Volume 89 - 2026 - Fasc.1 - Original articles
The impact of a care pathway with systematical screening for cardiopulmonary complications, frailty, malnutrition and minimal hepatic encephalopathy in cirrhosis on patient care and hospital financing
Background and aim of the study: Cardiopulmonary
complications, malnutrition, frailty and minimal hepatic
encephalopathy are underrecognized complications of cirrhosis
with a major impact on mortality and morbidity. The aim of this
study is to investigate a new locally introduced care pathway with
standardized screening for these complications and its impact on
patients care and hospital financing.
Patients and methods: We performed a single center
retrospective study of 40 patients hospitalized with cirrhosis who
participated in the care pathway between April 2023 and June
2024. Electronic medical records were evaluated for screened
complications and financial outcomes were calculated within our
population, consecutively with and without this care pathway.
Long term data regarding survival and referral were collected in
June 2025.
Results: Hepatopulmonary syndrome was diagnosed in 14.7%
of the patients. Frailty was present in 57.7% of the patients
and malnutrition in 45%. Minimal hepatic encephalopathy was
established in 17.5% of the patients. The median justified hospital
days were significantly higher with the care pathway compared
to without [8.4 (6.0-10.8) vs 6.2( 4.9-8.6) p<0.01 ( Z=-3.43)]. In
15 (37.5%) patients, the care pathway added a higher financial
reimbursement for the hospital compared to when the care
pathway would not have been performed.
Conclusions: This study emphasizes the importance of
systematic screening and education of these complications. Due to
systematical screening these underrecognized complications get
identified earlier. Performing this care pathway did significantly
and positively impact the number of justified hospital days and
financial reimbursement for the hospital.
Real-World Outcomes of [¹⁷⁷Lu]Lu-DOTA-TATE Peptide Receptor Radionuclide Therapy in Patients with Metastatic Gastroenteropancreatic Neuroendocrine Tumors: Data from a Belgian ENETS Center of Excellence
Background and study aims: Peptide receptor radionuclide
therapy (PRRT) has been reimbursed in Belgium since 2022.
Post marketing monitoring of efficacy in Belgian context has not
yet been performed. This study aimed to evaluate the efficacy
and safety of PRRT in patients with progressive metastatic
gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
Patients and methods: Our retrospective analysis included
GEP-NET patients who received at least one cycle of [177Lu]
Lu-DOTA-TATE at Institute Jules Bordet (Brussels, Belgium)
between 2013 and 2023. Treatment response was assessed
according to RECIST 1.1 (Response Evaluation Criteria in Solid
Tumors). Progression free survival (PFS) and overall survival
(OS) were estimated using Kaplan–Meier analysis. Treatment
safety profiles were reported descriptively.
Results: Following initial PRRT (PRRT-1), in 110 patients with
progressive metastatic GEP-NETs (grades 1-3), median PFS was
22.5 months (95% CI: 19.7–29), and median OS was 42.3 months
(95% CI: 34.3–55). RECIST 1.1 responses were complete response
in 1%, partial response in 21.6%, stable disease in 60.8%, and
progression in 16.7% of patients. Median time of follow-up post
PRRT-1 was 26.4 months (range: 0.8 – 106.4). Grade 3-4 anemia,
leukopenia, lymphopenia and thrombocytopenia occurred in
1.9%, 2.8%, 50.5% and 2.8% of patients, respectively. Two
patients (1.8%) developed myelodysplastic syndrome. Grade 3 or
4 renal toxicity was observed in two patients who had impaired
renal function prior to PRRT.
Conclusion: Post-marketing analysis in an ENETS Center of
Excellence confirmed that the efficacy and safety of PRRT in GEPNETs
are consistent with phase 3 trial data.
Rectal Indomethacin plus Lactated Ringer’s for Prophylaxis of Post-ERCP Pancreatitis in Children
Background and study aims: Pediatric data on post-endoscopic
retrograde cholangiopancreatography (ERCP) pancreatitis (PEP)
prophylaxis remains limited. This study evaluated the effectiveness
and safety of combined rectal indomethacin and lactated Ringer’s
(LR) as prophylaxis for PEP in children undergoing ERCP.
Patients and methods: We retrospectively reviewed all
pediatric ERCPs performed at a single tertiary center (2012–
2025). The study group consisted of procedures performed after
2021, when a standardized prophylaxis protocol (100 mg rectal
indomethacin before ERCP plus LR at 2.5 L·m-2, started 2 hours
before and continued 6 hours after) was implemented. Procedures
performed before 2021 served as the control group. Primary
and secondary endpoints were the development of PEP and
cholangitis, respectively. Analyses considered American Society for
Gastrointestinal Endoscopy (ASGE) procedural complexity, stent
placement/type, and naive papilla status.
Results: Seventy-five children underwent 95 ERCPs (prophylaxis
group: 23 patients/38 procedures; control group: 55
patients/65 procedures). Baseline demographic and procedural
characteristics were similar between the prophylaxis and
control groups. Post-ERCP pancreatitis developed in 13.2% of
procedures in the prophylaxis group and 13.8% in the control
group (RD −0.7%; 95% CI −18.5 to 19.9; p = 1.000). Cholangitis
developed in 5.3% of procedures in the prophylaxis group and
7.7% in the control group (RD −2.4%; 95% CI −15.3 to 14.0; p
= 1.000). Adjustment for stent type did not meaningfully alter the
associations between prophylaxis and outcomes. All PEP cases were
mild to moderate. No treatment-related adverse events—including
indomethacin -associated gastrointestinal or renal complications,
or fluid-overload events—were observed in either group.
Conclusions: Combined rectal indomethacin plus LR was
feasible and well tolerated in pediatric ERCP but did not
significantly reduce PEP or cholangitis. These findings highlight
the need for larger, multicenter pediatric trials to define optimal
prophylaxis.
Impact of a centralised pancreaticobiliary tumour board on the diagnosis of pancreatic lesions
Background and study aims: Since 2019, pancreatic surgery in
Belgium has been centralised to high-volume centres to improve
care quality and reduce postoperative morbidity and mortality.
All patients who are potential surgical candidates are discussed
preoperatively at a centralised multidisciplinary board (MCCC
= Multidisciplinair Consult Complexe Chirurgie). Typically,
patients with a (possible) malignancy have already been evaluated
by a multidisciplinary tumour board (MDT) in the referring
hospital. This study aimed to assess the impact of the MCCC on
the diagnosis of solid and cystic pancreatic lesions and to analyse
referral patterns.
Patients and methods: This single-centre, non-interventional
retrospective study included 217 patients with a newly diagnosed
pancreatic lesion, discussed at the MCCC of Ghent University
Hospital between July 1, 2019, and December 31, 2021. The
influence of the MCCC on the diagnosis of pancreatic lesions was
analysed.
Results: Among 217 patients (median age 65 years; 50% male),
the most frequent diagnoses were pancreatic adenocarcinoma
(n=99; 45,6%), IPMN (12%) and pancreatitis (7%). The MCCC
altered the initial diagnostic assessment in 18,4% of cases. Among
benign referrals, 20% (5/25) were ultimately found malignant,
likely altering treatment. None of the 166 patients referred with
a malignant diagnosis were reclassified as benign. During the
first three years after centralisation, referral quality remained
unchanged, with 12% unspecified lesions annually.
Summary: Centralisation may over time affect referral
quality as expertise concentrates. Initial diagnosis and staging
still occur in referring hospitals and are first discussed locally.
This early analysis shows stable referral appropriateness after
centralisation. Ongoing monitoring is needed to evaluate longterm
effects of centralisation on diagnostic quality and early
detection.
Estimated benefits and willingness of remote monitoring in IBD patients in remission under maintenance therapy: results of a questionnaire in a tertiary referral centre
Background: STRIDE II guidelines highlight the importance
of closely monitoring patients with inflammatory bowel disease
(IBD) to assess therapy effectiveness and predict or manage flares.
However, with a growing patient population, the outpatient clinic
capacity is strained, and many patients, especially those in longterm
remission, may not require frequent in-person visits. This
study aims to assess the interest for optimizing resources through
remote monitoring for patients with IBD in a high-volume
referral centre.
Methods : An anonymous survey was conducted in 281 adult
IBD patients, either untreated or on stable subcutaneous or
oral maintenance therapy for more than one year. We assessed
interest in a remote monitoring program and insights into their
preferences for its implementation as well as eventual cost and
time savings.
Results: Of the 281 patients (52% female, 67% Crohn’s disease,
32% ulcerative colitis, 1% IBD type unclassified), 76% expressed
interest in reducing their outpatient visits in favour of remote
monitoring. Of note, 79% of these 214 patients were willing to
attend outpatient clinic visits every two years. However, patients
emphasized the importance of personal contact in establishing a
trustworthy and safe remote monitoring system. Additionally, the
study identified cost and time savings for patients, as a visit to
the outpatient visit took a median (interquartile range) of 3 (2-4)
hours.
Conclusion: Remote monitoring is a promising program
for IBD patients in table remission, offering potential financial
and time savings for employers, patients, and society. However,
further research is required to evaluate the safety and feasibility
of this approach.
Preferences and acceptability of telemedicine in Belgian IBD patients
Introduction: Inflammatory bowel diseases (IBD), in particular
Crohn’s disease (CD) and ulcerative colitis (UC), are chronic
conditions that have a considerable impact on patients’ quality
of life and healthcare resources, as they require frequent visits
and hospitalisations. Telemedicine offers a potential advantage by
enabling remote healthcare. Studies have shown that telemedicine
can improve quality of life and reduce healthcare use, although
results vary depending on study design and location. Our study
investigates the views of French-speaking Belgian IBD patients
on telemedicine. It aims to assess acceptability and preferences to
guide future implementation.
Methods: We designed a questionnaire available online
(between October 2023 and June 2024) for which any patient with
IBD followed up in an adult gastroenterology consultation was
eligible. The 69-item questionnaire was validated by test patients
and distributed via Epic®, social media and printed forms.
Data were collected using REDCap® and analyzed using SPSS®,
applying univariate and multivariate analyses to identify factors
influencing acceptance of telemedicine.
Results: 257 respondents validated their questionnaire. The
majority were women (54%) with an average age of 45 years
[17-85]. Most patients had Crohn’s disease (63%) and were using
immunosuppressive therapy (44%) and/or biologics (30%), with
a high compliance rate (98%). Although 68% had discovered
telemedicine because of our survey, 82% were interested in remote
consultations, citing time savings and reduced absence from work
as advantages, while expressing concerns about reduced personal
contact and technical problems. Acceptance was significantly
associated with time saved and frequency of visits (p<0.05).
Conclusion: Our study reveals strong acceptance of
telemedicine, regardless of previous experience, with a preference
for video over telephone consultations. It also demonstrates
openness to follow-up without direct human contact (e.g.,
application-based tools), although concerns remain about the
potential loss of personal interaction. The results underline
the importance of addressing patient concerns and ensuring a
solid human and technical infrastructure for the expansion of
telemedicine.