Volume 87 - 2024 - Fasc.4 - Original articles
Decreased incidence and shift in stage distribution for colorectal cancers in Belgium during the COVID-19 pandemic
Background and study aims: The COVID-19 pandemic
substantially impacted the healthcare system and society in 2020.
This study assessed its possible impact on occurrence and stage of
colorectal cancer diagnoses in Belgium.
Methods: Population-based data from the Belgian Cancer
Registry were used to extrapolate 2017-2019 trends in incidence
and stage distribution to expected counts for 2020 that were
subsequently compared to the observed values. Stage-specific
predictions were corrected to account for the overall decline in
diagnoses.
Results: In 2020, 705 fewer than expected invasive and 255
fewer in situ colorectal cancers were diagnosed. For colon cancer,
significant declines were observed in all genders and regions, mainly
in the screening age group and in age 75+. For rectal cancers, there
was only a significant decline in the latter two groups. Colon cancer
pStage distribution did not change significantly. In situ rectal
tumors showed a relative decline in Flanders and in the screening
age group. In the latter group, more than expected cStage III rectal
cancers were observed in women.
Conclusions: The excess decline in in situ rectal cancers is
likely attributable to the temporary suspension of the colorectal
screening program during the first pandemic wave. The overall
decline in colon and rectal cancer incidence in Belgium in 2020 was
not accompanied by a stage shift. Longer-term effects or impact on
clinically relevant outcomes cannot be excluded.
Evaluation of the adherence of patients with chronic inflammatory bowel diseases to a PRO telemonitoring using connected devices: a prospective monocentric study
Background and study aims: Monitoring the symptoms of
inflammatory bowel diseases (IBD) patients is now frequently
made in the form of patient reported outcomes (PRO), rather than
historical clinical activity scores. Unlike several chronic diseases, the
role of telemonitoring in IBD has not yet been defined, particularly
in terms of patient compliance with remote monitoring; the aim of
our study was to assess patient compliance with digital monitoring
of PRO as part of routine medical follow-up.
Patients and methods: we performed a monocentric prospective
study in the Gastroenterology Unit of Liège’s University Hospital
between May 2023 and February 2024. Adherence was considered
optimal if 50% of the recordings planned for the duration of the
follow-up were carried out.
Results: 31% of the patients included achieved at least 50% total
encoding of their PRO over the 9 months of follow-up. The main
cause of failure cited by patients was technical difficulties, well
ahead of poor motivation. The overall satisfaction of practitioners
and patients was generally good. Male gender was the only factor
associated with adherence.
Conclusion: Overall adherence to PRO telemonitoring in IBD
was around 40% and was mainly impaired by technical difficulties.
Despite this, both patients and healthcare professionals found this
type of monitoring relevant.
G-POEM in Belgium : a retrospective study
Gastroparesis is a condition with a growing incidence and few
effective treatments. In recent years, GPOEM has demonstrated its
superiority to other existing treatments.
We report here on our experience in which 34 patients
underwent GPOEM, with 23 patients assessed for symptoms and
quality of life before and after the procedure.
We measured an average clinical success rate of 73.92% and
an excellent risk profile with only two minor complications. The
procedure was very well accepted by patients as all would be
willing to undergo it again.
Patients for whom GPOEM was successful saw a major
improvement in their quality of life, which returned to normal,
and, for those suffering from reflux, a significant reduction in their
PPI treatment.
As for the patients for whom the procedure was not a
success, we found that they were at high risk of somatization, so
screening questionnaires should be considered pre-intervention
to screen these patients and avoid unnecessary procedures.
Performance of novices in Endoscopic Submucosal Dissection starting directly in human patients under direct supervision of an expert endoscopist
Background and study aim: The ESGE curriculum guideline
on training in ESD advises an extensive experience in animal
models before commencing ESD training on humans. However, the
evidence on which this recommendation is based, is rather limited.
In this study we evaluate the performance of novices in ESD during
their one-year training period; with continuous supervision of an
endoscopist with extensive experience in ESD.
Patients and Methods: During a 6.5 years period, all ESD
procedures performed by an expert endoscopist (eESD) or by
one of the 3 novices (sESD), in a single non-academic center, were
retrospectively collected.
Primary outcome parameters were rate of en-bloc resection and
clinically relevant adverse events. The secondary outcome was R0
resection, recurrence rate and delayed adverse events.
Results: In total 210 ESD procedures were included. Of these
97 sESD (46.2%), were performed by a novice endoscopist under
supervision and 113 eESD (53,8%) by an expert. En-bloc resection
rate was 99.1% vs 99% (p = ns), R0 resection rate was 80.5 % vs
79.4 % (p=ns). Clinically relevant complications 14.2% vs 6.2 % (p
= 0.04) and severe complications 4.4% vs 2.1% (p=ns). Perforation
was the most frequent reported serious complication. Three
patients in the eESD group versus one in the other group needed
additionally surgery due to a complication (p=ns). Recurrence rate
was 2.2% for eESD and 1.3 % for sESD (p=ns).
Conclusion: This retrospective analysis demonstrates that
learning ESD in humans without extensive prior animal model
training is safe and feasible, on the condition that continuous
supervision by an expert is provided.
Treatment patterns and outcomes of patients with complex Crohn’s perianal fistula in five European countries: the PREFACE study
Background and study aims: Crohn’s disease (CD) is often
complicated by perianal fistulas or abscesses that worsen patient’s
quality of life, with 52-88% of CD-related perianal fistulas
(CPFs) being complex. This retrospective study describes sociodemographic
characteristics, treatment patterns and outcomes of
patients with complex CPFs in five European countries.
Patients and methods: PREFACE is a multi-national medical
chart review study of CD patients who started medical or surgical
treatment for a new episode of complex CPFs between September
2011 and September 2014 (index date). Effectiveness outcomes
were assessed as fistula remission rates based on fistula drainage
assessment. The most recent assessments prior to each timepoint
were used to calculate fistula remission rates.
Results: In total, 372 patients (51.3% male, mean age at index
date 37.8 years) with 498 complex CPFs between index date and
end of data collection were included. A quarter of patients with
CPF already had perianal fistulas at CD diagnosis.
Of the complex index CPFs, 39.8% were treated with antitumour
necrosis factor, 33.3% with antibiotics and 16.3% with
immunosuppressants. At least one surgery was performed for
93.8% of complex CPFs. By end of follow-up (median (IQR)
6.0 (5.2, 6.9) years), 61.2% of complex CPFs were not draining
anymore. Fistula remission rate at patient level was 28.0% after 6
months, 35.2% after 12 months and 64.8% overall.
Conclusions: Current therapeutic algorithms for CPFs are
not successful in a considerable proportion of patients. Improved
therapeutic strategies and new treatment options are required to
achieve better outcomes in complex CPFs.
Efficacy and safety of Aurantii Fructus Immaturus flavonoid Tablets vs. domperidone for functional dyspepsia: a multicenter, double-blind, double-dummy, randomized controlled phase III trial
Background: The clinical management of functional dyspepsia
(FD) is challenging. This study evaluated the efficacy and safety
of Aurantii Fructus Immaturus flavonoid (AFIF) tablets vs.
domperidone for FD.
Methods: This multicenter, randomized, double-blind, doubledummy,
positive-controlled trial recruited FD patients, who were
randomized 1:1 to the AFIF (AFIF and domperidone placebo)
and domperidone (domperidone and AFIF placebo) groups. The
primary endpoint was the rate of disappearance of all four FD
symptoms (postprandial feeling of fullness, early satiety, upper
abdominal pain, and upper abdominal burning sensation) after 4
treatment weeks.
Results: Totally 120 and 119 patients were included in the AFIF
and domperidone groups, respectively. The rates of disappearance
of all four symptoms after 4 treatment weeks were 28.33% and
31.93% in the AFIF and domperidone groups, respectively
(p=0.5748). The rate of disappearance of all four symptoms 4
weeks after treatment discontinuation was significantly higher
in the AFIF (21.05%) compared with the domperidone group
(4.39%, p=0.0002). The gastric emptying rates 2h after a meal
were significantly increased in both AFIF (7.58%, p<0.0001) and
domperidone (6.95%, p=0.0121) groups versus baseline, without
a significant between-group difference (p=0.8457). Twenty-two
(1 moderate) and 43 (3 moderate) adverse events occurred in the
AFIF (19.17%) and domperidone (36.13%) groups, respectively.
Conclusion: The efficacy of AFIF tablets is similar to that of
domperidone after 4 treatment weeks, while AFIF tablets may have
a better safety profile than domperidone. Additionally, AFIF tablets
have a significant advantage over domperidone in the rate of
symptom disappearance 4 weeks after treatment discontinuation.
