Gut PostScript

Response to: 'Differentiating gastroparesis from functional dyspepsia is no longer sufficient by OGrady et al

Camilleri, M., Talley, N. J. — 2026-06-09T03:23:36-07:00

We thank Drs O’Grady and colleagues for their interest1 in our commentary ‘Are functional dyspepsia and gastroparesis really ‘interchangeable’ diseases?’2 and their comment agreeing that improvement in tests of gastric emptying (GE) is highly desirable. Their plea for moving the field to understanding mechanisms and validating actionable biomarkers3 with the objective of personalising therapy4 is certainly consistent with our long track record. Consistent with the quest for pathophysiological characterisation of patients with symptoms considered to be arising in the stomach and duodenum, we previously published data on 1287 patients evaluated in the clinical practice using the non-invasive, validated measurements of GE of solids (GES) using the 320 kcal 30% fat chicken egg meal, and gastric accommodation (GA) following 300 mL (and kcal) liquid nutrient drink. We reported 29.8% patients with normal GE and GA, 21.9% abnormal GA only, 27.1% abnormal GE only and 21.1%...

Response to: Cutting waste in endoscopy: the roles of professional practice and staffing levels by Fujisawa and Fujikawa

Welsch, L., Michael, F. A. — 2026-06-09T03:23:36-07:00

We thank Drs Fujisawa and Fujikawa for their thoughtful comments, which highlight professional and organisational determinants that complement our data on waste generation.1 2 In our multicentre study, all centres adhered to German staffing recommendations (one endoscopist, one assisting nurse, one sedation nurse). This uniform baseline makes it unlikely that team composition alone explains the observed differences. A key finding of our comparative analysis was the effect of personal protective equipment (PPE) strategy: between two hospital units, the unit using reusable gowns generated fewer than half of PPE waste than the single-use unit; published life-cycle analyses similarly report up to 93% less solid waste and roughly two-thirds lower greenhouse gas emissions for reusable versus disposable gowns.3 These structural effects probably exceed the incremental gains achievable by awareness campaigns or small process changes. They do not, however, obviate the need for evidence-based PPE indications...

Response to: 'Lumen-apposing metal stents for pancreatic fluid collections: has advancing technology encouraged overreach? by Besim Fazil et al

2026-06-09T03:23:36-07:00

We sincerely thank Besim Fazil and colleagues1 for their interest in our recent study on the nationwide impact of lumen-apposing metal stent (LAMS) implementation on the clinical outcomes of endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs).2 They thoughtfully highlighted the clinical and research implications of our study. We agree that LAMS use should be reserved for selected subgroups of patients with PFCs. Recent randomised controlled trials,3–5 including our WONDER-01 trial, have demonstrated the superiority of immediate endoscopic necrosectomy following the initial EUS-guided drainage of walled-off necrosis over the step-up approach. In this setting, a LAMS may be particularly advantageous, functioning as a stable transluminal port for necrosectomy. Its lumen-apposing design facilitates prolonged, technically demanding necrosectomy procedures while minimising fluid leakage. In contrast, pancreatic pseudocysts—which, by definition, contain only non-necrotic fluid—may be effectively managed with a smaller calibre...

Heterogeneity and lack of standardisation in gut microbiome testing: a comparative assessment of French medical biology laboratories

2026-06-09T03:23:36-07:00

We read with interest the review by de Vos et al.1 The human gut microbiome plays a pivotal role in the maintenance of health and the development of disease.2 3 With the growing availability of microbiome testing products and publications, some patients feel that their health problems are not fully understood or addressed by doctors using conventional medical approaches.4 Concomitantly with a rise in consumer interest in self-testing, questions have emerged regarding the scientific validity, regulatory status and clinical interpretability of microbiome testing kits.5 6 In this context, we aimed to evaluate, on a nationwide French scale, the methods employed, the nature and quality of the results obtained, and the putative benefits that non-specialists/patients can derive from these readily accessible microbiota analyses.

Five French laboratories offering microbiome analysis without prior consultation were selected via standard internet searches...