bluuebunny/crossref_metadata_2025 huggingface dataset:
A94 PRE-RESECTION OPTICAL EVALUATION RELIABLY DIFFERENTIATES BETWEEN SERRATED AND ADENOMATOUS LARGE NON-PEDUNCULATED COLORECTAL POLYPS
Authors: Jiang S X , Zarrin A , Walia A , Galorport C , Xiong W , Enns R , Lam E , Shahidi N
Published: February 2024

Background

Modality selection between cold snare resection (CSR) and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is largely predicated on the ability to differentiate between serrated and adenomatous histopathology. While optical evaluation has modest accuracy for diminutive polyps, performance has not been evaluated for large non-pedunculated colorectal polyps (LNPCPs).

Aims

To evaluate the performance of pre-resection optical evaluation to differentiate between serrated and adenomatous LNPCPs.

Methods

Consecutive patients ampersand:003E 18 years of age who underwent endoscopic resection for a LNPCP were enrolled in a prospective single center observation cohort study (clinicaltrials.gov ID: NCT05402696). Pre-resection optical evaluation was performed using high-definition white-light and narrow-band imaging (NBI) with or without near-focus. The Japanese NBI Expert Team (JNET) classification was used to differentiate between serrated (JNET I) vs. adenomatous (JNET IIA, IIB) LNPCPs. Traditional serrated adenomas (TSAs) and cancers were excluded from analysis. Sensitivity, specificity, and accuracy were used to evaluate optical evaluation performance.

Results

From 06/2022-09/2023, 266 patients underwent 282 procedures for a total of 335 LNPCPs. Median size was 30mm (IQR 20-40mm). Histopathology identified 215 (64.2%) adenomatous, 91 (27.2%) serrated, 16 (4.8%) cancerous, and 13 (3.9%) other LNPCPs; including 5 TSAs. Of the 91 serrated lesions, 90 (98.9%) were predicted as serrated; sensitivity, specificity, and accuracy were 98.90% (95% CI 94.03-99.97), 99.53% (95% CI 97.44-99.99), 99.35% (95% CI 97.66-99.92), respectively. Of the 215 adenomatous lesions, 213 (99.1%) were predicted as adenomatous; sensitivity, specificity, and accuracy were 99.07% (95% CI 96.68-99.89), 98.90% (95% CI 94.03-99.97), 99.02% (95% CI 97.16-99.80), respectively.

Conclusions

Optical evaluation demonstrates excellent performance characteristics to differentiate between serrated and adenomatous LNPCPs; therefore, empowering endoscopists to reliably apply a selective resection algorithm between CSR, EMR and ESD.

Funding Agencies

None
A96 A QUALITY ASSESSMENT STUDY TO DETERMINE IF TISSUE ACQUISTION AND SPECIMEN HANDLING IMPACT THE DIAGNOSTIC YIELD OF ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION OF SOLID MASS
Authors: Khan S , Mathura P , Puttangunta L , Girgis S , Zhang J , Nilsson J , Wesilenko S
Published: February 2024

Background

Endoscopic ultrasound (EUS)-guided fine needle aspiration biopsy (FNAB) of solid mass lesions has a sensitivity and specificity between 50-100%. Tissue acquisition and specimen handling are factors that may contribute to this variability. At our institution, 3 endoscopists perform EUS. The aspirated material obtained is expressed onto slides for cytology (prepared by a nurse) and solid tissue fragments transferred into formalin. At the discretion of the endoscopist, aspirated material is collected in saline for cell block preparation.

Aims

To assess the impact of tissue collection and specimen handling on diagnostic yield of EUS-FNAB of solid mass lesions.

Methods

A chart audit was completed for all patients undergoing EUS-FNAB of solid mass lesions between January 1, 2022 and December 31, 2022. Descriptive statistics were completed. A definite diagnosis was considered when calculating the diagnostic yield.

Results

A total of 184 patients (100 M, 84 F), mean age 64±13 years (range 14-89 years), underwent 200 EUS-FNABs by 3 endoscopists. Pancreatic masses were the most common indication in 118/200 (59%) cases. A 22-gauge FNAB needle was used in 189/200 (95%) cases. A total of 285 needle passes were performed in 149 cases (mean 1.9/case). In the remaining 51 cases (26%), the number of needle passes was not specified. Tissue samples were transported in formalin in 190 cases, on cytology slides in 170 cases, and in saline for cell block preparation in 41 cases. Overall, a definite diagnosis was achieved in 149/200 cases (75%). Stratifying for needle passes, a definite diagnosis was achieved in 22/39 (56%), 71/85 (84%), 20/24 (83%), and 1/1 (100%) cases that had 1, 2, 3, and 4 needle passes. Of the 51 cases with unspecified needle passes, a definite diagnosis was achieved in 35 cases (69%). The diagnostic yield obtained with saline for cell block was similar to that obtained with formalin and cytology slides (30/41 [73%] vs. 144/190 [76%] and 132/170 [78%]).

Conclusions

Increasing the minimum number of needles passes for tissue acquisition to 3 per case may increase the diagnostic yield of EUS-FNAB. Documenting the number of needles passes in the endoscopy report is an important quality indicator. Cytology slides and tissue in formalin should be considered standard of care but aspirated material should continue to be used for cell block preparation. However, there is some concern that saline as a transport medium may de-vitalize the aspirated material, so it should be replaced with formalin to preserve tissue integrity.

Funding Agencies

None
A99 HIGHER HOSPITAL INPATIENT RACIAL DIVERSITY IS ASSOCIATED WITH BETTER OUTCOMES AMONG HISPANIC AND INDIGENOUS AMERICAN PATIENTS FOR FIVE COMMON GASTROINTESTINAL DIAGNOSES
Authors: Lawendy B , Sedarous M , Babajide O , Adekunle A , Rubens M , Okafor P
Published: February 2024

Background

There is evidence that gastrointestinal disease (GI) outcomes are poorer among patients from underrepresented backgrounds. However, the impact of hospital patient racial diversity on GI outcomes is understudied.

Aims

We aimed to investigate the impact of hospital patient racial diversity on GI outcomes

Methods

Using the 2019 National Inpatient Sample (NIS), racial diversity was defined by the percentage of Hispanic or Indigenous American patients discharged from each hospital. GI discharge diagnoses were defined by diagnostic related group. We included GI bleeding, inflammatory bowel diseases, GI obstruction, cirrhosis, and alcoholic hepatitis. Logistic regression was used to predict major complication rates or comorbidity (MCC), long length of stay (LOS), and high total charges. Control variables included age, gender, payer type, patient location, area-associated income quartile, hospital characteristics including size, urban vs. rural, teaching vs. nonteaching, region, and the interaction of the percentage of Hispanic and Indigenous Americans with patient race. Results were validated with the 2018 NIS dataset.

Results

Our analysis cohort of 537,830 hospitalizations included 252,225 GI bleeding discharges, 59,310 gastrointestinal obstruction discharges, 106,820 cirrhosis and alcoholic hepatitis discharges, and 119,475 inflammatory bowel diseases discharges. In the unadjusted analyses, MCC rates were higher among Hispanic (24.8%) and Indigenous American patients (30.4%), compared to Whites (18.3%). In adjusted analyses, compared to white patients, Hispanic patients had higher MCC rates [adjusted odds ratio (OR) 1.21, 95% Confidence Interval (CI) 1.15-1.28]. The same trend was seen among Indigenous American patients [OR 1.25, (95% CI) 1.09-1.43]. However, as hospital Hispanic diversity increased, inpatient MCC outcomes for Hispanics improved [OR 0.93, (95% CI) 0.87-1.14], and were even better among Indigenous American patients as hospital inpatient Indigenous American diversity increased [OR 0.83, (95% CI) 0.73-0.94] (Table 1). A similar improvement in MCC with increasing Hispanic and Indigenous American diversity was observed in the 2018 validation cohort. Table 1 highlights impact of increasing diversity on LOS and total charges.

Conclusions

Increasing hospital inpatient Hispanic and Indigenous American diversity is associated with better outcomes for these underrepresented minority groups. More research is needed on the impact of cultural competence and linguistic concordance on patient outcomes.

Funding Agencies

None
A100 HEREDITARY HEMORRHAGIC TELANGIECTASIA: MORE THAN JUST ANOTHER RECTAL BLEED
Authors: Leung D , Guo J Y , Zepeda-Gomez S , Wesilenko S , Halloran B , Vethanayagam D
Published: February 2024

Background

Hereditary hemorrhagic telangiectasia (HHT), previously known as Osler-Weber-Rendu syndrome, is an autosomal dominant disorder characterized by widespread telangiectasia and visceral arteriovenous (AV) malformations. Diagnosis of HHT is commonly guided by The Curaçao Diagnostic Criteria. Molecular genetics can help confirm the clinical diagnosis. Genes involved include ENG, ACVRL1, SMAD4, and GDF2, which affect the bone morphogenic protein signaling pathway important in maintaining vascular endothelial integrity.

Aims

This report aims to review the case of a young male from a rural community in Northern Alberta with a possible new diagnosis of HHT, presenting with rectal bleeding in the setting of family history of telangiectasias.

Methods

Retrospective review of one patient.

Results

We report the case of a 33-year-old male who presented with a 1-day history of rectal bleeding (bright red turning to black) with hemoglobin at 116g/L. Past medical history was significant for occasional epistaxis since age 8, previous gastrointestinal bleed and laparotomy with pathology showing small intestinal vascular malformation at the age of 15, and small bowel obstruction secondary to adhesions requiring resection at the age of 26. There was no history of iron deficiency anemia. Family history was positive for a mother who had Von Willebrand disease and partial colectomy at the age of 28 due to bowel telangiectasias. His mother had no formal HHT diagnosis, but it was unclear if molecular genetics had been performed. Inpatient colonoscopy showed no culprit lesions but free-floating blood clots throughout the colon (Image). EGD and push enteroscopy were normal. CT enterography was then performed showing AV fistula in the distal ileum and venous malformations in the jejunum. Video capsule endoscopy followed revealed a few non-bleeding telangiectasia and petechiae. The patient was assessed to have possible HHT by The Curaçao Diagnostic Criteria. He was supplemented with IV iron and started on short-acting octreotide. On discharge, he received funding approval for long-acting octreotide and was referred to the Edmonton HHT clinic for follow up and further screening.

Conclusions

HHT remains underdiagnosed in both children and adults. Maintaining a strong suspicion and prompt diagnosis via the Curaçao Criteria is crucial for appropriate screening of the multisystem complications which stem from the AV malformations. This multidisciplinary approach can aid in reducing morbidity and mortality.

Funding Agencies

None
A106 COLONOSCOPY TEACHING: A SURVEY OF CANADIAN GASTROENTEROLOGY RESIDENTS
Authors: Park G , Komeylian H , Kohansal A , Stewart M
Published: February 2024

Background

With the advancement in equipment and techniques, colonoscopy training continues to evolve. Programs such as the Skills Enhancement for Endoscopy (SEE) curriculum developed by the Canadian Association of Gastroenterology teach techniques such as loop reduction, patient turning, and water immersion aimed at improving adenoma detection, cecal intubation, and patient comfort. While there is vast literature focused on assessing learners’ endoscopic competencies, there is limited data pertaining to the training of specific colonoscopy techniques.

Aims

To assess various colonoscopy techniques used to train gastroenterology residents in Canada.

Methods

A survey of gastroenterology trainees was developed to assess specific aspects of their experience with colonoscopy education. This included questions on the frequency of position changes, use of pediatrics colonoscopes, water immersion, loops reduction, and SEE program initiatives. The survey was advertised at the 2023 Gastroenterology Residents-In-Training Course with a link to the survey e-mailed to all attendees. This survey has been re-distributed to the current gastroenterology resident cohort and therefore this abstract’s results are interim data pending further survey responses.

Results

At the time of survey administration, there were 69 gastroenterology residents registered in Canada. Responses were received from 21(30%) residents; 5 in post graduate year (PGY) 4 and 16 in PGY5. One quarter (24%) of residents reported that colonoscopy teaching methods were uniform amongst faculty members and one third (33%) reported that more than half of their preceptors mentioned SEE program initiatives. Thirty-eight percent of residents reported that more than half of their preceptors suggested position change on insertion when the scope is advancing well on insertion. Majority of residents (90%) reported that water immersion during colonoscope insertion was recommended by most preceptors. Most residents (76%) reported that position change to help with loop reduction was suggested by more than half of their preceptors. Fifty-seven percent of residents reported that more than half of their preceptors commented on type of loop formation and reduction techniques. Once the cecum is reached, a minority of residents (29%) reported that more than half of preceptors recommended position change specifically to improve cecal visualization.

Conclusions

Certain colonoscopy techniques such as turning patients, water immersion, and loop reduction can assist with adenoma detection rates and patient comfort. However, there exists considerable variability in colonoscopy techniques taught to Canadian gastroenterology residents. Increased standardization among colonoscopy technique education may benefit gastroenterology trainees.

Funding Agencies

None
A107 ANALYSIS OF THE EFFICACY IN TRANSITIONING FROM FOBT TO FIT FOR COLORECTAL CANCER SCREENING AT A SINGLE CENTRE IN ONTARIO
Authors: Nguyen A , Porwal G
Published: February 2024

Background

Colonoscopy is the gold standard for detecting colorectal cancer (CRC) and advanced lesions, but is an invasive and carries some risks, with limited availability and accessibility. Alternatively, the fecal occult blood test (FOBT) and fecal immunochemical test (FIT) are both non-invasive, cost-effective screening tests that can also be used to detect CRC, advanced lesions, and polyps, identifying individuals to be prioritized to undergo colonoscopy. FOBT screens for small amounts of blood in stool by detecting heme through a chemical reaction. FIT confirms the presence of blood in stool by using antibodies to detect hemoglobin. Prior to 2019, Ontario employed FOBT as the preferred method for CRC screening in eligible individuals. In early 2019, Ontario transitioned to FIT as the preferred screening test, due its established superior test performance for identifying patients with high risk lesions for colon cancer.

Aims

This single-centre retrospective study analyzed the change in efficacy of detecting advanced lesions, when transitioning from FOBT to FIT, as identified on subsequent colonoscopy

Methods

A retrospective chart review was conducted of approximately 1000 patients undergoing colonoscopy for FOBT or FIT at Cambridge Memorial Hospital, covering the period of transition from FOBT to FIT. Colonoscopies were performed by 10 endoscopists. Patients were stratified into 2 groups based on fecal test type, FOBT (N = 344) and FIT (N = 572). Overall and individual proportions of cancer, polyps, adenomas, advanced adenomas (AA), and sessile serrated adenomas (SSA) detection in the subsequent colonoscopies were calculated for both groups. The efficacy of both tests was then assessed using statistical analysis.

Results

In total, 344 patients were included for FOBT analysis and results included: cancer (5.52%), any polyp (56.69%), adenoma (43.6%), AA (20.64), and SSA (6.1%). In contrast, 572 patients were included for analysis of FIT group and results included: cancer (3.85%), any polyp (83.22%), adenoma (76.92%), AA (43.01), and SSA (12.94%). Cancer detection was similar in the 2 groups. There was significant improvement in polyp, adenoma, advanced adenoma, and sessile serrated adenoma detection with FIT compared to FOBT. This improvement was consistent in all endoscopists, but more pronounced in endoscopists with lower detection rates in FOBT cases.

Conclusions

The use of FIT as a screening stool test, as compared to FOBT, was associated with a significantly improved detection for polyps, adenomas, AA, and SSA, confirming greater accuracy and sensitivity of FIT as a screening tool. This result confirms the premise, at least at a single institution, that by switching to FIT, Ontario has improved colon cancer screening and prevention with more efficient and higher yield utilization of a limited and costly health care resource

Funding Agencies

None
A108 AN EVALUATION OF IMPLEMENTATION OF A CENTRALIZED REFERRAL AND BOOKING PROCESS ON WAIT TIMES FOR COLONOSCOPIES
Authors: Nguyen A , Porwal G
Published: February 2024

Background

Colonoscopies in the majority of centres in Ontario are booked by individual endoscopists via their individual offices (practices). As such, wait times for procedures will vary significant from centre to centre, or even from endoscopist to endoscopist at the same centre, depending on individual expertise, experience, procedure types, and local availability of endoscopic resources. This system could lead to significant variability in access to care for patients.

Aims

This study analyzed the effect of implementing a centralized referral and booking process for colonoscopy, for a specific indication, at a single centre in Ontario.

Methods

This was a single centre retrospective study analyzing wait times for patients that underwent a colonoscopy at Cambridge Memorial Hospital (CMH) between April 2017 to July 2022 for either positive fecal occult blood test (FOBT) or fecal immunochemistry test (FIT). The province of Ontario transitioned from FOBT to FIT as the primary tool for colon cancer screening in 2019. Prior to this transition, colonoscopy for positive FOBT performed at CMH were booked by individual endoscopists, with wait times from referral to procedure having great variability. In conjunction with Ontario’s transition to FIT for colon cancer screening, all endoscopists at CMH agreed to participate in a centralized referral and booking process specifically for colonoscopy for positive FIT indication. A chart review of all patients undergoing colonoscopy for either FOBT (non central booking) or FIT (central booking). Patients that self-delayed were excluded. Wait times (WT) was calculated as time between date of referral and date of procedure. The effect of the centralized booking system on wait times was then assessed using statistical analysis.

Results

In total, 344 patients were included for analysis from before March 2019 (non centralized booking process). The average WT in this group was determined to be 99.2 days (range 50-171 days), of which 147 patients had a WT of less than 56 days (42.7%). In contrast, a total 572 patients were included for analysis after March 2019 (centralized booking process), the average WT was determined to be 44.2 days (range 32-59 days), of which, 526 patients had a WT of less than 56 days (92.0%). The centralized booking process reduced average wait times by 55 days (55.4%), and improved procedure WTs meeting mandated time frame of 56 days by 49.3%. This improvement in wait times was most pronounced for endoscopists with the longest wait times in a non centralized system.

Conclusions

The implementation of a centralized referral and booking process (for a single indication for colonoscopy) was associated with significantly reduced WTs. These findings suggest a centralized referral and booking process (for well defined clinical needs) can potentially significantly improve patient wait times.

Funding Agencies

None
A109 A COMPARISON OF MULTIMORBIDITY AT DEATH AMONG PERSONS WITH AND WITHOUT INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED STUDY
Authors: Postill G , Tang F , Kuenzig E , Buajitti E , Harish V , Benchimol E I
Published: February 2024

Background

With improved care and life-expectancy, people with IBD are living longer and more likely to develop multiple chronic conditions. However, research on co-morbidities in the IBD population has typically focused on co-occurrences of a specific disease alongside IBD and employed a cross-sectional or short-term cohort perspective. To date, no work has taken a life-course perspective, evaluating retrospectively from death, to identify the population-level burden of multimorbidity.

Aims

To identify the burden of chronic conditions at time of death among people with IBD relative to their non-IBD counterparts.

Methods

We conducted a retrospective matched cohort study using health administrative data from Ontario, Canada. Individuals with IBD (identified using a validated algorithm) who died between 2010 to 2020 were matched to controls (1:5 ratio) based on sex, age at death, and year of death. We calculated the proportion of decedents with each of 17 different chronic conditions and the number of conditions at death. Conditions were identified using validated algorithms or clusters of diagnostic codes (when validated algorithms were not available). The number of chronic conditions at death among people with and without IBD was modeled using Poisson regression adjusting for Ontario Marginalization Index and accounting for matching.

Results

At the time of death, people with IBD (n=9728) were more likely than matched controls (n=42,389) to have mood disorders (69.0% vs. 60.2%), asthma (21.4% vs. 16.5%), renal failure (49.6% vs. 38.5%), osteoarthritis (76.8 vs. 67.6%), and osteoporosis (21.2% vs. 12.8%) (Figure 1B). Compared to their controls, people with IBD had were more likely to have ≥5 conditions (77.8% vs. 70.1%) (Figure 1A). People with IBD had significantly more chronic health conditions (RR 1.11, 95% CI 1.10-1.12).

Conclusions

People with IBD accumulate a greater degree of morbidity compared to those without IBD. Our findings add a novel understanding of multimorbidity among those with IBD from a life-course perspective. Our research highlights the need to provide quality multi-disciplinary care to people with IBD across the life course to address the increased frequency of multimorbidity.

Funding Agencies

ACG
A110 INVOLVING STAKEHOLDERS TO DEVELOP BREASTFEEDING EDUCATIONAL RESOURCES FOR PATIENTS WITH INFLAMMATORY DISEASE
Authors: Rho S , Ferenbok J , Marcon E , Habashi P , Berga K , Bradbury L , Huang V
Published: February 2024

Background

Inflammatory Bowel Disease (IBD) are incurable chronic inflammatory disease of the digestive tract that is often treated with immunosuppressive medications. Common IBD symptoms are frequent bowel movements that may be accompanied by blood, constipation, diarrhea, abdominal cramps and pain, fatigue, unintentional weight loss, and many more. Patients who are or are considering breastfeeding often face concerns and decisions about IBD medications and potential effects on breastfeeding and their breastfed infant, or they may have trouble with breastfeeding due to IBD symptoms. Despite the evident benefits of breastfeeding for infants, the rate of long-term breastfeeding amongst women with IBD is low at 55.2% at 6 months. A preliminary environmental scan revealed that there is a lack of informative educational resources for the population.

Aims

To develop a patient-centric educational resource that provides information and assurance on breastfeeding for a person living with IBD.

Methods

The study involved 4 stages: (1) phase 1 interview to collect perspectives and expertise, (2) prototype development, (3) phase 2 interview to obtain feedback on the prototype, and (4) prototype refinement. Participants included two groups: healthcare providers and IBD patients who have breastfed or are currently breastfeeding. All interviews were conducted remotely. Interview transcripts were coded to analyze the data.

Results

In total of 12 participants (6 healthcare providers and 6 patients) were recruited and completed the study. Through thematic analysis, three main themes were identified: 1) breastfeeding concerns that patients have prior to breastfeeding; 2) breastfeeding issues that patients experience while breastfeeding; 3) education format and content. These themes aided in the development and refinement of the prototype, which included graphics, easily digestible information, references, and short videos. The prototype is a webpage residing in a preconception and pregnancy in IBD website.

Conclusions

By involving the stakeholders, the intervention reflected the needs of patients and the expertise of healthcare providers. The main concern of IBD patients regarding breastfeeding was the IBD medication transfer via breastmilk and safety for breastfed infants. Interestingly, patients preferred to obtain information through short videos rather than the traditional counseling method that healthcare providers offer in clinics. These are included in the intervention. This study method can be applicable to other fields, to ensure that the needs of patients are well represented in patient education resources.

Funding Agencies

University of Toronto
A111 CHARACTERISTICS OF HOSPITALIZED PATIENTS WITH GASTROINTESTINAL DISEASE WHO LEAVE AGAINST MEDICAL ADVICE
Authors: Rivas A , Purdy E , Buhler K , Flemming J , Ma C
Published: February 2024

Background

Hospitalized inpatients who leave against medical advice (AMA) may have incomplete care, resulting in readmission and increased healthcare costs. Limited evidence exists in patients diagnosed with a primary gastrointestinal (GI) disease who leave AMA. Identifying patients with GI diagnoses who leave AMA may inform risk stratification to determine which patients are at risk of unplanned discharge.

Aims

Identify characteristics in patients diagnosed with GI diseases who leave AMA.

Methods

A retrospective evaluation was conducted using the National Inpatient Sample (NIS) from 2016 to 2020. The NIS provides national-level estimates of cost, quality, and outcomes from hospitalizations in the United States. We used International Classification of Diseases, Tenth Revision diagnostic coding to identify patients admitted with a primary GI problem. The proportion of patients who left AMA for each diagnosis was determined (Figure 1). A multivariable logistic regression was performed to determine factors associated with an AMA discharge, adjusting for age, sex, elective or weekend admission, primary payment method, race, hospital setting, geography, income, Elixhauser comorbidity index, alcohol and/or drug abuse and depression status.

Results

Between 2016 and 2020, 1.61% of patients with a GI primary problem left the hospital AMA. Characteristics associated with leaving AMA included: older age, female sex, non-white race, rural hospital admission, higher income and having comorbid conditions (Table 1). Patients with a history of alcohol abuse were more likely to leave AMA, while patients with a history of drug abuse were less likely to leave AMA.

Conclusions

Approximately 1 in 60 patients admitted with a primary GI problem leave hospital AMA and we identify both structural and patient-level factors associated with unplanned discharge.

Table 1: Factors Associated With AMA Discharge For GI-related Diagnoses

Funding Agencies

None
A116 PREVALENCE OF EDITORIAL BOARD MEMBERSHIP AMONG ORIGINAL RESEARCH PUBLISHED IN HIGH IMPACT GASTROENTEROLOGY-FOCUSED JOURNALS: A CROSS-SECTIONAL ANALYSIS
Authors: Verma Y , Scaffidi M , Gimpaya N , Li A , Khan R , Grover S C
Published: February 2024

Background

Editorial board members, as experts in their field, often publish relevant research in journals on which they serve. This combined role of “editor-as-author” may be a source for conflict of interest in the peer review process. In Gastroenterology-focused journals, the prevalence of instances for editor-as-author has not been explored.

Aims

To estimate the prevalence of editor-as-author among high impact factor (IF) Gastroenterology-focused journals.

Methods

We used a cross-sectional study design. We used InCites Journal reports to identify 30 Gastroenterology journals with the highest IF in 2020, wherein we included journals that had publicly accessible board membership that indicated the following: institution/city/country; and at least the first name initial and entire last name for editorial board members. We created a list of all editorial board members, excluding any emeritus editors and society representatives. Among these journals, we identified all original research articles using the Web of Science, wherein we excluded any editorial material, meeting abstracts, and clinical practice guidelines. Among these original publications, two authors then independently and in duplicate determined any instances of authors who had editorial board membership. The primary outcome measure was the prevalence of editors-as-authors. Secondary outcomes involved the number of editorial board members with first authorships and senior/corresponding authorships, as well as the number of articles that disclosed editorial board membership.

Results

Among the 30 Gastroenterology-focused journals that had the highest IF, 24 met the relevant inclusion criteria. These journals had a total of 6162 original publications, of which 992 (16.1%) had at least one instance of editor-as-author; 8 (0.1%) articles disclosed that there was editorial board membership among its authors. Among all 24 included journals, there were a total 2106 editorial board members. Of these members, 635 (30.2%) had at least one instance of editor-as-author, wherein 134 and 263 members were first authors and senior/corresponding authors, respectively.

Conclusions

Our study found that approximately one third of editorial board members among high IF Gastroenterology-focused journals were also authors in these same journals. Future analysis will focus on determining whether there is the difference in quality of published work compared to those without editorial board membership.

Funding Agencies

None
A117 WORK PRODUCTIVITY IMPAIRMENT IN PERSONS WITH INFLAMMATORY BOWEL DISEASES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Youssef M , Hossein-Javaheri N , Hoxha T , Mallouk C , Tandon P
Published: February 2024

Background

Inflammatory bowel diseases (IBD), which include Crohn’s disease (CD) and ulcerative colitis (UC), are chronic disorders that affect approximately 6.8 million people globally. IBD often develops at an early age and can have a significant impact on employment outcomes and work productivity. Individuals with IBD have higher rates of unemployment, sick leave, and work disability compared to the general population. Nevertheless, there remains a paucity of standardized reporting on work productivity impairment and the associated indirect costs in patients with IBD.

Aims

In this systematic review and meta-analysis, we evaluate work-related outcomes and employment data among patients with IBD. This may inform clinical and policy decisions to facilitate workplace accomodations for patients with IBD and improve their work productivity.

Methods

A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane library, in addition to Scopus, ProQuest, and clinicaltrials.gov from inception to February 2023. We included full-texts and abstracts of observational and clinical trials that reported work-related outcomes in patients with IBD aged ampersand:003E18 years. We collected work-related data as described by the Work Productivity and Activity Impairment (WPAI) tool, in addition to other outcomes including employment, sick leaves, disability pensions, and indirect costs due to productivity loss. Pooled effect analysis was conducted using a random-effects model for pooled estimates of continuous and proportional data with 95% confidence intervals (CIs). Odds ratios (ORs) and mean differences were used to compare data between patients with active disease vs. remission.

Results

We included 134 studies (96 full-text articles and 38 abstracts). Among all patients with IBD, the pooled estimates were 16.41% [13.89-18.93] for absenteeism, 35.91% [31.11-40.72] for presenteeism, 39.41% [33.93-44.88] for overall productivity loss, and 45.96% [39.46-52.46] for non-work related activity impairment. Indirect costs were estimated at 1,813.9, 3,562.49, and 5,131.09 euros/patient/year for absenteeism, presenteeism, and overall work impairment respectively. For other non-WPAI outcomes, the pooled estimate for employment was 65.6%, 39.5% of patients reported sick days, 21.3% reported disability at work due to IBD directly, 12.3% received disability pensions, and 29.6% had lost jobs due to IBD. Overall, patients with active disease had worse WPAI and employment outcomes than those in remission.

Conclusions

IBD may result in significant work productivity impairment, lower employment, and significant indirect costs due to productivity loss. Larger studies with standardized definitions for work outcomes are needed to better evaluate the impact of IBD on work productivity.

Funding Agencies

Mount Sinai Resident Research Funding
A124 A SYSTEMATIC REVIEW OF THE EFFICACY OF ARTIFICIAL INTELLIGENCE IN IDENTIFYING BARRETT'S ESOPHAGUS NEOPLASIA
Authors: Buttar J , Kim H , Byrne M
Published: February 2024

Background

Barrett’s Esophagus (BE) is a known precursor for esophageal adenocarcinoma and requires frequent surveillance with esophagogastroduodenoscopy. Due to tumour heterogeneity and logistical demands on endoscopists, identification of BE dysplasia is difficult and random biopsies are riddled with sampling error. Artificial Intelligence (AI), in the form of computer-aided detection, has entered the endoscopic realm to improve BE dysplasia detection. This systematic review aims to evaluate its efficacy in BE screening.

Aims

To survey the literature regarding the efficacy of machine learning tools in identifying BE dysplasia. The primary outcome was recognition of BE from a database of endoscopic images with histopathologic correlation utilizing a machine learning algorithm, with sensitivity and specificity reported.

Methods

Using the PRISMA framework, MEDLINE, EMBASE and Compendex databases were searched from inception to Sept 1, 2023. Of 1915 articles identified, 35 were selected for full-text review. Two reviewers, JB and JK, independently completed the literature review and discrepancies were reviewed by the PI. After applying inclusion and exclusion criteria, 20 studies were included in the systematic review. The quality of studies was assessed using the Newcastle-Ottawa Scale.

Inclusion Criteria:

-Must include Barrett's esophagus and / or EAC (esophageal adenocarcinoma)

-Must include novel research (not a systematic review or MA)

-Requires use of endoscopic images

-English only, full text manuscripts

Exclusion Criteria:

-No prior surgery (esophagectomy)

-Does not include esophageal squamous cell carcinoma

Results

Of the 20 articles selected, seven were published after 2021. All studies utilized a machine learning algorithm to aid in identification of BE dysplasia. Various imaging modalities were used, including white light imaging, narrow-band imaging, or volumetric laser endomicroscopy. A total of 3,886 patients were included with 5,605 images. Sensitivity ranged from 72 – 100%, specificity ranged from 64 – 94%. The overall quality of studies included was low.

Conclusions

Surveillance of BE dysplasia remains a difficult and time-intensive task. Computer-aided detection of BE dysplasia demonstrates strong performance independent of the machine learning algorithm or imaging modality. Meta-analyses are required to illustrate heterogeneity and power to bolster these preliminary findings.

Funding Agencies

None
A126 IMPACT OF TIME OF DAY ON PROCEDURAL OUTCOMES IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP): ANALYSIS FROM A TERTIARY REFERRAL CENTER
Authors: Deeb M , Sabrie N , Khalaf K , Calo N , Mosko J , Forbes N , Grover S
Published: February 2024

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is an established diagnostic and therapeutic tool for hepatobiliary disease. Given its technical demands, it remains one of the highest-risk endoscopic procedures. Addressing modifiable factors, such as operator fatigue, may mitigate procedural risk. In colonoscopy, there is conflicting data on whether procedure time of day, as a surrogate of operator fatigue, affects outcomes, with some literature demonstrating decreased procedure completion and polyp detection rates in the afternoon. There is a paucity of data evaluating this potential relationship in ERCP.

Aims

To evaluate the impact of procedure time of day on procedural success and short-term adverse outcomes in patients undergoing ERCP.

Methods

A retrospective review of ERCP's performed on adult patients at our tertiary referral center from January 1, 2011 to December 31, 2020 was performed. The primary outcome was the procedural success rate, defined as successful navigation to the papilla, selective duct cannulation and cholangiography, and realization of the intended therapeutic goals. Secondary outcomes included procedure duration, rate of deep ductal cannulation, rate of sphincterotomy, and short-term (30-day) adverse events (immediate bleeding, delayed bleeding, pancreatitis, perforation). Statistical analysis was conducted using R. Categorical variables were compared using the Chi-square test of independence or Fisher’s exact test. Continuous variables were compared using T-tests or the Mann-Whitney-U test.

Results

A total of 5755 ERCP’s were performed between 8 AM – 6 PM; 2863 were performed before 12PM (AM group) and 2892 after 12PM (PM group). Baseline characteristics were similar between the two cohorts, with the exception of hypertension (33.7% AM vs 30.1% PM; p=0.003), and anticoagulation (20.3% AM vs 18.3% PM; p=0.05). In both groups, the most common ERCP indication was choledocholithiasis. The primary operators in both cohorts were clinical fellows. There was no difference in procedural success rate (87.0 % AM vs 86.7% PM; p = 0.72), procedure duration (33.6 minutes AM vs 32.9 minutes PM; p = 0.29), rates of deep cannulation (82.6% AM vs 83.0% PM; p = 0.81) and sphincterotomies (63.2% vs 62.7%; p = 0.68). Rate of adverse events were similar, with slightly higher rates of immediate bleeding in the AM group (5.0% AM vs 3.8% PM; p = 0.03). Results were similar in a subgroup analysis of patients with altered anatomy.

Conclusions

In this large retrospective review of ERCPs performed at a tertiary referral center, the procedure time of day did not impact procedural success rate. There were slightly higher rates of immediate bleeding in the AM group, though this may be explained by higher rates of anticoagulation in that group.

Funding Agencies

None
A127 ENDOSCOPIC MUCOSAL RESECTION WITH HYBRID-ARGON PLASMA ABLATION TO PREVENT RECURRENCE OF 20 MM NON-PEDUNCULATED COLORECTAL POLYPS: A MULTI-CENTER PROSPECTIVE CLINICAL STUDY
Authors: Djinbachian R , Levenick J M , Bouchard S , Moyer M T , Deslandres E , Mosko J , Teshima C , Shahidi N , von Renteln D
Published: February 2024

Background

Endoscopic mucosal resection (EMR) is the mainstay of therapy for non-pedunculated colorectal polyps 20 mm or larger. Post EMR recurrence rates are about 15% if no margin ablation technique is used.

Aims

Study aim was to evaluate recurrence rates if hybrid Argon Plasma Coagulation ablation (h-APC) is routinely used after the EMR to ablate the margins, base and vessels.

Methods

A prospective multi-center study including adult patients (18-89 years) undergoing EMR of non-pedunculated colorectal polyps 20 mm or larger was conducted. h-APC was used to ablate all post EMR margins and to ablate the post EMR resection surface and visible submucosal vessels. The primary outcome was the biopsy proven recurrence rate at the first follow-up colonoscopy (4-6 months after EMR). All the resection sites were visually inspected, and biopsies were obtained from the EMR scar. Secondary outcomes included technical success and complication rates.

Results

A total of 220 EMRs were performed during the study for h-APC ablation of non-pedunculated colorectal polyps, with a size of ≥20 mm. The average size of the polyps included in the study was 35.7 mm (ranging from 20 mm to 100 mm). Among all resected polyps, 16.8% were sessile serrated lesions (SSL), while 66.3% were adenomas. Additionally, 4 cases of cancer were in the study. The application of hot snare EMR with h-APC ablation was technically successful and completed for all cases. The mean duration of the EMR procedure was 19.6 minutes, ranging from 2.3 to 103 minutes, while the mean duration of h-APC ablation was 6.4 minutes, ranging from 1 to 65 minutes.

A total of 147 EMRs with follow up examination (57 EMR involving lesions 40mm or larger) are available currently. The overall recurrence rate was 1.3% (2 out of 147 cases). For cases where complete base ablation was achieved, there was a 0% recurrence rate, including lesions 40mm or larger. For lesions measuring 40mm or larger, the recurrence rate was 1.8% (1 out of 54 cases). Out of the 220 total EMRs conducted, perforations were observed in 0.9% (2 cases, managed conservatively with antibiotics only), and clinically significant bleeding occurred in 2.3% (5 cases). In particular, clinically significant bleeding was noted in 2.3% (4 out of 167 cases) of lesions without clipping and in 4.0% (4 out of 99 cases) for right-sided lesions without clipping.

Conclusions

In this multicenter study EMR in combination with h-APC demonstrated a high technical success rate with low complication rates and showed very low post EMR recurrence in the preliminary data analysis.

Funding Agencies

Erbe
A130 RETROGRADE ENDOSCOPIC ULTRASOUND-GUIDED ENTERO-ENTEROSTOMY USING A LUMEN-APPOSING METAL STENT FOR THE MANAGEMENT OF A HIGH-OUTPUT ENTEROCUTANEOUS FISTULA AND ILEAL STRICTURE IN A COMPLEX SURGICAL ABDOMEN
Authors: Gupta S , Gupta S , Pawlak K , De Rezende-Neto J , May G , Mosko J , Calo N
Published: February 2024

Background

A 26-year-old male sustained significant traumatic thoracoabdominal injuries following a gunshot. He underwent several laparotomies, small bowel resections, an extended left hemicolectomy with end-colostomy formation, and a flap to close the abdomen. He subsequently developed a high-output enterocutaneous fistula (ECF) and loss of colostomy output. CT imaging confirmed an ECF from the ileum to the anterior abdominal wall and a severe ileal stricture distal to the fistula.

Aims

In the context of his complex surgical abdomen and proximity of the ECF to the abdominal flap, surgical re-intervention was deemed high-risk. He was placed on total parenteral nutrition and referred for endoscopic management.

Methods

Under fluoroscopic guidance, we injected methylene blue & contrast dye from the skin side of the ECF. A dilated segment of small bowel was filled, with no downstream passage of contrast (Fig 1A). Retrograde ileoscopy was performed with an Olympus pediatric colonoscope via the patient’s colostomy. 90 cm from the ileocecal valve (ICV), we encountered a benign enteric stenosis that could not be traversed. Contrast was injected, with fluoroscopy revealing a 10 cm long tortuous stenosis (Fig 1B), extending to the previously filled loop of small bowel. Given the length and characterof the stricture, endoscopic balloon dilation and enteral stenting were technically infeasible.

Results

We proceeded to retrograde endoscopic ultrasound (EUS)-guided entero-enterostomy creation. With the aid of a guidewire, and under endoscopic, fluoroscopic and endosonographic guidance, a linear echoendoscope was advanced into the ileum via the colostomy, cecum and ICV. 50 cm from the ICV, we identified an adjacent dilated loop of small bowel (Fig. 1C). Water was instilled through the ECF, with the endosonographic view demonstrating filling, thus indicating this location to be upstream from the ECF. A 19-gauge needle was punctured through, with subsequent aspiration of methylene blue (Fig. 1D). We then created an EUS-guided entero-enterostomy using a 15mm lumen-apposing metal stent (Hot-AXIOS; Boston Scientific, Massachusetts, USA; Fig. 1E). Passage of methylene blue & contrast through the stent confirmed accurate deployment (Fig. 1F&G). With both the ECF & stricture bypassed, the patient’s colostomy output returned and ECF output diminished.

Conclusions

Electrocautery-enhanced lumen apposition with metal stenting is well established. It can facilitate the formation of an anchored anastomosis across non-adherent luminal structures in a single-step fashion. Herein, we have reported a novel application of this technique in the management of a complex post-surgical trauma patient with a high-output ECF and deep enteric stenosis.

Figure 1: Retrograde EUS-guided entero-enterostomy

Funding Agencies

None
A132 A COLON-SPECIFIC SELECTIVE RESECTION ALGORITHM FOR LARGE NON-PEDUNCULATED POLYPS OPTIMIZES EFFICIENCY WITH HIGH TECHNICAL AND CLINICAL SUCCESS: A PROSPECTIVE COHORT STUDY
Authors: Jiang S X , Zarrin A , Walia A , Galorport C , Enns R , Lam E , Shahidi N
Published: February 2024

Background

Endoscopic resection is now the first line treatment strategy for most large (≥20 mm) non-pedunculated colonic polyps (LNPCPs); which includes endoscopic mucosal resection (EMR), cold snare resection (CSR), and endoscopic submucosal dissection (ESD). A selective resection algorithm incorporating EMR and ESD is cost effective and optimizes oncologic outcomes in the rectum. However, a focused evaluation for colonic lesions has not been described.

Aims

Assess the performance of a colon-specific selective resection algorithm for LNPCPs.

Methods

Consecutive patients ampersand:003E 18 years of age who underwent endoscopic resection for a LNPCP were enrolled in a prospective single center observation cohort study (clinicaltrials.gov ID: NCT05402696). Modality selection was determined by optical evaluation using the Paris and the Japan NBI Expert Team (JNET) classifications: 1) JNET I – CSR; 2) JNET IIA – EMR; 3) JNET IIB or Paris 0-IIC morphology – en bloc resection (EMR/ESD); 4) JNET III – referral to surgery/multi-disciplinary team review. Algorithm performance was evaluated by technical success (all neoplastic tissue removed at index procedure), procedure-related adverse events, referral to surgery, and recurrence at first surveillance colonoscopy (SC1).

Results

From 06/2022-09/2023, 230 patients underwent 244 procedures for 295 lesions. Median age was 67 years (IQR 61-74 years) and 127 (55.2%) were male. Median lesion size was 30mm (IQR 20-40mm). Cancer was identified in 12 (4.1%) LNPCPs. Based on pre-resection optical evaluation, 204 (69.2%), 86 (29.2%) and 5 (1.7%) LNPCPs underwent EMR, CSR and ESD, respectively. Technical success was 97.1%, 100.0% and 100.0% for EMR, CSR and ESD, respectively (p=0.245). Procedure duration was significantly shorter for CSR (10 min; IQR 8-15 min) compared to EMR (15 min; IQR 10-25 min) and ESD (30 min; IQR 30-60 min) (P ampersand:003C 0.001). There was no significant difference in intra-procedural perforation, clinically significant post-endoscopic resection bleeding, delayed perforation or serositis, with overall frequencies of 3.4%, 5.2%, 0% and 0.4% respectively. Surgery was performed for 15 lesions (11 submucosal invasive cancer (SMIC); 3 synchronous SMIC; 1 technical failure). Of LNPCPs completing SC1, there was 1 recurrence (1.2%) in the CSR group (p=0.366), which was successfully managed endoscopically.

Conclusions

A colon-specific selective resection algorithm optimizes procedural efficiency and the risk-benefit profiles of EMR, CSR and ESD for LNPCPs.

Funding Agencies

None