Objective Ampullary neoplastic lesions can be resected by endoscopic papillectomy (EP) or transduodenal surgical ampullectomy (TSA) while pancreaticoduodenectomy is reserved for more advanced lesions. We present the largest retrospective comparative study analysing EP and TSA. Design Of all patients in the database, lesions with prior interventions, benign histology advanced malignancy (T2 and more), patients with hereditary syndromes and those undergoing pancreatoduodenectomy were excluded. All remaining cases as well as a subgroup of them, after propensity-matching (nearest-neighbour-method) based on age, gender, anthropometrics, comorbidities, size and histological subtype, were analysed. The median follow-up was 21 months (IQR 10-47) after the primary intervention. Primary outcomes were rates of complete resection (R0) and complications. Groups were compared by Fisher's exact or chi(2) test, Mann-Whitney-U-test and log-rank test for survival. Results Of 1673 patients in the database, 1422 underwent EP and 251 TSA. Of them, 23.2% were excluded for missing or inconclusive data and 19.8% of patients for prior interventions or hereditary syndromes. Final histology showed in 24.2% of EP and 14.8% of TSA patients a histology other than adenoma or adenocarcinoma while advanced cancers were recorded in 10.9% of EP and 36.6% of TSA patients. Finally, 569 EP and 63 TSA were included in the overall analysis, with a higher rate of more advanced cases and higher R0 resection rates in the TSA groups (90.5% vs 73.1%; p<0.01), with additional ablation in the EP group in 14.4%. Severe adverse event rates were 3.2% (TSA) vs 1.9% (EP). Recurrence after histological R0 resection was 16% (EP) vs 3.2% (TSA; p=0.01), and additional therapy for R1 resection was applied in 67% of the 159 cases. Propensity-score-based matching identified 62 pairs of EP/TSA patients with comparable baseline patient and lesion characteristics. The initial R0-rate was 72.6% (EP) compared with 90.3% (TSA, p=0.02) with recurrences found in 8% (EP) vs 3.2% (TSA; p=0.07); reinterventions were more frequent in the EP group. Overall survival was comparable. Conclusions The rate of patients with poor indications due to non-neoplastic disease or advanced cancer is still high for both EP and TSA; multiple retreatments were necessary for EP. Although EP can be considered an appropriate primary therapy for certain ampullary adenomas, case selection for both therapies (especially with regard to the best step-up approach) should be studied further.

Objectives Pain is the foremost complication of chronic pancreatitis (CP), affecting about 70% of patients. However, the pathophysiological understanding and management of CP-related pain are complex, likely as patients have diverse “pain phenotypes” responding differently to treatment. This study aims to develop a bedside test panel to identify distinct pain phenotypes, investigate the temporal evolution, and determine whether they can be used to predict treatment response. Methods The INPAIN study is an international, multicenter, observational, longitudinal cohort study consisted of 4 substudies. The studies will prospectively enroll 400 CP patients (50 without pain and 350 with pain) and 50 control subjects, conducting biannual observations for 4 years. The test panel is consisted of comprehensive subjective and objective assessment parameters. Statistical analysis strategies differ across the substudies. A model to predict treatment efficacy will be developed using various machine learning techniques, including an artificial intelligence approach, with internal cross-validation. Trajectories in pain parameters will be characterized by graphical analysis and mixed effect models. Discussion The INPAIN study aims to comprehensively understand pain in CP through a test panel developed for routine clinical use. This tool has the potential to personalize treatments, improve clinical practice, enhance patient care, improve quality of life, and minimize treatment side effects.

Establishing and nurturing strong patient relations stands as an essential pillar in the framework of UEG. Within Europe's diverse healthcare landscape, fostering strong relations and collaboration among the digestive health community will not only optimize healthcare outcomes but also establish solidarity and mutual understanding between healthcare professionals, patients, and patient advocates. By prioritizing patient-centered approaches in our advocacy efforts, and recognizing patient advocates as active partners, we ensure that healthcare services are tailored to meet individual needs and preferences. With these considerations in mind, at UEG Week 2023 in Copenhagen, UEG launched the Digestive Health Roundtable, a new format of dialog between experts in digestive health and dedicated patient advocates. This event marked the first in a series of multidisciplinary meetings, all driven by a shared purpose—to address challenges, identify opportunities and reach consensus on joint actions aimed at improving digestive health across Europe. We were pleased to be joined by representatives from the Association of European Coeliac Societies, Digestive Cancers Europe, the European Federation of Crohn's & Ulcerative Colitis Associations (EFCCA), the European Liver Patient Association, the Danish Celiac Association, the Danish Colitis-Crohn Association, and the Danish Liver Association. The meeting was also joined remotely by Dr Kremlin Wickramasinghe—Regional Adviser for Nutrition, Physical Activity and Obesity at WHO/Europe. He reported that, according to WHO data (WHO Global Health Estimates 2020), the burden of noncommunicable diseases has increased continuously over recent years worldwide, and in 2021 they caused 90% of deaths and 85% of years lived with disability in the WHO European Region. Digestive diseases were reported as the fourth cause of death among all NCD-related deaths in 2019. Moreover, Dr Wickramasinghe reported alarming data on obesity and overweight, notably in children, where the findings show that 29% of children in Europe, aged 7–9 years old, are overweight or obese (WHO European Childhood Obesity Surveillance Initiative [or COSI], Report on the fifth round of data collection, 2018–2020 [https://apps.who.int/iris/handle/10665/363950]). The roundtable attendees discussed recommendations across three core topics crucial to shaping a healthier future: prevention, early diagnosis, and quality of life (Figure 1). Visual representation of the group discussions involving medical experts and patient advocates on three key topics: prevention, early diagnosis, and quality of life. Prevention was identified as a core priority for the digestive health community. Among the challenges identified were low health literacy at societal levels, exacerbated by inadequate awareness and/or tools for early diagnosis for some conditions, and the persistent lack of incentives at the societal level for addressing addictions and/or implementing measures to improve digestive health. Furthermore, the erosion of trust in medical information and healthcare professionals following the COVID pandemic underscored the urgent need for intervention. It was recognized that current measures targeting risk factors often place undue emphasis on individual responsibility, neglecting systemic changes and lack of basic living conditions (like unemployment, poor housing, unsafe neighborhoods, pollution etc.). In response to these challenges, the group rallied around a series of proactive measures aimed at effecting positive change. These included a commitment to investing more in education across all social groups to enhance health literacy and community awareness, particularly regarding early signs of diseases, healthy habits, and the critical role of healthy nutrition. Additionally, there was consensus on the necessity of enhancing healthcare professionals' training, particularly in areas such as nutrition. The group also advocated for addressing physical inactivity in the workplace through the implementation of designated exercise time and the provision of on-site facilities to support employees. Furthermore, there was a resounding call for increased governmental and international investment in combating misinformation and disseminating credible, well-targeted information to rebuild trust in scientific evidence. This will improve the uptake of national vaccination and screening programs, and thereby improve health outcomes. Underlining the need for collaboration across various sectors, the group identified key stakeholders for engagement. These include actors of change such as parents and educators, who play pivotal roles in shaping health behaviors and attitudes from an early age. Additionally, actors of power such as local policymakers, the WHO, and EU institutions were highlighted as crucial collaborators in driving policy changes and implementing systemic interventions. Furthermore, the group underscored the importance of engaging with the food and agriculture industry, particularly in advising on topics of mutual interest, such as dietary requirements for coeliac patients. However, it was also noted that aligning with industries contributing to health harms, such as alcohol and tobacco, would be contrary to the group's mission, emphasizing the need for ethical partnerships in pursuit of improved digestive health outcomes. The group who discussed challenges related to diagnosis identified persistent barriers to accessing primary care, characterized by a lack of specific knowledge among healthcare providers and the burden of repeated examinations. Additionally, the group emphasized the widespread difficulty in accessing timely diagnoses across many countries, highlighting the detrimental impact of misdiagnosis on patients' quality of life and mental well-being. Furthermore, concerns were raised regarding the risk of overdiagnosis, particularly in cases where treatments may impact on patients' quality of life, as observed in certain cancer diagnoses. Knowledge of age-related signs and symptoms affects the efficiency of timely diagnosis, especially in the younger patients. In response to these challenges, the group presented a series of best practice examples aimed at improving healthcare delivery and patient outcomes. These included prioritizing prevention as the most cost-effective investment, increasing awareness of early disease signs within healthcare settings, and championing patient-centered care by involving patients as partners in their illness experiences. The group also underscored the importance of anti-stigma training for healthcare providers and the prioritization of transitional care services. Looking ahead, the group emphasized the critical importance of collaboration between healthcare professionals and patient representatives in developing evidence-based guidelines, which should be translated at national levels and made accessible to non-specialists. Furthermore, joint advocacy projects were deemed essential involving key stakeholders such as patient representatives, healthcare professionals, and policymakers. Collaboration with educational institutions and representatives from the school system was also highlighted as a vital avenue for promoting health literacy and early intervention initiatives within communities. When discussing quality of care, the biggest reported challenge faced by the patient community was the prevalent stigma experienced by patients, which takes a heavy toll on their well-being, particularly among those diagnosed with liver diseases and inflammatory bowel diseases. The group also highlighted the detrimental effects of a lack of knowledge, which often manifests in patients experiencing feelings of guilt and shame. Additionally, the strain placed on healthcare systems was identified as a significant factor impacting both the quality of life of healthcare professionals and their ability to deliver personalized and compassionate care, and the well-being of family members caring for patients. In response to these pressing issues, the group formulated a set of recommendations aimed at tackling these challenges head-on. These recommendations included prioritizing self-management education for patients, fostering effective communication between healthcare professionals and patients, and ensuring the active involvement of patients in setting standards of care. Furthermore, the group advocated for the implementation of holistic care approaches and the reduction of logistical and bureaucratic barriers within healthcare systems. Moreover, the identification and implementation of transitions of care interventions were deemed crucial steps toward improving the quality of life among patients and alleviating the burden on healthcare systems and caregivers alike. Through concerted action on these recommendations, the group endeavors to address the multifaceted challenges faced by individuals within the digestive health community, fostering improved outcomes and well-being for all stakeholders involved. In conclusion, the collaborative efforts initiated by the first Digestive Health Roundtable mark a significant step forward in enhancing patient relations within the digestive healthcare landscape. As we navigate the complexities of modern healthcare, it is imperative that we continue to prioritize the voices and experiences of patients, recognizing them as invaluable partners in the pursuit of improved health outcomes and quality of care. Moving forward, we remain committed to nurturing these relationships, advocating for the integration of joint recommendations into policy-making and clinical practice, and ensuring that every individual receives optimal care. The authors have no conflicts of interest to declare. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Background and Aims: Ampullary lesions (ALs) of the minor duodenal papilla are extremely rare. Endoscopic papillectomy (EP) is a routinely used treatment for AL of the major duodenal papilla, but the role of EP for minor AL has not been accurately studied. Methods: We identi fi ed 20 patients with ALs of minor duodenal papilla in the multicentric database from the Endoscopic Papillectomy vs Surgical Ampullectomy vs Pancreatitcoduodenectomy for Ampullary Neoplasm study, which included 1422 EPs. We used propensity score matching (nearest-neighbor method) to match these cases with ALs of the major duodenal papilla based on age, sex, histologic subtype, and size of the lesion in a 1:2 ratio. Cohorts were compared by means of chi -square or Fisher exact test as well as Mann -Whitney U test. Results: Propensity score - based matching identi fi ed a cohort of 60 (minor papilla 20, major papilla 40) patients with similar baseline characteristics. The most common histologic subtype of lesions of minor papilla was an ampullary adenoma in 12 patients (3 low-grade dysplasia and 9 high -grade dysplasia). Five patients revealed nonneoplastic lesions. Invasive cancer (T1a), adenomyoma, and neuroendocrine neoplasia were each found in 1 case. The rate of complete resection, en -bloc resection, and recurrences were similar between the groups. There were no severe adverse events after EP of lesions of minor papilla. One patient had delayed bleeding that could be treated by endoscopic hemostasis, and 2 patients showed a recurrence in surveillance endoscopy after a median follow-up of 21 months (interquartile range, 12-50 months). Conclusions: EP is safe and effective in ALs of the minor duodenal papilla. Such lesions could be managed according to guidelines for EP of major duodenal papilla. (Gastrointest Endosc 2024;99:587-95.)

Background Endoscopic retrograde cholangiopancreatography (ERCP) still has a relatively high complication rate, underscoring the importance of high-quality training. Despite existing guidelines, real-world data on training conditions remain limited. This pan-European survey aims to systematically explore the perceptions surrounding ERCP training. Methods A survey was distributed through the friends of United European Gastroenterology (UEG) Young Talent Group network to physicians working in a UEG member or associated states who regularly performed ERCPs. Results Of 1035 respondents from 35 countries, 649 were eligible for analysis: 228 trainees, 225 trainers, and 196 individuals who regularly performed ERCP but were neither trainees nor trainers. The mean age was 43 years, with 72.1% identifying as male, 27.6% as female, and 0.3% as non-binary. The majority (80.1%) agreed that a structured training regimen is desirable. However, only 13.7% of trainees and 28.4% of trainers reported having such a structured program in their institutions. Most respondents (79.7%) supported the concept of concentrating training in centers meeting specific quality metrics, with 64.1% suggesting a threshold of 200 annual ERCPs as a prerequisite. This threshold revealed that 36.4% of trainees pursued training in lower-volume centers performing <200 ERCPs annually. As many as 70.1% of trainees performed <50 annual ERCPs, whereas only 5.0% of trainers performed <50 ERCPs annually. A low individual trainee caseload (<50 ERCPs annually) was more common in lower-volume centers than in higher-volume centers (82.9% vs. 63.4%). Conclusions The first pan-European survey investigating ERCP training conditions reveals strong support for structured training and the concentration of training efforts within centers meeting specific quality metrics. Furthermore, this survey exposes the low availability of structured training programs with many trainees practicing at lower-volume centers and 71% of all trainees having little hands-on exposure. These data should motivate to standardize ERCP training conditions further and ultimately improve patient care throughout Europe.

BACKGROUND AND AIMS:Patients with alcohol-related liver disease (ALD) might be at increased risk of acute pancreatitis (AP), but large-scale data are lacking. METHODS:Population-based cohort study using data from the Swedish National Patient Register on 37,062 patients with ALD from 1969 to 2020. Patients were matched to ≤10 general population comparators (n = 352,931). We used logistic regression to estimate the risk of acute or chronic pancreatitis prior to ALD diagnosis and Cox regression to estimate rates for hospitalization for AP after ALD diagnosis. RESULTS:Median age at ALD diagnosis was 59 years; 72% were men, and 67% had cirrhosis at baseline. Overall, 7% had experienced pancreatitis before ALD diagnosis, resulting in 9-fold higher odds of pancreatitis compared to comparators. The 10-year cumulative incidence of hospitalization for AP was 2.7% (95%CI = 2.5-2.8) in ALD and 0.6% (95%CI = 0.58-0.63) in comparators, yielding an adjusted HR of 6.3 (95%CI = 5.8-6.9). Younger age, male sex, and diagnoses of alcohol use disorders and chronic obstructive pulmonary disease were independent risk factors for developing AP in ALD. Continued drinking after baseline was associated with a higher risk of AP (adjusted hazard ratio [aHR] 2.6, 95%CI = 2.29-2.85). CONCLUSIONS:ALD is associated with 9-fold higher odds of prevalent pancreatitis compared to the general population. The hospitalization rate for AP following ALD diagnosis is 6-fold higher. About 10% of patients with ALD have or develop AP, suggesting that assessing history of pancreatitis and its sequelae might be relevant for patients with ALD.

Aims: Diabetic foot ulcer (DFU) is a leading cause of lower limb amputations in people with diabetes. This study was aimed to retrospectively analyze factors affecting DFU using real-world data from a large, prospective central-European diabetes registry (DPV [Diabetes-Patienten-Verlaufsdokumentation]). Materials and Methods: We matched adults with type 1 (T1D) or type 2 diabetes (T2D) and DFU to controls without DFU by diabetes type, age, sex, diabetes duration, and treatment year to compare possible risk factors. Cox regression was used to calculate hazard ratios for amputation among those with DFU. Results: In our cohort (N = 63 464), male sex, taller height, and diabetes complications such as neuropathy, peripheral artery disease, nephropathy, and retinopathy were associated with DFU (all p < .001). Glycated hemoglobin (HbA1c) was related to DFU only in T1D (mean with 95% confidence interval [CI]: 7.8 [6.9-9.0] % vs 7.5 [6.8-8.5] %, p < .001). High triglycerides and worse low-density lipoprotein/high-density lipoprotein ratio were also associated with DFU in T1D, whereas smoking (14.7% vs 13.1%) and alcohol abuse (6.4% vs 3.8%, both p < .001) were associated with DFU in T2D. Male sex, higher Wagner grades, and high HbA1c in both diabetes types and insulin use in T2D were associated with increased hazard ratios for amputations. Conclusions: Sex, body height, and diabetes complications were associated DFU risk in adults with T1D and T2D. Improvement in glycemic control and lipid levels in T1D and reduction of smoking and drinking in T2D may be appropriate interventions to reduce the risk for DFU or amputations.

Nine females and six males from Europe and beyond: a quintet of Italians among two English, two Dutch, one German, one Iranian, one Czech, one Portuguese, one Maltese and one Turkish. Our group consists of basic scientists, clinical researchers and clinicians covering all fields of gastroenterology and hepatology. We are the new Trainee Editors of the UEG Journal kicking off in 2023. For this new term, the UEG Journal casted an assorted group of colleagues that differs in many ways with regards to ideas, interests, perspectives and principles. The UEG Journal is committed to values, such as diversity and inclusion, and the composition of this group of Trainee Editors reflects just that. Despite our valuable differences, we shared this dream of joining the Editorial Board, and we are now sharing this responsibility! Together with the Senior Editors, we are planning the future of UEG Journal. We aim to be innovative and bring science closer to a broad readership in various (and sometimes unconventional) ways. To fuel the journal's growth, and keep up with the increasing number of submissions to the UEG Journal, there will be new tasks for the Trainee Editors. Of course, we would not be here today if it was not for the stellar work done by our predecessors; a team of 10 Trainee Editors who contributed to the UEG Journal becoming the prestigious journal as it is today. They not only assisted in reviewing of manuscripts, but also improved search engine optimization (SEO), increased visibility on social media, created eye‐catching visual abstracts, lobbied for the “Clinical Image” segment, and produced remarkable podcast series. Whilst we thank them for their impeccable work, we know we have very big shoes to fill.

AbstractBackgroundPost‐pancreatitis diabetes mellitus (PPDM) is a common consequence of chronic pancreatitis (CP). We aimed to determine the incidence and predictors of PPDM after CP onset, as well as complications and antidiabetic therapy requirements, in a high‐volume tertiary center.MethodsWe did a cohort study with retrospectively collected data from patients with definite CP seen at the Karolinska University Hospital between January 1999 and December 2020. Cause‐specific Cox regression analysis was used to assess PPDM predictors. To estimate risk of complications and need for therapy the Fine‐Gray subdistribution hazard model was employed, accounting for death as a competing risk.ResultsWe identified 481 patients with CP. The cumulative incidence of PPDM was 5.1%, 13.2%, 27.5% and 38.9% at 5, 10, 15 and 20 years, respectively. Compared to CP patients without diabetes, patients with PPDM were predominantly male (55% vs. 75%), had more frequently alcoholic etiology (44% vs. 62%) and previous acute pancreatitis. The only independent predictor of PPDM was presence of pancreatic calcifications (aHR = 2.45, 95% CI 1.30–4.63). Patients with PPDM had higher rates of microangiopathy (aSHR = 1.59, 95% CI 1.02–2.52) and infection (aSHR = 4.53, 95% CI 2.60–9.09) compared to CP patients who had type 2 diabetes (T2DM). The rate of insulin use was three‐fold higher, whereas metformin use rate was two‐fold higher in the same comparison.ConclusionsPatients with PPDM have a higher frequency of clinically significant complications and were more commonly prescribed insulin and metformin, suggesting a more aggressive phenotype than that of T2DM. Greater PPDM awareness is needed to optimize disease management.

Background Familial adenomatous polyposis ( FAP) is a rare inherited syndrome that predisposes the patient to cancer. Treatment of FAP-related ampullary lesions is challenging and the role of endoscopic papillectomy has not been elucidated. We retrospectively analyzed the outcomes of endoscopic papillectomy in matched cohorts of FAP-related and sporadic ampullary lesions (SALs). Methods This retrospective multicenter study included 1422 endoscopic papillectomy procedures. Propensity score matching including age, sex, comorbidity, histologic subtype, and size was performed. Main outcomes were complete resection (R0), technical success, complications, and recurrence. Results Propensity score matching identified 202 patients (101 FAP, 101 SAL) with comparable baseline characteristics. FAP patients were mainly asymptomatic (79.2% [95 %CI 71.2-87.3] vs. 46.5% [95 %CI 36.6-56.4]); P < 0.001). The initial R0 rate was significantly lower in FAP patients (63.4% [95%CI 53.8-72.9] vs. 83.2% [95%CI 75.8-90.6]; P = 0.001). After repeated interventions (mean 1.30 per patient), R0 was comparable (FAP 93.1% [ 95%CI 88.0- 98.1] vs. SAL 97.0% [95%CI 93.7-100]; P = 0.19). Adverse events occurred in 28.7%. Pancreatitis and bleeding were the most common adverse events in both groups. Severe adverse events were rare (3.5 %). Overall, 21 FAP patients (20.8% [95%CI 12.7-28.8]) and 16 SAL patients ( 15.8% [95%CI 8.6- 23.1]; P = 0.36) had recurrence. Recurrences occurred later in FAP patients (25 [95 %CI 18.3-31.7] vs. 2 [95 %CI CI 0.06-3.9] months). Conclusions Endoscopic papillectomy was safe and effective in FAP- related ampullary lesions. Criteria for endoscopic resection of ampullary lesions can be extended to FAP patients. FAP patients have a lifetime risk of relapse even after complete resection, and require long-time surveillance.

We would like to thank Dr. Yi and colleagues for their comments1 on our article “Post-pancreatitis diabetes mellitus (PPDM) is common in chronic pancreatitis (CP) and is associated with adverse outcomes”.2 Indeed, since the diabetes classification criteria used in this study3 largely relied on the timepoint of pancreatitis diagnosis, some patients with PPDM might have been misclassified as having type 2 diabetes mellitus (T2DM). To mitigate this potential pitfall, we attempted to capture the onset of pancreatitis as accurately as possible by taking the date of the first acute pancreatitis episode as an index date in CP patients with a history of acute pancreatitis. However, due to the well-known concept of “early CP”4 and the retrospective nature of the study, there could have been some patients in whom pancreatitis onset might have been recorded later than it actually occurred. Since this is also a common pitfall in daily clinical practice, the study reflects real challenges in everyday clinical settings. We therefore believe that the prospective validation of the PPDM definition may help to examine this issue more closely rather than excluding patients with T2DM from the study, as the letter writers infer. Dr. Yi and colleagues pondered whether patients with T2DM could have been initially prescribed glucose-lowering agents other than metformin, given the higher proportion of comorbidity in this group compared with PPDM. Apart from assessing the use of metformin and insulin, our study was conceptualized to also consider the use of non-metformin glucose-lowering drugs (sulfonylureas, alpha-glucosidase inhibitors, thiazolidinediones, DPP4- inhibitors, GLP1- receptor agonists, SGLT2-inhibitors, meglitinides) among patients. In this cohort, non-metformin antidiabetic agents (18/106) were taken either with insulin only (2/106) or in combination with insulin and metformin (16/106), whereas no patient received these drugs as a monotherapy. Accordingly, the results on metformin and insulin ever-use rate could not have been influenced by these figures. Moreover, as this is a retrospective study with the data originating from 1999 onwards, the newly updated American Diabetes Association recommendations5 have had less influence on the choice of treatment in the cohort. The letter writers point out that the pancreatic tissue damage that can occur as a complication of pancreatitis (pancreatic ductal changes, pseudocysts, etc.) might be a predictor of PPDM, which we concur with. Moreover, in the context of what we already reported as the study's limitations, one of the approaches to assess this hypothesis might include endoscopic procedures in a prediction model as a proxy for pancreatic duct strictures and intraductal stones. This will hopefully stimulate further studies to explore the abovementioned association. In conclusion, our findings emphasize the importance of conducting prospective studies that address the limitations and challenges in diagnosing and managing diabetes in patients with chronic pancreatitis, ultimately leading to improved patient outcomes. Data are available on request from the authors.

Objective To analyze the proportion of diabetes among all hospitalized cases in Germany between 2015 and 2020. Methods Using the nationwide Diagnosis-Related-Groups statistics, we identified among all inpatient cases aged ≥ 20 years all types of diabetes in the main or secondary diagnoses based on ICD-10 codes, as well all COVID-19 diagnoses for 2020. Results From 2015 to 2019, the proportion of cases with diabetes among all hospitalizations increased from 18.3% (3.01 of 16.45 million) to 18.5% (3.07 of 16.64 million). Although the total number of hospitalizations decreased in 2020, the proportion of cases with diabetes increased to 18.8% (2.73 of 14.50 million). The proportion of COVID-19 diagnosis was higher in cases with diabetes than in those without in all sex and age subgroups. The relative risk (RR) for a COVID-19 diagnosis in cases with vs without diabetes was highest in age group 40–49 years (RR in females: 1.51; in males: 1.41). Conclusions The prevalence of diabetes in the hospital is twice as high as the prevalence in the general population and has increased further with the COVID-19 pandemic, underscoring the increased morbidity in this high-risk patient group. This study provides essential information that should help to better estimate the need for diabetological expertise in inpatient care settings.

INTRODUCTION:Most patients with chronic pancreatitis (CP) develop pancreatic exocrine insufficiency (PEI) over the course of the disease. PEI may lead to hyperoxaluria and development of urinary oxalate stones. It has been postulated that the patients with CP may be at increased risk of kidney stone formation, but the data is scarce. We aimed to estimate incidence and risk factors for nephrolithiasis in a Swedish cohort of patients with CP. PATIENTS AND METHODS:We performed retrospective analysis of an electronical medical database of patients diagnosed with definite CP during 2003-2020. We excluded patients <18 years of age, those with missing relevant data in medical charts, patients with probable CP (according to the M-ANNHEIM classification system) and those in whom kidney stones were diagnosed before CP diagnosis. RESULTS:Some 632 patients with definite CP were followed over a median of 5.3 (IQR 2.4-6.9) years. There were 41 (6.5%) patients diagnosed with kidney stones, of whom 33 (80.5%) were symptomatic. Comparing to patients without kidney stones, patients with nephrolithiasis were older, with median age of 65 (IQR 51-72) years, and a male predominance (80% vs 63%). Cumulative incidence of kidney stones was 2.1%, 5.7%, 12.4% and 16.1% at 5, 10, 15, and 20 years after CP diagnosis, respectively. Multivariable cause-specific Cox regression analysis revealed PEI as independent risk factor for nephrolithiasis (adjusted HR 4.95, 95%CI 1.65-14.84; p = 0.004). Another risk factors were increase in BMI (aHR 1.16 95% CI 1.04-1.30; p = 0.001 per unit increment), and a male sex (4.51, 95% CI 1.01-20.3, p = 0.049). CONCLUSION:PEI and increase in BMI are risk factors for kidney stone development in patients with CP. Male CP patents are particularly at increased risk of nephrolithiasis. This should be taken into consideration in general clinical approach to raise awareness among patients and medical workers.

Introduction Although abdominal pain is the most prevalent and disabling symptom in patients with chronic pancreatitis (CP), there are also patients who have painless CP. Patients and methods We performed a retrospective analysis of patients with a diagnosis of CP. A total of 279 patients with definite CP with completed demographic and clinical data were included in the final analysis. Results There were 75 (26.9%) patients with painless CP. These patients had a significantly higher mean age at diagnosis, 61.7 years, than the 52.5 years of patients with pain (p < 0.001). Painless and painful CP had similar rates of diabetes mellitus (DM) (28.4% vs. 31.6%) and pancreatic exocrine insufficiency (PEI) (50.0% vs. 52.3%). Painless CP had lower rates of alcoholic etiology, 36.0%, than the 52.5% in painful CP (p < 0.05). Patients older than 55 at the time of CP diagnosis were associated with painless CP with an adjusted odds ratio (aOR) of 3.27 [95% confidence interval (CI): 1.62-6.60]. Alcoholic etiologies were not associated with painless CP, aOR of 0.51 (95% CI: 0.25-0.91). Conclusion Patients with painless CP had a significantly higher mean age than patients with painful CP and increased aOR for those older than 55 at CP diagnosis. Painless and painful CP patients had similar rates of DM and PEI, confirming the necessity of routine follow up in all patients with CP.

Background: Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied.Methods: Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi -institutional database (58 centers) between 2005 and 2018.Results: A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first pro-cedure had a higher morbidity with Clavien III and more complications, respectively, 28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy (P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n =1 for endoscopic papillectomy, P < .0001). Three-year overall survival and disease-free survival were comparable.Conclusion: Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival outcomes comparable to surgery. Surgery applies more to invasive recurrences, with transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers and pancreaticoduodenectomy for more advanced tumors.(c) 2022 Elsevier Inc. All rights reserved.

Universitäten spielen eine entscheidende Rolle in der Aus-, Fort- und Weiterbildung, Forschung und Patient:innenversorgung. Sie unterliegen der großen Herausforderung, allen diesen Punkten gerecht zu werden. Mit dem vorliegenden Positionspapier zu universitären Karrierewegen möchten wir hierfür Leitplanken bieten. Der folgende Text entstand gemeinsam während eines Treffens der Autor:innen in ihrer Funktion als Vertreter:innen des universitären gastroenterologischen Nachwuchses in Deutschland. Vorab hatten wir alle Mitglieder der AG Junge Gastroenterologie (JuGa), die an Universitäten tätig sind, zur aktiven Teilnahme an diesem Prozess der Konsensbildung eingeladen. Unser Ziel ist es, mit diesem Positionspapier eine Diskussionsgrundlage zu schaffen, um die klinische, didaktische und wissenschaftliche Aus- und Weiterbildung in der universitären Gastroenterologie weiterzuentwickeln. Wir sehen diesen Prozess als essenziell für die Zukunfts- und Wettbewerbsfähigkeit der Gastroenterologie an. Gemeinsam können wir dazu beitragen, die Aus- und Weiterbildung in diesem Bereich kontinuierlich zu verbessern und sowohl den individuellen Bedürfnissen der Nachwuchskräfte als auch den Anforderungen der Gastroenterologie gerecht zu werden.

Hintergrund Das Diabetische Fußsyndrom ist die häufigste Ursache für Amputationen oberhalb des Sprunggelenks in Deutschland. Nach wie vor sterben mehr als die Hälfte der Patienten mit einer Major-Amputation innerhalb von 5 Jahren.