To evaluate current international clinical practice in the assessment and management of rectal stump disease activity following colectomy in paediatric ulcerative colitis (UC). A web-based survey comprising 18 questions was distributed to paediatric gastroenterologists via European Porto inflammatory bowel disease (IBD) interest group and North America and the United Kingdom pediatric inflammatory bowel disease (PIBD) network groups over 6 months. The questionnaire recorded centre demographics, colectomy practices, rectal stump assessment methods, and management approaches. Responses were analysed using descriptive statistics with subgroup analysis by continent and centre size. Eighty paediatric gastroenterologists from 24 countries completed the survey. Most centres (n = 62, 78%) reported fewer than five colectomies annually, with 59% indicating that all patients retained a rectal stump for at least 3 months post-colectomy. Only 11% of centres had a formal protocol for rectal stump management. Clinical assessment tools varied, with 39% using none, and the remainder favouring Pediatric Ulcerative Colitis Activity Index (PUCAI) or Physician's Global Assessment. Frank rectal bleeding and painful rectal discharge were rated as the most significant symptoms. Endoscopy and histology were the most common investigations. Rectal therapy was the preferred first-line treatment for rectal stump disease recurrence, followed by systemic therapy and observation. There was wide variation in estimates of rectal disease activity at 6 months post-colectomy. There is considerable international variation and lack of standardisation in the management of rectal stump disease in paediatric UC. These findings underscore the need for evidence-based guidelines and collaborative research to optimise care for this understudied population.
ESGE and ESGENA recommend that informed consent for gastrointestinal endoscopic procedures should include consent for sedation and cover best practice as outlined in the ESGE Position Statement for informed consent.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend pre-assessment, a specific sedation regimen, and enhanced periprocedural monitoring in high-risk patients undergoing gastrointestinal procedures with sedation, to reduce the risk of sedation-related adverse events.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend that pre-assessment, sedation regimen, and periprocedural monitoring should be determined by the complexity (duration, invasiveness) of the endoscopic procedure.Strong recommendation, very low certainty of evidence. ESGE and ESGENA suggest that the management of sedation in patients on glucagon-like peptide-1 receptor agonists should be individualized. Conditional recommendation, very low certainty of evidence. ESGE and ESGENA suggest offering the option of diagnostic colonoscopy and gastroscopy without sedation, based on the patient's and endoscopist's preference.Conditional recommendation, very low certainty of evidence. ESGE and ESGENA recommend that sedation should be provided by a dedicated healthcare professional trained in sedation administration and patient monitoring.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend propofol for procedural sedation, as first line, depending on the country's human resources, service framework, and legislation.ESGE and ESGENA recommend midazolam for procedural sedation, in combination with opiates when analgesia is required.Strong recommendation, very low certainty of evidence. ESGE and ESGENA suggest the provision of the ultrashort-acting sedative remimazolam in elderly patients and patients with cardiovascular and/or respiratory comorbidities.Conditional recommendation, low certainty of evidence. ESGE and ESGENA suggest exercising caution when combining ultrashort-acting sedatives with other sedatives or analgesics.Conditional recommendation, low certainty of evidence. ESGE and ESGENA suggest capnography monitoring for patients undergoing sedated gastrointestinal endoscopy who are at higher risk of hypoxemia.Conditional recommendation, very low certainty of evidence. ESGE and ESGENA recommend that the use of reversal agents should be restricted to managing sedation-analgesia adverse events that do not improve with nonpharmacological intervention.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend that patients be monitored after endoscopy by trained and qualified staff until the return of the patient's baseline observations.Strong recommendation, very low certainty of evidence. ESGE and ESGENA suggest using scoring systems and standardized discharge checklists to facilitate patient readiness for discharge. Assessments should include a detailed record of vital signs, pain levels, and psychomotor performance.Conditional recommendation, very low certainty of evidence. ESGE and ESGENA suggest that the performing endoscopist holds the overall medicolegal responsibility for the patient's treatment, including safe recovery, but may delegate the assessment and discharge to trained and qualified personnel based on standardized discharge criteria.Conditional recommendation, very low certainty of evidence. ESGE and ESGENA recommend that patients receive oral and written information regarding the post-endoscopy period. Contact details should be provided for potential delayed complications, emergencies, or readmission.ESGE and ESGENA recommend that patients undergoing sedated endoscopy have an accompanying person at discharge.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend performing emergency endoscopy under moderate sedation in hemodynamically stable patients. Alternatively, emergency endoscopy without sedation in cooperative patients is feasible.ESGE and ESGENA recommend sedation administration by an anesthesiology specialist in emergency endoscopy in patients at increased risk of aspiration, or with hemodynamic instability or significant comorbidities.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend consultation with anesthetic and obstetric teams involved in the pregnant patient`s care, together with the patient's choice for the appropriateness and choice of sedation during gastrointestinal endoscopy.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend improving and expanding educational offerings on sedation strategies and the principles of airway management, using structured training.Strong recommendation, low certainty of evidence. ESGE and ESGENA recommend the development and implementation of a quality improvement program with performance indicators to monitor the quality of sedation practices in gastrointestinal endoscopy.Strong recommendation, very low certainty of evidence. ESGE and ESGENA recommend a rational use of sedatives to reduce the environmental impact of endoscopy.Strong recommendation, moderate certainty of evidence.
Heart failure and chronic liver disease account for substantial morbidity and mortality worldwide. Both conditions share common risk factors and a bidirectional pathophysiology, and the coexistence of both conditions is expected to increase over time. Management of coexisting heart failure and liver disease is challenged by the under-representation of participants with liver disease in landmark heart failure clinical trials, impaired hemodynamics at advanced stages of liver disease, altered drug metabolism, and higher risk of adverse events than portended by either condition alone. Moreover, diagnostic pitfalls might be encountered in relation to assessing the primary etiologies driving the disease process, estimating the degree of liver fibrosis, and differentiating primary liver disease from heart failure-related liver congestion particularly, given the complex interplay between sinusoidal pressure, congestion, and structural fibrosis. Cardiovascular-hepatic cross-thematic research, clinical education, and health care services could optimize management and patient outcomes. The purpose of the current review is to (i) highlight the growing epidemiology of concurrent heart failure-liver disease; (ii) provide diagnostic clues for liver disease and an approach for interpreting liver marker abnormalities amongst heart failure patients; (iii) describe the main therapeutic strategies in real-world clinical settings; and (iv) discuss current gaps in knowledge and future directions. This update on the framework of the heart failure-liver disease overlap phenomenon can inform clinical care policies and facilitate novel research in the field.
There is a lack of robust evidence regarding immunosuppressive therapy in children and adolescents after kidney transplantation (KTx), and as such, international practice is highly variable. Recent clinical practice recommendations advocating individualized immunosuppressive strategies that incorporate newer agents are often not implemented. This can potentially contribute to reduced patient and renal allograft survival. The guideline was developed between January 1, 2024, and December 12, 2025, according to the Guidance Manual of the German Association of Scientific Medical Societies by the German Societies for Pediatric Nephrology, Nephrology, Transplantation, and Pediatrics, the German Kidney Association, the International Pediatric Transplant Association, the European Society for Pediatric Nephrology and the Members of the Cooperative European Pediatric Renal Transplant Initiative. This evidence- and consensus-based guideline provides up-to-date, state-of-the-art recommendations for immunosuppressive therapy after KTx in pediatric kidney transplant recipients. It is based on the best available evidence and the consensus of the relevant German Medical Societies, Members of the Cooperative European Paediatric Renal Transplant Initiative, and the working group on transplantation of the European Society for Paediatric Nephrology, and the International Pediatric Transplant Association. The formal consensus reached is particularly significant in cases of weak or inconclusive evidence and where recommendations are based solely on expert opinion.
Pain is often the presenting symptom of acute pancreatitis (AP) and has a prognostic significance, with poorly treated pain affecting patient outcomes. Despite this, there are currently no international recommendations for pain management in patients admitted with AP. This current guideline was developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. Nine working groups were formed to develop statements on pain management in AP from admission to discharge. After systematic literature reviews, the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted using three rounds of Delphi method. The guidelines concluded that acute postoperative pain management guidelines are applicable for treating acute pain due to AP. The numerical rating scale is preferred for pain assessment because of better compliance. Opioids currently form the cornerstone of severe pain management. Potent opioids such as buprenorphine and pentazocine provide superior pain relief over non-opioid medications and decrease the need for rescue analgesia. Current evidence does not consistently demonstrate harm from opioids in AP. In patients with severe pain, safety concerns should not delay the timely use of opioids to ensure adequate pain management. Specific recommendations concerning the use of epidural analgesia, acupuncture and management of pain in the paediatric population and during pregnancy are provided based on evidence and expert opinions. Finally, the unmet needs for future research were discussed and proposed.
Inflammatory bowel disease (IBD) care is moving from a symptom-driven step-up model of care toward earlier effective intervention, complication-specific management, and more personalized treatment selection. This review synthesizes selected ECCO 2026 studies and offers an expert appraisal of their clinical relevance, methodological strengths, and remaining uncertainties. Particular emphasis is placed on studies most likely to influence current practice and further research, including late-breaking trials, complication-directed therapy, pediatric evidence, and technology-assisted assessment. Study findings spanned both ulcerative colitis (UC) and Crohn's disease (CD). New therapeutic studies presented included the phase 3 study of vedolizumab in pediatric UC, phase 2 efficacy data for picankibart in UC, and regenerative fistula data of AVB-114 in perianal CD. Real-world data presented included comparative data on different Janus kinase inhibitors in UC. Updates on interleukin-23 included durable extension data in UC, as well as efficacy data in advanced therapy‑exposed patients (mirikizumab in UC and risankizumab in CD). Innovative technologies included transperineal ultrasound for early identification of steroid non-response in acute severe UC, and multimodal artificial intelligence for Mayo endoscopic scoring. Beyond drug therapy, the 10-year LIR! C follow-up provided further data on surgical intervention as an early strategy in selected uncomplicated ileal CD, while the Preventing IBD ONset in Individuals at Risk study investigated potential benefits of a whole-food diet in high-risk first-degree relatives. ECCO 2026 emphasized durable, precision-oriented, multidisciplinary, and technology-enabled IBD care across the full continuum, from prevention to long-term modification. Apart from phase 3 and extension trials, other results remain preliminary and need broader comparative and practice-embedded studies before widespread adoption.
1: Before commencing hands-on upper gastrointestinal bleeding (UGIB) training, trainees should have thorough knowledge of: pathology, vascular anatomy, technical use of devices, clinical care pathways, and all relevant components of pre-, intra-, and postprocedural patient care. 2: Preadoption technical skills required for training in the management of UGIB include adequate scope handling, intubation technique, washing and suctioning of residue, mucosal examination, and handling of accessories. 3: Preadoption technical skills required for training in the management of UGIB should be assessed individually based on a competency framework and not solely on numerical thresholds. 4: The integrative skills required for the management of UGIB do not essentially differ from those needed in other endoscopic procedures and should include adequate situational awareness, collaboration, team leadership, and patient communication in order to ensure short- and long-term goals are achieved. 5: The trainee should reach minimum recommended standards for key performance indicators in upper GI endoscopy before starting training in the management of UGIB. 6: Attendance of at least one half-day training session on a dedicated simulator that provides GI bleeding training at the beginning of training for management of UGIB is advised. 7: Trainees should be supervised directly and carefully during UGIB training for a minimum of 20 procedures with endoscopic stigmata of recent hemorrhage in order to prevent failure of hemostasis and ensure adequate trainee skill acquisition. 8: Trainers should take into account pre-endoscopic and intraprocedural factors predicting outcome, technical complexity, and risk of hemostatic failure when deciding appropriateness and degree of trainee involvement in case management. 9: During their training, trainees should be exposed to all hemostatic modalities, as per ESGE guideline recommendations, and the opportunities for teaching arising from the specifics of each UGIB case. 10: Trainers should use "successful hemostasis," defined as the absence of any further bleeding (persistent or recurrent bleeding), as the ultimate goal of training in the endoscopic management of UGIB. 11: Patients with recurrent bleeding should be treated by experienced endoscopists or by a trainee under their direct supervision owing to the higher risk of failure of conventional endoscopic treatment. 12: Trainers who are teaching management of UGIB should fulfil the same standards as any trainer of basic endoscopy procedures. 13: Trainees should be exposed to multidisciplinary team discussions and care pathways for failed endoscopic treatment of UGIB. 14: Training centers with limited UGIB case volumes are encouraged to offer short-term immersive training in centers with high volume caseloads of UGIB in order to ensure sufficient exposure for trainees. 15: Competency in managing UGIB is defined as the ability to assess the need for endoscopy, and plan and carry out successful hemostasis. 16: Trainees should manage an indicative number of 30 cases in which successful hemostasis is achieved before evaluation of competence in management of UGIB. 17: UGIB-CAT is advised as a formative assessment tool during training to track acquisition of competence and provide trainee feedback. 18: Trainees should undergo a formal summative assessment of competence in managing UGIB during their training. 19: Endoscopists should continue a period of tracking results and mentored practice with an experienced colleague for at least 6 months after achieving competence in managing UGIB. 20: As trainees move to independent practice, they should have established access to or referral pathways for key supporting specialties involved in the nonendoscopic management of acute UGIB (including emergency medicine, surgery, and interventional radiology).
This analysis of insurer-complete administrative data and claims from a United States database (Komodo Health) assessed the risk of serious infections, myocardial infarction (MI), stroke, and venous thromboembolism (VTE) among patients with ulcerative colitis (UC) initiating tofacitinib or biologic treatments. Patients with UC initiating treatment with tofacitinib, ustekinumab, vedolizumab, or tumor necrosis factor inhibitors (TNFis) from May 31, 2018, to September 30, 2022, were included. Stabilized inverse probability treatment weights (sIPTWs) were calculated and Cox proportional hazards models with sIPTWs were used to calculate hazard ratios; bootstrapping was used to calculate 95% CIs. In total, 5171, 10 424, 17 129, and 29 872 patients initiated tofacitinib, ustekinumab, vedolizumab, and TNFis, respectively. The mean patient age at index was 43.1 years and the mean follow-up was 359.2 days. At baseline, a greater proportion of patients initiating tofacitinib vs biologics had used ≥ 2 prior biologics (46.3% vs 7.5%-33.7%, respectively). Incidence rates (IRs)/100 patient-years (PY) of serious infections were 2.62, 2.73, 2.45, and 3.25 for tofacitinib, ustekinumab, vedolizumab, and TNFi, respectively. For MI/stroke and VTE the IRs/100 PY were, respectively, 0.13 and 0.17 for tofacitinib, 0.17 and 0.16 for ustekinumab, 0.17 and 0.23 for vedolizumab, and 0.19 and 0.33 for TNFi. There were no significant differences in the risk of developing serious infections, MI/stroke, or VTE between treatments. No significant risk differences were observed among patients with UC initiating tofacitinib compared with biologics in a large US claims database. These findings add to evaluations of treatment risks vs benefits in patients with UC. EUPAS103443. In this large, claims-based analysis of patients with ulcerative colitis in the United States who initiated treatment with tofacitinib or a biologic no significant differences between treatments were found in the risk of serious infection, myocardial infarction, stroke, or venous thromboembolism.
Normothermic Regional Perfusion (NRP) is emerging as a game-changer in enhancing outcomes for Donation after Circulatory Determination of Death (DCDD). NRP maintains physiological conditions through perfusion with oxygenated blood, outperforming conventional super-rapid recovery techniques significantly improving outcomes and organ utilization. Despite its clinical benefits, widespread adoption of NRP is impeded by heterogeneous organizational, legal, and ethical frameworks. At the ESOT Bucharest Consensus Conference, leading experts in transplantation achieved consensus on 130 relevant NRP-related open issues to facilitate its implementation and guide global practice. Key recommendations include criteria for adoption of NRP, minimal requirements, procedures to be adopted before and during NRP, donor organ evaluation criteria and sequence of organ harvesting. Consensus extends to procedural components (including the configuration of perfusion parameters and strategic team coordination), ethical integrity of NRP in the context of the dead donor rule and key unmet needs for future developments. While significant strides were made in unifying practice, unresolved issues regarding maximum warm ischemic time and variability in legal standards indicate avenues for future research. This consensus underscores the imperative for global standardization in NRP application, promising to elevate the success rates of organ transplants and establish NRP as a foundational element in the evolution of DCDD.
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Recommendations on anticoagulation in patients with short bowel syndrome (SBS) following acute mesenteric ischaemia (AMI) or complicated by catheter-related thrombosis (CRT), are limited. Guidance is specifically lacking on antithrombotic drug selection, dosing, treatment duration and monitoring. Moreover, current recommendations do not account for the potentially impaired drug absorption in patients with SBS. This multidisciplinary position paper aims to develop a practical management guide for antithrombotic therapy in patients with SBS following AMI, as well as CRT. Nineteen intestinal failure experts, coagulation specialists, and clinical pharmacists completed a three-round Delphi voting procedure on 52 initial statements regarding antithrombotic drug and dose selection, duration and monitoring of treatment and testing for underlying diseases in case of AMI. After three voting rounds, 46 statements were retained with good agreement (i.e., >80%) for 38 of them, moderate agreement (i.e., >70-80%) for two statements, and low agreement (i.e., ≤70%) for the remaining six. While robust evidence is lacking regarding antithrombotic therapy in patients with SBS, consensus was reached on the majority of statements. More research in this field is required, particularly on oral drug absorption in SBS, development of alternative oral drug formulations, treatment strategies following arterial mesenteric stenting and direct oral anticoagulant (DOAC) dosing for secondary prophylaxis of CRT in SBS.
Blood proteins may play causal roles in cardiovascular diseases (CVDs) such as heart failure (HF) and peripheral artery disease (PAD). Proteome-wide Mendelian randomization (MR) has been widely used to prioritize drug targets for CVD in European populations, but its application to non-European populations remains limited. We conducted a proteome-wide MR analysis to evaluate the potential causal effects of 2,922 plasma proteins on five CVDs-atrial fibrillation (AF), coronary artery disease (CAD), HF, ischemic heart disease (IHD), and PAD. Analyses were performed across African (n = 931), East Asian (n = 262), and European (n = 10,840) populations using genetic instrument data from the UK Biobank cohort. Significant associations were further examined with genetic colocalization to strengthen causal inference. Using MR and colocalization analyses, we identified 53 significant protein-CVD associations across multi-populations, including 16 in African, six in East Asian, and 31 in European populations, respectively. Cross-population comparisons revealed four protein-CVD associations unique to African population and another four specific to East Asian population. Integration with clinical trial data prioritized 14 protein-disease pairs as promising candidates for therapeutic development or drug repurposing. Our findings highlight the value of proteome-wide MR in evaluating drug target applicability across populations. Several protein-disease associations were population-specific, emphasizing the need for inclusive genetic research to inform precision medicine in CVD prevention and treatment.
Noncoeliac gluten sensitivity (NCGS) remains a controversial clinical entity at the intersection between disorders of gut-brain interaction (DGBI) and disordered eating. We aimed to determine the prevalence of self-reported NCGS and to characterise its association with DGBI and avoidant/restrictive food intake disorder (ARFID) symptoms in an adult general population. We conducted a population-based internet survey with pre-defined demographic quotas across the United States of America and United Kingdom in 2023. Participants completed the Rome IV diagnostic questionnaire, the Nine-Item ARFID screen, and validated instruments for psychological distress, somatisation and quality of life. A total of 4002 participants (50% female; median age 46 years) were included in the analyses. The prevalence of NCGS was 14.2% (95% CI, 13.1-15.3). Participants with self-reported NCGS reported more nongluten food intolerances than those without self-reported NCGS (median 3 vs. 0, p < 0.001). Among individuals with NCGS, 69.4% (95% CI, 65.4-73.1) had concomitant DGBI and/or ARFID symptoms, with nearly one-quarter (24.0%; 95% CI, 20.6-27.8) meeting the criteria for all three conditions. Those with comorbid self-reported NCGS, DGBI and ARFID symptoms had the highest levels of psychological distress, somatic symptom reporting, increased healthcare utilisation and reduced quality of life (all p < 0.001). NCGS is reported by approximately one in seven adults in the United States of America and United Kingdom. Individuals with self-reported NCGS frequently meet diagnostic criteria for DGBI and/or ARFID symptoms, and those who experience all three entities represent a distinct high-severity phenotype. Our findings suggest that self-reported NCGS may represent a broader syndrome of food-related symptom attribution rather than gluten-specific pathology.
To evaluate the relationship between anti-tumour necrosis factor (TNF) use and surgical resection rates in a regional paediatric inflammatory bowel disease (IBD) cohort. This retrospective cohort study used prospectively maintained electronic data from a regional UK paediatric gastroenterology centre (2007-2024). Included were individuals with modified Porto IBD diagnosis, aged ≤17 years. Annual prevalent IBD population was estimated using incident diagnoses and transition to adult services. Abdominal surgery rates (strictureplasty, resection, primary stoma) and anti-TNF administration were collected and prevalence calculated. Three anti-TNF epochs, defined by the European Crohn's and Colitis Organisation/European Society of Paediatric Gastroenterology, Hepatology and Nutrition guidelines in 2014 and 2020, were compared: Epoch-1 (2007-2013; <20% anti-TNF), Epoch-2 (2014-2020; 20%-50%) and Epoch-3 (2021-2024; >50%). Kaplan-Meier analysis with log-rank testing compared surgery-free survival between early and later anti-TNF treatment groups. One thousand five hundred and thirty-eight children were included (915 Crohn's disease (CD), 529 ulcerative colitis (UC) and 94 IBD-unclassified). Median age at diagnosis was 13.3 years, and the prevalent population increased (253-597 patients). Anti-TNF-treated prevalence rose across epochs (5.9%, 31.9%, 61.1%; p<0.001). Resection rates declined 3.93%, 1.57% and 1.09% (Epoch 1-3) (p=0.003). Rates did not significantly decrease from Epoch 2 to 3 (p=0.217). CD surgery significantly decreased (4.9%, 1.7%, 1.5%, p=0.006); trends in UC rates did not reach significance (1.89%, 1.55%, 0.56%, p=0.314). Time to anti-TNF from diagnosis decreased (1.2, 0.8 and 0.26 years, p=0.008). Early vs later anti-TNF initiation was not associated with surgery-free survival. We report a significant increase in anti-TNF prevalence, with earlier deployment. Surgical resection rates have declined and plateaued; reflecting reduced CD surgery. Future research should focus on optimised anti-TNF and second-line biologic deployment to move beyond current levels of surgery.
Lynch Syndrome (LS) patients have a significantly increased risk for colorectal cancer (CRC), as well as extracolonic malignancies. This review aims to summarize published data on the prevalence of LS, affected genes, the cancer spectrum, and universal screening across different populations. We conducted a narrative review of English-language studies published in scientific databases addressing these key aspects of LS. The reported prevalence of LS among unselected CRC patients ranges from 0.7% to 4%, with a higher rate observed in selected high-risk patients. The overall prevalence of LS was reported to be 2.2% in a large meta-analysis. Among patients with endometrial cancer, the prevalence has been reported to reach 5.9% in Canadian patients. Notably, the prevalences of LS in both CRC and endometrial cancer show large variations across different geographic regions and ethnic groups. In most populations, the genes most frequently affected are path_MLH1 and path_MSH2. However, in certain regions, path_PMS2 mutations appear to be more common. This pattern has been observed in small cohorts from Arab countries, as well as in isolated studies from the United Kingdom and the United States. In addition, the cumulative cancer risk for CRC, endometrial, ovarian, and urothelial cancers varies widely in different populations. Studies involving unselected patients are more commonly conducted in European countries and the United States (US). In contrast, studies from other regions primarily included selected high-risk patients. In conclusion, the geographic and ethnic variations underscore the need for population-specific data and tailored screening strategies, with individualized genetic analysis and surveillance protocols.
Fecal incontinence (FI) affects up to 50% of patients with systemic sclerosis (SSc), significantly impairing quality of life and daily functioning. Despite its prevalence, patients may not disclose their symptoms and there is limited guidance on evaluation and management. Given the complexity of SSc and delays in gastroenterology referrals, rheumatologists often initiate care. To address this gap, an expert panel was convened to develop practical, consensus-based recommendations for assessing and managing SSc-FI. An international Steering Board (n=19) was assembled under the auspices of the World Scleroderma Foundation GI ad hoc committee, including clinicians from rheumatology, gastroenterology, and GI surgery, as well as a methodology expert and a patient representative. A working definition of SSc-FI was established. Draft recommendations were developed through a literature review and expert consensus. Two rounds of online voting were conducted, requiring ≥75% agreement in round one and ≥60% in round two for inclusion. In the first and second voting rounds, participation rates were 63.2% and 84.2%, respectively. All 22 draft recommendations were approved, with most (21) reaching consensus in the first round. Recommendations span five domains: general management approach (n=3); clinical assessment and non-pharmacological interventions (n=7 and n=3, respectively); management of FI in the context of diarrhea (n=5); and alternative interventions and strategies (n=4). These are the first practical recommendations for managing SSc-related FI. They emphasize a structured, multidisciplinary approach to care, highlight unmet clinical needs, and lay the foundation for a research agenda to advance the understanding and treatment of this underrecognized complication in patients with SSc.
The rapid adoption of robotic surgical systems globally has created a critical gap in training, assessment and certification for visceral and gastrointestinal (GI) surgical trainees. This study, led by the European Association for Endoscopic Surgery (EAES), aimed to achieve an international consensus on a structured, platform-agnostic robotic training curriculum for GI surgical trainees. A 106-item Delphi questionnaire was developed with an international committee of surgical experts, trainees, methodologists and patient representatives. It was disseminated to a multidisciplinary panel of 83 GI robotic surgeons, trainees, human factors experts, robotic theatre team members and industry providers. Two Delphi survey rounds were conducted, with a priori consensus standard set at 70% or higher for agreement. A consensus meeting was subsequently held to discuss and finalise the items needed for a robotic training curriculum for GI surgical trainees. Seventy-one (86%) participants from 15 countries completed round 1. A total of 82 items (77%) reached consensus and 32 new items were generated from free-text comments. Seventy of these participants (99%) completed the 56-item round 2 questionnaire, with 36 items (64%) reaching consensus and 5 new items generated. All 143 statements were discussed in the meeting and consensus was reached in the following areas: (i) key knowledge requirements of the bedside assistant and a console surgeon; (ii) training components; (iii) performance assessment and (iv) certification and supervision. International surgical experts, trainees and other key stakeholders reached consensus on the critical components of a platform-agnostic robotic training curriculum for GI surgical trainees. This will help shape the future of robotic surgical education and certification, promote standardised training practices and ultimately benefit patient safety and outcomes.
This is the second of two articles presenting the European Crohn's and Colitis Organisation [ECCO] evidence‑based consensus guidelines on the management of adult patients with ulcerative colitis [UC]. The first article covers the medical management of UC, including acute severe colitis. The present article addresses the surgical management of medically refractory UC, including the general surgical approach and perioperative optimisation, surgical strategies and techniques, and recommended levels of centre expertise and surgical specialisation. Together, these two articles aim to inform shared decision‑making and to guide clinicians and healthcare professionals involved in the care of patients with UC, drawing on the best available evidence.
Population ageing in Europe is reshaping the clinical profile and outcomes of lower gastrointestinal bleeding (LGIB), but age-related comparative data remain scarce. We aimed to compare clinical presentation, management and 30-day outcomes between older and younger adults with LGIB. This retrospective, multinational, cohort study included consecutive adults presenting to emergency departments with LGIB between January 1 and December 31 in 2024. European hospitals routinely managing LGIB were eligible to participate. Ethical approval was obtained at hospital level. Patients were categorised in two age groups (≥65 and <65 years). The primary outcome was 30-day mortality. Overall, 1058 patients from 11 centres in seven European countries were included. Of these, 77.3% (818/1058) were aged ≥65 years and demonstrated a higher Oakland (21.0 ± 7.15), ABC (4.0 ± 2.9), and ALIBI (8.94 ± 3.7) scores, and a higher transfusion rate (50.9%, 416/818). Aetiology differed by age, with anorectal and inflammatory bowel diseases more common in younger adults and diverticular bleeding predominating in older patients. Endoscopy was performed in most patients (84.9%, 899/1058) and the rates of endoscopic therapy, interventional radiology, and surgery were similar across groups. Overall, 30-day mortality was 11.7% (124/1058) and was higher in older adults (13.7%, 112/818 versus 5.0%, 12/240), mainly due to non-bleeding-related causes (89.3%, 100/112). In multivariable analyses, ALIBI score (OR = 1.26 per-point, 95% CI 1.14-1.39), ABC score (OR = 1.25 per-point, 95% CI 1.15-1.36), and Charlson Comorbidity Index (OR = 1.25 per-point, 95% CI 1.14-1.37) were independently associated with 30-day mortality (p < 0.001). Age was inversely associated with intensive care unit admission (OR = 0.95 per-year, 95% CI 0.92-0.98; p = 0.0028). LGIB in older adults presents distinct clinical features with more severe bleeding. Higher baseline vulnerability might explain the age-related differences in escalation of care and worse outcomes. This supports the need for better integrated pathways of care in ageing European populations. FCT-Fundação para a Ciência e a Tecnologia.