bluuebunny/crossref_metadata_2025 huggingface dataset:
A115 IMPROVING ENDOSCOPY ROOM EFFICIENCY: EVALUATION OF A VIDEO AS A SUPPLEMENTARY TOOL FOR INFORMED CONSENT
Authors: Kyei A , esenwa O , Tan C , Llovet D , Bernstein M , Mannino B , Cohen L , Griller N , Saibil F , Tartaro P , Yong E , Tinmouth J
Published: February 2025

Background

Endoscopy unit efficiency is critical because of the need to provide timely and quality care, despite limited resources. In previous work, obtaining informed consent negatively impacted efficiency. We developed a 3-minute animated video to facilitate the consent process, including describing colonoscopy, its purpose and potential risks/benefits.

Aims

1) Assess the ability of the video to support the informed consent process; 2) Determine the effectiveness of the video as a communication tool.

Methods

Using a critical case sample design with maximum variation, 12 participants completed pre- and post-colonoscopy 1:1 semi-structured interviews after viewing the video. Questions evaluated whether key components of informed consent were conveyed and assessed the video using principles of learner verification (attractiveness, usability, comprehension, impact on self-efficacy, acceptability). Interviews were recorded and transcribed. The data were coded inductively and deductively.

Results

Regarding components of informed consent, most participants understood the purpose and nature of a colonoscopy, but alternatives, including the right to refuse, were less effectively communicated. As a communication tool, the animations engaged participants and aided comprehension of complex material. The language was accessible, however, some participants found the video too fast and the font too small. Most participants found the video acceptable and characters relatable. Some identified information gaps included sedation level and procedure duration.

Conclusions

Endoscopy unit efficiency may be improved by providing consent information via video to patients scheduled for colonoscopy to supplement current approaches to informed consent. Our findings will inform revisions of the video and subsequent implementation into clinical practice.

Funding Agencies

This study is being funded by the principal investigator’s own funds (Jill Tinmouth)
A119 CLINICAL MANAGEMENT OF PATIENTS WITH COLORECTAL INTRAMUCOSAL CARCINOMA COMPARED TO HIGH-GRADE DYSPLASIA AND T1 COLORECTAL CANCER
Authors: Medawar E , Djinbachian R , Rex D , Vieth M , Pohl H , Popescu Crainic I , Taghiakbari M , Marques P , Kaufman D , Huang F , von Renteln D
Published: February 2025

Background

In the colorectum, intramucosal carcinoma (IMC), like high-grade dysplasia (HGD), should be resected endoscopically.

Aims

We were interested to understand how real-world treatment of IMC cases compares to the management of HGD and T1 colorectal cancer (CRC).

Methods

A multicenter retrospective cohort study was conducted. Through pathology databases, all patients diagnosed between 2010 and 2019 with HGD, IMC or T1 CRC were identified. Pathology and endoscopy reports were verified for HGD, IMC or T1 CRC polyps. The primary outcome was the proportion of surgical management of IMC compared to HGD and T1 cancer. Secondary outcomes were the adjusted odds ratios (OR) for surgical management, proportions of synchronous advanced neoplasia, and adjusted hazard ratios (HR) for metachronous advanced neoplasia.

Results

We identified 455 patients with follow-up endoscopy and pathology (mean age 67.1y, 42.2% female, median follow-up 3.4y): 269 with HGD, 60 with IMC, 126 with T1 CRC. Compared to patients with HGD, patients with IMC were significantly more likely to receive a CT of the abdomen despite a complete endoscopic resection (52.6% vs 13.2%, p<0.001). Surgery rates were 15.2% for HGD, 36.7% for IMC and 84.1% for T1 CRC (p<0.001). When evaluating reasons for surgery, patients with IMC were more likely to undergo unnecessary surgery after a complete endoscopic resection compared to patients with HGD (22.7% of surgical resection reasons in IMC group vs 0% in HGD group, p<0.001). After adjusting for select factors potentially affecting the decision for surgical management and that differed between groups (age, family history of CRC, lesion location, size and morphology, multiplicity of synchronous lesions, colonoscopy indication/context), the adjusted odds of surgery remained significantly higher in patients with IMC compared to HGD (OR 2.62 [1.18-5.85]). Proportions of synchronous advanced neoplasia were 24.2% for HGD, 26.7% for IMC and 25.4% for T1 CRC (p=0.908). The proportion of metachronous advanced neoplasia was 26.8% in the HGD group, 18.3% in the IMC group and 20.6% in the T1 CRC group (p=0.227). Compared to HGD, patients with IMC and T1 CRC had similar adjusted metachronous advanced neoplasia risks (respectively, HR 0.82 [0.43-1.59] and HR 1.16 [0.66-2.05]). No lymph nodes were positive (0/363) and no metastasis occurred among patients with IMC.

Conclusions

Patients diagnosed with colorectal IMC are more likely to receive imaging and surgery than when HGD is diagnosed, although they are not at increased risk of synchronous advanced neoplasia, metachronous advanced neoplasia, lymph node involvement or metastasis. Labeling colorectal lesions as IMC is associated with unnecessary surgical resections.

Funding Agencies

TRIANGLE
A120 METHYLGLYOXAL (MGO) AS A SUBSTRATE FOR LACTYLATION IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Hamilton M , Douchin J , Fréchette M , Giroux V
Published: February 2025

Background

Esophageal squamous cell carcinoma (ESCC) is deadly with a 5-year survival rate of only 15%. With frequent relapse observed in patients, it is known that exposure to treatment can select for certain types of cells known as cancer stem cells (CSC). Considering that, our laboratory established ESCC cell lines with prolonged exposure to anticancer treatments (radiotherapy, 5-FU chemotherapy and combined therapy). As expected, long-term anticancer treatments result in an increase in CSC proportion. Moreover, metabolic alterations were observed, such as enhanced intracellular lactate concentration. Since 2019, lactate has been linked to a new post-translational modification (PTM) called lactylation. This PTM can affect protein-protein interaction or gene expression regulation but little is known about lactylation in ESCC. In addition to lactate, methylglyoxal (MGO), mainly produced through glycolysis, can also be used as a substrate for this type of modification.

Aims

Investigate the role of lactylation in ESCC.

Methods

Three ESCC cell lines (TE11, TE5 and HCE4), an immortalized normal esophageal cell line (STR) and esophageal organoids derived from a chemically-induced ESCC mouse model were used. Cells were treated with lactate or MGO to increase lactylation. Lactylome was determined by mass spectrometry of peptides pulled down using L-lactyllysine (KLA) beads. Western blot (WB) and immunofluorescence (IF) were also performed with KLA specific antibodies.

Results

ESCC and normal cell lines are more sensitive to MGO than lactate to induce lactylation. Interestingly, when compared to normal samples, tumor organoids and ESCC cell lines show increased Glo1 and LDHA expression, 2 conversion enzymes important to produce lactylation substrates. Lactylome analysis of TE11 cells treated or not with MGO showed an increase in several lactylated proteins such as ACTB and CTNNA1. Treatment with MGO also modulated enrichment in biological processes, shifting from hits related to chromatin assembly and mRNA regulation to metabolic processes such as RNA, peptides and glycolytic metabolic processes. Interestingly, the predicted localization of proteins was more cytosolic in MGO-treated cells vs untreated, which was more nuclear. IF with a KLA antibody confirmed those predictions. Finally, lactylation can occur on multiple lysines of proteins. For example, lactylation could be detected on 21 and 16 lysines for NCL or HISTH1B, respectively. Interestingly, lactylation could be detected up to 5 times on the same peptides, for example on CHD5 and CNGA1, which could severely affect the function of that protein domain.

Conclusions

Our results showed that esophageal cells are sensitive to MGO as a substrate of lactylation and that MGO can induce the lactylation of proteins located in the cytoplasm, hence the difference in localization and associated biological processes.

Funding Agencies

CAGCIHR, TRIANGLE, Chaires de recherche du Canada, CRCHUS, Université de Sherbrooke
A125 DOES AI INFLUENCE ADENOMA DETECTION RATES IN FIT-POSITIVE PATIENTS
Authors: McGrath B S , Borgaonkar M , McGrath G S
Published: February 2025

Background

The Fecal Immunochemical Test (FIT) is a screening tool that identifies patients more likely to harbor adenomas or colorectal cancer (CRC). Rates of adenoma detection during colonoscopy can vary significantly among endoscopists. Artificial Intelligence (AI) has been shown to improve adenoma detection during colonoscopy.

Aims

To assess if AI assistance during colonoscopy can improve adenoma detection in FIT-positive patients.

Methods

In October and November of 2023, AI was utilized during colonoscopy for FIT-positive patients at Eastern Health, Newfoundland. The 61 FIT-positive patients who had colonoscopy with AI assistance were compared to 61 FIT-positive age, gender, and endoscopist-matched controls who had colonoscopies performed without AI assistance during the preceding 6 months. Demographic data were collected on all patients as well as colonoscopy findings, including CRC detection, polyp detection, and histology. The primary outcome was the proportion of patients with adenomas in the two groups. Secondary outcomes included advanced adenoma detection rate and sessile serrated lesion detection rate. Sample size was one of convenience as only 61 FIT-positive patients had colonoscopies with AI assistance while AI was temporarily available at our institution. Data were entered in SPSS version 17 for analysis. A chi-squared test was used to compare proportions. The study received approval from the local Health Research Ethics Board.

Results

122 colonoscopies performed by 13 endoscopists (7 General Surgeons, 6 Gastroenterologists) were included. Sixty-eight patients (55.7%) were female and fifty-four patients (44.3%) were male with an average age of 64 (SD = 6.729). Of the patients who underwent AI-assisted colonoscopies, 73.8% had adenomas. Of the patients who underwent colonoscopy without AI assistance, 63.9% had adenomas. There was a non-significant trend toward higher adenoma detection in the patients who had a colonoscopy with AI (x^2=5.165, p=0.076). AI-assisted colonoscopies found advanced adenomas in 44.3% of patients compared to 29.5% in the no AI group (x^2=3,020, p=0.221). In the AI group, 8.2% of patients had sessile serrated lesions (SSL), compared to 1.6% in the standard procedure group (x^2=2.805, p=0.094).

Conclusions

This study showed a trend toward higher adenoma, advanced adenoma, and SSL detection with AI assistance in FIT-positive patients. Repeating this study with a larger sample size might clarify the effect of AI assistance during colonoscopy in FIT-positive patients

Funding Agencies

None
A126 SIGNET-RING CELL CARCINOMA OF THE GALLBLADDER: A CASE REPORT OF UNIQUE BRAIN METASTASIS.
Authors: Alfaraj Z , Grin A , Rai M
Published: February 2025

Background

Signet-ring cell carcinoma (SRCC) is a rare and aggressive subtype of gallbladder adenocarcinoma, representing 1-3% of all gallbladder cancer cases. Diagnosis is established through histopathological examination, which reveals mucin-filled cells that push the nucleus to the periphery. This characteristic contributes to its aggressive nature, leading to local invasion and distant metastases. Diagnosis can be challenging due to its insidious onset, being detected incidentally after cholecystectomy for conditions, such as cholecystitis or cholelithiasis, or after only metastatic symptoms arise. While the most common metastatic sites are abdominal organs, this report presents a unique case of significant brain metastasis, underscoring its aggressiveness.

Aims

To describe a patient with poorly cohesive SRCC of the gallbladder, which exhibited exceptionally rare brain metastasis.

Methods

Case report and literature review.

Results

A 46-year-old male with no significant medical or surgical history presented with abdominal pain and jaundice lasting one week. An MRCP revealed a large gallbladder mass with multiple liver metastasis. Endoscopic ultrasound confirmed the gallbladder mass, and a fine needle biopsy established the diagnosis of poorly cohesive signet-ring cell carcinoma [Figure 1]. Staging images revealed multiple metastatic large brain lesions with mass effect, confirmed by MRI. A multidisciplinary team, including gastroenterology, medical oncology, and radiation oncology, developed a management plan. Due to the poor prognosis linked to brain metastases, the approach included palliative chemotherapy with cisplatin, gemcitabine, and durvalumab, alongside palliative radiotherapy to the brain and a tapering course of dexamethasone. Following the first cycle of chemotherapy, the patient reported significant relief from abdominal pain.

Conclusions

Treatment of SRCC of the gallbladder has not been well studied due to its rarity. For cases without metastasis, a combination of cholecystectomy and chemotherapy may enhance patient outcomes, though the roles of radiotherapy and immunotherapy remain unclear. Unfortunately, many patients present at advanced stages with metastasis, leading to a poor prognosis. This underscores the necessity for further research to identify risk factors and improve early detection. Additionally, more studies are needed to clarify diagnostic and therapeutic approaches to optimize treatment and improve patient outcomes.

Funding Agencies

None
A130 EVALUATING PLACEBO RATES IN EOSINOPHILIC ESOPHAGITIS RANDOMIZED CONTROLLED TRIALS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Ahmed N S , Rivas A , Yuan Y , Qasim A , O’Gorman D , Feagan B , Jairath V , Bredenoord A , Dellon E S , Ma C
Published: February 2025

Background

Eosinophilic esophagitis (EoE) is a chronic inflammatory and progressive fibrotic condition of the esophagus. There are limited treatment options for EoE and a substantial unmet need for effective and safe medical therapies. Drug development in EoE has been hampered by heterogeneous placebo response rates and uncertainty regarding appropriate endpoint configurations. Accurate characterization of placebo response in EoE randomized controlled trials (RCTs) will help inform more future efficient trial designs.

Aims

To conduct a systematic review and meta-analysis to characterize symptomatic, endoscopic, and histologic placebo response rates in placebo controlled EoE RCTs.

Methods

We updated a Cochrane systematic review and meta-analysis, searching MEDLINE, EMBASE, and CENTRAL to January 1, 2024, to identify placebo-controlled RCTs evaluating medical therapies for patients with EoE. Studies were screened independently by 2 reviewers, and full texts were then reviewed for eligibility; all data extracted in parallel. Primary outcome: pooled proportion of clinical, endoscopic, and histologic responders and remitters randomized to placebo, using an intention-to-treat approach and random-effects model. Potential sources of heterogeneity were explored using meta-regression.

Results

A total of 25 RCTs were included. The pooled proportion of clinical response was 40.9% [95% CI: 29.7%-52.8%] with substantial heterogeneity (I2=74.9%). On meta-regression, older age and a higher probability of being randomized to placebo reduced the likelihood of clinical response to placebo. The pooled proportion of histologic remission defined as a peak eosinophil count [PEC] ≤6 eosinophils per high power field [HPF] or ≤1 eos/HPF was 4.3% [95% CI: 2.6%-6.2%] (I2=23.6%) and 1.3% [95% CI: 0.5%-2.5%] (I2=0%), respectively. The mean difference in the EoE Endoscopic Reference score to placebo was -0.56 [95% CI: -0.91, -0.21].

Conclusions

Over 1/3 of patients in EoE trials clinically respond to placebo and this is associated with trial design factors such as randomization ratio and trial population. Objective endoscopic and histologic measures are associated with lower placebo responses. These findings highlight the need to re-evaluate clinical trial endpoint configurations in EoE

Table 1. Pooled proportion of placebo patients achieving response

Abbreviations: CI confidence interval; eos eosinophils; hpf high power field

Figure 3. Association between mean age of trial participants (A) and probability of receiving placebo (B) with proportion of clinical responders to placebo

Funding Agencies

None
A132 PREDICTIVE VALUE OF ENDOSCOPIC EVALUATION IN EOSINOPHILIC ESOPHAGITIS
Authors: Stukalin I , Kota M , Gonsalves N , Gupta M , Ma C
Published: February 2025

Background

Clinical trials for eosinophilic esophagitis (EoE) currently use the peak eosinophil count (PEC) and patient-reported outcomes as coprimary endpoints for determining therapeutic efficacy. Although the PEC reflects histological activity in EoE, it has not been consistently correlated with symptoms nor endoscopic appearance and the prognostic value of endoscopy relative to the PEC is unclear.

Aims

We evaluated the Endoscopic Reference Score for EoE (EREFS) as a predictor of clinically relevant endpoints.

Methods

We evaluated a retrospective prevalent cohort of adults (>18) with EoE undergoing upper endoscopy between 2010 and 2023 from two tertiary care institutions. The EREFS total score, individual components, inflammatory and fibrostenotic subscores were assessed. The primary endpoint was a composite outcome of food bolus impaction (FBI), requirement for esophageal dilation, and hospitalization for EoE within 12 months of the baseline endoscopy. Logistic regression was used to assess the association between EREFS and the composite endpoint.

Results

A total of 350 patients were included (225 [64.3%] male, mean age at presentation 35.0 years [SD 13.6], 299 [85.4%] presenting with predominantly dysphagia). Mean EREFS at baseline was 4.3 (SD 1.8), with a mean inflammatory subscore of 2.3 (SD 1.3) and fibrostenotic subscore of 2.0 (SD 1.0). Most patients had a baseline stricture (269/350, 76.9%) and 135 (38.6%) underwent dilation at baseline to a mean diameter of 14.3 mm (SD 2.4). The mean baseline PEC was 44.3 eos/HPF (SD 35.1). Baseline EREFS was significantly associated with the composite primary outcome (OR 1.32 [95% CI: 1.16, 1.50], p<0.001) whereas the PEC was not associated (OR 1.03 [95% CI: 0.97, 1.10], p=0.30 for each 10 eos/HPF increase). The baseline fibrostenotic EREFS (OR 2.04 [95% CI: 1.58, 2.64], p<0.001) and presence of stricture (OR 6.12 [95% CI: 3.28, 11.43], p<0.001) were significantly associated with the composite primary endpoint, even when patients with baseline dilation were excluded.

Conclusions

The fibrostenotic EREFS subscore is significantly associated with the requirement for future dilation and food bolus impaction, with prognostic value beyond that of the PEC alone.

Funding Agencies

None
A134 TRANSITION FROM PEDIATRIC TO ADULT CARE WITH EOSINOPHILIC ESOPHAGITIS: A PATIENT EXPERIENCE SURVEY
Authors: Hoang T T , Avinashi V , Ko H
Published: February 2025

Background

Healthcare transition for pediatric patients with chronic gastrointestinal diseases is a coordinated process that requires multidisciplinary collaboration to improve an otherwise challenging time for patients and their families. While this process has been explored in other areas such as inflammatory bowel disease, the transition experience has not been well characterized in eosinophilic esophagitis (EoE).

Aims

To better understand and characterize the experiences and attitudes of patients transition from pediatric to adult care with EoE in British Columbia.

Methods

We conducted an online, anonymous, self-administered, 10–15-minute survey of adult patients who had recently transitioned to adult care. EoE patients age ≥ 19 who were discharged from the EoE clinic at BC Children’s Hospital within the past three years and referred to adult gastroenterology at the Digestive Disease’s Centre in Vancouver, British Columbia were invited to participate. The survey included demographics and questions assessing patients’ pre-transition readiness based on a modified Transition Readiness Assessment Questionnaire (TRAQ), and post-transition challenges via a 5-point Likert scale. Free text entries were included to allow for qualitative thematic analysis of patients’ responses.

Results

Of the twenty patients identified who met inclusion criteria, eleven (55%) completed the survey. Only four (36.3%) patients at the time of transition felt prepared to graduate into adult care. While six (54.5%) reported feeling satisfied with the transition process, four (36.3%) felt that the process was more challenging than expected. Seven (63.6%) patients felt that communication between their pediatric and adult physicians was inadequate. Moreover, four (36.3%) patients felt they lost access to non-gastroenterology specialists such as allergists and pediatricians, as well as allied health care members after transition into adult care. Thematic analysis of patients’ free-text responses revealed that disjointed communication between healthcare teams, new therapeutic relationships, and loss of access to medical experts were three concerning themes for transitioning patients. Ten (90.9%) patients agreed a joint clinic between pediatric and adult gastroenterology would have improved their transition experience.

Conclusions

These preliminary data from our ongoing study highlight the challenges associated with EoE pediatric-to-adult transition. Given the identified unifying themes of inadequate communication between care providers, a joint transition EoE clinic between pediatric and adult physicians would be a potential solution to significantly streamline this process.

Figure 1: Patient attitudes regarding (A) pretransition readiness using a modified Transition Readiness Assessment Questionnaire (TRAQ) and (B) post-transition experience.

Funding Agencies

None
A137 A CANADIAN PILOT STUDY: UNSEDATED TRANS-NASAL ENDOSCOPY AND BIOPSIES IN ADOLESCENTS WITH EOSINOPHILIC ESOPHAGITIS WITH VIRTUAL REALITY DISTRACTION
Authors: Avinashi V , Greeley B , Greaney E , Bush J , Jacob J
Published: February 2025

Background

Esoinophilic Esophagitis (EoE) is a chronic condition that requires endoscopy and biopsies for diagnosis and treatment evaluation. In pediatrics, anaesthesiology OR based sedation is standard practice, but it is resource intense, requires full fasting, and involves some risk. Trans-Nasal Endoscopy (TNE) with virtual reality (VR) distraction has successfully been used and evaluated at multiple Children’s Hospitals in the US. It uses thin endoscopes to obtain esophageal biopsies. This service is not available in Canada.

Aims

Demonstrate that unsedated TNE:

- can be done safely in adolescents with EoE

- can be done reasonably comfortably

- tissue samples are adequate for histopathologic evaluation

Methods

A pilot was launched spring 2024 at BC Children’s Hospital offering TNE with VR for EoE patients.

All TNE procedures were evaluated for any complications. Comfort / tolerability, was described using patient surveys including self-reported pain (Faces Pain Scale), worst pain during the procedure; anxiety (Visual Analogue Scale), VR and overall satisfaction from patients, caregivers, and staff. Heart rate was measured throughout. Biopsy samples were reviewed by a pathologist regarding size and quality.

Results

7 teenage males have undergone and completed TNE, without complication. Mean procedure time was 9.6 minutes.

TNE resulted in some pain, which returned to baseline levels (Table 1). Patients’ (range = 5-6), caregivers’ (range = 6-7), and staffs’ (range = 6-7) scores demonstrated satisfaction with the overall procedure. All involved were very likely to recommend VR for the same procedure (range 9-10). All patients reported that they would do TNE with VR again.

Mean HR was elevated from baseline (68 BPM) compared to when the scope was inserted (78 BPM) and stayed elevated (74 BPM).

Mean # of biopsies obtained was 5.7. Average biopsy size in TNE was 0.16 cm (range: 0.1-0.4) compared to the patients’ historical EoE procedures of 0.22 cm (range: 0.1-0.6). One pathologist noted that orientation in one TNE sample was poor, due to small size. Pathologists felt the need to ink the tissues to ensure embedding. No samples were lost. All pathologists found TNE samples were sufficient for evaluation with eosinophil counts reported.

Conclusions

Unsedated TNE with VR distraction at this early junction seems to be safe, reasonably well tolerated, and able to provide adequate specimens. Further research is needed to understand its feasibility in a more diverse sample.

Funding Agencies

Health Innovation Pathway Program: Minstry of Health BC; Equipment by Amacon(R)
A138 EVALUATING THE ACCEPTABILITY AND EFFICACY OF CYTOSPONGE FOR BARRETT’S ESOPHAGUS: A SINGLE CENTRE CROSS-SECTIONAL STUDY
Authors: AlQattan A , Ten-Pow M , T’ien L , Choi M , Chan B , Galorport C , Enns R
Published: February 2025

Background

Barrett’s Esophagus (BE) is a pre-malignant condition defined by the presence of metaplastic columnar epithelial cells above the gastroesophageal junction. Once metaplasia is present, there is a 0.5% annual risk of progression to dysplasia and ultimately adenocarcinoma. Cytosponge is a new device and technique to diagnose BE. Furthermore, this test has a strong safety profile. Research showed increased patient tolerance for the Cytosponge compared to endoscopy; however, this has not been demonstrated in a Canadian setting. Ideally, patient acceptability of Cytosponge device should be evaluated before its integration in a Canadian context.

Aims

To assess patient acceptability, tolerability and integration of Cytosponge in the diagnosis of Barrett’s Esophagus in a Canadian healthcare setting. We also assessed the ease of use and familiarity with Cytosponge.

Methods

A single-centre, prospective cross-sectional study was conducted to evaluate the acceptability and comfort of patients undergoing Cytosponge procedure. Outpatients referred for EGD for Barrett’s Esophagus at St. Paul’s Hospital between 03/21-08/24 were included. 74 patients with BE have been enrolled in this project. Acceptability was evaluated through Visual Analogue Scale (VAS), Spielberger State Trait Anxiety Inventory (STAI), and Impact of Events Scale (IOES) on the day of procedure, day 7, and day 90 post-procedure. Data from health care providers administering the Cytosponge were collected using the System Usability Scale (SUS). One-way ANOVA and Tukey’s Honestly Significant Difference tests were completed to assess score differences between follow-ups.

Results

A total of 74 patients met the inclusion criteria and consented. 89.2% were successful in swallowing Cytosponge, 10.8% were unsuccessful. ANOVA test were statistically significant in VAS scores between day 0 and day 7, day 0 and day 90 with a p-value 0.006 and 0.00005 respectively. Average STAI scores pre- and post-Cytosponge were 41.7 (SD 3.1) and 40.7 (SD 4.4), ANOVA analysis of STAI scores between groups showed no statistical significance. The average IOES score at day 0 was 1.7 (SD 3.4), day 7 1.1, and day 90 0.7. There was no statistically significant difference in IOES scores at follow-up.

Conclusions

Our results demonstrate that Cytosponge is well tolerated in a Canadian healthcare setting. Average STAI and IOES scores were comparable at follow up. Additionally they were not statistically significant suggesting that patients found Cytosponge an acceptable. A score of 68 and above is above average on SUS which measures usability of Cytosponge. The average SUS score in this sample was 55.2 this suggests that there is a learning curve for healthcare providers to become familiar with Cytosponge. There were no complications with Cytosponge in this sample.

Expanded and retrieved Cytosponge device

Funding Agencies

Gastroenterology Institute of Research Institute
A139 SUBMUCOSAL TUNNELING ENDOSCOPIC RESECTION (STER) FOR ESOPHAGEAL GIST: A CASE REPORT
Authors: DASHTI A , Jiang S X , Winter R , Trasolini R
Published: February 2025

Background

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors found throughout the gastrointestinal tract, with esophageal GISTs being particularly uncommon. Surgical resection is the standard treatment option, though it is associated with significant morbidity. Submucosal Tunneling Endoscopic Resection (STER) is a minimally invasive technique for per-oral subepithelial tumor removal with preservation of the surrounding esophagus and no need for thoracoscopy or mediastinoscopy. Herein, we report a successful case of STER for esophageal GIST in an elderly Canadian patient.

Aims

To present the successful management of an esophageal GIST using submucosal tunneling endoscopic resection.

Methods

Case report and literature review.

Results: Case Report

An 80-year-old man with dysphagia underwent an EUS for a 1.5 cm subepithelial lesion identified in his mid-esophagus on EGD. EUS showed a hypoechoic lesion arising from the muscularis propria. Biopsy confirmed a spindle cell tumor, C-KIT positive consistent with GIST. The patient was offered transthoracic surgical resection but declined given the associated risks and complications. An interval CT scan demonstrated a 4 mm increase in the size of the tumor. The patient was referred for consideration of endoscopic resection. He ultimately underwent submucosal tunneled endoscopic resection of the GIST with no complications. The procedure was performed by creating a mucosal flap over the GIST via submucosal tunnelling with subsequent traction assisted full thickness myotomy surrounding the lesion while preserving the capsule, followed by clip closure of the mucosotomy. Pathology confirmed R0 resection with low mitotic rate. A routine esophagram post-procedure showed no contrast leakage, and the patient was discharged the following day.

Literature Review

STER is a minimally invasive technique for resection of gastrointestinal subepithelial lesions first reported in 2012. It offers several advantages including preservation of GI tract function, rapid recovery time, and low adverse event rate but requires careful lesion selection and technical facility with endoscopic submucosal dissection, myotomy and defect closure. Studies have demonstrated high rates of complete resection with low complication risks, particularly in treating small to medium-sized tumors. To our knowledge, this case represents the first reported use of STER in Canada.

Conclusions: Conclusions

STER is a minimally invasive option for resection of subepithelial lesions. In this case it was used effectively with readily available equipment in a Canadian hospital. It reduces recovery time, preserves esophageal structure, and minimizes complications.

Funding Agencies

None
A141 TREATMENT OPTIONS FOR LYMPHOCYTIC ESOPHAGITIS: A SYSTEMATIC REVIEW OF CASE REPORTS AND CASE SERIES
Authors: Nguyen B A , Jowhari F
Published: February 2025

Background

Lymphocytic esophagitis (LyE) is a novel rare disorder characterized by intraepithelial lymphocytic infiltration of the esophagus in a peripapillary distribution without granulocytes, first described by Rubio et al. in 2006. No systematic reviews or randomized controlled trials have been published to date on the treatment options for LyE.

Aims

To describe the current state of evidence published to date for the treatment of lymphocytic esophagitis.

Methods

We performed a systematic review according to PRISMA guidelines, searching MEDLINE, Embase, Scopus, and Web of Science. Descriptive statistics were performed after extracting data on the study design, patient characteristics, treatment modalities, and outcomes (symptomatic, endoscopic, and histologic). The absence of randomized controlled trials and heterogeneity in outcome measures precluded the ability to perform a formal meta-analysis.

Results

A total of 39 articles (36 case reports, 3 case series) from 2012-2024 were selected for analysis. Proton pump inhibitors (PPIs) were the most common initial therapy used in 73.2% of patients (60/82), followed by topical steroids in 26.8% (22/82). A greater proportion of patients experienced a symptomatic, histologic and endoscopic response from initial use of topical steroids as monotherapy or part of PPI/Steroids combination therapy compared to PPIs alone. Histologic response was highest in the steroid monotherapy group (Table 1). Symptomatic recurrence was more common after initial use of topical steroids (as monotherapy or part of combination therapy) compared to PPIs alone (Table 1) but the samples sizes were very small. Initial endoscopic dilation improved symptoms in 90% (9/10) of patients and 66.7% (4/6) had successful stricture resolution, but 25% of patients experienced symptomatic recurrence. Other therapies for LyE included Vedolizumab, Botox injection, Sucralfate and Tacrolimus. The average follow-up duration was 8.98 months.

Conclusions

For patients with histologically confirmed LyE, both PPIs and topical steroids are viable options for symptomatic relief, with topical steroids showing higher symptomatic and histologic improvement. Balloon dilation may alleviate dysphagia in cases of obvious strictures. Given the limited available data, further research, including randomized controlled trials, is necessary to better define optimal treatment targets (histologic vs. symptomatic outcomes) and to formally compare treatment efficacies.

Table 1: Initial treatment response and symptomatic recurrence

Funding Agencies

None
A142 ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTEROSTOMY: A CASE SERIES AND REVIEW OF LITERATURE
Authors: Shamatutu C , Trasolini R
Published: February 2025

Background

Gastric outlet obstruction (GOO) refers to the clinical syndrome of epigastric pain and postprandial vomiting due to mechanical obstruction in the distal stomach or proximal duodenum. Management is undertaken to alleviate symptoms with the aim of maintaining nutritional status and improving quality of life. Endoscopic gastroduodenal stenting and surgical gastroenterostomy (SGE) are two established methods in the management of GOO. Enteral stenting is associated with stent malfunction such as migration and obstruction often requiring reintervention; SGE is associated with a higher degree of morbidity and mortality compared to endoscopic approaches. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE), with the placement of a lumen-apposing metallic stents (LAMS) from the stomach to the small bowel distal to the obstruction, has emerged as an alternative approach in the management of GOO.

Aims

To describes a case series of patients who underwent EUS-GE and review the relevant literature.

Methods

This was a single-centre retrospective case series of 9 patients with GOO who underwent EUS-GE at Vancouver General Hospital. We looked at technical success, clinical success, and adverse outcomes. Technical success was defined as ability to place a LAMS between the stomach and the small bowel. Clinical success was defined as the patient’s ability to tolerate oral intake.

Results

A total of 9 patients with GOO underwent EUS-GE. The median age was 65. 5 were females (55%) and 4 (45%) were males. GOO was due to malignant tumors or metastases in 8 cases (89%) and in one case was due to afferent limb syndrome after pancreaticoduodenectomy. The technical and clinical success rate was 100%. The stents had a diameter of 15 mm in 7 cases (77%). The stents had a saddle length of 10mm in 7 cases (77%). All cases were performed under general anesthesia. There were no adverse outcomes. The median time to discharge was 8 days. At the time of the study, 5 patients had deceased, with a mean survival of 17 weeks.

We identified two systematic reviews and meta-analyses looking at EUS-GE. The majority of data comes from retrospective studies. They assessed 285 and 260 patients. Technical success was achieved in 92-93.5% of cases, clinical success was achieved in 90% across both studies, adverse outcomes occurred in 12% of cases in both studies.

Conclusions

EUS-GE is an alternative endoscopic approach in the management of GOO with the ability to ameliorate symptoms of GOO and improve quality of life. It is less invasive than SGE and provides a more durable approach compared to endoscopic stenting. We describe a series of patients at VGH who underwent EUS-GE with a technical and clinical success rate similar to that described in the literature. Further randomized studies comparing the different modalities of treatment for GOO are needed.

Funding Agencies

None
A144 EOSINOPHILIC GASTRITIS: A SERIES OF CHILDREN FROM BC CHILDREN’S HOSPITAL USING NASPGHAN/ESPGHAN CRITERIA
Authors: Greaves A , Bush J , Avinashi V
Published: February 2025

Background

Eosinophilic gastritis (EoG) involves eosinophilic infiltration of the stomach, leading to symptoms without identifiable secondary causes. It can occur with Eosinophilic Esophagitis (EoE) or independently (non-EoE EGID). Common symptoms include abdominal pain, vomiting, fatigue, and edema. Recent North American Society of Pediatric Gastroenterology, Hepatology and Nutrition/European Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN/ESPGHAN) criteria (Jan 2024) define EoG as >30 eosinophils per high-power field (hpf).

Aims

This study aimed to identify and review cases of gastric eosinophilia at BC Children’s Hospital over a five-year period, examining clinical details of those meeting the new NASPGHAN/ESPGHAN criteria.

Methods

Pathology reports from August 2019-2024 were reviewed to identify cases meeting EoG criteria. Clinical details, including symptoms, EoE association, food allergies, laboratory findings, and treatments, were analyzed.

Results

A total of 31 cases were identified, with 4 having secondary causes of eosinophilia (ulcers, liver transplant, Crohn’s disease). Of the remaining 27 EGID cases, 8 had both EoE and EoG, while 18 had non-EoE EGID (13 confined to the stomach, 5 involving both the stomach and duodenum).

1. Mean age: 6.3 years (EoE-EGID) vs. 8.7 years (non-EoE EGID)

2. Gender: EoE-EGID showed male predominance (67%), while non-EoE EGID was equally prevalent in males and females (50%).

3. IgE-based food allergies were common in both groups (58% vs. 67%).

4. Iron deficiency anemia was significantly more prevalent in non-EoE EGID (61% vs. 11%) and hypoalbuminemia (39% vs. 11%).

5. Nausea and vomiting were more frequent in EoE (55%), with dysphagia at 44%. Non-EoE cases had these symptoms less frequently (22%).

6. Treatment varied, including steroids, proton pump inhibitors (PPI), and dietary elimination. 80% of EoE-EGID cases were prescribed steroids or diet, compared to 35% and 45% for non-EoE EGID.

Conclusions

Eosinophilic gastritis was found in 27 patients in the past 5 years. Symptoms are quite non-specific and even overlap between EoE and non-EoE EGID cases. While EoG patients are more likely to present with iron deficiency anemia and hypoalbuminemia, these are far from universal. Further research is necessary to better understand the natural history of this condition which can also better guide disease specific treatment.

Funding Agencies

None
A146 THROAT TROUBLES: CASE REPORT OF LYMPHOCYTIC ESOPHAGITIS IN A CHILD WITH DYSPHAGIA.
Authors: Alzahrani I A
Published: February 2025

Background

Lymphocytic esophagitis (LE) is a rare and poorly understood inflammatory condition of the esophagus.it is characterized by presence of lymphocyte within esophageal mucosa. It has unique histologic phenotype characterized by increased intraepithelial lymphocytes in the absence or minimal presence of intraepithelial granulocytes. It is unclear whether LE is a unique primary inflammatory esophageal disease or a marker of an underlying esophageal or systemic immune-mediated disease process. Clinical presentations range from asymptomatic to dysphagia, heartburn, chest pain, nausea, vomiting, strictures, and food bolus impaction. Given the rarity of the disease, the incidence is not well known, with one study reporting incidence of LE 0.1% of total esophageal biopsies based on the results of a large pilot study in the United States of more than 40,000 patients.

Aims

To report on a patient with lymphocytic esophagitis who exhibited chronic dysphagia.

Methods

We describe a 6-year-old male, who has a history of coughing and choking with solid foods, as well as dysphagia. Although he has not experienced food impactions, he occasionally vomits undigested food. He was evaluated previously for eosinophilic esophagitis (EoE), with an unremarkable esophagogastroduodenoscopy (EGD). He was diagnosed with gastroesophageal reflux disease (GERD) in his first weeks of life due to projectile vomiting and arching of the back after feeding. He started on proton pump inhibitors (PPIs) at 7 weeks old, continuing until he was 2 years old, with initial vomiting persisting but gradually improving over time.

Results

He had an upper endoscopy again at 6 years which was unremarkable macroscopically. Pathology showed features of lymphocytic esophagitis in upper/mid/distal esophagus and focal basal spongiosis in mid esophagus, no intra-epithelial eosinophils are detected in all esophageal segments. He was started on proton pump inhibitors (PPIs) with good clinical response and improvement of dysphagia and reflux symptoms.

Conclusions

We present a patient with a history of chronic dysphagia and histological findings of LE. LE is a rare subtype of chronic esophagitis, that can include a wide range of clinical presentations. It should be considered in the differential diagnosis of dysphagia or reflux symptoms. Patients with LE can respond to proton PPI therapy and this should be the first line of therapy. However, steroid therapy should be considered for PPI non-responder LE patients. This case raises the importance of heightened awareness regarding the clinical presentation of LE and emphasizes the need for increased recognition of this condition. Although LE seems to have a chronic but benign course, more research is needed to better understand the pathophysiology and natural history of this condition.

Funding Agencies

None
A149 LYTIC PHAGE REDUCES COLITIS SEVERITY IN MICE COLONIZED WITH IBD-ASSOCIATED E. COLI NRG857C
Authors: Jackson K , Galipeau H , Hann A , Zangara M , Bording-Jorgensen M , Coombes B , Hosseinidoust Z , Verdu E
Published: February 2025

Background

Current therapies for inflammatory bowel disease (IBD) suppress inflammation rather than inhibiting the underlying drivers. Treatment failures can lead to dose escalation and risk of adverse effects. Bacteria with pathogenic potential, like adherent-invasive Escherichia coli (AIEC), have been postulated as one possible microbial driver in Crohn’s disease (CD), however, targeting these bacteria with precision in IBD remains challenging. Most antibiotics have broad-spectrum activity and disturb the background microbiome, which may exacerbate inflammation.

Aims

We aimed to assess whether and how bacteriophage, specific for a CD-associated bacterium, improves colitis severity in gnotobiotic mouse models.

Methods

Adult germ-free C57BL/6 mice were colonized with altered Schaedler-flora (ASF) and E. coli NRG857c (NRG), a CD-associated isolate. After 3 weeks, mice were treated with an NRG-specific lytic phage (1x109 PFU/dose; daily or TIW) or vehicle (PBS) for 2 weeks (n=6/group) and then exposed to 1 cycle of dextran sulfate sodium (2%; DSS) in drinking water. Additional PBS-treated mice (n=6) not exposed to DSS served as controls. Phage treatment was also tested in a spontaneous model of colitis using C57BL/6NTac-Il10em8Tac (IL-10-/-) mice, treated weekly with phage. In both models, mice were monitored daily for weight, stool consistency, and occult blood. Fecal contents were cultured to determine bacterial load, and the expression of NRG fimS was quantified using qPCR as an assessment of bacterial virulence. At endpoint, colon tissues were collected for histological and immunohistochemistry analysis to quantify colitis severity and NRG infiltration, respectively.

Results

In ASF and NRG colonized mice, phage treatment reduced clinical symptoms (p< 0.001, p<0.001) and histological scores (p< 0.0001, p< 0.001) of chemical and spontaneous colitis respectively. A1-log reduction in NRG bacterial load was observed in phage-treated mice (p< 0.001), and reisolated NRG exhibited a reduced FimS ON/OFF ratio (p-value < 0.01). Immunohistochemistry revealed reduced infiltration of NRG into the lamina propria following phage treatment, with greater accumulation in the epithelium.

Conclusions

Our results demonstrate that lytic phage targeting a CD-associated bacterium attenuates colitis in two gnotobiotic mouse models. Whereas this model did not lead to complete eradication of the disease-driving agent, phage treatment was associated with a reduction in a known AIEC virulence factor, attenuating colitis severity. The data suggest alternative mechanisms should be considered when translating phage therapy to treat IBD in clinical trials.

Funding Agencies

CIHRFarncombe Innovation Fund
A150 THE PARKINSON’S DISEASE-ASSOCIATED MUTATION LRRK2 G2019S INCITES NEUTROPHILIC INFLAMMATION AND INCREASED TISSUE DAMAGE IN A MOUSE MODEL OF INFECTIOUS COLITIS.
Authors: Oliveira N L , Pei J , Recinto S J , Kazanova A , Queiroz-Junior C , Li Z , Ribeiro C T , Milnerwood A J , Desjardins M , Thanabalasuriar A , Stratton J A , Gruenheid S
Published: February 2025

Background

The gut-brain axis is an area of intense interest in Parkinson’s disease (PD) research. PD is characterized by inflammation and gastrointestinal (GI) dysfunction, such as recurrent constipation, dysphagia, and intestinal bacterial overgrowth. GI symptoms in PD appear decades before motor symptoms. Mutations in the protein leucine-rich repeat kinase 2 (LRRK2) are associated with increased risk for PD and inflammatory bowel disease. Among them, the LRRK2 Gly2019Ser is the most common PD-associated mutation. It is unknown whether and how the LRRK2 mutation affects intestinal inflammation susceptibility or pathogenesis of PD.

Aims

To understand how the LRRK2 mutation affects intestinal inflammation susceptibility or pathogenesis of PD.

Methods

LRRK2 knock-in G2019S (GKI) and WT mice were infected with the mouse-specific pathogen Citrobacter rodentium and intestinal immune response was evaluated by single cell RNA sequencing (scRNAseq), flow cytometry, and ELISA.

Results

Results revealed that, at day 7 of infection, GKI mice had increased histopathology in colon after infection, compared to WT mice. The most prominent features were inflammatory infiltrate, edema, erosion, and goblet cells loss, although the control of infection was comparable, since the CFU counts were equal in both infected groups. Multiplex analysis of colon homogenates demonstrated that LRRK2 mutation changed cytokine production in response to the infection, including increase in G-CSF, CCL5, and decrease of IL-6 and CXCL2 levels. Myeloperoxidase ELISA in colon tissue showed a tendency to be higher in GKI mice, after infection, compared to WT mice. Single cell RNA sequencing (scRNAseq) of colonic LP cells demonstrated that after infection, LRRK2 G2019S mutation has a great impact in the number of differentially expressed genes (DEGs) on innate immune cells, such as neutrophils, monocytes, and NK cells. In fact, neutrophil was the only cell type proportionally significant after infection. Their DEGs were mostly upregulated and accounted for cell signalling, inflammatory pathways, myeloid leukocyte migration, and interferon response. In addition, flow cytometry revealed that after C. rodentium infection, GKI mice had increased neutrophil infiltration of colonic lamina propria (LP), compared to WT infected mice. Analysis in CD4 T cells by scRNA sequencing and RT-qPCR showed an increase in IL-17a expression, known for its G-CSF stimulating neutrophil migration effect.

Conclusions

Our results suggest that the LRRK2 GKI mutation promotes neutrophilic pathology in response to intestinal bacterial infection and this could be linked to an increase of IL-17a-mediated immune response.

Funding Agencies

Aligning Science Across Parkinson’s: ASAP - Michael Fox Foundation