Lars Aabakken

• Breder, Sigurd; Wang, Benny; Villard, Christina; Båve, Aiva; Lindström-Älgå, Lina & Eide, Emma [Show all 15 contributors for this article] (2026). Liver transplantation in primary sclerosing cholangitis with hepatobiliary neoplasia: survival outcomes and impact of diagnostic uncertainty. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. p. 1–12. doi: 10.1080/00365521.2026.2709611. Full text in Research Archive
• Ibsen, Jostein Holen; Rud, Ane Kristine Kongsgaard; Sovershaev, Michael; Lund, Stine Rosenqvist; Paulsen, Vemund & Darre-Næss, Ole [Show all 11 contributors for this article] (2026). Serology-based diagnosis of coeliac disease in secondary care: a single-centre study in Norway. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 61(3), p. 257–267. doi: 10.1080/00365521.2026.2615407. Full text in Research Archive
• Crinò, Stefano Francesco; Aabakken, Lars; Bapaye, Amol; Chan, Shannon; Kida, Mitsuhiro & Law, Ryan [Show all 17 contributors for this article] (2025). World Endoscopy Organization guidelines on endoscopic retrograde cholangiopancreatography biliary cannulation and sphincterotomy techniques. Digestive Endoscopy. ISSN 0915-5635. 37(10), p. 1029–1053. doi: 10.1111/den.15060. Full text in Research Archive
• Vignesh, Shivakumar; Kothari, Shivangi; Aabakken, Lars; Mwachiro, Michael; Munyika, Akutu & Bhat, Purnima [Show all 7 contributors for this article] (2025). WEO Position Statement on Telementoring in Gastrointestinal Endoscopy. Digestive Endoscopy. ISSN 0915-5635. 38(1). doi: 10.1111/den.70060. Full text in Research Archive
• Risnes, Louise Fremgaard; Brottveit, Margit; Robertsen, Ida; Ibsen, Jostein Holen; Aabakken, Lars & Johannesen, Marie Kongshaug [Show all 12 contributors for this article] (2025). Research Communication: Teriflunomide Does Not Affect Gluten-Specific T-Cell Activity in Coeliac Disease—A Randomised, Placebo-Controlled Trial. Alimentary Pharmacology and Therapeutics. ISSN 0269-2813. 62(10), p. 1027–1031. doi: 10.1111/apt.70301. Full text in Research Archive Show summary

  Coeliac disease is an autoimmune disorder driven by gluten and managed through a strict gluten-free diet. We tested teriflunomide, a drug known for its ability to alter T-cell activity, in a phase 2a trial of 15 patients with coeliac disease. Participants received teriflunomide or placebo including a loading dose, followed by a 3-day oral gluten challenge to monitor T-cell responses. The main aim was to observe attenuation of gluten-specific T-cell activation markers after gluten exposure. We found no significant differences in T-cell activity between groups, concluding that teriflunomide is ineffective as a non-dietary treatment for coeliac disease

• Carlsen, Arne; Steinsbø, Øyvind; Kvaløy, Jan Terje; Aabakken, Lars; Bolstad, Nils & Warren, David John [Show all 10 contributors for this article] (2025). Optimizing serum adalimumab levels in maintenance therapy via proactive therapeutic drug monitoring improves markers of disease activity in Crohn’s disease. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 60(12), p. 1214–1225. doi: 10.1080/00365521.2025.2573725. Full text in Research Archive Show summary

  Objects The benefit of a proactive therapeutic drug monitoring (TDM) strategy in patients with inflammatory bowel disease receiving biological therapy remains disputed. We aimed to evaluate whether optimizing serum adalimumab levels (s-ADL), guided by proactive TDM, is associated with improved markers of disease activity in patients with Crohn’s disease. Materials and methods In this longitudinal cross-sectional study, 72 patients receiving adalimumab maintenance therapy from our outpatient clinic, were included. Patients underwent five study visits at 3-month intervals over one year. Disease activity was assesed using the Harvey-Bradshaw Index, plasma C-reactive protein (CRP), and fecal calprotectin. s-ADL levels were measured at each visit, and dosing was adjusted to maintain a therapeutic target range of 5.0–12.0 mg/L. Results At baseline, subtherapeutic s-ADL levels were associated with higher CRP levels (p = 0.03), and in these patients’ drug levels increased significantly over the study (p = 0.001), whereas CRP levels decreased (p = 0.03). Longitudinal analysis demonstrated that higher s-ADL levels (≥5.0 mg/L) were associated with lower CRP levels (p = 0.008) and lower HBI scores (p = 0.03). Additionally, lower CRP- and fecal calprotectin levels at any visit were associated with higher s-ADL levels at the preceding visit (p = 0.04 for both). Lower CRP levels were also associated with higher s-ADL levels using 7.0 mg/L as the therapeutic threshold in longitudinal analyses (p = 0.003). Conclusion Proactive TDM-guided optimization of s-ADL levels in Crohn’s disease patients on adalimumab maintenance therapy was associated with the modest but significant improvements in markers of disease activity over one year of follow-up.

• Breder, Sigurd; Villard, Christina; Eide, Emma; Wang, Benny; Engesæter, Lise Katrine & Reims, Henrik Mikael [Show all 15 contributors for this article] (2025). A retrospective evaluation of preemptive liver transplantation for bile duct dysplasia in primary sclerosing cholangitis: Balancing risks and benefits. JHEP Reports. 7(12), p. 1–11. doi: 10.1016/j.jhepr.2025.101598. Full text in Research Archive Show summary

  Background & Aims Liver transplantation (LT) to prevent cholangiocarcinoma (CCA) in individuals with primary sclerosing cholangitis (PSC) and bile duct dysplasia was introduced in Norway and Sweden in the early 2000s. We aimed to evaluate this practice to potentially improve future selection of candidates for LT. Methods We conducted a retrospective study of 512 adults with PSC who underwent first-time LT between 2000–2021 at Oslo and Karolinska University Hospitals. Pre-LT findings in bile duct brush cytology and/or biopsy of low-grade dysplasia (LGD) and high-grade dysplasia (HGD) were compared with histological findings in the explanted livers and survival rates were assessed. Results Bile duct dysplasia, low-grade (LGD) or high-grade (HGD), was the primary LT indication in 17% (88/512). Among individuals transplanted for LGD, only 10% (3/29) had HGD or CCA in the explant, compared to 48% (28/59) in the HGD group. No neoplasia was found in 42% (12/29) of LGD and 24% (14/59) of HGD cases, meaning nearly one-third of patients transplanted for suspected bile duct dysplasia had no histological evidence of neoplasia in the explant. Five-year post-transplant survival according to the explant histology was 95% for no neoplasia, 89% for LGD, 85% for HGD, decreasing to 33% in those with CCA in the explant. Conclusions While favorable survival in confirmed dysplasia supports the role of preemptive LT, the absence of neoplasia in a substantial proportion of explants, particularly in suspected LGD, calls for a cautious, individualized approach. LT appears more clearly justified in accurately diagnosed HGD, given its strong association with early malignancy and the poor prognosis of advanced CCA. Impact and implications Individuals with primary sclerosing cholangitis (PSC) are at increased risk of developing bile duct cancer. In precancerous stages (bile duct dysplasia), liver transplantation (LT) may prevent progression to advanced, incurable cancer. In our evaluation of 512 patients with PSC who underwent LT, we found that the low diagnostic accuracy and unpredictable detection of mild dysplasia support a cautious, individualized approach to LT in precancerous stages of PSC, while more advanced dysplasia remains a valid indication for LT.

• Steinsbø, Øyvind; Aasprong, Ole Gunnar; Aabakken, Lars; Karlsen, Lars Normann & Grimstad, Tore Bjørn (2025). Fecal Calprotectin Correlates with Disease Extent but Remains a Reliable Marker of Mucosal Healing in Ulcerative Colitis. American Journal of Gastroenterology. ISSN 0002-9270. 120(11), p. 2623–2631. doi: 10.14309/ajg.0000000000003339. Full text in Research Archive Show summary

  Introduction: Fecal calprotectin (FC) is a marker of mucosal inflammatory activity in ulcerative colitis (UC). FC levels may also be influenced by the extent of disease. We aimed to examine the relationships between FC, mucosal activity, and disease extent and to assess how disease extent affects the diagnostic accuracy of FC. Methods: We conducted a single-center observational study of patients with UC. Mucosal inflammatory activity was rated by the Mayo Endoscopic Score (MES) and Nancy Histological Index (NHI). The endoscopic and histological extents of disease were categorized by the Montreal classification and colorectal distribution of histologically active inflammation (NHI ≥ 2), respectively. FC was measured by EliA Calprotectin Enzyme fluoroimmunoassay (Phadia). Results: A total of 518 visits by 254 patients were analyzed. In endoscopically active UC (MES ≥ 2), FC levels were significantly lower in proctitis (440 [interquartile range (IQR) 175–1,350] mg/kg) as compared with left-sided colitis (840 [IQR 298–2,011] mg/kg, P = 0.048) or pancolitis (1,690 [IQR 723–2,582] mg/kg, P = 0.00005). In MES ≤1, FC levels were significantly higher in pancolitis (85 [IQR 43–350] mg/kg) as compared with proctitis (24 [IQR 15–116] mg/kg, P = 0.00032) or left-sided colitis (40 [IQR 15–160] mg/kg, P = 0.012). However, FC remained a reliable marker of mucosal healing across all disease extents, with area under the receiver-operating characteristic curve ranging from 0.878 to 0.915, and no significant differences between the extent categories (DeLong test, P ≥ 0.2919). Discussion: FC showed a significant association with disease extent yet remained a reliable surrogate marker for mucosal healing across all disease extents.

• Grimstad, Tore Bjørn; Carlsen, Arne; Kvaløy, Jan Terje; Bolstad, Nils; Warren, David & Aabakken, Lars [Show all 10 contributors for this article] (2025). Fatigue in Inflammatory Bowel Disease: No Effect of Serum Concentrations of Infliximab, Adalimumab or Anti-Drug Antibodies During Maintenance Therapy. Scandinavian Journal of Immunology. ISSN 0300-9475. 101(5). doi: 10.1111/sji.70029. Full text in Research Archive Show summary

  Several studies have shown that infliximab and adalimumab ameliorate fatigue in inflammatory bowel disease. We investigated whether serum levels of these agents above or below a selected threshold influence fatigue severity. In this cross-sectional study, we measured serum concentrations (s-) of infliximab and adalimumab and corresponding anti-drug antibody levels. Therapeutic thresholds were defined as s-infliximab ≥ 5.0 mg/L and s-adalimumab ≥ 7.0 mg/L. Disease activity was assessed using the Harvey–Bradshaw Index for Crohn's disease, Partial Mayo Score for ulcerative colitis, and C-reactive protein (CRP) and faecal calprotectin levels for both conditions. Fatigue was assessed with the Fatigue Visual Analog Scale and Fatigue Severity Scale, and depression was evaluated with the Hospital Anxiety and Depression Scale, Depression subscale. Of 171 included patients (112 with Crohn's disease, 59 with ulcerative colitis), 66 (38.6%) were on infliximab and 105 (61.4%) were on adalimumab. Scores on the two fatigue scales were similar for serum values above versus below therapeutic thresholds for both drugs and did not differ with versus without anti-drug antibodies against either drug. CRP was numerically higher with infliximab levels below versus above the threshold (p = 0.06), whereas both CRP and faecal calprotectin were increased with adalimumab below versus above the threshold (p = 0.022, p = 0.0242). In patients with inflammatory bowel disease on maintenance therapy, s-infliximab and s-adalimumab levels below or above therapeutic thresholds or the presence of anti-drug antibodies did not affect fatigue severity.

• Fretheim, Håvard Halland; Barua, Imon Shoumitra; Bakland, Gunnstein; Dhainaut, Alvilde Sofie Strand; Halse, Anne Kristine Hjorteseth & Nordgård, Maylen Carstens [Show all 21 contributors for this article] (2025). Faecal microbiota transplantation in patients with systemic sclerosis and lower gastrointestinal tract symptoms in Norway (ReSScue): a phase 2, randomised, double-blind, placebo-controlled trial. The Lancet Rheumatology. 7(5), p. e323–e332. doi: 10.1016/S2665-9913(24)00334-5. Full text in Research Archive Show summary

  Background: Gastrointestinal tract involvement is highly prevalent in systemic sclerosis, with few treatment options. We assessed the efficacy and safety of faecal microbiota transplantation using standardised anaerobic cultivated human intestinal microbiome (ACHIM) as a novel treatment option for patients with systemic sclerosis and symptomatic lower gastrointestinal tract involvement. Methods: In this phase 2, randomised, double-blind, placebo-controlled trial done at four university hospitals in Norway, we enrolled adults aged 18-85 years with systemic sclerosis and moderate-to-severe lower gastrointestinal tract symptoms (bloating or diarrhoea). Participants were randomly assigned 1:1 to intestinal infusions of placebo or ACHIM at weeks 0 and 2, stratified by worst symptom (bloating or diarrhoea). The primary endpoint was change in worst lower gastrointestinal tract symptom (bloating or diarrhoea) from week 0 to week 12, measured using the University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 scoring system in the intention-to-treat population. Safety was assessed at weeks 0, 2, 4, 6, and 12 in all participants who received at least one infusion. A person with lived experience of systemic sclerosis was involved in the study planning and conduct. This trial was registered at ClinicalTrials.gov, NCT04300426. Findings: Between Sept 24, 2020, and Jan 14, 2022, 67 participants were enrolled and randomly allocated to placebo (n=34) or ACHIM (n=33). Mean age was 58·91 years (SD 11·59). 62 (93%) of 67 participants were women, five (7%) were men, and 50 (75%) were anti-centromere antibody positive. Change in worst lower gastrointestinal tract symptom from week 0 to week 12 did not differ between participants who received ACHIM (-0·13, 95% CI -0·37 to 0·11) and participants who received placebo (-0·33, -0·57 to -0·09; average marginal effect 0·20, 95% CI -0·12 to 0·52; p=0·22). Adverse events, mostly mild and short-lived gastrointestinal tract symptoms, were reported by 16 (48%) of 33 participants in the ACHIM group and 19 (56%) of 34 in the placebo group. During gastroscopy, one participant had a duodenal perforation. Interpretation: Faecal microbiota transplantation with ACHIM was well tolerated in participants with systemic sclerosis but did not result in an improvement in lower gastrointestinal tract symptoms. Funding: KLINBEFORSK. Translation: For the Norwegian translation of the abstract see Supplementary Materials section.

• Bhat, Purnima; Kaffes, Arthur John; Lassen, Kristoffer & Aabakken, Lars (2024). Upper gastrointestinal endoscopy in the surgically altered patient. Digestive Endoscopy. ISSN 0915-5635. 36(10), p. 1077–1093. doi: 10.1111/den.14823. Full text in Research Archive Show summary

  As management of upper gastrointestinal malignancies improves, and with popularization of bariatric surgery, endoscopists are likely to meet patients with altered upper gastrointestinal anatomy. Short-term, the surgery can cause complications like bleeding, leaks, and fistulas, and longer-term problems such as intestinal or biliary anastomotic strictures or biliary stones can arise, all necessitating endoscopy. In addition, the usual upper gastrointestinal pathologies can also still occur. These patients pose unique challenges. To proceed, understanding the new layout of the upper gastrointestinal tract is essential. The endoscopist, armed with a clear plan for navigation, can readily diagnose and manage most commonly occurring conditions, such as marginal ulcers and proximal anastomotic strictures with standard endoscopic instruments. With complex reconstructions involving long segments of small bowel, such as Roux-en-Y gastric bypass, utilization of balloon-assisted enteroscopy may be necessary, mandating modification of procedures such as endoscopic retrograde cholangiopancreatography. Successful endoscopic management of patients with altered anatomy will require prior planning and preparation to ensure the appropriate equipment, setting, and skill set is provided.

• Mwachiro, Michael & Aabakken, Lars (2024). Endoscopic Training in the African Context. Techniques and Innovations in Gastrointestinal Endoscopy (TIGE). ISSN 2666-5107. p. 252–260. doi: 10.1016/j.tige.2024.05.001. Full text in Research Archive
• Muchiri, Sheila W.; Ogutu, Elly O.; Oyiro, Peter O. & Aabakken, Lars (2024). Clinicopathologic characteristics and treatment outcomes of pancreatic cancer patients at a tertiary referral hospital in Kenya. ecancermedicalscience. 18. doi: 10.3332/ecancer.2024.1682. Full text in Research Archive Show summary

  The global incidence of pancreatic cancer (PC) continues to steadily increase whereas its prognosis remains poor. Previous studies have suggested worse outcomes among individuals of African descent. The characteristics of patients with PC in Kenya, and their contemporary management and survival outcomes remain largely unknown. This study aimed to describe the clinical and pathologic characteristics, management, and outcomes of patients diagnosed with PC at Kenyatta National Hospital (KNH), a tertiary referral hospital in Kenya. Records of 242 patients diagnosed with PC at KNH between 1st January 2014 and 30th September 2021 were assessed in this retrospective cohort study. Data on their clinical, histopathologic, and treatment characteristics was presented as mean (± standard deviation) and/or median (interquartile range) for continuous variables and frequency (percentage) for categorical variables. Kaplan–Meier and Cox proportional hazard ratios were used for survival analysis. PC occurred in a young population, the median age being 58.5 years (inter-quartile range 35–88). The majority of tumours (54%) were metastatic at diagnosis, while 28% and 14% were stage III and stage I/II, respectively. Surgical resections with curative intent were performed on 7% overall and 44% of stage I/II cases. The majority of patients with stage I/II disease (52.9%) received chemotherapy whereas the majority with stage III and IV disease received the best supportive care only (62.7% and 64.9%, respectively). Patients who underwent surgical resection (HR for mortality 0.20, 95% CI 0.05–0.83, p = 0.021) and chemotherapy (HR for mortality 0.15, 95% CI 0.08–0.29, p < 0.001) had significantly improved survival, reflecting a more favourable stage of the disease more amenable to aggressive therapies. The median survival time was 3 months and the 1-year survival rate was 32%.

• Knatten, Charlotte Kristensen; Dahlseng, Magnus Odin; Perminow, Gøri Margrete; Skari, Hans; Austrheim, Astrid Ingeborg & Nyenget, Tove [Show all 10 contributors for this article] (2024). Push-PEG or Pull-PEG: Does the Technique Matter? A Prospective Study Comparing Outcomes After Gastrostomy Placement. Journal of Pediatric Surgery. ISSN 0022-3468. 59(9), p. 1879–1885. doi: 10.1016/j.jpedsurg.2024.03.045. Full text in Research Archive Show summary

  Background Push-PEG (percutaneous endoscopic gastrostomy) with T-fastener fixation (PEG-T) allows one-step insertion of a balloon tube or button, and avoids contamination of the stoma by oral bacteria. However, PEG-T is a technically more demanding procedure with a significant learning curve. The aim of the present study was to compare outcomes after PEG-T and pull-PEG in a setting where both procedures were well established. Materials and methods The study is a prospective cohort study including all patients between 0 and 18 year undergoing PEG-T and pull-PEG between 2017 and 2020 at a combined local and tertiary referral center. Complications and parent reported outcomes were recorded during hospital stay, after 14 days and 3 months postoperatively. Results 82 (93%) of eligible PEG-T and 37 (86%) pull-PEG patients were included. The groups were not significantly different with regard to age or weight. Malignant disorders and heart conditions were more frequent in the pull-PEG group, whilst neurodevelopmental disorders were more frequent in the PEG-T group (p < 0.001). 54% in both groups had a complication within 2 weeks. Late complications (between 2 weeks and 3 months postoperatively) occurred in 63% PEG-T vs 62% pull-PEG patients (p = 0.896). More parents in the pull-PEG group (49%) reported that the gastrostomy tube restricted their child's activity, compared to PEG-T (24%) (p = 0.01). At 3 months follow-up, more pull-PEG patients (43%) reported discomfort from the gastrostomy compared to PEG-T (21%) (p = 0.03). Conclusion Overall complication rates were approximately similar, but pull-PEG was associated with more discomfort and restriction of activity. Levels of Evidence Treatment study level II.

• Farnes, Ingvild; Lund-Iversen, Marius; Aabakken, Lars; Verbeke, Caroline Sophie & Labori, Knut Jørgen (2024). Molecular testing for personalized therapy is underutilized in patients with borderline resectable and locally advanced pancreatic cancer–real world data from the NORPACT-2 study. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 59(9), p. 1093–1096. doi: 10.1080/00365521.2024.2373115. Full text in Research Archive Show summary

  Background International guidelines currently recommend the use of molecular testing in patients with advanced pancreatic cancer. The rate of actionable molecular alterations is low. The utility of molecular testing in patients with borderline resectable (BRPC) or locally advanced (LAPC) pancreatic cancer in real world clinical practice is unclear. Methods 188 consecutive patients included in a prospective, population-based study (NORPACT-2) in patients with BRPC and LAPC (2018–2020) were reviewed. Molecular testing was performed at the discretion of the treating oncologist and was not recommended as a routine investigation by the national guidelines. All patients were considered fit to undergo primary chemotherapy and potential surgical resection. The frequency and the results of molecular testing (microsatellite instability (MSI) and/or KRAS status) were assessed. Results Thirty patients (16%) underwent molecular testing. MSI tumour was detected in one (3.6%) of 28 tested patients. The patient received immunotherapy and subsequently underwent surgical resection. Histological assessment of the resected specimen revealed a complete response. KRAS wild type was detected in one (14.3%) of seven tested patient. Patients who initiated FOLFIRINOX as the primary chemotherapy regimen (p = 0.022), or were being treated at one of the eight hospital trusts (p = 0.001) were more likely to undergo molecular testing. Conclusions Molecular testing was rarely performed in patients with BRPC or LAPC. Routine molecular testing for all patients with BRPC and LAPC should be considered to increase identification of targetable mutations and improve outcomes.

• Farnes, Ingvild; Kleive, Dyre; Verbeke, Caroline Sophie; Aabakken, Lars; Issa-Epe, Aart Imran & Småstuen, Milada Cvancarova [Show all 10 contributors for this article] (2023). Resection rates and intention-to-treat outcomes in borderline and locally advanced pancreatic cancer: real-world data from a population-based, prospective cohort study (NORPACT-2). BJS Open. 7:zrad137(6), p. 1–10. doi: 10.1093/bjsopen/zrad137. Full text in Research Archive Show summary

  Background: Systemic chemotherapy is the initial treatment strategy for borderline resectable and locally advanced pancreatic cancer to facilitate curative resection. The aim of this study was to investigate the resection rates and overall survival in patients with borderline resectable pancreatic cancer and locally advanced pancreatic cancer. Methods: Consecutive patients with borderline resectable pancreatic cancer/locally advanced pancreatic cancer discussed by Oslo University Hospital multidisciplinary team between 2018 and 2020, serving a population of 3.1 million within a geographically defined area in south-eastern Norway, were included in this prospective Norwegian Pancreatic Cancer Trial-2 study, according to intention-to-treat principles. The total number of patients with pancreatic cancer was sought from the Cancer Registry of Norway. Results: A total of 1178 patients were diagnosed with pancreatic cancer, of whom 618 were referred to Oslo University Hospital. After multidisciplinary team evaluation, 230 patients were considered to have borderline resectable pancreatic cancer/locally advanced pancreatic cancer. The final study group consisted of 188 patients (borderline resectable pancreatic cancer n = 96, locally advanced pancreatic cancer n = 92) who were fit to receive primary chemotherapy. Resection rates were 46.9% (45 of 96) for borderline resectable pancreatic cancer and 13% (12 of 92) for locally advanced pancreatic cancer (P <0.001). Median overall survival was 14.6 months (borderline resectable pancreatic cancer 16.4 months; locally advanced pancreatic cancer 13.7 months, (P = 0.2)). Adjusted for immortal time bias, median overall survival for patients undergoing resection versus only chemotherapy was 24.4 months versus 10.1 months (P <0.001) for borderline resectable pancreatic cancer and 28.4 months versus 12.6 months for locally advanced pancreatic cancer (P = 0.001). Conclusion: Resection rates and survival in patients with borderline resectable pancreatic cancer and locally advanced pancreatic cancer treated at a high-volume centre in a universal healthcare system compare well with those treated at international expert centres.

• Tønnesen, Christer Julseth; Hjelmesæth, Jøran Sture; Aabakken, Lars; Lund, Randi Størdal; Johnson, Line Kristin & Hertel, Jens Kristoffer [Show all 9 contributors for this article] (2023). A pilot study of implementation of endoscopic sleeve gastroplasty (ESG) in Norway. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 58(10), p. 1180–1184. doi: 10.1080/00365521.2023.2204389. Full text in Research Archive Show summary

  Bariatric surgery is the most effective treatment for obesity but is invasive and associated with serious complications. Endoscopic sleeve gastroplasty (ESG) is a less invasive weight loss procedure to reduce the stomach volume by full-thickness sutures. ESG has been adopted in many countries, but implementation at Scandinavian centres has not yet been documented. We performed a clinical pilot trial at a Norwegian centre with the primary objective to assess the feasibility of the ESG procedure. Patients and methods We included the first 10 patients treated with ESG at a Norwegian centre in a single-arm pilot study. The eligibility criteria were either a body mass index (BMI) of 40–49.9 kg/m2, BMI 35–39.9 kg/m2 and at least one obesity-related comorbidity, or BMI 30–34.9 kg/m2 and type 2 diabetes. Patient follow-up resembled the scheme used for bariatric surgery at the center, including dietary plans and outpatient visits. Results All procedures were technically successful except for one patient who had adhesions between the stomach and anterior abdominal wall, related to a prior hernia repair, resulting in less-than-intended stomach volume reduction. Mean total body weight loss (TBWL) after 26 and 52 weeks was 12.2% (95% CI 8.1–16.2) and 9.1% (95% CI 3.3 − 15.0). One patient experienced a minor suture-induced diaphragmatic injury, which was successfully managed conservatively. Conclusions This first Scandinavian clinical trial of ESG, documenting the implementation of the procedure at a Norwegian center, demonstrated acceptable feasibility and safety, with large variations in individual weight loss during the 52-week follow-up period.

• Repici, Alessandro; Khalaf, Kareem; Troncone, Edoardo; Subramaniam, Sharmila; Hassan, Cesare & Bhandari, Pradeep [Show all 68 contributors for this article] (2023). International Delphi Consensus Study on disposable single-use endoscopy: A path to clinical adoption. Digestive and Liver Disease. ISSN 1590-8658. doi: 10.1016/j.dld.2023.07.026. Full text in Research Archive
• Mikalsen, Ina; Breder, Sigurd; Medhus, Asle Wilhelm; Folseraas, Trine; Aabakken, Lars & Ånonsen, Kim Vidar (2023). ERCP for the initial management of malignant biliary obstruction–real world data on 596 procedures. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. doi: 10.1080/00365521.2023.2282375. Full text in Research Archive Show summary

  Aims To evaluate outcomes of ERCP as first-line management in patients with malignant biliary obstruction (MBO) of all causes and stages, reflecting a real-life setting. Methods Retrospective observational study of patients with ERCP as the first-line management of MBO at Oslo University Hospital between 2015 and 2021. Primary outcome measure was a ≥ 50% decrease from the pre-procedural bilirubin within 30 days after ERCP. Secondary outcome measures were technical success of ERCP, complications and overall mortality. Results A total of 596 patients were included, median age 70 years. ASA score was ≥ III in 67% of patients. The most common cancers causing MBO were pancreatic cancer (52%), metastatic lesions (20%) and cholangiocarcinoma (16%). The primary outcome measure was achieved in 62% of patients. With endoscopic access, overall technical success was 80% with 85% for the distal extrahepatic group, 71% for the perihilar, 40% for the intrahepatic and 53% for multiple level MBOs. Reinterventions were performed in 27% of the patients. Complications occurred in 15% of the patients, including post-ERCP pancreatitis in 9%. Most complications were of minor/moderate severity (81%). Overall mortality was 33% within the first 90 days. Patients deceased by the end of the study period (83%) had median survival of 146 days (range 1–2,582 days). Conclusions ERCP has a high rate of clinical effect and technical success in the management of both distal extrahepatic and perihilar MBO. Our data indicate that ERCP is a valid option in the first-line management of MBO.

• Farnes, Ingvild; Paulsen, Vemund; Verbeke, Caroline Sophie; Tønnesen, Christer Julseth; Aabakken, Lars & Labori, Knut Jørgen (2023). Performance and safety of diagnostic EUS FNA/FNB and therapeutic ERCP in patients with borderline resectable and locally advanced pancreatic cancer - results from a population-based, prospective cohort study. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 59(4), p. 496–502. doi: 10.1080/00365521.2023.2290456. Full text in Research Archive Show summary

  Objective: Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS FNA/FNB) and potential endoscopic retrograde cholangiopancreatography (ERCP) for biliary decompression are indicated in patients with pancreatic cancer before initation of primary chemotherapy. This study aims to investigate the performance and safety of these two procedures in patients with borderline resectable (BRPC) or locally advanced pancreatic cancer (LAPC). Methods: Endoscopy and pathology reports, and hospital records of consecutive patients with a radiological diagnosis of BRPC/LAPC included in a population based, protocol-driven study (NORPACT-2) were reviewed. Results: Of 251 patients, 223 (88.9%) underwent EUS-FNA/FNB, and 133 (53%) underwent ERCP. Repeated EUS attempts were performed in 33 (14.8%), eight (3.6%), and four (1.8%) patients. FNA was performed in 155 procedures, FNB in 30, and combined EUS-FNA/FNB in 83. Diagnostic accuracy was 86.1% for first EUS-FNA/FNB. The cumulative diagnostic accuracy for all attempts was 96%. False positive rate for malignancy was 0.9%. Of a total of 149 ERCP procedures, 122 (81.9%) were successful, and 27 (18.1%) were unsuccessful. Success rate of first ERCP attempt was 80.5% (107/133). Sixteen patients (12%) underwent a second attempt with a success rate of 93.8% (15 of 16). Combined EUS and ERCP was performed in 41 patients. Complications occurred in eight procedures (3%) after EUS-FNA/FNB, 23 procedures (15.3%) after ERCP, and four (9.8%) patients after combined EUS-FNA/FNB and ERCP. Conclusion: EUS-FNA/FNB and ERCP with biliary stenting in patients with BRPC/LAPC demonstrated acceptable performance and safety. Repeat procedures were performed with high success rates. Same session EUS-FNA/FNB and ERCP for biliary decompression is safe.

• Strahm, Noemi; Didriksen, Henriette; Fretheim, Håvard Halland; Molberg, Øyvind; Midtvedt, Øyvind & Farstad, Inger Nina [Show all 13 contributors for this article] (2023). Effects of faecal microbiota transplantation on the small intestinal mucosa in systemic sclerosis. Rheumatology. ISSN 1462-0324. 62(8), p. 2918–2929. doi: 10.1093/rheumatology/kead014. Full text in Research Archive Show summary

  Abstract Objectives In SSc, gastrointestinal tract (GIT) involvement is a major concern, with no disease-modifying and limited symptomatic therapies available. Faecal microbiota transplantation (FMT) represents a new therapeutic option for GIT-affliction in SSc, showing clinical promise in a recent controlled pilot trial. Here, we aim to investigate effects of FMT on duodenal biopsies collected from SSc patients by immunohistochemistry and transcriptome profiling. Methods We analysed duodenal biopsies obtained pre-intervention (week 0) and post-intervention (weeks 2 and 16) from nine SSc patients receiving an intestinal infusion of FMT (n = 5) or placebo (n = 4). The analysis included immunohistochemistry (IHC) with a selected immune function and fibrosis markers, and whole biopsy transcriptome profiling. Results In patients receiving FMT, the number of podoplanin- and CD64-expressing cells in the mucosa were lower at week 2 compared with baseline. This decline in podoplanin- (r = 0.94) and CD64-positive (r = 0.89) cells correlated with improved patient-reported lower GIT symptoms. Whole biopsy transcriptome profiling from week 2 showed significant enrichment of pathways critical for cellular and endoplasmic reticulum stress responses, microvillus and secretory vesicles, vascular and sodium-dependent transport, and circadian rhythm. At week 16, we found enrichment of pathways mandatory for binding activity of immunoglobulin receptors, T cell receptor complexes, and chemokine receptors, as well as response to zinc-ions. We found that 25 genes, including Matrix metalloproteinase-1 were upregulated at both week 2 and week 16. Conclusion Combining selective IHC and unbiased gene expression analyses, this exploratory study highlights the potential for disease-relevant organ effects of FMT in SSc patients with GIT involvement. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT03444220.

• Mære, Berit Oterholm; Omdal, Roald; Hetta, Anne Kristine; Kvaløy, Jan Terje; Aabakken, Lars & Skoie, Inger Marie [Show all 7 contributors for this article] (2023). Less, but not gone—gluten-free diet effects on fatigue in celiac disease: a prospective controlled study. Frontiers in Medicine. 10. doi: 10.3389/fmed.2023.1242512. Full text in Research Archive Show summary

  Introduction: Fatigue is a frequent complaint in patients with celiac disease. A gluten-free diet is the only established treatment for celiac disease, but how this diet influences fatigue is uncertain. We aimed to investigate fatigue prevalence, severity, and associated factors in patients with celiac disease, at diagnosis and at 1 year after commencing a gluten-free diet. Methods: 78 patients with serologically and histologically verified celiac disease, 78 age- and sex-matched healthy subjects. Primary endpoints were Fatigue Visual Analog Scale (fVAS), Fatigue Severity Scale (FSS), and inverted Vitality subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36vs). Clinically relevant fatigue was defined as: FSS score ≥ 4, fVAS score ≥ 50 mm, or inverted SF-36vs score ≥ 65. Higher scores represented more fatigue. Results: Fatigue was reduced after a 12-month gluten-free diet. Median scores changed from 3.8 (interquartile range [IQR]: 2.2 to 4.8) to 1.9 (IQR: 1.4 to 3.5) for FSS, from 44.5 (IQR: 18.8 to 66.0) to 15.5 (IQR: 7.8 to 43.3) for fVAS, and from 65 (IQR: 40 to 75) to 35 (IQR: 25 to 55) for inverted SF-36vs (p < 0.001 for all). Fatigue prevalence also declined after treatment. However, scores were significantly higher in patients compared to control subjects. Higher fatigue scores were associated with depression and pain, but not with signs of disease activity or nutritional deficiency. Conclusion: At diagnosis, patients with celiac disease frequently had severe fatigue. Fatigue declined after a gluten-free diet, but it remained higher than that observed in healthy subjects.

• Megen, Frida van; Skodje, Gry Irene; Lergenmuller, Simon; Zühlke, Stephanie; Aabakken, Lars & Veierød, Marit Bragelien [Show all 8 contributors for this article] (2022). A low FODMAP diet reduces symptoms in treated celiac patients with ongoing symptoms–A randomized controlled trial. Clinical Gastroenterology and Hepatology. ISSN 1542-3565. 20(10), p. 2258–2266.E3. doi: 10.1016/j.cgh.2022.01.011. Full text in Research Archive Show summary

  Background & Aims A gluten-free diet usually leads to mucosal remission in celiac disease, but persistent symptoms are common. A low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet is an established treatment for irritable bowel syndrome (IBS). We have assessed the efficacy of a moderately low FODMAP diet on persistent symptoms in treated celiac patients. Methods A randomized controlled trial was performed from 2018 to 2019 in 70 adults with biopsy-proven celiac disease. Inclusion criteria were as follows: persistent gastrointestinal symptoms defined by a Gastrointestinal Symptom Rating Scale (GSRS)–IBS version score of 30 or higher, gluten-free diet adherence for 12 months or longer, and serologic and mucosal remission. Participants were randomized to a low FODMAP–gluten-free diet (intervention) or usual gluten-free diet (control). The GSRS-IBS score was recorded at baseline and at weeks 1 to 4, and the Celiac Symptom Index at baseline and at week 4. Statistics included marginal models for repeated data and analyses of covariance. Results We included 34 participants in the intervention group and 36 in the control group. Time development of GSRS–IBS total scores differed significantly between the groups (Pinteraction < .001), evident after 1 week (mean difference in intervention vs control, -8.2; 95% CI, -11.5 to -5.0) and persisting through week 4 (mean difference in intervention vs control, -10.8; 95% CI, -14.8 to -6.8). Moreover, significantly lower scores were found for the dimensions of pain, bloating, diarrhea, and satiety (Pinteraction ≤ .04), but not constipation (Pinteraction = .43). FODMAP intake during the intervention was moderately low (mean, 8.1 g/d; 95% CI, 6.7–9.3 g/d). The Celiac Symptom Index was significantly lower in the intervention group at week 4 (mean difference, -5.8; 95% CI, -9.6 to -2.0). Conclusions A short-term moderately low FODMAP diet significantly reduced gastrointestinal symptoms and increased celiac disease–specific health, and should be considered for the management of persistent symptoms in celiac disease. ClinicalTrials.gov: NCT03678935.

• Karstensen, John Gásdal; Ebigbo, Alanna; Desalegn, Hailemichael; Afihene, Mary; Anigbo, Gideon & Antonelli, Giulio [Show all 14 contributors for this article] (2022). Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy Cascade Guideline. Endoscopy International Open. 10(11), p. E1427–E1433. doi: 10.1055/a-1964-7965. Full text in Research Archive Show summary

  Colorectal cancer (CRC) is a major contributor to morbidity and cancer death globally with an increasing incidence also in low- and middle-income countries [1] [2]. However, CRC is preventable if precursor lesions are detected and treated [3] [4]. Throughout the world, national screening programs have been established that are aimed at the endoscopic detection and removal of polyps, as well as the diagnosis of cancers at an early stage [5] [6]. In addition to screening, diagnostic colonoscopy is crucial for investigation of symptoms. However, in resource-limited settings, screening programs might be absent, and the availability of colonoscopy might be limited by costs, travel distance, and lack of trained endoscopists. Furthermore, to achieve the full benefit of colonoscopy, detected lesions should be optimally removed to prevent recurrence and subsequent development of CRC, while avoiding adverse events (AEs) such as bleeding and perforation. This can be ensured with suitable training and mentoring programs and accompanied by guidelines developed with a generally high level of evidence [7] [8] [9] [10]. Nevertheless, some recommendations within these guidelines include utilization of accessories that are costly and additionally require appropriate training to use safely. Hence, in a resource-limited setting, adherence to current guidelines for colonoscopy and polypectomy may be challenging. In 2018, the European Society of Gastrointestinal Endoscopy (ESGE) and the World Endoscopy Organization (WEO) established an international working group with the aim of creating a set of guidelines amenable also in resource-sensitive communities [11]. Consequently, a cascade methodology was introduced developing adapted recommendations for different levels of available resources. The cascade methodology has already been applied to guidelines for non-variceal upper gastrointestinal bleeding, esophageal stenting, endoscopic treatment of variceal upper gastrointestinal bleeding, as well as a guideline in conjunction with the World Gastroenterology Organization for resuming endoscopy after the COVID pandemic [12] [13] [14] [15]. Based on the ESGE guideline by Ferlitsch et al, the aim of this cascade guideline is to propose recommendations for colorectal polypectomy and endoscopic mucosal resection (EMR) in resource-limited settings [7].

• Ainechi, Diba; Misawa, Masashi; Barua, Ishita; Larsen, Solveig; Paulsen, Vemund & Garborg, Kjetil Kjeldstad [Show all 21 contributors for this article] (2022). Impact of artificial intelligence on colorectal polyp detection for early-career endoscopists: an international comparative study. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. doi: 10.1080/00365521.2022.2070436. Full text in Research Archive Show summary

  Background Artificial intelligence (AI) for polyp detection is being introduced to colonoscopy, but there is uncertainty how this affects endoscopists’ ability to detect polyps and neoplasms. We performed a video-based study to address whether AI improved the endoscopists’ performance to detect polyps. Methods We established a dataset of 200 colonoscopy videos (length 5 s; 100 without polyps and 100 with one polyp). About 33 early-career endoscopists (50–400 colonoscopies performed) from 10 European countries classified each video as either ‘polyp present’ or ‘polyp not present’. The video assessment was performed twice with a four-week interval. The first assessment was performed without any AI tool, whereas the second was performed with an AI tool for polyp detection. The primary endpoint was early-career endoscopists’ sensitivity to detect polyps. Gold standard for presence and histology of polyps were confirmed by two expert endoscopists and pathologists, respectively. McNemar’s test was used for statistical significance. Results There were 86 neoplastic and 14 non-neoplastic polyps (mean size 5.6 mm) in the 100 videos with polyps. Early-career endoscopists’ sensitivity to detect polyps increased from 86.3% (95% confidence interval [CI]: 85.1–87.5%) to 91.7% (95%CI: 90.7–92.6%) with the AI aid (p < .0001). Their sensitivity to detect neoplastic polyps increased from 85.4% (95% CI: 84.0–86.7%) to 92.1% (95%CI: 91.1–93.1%) with the AI aid (p < .0001). Conclusion The polyp detection AI tool helped early-career endoscopists to increase their sensitivity to identify all polyps and neoplastic polyps during colonoscopy.

• Tejera, Valeria Castro; Öhman, Lena; Aabakken, Lars; Fellström, Bengt; Hausken, Trygve & Hovde, Øistein [Show all 11 contributors for this article] (2022). Randomised clinical trial and meta-analysis: mesalazine treatment in irritable bowel syndrome—effects on gastrointestinal symptoms and rectal biomarkers of immune activity. Alimentary Pharmacology and Therapeutics. ISSN 0269-2813. 56(6), p. 968–979. doi: 10.1111/apt.17182. Full text in Research Archive Show summary

  Background: Low-grade immune activation in the gut is a potential treatment target in irritable bowel syndrome (IBS). Aims: To determine improvement in IBS symptoms after mesalazine treatment, and the utility of measures of immune activity in the rectal mucosa METHODS: This was a randomised, double-blind, placebo-controlled, parallel-arm, multicentre trial in subjects with IBS (Rome III criteria), with an eight-week treatment period of mesalazine 2400 mg or plcebo once-daily. The primary endpoint was the global assessment of satisfactory relief of IBS symptoms in ≥50% of weeks during intervention. IBS symptoms were also measured with the IBS severity scoring system; immune activity was measured by mucosal patch technology. A post hoc meta-analysis of randomised placebo-controlled trials of mesalazine in IBS was added. Results: Of 181 included patients, 91 received mesalazine and 90 received placebo. The primary endpoint was met by 32 (36%) patients after mesalazine and 27 (30%) after placebo (p = 0.40). There were no differences in response rates related to IBS subtype or post-infection symptom onset. More reduction of abdominal bloating was noted in the mesalazine group (p = 0.02). The meta-analysis showed no effect of mesalazine on IBS symptoms. No mucosal patch technology measure could predict response to mesalazine, and found no differences in the effects of intervention on levels of immune markers. Conclusions: Mesalazine is ineffective in reducing IBS symptoms. Rectal measures of immune activity by the mucosal patch technology cannot predict a higher chance of response to mesalazine. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2022 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.

• Dietrich, Christoph F.; Braden, Barbara; Burmeister, Sean; Aabakken, Lars; Arciadacono, Paolo Giorgio & Bhutani, Manoop S. [Show all 26 contributors for this article] (2022). How to perform EUS-guided biliary drainage. Endoscopic Ultrasound. ISSN 2303-9027. 11(5), p. 342–354. doi: 10.4103/EUS-D-21-00188. Full text in Research Archive
• Mikkelsen, Audun; Møinichen, Unn Inger; Reims, Henrik Mikael; Grzyb, Krzysztof; Aabakken, Lars & Mørkrid, Lars [Show all 8 contributors for this article] (2022). Clinical variables as indicative factors for endoscopy in adolescents with esophageal atresia. Journal of Pediatric Surgery. ISSN 0022-3468. 00(0), p. 1–9. doi: 10.1016/j.jpedsurg.2022.10.003. Full text in Research Archive Show summary

  Introduction Gastro-esophageal reflux disease (GERD) occurs frequently in patients operated for esophageal atresia (EA). Longstanding esophagitis may lead to dysphagia, strictures, columnar metaplasia, and dysplasia with an increased risk of adenocarcinoma. Are clinical factors and non-invasive assessments reliable indicators for follow-up with endoscopy? Material and method A follow-up study with inclusion of EA adolescents in Norway born between 1996 and 2002 was conducted. Clinical assessment with pH monitoring, endoscopy with biopsies, along with interviews and questionnaires regarding gastroesophageal reflux disease (GERD) and dysphagia were performed. Results We examined 68 EA adolescents. 62% reported GERD by interview, 22% by questionnaire. 85% reported dysphagia by interview, 71% by questionnaire. 24-hour pH monitoring detected pathological reflux index (RI) (>7%) in 7/59 (12%). By endoscopy with biopsy 62 (92%) had histologic esophagitis, of whom 3 (4%) had severe esophagitis. Gastric metaplasia was diagnosed in twelve (18%) adolescents, intestinal metaplasia in only one (1.5%). None had dysplasia or carcinoma. Dysphagia and GERD were statistically correlated to esophagitis and metaplasia, but none of the questionnaires or interviews alone were good screening instruments with high combined sensitivity and specificity. A compound variable made by simply taking the mean of rescaled RI and dysphagia by interview showed to be the best predictor of metaplasia (85% sensitivity, 67% specificity). Conclusion The questionnaires and interviews used in the present study were not good screening instruments alone. However, combining dysphagia score by interview and RI may be helpful in assessing which patients need endoscopy with biopsy at each individual follow-up examination. Level of Evidence Level II prognostic study Keywords Esophageal atresia Gastroesophageal reflux Dysphagia Metaplasia Endoscopy Columnar metaplasia ROC-curve

• Steinsbø, Øyvind; Carlsen, Arne; Aasprong, Ole Gunnar; Aabakken, Lars; Tvedt-Gundersen, Espen & Bjørkhaug, Steinar Traae [Show all 9 contributors for this article] (2022). Histologic healing and factors associated with complete remission following conventional treatment in ulcerative colitis. Therapeutic Advances in Gastroenterology. ISSN 1756-283X. 15, p. 1–14. doi: 10.1177/17562848221140659. Full text in Research Archive Show summary

  Background: Endoscopic and histological activity scores in ulcerative colitis (UC) are associated with clinical outcomes and have become important targets of clinical trials. However, these endpoints have been scarcely investigated in patients receiving only conventional treatment. Objective: We aimed to assess the deep and complete remission rates after 3 months of conventional treatment in patients with newly diagnosed UC with moderate to severe endoscopic activity. We also aimed to investigate whether selected clinical and biochemical variables at baseline were associated with complete remission status after 3 months. Design: This was a prospective cohort study. Methods: Newly diagnosed patients with active UC commencing 5-aminosalicylate, corticosteroid, and/or azathioprine treatment were consecutively included. Clinical, biochemical, endoscopic, and histological data were collected at baseline and after 3 months. Rates of clinical remission (Partial Mayo Score ⩽ 2), mucosal healing (Mayo Endoscopic Score ⩽ 1), and histologic healing (Nancy Index ⩽ 1) were determined. Deep remission was assessed as clinical remission plus mucosal healing and complete remission as deep remission plus histologic healing. Predictors of complete remission were identified by logistic regression. Results: A total of 180 patients were included in the study. Deep remission and complete remission occurred in 62.8% and 42.2% of patients, respectively. Thus, of patients in deep remission one-third had persistent histologic activity. Histologic activity in mucosally healed patients was associated with higher symptom scores and faecal calprotectin levels. Of baseline variables, less endoscopic distribution and disease activity showed strongest association with achieving complete remission, and limited distribution in combination with moderate activity gave highest odds for complete remission (odds ratio: 4.1, 95% confidence interval: 7.69–2.18). Conclusion: In patients with mucosal healing, persistent histologic activity was a common finding and was associated with increased disease activity. Pancolitis and severe inflammatory activity at baseline were associated with lower complete remission rates.

• Beyna, Torsten; Moreels, Tom; Arvanitakis, Marianna; Pioche, Mathieu; Saurin, Jean-Christophe & May, Andrea [Show all 18 contributors for this article] (2022). Motorized spiral enteroscopy: Results of an international multicenter prospective observational clinical study in patients with normal and altered gastrointestinal anatomy. Endoscopy. ISSN 0013-726X. doi: 10.1055/a-1831-6215. Full text in Research Archive
• Baddeley, Robin; Aabakken, Lars; Veitch, Andrew & Hayee, Bu'Hussain (2022). Green Endoscopy: Counting the Carbon Cost of Our Practice. Gastroenterology. ISSN 0016-5085. p. 1–5. doi: 10.1053/j.gastro.2022.01.057. Full text in Research Archive
• Skjellerudsveen, Berit Mære; Omdal, Roald; Hetta, Anne Kristine; Kvaløy, Jan Terje; Aabakken, Lars & Skoie, Inger Marie [Show all 7 contributors for this article] (2022). Fatigue: a frequent and biologically based phenomenon in newly diagnosed celiac disease. Scientific Reports. 12. doi: 10.1038/s41598-022-11802-8. Full text in Research Archive Show summary

  Fatigue is increasingly recognized as a major complaint in patients with chronic inflammatory and autoimmune diseases. Although fatigue is assumed to represent a significant problem in celiac disease, existing knowledge is scarce, and opinions are conflicting. This study aimed to investigate the prevalence and severity of fatigue in patients with newly diagnosed celiac disease and compare it with healthy control subjects. Ninety patients with newly diagnosed celiac disease were compared with 90 age- and sex-matched healthy subjects. The primary endpoints were fatigue severity as measured by: the fatigue Visual Analog Scale (fVAS), the Fatigue Severity Scale (FSS), and the inverted Vitality subscale of the MOS36 (SF-36vs). Higher scores indicate more severe fatigue. Clinically relevant fatigue was determined using predefined cut-off values. Secondary endpoints were the associations between fatigue, and sex, age, depression, pain, and selected biochemical variables. The median (IQR) fVAS-scores were 43.0 (18.0–64.5) in patients, and 9.0 (2.0–16.0) in the control group (p < 0.001); and the FSS scores 3.8 (2.0–4.8) in patients, and 1.4 (1.0–1.9) in control subjects (p < 0.001). Inverted SF-36vs scores had a mean (SD) value of 58.8 (23.6) in patients, and 29.7 (14.3) in healthy subjects (p < 0.001). The presence of clinically relevant fatigue ranged from 41 to 50% in patients. Increased fatigue severity was associated with female sex, younger age, and elevated pain and depression scores, but not with levels of selected biochemical variables, including hemoglobin. Fatigue is a severe and frequent phenomenon in patients with untreated celiac disease.

• Waage, Anne; Holmquist, Olof Dan Sebastian; Labori, Knut Jørgen; Paulsen, Vemund; Lenz, Harald & Aabakken, Lars [Show all 9 contributors for this article] (2022). Tailored surgery in chronic pancreatitis after implementation of a multidisciplinary team assessment; a prospective observational study. HPB. ISSN 1365-182X. 24(12). doi: 10.1016/j.hpb.2022.09.007. Full text in Research Archive Show summary

  Introduction - Optimal management of chronic pancreatitis involves several specialties. Selection of patients for surgery may benefit from evaluation by a multidisciplinary team (MDT), similar to cancer care. The aim of this study was to evaluate outcomes in patients selected for surgery after MDT decision. Methods - A prospective, observational study of consecutive patients operated for pain due to chronic pancreatitis after implementation of a MDT. The main outcome was Quality of life (QoL) assessed by EORTC-QLQ C30 and pain relief in patients followed >3 months. Complications were registered and predictive factors for pain relief analyzed. Results - Of 269 patients evaluated by the MDT, 60 (22%) underwent surgery. Postoperative surgical complications occurred in five patients (8.3%) and reoperation within 30 days in two. There was no 90-days mortality. Complete or partial pain relief was achieved in 44 of 50 patients followed >3 months (88%). Preoperative duration of pain predicted lower probability of success. Postoperative improvement in QoL was most prominent for pain, appetite and nausea. Conclusions - After MDT evaluation, one in five patients was selected for surgery. Pain relief was obtained in a majority of patients with improved QoL. A tailored approach through a MDT seems warranted and efficient.

• Mekonen, Yemesrach Fereja; Aabakken, Lars & Mekonnen, Hailemichael Desalegn (2022). DYSPEPSIA AND PREVALENCE OF CLINICALLY SIGNIFICANT ENDOSCOPY FINDINGS IN A GASTROENTEROLOGY REFERRAL CLINIC IN ETHIOPIA. Ethiopian Medical Journal (EMJ). ISSN 0014-1755. 60(1), p. 57–62. Full text in Research Archive
• Teoh, Anthony Yuen Bun; Ma, Mark Tsz Wah; Aabakken, Lars; Seo, Dong Wan & Reddy, D. Nageshwar (2022). International cross-sectional survey on endoscopic retrograde cholangiopancreatography training by the World Endoscopy Organization. Digestive Endoscopy. ISSN 0915-5635. doi: 10.1111/den.14404. Full text in Research Archive
• Gkolfakis, Paraskevas; Papaefthymiou, Apostolis; Facciorusso, Antonio; Tziatzios, Georgios; Ramai, Daryl & Dritsas, Spyridon [Show all 15 contributors for this article] (2022). Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis. Life. 12(10). doi: 10.3390/life12101646. Full text in Research Archive Show summary

  Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP), in surgically altered anatomy (SAA), can be challenging and the optimal technique selection remains debatable. Most common foregut interventions resulting to this burden consist of Billroth II gastrectomy, Whipple surgery and Roux-en-Y anastomoses, including gastric by-pass. This systematic review, with meta-analysis, aimed to compare the rates of successful enteroscope-assisted (EA)-, endosonography-directed transgastric- (EDGE), and laparoscopy-assisted (LA)-ERCP. Methods: A systematic research (Medline) was performed for relative studies, through January 2022. The primary outcome was technical success, defined as approaching the ampulla site. Secondary outcomes included the desired duct cannulation, successful therapeutic manipulations, and complication rates. We performed meta-analyses of pooled data, and subgroup analysis considering the EA-ERCP subtypes (spiral-, double and single balloon-enteroscope). Pooled rates are reported as percentages with 95% Confidence Intervals (95%CIs). Results: Seventy-six studies were included (3569 procedures). Regarding primary outcome, EA-ERCP was the least effective [87.3% (95%CI: 85.3–89.4); I2: 91.0%], whereas EDGE and LA-ERCP succeeded in 97.9% (95%CI: 96.4–99.4; I2: 0%) and 99.1% (95%CI: 98.6–99.7; I2: 0%), respectively. Similarly, duct cannulation and therapeutic success rates were 74.7% (95%CI: 71.3–78.0; I2: 86.9%) and 69.1% (95%CI: 65.3–72.9; I2: 91.8%) after EA-ERCP, 98% (95%CI: 96.5–99.6; I2: 0%) and 97.9% (95%CI: 96.3–99.4) after EDGE, and 98.6% (95%CI: 97.9–99.2; I2: 0%) and 98.5% (95%CI: 97.8–99.2; I2: 0%) after LA-ERCP, respectively. The noticed high heterogeneity in EA-ERCP results probably reflects the larger number of included studies, the different enteroscopy modalities and the variety of surgical interventions. Comparisons revealed the superiority of LA-ERCP and EDGE over EA-ERCP (p ≤ 0.001) for all success-related outcomes, though LA-ERCP and EDGE were comparable (p ≥ 0.43). ERCP with spiral-enteroscope was inferior to balloon-enteroscope, while the type of the balloon-enteroscope did not affect the results. Most adverse events were recorded after LA-ERCP [15.1% (95%CI: 9.40–20.8); I2: 87.1%], and EDGE [13.1% (95%CI: 7.50–18.8); I2: 48.2%], significantly differing from EA-ERCP [5.7% (95%CI: 4.50–6.80); p ≤ 0.04; I2: 64.2%]. Conclusions: LA-ERCP and EDGE were associated with higher technical, cannulation, and therapeutic success compared to EA-ERCP, though accompanied with more adverse events.

• Vedeld, Hege Marie; Grimsrud, Marit Mæhle; Andresen, Kim; Pharo, Heidi Dietrichson; Seth, Erik von & Karlsen, Tom Hemming [Show all 15 contributors for this article] (2021). Early and accurate detection of cholangiocarcinoma in patients with primary sclerosing cholangitis by methylation markers in bile. Hepatology. ISSN 0270-9139. doi: 10.1002/hep.32125. Full text in Research Archive Show summary

  Background and Aims Primary sclerosing cholangitis (PSC) is associated with increased risk of cholangiocarcinoma (CCA). Early and accurate CCA detection represents an unmet clinical need as the majority of patients with PSC are diagnosed at an advanced stage of malignancy. In the present study, we aimed at establishing robust DNA methylation biomarkers in bile for early and accurate diagnosis of CCA in PSC. Approach and Results Droplet digital PCR (ddPCR) was used to analyze 344 bile samples from 273 patients with sporadic and PSC-associated CCA, PSC, and other nonmalignant liver diseases for promoter methylation of cysteine dioxygenase type 1, cannabinoid receptor interacting protein 1, septin 9, and vimentin. Receiver operating characteristic (ROC) curve analyses revealed high AUCs for all four markers (0.77–0.87) for CCA detection among patients with PSC. Including only samples from patients with PSC diagnosed with CCA ≤ 12 months following bile collection increased the accuracy for cancer detection, with a combined sensitivity of 100% (28/28) and a specificity of 90% (20/203). The specificity increased to 93% when only including patients with PSC with longtime follow-up (> 36 months) as controls, and remained high (83%) when only including patients with PSC and dysplasia as controls (n = 23). Importantly, the bile samples from the CCA-PSC ≤ 12 patients, all positive for the biomarkers, included both early-stage and late-stage CCA, different tumor growth patterns, anatomical locations, and carbohydrate antigen 19-9 levels. Conclusions Using highly sensitive ddPCR to analyze robust epigenetic biomarkers, CCA in PSC was accurately detected in bile, irrespective of clinical and molecular features, up to 12 months before CCA diagnosis. The findings suggest a potential for these biomarkers to complement current detection and screening methods for CCA in patients with PSC.

• Bhat, Purnima & Aabakken, Lars (2021). Role of endoscopy in primary sclerosing cholangitis. Clinical Endoscopy (CE). ISSN 2234-2400. 54(2), p. 193–201. doi: 10.5946/CE.2020.019-IDEN. Full text in Research Archive Show summary

  Primary sclerosing cholangitis (PSC) is a progressive disease of the bile ducts that usually results in chronic liver disease often requiring liver transplantation. Endoscopy remains crucial to the care of these patients, although magnetic resonance cholangiopancreatography has replaced endoscopic retrograde cholangiopancreatography (ERCP) as the primary imaging modality for diagnosis. For detection of dysplasia or cholangiocarcinoma, ERCP with intraductal sampling remains compulsory. Moreover, dominant strictures play an important part in the disease development, and management by balloon dilatation or stenting could contribute to long-term prognosis. In addition, endoscopy offers management for adverse events such as bile leaks and anastomotic strictures after liver transplantation. Finally, the special phenotype of inflammatory bowel disease associated with PSC as well as the frequent occurrence of portal hypertension mandates close follow-up with colonoscopy and upper endoscopy. With the emergence of novel techniques, the endoscopist remains a key member of the multidisciplinary team caring for PSC patients.

• Ponsioen, Cyriel Y.; Assis, David N.; Boberg, Kirsten Muri; Bowlus, Christopher; Deneau, Mark & Thorburn, Douglas [Show all 11 contributors for this article] (2021). Defining Primary Sclerosing Cholangitis: Results From an International Primary Sclerosing Cholangitis Study Group Consensus Process. Gastroenterology. ISSN 0016-5085. 161(6), p. 1764–1775. doi: 10.1053/j.gastro.2021.07.046. Full text in Research Archive
• Kylänpää, Leena; Koskensalo, Vilja; Saarela, Arto; Ejstrud, Per; Udd, Marianne & Lindström, Outi [Show all 15 contributors for this article] (2021). Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation: A randomized controlled trial. Endoscopy. ISSN 0013-726X. doi: 10.1055/a-1327-2025. Full text in Research Archive
• Leddin, Desmond; Omary, M. Bishr; Veitch, Andrew; Metz, Geoffrey; Amrani, Naima & Aabakken, Lars [Show all 26 contributors for this article] (2021). Uniting the Global Gastroenterology Community to Meet the Challenge of Climate Change and Non-Recyclable Waste. Gastroenterology. ISSN 0016-5085. 161(5), p. 1354–1360. doi: 10.1053/j.gastro.2021.08.001. Full text in Research Archive
• Bekkelund, Mattis; Sangnes, Dag André; Søfteland, Eirik Wigtil; Aabakken, Lars; Biermann, Martin & Steinsvik, Elisabeth Kjelsvik [Show all 9 contributors for this article] (2021). Gastroparesis symptoms associated with intestinal hypomotility: An explorative study using wireless motility capsule. Clinical and Experimental Gastroenterology. 14, p. 133–144. doi: 10.2147/CEG.S304854. Full text in Research Archive Show summary

  Objective: Gastric emptying measurements are mandatory in gastroparesis diagnostics, but the association between delayed emptying and symptoms is questionable. It is imperative to find biomarkers better correlated to symptom generation. Hence, we examined the association between symptom severity and gastrointestinal motility measured by wireless motility capsule. Patients and Methods: In this prospective single-centre study, patients with gastroparesis symptoms were simultaneously investigated with gastric emptying scintigraphy and wireless motility capsule, measuring regional transit times and contractility parameters. Symptom severity was assessed with the Patient Assessment of Upper Gastrointestinal Symptom Severity Index (PAGI-SYM), including the Gastroparesis Cardinal Symptom Index (GCSI). Results: We included 107 patients (70% women). In the whole patient group, nausea correlated with the gastric (rs = − 0.31, p = 0.007), small bowel (rs = − 0.41, p < 0.001) and colonic (rs = − 0.33, p = 0.012) motility indices. In patients with idiopathic etiology, nausea correlated with small bowel motility index (rs = − 0.81, p < 0.001) and mean stomach pressure (rs = − 0.64, p = 0.013). We also found negative correlations between total GCSI score and maximum pressure of the small bowel (rs = − 0.77, p < 0.001) and colon (rs = − 0.74, p = 0.002). In diabetes patients, total PAGI-SYM score correlated with colonic motility index (rs = − 0.34, p = 0.012), and mean pressure of the colon correlated with upper abdominal pain (rs = − 0.37, p = 0.007). We found no association between symptoms, gastric emptying nor any other transit times. Conclusion: In patients with gastroparesis symptoms, we found that symptom severity was associated with intestinal hypomotility. Based on these results, gastroparesis diagnostics should also include an evaluation of the small bowel and colon.

• Leddin, Desmond; Omary, M Bishr; Veitch, Andrew; Metz, Geoffrey; Amrani, Naima & Aabakken, Lars [Show all 26 contributors for this article] (2021). Uniting the Global Gastroenterology Community to Meet the Challenge of Climate Change and Nonrecyclable Waste. Journal of Clinical Gastroenterology. ISSN 0192-0790. 55(10), p. 823–829. doi: 10.1097/MCG.0000000000001619. Full text in Research Archive
• Tønnesen, Christer Julseth; Hjelmesæth, Jøran; Hofsø, Dag; Tonstad, Serena; Hertel, Jens Kristoffer & Heggen, Eli [Show all 14 contributors for this article] (2021). A novel intragastric balloon for treatment of obesity and type 2 diabetes. A two-center pilot trial. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 57(2), p. 232–238. doi: 10.1080/00365521.2021.1994641. Full text in Research Archive Show summary

  Background and aims: Obesity with type-2 diabetes is a global challenge. Lifestyle interventions have limited effect for most patients. Bariatric surgery is highly effective, but resource-demanding, invasive and associated with serious complications. Recently, a new intragastric balloon was introduced, not requiring endoscopy for placement or removal (Elipse™, Allurion Inc., Natick, MA). The balloon is swallowed in a capsule and filled with water once in the stomach. The balloon self-deflates after 4 months and is naturally excreted. The present trial investigated balloon feasibility, safety and efficacy in patients with obesity and type-2 diabetes. <p> <p>Patients and methods: We treated 19 patients, with type-2 diabetes and body mass index (BMI) of 30.0-39.9 kg/m2 at two Norwegian centers with the Elipse balloon. Patient follow-up during balloon treatment mimicked real-world clinical practice, including dietary plan and outpatient visits. The primary efficacy endpoints were total body weight loss (TBWL) and HbA1c at weeks 16 and 52. <p> <p>Results: All patients underwent balloon insertion uneventfully as out-patients. Mean TBWL and HbA1c reduction after 16 and 52 weeks of balloon insertion was 3.9% (95%CI 2.1-5.7) and 0.8% (95%CI 1.9-3.5); and 7 (95%CI 4-10), and 1 (95%CI -6 to 9) mmol/mol, respectively. Adverse events occurred in two patients (10.5%): one developed gastric outlet obstruction, managed by endoscopic balloon removal; the other excessive vomiting and dehydration, managed conservatively. <p> <p>Conclusions: This first Scandinavian real-world clinical trial with a new minimally invasive intragastric balloon system demonstrated good feasibility, but did not confirm expected efficacy for weight loss and diabetes control.

• Grimstad, Tore Bjørn; Mære, Berit Oterholm; Kvaløy, Jan Terje; Skoie, Inger Marie; Carlsen, Arne & Karlsen, Lars Normann [Show all 8 contributors for this article] (2021). The influence of disease activity on fatigue in patients with ulcerative colitis–a longitudinal study. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. doi: 10.1080/00365521.2021.2007281. Full text in Research Archive
• Hoff, Geir; Botteri, Edoardo; Huppertz-Hauss, Gert; Kvamme, Jan-Magnus; Holme, Øyvind & Aabakken, Lars [Show all 13 contributors for this article] (2021). The effect of train-the-colonoscopy-trainer course on colonoscopy quality indicators. Endoscopy. ISSN 0013-726X. 53(12), p. 1229–1234. doi: 10.1055/a-1352-4583. Full text in Research Archive Show summary

  Background: Systematic training in colonoscopy is highly recommended; however, we have limited knowledge of the effects of "training-the-colonoscopy-trainer" (TCT) courses. Using a national quality register on colonoscopy performance, we aimed to evaluate the effects of TCT participation on defined quality indicators. Methods: This observational study compared quality indicators (pain, cecal intubation, and polyp detection) between centers participating versus not participating in a TCT course. Nonparticipating centers were assigned a pseudoparticipating year to match their participating counterparts. Results were compared between first year after and the year before TCT (pseudo)participation. Time trends up to 5 years after TCT (pseudo)participation were also compared. Generalized estimating equation models, adjusted for age, sex, and bowel cleansing, were used. Results: 11 participating and 11 nonparticipating centers contributed 18 555 and 10 730 colonoscopies, respectively. In participating centers, there was a significant increase in detection of polyps ≥ 5 mm, from 26.4 % to 29.2 % (P = 0.035), and reduction in moderate/severe pain experienced by women, from 38.2 % to 33.6 % (P = 0.043); no significant changes were found in nonparticipating centers. Over 5 years, 20 participating and 18 nonparticipating centers contributed 85 691 and 41 569 colonoscopies, respectively. In participating centers, polyp detection rate increased linearly (P = 0.003), and pain decreased linearly in women (P = 0.004). Nonparticipating centers did not show any significant time trend during the study period. Conclusions: Participation in a TCT course improved polyp detection rates and reduced pain experienced by women. These effects were maintained during a 5-year follow-up.

• Åvitsland, Tone Lise & Aabakken, Lars (2021). Endoscopic retrograde cholangiopancreatography in infants and children. Endoscopy International Open. doi: 10.1055/a-1337-2212. Full text in Research Archive Show summary

  Abstract Background and study aims Previous reports have suggested that endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients are safe. However, the total number of cases presented in the literature remains small. We present results regarding safety and outcomes in pediatric patients undergoing ERCP at Oslo University Hospital. Patients and methods Patients &lt; 18 years who underwent ERCP between April 1999 and November 2017 were identified using procedure codes. Medical records were examined for age, gender, diagnosis, indications, type of sedation, findings, interventions, and complications. Results A total of 244 procedures were performed in 158 patients. Fifty-six of these were in 53 infants (age ≤ 1 year). Mean age was 8.8 years. The youngest patient was 8 days old. Mean weight was 5.0 kg in infants, the smallest weighing 2.9 kg. Cannulation failed in 19 (7.8 %). The main indication in infants was suspicion of biliary atresia (n = 38). Six of the procedures (10.7 %) were therapeutic. In children the main indications were biliary stricture (n = 64) and investigation of primary sclerosing cholangitis (PSC) (n = 45). 119 (63.2 %) of these procedures were therapeutic. Complications were uncommon in infants; only two episodes of infection were registered. In children (&gt; 1 year) post-ERCP pancreatitis were seen in 10.4 %. Conclusions Our retrospective series of ERCP procedures includes 56 procedures in infants, which is one of the largest series presented. Complications in infants are rare and post-ERCP pancreatitis was not seen. In older children 10.4 % experienced post-ERCP pancreatitis. In expert hands, ERCP was shown to be acceptably feasible and safe in infants and children.

• Aabakken, Lars & Bhat, Purnima (2021). How to access the common bile duct. Mini-invasive Surgery. doi: 10.20517/2574-1225.2021.09. Full text in Research Archive
• Antonelli, Giulio; Karstensen, Johan Gasdal; Bhat, Purnima; Ijoma, Uchenna; Osuagwu, Chukwuemeka & Desalegn, Hailemichael [Show all 18 contributors for this article] (2021). Resuming endoscopy during COVID-19 pandemic: ESGE, WEO and WGO Joint Cascade Guideline for Resource Limited Settings. Endoscopy International Open. doi: 10.1055/a-1400-9135. Full text in Research Archive
• Dumonceau, Jean-Marc; Kapral, Christine; Aabakken, Lars; Papanikolaou, Ioannis S.; Tringali, Andrea & Vanbiervliet, Geoffroy [Show all 15 contributors for this article] (2020). ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. ISSN 0013-726X. 52(2), p. 127–149. doi: 10.1055/a-1075-4080. Full text in Research Archive
• Tønnesen, Christer Julseth; Young, Juliet; Glomsaker, Tom Birger; Mala, Tom; Løberg, Magnus & Bretthauer, Michael [Show all 8 contributors for this article] (2020). Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass. Endoscopy. ISSN 0013-726X. 52(8), p. 654–661. doi: 10.1055/a-1139-9313. Full text in Research Archive
• Beg, Sabina; Wronska, Ewa; Araujo, Isis; Suárez, Begona González; Ivanova, Ekaterina & Fedorov, Evgeny [Show all 13 contributors for this article] (2020). Use of rapid reading software to reduce capsule endoscopy reading times while maintaining accuracy. Gastrointestinal Endoscopy. ISSN 0016-5107. 91(6), p. 1322–1327. doi: 10.1016/j.gie.2020.01.026. Full text in Research Archive
• Qadir, Hemin Ali Qadir; Shin, Younghak; Sølhusvik, Johannes; Bergsland, Jacob; Aabakken, Lars & Balasingham, Ilangko (2020). Toward real-time polyp detection using fully CNNs for 2D Gaussian shapes prediction. Medical Image Analysis. ISSN 1361-8415. 68. doi: 10.1016/j.media.2020.101897. Full text in Research Archive Show summary

  To decrease colon polyp miss-rate during colonoscopy, a real-time detection system with high accuracy is needed. Recently, there have been many efforts to develop models for real-time polyp detection, but work is still required to develop real-time detection algorithms with reliable results. We use single-shot feed-forward fully convolutional neural networks (F-CNN) to develop an accurate real-time polyp detection system. F-CNNs are usually trained on binary masks for object segmentation. We propose the use of 2D Gaussian masks instead of binary masks to enable these models to detect different types of polyps more effectively and efficiently and reduce the number of false positives. The experimental results showed that the proposed 2D Gaussian masks are efficient for detection of flat and small polyps with unclear boundaries between background and polyp parts. The masks make a better training effect to discriminate polyps from the polyp-like false positives. The proposed method achieved state-of-the-art results on two polyp datasets. On the ETIS-LARIB dataset we achieved 86.54% recall, 86.12% precision, and 86.33% F1-score, and on the CVC-ColonDB we achieved 91% recall, 88.35% precision, and F1-score 89.65%.

• Ebigbo, Alanna; Karstensen, John Gasdal; Bhat, Purnima; Osuagwu, Chukwuemeka; Desalegn, Hailemichael & Oyeleke, Ganiyat K. [Show all 12 contributors for this article] (2020). Impact of the COVID-19 pandemic on gastrointestinal endoscopy in Africa. Endoscopy International Open. p. 1–5. doi: 10.1055/a-1210-4274. Full text in Research Archive Show summary

  Abstract Background and study aims As with all other fields of medical practice, gastrointestinal endoscopy has been impacted by the COVID-19 pandemic. However, data on the impact of the pandemic in Africa, especially sub-Saharan Africa are lacking. Methods A web-based survey was conducted by the International Working Group of the European Society for Gastrointestinal Endoscopy and the World Endoscopy Organization to determine the impact and effects the COVID-19 pandemic has had on endoscopists in African countries. Results Thirty-one gastroenterologists from 14 countries in north, central, and sub-Saharan Africa responded to the survey. The majority of respondents reduced their endoscopy volume considerably. Personal protective equipment including FFP-2 masks were available in almost all participating centers. Pre-endoscopy screening was performed as well. Conclusion The COVID-19 pandemic has had a substantial impact on gastrointestinal endoscopy in most African countries; however, the impact may not have been as devastating as expected.

• Casado, Raquel Bartolomé; Landsverk, Ole J. B.; Chauhan, Sudhir Kumar; Sætre, Frank Ove; Hagen, Kjersti Thorvaldsen & Yaqub, Sheraz [Show all 12 contributors for this article] (2020). CD4+ T cells persist for years in the human small intestine and display a TH1 cytokine profile. Mucosal Immunology. ISSN 1933-0219. 14(2), p. 402–410. doi: 10.1038/s41385-020-0315-5. Full text in Research Archive Show summary

  Studies in mice and humans have shown that CD8+ T cell immunosurveillance in non-lymphoid tissues is dominated by resident populations. Whether CD4+ T cells use the same strategies to survey peripheral tissues is less clear. Here, examining the turnover of CD4+ T cells in transplanted duodenum in humans, we demonstrate that the majority of CD4+ T cells were still donor-derived one year after transplantation. In contrast to memory CD4+ T cells in peripheral blood, intestinal CD4+ TRM cells expressed CD69 and CD161, but only a minor fraction expressed CD103. Functionally, intestinal CD4+ TRM cells were very potent cytokine producers; the vast majority being polyfunctional TH1 cells, whereas a minor fraction produced IL-17. Interestingly, a fraction of intestinal CD4+ T cells produced granzyme-B and perforin after activation. Together, we show that the intestinal CD4+ T-cell compartment is dominated by resident populations that survive for more than 1 year. This finding is of high relevance for the development of oral vaccines and therapies for diseases in the gut.

• Qadir, Hemin Ali; Sølhusvik, Johannes; Bergsland, Jacob; Aabakken, Lars & Balasingham, Ilangko (2019). A framework with a fully convolutional neural network for semi-automatic colon polyp annotation. IEEE Access. 7, p. 169537–169547. doi: 10.1109/ACCESS.2019.2954675. Full text in Research Archive Show summary

  Deep learning has delivered promising results for automatic polyp detection and segmentation. However, deep learning is known for being data-hungry, and its performance is correlated with the amount of available training data. The lack of large labeled polyp training images is one of the major obstacles in performance improvement of automatic polyp detection and segmentation. Labeling is typically performed by an endoscopist, who performs pixel-level annotation of polyps. Manual polyp labeling of a video sequence is difficult and time-consuming. We propose a semi-automatic annotation framework powered by a convolutional neural network (CNN) to speed up polyp annotation in video-based datasets. Our CNN network requires only ground-truth (manually annotated masks) of a few frames in a video for training and annotating the rest of the frames in a semi-supervised manner. To generate masks similar to the ground-truth masks, we use some pre and post-processing steps such as different data augmentation strategies, morphological operations, Fourier descriptors, and a second stage fine-tuning. We use Fourier coefficients of the ground-truth masks to select similar generated output masks. The results show that it is possible to 1) produce ~ 96% of Dice similarity score between the polyp masks provided by clinicians and the masks generated by our framework, and 2) save clinicians time as they need to manually annotate only a few frames instead of annotating the entire video, frame-by-frame.

• Qadir, Hemin Ali; Balasingham, Ilangko; Sølhusvik, Johannes; Bergsland, Jacob; Aabakken, Lars & Shin, Younghak (2019). Improving Automatic Polyp Detection Using CNN by Exploiting Temporal Dependency in Colonoscopy Video. IEEE Journal of Biomedical and Health Informatics. ISSN 2168-2194. 24(1), p. 180–193. doi: 10.1109/JBHI.2019.2907434. Full text in Research Archive Show summary

  Automatic polyp detection has been shown to be difficult due to various polyp-like structures in the colon and high interclass variations in polyp size, color, shape, and texture. An efficient method should not only have a high correct detection rate (high sensitivity) but also a low false detection rate (high precision and specificity). The state-of-the-art detection methods include convolutional neural networks (CNN). However, CNNs have shown to be vulnerable to small perturbations and noise; they sometimes miss the same polyp appearing in neighboring frames and produce a high number of false positives. We aim to tackle this problem and improve the overall performance of the CNN-based object detectors for polyp detection in colonoscopy videos. Our method consists of two stages: a region of interest (RoI) proposal by CNN-based object detector networks and a false positive (FP) reduction unit. The FP reduction unit exploits the temporal dependencies among image frames in video by integrating the bidirectional temporal information obtained by RoIs in a set of consecutive frames. This information is used to make the final decision. The experimental results show that the bidirectional temporal information has been helpful in estimating polyp positions and accurately predict the FPs. This provides an overall performance improvement in terms of sensitivity, precision, and specificity compared to conventional false positive learning method, and thus achieves the state-of-the-art results on the CVC-ClinicVideoDB video data set.

• Grimstad, Tore; Kvivik, Ingeborg; Kvaløy, Jan Terje; Aabakken, Lars & Omdal, Roald (2019). Heat-shock protein 90α in plasma reflects severity of fatigue in patients with Crohn’s disease. Innate Immunity. ISSN 1753-4259. 26, p. 146–151. doi: 10.1177/1753425919879988. Full text in Research Archive Show summary

  Heat-shock proteins (HSPs) are evolutionarily conserved proteins with important cellular homeostasis functions during harmful conditions, including inflammation. Some HSPs are secreted extracellularly and act on distant cells by down-regulating inflammation and increasing cellular stress defence mechanisms. HSP90α has been postulated to signal fatigue in chronic inflammation. We investigated whether HSP90α is associated with fatigue in patients with Crohn’s disease. Fifty-three patients with newly diagnosed Crohn’s disease were included in a cross-sectional study. Data on demographics and disease distribution were obtained. Fatigue was measured by the fatigue visual analogue scale (fVAS). Disease activity was assessed by the Simple Endoscopic Score for Crohn’s disease and Harvey Bradshaw Index. C-reactive protein, faecal calprotectin and HSP90α were also measured. The median fVAS score was 52 mm, indicating significant fatigue. HSP90α scores correlated significantly with fVAS (r = 0.31, P = 0.03). In a multivariate regression model, HSP90α was the only significant contributor to fVAS scores (β = 0.31, P = 0.03). When patients were dichotomised into groups with high and low HSP90α concentrations, significantly higher fVAS scores were demonstrated in the group with high HSP90α (M = 62.4, confidence interval 53.0–71.8 vs. 43.3, 31.6–55.0; P = 0.01). Thus, HSP90α may contribute to fatigue generation and/or modulation in patients with Crohn’s disease.

• Manes, Gianpiero; Paspatis, Gregorios; Aabakken, Lars; Anderloni, Andrea; Arvanitakis, Marianna & Ah-Soune, Philippe [Show all 23 contributors for this article] (2019). Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. ISSN 0013-726X. 51(5), p. 472–491. doi: 10.1055/a-0862-0346. Full text in Research Archive
• Ebigbo, Alanna; Karstensen, John Gásdal; Aabakken, Lars; Dinis-Ribeiro, Mario; Spaander, Manon & Moine, Olivier Le [Show all 15 contributors for this article] (2019). Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Cascade. Endoscopy International Open. 07, p. E833–E836. doi: 10.1055/a-0898-3523. Full text in Research Archive Show summary

  Dysphagia and obstruction are among the most common indications for upper gastrointestinal endoscopy in African countries [1]. In a survey conducted by the European Society of Gastrointestinal Endoscopy (ESGE) International Affairs Working Group (IAWG), benign esophageal strictures as well as malignant upper gastrointestinal obstruction were reported as some of the most prevalent diseases leading to gastrointestinal endoscopy [1]. Management of esophageal obstruction may vary, depending on the cause of obstruction as well as the availability of resources. According to the ESGE original guideline, it could involve, for example, stent placement, radiotherapy/brachytherapy, or bypass surgery [2]. For resource-limited settings, however, a number of additional factors need to be considered before recommendations can be made. These involve economic considerations and resource availability. Furthermore, patients in low-resource settings presenting with malignant esophageal obstruction are often unfit for surgery due to presentation with advanced malignant disease as well as comorbidities such as HIV/AIDS and tuberculosis [3]. For such situations, self-expanding metal stents (SEMS) of the esophagus may provide a suitable palliative option [3, 4].

• Bekkelund, Mattis; Sangnes, Dag André; Hatlebakk, Jan Gunnar & Aabakken, Lars (2019). Pathophysiology of idiopathic gastroparesis and implications for therapy. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 54(1), p. 8–17. doi: 10.1080/00365521.2018.1558280. Full text in Research Archive Show summary

  Objectives: Idiopathic gastroparesis is a gastric motility disorder characterized by chronic upper gastrointestinal symptoms and delayed gastric emptying without an identifiable underlying condition. This review summarizes recent understanding of the pathophysiology and treatment of idiopathic gastroparesis. Materials and methods: Structured literature search in the PubMed, Embase and ClinicalTrials.gov databases. Results: Idiopathic gastroparesis involves several alterations in gastric motility and sensation, including delayed gastric emptying, altered myoelectrical activity, impaired fundic accommodation, visceral hypersensitivity and disturbances in antropyloroduodenal motility and coordination. Multiple cellular changes have been identified, including depletion of interstitial cells of Cajal (ICC) and enteric nerves, as well as stromal fibrosis. The underlying cause of these changes is not fully understood but may be an immune imbalance, including loss of anti-inflammatory heme-oxygenase-1 positive (HO-1) macrophages. There is currently no causal therapy for idiopathic gastroparesis. The treatment ladder consists of dietary measures, prokinetic and antiemetic medications, and varying surgical or endoscopic interventions, including promising pyloric therapies. There are ongoing trials with several novel medications, raising hopes for future treatment. Conclusions: Patients with idiopathic gastroparesis present several pathophysiological alterations in the stomach, where depletion of ICC is of special importance. Treatment is currently focused on alleviating symptoms through dietary adjustments, medication or surgical or endoscopic interventions.

• Carlsen, Arne; Omdal, Roald; Karlsen, Lars Normann; Kvaløy, Jan Terje; Aabakken, Lars & Steinsbø, Øyvind [Show all 10 contributors for this article] (2019). Determination of lower cut-off levels of adalimumab associated with biochemical remission in Crohn's disease. Journal of Gastroenterology and Hepatology Open (JGH Open). p. 1–7. doi: 10.1002/jgh3.12266. Full text in Research Archive Show summary

  Background and Aim: Adalimumab is administered and dosed using a standardized treatment regimen. Although therapeutic drug monitoring (TDM) may help optimize treatment efficacy, the lower cut‐off concentration of adalimumab needed to retain disease remission has not been established. This cross‐sectional study of patients with Crohn's disease on stable medication aimed to determine a lower therapeutic drug concentration threshold of adalimumab associated with biochemical disease remission. Methods: C‐reactive protein (CRP) and fecal calprotectin were used as established markers and albumin as an explorative marker of disease activity. Time since introduction, treatment interval, drug dosage, serum drug concentration and antidrug antibodies, disease duration, age, and sex were recorded. Results: The study included 101 patients who were divided into “active disease” and “remission” groups for inflammatory markers based on cut‐off levels of 5 mg/L for CRP and 50 mg/kg for fecal calprotectin. Cut‐off levels for albumin of 36.5 and 41.5 g/L were also added as further indicatives of remission. Receiver operating characteristic analysis found optimal thresholds for adalimumab associated with remission at 6.8–7.0 mg/L for the combination of CRP and fecal calprotectin and when combining CRP, fecal calprotectin, and albumin. Conclusions: In patients with Crohn's disease, serum adalimumab of at least 6.8 mg/L was associated with biochemical disease remission based on CRP and fecal calprotectin, supporting the use of TDM to ensure disease control. Albumin should be further tested in this setting.

• Qadir, Hemin Ali Qadir; Shin, Younghak; Sølhusvik, Johannes; Bergsland, Jacob; Aabakken, Lars & Balasingham, Ilangko (2019). Polyp detection and segmentation using Mask R-CNN: Does a deeper feature extractor CNN always perform better? International Symposium on Medical Information and Communication Technology. ISSN 2326-828X. 2019-May, p. 1–6. doi: 10.1109/ISMICT.2019.8743694. Full text in Research Archive Show summary

  Automatic polyp detection and segmentation are highly desirable for colon screening due to polyp miss rate by physicians during colonoscopy, which is about 25%. However, this computerization is still an unsolved problem due to various polyp-like structures in the colon and high interclass polyp variations in terms of size, color, shape and texture. In this paper, we adapt Mask R-CNN and evaluate its performance with different modern convolutional neural networks (CNN) as its feature extractor for polyp detection and segmentation. We investigate the performance improvement of each feature extractor by adding extra polyp images to the training dataset to answer whether we need deeper and more complex CNNs, or better dataset for training in automatic polyp detection and segmentation. Finally, we propose an ensemble method for further performance improvement. We evaluate the performance on the 2015 MICCAI polyp detection dataset. The best results achieved are 72.59% recall, 80% precision, 70.42% dice, and 61.24% jaccard. The model achieved state-of-the-art segmentation performance.

• Bjørnland, Kristin; Hinna, Maren Tveit; Aksnes, Gunnar; Stensrud, Kjetil Juul; Ertresvåg, Kjetil & Østensen, Inger Anniken Bjørnstad [Show all 12 contributors for this article] (2018). Outcome for biliary atresia patients treated at a low-volume centre. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 53(4), p. 471–474. doi: 10.1080/00365521.2018.1439097. Full text in Research Archive Show summary

  Objectives: The importance of case load for treatment of extrahepatic biliary atresia (BA) is debated. The aim of this study was to register results of BA treatment in a small volume centre. Methods: Retrospective chart review study of patients with BA treated from 2000 to 2017. The institutional review board approved the study. Results: 45 babies were identified of which 42 (93%) are alive. 41 patients had a Kasai portoenterostomy (PE), two a hepaticojejunostomy and two a primary liver transplantation. The age at PE/hepaticojejunostomy was median 63 (4-145 days). Seven surgeons performed the operations, and the median duration of the diagnostic work-up was 8 (3-24) days. Clearance of jaundice was achieved in 23/43 (53%) babies, and 3- and 5-year native liver survival was 47% and 40% respectively. Clearance of jaundice post PE/hepaticojejunostomy was a strong predictor of native liver survival (adjusted OR: 0.027; 95%; P=0.009). Plasma level of conjugated bilirubin at time of referral was also a significant predictor of native liver survival (adjusted OR: 1.053; P=0.017). Conclusion: A small volume centre may achieve satisfactory results for BA patients. The study has, however, identified factors that may further improve results; earlier referral, optimizing diagnostic work-up, and establishing one dedicated surgical team.

• Domagk, Dirk; Oppong, Kofi W.; Aabakken, Lars; Czakó, László; Gyökeres, Tibor & Manes, Gianpiero [Show all 23 contributors for this article] (2018). Performance measures for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. United European Gastroenterology Journal (UEG Journal). ISSN 2050-6406. 6(10), p. 1448–1460. doi: 10.1177/2050640618808157. Full text in Research Archive
• Nordheim, Espen; Horneland, Rune; Aandahl, Einar Martin; Grzyb, Krzysztof; Aabakken, Lars & Paulsen, Vemund [Show all 9 contributors for this article] (2018). Pancreas transplant rejection episodes are not revealed by biopsies of the donor duodenum in a prospective study with paired biopsies. American Journal of Transplantation. ISSN 1600-6135. 18(5), p. 1256–1261. doi: 10.1111/ajt.14658. Full text in Research Archive
• Zenouzi, Roman; Liwinski, T; Yamamura, J; Weiler-Normann, Christina; Sebode, Marcial & Keller, S [Show all 50 contributors for this article] (2018). Follow-up magnetic resonance imaging/3D-magnetic resonance cholangiopancreatography in patients with primary sclerosing cholangitis: challenging for experts to interpret. Alimentary Pharmacology and Therapeutics. ISSN 0269-2813. 48(2), p. 169–178. doi: 10.1111/apt.14797. Full text in Research Archive
• Grimstad, Tore; Kvivik, Ingeborg; Kvaløy, Jan Terje; Aabakken, Lars & Omdal, Roald (2018). Heat shock protein 90 and inflammatory activity in newly onset Crohn’s disease. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 53(12), p. 1453–1458. doi: 10.1080/00365521.2018.1533582. Full text in Research Archive
• Eskeland, Sigrun Losada; Rueegg, Corina Silvia; Brunborg, Cathrine; Aabakken, Lars & Lange, Thomas de (2018). Electronic checklists improve referral letters in gastroenterology: a randomized vignette survey. International Journal for Quality in Health Care. ISSN 1353-4505. 30(6), p. 450–456. doi: 10.1093/intqhc/mzy057. Full text in Research Archive Show summary

  Objective: Investigate whether gastroenterologists rate the quality of referral letters higher if electronic dynamic checklist items are added to a standard free-text referral letter. Assess how this affects the gastroenterologists’ assessment of the patient’s need for healthcare and the agreement between their assessments. Intervention: Between June 2015 and January 2016, participants were recruited through an open invitation to all members of the Norwegian Society of Gastroenterology. They were asked to rate 16 referral letters (vignettes) in a web interface: eight letters in free text following a general template and eight letters based on a general referral template combined with diagnosis-specific checklist items. The study was completed in two subsequent rounds ≥3 months apart. Main Outcome Measures: Quality of referral letters assessed on a rating scale from 0 to 10. Agreement in the referral assessment and accuracy of the selection of correct preliminary diagnosis and appropriate work-up. Results: The mean quality assesses on the rating scale was 7.0 (95% confidence interval [CI] 6.8–7.2) for all letters combined (n = 511), 6.5(CI 6.2–6.8) for the free-text referrals (n = 256) and 7.5 (CI 7.3–7.7) for the checklist referrals (n = 255) (P < 0.001, paired t-test). No difference was observed in the triage of the patients, but fewer gastroenterologists felt the need to collect additional information about the patients in the checklist group. Conclusion: Checklist items may ease the assessment of the referrals for gastroenterologists. We were not able to show that checklists significantly influence the management of patients.

• Holme, Øyvind; Pedersen, Ina Borgenheim; Medhus, Asle Wilhelm; Aabakken, Lars; Glomsaker, Tom Birger & Kvamme, Jan-Magnus [Show all 14 contributors for this article] (2018). Endoscopy assistants influence the quality of colonoscopy. Endoscopy. ISSN 0013-726X. 50(9), p. 871–877. doi: 10.1055/s-0044-101706. Full text in Research Archive Show summary

  Background: Colonoscopy performance varies between endoscopists, but little is known about the impact of endoscopy assistants on key performance indicators. We used a large prospective colonoscopy quality database to perform an exploratory study to evaluate differences in selected quality indicators between endoscopy assistants. Methods: All colonoscopies reported to the Norwegian colonoscopy quality assurance register Gastronet can be used to trace individual endoscopy assistants. We analyzed key quality indicators (cecum intubation rate, polyp detection rate, colonoscopies rated as severely painful, colonoscopies with sedation or analgesia, and satisfaction with information) for colonoscopies performed between 1 January 2013 and 31 December 2014. Differences between individual assistants were analyzed by fitting multivariable logistic regression models, with the best performing assistant at each participating hospital as reference. All models were adjusted for the endoscopist. Results: 63 endoscopy assistants from 12 hospitals assisted in 15 365 colonoscopies. Compared with their top performing peers from the same hospital, one assistant was associated with cecum intubation failure, four with poor polyp detection, nine with painful colonoscopy, 16 with administration of sedation or analgesics during colonoscopy, and three with patient dissatisfaction about information given relating to the colonoscopy. The number of procedures during the study period or lifetime experience as an endoscopy assistant were not associated with any quality indicator. Conclusion: In this exploratory study, there was little variation on important colonoscopy quality indicators between endoscopy assistants. However, there were differences among assistants that may be clinically important. Endoscopy assistants should be subject to quality surveillance similarly to endoscopists. © 2018 Georg Thieme Verlag KG Stuttgart

• Carlsen, Arne; Omdal, Roald; Leitao, Kristian Øgreid; Isaksen, Kjetil; Hetta, Anne Kristine & Karlsen, Lars Normann [Show all 11 contributors for this article] (2018). Subtherapeutic concentrations of infliximab and adalimumab are associated with increased disease activity in Crohn's disease. Therapeutic Advances in Gastroenterology. ISSN 1756-283X. 11, p. 1–11. doi: 10.1177/1756284818759930. Full text in Research Archive
• Tringali, Alberto; Hassan, Cesare; Rota, Matteo; Rossi, Marta; Mutignani, Massimiliano & Aabakken, Lars (2018). Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: A systematic review and meta-analysis. Endoscopy. ISSN 0013-726X. 50(6), p. 631–641. doi: 10.1055/s-0043-125062. Full text in Research Archive
• Ponsioen, Cyriel Y; Arnelo, Urban; Bergquist, Annika; Rauws, Erik A; Paulsen, Vemund & Cantu, Paolo [Show all 21 contributors for this article] (2018). No Superiority of Stents vs Balloon Dilatation for Dominant Strictures in Patients With Primary Sclerosing Cholangitis. Gastroenterology. ISSN 0016-5085. 155(3), p. 752–759.e5. doi: 10.1053/j.gastro.2018.05.034. Full text in Research Archive
• Shin, Younghak; Qadir, Hemin Ali Qadir; Aabakken, Lars; Bergsland, Jacob & Balasingham, Ilangko (2018). Automatic colon polyp detection using region based deep CNN and post learning approaches. IEEE Access. 6, p. 40950–40962. doi: 10.1109/ACCESS.2018.2856402. Full text in Research Archive Show summary

  Automatic image detection of colonic polyps is still an unsolved problem due to the large variation of polyps in terms of shape, texture, size, and color, and the existence of various polyp-like mimics during colonoscopy. In this paper, we apply a recent region-based convolutional neural network (CNN) approach for the automatic detection of polyps in the images and videos obtained from colonoscopy examinations. We use a deep-CNN model (Inception Resnet) as a transfer learning scheme in the detection system. To overcome the polyp detection obstacles and the small number of polyp images, we examine image augmentation strategies for training deep networks. We further propose two efficient post-learning methods, such as automatic false positive learning and offline learning, both of which can be incorporated with the region-based detection system for reliable polyp detection. Using the large size of colonoscopy databases, experimental results demonstrate that the suggested detection systems show better performance than other systems in the literature. Furthermore, we show improved detection performance using the proposed post-learning schemes for colonoscopy videos.

• Domagk, Dirk; Oppong, Kofi W.; Aabakken, Lars; Czakó, László; Gyökeres, Tibor & Manes, Gianpiero [Show all 23 contributors for this article] (2018). Performance measures for ERCP and endoscopic ultrasound: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy. ISSN 0013-726X. 50(11), p. 1116–1127. doi: 10.1055/a-0749-8767. Full text in Research Archive
• Nymo, Linn Såve; Aabakken, Lars & Lassen, Kristoffer (2018). Priority and prejudice: does low socioeconomic status bias waiting time for endoscopy? A blinded,randomized survey. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 53(5), p. 621–625. doi: 10.1080/00365521.2017.1402207. Full text in Research Archive
• Aabakken, Lars; Karlsen, Tom Hemming; Albert, Jörg; Arvanitakis, Marianna; Chazouilleres, Olivier & Dumonceau, Jean-Marc [Show all 20 contributors for this article] (2017). Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline. Endoscopy. ISSN 0013-726X. 49(6), p. 588–608. doi: 10.1055/s-0043-107029. Full text in Research Archive
• Knatten, Charlotte Kristensen; Fjeld, Jan Gunnar; Medhus, Asle Wilhelm; Pripp, Are Hugo; Fyhn, Thomas Johan & Aabakken, Lars [Show all 10 contributors for this article] (2017). Preoperative liquid gastric emptying rate does not predict outcome after fundoplication. Journal of Pediatric Surgery. ISSN 0022-3468. 52(4), p. 540–543. doi: 10.1016/j.jpedsurg.2016.09.068. Full text in Research Archive
• Thomson, Mike; Tringali, Andrea; Dumonceau, Jean-Marc; Tavares, Marta; Tabbers, Merit M. & Furlano, Raoul [Show all 28 contributors for this article] (2017). Paediatric gastrointestinal endoscopy: European society for paediatric gastroenterology hepatology and nutrition and European society of gastrointestinal endoscopy guidelines. Journal of Pediatric Gastroenterology and Nutrition - JPGN. ISSN 0277-2116. 64(1), p. 133–153. doi: 10.1097/MPG.0000000000001408. Full text in Research Archive
• Bujko, Anna; Atlasy, Nader; Landsverk, Ole J. B.; Richter, Lisa Maria; Yaqub, Sheraz & Horneland, Rune [Show all 12 contributors for this article] (2017). Transcriptional and functional profiling defines human small intestinal macrophage subsets. Journal of Experimental Medicine (JEM). ISSN 0022-1007. 215(2), p. 441–458. doi: 10.1084/jem.20170057. Full text in Research Archive
• Hoff, Geir; Lange, Thomas de; Bretthauer, Michael; Buset, Magne; Dahler, Stein & Halvorsen, Fred-Arne [Show all 15 contributors for this article] (2017). Patient-reported adverse events after colonoscopy in Norway. Endoscopy. ISSN 0013-726X. 49(8), p. 745–753. doi: 10.1055/s-0043-105265. Full text in Research Archive
• Eskeland, Sigrun Losada; Brunborg, Cathrine; Rueegg, Corina Silvia; Aabakken, Lars & Lange, Thomas de (2017). Assessment of the effect of an Interactive Dynamic Referral Interface (IDRI) on the quality of referral letters from general practitioners to gastroenterologists: a randomised cross-over vignette trial. BMJ Open. 7(6). doi: 10.1136/bmjopen-2016-014636. Full text in Research Archive Show summary

  Objectives: We evaluated whether interactive, electronic, dynamic, diagnose-specific checklists improve the quality of referral letters in gastroenterology and assessed the general practitioners’ (GPs’) acceptance of the checklists. Intervention: The GPs participated in the trial and were asked to refer eight clinical vignettes in an internet-based electronic health record simulator. A referral support, consisting of dynamic diagnose-specific checklists, was created for the generation of referral letters to gastroenterologists. The GPs were randomised to refer the eight vignettes with or without the checklists. After a minimum of 3 months, they repeated the referral process with the alternative method. Main outcome measures Difference in quality of the referral letters between referrals with and without checklists, measured with an objective Thirty Point Score (TPS). Difference: in variance in the quality of the referral letters and GPs’ acceptance of the electronic dynamic user interface. Results: The mean TPS was 15.2 (95% CI 13.2 to 16.3) and 22.0 (95% CI 20.6 to 22.8) comparing referrals without and with checklist assistance (p<0.001), respectively. The coefficient of variance was 23.3% for the checklist group and 39.6% for the non-checklist group. Two-thirds (16/24) of the GPs thought they had included more relevant information in the referrals with checklists, and considered implementing this type of checklists in their clinical practices, if available. Conclusions: Dynamic, diagnose-specific checklists improved the quality of referral letters significantly and reduced the variance of the TPS, indicating a more uniform quality when checklists were used. The GPs were generally positive to the checklists.

• Tringali, Andrea; Thomson, Mike; Dumonceau, Jean-Marc; Tavares, Marta; Tabbers, Merit M. & Furlano, Raoul [Show all 28 contributors for this article] (2017). Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary. Endoscopy. ISSN 0013-726X. 49(1), p. 83–91. doi: 10.1055/s-0042-111002. Full text in Research Archive

View all works in NVA

• Birkeland, Kåre Inge; Gullestad, Lars & Aabakken, Lars (2022). Indremedisin I. Fagbokforlaget. ISBN 9788245043365. 479 p. Full text in Research Archive
• Birkeland, Kåre Inge; Gullestad, Lars & Aabakken, Lars (2022). Indremedisin I & II, 2. utgave. Fagbokforlaget. ISBN 9788245040968. 1024 p. Full text in Research Archive
• Birkeland, Kåre I.; Gullestad, Lars & Aabakken, Lars (2017). Indremedisin I & II. Forlaget Vett & Viten AS. ISBN 9788241207402. 1056 p. Full text in Research Archive
• Dvergsdal, Henrik & Aabakken, Lars (2016). Virtuell virkelighet. Store norske leksikon. Full text in Research Archive Show summary

  Virtuell virkelighet er en illusjon, vanligvis generert ved hjelp av ulike typer informasjonsteknologi, som gir brukeren en opplevelse av å befinne seg på et annet, oppdiktet eller virkelig sted.

View all works in NVA

• Topazian, Mark & Aabakken, Lars (2024). Preface: Endoscopy in Resource-Limited Settings. Techniques and Innovations in Gastrointestinal Endoscopy (TIGE). ISSN 2666-5107. 26(3), p. 205–205. doi: 10.1016/j.tige.2024.06.003. Full text in Research Archive
• Helgadottir, Holmfridur; Folseraas, Trine; Kemmerich, Gunter; Aabakken, Lars; Jørgensen, Kristin Kaasen & Vesterhus, Mette Nåmdal (2023). Primær skleroserende kolangitt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(17). doi: 10.4045/tidsskr.23.0156. Full text in Research Archive
• Neves, João A. Cunha; Santiago, Enrique Rodriguez de & Aabakken, Lars (2023). Approaches for greening endoscopy and reducing waste. Gut. ISSN 0017-5749. doi: 10.1136/gutjnl-2023-330917. Full text in Research Archive
• Aabakken, Lars & Paulsen, Vemund (2022). ESWL pancreatitis: yet another post-procedural pancreatitis to worry about? The Lancet Gastroenterology and Hepatology. ISSN 2468-1253. doi: 10.1016/S2468-1253(21)00476-3. Full text in Research Archive
• Aabakken, Lars (2022). Preemptive clipping for post-ampullectomy bleeding: the jury is still out. Endoscopy. ISSN 0013-726X. doi: 10.1055/a-1762-5625. Full text in Research Archive
• Yamamoto, Hironori & Aabakken, Lars (2019). Small-bowel endoscopy. Endoscopy. ISSN 0013-726X. 51(5), p. 399–400. doi: 10.1055/a-0879-1823. Full text in Research Archive
• Garborg, Kjetil Kjeldstad & Aabakken, Lars (2019). Plastic or metal stents for biliary duct-to-duct anastomotic strictures – Is the jury still out? Liver international (Print). ISSN 1478-3223. 39(7), p. 1197–1198. doi: 10.1111/liv.14045. Full text in Research Archive
• Hassan, Cesare; Aabakken, Lars; Ebigbo, Alanna; Karstensen, Johan Gasdal; Guy, Claire & Dinis-Riberio, Mario [Show all 9 contributors for this article] (2018). Partnership with African Countries: European Society of Gastrointestinal Endoscopy (ESGE) - Position Statement. Endoscopy International Open. doi: 10.1055/a-0677-2026. Full text in Research Archive
• Holme, Øyvind & Aabakken, Lars (2018). Making colonoscopy smarter with standardized computer-aided diagnosis. Annals of Internal Medicine. ISSN 0003-4819. 169(6), p. 409–410. doi: 10.7326/M18-1901. Full text in Research Archive
• Aabakken, Lars & Haber, Gregory (2018). How I perform sphincterotomy. Gastrointestinal Endoscopy. ISSN 0016-5107. 88(2), p. 207–208. doi: 10.1016/j.gie.2018.05.011. Full text in Research Archive
• Karstensen, John Gasdal; Ebigbo, Alanna; Aabakken, Lars; Dinis-Riberio, Mario; Gralnek, Ian & Moine, Olivier Le [Show all 13 contributors for this article] (2018). Nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Cascade Guideline. Endoscopy International Open. Full text in Research Archive
• Tringali, Alberto; Hassan, Cesare; Rota, Matteo; Rossi, Marta; Mutignani, Massimiliano & Aabakken, Lars (2018). Correction: Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis. Endoscopy. ISSN 0013-726X. 50(6), p. C5–C5. doi: 10.1055/s-0044-102160. Full text in Research Archive
• Eskeland, Sigrun Losada; Aabakken, Lars; Riegler, Michael; Schmidt, Peter Thelin; Johansen, Dag & Halvorsen, Pål [Show all 7 contributors for this article] (2017). EIR: Changing the scene of automatic detection software for gastrointestinal endoscopy. Full text in Research Archive

View all works in NVA