Volume 88 - 2025 - Fasc.1 - Original articles
Selective internal radiation therapy for neuroendocrine liver metastases: efficacy, safety and prognostic factors. A retrospective single institution study
Background and study aims: Selective internal radiation therapy
(SIRT) has shown good results in unresectable liver metastases
from neuroendocrine neoplasms (NELM) with a high disease
control rate (DCR) reported. The aims of the study is to assess
retrospectively the efficacy and safety of 10y of SIRT for NELM.
Patients and methods: Primary endpoint was objective response
rate (ORR) and DCR by RECIST 1.1 at 2, 4 and 12 months (m).
Secondary endpoints were overall survival (OS), liver progressionfree
survival (liver-PFS), clinical response (NEN-related symptoms
improvement) and safety.
Results: 50 consecutive patients with NELM who got SIRT
from 2011 to 2021 in one center. The two major NEN primary sites
were pancreas (46%) and small intestine (36%). Histological NEN
grades were 10%, 46% and 44% for grades 1, 2 and 3 respectively.
ORR and DCR were 16% and 80% at 2m, 22% and 92% at 4m and
32% and 82% at 12m. Survival rates at 1 and 2 y were 76% and
72% respectively. Prognostic factors for OS and liver-PFS were
NEN histological grade (3 vs 1+2) (hazard ratio (HR) for OS: 4.33
[1.8-10.6], for liver-PFS: 3.91 [1.3-11.4]), and early (2m) DCR (HR
for OS: 0.14 [0.1-0.4], for liver-PFS: 0.016 [0.003-0.08]). Clinical
response occurred in 7 of the 10 symptomatic patients. One patient
died from radioembolization-induced liver disease.
Conclusion: SIRT showed efficacy in NELM pts, with a high
DCR and an good safety profile. G1-2 grade and early DCR were
associated with a better OS and liver-PFS.
Indirect calorimetry in canopy mode in healthy subjects: performances of the Q-NRG device compared to the Deltatrac II
Background: Extensive validation of the Q-NRG indirect
calorimeter in canopy mode, especially against reference devices,
is lacking. The aim of this study was to test its agreement in canopy
mode with the Deltratrac II, which has always been considered as
the gold standard indirect calorimeter in daily practice.
Methods: Healthy volunteers underwent indirect calorimetry
with two consecutive assessments, using Q-NRG and Deltatrac II,
both in canopy mode, in a random order, after careful calibrations.
Body position, fasting conditions and environment were
standardized. Agreement between the two devices was evaluated by
paired Student’s t test, correlation coefficients, and Bland-Altman
plots.
Results: Sixty-one adults (85.2% male, aged 25.7±8.4 y, BMI
23.3±2.9 kg/m2) were included. Measured energy expenditure was
similar whether it was measured using Q-NRG or Deltatrac II:
1816±361 kcal/day or 1809±260 kcal/day (p=0.803), respectively.
There was a significant positive correlation between the two
measures (ρ=0.78, p= <0.01). The Q-NRG slightly overestimated
the energy expenditure compared to the Deltatrac II measure: the
bias ± limits of agreement was 7 ± 227 kcal/day.
Conclusion: In healthy volunteers breathing spontaneously, the
Q-NRG in canopy mode performed similarly to the Deltatrac II
for energy expenditure measurement. The present study confirms
the previously demonstrated accuracy of the Q-NRG device, and
supports its clinical use in canopy mode.
Switching intravenous to subcutaneous infliximab was safe and successful during 1-year follow up in Ulcerative Colitis and Crohn patients – a Belgian single center experience
Background: Subcutaneous (SC) infliximab CT-P13 (IFX) has recently been registered for the treatment of moderate-to-severe inflammatory bowel disease (IBD). The SC route is an attractive option for patients. However, many open questions remain on how to safely switch patients from maintenance IV to SC administration.
Objective: to assess switching from IV to SC IFX therapy in IBD patients through clinical and biochemical evaluation.
Methods: Patients in durable remission on eight-weekly (or six-weekly) IV infliximab and therapeutic IFX trough levels were switched to SC therapy every two weeks. All patients were monitored prospectively every 3 months with patient reported outcomes (PRO), labs including IFX concentrations and faecal calprotectin every 6 months for minimum one-year follow up.
Results: 55 patients (21 UC, 34 CD) agreed to switch to SC therapy. The median follow up in CD patients was 15.5 months, respectively 20 months in UC patients. All patients remained in deep remission according to PRO2, CRP and calprotectin. IFX serum concentrations more than tripled 3 months after the switch (18.31 ± 10.53 μg/mL vs. 4.82 ± 3.06 μg/mL at the start) and remained stable during further follow up. Local pain and injection site reactions both transient were reported in 47% and 42% patients respectively but disappeared in > 50% when injecting in the abdomen or when changing pen to syringe.
Conclusion: Switching UC and Crohn patients in clinical remission and adequate trough levels from maintenance IV tot SC infliximab therapy was successful for at least one year. A proportion of patients experienced pain and or injection site reactions.
Endoscopic retrograde cholangiopancreatography in patients with different types of total and partial gastrectomy
Background and study aims: Endoscopic retrograde
cholangiopancreatography (ERCP) in surgically altered anatomy
patients is challenging. We analyzed ERCP procedures after gastric
surgery with maintained Vater’s papilla: total/partial gastrectomy
Roux-en-Y, Billroth II gastrectomy, sleeve gastrectomy and
gastrojejunostomy.
Methods: Monocentric retrospective analysis of prospective
ERCP cohort in surgically altered gastric anatomy (SAGA)
patients with maintained Vater’s papilla between 2006 and 2024.
Results: 186 ERCP procedures in 110 patients with SAGA
proportions: 37% total gastrectomy Roux-en-Y, 32% Billroth II
partial gastrectomy, 15% partial gastrectomy Roux-en-Y, 11%
gastrojejunostomy, 4% sleeve gastrectomy and 1% less common
reconstructions. ERCP indications were mainly biliary (87%).
Total technical success was 82% with lower technical success in
Roux-en-Y gastric surgery (73%) vs gastric surgery without Rouxen-
Y (92%). 13 adverse events (GRADE II – IV) were encountered
(7%) with 1 mortality due to perprocedural cardiac arrest. Sleeve
gastrectomy allowed the use of conventional duodenoscopes with
100% technical success. In Billroth II patients both duodenoscopes,
gastroscopes and colonoscopes as well as balloon-assisted
enteroscopes were used with high technical success (94-100%), as
well as in gastrojejunostomy patients (57-100%). For Roux-en-Y
reconstructions, only single-balloon enteroscopes were used with
acceptable success (75% in partial and 74% in total gastrectomy
Roux-en-Y).
Conclusions: ERCP in SAGA patients is challenging requiring
different types of endoscopes, especially after Roux-en-Y total or
partial gastrectomy with lower technical success as compared to
Billroth II gastrectomy, sleeve gastrectomy and gastrojejunostomy.
Adverse event rates are comparable to ERCP procedures in patients
with normal anatomy.
Decision making in technical evaluation and treatment of pelvic floor multidisciplinary team discussion. Will multidisciplinary team discussion change policy?
Pelvic floor multidisciplinary team (MDT) discussion is
emerging as a standard part of care for patients with pelvic floor
disorders. Although its use is encouraged by guidelines, there is still
a lack of solid evidence supporting its benefits.
The aim of this study is to evaluate the impact of pelvic floor
MDT discussions on the diagnostic approach and treatment of a
patient population at Antwerp University Hospital. After reviewing
26 patient cases, the study demonstrated a change in technical
investigations in 69% of cases and a change in diagnostics in 85%
of cases.
These findings indicate that pelvic floor MDT discussions have a
significant impact on both the diagnostic and treatment approaches
for pelvic floor disorders.
Medical malpractice litigations against gastroenterologists in Belgium
Introduction: Medical malpractice litigations represent a reality for clinical physicians. However, no data are available about the impact on gastroenterologists in Belgium.
Aim: We estimated the number of malpractice litigations against gastroenterologists in Belgium based on the annual reports of the Fund for Medical Accidents (FMA), residing under the Belgian national social security service (RIZIV-INAMI).
Methods: FMA annual reports are available online in the public domain from 2012 onwards. We reviewed all available annual reports, focussing on results within the fields of Gastroenterology and Cardiology.
Results: From 2010 to 2023 a total of 6884 applications for malpractice litigations were filed resulting in a final decision for 3185 care providers between 2014 and 2023. In this 10 years period claims were filed against 92 gastroenterologists, placing them in the top 10 of care providers at risk for malpractice litigations in Belgium. There are currently 777 practicing gastroenterologists in Belgium, indicating that over 10 years time the cumulative risk of malpractice litigation through the FMA alone is as high as 12%. The subject of the claims is not mentioned in the FMA reports, and therefore remains unknown. Compared to Cardiology, another interventional speciality within the field of Internal Medicine, gastroenterologists are more prone to malpractice litigations. Only 73 (6%; p<0.001 Chi-square) on a total of 1237 practicing cardiologists faced malpractice litigations through the FMA.
Conclusions: Based on the FMA annual reports, Belgian gastroenterologists are considerably at risk of malpractice litigations reaching 12% over a 10 years time period, as compared to only 6% cumulative risk of practicing cardiologists. Endoscopy-related complications are supposedly the most common reason of malpractice litigation and Belgian gastroenterologists should be aware of this risk
