Endoscopic management of buried bumper syndrome using the Balloon Dilation Pull (BDP) technique: a multicenter analysis.

Background and study aims: Buried bumper syndrome (BBS) may complicate percutaneous endoscopic gastrostomy placement. In these patients, endoscopic treatment ought to be considered. Various approaches have been published, ranging from dissectionbased techniques to novel dedicated devices, although the evidence supporting the use of the Balloon Dilation Pull (BDP) technique has been limited to single case reports. The aim of this paper is to assess the feasibility, efficacy and safety of the systematic use of the BDPtechnique for the endoscopic treatment of BBS. Patients and methods: We performed a retrospective multicenter analysis of prospectively collected data from all patients treated with the BDP-technique between January 2011 and November 2021. Results: In total, 26 patients were identified (median age 72 (SD ± 13) years, 74% male, 84.6% underlying neurological disease). Technical success was achieved in 92.3%, with a median procedure time of 17.5 minutes (range 5-27). Adverse events were identified in 3.8% of patients (N=1, aspiration, ASGE lexicon severity grade: moderate). Conclusions: Our experience suggests that the BDP-technique is highly efficacious and safe, using accessories readily available in every endoscopic unit. Given the limited procedure time and tools required, this procedure has the potential to further optimize patient care in the context of BBS.

Parvovirus B19-triggered hemophagocytic lymphohistiocytosis in a patient with Crohn's disease.

Background: Hemophagocytic lymphohistiocytosis (HLH) is a life threatening condition caused by inappropriate immune activity. Infection is often the trigger, both in genetically predisposed and in sporadic cases. Although more commonly seen in the paediatric population, patients of all ages can be affected. Case presentation: A 26-year-old male patient with Crohn's disease, treated with ustekinumab, presented with high fever, epistaxis and anorexia. Laboratory results showed pancytopenia, and a high serum levels of ferritin and LDH. Colonoscopy revealed only mild signs of disease activity. CT-scan showed splenomegaly and multiple lymphadenopathies. Bone marrow aspirate was suggestive for hemophagocytosis. PCR & serology for parvovirus B19 came back positive. Treatment with ustekinumab was temporarily put on hold and supportive care was given. Viral replication decreased and he recovered completely. Conclusion: There is a known association between HLH and Crohn's disease. This is probably because they are more susceptible to infections with CMV, EBV and parvovirus B19, all known as triggers for HLH. The role of ustekinumab is unclear: did it play a role in the pathophysiological evolution of this primo-infection with parvovirus B19? On the other hand, did it contribute to the rather mild course of the disease, acting as a immunomodulator that works on interleukin-12, a cytokine that plays a role in HLH? Further study is warranted to answer these questions.

Current ERCP practice in Belgium: the BSGIE survey.

Background and study aims: Data on procedural outcome and quality of endoscopic retrograde cholangiopancreatography (ERCP) in Belgian practice are scarce. The aim of this study is to assess current status of ERCP-performance in Belgium. Methods: National multi-institutional survey (online questionnaire) among members of the Belgian Society of Gastrointestinal Endoscopy (BSGIE), conducted in the period June-August 2018. The RIZIV/INAMI provided real-life data on the total number of ERCPs performed in Belgium. Results: Forty-five responders completed the survey (for 43 centers performing ERCP), providing information for 8368 ERCPs performed in 45% (43/95) of institutions performing ERCP in Belgium. Fifty-eight percent of centers performed > 100 ERCPs/year and 7% of centers (n=3) performed < 50 ERCPs/year. According to the RIZIV/INAMI data, low case-volume centers are underrepresented in this survey. The most common ERCPindication was stone extraction (52%). 74% of endoscopists had more than 10 years of experience in performing ERCP. The majority of centers had their own written protocol (84%) for microbiological duodenoscope surveillance. Monitoring of cannulation rate and post-ERCP pancreatitis (PEP) was only performed in a minority of centers (30%). The majority of centers (76%) provided verbal informed consent relating to the ERCP-procedure ; a minority also requested a written informed consent (23%). 65% of centers systematically use NSAIDs for PEP prophylaxis. Conclusion: This is the first survey of ERCP performance in Belgium. There were wide variations in practice. Adherence to key performance measures and measurement and evaluation of ERCP performance in daily practice at center and endoscopist level are not uniformly widespread.

BSGIE survey on COVID-19 and gastrointestinal endoscopy in Belgium : results and recommendations.

BACKGROUND AND AIMS: With the first wave of the COVID-19 pandemic declining, activities in the gastrointestinal clinic are being recommenced after a period of stringent measures. Since a second COVID-19 wave is not entirely ruled out health care professionals might remain faced with the need to perform endoscopic procedures in patients with a confirmed positive or unknown COVID-19 status. With this report we aim to provide a practical relevant overview of preparation and protective measures for gastroenterologists based on the currently available guidelines and our local experience and results of a national Belgian survey, to guarantee a fast recall of an adequate infection prevention if COVID-19 reoccurs. METHODS: From the 23rd of March 2020 and the 13th of May 2020 we performed a Pubmed, Embase and Medline search, resulting in 37 papers on COVID-19 and endoscopy. Additionally, we combined these data with data acquired from the national BSGIE survey amongst Belgian gastroenterologists. RESULTS: Based on 72 completed surveys in both university and non-university hospitals, the results show (1) a dramatic (<20%) or substantial (<50%) decrease of normal daily endoscopy in 74% and 22% of the units respectively, (2) a difference in screening and protective measures between university and non-university hospitals. These findings were subsequently compared with the current guidelines. CONCLUSION: Based on new data from the BSGIE survey and current guidelines we tried to realistically represent the current COVID-19 trends in protective measures, screening and indications for endoscopy and to provide a practical overview as preparation for a possible second wave.

Eikenella corrodens perirenal abscess resulting from a pancreatic fistula in a patient with chronic pancreatitis. Case report and literature review.

We present a case of a right perirenal Eikenella corrodens abscess in a patient with chronic pancreatitis and poor dental hygiene. Endoscopic Retrograde CholangioPancreaticography (ERCP) revealed a pancreatic fistula draining to the right perirenal loge. The patient was treated with broad-spectrum antibiotics, percutaneous drainage and endoscopic stenting of the duct of Wirsung, stopping the supply of the fistula. A full recovery in our patient was observed. Considering the uncommon location of the abscess, a review of the different aetiologies of perirenal abscesses and their distrubution patterns, and the endoscopic treatment of symptomatic pancreatic fistulas seemed worthwhile.

The predictive value of negative capsule endoscopy for the indication of Obscure Gastrointestinal Bleeding: no reassurance in the long term.

BACKGROUND: Capsule Endoscopy (CE) has become the first-line tool to identify an underlying etiology for Obscure Gastrointestinal Bleeding (OGIB) in the small bowel (SB). This study aims to investigate the long-term outcome of patients with a negative CE. METHODS: Retrospective review of standardized application forms of all patients who underwent CE for OGIB at the Ghent University Hospital between 2002 and 2013. Follow-up data on patients with a negative CE result (n=263) were collected by contacting the referring physician. RESULTS: Follow-up was available for 211 patients (Male, n=107 ; Female, n=104 ; Overt bleeding, n=76 ; Occult bleeding, n=135). Median follow-up time was 51.7 months (range 1.4-139.6 months). Ninety-six patients underwent further diagnostics, showing a cause for OGIB in 57 (59.4%). Final outcome for the complete cohort of negative CEs was : 139 (65.9%) true negative (i.e. non-SB cause of bleeding/ resolved OGIB), 19 (9%) false negative (i.e. SB cause of OGIB) and 53 (25.1%) ongoing bleeding without cause. Missed SB lesions were : angiodysplasia (n=11), Meckel's diverticulum (n=3), SB malignancy (n=3), jejunal erosions (n=1) and NSAID-induced SB ulcerations (n=1). Bleeding resolved in 138/209 patients (66%) of which 79 underwent non-specific therapy. CONCLUSIONS: Negative CEs in patients with OGIB do not reassure the treating physician, but warrant close monitoring. In suspicious cases, alternative diagnostic modalities are recommended, showing a high diagnostic yield. (Acta gastroenterol. belg., 2016, 79, 405-413).

Ascites: not always the usual suspects.

A case report of a 44-year-old woman with an infrequent cause of ascites, i.e. intraperitoneal urine leakage, is presented. Urinary ascites due to spontaneous bladder rupture or fistula after radiation therapy for cervical cancer is not a rare complication and can develop several years after initial treatment. Diagnosis of urinary ascites should be suspected in patients with ascites and a history of radiation therapy for a bladder or a gynaecological disease. Measurement of urea and creatinine levels in urine, ascites and plasma is a simple and non-invasive diagnostic test. In physiological conditions, the ascites/plasma creatinine ratio approximates a ratio of one to one. This ratio is elevated to a value of 5/1 in case of urinary ascites. Although cystoscopy and imaging techniques such as cystography and computed tomography (with or without cystography) are extremely helpful, definitive diagnosis is frequently based on intraoperative findings, because of the lack of pathognomonic symptoms or signs. Surgery is the treatment of choice.

Reclassification of Lactobacillus thermotolerans Niamsup et al. 2003 as a later synonym of Lactobacillus ingluviei Baele et al. 2003.

The relatedness of the species Lactobacillus ingluviei and Lactobacillus thermotolerans was investigated by comparing partial sequences of the 16S rRNA gene (99.9 % similarity over 1504 bp), the hsp60 gene (98.8 % similarity over 954 bp) and the recA gene (98.5 % similarity over 452 bp) and by determining DNA-DNA binding levels (79+/-3 %) and genomic DNA G+C contents (50 and 49 mol%, respectively). These data, in addition to their similar biochemical characteristics, suggest that the two taxa constitute a single species. According to Rules 38 and 42 of the Bacteriological Code, they should be united under the name Lactobacillus ingluviei, with the name Lactobacillus thermotolerans as a later heterotypic synonym.

Lactobacillus acidifarinae sp. nov. and Lactobacillus zymae sp. nov., from wheat sourdoughs.

Three heterofermentative lactic acid bacteria, obtained from Greek and Belgian artisanal wheat sourdoughs, were preliminarily identified as Lactobacillus brevis-like after screening using whole-cell protein fingerprinting and 16S rRNA gene sequence analysis. The three sourdough isolates showed nearly identical sequences (>99.7 % sequence similarity), and highest similarities of 98.2 and 97.6 % were obtained to the species Lactobacillus spicheri and Lactobacillus brevis, respectively. Growth characteristics, biochemical features, amplified fragment length polymorphism fingerprinting, DNA-DNA hybridizations and DNA G+C contents demonstrated that the isolates represent two novel Lactobacillus species. The names Lactobacillus acidifarinae sp. nov. and Lactobacillus zymae sp. nov. are proposed and the type strains are LMG 22200(T) (=R-19065(T)=CCM 7240(T)) and LMG 22198(T) (=R-18615(T)=CCM 7241(T)), respectively.

Streptococcus minor sp. nov., from faecal samples and tonsils of domestic animals.

Nine isolates, which were obtained from tonsils, anal swabs and faeces of dogs and from tonsils of a cat and a calf, constituted a homogeneous but unidentified taxon after screening with tRNA intergenic length polymorphism analysis and whole-cell protein fingerprinting. 16S rDNA sequence analysis classified representative strains in the genus Streptococcus. Highest sequence similarity (95.9 %) was obtained with Streptococcus ovis. Growth characteristics, biochemical features, DNA-DNA hybridization and DNA G+C contents of selected strains demonstrated that they represent a single, novel streptococcal species. The name Streptococcus minor sp. nov. is proposed for the novel species; the type strain (ON59(T)=LMG 21734(T)=CCUG 47487(T)) was isolated from a dog tonsil.

Phylogeny of Maricaulis Abraham et al. 1999 and proposal of Maricaulis virginensis sp. nov., M. parjimensis sp. nov., M. washingtonensis sp. nov. and M. salignorans sp. nov.

Thirteen marine bacteria isolated from different locations, belonging to the genus Maricaulis, were characterized by 16S rRNA gene sequencing, DNA-DNA hybridizations and analysis of the internally transcribed 16S-23S rDNA spacer (ITS1) region, analysis of fatty acids from total lipids, mass spectrometry of polar lipids and determination of temperature and NaCl tolerances. The data obtained led to the identification of five new sulfoquinovosyl diacylglycerols, using tandem mass spectrometry, and the fragmentation patterns of the individual compounds. Four novel species were identified and described as Maricaulis virginensis sp. nov. (type strain VKM B-1 5139T)), Maricaulis parjimensis sp. nov. (type strain MCS 25(T)), Maricaulis washingtonensis sp. nov. (type strain MCS 6(T)) and Maricaulis salignorans sp. nov. (type strain MCS 18(T)). They differ in their temperature and salt tolerances and can be differentiated by their polar lipids and fatty acid patterns, as well as their ITS1 and 16S rRNA gene sequences.

Globicatella sulfidifaciens sp. nov., isolated from purulent infections in domestic animals.

DNA-DNA hybridization experiments and comparative 165 rDNA sequence analysis revealed that six isolates from purulent joint and lung infections in calves, from a lung lesion in a sheep, and from a joint infection of a pig represented a novel species belonging to the genus Globicatella. Whole-cell protein electrophoresis and biochemical activity testing revealed that the isolates formed a homogeneous group differing from Globicatella sanguinis, the only species of this genus described to date. These animal isolates were classified as Globicatella sulfidifaciens sp. nov. with LMG 188441 (= CCUG 44365T), isolated from the lung of a calf, as the type strain. A detailed description of its phenotypic characteristics is presented. Hydrogen sulphide production was found to be a very useful diagnostic feature.

Enterococcus villorum sp. nov., an enteroadherent bacterium associated with diarrhoea in piglets.

The taxonomic positions of five enteroadherent bacterial pig isolates, showing phenotypic characteristics most similar to those of Enterococcus durans and Enterococcus hirae, were investigated in a polyphasic study that included 16S rDNA sequence analysis, DNA-DNA hybridizations, DNA base-ratio determinations, whole-cell protein fingerprinting, D11344-primed PCR typing and an extensive examination of phenotypic properties. The results demonstrated that the organisms represent a new species in the Enterococcus faecium species group, for which the name Enterococcus villorum sp. nov. is proposed. The type strain is LMG 12287T (= CCM 4887T).

Sphingomonas alaskensis sp. nov., a dominant bacterium from a marine oligotrophic environment.

Seven Gram-negative strains, isolated in 1990 from a 10(6)-fold dilution series of seawater from Resurrection Bay, a deep fjord of the Gulf of Alaska, were identified in a polyphasic taxonomic study. Analysis of 16S rDNA sequences and DNA-homology studies confirmed the phylogenetic position of all strains in the genus Sphingomonas and further indicated that all of the strains constitute a single homogeneous genomic species, distinct from all validly described Sphingomonas species. The ability to differentiate the species, both phenotypically and chemotaxonomically, from its nearest neighbours justifies the proposal of a new species name, Sphingomonas alaskensis sp. nov., for this taxon. Strain LMG 18877T (= RB2256T = DSM 13593T) was selected as the type strain.