00:00:00: Jörn Schattenberg: Hello and welcome, everyone.

00:00:01: Jörn Schattenberg: My name is Jörn Schattenberg.

00:00:02: Jörn Schattenberg: I'm the current chair of the scientific committee,

00:00:05: and I'm very excited to do this UEG Week recording best of HPB today

00:00:11: with my respected colleague and good friend, Dr.

00:00:15: Archibugi from Italy.

00:00:16: Jörn Schattenberg: Ciao, Livia.

00:00:18: Livia Archibugi: Hi, Jörn.

00:00:19: Livia Archibugi: Good seeing you.

00:00:20: Livia Archibugi: Thanks for having me.

00:00:21: Jörn Schattenberg: Thanks, of course.

00:00:22: Jörn Schattenberg: It's a pleasure to have you.

00:00:23: Jörn Schattenberg: How was your trip back?

00:00:25: Jörn Schattenberg: How did you get back okay in one piece?

00:00:27: Livia Archibugi: Yeah, I went back okay, and actually I was pretty lucky because a few colleagues of

00:00:31: mine had lots of delays with the flight, but actually mine went very smooth,

00:00:35: so I guess I was very, very lucky.

00:00:38: Jörn Schattenberg: Okay, back to work and I can see you're in the hospital.

00:00:41: Jörn Schattenberg: We already heard some Italian background that always makes me feel very relaxed,

00:00:45: feeling like on holidays as a German.

00:00:47: Jörn Schattenberg: But again, this is about the science and the week.

00:00:50: Jörn Schattenberg: I have to say I was very excited about the week.

00:00:53: Jörn Schattenberg: Of course, it is exciting to see the programme roll out and then actually be

00:00:57: presented.

00:00:58: Jörn Schattenberg: What was your overall expression?

00:01:00: Jörn Schattenberg: What did you take home from the week?

00:01:02: Livia Archibugi: Well, I have to say that UEG Weeks always surprised me, both in terms of,

00:01:08: first of all, the amount of people that attend,

00:01:10: because I saw that this year it was more than 14,000 attendees and top

00:01:16: players were the Italians, so I'm very proud of that,

00:01:18: to be part of the Italian community contributing to the UEG Week.

00:01:23: Jörn Schattenberg: And they're by far the country with the highest participation.

00:01:27: Livia Archibugi: Yes, yes, no, no, I'm very proud.

00:01:29: Livia Archibugi: At least it means that, you know, Italians do care about progressing,

00:01:33: learning, networking, because UEG Week is also about networking,

00:01:37: and that's one of the parts that I really like.

00:01:40: Livia Archibugi: And it's also a very modern Congress, if I can say,

00:01:44: compared to other international conventions.

00:01:46: Livia Archibugi: UEG Week, I believe it stands out for the modernity, for example, the...

00:01:52: Livia Archibugi: The poster stages, it's incredible.

00:01:54: Livia Archibugi: There are other big congresses that still have to print out the posters.

00:01:59: Livia Archibugi: And to me, you know, also wanting to be some environment-friendly,

00:02:03: I don't really like that.

00:02:05: Livia Archibugi: But I believe UEG Weeks really stands out for the modernity,

00:02:08: the people that attend, the networking experiences.

00:02:12: Livia Archibugi: Also, the laid-back feeling that you get.

00:02:15: Livia Archibugi: I played foosball a little bit with some colleagues, used that to chit-chat.

00:02:19: Livia Archibugi: It was really, really nice.

00:02:22: Livia Archibugi: I really enjoy it.

00:02:23: Jörn Schattenberg: That goes back to the office and the good work.

00:02:25: Jörn Schattenberg: Of course, the SciComm picks the content, but the conduct of the Congress,

00:02:29: I agree, was great.

00:02:30: Jörn Schattenberg: All right, so we're meeting here today, me being a hepatologist.

00:02:33: Jörn Schattenberg: I didn't go see all the endoscopic sessions.

00:02:36: Jörn Schattenberg: You are a very experienced endoscopist, and we can learn a lot from you.

00:02:40: Jörn Schattenberg: So I'd be very interested to hear some of your highlights from the HPB programme.

00:02:45: Jörn Schattenberg: I might chip in a couple of my liver views here, but, you know,

00:02:49: what was your highlight?

00:02:49: Jörn Schattenberg: Or maybe also, did you present?

00:02:51: Jörn Schattenberg: What was your part this year?

00:02:53: Livia Archibugi: I presented a few things.

00:02:55: Livia Archibugi: It was mostly about the screening programmes or the

00:03:01: molecular evaluation of pancreatic tumours.

00:03:03: Livia Archibugi: But I believe in general, the HPB programme of this year was really about

00:03:08: innovation, but it wasn't really like

00:03:09: Livia Archibugi: about innovation like new technologies.

00:03:12: Livia Archibugi: But it was more like making probably existing technologies work smarter.

00:03:17: Livia Archibugi: This is pretty much what I had the feeling because, for example,

00:03:21: and maybe I'll comment some of those.

00:03:23: Livia Archibugi: I saw some abstracts about preventing complications earlier,

00:03:28: but usually using commonly used drugs, for example,

00:03:33: or avoiding unnecessary interventions, playing smart, putting together EUS, ERCP.

00:03:39: Livia Archibugi: or employing, for example, genetics data,

00:03:41: which is something that we've started using quite a while ago,

00:03:45: but to define the risk to develop disease,

00:03:48: whether associated to merely genetic mutation or the association between

00:03:54: risk scores and lifestyle, which is pretty much what I think we will see in the

00:03:59: future.

00:04:00: Livia Archibugi: You know, only about my mutation and that's it, or my lifestyle.

00:04:05: Livia Archibugi: It's more probably like a mix of the things.

00:04:07: Livia Archibugi: So I really believe the innovation in this was plain smart compared to

00:04:13: maybe, you know, the new, super new technologies.

00:04:17: Jörn Schattenberg: Good.

00:04:17: Jörn Schattenberg: Well, and talking about two new technologies, in the opening,

00:04:20: we had Jakob Kather present on artificial intelligence.

00:04:23: Jörn Schattenberg: And it sounds some of the data that you're mentioning,

00:04:26: the combination of lifestyle and findings from the clinic being combined with

00:04:31: artificial intelligence in the future could tell us something about risk prediction.

00:04:34: Jörn Schattenberg: And that's what I heard in his opening talk that will get more AI there.

00:04:39: Jörn Schattenberg: Okay, interesting.

00:04:40: Jörn Schattenberg: I know you maybe picked some abstracts where you felt those were specifically

00:04:44: interesting.

00:04:45: Jörn Schattenberg: Did you want to share them with us?

00:04:47: Livia Archibugi: Yeah, one of the nicest ones that I saw,

00:04:51: it was actually about really the concept of playing smart.

00:04:55: Livia Archibugi: It was a randomised trial from China by Dr.

00:04:58: Li, and it was about the same session EUS and ERCP compared to only

00:05:04: ERCP, which is something that if you think about it, it's...

00:05:07: Livia Archibugi: Not that, you know, new, brand new,

00:05:10: but actually putting it in a randomised trial is what we need to have

00:05:14: evidence-based, you know, medicine.

00:05:18: Livia Archibugi: And what it was shown, it was that if you combine EUS-ERCP,

00:05:22: actually you're able to avoid 17% of unnecessary ERCP.

00:05:28: Livia Archibugi: And this is very important, you know,

00:05:30: about playing smart compared to just do brand new technologies.

00:05:36: Livia Archibugi: And this is something, for example, that we do every day in our clinic,

00:05:41: but we are a tertiary centre, and I know that this is not maybe possible in all

00:05:45: centres, but it's probably the way.

00:05:48: Livia Archibugi: And what stood out is was really, let's say, it's a simple trial,

00:05:52: but nobody put it in a trial before.

00:05:55: Livia Archibugi: So this is something very important because

00:05:57: Livia Archibugi: Reducing the need of unnecessary ERCP is important both in terms of reducing

00:06:03: the risk of adverse events that we know is associated with ERCP.

00:06:07: Livia Archibugi: But they also showed, I think the cohort was more than 200 patients,

00:06:13: lower fluoroscopy time, of course, lower radiation dose,

00:06:17: but also the length of ERCP procedure.

00:06:20: Livia Archibugi: Because the idea of adopting EUS before ERCP is not only to avoid

00:06:26: unnecessary ERCP,

00:06:27: Livia Archibugi: But also to get, let's say, a better strategy.

00:06:31: Livia Archibugi: This is something we see every day in our endoscopic rooms.

00:06:35: Livia Archibugi: Just knowing the anatomy, for example, of the bile duct behind the papilla,

00:06:39: it's something that really helps you, let's say, tailor the procedure.

00:06:44: Livia Archibugi: So I do believe that this is the way to go.

00:06:48: Jörn Schattenberg: That is an interesting abstract.

00:06:50: Jörn Schattenberg: I agree.

00:06:50: Jörn Schattenberg: And this is something we see in clinic every day, right?

00:06:52: Jörn Schattenberg: So we doubt the transcutaneous ultrasound.

00:06:55: Jörn Schattenberg: We're not sure are there stones or not.

00:06:57: Jörn Schattenberg: You add on the EUS.

00:06:59: Jörn Schattenberg: Of course, it prolongs maybe the procedure, but I heard you say, you know,

00:07:03: Jörn Schattenberg: Instead of doing EUS and ERCP by doing just ERCP, you're maybe faster,

00:07:07: but you even said that it shortens radiation time.

00:07:09: Jörn Schattenberg: I think that is interesting, as you say, because you know the anatomy.

00:07:13: Jörn Schattenberg: In one of the sessions, we had the challenging papilla is always an issue.

00:07:18: Jörn Schattenberg: Where to cut, how to cut, where does it flow?

00:07:21: Jörn Schattenberg: And it makes a lot of sense that this helps.

00:07:23: Jörn Schattenberg: I mean, as a follow-up question, are there any ERCPs we can combine with EUS?

00:07:28: Jörn Schattenberg: Like you get the ultrasound device in the ERCP,

00:07:31: that probably makes it too difficult to handle, huh?

00:07:34: Livia Archibugi: Well, I mean, changing the scope is very fast and very easy.

00:07:39: Livia Archibugi: One thing that, for example, we do is if the probability of ERCP is very

00:07:45: high, in our endoscopic room, we start with the patient already prone,

00:07:48: in prone position, because this is something that we do ERCP in prone position.

00:07:53: Livia Archibugi: And we just go down with the EUS, make sure we know that, for example,

00:07:57: the stones are still there, and then just exchange the scope very fastly.

00:08:02: Livia Archibugi: And, you know, it's not a matter, I think, of having the same scope.

00:08:07: Livia Archibugi: There are some studies that show that you can actually try to use the same scope,

00:08:11: but I'm not sure it's that necessary.

00:08:13: Livia Archibugi: But, you know, having...

00:08:15: Livia Archibugi: A plan about it, for example, I'm thinking if I know the anatomy behind the papilla

00:08:20: of the bile duct, I already know if I can go for an early pre-cut kind of

00:08:26: safely or, you know, I prefer to insist with my cannulation attempts.

00:08:30: Livia Archibugi: And that's probably something that might be related to the prolonged time of the

00:08:35: ERCP in this trial.

00:08:37: Livia Archibugi: Who knows?

00:08:38: Jörn Schattenberg: Fully agree.

00:08:39: Jörn Schattenberg: And it could also support people that are a little bit more early in their training

00:08:42: with less experience.

00:08:43: Livia Archibugi: Absolutely.

00:08:44: Jörn Schattenberg: Good.

00:08:45: Jörn Schattenberg: All right.

00:08:45: Jörn Schattenberg: Well, I can throw in that I attended a session we did on novel anti-obesity drugs.

00:08:51: Jörn Schattenberg: This comes a little bit more from the nutrition, obesity, and hepatobiliary arena.

00:08:55: Jörn Schattenberg: And there's a big discussion in our field how the increase of metabolic syndrome

00:08:59: affects GI health.

00:09:03: Jörn Schattenberg: This was an invited, non-original programme.

00:09:06: Jörn Schattenberg: Amalia Gastaldelli gave an overview of new treatment approaches in

00:09:12: mostly incretin GLP-1-based therapies.

00:09:14: Jörn Schattenberg: We had a...

00:09:15: Jörn Schattenberg: Julia Mader from Innsbruck, and she educated us on therapies and nutritional

00:09:21: interventions, so lifestyle interventions, and that was followed up by Dr.

00:09:25: Naim Alkhouri from the United States,

00:09:27: who came in and gave a perspective of treating liver disease with incretins and the

00:09:31: combination of various drugs.

00:09:33: Jörn Schattenberg: There is one approved drug for metabolic liver disease, MASH, which is resmetirom.

00:09:37: Jörn Schattenberg: We discussed how to combine these drugs.

00:09:40: Jörn Schattenberg: From my perspective, it was very educational.

00:09:42: Jörn Schattenberg: It worked well, as you said, in the setting where we had an open space and people

00:09:46: could stroll by and stop, put on the headsets and listen in.

00:09:49: Jörn Schattenberg: Content-wise, I think there is strong data that we can significantly reduce body

00:09:55: weight and improve the liver phenotype of these patients.

00:09:59: Jörn Schattenberg: I know some of these drugs sometimes also affect the stomach emptying times.

00:10:03: Jörn Schattenberg: And if we turn towards endoscopy coming out of that session,

00:10:08: maybe my question is how do you handle this with your patients on incretins?

00:10:12: Jörn Schattenberg: Let's say, I think semaglutide is approved in Italy.

00:10:16: Jörn Schattenberg: What are your recommendations?

00:10:18: Jörn Schattenberg: Is this something you see in clinical practice?

00:10:21: Livia Archibugi: Well, we do see and we have had a few patients coming to perform

00:10:27: endoscopy and we would see that there was some food stuck in the stomach despite

00:10:33: they were fasting for quite a while, more than 12 hours.

00:10:38: Livia Archibugi: We do believe that probably we should turn into having new guidelines for especially

00:10:43: the anesthesiological risk also in this term.

00:10:47: Livia Archibugi: For now, what we are adopting is just to refer to have

00:10:53: more than 12 hours of fasting, despite for gastroscopy,

00:10:57: we usually ask for six hours of fasting when it's in deep sedation,

00:11:02: gastroscopy or EUS or ERCP.

00:11:05: Livia Archibugi: But we still don't have a defined protocol,

00:11:11: but we do see some patients like this.

00:11:14: Livia Archibugi: Yes, absolutely.

00:11:15: Jörn Schattenberg: Some recommendations are to skip one weekly dose and then start up again,

00:11:19: but of course this has to be debated.

00:11:21: Jörn Schattenberg: Okay, that was just a quick thought about the session I chaired and I attended.

00:11:26: Jörn Schattenberg: Any other abstract that came to your perspective from the biliary pancreatic field?

00:11:30: Livia Archibugi: Another one that I remember,

00:11:35: again it was a trial comparing the use of peppermint oil

00:11:40: versus ursodeoxycholic acid for the prevention of recurrent choledocholithiasis

00:11:46: after ERCP stone clearance from the bile duct.

00:11:51: Livia Archibugi: Really, it's very, very interesting because, again, to me,

00:11:53: it's like trying to play smart with simple drugs.

00:11:58: Livia Archibugi: And it's something that I believe is going to be very important,

00:12:03: not only for ERCP stone clearance, but, for example,

00:12:05: we are a tertiary care centre for pancreatic cancer patients.

00:12:08: Livia Archibugi: And one of the biggest problems we have is after we put a biliary stent,

00:12:13: we see lots of these stents clogging up with...

00:12:17: Livia Archibugi: Either stones or we see this sludge, but we are not sure.

00:12:20: Livia Archibugi: There was some data a few years ago showing that actually the thing that goes inside

00:12:25: the stent and gets clogged is actually ursodeoxycholic acid.

00:12:31: Livia Archibugi: So it could be interesting to try also this in...

00:12:35: Livia Archibugi: ERCP patients with self-expandable metal stent.

00:12:40: Livia Archibugi: And what they saw in this trial,

00:12:41: despite I think it wasn't statistically significant,

00:12:45: but it was borderline significant,

00:12:47: it was that actually stone recurrence was way lower in the peppermint oil

00:12:53: group compared to the UDCA group.

00:12:56: Livia Archibugi: And also UDCA patients sometimes tend to have the incidence of diarrhoea

00:13:02: while of course in the...

00:13:03: Livia Archibugi: The peppermint oil, there was none,

00:13:05: despite sometimes you might have reflux disease due to the mint in the

00:13:11: oil.

00:13:12: Livia Archibugi: But this really stood out to me also because I really thought about, okay,

00:13:17: new applications, not only in ERCP for stones,

00:13:20: but also for pancreatic cancer patients, which is what I do every day.

00:13:25: Jörn Schattenberg: I'm just thinking, did they report side effects of like smelling like peppermint

00:13:29: oil?

00:13:29: Jörn Schattenberg: Was this something that patients complain on?

00:13:31: Jörn Schattenberg: It's probably not on the paper,

00:13:32: but I'm thinking not everybody tolerates peppermint oil.

00:13:35: Jörn Schattenberg: But it's cool that it actually, it seems to be working at least at the level of

00:13:40: UDCA, if I understood you correctly.

00:13:42: Livia Archibugi: Also, slightly better, I think the P was 0.06 or 0.07,

00:13:48: so not statistically significant, but still a trend towards.

00:13:52: Livia Archibugi: Yes, I remember they did report some mental

00:13:58: eruptation, they would say, which is something that does happen to peppermint oil.

00:14:04: Livia Archibugi: I took peppermint oil and I can confirm that it does happen.

00:14:08: Livia Archibugi: It's really not very pleasant, but...

00:14:12: Livia Archibugi: If it can spare me from a new ERCP, why not?

00:14:17: Jörn Schattenberg: And you know, if they underwent cholecystectomy,

00:14:20: because after this is recurrence, right?

00:14:23: Jörn Schattenberg: So you'd probably recommend a cholecystectomy or not, is that?

00:14:27: Livia Archibugi: I think, yes.

00:14:28: Livia Archibugi: I think most of them underwent,

00:14:30: but I can't remember the rate between the two groups.

00:14:33: Livia Archibugi: But I think it was balanced.

00:14:35: Jörn Schattenberg: It shows nicely how with very simple tools you can try to improve patients'

00:14:39: outcomes.

00:14:40: Livia Archibugi: Exactly.

00:14:41: Jörn Schattenberg: Cool study.

00:14:41: Livia Archibugi: Yeah, I believe that we need to play smart and not only bring out the best

00:14:47: technologies that might be even the most expensive ones.

00:14:51: Livia Archibugi: Also because I really believe that what we show in our congresses should be

00:14:56: something that possibly can be applied all over Europe or all over the world.

00:15:01: Livia Archibugi: So it's not like...

00:15:03: Livia Archibugi: I come from a tertiary care centre and I have all technologies,

00:15:06: but I want to make sure that also in other centres they can try to apply,

00:15:11: you know, what's discovered out there.

00:15:14: Jörn Schattenberg: Okay.

00:15:14: Jörn Schattenberg: You are going to share another one with us.

00:15:16: Livia Archibugi: Yes, another one that is, to me, is really,

00:15:19: really interesting because besides being an endoscopist,

00:15:22: I'm also a pancreatologist, let's say.

00:15:25: Livia Archibugi: It's a trial on the use of celecoxib for acute pancreatitis because for

00:15:31: acute pancreatitis, we haven't had anything in terms of drugs in the past years,

00:15:36: or at least anything that was shown to actually work besides, you know,

00:15:41: hydration with the lactate and ringer and so on.

00:15:45: Livia Archibugi: But there was this trial, I think from China again.

00:15:50: Livia Archibugi: China has sent lots of abstracts and some were very good quality abstracts.

00:15:55: Livia Archibugi: And it was a trial, multi-center trial,

00:15:59: I think more than 20 hospitals throughout China,

00:16:02: administrating celecoxib compared to placebo in patients with...

00:16:08: Livia Archibugi: non-mild acute pancreatitis that were predicted to have non-mild acute pancreatitis

00:16:13: and actually they could see that the occurrence of organ failure

00:16:19: which is something that we are so scared about was definitely lower compared to

00:16:24: Livia Archibugi: It was around 17% in the celecoxib compared to 35% in the placebo one.

00:16:32: Livia Archibugi: So significantly lower.

00:16:35: Livia Archibugi: And this is something that to me is incredible because celecoxib was administered

00:16:41: orally for seven days, twice a day, I think.

00:16:45: Livia Archibugi: And just by doing that, if you can reduce the occurrence of organ failure in acute

00:16:50: pancreatitis,

00:16:52: Livia Archibugi: It's incredible.

00:16:54: Livia Archibugi: Considering that in the past years, really,

00:16:56: we couldn't see anything that was like a groundbreaking discovery for the treatment

00:17:02: of acute pancreatitis.

00:17:03: Livia Archibugi: So really, this is something that we need to see, you know, better,

00:17:08: larger studies, more patients, but this could really be the next big change in

00:17:15: pancreas diseases, you know.

00:17:17: Jörn Schattenberg: Interesting.

00:17:17: Jörn Schattenberg: Yeah.

00:17:17: Jörn Schattenberg: And on the background that cytokine activation and inflammation plays a very

00:17:22: dominant role in the pathophysiology of this disease.

00:17:25: Jörn Schattenberg: I mean, you probably have to start early enough, I would think,

00:17:28: because the way I understand acute pancreatitis, it's a self-amplifying process.

00:17:33: Jörn Schattenberg: And once you cross a threshold, your pancreas is just eaten up by inflammation.

00:17:39: Livia Archibugi: Yeah, exactly.

00:17:40: Livia Archibugi: And the enzymes go out and you start having a

00:17:46: systemic problem.

00:17:47: Livia Archibugi: It's not about the pancreas anymore.

00:17:49: Livia Archibugi: And once it starts, it might be hard to stop it down.

00:17:53: Livia Archibugi: But yeah, in the trial, they would administer it very, very early, within,

00:17:58: I think, 48 hours from...

00:18:02: Livia Archibugi: onset of symptoms or presentation to the ER.

00:18:05: Livia Archibugi: I think onset of symptoms, which is very important.

00:18:08: Livia Archibugi: So this is something really, really relevant.

00:18:13: Jörn Schattenberg: So identify acute pancreatitis early.

00:18:15: Jörn Schattenberg: It could be a take-home message for our listeners,

00:18:18: even for totally independent intervention, a little bit like sepsis, maybe,

00:18:23: to treat and intervene.

00:18:24: Livia Archibugi: Absolutely, yeah.

00:18:25: Livia Archibugi: Once the patient arrives to the emergency room,

00:18:29: it's very important to diagnose the patient and possibly if,

00:18:34: I mean, the trial was on patients that were predicted to, you know,

00:18:39: be non-mild pancreatitis.

00:18:42: Livia Archibugi: So you have to stratify your patient and prescribe the drug.

00:18:47: Livia Archibugi: This could be, you know, really a game changer.

00:18:50: Livia Archibugi: We will see in general what happens.

00:18:53: Livia Archibugi: We will need new trials, but this is really the start of, who knows,

00:18:57: maybe the next discovery for the treatment of this disease,

00:19:00: because currently we have nothing, let's say, besides hydration.

00:19:06: Jörn Schattenberg: All right.

00:19:07: Jörn Schattenberg: Well, anything towards the end?

00:19:09: Jörn Schattenberg: Short summaries or something that popped out at you in addition?

00:19:14: Jörn Schattenberg: I mean, those were three great abstracts already.

00:19:17: Livia Archibugi: Other couple ones, which is a topic that I really care about, it's genetics,

00:19:22: because I take care also of the screening of the pancreas and genetic chronic

00:19:26: pancreatitis, so it's something that really stood out to me.

00:19:29: Livia Archibugi: There was an abstract about PRSS1.

00:19:32: Livia Archibugi: They combined in France all PRSS1 patients.

00:19:36: Livia Archibugi: It was more than 400 patients with PRSS1 mutation, which is...

00:19:41: Livia Archibugi: actually very, very rare, because PRSS1 prevalence is one, like,

00:19:46: one out of a hundred thousand patients,

00:19:49: and they were able to properly describe, you know,

00:19:52: the penetrance of the mutation during the follow-up,

00:19:57: the onset of exocrine pancreatic insufficiency, diabetes,

00:20:02: and also the risk of pancreatic cancer, because

00:20:04: Livia Archibugi: for example, for someone like me that I do screening for pancreatic cancer,

00:20:09: for these patients, PRSS1 scares me a lot because previous reports show that

00:20:15: lifetime risk is around 35-40%.

00:20:18: Livia Archibugi: So it's one of the highest ones.

00:20:21: Livia Archibugi: Actually, in their study, it was kind of low.

00:20:23: Livia Archibugi: It was about, I think, 4-5%.

00:20:26: Livia Archibugi: So it was pretty low, and this is something that might really change the nature of

00:20:32: the course of these patients in general.

00:20:35: Livia Archibugi: And another one concerning genetic was the use of a polygenic risk score.

00:20:40: Livia Archibugi: It was a UK Biobank study about the risk of pancreatic cancer onset

00:20:46: Livia Archibugi: in associated to sweetened beverages,

00:20:50: but also associated to the polygenic risk scores.

00:20:53: Livia Archibugi: And I believe this is going to be the future, you know,

00:20:55: knowing the genetic background,

00:20:57: Livia Archibugi: Not only in terms of single big mutations, but knowing the score,

00:21:02: your polygenic risk scores, and associate it to lifestyle,

00:21:07: whether it's diet, smoking, or anything about the lifestyle,

00:21:12: to create an idea of your risk of disease.

00:21:16: Livia Archibugi: This is going to be, to me, is going to be the change,

00:21:19: not only in pancreatic diseases, but yeah, anything.

00:21:22: Jörn Schattenberg: Very interesting.

00:21:23: Jörn Schattenberg: Can you remind me what current guidelines do say on genetics?

00:21:27: Jörn Schattenberg: There is no screening recommended.

00:21:29: Jörn Schattenberg: I know you're working in a specialised place.

00:21:32: Jörn Schattenberg: You screen them in particular if you suspect hereditary cases, right?

00:21:36: Jörn Schattenberg: This is where the genetics come in.

00:21:38: Jörn Schattenberg: Or maybe your perspective on how to use genetics today.

00:21:42: Livia Archibugi: Well, genetics is difficult because there are guidelines that suggest you to screen

00:21:47: these patients, but actually, you know, it's still not cost effective.

00:21:54: Livia Archibugi: The incidence of lesions is still very, very rare.

00:21:58: Livia Archibugi: And the risk is very different compared to the type of genetic background you have.

00:22:03: Livia Archibugi: There are some mutations like CDKN2A that have a lifetime risk of pancreatic cancer

00:22:09: development, but around 17%.

00:22:12: Livia Archibugi: But there are other ones like BRCA1, for example,

00:22:17: that is very low, around 3-5%.

00:22:20: Livia Archibugi: So it's really, really different.

00:22:22: Livia Archibugi: We do have guidelines, ASGE, we have the Italian ones.

00:22:28: Livia Archibugi: So we do have guidelines that recommend surveillance of these patients,

00:22:33: of these high-risk individuals.

00:22:34: Livia Archibugi: But actually, it's not like, you know,

00:22:36: the colon cancer that has been proven that a screening measure can really impact,

00:22:42: you know, it's cost-effective and it can impact the survival.

00:22:46: Livia Archibugi: We still have very few data on it.

00:22:48: Jörn Schattenberg: So in which of my patients should I order genetics?

00:22:51: Livia Archibugi: Well, first of all, the indications to prescribe genetics are very different between

00:22:57: country to country.

00:22:58: Livia Archibugi: For example, in Italy,

00:22:59: we follow the breast indications for BRCA1 and 2,

00:23:04: and then we expand the panel because testing BRCA1 and 2 or testing a bigger panel

00:23:09: usually costs the same.

00:23:10: Livia Archibugi: So usually we do a bigger test.

00:23:12: Livia Archibugi: The indication in Italy for pancreatic cancer patients is if they have pancreatic

00:23:18: cancer.

00:23:18: Livia Archibugi: So from there you screen, you might find a mutation and then you expand as a cascade

00:23:25: testing to the first degree relative.

00:23:28: Livia Archibugi: So that's how you find individuals at risk without a disease.

00:23:33: Livia Archibugi: or if you've had at least three relatives first grade,

00:23:37: you have an indication to do the testing.

00:23:39: Livia Archibugi: But this is really country-specific, also because genetics is very expensive.

00:23:44: Livia Archibugi: So it's really, really country-specific.

00:23:48: Jörn Schattenberg: But there's more to expect in the coming years.

00:23:50: Jörn Schattenberg: Absolutely.

00:23:51: Jörn Schattenberg: And that brings me almost to the final questions.

00:23:53: Jörn Schattenberg: Are you going to join us in Copenhagen for UEG Week 2027?

00:23:57: Jörn Schattenberg: And what from the programme would you expect there?

00:24:00: Livia Archibugi: Of course, I will come.

00:24:03: Livia Archibugi: I'd say that UEG Week is one of those congresses that I do not miss whatsoever.

00:24:08: Livia Archibugi: What I'm expecting, well, probably I would still expect a lot about AI

00:24:14: because artificial intelligence is really taking over.

00:24:18: Livia Archibugi: I'm not sure whether everything that's out there is of great quality because...

00:24:24: Livia Archibugi: It's like one of those trends where everybody wants to do it,

00:24:27: but are we sure that we are doing it properly?

00:24:30: Livia Archibugi: Same with microbiome.

00:24:32: Livia Archibugi: I'm a little bit scared about these two fields.

00:24:34: Livia Archibugi: They are very interesting, but I'm a bit scared.

00:24:37: Livia Archibugi: Let's say, I don't know, maybe new trials on new drugs and a bit more

00:24:43: also of molecular evaluation of diseases.

00:24:46: Livia Archibugi: For example, to me...

00:24:47: Livia Archibugi: Pancreatic cancer molecular analysis is really important,

00:24:51: especially in the past months.

00:24:52: Livia Archibugi: We have seen the application of targeted therapy like the daraxonrasib for the

00:24:58: KRAS.

00:24:58: Livia Archibugi: So I'm sure next year we will have a lot focusing on the molecular

00:25:04: part of pancreatic cancer.

00:25:06: Livia Archibugi: That's my...

00:25:07: Jörn Schattenberg: Yes, very exciting, the new treatment options for pancreatic cancer, I agree.

00:25:11: Jörn Schattenberg: And just to finalise and highlight that,

00:25:13: we have the Digestive Disease Mechanism Summit this year,

00:25:17: where there's a lot of basic scientists joining us for UEG Week,

00:25:20: and we're going to have that again next year,

00:25:22: where we understand those mechanisms and we learn from our colleagues in basic

00:25:25: science.

00:25:26: Jörn Schattenberg: and they help us to develop those new targets.

00:25:28: Jörn Schattenberg: So clinical trials would be great.

00:25:31: Jörn Schattenberg: I'm really excited and looking forward.

00:25:33: Jörn Schattenberg: Of course, UEG offers aspects during the year too.

00:25:37: Jörn Schattenberg: There will be more podcasts.

00:25:38: Jörn Schattenberg: There's the summer school for training and it's going to be an exciting year until

00:25:43: we meet again in Copenhagen.

00:25:45: Jörn Schattenberg: Livia, thank you so much for taking the time summarising this.

00:25:49: Jörn Schattenberg: I tremendously enjoyed this conversation and even making

00:25:53: Jörn Schattenberg: the programme with my colleagues.

00:25:55: Jörn Schattenberg: There is aspects I learned from you here.

00:25:57: Jörn Schattenberg: So thank you so much for taking this time.

00:25:59: Livia Archibugi: Thanks to you for having me.

00:26:01: Jörn Schattenberg: Absolutely.

00:26:02: Jörn Schattenberg: This brings us to the end of this recording.

00:26:04: Jörn Schattenberg: If you want to share some last words.

00:26:07: Livia Archibugi: I'd just like to stress the fact that to me,

00:26:11: UEG Week and UEG in general is a community and a way to

00:26:17: meet colleagues, learn from them, network, have fun.

00:26:22: Livia Archibugi: And to me, it's always like a great experience under many

00:26:27: types of aspects.

00:26:30: Livia Archibugi: So I hope many people will join us like they did this year.

00:26:33: Jörn Schattenberg: And we need the future gastroenterologists there to support our field and to educate

00:26:37: them.

00:26:38: Jörn Schattenberg: All right.

00:26:39: Jörn Schattenberg: Have a lovely afternoon.

00:26:41: Jörn Schattenberg: I'm sending your best wishes from here to Italy.

00:26:44: Jörn Schattenberg: And it was a pleasure speaking with you.

00:26:46: Livia Archibugi: Thank you.

00:26:47: Livia Archibugi: Thank you very much.