INTRODUCTION AND OBJECTIVES:The screening accuracy of non-invasive fibrosis tests like FIB-4 in metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear. Using standard cut-offs, this study evaluated FIB-4's agreement with vibration-controlled transient elastography (VCTE) and identified and validated new thresholds. PATIENTS AND METHODS:A prospective cohort study (2019-2024) in Belgian and Dutch primary care used VCTE by FibroScan® (Echosens, France) as a proxy for the fibrosis stage. The FIB-4 index was derived from electronic patient data and study blood samples. Agreement between VCTE and FIB-4 was analysed using weighted Cohen's kappa. New fibrosis cut-offs (≥F2; ≥8 kPa) for ≤65 and >65 years were determined via Youden's Index and validated in a Turkish primary care cohort and a Belgian secondary care T2DM cohort. RESULTS:Among 563 participants (median age 62 years, 47.1 % male, 14.2 % with T2DM, median BMI 28.2 kg/m²), FIB-4 showed poor agreement with VCTE (κ = 0.138, 95 % CI: 0.069-0.207). Suggested new cut-offs of 1.29 (≤65 years) and 1.72 (>65 years) were proposed. The 1.29 cut-off performed similarly to the existing 1.3 in validation cohorts. In the Türkiye and T2DM cohorts, the 1.72 cut-off improved sensitivity over 2.0 but had lower specificity. CONCLUSIONS:The FIB-4 index showed poor agreement with VCTE and low sensitivity, making it an unreliable standalone diagnostic tool for liver fibrosis in people with MASLD in both primary and secondary care. Alternative non-invasive tests or improved cut-off values are needed for accurate fibrosis detection in clinical practice.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely intertwined with glucose metabolism status (GMS). Bi-national comparative epidemiological data are lacking; therefore, this study aimed to provide new insights into MASLD and fibrosis prevalence and risk factors in Belgium, while comparing data from The Netherlands to uncover cross-country differences. Materials and Methods: A prospective cohort study (2019–2024) in Belgian primary and secondary care was compared with the Dutch Maastricht Study. Liver fat was measured using CAP (FibroScan®), and anthropometric, clinical, and biochemical data were collected. Associations with CAP were analysed using multivariable linear regression, including sex, age, BMI, MetS, high SBP, CVD history, and country. Results: A total of 2436 individuals (Belgium and The Netherlands) were screened, of which 1928 were eligible: MASLD with normal GMS (38.3%), prediabetes (19.2%), and type 2 diabetes mellitus (T2DM; 42.5%). Belgian participants with T2DM had higher BMI and prevalence of MASLD. CAP values were significantly associated with female sex (−7.5 dB/m, 95%CI (−11.834; −3.056), p < 0.001), BMI (5.184 dB/m, 95%CI (4.627; 5.741), p < 0.001), and MetS (13.7 dB/m, 95%CI (8.456; 18.994), p < 0.001). Country-specific interactions showed differing effects of high SBP and CVD on CAP between Belgium and The Netherlands, with only the inverse association of CVD history (−10.756, 95%CI (−17.485; −4.027), p = 0.002) with CAP in The Netherlands being significant. Conclusions: MASLD and fibrosis are common in people with prediabetes and T2DM, underscoring the need for early detection and management. Obesity and metabolic risk were key factors, while a history of CVD appeared protective in the Dutch cohort but not in the Belgian one.

Biliary papillomatosis (BP) is a rare disorder of the biliary tract characterized by the presence of multiple papillary adenomas spread along the biliary tree. Although benign, it carries a significant risk of malignant transformation. Due to low sensitivity and specificity of conventional radiologic modalities, the diagnosis as well as estimation of disease extent is difficult. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreaticography (ERCP) are superior although direct peroral cholangioscopy (POC) is currently the most accurate diagnostic method. Mainly because it provides more detailed information and makes targeted histological diagnosis possible. The treatment of biliary papillomatosis consists of surgical resection, liver transplantation (LT) or a combination of both. Unfortunately, the recurrence rate after radical surgery without LT remains high due to the diffuse distribution of the disease.

Bouveret syndrome is an exceptionally rare form of gallstone ileus secondary to a bilioenteric fistula, through which a voluminous gallstone can migrate into the pylorus or duodenum, thereby causing gastric outlet obstruction. In order to increase awareness, we reviewed the clinical features, diagnostic tools and management options for this uncommon entity. We specifically focus on endoscopic therapeutic options, illustrated by a case of a 73 year old woman with Bouveret syndrome, where endoscopic electrohydraulic lithotripsy was successful in relieving gastroduodenal obstruction.

Purpose Hernia management in patients with cirrhosis is a challenging problem, where indication, timing and type of surgery have been a subject of debate. Given the high risk of morbidity and mortality following surgery, together with increased risk of recurrence, a wait and see approach was often advocated in the past. Methods The purpose of this review was to provide an overview of crucial elements in the treatment of patients with cirrhosis and umbilical hernia. Results Perioperative ascites control is regarded as the major factor in timing of hernia repair and is considered the most important factor governing outcome. This can be accomplished by either medical treatment, ascites drainage prior to surgery or reduction of portal hypertension by means of a transjugular intrahepatic portosystemic shunt (TIPS). The high incidence of perioperative complications and inferior outcomes of emergency surgery strongly favor elective surgery, instead of a "wait and see" approach, allowing for adequate patient selection, scheduled timing of elective surgery and dedicated perioperative care. The Child-Pugh-Turcotte and MELD score remain strong prognostic parameters and furthermore aid in identifying patients who fulfill criteria for liver transplantation. Such patients should be evaluated for early listing as potential candidates for transplantation and simultaneous hernia repair, especially in case of umbilical vein recanalization and uncontrolled refractory preoperative ascites. Considering surgical techniques, low-quality evidence suggests mesh implantation might reduce hernia recurrence without dramatically increasing morbidity, at least in elective circumstances. Conclusion Preventing emergency surgery and optimizing perioperative care are crucial factors in reducing morbidity and mortality in patients with umbilical hernia and cirrhosis.

A 53-year-old woman, G2P2, was referred to the outpatient clinic because of chronic abdominal pain. Abdominal examination revealed tenderness in the right lower quadrant without peritoneal signs and blood analysis was normal. To exclude slow transit constipation a pellet study was performed: plain abdominal radio-graphy showed the presence of all ingested pellets and an abnormal, slightly lateralized and angulated position of the intrauterine device, a levonorgestrel intrauterine system called Mirena® which was placed five years earlier (figure 1). Subsequently an abdominal computed tomography was executed.

Erythema multiforme is an immune-mediated mucocutaneous disorder. Mucosal involvement usually affects the oral region, the genitals or the eyes. We report a case of esophagitis caused by erythema multiforme in a patient diagnosed with lung cancer. Esophageal manifestation in erythema multiforme is rarely seen. Besides esophagitis it can lead to esophageal strictures. Erythema multiforme is mostly triggered by infection or drugs but the association with malignancy has been described.

Persisting suture dehiscence with oesophageal anastomotic leaks after thoracic surgery is a difficult complication, especially when a surgical repair fails. We report here endoscopic vacuum-assisted closure therapy as a novel endoscopic treatment for the management of oesophageal anastomotic leaks. Endoscopic vacuum-assisted closure therapy is a minimally invasive method to treat anastomotic leakage by positioning an open-pored polyurethane sponge and a suction tube connected to a wound drainage system into the opening of the wound cavity. This multidisciplinary endoscopic and surgical approach is a successful therapy for the management of suture dehiscence with oesophageal anastomotic leaks after thoracic surgery or oesophageal perforations.