Submucosal Thickness Research Articles

Novel device for blunt dissection in third space endoscopy: Preliminary animal study (with video)

AbstractBlunt dissection is not commonly performed in flexible endoscopic procedures. We developed a novel blunt dissection device and evaluated its feasibility, safety, and potential effectiveness in third space endoscopy procedures.The device consists of a cotton swab and a flexible shaft. To evaluate its functionality, creation of 4-cm submucosal tunnels in live swine stomachs was attempted by either blunt dissection using our device or sharp dissection using a standard monopolar knife. Data on factors such as completion rate, operating time, adverse events, necessity of submucosal injection, and dissected submucosal thickness were collected.Eighteen submucosal tunnels were successfully created (sharp: 9, blunt: 9) by two experienced endoscopists and one novice endoscopist. Median operating time was significantly shorter in the blunt dissection group (239 vs. 429 s, P = 0.008). In the sharp dissection group, the experienced endoscopists did not cause any muscle layer injuries, but the novice endoscopist caused muscle layer injuries in all cases. In the blunt dissection group, neither experienced nor novice endoscopists caused muscle layer injuries. The blunt dissection group required significantly fewer submucosal injections (0 vs. 5, P < 0.001). Median dissected submucosal thickness was similar between the groups.Blunt dissection using our device was feasible, safe, and potentially effective in third space endoscopy procedures by shortening operating time, reducing submucosal injections, and potentially minimizing muscle layer injury.

P0280 Evaluation of the diagnostic accuracy of trans-perineal ultrasound for predicting rectal histoendoscopic remission in Ulcerative Colitis (The TRINITY Study): A prospective, paired, comparative study with endoscopic ultrasound and trans-abdominal ultrasound

Abstract Background Rectum, frequently involved in Ulcerative colitis (UC) is challenging to evaluate using trans-abdominal sonography (TAS). Earlier single centre study have shown that rectal total wall thickness (TWT) (<4 mm) on trans-perineal ultrasound (TPUS) accurately predicts rectal inflammation(1). Inspite of being point-of-care, TPUS can only evaluate the lower rectum (~5 cm) and studies with trans-vaginal ultrasound have shown higher cut offs for rectal TWT(2). This study (comparison of TRIple Rectal UltrasouNd Imaging Technology : TRINITY) aimed to comprehensively evaluate the diagnostic accuracy of TPUS in predicting rectal histoendoscopic activity, using endoscopic ultrasound (EUS) as the reference standard. Methods 114 UC patients [age 18-70 yr (median- 37), 64 % male, E1: 16, E2: 61, E3: 37] underwent point-of-care TAS and TPUS followed by sigmoidoscopy with biopsy and rectal EUS. On TAS and TPUS, rectal TWT (average of anterior and posterior) and vascularity (Modified Limberg Score, MLS) were evaluated. On EUS, rectal TWT (average of upper, middle and lower and separately lower), vascularity (MLS), mucosal thickness (MT), and submucosal thickness (SMT) were measured. Diagnostic accuracy for predicting endoscopic activity (Ulcerative colitis endoscopic index of severity: UCEIS>1 in rectum) and histologic activity (Nancy Index≥1) was evaluated using receiver operating characteristic (ROC) curves. Results For prediction of both endoscopic and histologic activity, EUS outperformed TPUS. TAS was not useful (p>0.05) For endoscopic activity (n=114): EUS: Mucosal thickness>0.95 mm: AUC:0.95 (p<0.001); average TWT> 4 mm: AUC:0.89 (p<0.001); Vascularity (MLS) >1: AUC:0.93 (p<0.001); SMT>2.2 mm: AUC:0.84,(p<0.001). TPUS: rectal TWT >5.6 mm: AUC:0.68 (p=0.001); MLS ≥1:AUC:0.74 (p<0.001). TAS: TWT >6.3 mm:AUC: 0.57(p=0.25); MLS ≥1:AUC: 0.61 (p=0.04). For predicting histologic activity(n=81): EUS: lower rectal vascularity (MLS ≥1): AUC: 0.84, p<0.001; SMT>2.1 mm: AUC: 0.71, p<0.001; MT≥1 mm: AUC:0.81, p<0.001; TWT>5.6 mm: AUC:0.65, p=0.02. TPUS:rectal TWT≥ 5.6 mm: AUC:0.65 (p=0.02); vascularity (MLS≥1) AUC: 0.65 (p=0.036). TAS:TWT ≥ 6.3 mm: AUC:0.56, p=0.44; vascularity (MLS ≥1), AUC:0.59, p=0.18. Conclusion Although EUS remains the gold standard for assessing rectal inflammation, its invasive nature limits routine clinical use. TPUS offers a point-of-care, non-invasive alternative with moderate accuracy for predicting histoendoscopic remission with higher cut off levels contrary to previous reports. Further refinements in TPUS techniques and protocols are warranted to enhance its widespread applicability in clinical practice.

P0566 Submucosal, but not mucosal, wall thickness and stiffness correlate with bowel urgency in Ulcerative Colitis

Abstract Background Patients with ulcerative colitis (UC) may have bowel urgency (BU), which has been recognised as important due to its links with anxiety, depression, and reduced social quality of life. This study examines intestinal ultrasound (IUS) findings associated with BU, comparing them to endoscopic findings and biomarkers. Methods This prospective, single-centre study included UC patients undergoing colonoscopy from January to September 2023. Transabdominal and transperineal IUS was performed, assessing bowel wall thickness (BWT), colour Doppler signal (CDS), and shear wave elastography (SWE) in the sigmoid colon. The thickness of each layer of the sigmoid colon was also measured. Patients were grouped by urgency status per the Simple Clinical Colitis Activity Index. Statistical methods included the Wilcoxon rank-sum test, logistic regression, and ROC curve analysis. Results A total of 59 patients were enrolled, of which 33 patients (56%) had BU. CRP, MES, BWT (descending, sigmoid colon and rectum), thickness of submucosa and muscularis propria, CDS (sigmoid and rectum), and SWE were significantly higher (P<0.05) in patients with BU, while faecal calprotectin (FC). was not different (P=0.48). Logistic regression adjusted for MES identified BWT (sigmoid and rectum) and SWE as factors associated with BU. Interestingly, thickness of submucosa (p<0.01) and muscularis propria (P=0.03) but not mucosal layer (P=0.97) correlates with BU (Table). ROC analysis showed that thickness of submucosa predicted BU with high accuracy, outperforming mucosal thickness (P<0.05) (Figure). Conclusion Sigmoid BWT, especially submucosal thickness and wall stiffness assessed via IUS, correlates strongly with BU, independent of endoscopic severity. These findings provide important insights into the pathophysiology of BU in UC.

P0503 Submucosal hyperechogenicity on intestinal ultrasound is associated with fat deposition and is a predictor of endoscopic non-response to anti-inflammatory treatment in Ulcerative Colitis

Abstract Background The submucosa is the most responsive wall layer in the monitoring of treatment response in ulcerative colitis (UC) with intestinal ultrasound (IUS).1 However, persistent submucosal thickening, often seen in combination with hyperechogenicity, could be associated with treatment non-response.2 We aimed to understand these transmural changes in UC by correlating IUS findings with histopathology in colectomy specimens. Methods In total, 118 patients were included: (cohort 1) 19 UC patients and 52 controls without inflammatory bowel disease who all underwent colectomy, and (cohort 2) 47 UC patients in a prospective longitudinal validation cohort receiving anti-inflammatory treatment. In cohort 1, histopathology slides were scored for inflammation, fat, and collagen deposition in the submucosa by two pathologists, independently, using a semi-quantitative scale (0-3) (Figure 1). For the UC patients in cohort 1, images and histopathology slides of the sigmoid were location matched. IUS parameters were assessed by one sonographer, including relative submucosal echogenicity (RSE), quantified in grayscale units. In cohort 2, baseline RSE in the sigmoid was compared between endoscopic responders (≥1 point decrease in endoscopic Mayo score [EMS] after 8-26 weeks), and non-responders. Results In cohort 1, the indication for colectomy in UC was therapy-refractory disease (16/19, 84%), followed by acute severe colitis (2/19, 11%) and dysplasia (1/19, 5%). In the control groups, indications for surgery included cancer (31/52, 59%), diverticulitis (17/52, 33%), and obstipation (4/52, 8%). No significant differences in fat or collagen deposition in the submuosa were observed within cohort 1. In UC colectomy patients with the presence of submucosal fat deposition (score≥1), the submucosal thickness and RSE were significantly increased on IUS (Table 1). Linear regression showed fat deposition was independently associated with RSE (B=31.27, p<0.001), but fibrosis was not (B=14.89, p=0.097). In cohort 2, baseline RSE was significantly higher in endoscopic non-responders (n=17) than responders (146.8 vs. 88.7 grayscale units, p=0.003). A cut-off of >108 grayscale units predicted endoscopic non response with 82% sensitivity, 64% specificity, 58% positive predictive value and 86% negative predictive value. This cut-off was associated with an odds ratio of 0.12 (95% CI: 0.03-0.52, p=0.004) for endoscopic response. Conclusion In UC, hyperechogenicity of the submucosal layer on IUS is caused by fat deposition. Submucosal hyperechogenicity can be quantified and is a predictor of treatment non-response in UC patients.

DOP076 Translational and preclinical study validating anterior gradient 2 as a novel epithelial therapeutic target in Inflammatory Bowel Disease (IBD) involved in inflammation, fibrosis, and intestinal barrier integrity

Abstract Background Anterior Gradient 2 (AGR2) is an endoplasmic reticulum (ER) resident protein involved in protein folding, predominantly expressed in mucin-secreting epithelial cells. Under stress, AGR2 is secreted into the extracellular milieu (eAGR2), where it disrupts epithelial integrity, attracts monocytes, and activates fibroblasts. We explored the relationship between AGR2 tissue expression in IBD patients and the efficacy of a neutralizing anti-eAGR2 antibody (TH-009) in murine models of colonic inflammation and fibrosis Methods AGR2 expression was analyzed by immunohistochemistry on ileal and colonic biopsies from IBD patients and controls. In mice, the efficacy of TH-009 was evaluated in models of colitis (3% DSS) and digestive fibrosis (3 cycles of 1.5% DSS) Results 132 ileal and colonic endoscopic biopsies from 66 patients with Crohn’s disease (CD), 50 patients with ulcerative colitis (UC), and 16 controls, and 96 surgical samples from 11 CD patients, 24 UC patients, and 11 controls were included. AGR2 expression correlated with mucosal inflammation (R² = 0.416, p<0.0001) and tissue damage (R² = 0.329, p<0.0001). All patients with mucosal inflammation showed AGR2 overexpression, while 38% of histologically healed patients had high AGR2, with a relapse rate at 18 months three times higher than those whose AGR2 levels were comparable to controls.In a murine acute colitis model (3% DSS), intravenous (IV) treatment with TH-009 at doses of 5 and 20 µg showed an improvement in weight (p<0.005 and p=0.0001, respectively), in the global colitis DAI score (p=0.002 and p=0.001), and in the histological colitis score (p=0.04 for 5 µg) compared to controls. Intraperitoneal and subcutaneous administration were also effective. There was a significant reduction in tissue infiltration by macrophages (p<0.01) and T lymphocytes (p<0.001), in myeloperoxidase activity, and in the tissue and serum expression of pro-inflammatory cytokines TNFα and IL-6. TH-009-treated mice restored intestinal permeability, measured by FITC-Dextran blood passage, to levels comparable to unexposed DSS mice, unlike DSS-only exposed mice (p<0.01). In a fibrosis model (3 cycles of 1.5% DSS), preventive and curative treatment with TH-009 reduced digestive fibrosis by 49% (p<0.0001), and reduced submucosal fibrosis thickness by 59% (p<0.0001). There was a significant decrease in the colonic expression of fibrosis-related genes (Collagen A1, αSMA, fibrinogen, and TGFβ). Conclusion AGR2 is a novel therapeutic target in IBD, correlating with inflammation and complications. Its expression is not affected by major therapies and is overexpressed in 40% of patients with deep histological healing. TH-009 improves inflammation, reverses fibrosis, and restores epithelial barrier functions.

Dietary Tannic Acid Promotes Growth Performance and Resistance Against Aeromonas hydrophila Infection by Improving the Antioxidative Capacity and Intestinal Health in the Chinese Soft-Shelled Turtle (Pelodiscus sinensis).

To investigate the effect of tannic acid (TA) on the growth, disease resistance, and intestinal health of Chinese soft-shelled turtles, individual turtles were fed with 0 g/kg (CG), 0.5 g/kg, 1 g/kg, 2 g/kg, and 4 g/kg TA diets for 98 days. Afterwards, the turtles' disease resistance was tested using Aeromonas hydrophila. The results showed that 0.5-4 g/kg of dietary TA increased the growth performance and feed utilization (p < 0.05), with 2.38 g/kg being the optimal level for the specific growth rate (SGR). The addition of 0.5-4 g/kg of TA in diets increased the mucosal fold height and submucosa thickness of the small intestine, which reached a maximum of 2 g/kg. The addition of 0.5-2 g/kg of TA effectively reduced the cumulative mortality that had been induced by A. hydrophila, with the 2 g/kg dosage leading to the lowest mortality. Additionally, 1-4 g/kg of TA improved the T-SOD, CAT, and GSH-Px activities during infection, while 2 g/kg of dietary TA enhanced the richness and diversity of the microbiota, for example, by increasing Actinobacteria but inhibiting Firmicutes. The transcriptome demonstrated that the predominant differentially expressed genes (DEGs) in TA2 were mainly enriched in the PPAR signaling pathway (Acsl5, Apoa2, Apoa5, Fabp1, Fabp2, and Fabp6); in glycine, serine, and threonine metabolism (Chdh, Gatm, and Shmt1); and in steroid biosynthesis (Cel, Hsd17b7, Soat2, and Sqle). The main differentially expressed metabolites (DEMs) that were discovered by means of metabolome analysis included cholylhistidine, calcipotriol, 13-O-tetradecanoylphorbol 12-acetate, and hexahomomethionine in CG vs. TA2. Integrative analyses of two omics revealed that 2 g/kg of TA mitigated inflammation by activating the PPAR signaling pathway and regulating the lipid metabolism via multiple pathways, such as steroid biosynthesis and α-linolenic acid metabolism. In general, the inclusion of 2 g/kg of TA in turtle diets can optimally promote growth and bacterial resistance by maintaining intestinal health and improving antioxidant capacity.

Effects of on-farm hatching versus hatchery hatching on growth performance, gut development, and intestinal health and function in broiler chickens.

An alternative hatching system known as hatch on-farm (HOF) provides early access to feed compared to hatch in hatchery (HH) system. Early feeding may promote favorable gut development, potentially improving intestinal health and broiler performance. Previous studies have assessed the effects of HOF on chick quality, welfare and performance, its impacts on gut health remain inconclusive. A total of 560 Ross 308 male chicks were reared until d 38, hatched either in a hatchery (n = 280) or on-farm (n = 280), with 14 replicates per system and 20 birds per pen. Production parameters were periodically monitored. Digestive and immune organ characteristics, intestinal permeability and histomorphology were assessed on d 7, 14, and 38. High-throughput qPCR analyzed 79 ileal genes regarding barrier integrity, immune function, nutrient transporters, gut hormones, metabolism, and oxidation. HOF chicks had higher d1 body weights than HH chicks (P < 001), but this advantage disappeared within first week, with no subsequent performance differences. HOF chickens demonstrated increased duodenal villus width on d 7 and 14, and increased ileal crypt depth and submucosal thickness on d 7 (P < 0.05). Relative bursal weight was higher on d 14 (P = 0.018) and tended to be higher on d 38 in HOF chickens (P = 0.094). Intestinal permeability remained unaffected (P > 0.05), while HH chicks showed upregulation of gut barrier genes such as MUC5ac on d 7 and CLDN2 and MUC2 on d 14 (P < 0.05). HH chicks also showed upregulation of nutrient transports including VDR on d 7 and SLC30A1 and SLC5A9 on d 38, and decreased expression of the appetite-suppressing hormone CCK on d 7 (P < 0.05). HOF chicks upregulated immune-related genes, including IL-8 on d 7, IL-6, IFN-γ, AVBD9 on d 14, and NOS2 on d 38 (P < 0.05), and the oxidation gene HIF1A on d 38 (P = 0.039). In conclusion, although the HOF showed only transient growth advantages, it enhanced mucosal morphology and modulated immunity, indicating improved intestinal health.

Ultrasound Features of Helicobacter pylori-Related Gastritis.

Background Abdominal ultrasound (US) is a reliable method for visualizing gastric wall layers and measuring their thickness. The objective of this study is to characterize the ultrasound features of H. pylori-induced gastritis and assess its predictive potential role for this condition. Methods A cohort of 119 patients underwent gastroscopy with biopsy and abdominal US to evaluate antral wall thickness (AWT), submucosal wall thickness (SLT), mucosal wall thickness (MLT), gastric motility, and the presence of ingested material. They were divided into three groups: group A (normal mucosa without H. pylori infection), group B (gastritis H. pylori negative) and group C (gastritis H. pylori positive). Results: SLT and reduced gastric motility were significantly increased in the H. pylori gastritis group (p < 0.001). Multivariate analysis identified SLT as the only significant independent predictor of H. pylori gastritis (p < 0.001). An SLT threshold of 1.55 mm was determined as optimal for differentiating H. pylori-positive patients from -negative, yielding a sensitivity of 77% and a specificity of 72%. Conclusions These findings suggest that H. pylori gastritis is characterized by submucosal layer thickening and impaired gastric motility.

Evaluation of Deep Remission with Through-The-Scope Catheter-Based Endoscopic Ultrasound during Double Balloon Enteroscopy in Small Bowel Crohn’s Disease

Evaluation of deep remission in Crohn's disease (CD) can be challenging when the disease is confined to the small intestine. The aim of this study was to evaluate the effectiveness of through-the-scope (TTS) endoscopic ultrasound (EUS) during Double-balloon enteroscopy (DBE) in distinguishing small-bowel CD patients in endoscopic remission from those with active disease. Patients who underwent DBE-EUS were divided into groups of endoscopic remission and endoscopic activity according to segmental Simple Endoscopic Score for Crohn's Disease (SES-CD). Thickness of small intestinal wall layers and other parameters were evaluated by EUS. EUS using the ultrasonic catheter probe via DBE showed that the total wall thickness (TWT) and submucosal thickness (SMT) of the small intestine in the active group were significantly greater than those in the remission group (TWT 3.84±1.02 vs 2.42±0.25mm, SMT 1.23±0.34 vs 0.79±0.13mm, respectively, p<0.001). Cut-off values of 2.65 mm for TWT and 0.95 mm for SMT can distinguish active small-bowel CD from inactive disease (Sensitivity 91.5%, Specificity 80.8% and Sensitivity 70.2%, Specificity 88.6%, respectively). The correlation analysis revealed a significant positive correlation between TWT and SES-CD (r=0.930, p<0.001). Furthermore, TWT was strongly correlated with FC (r=0.861, p<0.001) and CDAI (r=0.805, p<0.001). Similar results were observed for SMT. EUS using an ultrasonic catheter probe during DBE is effective in evaluation of both mucosal and transmural healing in small-bowel CD patients. DBE-EUS could become an important tool in the management of patients with small-bowel CD.

Role of Trans perineal Ultrasound in Inflammatory Bowel Disease

Abstract Background Inflammatory Bowel Disease (IBD) is a medical terminology for a group of diseases that cause chronic intestinal inflammation. It is categorized into two subtypes: Ulcerative colitis and Crohn’s disease. Fistulae are frequently seen manifestations of perianal IBD, and their clinical course these consists of flare-ups with bouts of active drainage, followed by intervals of clinical remission. Improved prognosis, treatment, and assessments of perianal disease activity may all contribute to a better patient quality of life. Aim of the Work to explore the role of trans perineal ultrasound in assessment of disease activity and/or complications in patients with inflammatory bowel disease. Patients and Methods The Diagnostic Radiology Unit; Radiology Department, Ain Shams University Hospitals. For 6 months. We studied the relevance of 23 different ultrasound parameters and 6 indices in conjunction with clinical, endoscopic based scores. Sample size of at least 30 patients with IBD with affection of anal or perianal area were sufficient to achieve study objective. Results Rectal wall thickness and submucosal band thickness could be used as indicators for presence of disease in ulcerative colitis patients. TPUS could be used to assess the internal sphincter thickness, external sphincter integrity in Crohn’s disease. Partial Mayo clinical score showed significant correlation with Mayo endoscopic score; however, it couldn’t predict degree of severity. Internal sphincter thickening increased anal canal vascularity and perianal fistula is more common in Crohn’s disease than ulcerative colitis. Conclusion Trans perineal ultrasound is considered as a good tool that is noninvasive, cost effective and convenient and shows a potential in the assessment of disease activity and complications in inflammatory bowel disease.

Reliability of Intestinal Ultrasound for Evaluating Crohn’s Disease Activity Using Point-of-care and Central Reading

Intestinal ultrasound (IUS) is increasingly used to assess Crohn's disease (CD) activity in clinical practice. However, application in clinical trials has been limited by heterogeneous scoring methods and concerns about reliability. We aimed to determine the inter- and intra-rater reliability of locally and centrally read IUS parameters for evaluating CD using prospectively performed scans. Twenty-four participants with CD and 6 gastroenterologists participated in a 2-day workshop where each participant underwent 6 IUS scans in total. Eight IUS parameters (bowel wall thickness [BWT], bowel wall stratification [BWS], color Doppler signal [CDS], inflammatory mesenteric fat [i-fat], submucosal prominence, submucosal layer thickness, haustra coli/peristalsis, and affected segment length) and an overall measure of sonographic disease activity were blindly assessed by the 6 local readers and 4 central gastroenterologist-sonographers. Reliability was quantified using intraclass correlation coefficients (ICCs). Institutional review board approval was granted for this study (12938). Five IUS parameters demonstrated at least moderate (ICC ≥0.41) inter- and intra-rater reliability when local and central reading was performed (BWT, CDS, i-fat, submucosal prominence, and affected segment length). Reliability was generally better with central, in distinction to local, reading. ICCs for BWS and i-fat were highest when evaluated as binary outcomes. Sensitivity analyses demonstrated that IUS parameters are most reliable when evaluated in the worst affected segment. Fair reliability was observed when local readers identified the worst affected segment. Local and central reading of IUS demonstrated at least moderate inter- and intra-rater reliability for several parameters. This study supports refining existing activity indices and incorporating IUS central reading into clinical trials.

Clinical and diagnostic value of transrectal ultrasound in assessing the severity of ulcerative colitis

Background. Endoscopic and histological studies play a decisive role in the diagnosis of inflammatory bowel diseases, as they allow confirming the diagnosis, determining the degree of inflammatory activity, the extent of intestinal damage, and monitoring the course of disease and the effectiveness of therapy. Howe­ver, it is not possible to assess the state of all intestinal layers with colonoscopy. Modern non-invasive methods such as ultrasound, computed tomography, and magnetic resonance imaging cope best with this purpose. With their help, you can assess the state of the intestinal wall and obtain a cross-sectional image of the intestine, evaluate extraintestinal structures (lymph nodes, vessels, fatty tissue). It can be said that endoscopy and ultrasound search for the same type of information but look at different things. Deepening the knowledge about the role of ultrasound of the distal parts of the colon in ulcerative colitis (UC) will contribute to the improvement of diagnosis, development of methods for determining the activity of UC, control of therapy, which will allow optimizing the choice of adequate treatment measures. The goal of the work: to improve the diagnosis of ulcerative colitis based on the study of ultrasonographic parameters of the rectum. Materials and methods. Transrectal ultrasound was performed on an expert-class SonoScape S60 ultrasound scanner using a low-frequency convex probe of 3.5 MHz and a rectovaginal convex probe of 6 MHz. Transperineal and transrectal approaches were used. Results. Wall thickness and submucosal thickness differed significantly in moderate and severe UC. Analysis of transrectal ultrasound indicators depending on the endoscopic activity of the UC revealed no significant differences in the rectal wall thickness. But there was a tendency to increase in the thickness of the mucous layer and the coefficient of deformation with increasing endoscopic activity. Most patients had an increase in the degree of blood flow density, which depended on the disease severity. During the regression analysis, a relationship was found between the intestinal wall thickness (r = 0.44; p = 0.0121) and submucosal layer thickness (r = 0.86; p = 0.006) with the Mayo index. A correlation was revealed between the thickness of the colon wall and the frequency of bowel movements (r = 0.37; p = 0.018), leukocytosis (r = 0.38; p = 0.016) and erythrocyte sedimentation rate (r = 0.35; p = 0.027). The blood flow density in the intestinal wall positively correlated with the presence of edema (r = 0.32; р = 0.045), the severity of the vascular pattern (r = 0.42; р = 0.008), the presence of erosions (r = 0.4; р = 0.011) and bleeding of the mucous membrane (r = 0.50; p = 0.001). The coefficient of deformation positively correlated with the presence of flatulence (r = 0.35; р = 0.048). Conclusions. Endoscopic exa­mination in patients with UC should be supplemented with transrectal ultrasound. A correlation was found between the intestinal wall thickness and the thickness of the submucosal layer in patients with UC and the Mayo index. A tendency to increase in the thickness of the mucous layer and the coefficient of deformation with increasing endoscopic activity was determined. Relationships between endoscopic and ultrasound parameters can be used to assess disease activity.

Impact of dietary Moringa oleifera leaf supplementation on gut morphometry, behaviour and physiological parameters in growing male rabbits.

Moringa oleifera (MO), a cultivated species of the Moringa, is known for its high concentration of essential nutrients that promote growth. To assess its impact on rabbits' gut morphometric, behavioural, and physiological parameters, a study was conducted using sixty growing male white New Zealand rabbits at 40 days old. The rabbits were divided into four groups and supplemented with dried MO leaves at varying levels (0%, 0.5%, 1% and 2% of body weight) for four weeks. The results revealed significant increases in organ weights, such as liver and intestinal length, and the height of intestinal villi and crypt depth in the large intestine. The muscular layer's and submucosa's thickness also increased in different parts of the intestine in rabbits fed with MO compared to the control group. No significant effect was observed on the caecum mucosa depth. Interestingly, no significant differences were found in body weight or weight gain between the Moringa supplementation groups and the control group. However, rabbits offered 0%, 0.5% and 1% MO spent more time feeding and resting than those given 2% MO. The grooming and sniffing percentage remained unaffected by Moringa supplementation. Regarding blood parameters, rabbits that received MO leaves in their diet showed improvements in red blood cell count, haemoglobin levels, packed cell volume, white blood cell count, neutrophil count, total protein, globulin, and A/G ratio. Moreover, there was a significant decrease in malondialdehyde levels and an increase in glutathione and high-density lipoprotein levels, indicating an antioxidative effect. Overall, the study concluded that MO leaves supplementation in the rabbit diet positively influenced the rabbits' health by modulating the immune system, improving histological aspects of the intestine, liver, and spleen, and enhancing physiological parameters through its antioxidative properties.

Dietary Supplementation of Astragalus membranaceus Extract Affects Growth Performance, Antioxidant Capacity, Immune Response, and Energy Metabolism of Largemouth Bass (Micropterus salmoides).

The present study investigated the effects of Astragalus membranaceus extract (AME) on growth performance, immune response, and energy metabolism of juvenile largemouth bass (Micropterus salmoides). Seven diets containing 0%, 0.1%, 0.2%, 0.3%, 0.4%, 0.5%, and 0.6% AME (Con, AME0.1, AME0.2, AME0.3, AME0.4, AME0.5, and AME0.6 groups) were formulated and fed to M. salmoides for 8 weeks. Final body weight (FBW), feed intake (FI), weight gain (WG), and specific growth rate (SGR) were all significantly higher in AME0.4 group than in Con group (P < 0.05). Feed conversion rate (FCR) was significantly improved in AME0.5 group compared with Con group (P < 0.05). Whole-body crude protein contents were significantly increased in AME0.2 group (P < 0.05). Whole-body crude lipid contents were significantly lower in AME0.2 and AME0.3 groups, while muscle lipid was upregulated by dietary AME (P < 0.05). Hepatic malondialdehyde (MDA) contents were significantly lowered in AME0.3 and AME0.4 groups, and catalase (CAT) activities were significantly increased in AME0.1 and AME0.2 groups (P < 0.05). Plasma aspartate aminotransferase (AST) level was significantly lowered in AME0.5, and AME0.6 groups, and alanine aminotransferase (ALT) level was lowered in AME0.5 groups (P < 0.05). Plasma triglyceride was declined in AME0.6 group, and glucose was decreased by 0.3%-0.5% AME (P < 0.05). Significantly higher hepatocyte diameter, lamina propria width, and submucosal layer thickness were recorded in AME0.6 groups, while the longest villi height was obtained in AME0.2 and AME0.3 groups (P < 0.05). The mRNA expression levels of insulin-like growth factor 1 (igf1) revealed the growth-promoting effect of AME. The anti-inflammatory and antiapoptotic effects of AME were demonstrated by transcription levels of interleukin 8 (il-8), tumor necrosis factor-alpha (tnf-a), caspase, B-cell lymphoma-xl (Bcl-xl), bcl-2 associated x (Bax), and bcl-2-associated death protein (Bad). The transcription levels of lipid metabolism and gluconeogenesis related genes, including acetyl-CoA carboxylase alpha (acc1), fatty acid synthase (fasn), fatty acid binding protein 1 (fabp1), phosphoenolpyruvate carboxykinase 2 (pepck2), and glucose-6-phosphatase catalytic subunit 1a (g6pc), were reduced by AME treatment, while the levels of glycolysis-related genes, including glucokinase (gck) and pyruvate kinase (pk), were the highest in AME0.2 and AME0.3 groups (P < 0.05). According to polynomial regression analysis of SGR, WG, FCR, whole-body crude lipid, MDA, and ALT, the optimal AME supplementation level was estimated to be 0.320%-0.429% of the diet. These results provided insights into the roles of AME in regulating immunity and metabolism, which highly indicated its potential as immunostimulants and metabolic regulators in diverse aquatic animals.

P410 Intraoperative Ultrasonography of the Small Bowel in the evaluation of resection margins during surgery for Crohn's Disease

Abstract Background Histological involvement of surgical resection margins in Crohn’s Disease (CD) is considered an important risk factor for disease recurrence after surgery. The extent of resection is currently left to preoperative investigations and surgeon's experience. Aim of the study is to evaluate usefulness of intra-operative ultrasonography (IOUS) of the small bowel to best identify the surgical site of resection and reduce the risk of histological involvement of resection margins. Methods Consecutive patients who underwent surgery for CD (ileocaecal or ileal resections for first or repeated surgery) from April 2022 to April 2023 were prospectively enrolled (IOUS group). All patients underwent to IOUS through a small mini-laparotomy with a linear wireless probe performed by an expert gastroenterologist and the location of the proximal ileal resection was decided considering the absence of intraoperative small bowel ultrasonographic signs of CD (wall thickness, mucosal, submucosal and muscular layer thickness, echogenicity of the wall stratification and mesenteric fat). A control group from the historical cohort of patients undergoing the same surgical procedures was included; for whom the site of the proximal ileal resection was decided only on the basis of the absence of macroscopic signs of disease as usually assessed. To minimize the selection bias, a propensity score analysis was performed identifying a subgroup of the historical cohort (non-IOUS group) matched for location of disease and repeated surgery. The primary endpoint was histological involvement of the resection margins, judged positive in case of granulomas or signs of active ulcerative inflammation. Results 27 patients (59% male, mean age 39.3 y [SD 16.5], mean BMI 21.24 [SD 2.03]) were consecutively enrolled in the IOUS group. A 1:1 propensity score matching analysis was performed identifying 27 patients included in the non-IOUS group . The two groups were homogeneous in terms of gender, age, smoking, BMI, behavior of disease and surgical technique (laparoscopic or open technique). IOUS group presented a lower rate of histological positive margins compared to the non-IOUS group (18.5% vs 48.1% p = 0.021). No significant differences were found in terms of mean duration of surgery between the two groups (254.2 min vs 225 min [49.3-77.8]; p = 0.11) or in terms of mean length of surgical specimen (24.1 cm vs 34.1 cm [SD 13.5 -23.1]; p = 0.058) Conclusion IOUS of the small bowel appears to be a useful tool for IBD-surgeon in order to obtain a lower rate of histologically positive margins with a comparable duration of the surgery and no significant difference in length of the intestinal specimen.

A combination of bowel wall thickness and submucosa index is useful for estimating endoscopic improvement in ulcerative colitis: external validation of the Kyorin Ultrasound Criterion.

Endoscopic improvement (EI; a Mayo endoscopic subscore of 0 or 1) is considered a therapeutic target in ulcerative colitis (UC) treatment. The potential to estimate EI non-invasively is an advantage of intestinal ultrasound (IUS). In a previous study, we developed a new sonographic parameter, the submucosa index (SMI), calculated as the ratio of the submucosal thickness to bowel wall thickness (BWT), and reported that combining BWT and SMI results in a practical and promising criterion for estimating EI without color Doppler assessment. This study aimed to validate the EI estimation ability of our B mode-based criterion, the 'Kyorin Ultrasound Criterion for UC' (KUC-UC; BWT < 3.8mm and SMI < 50%), using an external cohort. Patients with UC who underwent IUS and colonoscopy within 15days without a treatment change between examinations were included. IUS findings, including BWT, SMI, and modified Limberg score for vascularity of the colon, were assessed. Forty-four test pairs of IUS and colonoscopy examinations in a total of 122 colonic segments were analyzed. The KUC-UC showed positive predictive value (PPV) of 94.6% and negative predictive value (NPV) of 80.0% for EI. In comparison, PPV and NPV were 85.4% and 79.0%, respectively, for the common criterion BWT of < 3mm, and 83.0% and 82.7% for the validated Milan Ultrasound Criteria (a score of ≤ 6.2). External validation showed that the KUC-UC using only B mode findings without complicated calculations is a feasible and accurate sonographic criterion for estimating the EI of UC.

Nandrolone decanoate impairs gastrointestinal motility and duodenal morphometry in moderately exercised rats.

The misuse of anabolic androgenic steroid associated or not with physical workouts disrupts gastrointestinal (GI) function homeostasis. Our goal was to investigate the effects of nandrolone decanoate (ND) and moderate swimming on the GI transit of solid meals, GI motor contractility, and intestinal histology in rats. Male Wistar rats were allocated to four groups that received intramuscular injections of ND (5.0 mg/kg) or vehicle (60.0 µL) and were submitted or not to swimming sessions (60 min, 5% body weight overload) for 4 weeks. Gastric emptying, intestinal transit, in vitro GI contractility, intestinal morphometry, and duodenal mucosal mast cells were evaluated in all experimental groups. ND treatment accelerated gastric emptying, slowed small intestine transit time, enhanced gastric carbachol-mediated reactivity, decreased crypt depth and villus height, reduced mucosal thickness, and increased the circular and longitudinal muscle layer thickness of the duodenum in sedentary rats. Moderate exercise accelerated intestinal transit time and reduced submucosa thickness. In vehicle-treated animals, a strong negative correlation was found between intestinal transit and mucosal mast cells, which was reversed by ND treatment. Combining ND treatment and swimming accelerated gastric emptying, increased duodenal cholinergic reactivity, inhibited the sodium nitroprusside relaxing response, increased the number of duodenal mast cells, decreased villus height, and increased the thickness of all muscle layers. ND changed the morphological and functional properties of the GI tract over time, with intense dysmotility, especially in sedentary animals, but moderate exercise seemed to have played a compensatory role in these harmful effects in the gut.

Resectability of Small Duodenal Tumors: A Randomized Controlled Trial Comparing Underwater Endoscopic Mucosal Resection and Cold Snare Polypectomy.

Underwater endoscopic mucosal resection (UEMR) and cold snare polypectomy (CSP) are novel endoscopic procedures for superficial nonampullary duodenal epithelial tumors (SNADET). However, consensus on how to use both procedures appropriately has not been established. In this study, we evaluated treatment outcomes of both procedures, including resectability. In this single-center randomized controlled study conducted between January 2020 and June 2022, patients with SNADET ≤12 mm were randomly allocated to UEMR and CSP groups. The primary end point was sufficient vertical R0 resection (SVR0), which was defined as R0 resection including a sufficient submucosal layer. We compared treatment outcomes including SVR0 rate between groups. The SVR0 rate was significantly higher in the UEMR group than in the CSP group (65.6% vs 41.5%, P = 0.01). By contrast, the R0 resection rate was not significantly different between study groups (70.3% vs 61.5%, P = 0.29). The submucosal layer thickness was significantly greater in the UEMR group than in the CSP group (median 546 [range, 309-833] μm vs 69 [0-295] μm, P < 0.01). CSP had a shorter total procedure time (median 12 [range, 8-16] min vs 1 [1-3] min, P < 0.01) and fewer total bleeding events (9.4% vs 1.5%, P = 0.06). UEMR has superior vertical resectability compared with CSP, but CSP has a shorter procedure time and fewer bleeding events. Although CSP is preferable for most small SNADET, UEMR should be selected for lesions that cannot be definitively diagnosed as mucosal low-grade neoplasias.

Early Intestinal Ultrasound Predicts Clinical and Endoscopic Treatment Response and Demonstrates Drug-Specific Kinetics in Moderate-to-Severe Ulcerative Colitis.

Intestinal ultrasound (IUS) is an emerging modality in monitoring disease activity in ulcerative colitis (UC). Here, we aimed to identify early IUS predictors of treatment response as evaluated by endoscopy and assessed the kinetics of IUS changes. This prospective, longitudinal study included UC patients with endoscopic disease activity (endoscopic Mayo score [EMS] ≥2) starting anti-inflammatory treatment. Clinical scores, biochemical parameters and IUS were assessed at baseline (W0), at week 2 (W2), at W6(W6), and at the time of second endoscopy (W8-W26). Per colonic segment, endoscopic remission (EMS = 0), improvement (EMS ≤1), response (decrease in EMS ≥1), and clinical remission (Lichtiger score ≤3) were assessed and correlated with common IUS parameters. Additionally, drug-specific responsiveness of bowel wall thickness (BWT) was assessed. A total of 51 patients were included and followed, and 33 patients underwent second endoscopy. BWT was lower from W6 onward for patients reaching endoscopic improvement (3.0 ± 1.2 mm vs 4.1 ± 1.3 mm; P = .026), remission (2.5 ± 1.2 mm vs 4.1 ± 1.1 mm; P = .002), and clinical remission (3.01 ± 1.34 mm vs 3.85 ± 1.20 mm; P = .035). Decrease in BWT was more pronounced in endoscopic responders (-40 ± 25% vs -4 ± 28%; P = .001) at W8 to W26. At W6, BWT ≤3.0 mm (odds ratio [OR], 25.13; 95% confidence interval, 2.01-3.14; P = .012) and color Doppler signal (OR, 0.35; 95% confidence interval, 0.14-0.88; P = .026) predicted endoscopic remission and improvement, respectively. Submucosal layer thickness at W6 predicted endoscopic remission (OR, 0.09; P = .018) and improvement (OR, 0.14; P = .02). Furthermore, BWT decreased significantly at W2 for infliximab and tofacitinib and at W6 for vedolizumab. BWT and color Doppler signal predicted endoscopic targets already after 6 weeks of treatment and response was drug specific. IUS allows close monitoring of treatment in UC and is a surrogate marker of endoscopy.

Effects of Low-Fish-Meal Diet Supplemented with Coenzyme Q10 on Growth Performance, Antioxidant Capacity, Intestinal Morphology, Immunity and Hypoxic Resistance of Litopenaeus vannamei.

The aim of this study was to evaluate the effects of a low-fish-meal diet supplemented with coenzyme Q10 on the growth, antioxidant capacity, immunity, intestinal health and hypoxic resistance of Litopenaeus vannamei. L.vannamei with an initial weight of 0.66 g were fed with the experimental diets for 56 days. Diets D1 (20% FM level) and D2-D7 (15% FM level), supplemented with 0%, 0.002%, 0.004%, 0.006%, 0.008% and 0.01% coenzyme Q10 were formulated. In terms of growth performance, the weight gain and specific growth rate in the D2 diet were significantly lower than those in the D1 diet (p < 0.05). The final body weight, weight gain and specific growth rate in the D2-D7 diets had an upward trend, and the condition factor in the D2-D7 diets was lower than those in the D1 diet (p < 0.05). There were no significant differences in the crude protein and crude lipid levels in the whole body among all diet treatments (p > 0.05). In terms of hepatopancreas antioxidant parameters, the D5 and D6 diets significantly promoted the total antioxidant capacity and total superoxide dismutase activity, and significantly decreased the malondialdehyde content (p < 0.05). The expression levels of cat, mnsod and gpx in shrimp fed with the D5 and D6 diets were significantly higher than those of shrimp fed with the D2 diet (p < 0.05). In addition, the mRNA level of ProPO was increased in the D4 and D5 diets, and LZM expression was increased in the D6 diet compared with the D1 diet (p < 0.05). The villus height of shrimp fed with diets supplemented with coenzyme Q10 was significantly increased (p < 0.05), and the intestinal thickness and submucosal thickness of shrimp fed with the D6 diet were the highest (p < 0.05). After acute hypoxia stress, lethal dose 50 time in the D3-D7 diets was significantly increased compared with the D1 and D2 diets (p < 0.05), and the highest value was found in the D4 diet (p < 0.05). After stress, the expression levels of TLR pathway-related genes (Toll, Myd88, Pelle, TRAF6 and Dorsal) in the D4 and D6 diets were significantly increased compared with the D2 diet. In general, Litopenaeus vannamei fed with the D6 diet achieved the best growth, antioxidant capacity, immunity, and intestinal morphology among all low FM diets and D4-D6 diets improved hypoxic resistance.