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• W3029355360 abstract "United European Gastroenterology JournalVolume 6, Issue S8 p. A1-A134 UEG Week 2018 Oral PresentationsOpen Access UEG Week 2018 Oral Presentations First published: 01 October 2018 https://doi.org/10.1177/2050640618792817AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Monday, October 22, 201808:00–10:00 Opening Session: Part 1 – Room A____________________ OP001 EARLY ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY WITH BILIARY SPHINCTEROTOMY OR CONSERVATIVE TREATMENT IN PREDICTED SEVERE ACUTE BILIARY PANCREATITIS (APEC): A MULTICENTER RANDOMIZED CONTROLLED TRIAL N.J. Schepers 1,2, on behalf of the Dutch Pancreatitis Study Group 1Erasmus MC University Medical Center, Dept. of Gastroenterology and Hepatology, Rotterdam, Netherlands 2St. Antonius Hospital, Dept. of Gastroenterology and Hepatology, Nieuwegein, Netherlands Contact E-Mail Address: n.schepers@pancreatitis.nl Introduction: Patients with acute biliary pancreatitis may develop cholangitis, organ failure and other life-threatening complications. Early biliary decompression by endoscopic retrograde cholangiography (ERC) and biliary sphincterotomy may ameliorate the disease course, but previous randomized trials have shown conflicting results. Recent guidelines advise ERC in biliary pancreatitis only in case of cholangitis, and to consider ERC in case of (persistent) cholestasis. Whether early ERC and biliary sphincterotomy is beneficial in patients with predicted severe acute biliary pancreatitis with or without cholestasis, but without cholangitis, remains debated. Aims and Methods: We randomized 230 patients in 25 Dutch hospitals with predicted severe acute biliary pancreatitis (based on an Acute Physiology and Chronic Health Evaluation [APACHE II] score of ≥8, a modified Imrie score of ≥3 or a C-reactive protein level of >150 mg/L within 24 hours of admission) and without cholangitis, to early ERC with biliary sphincterotomy within 24 hours after presentation at the emergency department or conservative treatment with on-demand ERC in case of cholangitis or persistent cholestasis. The primary end point was a composite of death or major complications (i.e. new-onset persistent organ failure, cholangitis, bacteremia, pneumonia, pancreatic necrosis and pancreatic insufficiency) during 6 months of follow-up. Patients were stratified for the presence of cholestasis (based on a bilirubin level of >40µmol/L or a dilated common bile duct (defined as >8mm in patients ≤75 years or >10mm in patients >75 years)). Results: The primary end point occurred in 45 of 117 patients (39%) in the early ERC group compared with 50 of 113 patients (44%) in the conservative group (risk ratio 0.89; 95% confidence interval 0.68-1.15; p = 0.37). 112 patients (96%) in the early ERC group underwent ERC at a median of 20 hours after presentation at the emergency department (interquartile range [IQR] 14-23 hours), and after a median of 29 hours after onset of symptoms (IQR 22-44 hours). Biliary sphincterotomy was performed in 90 patients (78%). In 35 of the 113 patients (31%) allocated to conservative treatment, ERC was performed later in the disease course for cholangitis or persisting cholestasis after a median of 8 days (IQR 3-34 days) after randomization. In the early ERC group, cholangitis occurred less often compared with conservative treatment (2% versus 10%; p = 0.01) without significant differences in patient outcome including new-onset organ failure (19% versus 15%; p = 0.45), death (7% versus 9%; p = 0.57) or other components of the primary end point. In the conservative group with on-demand ERC, the total number of ERCs decreased with 66% (128 versus 44 ERCs) without negatively impacting overall outcome. In the subgroup of patients with cholestasis at randomization, no statistically significant difference in the primary end point was found (32% versus 43%; risk ratio 0.79; 95% confidence interval 0.57-1.10; p = 0.18). Conclusion: In patients with predicted severe acute biliary pancreatitis without cholangitis, early ERC with endoscopic biliary sphincteromy within 24 hours after presentation at the emergency department did not reduce the primary end point of death or major complications. Disclosure: NJS reports grants from Dutch Organization for Health Research and Development (ZonMw, Grant no. 837002008) and from Fonds NutsOhra (Grant no. 1203-052). The sponsors had no involvement in any stage of the study design or analysis and interpretation of the study results. Reference 1Schepers NJ, Bakker OJ, Besselink MG, et al. Early biliary decompression versus conservative treatment in acute biliary pancreatitis (APEC trial): study protocol for a randomized controlled trial. Trials 2016; 17: 5. OP002A COMPREHENSIVE MOLECULAR CLASSIFICATION OF CROHN'S DISEASE USING GENE EXPRESSION DATA K. Perez 1,2, L. Le Bourhis1, M. Ngollo1, J. Panés3, A. Salas3, P. Seksik4, D. Haller5, M.J. Daly2, M. Allez1 1Hopital Saint-Louis APHP, Université DenisDiderot Paris 7, Paris, France 2Broad Institute of MIT and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, United States 3Hospital Clínic Barcelona Dept. of Gastroenterology – Dept. of Gastroenterology, Hospital Clínic Bar, Barcelona, Spain 4Gastroenterology & Nutrition Department, Gastroenterology and Nutrition Unit, Paris, France 5Technische Universität München Inst. für Ernährungswissenschaften, Freising, Germany Contact E-Mail Address: kperez@broadinstitute.org Introduction: There is an important heterogeneity among Crohn's disease patients including clinical presentation and severity, disease location, disease behavior, presence of extra-intestinal manifestations or not, disease course or individual response to therapies. There is also a huge number of genetic combinations and exposition to environmental factors. At the molecular level, transcriptome performed on mucosal samples exhibit a striking heterogeneity. A molecular classification could prove more relevant to predict disease course, response to treatment and to identify new drug targets. Aims and Methods: Our aims are to identify shared and unique molecular features, clinically significant subtypes, and potential therapeutic targets. We conducted an integrated analysis of several cohorts from the IBD Over Time (IBDOT) consortium, including surgical samples of ileal disease and endoscopic samples of both ileal and colonic disease. We also searched for data available in the public domain. We performed molecular clustering (ConsensusClusteringPlus) using mRNA from microarray and RNA-seq, after correcting for batch effect. Cibersort was used to impute immune cells fractions from bulk transcriptome. Finally, KEGG pathway analysis was performed to characterize identified clusters. Results: We included in the analysis 580 samples of the IBDOT consortium (all by microarray) and 971 samples available in the public domain (508 by RNA-Seq and 736 by microarray). We saw a clear batch effect between the different platforms and cohorts. Colonic and ileal samples were well clustered together in each cohort. After correction for batch effect using biopsy location as a covariate, we identified 4 robust clusters of Crohn's disease samples. Colonic samples clustered together (C3). Ileal samples clustered mainly in 2 groups, 1 APOA1-low highly inflammatory (C1), the other APOA1-high less inflammatory (C2). The fourth group (C4) was smaller and contained ileal samples only. Immune cells fractions showed a neutrophilic infiltration in C1, and a higher proportion of CD8 T cells and Gamma-Delta T cells in C2. Pathway analysis confirmed a typical IBD-like inflammation in C1, and a more subdued inflammation in C2. Conclusion: We performed the first molecular classification of Crohn's disease using more than 1500 gut samples from 6 different cohorts. 4 robust disease groups were identified, representing both disease location and levels of inflammation. Some limitations were the high heterogeneity of disease stage and limited data on disease characteristics for the data collected in the public domain. Future work could look at the disease course of these 4 clusters and determine their persistence over time. Disclosure: Nothing to disclose Monday, October 22, 201810:30–12:00 Opening Session: Part 2 – Room A____________________ OP003NLRP6 SUPPORTS SURVIVAL OF T HELPER 1 CELLS BY REGULATING APOPTOSIS K. Radulovic 1, B. Kaya1, P. Wuggenig1, P. Hruz1,2, B. Weigmann3, J.H. Niess1,2 1University of Basel, Department of Biomedicine, Basel, Switzerland 2Basel University Hospital, Gastroenterology and Hepatology, Basel, Switzerland 3University of Erlangen-Nuremberg, Department of Medicine 1, Erlangen, Germany Contact E-Mail Address: janhendrik.niess@usb.ch Introduction: NOD-like family pyrin domain containing 6 (NLRP6) protects from DSS colitis, and NLRP6-deficient animals have a dysbiotic microbiota (1,2). In other animal facilities variants in the composition of the microbiota between wt and NLRP6-deficient animals are explained by cage effects and mother variates but not by the genotype (3,4). Although intestinal epithelial cells highly express NLRP6, the reconstitution of wt animals with Nlrp6-deficient bone marrow leads to similar colitis-associated tumor formation as in Nlrp6-deficient animals (5). Aims and Methods: NLRP6 is highly expressed by epithelial and goblet cells, but its function in hematopoietic cells is rather unknown. Here, we determined the expression of NLPR6 in in vitro differentiated T cells, and in T cells after co-transfer of wt and NLPR6-deficient T cells in RAG hosts to minimize the influence of different microbiotas on NLPR6 expression by T cells. Results: NLPR6 is not expressed by naïve CD4 and CD8 T cells, B cells and bone marrow-derived macrophages in contrast to epithelial cells. When naïve T cells are differentiated to Th1 cells, Th1 cells express NLPR6, whereas only a minority of differentiated Th2 cells and Th17 have NLPR6. Promoter analysis of the human and mouse NLPR6 starting site revealed binding regions for STAT1, STAT5a and Tbx21 (T-bet). T-bet induced NLPR6 expression in differentiated Th1 cells because NLPR6 was not detected in Tbx21-deficient T cells. The production of IFNg by NLPR6-deficient Th1 cells is reduced compared to wt T cells, which is independent of inflammasome assembly, because in ASC-deficient T cells differences in IFNg production was not observed. Moreover, differences in IL-13 and IL-17 production by in vitro differentiated Th2 and Th17 cells and differences in Foxp3 Treg cells between wt and NLPR6-deficient T cells was not observed. Similar frequencies of wt and NLPR6-deficient T cells entered the active phase of the cell cycle as indicated by Ki67 staining and had similar proliferative capacities as determined by CFSE washout. T cell developmental defects were not observed in wt and NLPR6-deficient littermates in thymus, spleen lymph nodes and colonic lamina propria. However, reduced numbers of NLPR6-deficient T cells with reduced IFNg production were noted after co-transfer of wt and NLPR6-deficient T cells in RAG hosts. Principle component analysis of RNA-seq from wt and NLPR6-deficient T cells obtained from reconstituted RAG hosts revealed a two-cluster structure, which was confirmed by hierarchical clustering of all differentiated genes with no influence of the host on T cells. The 628 down- and the 923 up-regulated genes were compared to hallmark signatures, which revealed enrichment of apoptosis, interferon gamma response, inflammatory response, IL-6 JAK STAT3 signaling and TNFα signaling signatures in NLPR6-deficient T cells. Annexin V/viability staining confirmed increased apoptosis of NLPR6-deficient T cells compared to wt T cells after co-transfer in RAG hosts. Transfer of wt CD45RBhigh T cells into RAG hosts resulted in somewhat increased body weight loss and increased disease scores compared to RAG hosts receiving NLPR6-deficient T cells two weeks after transfer. Conclusion: The expression of NLPR6 by differentiated Th1 cells is rather intrinsic induced and independent of different microbiotas because NLPR6 expression was observed by in vitro differentiated T cells. As consequence increased apoptosis was observed after transfer of NLPR6-deficient T cells in RAG hosts. NLRP6 facilitates the survival of CD4 T cells. Disclosure: Nothing to disclose References 1Levy M et al, Cell. 2015 Dec 3; 163(6): 1428– 43. 2Elinav E et al., Cell. 2011 May 27; 145(5): 745– 57. 3Mamantopoulos M et al. Immunity. 2017 Aug 15; 47(2): 339– 348. 4Lemire P et al. Cell Rep. 2017 Dec 26; 21(13): 3653– 3661. 5Chen GY et al. J Immunol. 2011 Jun 15; 186(12): 7187– 94. OP004 EARLY SURGERY VERSUS STEP-UP PRACTICE INCLUDING ENDOSCOPY FOR CHRONIC PANCREATITIS: A MULTICENTER RANDOMIZED CONTROLLED TRIAL [ESCAPE TRIAL] Y. Issa 1, M.A. Kempeneers2, M.J. Bruno3, P. Fockens4, J.W. Poley5, U. Ahmed Ali2, T. Bollen6, O.R.C. Busch7, C.H. Dejong8, P. Van Duijvendijk9, H. van Dullemen10, C.H.J. van Eijck11, H.V. Goor, M. Hadithi12, J.W Haveman13, Y.C.A. Keulemans14, V. Nieuwenhuijs15, A.C. Poen16, E.A.J. Rauws17, A.C. Tan14, W.J. Thijs18, R. Timmer19, B.J.M. Witteman20, M.G.H. Besselink21, J.E. van Hooft2, H.C. van Santvoort22, M.G.W. Dijkgraaf23,24, M.A. Boermeester25, Dutch Pancreatitis Study Group.1 1Academic Medical Center (AMC), Amsterdam, Netherlands 2Academic Medical Center (AMC), Department of Surgery, Amsterdam, Netherlands 3University Medical Center Rotterdam, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands 4Academic Medical Center Gastroenterology & Hepatology, Amsterdam, Netherlands 5Erasmus University Medical Center, Rotterdam, Netherlands 6St. Antonius Ziekenhuis, Nieuwegein, Netherlands 7Academic Medical Center (AMC), Gastro-Intestinal Surgery, Amsterdam, Netherlands 8Maastricht University Medical Center +, Surgery, Maastricht, Netherlands 9Gelre Ziekenhuizen Apeldoorn, Surgery, Apeldoorn, Netherlands 10University Medical Centre Groningen, Gastroenterology and Hepatology, Groningen, Netherlands 11Erasmus Medical Center, Rotterdam, Netherlands 12Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands 13Maasstad Hospital, Dept. Internal Medicine, Rotterdam, Netherlands 14UMC Groningen, Groningen, Netherlands 15Zuyderland Medical Center, Netherlands 16Isala Clinics, Zwolle, Netherlands 17Isala Clinics, Isala Zwolle, Zwolte, Netherlands 18Canisius Wilhelmina Hospital Dept. of Hepatogastroenterology, Nijmegen, Netherlands 19Martiniziekenhuis Dept. of Gastroenterology, Groningen, Netherlands 20St. Antonius Hospital, Dept. of Gastroenterology, Nieuwegein, Netherlands 21Gelderse Vallei Hospital, Wageningen, Netherlands 22Academic Medical Center (AMC), Gastroenterology and Hepatology, Amsterdam, Netherlands 23University Medical Center Utrecht, Surgery, Utrecht, Netherlands 24St. Antonius Hospital, Nieuwegein, Netherlands Contact E-Mail Address: m.a.kempeneers@amc.uva.nl Introduction: Surgery for chronic pancreatitis is currently used as last resort treatment when the first steps of the step-up approach, medical and endoscopic treatment, have failed. It has been suggested that early surgery may lead to better pain relief and preservation of pancreatic function, as compared to the current step-up approach of medical and endoscopic treatment, and surgical therapy if all else fails. We conducted a multicenter randomized controlled trial to compare early surgery with the current step-up approach. Aims and Methods: We included patients with chronic pancreatitis according to the MANNHEIM criteria with a dilated pancreatic duct (≥ 5 mm) and severe continuous or intermittent pain attacks, who had only recently started treatment with opioids. Patients who used strong opioids for more than 2 months or weak opioids for more than 6 months in the last 2 years were excluded. Patients were randomly assigned to early surgery (6 weeks after randomization; if pancreatic head < 4cm: lateral pancreatojejunostomy, if ≥4cm: Frey procedure) or to the step-up approach (step 1: pain medication, step 2: endoscopic intervention, if step 1 failed, step 3: surgical intervention, if step 2 failed). Failure criteria were strictly defined. The primary endpoint was the mean Izbicki pain score during 18 months of follow-up. Secondary endpoints included pain relief, complications, mortality, number of interventions, pancreatic function, and quality of life. Results: 88 patients were randomized according to calculated sample size; 44 to early surgery (41 indeed underwent surgery) and 44 to the step-up approach (44 underwent medical treatment, 39 endoscopic intervention, and 13 surgical intervention thereafter). During 18 months' follow-up patients in the early surgery group had a lower mean Izbicki pain score as compared to patients in the step-up approach (35 vs. 48, p = 0.018). Taken into account the baseline pain score, early surgery showed a larger decrease in Izbicki pain score during follow-up (-26 vs. -16, p = 0.04). Complete or partial pain relief during follow-up was achieved in 54% of patients in early surgery and in 33% of patients in the step-up approach (RR: 1.52 [1.40-1.66], p < 0.001). Fewer interventions were performed in the early surgery group compared to the step-up group (median 1 vs. 3, P < 0.001). Complications, mortality (0%), hospital readmission, pancreatic function and quality of life were comparable between groups. Conclusion: Early surgery, within the first months of need for opioid use, for patients with chronic pancreatitis and a dilated pancreatic duct provides better pain relief with less interventions than the current step-up approach including endoscopy first, but quality of life is comparable. Disclosure: Nothing to disclose Monday, October 22, 201810:30–12:00 Endoscopic resection of polyps – Room B____________________ OP005 ASSISTANCE OF A REAL-TIME AUTOMATIC COLON POLYP DETECTION SYSTEM INCREASES POLYP AND ADENOMA DETECTION DURING COLONOSCOPY: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY P. Wang 1, S. Bharadwaj2, T.M. Berzin2, A. Becq2, L. Li1, P. Liu1, X. Xiao1, Y. Song1, D. Zhang1, Y. Li1, G. Xu1, M. Tu1, X. Xiao3, Z. Zhang3, J. He3, X. Yi3, W. Pan3, J. Liu3, X. Liu1 1Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China 2Beth Israel Deaconess Medical Center and Harvard Medical School, Center for Advanced Endoscopy, Boston, United States 3Shanghai Wision AI Co. Ltd, Shanghai, China Contact E-Mail Address: 360649580@qq.com Introduction: Screening colonoscopy can reduce the incidence and mortality of colorectal cancer through detection of polyps. However, a miss rate of up to 27% has been reported for adenomas. Aims and Methods: The aim of this study was to investigate whether an automatic polyp detection system during colonoscopy increased the polyp and adenoma detection rate. Consecutive patients were prospectively randomized to undergo routine colonoscopy with or without assistance of real-time automatic polyp detection system providing a simultaneous visual notice and sound alarm when a polyp was detected. The automatic polyp detection system used in this study was a previously validated deep-learning polyp detection software1. Results: Out of 1,058 patients, 536 were randomized to a colonoscopy (control group), and 522 to a colonoscopy with computer-aided diagnosis (CAD group). There is no statistical difference between 2 groups in demographics and adenoma risk factors, including age (p = 0.16), gender (p = 0.19), BMI (p = 0.99), family/personal adenoma history (p = 0.34/0.8), and family colon cancer history (p = 0.78) etc. A total of 767 polyps, 422 adenomas and 31 serrated adenomas were detected. The polyp detection rate (PDR) of the control and CAD groups were 29.10% and 45.02% respectively (OR = 1.995, 95% CI 1.532-2.544, p < 0.001). The adenoma detection rates (ADR) were 20.34% and 29.12% respectively (OR = 1.61, 95% CI 1.213-2.135, p < 0.001). The average number of polyps detected were 0.50 and 0.95 respectively (Change Folds = 1.89, 95% CI 1.63-2.192, p < 0.001). The average number of adenomas detected were 0.31 and 0.53 respectively (Change Folds = 1.72, 95% CI 1.419-2.084, p < 0.001). There was a total of 39 false alarms and no missed polyp by the automatic polyp detection. Conclusion: Automatic polyp detection during colonoscopy resulted in an increase in the number of polyps and adenomas found per colonoscopy and improved the overall ADR and PDR. Control Group (N = 269) CAD Group (N = 498) P value Pathology. Carcinoma 0 (0%) 0 (0%) 1 Pathology.SSAP 14 (5.20%) 17 (3.41%) 0.541 Pathology. Adenoma 160 (59.48%) 262 (52.61%) <0.001 Pathology. Benign Lesions 95 (35.32%) 219 (43.98%) <0.001 Polyp Location <0.001 Polyp Location. Cecum 3 (1.12%) 5 (1.00%) 0.462 Polyp Location. Transverse 45 (16.73%) 110 (22.09%) <0.001 Polyp Location. Descending 26 (9.67%) 75 (15.06%) <0.001 Polyp Location. Rectum 69 (25.65%) 81 (16.27%) 0.254 Polyp Location. Ascending 47 (17.47%) 97 (19.48%) <0.001 Polyp Location. Sigmoid 79 (29.37%) 130 (26.10%) <0.001 Polyp Shape 0.076 Polyp Shape. Pedunculated 38 (14.13%) 49 (9.84%) 0.194 Polyp Shape. Not Pedunculated 231 (85.87%) 449 (90.16%) <0.001 Polyp Size (mm) Mean 5.03 (SD 3.72) Mean 4.51 (SD 2.55) 0.05 Polyp Size Category 0.096 Polyp Size Category.0-5 mm 198 (73.61%) 399 (80.12%) <0.001 Polyp Size Category.6-10 mm 61 (22.68%) 83 (16.67%) 0.047 Polyp Size Category.>10 mm 10 (3.72%) 16 (3.21%) 0.218 [Comparison of polyp characteristics by automatic polyp detection status] Disclosure: Nothing to disclose Reference 1A Prospective Validation of Deep Learning for Polyp Auto-detection during Colonoscopy. World Congress at ACG2017. https://www.eventscribe.com/2017/wcogacg2017/ajaxcalls/PresentationInfo.asp?efp=S1lVTUxLQVozODMy&PresentationID=304929&rnd=0.7090379 . OP006 POTENTIAL ACCEPTABILITY OF A WATCH-AND-WAIT APPROACH FOR DIMINUTIVE COLORECTAL ADENOMAS: FIVE-YEAR INCIDENCE OF ADVANCED COLORECTAL NEOPLASIA IN INDIVIDUALS WITH UNTREATED DIMINUTIVE ADENOMAS M. Sekiguchi 1,2,3, Y. Otake4, Y. Kakugawa3, M. Matsumoto3, Y. Saito3, T. Matsuda1,2,3 1National Cancer Center Hospital, Cancer Screening Center, Tokyo, Japan 2Center for Public Health Sciences, National Cancer Center, Division of Screening Technology, Tokyo, Japan 3National Cancer Center Hospital, Endoscopy Division, Tokyo, Japan 4Ota Memorial Hospital, Division of Gastroenterology, Gunma, Japan Contact E-Mail Address: masekigu@ncc.go.jp Introduction: Removal of all colorectal adenomas during colonoscopy (CS) is recommended; however, the increasingly frequent detection of diminutive adenomas raises the question as to whether the removal of all is mandatory, balancing benefit and harms.1 The increasing use of antithrombotic drugs and possibility of missed diminutive adenomas may also require discussion regarding the acceptability of a watch-and-wait approach for diminutive adenomas. Although the watch-and-wait approach is allowed in Japan,2 evidence is lacking for it. Aims and Methods: This study aimed to evaluate the cumulative incidence of advanced colorectal neoplasia (ACN) in individuals with untreated diminutive adenomas, and to compare this with the incidence in those without adenomas. The incidence was also evaluated after identifying and adjusting for risk factors for the incidence of ACN. Data from 1,378 consecutive asymptomatic individuals who underwent first screening CS and at least one follow-up CS without polypectomy at the Cancer Screening Center, National Cancer Center, Tokyo, between February 2004 and March 2013 were analyzed. Those with no adenomas or only nonadvanced diminutive adenomas (<5 mm) confirmed by image-enhanced magnifying endoscopy were scheduled to undergo follow-up CS within 5 years after the initial CS without treatment. Thus, participants were classified into two groups; those with untreated diminutive adenomas (group A) and those without any adenomas (group B). The cumulative incidence of ACN in both groups was assessed in March 2018, using Gray's test with consideration of competing risk situations. Multivariate analysis using the Fine and Gray model was performed to identify independent risk factors for the incidence of ACN among the following factors: age, sex, family history of colorectal cancer, smoking, drinking, nonsteroidal anti-inflammatory drugs, body mass index, diabetes mellitus, and the presence and number of untreated diminutive adenomas. Results: There were 361 and 1,017 participants in groups A and B, respectively. There were 1-6 untreated diminutive adenomas in each group A participant, and 335 participants (92.8%) had less than 3. During a median follow-up of 60.9 months (interquartile range 40.8-64.2), 21 ACNs, including one T1 colon cancer, were detected in 18 individuals. The number of colonoscopies performed per individual was two in both groups (p = 0.93), and the 5-year cumulative incidences of ACN in group A and B were 1.4% (95% CI 0.5-3.4) and 0.8% (95% CI 0.3-1.7), respectively, with no significant difference between the groups (p = 0.23). Endoscopic findings showed that no ACN grew from an untreated adenoma. The only independent risk factor for the incidence of ACN was current smoking (hazard ratio 5.7; p < 0.01); presence and number of untreated diminutive adenomas did not affect the incidence of ACN. After adjustment for smoking status, the 5-year cumulative incidences of ACN in groups A and B were 1.0% (95% CI 0.0-2.2) and 0.7% (95% CI 0.1-1.2), respectively. Conclusion: The 5-year cumulative incidence of ACN in those with untreated diminutive adenomas was sufficiently low, and was similar to that in those with no adenomas, indicating the potential acceptability of a watch-and-wait approach for diminutive adenomas. The present findings may be useful for consideration of more practical screening and surveillance programs, although further assessment is required particularly for cases with many diminutive adenomas. The potential necessity for consideration of smoking status in surveillance is also worth further investigation. Disclosure: Nothing to disclose References 1Brenner H, et al. Gastrointest Endosc. 2017; 85: 1177– 9. 2Tanaka S, et al; Japanese Society of Gastroenterology. J Gastroenterol. 2015; 50: 252– 60. Monday, October 22, 201810:30–12:00 Epidemiology and treatment options in NASH – Room E1____________________ OP007 SERUM SRAGE LEVELS ARE ASSOCIATED WITH LIFESTYLE AND WITH NON-ALCOHOLIC FATTY LIVER DISEASE D. Ivancovsky-Wajcman 1, S. Zelber-Sagi1,2, N. Fliss Isakov2, M. Webb2,3, O. Shibolet2,3, R. Kariv2,3 1University of Haifa, School of Public Health, Haifa, Israel 2Tel-Aviv Medical Center, Department of Gastroenterology, Tel Aviv, Israel 3Tel-Aviv University, The Sackler Faculty of Medicine, Tel Aviv, Israel Contact E-Mail Address: danaivanc@gmail.com Introduction: Non-alcoholic fatty liver disease (NAFLD) is strongly related with lifestyle. Advanced glycation end products (AGEs), derived also from diet, have been positively related with NAFLD, while its soluble receptor (sRAGE) acts as a decoy. The association of sRAGE with NAFLD has been scarcely studied. Moreover, little is known about lifestyle-related determinants of sRAGE levels. Aims and Methods: The aim of this study was to test the association of sRAGE with lifestyle and NAFLD. A cross-sectional study among subjects 40-70 years old, participating in a screening study, undergoing abdominal ultrasonography to diagnose NAFLD and fasting blood tests. Nutritional index consumption was measured by food frequency questionnaire (FFQ) and life-style habits were measured by a structured questionnaire. Low sRAGE levels were defined as a level below the population lower tertile (<1013 pg/ml). Results: A total of 789 subjects had valid FFQ. High processed and/or red meat consumption (above the third tertile) was associated with higher odds of low sRAGE, respectively (OR = 1.49, 1.00-2.21, p = 0.048), adjusting for gender, age, abdominal obesity and caloric intake. Conversely, greater exercise time (above the median) was associated with reduced odds for low sRAGE (OR = 0.68, 0.49-0.94, p = 0.020). Subjects with low sRAGE had higher odds for NAFLD (OR = 1.51, 1.01-2.27, p = 0.045) and elevated ALT among NAFLD subjects (OR = 1.72, 1.12-2.64, p = 0.014) and among the entire sample (OR = 2.27 95%CI 1.28-4.04, p = 0.005). Conclusion: Diet and exercise are associated with serum sRAGE levels and, in turn, low levels of sRAGE are associated with NAFLD and elevated ALT levels. Disclosure: Nothing to disclose OP008 HYPOXIA-INDUCIBLE FACTOR 2ALPHA IS CRITICAL FOR NASH-RELATED EXPERIMENTAL LIVER CARCINOGENESIS B. Foglia 1, E. Morello1, S. Sutti2, S. Cannito1, E. Novo1, C. Bocca1, S. Bruzzi'2, N.N. Ramavath2, C. Rosso3, R. Younes3, E. Bugianesi3, E. Albano2, M. Parola1 1Università Degli Studi Di Torino, Clinical and Biological Sciences, Torino, Italy 2A. Avogadro University, Dept. Health Sciences, Novara, Italy 3AOU Città della Salute e della Scienza University of Torino, Torino, Italy, Medical Sciences, Torino, Italy Contact E-Mail Address: beatrice.foglia@u" @default.
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