Upper Gastrointestinal Research Articles

Management of Gastric Variceal Bleed by Endoscopic Cyanoacrylate Injection: A Case Series.

Background and aims Cyanoacrylate glue (CAG) is the standard of care for gastric varices (GVs) but has serious complications too. The literature is scarce on determining the safe and effective amount of glue before the procedure objectively. Our study aimed to fill this gap. Methods It was an interventional case series,from January to December 2022. Patients with GVs, in whom CAG was injected, were included. Demographic, clinical, and endoscopic data with emphasis on cumulative variceal diameter (CVD, sum of maximum diameter of each varix), the total amount of glue injected (GTotal), outcomes (technical and clinical success), and complications intra- and post-procedural) were noted. Results Among 467, 18 (4%) patients had gastric varices. Glue was injected in six (1%) patients. Five had type 2 gastro-esophageal varices (GOV2) and one had type 1 isolated gastric varix(IGV1). Four had a history of upper GI bleed. Numbers of GVs ranged between 1 and 4, sizes 0.5-2.5 cm, and CVDs between 3.5 and 5.0 cm. GTotal ranged between 2 and 4 ml, the number of aliquots was one to two, and the maximum amount of glue in each aliquot was between 2 and 3 ml. The calculated relationship between CVD and GTotal ranged was CVD minus 0.5 to 1. Clinical and technical success was achieved in all. Two patients had intra-procedural, self-subsiding bleeding, and one patient had severe abdominal pain, which subsided with analgesics. None of them had fatal complications, transfusion requirements, or prolonged hospital stays. Conclusions CVD is a potential determinant factor for the total amount of glue injected during the endotherapy of GVs to achieve favorable clinical and technical outcomes.

S969 Comparative Analysis of Patients With Upper GI Bleed Undergoing Early versus Late Endoscopy: A National Readmission Database Study

S969 Comparative Analysis of Patients With Upper GI Bleed Undergoing Early versus Late Endoscopy: A National Readmission Database Study

In patients receiving invasive ventilation, PPIs reduce upper GI bleeding but did not affect mortality at 90 d.

Cook D, Deane A, Lauzier F, et al; REVISE Investigators. Stress ulcer prophylaxis during invasive mechanical ventilation. N Engl J Med. 2024;391:9-20. 38875111.

High Blood Ammonia Level Is a Predictor of Medium and Large Size Esophageal Varices In Cirrhotic Patients

Background: The development of esophageal varices (EV) and rupture of them are the most serious complications of portal hypertension. Upper gastrointestinal endoscopy is the gold standard for diagnosis of EV but it is a costly and troublesome invasive procedure. To find a non-invasive method for detection of size of EV and to predict the bleeding risk is appealing and would decrease the indications cost and discomfort of upper GI endoscopy. The aim of the study is to evaluate high blood ammonia level is a predictor of medium and large size of esophageal varices in Cirrhotic patients. Methods: This was an observational Cross-sectional study conducted on 40 cirrhotic patients in Department of Gastroenterology, BSMMU using a pre-designed data collection sheet. Information about clinical profile, laboratory parameters- blood ammonia, serum bilirubin, serum albumin, prothrombin time, and ultrasonography of abdomen, endoscopy upper GIT was collected and recorded. The collected data was analyzed by computer with the help of SPSS version 22. Statistical analysis was done by using appropriate statistical tool like Chi-square test, Student’s t- test. P value < 0.05 was considered as significant. Diagnostic efficacy of blood ammonia was calculated by using a value. Results: A total of 40 patients with cirrhosis. Mean age of cirrhotic patients were 47.47±12.98 years. Mean blood ammonia of small size EV of cirrhotic patients was 73.70±32.11 (μmol/L) and medium and large size EV was 118.3±38.37 (μmol/L) (P< .001). At the level of 78.5 (μmol/L), sensitivity and specificity of blood ammonia was 95% and 65% respectively in detection of size of EV. Conclusion: Blood ammonia estimation could be a good tool for identifying individuals with medium and large size esophageal who will need to undergo endoscopy more frequently. Bangladesh J Medicine 2024; 35: 167-172

Tumor Budding in Upper Gastrointestinal Carcinomas: A Systematic Review and Meta-Analysis.

Gastrointestinal (GI) carcinomas represent a heterogeneous composition of malignancies that stem from the organs of the GI tract. They are among the most prevalent and are associated with high mortality alongside morbidity rates. This study utilized the guidelines set forth by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), whereby four medical databases were searched for relevant scholarly publications published between 2010 and 2024. These databases were PubMed, Web of Science, and ScienceDirect. Risk of bias (RoB) for cohort, case-controlled, and cross-sectional studies was assessed using the Newcastle-Ottawa Scale (NOS), whereas randomized controlled trials (RCTs) used the Cochrane (RoB) tool. With the assumption that the observed estimate of the treatment effect differs between the included studies, a random effect meta-analysis was carried out. In the meta-analysis, fifteen trials with 7607 patients were considered. The findings indicate a substantial correlation between high-grade tumor budding and tumor stage, (χ²=480472.97, P<0.00001) with a mean difference of -6.18 at 95% confidence interval (95% CI) (-14.66 to 2.30), tumor differentiation (χ²=23.31, P<0.00001) with a mean difference of -12.60 at 95% CI (-35.89 to 10.68), lymph vascular invasion (χ²=29.59, P<0.00001) with a mean difference of -5.03 at 95% CI (-11.26 to 1.21), and lymph node metastasis (χ²​​​​​​​=158.30, P<0.00001) with a mean difference of -3.44 at 95% CI (-4.72, -1.78). Furthermore, in upper gastrointestinal (UGI) patients, high-grade tumor budding was associated with a negative five-year overall survival (P<0.00001) and a mean difference of -0.09 at 95% CI (-0.20 to 0.02). In regards to the risk of bias, most of the retrospective, prospective, case-control, and cohort studies 10/14 were of satisfactory quality. Moreover, 5/7 of the clinical trials had a low risk of bias. However, the funnel plot indicated that there is a probability of publication bias in favor of tumor budding. The study revealed a significant link between tumor budding and key prognostic factors-overall survival, lymph node metastasis, tumor differentiation, and lymphovascular invasion-in upper gastrointestinal carcinomas. High-grade tumor budding is associated with poor clinicopathological characteristics and a five-year overall survival. Tumor budding may serve as a unique prognostic marker. To confirm these results, further research with larger preoperative UGI biopsies is recommended.

Porto-mesenteric four-dimensional flow MRI: a novel non-invasive technique for assessment of gastro-oesophageal varices

ObjectivesTo assess the role of 4D flow MRI in the assessment of gastro-oesophageal varices and in the prediction of high-risk varices in patients with chronic liver disease.MethodsThirty-eight patients diagnosed with either oesophageal or gastric varices were included in this single-centre prospective study. 4D flow MRI was used to calculate peak flow, average flow and peak velocity at the portal vein confluence (PV1) and hilum (PV2), splenic vein hilum (SV1) and confluence (SV2), and superior mesenteric vein (SMV). PV and SV fractional flow changes were also measured.ResultsROC analysis revealed that both PV2 average flow and PV fractional average flow change had 100% sensitivity to predict high-risk patients with the PV fractional peak flow change having the widest area under the curve (AUC) and the highest specificity (92.3%). SV1 average flow, SV2 average flow, SV2 peak flow, and SV2 peak velocity increased significantly in patients with oesophageal compared to gastric varices included (p = 0.022, < 0.001, < 0.001 and 0.001, respectively).ConclusionBased on certain porto-mesenteric blood flow, velocity, and fractional flow change parameters, 4D flow MRI showed excellent performance in identifying high-risk patients and giving an idea about the grade and location of varices.Critical relevance statementVariceal bleeding is a major consequence of unidentified risky upper GI varices. Thus, by identifying and locating high-risk varices early, either oesophageal or gastric, using a non-invasive method like MRI, adverse events might be avoided.Key Points4D flow MRI can be used as a potential alternative for endoscopy to predict patients with high-risk varices.Based on portal vein fractional flow change, splenic flow and velocity, 4D MRI can predict and locate high-risk varices.Earlier identification of high-risk varices can allow for interventions to prevent adverse events.Graphical

A New Tool for Identifying Low-risk Upper GI Bleeds

A New Tool for Identifying Low-risk Upper GI Bleeds

Report on the first All-Russian Student Olympiad on Endoscopy

Purpose: To demonstrate the results of the first All-Russian Student Olympiad on Endoscopy. Materials and methods: The team of authors prepared and conducted the first All-Russian Student Olympiad on Endoscopy within the framework of the conference «Topical Issues of Endoscopy». The Olympiad was held in two stages, which allowed evaluating the theoretical knowledge and practical skills of the participants. The topic of the first All-Russian Student Olympiad was upper GI tract endoscopy. The first stage consisted of testing and a quiz. The test was devoted to general issues of endoscopy, and the quiz was devoted to bleeding from the upper GI tract and methods of endoscopic hemostasis. The second stage consisted of a practical part and answers to the judges’ questions. The practical part involved performance of video endoscopy on a biopreparation (porcine esophagus and stomach), identification of a conditional ulcer complicated by bleeding and performance of endoscopic hemostasis by clipping. When performing the task, the team spoke through all their actions. After the manipulation, each team answered 2 questions from the judges. Results: The results of the All-Russian Student Olympiad revealed three winners. 1st place: the team of the N. I. Pirogov Russian National Research Medical University (A. A. Klimenko, 3rd year student; K. A. Kuznetsova, 5th year student; A. I. Khizhnyak, 5th year student); 2nd place: the team of the St. Petersburg State Pediatric Medical University (D. K. Skalinsky, 3rd year student; A. D. Komarova, 3rd year student; I. A. Cherepakhina, 5th year student); 3rd place: the team of the V. A. Almazov National Medical Research Center FSBI of the Ministry of Health of Russia (A. D. Shelimanova, 4th year student; Yu. M. Bogdanov, 5th year student; M. V. Chukin, 4th year student). Conclusion: The event enabled the students to show curiosity, determine the attitude to the future profession, demonstrate their knowledge and manual skills in the field of endoscopy, as well as gain experience in teamwork. Evaluating the work of the novice endoscopists, the leading specialists in the field of surgery and endoscopy identify promising students, which has a positive impact on attracting young promising specialists to the profession.

Causal association between metabolites and upper gastrointestinal tumors: A Mendelian randomization study.

Upper gastrointestinal (UGI) tumors, notably gastric cancer (GC) and esophageal cancer (EC), are significant global health concerns due to their high morbidity and mortality rates. However, only a limited number of metabolites have been identified as biomarkers for these cancers. To explore the association between metabolites and UGI tumors, the present study conducted a comprehensive two‑sample Mendelian randomization (MR) analysis using publicly available genetic data. In the present study, the causal relationships were examined between 1,400 metabolites and UGI cancer using methods such as inverse variance weighting and weighted medians, along with sensitivity analyses for heterogeneity and pleiotropy. Functional experiments were conducted to validate the MR results. The analysis identified 57 metabolites associated with EC and 58 with GC. Key metabolites included fructosyllysine [EC: Odds ratio (OR)=1.450, 95% confidence interval (CI)=1.087‑1.934, P=0.011; GC: OR=1.728, 95% CI=1.202‑2.483, P=0.003], 2'‑deoxyuridine to cytidine ratio (EC: OR=1.464, 95% CI=1.111‑1.929, P=0.007; GC: OR=1.464, 95% CI=1.094‑1.957, P=0.010) and carnitine to protonylcarnitine (C3) ratio (EC: OR=0.655, 95% CI=0.499‑0.861, P=0.002; GC: OR=0.664, 95% CI=0.486‑0.906, P=0.010). Notably, fructosyllysine levels and the 2'‑deoxyuridine to cytidine ratio were identified as risk factors for both EC and GC, while the C3 ratio served as a protective factor. Functional experiments demonstrated that fructosyllysine and the 2'‑deoxyuridine to cytidine ratio promoted the proliferation of EC and GC cells, whereas carnitine inhibited their proliferation. In conclusion, the present findings provide insights into the causal factors and biomarkers associated with UGI tumors, which may be instrumental in guiding targeted dietary and pharmacological interventions, thereby contributing to the prevention and treatment of UGI cancer.

In Vitro Human Gastrointestinal Digestibility and Colonic Fermentation of Wheat Sourdough and Yeast Breads.

Bread can vary in textural and nutritional attributes based on differences in the bread making process (e.g., flour type, fermentation agent, fermentation time). Four bread recipes (BRs) made with sourdough preferments (BR1, white flour; BR2, whole grain flour) or regular yeast breads (BR3, white flour; BR4, whole grain flour) were evaluated for texture, digestibility, and their effect on the metabolic activity and composition of the gut microbiota using texture profile analysis (TPA) coupled with in vitro upper gastrointestinal (GIT) digestion and colonic fermentation (Colon-on-a-plate™ model), using fecal samples from eight healthy human donors. TPA revealed significantly higher values for hardness, fracturability, gumminess, and chewiness, and significantly lower values for springiness, cohesiveness, and resilience with whole grain versus white breads (all p < 0.001); values for springiness, cohesiveness, and resilience were significantly higher for sourdough versus yeast bread (p < 0.001). Nutrient composition and bioaccessibility were generally comparable between sourdough and yeast bread with similar flours. Following simulation of upper GIT digestion, all BRs demonstrated good digestibility of minerals, carbohydrates, and proteins. Colonic fermentation revealed changes in gut microbiota composition, significant increases in short-chain fatty acids, and a significant decrease in branched short-chain fatty acids with all BRs versus a blank. Overall, new insights into wheat bread digestibility and colonic fermentation were provided, which are important aspects to fully characterize bread nutritional profile and potential.

Hemorragia digestiva grave debido a ectasia vascular de yeyuno

Introduction: bleeding from the small bowel represents 5% of all cases of gastrointestinal (GI) bleeding and is mainly due to vascular malformations. Diagnosis is made by capsule endoscopy, although it depends on the patient´s condition as well as capsule endoscopy availability. Case report: a 22-year-old female patient presenting with hematochezia leading to hypovolemic shock and cardiorespiratory arrest, with negative upper and lower GI endoscopies. Given the impossibility of accessing capsule endoscopy, a surgical intervention was performed which identified jejunal vascular ectasia.

Compromiso gástrico por enfermedad relacionada con IgG4

Introduction: IgG4-related disease (IgG4-RD) is a recently described entity, characterized by IgG4+ infiltration of plasma cells and storiform pattern sclerosis mediated by CD4+ lymphocytes and follicular helper T-cells (Tfhs). Most patients present with adenopathy and weight loss. Among the most affected sites are the pancreas, salivary and lacrimal glands, aorta, and retroperitoneum. Gastric involvement is rare. Diagnosis is based on histopathological examination of the involved organ, clinical manifestations, and serological results. Glucocorticoid therapy is the first line management. Case report: a 38-year-old male patient with symptoms suggestive of upper gastrointestinal (GI) bleeding, upper GI endoscopy revealed a gastric corpus ulcer, suspicious of an ulcerated gastric subepithelial lesion, possibly a gastrointestinal stromal tumor (GIST). Consequently, laparoscopic subtotal gastrectomy was performed. Histology was compatible with an ulcerated IgG4-related fibrosclerosing tumor. Glucocorticoid therapy was started with patient´s favorable response. Conclusion: in this paper, we will review the cases of IgG4-RD with gastric involvement reported in the literature to describe the most important features of this condition.

Narrow band imaging: Important tool for early diagnosis, management, and improved outcomes in gastrointestinal lesions.

Narrow band imaging-magnifying endoscopy (NBI-ME) is used to identify changes in mucosal or vascular pattern observed on GI endoscopy in real time on the basis of optical image enhancement.It has a significant role in early detection of dysplasia, premalignant, and Malignant lesions along with its depth of invasion. Upper and lower GI endoscopy performed in 1742 patients who presented with gastrointestinal symptoms at this tertiary center over 5years out of which 1623 were evaluated with both NBI-ME and histopathology. Real time endoscopic assessment was performed. Targeted biopsies were taken for comparative analysis. Of the 1742 patients, 119 were excluded from the study. 807 underwent upper GI endoscopy and 816 underwent lower GI endoscopy. Mean age of presentation was 38 +/- 2.7years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME for neoplastic esophageal lesions were 96.3%, 90.6%, 91.1%, 96.03%, respectively. For Barrett's esophagus it was 95.4%, 90.7%, 86.1%, and 90.7%; For gastric neoplastic lesions the values were 96.1%, 91.04%, 83.8%, and 97.9%. For colorectal it was 96.7%, 91.3%, 88.0%, and 97.7%. Overall sensitivity, specificity, PPV, andNPVof NBI-ME for neoplastic lesions (both upper and lower GI) were 96.2%, 91.0%, 96.2%, and 97.2%. Of the 1623 patients, 951 received medical management with regular surveillance and 672 patients with high-grade dysplasia, premalignant, and malignant conditions underwent interventions in form of either endoscopy or surgery. NBI-ME has a greater role and can be considered as an effective tool in making early diagnosis and guiding optimum treatment.

Double the Trouble: A Rare Finding of Gastritis Cystica Profunda in a Previously Unoperated Young Female with Concomitant Helicobacter Pylori Infection.

Gastritis cystica profunda (GCP) is a rare lesion of the stomach.GCP is seldom included in the differential diagnosis of an upper GI bleed.GCP can be considered as a premalignant lesion or can portend an underlying malignancy.

Abstract B023: Unravelling fibroinflammatory and immune signatures for pancreatic cancer early detection

Abstract Pancreatic cancer is associated with late-stage diagnosis and poor patient prognosis. The disease is characterised by chronic dysregulated immunity and inflammation. Moreover, chronic pancreatitis is linked with an increased risk of pancreatic cancer. Tissue remodelling during disease progression involves a complex network of cells and a crosstalk between cancer cells, stromal components and immune cells, but it remains poorly explored. Thus, to improve the outcome of patients, there is a need for better understanding of biological changes associated with the initiation and progression of pancreatic cancer at the molecular and spatial levels. Using samples obtained from our Accelerated Diagnosis of neuroEndocrine and Pancreatic TumourS (ADEPTS) biobank, we have evaluated blood samples for the discovery of non- invasive biomarkers to discriminate patients with pancreatic cancer from symptomatic patients without cancer. In this pilot study, the transcriptome of peripheral blood mononuclear cells (PBMCs), isolated using a ficoll gradient was explored to identify PDAC-associated mRNA signatures. Moreover, the Olink® Explore Inflammation and Oncology panels were performed in a cohort of 40 patients with early stage (I-II) PDAC, 40 chronic pancreatitis samples and 40 control patients with benign symptomatic upper GI diseases. To validate and enrich these results, a panel of inflammatory and immune markers including immunoglobulins, cytokines and chemokines was also run using multiplex techniques. Symptoms observed in our cohort were also analysed together with clinical (e.g diabetic status, biochemistry profile) and demographic data (age, sex, ethnicity, post code etc). We have identified mRNA transcriptome signatures and differentially expressed proteins associated with inflammatory and immunological processes in PDAC compared to benign symptomatic samples. Our results offer potential diagnostic utility for early-stage disease. Additionally, our unique cohort of patient samples comprising of those with confirmed PDAC and those presenting to clinic with benign disease and similar non-specific symptoms, allows for the development of non-invasive diagnostic tests with better translational applicability. Future work will involve the validation of these findings in a larger patient cohort and the use of NanoString GeoMx® Digital Spatial Profiler to perform whole transcriptome and proteome profiling in human chronic pancreatic and pancreatic cancer tissue samples. Citation Format: Kyra Fraser, Maria Rosado, Stephen P Pereira, Pilar Acedo. Unravelling fibroinflammatory and immune signatures for pancreatic cancer early detection [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr B023.

The prevalence of mutations underlying development of Helicobacter pylori resistance to antibiotics in Kazan

One of the reasons for the decrease of Helicobacter pylori eradication effectiveness is its resistance to antibiotics. To examine the prevalence of H. pylori point mutations responsible for clarithromycin and levofloxacin resistance among the patients with upper gastrointestinal (GI) tract disorders in Kazan. The study included 203 patients with symptoms of dyspepsia who underwent upper GI endoscopy at the University Hospital of Kazan Federal University (Kazan, Russia) in 2019-2021. DNA isolation from gastric antrum mucosal biopsies was performed using PureLink Genomic DNA Mini Kits (Thermo Fisher Scientific, USA). Polymerase chain reaction was performed using primers specific for the V-region of the 23S gene and the A subunit DNA gyrase encoding gyrA gene region. The sequencing of obtained DNA fragments was performed on 3730 DNA Analyzer. The sequences were searched for point mutations responsible for H. pylori resistance to clarithromycin (A2143G, A2142G and A2142C193 mutations) and levofloxacin (mutations of the gyrA gene). H. pylori was detected in 47.78% of biopsy specimens using polymerase chain reaction. The proportion of H. pylori strains with mutations leading to clarithromycin resistance was 17.53%. Amino acid substitutions in the gyrA gene were found in 12.37% of samples. In case of two H. pylori strains (2.06%), dual resistance to clarithromycin and levofloxacin was found. So high incidence of mutations underlying the development of H. pylori resistance to clarithromycin and levofloxacin was observed among examined patients in Kazan.

Comparative incidence and risk factors for gastrointestinal bleeding following percutaneous coronary intervention for coronary artery disease: Insights from the Keio Cardiovascular Registry in Japan

BackgroundIn patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), antiplatelet medication usage is crucial for preventing thrombotic events. However, it requires careful monitoring, especially because of the risk of life-threatening bleeding complications. In hemorrhagic complications, assessment of patient background and risk of gastrointestinal bleeding (GIB) remain limited for GIB that develops during long-term observation after hospital discharge. This study aimed to examine the incidence of GIB and patient characteristics in CAD post-PCI. MethodsAll CAD patients undergoing PCI for urgent, emergent, or elective indications were enrolled in the Keio Interhospital Cardiovascular Studies (JCD-KiCS)-PCI registry (January 2009 and December 2017) and followed up to 2 years after PCI discharge. From the JCD-KiCS PCI registry, 8864 patients (median [interquartile range [IQR]] age: non-GIB: 69.0 y [16 y], upper GIB (UGI): 72.0 y [15.5 y], lower GIB (LGI): 73.0 y [IQR: 13 y]) were categorized based on the occurrence of hospitalization-requiring GIB. Patient characteristics and detailed information regarding these GIB events, including the location (upper vs lower GI) and bleeding severity, were analyzed. ResultsOverall, 36 patients experienced UGI, while 85 patients experienced LGI. The rates of dual antiplatelet therapy (DAPT) and triple therapy were significantly different among the non-GIB (n = 8734), UGI (n = 36) and LGI (n = 85) groups (DAPT [aspirin + P2Y12 (clopidogrel/prasugrel/ticlopidine)]: 64 [76.2 %] in the LGI group vs 24 [68.6 %] in the UGI group vs 7330 [84.6 %] in the non-GIB group; triple therapy [aspirin + P2Y12 (clopidogrel/prasugrel/ticlopidine)] + oral anticoagulant (OAC) (warfarin/direct oral anticoagulant [DOAC]): 17 [20.2 %] in the LGI group vs 8 [22.9 %] in the UGI group vs 836 [9.6 %] in the non-GIB group; p < 0.001). In the LGI and UGI groups, aspirin and warfarin were used in 2 (2.4 %) and 2 (5.7 %) patients, respectively, but not in combination with DOAC. The 2-year post-PCI hospitalization incidence for GIB was 1.4 % (LGI, 1.0 %; UGI, 0.4 %). The most common causes were colonic diverticular hemorrhage (43.5 %) for LGI and duodenal ulcer (21.9 %) for UGI. No significant differences were found in the cumulative 2-year post-PCI risks between the LGI and UGI groups (log-rank p = 0.97). Most GIB events were Bleeding Academic Research Consortium 2-equivalent (hemoglobin decrease <3 g/dL). Notably, the use of OACs at PCI discharge, bleeding complications within 72 h, and preprocedural anemia were significantly correlated with an increased GIB risk. ConclusionsThe real-world incidence of LGI is two times higher than that of UGI in CAD patients undergoing PCI, and most events are mild. OAC use at PCI discharge is the strongest potential risk factor for GIB development.

Reasons for Surgical Attrition Among Nonmetastatic Upper Gastrointestinal Cancer Patients: A Single Institutional Experience.

Upper gastrointestinal (UGI) cancers require multidisciplinary treatment, but surgery provides the only potentially curative option. We sought to understand reasons for attrition before surgery within our regional hospital network. We performed chart reviews of patients (age 18-80) with stage I-III UGI cancers (gastroesophageal junction, gastric, and hepatopancreatobiliary adenocarcinomas) in our multihospital cancer registry from 2015 to 2021. Our primary outcome was reasons for surgical attrition. Univariable analysis identified factors related to surgical attrition and the Kaplan-Meier method estimated overall survival based on surgery receipt. Seven hundred and ninety-two patients were included in our analysis, of whom 107 (13.5%) did not undergo curative surgery. Reasons for not undergoing surgery included medical comorbidities (30.8%), patient preference/nonmedical barriers (24.3%, which included: not interested without further explanation, worried about complications, nonadherence to appointments, insurance issues, did not wish for blood transfusion, lack of social support, preferring home care, and worried about recurrence), psychosocial (5.6%), progression while on neoadjuvant therapy or waiting for transplant (15.0% and 7.5%), poor performance status (3.7%), side effects of neoadjuvant therapy (3.7%), and death unrelated to treatment or unknown cause (9.4%). Nonsurgical management was not associated with race, socioeconomic status, or distance traveled for care. Survival was greatly improved for patients who underwent surgery (158 vs. 63 weeks, p < 0.05). Nearly one in seven patients (18-80 years old) with UGI cancers evaluated at our academic cancer center did not undergo surgical resection. Reasons for surgical attrition included potentially modifiable issues, and addressing these barriers could help overcome inequities in cancer treatment and survival.

Feasibility and safety of endoscopic full-thickness resection for submucosal tumors in the upper gastrointestinal tract, including predominantly extraluminal submucosal tumors (with video).

Endoscopic full-thickness resection (EFTR) for submucosal tumors (SMTs) has been technically challenging. This retrospective study aimed to evaluate the feasibility, safety, and efficacy of EFTR for upper gastrointestinal (GI) SMTs, including extraluminal lesions. We retrospectively investigated 232 patients with SMTs who underwent EFTR from January 2014 to August 2023. Clinicopathologic characteristics, procedure-related parameters, adverse events (AEs), and follow-up outcomes were assessed in all patients. The en-bloc resection and en-bloc with R0 resection rates were 98.7% and 96.1%, respectively. The average endoscopic tumor size measured 17.2 ± 8.7 mm, ranging from 6 to 50 mm. The resection time and suture time were 49.0 ± 19.4 min and 22.5 ± 11.6 min, respectively. In all, 39 lesions (16.8%) exhibited predominantly extraluminal growth. Gastrointestinal stromal tumors (GISTs) were the predominant pathology, accounting for 78.4% of the cases. Twenty-one patients (9.1%) encountered complications, including pneumothorax (1/232, 0.43%), hydrothorax (1/232, 0.43%), localized peritonitis (3/232, 1.29%), and fever (16/232, 6.9%). Although the incidence of postoperative fever was notably higher in the predominantly extraluminal group (7/39, 17.9%) compared to the predominantly intraluminal group (9/193, 4.7%, P = 0.008), there were no significant differences in outcomes of the EFTR procedure. No instances of recurrence were observed during the mean follow-up period of 3.7 ± 2.3 years. EFTR was found to be feasible, safe, and effective for resecting upper GI SMTs, including lesions with predominantly extraluminal growth. Further validation in a prospective study is warranted.

ThP3.12 - Assessing Photo-documentation Compliance in Oesophago-Gastroduodenoscopy: A Review of Adherence to BSG and AUGIS Recommendations

Abstract Aim In 2017, the British Gastroenterology Society (BSG) and the Association of Upper GI Surgeons of Great Britain and Ireland (ASGBI) issued a position statement outlining specific quality parameters for oesophago-gastroduodenoscopy (OGD), including photo-documentation of eight specified anatomical sites. This audit assesses the appropriate utilization of photo-documentation for diagnostic OGD. Methods A retrospective analysis of diagnostic OGD preformed in a single centre. General surgeons, gastroenterologist and nurse endoscopists performed OGDs. Patient with incomplete OGD or those carried out for therapeutic purposes were excluded. OGD report included photo-documentation was analysed. Results 250 OGD were included; 54.8% were male and median age was 61 years. Indications for OGD were: 28% for nausea/vomiting, 26% for dysphagia, 22.4% for upper GI bleed, 12.4% for abdominal pain, 12% for anaemia, 11.2% for weight loss and 8.4% for dyspepsia. 62% of OGDs had photo-documentation: 9.6% upper oesophagus, 45.2% gastro-oesophageal junction, 36.8% fundus in retroflexion, 26% body of stomach, 8% incisura in retroflexion, 30.8% antrum, 17.2% duodenal bulb and 36% distal duodenum. Overall, 1.2% of OGDs had all eight anatomical sites photo-documented, all by the same endoscopist. Conclusion Robust photo-documentation plays a crucial role in ensuring both accurate clinical assessments and meeting medico-legal requirements. Our audit indicates that the current level of photo-documentation in OGD is less than optimal. Enhancing endoscopist education and raising awareness about recommended practices may lead to improved results. Further research is imperative to explore the underlying factors contributing to suboptimal photo-documentation, fostering a deeper understanding and facilitating targeted interventions for improvement.