The 2024 MASLD treatment guidelines are already changing. Pradeep Mundre and Professor Sven Francque (Antwerp), guideline co-author, cover weight-loss targets (7% and 10%), resmetirom in F2-F3 fibrosis, semaglutide's positive phase 3 in MASH, plus pioglitazone, bariatric surgery, and liver transplantation in this population.

Around one in three adults has MASLD, but only a few percent reach cirrhosis. Pradeep Mundre and Professor Sven Francque (Antwerp), co-author of the 2024 EASL guidelines, cover the new nomenclature, dysfunctional adiposity versus BMI, and how to use FIB-4 to decide who needs a hepatologist.

Sphincter-preserving surgery spares most rectal cancer patients a stoma, but hands many of them low anterior resection syndrome (LARS). Three European surgeons join Harald Rosen in discussing follow-up, where transanal irrigation lands, when to involve the gastroenterologist, and where sacral neuromodulation fits.

EoE requires long-term management, but what does that look like in practice? In Part 2, Prof. Alex Straumann discusses the realities of treating a chronic, relapsing disease, where remission is achievable but a cure is not.

The episode explores how to approach maintenance therapy, manage persistent symptoms despite histological remission, and when to escalate treatment to biologics. It also addresses the practical limitations of dietary strategies and the ongoing challenge of identifying trigger foods.

Looking ahead, the discussion highlights key unmet needs in EoE, including the absence of reliable diagnostic tools for food triggers and the potential influence of modern food production on disease prevalence.

Part 2 will be released on Wednesday, the 29th of April.

Eosinophilic oesophagitis (EoE) is now a well-recognised condition. But it was not always so. In this episode, Prof. Alex Straumann shares how EoE was first identified, taking us back to the late 1980s when unusual cases of food impaction and eosinophilic inflammation did not fit any known diagnosis.

He discusses the clinical observations that led to recognising EoE as a distinct disease, the early case series that defined its phenotype, and the initial treatment approaches that shaped current practice. The episode also addresses key diagnostic challenges that remain relevant today, including the distinction from oesophageal eosinophilia and the limitations of symptom-based assessment.

In this episode, Pradeep Mundre speaks with Hannah Gordon about one of the most challenging areas in inflammatory bowel disease management: balancing effective treatment with cancer risk. As therapeutic options expand, clinicians increasingly face complex scenarios involving patients with prior malignancy in remission or those undergoing active cancer treatment. The discussion examines how cancer risk relates both to IBD itself and to immunosuppressive or biologic therapies. The episode highlights limitations in current evidence, differences across drug classes, and the importance of individualised decision-making. Emphasis is placed on multidisciplinary collaboration, patient communication, and navigating uncertainty in real-world clinical practice.

Cristian Costas, a leading dietitian in coeliac disease, shares insights on managing celiac disease through diet, setting up specialised services, and navigating dietary challenges. We explore diagnosis, implementation of a gluten-free diet, and strategies to improve patient outcomes.

In the second part of this in-depth conversation, host Egle Dieninyte continues her discussion with Professor Nageshwar Reddy, shifting the focus from technological innovation to ethics, responsibility and the human dimension of endoscopy.

Professor Reddy shares how mobile endoscopy units have brought life-saving care to rural populations, and why cascade hygiene strategies are sometimes necessary when resources are limited.

The conversation then turns to a topic rarely discussed openly: mistakes. What constitutes a true medical mistake? How do we distinguish adverse events from preventable errors? And why should ERCP only ever be performed with strict indication?

Finally, Professor Reddy reflects on mentorship, generational change, work–home balance, and why compassion is not an innate trait — but a skill that can and must be cultivated.

A powerful conclusion to a two-part conversation on what it really means to practise endoscopy.

What has truly transformed endoscopy over the past decades?

In this first part of a two-part conversation, host Egle Dieninyte sits down with Professor Nageshwar Reddy, one of the most influential pioneers in modern therapeutic endoscopy, to reflect on how the field has evolved — and where it is heading next.

From the transition from rigid to fibreoptic endoscopy, to the introduction of video systems that reshaped team dynamics in the endoscopy suite, Professor Reddy explains why some of the most powerful innovations were not necessarily the most glamorous ones.

The discussion also explores:
• Disposable scopes and environmental responsibility
• Antibiotic resistance and global practice differences
• The role of passion and compassion in medicine
• Regenerative endoscopy and stem cell applications
• The story behind the “Nagi stent”

Beyond technology, this episode offers a personal perspective on success, mentorship, and what it truly means to be a good endoscopist.

🎧 Listen now to Part 1 — and stay tuned for Part 2, which will be released in a week from now on the 4th of March.

- What happens when optical diagnosis and histology don’t align?
- Does better polyp detection always mean better outcomes?
- And how should AI, quality metrics and surveillance intervals really shape daily endoscopy practice?

In this special episode, we share an unfiltered round-table discussion recorded during the UEG Online Course on the impact of polyp detection in colonoscopy. Leading experts Raf Bisschops, Manuele Furnari, Veronique Van der Voort and Pieter Sinonquel debate real-world dilemmas around serrated lesions, pathology discordance, documentation, bowel preparation and the clinical consequences of rising ADRs.

Also watch it as a video podcast on Spotify

Listen now and explore the full course for free (login required) on gutflix.eu: [The impact of polyp detection in colonoscopy](https://gutflix.eu/r/i6GfsYAhus8u)