TBD Meeting (3042-24)

WASHINGTON — As part of a quality improvement initiative, gastroenterologists at the University of Texas Health Science Center reduced endoscopic waste by using a single tool rather than multiple tools during colonoscopies, according to a study presented at Digestive Disease Week^® (DDW).

After discussing environmentally conscious practices during regular meetings, the odds of gastroenterologists using a single tool — either biopsy forceps or a snare — compared with multiple disposable tools was three times higher.

“The burden of waste is massive, with GI being the third-largest waste generator in healthcare. The number of procedures is increasing, which just means more waste, and we have to look at ways to reduce it,” said lead author Prateek Harne, MD, a gastroenterology fellow at the University of Texas Health Science Center.

Overall, the healthcare industry generates 8.5% of U.S. greenhouse emissions, with more than 70% coming from used instruments and supplies, he said. GI endoscopy generates 85,000 metric tons of carbon dioxide waste annually. That waste stems from high case volumes, patient travel, the decontamination process, and single-use devices.

After seeing the waste at his institution, Dr. Harne wondered how to reduce single-use device and nonrenewable waste, particularly the tools used during polypectomies. He and colleagues decided to focus on single-tool use and collected data about the tools used during screening colonoscopies for 8 weeks before an intervention.

As part of the intervention, Dr. Harne and colleagues discussed green endoscopy initiatives supported by North American gastrointestinal societies during a journal club meeting with gastroenterology faculty. They also discussed potential strategies to reduce waste in day-to-day practice during a monthly business meeting, particularly focused on being mindful of using tools during polypectomies. The meetings occurred 3 days apart.

Then Dr. Harne and colleagues collected data regarding tool use during screening colonoscopies, looking at the number and type of instruments used. Before the meetings, 210 patients underwent colonoscopies, including 34% that required no intervention, 32% that required one tool, and 33% that required multiple tools.

After the meetings, 112 patients underwent colonoscopies, including 34% that required no tools, 49% that used one tool, and 17% that used multiple tools. This represented a 17% increase in the use of one tool (P < .01) and a 16% decrease in the use of multiple tools (P < .01). The odds of using a single tool compared with multiple tools was 2.98, and there was a statistically significant increase in uptake of snare for polypectomy.

The study was limited by being at a single center, having a small sample size, and using a short-term assessment. At the same time, the findings show potential for a low-cost solution through open discussion with gastroenterologists.

“Sir Isaac Newton had two holes for two different sized cats in his home, but all of his cats ended up using the bigger hole,” Dr. Harne said in his conclusion. “Maybe we can do the same for polypectomies and use only the tools that we need.”

In an interview, Dr. Harne noted he spoke with the janitorial staff at his institution to learn more about endoscopy unit waste, including how much is recycled, how much is incinerated, and who handles the waste. He recognized the work being done in Europe to understand and reduce endoscopic waste and hopes U.S. groups begin to implement more measures.

“Gastroenterologists and their teams need to be more cognizant of the impact we have on the environment,” Dr. Harne said. “As our study shows, if providers are aware that they can and should use fewer tools to get the same results, it can lead to a statistically significant impact, just with a friendly reminder to reduce use.”

After the presentation, Dr. Harne discussed other shifts with conference attendees, such as not opening or unwrapping tools until needed during a procedure.

“Small changes could have big impacts. Everything that we do in QI [quality improvement] is meant to help patients and the environment,” said Amanda Krouse, MD, a research fellow at the University of California, San Diego, who was a moderator of the DDW session on GI fellow–directed QI projects.

In an interview, Alana Persaud, MD, an endoscopy fellow at Geisinger Medical Center in Danville, Pennsylvania, also a moderator of the session, said: “Ultimately, the medical services we’re providing are for the longevity of our patients, but at the same time, we don’t want it to be to the detriment of the environment, so paying attention to green endoscopy when we can preserve and use more discretion with our devices is worth it so we can all thrive together.”

Dr. Harne did not have any disclosures.

WASHINGTON — As part of a quality improvement initiative, gastroenterologists at the University of Texas Health Science Center reduced endoscopic waste by using a single tool rather than multiple tools during colonoscopies, according to a study presented at Digestive Disease Week^® (DDW).

After discussing environmentally conscious practices during regular meetings, the odds of gastroenterologists using a single tool — either biopsy forceps or a snare — compared with multiple disposable tools was three times higher.

“The burden of waste is massive, with GI being the third-largest waste generator in healthcare. The number of procedures is increasing, which just means more waste, and we have to look at ways to reduce it,” said lead author Prateek Harne, MD, a gastroenterology fellow at the University of Texas Health Science Center.

Overall, the healthcare industry generates 8.5% of U.S. greenhouse emissions, with more than 70% coming from used instruments and supplies, he said. GI endoscopy generates 85,000 metric tons of carbon dioxide waste annually. That waste stems from high case volumes, patient travel, the decontamination process, and single-use devices.

After seeing the waste at his institution, Dr. Harne wondered how to reduce single-use device and nonrenewable waste, particularly the tools used during polypectomies. He and colleagues decided to focus on single-tool use and collected data about the tools used during screening colonoscopies for 8 weeks before an intervention.

As part of the intervention, Dr. Harne and colleagues discussed green endoscopy initiatives supported by North American gastrointestinal societies during a journal club meeting with gastroenterology faculty. They also discussed potential strategies to reduce waste in day-to-day practice during a monthly business meeting, particularly focused on being mindful of using tools during polypectomies. The meetings occurred 3 days apart.

Then Dr. Harne and colleagues collected data regarding tool use during screening colonoscopies, looking at the number and type of instruments used. Before the meetings, 210 patients underwent colonoscopies, including 34% that required no intervention, 32% that required one tool, and 33% that required multiple tools.

After the meetings, 112 patients underwent colonoscopies, including 34% that required no tools, 49% that used one tool, and 17% that used multiple tools. This represented a 17% increase in the use of one tool (P < .01) and a 16% decrease in the use of multiple tools (P < .01). The odds of using a single tool compared with multiple tools was 2.98, and there was a statistically significant increase in uptake of snare for polypectomy.

The study was limited by being at a single center, having a small sample size, and using a short-term assessment. At the same time, the findings show potential for a low-cost solution through open discussion with gastroenterologists.

“Sir Isaac Newton had two holes for two different sized cats in his home, but all of his cats ended up using the bigger hole,” Dr. Harne said in his conclusion. “Maybe we can do the same for polypectomies and use only the tools that we need.”

In an interview, Dr. Harne noted he spoke with the janitorial staff at his institution to learn more about endoscopy unit waste, including how much is recycled, how much is incinerated, and who handles the waste. He recognized the work being done in Europe to understand and reduce endoscopic waste and hopes U.S. groups begin to implement more measures.

“Gastroenterologists and their teams need to be more cognizant of the impact we have on the environment,” Dr. Harne said. “As our study shows, if providers are aware that they can and should use fewer tools to get the same results, it can lead to a statistically significant impact, just with a friendly reminder to reduce use.”

After the presentation, Dr. Harne discussed other shifts with conference attendees, such as not opening or unwrapping tools until needed during a procedure.

“Small changes could have big impacts. Everything that we do in QI [quality improvement] is meant to help patients and the environment,” said Amanda Krouse, MD, a research fellow at the University of California, San Diego, who was a moderator of the DDW session on GI fellow–directed QI projects.

In an interview, Alana Persaud, MD, an endoscopy fellow at Geisinger Medical Center in Danville, Pennsylvania, also a moderator of the session, said: “Ultimately, the medical services we’re providing are for the longevity of our patients, but at the same time, we don’t want it to be to the detriment of the environment, so paying attention to green endoscopy when we can preserve and use more discretion with our devices is worth it so we can all thrive together.”

Dr. Harne did not have any disclosures.

WASHINGTON — As part of a quality improvement initiative, gastroenterologists at the University of Texas Health Science Center reduced endoscopic waste by using a single tool rather than multiple tools during colonoscopies, according to a study presented at Digestive Disease Week^® (DDW).

After discussing environmentally conscious practices during regular meetings, the odds of gastroenterologists using a single tool — either biopsy forceps or a snare — compared with multiple disposable tools was three times higher.

“The burden of waste is massive, with GI being the third-largest waste generator in healthcare. The number of procedures is increasing, which just means more waste, and we have to look at ways to reduce it,” said lead author Prateek Harne, MD, a gastroenterology fellow at the University of Texas Health Science Center.

Overall, the healthcare industry generates 8.5% of U.S. greenhouse emissions, with more than 70% coming from used instruments and supplies, he said. GI endoscopy generates 85,000 metric tons of carbon dioxide waste annually. That waste stems from high case volumes, patient travel, the decontamination process, and single-use devices.

After seeing the waste at his institution, Dr. Harne wondered how to reduce single-use device and nonrenewable waste, particularly the tools used during polypectomies. He and colleagues decided to focus on single-tool use and collected data about the tools used during screening colonoscopies for 8 weeks before an intervention.

As part of the intervention, Dr. Harne and colleagues discussed green endoscopy initiatives supported by North American gastrointestinal societies during a journal club meeting with gastroenterology faculty. They also discussed potential strategies to reduce waste in day-to-day practice during a monthly business meeting, particularly focused on being mindful of using tools during polypectomies. The meetings occurred 3 days apart.

Then Dr. Harne and colleagues collected data regarding tool use during screening colonoscopies, looking at the number and type of instruments used. Before the meetings, 210 patients underwent colonoscopies, including 34% that required no intervention, 32% that required one tool, and 33% that required multiple tools.

After the meetings, 112 patients underwent colonoscopies, including 34% that required no tools, 49% that used one tool, and 17% that used multiple tools. This represented a 17% increase in the use of one tool (P < .01) and a 16% decrease in the use of multiple tools (P < .01). The odds of using a single tool compared with multiple tools was 2.98, and there was a statistically significant increase in uptake of snare for polypectomy.

The study was limited by being at a single center, having a small sample size, and using a short-term assessment. At the same time, the findings show potential for a low-cost solution through open discussion with gastroenterologists.

“Sir Isaac Newton had two holes for two different sized cats in his home, but all of his cats ended up using the bigger hole,” Dr. Harne said in his conclusion. “Maybe we can do the same for polypectomies and use only the tools that we need.”

In an interview, Dr. Harne noted he spoke with the janitorial staff at his institution to learn more about endoscopy unit waste, including how much is recycled, how much is incinerated, and who handles the waste. He recognized the work being done in Europe to understand and reduce endoscopic waste and hopes U.S. groups begin to implement more measures.

“Gastroenterologists and their teams need to be more cognizant of the impact we have on the environment,” Dr. Harne said. “As our study shows, if providers are aware that they can and should use fewer tools to get the same results, it can lead to a statistically significant impact, just with a friendly reminder to reduce use.”

After the presentation, Dr. Harne discussed other shifts with conference attendees, such as not opening or unwrapping tools until needed during a procedure.

“Small changes could have big impacts. Everything that we do in QI [quality improvement] is meant to help patients and the environment,” said Amanda Krouse, MD, a research fellow at the University of California, San Diego, who was a moderator of the DDW session on GI fellow–directed QI projects.

In an interview, Alana Persaud, MD, an endoscopy fellow at Geisinger Medical Center in Danville, Pennsylvania, also a moderator of the session, said: “Ultimately, the medical services we’re providing are for the longevity of our patients, but at the same time, we don’t want it to be to the detriment of the environment, so paying attention to green endoscopy when we can preserve and use more discretion with our devices is worth it so we can all thrive together.”

Dr. Harne did not have any disclosures.

WASHINGTON — Ablation of the gastric fundus to reduce production of the “hunger hormone” ghrelin resulted in decreased appetite and significant weight loss among participants in a small first-in-human trial.

“Patients reported a decrease in hunger, appetite, and cravings and an increase in control over [their] eating,” said senior study investigator Christopher McGowan, MD, AGAF, a gastroenterologist in private practice and medical director of True You Weight Loss in Cary, North Carolina.

Brian Strickland Photography

Major Findings

In the trial, 10 women (mean age, 38 years; mean body mass index, 40.2) underwent endoscopic fundic mucosal ablation via hybrid argon plasma coagulation in an ambulatory setting under general anesthesia from November 1, 2022, to April 14, 2023. The procedure took less than an hour on average, and the technique gave them easy access to the fundus, Dr. McGowan said.

Compared with baseline, there were multiple beneficial outcomes at 6 months:

• 45% less circulating ghrelin in the blood.
• 53% drop in ghrelin-producing cells in the fundus.
• 42% reduction in stomach capacity.
• 43% decrease in hunger, appetite, and cravings.
• 7.7% body weight loss.

Over the 6 months of the study, mean ghrelin concentrations dropped from 461.6 pg/mL at baseline to 254.8 pg/mL (P = .006).

It is fascinating that the hormone ghrelin decreased just by ablating, said Loren Laine, MD, AGAF, professor of medicine (digestive diseases) at Yale School of Medicine and chair of DDW 2024. “They used the same device that we use to treat bleeding ulcers or lesions in the stomach and applied it broadly over the whole upper part of the stomach.”

Another Anti-Obesity Tool?

“We’re all familiar with the epidemic that is obesity affecting nearly one in two adults, and the profound impact that it has on patients’ health, their quality of life, as well as the healthcare system,” Dr. McGowan said. “It’s clear that we need every tool possible to address this because we know that obesity is not a matter of willpower. It’s a disease.”

Gastric fundus ablation “may represent, and frankly should represent, a treatment option for the greater than 100 million US adults with obesity,” he added.

Not every patient wants to or can access GLP-1 medications, Dr. McGowan said. Also, “there’s a difference between taking a medication long-term, requiring an injection every week, vs a single intervention in time that carries forward.”

Ablation could also help people transition after they stop GLP-1 medications to help them maintain their weight loss, he said.

Weight loss is the endpoint you care about the most, said Dr. Laine, who co-moderated the press briefing.

Though the weight loss of 7.7% was not a large percentage, it was only 10 patients. We will have to see whether the total body weight loss is different when they do the procedure in more patients or if they can combine different mechanisms, Dr. Laine said.

It remains unclear whether gastric fundus ablation would be a stand-alone procedure or used in combination with another endoscopic weight-management intervention, bariatric surgery, or medication.

The endoscopic sleeve, which is a stomach-reducing procedure, is very effective, but it doesn’t diminish hunger, Dr. McGowan said. Combining it with ablation may be “a best-of-both-worlds scenario.”

Dr. Laine added that another open question is whether the gastric fundal accommodation will be associated with any side effects such as dyspepsia.

Dr. McGowan reported consulting for Boston Scientific and Apollo Endosurgery. Dr. Laine reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

WASHINGTON — Ablation of the gastric fundus to reduce production of the “hunger hormone” ghrelin resulted in decreased appetite and significant weight loss among participants in a small first-in-human trial.

“Patients reported a decrease in hunger, appetite, and cravings and an increase in control over [their] eating,” said senior study investigator Christopher McGowan, MD, AGAF, a gastroenterologist in private practice and medical director of True You Weight Loss in Cary, North Carolina.

Brian Strickland Photography

Major Findings

In the trial, 10 women (mean age, 38 years; mean body mass index, 40.2) underwent endoscopic fundic mucosal ablation via hybrid argon plasma coagulation in an ambulatory setting under general anesthesia from November 1, 2022, to April 14, 2023. The procedure took less than an hour on average, and the technique gave them easy access to the fundus, Dr. McGowan said.

Compared with baseline, there were multiple beneficial outcomes at 6 months:

• 45% less circulating ghrelin in the blood.
• 53% drop in ghrelin-producing cells in the fundus.
• 42% reduction in stomach capacity.
• 43% decrease in hunger, appetite, and cravings.
• 7.7% body weight loss.

Over the 6 months of the study, mean ghrelin concentrations dropped from 461.6 pg/mL at baseline to 254.8 pg/mL (P = .006).

It is fascinating that the hormone ghrelin decreased just by ablating, said Loren Laine, MD, AGAF, professor of medicine (digestive diseases) at Yale School of Medicine and chair of DDW 2024. “They used the same device that we use to treat bleeding ulcers or lesions in the stomach and applied it broadly over the whole upper part of the stomach.”

Another Anti-Obesity Tool?

“We’re all familiar with the epidemic that is obesity affecting nearly one in two adults, and the profound impact that it has on patients’ health, their quality of life, as well as the healthcare system,” Dr. McGowan said. “It’s clear that we need every tool possible to address this because we know that obesity is not a matter of willpower. It’s a disease.”

Gastric fundus ablation “may represent, and frankly should represent, a treatment option for the greater than 100 million US adults with obesity,” he added.

Not every patient wants to or can access GLP-1 medications, Dr. McGowan said. Also, “there’s a difference between taking a medication long-term, requiring an injection every week, vs a single intervention in time that carries forward.”

Ablation could also help people transition after they stop GLP-1 medications to help them maintain their weight loss, he said.

Weight loss is the endpoint you care about the most, said Dr. Laine, who co-moderated the press briefing.

Though the weight loss of 7.7% was not a large percentage, it was only 10 patients. We will have to see whether the total body weight loss is different when they do the procedure in more patients or if they can combine different mechanisms, Dr. Laine said.

It remains unclear whether gastric fundus ablation would be a stand-alone procedure or used in combination with another endoscopic weight-management intervention, bariatric surgery, or medication.

The endoscopic sleeve, which is a stomach-reducing procedure, is very effective, but it doesn’t diminish hunger, Dr. McGowan said. Combining it with ablation may be “a best-of-both-worlds scenario.”

Dr. Laine added that another open question is whether the gastric fundal accommodation will be associated with any side effects such as dyspepsia.

Dr. McGowan reported consulting for Boston Scientific and Apollo Endosurgery. Dr. Laine reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

WASHINGTON — Ablation of the gastric fundus to reduce production of the “hunger hormone” ghrelin resulted in decreased appetite and significant weight loss among participants in a small first-in-human trial.

“Patients reported a decrease in hunger, appetite, and cravings and an increase in control over [their] eating,” said senior study investigator Christopher McGowan, MD, AGAF, a gastroenterologist in private practice and medical director of True You Weight Loss in Cary, North Carolina.

Brian Strickland Photography

Major Findings

In the trial, 10 women (mean age, 38 years; mean body mass index, 40.2) underwent endoscopic fundic mucosal ablation via hybrid argon plasma coagulation in an ambulatory setting under general anesthesia from November 1, 2022, to April 14, 2023. The procedure took less than an hour on average, and the technique gave them easy access to the fundus, Dr. McGowan said.

Compared with baseline, there were multiple beneficial outcomes at 6 months:

• 45% less circulating ghrelin in the blood.
• 53% drop in ghrelin-producing cells in the fundus.
• 42% reduction in stomach capacity.
• 43% decrease in hunger, appetite, and cravings.
• 7.7% body weight loss.

Over the 6 months of the study, mean ghrelin concentrations dropped from 461.6 pg/mL at baseline to 254.8 pg/mL (P = .006).

It is fascinating that the hormone ghrelin decreased just by ablating, said Loren Laine, MD, AGAF, professor of medicine (digestive diseases) at Yale School of Medicine and chair of DDW 2024. “They used the same device that we use to treat bleeding ulcers or lesions in the stomach and applied it broadly over the whole upper part of the stomach.”

Another Anti-Obesity Tool?

“We’re all familiar with the epidemic that is obesity affecting nearly one in two adults, and the profound impact that it has on patients’ health, their quality of life, as well as the healthcare system,” Dr. McGowan said. “It’s clear that we need every tool possible to address this because we know that obesity is not a matter of willpower. It’s a disease.”

Gastric fundus ablation “may represent, and frankly should represent, a treatment option for the greater than 100 million US adults with obesity,” he added.

Not every patient wants to or can access GLP-1 medications, Dr. McGowan said. Also, “there’s a difference between taking a medication long-term, requiring an injection every week, vs a single intervention in time that carries forward.”

Ablation could also help people transition after they stop GLP-1 medications to help them maintain their weight loss, he said.

Weight loss is the endpoint you care about the most, said Dr. Laine, who co-moderated the press briefing.

Though the weight loss of 7.7% was not a large percentage, it was only 10 patients. We will have to see whether the total body weight loss is different when they do the procedure in more patients or if they can combine different mechanisms, Dr. Laine said.

It remains unclear whether gastric fundus ablation would be a stand-alone procedure or used in combination with another endoscopic weight-management intervention, bariatric surgery, or medication.

The endoscopic sleeve, which is a stomach-reducing procedure, is very effective, but it doesn’t diminish hunger, Dr. McGowan said. Combining it with ablation may be “a best-of-both-worlds scenario.”

Dr. Laine added that another open question is whether the gastric fundal accommodation will be associated with any side effects such as dyspepsia.

Dr. McGowan reported consulting for Boston Scientific and Apollo Endosurgery. Dr. Laine reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

WASHINGTON, DC – A mouth rinse used to identify oral microbiome composition could serve as an early-detection tool for gastric cancer, new evidence suggests.

Researchers found distinct bacterial composition differences in patient samples that point to the potential for oral microbial signatures to be used as biomarkers for assessing gastric cancer risk. 

“Too many patients are being diagnosed too late. There are no formal screening guidelines for gastric cancer, and more than half of patients with gastric cancer do not receive a diagnosis until their cancer is already at an advanced stage,” said Shruthi Reddy Perati, MD, a general surgery resident at Rutgers University Robert Wood Johnson School of Medicine in New Brunswick, New Jersey.

Detecting gastric cancer now generally requires an invasive procedure, such as endoscopy. Therefore, a noninvasive “swish and spit” test could be more accessible and allow for more widespread screening, Dr. Perati said at a May 8 press briefing during which her research (Abstract 949) was previewed for Digestive Disease Week^® (DDW).

Gastric cancer, also known as stomach cancer, is the fourth most common cause of cancer-related death in the world. The United States can expect 26,890 new cases and 10,880 deaths from this type of cancer in 2024, the American Cancer Society estimates.
 

Microbial Signatures Found

Dr. Perati and colleagues collected oral rinse samples from 98 patients: 30 known to have gastric cancer , 30 with precancerous gastric conditions (pre–gastric cancer), and 38 control participants without pre-gastric or gastric cancer. Sixty-two percent were women, 32% were Hispanic, 31% had diabetes, and 18% were smokers.

The researchers analyzed the samples for alpha and beta diversity and conducted differential analysis using the framework called analysis of compositions of microbiomes.

They found distinct differences between the oral microbiomes of the healthy group and those of the groups with gastric cancer and pre–gastric cancer. In addition, the microbiomes of participants with cancer and of those with precancerous conditions were similar.

The results suggest that the microbiome changes may occur as soon as the stomach environment starts to undergo changes that can eventually turn into cancer.

“The oral microbiome may serve as a window into the composition of the stomach environment,” Dr. Perati said.

The investigators created a screening model to detect the most relevant 13 bacterial genera that differed between the control group and the gastric cancer and pre–gastric cancer groups. The tenfold cross-validation model demonstrated good ability to discriminate using bacteria alone (area under the curve [AUC], 0.74) and was further improved with the addition of clinical variables, including demographics and comorbidities (AUC, 0.91), the researchers noted.

As the investigators noted, the model’s performance improved with the addition of clinical variables, said Loren Laine, MD, professor of medicine (digestive diseases) at Yale School of Medicine and chair of DDW 2024.

An AUC of 0.74 using bacteria alone, which increased to 0.91 by adding demographics and comorbidities, “[is] starting to be really meaningful,” Dr. Laine said.

Further studies should evaluate the test’s sensitivity and specificity, Dr. Laine added.
 

Additional Considerations

The microbiome can vary between people and within the same individual over time. Probiotics, antibiotics, and diet can lead to changes in the microbiome, Dr. Perati said.

When asked how these changes could affect the accuracy of an oral rinse test, Dr. Perati said “it’s known that, in general, dietary modifications can have an impact on the diversity and the prevalence of certain bacteria throughout the GI tract.”

Though variance is expected, we’re hoping to see that the differences in the microbiome composition between the malignant groups and the control groups are more significant than those lower-level background changes due to dietary modifications, for example, she added.

The research is in its early days, and the results need to be validated in a larger study, Dr. Perati said.

Ninety-eight patients is “still a very small number,” said Dr. Laine, who co-moderated the press briefing. “More research is needed.”

Still, the study “has huge implications that could eventually lead to the development of noninvasive and accessible early screening for gastric cancer,” she said.

Dr. Perati and Dr. Laine reported no relevant financial relationships. The study was independently supported.

A version of this article appeared on Medscape.com.

WASHINGTON, DC – A mouth rinse used to identify oral microbiome composition could serve as an early-detection tool for gastric cancer, new evidence suggests.

Researchers found distinct bacterial composition differences in patient samples that point to the potential for oral microbial signatures to be used as biomarkers for assessing gastric cancer risk. 

“Too many patients are being diagnosed too late. There are no formal screening guidelines for gastric cancer, and more than half of patients with gastric cancer do not receive a diagnosis until their cancer is already at an advanced stage,” said Shruthi Reddy Perati, MD, a general surgery resident at Rutgers University Robert Wood Johnson School of Medicine in New Brunswick, New Jersey.

Detecting gastric cancer now generally requires an invasive procedure, such as endoscopy. Therefore, a noninvasive “swish and spit” test could be more accessible and allow for more widespread screening, Dr. Perati said at a May 8 press briefing during which her research (Abstract 949) was previewed for Digestive Disease Week^® (DDW).

Gastric cancer, also known as stomach cancer, is the fourth most common cause of cancer-related death in the world. The United States can expect 26,890 new cases and 10,880 deaths from this type of cancer in 2024, the American Cancer Society estimates.
 

Microbial Signatures Found

Dr. Perati and colleagues collected oral rinse samples from 98 patients: 30 known to have gastric cancer , 30 with precancerous gastric conditions (pre–gastric cancer), and 38 control participants without pre-gastric or gastric cancer. Sixty-two percent were women, 32% were Hispanic, 31% had diabetes, and 18% were smokers.

The researchers analyzed the samples for alpha and beta diversity and conducted differential analysis using the framework called analysis of compositions of microbiomes.

They found distinct differences between the oral microbiomes of the healthy group and those of the groups with gastric cancer and pre–gastric cancer. In addition, the microbiomes of participants with cancer and of those with precancerous conditions were similar.

The results suggest that the microbiome changes may occur as soon as the stomach environment starts to undergo changes that can eventually turn into cancer.

“The oral microbiome may serve as a window into the composition of the stomach environment,” Dr. Perati said.

The investigators created a screening model to detect the most relevant 13 bacterial genera that differed between the control group and the gastric cancer and pre–gastric cancer groups. The tenfold cross-validation model demonstrated good ability to discriminate using bacteria alone (area under the curve [AUC], 0.74) and was further improved with the addition of clinical variables, including demographics and comorbidities (AUC, 0.91), the researchers noted.

As the investigators noted, the model’s performance improved with the addition of clinical variables, said Loren Laine, MD, professor of medicine (digestive diseases) at Yale School of Medicine and chair of DDW 2024.

An AUC of 0.74 using bacteria alone, which increased to 0.91 by adding demographics and comorbidities, “[is] starting to be really meaningful,” Dr. Laine said.

Further studies should evaluate the test’s sensitivity and specificity, Dr. Laine added.
 

Additional Considerations

The microbiome can vary between people and within the same individual over time. Probiotics, antibiotics, and diet can lead to changes in the microbiome, Dr. Perati said.

When asked how these changes could affect the accuracy of an oral rinse test, Dr. Perati said “it’s known that, in general, dietary modifications can have an impact on the diversity and the prevalence of certain bacteria throughout the GI tract.”

Though variance is expected, we’re hoping to see that the differences in the microbiome composition between the malignant groups and the control groups are more significant than those lower-level background changes due to dietary modifications, for example, she added.

The research is in its early days, and the results need to be validated in a larger study, Dr. Perati said.

Ninety-eight patients is “still a very small number,” said Dr. Laine, who co-moderated the press briefing. “More research is needed.”

Still, the study “has huge implications that could eventually lead to the development of noninvasive and accessible early screening for gastric cancer,” she said.

Dr. Perati and Dr. Laine reported no relevant financial relationships. The study was independently supported.

A version of this article appeared on Medscape.com.

WASHINGTON, DC – A mouth rinse used to identify oral microbiome composition could serve as an early-detection tool for gastric cancer, new evidence suggests.

Researchers found distinct bacterial composition differences in patient samples that point to the potential for oral microbial signatures to be used as biomarkers for assessing gastric cancer risk. 

“Too many patients are being diagnosed too late. There are no formal screening guidelines for gastric cancer, and more than half of patients with gastric cancer do not receive a diagnosis until their cancer is already at an advanced stage,” said Shruthi Reddy Perati, MD, a general surgery resident at Rutgers University Robert Wood Johnson School of Medicine in New Brunswick, New Jersey.

Detecting gastric cancer now generally requires an invasive procedure, such as endoscopy. Therefore, a noninvasive “swish and spit” test could be more accessible and allow for more widespread screening, Dr. Perati said at a May 8 press briefing during which her research (Abstract 949) was previewed for Digestive Disease Week^® (DDW).

Gastric cancer, also known as stomach cancer, is the fourth most common cause of cancer-related death in the world. The United States can expect 26,890 new cases and 10,880 deaths from this type of cancer in 2024, the American Cancer Society estimates.
 

Microbial Signatures Found

Dr. Perati and colleagues collected oral rinse samples from 98 patients: 30 known to have gastric cancer , 30 with precancerous gastric conditions (pre–gastric cancer), and 38 control participants without pre-gastric or gastric cancer. Sixty-two percent were women, 32% were Hispanic, 31% had diabetes, and 18% were smokers.

The researchers analyzed the samples for alpha and beta diversity and conducted differential analysis using the framework called analysis of compositions of microbiomes.

They found distinct differences between the oral microbiomes of the healthy group and those of the groups with gastric cancer and pre–gastric cancer. In addition, the microbiomes of participants with cancer and of those with precancerous conditions were similar.

The results suggest that the microbiome changes may occur as soon as the stomach environment starts to undergo changes that can eventually turn into cancer.

“The oral microbiome may serve as a window into the composition of the stomach environment,” Dr. Perati said.

The investigators created a screening model to detect the most relevant 13 bacterial genera that differed between the control group and the gastric cancer and pre–gastric cancer groups. The tenfold cross-validation model demonstrated good ability to discriminate using bacteria alone (area under the curve [AUC], 0.74) and was further improved with the addition of clinical variables, including demographics and comorbidities (AUC, 0.91), the researchers noted.

As the investigators noted, the model’s performance improved with the addition of clinical variables, said Loren Laine, MD, professor of medicine (digestive diseases) at Yale School of Medicine and chair of DDW 2024.

An AUC of 0.74 using bacteria alone, which increased to 0.91 by adding demographics and comorbidities, “[is] starting to be really meaningful,” Dr. Laine said.

Further studies should evaluate the test’s sensitivity and specificity, Dr. Laine added.
 

Additional Considerations

The microbiome can vary between people and within the same individual over time. Probiotics, antibiotics, and diet can lead to changes in the microbiome, Dr. Perati said.

When asked how these changes could affect the accuracy of an oral rinse test, Dr. Perati said “it’s known that, in general, dietary modifications can have an impact on the diversity and the prevalence of certain bacteria throughout the GI tract.”

Though variance is expected, we’re hoping to see that the differences in the microbiome composition between the malignant groups and the control groups are more significant than those lower-level background changes due to dietary modifications, for example, she added.

The research is in its early days, and the results need to be validated in a larger study, Dr. Perati said.

Ninety-eight patients is “still a very small number,” said Dr. Laine, who co-moderated the press briefing. “More research is needed.”

Still, the study “has huge implications that could eventually lead to the development of noninvasive and accessible early screening for gastric cancer,” she said.

Dr. Perati and Dr. Laine reported no relevant financial relationships. The study was independently supported.

A version of this article appeared on Medscape.com.