APDW 2025, Singapore

RRI as an early warning: Doppler-based renal resistive indices are being studied as non-invasive predictors of AKI risk/severity in cirrhosis.

Therapeutic pathway context: contemporary cirrhosis-AKI frameworks emphasize early recognition and standardized management (volume assessment, stopping nephrotoxins, albumin where indicated, HRS-AKI algorithms).

Albumin + midodrine evidence: a 2025 study reports response-guided midodrine + weekly albumin with standard care improved ascites control and survival outcomes (important to interpret by population and protocol).

Rationale: FMT can shift gut microbiota away from urease-producing/Pro-inflammatory patterns, improving cognition/HE-related outcomes.

Your cited study context: “two-session fresh FMT” in minimal HE has been presented as an open-label pilot RCT (FLAME trial) in 2025 conference abstract listings.

Practical lens: promising, but center expertise, donor screening, route (capsule/enema), durability, and infection risk define real-world uptake.

Body composition is prognostic: sarcopenia/low skeletal muscle and adverse adiposity patterns correlate with outcomes; CT-based body composition metrics are increasingly studied.

CEA adds biological risk signal: combining CEA with body composition can sharpen risk stratification (several studies explore composite scores/ratios).

Clinical takeaway: beyond TNM, host factors (muscle/fat phenotype) influence chemo tolerance, complications, and survival—useful for prehab and treatment planning.

Yes, increasingly, modern intestinal rehabilitation programs (IRP) can reduce PN dependence and improve survival via nutrition optimisation, sepsis prevention, medical therapy, and reconstructive surgery when feasible.

Core idea: treat IF like a chronic condition with a rehab pathway, reserving transplant for failures/IFALD complications.

CADe (detection): strong RCT-level evidence that CADe increases polyp detection and ADR; major 2025 guidance/meta-analyses support benefit.

CAQ (quality): aims to standardize quality indicators (mucosal exposure, withdrawal technique, bowel prep scoring) and reduce operator variability—evidence is emerging and implementation-focused.

Important nuance: higher ADR does not automatically mean fewer CRCs unless we also improve SSL detection, complete resection, and surveillance adherence; false positives and workflow burden must be tracked.

This is now formally addressed (2025 consensus): provides guidance on when and how to use AI-assisted colonoscopy in screening/surveillance practice.

Key messages likely emphasised:

• AI should be integrated with quality systems (withdrawal time, bowel prep, completeness), not treated as a stand-alone fix.

• Governance: validation, training, data privacy, workflow integration, and monitoring for drift/bias.

Why PNPLA3 matters: PNPLA3 I148M is a major genetic driver of progressive MASLD/SLD; gene-edited / iPSC / in-vivo models help map variant-specific pathways.

What “transcriptomic + metabolomic” adds: links genotype → cell programs (lipid droplet handling, stellate activation, inflammation) → measurable metabolic signatures.

Therapeutic direction: PNPLA3-targeted therapies are moving forward (e.g., antisense approaches in early-phase trials), making these models clinically relevant.

It’s uncommon but high-stakes: tunnel infection is a “major AE” in ESTP and needs early recognition.

Management pattern (from published series): drainage is central—approaches include placing a gastric tube into the tunnel for drainage, tunnel mucosal incision, plus antibiotics and supportive care.

Prevention pearl: meticulous closure of entry, peri-procedure antibiotics (as per unit protocol), and early imaging/endoscopic reassessment if fever/chest pain/leukocytosis occurs.

A single-centre, single-blind, randomised non-inferiority trial compared a novel motorised endoscope vs conventional endoscopy in screening EGD.

What matters in results: completion rate, visualisation quality, procedure time, patient comfort/sedation needs, adverse events, and operator learning curve.

Clinical lens: motorised platforms may improve ergonomics and scope control, but adoption depends on safety + time neutrality, + cost in real-world workflows.

Why this is being explored: Standard ESD is reserved for lesions with very low LN metastasis risk; “beyond-indication” ESD increases non-curative resection risk → the question becomes how to add targeted nodal assessment while preserving stomach function.

Key concept: Sentinel node navigation surgery and limited laparoscopic LN dissection are evolving strategies to avoid full gastrectomy + D1/D2 in select EGC while maintaining oncologic safety.

Practical takeaway: Post-ESD pathology drives escalation—LVI, deeper submucosal invasion, poor differentiation, positive margins strongly push toward additional surgery; risk tools like eCura help decide “observe vs operate.”