7%). Average disease duration was 7.8 ± 9.5 years. Patients had presenting complaint of bleeding PR (65.4%), abdominal pain (61.5%) & diarrhea (42.3%). Majority had ulcerative colitis (76.9%). Out of these 22 (76.9%), 3 had remission, 10 had mild and 7 had moderate & 2 had severe disease. Out of 7 (23.1%) patients with Crohn's, 1 had mild, 1 had remission and 3 had moderate & 1 had severe disease. IPQ-R scale showed average score for identity, timeline, timeline cyclical, consequences, personal control, treatment control illness coherence, emotional representation 4.7 ± 2.5, 37.6 ± 4.5, 14.1 ± 2.5, 20.2 ± 3.1, 18.7 ± 2.8, 16.5 ± 1.6, 14.9 ± 3.0 and 25.7 ± 3.7 respectively.

Conclusion: Patients with active disease have more negative thoughts which can reduce their trust in treatment while patients in remission phase have positive influence on illness perception. The result provide evidence for assumption of IPQ-R scale and suggest the importance of addressing illness, perception for improving quality and health care of IBD patients.

OP-27-08

Increased risk of steroid exposure and malignancy in elderly onset IBD

Chin Kimg Tan¹, Yi Yuan Tan², Tze Tong Tey³, Xuan Han Koh¹, Jeannie Ong¹, Tiing Leong Ang¹, Malcolm Tan², Ennaliza Salazar², Chong Teik Lim², Shu Wen Tay² and Webber Chan²

¹Changi General Hospital, Singapore, Singapore; ²Singapore General Hospital, Singapore, Singapore; ³Sengkang General Hospital, Singapore, Singapore

Oral Presentation 27, Uluwatu 1, November 23, 2024, 2:10 PM - 3:40 PM

Background/Aim: Elderly onset inflammatory bowel disease (EOIBD) has variable characteristics in the published literature. This study aims to compare the treatment and clinical outcomes of between EOIBD and adult onset IBD (AOIBD).

Methods: This is a retrospective study involving IBD patients seen at three hospitals in Singapore from 2020 to 2023. Patients were identified from the Singapore National IBD registry. Those with missing data on age of IBD diagnosis were excluded. EOIBD is defined as age of diagnosis ≥ 60 years old and AOIBD as age of diagnosis from 18 to 59 years old. We performed 2:1 nearest neighbor propensity score matching (by gender, year of IBD diagnosis and type of IBD) of participants with AOIBD to EOIBD. The matched samples were analyzed using modified poisson regression with robust standard errors, linear regression, and Cox proportional hazards regression.

Results: A total of 1,195 participants were identified after excluding those with missing date of IBD diagnosis, of which 10.8% were EOIBD (n=130). 164 AOIBD were identified as suitable matches, and 128 with EOIBD had at least one suitable match. After accounting for differential follow-up time between the two groups, modified poisson regression with robust standard errors showed a higher risk of steroid exposure (risk ratio [RR] 1.38, 95% CI 1.07 to 1.80) and malignancy (RR 2.39, 95% CI 1.24 to 4.60) among EOIBD compared to adult-onset participants.

Conclusion: EOIBD is associated with increased risk of steroid exposure and malignancy. Judicious use of steroids and malignancy screening should be performed for EOIBD.

OP-27-09

High-density-Lipoprotein Is a New Predictive Biomarker of the Effectiveness of Infliximab Therapy in Crohn’s Disease

Keke Tang^1,2, Ziheng Peng^1,2, Yong Li^1,2, Duo Xu^1,2, Xiaowei Liu^1,2,3 and Yu Peng^1,2,3

¹Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; ²Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; ³Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China

Oral Presentation 27, Uluwatu 1, November 23, 2024, 2:10 PM - 3:40 PM

Objectives: To assess whether baseline serum high density lipoprotein (HDL) levels predict the effectiveness of infliximab in patients with Crohn's disease (CD).

Materials and Methods: This was a retrospective study, and 166 patients were enrolled. All the data were collected from Xiangya Hospital, Central South University, between January 2016 and September 2021. Adverse events during 52 weeks were the endpoint.

Results: Of the 166 patients, 37 (22.3%) experienced adverse events within 52 weeks of follow-up. To predict the occurrence of adverse events, a receiver operating characteristic curve was established. The area under the curve for HDL was 0.663 (p=0.003), while the area under the curve for C-reactive protein was 0.656 (p=0.004). The cut-off value for HDL was determined to be 0.855. Therefore, HDL is a better predictor of adverse events than C-reactive protein is. Linear regression analysis revealed a negative correlation between HDL levels and white blood cell counts and C-reactive protein levels and a positive correlation between HDL and albumin levels. Univariate and multivariate logistic regression analyses showed that HDL levels were an independent risk factor for adverse events in patients with CD treated with infliximab within 52 weeks (p=0.047). Furthermore, the incidence of adverse events was lower in the high-HDL subgroup than in the low-HDL subgroup (p=0.002), as demonstrated by the Kaplan–Meier curve.

Conclusions: HDL can be used as a predictor in CD patients treated with infliximab, and HDL is an independent risk factor for adverse events within 52 weeks in CD patients treated with infliximab.

OP-28-01

Frequency of Celiac disease among patients of Type I Diabetes mellitus in North western India

Prashanth Kalabandi and Payush Khurana and Mahaveer Singh and Shobna J Bhatia and Rakesh Kochhar

Department of Medical Gastroenterology Nims &R Jaipur, Jaipur, India; NIMS &R, Jaipur, India

Oral Presentation 28, APDW Theatre 1, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objective: This study aims to determine the frequency of celiac disease among patients with Type 1 Diabetes Mellitus (T1DM) in a rural northwestern Indian population over a period of six months

Methods: A total of 38 patients with T1DM were screened for celiac disease using serological tests and confirmed with biopsy when necessary. Demographic details, including age, and clinical features such as hypothyroidism, abdominal pain, failure to thrive, and anemia were documented.

Results: Out of the 38 patients screened, 8 (21.1%) were diagnosed with celiac disease, including one seronegative case. Among these 8 patients, 6 (75%) were less than 18 years old. Hypothyroidism was present in 3 (37.5%) patients within the celiac group and 2 (6.7%) patients in the non-celiac group. Abdominal pain was reported in 2 (25%) patients with celiac disease. Failure to thrive was observed in 3 (37.5%) patients, while anaemia was noted in 4 (50%) patients within the celiac group.

Conclusion: Preliminary findings indicate a notable prevalence of celiac disease (21.1%) among patients with T1DM in this rural population, particularly in those under 18 years of age (75%). The coexistence of hypothyroidism (37.5% in celiac group), abdominal pain (25% in celiac group), failure to thrive (37.5% in celiac group), and anemia (50% in celiac group) in these patients highlights the need for comprehensive screening and management of co morbid conditions. follow-up and further analysis awaited

Keywords: Celiac disease, Type 1 Diabetes Mellitus, Hypothyroidism, Seronegative celiac disease, Abdominal pain, Failure to thrive, Anaemia, Prevalence, Rural India.

OP-28-02

A prospective study to assess diagnostic accuracy of bacterial gene markers for colorectal advanced neoplasia

Ho Shing Louis Lau^1,2, Min Dai¹, Alan LC Chu¹, Connie WY Seto¹, Max HY Hui¹, Jessica YL Ching¹, Francis KL Chan^1,2,3 and Siew C Ng^1,2,3

¹Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University Of Hong Kong, Hong Kong, Hong Kong; ²Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong; ³Microbiota I-Center (MagIC), The Chinese University of Hong Kong, Hong Kong, Hong Kong

Oral Presentation 28, APDW Theatre 1, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objective: Non-invasive biomarkers are used primarily for most population-based colorectal cancer (CRC) screening programmes, especially in Asia-Pacific region. Stool-based microbial markers are potentially better than the existing gold standard – faecal immunochemical tests (FIT).

Methods: We reported the Hong Kong cohort from an investigator-initiated, multicenter, prospective study. (NCT05405673) Adult subjects who underwent colonoscopies for all indications (screening, surveillance or diagnostic) were recruited. Baseline data and stool samples were collected before bowel preparation, with antibiotics and probiotics prohibited. Colonoscopy findings were confirmed by histopathology evaluated by independent pathologists. Diagnostic performance of bacterial gene markers (Fusobacterium nucleatum, Bacteroides clarus, Clostridium hathewayi, Lachnoclostridium – M3CRC) was compared with FIT. The primary outcome was the sensitivity of M3CRC and FIT in detecting advanced neoplasia, defined as the presence of CRC or advanced adenoma (AA).

Results: From December 2021 to May 2024, 1,631 subjects were recruited with 1,396 subjects eligible for analysis, after exclusion of inadequate bowel preparation, incomplete colonoscopy or invalid FIT results. (Figure 1A) There were 21 (1.5%), 120 (8.6%), 592 (42.4%), and 663 (47.5%) subjects with CRC, AA, non-advanced adenoma and normal finding respectively. The sensitivity of M3CRC (53.2%, 95%CI 45.0%-61.4%) was significantly higher than that of FIT (43.7%, 95%CI 34.8%-52.6%, p=0.019) in advanced neoplasia detection, with a specificity of 80.2% (95%CI 78.0%-82.4%). In subgroup analysis, M3CRC was more sensitive than FIT in detecting ≤20mm or proximal colon lesions. (Figure 1B)

Conclusion: Stool-based bacterial gene markers panel (M3CRC) had a higher sensitivity than FIT for colorectal advanced neoplasia in a Chinese-population cohort.

OP-28-03

Spatial transcriptomics reveals the heterogeneity and tumor microenvironment within mixed adenoneuroendocrine carcinoma

Rong Lin

Huazhong University of Science and Technology, Wuhan, China

Oral Presentation 28, APDW Theatre 1, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: Mixed adenoneuroendocrine carcinoma (MANEC) is a highly malignant and rare subtype of neuroendocrine tumor, often associated with distant metastasis and poor prognosis. MANEC is a mixed tumor composed of both neuroendocrine carcinoma (NEC) and adenocarcinoma (AC) components, with each component comprising more than 30% of the tumor. The origin and formation mechanisms of MANEC remain unclear, and there are currently no established treatment protocols or specific therapeutic targets.

Materials and Methods: In this study, we employed spatial transcriptomics to analyze three MANEC specimens, tracing the origins of the tumor.

Results: We discovered that the NEC and AC components in MANEC share the same origin, with the NEC component likely arising from the AC component. During the formation of the NEC component, aberrant activation of the transcription factor HCFC1 acts as a driver, promoting neuroendocrine differentiation of gastric adenocarcinoma cells in in vitro models.The results of this study provide strong evidence supporting the hypothesis that NEC and AC components in MANEC have a common origin.

Conclusion: Our findings offer a detailed elucidation of the formation mechanism of MANEC and identify a potential new target for its treatment.

OP-28-05

Food allergy as aetiology for recurrent pain abdomen in Indian children

Priyanka Udawat

SIR H N Reliance Hospital, Mumbai, India; Consultant, Pediatric Gastroenterologist, Mumbai, India

Oral Presentation 28, APDW Theatre 1, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: To determine prevalence of food allergy and their clinical profile in children with recurrent abdominal pain (RAP)

Material/Methods: Pediatric patients (1month to 18years) with recurrent pain abdomen in pediatric gastroenterology opd were enrolled in retrospective study(July 2016 and July 2024). Diagnosis of food allergy was made with history, clinical examination and investigations done to exclude other causes of pain abdomen (CBC, IgE level, Peripheral smear, Serum IgE levels, TTG IgA, LFT, Amylase, Lipase, RFT, Urine routine & microscopy examination and Ultrasound abdomen). Patients with high IgE levels and GI symptoms of >3months underwent gastroduodenoscopy and skin prick testing. Patients with high fecal calprotectin additional ileocolonoscopic examination was done. Duodenal, ileal and colon biopsies sent for histopathology. After Dietary elimination their clinical symptoms recorded till 3months of followup.

Results: 784 children (404 -M, 380- F, mean age7 yr) included. 8% subjects were diagnosed for food allergy. A total of 30 patients (48%) had a positive SPT. Out of 62 patients, 30 patients(48%) with persistent GI symptoms of more then 3months and high fecal calprotectin underwent endoscopies and found in 24 (80%) lymphonodular duodenitis, aphthous ulcers in colon and ileal nodularity. Twenty patients showed significant infiltration of eosinophils especially in duodenum and ileum. Positive skin-prick test with 40% patient found association with clinical symptoms. 80% of patients improved 3month follow up on elimination diet.

Conclusion: Skin prick test, endoscopy with biopsy and clinical correlation may help in deciding in allergen specific elimination diet for better outcomes

OP-28-06

Rate and associated factors of acute rebleeding peptic ulcer diseases after successful endoscopic hemostasis

Toan Dang Vo¹ and Duc Trong Quach²

¹Tam Anh Ho Chi Minh City General Hospital, Ho Chi Minh, Viet Nam; ²University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Viet Nam

Oral Presentation 28, APDW Theatre 1, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: To determine the rate, timing, and factors associated with in-hospital rebleeding in patients with upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) after successful endoscopic hemostasis.

Materials and Methods: A cross-sectional study was conducted on 153 patients diagnosed with UGIB due to PUD classified as Forrest Ia, Ib, IIa, IIb, who underwent successful endoscopic hemostasis at Nhan Dan Gia Dinh Hospital from January 2019 to January 2023.

Results: The average age of patients in the study was 61.2 ± 17.2 years, with males accounting for 76.5%. After successful endoscopic hemostasis, the rebleeding rate during hospitalization was 9.8%, with 53.3% of rebleeding cases occurring within 72 hours after the endoscopic intervention. Multivariate analysis indicated that shock, heart rate ≥ 100 beats/min, INR ≥ 1.3, and ulcer size ≥ 1 cm were risk factors for in-hospital rebleeding.

Conclusion: Half of the in-hospital rebleeding cases in patients with UGIB due to PUD after successful endoscopic intervention occurred within the first 72 hours. Shock, heart rate ≥ 100 beats/min, INR ≥ 1.3 at the time of admission, and ulcer size ≥ 1 cm were identified as risk factors for rebleeding.

OP-28-07

Test-and-treat for Helicobacter Pylori in direct oral anticoagulants and upper gastrointestinal bleeding risk: population-based analysis

Xiang Xiao^1,2, Terry Cheuk-Fung Yip^1,2,3, Bonaventure Yiu-Ming Ip¹, Vincent Wai-Sun Wong^1,2,3, Francis Ka-Leung Chan^1,3, Grace Lai-Hung Wong^1,2,3 and Louis Ho-Shing Lau^1,3

¹Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; ²Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong; ³Institute Digestive Disease, The Chinese University of Hong Kong, Hong Kong

Oral Presentation 28, APDW Theatre 1, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: Direct oral anticoagulant (DOAC) users are at risk of upper gastrointestinal bleeding (UGIB). We aimed to investigate whether Helicobacter pylori (HP) eradication can reduce the subsequent risk of UGIB among new DOAC users.

Materials and Methods: A territory-wide registry, population-based, retrospective study was performed in Hong Kong. Subjects with new exposure to apixaban, dabigatran, edoxaban or rivaroxaban between 2011 and 2020 were included. HP test and treatment records were extracted based on rapid urease test, histology, diagnosis code and drug prescription.

Subjects were classified into two groups, “HP tested-and-treated” (as HP infection diagnosed and treated on or before DOAC exposure) and “Unknown HP status”. Inverse probability of treatment weighting (IPTW) was applied to balance the baseline characteristics (Table1).

The primary outcome was severe UGIB, defined as UGIB-related deaths or endoscopically confirmed bleeders with either hemoglobin drop >2g/dL, blood transfusion or rebleeding requiring interventions within 30 days. Subjects were followed for 2 years from the DOAC exposure and censored at new HP therapy or DOAC discontinuation. Non-UGIB-related death was considered as competing risk.

Results: 57,410 subjects were included in the study (Table 1). All baseline characteristics were balanced. The 2-year cumulative incidences of severe UGIB in ‘HP tested-and-treated’ and ‘unknown HP status’ groups were 0.48% and 0.61% respectively, with sub-distribution hazard ratio by Fine-Gray model = 0.75, 95% C.I. = [0.39, 1.44]. (Figure 1)

Conclusion: A test-and-treat strategy for HP was not associated with a reduced risk of UGIB among DOAC users in the first 2 years after drug initiation.

OP-29-01

Natural history and outcomes in patients with liver cirrhosis after index gastric variceal hemorrhage

Sagnik Biswas, Sanchita Gupta, Anuradha Sharma, Arnav Aggarwal, Umang Arora, Shekhar Swaroop, Rajkumar Bayye, Amitkumar Chavan, Swapnil Chaudhary, Ayush Agarwal, Samagra Agarwal, Anshuman Elhence, Soumya Jagannath Mahapatra, Deepak Gunjan, Shivanand Gamanagatti and Shalimar

All India Institute Of Medical Sciences, New Delhi, New Delhi, India

Oral Presentation 29, APDW Theatre 2, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: Limited data exists on the natural history of patients with liver cirrhosis after the first episode of bleeding from fundal varices (FV).

Methods: Patients with liver cirrhosis with index bleeding from large FV (≥2 cm) were prospectively recruited from January 2017 to January 2024 and followed till death or last well-known.

Results: Two hundred and sixty nine patients were recruited. Median baseline Child and MELD score was 7 (6-9) and 12.3 (10.2-15.5) respectively.

Two hundred patients received endoscopic glue injection (ECI) alone while 47 and 22 patients received BRTO and TIPSS after ECI respectively.

Over a median follow-up of 870 (214-1319) days in the ECI group, 74 (37%) patients had further decompensation with the most common event being ascites and rebleeding in 23 (31.1%) patients. The 1, 3- and 5-year rates of decompensation were 25%, 36.3% and 40% respectively. The 1, 3- and 5-year mortality rates were 21.8%, 32.6% and 45% respectively. Risk of all-cause rebleeding at 1, 3-and 5-years was 17.8%, 26.3% and 29.7% respectively. Age and size of afferent shunt vessels of FV were independently associated with rebleeding. Patients undergoing BRTO or TIPSS had significantly lower rebleeding rates than those undergoing ECI alone (log-rank p=0.03) [Figure 1a], although there was no difference in mortality rates among patients of all 3 groups (log-rank p=0.17) [Figure 1b].

Conclusion: Patients with liver cirrhosis are at high risk of further decompensation after index bleeding episode from fundal varices. TIPSS and BRTO reduce rebleeding risk but do not improve overall survival.

OP-29-02

Slc26a9 protects the mucosal defense barrier against portal-hypertensive-gastropathy by attenuating ERS mediated mitochondria-dependent apoptotic signaling

Bei Ji and Xuemei Liu and Zhiyuan Ma and Zhiqiang Yi and Zilin Deng and Jiaxing Zhu and Biguang Tuo and Taolang Li

Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, 遵义, China

Oral Presentation 29, APDW Theatre 2, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Aim: Endoplasmic reticulum stress induced mitochondria-dependent mucosal apoptosis and impaired mucosal defense barriers have been shown to be fundamental pathological features of portal hypertensive gastropathy (PHG). Slc26a9 is highly expression in the stomach, which is a key regulator to maintain gastric mucosal homeostasis. Slc26a9 deletion in mice impaired gastric mucosal barrier. However, the role of Slc26a9 in PHG is never investigated.

Methods: Gastric mucosal injury and apoptosis were studied in both PHG patients and PHG animal models by using parietal-specific Slc26a9 knockout (Slc26a9-KO) and Slc26a9 wild-type (Slc26a9-WT) mice.

Results: Compared with sham operated mice, the mucosa of portal vein ligated (PVL) mice displayed obvious gastric mucosal damage. Slc26a9-KO-PVL mice displayed severe gastric mucosal injury than that in Slc26a9-WT-PVL mice. Excessive gastric epithelial cells apoptosis was detected in Slc26a9-KO-PVL mice, accompanied with upregulation of endoplasmic reticulum stress markers, including Caspase12, eIF α-1, xBP-1, p53 upregulated apoptosis regulator, as well as mitochondrial apoptosis markers, such as Bax, Bak, Cyt-c, Caspase 9 and Caspase 3, when compared with Slc26a9-WT-PVL mice. Recombinant adeno-associated virus with Slc26a9 overexpressed in Slc26a9-KO-PVL mice showed significant reversed gastric mucosal damage, including parietal and chief cells restore, reversal of cystic dilatation, and reduction of inflammatory cells, accompanied with significant reduction of gastric epithelial cell apoptosis, as well as ER stress mediated mitochondria-dependent apoptotic signalling. Moreover, human PHG showed significantly reduced both Slc26a9 mRNA and protein expression when compared to healthy controls.

Conclusion: Slc26a9 protects the mucosal defense barrier against PHG by attenuating ER stress mediated mitochondria-dependent apoptotic signaling.

OP-29-03

Predictive Value of Superior Mesenteric Vein Diameter for Anticoagulation Response in Portal Vein Thrombosis

Siyu Jiang¹, Xiaoquan Huang^1,2 and Shiyao Chen^1,2

¹Zhongshan Hospital, Fudan University, Shanghai, China; ²Evidence-based Medicine Center, Fudan University, Shanghai, China

Oral Presentation 29, APDW Theatre 2, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: The aim of this study was to explore factors affecting anticoagulation response, emphasizing the predictive value of the superior mesenteric vein's internal diameter for PVT recanalization.

Materials and Methods: We gathered data on 32 variables (clinical, ultrasonographic, and hemostatic factors) from 316 patients with portal hypertension and portal vein thrombosis. Shapley additive explanations (SHAP) method was used to illustrate the effects of leading features attributed to portal vein thrombosis recanalization. The predictive performance of predictors was evaluated using time-dependent ROC curves and Kaplan-Meier analysis.

Results: During the follow-up period, 134(42.41%) patients experienced a reduction in portal vein thrombosis. The internal diameter of the superior mesenteric vein (HR: 1.13, 95%CI: 1.03-1.25, P=0.010) was identified as an independent predictive factor for portal vein thrombosis reduction. Using the SHAP method, we found that the internal diameter of the superior mesenteric vein (Shapley value: 0.243) contributed the most to predicting portal vein thrombosis recanalization in cirrhosis. The internal diameter of superior mesenteric vein showed relative higher prognostic accuracy within 3 months and 36 months , with an area under the curve (AUC) of 0.61 and 0.62, respectively. Patients with an internal diameter of the superior mesenteric vein > 8.5 mm had a significantly higher rate of portal vein thrombosis recanalization compared to those with ≤ 8.5 mm (42.64% vs. 15.36%, P < 0.001).

Conclusion: Increased internal diameter of the superior mesenteric vein offers reliable assessments of portal vein thrombosis recanalization and is recommended for evaluating and predicting reduction post-anticoagulation.

OP-29-04

Identification of vWF and RBP7 as potential targets in Oxaliplatin-Induced Portal Hypertension

Xinghuan Li, Sitao Ye, Yingjie Ai, Xiaoquan Huang and Shiyao Chen

Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China

Oral Presentation 29, APDW Theatre 2, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objective: Portal hypertension occurs in colorectal cancer patients undergoing oxaliplatin chemotherapy, significantly affecting survival and quality of life. This study aims to evaluate the value of vWF factor activity for predicting hepatic venous pressure gradient (HVPG) and identify role of vWF and RBP7 in oxaliplatin-induced portal hypertension.

Materials and Methods: HVPG measurement and vWF factor activity detection were performed on 246 patients with gastroesophageal varices, followed by correlation analysis. The GSE32384 dataset, comprising 24 samples divided into three groups (control, grade0, and grade3), was analyzed to screen for potential targets.

Results: A significant positive correlation between vWF factor activity and HVPG was found (HVPG = 0.02238*vWF activity + 8.492, p<0.0001). Transcriptome showed VWF upregulated with the progression of portal hypertension, consistent with clinical results. Differential genes in the ECM-receptor interaction pathway showed significant changes, with LAMA2 highly correlated with VWF (correlation coefficient = 0.75). Further analysis identified RBP7 and 13 other genes as potential targets with high correlation with both VWF and LAMA2 (correlation coefficient >0.7). EGO analysis showed significant enrichment in fibrosis-related pathways. Metabolic reprogramming analysis indicated RBP7's role in oxaliplatin-induced portal hypertension might be regulated through the fatty acid metabolism pathway.

Conclusion: vWF factor activity is an effective predictor of HVPG, indicating its important role in oxaliplatin-induced portal hypertension. vWF and RBP7 may serve as new intervention targets, providing new directions for the non-invasive diagnosis and treatment of oxaliplatin-induced portal hypertension.

OP-29-05

SOX9 promotes hepatocyte proliferation via paracrine TGF-α during liver regeneration

Shu Qing Liu¹, Weifen Xie² and Xin Zhang²

¹Shanghai East Hospital, Shanghai, China; ²Changzheng Hospital, Shanghai, China

Oral Presentation 29, APDW Theatre 2, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: The hybrid hepatocytes (HybHP) co-expressing HNF4α and low levels of SOX9 exist as liver progenitor cells, contributing to chronic liver injury repairing. Deletion of HNF4α results in sustained hepatocyte proliferation after partial hepatectomy. This study aims to explore the role of SOX9 on liver regeneration (LR) and the regulatory effect of HNF4α on SOX9 expression.

Materials and Methods: The effect of HNF4α-related miRNA on SOX9 expression was investigated in hepatocyte-specific Hnf4α knockout (Hnf4αHKO) mice and HepG2 cells. Hepatocyte-specific Sox9 knockout (Sox9HKO) or overexpression (Sox9HOE) mice were utilized to confirm the regulatory role of SOX9 on LR. LR capacity was evaluated by liver/body weight ratio, histology, immunofluorescence, and real-time PCR. SnRNA-seq and RNA-sequencing of Sox9HKO mice were used to explore the mechanism of SOX9 in promoting hepatocyte proliferation.

Results: The expression of SOX9 and HNF4α was negatively correlated during LR. Moreover, the depletion of HNF4α increased the SOX9 expression in mice and HepG2 cells, and miR-124/381 inhibitors partially reversed the effect of HNF4α on SOX9 expression. Notably, hepatocyte-specific deletion of Sox9 decreased but overexpression of Sox9 increased liver/body weight ratio, hepatocyte proliferation, and survival rate in LR and SFSS models. Additionally, SOX9 transcriptionally activated the TGF-α expression. Importantly, we confirmed that canertinib (EGFR inhibitor) partially inhibited the hepatocyte proliferation induced by SOX9 both in mice and primary hepatocytes.

Conclusion: Our findings unravel the machinery of HNF4α inhibiting SOX9 expression through miR124/381, and indicate that HNF4α-miR124/381-SOX9-TGF-α axis may be critical for LR.

OP-29-06

The diagnostic accuracy of fibrosis-4 (FIB-4) index in detecting hepatic fibrosis on liver elastography

Rafael Emmanuel Mendoza, Dyan Gabrelle De Guzman-David, Arielle Nicole Cheng and Ian Homer Cua

St. Luke's Medical Center - Global City, Taguig City, Philippines

Oral Presentation 29, APDW Theatre 2, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Background: The Philippines has the third highest mortality growth worldwide from cirrhosis. The Fibrosis-4 (FIB-4) index is a non-invasive scoring system using age, platelet count, and liver transaminase levels generally used to estimate the degree of hepatic fibrosis. No previous study has looked into the applicability of this tool in Filipino patients.

Objectives: The aim of this study is to determine the diagnostic accuracy of the FIB-4 index compared to liver elastography for assessment of liver fibrosis in Filipinos.

Methodology: This cross-sectional study collected clinical data, laboratory results, and liver elastography findings. Data was analyzed using an area under the receiver operating characteristic (AUROC) curve.

Results: In 459 patients (57.1 percent male, mean age 53.1 years, mean BMI 28.79 kg/m2), the FIB-4 has an AUROC of 0.698 (95% CI 0.653-0.739). Using the best cut-off score through Youden's index 1.21, FIB-4 showed sensitivity of 63.3% (95% CI 56-70.2) and specificity of 73.1% (95% CI 67.4 to 78.3) in detecting the presence of fibrosis on liver elastography.

In the subset of non-obese Filipinos, FIB-4 has an AUC of 0.778 (95% CI 0.695-0.847). The best cut-off score through Youden's index is 1.37, sensitivity of 69.8% (95% CI 53.9-82.8), and specificity of 82.9% (95% CI 73-90.3).

Conclusion: FIB-4 still has a low sensitivity and low to moderate specificity in predicting hepatic fibrosis in Filipinos. Thus, we recommend further research on other feasible and accessible non-invasive modalities to assess liver fibrosis.

OP-29-07

Deep-learning analysis of cirrhotic and non-cirrhotic features for improved liver lesion localization via multi-sequence MRI-voting

Sulagna Mohapatra^1,2, Chun-Ying Wu^2,3,4,5,6, Yao-Chun Hsu^7,8, Teng-Yu Lee^1,9, Che-Lun Hung^2,3, Yuan-Chia Chu^10,11, Chia-Sheng Chu^12,13 and Pushpanjali Gupta^2,3,4

¹Division of Gastroenterology & Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan; ²Health Innovation Center, National Yang Ming Chiao Tung University (NYCU), Taipei, Taiwan; ³Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taiwan; ⁴Institute of Public Health, National Yang Ming Chiao Tung University, Taiwan; ⁵Division of Translational Research, Taipei Veterans General Hospital, Taiwan; ⁶Department of Public Health, China Medical University, Taichung, Taiwan; ⁷Division of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan; ⁸School of Medicine, I-Shou University, Kaohsiung, Taiwan; ⁹School of Medicine, Chung Shan Medical University, Taichung, Taiwan; ¹⁰Information Management Office & Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan; ¹¹Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; ¹²Division of Gastroenterology and Hepatology, Taipei City Hospital Yang Ming Branch, Taipei, Taiwan; ¹³Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

Oral Presentation 29, APDW Theatre 2, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: To develop a dual-step system inspired by deep learning, called BiDL-LivFLLD, aimed at automatically detection the liver and focal liver lesions (FLLs) in both cirrhotic and non-cirrhotic patients by leveraging the extensive imaging characteristics of FLLs within multi-sequence MRI.

Materials and Methods: This retrospective study included 271 patients (60 cirrhotic, 211 non-cirrhotic) with MRI data collected from January 2010 to December 2014. It utilized diverse imaging features from contrast (arterial, venous, delay phases) and non-contrast (T1, T2, T1 Dual Echo, and T1/T2 ratio) MRI sequences. The dataset included 144 cirrhotic and 560 non-cirrhotic nodules. Based on the development paradigm, BiDL-LivFLLD's initially localized the liver, facilitating the automatic identification of FLLs through a novel voting scheme, combining individual outcomes of multi-sequence MRI for precise FLL localization.

Results: The BiDL-LivFLLD's initial phase achieved mean average precision (mAP) scores of 0.96 for cirrhotic and 0.98 for non-cirrhotic liver localization. The average precision and recall for non-cirrhotic cases were 0.96 and 0.88, respectively, and 0.73 and 0.86 for cirrhotic cases. Additionally, the system achieved F1-score of 0.80 for cirrhotic and 0.87 for non-cirrhotic fatty liver cases. Furthermore, size-wise true positive rates (TPRs) were 0.53 and 0.86 for lesions ≤ 1.5 cm, and 0.81 and 0.87 for 1.5 cm-3 cm lesions in both case types. For larger lesions > 3cm, the model had 100% localization accuracy (Figure 1).

Conclusion: The advanced BiDL-LivFLLD system utilizes multi-sequence MRI to auto-detect FLLs over 0.3 cm in cirrhotic and non-cirrhotic patients, significantly reducing errors, workload, and diagnostic time.

OP-29-08

Diagnostic value of biliary atresia screening tools in an Indonesian liver transplant center

Himawan Aulia Rahman and Hanifah Oswari

Gastrohepatology Division, Department Of Child Health, Faculty Of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Oral Presentation 29, APDW Theatre 2, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: Early biliary atresia (BA) detection remains a significant problem in Indonesia. Diagnosis should be made early to reduce the need for liver transplantation. Hence a rapid method for BA screening is essential. In our center, we use three parameters as screening tools, i.e., stool color, high γ-GT, and abdominal ultrasound (US). This study aims to assess the diagnostic value of these three parameters.

Materials and Methods: This study took medical record data from November 2021 to July 2023. The subjects were cholestatic patients who underwent intraoperative cholangiography, resulting in two groups: BA and non-BA. The data comprised sociodemographic, clinical, laboratory, and abdominal US. We calculated each diagnostic parameter's sensitivity, specificity, PPV, and NPV. Using the ROC curve, we also looked for a cut-off of γ-GT for BA detection.

Results: We included 46 subjects, consisting of 33 BA and 13 non-BA patients. Sensitivity for each parameter of acholic stool, high γ-GT (>250 U/L), and US suggestive of BA were 97%, 93.9%, and 93.9%, with a specificity of 15.4%, 69.2%, and 53.8%. The sensitivity and specificity for the combination of acholic stool and γ-GT were 97% and 15.4%; acholic stool and US were 100% and 7.7%; and γ-GT and US were 100% and 38.5%. The most reliable γ-GT level for detecting BA is ≥373.5 U/L (93.9% sensitivity, 92.3% specificity).

Conclusion: Combining two of three parameters (acholic stool, high γ-GT, or abdominal US) is helpful as a screening tool for BA. The most reliable γ-GT for BA detection is ≥373.5 U/L.

OP-29-09

Splenic Vein Velocity as a predictor of Oesophageal Varices in Clinically Significant Portal Hypertension

Minu Sajeev Kumar

Government Medical College Trivandrum, Thiruvananthapuram, India

Oral Presentation 29, APDW Theatre 2, Exhibition Hall, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: Esophagogastroduodenoscopy (OGD) is the gold standard tool in both screening of varices in patients with liver cirrhosis.

Many noninvasive clinical, laboratory, and radiological parameters have been evaluated as screening predictors of varices, to decrease the economic and physical burden on patients before referral for endoscopy. We tried to evaluate the association of Clinically significant portal hypertension [CSPH] and esophageal varices [EV], with splenic vein velocity [SVV] in patients with liver fibrosis.

Materials and Methods: Cross-sectional study of 85 consecutive patients. Hematological and biochemical parameters were recorded. Doppler ultrasound was done. OGD was the gold standard for oesophageal varices.

Results: Two groups were identified. Group 1- CSPH/EV defined as per Baveno VII “rule of five” or esophageal varices and group 2 -those without CSPH/EV. Group 1 had 46 [54%] and group 2 had 39 [45.8%] patients. The splenic vein velocity [SVV] exceeded portal vein velocity [PVV] in 87% of group 1 and 25.6% in group 2 [p <0.001]. The AUC of splenic vein velocity was 0.885[0.814-0.956, 95% CI]. The sensitivity of Baveno VII “rule of five” for detecting the presence of oseophageal varices was 75.8% while that with SVV>PVV was 87%. This study demonstrates that SVV increases with an increase in LSM, an increase in splenic stiffness, an increase in splenic vein diameter (SVD), and with decrease in platelet count.

Conclusion: The splenic vein velocity is a safe, widely available, cheap, and reproducible means to predict EV. We found it better than the Baveno VII criteria for predicting oesophageal varices.

OP-30-01

Machine learning-based prediction of response to ustekinumab in Chinese patients with Crohn's disease

MD Ziyi Xiong, Pan Gong, Mingmei Ye, Yuanyuan Huang, Xiayu Mao, Panpan Zhao and Li Tian

The Third Xiangya Hospital of Central South University, Changsha, China

Oral Presentation 30, Uluwatu 1, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: A reliable approach to predict the response to Ustekinumab (UST) in Chinese patients with Crohn's disease (CD) is lacking. This study aims to develop and validate machine learning (ML) models to predict the response to UST, and further achieving personalized therapy.

Materials and Methods: This study included 102 CD patients treated with UST between May 2022 and May 2023. Four ML algorithms were integrated to identify the optimal model, and Shapley Additive exPlanations (SHAP) interpretation was used for visual explainability. Two models were established to forecast the response to UST, with the outcomes of the remission situation at week 26 and secondary loss of response (sLOR) status at week 52, respectively. 32 CD patients from other three centers were applied for week-26 model's external validation.

Results: XGBoost performed excellently among the four ML algorithms. Seven features were finally selected for week-26 model and ten for sLOR model. The week-26 model exhibited good performances of 0.94 AUC, 95.23% accuracy, 92.86% precision, 100.00% recall, and 96.30% F1 score. Similarly, sLOR model performed well with 0.88 AUC, 92.31% accuracy, 100% precision, 75.00% recall and 85.71% F1 score.

Conclusion: We developed and validated models to predict UST response for CD patients in China and interpreted related factors by SHAP method. We hope that the models can assist physicians to identify patients who are suitable for UST at baseline and further explore who are at high risk for sLOR.

OP-30-02

Natural course of Crohn’s disease in China: Results from Chinese database for inflammatory bowel disease(CHASE-IBD)

Jian Wan¹, Jun Shen², Jie Zhong³, Naizhong Hu⁴, Lanxiang Zhu⁵, Yinglei Miao⁶, Wensong Ge⁷, Zhonghui Wen⁸, Yufang Wang⁸, Jie Liang¹ and Kaichun Wu¹

¹Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China; ²School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China; ³School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China; ⁴The First Affiliated Hospital of Anhui Medical University, Hefei, China; ⁵The First Affiliated Hospital of Soochow University, Suzhou, China; ⁶The First Affiliated Hospital of Kunming Medical University, Kunming, China; ⁷Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; ⁸West China Hospital, Sichuan University, Chengdu, China

Oral Presentation 30, Uluwatu 1, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: Data on the natural course of Crohn's disease (CD) in China is limited. We aimed to provide a comprehensive description of the natural course of CD in China

Materials and Methods: Based on a prospective Chinese nationwide registry of consecutive patients with inflammatory bowel diseases, the medical treatments and natural history of CD were described in detail, including disease location extension, progression of disease behaviour, and surgery.

Results: A total of 1354 UC patients were included with a median follow-up duration of 6.0 years. The overall cumulative exposure was 71.9% to 5-aminosalicylic acids, 52.5% to corticosteroids, 58.6% to immunomodulators, and 71.6% to biologics. Disease extent at diagnosis was ileal in 24.7%, colonic in 21.9%, ileocolonic in 47.2%, and upper gastrointestinal involved in 6.3%. At diagnosis, 66.3% had non-stricturing non-penetrating disease, 25.0% had stricturing disease, and 8.6% had penetrating disease. The cumulative proportions of progression of disease behaviour at 1, 5, and 10 years after diagnosis were 9.8%, 36.4%, and 57.1%, respectively. The cumulative proportion of developing perianal disease was 46.7%. In addition, 416 (30.7%) patients underwent surgical resection, demonstrating cumulative proportions of surgery at 1, 5, and 10 years after diagnosis of 15.8%, 34.9%, and 40.2%, respectively.

Conclusion: Although the proportion of CD patients receiving biologics is high in China, the risk of disease behavior progression and surgery is still high. This may indicate a different natural course, and then close monitoring needs for CD in China. However, these results must be confirmed in population-based study.

OP-30-03

Akkermansia muciniphila/Amuc-1100 attenuates dextran sulfate sodium-induced ulcerative colitis in mice by VDR-induced SLC26A3 transcription

Suhong Xia and Qin Yu

Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Oral Presentation 30, Uluwatu 1, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: We have previously found that adenovirus-SLC26A3 overexpressed improves colitis and promotes the increase of Akkermansia muciniphila (AKK), but the role of AKK in colitis and the effect on SLC26A3 remain to be elucidated.

Materials and Methods: Microbiome supplement therapy, fecal microbiota transplantation (FMT) and its outer membrane protein Amuc-1100 models were applied to show the intestinal epithelial response, the infiltration of different immune cells and expression of SLC26A3. LPS-treated Caco2-BBE cells were incubated with different concentrations of Amuc-1100 protein to analyze the level of SLC26A3. Next the proteins interacting with Amuc-1100 were analyzed and verified by pull-down experiment.

Results: In DSS mice model, the supplement therapy with AKK or outer membrane protein Amuc-1100 could recover the loss of body weight and alleviate the disease activity index (DAI). Moreover, the supplement therapy with AKK could increase the expression of SLC26A3, restore the damaged epithelial barrier, strengthen the tight junctions and decrease inflammatory cytokine. The Fecal microbiota transplantation (FMT) was able to augment in body weight, gain lower DAI and diminish the inflammatory response and inflammatory cell infiltration. The up-regulated expression of SLC26A3 were found in Amuc-1100-treated Caco2-BBE cells with LPS. Moreover, the pull down indicated that RXRG was beneficial to the uptake of Amuc-1100 and promoted the upregulation of VDR. The level of SLC26A3 was governed by VDR confirmed by luciferase reporter experiments.

Conclusion: Our findings demonstrated that AKK supplement or Amuc-1100 plays a core role in relieving ulcerative colitis by VDR-induced SLC26A3 transcription.

OP-30-04

Salivary exosomal microRNAs: Emerging biomarkers for non-invasive diagnosis and monitoring of inflammatory bowel disease

Congyi Yang, Yuzheng Zhao and Ning Chen

Peking University People's Hospital, Beijing, China

Oral Presentation 30, Uluwatu 1, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: This study aims to unearth that miRNAs in salivary exosomes have the potential to monitor IBD disease status and offer novel possibilities for the diagnosis and follow-up of IBD.

Materials and Methods: In this work, the discovery cohort included 24 IBD patients (11 with active disease, 13 in remission) and 6 healthy controls (HC). The validation cohort consisted of 102 IBD patients (53 with active disease, 49 in remission) and 18 HC. To demonstrate the potential of miRNA expression as a diagnostic biomarker, we conducted a receiver operating characteristic (ROC) analysis and calculated the area under the curve (AUC) to assess the discriminatory power.

Results: In the discovery cohort, we observed a significant increase in the expression of 23 miRNAs in the salivary exosomes of the IBD group. Furthermore, we have identified a signature comprising 8 salivary exosomal microRNAs that distinctly distinguishes patients with IBD from healthy controls within the validation cohort. Notably, hsa-miR-1246, hsa-miR-142-3p, hsa-miR-16-5p, hsa-miR-301a-3p, and hsa-miR-4516 exhibit a significant correlation with the activity of IBD. the combination of has-miR-16-5p and has-miR-4516 demonstrated an AUC of 0.925 for distinguishing IBD patients from HC, and an AUC of 0.82 when differentiating between disease activity and remission. The final predictive model, incorporating all five microRNAs, achieved an AUC of 1 for distinguishing IBD patients from HC and an AUC of 0.86 for differentiating active disease states from remission.

Conclusion: we propose that the saliva-derived exosomes of IBD patients harbor unique miRNAs signatures which dynamically correlate with the disease activity.

OP-30-05

From West to East: Dissecting the Global Shift in Inflammatory Bowel Disease Burden

Kaiqi Yang, Changhao Zhang, Rui Gong and Xiujing Sun

Department Of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China

Oral Presentation 30, Uluwatu 1, November 23, 2024, 3:40 PM - 5:00 PM

Background: The epidemiology of inflammatory bowel disease (IBD) has changed dramatically worldwide. This survey analyzed patterns and trends in the burden of IBD to aid future decision making.

Methods: The incidence, prevalence, mortality, and disability-adjusted life year data for IBD were derived from the GBD (Global Burden of Disease) study.

Results: In 2021, there were 3,830,119 cases of IBD worldwide, including 375,140 new cases, 42,423 IBD-related deaths, and 1,510,784-year healthy life loss due to IBD. The burden of IBD is usually concentrated in regions and countries with high sociodemographic indices(SDI). In 2021, the number of cases (2,000,478) and deaths (22,968) in women were higher than those in men, but the number of new cases in men was higher (188,005 cases). At the global, regional, and national levels, the number of IBD-related illnesses and deaths is still slowly increasing, but the age-standardized rate(ASR) is on a downward trend. The decomposition analysis showed that the change in the burden of IBD was mainly due to the growth of the global population. Frontier analysis showed that age-standardized incidence rate(ASIR) were positively correlated with sociodemographic indexes. As SDI declines, IBD ASIR's effective difference (EF) for a particular SDI is smaller.

Conclusion: As a major global public health issue, there are significant regional differences in the burden of IBD. There data are crucial for healthcare professionals, policymakers, and researchers to refine and enhance management strategies, aiming to further mitigate IBD 's global impact.

OP-30-06

Colonic Transendoscopic Enteral Tubing Can Improve Crohn's Disease with Intestinal Obstruction: A Prospective Cohort Study

You Yu, Xinyi He, Weihong Wang and Faming Zhang

Department of Microbiota Medicine and Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China

Oral Presentation 30, Uluwatu 1, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: Patients with Crohn's disease (CD) and intestinal obstruction face a higher risk of surgery if conservative treatments fail. Given the lack of alternative interventions, we aimed to determine whether colonic transendoscopic enteral tubing (TET) can effectively treat intestinal obstruction in patients with CD.

Materials and Methods: This study began in March 2018. We screened patients with active CD and confirmed intestinal obstruction through imaging who had not responded to three days of basic treatment. Based on their preferences, patients chose between receiving colonic TET or continuing basic treatment. The primary outcome was the obstruction improvement rate at 14 and 28 days.

Results: From March 2018 to March 2024, 43 patients were analyzed, divided into the colonic TET group (n=17) and the non-colonic TET group (n=26). Both groups had similar baseline characteristics, except for the presence of fistulas. All patients in the colonic TET group received washed microbiota transplantation, and seven with significant colonic inflammation also received dexamethasone infusions. At 14 days, the obstruction improvement rate was 64.7% in the colonic TET group compared to 50.0% in the non-colonic TET group (p=0.342). At 28 days, the rates were 94.1% and 69.2%, respectively (p=0.036). In the secondary outcome, only CD obstruction score ≤3 one month post-discharge showed a significant difference (p=0.005).

Conclusion: Colonic TET is a novel and safe endoscopic intervention for CD with intestinal obstruction, providing a higher obstruction improvement rate than basic treatment. This technique offers a promising new approach in interventional inflammatory bowel disease.

OP-30-07

Verbenalin alleviates colitis by inhibiting GSDME-mediated macrophage pyroptosis

Junjie Yuan, Junming Miao, Xin Chen and Jingwen Zhao

Tianjin Medical University General Hospital, Tianjin, China

Oral Presentation 30, Uluwatu 1, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: To evaluate the therapeutic efficacy of Verbenalin in Ulcerative Colitis (UC) and elucidate its specific molecular mechanism.

Materials and Methods: Mice were treated with Dextran Sodium Sulfate (DSS) and Verbenalin to observe inflammatory changes in the colon. Network pharmacology was utilized to predict Verbenalin targets for UC. The binding ability between Verbenalin and the target protein was assessed using Cell Thermal Shift Assay (CETSA) and Bio-Layer Interferometry (BLI). Immunofluorescence (IF) was used to evaluate the effect of Verbenalin on macrophages in colon tissue. RAW246.7 and BMDM cells, stimulated with Lipopolysaccharide (LPS) and Adenosine Triphosphate (ATP), were used to investigate the role of pyroptosis in this process.

Results: Verbenalin alleviated weight loss, colon shortening, and Disease Activity Index (DAI) scores in DSS-treated mice. It also upregulated the expression of claudin and ZO-1, thus protecting intestinal barrier function. Furthermore, Verbenalin downregulated the pro-inflammatory cytokines IL-1β, IL-6, and TNF-α, while upregulating the expression of the anti-inflammatory cytokine IL-10. Network pharmacology revealed that Verbenalin can interact with Caspase-3, a component of the non-classical pyroptosis signaling pathway. Additionally, co-localization of GSDME and IL-1β with macrophages in the colon was reduced in Verbenalin-treated mice. Both CETSA and BLI confirmed stable binding between Verbenalin and Caspase-3. Cell experiments indicated that LPS upregulated the expression of Caspase-3, GSDME, and IL-1β, which was inhibited by Verbenalin.

Conclusion: This study highlights the potential targets and molecular mechanism of Verbenalin in combating UC, suggesting Verbenalin as a promising therapeutic option for UC.

OP-30-08

A link between circadian rhythm and colonic immune microenvironment in elderly ulcerative colitis

Yang Zhang, Jun Xu, Junyao Wang, Yiken Lin and Yulan Liu

Peking University People's Hospital, Beijing, China

Oral Presentation 30, Uluwatu 1, November 23, 2024, 3:40 PM - 5:00 PM

Objectives: Circadian rhythms have been recognized to be associated with autoimmune diseases and aging. Herein, we aimed to explore the implication of circadian rhythm in elderly UC.

Materials and Methods: We downloaded datasets from GEO database. The differential expression of circadian regulators between early adult (15-25 years old) and elderly (≥ 60 years old) UC patients was identified. Random forest (RF) and support vector machine (SVM) were performed to select feature genes and ROC curves were used to validate the performances of signature genes. The infiltration of 22 kinds of immune cells in elderly UC was analyzed by ssGSEA, and the relationship between feature circadian genes and immune infiltration was determined. Finally, we identified circadian subtypes based on signature circadian regulatory genes.

Results: A total of 44 differentially expressed circadian regulators were identified between early adult and elderly UC patients. Five feature circadian regulatory genes, AGT, EGF, NR3C2, PPY, and PYY were determined to establish a nomogram model that can predict the incidence of elderly UC. The signature circadian regulators were found to be correlated with activated memory CD4+ T cells, gamma delta T cells, and macrophages. We identified two circadian subtypes based on the five significant circadian regulatory genes. Cluster A had a higher immune infiltration of activated CD4+ T cells, CD8+ T cells and B cells than cluster B (p < 0.01).

Conclusion: The circadian regulatory genes play non-negligible roles in elderly UC, which may provide insights into the guide treatment of elderly UC patients.

OP-30-09

Natural course of ulcerative proctitis: a single-center retrospective study

Jiaming Zhou, Jian Wan, Zhuo Wang, Hao Zhang, Jingmin Yu and Kaichun Wu

Xijing Hospital Of Digestive Diseases, Air Forth Medical University, Xi’an, China

Oral Presentation 30, Uluwatu 1, November 23, 2024, 3:40 PM - 5:00 PM

Objective: This study aimed to provide a comprehensive description of natural course of ulcerative proctitis (UP).

Methods: Patients diagnosed with UP between January 2000 and May 2023 were prospectively registered and retrospectively analyzed.All patients were ≥ 18 years old at diagnosis and followed up for more than one year.The disease extent at diagnosis and during follow-up was assessed according to the Montreal classification.The Kaplan-Meier method was used to describe the cumulative proportions of disease extent progression,and the Cox proportional hazards regression model was used to identify risk factors associated with disease extent progression.

Results: A total of 184 UP patients were included,with a median follow-up time of 4.79 years (IQR: 2.81-8.46).Among them, 52.2% were male and 47.8% were female, with a median age at diagnosis of 39.08 years (IQR: 28.84-49.69). 116 patients (63.0%) experienced disease extent progression in a median time of 4.16 years (IQR: 1.77-9.02). The cumulative proportions of disease extent progression in 1, 3, 5, and 10 years were 13.0%, 35.9%, 48.4%, and 58.7%, respectively. Cox regression analysis identified the use of 5-ASA as a protective factor against disease extent progression (HR=0.55, 95% CI: 0.31-0.96, P=0.035). During follow-up, only one patient (0.5%) underwent surgery. Five patients (2.7%) were diagnosed with dysplasia, and these five patients had experienced disease progression before the development of dysplasia.

Conclusion: Despite limited disease extent, a high proportion of UP patients have moderate-to-severe activity on endoscopy, with over half experiencing disease extent progression. 5-ASA, as a first-line therapy for UP, is a protective factor against disease extent progression.

OP-31-01

Injectable, Bio-inspired Self-Healing Hydrogel for Fast Hemostasis and Accelerated Wound Healing of Gastric Ulcers

Xueping Huang¹, Na Wen², Shiyun Lu¹, Ms Shuangshuang Li², Zhihui Lin¹, Xunbin Yu¹ and Tianhua Zhou²

¹Fujian Provincial Hospital, Fuzhou, China; ²Fuzhou University, Fuzhou, China

Oral Presentation 31, APDW Theatre 1, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Gastric ulcers accompanied by acute or chronic bleeding pose a significant risk of fatality. However, the development of effective strategies for achieving rapid hemostasis and wound healing in gastric ulcer bleeding represents a formidable challenge.

Materials and Methods: We employed thrombin-derived C-terminal peptide (TCP-25) a targeted agent and incorporated it into two novel injectable and biocompatible carboxymethyl chitosan (CMCs) hydrogels via Schiff's base reaction. The TCP-25 peptide hydrogel exhibited optimal adaptive properties in the distinctive gastrointestinal microenvironment, including the balance of acid resistance and degradation, the release and bioactivity, self-healing capabilities and good bioadhesive properties under gastric acid to ensure rapid and non-invasive in vivo hemostasis and wound healing.

Results: Both in vitro and in vivo antibacterial experiments demonstrated the potent antibacterial effect of the TCP-25 peptide hydrogel against standard strains as well as clinically isolated multi-drug resistant strains. Additionally, experimental investigations utilizing a rat liver injury model revealed that the hydrogel achieved rapid hemostasis within approximately 9 seconds. Furthermore, evaluations conducted in an ethanol-induced gastric ulcer model in rats demonstrated that the hydrogel effectively inhibited gastric ulcer bleeding by 92% within 24-hour, surpassing the effect of omeprazole, a commonly used clinical treatment. This enhanced performance was attributed to the synergistic effects of the CMCs hydrogel and TCP-25 peptide in effectively achieving hemostasis, inhibiting bacterial growth, and promoting gastric wound healing in acute or chronic bleeding gastric ulcers.

Conclusion: This work offers a promising clinical application for fast hemostasis and wound healing in gastric ulcer disease.

OP-31-02

Mitochondrial DNA leakage promoting persistent pancreatic acinar cell injury in acute pancreatitis via cGAS-STING-NF-κB pathway

Jiayu Li^1,2, Deyu Zhang¹, Zhendong Jin¹ and Haojie Huang¹

¹Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China; ²College of Basic Medical Science, Naval Medical University, Shanghai, China

Oral Presentation 31, APDW Theatre 1, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Previous studies show that activating the cyclic GMP-AMP synthase (cGAS) - stimulator of interferon genes (STING) pathway in macrophages promotes severe acute pancreatitis via inflammatory factors. However, the potential role of the STING pathway in pancreatic acinar cells remains unexplored. Investigating the cGAS-STING pathway's mechanism in these cells is essential for understanding related inflammation in acute pancreatitis.

Materials and Methods: Plasma from 50 acute pancreatitis patients and 10 healthy donors analyzed via digital PCR correlated mtDNA levels with acute pancreatitis severity. Single-cell sequencing of acute pancreatitis pancreas identified differential genes and pathways in acinar cells. Experiments on mice and cells examined mtDNA leakage and STING-related pathway activation, confirmed by microscopy mtDNA staining and quantitative PCR, suggesting inflammation mechanisms in acute pancreatitis.

Results: Our study found that the concentration of free mtDNA in peripheral blood of patients with acute pancreatitis showed an obvious increasing trend consistent with severity of pancreatitis. Single-cell sequencing data shows continuous STING pathway activation in pancreatic acinar cells during acute pancreatitis. Modulating the cGAS or STING affected the NF-κB pathway and downsteam inflammatory cytokines, with observed mtDNA leakage post-acute pancreatitis in vitro.

Conclusion: In conclusion, our study indicated that mtDNA-STING-NF-κB pathway axis in pancreatic acinar cell could be a novel pathogenesis in acute pancreatitis.

OP-31-03

Microbial variations in the multibody sites of the pancreatic ductal adenocarcinoma patients

Zhen Li, Yiqing Zhu, Xiao Liang, Lixiang Li and Ning Zhong

Qilu Hospital of Shandong University, Jinan, China

Oral Presentation 31, APDW Theatre 1, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: To investigate microbial characteristics among multibody sites of pancreatic ductal adenocarcinoma (PDAC) patients, and to identify new microbial markers as novel screening methods for PDAC.

Materials and Methods: We applied 16S ribosomal RNA (rRNA) amplicon sequencing to saliva, duodenal fluid, and pancreatic tissues obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) from 63 PDAC patients and 22 benign controls. Neutral community model (NCM) assessed the assembly contribution, MaAslin2 indicated the differential microbes, and Netshift revealed the “driver” microbes.

Results: From controls to PDAC patients, contribution of oral and duodenal microbes to the assembly of pancreatic microbes increased. In PDAC patients and controls, contribution of duodenal microbes to the pancreatic microbial assembly was higher than oral microbes. Prevotella dentalis, Peptoanaerobacter stomatis, Slackia exigua, etc. were enriched, whereas Loigolactobacillus coryniformis, Akkermansia muciniphila, Faecalibacterium prausnitzii, etc. were reduced in the pancreas, duodenum, and oral cavity of PDAC patients (P < 0.05). We developed microbial markers for discriminating PDAC based on the differential species shared among the three sites with the areas under the curves (AUCs) of 0.946, 0.991, and 0.971 in the pancreas, duodenum, and oral cavity, respectively. Faecalibacterium prausnitzii in the duodenum, Prevotella dentalis and Slackia exigua in the oral cavity, and Anaeroglobus geminatus and Propionibacterium acidifaciens across three sites were “driver” microbes of the variations from controls to PDAC patients.

Conclusion: Oral and duodenal microbes were significant contributors to the microbial composition associated with PDAC. Novel microbial markers with high discriminative power were developed, underscoring their potential for PDAC detection.

OP-31-04

Identification of novel biomarkers for autoimmune pancreatitis by single-cell sequencing and multicolor flow cytometry

Chenxiao Liu, Yao Zhang, Xianda Zhang, Xiaonan Shen, Chunhua Zhou and Duowu Zou

Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Oral Presentation 31, APDW Theatre 1, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Autoimmune pancreatitis (AIP) is a unique type of chronic pancreatitis(CP), with the vast majority of cases in Asia being type 1 AIP. IgG4 is the only recognized biomarker for type 1 AIP but still lacks sensitivity and specificity. Therefore, we aim to discover novel biomarkers to enhance its diagnostic capabilities.

Materials and Methods: Peripheral blood mononuclear cells (PBMC) from 10 patients with type 1 AIP (including IgG4-negative patients) were isolated for single-cell transcriptome sequencing. Additionally, PBMC from 13 patients with pancreatic cancer served as disease controls. Healthy control data was obtained from a public database. Single-cell sequencing data were subjected to a series of analyses. Flow cytometry and qPCR experiments were conducted in an additional cohort of AIP, PDAC, and CP patients.

Results: The analysis revealed a significant increase in the proportion of IgD+IgM+CD11c+Tbet+ B cells in the peripheral blood of AIP patients. Additionally, a group of IgG4high-switched memory B cells participating in antigen processing and presentation via MHC-II molecules were identified to be elevated.CXCR5+PD-1+ T follicular helper cells were observed to be increased and active in IL-10 production. Finally, CD14+CD16+HLADPhigh monocytes were also increased in AIP patients. Multicolor flow cytometry validated these changes and demonstrated higher diagnostic efficacy compared to IgG4.

OP-31-05

Characterization and clinical outcomes of pancreatic cancer in elderly patients

Yoshihide Matsumoto and Seiji Shio

Shinko Hospital, Kobe, Japan

Oral Presentation 31, APDW Theatre 1, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Japan's high life expectancy results in many elderly people and a higher prevalence of pancreatic cancer in this group. This study aims to elucidate the characteristics and outcomes of pancreatic cancer in elderly patients.

Methods: We retrospectively analyzed patients diagnosed with pancreatic cancer at our institution from January 2021 to April 2024. Patients were divided into two groups: elderly (≥75 years) and non-elderly (<75 years). We compared clinical data, diagnostic findings, and treatment outcomes between the groups.

Results: The study included 101 patients: 62 elderly (mean age 82.4) and 39 non-elderly (mean age 67.5). Pain was significantly less common in the elderly group. The elderly group exhibited a higher, albeit not statistically significant, rate of incidental diagnosis through imaging studies. Notably, stage I pancreatic cancer was more frequently diagnosed in the elderly group (p=0.0207), while non-resected pancreatic cancer was more common in the non-elderly group (p=0.0264). Serum markers DUPAN-2 and SPan-1 were elevated in the non-elderly cohort. Overall survival from diagnosis was comparable between both groups. Among patients with unresectable pancreatic cancer (27 elderly, 26 non-elderly), chemotherapy administration rates were similar; however, the elderly group predominantly received reduced-dose chemotherapy (88% vs. 38%, p=0.009). Survival rates in non-resected cases did not differ significantly between the groups (p=0.286).

Conclusion: Reduced-dose chemotherapy enabled optimal treatment in the elderly, resulting in survival rates similar to those of the non-elderly group. Early-stage detection was more common in the elderly, potentially attributable to routine imaging for pre-existing conditions.

OP-31-06

Cine dynamic magnetic resonance cholangiopancreatography offers novel diagnosis for sphincter of oddi dysfunction

Yuki Oka, Arata Sakai, Atsuhiro Masuda and Yuzo Kodama

Kobe University Graduate School of Medicine, Kobe, Japan

Oral Presentation 31, APDW Theatre 1, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Sphincter of Oddi Dysfunction (SOD) may be a part of idiopathic pancreatitis, however, it is often underdiagnosed due to limitations of Sphincter of Oddi Manometry, such as its invasiveness. This study aims to evaluate the feasibility of cine dynamic Magnetic Resonance Cholangiopancreatography (MRCP) as a less invasive alternative for assessing the Sphincter of Oddi function.

Materials and Methods: This was a single-center observational pilot study. We enrolled 10 patients with idiopathic recurrent acute pancreatitis and 10 healthy volunteers. Cine Dynamic MRCP involved creating a 2D MRCP image and applying a 20mm inversion pulse to suppress water signals at the Sphincter of Oddi. Sequential images (20 frames over 5 minutes) were analyzed on a 5-point scale to measure the frequency and distance of pancreatic juice. These metrics were compared between the patient and control groups.

Results: There was no significant difference in the male-to-female ratio between the patient group and the control group, but the patient group had a significantly older age (48.5 years vs. 39.3 years, P=0.005). The patient group had a significantly lower number of entries into the pancreas (11.5 times vs. 16 times, P=0.001) and a lower pancreatic secretion grade (1.025 vs. 2.25, P=0.006) compared to the control group. In two cases where EST was performed for suspected SOD, cine dynamic MRCP showed the increase in inflow frequency and the improvement of secretion grade after EST.

Conclusion: Our findings suggested that cine dynamic MRCP is a promising non-invasive method for assessing the Sphincter of Oddi function.

OP-31-07

Characteristics of metallic stent migration in malignant biliary stricture

Akiko Shimizu, Yoshihide Matsumoto and Seiji Shio

Shinko Hospital, Kobe, Japan

Oral Presentation 31, APDW Theatre 1, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Guidelines recommend self-expandable metallic stents (SEMS) for unresectable malignant distal bile duct stricture. In Japan, covered SEMS is favored due to its repositionability and removability post-placement. At our hospital, SEMS is commonly used for malignant bile duct stenosis. This study aims to evaluate the incidence and factors associated with migration of metallic stents in patients with malignant bile duct stenosis.

Methods: This retrospective case-control study included 45 patients who received metal stents for malignant bile duct stenosis between 2018 and 2023. We analyzed patient status, stent characteristics (diameter, shape, length), bile duct stenosis status, chemotherapy administration, survival, event-free period, and complications.

Results: Four out of 45 patients experienced stent migration. The median age of patients with stent migration was 79 years, compared to 83 years in the control group. The migration occurred between 3 and 11 months after stent placement. The stenosis length was similar between groups (37.5 mm vs. 40 mm). There was no significant difference in stent length or diameter, but migration was significantly higher in patients with covered SEMS (p=0.0296). Survival and event-free periods did not significantly differ between covered and uncovered SEMS. Although not statistically significant, chemotherapy appeared to influence stent migration, as 3 out of 4 patients with stent migration had undergone chemotherapy (p=0.08).

Conclusion: Covered SEMS is associated with a higher risk of migration but does not impact survival or event-free period. Optimal treatment may involve individualized stent selection considering potential complications and the need for re-intervention.

OP-31-08

Critical role and molecular mechanism of CARM1 in impaired autophagy of severe acute pancreatitis

Weijia Sun¹, Hongli Yang², Qianqian Xu² and Hongwei Xu¹

¹Shandong University, Ji Nan, China; ²Shandong Provincial Hospital, Ji Nan, China

Oral Presentation 31, APDW Theatre 1, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: To investigate the expression of Coactivator-associated arginine methyltransferase 1 (CARM1) in severe acute pancreatitis (SAP) and determine it's role on autophagy.

Materials and Methods: The experimental SAP model was induced in BALB/c mice by intraperitoneal injection of cerulein and lipopolysaccharide. Peripheral blood and pancreas were collected. Histopathological changes were observed by HE staining. The levels of serum related indicators (TNF-α, IL-6, amylase and lipase) were determined by ELISA. The protein level of CARM1 and autophagy-related proteins (Beclin1, p62, and LC3B) were detected by Western Blot and IHC. An in vitro model of SAP was established by cerulein-induced on AR42J cell line and the expression level of CARM1 was detected by Western Blot. The effects of CARM1 on pancreatic inflammation and autophagy were explored by overexpressing CARM1 in AR42J cells.

Results: Compared with the NS group, the levels of amylase, lipase, IL-6 and TNF-α were elevated in SAP group. HE staining of the SAP group showed inflammatory cell infiltration, interstitial edema, and necrosis of pancreatic cells. Western Blot showed that Beclin1, p62 and LC3B II protein levels were increased, while CARM1 was decreased in SAP mice and AR42J cells induced by cerulein. Overexpression of CARM1 in cerulein-induced AR42J cells resulted in decreased inflammation and autophagy.

Conclusion: CARM1 level is decreased in SAP mice and AR42J cells induced by cerulein, which is closely associated with impaired autophagic flux. Overexpression of CARM1 can attenuate pancreatic injury by repairing autophagy.

OP-31-09

Metagenomic analysis revealed the correlation between Gut microbiome imbalance and acute pancreatitis in mice

Hongli Yang, Weijia Sun, Feifei Zhou and Hongwei Xu

Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China

Oral Presentation 31, APDW Theatre 1, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Acute pancreatitis (AP) is a severe inflammatory disease of pancreas with 20% of cases progressing to severe acute pancreatitis (SAP). Gut bacterial translocation is a key process for aggravating AP. This study aims to detect the microbial community in AP mice through metagenomic approaches, and to provide a theoretical basis in treatment of AP.

Materials and Methods: BALB/c mice were randomly divided into normal saline (NS), mild acute pancreatitis (MAP), and SAP groups. The AP model was constructed by intraperitoneal injection of caerulein. Peripheral blood, pancreas and feces were collected. Histopathological changes were observed by HE staining. ELISA was performed to measure the levels of AMY, LPS, TNF-α and IL-6. Metagenomic sequencing was used to analyse the differences of intestinal microflora.

Results: Compared to NS group, HE staining demonstrated successful modeling, with milder pathological changes in MAP group compared to SAP group; the levels of AMY, LPS, TNF-α and IL-6 were elevated in AP groups. PCoA revealed that axis 1 discriminated the AP groups from NS group. In AP groups, the α-diversity was significantly declined; Firmicutes and Bacteroidetes were the dominant phyla at phylum level; Acidifaciens, Duncaniella_muris and caecimuris were significantly increased at species level. Through KEGG functional analysis, AP groups showed a significant enrichment for Arginine biosynthesis and antimicrobial peptide resistance. Spearman correlation analysis showed that AMY and IL-6 were positively correlated with acidifaciens, but negatively correlated with Eubacterium.

Conclusion: The intestinal microbiota of AP mice had significant changes and functional differences, and were correlated with serum indicators.

OP-31-10

The correlation between appropriate antibiotic use and mortality in acute cholangitis

Vesri Yoga¹, Achmad Fauzi² and Hasan Maulahela²

¹Dr. M. Djamil General Hospital, Padang, Indonesia; ²Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Oral Presentation 31, APDW Theatre 1, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Severe acute cholangitis poses a life-threatening risk, leading to an increased mortality rate. The current treatment involves antibiotics and surgical drainage of pus. Early and appropriate antibiotic therapy is crucial due to the emergence of multi-drug-resistant Gram-negative bacteria.1 The Tokyo Guidelines 2018 (TG18) have recommended the appropriate selection of initial antimicrobial treatment based on infection type (community-acquired or healthcare-associated) and severity.2-3 In a recent study by Tagashira et al. inadequate use of antibiotics was associated with a higher mortality rate (OR 2.78; 95% CI 1.27-6.11; p=0.01) in acute cholangitis patients.4 Patients on antibiotics not following guidelines have an increased risk of mortality due to potential bacteremia from extended-spectrum beta-lactamase (ESBL) organisms. Following antibiotic guidelines can help prevent complications and reduce mortality.

Materials and Methods: The study was a retrospective cohort study at Cipto Mangunkusumo Hospital, focusing on acute cholangitis patients hospitalized from 2019 to 2022. 163 individuals were selected using consecutive sampling based on specific criteria. Antibiotic appropriateness was assessed using medical record data adjusted to TG18 guidelines. Patient outcomes were assessed based on mortality.

Results: In adherence to the TG18 guidelines, 107 cases (65.6%) utilized antibiotics. Bivariate analysis revealed that inappropriate use of antibiotics according to TG18 guidelines was a significant predictor of mortality (p<0.05). Additionally, in backward multivariate analysis, non-guideline antibiotic use was identified as an independent predictor of significant mortality (RR 2.923; 95% CI 1.342–6.367; p=0.007).

Conclusion: Inappropriate use of antibiotics based on TG18 guidelines was an independent factor in predicting mortality in acute cholangitis.

OP-32-03

Tuberculosis drug-induced liver injury treatment pattern, risk factors and outcomes : a retrospective cohort study

Fatnan Setyo Hariwibowo¹, Harli Amir Mahmuji², Dina Nur Faiza³ and Trianta Yuli Pramana⁴

¹PKU Muhammadiyah Temanggung Hospital, Temanggung, Indonesia; ²RS Prof Soerojo Magelang, Magelang, Indonesia; ³Klinik Laras Medika Payaman, Magelang, Indonesia; ⁴Moewardi Hospital, Surakarta, Indonesia

Oral Presentation 32, APDW Theatre 2, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objective: Despite lack of evidence, Indonesian tuberculosis patients are often given hepatoprotective medications for drug-induced liver damage (DILI). This study aimed to examine the clinical features, results, and risk factors of anti-TB drug-induced liver injury (DILI).

Material and Methods: In a retrospective study at PKU Muhammadiyah Temanggung Hospital and Soerojo Hospital Magelang, we enrolled 43 hospitalized patients diagnosed with anti-TB DILI from January 2018 to March 2024 through the Electronic Medical Records System. T-tests compare groups, while multivariate logistic regression models examine treatment patterns and clinical outcomes. We investigated baseline characteristics and followed patients at an outpatient clinic until week 12.

Results: The study population was 78.6% male, with 15.6 % having grades 3-4 DILI and 74.4 % grades 1–2. Male patients were diagnosed with grades 3-4 DILI more often than grades 1-2 (p=0.03). Grade 3-4 DILI was more common in multidrug anti-TB patients (p=0.04). N-acetylcysteine with 1–6 hepatoprotective medicines. Patients reported DILI symptoms after 4 weeks of anti-TB treatment (60%). Multivariate analysis showed no significance for hepatoprotective medication numbers (p = 0.23). Reinstating anti-TB therapy caused grade 3-4 DILI more often than grades 1–2 (P=0.02). Laboratory tests showed that grades 3-4 had higher ALT and TBL and a larger decrease percentage after 12 weeks.

Conclusions: ALT and TBL recovered to normal after 12 weeks in 65% of patients. Multiple hepatoprotective medications did not hasten recovery. Men, multi-drug anti-TB regimens, and reinitiated therapy are related with anti-TB drug-induced liver impairment.

OP-32-04

Case reports of hereditary hemochromatosis

Phuong Huynh, Cuong Ho, Thuy Le, Hung Nguyen and Ngan Le

Tam Anh Hospital, Ho Chi Minh City, Viet Nam

Oral Presentation 32, APDW Theatre 2, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objective: We report three cases of hereditary hemochromatosis with liver diseases diagnosed at Tam Anh General Hospital, Ho Chi Minh City.

Materials and Methods: Hereditary hemochromatosis (HH) is an autosomal recessive genetic disease with a variety of clinical manifestations, mainly in the liver. Although hereditary hemochromatosis is common in Caucasians, affecting more than 1 in 300 Northern Europeans, there is lack of evidence in other populations. Currently in Vietnam data on this disease is still insufficient.

Methods: Clinical case reports and literature review

Results: The patients were diagnosed with liver diseases due to hereditary hemochromatosis, and their conditions are stable during follow-up period.

Conclusion: HH should be considered in cases of unexplained liver dysfunction. Liver imaging and gene sequencing are useful in diagnosis. Liver biopsy, although invasive, is useful to confirm the diagnosis in some cases, thereby allowing early intervention to improve the patient's prognosis and quality of life.

OP-32-06

Serum bilirubin as a predictor of outcome in refractory cardiac arrest

Libor Vitek, Jan Pudil, Martin Leníček, Petra Kaválková, Daniel Rob, Milan Dusík, Ján Tvrdoň, Jana Šmalcová, Tomáš Kovárník and Jan Bělohlávek

General University Hospital, Praha 2, Czech Republic

Oral Presentation 32, APDW Theatre 2, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: We aimed to investigate the potential role of serum bilirubin and the UGT1A1 gene variations in refractory out-of-hospital cardiac arrest (OHCA) and hypothesized that increased antioxidant capacity associated with a higher initial serum bilirubin concentration could be related to better outcomes.

Materials and Methods: In patients with refractory OHCA enrolled in the Prague OHCA study, who reached the hospital (n=164), we investigated the impact of higher initial serum bilirubin concentration (>10 μmol/l) on survival and cardia and neurologic recoveries at 30 and 180 days, respectively. We also performed an analysis of the UGT1A1 gene variations to assess the influence of genetic predisposition for Gilbert´s syndrome on the outcomes.

Results: Favorable neurological survival after 180 days occurred in 50 of 99 patients (50.5%) in the group with higher initial serum bilirubin concentration and 18 of 65 patients (27.7%) in the lower bilirubin group (OR 2.66 [95%CI 1.36-5.21; P<0.05]. The effect remained significant after adjustment for age, gender, AST, GGT, total cholesterol and CRP (OR 3.32 [95%CI, 1.12-9.85]; P<0.05). Similarly, the beneficial effect of higher initial serum bilirubin was observed on a 30-day neurologic (OR 3 [95%CI, 1.57-5.74]; P<0.05) and cardiac recovery (OR 2.33 [95%CI, 1.23-4.43]; P<0.05). Genetic analysis of UGT1A1 did not show any significant difference in outcomes.

Conclusion: A higher initial serum bilirubin concentration appears to be an important predictor of better outcome in patients with refractory OHCA. The UGT1A1 gene promotor variations have no impact on the outcomes of refractory out-of-hospital cardiac arrest.

OP-32-07

Unexpected low prevalence of hepatitis delta virus infection in Southern Viet Nam

Thuy Nguyen¹, Van Vo Huy², An Luong Bac³, Chuong Nguyen Dinh², Phong Quach Tien², Chi Mai Bich⁴, Vu Hoang Anh³, Thuy Trinh Thi Thanh², Tuan Cao Ngoc², Sang Phan The², Frank Maldarelli¹ and Hoang Bui Huu^2,5

¹HIV Dynamics and Replication Program, NCI, Frederick, United States; ²Department of Gastroenterology, University Medical Center, Ho Chi Minh, Vietnam; ³Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam; ⁴Diagnostic Laboratories, University Medical Center, Ho Chi Minh, Vietnam; ⁵Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam

Oral Presentation 32, APDW Theatre 2, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: HBV/HDV co-infection is the most severe form of viral hepatitis but screening for HDV is not universally recommended. Vietnam has one of the highest incidences of viral hepatitis-related hepatocellular carcinoma (HCC), but little is known about the contribution of HDV to this burden.

Materials and Method: We used the standardized assay (LIAISON® XL Anti-HDV) to detect HDV antibodies (anti-HDV) in 524 patients with stable chronic hepatitis B (CHB) (n=84), hepatitis flare (HF) (155), liver cirrhosis (LC) (120), and HCC (165). Socio-demographic and clinical parameters were collected from patients’ records.

Results: The median age of CHB, HF, LC, and HCC patients was 47, 43, 56, and 60, and 47, 76, 64, 81% were male, respectively. HF patients had significantly higher ALT (162-4744 U/L) and HBV DNA (1.4-10.6 log (IU/mL) due to treatment withdrawal (18%) or unexplained causes (70%). HBeAg was positive in 19.4, 41.0, 22.5, 30.8 % of CHB, HF, LC, and HCC, respectively. Anti-HDV was barely found: 0/84 (0%) in CHB, 2/155 (1.3%) in HF, 3/120 (2.5%) in LC, and 4/165 (2.4%) in HCC. There was a trend of a higher proportion but not significant difference of HDV infection in HF, LC, and HCC (2.04%) patients compared to CHB (0%).

Conclusion: We observed an unexpectedly lower rate of HDV prevalence in the South of Vietnam suggesting the heterogeneous geographic distribution of HDV or variability in anti-HDV detection methods. HDV infection might be associated with advanced liver disease but did not contribute to its high burden in Southern Vietnam.

OP-32-08

Impaired hepatic regulatory T cells aggravate autoimmune hepatitis

Han Wang and Shuhui Wang and Yu Lei and Yu Chen and Wei Yan and Dean Tian and Mei Liu

Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Oral Presentation 32, APDW Theatre 2, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Autoimmune hepatitis (AIH) is a chronic, progressive, and immune-mediated liver disorder with an increasing global prevalence. Regulatory T cells (Tregs), essential for maintaining immune homeostasis and preventing various autoimmune diseases, present a potential therapeutic target for AIH. However, the role of Tregs in AIH pathogenesis remains unclear.

Materials and Methods: A well-established AIH model was performed by transfecting with CYP2D6 plasmid. Human samples were collected to analyze the correlation between Tregs and disease severity. The role of Tregs in AIH was evaluated through adoptive Treg transfer, and Treg depletion was achieved using FoxP3-DTR mice.

Results: Tregs increased in AIH mice liver as the disease progressed, a trend also observed in human AIH livers. However, despite the increase in Tregs, the proportion of Th17 cells, Th1 cells, CD8+T cells also progressively increased in the mouse liver. Treg depletion in mice exacerbated liver inflammation and fibrosis, yet adoptive transfer did not significantly ameliorate inflammation. RNA sequencing suggests that Tregs in AIH livers exhibited impaired suppressive function and enhanced effector functions, adopting Th17 and Th1 phenotypes. In vitro co-culture with Teff cells revealed diminished suppressive function of hepatic Tregs from AIH mice, while peripheral Tregs maintained normal suppressive capacity.

Conclusion: Although the number of Tregs increases in AIH liver, their function is impaired. Tregs exhibit a diminished suppressive phenotype and an enhanced effector phenotype, failing to control the escalating inflammation in AIH. Therefore, AIH treatment should not only aim to increase the number of Tregs but also to restore their functional capacity.

OP-32-09

The relationship between primary tumor site and oxaliplatin-induced portal hypertension: A FAERS database analysis

Sitao Ye, Yingjie Ai, Huishan Wang, Xiaoquan Huang and Shiyao Chen

Zhongshan Hospital, Fudan University, Shanghai, China

Oral Presentation 32, APDW Theatre 2, Exhibition Hall, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Oxaliplatin has significant efficacy against colorectal cancer, and is also used in treating gastric cancer, lymphoma, and pancreatic cancer, et al. Research on oxaliplatin-related portal hypertension is limited to patients with colorectal cancer. This study explores whether oxaliplatin-related portal hypertension is related to the primary site of the tumor.

Materials and Methods: Data with the indication of terms related to colorectal cancer, gastric cancer, lymphoma, and pancreatic cancer were extracted from the FAERS database from Q1 2004 to Q1 2024. Preferred Terms (PT) under the High-Level Terms (HLT) of portal hypertensions, gastrointestinal varices and hemorrhoids, hepatic vascular and portal embolism and thrombosis categories, and splenomegaly and ascites in MedDRA 27.0 were selected as the target adverse event(ADE). The Reporting Odds Ratio (ROR) method was used to analyze the adverse drug reaction signals(ADR), which was considered significant when the lower limit of the 95% CI was >1.0.

Results: Colorectal cancer patients treated with oxaliplatin had 12 target ADR signals, of which "splenorenal shunt" (45.28 [5.74~357.43]), "gastric varices haemorrhage" 13.6 (6.58~28.09) and "non-cirrhotic portal hypertension" (5.9 [3.89~8.95]) had the top ROR. Gastric cancer had 4 target ADRs, the 3 with the highest ROR were "non-cirrhotic portal hypertension,"(all caused by oxaliplatin), "gastric varices" 26.83 (6~119.93) and "splenomegaly"(4.79 [2.31~9.93]). Lymphoma had 1 target ADR-"ascites"(11.67 [9.74~13.98]). Pancreatic cancer had no target ADR.

Conclusion: Oxaliplatin-related ADRs related to portal hypertension vary from different primary tumor sites. There are more ADR signals related to portal hypertension in patients with colorectal and gastric cancer.

OP-33-01

Dietary copper, zinc, copper/zinc ratio intakes and irritable bowel syndrome: a large-scale prospective cohort study

MD Yan Zhuang, Laifu Li, Yan Ran and Fei Dai

The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China

Oral Presentation 33, Uluwatu 1, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: This study aimed to prospectively investigate the relationship between dietary copper, zinc, and copper/zinc (Cu/Zn) ratio intakes and the development of IBS in a long-term cohort.

Materials and Methods: A total of 175,421 participants in the UK Biobank without IBS at baseline were included. Dietary intake was assessed by the Oxford WEbQ. New-onset IBS was identified using ICD-10 codes (K58). Cox proportional hazard models were applied for analyses.

Results: A total of 2240 individuals developed IBS during a median follow-up of 13.3 years. Copper, zinc, and Cu/Zn ratio intakes all showed U-shaped relationships with the incidence of IBS. When copper intake <1.5 mg/day and zinc intake <10 mg/day, the risk of IBS significantly decreased with increasing copper and zinc intakes [HR copper (95%CI), 0.791(0.647,0.967); HR zinc (95%CI), 0.967(0.937,0.998)]. No significant association was found when copper intake ≥1.5 mg/day and zinc intake ≥10 mg/day. When taking dietary copper, zinc, and Cu/Zn ratio as categorical variables, compared with Q4, participants in Q1 [HR (95%CI), 1.150(1.007,1.312)] and Q5 [HR (95%CI), 1.146(1.001,1.313)] copper intakes, Q1 [HR (95%CI), 1.142(1.002,1.301)] zinc intake had a significantly higher risk of IBS. An elevated risk of IBS was observed in individuals with T3 [HR (95%CI), 1.115(1.006,1.235)] Cu/Zn ratio intake compared with T2. Subgroup analysis suggested a moderate increase in zinc intake was more helpful for preventing IBS in < 60-year-old participants.

Conclusion: Moderately increasing dietary zinc intake and maintaining dietary copper and Cu/Zn ratio in a reasonable range is beneficial in reducing the incidence of IBS.

OP-33-02

Combinatorial feature selection based machine learning for identifying digital biomarkers of irritable bowel syndrome

Noman Haleem

University Of Groningen, Leeuwarden, The Netherlands

Oral Presentation 33, Uluwatu 1, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Irritable bowel syndrome (IBS) is a multifaceted and multi-organ gastrointestinal disorder. Due to the complex heterogeneous nature of IBS, its exact aetiology remains unknown which limits our ability to effectively diagnose and manage it in the clinical setting. The aim of this study is to develop a computational machine learning based method for data-driven identification of digital IBS biomarkers.

Materials and Methods: We propose a machine learning based approach to identify IBS biomarkers using combinatorial feature selection techniques. The framework takes multi-organ and multi-system patient data (e.g. faecal microbiome, short-chain fatty acids, gut anatomical features, etc.) as input and searches for unique feature combinations that lead to accurate classification between IBS and non-IBS cases, as well as between different IBS subtypes. The proposed framework is then validated on a synthetic dataset of varying sample size and patient characteristics to demonstrate its potential for identifying digital IBS biomarkers.

Results: The application of our proposed machine learning approach to a synthetic IBS dataset resulted in high classification accuracy for IBS and non-IBS cases (>90%) when provided with sufficient sample size proportional to the heterogeneity in patient characteristics. Furthermore, different IBS subtypes were effectively distinguished with comparable accuracy.

Conclusion: This study demonstrates the promising potential of combinatorial feature selection based machine learning techniques to study the complex pathophysiology of IBS. The resulting digital biomarkers can be used to improve the diagnosis and management of IBS in the clinical setting.

OP-33-03

Endoscopic findings of terminal ileum in chronic diarrhea patients of an academic hospital in Bangladesh

Mohammed Tozammel Haque, Mir Jakib Hossain, M Masudur Rahman and Md Golam Kibria

Sheikh Russel National Gastroliver Institute & Hospital, Dhaka, Bangladesh

Oral Presentation 33, Uluwatu 1, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Terminal ileal intubation is an integral part of colonoscopy in patients with chronic diarrhea. But it may be required to diagnose different conditions other than diarrhea.This study was conducted to assess the additional diagnostic yield of ileal intubation in chronic diarrhea.

Materials & Methods: This cross-sectional study was conducted in the department of gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital. Consecutive patients of chronic diarrhea were screened through history, clinical examination and some investigations based on clinical suspicion. In all patients, terminal ileal intubation was done and biopsies were taken from any visible lesion. Biopsy specimens were sent for histopathology and gene X-pert for MTB detection.

Results: Among 103 chronic diarrhea patients, , 65(63.1%) were male and 38 (36.9%) were female. The mean age was 35.63 ± 15.21 years. Macroscopic abnormality of ileum only was found in 11.65%(12) and in both ileum and colon 12.62%(13) respectively which gave a diagnostic yield of 24.27% of all ileal intubation. More than one fourth 30 (29.1%) patients had irritable bowel syndrome followed by functional diarrhea 22(21.4%), intestinal TB 13(12.62%), Crohn's disease 9(8.7%) , ulcerative colitis 6(5.8%) , colonic malignancy 2(1.9%) and tropical sprue 1(1.0%). But etiology of chronic diarrhea could not be determined in rest of the 20(19.5%) patients.

Conclusions: Routine terminal ileal intubation during colonoscopy, yields additional benefit to the diagnosis of chronic diarrhea. In this study, half of the study population had diarrhea of functional origin and more than one fourth of study population had organic causes.

OP-33-04

Post COVID functional gastrointestinal disorders and risk factors: A retrospective cohort study during COVID pandemic

Tanapol Kitthavorn¹, Tanapol Kitthavorn¹ and Kasemsak Jandee²

¹Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand; ²Department of Community Public Health, School of Public Health, Walailak University, Thasala, Thailand

Oral Presentation 33, Uluwatu 1, November 23, 2024, 5:00 PM - 6:20 PM

Background: The etiology of Functional gastrointestinal disorders (FGIDs), including dyspepsia, irritable bowel syndrome (IBS) is multifactorial, with post-infectious causes being implicated. COVID-19 infection has raised concerns regarding its potential association with FGIDs development.

Objectives: This study aimed to investigate FGIDs prevalence after COVID-19 infection, identify risk factor, and study its clinical course.

Materials and Methods: We conducted a retrospective cohort study on COVID-19 patients admitted to Songklanagarind Hospital between April and December 2021. At one-year post-infection, patients were contacted to complete an online questionnaire assessing symptoms compatible with IBS, dyspepsia, or GERD, as well as psychological and somatic symptoms severity. Clinical symptoms and laboratory data during COVID-19 admission were reviewed for analysis.

Results: A total of 122 patients had complete the questionnaire. Among the participants, 62 patients (51%) developed FGIDs symptoms within one-year post infection. Majority (70%) of patients with post-COVID FGIDs reported symptom improvement within one year. Patients with underlying diseases (56.5% vs. 33.3%, p = 0.017) and those prescribed gastrointestinal medications during admission (25.8% vs. 6.7%, p = 0.009) were more likely to develop post-COVID FGIDs. The presence of underlying disease and needed GI medications were the significant risk factors to predict developing post-COVID FGIDs (OR 3 (1.2, 7.48), p = 0.019 and OR 6.56 (1.35, 31.88), p = 0.02).

Conclusion: Dyspepsia and IBS are common after COVID-19 infection, with symptoms showing improvement over time, supporting the post-infectious pathophysiology. Patients with underlying diseases and those requiring medications for GI symptoms are at higher risk of developing post-COVID FGIDs.

OP-33-05

The efficacy and safety of antidepressants and psychotherapy in irritable bowel syndrome: a meta-analysis

Zilin Ma, Guan Zhou Zhou, Ms Xiaoyan Chi and Fei Pan

PLA General Hospital, Beijing, China

Oral Presentation 33, Uluwatu 1, November 23, 2024, 5:00 PM - 6:20 PM

Objective: To assess the efficacy and safety of antidepressants and psychotherapy for irritable bowel syndrome (IBS) patients.

Materials and Methods: We conducted a literature search in Medline, Embase, Cochrane Library, and PubMed for randomized controlled trials (RCTs) up to June 2024, investigating the impact of antidepressants and psychotherapy on IBS versus placebo or control. A network meta-analysis with a multivariate consistency model random-effect meta-regression was utilized. The primary outcome was the comparative effect of antidepressants or psychotherapy on overall IBS symptoms. Secondary outcomes included efficacy assessment based on antidepressant type or psychological therapy and adverse events.

Results: This study included 74 RCTs (10,128 participants, 69% female): 32 studies compared antidepressants to placebo, and 42 compared psychological therapies to control, encompassing 22 different antidepressants and 36 psychological therapy modalities (Figure 1). Antidepressants generally showed greater efficacy than placebo (relative risk RR 0.84, 95% confidence interval CI 0.78-0.95). Tricyclic antidepressants (TCAs) were notably more effective in reducing overall IBS symptoms (RR 0.66, 95% CI 0.52-0.79), albeit with moderate heterogeneity (I2=49%, P=0.08). Adverse events were more common with antidepressants, but none were serious. Among psychological therapies, cognitive behavior therapy (CBT) was the most efficacious for IBS (RR 0.81, 95% CI 0.68-0.95). No significant differences were observed in adverse effect rates among the various psychotherapies and control therapy.

OP-33-06

Neutrophil lymphocyte ratio for predicting acute cholangitis in patients undergoing biliary drainage

Abhay Mahajan, Ganesh Pai C, Ganesh Bhat and Shiran Shetty

KMC, Manipal, Udupi, India

Oral Presentation 33, Uluwatu 1, November 23, 2024, 5:00 PM - 6:20 PM

Objective: The present study aims to examine if the neutrophil-lymphocyte ratio (NLR) can accurately forecast the clinical outcome of acute cholangitis cases undergoing biliary drainage (PTBD and ERCP).

Methods and Material: This prospective study was conducted at a tertiary care center in coastal Karnataka. Patients of age ≥18 with suspected cholangitis undergoing biliary drainage were included in the study. Bile specimens were collected and transported to the microbiology lab in blood culture bottles using an aerobic transport system.

Results: Total of 50 patients was enrolled in the study with the mean age of 48.39±13.5, with most being male individuals [n, 42 (84%)]. Of 50, 23 were culture-positive, with Escherichia coli [n, 12 (24%)] being the most common organism, followed by Klbesilla [n,11 (22%)]. In univariate analysis, the clinical response to PTBD was significantly associated with baseline TLC (p-value: 0.033) and NLR (p-value: 0.016). There was no association with age, comorbidities, prior endoscopic retrograde cholangiopancreatography, admission to PTBD interval, or diagnosis (benign vs. malignant). The logistic regression analysis indicates that NLR is a significant predictor of acute cholangitis, with an odds ratio of 1.5 (95% CI: 0.99-2.6). The receiver operating characteristic curve for NLR showed the highest significance with a cut-off of >4.72 (Sensitivity: 73%; Specificity: 37.5%; and AUC:70.9%].

Conclusion: The present study demonstrates that the neutrophil-lymphocyte ratio (NLR) at baseline significantly predicts culture-positive status in patients with cholangitis. This finding suggests that NLR can be used as a valuable marker in the clinical assessment and management of cholangitis.

OP-33-07

Rome-III vs Rome-IV criteria for IBS: disease severity, quality of life, somatization and psychological issues

Karzan Dey Sarker, Shahana Parvin, Rashedul Hasan, Mohammad Iqbal Hossain, Md. Golam Kibria and Mohammed Masudur Rahman

Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh

Oral Presentation 33, Uluwatu 1, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: The aims of this study were to assess the disease severity, quality of life, somatization and psychological issues between IBS patients diagnosed by Rome III and Rome IV criteria attending in a gastroenterology clinic.

Materials and Methods: Consecutive patients were screened for IBS at Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh using translated-validated Rome III and IV questionnaires in local language. The somatization, quality of life, psychological distress and IBS symptom severity were compared between Rome III and Rome IV criteria using PHQ-15, PROMIS-10, PHQ-4 and IBS symptoms severity score (IBS-SSS).

Results: Consecutive 309 IBS patients were included [ male 207 (66.99%)]. Of them 71 (11.8%), 135 (22.5%) and 103 (17.1%) met Rome III and IV criteria, Rome III criteria only and Rome IV criteria only, respectively. There were no significant differences in age (p = 0.204), gender (p = 0.716), IBS-SSS (p = 0.766), global physical health score (p = 0.182), global mental health score (p = 0.447), somatization score (p = 0.57), anxiety state (p = 0.163), and depression level (p = 0.205) between IBS patients meeting Rome III alone and both Rome III and IV or Rome IV criteria alone as shown in table 1.

Conclusion: There are no differences in symptoms severity, quality of life, somatization and anxiety or depression between IBS patients diagnosed by Rome III alone and both Rome IV and Rome III criteria attending in a gastroenterology clinic.

OP-33-08

Examining the prevalence and impact of irritable bowel syndrome in medical students: a cross-sectional study

Worakarn Leelakunakorn¹, Sittisak Kanchanasapha¹, Soonthorn Chonprasertsuk², Bubpha Pornsthisarn², Ratha-korn Vilaichone², Sith Siramolpiwat², Pongjarat Nunanan², Patommatat Bhanthumkomol², Navapan Issariyakulkarn², Natsuda Aumpan² and Arti Wongcha-um¹

¹Faculty of Medicine, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand; ²Department of Medicine, Gastroenterology Unit, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand

Oral Presentation 33, Uluwatu 1, November 23, 2024, 5:00 PM - 6:20 PM

Introduction: This cross sectional study focuses on the emotional distress among medical students, who face rigorous academic standards, and its possible association with the development of Irritable Bowel Syndrome (IBS).

Description: This cross-sectional study investigates the prevalence of Irritable Bowel Syndrome (IBS) among medical students and its correlation with anxiety and/or depression. Medical students often face significant stress due to rigorous academic demands, high expectations, and exposure to emotionally challenging clinical environments. Thus, the study aims to focus on perceived prevalence and severity of IBS symptoms among medical students, while exploring potential associations with anxiety and/or depression levels exacerbated by these stressors. To measure anxiety and depression symptoms, respectively, the research uses a structured questionnaire that was created based on the Generalised Anxiety Disorder 7-item (GAD-7) scale and the Hospital Anxiety and Depression Scale (HADS). The ROME IV criteria is used to evaluate symptoms of irritable bowel syndrome (IBS). Medical students, interns, or residency doctors between the ages of 18 and 30 make up the sample of this study.

Discussion: The implementation of the ROME IV criteria, GAD-7, and HADS will allow for a robust assessment of IBS and measurement of emotional stress, ensuring that the diagnosis was stringent and aligned with up to date clinical guidelines. Importantly, the study also sheds light on the need for better diagnostic approaches in the medical student community, where symptoms of IBS might be overlooked or misattributed to transient academic stress.

OP-33-09

A Comprehensive study on traditional chinese medicine strategies for managing adult irritable bowel syndrome

Linda Zhong¹, Dong-jue Wei², Hui-juan Li², Ai-ping Lyu², Zhao-Xiang Bian² and Kewin TH Siah³

¹Nanyang Technological University, Singapore, Singapore; ²School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong; ³Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

Oral Presentation 33, Uluwatu 1, November 23, 2024, 5:00 PM - 6:20 PM

Objectives: Recent studies have witnessed the incorporation of herbal medicine into the management of Disorders of Gut-Brain Interactions, reflecting a paradigm shift towards holistic healing modalities. There exists a substantial gap in comprehending the utilization of Traditional Chinese Medicine (TCM) for Irritable Bowel Syndrome (IBS), particularly beyond the confines of China. This study endeavors to bridge this knowledge gap by meticulously identifying existing guidelines, critically reviewing TCM practices, and crafting contemporary treatment recommendations.

Materials and Methods: We systematically searched several databased to retrieve related evidence in June 2023. Firstly, we employed the AGREE II tool to evaluate the guideline recommendations within IBS TCM guidelines, establishing a structured treatment selection hierarchy for different TCM patterns of IBS patients. Subsequently, we conducted an expert questionnaire to gain insights into the common treatment methods and medication choices.

Results: Based on CM theory and expert’ opinions, IBS with predominant Diarrheal (IBS-D) is divided into five Chinese medicine syndrome patterns, and IBS with predominant Constipation (IBS-C) is classified to four. Twenty-two TCM prescriptions were recommended for the management of IBS, thirteen for IBS-D and nine for IBS-C.

Conclusion: These findings provide IBS patients with enhanced treatment choices while offering clinical physicians more specific treatment regimens. The uniqueness of this research lies in being the first to conduct a comprehensive study that combines guidelines with real clinical practices in the realm of TCM IBS treatment. This serves as a foundation for providing more personalized treatment options and improving the quality of life for patients.

OP-33-10

Mechanism of E. coli Flagellin Regulating Visceral Sensitivity in IBS-D and Intervention Effect of MMF

Zhaomeng Zhuang and Yue Hu and Bin Lv

the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China

Oral Presentation 33, Uluwatu 1, November 23, 2024, 5:00 PM - 6:20 PM

Objective to Elucidate the effects of E.coli flagellin on visceral sensitivity in rats with IBS-D and the intervention effect and mechanism of MMF.

Methods: 75 adult male SD rats were randomly divided into NC group; IBS-D model group Model; TLR5-/- group; eEmpty-virus group; and MMF group. AWR scoring criteria were used to evaluate the model effect; qPCR, FITC-Dextran, immunofluorescence, MACS , FACS ,WB , CCK8 ,flow cytometry ,ELISA was used to detect.

Results: there is an increase in colonization of Escherichia coli in the colon, a decrease in lactobacillus and bifidobacterium, an increase in colonic mucosal permeability, infiltration of colonic Escherichia coli flagellin protein FliC in the mucosal lamina propria, and high expression of TLR5 on LPDCs. increased ability of LPDCs proliferation, and the proliferation capacity of CD4+ T lymphocytes by LPDCs, excessive secretion of inflammatory and immune-related cytokines by lymphocytes.

Conclusion: MMF can inhibit the growth of colonic Escherichia coli, reduce the immune overactivation of LPDCs through the Flagellin-TLR5-TRIF-ERK1/2 pathway, alleviate abnormal mucosal immune responses, and reduce visceral hypersensitivity in IBS-D.

OP-33-11

Prevalence of pancreatic exocrine insufficiency in patients with diabetes mellitus: systematic review and meta-analysis

Martin Downes, Miroslav Vujasinovic, Juan Enrique Dominguez Munoz, Christian Gardner, Sakkarin Chirapongsathorn, Zhuan Liao, Kok Ann Gwee, Lázaro Antonio Arango, Dilek Oguz, MaTthias Löhr, Dafni Fragkogianni and Kyoo Kim

Griffith University, Nathan, Australia

Oral Presentation 33, Uluwatu 1, November 23, 2024, 5:00 PM - 6:20 PM

Introduction: Type 1, type 2 and type 3c diabetes (pancreatogenic diabetes, or DEP) are associated with increased rates of pancreatic exocrine insufficiency (PEI). This review evaluated the current evidence on the prevalence of PEI in type 1, 2 and 3c diabetes, and the factors associated with increased risk.

Methods: A systematic search was performed in Medline (1946 - 2024), Web of Science (1900 - 2024), and Embase (1966 – 2024). Relevant search terms included variations of "diabetes" and "PEI" and were tailored for the different databases. Where appropriate a random effects meta-analysis using the most appropriate studies were carried out to pool prevalence. All analyses were done using OpenMeta.

Results: In total, 28 publications were included in the final evidence synthesis. The pooled estimates used the most appropriate studies to reduce heterogeneity in the meta-analyses. The pooled prevalence of PEI for type 1 diabetes was 31% (95% CI: 27%-34%; I2 0%) and 31% (95% CI: 27%-35%; I2 0%) for 2 diabetes. One study identified that only 17.6% (95% CI: 6.8% to 34.5%) patients with PEI, had previously received PERT. Two studies put the prevalence of PEI (FE-1 <200 μg/g) in DEP at 100%.

Conclusion: The prevalence of PEI is likely to be similar in both type 1 and type 2 diabetes and occur in around one third of patients. The high prevalence suggests that PEI may be underdiagnosed in diabetic patients and clinicians should consider screening diabetes patients for PEI especially in cases with signs and symptoms of PEI.

OP-34-02

Features of endoscopic hemostasis in intensive care patients with lower gastrointestinal bleeding

Evgeny Lebedev, Valeria Kamalova, Dmitry Baranov and Evgeniy Solonitsyn

Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation

Oral Presentation 34, APDW Theatre 1, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: There are clinical guidelines for managing patients with lower gastrointestinal bleeding (LGIB), but their applicability is limited for intensive care(IC) patients due to their severe general condition and the presence of comorbidities such as procoagulant deficiencies, protein-energy malnutrition, physical inactivity, and both local and generalized circulatory disturbances. In these conditions, classical endoscopic hemostasis methods demonstrate lower effectiveness.

Materials and Methods: Retrospective single-center study was conducted from 2022 to 2024 which included IC patients who needed colonoscopy for LGIB suspect with cardiological, neurological, oncohematological, rheumatic, oncological, and surgical pathologies. 67 colonoscopies were performed in 51 patients.

Results: Among the 51 patients, the male-to-female ratio was 1:1.8, with an average age of 66 years (range 19-90). The most common hemostasis methods were clipping 25.4% and combined clipping with injection in 20.9%. In 7.5% emergency endoscopic interventions, a full set of endoscopic hemostasis methods was required, including clipping, adrenaline injection, APC, and surface irrigation with aminocaproic acid solution. In 13 cases (19.4%), hemostasis was not performed, with 5 of these cases (7.5%) having a bleeding source located outside the colon despite the clinical presentation of LGIB. In 8 cases, active bleeding was observed but did not require endoscopic hemostasis. Recurrent bleeding occurred in 31.3%, which required repeated endoscopic intervention. It was most common in patients with cardiological 17.9% and oncohematological 7.5% profiles.

Conclusion: Bleeding in IC patients has worse prognoses and higher risks of recurrent bleeding even with effective endoscopic hemostasis, requiring a personalized approach.

OP-34-04

A bayesian network meta-analysis of three and six-month weight-loss outcomes among endoscopic intragastric balloon

Edwin Nugroho Njoto¹, Citra Aryanti² and Erwin Syarifuddin²

¹Faculty of Medicine and Health, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia; ²Division of Digestive Surgery, Department of Surgery, Hasanuddin University, Makassar, Indonesia

Oral Presentation 34, APDW Theatre 1, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: This study aimed to compare the effectiveness of different endoscopic intragastric balloons for weight loss over a 3- and 6-month period using a network meta-analysis (NMA). Obesity is a complex issue with various side effects, and while bariatric surgery is effective, it is not suitable for many obese patients. Endoscopic intragastric ballooning has emerged as a promising alternative due to its improved efficacy and reduced side effects.

Material and Methods: The researchers followed PRISMA and NMA protocols and searched for relevant randomized controlled trials (RCTs) in databases such as Medline, Scopus, and Cochrane libraries. The selected studies reported weight loss outcomes after 3 and 6 months of treatment with intragastric balloons. Statistical computations were performed using the Bayesian framework, BUGSnet 1.1.0, and the Markov Chain Monte Carlo algorithm in R Studio.

Results: Fourteen RCTs were totaling eleven59 participants. The Orbera group significantly lost weight compared to the control group in four studies with a 3-month follow-up (MD 2.45; 95%CI 1.66-3.23; I2 88%, p<0.001). Three intragastric balloons were used in ten studies with a 6-month follow-up as opposed to the control group. Statistically significant weight loss was demonstrated by Orbera and Reshaped Duo (MD 8.43; 95%CI 3.76-13.2; p<0.001 and MD 8.51; 95%CI 0.42-16.5; p<0.001, respectively). Although the Heliosphere also demonstrated a positive weight loss outcome (MD 8.9; 95% -0.41-18.4), insufficient study results precluded drawing any statistical conclusions.

Conclusion: Both Orbera and Reshaped Duo showed significant weight-loss results. More randomized controlled trials for long-term follow-up should be carried out.

OP-34-08

Endoscopic evaluation in adults with suspected gastrointestinal (GI) bleeding: A 9-year retrospective, single-centre review

Shahreedhan Shahrani¹, Sandeep Singh Gill², Xin Tong Ng², Kah Hee Looi², Nurul Safirah Norhisyam², Sher Weyne Chee², Xin Hui Khoo¹, Imran Zainal Abidin² and Sanjiv Mahadeva²

¹Gastroenterology Unit, Department of Internal Medicine, University Malaya Medical Centre, Malaysia; ²Faculty of Medicine, Universiti Malaya, Malaysia

Oral Presentation 34, APDW Theatre 1, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: Gastrointestinal bleeding (GIB) is one of the most common medical emergencies. Despite newer advances in medical therapy and intervention, it still carries a significant mortality rate.

This study aims to determine the endoscopy findings in patient who were referred for suspected GI bleeding; and to study its’ possible associated risk factors.

Materials and Methodology: This was a retrospective audit in University Malaya Medical Centre (UMMC), a tertiary hospital in Kuala Lumpur, Malaysia with gastroenterology subspecialty expertise. All adult patients who were referred for suspected GI bleeding and underwent GI endoscopy (gastroscopy and colonoscopy) from 1st January 2013 to 31st December 2021 were included.

Results: There were 5222 patients included in the study, of which they were predominantly male (55.6%), ethnic Chinese (49.1%) and had hypertension co-morbidity (59.9%). 6.5% of patients were on anticoagulants, whereas 23.2% of patients were on antiplatelets.

The most common endoscopic findings from OGDS were peptic ulcer disease (28.3%), varices (6.7%) and normal findings (45.3%). A third of patients who underwent colonoscopy had normal findings (33.7%). Presence of comorbidities such as hypertension, chronic kidney disease, ischaemic heart disease and atrial fibrillation; and antiplatelet use were found to be significant risk factors for GI bleeding (p<0.001).

Conclusion: A large proportion of patients who were referred for suspected GI bleeding had normal endoscopy findings. Presence of co-morbidities and antiplatelet use were significant risk factors for GI bleeding.

OP-34-10

Jejunal varix as the source of gastrointestinal bleeding in a patient with cirrhosis

Muhammad Usama and Athesham Zafar

Walsall Healthcare Nhs Trust, Walsall, United Kingdom

Oral Presentation 34, APDW Theatre 1, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

A 53-year-old male with a known history of cirrhosis presented to the emergency department with complaints of melena and fatigue. On admission, his hemoglobin (Hb) level was 7.5 g/dL, indicating significant blood loss. The patient was hemodynamically stable but required multiple blood transfusions.

An urgent upper endoscopy was performed to identify the source of the gastrointestinal (GI) bleeding, but the examination revealed no abnormalities in the esophagus, stomach, or duodenum. Despite the normal endoscopic findings, the patient’s hemoglobin levels continued to drop, suggesting ongoing bleeding.

Given the unexplained drop in hemoglobin, further investigation with a contrast-enhanced CT scan of the abdomen was conducted, revealing the presence of varices in the jejunum. Jejunal varices are a rare but potentially life-threatening source of GI bleeding, often associated with portal hypertension secondary to cirrhosis.

To manage the bleeding, a balloon-occluded retrograde transvenous obliteration (BRTO) was performed. This interventional radiological procedure successfully obliterated the varices, and the patient’s hemoglobin levels stabilized post-procedure without further need for transfusions. The patient had an uneventful recovery and was discharged in stable condition with a plan for close outpatient follow-up.

This case highlights the importance of considering uncommon sources of GI bleeding in patients with cirrhosis, particularly when initial diagnostic modalities do not reveal the bleeding site. Early identification and appropriate management of jejunal varices can significantly improve patient outcomes

OP-34-11

Endoscopic foam sclerobanding for treatment of grade II-III internal hemorrhoids: A prospective, multi-center, randomized study

Chunying Qu, Feiyu Zhang, Leiming Xu and Feng Shen

Department Of Gastroenterology & Endoscopy, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School Of Medicine, Shanghai, China

Oral Presentation 34, APDW Theatre 1, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: To evaluate satisfaction, long-term recurrence, and post-procedural pain in managing internal hemorrhoids using polidocanol foam sclerotherapy and ERBL combination.

Materials and Methods: This was a prospective, multi-center, and randomized study. A total of 195 consecutive patients, diagnosed with grade II-III internal hemorrhoids, were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding (EFSB) or an ERBL group. All patients were followed up for 12 months. Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score (HSS) and visual analog scale (VAS). Continuous variables are presented as medians and interquartile ranges.

Results: One hundred and ninety-five patients were enrolled, with 98 in the EFSB group. HSS was lower in the EFSB group than in the ERBL group at 8-week [4.0 (3.0-5.0) vs 5.0 (4.0-6.0), P = 0.003] and 12-month [2.0 (1.0-3.0) vs 3.0 (2.0-3.0), P < 0.001] follow-ups. The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% vs 21.6%; P = 0.038). Multiple linear regression analysis demonstrated that EFSB treatment [B = -0.915, 95% confidence interval (CI): -1.301 to -0.530; P = 0.001] and rubber band number (B = 0.843; 95%CI: 0.595-1.092; P < 0.001) were negatively and independently associated with VAS 24 hours post-procedure. The median VAS in the EFSB group was lower [2.0 (1.0-3.0) vs 3.0 (2.0-4.0), P < 0.001].

Conclusion: Cap-assisted EFSB provides long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.

OP-34-12

The role of enteric glial cell and AQP1 in the ameliorating effect of electroacupuncture

Laifu Li, Lijuan Xu, Lilianli Wang, Yating Sun, Yan Ran, Yan Zhuang and Fei Dai

The Second Affiliated Hospital Of Xi’an Jiaotong University, Xi’an, China

Oral Presentation 34, APDW Theatre 1, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: This study was to investigate the involvement of AQP1 in the ameliorating effect of electroacupuncture (EA) on the visceral hypersensitivity of IBS.

Materials and methods: This study was performed in SD rats and enteric glial cell (EGC) culture in vitro. The mRNA and protein expressions of AQP1, S100β, and NF-κB in colonic tissues, DRG and EGCs, were assessed by real-time PCR, Western-blot, immunohistochemistry, and immunofluorescence. Serum levels of IL-1β and IL-18 were determined by ELISA.

Results: (1) EA (2Hz/100Hz, 1mA) and NF-κB inhibitor (50mg/kg) significantly reduced EMG activity at 0.8 mL and 1.2 mL distention pressures (P< 0.01, respectively). (2) The immunofluorescence results showed that S100β and AQP1 were co-expressed in the colonic tissues. The mRNA and protein expression of AQP1, S100β, and NF-κB in the colonic tissues, and the serum levels of IL-1β and IL-18 were up-regulated in the model group (P < 0.001, respectively), and were down-regulated in the EA group and NF-κB inhibitor group (vs. Model, P < 0.01, respectively). (3) The expression of AQP1 and NF-κB in DRG were significantly increased in the model group (P < 0.05, respectively), and normalized after EA and NF-κB inhibitor treatment (P < 0.05, respectively). (4) In vitro, the protein and mRNA expression of AQP1 and S100β were increased in LPS-treated EGCs compared with the control (P < 0.05, respectively), and reduced by NF-κB inhibitor (P < 0.05, respectively).

Conclusion: AQP1 may be a target for EA to improve visceral hypersensitivity.

OP-34-13

Safety and efficacy of linaclotide combined with polyethylene glycol in bowel preparation: a systematic meta-analysis

Ahmed Farag¹, Amany Mahmoud Genidy², Mahmoud Raslan², Safia Elshennawy³ and Mohamed Nasr Gadelrab⁴

¹College of Medicine, Misr University for Science and Technology, 6th October City; ²College of Medicine, Tanta University, Tanta; ³College of Medicine, Aswan University, Aswan, Egypt; ⁴Shebin Elkom Teaching Hospital

Oral Presentation 34, APDW Theatre 1, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: High-volume polyethylene glycol (PEG) regimens are standard for bowel preparation, but their large volume and unpleasant taste often decrease patient compliance. Linaclotide, an FDA-approved constipation drug, shows promise in reducing the required PEG volume.

Materials and Methods: We searched MEDLINE via PubMed, Scopus, WOS, and Cochrane. We included RCTs with no language restrictions. Subgroup analysis was used for further stratification. Results: Ten studies with 3251 patients were included. The overall effect estimates regarding total BBPS score favored linaclotide group [MD 0.33, 95% CI (0.22–0.44), P<0.00001]. Further stratification showed linaclotide’s superiority over the control group with equal PEG dosage [MD 0.83, 95 % CI (0.67–1.00), P< 0.00001] and non-inferiority to the group with double the PEG dosage [MD -0.07, 95 % CI (-0.22–0.07), P= 0.32]. The overall effect estimate regarding BBPS score of right side, left side and transverse colon showed statistically significant results favoring linaclotide group.

Regarding adenoma and polyp detection rates, superiority of linaclotide group could only be detected when compared to the control group receiving an equal dosage of PEG [RR 1.53, 95 % CI (1.22–1.92), P = 0.0002] but not in the overall effect estimate [RR 1.09, 95 % CI (0.98–1.22), P = 0.13]. Moreover, linaclotide group showed a favoring statistically significant difference regarding nausea, vomiting, abdominal pain, bloating, sleep and Willingness to repeat the colonoscopy.

Conclusion: Linaclotide is superior to the control group with equal PEG dosage and non-inferior to the group with double PEG dosage, while also resulting in fewer adverse events.

OP-34-14

Efficacy and Safety of anti reflux mucosal ablation therapy at 12 months

Krithi Krishna Koduri, Neeraj Singla, Nitin Jagtap, Aniruddha Pratap Singh, Rakesh Kalpala and d. Nageshwar reddy

AIG Hospitals, Hyderabad, India

Oral Presentation 34, APDW Theatre 1, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: Anti-reflux mucosal ablation(ARMA) is a minimally invasive therapy for patients with PPI-controlled gastro-esophageal reflux disease (GERD). This study evaluated the safety and efficacy of ARMA over 12 months.

Materials and Methods: This single-center prospective study included PPI-dependent-GERD patients(acid exposure time[AET] > 4.2% on 24-hour-pH-impedance monitoring). ARMA was performed using hybrid technique(submucosal lift followed by ablation). Patients were evaluated using the GERD Health-Related Quality of Life Questionnaire(HRQL) at baseline, 3 months, and 12 months, with 24-hour-pH-impedance monitoring at baseline and 12 months.

Results: 216 patients(61.13% males, mean age: 38.7 years) underwent ARMA. At baseline, 123(56.9%) patients had Hill’s grade I and 93 (43.1%) had Hill’s grade II on endoscopy. 90(41.7%) patients had LA grade-A and 2(92.6%) had LA grade-B. There was a significant improvement in GERD-HRQL score from 43.8(12.6) at baseline to 20.6(13.8) at 3 months, and 8.3(12.3) at 12 months(p = 0.001). The mean(SD) heartburn and regurgitation scores improved from 22.9(10.8) and 20.6(9.4) at baseline to 11(8.7) and 9.5(8.7) at 3 months, and 3.9(6.9) and 3.9(6.9) at 12 months, respectively(p = 0.001). The median AET[median (IQR)] decreased from 11.9(15.9) to 7.6(10.8)(n = 125, p = 0.009) at 12 months, and the median DeMeester score reduced from 42.4(47.1) to 26.2(32.3)(p = 0.001). There was significant improvement in Hill’s grading and endoscopic esophagitis at 1 year. No major adverse events were observed.

Conclusion: In PPI-dependent-GERD patients, ARMA resulted in sustained symptom reduction and improved quality of life at 12 months. This procedure is relatively simple, widely accessible, and has a good safety profile.

OP-35-12

The role of vasoactive intestinal peptide in the mechanism of liver fibrosis

Qimin An and Ya Deng and Rui Xie and Jingyu Xu

遵义医科大学附属医院, Zunyi City, China

Oral Presentation 35, APDW Theatre 2, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objective: VIP can regulate the activation of hepatic stellate cells, and the mechanism may involve the change of Ca2+ and the process of cell autophagy under the stimulation of VIP.

Method: CCK8 technology, Western blot, high calcium imaging detection methods.

Results: After the stimulation of vasoactive intestinal peptide, TRPV4 channels on the cell membrane are activated, and mediate the influx of extracellular calcium ions, calcium signal reconstruction, and inhibit the autophagy of hepatic stellate cells through the receptor VPAC1, thereby inhibiting the activation of hepatic stellate cells. The mechanism involves the regulation of MAPK-ERK1/2-mTOR autophagy classical signaling pathway to inhibit the occurrence of autophagy in hepatic stellate cells, thereby affecting the activation of hepatic stellate cells.

Conclusion: After VIP stimulation, TRPV4 was activated to mediate extracellular calcium influx and inhibit autophagy in hepatic stellate cells through the MAPK-ERK1/2-mTOR pathway through the receptor VPAC1.

Keywords: Liver fibrosis; Vasoactive intestinal peptide; Transient receptor potential vanilloid 4; Cell autophagy

OP-35-13

The disturbance of intracellular chloride is a key pathogenesis of nonalcoholic fatty liver disease

Yanxia Hu, Shun Yao, Li Zhang, Liming Zheng, Xin Li, Yongfeng Wang, Qian Du and Biguang Tuo

Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital Of Zunyi Medical University, ZunYi, China

Oral Presentation 35, APDW Theatre 2, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: The mechanisms of Non-alcoholic fatty liver disease (NAFLD) remain to be elucidated. Here we demonstrate that the disturbance of intracellular chloride is a key pathogenesis of NALFD.

Materials and Methods: Hepatocyte-specific transgene mice for chloride channels, CLIC1, CLCN2, SLC12A9, and SLC26A6, were generated by Cyagen Biosciences Inc. High-fat diet (HFD)-induced simple NAFLD and high-fat high-cholesterol (HFHC) diet-induced non-alcoholic steatohepatitis (NASH) models in mice were established.

Results: The hepatocyte-specific CLIC1, CLCN2, SLC12A9 and SLC26A6 overexpression mice all spontaneously developed liver steatosis at the age of 6 months and NASH at the age of 12 months. The intracellular chloride content in the liver tissues of CLIC1, SLC12A9 and SLC26A6 overexpression mice was higher than that in control mice, but intracellular chloride content in the liver tissues of CLCN2 overexpression mice was lower than that in control mice. In HFD-induced simple NAFLD and HFHC-induced NASH in mice, the intracellular chloride content in the liver were markedly altered at 4, 8, and 16 weeks after feeding HFD or HFHC. In murine primary hepatocytes and normal liver cells, HepLi5 cells and MIHA cell, the results from intracellular lipid assays showed that low chloride (38 mM) and high chloride (158 mM) mediums, markedly enhanced palmitate-induced intracellular lipid deposition in comparison with normal chloride (118 mM) medium.

Conclusion: These data demonstrated that the disturbance of intracellular chloride plays a key role in the pathogenesis of NALFD and targeting chloride disturbance may be a promising therapeutic target for the treatment of NAFLD and NASH.

OP-35-14

The role and mechanism of S100A6 in promoting MASLD by negatively regulating lipophagy signaling pathway

Rui Xie¹, Qian Du¹, Jingyu Xu¹, Xiong Ma², Biguang Tuo¹ and Manman Zhang¹

¹Affiliated Hospital of Zunyi Medical University, Zunyi; ²Shanghai Jiao-Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Oral Presentation 35, APDW Theatre 2, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objective: This study will explore the mechanism of S100A6 in NAFLD, so as to provide new ideas and strategies for the diagnosis and treatment of NAFLD

Method: Overexpression/knockdown of S100A6 cell models constructed by lentivirus,overexpression/knockout of S100A6 mice models by adeno-associated virus, RFP-GFP-LC3 adenovirus, BODIPY 493/503 staining, autophagy activator and inhibition and other methods

Results: 1. The GEO database analysis showed that S100A6 was highly expressed in each NAFLD model. These results suggest that S100A6 is highly expressed in NAFLD, which may act as a novel key factor promoting lipid metabolism disorders. 2. In the NAFLD cell model, overexpression of S100A6 aggravated the accumulation of PA/OA-stimulated intracellular lipids and induced lipid metabolism-related gene expression. After knocking down S100A6, the above changes were reversed. 3. In the NAFLD animal model, the AAV was used to knock down the hepatic S100A6 expression in vivo, and it was found that knocking down S100A6 could significantly reduce the fat accumulation, glucose tolerance, insulin resistance and other processes induced by HFHC, and significantly reduce liver weight and serum triglyceride and low-density lipoprotein levels. 4. In the mechanism study, we found that PA/OA stimulation significantly enhanced the expression of LC3II and down-regulated the expression of P62 in S100A6 knockdown cells. Moreover, the expression of autophagy-related genes was also significantly up-regulated

Conclusion: S100A6 may be a key target to promote the development of NAFLD.HFHC-induced S100A6 to negatively regulate the process of lipophagy, resulting in autophagy damage, which leads to lipid accumulation in the liver and ultimately promotes the development of NAFLD

OP-35-15

Para-esophageal and para-gastric vessels compromise the secondary prophylactic efficacy of endoscopic treatment of varices

Ling Wu, Xiaoquan Huang, Feng Li, Yingjie Ai and Shiyao Chen

Zhongshan Hospital, Fudan University, Shanghai, China

Oral Presentation 35, APDW Theatre 2, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: Esophagogastric varices (EGV) are a common complication of portal hypertension, and EGV bleeding is a fetal emergency. In our clinical practice, we have noticed that some patients who suffer from rebleeding tend to have para-esophageal and para-gastric variceal branches (PEPG V). This study aimed to evaluate the effect of PEPGV on endoscopic secondary prophylaxis.

Materials and Methods: The clinical data of patients with cirrhosis-related EGV who underwent EVO or EVL to prevent rebleeding between January 2020 and December 2020 were retrospectively analyzed. Patients were divided into a group without PEPGV and a group with PEPGV. The main outcome measure was 2-year rebleeding.

Results: A total of 69 patients were analyzed, and 27 of them had PEPGV. Baseline characteristics were all comparable between the two groups, including the HVPG (14.4±6.7) mmHg, p=0.829) and Child-Pugh grade (p=0.170). All patients received similar secondary prophylactic endoscopic treatment (p=0.337). A total of 25 patients experienced rebleeding within 2 years. Kaplan-Meier analysis showed that the cumulative 2-year rebleeding rate was significantly higher in patients with PEPGV than in those without (60.07% vs 32.79%, p=0.022). PEPGV presented to be an independent predictor of rebleeding after endoscopic treatment (HR 2.33, 95% CI 1.01-5.39, p=0.047).

Conclusion: The presence of PEPGV is an independent predictor of rebleeding after endoscopic treatment. When patients with EGV receive endoscopic treatment to prevent rebleeding, portal vascular CT should be used to evaluate PEPGV. For patients with giant extraluminal vascular masses, fully evaluating other treatment options such as transjugular portosystemic shunt under intervention is recommended.

OP-35-16

Cell-Free-Fecal Transplantation alters hepatic proteome similar to Fecal-Microbiota Transplantation, achieving remission of Alcohol-associated Liver Disease

Ashi Mittal, Nishu Choudhary, Kavita Yadav, Anupama Kumari, Jaswinder Maras, Shiv Kumar Sarin and Shvetank Sharma

Institute of Liver and Biliary Sciences, New Delhi, India

Oral Presentation 35, APDW Theatre 2, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: Fecal Microbiota Transplantation (FMT) is effective in treating alcohol-associated liver disease (ALD). The microbiota of donor, along with gut environment, contributes to disease remission. Thus, factors other than bacteria in the gut may also have a role in the remission of the disease. To confirm, we compared bacterial cell-free transplantation (CFT) efficacy against FMT.

Materials and Methods: Male-C57BL/6N-mice were pair-fed control or ethanol-22% Lieber-DeCarli diet with thioacetamide for 8-weeks to induce ALD. FMT and CFT (0.22μ filtered stool-slurry) from healthy donors were performed in ALD mice. Liver injury was assessed by histopathology, biochemistry and RT-PCR of inflammatory genes post day7 of transplant. Fecal-microbiota and hepatic proteome was assessed by 16SrRNA sequencing and mass-spectrometry, respectively.

Results: Both FMT and CFT improved hepatic injury by reducing serum AST (~2-fold, p=0.002), ALT (~5-fold, p=0.0001), and bilirubin (~4-fold, p=0.03), accompanied with a significant reduction in hepatic inflammation [IL6 (~3-fold, p<0.05) and Tnfα (~3.5-fold, p<0.05)]. Liver histology showed significant reduction in steatosis (9-fold-reduction, p=0.002) and fibrosis (5-fold-reduction, p=0.005). FMTsignificantly decreased the abundance of opportunistic gut bacteria: Staphylococcus (2.8-fold, p=0.001) and Sporosarcina (2-fold, p=0.01) while CFT decreased Desulfovibrio (1.5-fold, p=0.0001), Mucispirillum (10-fold, p<0.0001) and Escherichia-Shigella (9-fold, p<0.0001). FMT altered 389 hepatic proteins, while CFT altered 407 proteins significantly (p<0.05, FC>2). Pathway enrichment showed that both groups led to up-regulation of proteins involved in PPAR signaling, oxidative phosphorylation & cholesterol metabolism and downregulation of pentose-phosphate pathway, beta-alanine metabolism and Salmonella infection.

Conclusion: FMT and CFT reduce opportunistic bacteria in ALD variably. Pathways modulated by either of the strategies result in similar disease remission, highlighting the importance of bacterial milieu as a therapeutic alternative.

OP-35-17

Improved metabolism from soya protein-modulated fecal-microbiota-transplant in comparison to egg protein in alcoholic liver disease

Nishu Nishu, Ashi Mittal, Anupama Kumari, Kavita Yadav, Jaswinder Singh Maras, Shiv Kumar Sarin and Shvetank Sharma

Institute of Liver and Biliary Sciences, New Delhi, India

Oral Presentation 35, APDW Theatre 2, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: Fecal microbiota transplantation (FMT) is a promising treatment for alcohol-related liver disease (ALD). We evaluated impact of pre-modulating donor microbiota with soy and egg proteins to enhance efficacy of FMT and metabolic outcomes in ecipients.

Materials and Methods: Donors for FMT were fed with egg and soya protein diet for 2wks. FMTwas performed in ALD mice developed in 8wks by alcohol Lieber-DeCarli diets with thioacetamide (i.p;150mg/kgbw) Samples were collected at baseline and post-FMTday 7. Assessed serum biomarkers of liver injury, histopathology and gene expression of inflammation by RT-PCR. Gut microbiota was assessed by 16s-rRNA sequencing. Fecal and hepatic metabolome was assessed by LC-MS/MS.

Results: Soya-FMT reduced the liver injury significantly compared to egg-FMT as assessed by reduction in AST (1.2FC, p=0.002) and Bilirubin (1.2FC, p=0.03) and steatosis (1.7FC, p=0.01). Soya-FMT also decreased hepatic pro-inflammatory markers-TNFα (1.5FC, p=0.02) and IL6 (1.6FC, p=0.02). Soya-FMT significantly increased the abundance of commensal taxa- Coriobacteriaceae UCG-002 (1.5FC, p=0.04) and Acinetobacter (5.2FC, p= 2.55E-13) and reduces abundance of opportunistic taxa- Desulfovibrio (2.14FC, p=0.02) and Staphylococcus (9.6FC, p=2.20E-33). Metabolomics identified 400-hepatic and 647-fecal metabolites across groups. Soya-FMT significantly (p<0.05) altered 212 fecal and 175 hepatic metabolites. Stool bile acid and SCFA levels showed significant (p<0.05) increases in soya-FMT. There was also a significant increase in hepatic glutathione metabolism (p=0.04) and beta-oxidation of fatty acids (p=0.03) and reduction in arachidonic acid (p=0.04) and linoleic acid (p=0.01) metabolism in soya-FMT group.

Conclusion: Soya protein-modulated FMT effectively diminishes opportunistic taxa and suppresses inflammatory pathways better than egg-proteinbased FMT. It also promotes the synthesis of ursodeoxycholic acid and short-chain fatty acids (caproic and butyric acids), enhancing energy metabolism.

OP-35-18

Study on the mechanism of HIF-1α ubiquitination inhibited by CaSR

Ting Zhang, Jingyu Xu and Rui Xie

Affiliated Hospital of Zunyi Medical University, Zunyi, China

Oral Presentation 35, APDW Theatre 2, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Aim: The aim of this study was to elucidate the effect of CaSR changes on HIF-1α ubiquitination in the course of liver fibrosis and its possible regulatory mechanism through cell and animal experiments.

Method: The expressions of α-SMA, HIF-1α and CaSR were detected by immunohistochemistry and Western blot. The effect of CaSR on HIF-1α transcription was detected by RT-qPCR. The interaction of E3 ubiquitin ligase with HIF-1α and its ubiquitination were detected by CO-IP.

Result: The expressions of α-SMA and HIF-1α were increased and the expression of CaSR was decreased in the hepatic fiber group. CaSR agonist CaCl2 reversed hypoxia-induced α-SMA and HIF-1α protein expression, and CaSR inhibitor NPS-2143 enhanced hypoxia-induced α-SMA and HIF-1α protein expression. mRNA expression of HIF-1α did not change after CaSR activation. After overexpression of CaSR, the half-life of HIF-1α was shortened. Both stimulation of CaCl2 and overexpression of CaSR enhanced HIF-1α ubiquitination, but blocking CaSR with NPS-2143 reversed this phenomenon. CO-IP showed that the E3 ubiquitin ligase β-TrCP interacts with HIF-1α, and overexpression of β-TrCP can enhance the ubiquitization level of HIF-1α, and interference with the expression of β-TrCP can reverse the phenomenon. Hypoxia activated the ERK signaling pathway, CaCl2 inhibited the phosphorylation level of ERK signaling pathway and decreased β-TrCP expression. NPS-2143 increases phosphorylation of the ERK signaling pathway.

Conclusion: CaSR may act as a protective factor in the process of liver fibrosis, and its mechanism may be related to the enhancement of HIF-1α degradation through ubiquitination pathway.

OP-35-19

Targeting 5-Hydroxytryptamine receptor 1A in portal vein to alleviate portal hypertension

Chang-Peng Zhu¹, Shu-Qing Liu¹, Ke-Qi Wang¹, Peio Aristu-Zabalza², Zoe Boyer-Díaz², Ji-Feng Feng¹, Shao-Hua Song³, Cheng Luo⁵, Wan-Sheng Chen⁶, Xin Zhang¹, Wei-Hua Dong⁷, Jordi Gracia-Sancho² and Wei-Fen Xie¹

¹Department Of Gastroenterology, Changzheng Hospital; ²Liver Vascular Biology Research Group, IDIBAPS-Hospital Clínic de Barcelona, CIBEREHD, Barcelona, Spain; ³Organ Transplantation Center, Changzheng Hospital; ⁴Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School ofMedicine, Shanghai; ⁵Drug Discovery and Design Center, CAS Key Laboratory of Receptor Research, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), Shanghai, China; ⁶Department of Pharmacy, Changzheng Hospital; ⁷Department of Interventional Radiology, Changzheng Hospital, Naval Medical University; ⁸Department for Biomedical Research, Hepatology, University of Berne, Berne, Switzerland

Oral Presentation 35, APDW Theatre 2, Exhibition Hall, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: Portal hypertension (PH) is the main consequence of chronic liver disease. The peripheral 5-Hydroxytryptamine (5-HT) level was increased in cirrhotic patients. We aimed to elucidate the function and mechanism of 5-HT receptor 1A (HTR1A) in portal vein (PV) on PH.

Materials and Methods: PHmodelswere induced by TAAinjection, BDL or PPVL. HTR1A expression was detected using real-time PCR and in situ hybridization. In situ intraportal infusion was employed to assess the effects of 5-HT, the HTR1A agonist 8-OH-DPAT, and the HTR1A antagonist WAY-100635 on portal pressure (PP).Htr1a knock-out (Htr1a-/-) rats and vascular smooth muscle cell (VSMC)-specific Htr1a knock-out (Htr1aΔVSMC) mice were utilized to confirm the regulatory role of HTR1A on PP.

Results: HTR1A expression was significantly increased in the hypertensive PV of cirrhotic rats and humans. Additionally, 8-OH-DPAT increased but WAY-100635 decreased PP in rats, without affecting liver fibrosis and systemic hemodynamics. Furthermore, 5-HT or 8-OH-DPAT directly induced the contraction of isolated PVs. Genetic deletion of Htr1a in rats and VSMCs-specific Htr1a knock-out in mice prevented the development of PH. Moreover, 5-HT triggered the cAMP pathway-mediated PVSMCs contraction via HTR1A in PV. We also confirmed alverine as an HTR1A antagonist and demonstrated its capacity to alleviate PH in cirrhotic and non-cirrhotic animal models.

Conclusion: Our findings reveal that 5-HT promotes PH by inducing the contraction of PV, and identify HTR1A as a promising therapeutic target for attenuating PH. As an HTR1A antagonist, alverine is expected to become a candidate for clinical PH treatment.

OP-36-01

Unveiling prevalence of Osteopathy in Chronic Pancreatitis: Insights from a Prospective Observational Study

Sudipta Dhar Chowdhury, Aman Bajaj, Gauri Kumbhar, Kripa Elizabeth Cherian and Reuben Thomas Kurien

Christian Medical College, Vellore, Vellore, India

Oral Presentation 36, Uluwatu 1, November 24, 2024, 8:30 AM - 10:00 AM

Objective: Pancreatic exocrine insufficiency(PEI) is common in chronic pancreatitis(CP). PEI coupled with lifestyle factors like poor diet and alcoholism, increases risk of osteopathy. This study aims to assess the prevalence of osteopathy in CP.

Material and methods: This prospective single center study included consecutive patients with CP. Demographic and anthropometric details were recorded. Investigations including imaging, faecal elastase -1, serum bone-turnover markers, calcium, phosphorus, vitamin-D, and parathyroid hormone levels were done. DEXA scan was employed to assess bone mineral density (BMD).

Results: 94 patients with CP were included in the study. Of them 54% were males, and the mean age was 37.3 years (SD 10.7). In 67(72%) patients no definite cause was identified and they were labelled as idiopathic CP. Calcification was noted in (66)70%. Low serum Vitamin D level (< 20 ng/ml) was noted in 55 (59%) participants. DEXA scan revealed metabolic osteopathy in 78 (83%), with osteopenia in 62(66%) and osteoporosis in 16(17%). Patients with osteopathy demonstrated significantly higher serum beta-crosslaps levels (715.9.2 pg/ml vs. 462.84 pg/ml, p=0.001) and Procollagen type 1 N-terminal propeptide levels (64.5 ng/ml vs. 47.4 ng/ml, p=0.02) than those with normal BMD. A higher proportion of smokers was observed in the osteopathy group (p=0.036). In univariate analysis low BMI emerged as a single risk factor for osteoporosis (OR- 0.74, C.I -0.58-0.9)

Conclusion: There is a high prevalence of osteopathy amongst Indian patients with CP. A low BMI and smoking appear to be risk factors for development of osteopathy in CP.

OP-36-03

Magnetically controlled capsule endoscopy for assessing antro-pyloro-duodenal junction motility in patients with functional dyspepsia

Adam Finta, Milan Szalai, Laszlo Oczella and Laszlo Madacsy

Endo-kapszula Ltd., Szekesfehervar, Hungary

Oral Presentation 36, Uluwatu 1, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: The antro-pyloro-duodenal (APD) coordination is key for regulating gastric emptying and motility. High-resolution manometry and impedance monitoring assess pressure profiles and bolus transit through the APD but lack direct visualization. This study evaluated the feasibility and effectiveness of magnetically controlled stomach capsule endoscopy (MCCE) for assessing APD contractions, pyloric function, and duodeno-gastric bile reflux.

Materials and Methods: This prospective study involved the evaluation of CE videos obtained from patients with functional dyspeptic symptoms using Anx Robotics MCCE system. Patients were divided into two groups: study group (A) and control group(B). The inclusion criterion for the study group was a capsule gastric transit time exceeding 60 minutes, while the control group consisted of patients with a transit time of less than 30 minutes.

Results: GroupA and GroupB had an average stomach transit time of 141mins (SD: 24mins), and 17 mins (SD: 4mins), respectively.

The distribution of pyloric ring conditions (1 = non-functional or "gaping"; 2 = functional "opens-closes"; 3 = spastic "needle-tip") in Group A and B was 4vs8, 22vs42, 24vs0, and antral contractions (0 = absence; 1 = visible but weak; 2 = lumen-occluding) were: 6vs0, 32vs6, 12vs44, respectively.

The analyses show statistically significant differences between GroupA and B in terms of pylorus condition, antral contraction patterns (p<0,0001) and presence of visible bile reflux episodes (p=0,0003). No cases of organic pyloric stenosis or capsule retention were observed.

Conclusion: The Anx Robotics MCCE system provide a feasible and effective diagnostic method to study the APD coordination and duodeno-gastric bile reflux.

OP-36-06

Relationship between psychological variables with severity and quality of life among people with abdominal bloating

Nurzulaikha Abdullah^1,2, Yee Cheng Kueh², Garry Kuan³, Nur-Fazimah Sahran⁴ and Yeong-Yeh Lee^5,6

¹Faculty of Data Science and Computing, Universiti Malaysia Kelantan, Kota Bharu, Malaysia; ²Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelanta, Kubang Kerian, Malaysia; ³Exercise and Sport Science, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia; ⁴School of Health Science, health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia; ⁵Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia; ⁶GI & Motility Unit, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia

Oral Presentation 36, Uluwatu 1, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: The prevalence rate of abdominal bloating or distension are alarming and the symptoms may be expressed differently in different populations because of psychological disturbance. As such, the present study aimed to examine the difference of severity and quality of life among different group level of anxiety and depression.

Materials and Method: Cross-sectional study was employed using purpose sampling. A questionnaire consisting of questions related to socio-demographic variables, severity, and quality of life with Hospital Anxiety Depression Scale (HADS) were distributed to gather related information. The submission of completed consent form and questionnaire confirmed their volunteerism to participated. Both anxiety and depression score were categorized as no symptom (score less than 7), mild (score 8-10), moderate (score 11-14) and severe (score 15-21). Then, independent t-test and one way ANOVA was used to compare the mean difference of total score for severity general, severity 24 hours and quality of life between the category of anxiety and depression.

Results: Among the total of 355 subjects were screened, 323 participants were eventually recruited for the study. The mean score of severity general, severity 24 hours and quality of life among people with bloating/distension was 14.70 (SD=3.69), 9.94 (SD=4.31) and 25.93 (SD=5.34). For anxiety, the severity general (p=0.004) and quality of life (p=0.012) was significantly different among the distinct anxiety group level.

Conclusion: There were significant relationship between the severity and quality of life level among different stages of psychological variables. It is important to consider psychological factors for prediction of outcomes among people with abdominal bloating.

OP-36-11

Relationship Between Anxiety Before Endoscopy and Gastrointestinal Symptoms - A Single Center Clinical Study from China

Zhenpeng Huang, Hui-Ni Tan, Li-Ping Yang and Jia-Feng Lin

Guangxi International Zhuang Medical Hospital, Nanning, China

Oral Presentation 36, Uluwatu 1, November 24, 2024, 8:30 AM- 10:00 AM

Objective: Patients who were within anxiety before endoscopic examination, and then had a significant effect on patients’ medical experience.

The study is aim to explore the relationship between anxiety and physical symptoms and impact factors before gastrointestinal endoscopy.

Methods: Patients who have participated in this study that were treated from November 2023 to February 2024 and diagnosed with chronic nonatrophic gastritis by endoscopy. Generalized Anxiety Disorder-7 was used to detect anxiety before endoscopy. Gastrointestinal Symptom Rating Scale (GSRS) was used to evaluate gastrointestinal symptom. Pittsburgh Sleep Quality Index was used to evaluate the sleep quality. Patients’ life style and behaviors information were collected.

Results: 202 patients have participated in this study, including 105 males and 97 females, aged 18-79 years old. Incidence of anxiety before endoscopy was 31.68%, of which 82.81% were mild anxiety. Most of patients were in 1 or 2 (26.2% for each) gastrointestinal symptoms. GSRS was positively correlated with anxiety before endoscopy (r=0.291, P<0.05). GSRS was positively correlated with family history and sleep quality (r values were 0.163 and 0.248; both P<0.05). There was no statistical significance between the GSRS and occupation, smoking, alcohol, eating preferences, and educational level (r values were -0.049, 0.015, 0.073, 0.009, -0.056, respectively; all P>0.05). Anxiety state was positively correlated with gender and sleep quality (r values were 0.228 and 0.248; both P<0.05).

Conclusion: Incidence of anxiety before endoscopy is common, and anxiety would affect the occurrence and severity of gastrointestinal symptoms. Various factors would have an impact on anxiety before endoscopy.

OP-36-12

Relationship between immunohistochemical markers ALDH and KRAS with histopathological features of gastric cancer

Thuy Tran Ngoc¹ and An Le Viet²

¹Thai Nguyen Medical College, Thai Nguyen; ²Tien Du District Medical Center, Bac Ninh, Viet Nam

Oral Presentation 36, Uluwatu 1, November 24, 2024, 8:30 AM - 10:00 AM

Objectives: To evaluate the relationship between immunohistochemical markers ALDH and KRAS with histopathological characteristics of gastric cancer (GC).

Materials and Methods: This was a cross-sectional study on 103 patients with confirmed diagnosis of gastric cancer and surgical resection of the tumor at K Hospital, Hanoi, Vietnam. Analysis of the relationship between ALDH, KRAS and histopathological features.

Results: Patients with intestinal gastric cancer had the highest rate of ALDH expression at 71.4%. Patients with tubular adenocarcinoma GC had the highest rate of ALDH expression at 65.7%, with differences in ALDH expression according to WHO histopathological characteristics, p < 0.05. Low-differentiated GC patients had the highest rate of ALDH expression at 35.7%, with a difference in ALDH expression according to differentiation level, p < 0.05. Intestinal GC patients had the highest KRAS expression rate with 70.2%, p > 0.05. Tubular adenocarcinoma GC patients had the highest KRAS expression rate with 63.2%, p > 0.05. Low-differentiated GC patients had the highest KRAS expression rate with 33.3%, p > 0.05.

Conclusion: There is a relationship between ALDH expression and tubular adenocarcinoma, low differentiation. KRAS expression has not been found to have a relationship with histopathological characteristics.

OP-36-13

Predicting Colorectal Cancer Stage with Platelet-Index Based Scoring: A Novel Machine Learning Approach

Citra Aryanti, Ronald Erasio Lusikooy, Samuel Sampetoding, Sachraswaty Laidding, Warsinggih Warsinggih, Erwin Syarifuddin, Julianus Aboyaman Uwuratuw, M. Ihwan Kusuma, Ibrahim Labeda and Murny Abdul Rauf

Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Oral Presentation 36, Uluwatu 1, November 24, 2024, 8:30 AM - 10:00 AM

Background: Platelet index has been found to reflect the level of aggressiveness of colorectal cancer. Until now, there has been no colorectal cancer stage predictor in Indonesia. The study aims to determine the relationship between platelet index and stage of colorectal cancer patients, then develop the score and application using a machine learning model.

Materials and Methods: This cross-sectional study included 369 subjects of colorectal cancer in Makassar, Indonesia. The parameters in this study were age, gender, tumor location, platelet index (platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit, and mean platelet volume-platelet count ratio. The prediction model was built using machine learning algorithm in the Matlab, then the pickle transform into application using streamlit.

Results: A total of 369 colorectal cancer patients who visited Dr. Wahidin Sudirohusodo Central General Hospital in 2023. The results showed that an increase in PC, MPV, PDW, PCT, and the rasio of MPV/PC had a significant relationship with an increase in the stage of colorectal cancer. The best machine learning algorithm for the prediction model were Supported Vector Machine (82.9%), followed by K-Nearest Neighbors (82.7%), neural network (81.5%), naive bayes (80.5%), and logistic regression (51.5%). The model was then deployed into a portable application with Streamlit with internal validation 79.2% and an external validation 89.2%.

Conclusion: There is a significant relationship between increasing platelet index and colorectal cancer stage and the predictor built based on platelet index can facilitate the individualization of the clinical decision-making process

https://trombositbaru-uekiugszspno4u4wxqqpio.streamlit.app/.

OP-36-14

Diagnostic Utility of 13C-UBT on RUT Negative Dyspeptic Patients who are on Long term PPI

Sukanta Chandra Das¹ and Naymul Hasan²

¹Kurmitola General Hospital, Dhaka; ²Shaheed Ziaur Rahman Medical College, Bogra, Bangladesh

Oral Presentation 36, Uluwatu 1, November 24, 2024, 8:30 AM - 10:00 AM

Aims: The migration of H. pylori from the gastric antrum to the proximal stomach following acid suppression therapy is a established phenomenon.

Methods: This cross sectional study was done among 50 patients attended in OPD at General Hospital,Narayanganj Bangladesh, who were diagnosed as RUT negative Non Ulcer Dyspepsia according to ROME IV criteria after Esophagogastroduodenoscopy and who were on long term PPI.Then patients were re-evaluated for H. pylori status by UBT using film-coated [13C] urea tablets afger stopping PPI for 2 weeks.Breath samples were collected at 0 and 30 min after administration of a UBT tablet and values were measured by infrared spectrometry.The chi-squared test was used for testing association between qualitative variables and the ‘t’ test was used for quantitative variables.A value of p<0.05 was considered significant.

Results: Mean age of the patients of this study was 35.96±13.37.Among them 64% was male and 36% was female.Total 18% of RUT negative dyspeptic patients had positive UBT.Among them 55.55% patients showed Gastritis on endoscopyv and 9.75% showed no mucosal abnormality.This difference is also statistically significant (P=0.008).

Conclusions: UBT can be a better tool for investigating H. pylori in dyspeptic patients particularly who are on long term PPI.

OP-36-15

Randomized, Double-blind, Phase 3 Study for Evaluation of Zastaprazan compared to Esomeprazole in Erosive Esophagitis

Jung-Hwan Oh¹, Hyun-Soo Kim², Dae Young Cheung¹, Hang Lak Lee³, Dong Ho Lee⁴, Gwang Ha Kim⁵, Suck Chei Choi⁶, Yu Kyung Cho¹, Woo Chul Chung¹, Ji Won Kim⁷, Eunju Yu⁸, Hyesoo Kwon⁸, Jun Kim⁸, John Kim⁸ and Hwoon-Yong Jung⁹

¹The Catholic University of Korea; ²Yonsei UniversityWonju College of Medicine, Wonju; ³Hanyang University College of Medicine; ⁴Seoul National University Bundang Hospital, Seongnam; ⁵Pusan National University School of Medicine and Biomedical Research Institute, Pusan; ⁶Wonkwang University Hospital, Iksan, South Korea; ⁷Seoul National University College of Medicine; ⁸Onconic Therapeutics; ⁹Asan Medical Center, Seoul

Oral Presentation 36, Uluwatu 1, November 24, 2024, 8:30 AM - 10:00 AM

Introduction: Zastaprazan is a potent potassium-competitive acid blocker (P-CAB) for treating GERD. This study aims to evaluate the efficacy and safety of zastaprazan compared to esomeprazole in patients with erosive esophagitis (EE).

Methods: A phase III, multicenter, randomized, double-blind, non-inferiority clinical study was conducted with 300 subjects with confirmed EE. Subjects were randomized to receive zastaprazan 20 mg or esomeprazole 40 mg once daily up to 8 weeks. The primary endpoint was the cumulative proportion of subjects with healed EE confirmed by endoscopy at week 8. The secondary endpoints included the healing rate at week 4, symptom response and quality of life assessment. Safety profiles and serum gastrin levels were also assessed.

Results: In the full analysis set, the cumulative healing rate at week 8 were 97.92% (141/144) for zastaprazan and 94.93% (131/138) (P = 0.178) for esomeprazole. The healing rate at week 4 in the zastaprazan group was higher than esomeprazole group (95.14% (137/144) vs. 87.68% (121/138); P = 0.026). There was no significant difference between groups in healing rates (the per-protocol set) atweek 8 and week 4, symptomresponses, quality of life assessments and safety profiles. In addition, serum gastrin levels increased during treatment in both groups, with a significant difference between the two groups (P = 0.047), but both decreased after treatment.

Discussion: An 8-week therapy of zastaprazan 20 mg is non-inferior to esomeprazole 40 mg in subjects with predominantly low-grade EE. The healing rate at week 4 appears to be higher for zastaprazan than esomeprazole.

OP-37-03

An unusual cause of cholangitis by multiple drug resistant strain of salmonella typhi

Talal Bhatti and Muslim Atiq

Szabmu, Islamabad, Pakistan

Oral Presentation 37, APDW Theatre 1, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Multiple drug resistant strain of salmonella typhi can often lead to serious complications as we present in our case.

A 28 year old male of Asian ethnicity with no comorbid, presented with history of 1.5 months of RUQ pain, intermittent fever and weight loss. He also complained of decreased oral intake associated with vomiting. Patient also gave history of clay color stool associated with jaundice, and dark urine.

Laboratory findings on admission showed a raised TLC OF 40,000 u/dl, platelet count of 566,000, hemoglobin of 8.3, and CRP of 199.4.

His (MRCP) was done and revealed choledocholithiasis 11.8 mm calculus in distal CBD, dilated biliary tree and multiple rounded hepatic cyst structures concerning for mucinous cystic neoplasm of liver

(CT) scan was done and showed cystic hypodensities of variable sizes continuing with bile ducts scattered in hepatic parenchyma and mild to moderate intrahepatic biliary dilatation with dilated CBD with an 11.8 mm calculus suggesting choledocholithiasis . Keeping in view the radiological and laboratory findings, an impression of cholangitis with liver abscess was made. All the markers of viral hepatitis and autoimmune hepatitis were negative.

ERCP was planned in same admission and CBD cannulation was done. The stone was visualized on cholangiogram in distal CBD. 10 Fr x 7 cm plastic stent was deployed, while thick bile was aspirated and sent for culture and sensitivity.

Quite surprisingly, his bile fluid showed Salmonella Typhi, a rare finding in cases of cholangitis. Diagnosis of Biliary sepsis was made.

OP-37-05

Efcacy and safety of pocket-creation method for early gastric cancers

Min Lin and Wu Jiajia

The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Jiangsu, China

Oral Presentation 37, APDW Theatre 1, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Background: Endoscopic submucosal dissection (ESD) is the standard endoscopic treatment for early gastric cancers (EGCs). However, obscured view and difculty in submucosal lifting during ESD have been demonstrated. Additionally, ESD is time consuming and poses a high risk of perforation and bleeding when performed in challenging locations. The pocket-creation method (PCM) is a newly developed strategy for colorectal tumors, while the outcomes of application in the treatment of EGCs are rarely reported. In the present study, we aimed to compare the technical efcacy and safety of PCM-ESD and the conventional ESD (c-ESD) technique for the treatment of EGCs.

Methods: This was a single-center retrospective study consisting of 162 patients with EGCs who underwent ESD. One-to-one propensity score matching (PSM) was performed. In addition, clinicopathological characteristics and treatment outcomes were also compared.

Results: PCM-ESD was more likely to be used in patients with larger lesions than c-ESD with/without traction. In addition, the resection speed for lesions of the PCM-ESD was faster compared with c-ESD without traction (median dissection speed: 19.6 mm2 /min vs. 15 mm2 /min; p<0.001) and c-ESD with traction (median dissection speed after PSM: 19.9 mm2 /min vs. 15 mm2/min; p=0.001). In multiple linear regression analysis, signifcant factors related to a higher dissection speed were the treatment method of PCM-ESD (p=0.034), the long diameter of the resected lesion (p=0.001), and lesion location (p=0.046).

Conclusions Collectively, PCM-ESD appeared to be a safer and more efective treatment for EGCs than c-ESD. In addition, PCM-ESD could signifcantly improve the speed of tumor resection.

OP-37-08

Novel, Non-Invasive, MRI-based assessment of Pressure in Pancreatic Duct to predict response to Pancreatic Endotherapy

Jahangeer Basha Medarapalem¹, Venkata Akshintala², Zaheer Nabi¹, Ayesha Kamal², Vikesh Singh², Mouen Khasab², Atif Zaheer², Soumya Jagannath⁴, Nitin Jagtap¹, Rupjyoti Talukdar¹, Sundeep Lakhtakia¹ and D Nageshwar Reddy¹

¹Asian Institute Of Gastroenterology, Hyderabad, India; ²Johns Hopkins University School of Medicine, USA; ³Johns Hopkins University School of Engineering, USA; ⁴All India Institute of Medical Sciences, India

Oral Presentation 37, APDW Theatre 1, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Objectives: Pain in chronic pancreatitis(CP) is mainly due to pancreatic ductal(PD) hypertension. No technology measures PD pressure. We aim to develop an MRI-MRCP-based technology to measure PD pressure and validate using ERCP-based direct PD pressure measurement using a pressure sensor guidewire.

Methods: In the development cohort, MRI-MRCP images were obtained from 75 symptomatic CP patients and 75 normal controls. MRCP images were segmented using MIMICS software to generate a 3D model of the PD. Using computational fluid dynamics principles, PD flow was simulated to calculate the pressure gradient along the PD. To validate this, a cardiac pressure sensor guidewire was placed within PD during ERCP in 27 patients, and pressures were recorded. A pair-wise analysis compared the pressures from the MRCP simulation with the ERCP direct pressure measurement.

Results: Of the 27 CP patients in the validation study (mean age-38 yrs, 63% male), 22% had PD calculi, and 78% had PD stricture. Patients with severe pain had a higher mean PD pressure than patients with mild symptoms [19.1mmHg vs 7.3 mmHg,p=0.04]. MRCP-based PD pressure gradient simulations were comparable to the direct PD pressures from ERCP (p=0.028), with the strongest correlation (R2=0.89) noted in the subset of patients undergoing secretin-stimulated MRCP. Interestingly, 92.5% of patients with a high-pressure gradient on MRCP simulation responded to endoscopic interventions.

Conclusion: This novel MRCP-based technology can quantify PD pressure and correlates well with direct intraductal pressure measurement. It helps to identify CP patients who are likely to benefit and predict response to Pancreatic Endotherapy.

OP-37-09

A quality improvement project to implement green endoscopy by using PDSA model

Zainish Surani and Adeel Rehman

Akuh, Karachi, Pakistan

Oral Presentation 37, APDW Theatre 1, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Background Climate change has affected everyone and has increased health issues for all. Endoscopy is one of the heavy resource centers that produces uncountable waste that leads to greenhouse gases and carbon footprints. Climate change has prompted the need for sustainable practices in healthcare, including endoscopy procedures, which generate substantial waste and contribute to greenhouse gas emissions. The Green Endoscopy project aims to address this issue through the implementation of the 5Rs framework (reduce, reuse, recycle, rethink, and research) and the PDSA (Plan, do, study, act) model.

Methods: The PDSA (Plan, do, study, act) model was utilized for this project in four phases. Firstly, a multidisciplinary team was formed. They reviewed the current waste and disposable items that are non-biodegradable.

Results: A multidisciplinary team was assembled to assess current waste generation and identify opportunities for improvement. By replacing disposable items with reusable alternatives and optimizing resource utilization, significant reductions in waste production and carbon emissions were achieved. Key outcomes include the elimination of plastic bottles and disposable gowns, as well as the introduction of reusable alternatives for various items such as biopsy forceps and suction equipment. Overall, the project resulted in a monthly carbon footprint saving of 2306kg/month and the institution’s amount of PKR 6357500/month, demonstrating the feasibility and effectiveness of sustainable practices in endoscopy.

OP-37-11

The Efficacy and Safety of Endoscopic Submucosal Dissection in Superficial Esophageal Cancer with Cirrhosis

Bihan Xia, Yuzhi Liu and Jinlin Yang

West China Hospital Of Sichuan University, Chengdu, China

Oral Presentation 37, APDW Theatre 1, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Objectives: Patients with superficial esophageal squamous cell carcinoma (SESCC) and cirrhosis often have complications such as thrombocytopenia, coagulopathy, and gastroesophageal varices, increasing surgical risks. Endoscopic submucosal dissection (ESD) may offer benefits, but its efficacy and safety in this group are unclear and require further investigation.

Methods: We retrospectively analyzed data from SESCC patients who underwent ESD at West China Hospital, Sichuan University, from January 1, 2014, to February 1, 2024. Patients were divided into cirrhosis and non-cirrhosis groups. We compared ESD efficacy and safety between these groups. Propensity score matching (PSM) was used when group sizes differed by ≥10 times.

Results: A total of 34 SESCC patients with cirrhosis underwent ESD. Their average preoperative platelet count was 101.8 ± 63.7×10⁹/L, PT was 13.3 ± 2.1 seconds, and INR was 1.1 ± 0.2. Cirrhosis etiology: 52.9% alcohol-related, 41.2% hepatitis B-related, 5.9% hepatitis C-related. Child-Pugh classification: 64.7% A, 35.3% B, none C. Esophageal varices: 64.7% none, 11.8% mild, 5.9% moderate, 17.6% severe; 5.9% had lesions on varices. After PSM at 1:2, baseline characteristics were balanced. There were no significant differences in operation time, resection speed, en bloc resection rate, R0 resection rate, postoperative bleeding, muscularis propria injury, perforation, or postoperative stricture rates between groups (all P>0.05).

Conclusion: ESD efficacy and safety in SESCC patients with cirrhosis are comparable to those without cirrhosis, suggesting ESD is a viable treatment option for early esophageal lesions in patients with severe liver disease.

OP-37-12

Inside stent is the suitable stent for preoperative biliary drainage in patients with perihilar cholangiocarcinoma

Reiko Yamada¹, Naohisa Kuriyama², Yasuaki Shimada¹, Hirono Owa¹, Takamitsu Tanaka¹, Kenji Nose¹, Yoshifumi Nakamura¹, Tetsuro Miwata¹, Junya Tsuboi¹, Shugo Mizuno² and Hayato Nakagawa¹

¹Gastroenterology and Hepatology, Mie University, Tsu-city, Japan; ²Hepatobiliary Pancreatic and Transplant Surgery, Mie University, Tsu-city, Japan

Oral Presentation 37, APDW Theatre 1, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Objectives: Endoscopic biliary stenting (EBS) is generally used for preoperative drainage of localized perihilar cholangiocarcinoma (LPHC). This retrospective study compared the efficacy of inside stent (IS) and conventional stent (CS) in preoperative EBS for LPHC.

Methods: EBS was performed on 56 LPHC patients, with 32 inserting CS and 24 inserting IS. Treatment outcomes were compared between the two groups.

Results: Preoperative recurrent biliary obstruction (RBO) occurred in 71.9% (23/32) of CS patients and 29.2% (7/24) of IS patients (p = 0.002). IS demonstrated significantly longer time to RBO (log-rank: p < 0.001, Figure) and fewer stent replacements [0.38 (0–3) vs. 1.88 (0–8), respectively; p < 0.001]. IS patients had shorter preoperative and postoperative hospital stays ((20.0 vs. 37.0 days; p = 0.024, and 33.5 vs. 41.5 days; p = 0.016). Both the preoperative and the postoperative costs were significantly lower in IS-group than in CS-group (p=0.049 and p = 0.0034, respectively).

Conclusion: IS for preoperative EBS in LPHC patients showed fewer complications and re-interventions compared to CS. IS usage potentially benefits both patients and healthcare systems with shorter hospital stays and lower costs.

For the article refer to: Yamada R, et al. BMC Gastroenterol. 2024. 20;24(1):174. doi: 10.1186/s12876-024-03266-z.

OP-38-02

Stereotactic body radiation therapy following transarterial chemoembolization versus transarterial chemoembolization monotherapy for Hepatocellular Carcinoma

Hoang Dong Duc¹, Ky Thai Doan² and Bang Mai Hong²

¹Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Viet Nam; ²108 Military Central Hospital, Ha Noi, Viet Nam

Oral Presentation 38, APDW Theatre 2, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Objectives: To evaluate the long-term survival results of stereotactic body radiation therapy (SBRT) combined with Transarterial Chemoembolization (TACE) compared with Transarterial Chemoembolization monotherapy in the treatment of hepatocellular carcinoma.

Materials and Methods: Prospective, controlled intervention study on 42 patients with intermediate-stage hepatocellular carcinoma treated with TACE combined with SBRT (group I) and 38 patients treated with TACE alone use DC Bead microspheres (group II). Evaluation of survival by Kaplan Meier curve and Log Rank test.

Results: The average follow-up time was 30.2 ± 16.6 months (6.5 - 68.3 months). The overall survival time of patients in group I (38.2 ± 3.1 months) was different from that in group II (24.5 ± 2.4 months), p < 0.05. Overall survival rates at 12, 24, 36, and 60 months in group I was 92.9%, 69.0%, 52.4%, and 16.3%, respectively, different from those in group II were 76.3%, 42.1%, 21.1% and 10.5%, respectively, p < 0.05. The progression-free survival time of patients in group I (22.1 ± 2.8 months) was different from that in group II (9.7 ± 1.4 months), p < 0.05. The progression-free survival rates at 12, 24, 36, and 60 months in group I were 57.1%, 35.7%, 23.8%, and 2.4%, respectively, with differences compared to group II were 18.4%, 5.3%, 2.6% and 0%, respectively, p < 0.05.

Conclusion: SBRT combined with TACE is a treatment method with higher long-term survival results than TACE alone for patients with intermediate-stage hepatocellular carcinoma.

OP-38-04

Implementing Non-alcoholic Fatty Liver Disease (NAFLD) Guidelines in India - Chhattisgarh NAFLD Model

Kanica Kaushal¹, Priyanka Aggarwal¹, Sumridhi Gautam¹, Sumi Jain² and Guresh Kumar¹

¹Institute of Liver and Biliary Sciences, New Delhi, India; ²State Programme Coordinator, NCD, India; ³Institute of Liver and Biliary Sciences, New Delhi, India

Oral Presentation 38, APDW Theatre 2, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Objectives: Identifying existing issues is the initial step toward effectively implementing NAFLD guidelines in real-world settings in India, considering the contextual nuances. The aim was to assess the knowledge gaps and training requirements for implementing NAFLD within India's National Program for NCDs in Chhattisgarh state.

Materials and Methods: A cross-sectional study used a pretested questionnaire to assess state medical officers' knowledge gaps for the early identification and referral of NAFLD at all levels. A three-day training-of-trainers session was organized, and new monthly reporting forms were also introduced to ensure consistent data collection and referral of suspected NAFLD cases.

Results: The study involved 85 medical officers from different healthcare levels. It found that only 8% consistently adhered to the NAFLD guidelines, while 11% used them most of the time. The majority (81%) seldom used these guidelines. Additionally, over 70% of the participants were unaware of the guidelines, and 12% didn't have access to them. The mean pre-assessment score was 3.76 ± 1.57, significantly increasing to 5.87 ± 1.65 after the training intervention (p < 0.001). The training resulted in a notable 56% improvement in knowledge, particularly in understanding the causes of liver cancer, different criteria for referral, liver stiffness measurement thresholds, and the FIB-4 index for liver fibrosis.

Conclusion: Collaborative efforts are crucial for implementing NAFLD guidelines effectively in Chhattisgarh. Training program improved medical officers' ability to identify and manage NAFLD, aligning with the national program (NP NCD). Future initiatives should enhance knowledge and intersectoral coordination to improve healthcare delivery.

OP-38-05

Predictor Factors of 6-Month Survival after TACE in HCC Patients at dr Soetomo Hospital Surabaya

Ulfa Kholili, Made Bayu Agastia Rakateja, Husin Thamrin, Choirina Windradi, Kartika Wensdi Renantriandani, Arfika Wida Ekacitta, M Zulfikar Defianto, Ummi Maimunah, Titong Sugihartono, Poernomo Boedi Setiawan and Muhammad Miftahussurur

FK Unair-RSUD Dr. Soetomo, Surabaya, Indonesia

Oral Presentation 38, APDW Theatre 2, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Background and the aim: Most of HCC patients diagnosed already at advanced stage. The aim of this study to analyze age, AAR Ratio (Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) Ratio, tumor size, AFP, albumin, bilirubin level and total TACE as predictor factors of survival 6 months after TACE in HCC patients.

Methods: Observational analytic study, cross-sectional, patients who underwent TACE from January 2018 to June 2022 at Dr. Soetomo Hospital. The data prior before TACE procedure analyzed for predictor of 6-months survival.

Results: This study involved 119 HCC patients, consist of male (75.6%), age 56 y.o, HCC related hepatitis B (65.5%), CTP-A (86.6%), total TACE once (58%), twice (28.6%), three times (13.4%), The Bivariate test of these factors age < 60 yo, AAR < 1.2, tumor size <5cm, AFP < 400 ng/dL, albumin > 3.5mg/dL, bilirubin <1.2 mg/dL and TACE more than once revealed that AAR score, tumor size, AFP, albumin level, TACE more than once were significant associated with survival 6 months after TACE with p <0.05. The multivariate test resulted that low AAR score, high albumin level, TACE more than once as significant factors respectively with OR 0.035 (95% CI 0.004-0.311) with p = 0.003), OR 3.511 (95% CI 1.013-12.166); p =0.048) and OR 15.111 (95% CI 3.756-60.797) with p <0.001) as independent predictor factor of survival 6-months after TACE

Conclusion: Low AAR score, high albumin level, and TACE more than once were independent predictive factor of survival 6 months after TACE in HCC patients

OP-38-06

Non-contrast Abbreviated MRI for Detection of Hepatocellular Carcinoma in Patients with MRI LI-RADS LR-3/LR-4 Observations

Soe Thiha Maung¹, Natthaporn Tanpowpong², Minchanat Satja², Sombat Treeprasertsuk¹ and Roongruedee Chaiteerakij^1,3

¹Division of Gastroenterology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; ²Division of Diagnostic Radiology, Department of Radiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; ³Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Thailand

Oral Presentation 38, APDW Theatre 2, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Objectives: Given limited ultrasound sensitivity in hepatocellular carcinoma (HCC) surveillance, and few prospective studies exploring non-contrast abbreviated MRI (NC-AMRI) for this purpose, this study aimed to assess the diagnostic performance of NC-AMRI in detecting HCC.

Methods: This prospective study involved cirrhotic patients with contrast-enhanced MRI (CE-MRI) Liver Imaging Reporting and Data System (LI-RADS) LR-3/LR-4 observations detected during HCC surveillance. Patients underwent an average of three complete CE-MRI rounds at 3-6 months interval, with approximately 12-month follow-up. NC-AMRI included diffusion-weighted (DWI), T2-weighted imaging (T2WI-FS), and T1-weighted gradient imaging (T1WI). NC-AMRI protocol images were separately analyzed for diagnostic performance, with subgroup analyses. CE-MRI and NC-AMRI images were independently reviewed by two experienced radiologists, with inter-reader agreement assessed using Kappa coefficient. The reference standard was the presence of arterial hypervascularity and washout on CE-MRI, following AASLD guidelines.

Results: In 166 CE-MRI follow-ups of 63 patients (median age: 63 years; 60.3% male, 39.7% female), 12 patients developed HCC, with an average size of 19.6 mm. The NC-AMRI protocol (DWI+T2WI FS+T1WI) showed 91.7% sensitivity (95%CI: 61.5–99.8) and 91.6% specificity (95%CI: 86.0–95.4), area under the receiver operating characteristic (AUROC) 0.92 (95%CI: 0.83–1.00). Across different Body Mass Index (BMI) categories, lesion size, Child-Turcotte-Pugh (CTP) classes, Albumin-Bilirubin (ALBI) grades, and Model for End-Stage Liver Disease (MELD) score classes, sensitivity remained consistent. However, specificity differed significantly between ALBI grade 1 and 2 (86.7% vs. 98.4%, p=0.010), and between viral and non-viral cirrhosis (93.8% vs. 80.8%, p=0.010).

Conclusions: NC-AMRI proved clinically feasible, and exhibits high diagnostic performance in HCC detection.

OP-38-09

Nimbolide attenuates genes involved in tumor growth and metastasis by improving miR145 expression in HCC

Balasubramaniyan Vairappan and Amit Kumar Ram

Jawaharlal Institute Of Postgraduate Medical Education And Research, Puducherry, India

Oral Presentation 38, APDW Theatre 2, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Background: Liver cancer remains a substantial public health problem and represents the 3rd leading cause of cancer-related deaths globally. However, many advanced therapies are in place, the prognosis remains poor. Here, we aimed to ascertain the anti-cancer and metastatic effects of Nimbolide (a major limonoid constituent of Azadirachta indica) by regulating specific microRNA 145 and its target genes in experimental liver cancer.

Methods: Diethyl nitrosamine and N-nitrosomorpholine-induced hepatocellular carcinoma (HCC) mice were administered Nimbolide (6mg/kg b.wt.) orally for four weeks following induction of HCC at 28 weeks.

Results: We found significantly decreased expressions of miR145 in HCC mice compared to naive. Following treatment with Nimbolide to HCC mice showed increased miR145 expression considerably. Moreover, miR145 direct target genes such as MUC1, ROCK-1, MMP-9 and ADAM 17 were significantly elevated in HCC and were downregulated following Nimbolide treatment. The epithelial-mesenchymal transition (EMT) markers E-cadherin expression decreased whilst N-cadherin expression increased in HCC mice. Furthermore, miR145 inhibitor treatment to HepG2 cells showed increased MUC1, ROCK-1, MMP-9, ADAM 17 and EMT marker expression. Nimbolide treatment positively regulated the above indices.

Conclusion: Our novel data suggested that Nimbolide treatment improved miR145 expression and decreased its target genes involved in cancer growth and metastatic development in HCC. Consequently, Nimbolide could be considered a future therapeutic approach in managing HCC pathogenesis.

OP-38-11

Dopamine through DRD1 to regulate autophagy during TGF-β-induced hepatic stellate cell activation

Yang Xiaoxu and Lu Xianmin and Li Jiajing and Lou Jun and Shan Weixi and Du Qian and Liao Qiushi and Xie Rui and Xu Jingyu

Affiliated Hospital of Zunyi Medical University, Zunyi, China

Oral Presentation 38, APDW Theatre 2, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Background and Aims: Hepatic stellate cells(HSCs) are essential in liver fibrogenesis. The intracellular calcium and autophagy affect HSCs’s activation. Previous studies showed dopamine stimulation increases intracellular calcium and TRPV1 calcium channel inhibit the increased autophagy during TGF-β-induced HSCs activation. Aimed at the underlying mechanism of The intracellular calcium induced by dopamine and dopamine receptor in the autophagy of HSCs activation from animal experiments in vivo and cell experiments in vitro, that provides a targeted therapy for liver fibrosis.

Methods: Dopamine concentration determination in human serum by ELISA. Immunohistochemistry detect the expressions of TRPV1、DRD1 and a-SMA and a-SMA, LC3, p62 detect by western blot analysis. change of ntracellular calcium in HSCs was examined through cell calcium imaging. Constructed liver fibrosis model.

Results: 1.Optimized clinical samples showed dopamine has a negative correlation with liver cirrhosis patients, yet a positive correlation between autophagy and liver cirrhosis tissue.

2.Constructed HSCs activation cell model to verify dopamine inhibit autophagy and activation of HSCs. Performed dynamic high-speed calcium imaging experiment to detect intracellular Ca2+ in HSCs.

3.Filter out specific calcium channel and dopamine receptor is TRPV1 and DRD1 mediating inhibition effect of DA on HSCs and verify the connection between them. Detected TGF-β1/Smad3 signaling is the underlying pathway.

4.Constructed liver fibrosis model with C57 mice by CCL4 to verify DA’s therapeutic effect.

Conclusions: Dopamine activated DRD1 to bind TRPV1to inhibit autophagy and HSCs activation mediated by TGF-β1/Smad3 signaling pathway. Targeting TRPV1 serve as a therapeutic strategy against liver fibrosis.

OP-38-12

The mechanism of CaSR/TRPV4-mediated calcium signaling in regulating the activation of hepatic stellate cells

Lady Chen Luo and Lady Rui Xie and Jingyu Xu and Jianling Zhu

Zunyi Medical College Affiliated Hospital, Zunyi City, China

Oral Presentation 38, APDW Theatre 2, Exhibition Hall, November 24, 2024, 10:00 AM - 11:20 AM

Objective: To explore the role of CasR-mediated calcium signal in the activation of hepatic stellate cells, to find new potential targets for anti-liver fibrosis, and to guide clinical treatment of liver fibrosis more accurately and effectively, so as to reduce the incidence of liver cancer.

Methods: Immunohistochemistry, Western-blot, high-speed calcium ion imaging, flow cytometry, immunofluorescence and co-immunoprecipitation were used to investigate the role and mechanism of CaSR in liver fibrosis.

Results: 1.Compared with is healthy people, different types of blood calcium concentration in patients with cirrhosis reduced (p < 0.005).

2. Compared with normal liver tissues, the expression of CaSR was decreased and the expression of α-SMA was increased in patients with liver fibrosis;

3. Flow cytometry showed that Cacl2 pretreatment could increase the apoptosis of HSC-T6 and LX-2 cells induced by TGF-β1. After inhibiting the function of CaSR, the increased expression of CaSR and Bax and the decreased expression of α-SMA and Bcl-2 induced by TGF-β1 stimulated by Cacl2 were reversed (p<0.05).

4, found that high calcium imaging suppression TRPV4, Spermine induced changes in calcium signal reduced very significantly (p < 0.05).

5. The interaction between CaSR and TRPV4 was identified in HSC-T6 and LX-2 cells by immunofluorescence and co-immunoprecipitation.

6. Western blot confirmed that TPA could down-regulate the expression of PKCα in HSC-T6 and LX-2 cells induced by TGF-β1.

Conclusion: CaSR-mediated calcium signaling serves as a protective factor in the activation of hepatic stellate cells. CaSR/TRPV4 coupling mediates the function of hepatic stellate cells through PKCα signaling pathway.

OP-39-03

RCT, non-inferiority study of intermittent PPI following non-variceal upper gastrointestinal bleeding: Insight for current guideline

Burhan Gunawan and Raymond Sebastian Purwanta

Sumber Waras Hospital, West Jakarta, Jakarta Barat, Indonesia

Oral Presentation 39, Uluwatu 1, November 24, 2024, 10:00 AM - 11:20 AM

Introduction: Current guideline recommend use infusion PPI for non-variceal upper gastrointestinal bleeding, but the optimal dose and method of administration remains controversial. The aim of study was to determine the intermittent PPI was non-inferior to continuous PPI

Method: The RCT study held in Sumber Waras Hospital, from January 2022 until June 2024. Inpatient >18 years old with non-variceal gastrointestinal bleeding from ER included in this study. The randomization enrolled to treatment with intermittent omeprazole (2x40mg bolus IV) and continuous omeprazole (drip 8mg/hour). Outcome was re-bleeding rate at 7 days, mortality at day 30, and length of stay (LOS). The non-inferiority margin was pre-defined as 0.96 and 0.91 for re-bleeding and mortality respectively.

Result: Total 205 subject (110 intermittent PPI, 95 continuous PPI) included in ITT final analysis. Mean age was 59.7 ± 14.7 years old, 36.5% female. No difference in baseline data between groups. The intermittent group shows significantly lower rate of re-bleeding (42.1% vs 53.62%) with OR 0.85 (95% C.I. :0.71-0.98), p=0.03. The intermittent PPI also show lower rate of mortality (11.4% vs 18.1%), with OR 0.92 (95% C.I :0.76-1.13), p=0.07. The LOS lower significantly in intermittent group (3.98 ± 0.89 vs 5.12 ± 0.95 days), p=0.02. Use of high-dose tranexamic acid, broad spectrum antibiotic, longer fasting period (>2 days) related with lower rate of re-bleeding.

Conclusion: The intermittent PPI shows the non-inferiority efficacy for non-variceal gastrointestinal bleeding. Given the delivery of PPI via infusion is more costly, timely, and inconvenient, its supports the change in clinical practice

OP-39-07

Impact of Pancreatic Enzyme Replacement Therapy on Abdominal Pain and Gastrointestinal Symptoms: A Longitudinal Study

Malith Nandasena, Hasthaka Dissanayaka, Hasangi Gamage and Aloka Pathirana

Colombo South Teaching Hospital, Colombo, Sri Lanka

Oral Presentation 39, Uluwatu 1, November 24, 2024, 10:00 AM - 11:20 AM

Objectives: Pancreatic insufficiency (PI) often results in debilitating gastrointestinal symptoms, including abdominal pain, diarrhea, and steatorrhea, significantly impairing quality of life. This study investigates the impact of Pancreatic Enzyme Replacement Therapy (PERT) on these symptoms.

Methods: We conducted a longitudinal study on 95 PI patients (31 females, 64 males; mean age 47.51 ± 15.23 years) to evaluate changes in abdominal pain, diarrhea, and steatorrhea pre-PERT and post-PERT initiation. Symptom severity and quality of life improvements were assessed, with statistical analyses performed using the Wilcoxon Signed-Rank Test and Pearson Chi-Square.

Results: Abdominal pain scores significantly decreased post-PERT (Z = -7.936, p < 0.001), with mean scores reducing from 6.64 ± 1.97 to 2.16 ± 1.67. Diarrhea condition improved in 20 patients (21.1%) and steatorrhea in 33 patients (34.7%). Pearson Chi-Square analysis revealed no significant gender differences in the improvement of diarrhea (χ²(1) = 0.490, p = 0.484) and steatorrhea (χ²(1) = 0.429, p = 0.513).

Conclusion: The initiation of PERT resulted in significant reductions in abdominal pain and moderate improvements in diarrhea and steatorrhea among PI patients. The lack of gender differences in symptom improvement underscores the broad efficacy of PERT across demographics. PERT markedly reduces abdominal pain and moderately alleviates other gastrointestinal symptoms in PI, enhancing overall patient quality of life. This study supports the routine use of PERT in managing PI symptoms. 

OP-39-12

Fexuprazan versus Proton-Pump Inhibitors: Efficacy and Safety in Gastric Acid Related Disease

Anjani Larasati¹, Visabella Rizky Triatmono¹, Muhammad Maulana Wildani¹, Bagus Ramasha Amangku¹, Liovicinie Andarini¹, Rabbinu Rangga Pribadi², Muhammad Firhat Idrus² and Ari Syam²

¹Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; ²Gastroenterology Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia

Oral Presentation 39, Uluwatu 1, November 24, 2024, 10:00 AM - 11:20 AM

Objectives: Gastric acid-related diseases affect millions globally, impacting quality of life. While proton pump inhibitors (PPIs) are standard treatment, alternatives are being explored. Fexuprazan, a potassium-competitive acid blocker (P-CAB), shows promise as an effective and safe option. This review assesses Fexuprazan's efficacy and safety compared to PPIs in treating these conditions.

Materials and methods: Randomized clinical trials (RCTs) discussing the efficacy and safety of Fexuprazan in comparison with other PPIs in patients with gastric-acid related disease were included. Published papers were retrieved through six databases, namely OVID MEDLINE, EMBASE, PUBMED, CENTRAL, PROQUEST, and SCOPUS up to June 21st, 2024. Cochrane Risk of Bias 2.0 was used to assess the risk of bias of included studies.

Results: Three RCTs with a total of 886 patients were eligible for inclusion. All RCTs were of low risk-of-bias. As compared to placebo, fexuprazan 20 mg qd and 10 mg bid groups had significantly higher erosion improvement rates at 8 weeks in FAS analysis [17.9% (95%CI, 3.9% to 31.9%) and 24.9% (95%CI, 11.3% to 38.5%)]. In comparison with esomeprazole 40 mg, fexuprazan 40 mg showed non-inferiority in EE healing of GERD at 8 weeks from PPS analysis (Common risk difference 0.9% (95%CI, -0.9 to 2.6)). Symptomatic relief, safety profile, and medical compliance in fexuprazan group was found to be higher compared to placebo or esomeprazole groups, however the difference was not found to be significantly different.

Conclusion: Fexuprazan is as effective as PPIs for treating patients with gastric-acid related diseases, mainly gastritis and erosive esophagitis.

OP-39-13

Estrogen regulates duodenal glucose absorption by affecting estrogen receptor-α on glucose transporters

Rui Xie², Qian Du¹, Zhuo Li¹, Ya Deng¹ and Jingyu Xu¹

¹Affiliated Hospital of Zunyi Medical University, Zunyi; ²Guizhou Provincial People’s Hospital, China

Oral Presentation 39, Uluwatu 1, November 24, 2024, 10:00 AM - 11:20 AM

Objective: The mechanisms of estrogen in glucose metabolism are well established; however, its role in glucose absorption remains unclear. This study focused on the role of estrogen in the regulation of duodenal glucose absorption and the underlying molecular mechanisms.

Methods: The ovariectomized (OVX) animal model was established. Radioimmunoassay was used to detect the serum estradiol level. OGTT test was used to detect the glucose tolerance of ovariectomized mice and young women. Ussing chamber experiments were performed to measure glucose absorption ex vivo in the duodenum of the mice. Western blot and Immunohistochemistry was used to detect the expressions of the expression of ERα, ERβ, SGLT1,GLUT2, and p-PKC.

Results: We first observed a correlation between estrogen and blood glucose in young women and found that glucose tolerance was significantly less in the premenstrual phase than in the preovulatory phase. Similarly, with decreased serum estradiol levels in ovariectomized mice,ERα and ERβ in the duodenum were reduced, and weight and abdominal fat increased significantly. The expression of SGLT1and GLUT2 and glucose absorption in the duodenum decreased significantly. Estrogen significantly upregulated SGLT1 and GLUT2 expression in SCBN cells. Silencing of ERα, but not ERβ, reversed this trend, suggesting that ERα may be key to estrogen-regulating glucose transporters. A mechanistic study revealed that downstream, estrogen regulates the PKC pathway.

Conclusions: This study is the first to demonstrate that estrogen regulates duodenal glucose absorption through the effect of ERα on glucose transporters and inhibits PKC signaling to regulate this process.

OP-39-14

Clinical efficacy and safety of personalized, precision-matched FMT of patients with moderate to severe UC

Pengguang Yan, Xiang Xu and Jingnan Li

Peking Union Medical College Hospital, Beijing, China

Oral Presentation 39, Uluwatu 1, November 24, 2024, 10:00 AM - 11:20 AM

Objective: To evaluate the clinical efficacy and safety of personalized, precision-matched fecal microbiota transplantation (FMT) in patients with moderate to severe ulcerative colitis.

Methods: A prospective single-center study enrolled patients with moderate to severe UC in Peking Union Medical College Hospital from June 2023 to May 2024. Baseline stool samples were collected for 16sRNA analysis and evaluated based on nine dimensions, including dysbiosis of neutral bacteria, increase in harmful bacteria, loss of butyrate-producing bacteria, etc. Precision matching was performed using a secondary screening from “young” gut microbiota bank. After vancomycin pretreatment, FMT was given through a colonic catheter, 50ml daily for 6 days, with an estimated total viable bacterial count of 8-9×1013 per course.

Results: A total of 21 patients with ulcerative colitis were enrolled, including 13 men and 8 women. Among them, 7 patients were steroid-dependent, 6 patients on biologics (4 on vedolizumab, 2 on infliximab) did not achieve clinical improvement, and 4 patients had recurrent Clostridium difficile infection. Based on the modified Mayo score, 3 patients had severe disease activity, 15 patients had moderate activity. Eight weeks after FMT, 12 patients (57.1%) achieved clinical remission, 6 patients (28.6%) showed clinical improvement. 2 patients developed low-grade fever within 2 weeks after FMT, but there was no evidence of bacteremia.

Conclusion: Personalized, precision-matched FMT can improve clinical disease activity in patients with moderate to severe UC, with no severe adverse reactions observed. It can be considered an adjunctive treatment option when conventional drug therapy is challenging in refractory UC.

OP-39-15

A New IBD Clinical Database with the Eastern and Western characteristics

Yunsheng Yang¹, Jingshuang Yan¹, Ruqi Chang¹, Rongrong Ren¹, Gary Wu² and Lihua Peng¹

¹The FirstMedical Center, Chinese PLA General Hospital, Beijing, China; ²School of Medicine, University of Pennsylvania, USA

Oral Presentation 39, Uluwatu 1, November 24, 2024, 10:00 AM - 11:20 AM

Objectives: The development of an IBD database with the Eastern and Western characteristics is of great potential for the collaborative research on IBD.

Materials and Methods: We developed a new IBD database which named the 301 IBD database that integrated the IBD clinical characteristics of China and America. The 301 IBD database is based on the Penn IBD database and the latest IBD guidelines and consensus of China. A single-center analysis of the clinical data of UC and CD from the Chinese PLA General Hospital during 2008 to 2023 were conducted.

Results: The 301 IBD database contains 490 items in 6 sections including demographic characteristics, personal history, clinical phenotype, disease activity, examination, and treatment. Features of the 301 IBD database includes inpatient focus, opportunistic infection test focus, and more about UC-associated complications. A total of 1053 UC cases (1944 hospitalizations) and 305 CD cases (661 hospitalizations) had been recorded. Hospitalization of IBD patients showed an increasing trend, from 2.35% in 2008 to 3.95% in 2023. Clinical characteristics of Chinese UC inpatients are predominantly male (62.5%), extensive lesions (55.1%), low usage of biologics (4.1%), and a high incidence of UC-CRC (3.0%). The clinical features of CD include male predominant (68.5%), mainly ileal involvement (39.0%), nonstricturing, non-penetrating phenotype (66.2%), high rate of extraintestinal manifestation (24.3%) and surgical intervention (24.9%).

Conclusion: A new IBD clinical database has been formed with the Eastern and Western characteristics. It provides a common database basis for the Eastern and Western collaborative research on IBD in future.