bluuebunny/crossref_metadata_2025 huggingface dataset:
A85 PATTERN OF SEMAGLUTIDE PRESCRIPTION IN A REAL-WORLD PATIENT COHORT
Authors: Farahvash A , Lee M , Jain R , Jaakkimainen L
Published: February 2025

Background

The weight-loss effects of semaglutide has been studies in many randomized controlled trials. However, real-world data on its use is limited, particularly in the Canadian healthcare setting.

Aims

This study aims to explore the pattern of semaglutide prescription and associated outcomes in an academic family medicine practice in Canada.

Methods

We conducted a retrospective study of patients at the Sunnybrook Hospital family health team in Toronto, Ontario. Patients aged ≥18 years who were prescribed semaglutide between January 2018 and April 2024 were included. Baseline demographics and follow-up safety and efficacy measures were collected up to 16 months after semaglutide initiation.

Results

Of the 9930 rostered patients, 368 (3.71%) were prescribed semaglutide during the study period. The average age of patients who were prescribed semaglutide was 57.7±14.1 years and 63.3% were female. The average BMI was 36.6±7.84 kg/m2 and 189 patients (51.4%) had diabetes. The indication for semaglutide prescription was weight-loss for 206 patients (56.0%), diabetes for 118 patients (32.1%), and both weight-loss and diabetes for 39 patients (10.6%). We observed that since 2018, there has been a growing number of family physicians prescribing semaglutide compared to endocrinologists. In 2023 and 2024, over 80% of all semaglutide prescribers for our patients were family physicians, and endocrinologists were in the minority. Despite being prescribed semaglutide, 20 patients (5.4%) did not initiate the medication and 66 (17.9%) discontinued it within 16 months. Reasons for discontinuation included gastrointestinal adverse effects (26/66, 39.4%), difficulty in access (30/66, 54.5%), and perceived lack of response (6/66, 9.1%).

Baseline and follow up weights were recorded for 211 patients (57.3%). Mean weight-loss was 7.36%. Mean weight-loss by 16 months was significantly greater in patients without diabetes (8.83% vs. 6.18%, p=0.003) and in females (8.30% vs. 5.90%, p=0.009), although there were more females without diabetes compared to males. The mean HbA1c at follow-up was 6.5±1.1%, which represents a significant reduction of 10.7% from baseline (p <0.001).

Conclusions

Our analysis of a real-world cohort of patients who used semaglutide demonstrated its wight-loss effects, particularly in those without diabetes. Understanding the demographics of patients using semaglutide and its potential effects will help inform future prescription practices.

Funding Agencies

None
A86 DIETARY BIOMARKERS OF ULTRA-PROCESSED FOODS: A NARRATIVE REVIEW
Authors: Armstrong T S , Chappell K , Ajibulu L J , Wong K
Published: February 2025

Background

The rapidly increasing prevalence of ultra-processed foods (UPFs) in global diets necessitates a more comprehensive understanding of this food group’s effects on health and disease. Nutritional biomarkers are critical for developing this understanding, as they provide an objective assessment of the body’s response to UPF intake.

Aims

This study aimed to assemble a comprehensive list of the current clinical biomarkers of ultra-processed foods, then categorize them and evaluate their links to disease states and health.

Methods

This narrative review assessed the findings of eight studies, all of which focused on the biomarkers of ultra-processed foods and were identified via a systematic search of the literature that included stringent criteria. Pertinent information was extracted and summarized from these studies, with a primary focus on the biomarkers identified and an exploration of some of these biomarkers’ connections with disease.

Results

Based on the data extracted from the eight included studies, we categorized ultra-processed food biomarkers into organic acids (including amino acids), lipids/lipid-like molecules, xenobiotic food components (specifically associated with UPFs), and other molecular compounds (dietary oxysterols, nucleotides, proteins, etc). Via correlations between these four categories and diseases, biomarkers of ultra-processed foods were found to be associated with inflammatory mechanisms, as well as a variety of pathologies including intestinal disorders, atherosclerosis, chronic kidney disease, and others.

Conclusions

The usefulness of our review lies in its narrative format and succinct accumulation of information pertinent to ultra-processed food analysis, while also reinforcing the detrimental impacts of this food group on health and nutrition. These findings emphasized the importance of future studies concerning ultra-processed foods and food processing techniques, while providing a succinct summary of the current biomarkers of ultra-processed foods in relevant literature.

Funding Agencies:
A90 ASSESSMENT OF A MULTI-COMPONENT QUALITY IMPROVEMENT INTERVENTION TO IMPROVE DIAGNOSTIC YIELD FROM ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION BIOPSY OF SOLID MASS LESIONS
Authors: Sandha G , Khan S , Mathura P , Puttagunta L , Girgis S , Thiesen A , Zhang J , Nilsson J , Wasilenko S , Zepeda-Gomez S
Published: February 2025

Background

A chart audit to review endoscopic ultrasound (EUS)-fine needle aspiration biopsy (FNAB) of solid mass lesions from 01/2022-12/2022 identified a diagnostic yield of 75%. To improve this, a quality improvement intervention including increasing the number of needle passes to 3/case, improving needle pass documentation in endoscopy reports, reducing the number of individuals making cytology slides, and using formalin as transport medium for cell block preparation instead of saline was developed and trialed for 9 months.

Aims

To assess intervention impact on improving the diagnostic yield of EUS-FNAB of solid mass lesions.

Methods

Three endoscopists were provided targeted education and a chart audit was completed for all patients undergoing EUS-FNAB of solid mass lesions from 01/2024-09/2024. Descriptive statistics were completed. Only a definite diagnosis, as confirmed on histological examination, was considered when calculating the diagnostic yield.

Results

A total of 183 patients (112 M, 71 F), mean age 63±13 years (range 12-88 years), underwent 198 EUS-FNABs by 3 endoscopists (who made cytology slides, ensured transport medium and completed documentation). Pancreatic masses were the most common (122/198, 62%). A 22-gauge FNAB needle was used in 194/198 (98%) cases. A total of 420 needle passes were performed for 191 patient cases (mean 2.2/case) compared with mean of 1.9/case pre-intervention. Documentation improved, 7 cases (3.5%) did not have the number of needle passes specified compared with 51 cases (26%) pre-intervention. Tissue samples were transported in formalin for histology in 197 cases, on cytology slides in 165 cases, and in formalin for cell block preparation in 42 cases, similar to pre-intervention. Overall, a definite diagnosis was achieved in 156/198 cases (79%) compared with 149/200 (75%) in the pre-intervention year. Stratifying for needle passes, a definite diagnosis was achieved in 20/36 (56%), 69/87 (79%), 56/63 (89%), and 5/5 (100%) cases that had 1, 2, 3, and >3 needle passes, respectively. The number of passes was seen to independently impact diagnostic yield regardless of type of solid mass, endoscopist, type/size of needle used, and whether or not tissue was provided for cell block preparation.

Conclusions

Although we did not reach our goal of 3 needle passes per case, documentation and the number of tissue samples transported in formalin improved. The results suggest 3 or more needle passes per case may improve diagnostic yield and attempts should be made to avoid performing single needle pass FNAB.

Funding Agencies

None
A91 OUTCOMES OF PATIENTS WITH PRIOR BIOLOGIC INTOLERANCE ARE BETTER THAN THOSE WITH BIOLOGIC FAILURE IN CLINICAL TRIALS OF INFLAMMATORY BOWEL DISEASE
Authors: Samnani S , Wong E , Hamam H , Dulai P , Marshall J , Jairath V , Reinisch W , Narula N
Published: February 2025

Background

Inflammatory bowel disease (IBD) trials often stratify patients by prior biologic exposure, including prior biologic failure or intolerance.

Aims

This study aimed to assess clinical outcomes in IBD patients with prior biologic failure versus intolerance treated with ustekinumab or vedolizumab.

Methods

A post-hoc analysis of ulcerative colitis (UC) and Crohn’s disease (CD) clinical trials for ustekinumab (UNITI, UNIFI) and vedolizumab (GEMINI-1, GEMINI-2) was performed. Clinical response, clinical remission, and endoscopic improvement (for UC) were compared among biologic naïve, biologic-failure, and biologic intolerant patients. Statistical analyses, including chi-square tests and logistic regression, were performed.

Results

1178 UC and 1439 CD patients received either ustekinumab or vedolizumab. In UC, biologic intolerant patients exhibited higher clinical response (54.7% vs. 38.8%, aOR 1.87 [95% CI 0.93-3.73]), clinical remission (25.0% vs. 11.0%, aOR 2.84 [95% CI 1.47-5.49]), and endoscopic improvement (40.6% vs. 24.8%, aOR 2.76 [95% CI 1.28-5.94]) compared to biologic failure, with outcomes similar to biologic naïve patients. In biologic-intolerant CD patients, clinical response was similar between prior biologic failure and intolerance (34.2% vs 32.8%), but after adjustment for potential confounders, biologic intolerance was associated with higher odds of clinical response (aOR: 1.67, 95% CI 1.09-2.55), with no significant difference observed for clinical remission (aOR: 1.48, 95% CI 0.88-2.49).

Conclusions

Improved treatment outcomes were generally observed in patients with biologic intolerance compared to failure, especially in UC, where outcomes were similar to biologic naïve patients. Future clinical trials should meticulously differentiate prior biologic failure versus intolerance to mitigate potential bias.

Funding Agencies

None
A93 A RETROSPECTIVE REVIEW OF FECAL DIVERSION SYSTEM USE IN A TERTIARY CARE INTENSIVE CARE UNIT
Authors: Monod A , Lin Z , Rostom A
Published: February 2025

Background

Fecal diversion systems (FDS) are frequently deployed in intensive care units (ICUs), although recommendations for their use are heterogeneous. Complications can include pain, bleeding, perforation, infection and death. Risk assessment prior to FDS use may reduce the incidence of complications.

Aims

We analyzed FDS usage in ICUs at The Ottawa Hospital (TOH), to determine complication rates and identify patients who may be at greatest risk.

Methods

We performed a retrospective chart review of FDS deployments in TOH ICUs, from July 2021-July 2023. Continuous variables were analyzed for mean and standard deviation, and significance was determined using unpaired t-tests. Categorical variables were recorded as counts and percentages, and significance determined using chi-squared tests.

Results

263 patients were included. 156 (59.3%) were male, and the mean age was 59.7. The most common admission diagnoses were sepsis (10.3%), COVID (7.6%), and respiratory failure (7.3%). The mean FDS duration was 11.6 days. FDS were most frequently deployed for diarrhea (85.0%), and perineal wounds (9.3%). Further patient characteristics are summarized in Table 1. 25(9.5%) patients developed new clinical bleeding after FDS placement, after a mean of 10.4 days. Post-FDS bleeding was associated with admissions for bowel ischemia (p<0.01) or a prior episode of GI bleeding (p=0.02). 9(36.0%) patients with post-FDS bleeding were on anticoagulants or antiplatelet agents, compared to 99(41.6%) patients without (p=0.59). 17(68.0%) patients with post-FDS bleeding underwent endoscopy; 9(52.9%) had rectal ulcers and 3(17.6%) had rectal ischemia. The mean number of endoscopic procedures to achieve hemostasis was 1.9. The mean length of ICU stay among patients with post-FDS bleeding was 25 days, compared to 16.8 days for those without (p=0.25). 1 patient required surgery for bleeding, 1 sustained a perforation, and 5 required FDS discontinuation due to pain. 3 patients (1.1%) died after post-FDS bleeding.

Conclusions

In our cohort, post-FDS bleeding was seen in a substantial proportion of patients. Post-FDS bleeding was more likely in patients admitted to ICU for prior GI bleeding and ischemic colitis. Post-FDS bleeding resulted in longer ICU stays, though the difference was not statistically significant. Complications from FDS are difficult to predict, and FDS usage in ICUs should be minimized.

Characteristics of patients with and without post-FDS bleeding

Funding Agencies:
A96 WHICH IS THE BEST ENDOSCOPIC HEMOSTATIC THERAPY FOR DIEULAFOY’S LESIONS? A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Samnani S , Yuan Y , Leontiadis G , Barkun A , Laine L , Tse F
Published: February 2025

Background

Dieulafoy’s lesion (DL) is an uncommon but serious cause of significant gastrointestinal bleeding, typically treated with various endoscopic therapies.

Aims

This systematic review and meta-analysis is the first to evaluate the effectiveness and safety of endoscopic hemostatic therapies for treating DL, including endoscopic band ligation (EBL), endoscopic hemoclip placement (EHP), over-the-scope clips (OTSC), thermocoagulation, topical hemostatic agents (THA) and injection methods (epinephrine, sclerosant).

Methods

We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials up to March 2024, including randomized controlled trials (RCTs) and observational cohort studies comparing different endoscopic techniques for DL. Two authors conducted study selection, data extraction and quality assessment independently. The primary outcome was 7-day further bleeding. Further bleeding is a composite outcome of failure to achieve immediate hemostasis and rebleeding. Secondary outcomes included failure to achieve immediate hemostasis, rebleeding, overall mortality, adverse events, and additional hemostatic therapy. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using RevMan 5.4. Heterogeneity was assessed by Chi2 (P<0.15) and I2 tests (>25%). The GRADE approach was used to assess the certainty of evidence (CoE).

Results

We included 7 RCTs, 4 comparative cohort studies, and 27 single-arm cohort studies from 5501 citations. Meta-analyses of EBL compared to EHP showed RRs for 7-day further bleeding in RCTs and cohort studies of 0.66, 95%CI 0.09-5.03 and RR 0.22, 95% CI0.05-0.95, respectively (very low CoE). Additionally, RR for EBL compared to thermocoagulation for 7-day further bleeding in a cohort study was 0.15, 95%CI 0.01- 2.71 (very low CoE). RRs for epinephrine injection alone compared to EBL/EHP and thermocoagulation were 4.37, 95%CI 1.43-13.33 and 10.08, 95%CI 0.63-162.0, respectively (very low CoE). Table 1 shows the results of the standard meta-analyses and proportional meta-analyses.

Conclusions

Epinephrine should not be used as monotherapy for the treatment of DL. Mechanical endoscopic therapies, especially EBL, appear to be an effective option for DL. Further research is needed to assess the roles of OTSC and THA in managing DL and obtain more precise estimates of the effectiveness of EBL, EHP, and thermocoagulation.

Table: Outcomes in patients with DL treated with different endoscopic interventions.

Funding Agencies

None
A97 PHYSICIAN AND PATIENT PERCEPTIONS REGARDING LOW DOSE ASPIRIN FOR THE PREVENTION OF PREECLAMPSIA IN PREGNANT PEOPLE WITH INFLAMMATORY BOWEL DISEASE
Authors: Hothi H , Jogendran R , Hanna Y , Srikanth V , O’Connor K , Tandon P , Huang V
Published: February 2025

Background

Preeclampsia, characterized as high blood pressure and end organ dysfunction in pregnancy, is the second leading cause of maternal mortality worldwide. Patients with inflammatory bowel disease (IBD) are at increased risk of developing severe preeclampsia. While there is emerging evidence that prevention with low dose aspirin (LDA) is safe in pregnant patients with IBD, patient and physician perceptions of LDA use remain unclear.

Aims

To examine Canadian patient and physician perceptions on LDA use for the prevention of preeclampsia in pregnant people with IBD.

Methods

This is a cross-sectional study with a survey for patients with IBD and a second survey for Canadian healthcare providers (HCPs). We collected demographic information and Likert scale answers on perceptions of LDA use including perceived side effects, utility, and optimal prescribing practices. Bivariate assessments were performed using Chi-square analysis and Fischer’s Exact Test.

Results

125 patients and 46 HCPs responded. Patient median age was 35 and 60.8% were diagnosed with Crohn’s disease, 40% with Ulcerative Colitis, and 2.4% with indeterminate disease. 73.15% of patients did not consider Aspirin to pose significant risks such as increased gastrointestinal side effects, IBD flares, or fetal harm. 64.8% of patients agreed with being comfortable taking aspirin if prescribed for preeclampsia risk. There was no association between age, education level, income, or ethnicity and perceived comfort (all p > 0.05). Among HCPs, 43% were gastroenterologists, 30% obstetricians, and 27% other (General Practitioners, General Internists, Nurse Practitioner, Rheumatologist, Midwife, Gynecologist). Respondents (38.0%) most commonly recommended that obstetricians should prescribe LDA. For dosages, 51% of HCPs indicated 162 mg daily and 16.3% indicated 81 mg daily should be prescribed if indicated, while 18.4% reported not knowing. There was no association between years in practice, setting (academic versus community),or volume of IBD or pregnant patients seen in clinic (i.e., scope of practice), with HCP reported comfort levels in managing pregnancy related care in IBD (all p > 0.05). Scope of practice was also not associated with HCP perception that pregnant patients with IBD would develop pre-eclampsia or have worse outcomes than those without IBD.

Conclusions

Although IBD patient and HCP perceptions vary, LDA use is generally accepted for pre-eclampsia prophylaxis in pregnant patients with IBD. Future research should focus on targeted educational approaches to increase awareness and uptake of LDA therapy.

Funding Agencies

CAG
A98 PATIENT NAVIGATOR PROGRAMS FOR CHRONIC GASTROINTESTINAL DISORDERS: A SCOPING REVIEW
Authors: Souza Lira A P , Osei J , Sanderson R , McIlduff C D , Fowler S , Peña-Sánchez J
Published: February 2025

Background

Individuals living with chronic gastrointestinal disorders (CGIDs), including inflammatory bowel disease (IBD), diverticulitis (DI), gastroesophageal reflux disease (GERD), and undiagnosed gastrointestinal complaints (UGCs), could encounter healthcare barriers, such as delays in diagnosis, frequent hospital visits, complex treatment plans, financial concerns, transportation difficulties, among others. Patient navigator programs (PNPs) have emerged as a potential solution to enhance healthcare access and improve care for chronic diseases, including CGIDs.

Aims

To synthesize available literature on PNPs for CGIDs, describing their focus and impacts.

Methods

A scoping review was completed across seven databases: MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science, Global Health, and Public Health. Qualitative, quantitative, mixed-method studies and abstracts published between 2012 and 2022 were included in this review. Eligibility criteria included publications in English focused on PNPs for CGIDs. Two independent reviewers screened titles, abstracts, and available full texts. The included publications were classified and summarized.

Results

11 publications were included in the review; the majority were from the United States (n=5). There were two publications from Australia, two from Canada, one from Belgium, and one from Chile. There were nine full papers and two conference abstracts. By study design, there were four retrospective cohorts, three cross-sectionals, two case-control, one prospective cohort, and one study protocol for a randomized controlled trial. The 11 publications described 10 PNPs for CGIDs, which were implemented between 2008 and 2022 in urban areas, and all were linked to hospital clinics or tertiary referral centres. Nurses led ten PNPs, and eight programs were for IBD care. The other three programs were for persons with GERD, DI, or UGCs. These publications reported the positive impact of PNPs on multiple healthcare utilization and patient outcomes, including more timely access to appointments and diagnostic tests, decreased hospital admission rates, fewer emergency department visits, high user satisfaction levels, reductions in no-show rates for gastroenterology appointments and direct healthcare costs, and a reduced need for pain medications post-hospital discharge.

Conclusions

This scoping review identified 10 PNPs for CGIDs around the world; the majority of these PNPs were led by nurses and designed for IBD care. PNPs for CGIDs have evidence of multiple benefits for individuals and the healthcare system. Further research could explore the impact on patient outcomes of PNPs for CGIDs living in rural and remote locations, as well as their impact on individuals with CGIDs belonging to equity-deserving groups.

Funding Agencies

None
A99 INCREASING THE NUMBER OF PASSES FOR ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION BIOPSY OF SOLID MASS LESIONS – A QUALITY IMPROVEMENT INITIATIVE TO IMPROVE DIAGNOSTIC YIELD
Authors: Sandha G , Khan S , Mathura P , Puttagunta L , Girgis S , Thiesen A , Zhang J , Nilsson J , Wasilenko S , Zepeda-Gomez S
Published: February 2025

Background

A retrospective chart audit (01/2022-12/2022) of endoscopic ultrasound (EUS)-guided fine needle aspiration biopsy (FNAB) of solid mass lesions revealed a disappointing diagnostic yield of 56% with a single needle pass. To improve this, a quality improvement (QI) intervention where endoscopists (three) were encouraged to perform three needle passes per patient was developed and trialed.

Aims

To assess intervention impact on improving the diagnostic yield of EUS-FNAB of solid mass lesions over a 9-month study period.

Methods

A chart audit was completed quarterly for all patients undergoing EUS-FNAB of solid mass lesions from 01/2024-09/2024. Descriptive statistics were completed. Only a definite diagnosis, as confirmed on histological examination, was considered when calculating the diagnostic yield.

Results

A total of 183 patients (112 M, 71 F), mean age 63±13 years (range 12-88 years), underwent 198 EUS-FNABs by 3 endoscopists over 9 months. A single pass with an FNAB needle was undertaken in 36/198 cases (18%). The diagnostic yield was 20/36 (56%), similar to the pre-intervention year. The solid mass lesions targeted were pancreas (16), lymph nodes (12), subepithelial (3), rectal and retro-peritoneal (2 each), and ampulla (1). One endoscopist performed 25/36 cases (69%) whereas the other two performed 11/36 (31%) and 0/36 cases. Proximity to vasculature and technical difficulty were reasons provided in 11 and 1 case(s), respectively, whereas no reason was documented in 24 cases. There was no difference in these variables between the groups with a definite diagnosis (20/36) vs. those without (16/36). After the first quarter audit, the need to avoid a single needle-pass was reinforced. Figure 1 shows the trend of single vs. 3 or more needle passes for the pre-intervention vs. the post-intervention year. There is a trend towards performing fewer single needle passes (39 pre vs. 36 post) and increasing 3 or more needle passes (25 pre vs. 68 post). This was associated with an improvement in diagnostic yield in the pre (22/39 [56%] vs. 21/25 [84%]) vs. post groups (20/36 [56%] vs. 61/68 [90%]).

Conclusions

Education, regular audit, and continued reinforcement has demonstrated an improvement in the diagnostic yield of EUS-FNAB by increasing the number of needle passes to 3 or more for solid mass lesions.

Funding Agencies

None
A100 ADULT GASTROENTEROLOGIST PERSPECTIVES ON AN EDUCATIONAL PLATFORM TO SUPPORT YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE
Authors: Mohmand Z , Miatello A , Allemang2 B , Tausif A , Lawrence S , Deslandres C ,   C.Education Committee, Wang Y , de Guzman J , Lee K , Barwick M , Benchimol E I , Fu N , Bollegala N
Published: February 2025

Background

Adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) encounter challenges during the transition from pediatric to adult healthcare, where they must manage their care with increasing independence. The Transition Adolescent & Young Adults implementioN (IBD-TrAYN) is a randomized clinical trial (NCT05221281) of a program to address care gaps during this critical period. As part of the intervention arm, we developed an online educational platform with 19 modules to enhance disease knowledge and self-management skills among AYAs.

Aims

This quality improvement project aims to understand the perspectives of adult gastroenterologists (GIs) on the relevance of the module content for AYAs with IBD.

Methods

Adult GIs with experience treating AYAs (18-25y) with IBD in Canada were recruited using purposive and snowball sampling techniques. Three virtual focus groups were conducted to explore perceptions of module applicability and potential gaps in the curriculum. Content analysis was performed on the transcripts for emergent themes by two independent reviewers.

Results

Eleven GIs were recruited, who recognized the educational platform as a valuable tool for addressing critical gaps in care due to limited clinic time, allied health support, and varying patient knowledge and transition readiness levels. Modules identified as high-priority included disease self-management, mental health, and sexual health. Concerns about information overload led to suggestions for combining related topics, such as family planning and sexual health, and integrating features like searchability and interactive elements to make the content more engaging and personalized. Participants recommended the development of education modules to support parallel caregiver role transitions. Participants stressed the importance of a flexible, accessible approach that allows AYAs access to relevant information at their own pace.

Conclusions

Adult GIs endorsed the value of the platform and its relevance in addressing their clinical priorities and the needs of their AYA patients. The perspectives gathered will inform content refinement to prevent information overload and enhance the curriculum, ultimately contributing to enhanced knowledge and transition readiness for AYAs with IBD.

Funding Agencies

CCC
A101 SCALES EVALUATING THE CLEANLINESS AND MUCOSAL VISIBILITY OF THE UPPER GI TRACT: A SCOPING REVIEW
Authors: Tham D , Gimpaya N , Tran W , Ibrahim A , Verma Y , Grover S
Published: February 2025

Background

Esophagogastroduodenoscopy (EGD) requires clear mucosal visualization for detecting lesions in the upper gastrointestinal (UGI) tract. Historically, studies have evaluated UGI cleanliness using non-validated scales. The validation of scoring methods for UGI cleanliness is necessary to be able to document EGD quality in a standardized and reproducible manner. Recently, there have been multiple published studies which describe the development of novel cleanliness scales for EGD, and there is a need to synthesize the currently available data.

Aims

To summarize and compare novel UGI cleanliness scales for EGD.

Methods

A literature search of MEDLINE and Web of Sciences from inception to September 2024 identified randomized and cohort studies that used UGI cleanliness scoring systems. Two reviewers screened abstracts/articles and extracted data. Baseline study characteristics and information about cleanliness scales were extracted. The primary outcome was characteristics and validity evidence for UGI cleanliness scales.

Results

Of 1729 articles screened, 65 were analyzed (Figure 1). 53 studies developed scales for EGD and 11 for capsule endoscopy. 27 articles described novel scales that were not based on prior studies. The primary objectives of these studies were to develop or validate an UGI cleanliness scale (5), evaluate devices (5), or assess intervention efficacies (17). Table 1 summarizes studies that developed a UGI cleanliness scale as a primary aim.

Among the 38 studies which created or utilized UGI cleanliness scales based on other studies, the most highly cited scale (13) was proposed by Kuo et al. in 2002. This 4 point scale (1=optimal visibility, 4=poor visibility) evaluated the gastric antrum, lower body, upper body, and fundus. No validation studies were performed, but scores between multiple endoscopists showed a correlation with each other (r = 0.59-0.78, P < 0.001).

Conclusions

In this review, we have synthesized the current body of literature on UGI scales, highlighting their testing and validity. Future studies should compare the scores from UGI scales with clinical outcomes to determine the utility of standardized scales in improving EGD quality.

Table 1: Summary of studies with UGI cleanliness scale validation/development as the primary outcome.

Funding Agencies

None
A103 GUTLINK SMARTPATH: AN ONLINE TOOL TO IMPROVE PATIENT CARE
Authors: Park G , Stewart M , Jones J , Willett N
Published: February 2025

Background

Lower gastrointestinal (GI) symptoms are common reasons patients present to primary healthcare providers (PHCP). It can be challenging for PHCPs to identify dietary and functional conditions versus serious illnesses that require specialty assessment. Unfortunately, access to GI care in Nova Scotia is limited with patients waiting well beyond published standards.

The Division of Digestive Care and Endoscopy (DDCE) at Dalhousie University has developed a referral management system to prioritize patients. Unfortunately, the lack of standardization in referral requirements creates challenges to implementing a robust and accurate referral management system.

To support the evaluation and management of patients with lower GI symptoms within primary care, we developed an adaptive clinical care pathway (SmartPath), delivered within an online platform, Virtual Hallway (VH). The SmartPath is an evidence-informed clinical support tool facilitating appropriate primary care investigations and management as well as specialist referrals, as required.

Aims

To evaluate the implementation and early effectiveness of the lower GI symptom SmartPath.

Methods

We conducted a cohort study of SmarthPaths initiated with primary care. Descriptive data was extracted from the Virtual Hallway platform, with results of a short survey PHCPs were asked to complete following completion of a SmartPath. To assess the quality of referrals facilited by SmartPath versus traditional referral pathways, a series of 20 consecutive referrals for 3 common lower GI complaints (diarrhea, constipation and rectal bleeding) were selected for comparison. Interim data is presented for Smartpaths initiated between October 2023 and August 2024.

Results

A total of 272 SmartPaths were initiated by 103 unique PCHPs, of which 179 (65.8%) led to a specific action, with the 93 (34.2%) remaining in process within primary care. Of the 37 DDCE referrals, 26 (62.1%) were accepted, 11 (29.7%) were declined or redirected to another service.

60 consecutive traditional lower GI symptoms referrals were analyzed, 27 (45%) of which were declined. 31 (51.7%) did not provide any investigations, 42 (70%) did not provide physical examinations, and 34 (56.7%) did not provide a past medical history.

Survey responses were provided by 57 PHCPs with mean scores (out of 5) of 4.2 for ease of use, 3.9 for overall satisfaction, and 4.2 for likelihood to use again.

Conclusions

An adaptive care pathway is effective for facilitaing investigation and management of common lower GI symptoms within primary care while facilitating access to specialized services, as required. Referrals received through smartpath had a higher acceptance rate.

Funding Agencies

None
A107 EXAMINING FACTORS CONTRIBUTING TO GENDER PAY DIFFERENCES AMONG ONTARIO PHYSICIANS IN PROCEDURAL SUBSPECIALTIES OF INTERNAL MEDICINE, INCLUDING GASTROENTEROLOGY
Authors: Bushra M , Balderrama F , Sibley L , Bollegala N
Published: February 2025

Background

Prior research has shown that gender pay inequity exists among physicians, with little improvement in the last few years. A study examining the physician gender pay gap in Ontario showed that women physicians earned 13.5% less than men daily, even after correcting for factors such as practice characteristics, specialty and rurality.

Aims

We aimed to identify factors contributing to gender-based differential billing among physicians in Ontario, with a specific focus on providers in procedural sub-specialties of internal medicine including gastroenterology.

Methods

We performed a cross-sectional study using data from the Ontario Health Insurance Plan (OHIP) in the 2021 and 2022 fiscal years. OHIP billings were used to estimate differences in gross payments between male and female physicians in procedural subspecialties of internal medicine, including gastroenterology, cardiology and respirology. Physicians who submitted claims to OHIP were included. Pay gaps were calculated annually. Chi-square test was used to calculate differences between categorical variables, and t-test for continuous variables.

Results

A total of 3600 physicians were included in the study sample (1212 [33.7%] women and 2388 [66.3%] men). Male physicians in procedural subspecialties earned an average of $391,734.76 more than female physicians (p<0.001) with male gastroenterologists earning an average of $154,698.86 more (p<0.001). The total number of procedural days was higher for men (49 vs 25; p<0.001), with male gastroenterologists having more endoscopy days as compared to their female counterparts (134 vs 108; p<0.001). Male physicians in procedural subspecialties had higher percentage of days with after-hours billings (8.5 vs 5.4; p< 0.001) and weekend billings (4.2 vs 3.5; p<0.01) compared to female physicians, and were less likely to work part-time (343 men [14%] vs 334 women [28%]; p<0.001).

Conclusions

Our study noted significant differences in gross payments between men and women physicians in procedural specialties of internal medicine including gastroenterology, which may be explained by total hours worked, after-hours work and number of procedural days.

Funding Agencies

None
A109 A SIMPLE METHOD TO CALCULATE ADENOMA DETECTION RATES
Authors: Sadowski D C , Min A , Byun P , Miller T
Published: February 2025

Background

The adenoma detection rate (ADR) is a key indicator of the effectiveness of colonoscopy, which remains the gold standard for colorectal cancer detection. Many centers in Canada are increasingly adopting EPIC as their electronic health record system. However, the ADR calculation tool in the EPIC foundation build is not well-suited for Canadian practices, as it fails to account for colonoscopies performed due to positive fecal immunochemical tests (FIT) and relies on synoptic reporting of polyp histology by pathologists. To address this, we developed a straightforward text-based search strategy to identify adenomas in dictated pathology reports.

Aims

This study aims to compare the accuracy of our new ADR metric against calculations based on manual reviews of pathology reports.

Methods

We analyzed all screening colonoscopies conducted in Alberta from January to August 2024. For cases with specimens submitted for pathology, we examined the reports using a text string search for the terms “adenoma,” “tubular adenoma,” and “tubulovillous or villous adenoma” in the Final Diagnosis section. Reports were excluded if they contained the phrases “no adenoma,” “history of adenoma,” or “serrated adenoma.” Our reference standard was a manual review of pathology reports performed by trained polyp reconciliation nurses.

Results

From January to August 2024, a total of 46,364 screening colonoscopies were conducted, with 45% of the patients being female. Manual record reviews revealed that 56% of cases had at least one adenoma, 20% had at least one sessile serrated lesion, 171 cases included at least one traditional serrated adenoma, and 345 cases of colorectal cancer were detected. Using manual chart review as the reference standard, our text-based ADR metric demonstrated a sensitivity of 81% and a specificity of 70%.

Conclusions

The text search-based ADR metric shows promise in simplifying the calculation of ADR, especially for centers that lack synoptic pathology reporting or the capacity for manual pathology report reviews. Further research is necessary to enhance the accuracy of this metric.

Funding Agencies

None
A110 SUSTAINABILITY IN EVERYDAY GI PRACTICE: QUANTIFYING TRAVEL RELATED CARBON EMISSIONS FOR IN-PERSON APPOINTMENTS AND MODELS FOR REDUCTION THROUGH USE OF TELEHEALTH
Authors: Galts C , Anvari S , Leontiadis G
Published: February 2025

Background

The health care industry alone contributes to approximately 5% of annual carbon emissions and gastroenterology represent a more resource intensive subspecialty so much so that multiple societies have begun initiatives with aims to reduce the environmental impact of gastroenterology practice. After COVID-19 there was a large adoption of telehealth across many disciplines including gastroenterology. This had the benefit of reducing viral transmission but also significantly reduced travel related emissions for routine appointments. Since that time there has been a varied continuation of virtual care.

Aims

We aimed to quantify the average carbon emissions associated with travel to non-endscopic gastroenterology appointments. We also aimed to develop models for emission reductions based on possible changes to practice (e.g. conversion of follow-up appointments to telehealth).

Methods

Over a 2-week period, we conducted a cross-sectional analysis evaluating carbon emissions associated with travel to gastroenterology appointments. The average number of appointments per day was determined and by using postal codes we were able to estimate travel distances for patients. Carbon emissions were based on these travel distances using standard estimates (including average emissions by car, percentage of patients using alternate transportation, non-tail pipe emissions) and we assessed various estimated of emissions related to telehealth. We then used variable practice models to determine the potential emissions reductions.

Results

We assessed 975 appointments, of which 71 were excluded (e.g. insufficient data, non-physician appointments), leaving 904 included appointments of which 75% were follow-up (678) and the remained were new consultations (226). Sixteen different gastroenterologists had an average of 22.7 patients per day. The mean return distance travelled per appointment was 57.3 km which translates to 14.9 kg CO2 per patient visit. An average day at in clinic would then equate to 337.3 kg CO2 per day, equivalent to 146.6 L gasoline or 15.5 trees’ annual carbon capture. By converting only appointments with a return distance over 100 km or follow-up appointments, we found that a 77% emissions reduction could be achieved.

Conclusions

There can be significant emissions savings with conversion of in-person visits to telehealth while still allowing for some visits to be in-person. Given the unique nature of gastroenterology requiring in-person visits for endoscopy, this may serve as one mechanism by which the collective group of Canadian gastroenterologists can substantilally reduce carbon emissions related to their practice.

Impact on carbon emissions from conversion of in-person appointments to telehealth for gastroenterology

Funding Agencies

None
A112 OUTCOMES OF PATIENTS AT INCREASED RISK FOR GASTRIC NEOPLASIA: A RETROSPECTIVE COHORT STUDY
Authors: Koerber D , Roda C , Pang S , Tavakoli P , Ten-Pow M , Walia A , Lam E , Motomura D , Xiong W , Shahidi N
Published: February 2025

Background

Gastric cancer is the third most common cause of cancer-related deaths, with 784,000 deaths annually and a 26% five-year overall survival. In contrast, the five-year survival in Japan exceeds 70%, which is in part attributed to increased awareness and surveillance for patients and increased risk of gastric cancer.

Aims

We aimed to evaluate outcomes of patients at increased risk of gastric cancer in a North American tertiary referral center.

Methods

Between 01/2012 to 07/2024, consecutive patients with gastric atrophy, intestinal metaplasia, and low-grade or high-grade gastric dysplasia were identified using a validated histopathology registry at St. Paul’s Hospital (Vancouver, BC, Canada). Full chart review was then completed, including demographic and outcome variables. Continuous variables were summarised using median (IQR) and categorical variables were summarised as frequencies (%).

Results

Preliminary analysis from 01/2012 to 5/2014 identified 127 patients: 8 (6%) gastric atrophy, 114 (90%) gastric intestinal metaplasia, 5 (4%) low- or high-grade dysplasia. Median patient age was 65 (56-75) years, with 61 (48%) being female. Concomitant Helicobacter pylori was identified in 34 (27%) with 12 (9%) receiving eradication therapy and confirmation of eradication. Follow-up data was available for a median of 5.7 (0.4-10.3) years. Endoscopic surveillance was performed in 38 (30%) patients. Gastric cancer was not identified during surveillance, with 1 (1%) patient developing dysplasia.

Conclusions

Patients at increased risk of gastric cancer represent a significant clinical burden within tertiary gastroenterology centers. Gastric cancer risk commonly goes unrecognized leading to low rates of endoscopic surveillance. Programmatic management may lead to optimized outcomes and resource utilization.

Funding Agencies

None
A113 FACILITATORS FOR EVIDENCE-BASED INTERVENTIONS FOR PSYCHOLOGICAL DISTRESS IN PERSONS LIVING WITH IBS: A ROADMAP FOR HUMAN-CENTERED DESIGN AND IMPLENTATION
Authors: MacDonald M C , Heisler C , Willett N , Rohatinsky N , Farina S , Stewart M , Vallis M , Shepherd T , Currie B , Robar J , Huard T , Neil E , Jones J
Published: February 2025

Background

IBD-related psychological distress (IBD-PD) refers to the emotional impact of IBD and has been associated with increased disease severity, co-morbid mental health disorders (i.e., anxiety and depression), and increased mortality. Ensuring high-quality, patient-centered care for IBD-PD that is proportionate to the level of distress severity will address a key evidence-practice gap in our healthcare system.

Aims

This study aims to identify the facilitators for accessing evidence-based interventions for IBD-PD to inform the design and implementation of patient-centered models for IBD mental health support in the future.

Methods

This was a qualitative research study in which a semi-structured interview script was developed by a multi-disciplinary team guided by the domains of the COM-B Behaviour Change Wheel framework. Participants were asked about facilitators and preferences related to psychological support services throughout their disease course. Using thematic analysis, codes were generated to identify themes using an inductive approach.

Results

Fourteen participants were successfully recruited (n=14). Thematic analyses identified the following major themes: 1) Mental health should be treated as an integrated component of specialty IBD care; 2) Use of self-help strategies alongside existing supports is feasible, acceptable, and accessible; 3) Accessing support for IBD-PD through virtual care is often acceptable; 4) Flexible, multifaceted delivery models for IBD-PD are needed. All participants felt that mental health should be discussed at IBD clinic visits. Preferences for a range of psychological support formats were clear. Half of the participants said that they did not access formal psychological support services. Instead, this group preferred informal support networks or self-help strategies they already had in place. Most participants felt it was important for psychological support persons to also have IBD knowledge, but there were concerns regarding access to these services. Overall, participants felt strongly that a more qualified psychologist, even in the absence of IBD knowledge, was their top priority. No single approach or setting seemed to be acceptable for everyone. This illustrated that offering hybrid formats for IBD care would provide the greatest benefit to patients.

Conclusions

Facilitators to accessing care start with the IBD healthcare provider, but it is important to recognize that other facilitators such as informal support through family and friends can also have an impact on care. Structural health system changes that support the delivery of integrated care still need to occur to improve overall access to multidisciplinary care.

Funding Agencies

None
A114 INTERRATER RELIABILITY BETWEEN ENDOSCOPISTS USING LOW-COST SIMULATED POLYPS
Authors: Almneni A , Lisondra J , Gimpaya N , Zhao A Y , Tham D , Pattni C , Jugnundan S , Brar G S , Gupta S , Sabrie N , Grover S
Published: February 2025

Background

The identification and removal of polyps are essential skills as they remove premalignant lesions found ad hoc during colonoscopy. Simulation training helps with trainee learning curves and help train novices in polyp identification and polypectomy skills acquisition. The cost of simulators, however, limits trainee access to simulation-based training.

Aims

To determine the interrater reliability between endoscopists in identifying the Paris Classification of low-cost simulated polyps.

Methods

Using the Paris classification, novel simulated polyps with various morphologies were developed. 5 endoscopists of varying experience levels (1 expert (>1000 endoscopies), 2 intermediates (500-1000 endoscopies), and 2 novices (<500 endoscopies)) completed a knowledge test. The knowledge test showed images of simulated polyps and the endoscopists identified the Paris classification (Figure 1). The primary outcome measure was the interrater reliability between endoscopists during the knowledge test. A two-way random effects intraclass correlation coefficient (ICC), with absolute agreement between the raters was used to estimate the interrater reliability. Another outcome measure was content validity which was assessed via survey completed by 3 experts and 21 novice endoscopists during a previous simulation course.

Results

The raters correctly identified all 1p polyps. The Average Measures ICC between all 5 raters was 0.961 (95% CI: 0.93-0.98) indicating excellent reliability. One rater correctly identified all 1s polyp and was removed from ICC analysis due to lack of variance. The Average Measures ICC for 1s polyps was 0.524 (95%CI: 0.15-0.76) indicating moderate reliability. All errors were misidentification of 1s for 2a polyps. The survey showed content validity in terms of setup, usefulness in trainee programs, realism, and perceived trainee improvement.

Conclusions

Excellent reliability for 1p polyps suggests its usefulness for training polypectomy. Further work is needed to differentiate 1s polyps from 2a polyps. A limitation to interrater reliability is the use of images instead of videos in the knowledge test. The content validity of the polyps suggests practicality for low-cost training to achieve trainee improvement. Further studies are needed to assess other polyp classifications and correlate endoscopist experience level with ability to identify the simulated polyps.

Knowledge Test Scores of 5 Endoscopists

ICC, intraclass correlation coefficient. (*)excluded from ICC analysis due to lack of variance.

Figure 1. Simulated gel polyps based on Paris classification A-B) 1p, C-D) 1s.

Funding Agencies

None