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BackgroundBarretts esophagus (BE), characterized by specialized intestinal metaplasia (SIM), is the precursor to esophageal adenocarcinoma (EAC). Despite published BE screening guidelines for at-risk individuals, uptake of endoscopic screening remains low. We present 18 months of real-world data on non-endoscopic BE screening using EsoGuard(R) (EG), the first commercially available U.S. molecular biomarker test for this purpose, performed on esophageal cell samples collected with the swallowable...

BackgroundCurrent British Society of Gastroenterology (BSG) guidelines misclassify metachronous lesion risk after polypectomy in approximately 40% of patients. Building on evidence that immune exclusion drives progression of adenomas to colorectal cancer, this study examined immune profiles in screen-detected adenomas as a predictive biomarker for metachronous lesion risk. MethodsPatients undergoing polypectomy within the Scottish Bowel Screening Programme, with surveillance colonoscopy between...

Background and AimsPerianal fistulizing Crohns disease (CD-PAF) is an aggressive phenotype of Crohns disease (CD) defined by frequent relapses and disabling symptoms. A novel consensus classification system was recently outlined by Geldof et al. that seeks to unify disease severity with patient-centered goals but has not yet been validated. We aimed to apply this to a real-world cohort and identify factors that predict transition between classes over time. MethodsWe identified all patients with...

AO_SCPLOWBSTRACTC_SCPLOWO_ST_ABSBackground and AimsC_ST_ABSThe progressive nature of Crohns disease is highly variable and hard to predict. In addition, symptoms correlate poorly with mucosal inflammation. There is therefore an urgent need to better characterise the heterogeneity of disease trajectories in Crohns disease by utilising objective markers of inflammation. We aimed to better understand this heterogeneity by clustering Crohns disease patients with similar longitudinal faecal calprotec...

Background and study aimsEndoscopic resection (ER) is curative for early-stage oesophageal adenocarcinoma (OAC) without high-risk features. Piecemeal endoscopic mucosal resection (pEMR) prevents assessment of lateral margins, complicating risk estimation for neoplastic recurrence. We investigated risk factors for residual and recurrent OAC post-pEMR. MethodsWe performed a longitudinal study of two independent patient cohorts: the test cohort, who underwent piecemeal or en-bloc ER, (n=138) and t...

BackgroundGuidelines support Barretts esophagus (BE) screening, but most eligible patients do not undergo endoscopic evaluation; non-endoscopic strategies are now supported as a reasonable alternative by U.S gastroenterology societies. EsoGuard (EG) is a DNA assay used with EsoCheck, a non-endoscopic cell collection device for detection of BE, which can be utilized as a triage to esophagogastroduodenoscopy (EGD) in patients meeting screening criteria. In doing so, EG may serve to enrich the popu...

BACKGROUND & AIMSScreening for precancerous lesions by colonoscopic surveillance in patients with longstanding inflammatory bowel disease (IBD) has been a standard practice. However, failure of detecting precursors and preventing colorectal carcinoma (CRC) development is still common. This study aims to assess whether some lesions shown in the surveillance biopsies eluded our attention due to atypical histopathology. METHODS91 patients (M 67/F 24, UC 59/CD 32) with surgically resected IBD-CRC w...

BackgroundChronic ulcerative colitis is an inflammatory condition associated with a pro-neoplastic drive, predisposing to colorectal cancer. Repeated colonoscopy is undertaken to detect preneoplastic change, but cancer diagnosis is still frequently missed. AimsTo determine if a predetermined panel of methylation markers could better risk stratify patients, aiding earlier detection of neoplasia. MethodsENDCaP-C (https://doi.org/10.1186/ISRCTN81826545) was a prospective multicentre test accuracy...

ObjectivesAdenomas are known precursors to colorectal cancer (CRC). Current UK post-polypectomy surveillance guidelines use polyp size, numbers, and histology to stratify the risk of patients developing metachronous polyps or CRC. However, these risk guidelines suffer from poor predictive value, often leading to under/over surveillance. DesignAdenomas removed from 1257 patients at bowel screening colonoscopy were retrospectively identified to investigate mutational profile and protein expressio...

Background and AimsBarretts Esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC). We aimed to assess performance, safety, and tolerability of the EsoGuard (EG) assay on samples collected non-endoscopically with the EsoCheck (EC) device (EG/EC) for BE detection in the intended-use population, meeting American College of Gastroenterology (ACG) guideline criteria (chronic gastroesophageal reflux disease (GERD) and 3+ additional risk factors). MethodsWe performed a prospective, multic...

BackgroundAnti-tumor necrosis factor (anti-TNF), particularly infliximab, have transformed inflammatory bowel disease (IBD) management, but their high cost imposes a significant economic burden. Infliximab biosimilars were introduced to reduce the unmet needs. Despite the approval of infliximab biosimilars, real-world evidence of cardiovascular safety and effectiveness of infliximab biosimilars is lacking among patients with IBD. In this trial emulation, we compared the effectiveness and cardiov...

ObjectiveEsophageal adenocarcinoma (EAC) and its precursor, Barretts esophagus (BE), are associated with a pro-inflammatory, Gram-negative-dominated esophageal microbiome. We investigated whether Lactobacillus casei Shirota (LcS) consumption could shift the microbiome towards a more Gram-positive profile in BE patients. DesignIn a single-arm intervention study, 23 BE patients used LcS twice daily for 4 weeks. Endoscopic biopsies from normal squamous epithelium (NSE) and metaplastic columnar epi...

IntroductionHereditary diffuse gastric cancer (HDGC) associated with CDH1 germline pathogenic variants (GPV), carries a high lifetime risk of signet ring cell carcinoma (SRCC). Currently, there is uncertainty regarding to whom and when to recommend prophylactic total gastrectomy (PTG). We hypothesise a small number of early SRCC lesions correlates with low risk of progression to clinical gastric cancer. This study aimed to identify predictors of early SRCC burden and provide evidence to inform b...

ObjectiveIn previous studies, the protective effect of colonoscopy was generally stronger for distal than for proximal colorectal cancer (CRC). This study aimed to investigate whether the association of colonoscopy and CRC risk varies according to major molecular pathological features and pathways of CRC. DesignPopulation-based case-control study from Germany, including 2132 patients with a first diagnosis of CRC and information on major molecular tumor markers, and 2486 control participants wi...

MessageThe COVID-19 pandemic has severely curtailed the practice of endoscopy (as an exemplar for outpatient diagnostic procedures) worldwide. Restart and recovery processes will be influenced by the need to protect patients and staff from disease transmission, but data on the risk of COVID-19 transmission after endoscopy are sparse. This is of particular importance in later pandemic phases when the risk of harm from delayed or missed significant diagnoses is likely to far outweigh the risk of i...

ObjectiveThe impact of medications on COVID-19 vaccine efficacy in IBD patients is unknown, as patients with immunosuppressed states and/or treated with immunosuppressants were excluded from vaccine trials. To address this, we evaluated serological responses to COVID-19 vaccination with the SARS-CoV-2 spike (S) mRNA BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (NIH-Moderna) vaccines in IBD patients enrolled in an ongoing SARS-CoV-2 sero-survey at the Icahn School of Medicine at Mount Sinai in New Yo...

BackgroundAdult coeliac disease (CD) has delays in diagnosis but the reasons for this have not been explored. MethodsGroup 1) Time from primary care presentation to diagnostic endoscopy was prospectively quantified in 151 adult patients with a positive endomysial antibody test and compared with the diagnostic pathway of 92 adult patients with suspected inflammatory bowel disease (IBD). Group 2) Across 4 hospitals over a 3-month period, duodenal biopsy reports for suspected CD were reviewed (n=1...

ObjectiveThe intestinal microbiota are hypothesized to play a role in the pathogenesis of diverticulitis. We compared fecal microbial communities in individuals with diverticulitis to those with uncomplicated diverticulosis. MethodsWe used 16S ribosomal RNA gene sequencing to assess and compare the microbiota composition of fecal samples from 10 patients presenting with acute diverticulitis (cases) and 10 controls with asymptomatic diverticulosis matched on age and sex. ResultsWe found differe...

BackgroundFirefighters have frequent exposure to compounds shown to increase risk of esophageal neoplasia. EsoGuard(R) (EG) is a DNA biomarker assay that can be utilized with efficiency and high tolerability as a triage to endoscopy for diagnosis of patients with Barretts Esophagus (BE), a known precursor to esophageal adenocarcinoma (EAC). This diagnostic tool may facilitate disease testing among busy at-risk firefighters. MethodsRetrospective analysis of prospectively collected clinical utili...

BackgroundPerianal Crohns disease (PCD) represents one of the most severe and refractory forms of pediatric inflammatory bowel disease (IBD). Constipation and colonic redundancy, particularly type 1 dolichocolon (T1-DC), may increase distal rectosigmoid pressure, and exacerbate perianal pathology. We hypothesized that T1-DC is more common in children with PCD than in those with uncomplicated ileocolonic Crohns disease (CD) or non-IBD controls. MethodsWe retrospectively analyzed 20 consecutive p...