UEGWeek: The modern School of Athens

INTRODUCTION

The School of Athens is a XVI century fresco by Raphael, representing all the greatest minds gathered together, sharing their knowledge and discussing ideas. UEGWeek differs from it as it gathers not only the greatest minds, but also those who long to become one and learn from the others (Figure 1).

FIGURE 1.

The UEGWeek meeting resembled as a modern School of Athens

The future of the gastroenterology field depends on it: sharing cutting‐edge discoveries and tickling each others' mind in order to ask more questions to the science and reach more knowledge.

The first UEGWeek was held in 1992 and the attendance increased fast reaching a number of more than 13,000 people. This is what Europe needed (and this high attendance demonstrated it) but not only, as attenders gathered from more than 120 countries all over the world.

The last “in presence” UEGWeek was in 2019 in Barcelona, with an attendance of more than 13,000 people. In 2020, due to the SARS‐CoV‐2 pandemic, the meeting was held completely virtually for the first time. Despite the profound change in terms of attendance modality, the conference met its goals with a number of participants of almost 11,000 from 123 countries all over the world, and a number of submitted abstracts of 2788, with 1915 of them accepted (acceptance rate = 68.7%). The 2021 edition is going to be the second one held virtually and has received 1966 abstracts, 1482 of which were accepted (acceptance rate = 74.2%).

The audience of 2020 UEGWeek reported to be mostly interested in the endoscopy field (67.41% of delegates reporting interest, with a 15.3% of total expressed votes), in inflammatory bowel disease (IBD; 15.2%) and on topics related to esophagus/stomach/H.Pylori (H.P.) (15.7%), followed by hepatobiliary topics, pancreas, and small intestine & nutrition (Figure 2). The number of presented posters and oral communications would pretty much trace these numbers.

FIGURE 2.

Main fields discussed at UEGWeek, with comparison of delegates interest (data from 2020 survey, presented as percentage of the total number of expressed votes) and rate of 2019 and 2020 presentations (poster and oral) on the topic

Among the almost 6000 abstracts submitted to 2019 and 2020 UEGWeek editions, 32 were then accepted as full‐text publication to UEG Journal.¹, ², ³, ⁴, ⁵, ⁶, ⁷, ⁸, ⁹, ¹⁰, ¹¹, ¹², ¹³, ¹⁴, ¹⁵, ¹⁶, ¹⁷, ¹⁸, ¹⁹, ²⁰, ²¹, ²², ²³, ²⁴, ²⁵, ²⁶, ²⁷, ²⁸, ²⁹, ³⁰, ³¹ Here we will summarize these “hot” papers (see also Figure 3).

FIGURE 3.

The hottest results from UEGWeeks 2019‐2020 briefly summarized. 5‐ASA, 5‐aminosalicylic acid; ADA, adalimumab; AIP, autoimmune pancreatitis; AP, acute pancreatitis; CP, chronic pancreatitis; CT, Computed Tomography; EPI, exocrine pancreatic insufficiency; EUS, endoscopic ultrasound; GI, gastrointestine; H.P., Helicobacter Pylori; IFX, infliximab; MPD, main pancreatic duct; p‐CLE, probe‐based confocal laser endomicroscopy; PEP, post‐ERCP pancreatitis; PERT, pancreatic enzyme replacement therapy; PRO‐C23, cleaved form of cell adhesion regulator type 23 collagen; PSC, primary sclerosing cholangitis; RTX, rituximab; UST, ustekinumab; VDZ, vedolizumab; WOPN, walled‐off pancreatic necrosis

ENDOSCOPY

A real‐time measure of the pH during endoscopy was able to provide, on 122 prospectively enrolled patients, a good correlation with the 24‐h esophageal acid exposure time on pH impedance.¹

Still related to the esophagus (and also stomach), the use of probe‐based confocal laser endomicroscopy (p‐CLE) on 74 lesions was investigated, with p‐CLE providing overall diagnostic accuracy for malignant lesions of 89%, versus biopsies with 85% of accuracy.²

The advent of new devices in the endoscopy field was also highlighted in a study on the use of Hemospray where a single‐arm, prospective multicenter study on 73 patients reported a rate of immediate hemostasis achieved in 100%, with only 4% of patients suffering from re‐bleeding and no adverse events due to the use of Hemospray.³ On the same topic, Association Nationale des Hépato‐gastroentérologues des Hopitaux généraux for the SANGHRIA Study Group defined, in a large multicenter prospective study, how, among 2498 patients with upper gastrointestine (GI) bleeding, bleeding would happen in inpatients (compared to outpatients) in case of older patients, with more comorbidities and these had a higher rate of mortality and re‐bleeding.⁴

When moving to the lower GI, a randomized trial comparing a 3‐day low‐fiber diet to a 1‐day diet showed no difference on colonoscopy preparation, but the 3‐day low‐fiber diet was more difficult to be followed.⁵

The Dutch T1 CRC Working Group investigated the role of tumor‐stroma ratio in a retrospective multicenter cohort of patients with non‐pedunculated surgically treated T1 colorectal cancer. Despite this factor has been widely described and identified as prognostic factor on more advanced cancers, on these 261 T1 patients, the stroma‐high tumors were not associated with an increased risk for adverse outcomes, underlying the need of identifying new prognosticators.⁶

Moving to a benign, yet sometimes symptomatic condition, whether to treat symptomatic colonic lipoma with unroofing, dissection, endoscopic mucosal resection (EMR), or loop‐assisted resection was investigated in a systematic review by Michiel Bronswijk et al., in which a similar clinical remission rate was observed among the different techniques; nevertheless, EMR and loop‐assisted resection slightly increased endoscopic resolution rates at the expenses of more adverse events.⁷

When it comes to pancreas‐related endoscopy, what is the best needle for endoscopic ultrasound (EUS)‐guided acquisition of pancreatic solid lesion is still a matter of debate and many characteristics can make the difference. In a randomized trial on 46 patients, two 19G needles were employed: a nitinol‐based and a stainless steel one. The diagnostic accuracy was similar for both needles, with a slight reduction in time spent for puncturing for nitinol‐based needle.⁸

How to reduce the risk of post‐ERCP acute pancreatitis (PEP) and in which patients provide which preventive measure is still a “hot topic” of the moment. In a retrospective case‐control study on 923 patients with primary sclerosing cholangitis, the use of diclofenac would not seem to reduce the risk.⁹ On the contrary, a large experience on endoscopic retrograde cholangio‐pancreatography on newborns was reported in a multicenter study on 126 children aged <1 year, with an interesting finding of no PEP being observed, despite the rare use of prophilactic measures.¹⁰

INFLAMMATORY BOWEL DISEASE

Burisch and the Epi‐IBD group prospectively investigated the use of 5‐aminosalicylate (5‐ASA) in patients with Crohn's disease. Out of 488 patients in the cohort, 60% were treated with 5‐ASA despite the controversy regarding the efficacy of this treatment in the current literature and guidelines, and among patients receiving monotherapy with 5‐ASA, most experienced a mild disease course with only 12% requiring additional treatment during follow‐up.¹¹

Moving to biologics, the Young GETECCU Group published a multicenter retrospective study including 262 adult patients with symptomatic stricturing Crohn's disease receiving their first anti‐tumor necrosis factor therapy, with no previous history of biological, endoscopic or surgical therapy. The treatment with either infliximab or adalimumab was effective in 87% and 73% of patients after 6 and 12 months, with 68% patients being free of surgery after a median of 40 months.¹²

The USTEK Post‐Op study group collected retrospectively data in nine centers on Crohn's patients undergoing resection, and being treated afterwards with ustekinumab or azathioprine, with ustekinumab lowering the rate of post‐operative recurrence at 6 months (28.0% vs. 54.5% for the azathioprine) and endoscopic Rutgeerts' score.¹³

Nonetheless, in a post‐hoc analysis on the UNITI trials, Narula N et al. found no difference between the use of Ustekinumab or placebo on the remission of extra‐intestinal manifestation of Crohn.¹⁴

The Sicilian Network for Inflammatory Bowel Disease evaluated the role of vedolizumab on 172 consecutive patients demonstrating its effectiveness with a clinical response at 14 weeks of about 68% and remission in about 73%–77% at 52 weeks.¹⁵ Furthermore, in a prospective observational study, a trough level cut‐off of 16.55 μg/ml at week 14 was associated with a higher probability of maintaining Vedolizumab therapy over the first year, due to sustained clinical benefit.¹⁶

Moving to IBD translational studies, the cleaved form of the cell adhesion regulator type 23 collagen (PRO‐C23) was found to be a potential biomarker to monitor disease activity in IBD, as shown elevated in mouse models and human serum of patients. A new enzyme‐linked immunosorbent assay test was developed ad hoc for this investigation.¹⁷

Lastly, using cultured mucosal biopsies from inflammed and uninflammed areas of IBD patients, the manipulation of the cannabinoid system seemed to affect colon cells and secretome characteristics that might facilitate mucosal healing, giving new insights on possible future therapeutic measures.¹⁸

ESOPHAGUS, STOMACH AND H.P.

In a retrospective cohort study in collaboration with the Netherlands Cancer Registry, including more than 9000 patients with primary esophageal squamous cell carcinoma, a significantly increased risk of both synchronous and metachronous multiple primary tumors was found, with half of them located in the head and neck region.¹⁹ This was further confirmed in a systematic review and meta‐analysis by the same group.²⁰

In a retrospective cohort study on primary care databases covering about 640,000 patients with symptomatic esophageal and also gastric cancer, diagnostic intervals were investigated in order to find some room for improvement. Mean patient interval was 29 days (comparable for patients with and without alarm symptoms), primary care interval 12 days, secondary care interval 13 days, and diagnostic interval 31 days. Absence of cancer‐specific alarm symptoms was associated with “long duration” of primary and secondary care interval.²¹

Concerning benign, yet scary diseases, about rare giant paraesophageal hernias a retrospective study on 186 treated conservatively reported a mortality rate of 1.6% and a complication rate of 8.1%; presence of symptoms (vomiting, epigastric pain and chest pain) were associated with the occurrence of complications.²²

Lastly, with the Hp‐EuReg, a large prospective multicenter registry investigated on 2100 patients the effectiveness of single‐capsule bismuth quadruple therapy for H.P., with eradication being around 90% both when used as first, second and up to the sixth line of therapy.²³

HEPATOBILIARY

As it is fundamental to discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis, the role of immunoglobulin subclasses as diagnostic markers was performed in a retrospective cohort of 142 patients, with Immunoglobulin G1 and even more G2 helping discriminating with high specificity these patients.²⁴

PANCREAS

In a study by Barresi L et al., a clear Italian picture of autoimmune pancreatitis epidemiology, diagnosis and management was reported, with a low use of histology and steroid trial for the diagnosis and of immunosuppressants and rituximab for the management. Furthermore, despite the high prevalence of exocrine insufficiency, its evaluation was scarcely performed.²⁵

When it comes to pancreatitis, one main current distress is finding early markers of severity. Adipose and muscle CT scan parameters were evaluated and associated with the severity of acute pancreatitis in the context of a Pancreas2000 study, reporting no variation in adipose tissue, but low muscle attenuation associated with severity.²⁶

Yet related to pancreatitis, in the evaluation of the long‐term outcome of patients with walled‐off pancreatic necrosis treated with endoscopic transmural drainage and necrosectomy, 7% eventually died, 18% developed exocrine insufficiency and 32% endocrine, with endoscopic necrosectomy and intervention on the pancreatic duct being associated to an increased risk of exocrine impairment.²⁷

Moving to chronic pancreatitis, Dominguez‐Munoz et al. presented a prospective cohort of 53 patients in which EUS elastography, peak bicarbonate in the pancreatic juice and the compliance of the main pancreatic duct after secretin stimulation were adopted as a multimodal approach in evaluating patients with suspected early chronic pancreatitis.²⁸

The Pancreas2000 group led by de Madaria and Capurso published a systematic review and meta‐analysis, reporting for 11 studies a pooled prevalence of pancreatic exocrine insufficiency in advanced pancreatic cancer of 72%, especially for tumors of the head (relative risk = 3.36), with the use of pancreatic enzyme replacement therapy associated with 3.8 months survival benefit.²⁹

Yet related to pancreatic cancer, a beautiful example of in vitro feasibility study was performed by Frappart et al., setting up patient‐derived xenograft tumor (PDX), PDX‐derived organoids, patient‐derived organoids as also a drug testing platform, to make personalized therapy for pancreatic cancer a little more thinkable.³⁰

MICROBIOTA

Richard N. et al. finally gave a hint on which could be the better strategy in small intestinal bacterial overgrowth (SIBO) treatment; his group investigated retrospectively the use of a single antibiotic or a rotating course for 10 days per month for 3 months in 223 patients with SIBO, defining how the rotating course was associated to a significantly higher rate of remission and improvement in symptoms and quality of life.³¹

CONCLUSION

UEGWeek and UEG Journal bring to light the advances in our field, with cutting‐edge discoveries and techniques in endoscopy, IBD management and everything our community turns its interest onto. Whether you have submitted an abstract to the 2021 UEGWeek or not, we hope to see you join us on October 3rd in this “modern” School of Athens, where gastroenterologists find their breeding place for science.

Archibugi L. UEGWeek: The modern School of Athens. United European Gastroenterol J. 2021; 1–6. 10.1002/ueg2.12149

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no new data were created or analyzed in this study.