bluuebunny/crossref_metadata_2025 huggingface dataset:
A75 AUTOMATED FOLLOW-UP USING A PATIENT-GUIDED COMPLICATION TRACKING SYSTEM (PACTS): AN UPDATE ON PROGRESS
Authors: Calman T’ien L , Galorport C , Telford J J , Enns R A
Published: February 2022

Background

In recent years, there has been an increase in automated interventions in medicine. The COVID-19 outbreak has further fueled this rise. In response to the pandemic, Healthcare systems have developed a multitude of technological strategies for case identification and contact tracing. It is in this evolving digital landscape, that a PAtient-guided Complication Tracking System (PACTS) was launched.

PACTS allows clinics to track complications using the Short Message Service (SMS). This program also offers opportunities to augment medical services and support patients having complications.

Before PACTS can be widely implemented in clinics, research needs to be conducted to investigate its potential as a complication tracking software.

Aims

To assess the outcomes of an automated follow-up program implemented at St. Paul’s Hospital in Vancouver, BC.

Methods

A prospective study was designed to contact outpatients one-week post-procedure using PACTS.

This program was delivered in two phases. Stage 1 ran from November 2019-March 2020. During this pilot stage, patients having a colonoscopy or gastroscopy were asked to participate in the study. Stage 2 ran from August 2020-August 2021. For this phase, patients having a colonoscopy, gastroscopy or flexible sigmoidoscopy were automatically enrolled in the study. An independent t-test was completed to assess response rate differences between stages.

SMS responses were recorded and patients having unplanned events were contacted by phone to categorize complications. Adverse events (AE) were defined as side-effects requiring telehealth follow-up or emergency room visitation. Severe adverse events (SAE) were classified as complications requiring admission to hospital (>24 hrs).

Results

SMS prompts were sent to 6975 patients and the overall mean response rate was 89%. The mean response rates from Stages 1 and 2 were 92% and 88% respectively. The independent t-test revealed a statistically significant difference in response rates between phases, two-sample t(174) = 4.56, p = 9.58 x 10–6.

498 (8%) of SMS respondents reported having unplanned events. Of these patients, 372 (75%) were reached by phone and 257 (69%) were confirmed to have had a side effect. 65 of these complications were AEs and of these, 3 cases were SAEs. The most common AEs were abdominal pain (37%), bleeding (35%), nausea and vomiting (14%).

Conclusions

The high response rates achieved during this study provide further evidence for the use of automated follow-up systems in medicine. This study also demonstrates the potential of PACTS as a complication tracking software.

Future research should devise strategies to optimize the collection of complication data using an SMS-based service.

Funding Agencies

None, NRC
A78 “CHALLENGING PERSPECTIVES:” UNDERSTANDING CLINICIANS VIEWS ON MANAGING ALCOHOL USE DISORDER AND CIRRHOSIS
Authors: Johnson E , Ghosh S M , Daniels V J , Wild T C , Tandon P , Hyde A
Published: February 2022

Background

Alcohol use disorder (AUD) is one of the leading etiologies for liver cirrhosis and liver transplantation. Few individuals with AUD receive guideline-based care in the form of screening, brief intervention, referral to treatment, or prescription of anti-relapse pharmacotherapies. We interviewed clinicians across Alberta to assess the current experience and perceived barriers to managing AUD in people who have cirrhosis.

Aims

The aim of this project is to summarize these findings to inform the development of an educational intervention.

Methods

We used a qualitative descriptive approach to explore the experiences of clinicians who provide care for patients with cirrhosis and AUD in Alberta. We conducted semi-structured interviews directed by an interview guide. Interviews were recorded and transcribed verbatim. We used an inductive thematic analysis approach whereby transcripts were coded, with codes grouped into larger categories, then themes.

Results

Sixteen clinicians participated in this study. Many participants acknowledged that they do not use a standardized approach to screening, brief intervention, and referral to treatment. Through thematic analysis we identified three themes surrounding barriers to managing AUD in patients with cirrhosis: (i) Practicing within knowledge constraints, (ii) Navigating limited resources and system challenges, and (iii) Acknowledging the complexity of patients who have cirrhosis and AUD.

Conclusions

This research presents the perspectives of clinicians who manage people who have AUD and cirrhosis. Our results indicate that significant barriers exist that affect how clinicians manage AUD in the context of cirrhosis, including limited knowledge and resources, systemic challenges, and patient complexity. The information gathered in this investigation will be used to develop an accredited educational intervention that will delve deeper into these issues in order to have the greatest impact on clinicians who routinely interface with this patient population.

Funding Agencies

Alberta Innovates Health Solutions
A81 TRANSITION PRACTICES FROM PEDIATRIC TO ADULT CARE OF CHILDREN LIVING WITH CROHN’S DISEASE IN QUEBEC
Authors: Gong R , Kafyeke R , Bah B , Weber A , Morsa M , Deslandres C , Jantchou P
Published: February 2022

Background

Nearly 25% of Crohn’s disease cases are diagnosed during childhood. Among them, several adolescents may have extensive or complex disease implying specific needs during transition to adult care.

Aims

The primary aim was to describe current transition practices from pediatric to adult care in patients diagnosed with Crohn’s disease at CHU Sainte-Justine. The secondary aim was to determine factors that influenced the type of adult health centers (academic vs non-academic) to which patients were referred.

Methods

This single center study included patients diagnosed with Crohn’s disease at CHU Sainte-Justine between 2009 and 2019. Adult centers were separated into five categories: academic centers in Montreal (CHU-Mtl) and outside of Montreal (CHU), non-academic centers in Montreal (CHG-Mtl) and outside of Montreal (CHG), and other centers. The following factors influencing the transfer to an academic center were analyzed in a multivariate logistic regression model: age at diagnosis, gender, disease location, disease activity: relapses, hospitalizations, emergency room (ER) visits, and place of residence.

Results

A total of 366 patients were included: 44% female, median (IQR) age at transfer 18.0 (17.9–18.4). Among them, 169 (48%) were transferred to CHU-Mtl, 144 (39%) to CHG, 22(6%) to CHU, 4 (1%) to CHG-Mtl, 27 (7%) to other centers. There was a significant increase in the annual number of patients referred to CHG and CHU-Mtl across the decade, compared to other centers. Patients transferred to CHU-Mtl had more relapses per year (mean (SD) 0.8 (0.5) versus patients transferred to CHU, CHG and CHG-Mtl, p=0.0348), and 57% (N=97) of patients sent to CHU-Mtl had already visited the ER, as compared to 54%, 40% and 25% for CHU, CHG and CHG-Mtl respectively (p=0.0258). However, gender, age at diagnosis, maintenance treatment, number and duration of hospitalisations, extraintestinal manifestations, perianal inflammation or extensive disease location did not correlate with the type of adult center. Place of residence played a role in the choice of adult center: 56% (N= 95) of patients transferred to CHU-Mtl lived in Montreal (p<0.0001).

Conclusions

Clinical evolution and disease burden have an impact on the type of adult center. Efforts should be put to understand patient factors associated with the transfer to an academic vs non-academic center, for a better utilization of healthcare resources and adequate patient quality of life during transition.

Funding Agencies

NonePrincipal researcher funds
A91 CANADIAN FEMALE FELLOW PERSPECTIVES ON TRAINING IN THE BOYS CLUB: ADVANCED THERAPEUTIC ENDOSCOPY
Authors: Jain A , Barker M , Telford J J
Published: February 2022

Background

Unequal female representation in the field of advanced therapeutic endoscopy (ATE) has been recently highlighted in the United States. Previous attempts to determine the barriers of entry into the career have found reasons including lack of mentorship, patriarchy, inflexible hours/call and exposure to fluoroscopy. There is no current literature describing the landscape of exposure to ATE for trainees in Canada or determining differences in experience based on gender.

Aims

We sought to determine the barriers to pursuing a career in advanced therapeutic endoscopy, specifically focussing on the perspectives of Canadian female gastroenterology fellows.

Methods

A survey was developed and distributed to the gastroenterology fellows enrolled in Royal College accredited programs across Canada via an online survey platform.

Results

Responses were received from gastroenterology fellows at 12 out of the 14 Canadian universities with Royal College accredited programs. The response rate was 46% (n=42, 16 female respondents, 26 male respondents). An equal proportion of male (42%, n=11) and female (38%, n=6) trainees indicated interest in a career in ATE. 38% (n=6) of female trainees felt that they had inadequate mentorship opportunities/role models within ATE, in comparison to 4% (n=1) of males (p=0.004). Furthermore, 19% (n=3) of females felt that this lack of mentorship/role models was a primary deterrent from pursuing ATE as a career, in comparison to 0% of males (p=0.02). There was equal self-perceived competency surrounding ATE knowledge between both genders.

Conclusions

Female gastroenterology fellows in Canada lack mentorship and role models in ATE, which they also indicated as a primary deterrent from pursuing it as a career when compared to their male counterparts. Recognizing and addressing the lack of female leadership and visibility is necessary to improve parity and encourage women to train in the male-dominated field of ATE.

Funding Agencies

None
A94 PERI-PROCEDURAL MANAGEMENT OF PATIENTS RECEIVING A DIRECT ORAL ANTICOAGULANT UNDERGOING A DIGESTIVE ENDOSCOPY
Authors: Barkun A N , Barkun C , Martel M , INVESTIGATORS P
Published: February 2022

Background

The peri-procedural management of patients on a direct oral anticoagulant (DOAC) requiring an elective digestive (GI) endoscopic procedure remains uncertain.

Aims

To investigate the safety of a standardized peri-procedural DOAC management strategy.

Methods

The Perioperative Anticoagulation Use for Surgery Evaluation (PAUSE) cohort study was conducted at 23 clinical centers in North America and Europe. Participants (n=3007) all had atrial fibrillation (AF), were >18 years old, long-term users of Apixaban, Rivaroxaban, or Dabigatran, and scheduled for an elective procedure or surgery; all could adhere to the DOAC interruption protocol. This analysis focuses on the 579 patients undergoing a digestive endoscopic procedure. The DOAC interruption (1–2 days pre-endoscopy) and resumption (1–3 days post-endoscopy) strategy is based on the DOAC molecule, patient renal function, with most GI procedures considered at low-risk for bleeding. Follow-up occurred at 30 days. Outcomes included GI bleeding and thromboembolic events (ischemic stroke, transient ischemic attack, myocardial infarction, systemic embolism, deep vein thrombosis, and pulmonary embolism) and mortality.

Results

Of the 556 patients (72.5 +8.6 yrs; 37.4 % female), 38.9%) were on Apixaban, 36.9% on Rivaroxaban, and 24.3% on Dabigatran; 10.1% were on anti-platelet therapy. The overall CHADS score was 1.7 +1.0. Overall, 525 patients were categorized as having a low risk for bleeding, and 31 were at high-risk. DOAC were stopped 2.0 +0.5 days pre-procedure and restarted 1.9 +1.5 days post-procedure. Overall rates were: all bleeding 4.4% (2.9–6.4), GI bleeding 2.5% (1.4–4.2%), while 0.7% (0.3–1.8%) experienced a thromboembolic event. Additional results are listed in Table 1.

Conclusions

Patients with AF undergoing a standardized DOAC therapy interruption management protocol for elective digestive endoscopy experienced low rates of major bleeding and arterial thromboembolism.

All results reported as % and 95% CI * outcomes were missing for 4 patients that had the procedure

Funding Agencies

None
A101 BLASTIC PLASMACYTOID DENDRITIC CELL NEOPLASM OCCURRING POST-LIVER TRANSPLANT FOR PSC WITH CLINICAL REMISSION OF ULCERATIVE COLITIS AFTER STEM CELL TRANSPLANTATION
Authors: Donaldson M A , Akhtar D , Buttar J , Salh B
Published: February 2022

Background

Primary sclerosing cholangitis (PSC) is a rare autoimmune fibroinflammatory disease that is associated with inflammatory bowel disease (IBD) and can progress to end-stage liver disease (ESLD) requiring liver transplantation (LT). Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a highly aggressive and rare hematologic malignancy (HM) that usually affects elderly males. High-dose chemotherapy followed by allogenic stem cell transplantation (SCT) offers the best chance of long-term remission in BPDCN. While it is well described that there is an increased risk of de-novo cancer development after solid organ transplantation (SOT), these are less commonly HMs. There are currently no documented cases of BPDCN in post-SOT patients in the literature.

Aims

To describe one of the first cases of BPDCN in a patient post-SOT, and subsequent clinical resolution of UC post SCT.

Methods

Case Report

Results

A 19-year-old previously healthy male initially presented with cholangitis and was diagnosed with PSC. Two years after the diagnosis of PSC, he progressed to ESLD and underwent live donor LT in India. He subsequently presented with episodes of bloody diarrhea and a colonoscopy then revealed diffuse mucosal edema, erosions, and spontaneous bleeding, with scattered inflammatory polyps throughout the colon. UC was diagnosed and Infliximab therapy was started. He later presented with a UC flare and Vedolizumab therapy was initiated. A liver biopsy showed recurrent sclerosing cholangitis and ultimately the patient required a second liver transplant. After the second LT he developed weight loss, arthralgias, and progressive splenomegaly following which BPCDN was diagnosed. His Vedolizumab was subsequently stopped. He received induction chemotherapy followed by a single antigen mismatched allogenic SCT. Whilst he had numerous complications associated with his chemotherapy induction, his UC appeared to be in clinical remission. No repeat colonoscopies were completed, however, on follow-up assessments, he denied abdominal pain and reported having formed, non-bloody stools. Unfortunately, he suffered an aggressive relapse of his BPCDN, and he was palliated.

Conclusions

The development of de-novo cancers after LT is common, and patients with PSC are at particularly high risk. PSC-LT patients have also been found to have the highest rate of hematological malignancies post LT; however, these are most commonly post-transplant lymphoproliferative disorder. Additionally, there have been a few reports of complete resolution of IBD after allogenic mismatched SCT. Here we describe one of the first cases of BPCDN post-LT in a PSC-UC patient and display another example of UC clinical remission post allogenic SCT. These findings emphasize that close follow-up of these patients after LT is imperative.

Funding Agencies

None
A103 META-ANALYSIS: NEOPLASIA OF THE POUCH IN PATIENTS WITH ULCERATIVE COLITIS POST ILEAL POUCH-ANAL ANASTOMOSIS
Authors: Alazemi K , Hussain M , Hudson D , Khanna R
Published: February 2022

Background

Ileal anal pouch anastomosis (IPAA) is often used for patients with severe ulcerative colitis that is refractory to medical treatment or for patients with neoplasia/dysplasia to maintain intestinal continuity. Patients with ulcerative colitis have an increased risk of developing dysplasia or colorectal cancer compared to the general population, however the need for pouch surveillance is debated. A meta-analysis was performed to identify the risk and prevalence of pouch related malignancy in patient with ulcerative colitis following IPAA.

Aims

Our aim is to assess of the rate of dysplasia and malignancy post IPAA in patients with ulcerative colitis and also assess what the factors associated with developing malignancy post IPAA

Methods

A search of Embase and Ovid MEDLINE was conducted to identify studies from 2014 to June 2021 that reported the incidence of dysplasia or malignancy following IPAA in patients with ulcerative colitis. Abstracts and conferences were not included in the search. The studies were assessed for relevance and data were extracted independently by two reviewers.

Results

This analysis included 11, 268 patients with variable follow-up. The evidence was graded as low-certainty due to significant heterogeneity and low-quality studies. The pooled prevalence of carcinoma or dysplasia (low or high grade) in pouch or the rectal cuff was 0.4% [95% CI 0.2- 0.7]. However, in patients with prior colectomy for colorectal cancer the odds ratio was 32.20 [95% CI 15.58 - 66.53] for pouch malignancy. Significant heterogeneity and variability of the pooled studies was identified (I2 = 77.5%).

Conclusions

Although the rate of dysplasia or malignancy was 0.4% for all IPAA, the odds ratio for these outcomes in patients with IPAA for prior malignancy was 32.20 [95% CI 15.58 - 66.53]. Further studies are required to validate these findings.

Funding Agencies

None
A115 ACCURACY OF OPTICAL DIAGNOSIS IN ENDOSCOPY AT A TERTIARY ACADEMIC CENTER
Authors: Pattni C , Fecso A , Jugnundan S , Gupta S , Teshima C W , Mosko J
Published: February 2022

Background

Optical diagnosis relies on the ability of the endoscopist to visualize normal and abnormal patterns on the epithelial surface of the gastrointestinal tract. With ongoing technologic advances in image-enhanced and magnifying endoscopy, there has been more attention given to improving our ability to visually evaluate and classify lesions as this can help guide decisions around resection techniques. However, the accuracy of optical diagnosis of epithelial lesions remains under investigated.

Aims

To analyse (1) the presence or absence of descriptive details (size, gross morphology, and classification systems used) of lesions of interest within the endoscopy report and (2) the accuracy of the optical diagnosis, when stated, as compared to the final pathology report.

Methods

This is a single-centre retrospective chart review and quality improvement initiative conducted at St. Michael’s Hospital, Toronto, Ontario. All patients who had polypectomy performed between January 1st, 2019 and December 31st, 2020 for polyp(s) > 10mm in size, were eligible for study inclusion. Patients were excluded if polyps did not meet the size criteria, the polyp was not resected, or absent documentation. Descriptive statistics were conducted.

Results

2100 patients had polypectomies during the study period. 714 patients with 833 polyps >10mm in size were included in the data analysis. Estimated size was reported for 93% of polyps, gross morphology for 68%, and a classification system for 72%. All three description parameters were reported for 52% of polyps. Predicted pathology was recorded in 41% of polyps. When documented, the accuracy of optical diagnosis was 71%.

Conclusions

In our study, the presence of key descriptive details attributed to polyps at the time of polypectomy was lower than expected. In addition, an optical diagnosis was documented in less than half of the time. Finally, the overall accuracy of optical diagnosis was lower than predicted potentially related to the underreporting and underutilization the important predictors of submucosal invasion. Considering that making real-time endoscopic diagnoses has major implications on treatment decisions, it is imperative that we work on these skills to improve patient outcomes (increasing R0 resection rates, decreasing recurrence and avoiding unnecessary surgeries). Through this project, recommendations will be made regarding the implementation of synoptic reporting in addition to guiding future quality improvement initiatives.

Funding Agencies

None
A122 OUTCOMES OF COLD SNARE POLYPECTOMY FOR POLYPS GREATER THAN 20 MM: DATA FROM AN ACADEMIC CENTER
Authors: Johar J , Kohansal A R , Farina D , Gruchy S E , Williams G , Patel S
Published: February 2022

Background

Cold snare polypectomy (CSP) is widely utilized for resection of small polyps (less than 10mm), due to the technique’s favourable safety profile. However, Hot Snare Endoscopic Mucosal Resection (HSEMR) remains the standard of care for large polyps greater than or equal to 20mm. HSEMR carries an increased risk of complications. These include delayed bleeding, perforation, and post-polypectomy syndrome, along with residual or recurrent adenomatous (RRA).

More recently, Cold Snare Endoscopic Mucosal Resection (CSEMR) technique has been used selectively for polyps greater than 20mm. Published studies have demonstrated a significantly lower adverse event rate of complications as compared with HSEMR. RRA utilizing CSP remains a concern, with a recent publication reporting a recurrence of 34.8% on follow-up endoscopy. We present the experience at a single Canadian academic centre with patients undergoing CSEMR for polyps greater than 20mm.

Aims

To demonstrate the efficacy and safety of cold snare endoscopic mucosal resection CSEMR of large (greater than or equal to 20mm) polyps at a single Canadian academic centre.

Methods

We retrospectively reviewed colonoscopies performed by endoscopists employing this technique at our centre from January 2020 to August 2021. 15 total cases were identified for patients with polyps greater than or equal to 20 mm, removed by CSEMR technique.

Results

Patient age ranged from 41 to 76, with a median patient age was 66. There were 10 males and 5 females. There were no adverse events intraoperatively. 15/15 (100%) polyps were successfully resected using CSEMR technique. Polyp size ranged from 2 cm to 7 cm, and there was a median polyp size of 3 cm. 14/15 (93%) polyps were proximal to the splenic flexure, with 1/15 (7%) polyp in the rectum. 6/15 (40%) patients received snare tip soft coagulation to the edges of the polypectomy site. Polyp histology included 7 tubular adenomas, 3 tubulovillous adenomas, 4 sessile serrated polyps, and one hyperplastic polyp. Two patients were on aspirin 81 mg daily, and there were zero patients on any other antiplatelets or anticoagulation. 1/15 patient presented with late bleeding requiring emergent colonoscopy. There were no immediate or delayed perforations or other serious adverse events recorded.

Approximately 50% of patients have had follow-up colonoscopy within 3–6 months of their initial procedure. Follow-up ranged from 12 to 252 days, with a median time to follow up of 171 days. 3/7 (43%) patients had histologic evidence of recurrence at follow-up colonoscopy, all of which were successfully treated endoscopically.

Conclusions

Selective CSEMR is a safe and effective technique, with a low risk of complications. There may be a higher rate of residual polyp at follow-up colonoscopy compared to HSEMR. This data will need further validation with a larger sample size.

Funding Agencies

None
A125 A NOVEL TECHNIQUE COMBINING EUS AND SPYGLASS DS SYSTEM GUIDANCE FOR BOTH THE DIAGNOSIS AND MANAGEMENT OF AFFERENT LIMB SYNDROME
Authors: Almousawi F , Kim B , Mosko J
Published: February 2022

Background

Afferent limb syndrome is obstruction of a biliary-enteric limb following pancreaticoduodenectomy. In the past, treatment was limited to surgery or insertion of a percutaneous transhepatic biliary drainage tube. A more recent approach to treatment is Endoscopic Ultrasound (EUS)-guided gastrojejunostomy using a lumen apposing metal stent (LAMS). It was first described in two single case reports in 2015 and has been growing in its application. We present a case series of 2 patients where afferent limb syndrome was successfully managed with EUS guided gastrojejunostomy using LAMS.

Aims

1-To demonstrate a novel technique for diagnosis and management of afferent limb syndrome.

Methods

Case # 1- 79 year old female post Whipple’s surgery for ampullary carcinoma, presented two years after surgery with significant nausea and vomiting. CT scan showed obstruction of the afferent loop suspicious for local tumor recurrence. Patient underwent EUS-guided gastrojejunostomy with successful insertion of 20 x 10 mm (AXIOS EC, Boston Scientific) stent.

Case # 2-. A 51 year old male with pancreatic CA status post Whipple surgery presented with worsening abdominal pain and nausea. CT scan confirmed afferent limb syndrome. He underwent EUS- guided gastrojejunostomy with successful placement of 10 x 10 mm (AXIOS EC, Boston Scientific).

Results

Case #1: Patient improved dramatically within days and resumed oral diet. Fourteen days later, an upper endoscopy was performed in order to assess the stricture via an anterograde approach. The adult Olympus HQ gastroscope was advanced through the AXIOS stent into the afferent limb to the level of the stenosis where a tight stricture was seen. Multiple biopsies taken and were negative for malignancy. Four weeks later, she continued to tolerate oral diet well with no abdominal pain or discomfort.

Case # 2: Patient continued to do well clinically 12 weeks post operation. Follow-up upper endoscopy was performed to determine the etiology of the obstruction but due to a sharp angulation, the gastroscope could not be advanced through the AXIOS stent. As such, we advanced an adult Olympus 1T gastroscope down to the site of the AXIOS stent and then utilized the Spyglass DS system to advanced deep into the afferent limb to the level of the stricture and took multiple biopsies for diagnostic purposes.

Conclusions

Interventional endoscopic management of afferent limb syndrome has been evolving in the past few years with EUS guided LAMS gastrojejunostomy becoming a well stablished modality. We have demonstrated this technique with subsequent endoscopic anterograde assessment. In one of these cases, this anterograde assessment was performed using the cholangioscope in conjunction with the gastroscope to overcome unfavorable angulated anatomy which to our knowledge has not been described in the literature previously.

Funding Agencies

None
A130 LONGITUDINAL GROWTH OF PREESCHOOLERS WITH EOSINOPHILIC ESOPHAGITIS
Authors: Carrión-Jaramillo E , Vurzinger M , Avinashi V
Published: February 2022

Background

Eosinophilic esophagitis (EoE) is an immune-mediated condition involving eosinophils infiltrating the esophagus. While adults predominantly present with dysphagia, infants and preschoolers can present with vomiting, poor solid food progression, and oral aversion. Growth is a concern at diagnosis as well as in follow-up based on poor intake, prescribed food elimination, and the potential impact of swallowed steroids.

Aims

Assess baseline anthropometric measurements in preescholers with EoE and evaluate their growth parameters in follow up.

Methods

A retrospective chart review of patients with EoE at BC Children’s Hospital from 2007–21. Inclusion criteria were patients diagnosed before 5 years, with > 2 anthropometrics measurements. Variables included weight, height, BMI, and Z-scores (CDC >2 years; WHO <2 years). The change in Z-scores were calculated between the first registered clinical visit after diagnosis and the most recent growth parameters available. Statistical difference between Z-scores for height and BMI was determined with a paired t-test. Differences in growth according to treatment used one way t-test.

Results

There were 44 patients included. Mean age of diagnosis was 3 years, 82% were male. The average follow up time was 4.9 years (0.5–12.2 years). At baseline, 1 patient was severely malnourished (Z<-3) and 1 was moderately malnourished based on BMI (Z<-2). At follow-up there were 2 patients with moderate malnutrition. The change in BMI Z-scores over time was relatively neutral -0.05±1.3SD but there were 3 patients with a decline in Z-score more than 2, a different way to represent malnutrition.

Stunting was more common at baseline with 3 patients having severe stunting (Z<-3), and 5 having moderate stunting (Z<-2). At follow-up 1 patient had severe stunting BMI (Z<-3), and 1 had moderate stunting (Z<-2). The change in height Z-scores was net +0.41±1.21SD.

Last reported treatments included 45.5% on steroids, 18.2% on elimination diet, 11.4% on steroid/diet, 4.5% on PPI, 4.5% on PPI/diet and 15.9% no treatment. There were no significant differences in BMI Z-scores or height Z-scores according to treatment.

Conclusions

Among those diagnosed with EoE at less than 5 years of age, BMI was stable from diagnosis through follow up and reflected the general population. Stunting was observed in as many as 1/5 of patients at diagnosis but did show improvement in follow up. Further analysis would benefit from a larger sample, further treatment details and correlation with esophageal inflammation.

Funding Agencies

None
A140 INTEROBSERVER RELIABILITY OF THE PARIS CLASSIFICATION FOR SUPERFICIAL GASTROINTESTINAL TRACT NEOPLASMS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Gupta S , Seleq S , Gimpaya N , Khan R , Scaffidi M , Grover S
Published: February 2022

Background

The Paris classification is an international classification system that characterizes the morphology of superficial gastrointestinal tract neoplasms. Given its ability to predict the risk of submucosal invasion, this tool plays an important role in the preliminary endoscopic assessment of early gastrointestinal neoplastic lesions. Despite its international prevalence, there are no pooled reliability analyses to assess agreement amongst endoscopists using this classification system.

Aims

To systematically review and meta-analyze the interobserver reliability (IOR) of the Paris classification system.

Methods

We conducted a systematic review and meta-analysis according to the PRISMA recommendations. A comprehensive literature query was conducted on biomedical databases through December 2020. Studies were included if they quantitively evaluated the IOR of the Paris classification with at least 5 endoscopists participating in the study cohort. Two authors independently screened studies and abstracted data using an a priori designed data collection form. We pooled the results of studies which provided IOR with kappa statistics and confidence intervals using DerSimonian and Laird random effects models. Risk of bias was independently assessed by two study authors using the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) tool.

Results

From an initial 1541 studies, 5 were included in the qualitative review and 3 reported data that allowed for a quantitative analysis of the primary outcome, representing a total of 28 endoscopists. All three of these studies were high quality. The IOR for the Paris classification amongst all endoscopists was 0.541 (95% CI, 0.466–0.617). There was no significant improvement (p=0.551) in the IOR of the Paris classification system following an educational training intervention (pre-education pooled kappa, 0.498; 95% CI, 0.429–0.567 compared to post-education pooled kappa, 0.530; 95% CI, 0.451–0.608).

Conclusions

Interobserver reliability of the Paris classification is moderate with no significant improvement following educational intervention.

Funding Agencies

None
A145 EFFICACY AND SAFETY OF UPADACITINIB MAINTENANCE THERAPY IN PATIENTS WITH MODERATELY TO SEVERELY ACTIVE ULCERATIVE COLITIS: RESULTS FROM A RANDOMIZED PHASE 3 STUDY
Authors: Panaccione R , Danese S , Zhouwen W , Pangan A , Hébuterne X , Nakase H , D’Haens G , Panes J , Lindsay J , Higgins P , Loftus E , Sandborn W , Xie W , Sanchez gonzalez Y , Liu J , Weinreich M , Vermeire S
Published: February 2022

Background

Upadacitinib (UPA), an oral selective and reversible JAK inhibitor, demonstrated significantly greater efficacy compared with placebo (PBO) for induction of remission in patients with moderately to severely active ulcerative colitis (UC) in two phase 3 induction trials.

Aims

Evaluate safety and efficacy of 52 weeks of UPA 15 mg QD (UPA15) and 30mg QD (UPA30) compared to placebo in patients achieving clinical response following UPA 45 mg treatment in the induction trials.

Methods

The primary analysis (n=451) evaluated efficacy and safety of UPA15 and UPA30 compared to PBO as maintenance therapy. The primary endpoint was clinical remission via adapted Mayo score at wk 52. Ranked secondary endpoints included endoscopic improvement, maintenance of clinical remission, corticosteroid-free clinical remission, maintenance of endoscopic improvement, endoscopic remission, maintenance of clinical response and Histologic-endoscopic mucosal improvement (HEMI).

Results

Baseline characteristics were similar between all treatment groups. Both UPA15 and UPA30 met the primary endpoint, and all secondary endpoints. Significantly greater percentages of patients receiving UPA15 and UPA30 vs. PBO achieved clinical remission (42.3% and 51.7%, vs. 12.1%), endoscopic improvement (48.7% and 61.6%, vs. 14.5%), maintenance of clinical remission (59.2% and 69.7%, vs. 22.2%), corticosteroid-free clinical remission (57.1% and 68.0%, vs. 22.2%), maintenance of endoscopic improvement (61.6% and 69.5%, vs. 18.9%), endoscopic remission, (24.2% and 25.9%, vs. 5.6%) and HEMI (34.8% and 49.3%, vs. 11.8%) (p<0.001 for all endpoints). UPA15 and UPA30 were both well-tolerated and no new safety signals were observed. Rates for serious adverse events (AEs) and AEs leading to treatment discontinuation were similar between UPA15 and UPA30 groups and lower compared to the PBO group. Most common AEs were nasopharyngitis and creatine phosphokinase elevation among UPA groups and UC exacerbation within the PBO group (30.2%). Herpes zoster was only reported in UPA groups (3.9%-4.1%). Similar rates of malignancy excluding NMSC were seen within all groups (0.7%-1.3%). MACE were only reported among patients receiving PBO (0.7%), while VTE were only found with UPA30 (1.3%).

Conclusions

In patients responding to UPA induction therapy, both UPA15 and UPA30 were safe and effective as maintenance treatment at 52 wk for all primary and secondary endpoints. Patients receiving UPA30 responded approximately 10% better for most endpoints compared to those receiving UPA15. Both doses were well-tolerated, with no new safety signals observed.

Funding Agencies

AbbVie
A147 SIMILAR OUTCOMES IN PATIENTS SWITCHED TO INFLIXIMAB BIOSIMILARS COMPARED TO THOSE REMAINING ON REMICADE IN A BRITISH COLUMBIA INFLAMMATORY BOWEL DISEASE PRACTICE
Authors: Painchaud M , Singh S , Penner R M
Published: February 2022

Background

In 2019 the Canadian province of British Columbia (BC) launched an initiative to switch inflammatory bowel disease (IBD) patients on the infliximab originator, Remicade, to biosimilars Inflectra or Renflexis. Evidence shows that such switches can be made without compromising efficacy or safety of treatment.

Aims

We examined results in a large IBD practice, with the hypothesis that patients required to switch to a biosimilar would have similar remission rates to those who remained on Remicade.

Methods

A total of 113 patients were included in this retrospective chart study. 80 of these were switched to biosimilars and were compared with 33 who remained on Remicade based on availability of private or compassionate coverage. Individual patient timelines were created, the start set as when the mandated switch was discussed. Data was collected retrospectively for 6 months. Outcomes included remission status, occurrence of flares, adverse events, hospitalizations, and necessity of dosage or drug change.

Results

Pre-switch, 49 of the 113 patients were in complete remission on Remicade (43.4%). 27% of the Remicade patients and 28.8% of the biosimilar patients remained in complete remission throughout follow up (p=0.87). Of the patients who began the study in complete remission, similar numbers of patients in the Remicade and biosimilar groups experienced flares (11.1% vs 27.5%; p=0.3); adverse events (33.3% vs 25%; p=0.61) and hospitalizations (0% vs 5.0%; p=0.49) respectively. 6.1% of patients beginning the trial in complete remission required a change in medication after the switch, all of which were in the biosimilar group (0% vs 7.5%; p=0.39). Among all 113 patients in the study, there was a numerical difference between the Remicade group and biosimilar group of patients who required a change in medication to another biologic. While clinically important, this was not statistically significant (0% vs 8.8%; p=0.08). Other clinical outcomes were similar between Remicade and biosimilar patients in the full group of 113 patients.

Conclusions

IBD patients remaining on Remicade or switching to biosimilars demonstrated similar patient outcomes after a 6-month period.

Funding Agencies

None
A149 REAL WORLD OUTCOMES OF NON-MEDICAL SWITCHING OF INFLIXIMAB BIOSIMILAR IN BRITISH COLUMBIA FOR THE TREATMENT OF INFLAMMATORY BOWEL DISEASE (IBD)
Authors: Reid J , Rosenfeld G , Galorport C
Published: February 2022

Background

A mandated non-medical switch to the infliximab biosimilars was launched in British Columbia in 2019. British Columbia was the first province in Canada to mandate the switch from the originator infliximab (RemicadeTM) to one of the 2 approved biosimilars (InflectraTM or RenflexisTM). There is limited data for mandatory non-medical switching in IBD as was undertaken in BC.

Aims

This study aimed to obtain real-world evidence evaluating the clinical outcomes of nonmedical switch from Remicade to the infliximab biosimilars.

Methods

This is a retrospective observational study from the IBD Centre of BC (a tertiary care referral centre in Vancouver, BC). Patients on infliximab at the time of the mandated switch were identified through search of the electronic medical record. The primary outcome was drug continuation at 12 months post switch. Secondary outcomes included flare of disease, adverse events, and number of doctor visits within the first 12 months post switch. A comparison group included patients maintained on originator infliximab.

Results

A total of 235 patients were evaluated; 175 patients in the biosimilar switch group, and 60 patients in the control group. Baseline characteristics of the groups were similar. Discontinuation of infliximab occurred in 22 patients (17 in biosimilar switch group and 5 in the control group. There was no difference in the rate of discontinuation of infliximab between the biosimilar group (9.7%) and the originator molecule group (8.3%); chi squared (1, N=235) = 0.1004, p = .75. The most common reason for discontinuation was flare of disease in 6 patients in the biosimilar group and 4 patients in the control group. An additional 4 patients in the biosimilar group and 3 patients in the control group had a flare of symptoms but were maintained on therapy with an escalation of dosage or course of corticosteroids. Two patients had active disease at the time of switch and discontinued therapy. Adverse events accounted for discontinuation in 5 patients on biosimilar and 1 in the control group. These included joint pain, epigastric symptoms, drug intolerance, drug induced lupus, and drug induced pulmonary nodules in the biosimilar group, and drug induced vasculitis in the control group. Two patients in the biosimilar group discontinued due to antibody formation. Two patients in the biosimilar group discontinued therapy due to preference.

Conclusions

In this small subset of the BC IBD population undergoing a non-medical biosimilar switch of infliximab, there was no difference in the discontinuation rate between the biosimilars or the originator infliximab molecule. These findings are consistent with the existing real-world evidence.

Funding Agencies

None
A150 ASSOCIATION BETWEEN SERUM USTEKINUMAB CONCENTRATIONS AND ENDOSCOPIC DISEASE ACTIVITY IN CROHN’S DISEASE
Authors: Yanofsky R , Abduallah Y , Golovics P , Lakatos P L , Bitton A , Wild G , Afif W , Bessissow T
Published: February 2022

Background

Therapeutic drug monitoring, the measurement of serum biologic concentrations and immunogenicity, has become an important method in guiding the management of biologic therapy in patients with Crohn’s disease (CD). Ustekinumab, an inhibitor of the p40 subunit of interleukins 12 and 23, is an approved therapy for patients with CD. However, few studies have explored the relationship between serum ustekinumab drug levels and outcomes in CD. Thus, the utility of serum ustekinumab drug levels in the management of CD remains unknown.

Aims

The primary objective of the study was to evaluate the association between serum ustekinumab drug levels and endoscopic remission (ER) in CD. Secondary outcomes included evaluating the association between serum ustekinumab drug levels and clinical (CR), biochemical, and histological remission (HR).

Methods

Adult patients with CD maintained on ustekinumab were prospectively recruited at the time of routine colonoscopy from 2018 to 2021 at the Montreal University Health Centre, Montreal, Quebec. Clinical and demographic information was obtained from chart and patient review. CD symptom severity was assessed by the Harvey-Bradshaw Index (HBI), with clinical remission defined as an HBI score less than 5. Blood samples were drawn for measurement of serum ustekinumab drug level and C-reactive protein. Stool samples for fecal calprotectin were also collected. Elevated C-reactive protein and fecal calprotectin were defined as a value greater than 5 mg/L and 200 ug/g, respectively. Endoscopic remission was evaluated by the Simplified Endoscopic Score for Crohn’s Disease (SES-CD), with ER defined by an SES-CD score less than 3. If biopsies were taken, histological outcomes were recorded. HR was defined as inactive colitis.

Results

53 patients were included in the study, of which 22 (41.5%) were in ER. Median [interquartile range] ustekinumab drug levels were not associated with ER (ER = 5.4 mg/L [2.6–9.4 mg/L], no ER = 4.3 mg/L [2.3–9.4 mg/L]; P=0.843). There was also no association between quartiles of ustekinumab drug levels and ER (P=0.772). In addition, there was no association observed between median ustekinumab drug level and CR (CR = 4.7 mg/L [2.7–8.3 mg/L], no CR = 3.8 mg/L [2.1–9.6 mg/L]; P=0.993) or HR (HR = 6.4 mg/L [3.5–9.5 mg/L], no HR = 3.7 mg/L [2.2–8.0 mg/L]); P=0.168). There was no association observed between median ustekinumab drug level and C-reactive protein or fecal calprotectin as well (P=0.158 and 0.923, respectively).

Conclusions

There was no association observed between serum ustekinumab drug levels and endoscopic remission. Further studies are required to validate our findings.

Funding Agencies

None
A151 RISK FACTORS FOR VENOUS THROMBOEMBOLISM AFTER HOSPITAL DISCHARGE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Gozdzik M , Unninayar D , Sarker A , Chin Koon Siw K , McCurdy J
Published: February 2022

Background

Inflammatory bowel disease (IBD) is a chronic inflammatory condition which is independently associated with venous thromboembolism (VTE). Although the absolute risk of VTE is greatest during hospitalization, the risk remains elevated in the early post-discharge period. The risk factors for VTE during this vulnerable period remain unknown.

Aims

We performed a systematic review and meta-analysis to determine risk factors for VTE in the post discharge period among adult patients with IBD.

Methods

We performed a systematic search of Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials from inception through April 29, 2021 for publications that reported risk factors for VTE during the post-discharge period among patients with IBD. Study eligibility was assessed independently in duplicate without age or language restriction. We defined the post-discharge period as within 6 months of discharge. Pooled summary estimates of adjusted hazard/odds ratios, when available, were calculated for individual risk factors using random effects model with 95% confidence intervals. The analysis was performed when a minimum of three studies were available for a given risk factor. Heterogeneity was assessed using I2 statistic. Study quality was assessed using an adapted version of the National Institute of Health criteria.

Results

We identified 10 studies from a total of 4339 abstracts that met our inclusion criteria: 8 population-based studies, 1 multicenter observational study and 1 single center observational study. Risk factors for post-discharge VTE were assessed at 6 weeks in 1 study, 1 month in 5 studies, 3 months in 2 studies, and 6 months in 2 studies. The variables assessed in our meta-analysis are reported in Table 1. Exposure to corticosteroid (odds ratio [OR], 1.77; 95% CI, 1.53–2.06) but not biologics (OR, 1.21; 95% CI 0.80–1.82) was associated with an increased risk of VTE. Furthermore, greater length of stay (OR 1.49; 95% CI, 1.01–2.20), ulcerative colitis (OR 1.41; 95% CI, 1.19–1.66), history of malignancy (OR 1.35; 95% CI, 1.12–1.62), and surgery during admission (OR 1.26; 95% CI, 1.12–1.42) but not female sex (OR 0.98; 95% CI, 0.88–1.10) or surgery type (OR 1.09; 95% CI, 0.75–1.57) were associated with increased risk of VTE after discharge. Overall, the study quality was rated as fair.

Conclusions

In our meta-analysis, which consisted of moderate quality of evidence, we identified multiple risk factors associated with VTE in the post-discharge period. This work will help inform which factors should be considered for developing point of care clinical predictive models to help guide when extended VTE prophylaxis is required.

Funding Agencies

None