Gallbladder cancer (GBC) is the most common primary tumor site of biliary tract cancer (BTC), accounting for 0.6% of newly diagnosed cancers and 0.9% of cancer-related deaths. Risk factors, including female sex, age, ethnic background, and chronic inflammation of the gallbladder, have been identified. Surgery is the only curative option for early-stage GBC, but only 10% of patients are primary eligible for curative treatment. After neoadjuvant treatment, up to one-third of locally advanced GBC patients could benefit from secondary surgical treatment. After surgery, only a high-risk subset of patients benefits from adjuvant treatment. For advanced-stage GBC, palliative chemotherapy with gemcitabine and cisplatin is the current standard of care in line with other BTCs. After the failure of gemcitabine and cisplatin, data for second-line treatment in non-resectable GBC is poor, and the only recommended chemotherapy regimen is FOLFOX (5-FU/folinic acid and oxaliplatin). Recent advances with the PD-L1 inhibitor durvalumab open the therapy landscape for immune checkpoint inhibition in GBC. Meanwhile, targeted therapy approaches are a cornerstone of GBC therapy based on molecular profiling and new evidence of molecular differences between different BTC forms and might further improve the prognosis of GBC patients.

Pancreatic ductal adenocarcinoma (PDAC) is still difficult to treat due to insufficient methods for early diagnosis and prediction of therapy response. Furthermore, surveillance after curatively intended surgery lacks adequate methods for timely detection of recurrence. Therefore, several molecules have been analyzed as predictors of recurrence or early detection of PDAC. Enhanced understanding of molecular tumorigenesis and treatment response triggered the identification of novel biomarkers as predictors for response to conventional chemotherapy or targeted therapy. In conclusion, progress has been made especially in the prediction of therapy response with biomarkers. The use of molecules for early detection and recurrence of PDAC is still at an early stage, but there are promising approaches in noninvasive biomarkers, composite panels and scores that can already ameliorate the current clinical practice. The present review summarizes the current state of research on biomarkers for diagnosis and therapy of pancreatic cancer.

Background: Gastrointestinal diseases are associated with substantial cost in health care. In times of the COVID-19 pandemic and further digitalization of gastrointestinal tract health care, mobile health apps could complement routine health care. Many gastrointestinal health care apps are already available in the app stores, but the quality, data protection, and reliability often remain unclear. Objective: This systematic review aimed to evaluate the quality characteristics as well as the privacy and security measures of mobile health apps for the management of gastrointestinal diseases. Methods: A web crawler systematically searched for mobile health apps with a focus on gastrointestinal diseases. The identified mobile health apps were evaluated using the Mobile Application Rating Scale (MARS). Furthermore, app characteristics, data protection, and security measures were collected. Classic user star rating was correlated with overall mobile health app quality. Results: The overall quality of the mobile health apps (N=109) was moderate (mean 2.90, SD 0.52; on a scale ranging from 1 to 5). The quality of the subscales ranged from low (mean 1.89, SD 0.66) to good (mean 4.08, SD 0.57). The security of data transfer was ensured only by 11 (10.1%) mobile health apps. None of the mobile health apps had an evidence base. The user star rating did not correlate with the MARS overall score or with the individual subdimensions of the MARS (all P>.05). Conclusions: Mobile health apps might have a positive impact on diagnosis, therapy, and patient guidance in gastroenterology in the future. We conclude that, to date, data security and proof of efficacy are not yet given in currently available mobile health apps.

Atezolizumab plus bevacizumab is the standard of care for first-line systemic therapy for advanced hepatocellular carcinoma (aHCC). Data on the efficacy and safety of atezolizumab plus bevacizumab in patients with aHCC who have received prior systemic therapy are not available. Methods: Patients with aHCC who received atezolizumab plus bevacizumab after at least one systemic treatment between December 2018 and March 2022 were retrospectively identified in 13 centers in Germany and Austria. Patient characteristics, tumor response rates, progression-free survival (PFS), overall survival (OS), and adverse events (AE) were analyzed. Results: A total of 50 patients were identified; 41 (82%) were male. The median age at initiation of treatment with atezolizumab plus bevacizumab was 65 years, 41 (82%) patients had cirrhosis, 30 (73%) Child A, 9 (22%) B, and 2 (5%) C. A total of 34 patients (68%) received atezolizumab plus bevacizumab in the second-line setting and 16 (32%) in later lines. The best radiologic tumor responses were complete remission (2%), partial remission (30%), stable disease (36%), and progressive disease (18%), resulting in an objective response rate of 32% and a disease control rate of 68%. Median OS was 16.0 months (95% confidence interval 5.6–26.4 months), and median PFS was 7.1 months (95% confidence interval 4.4–9.8 months). AE grades 3–4 were observed in seven (14%) and resulted in death in three patients (6%). There were five (10%) bleeding events with a grade ≥ 3, including one (2%) with a fatal outcome. Conclusions: Atezolizumab plus bevacizumab is effective in patients with aHCC who did not have access to this option as first-line therapy. The safety profile was consistent with previous reports.

Aims Endoscopic necrosectomy is the favored minimal invasive approach for necrotizing pancreatitis. Even experienced endoscopists are challenged to transfer information from CT-scan into endoscopic location and orientation because visual information about necrotic mass and surrounding structures are not primarily visible. Methods A 3D-printed phantom was built based on segmented CT-scans. An electromagnetic (EM) sensor was integrated into the endoscope’s working channel to localize it by EM-tracking. A custom software-prototype based on the Medical-Imaging-Interaction-Toolkit (MITK, www.mitk.org) was developed which provides a 3D-visualization of necrosis and surrounding organs by a point-based registration of CT data to the endoscopic scene in tracking coordinates.An ex-vivo experiment was conducted. Six experimental runs were conducted by four interventional endoscopists. Supported by the 3D-visualization, each user adressed seven targets spread inside the phantom. Afterwards the Euclidean distance between final position and registered target in tracking coordinates was determined and additionally checked visually. Results All users managed to reach the targets with mean error ranging between (2.6–6.5mm). The endoscope image showed a visual match of the 3D-navigation scene, without problems in registration accuracy. Users’ feedback regarding usefulness and realistic implementation was very positive. Conclusions Although the results are very preliminary, the 3D-approach could have big potential for future clinical use. Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Aims Objective:Anthropogenic climate change is named as the biggest global health threat of the 21st century. Unfortunately, health care system itself and so endoscopy as well significantly contributes to carbon footprint. Waste produced within endoscopic procedures is one aspect. Approaches to generate less land fill waste and more recyclable materials are already initiated. But energy consumption and potential options for power savings within endoscopy are poorly addressed up to now. Methods In a high-volume endoscopy unit, energy consumption of conventional endoscopy was measured. Endoscopy rooms were equipped with power consumption meter. Idle and regular operation power consumption was measured over 30 working days. Operating time, number and type of endoscopic examinations performed were measured. Results Mean standby power consumption was 16.3W. Mean idle power consumption was 321.9W. Mean power consumption of endoscopy rooms was 2.3(±0.41) kWh, 2.9(±0.72)kWh, 2.6(±0.84)kWh per working day. Average power consumption per examination was 0.24(±0.03) kWh for room 1 (EGD), 0.48(±0.05) kWh for room 2 (EUS), 0.45(±0.01) kWh for room 3 (colonoscopy equipped with AI polyp detection system). In a second step for power saving reasons light source was switched off consequently within waiting time. Mean difference in actual power consumption was 16.4W. Conclusions In comparison to other medical departments energy consumption in endoscopy seems to be moderate on first glance. But nevertheless, energy consumption is still high. Hence, energy saving options should be consequently used to reduce power consumption in endoscopy. Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany