bluuebunny/crossref_metadata_2025 huggingface dataset:
P267 Real-world artificial intelligence-aided colonoscopy does not improve adenoma detection rates in patients with Inflammatory Bowel Disease
Authors: Levartovsky A , Levy I , Bruckmayer L , Klang E , Ben-Horin S , Kopylov U
Published: January 2023

Background

Recently, the implementation of artificial intelligence-aided colonoscopy (AIAC) has resulted in improved performance of colorectal cancer (CRC) screening. The adenoma detection rate (ADR) is a key quality indicator in screening colonoscopies and achieving high ADRs is crucial for optimal prevention of CRC. Guidelines suggest that ADRs of 20% in women and 30% in males are indicative of adequate performance. Patients with inflammatory bowel disease (IBD) may be at increased risk for CRC based on disease extent and duration. However, ADR in patients with IBD can be generally lower than in average-risk patients, mainly due to an age gap and the presence of dysplasia associated lesions as opposed to sporadic adenomas. Indeed, there is no consensus for an accepted ADR target in these patients. In addition, the impact of AIAC on ADR in these patients has yet to be described. We aimed to explore the ADR of patients with IBD in a large-volume endoscopic center and evaluate the effect of AIAC on ADR.

Methods

This was a retrospective study conducted at a high-volume gastroenterology department where all endoscopy suites were equipped with an AIA device (GI Genius, Medtronic, Ireland) starting from July 1st 2021. Data was collected on all colonoscopies performed in the 11 months before the mentioned date and compared to a 15-month period afterwards. We excluded patients that performed colonoscopy due to evaluation of IBD severity, for known or suspected malignancy, therapeutic endoscopies, incomplete colonoscopies and colonoscopies with inadequate preparation. The primary outcome of the study was ADR.

Results

Our study included 996 colonoscopies (237 pre-AIAC, 759 AIAC). The groups were similar in age (median 43.8 years, interquartile ratio (IQR) 28.7-61.2 vs 44.5 years, IQR 30.7-59.1, p=0.76) and gender distribution (55.3% vs 54.3% males, p=0.82). In both groups, there were more Crohn’s disease (62.9% pre-AIAC, 57.2% AIAC, p=0.13) than ulcerative colitis patients. The ADR in the pre-AIAC group tended to be higher in comparison to AIAC (6.3% vs 4%, p=0.15); When limiting to experienced gastroenterologists only (≥ 5 years), ADR results were significant higher in the pre-AIAC group (7.6% vs 3.8%, p=0.035). In addition, total procedure time (considered the time from procedure start and end as recorded by the endoscopy nurse) was significantly shorter in the AIAC group (21 minutes, IQR 17-28 vs 25 minutes, IQR 19-37, p<0.0001).

Conclusion

In a large-volume tertiary center cohort, the introduction of AIAC to real-world colonoscopies did not improve ADR in patients with IBD, questioning the integration of AIAC in routine practice.
P275 Anastomotic technique drives endoscopic recurrence in Postoperative Crohn's Disease: a systematic review and meta-analysis
Authors: Nardone O M , Luglio G , Calabrese G , Giglio M , Castiglione F , Ghosh S , Iacucci M
Published: January 2023

Background

Patients with Crohn's disease (CD) after Ileo-colic resection may develop an endoscopic postoperative recurrence (ePOR) that reaches approximately 70% of incidence within six months. ECCO guidelines favour a stapled side-to-side anastomosis. However, the advent of the Kono-S ileocolic anastomosis, a hand-sewn antimesenteric functional end-to-end anastomosis, seems to reduce clinical risk and ePOR. Whilst the majority of the studies have assessed the rate of ePOR individually, currently there is limited data comparing surgical techniques of the anastomosis. Hence, we aimed to assess the impact of different surgical techniques on ePOR in CD

Methods

We searched PubMed and Embase in October 2022 for eligible studies reporting the surgical types of anastomosis and, based on these, the rate of endoscopic recurrence at a minimum of six months. Studies were grouped by conventional anastomosis vs Kono, and comparisons were made between these groups. Pooled incidence rates of ePOR were computed using random-effect modelling. Meta-regression and subgroup analyses were performed to examine the impact of the type of anastomosis on the incidence of ePOR ≥ 6 months

Results

Thirteen studies, including 1816 patients who underwent ileocolic resection for CD, were included. Among these patients, 282 (15.5%) received a Kono-S anastomosis, while 1534 (84.4%) had a conventional anastomosis. ePOR at ≥≥ six months showed a pooled incidence of 31.8% (95% CI, 24.8 to 39.2), with significant heterogeneity among the studies (p<0.01). Meta-regression analysis showed that Kono-S anastomosis was associated with a significant reduction in the ePOR at endoscopic follow-up (p=0.001). In detail, patients receiving a Kono-S anastomosis had a pooled incidence of ePOR of 12% (95% CI, 3.1 to 24.9), while patients receiving a conventional anastomosis had an ePOR of 38.2 (95% CI, 30 to 46.9%) [Figure1].

Funnel plot asymmetry [Figure 2] and Egger's regression test (p=0.118) indicated the absence of a publication bias

Conclusion

Kono-S anastomosis was associated with a significant reduction of ePOR at ≥ six months compared to the conventional anastomosis. Our findings highlight the need to standardize and implement the use of Kono-S anastomosis, particularly for difficult-to-treat patients with high risk for a post-operative recurrence
P278 Endoscopic scoring system utilization for Inflammatory Bowel Disease activity assessment: a multicenter real-world evidence study from Argentina (DARE study)
Authors: Lasa J , Martínez S , Smolarczuk A , Navar S , Espinosa F , Pereyra L , Rainero G , Meligrana N , Marturano V , Steinberg L , Reyes K , Giraudo F , Garbi L , Gullino L , Yantorno M , Correa G , Ponce C , Orellana D , Galvarini M , Caruso E , Olivera P
Published: January 2023

Background

The use of scores for the assessment of endoscopic activity in inflammatory bowel disease (IBD) patients is crucial for accurate and reproducible evaluation of mucosal healing, which is a relevant marker of prognosis. Frequency and patterns of their use in a real-life setting are not known. We aimed to describe the prevalence of adequate use of endoscopic scores in IBD patients who underwent colonoscopy in a real-life setting.

Methods

A multicenter observational study comprising six community hospitals in Argentina was undertaken. Patients with a diagnosis of Crohn’s disease or ulcerative colitis who underwent colonoscopy for endoscopic activity assessment between July 2018 and July 2022 were included. Colonoscopy reports of included subjects were manually reviewed to determine the proportion of colonoscopies that included an endoscopic score report. We compared the endoscopic findings to determine if there were differences in the score reported and the inflammatory activity described. Finally, we determined the proportion of colonoscopy reports that included all of the IBD colonoscopy report quality elements proposed by BRIDGe group. Endoscopist’s specialty, years of experience as well as expertise in IBD were assessed. Chi square test was used for the comparison of categorical variables; Student t test for the comparison of numerical variables. A multivariate analysis was performed using a logistic regression model. A p value of less than 0.05 was considered to be statistically significant.

Results

A total of 1206 patients were included for analysis (32.25% patients with Crohn’s disease). Mean age was 45.48±15.6. Endoscopic score reporting was found in only 34.45% of Crohn’s disease colonoscopies and in 52.87% of ulcerative colitis colonoscopies. Most frequently used scores were Mayo endoscopic score (90.56%) and SES-CD (56.03%).

We found discrepancies between the score reported and the findings described in colonoscopies in 10.92% of cases; only 26% of reports included all recommendations proposed by BRIDGe group. On multivariate analysis, surgeons as operators [OR 0.08 (0.03-0.18)], >15 years of endoscopist experience [OR 0.24 (0.07-0.37)], IBD expertise [OR 2.86 (1.86-4.41)] and compliance of quality elements of reporting [OR 2.48 (1.24-3.76)] were significantly associated with endoscopic score reporting.

Conclusion

We identified a low prevalence of endoscopic activity score reporting in IBD patients’ colonoscopies. This finding is associated with operator-dependent characteristics. Educational interventions can be introduced to increase adequate score reporting.
P281 Conversion of the ileal pouch-anal anastomosis to a continent ileostomy – outcome and patient satisfaction
Authors: Hermanson M , Bengtson J , Block M
Published: January 2023

Background

This is a description of consecutive patients converted from ileal pouch-anal anastomosis (IPAA) to continent ileostomy (CI) at a tertiary centre, outcome after surgery and patient satisfaction after long time follow-up.

Methods

All consecutive patients operated with IPAA which later was converted to a CI at Sahlgrenska University Hospital, Gothenburg, Sweden, were included in the study. Demographic data was registered and a questionnaire regarding quality of life was sent to included patients.

Results

A total of 28 patients were included during the period of 1985-2022. The most common diagnosis was Ulcerative Colitis (UC) (n=23), other diagnoses included Crohn′s disease (n=2) and Familial Adenomatous Polyposis (n=1) (missing data n=2). IPAA was performed at a mean age of 30 (15-49) years and IPAA converted to CI at a mean age of 39 (22-62) years. At follow-up, three of the patients were diseased, not related to conversion surgery, and one had moved abroad. All of the remaining 24 patients completed the questionnaire. 20/28 (71%) patients still had their CI in function. 17/28 (61%) were converted due to fistula problems and the rest due to functional problems. 20/28 (71%) were converted using their IPAA-pouch and 4/28 (14%) had a new-constructed reservoir (missing data n=4). Totally, 18/20 (90% p<0.001) were satisfied with the CI and 19/20 (95% p<0.001) would choose it again if they were facing the same situation, even if most of the patients needed revision of the reservoir (mean 2 (0-5) surgeries). Four patients required excision of the CI. All excised patients had UC and was converted using their original IPAA. The main reason for conversion in the excised group was fistula with the inner meatus in the IPAA (three woman with anovaginal fistula and one man with perianal fistula).

Conclusion

A CI is an alternative that patients seem to be satisfied with, even after long follow-up time, when IPAA is no longer a suitable alternative. The majority of the patients in this study were converted from IPAA to CI using their IPAA-pouch.
P282 Isolated colonic Crohn’s disease and extensive ulcerative colitis: is there a reel difference?
Authors: Ben Safta N , Ben Mustpha N , Khemiri W , Serghini M , Laabidi S , Fekih M , Labidi A , Boubaker J
Published: January 2023

Background

The management of isolated colonic Crohn's disease (CDc) is often modeled on that of Ulcerative Colitis (UCc).

The aim of our study was to compare epidemiological and evolutive profiles of CDc and UCc.

Methods

We conducted a retrospective, descriptive and comparative study, including patients diagnosed with CDc as well as UCc, who were hospitalized in our department over a 9-year period [January 2011 - January 2020]. The group 1 included patients with CDc and group 2 included patients with UCc. Patients with less than 2 years of follow-up were excluded. Data were recorded and analyzed by SPSS software version 26.

Results

We included 130 patients with a sex ratio M/F= 0.68. The mean age at diagnosis was 34.85 years [6-68 years]. Sixty-three patients had CDc, while 67 patients had UCc. The two groups were comparable for age (p=0.56) and sex (p=0.54). The percentage of patients with smoking and alcoholism was also comparable between the two groups (p=0.4 and p=0.8 respectively). The presence of at least one autoimmune disease and a family history of Inflammatory Bowel Disease were more noted in patients in group 1 than in group 2 (p= 0.011 and p=0.046 respectively). The mean BMI at diagnosis was 22.28 kg/m² and was comparable between the 2 groups. The main phenotype was inflammatory (93.6%) in group 1. Twenty-five patients in group 1 (39.6%) and 22 patients (32.8%) in group 2 had associated extra-intestinal involvement (p=0.41), represented mainly by rheumatological involvement (n=39, 30%). The mean albumin level at diagnosis was 29.21 g/L and 30.96 g/L in groups 1 and 2 respectively. The occurrence of Severe Acute Colitis during follow-up was more frequent in group 2 than in group 1 (58.2% vs. 46%), although the difference was not significant (p=0.13). However, the rate of colectomy was significantly higher in group 2 (p=0.029). The use of anti-TNF therapy was significantly higher in group 1 (p=0.046). The maximum duration of hospitalization and the number of relapses were not statistically different between the 2 groups (p=0.81 and p=0.8 respectively). Finally, there was no significant difference between the 2 groups considering the use of corticosteroid or immunosuppressive therapy (p=0.88 and p=0.96 respectively). The main limit of our study is that it was conducted only in hospitalized patients who had relatively severe disease.

Conclusion

CDc is more prone to intensive medical treatment, whereas colectomy is more noted in UCc.
P286 Combined F18-FDG-PET-MRI-imaging: A promising tool for diagnostics of small bowel Crohn’s disease
Authors: Mattila J , Virtanen J , Nuutila P , Koffert J ,   CD-PET
Published: January 2023

Background

Diagnostics of small bowel Crohn’s disease (CD) may be difficult. Combined PET-MRI has been documented to be a reliable tool for evaluating intestinal metabolism, but clinical use has been limited due to accessibility, costs and lack of standardized methods to quantify inflammation. Our study aims to prove that combined PET-MRI can be used to detect active CD inflammation in small bowel.

Methods

25 patients with suspected ileal CD in ileocolonoscopy were recruited from Turku University Hospital’s outpatient clinic. The patients’ endoscopic findings in ileum were graded according to SES-CD- score (Simple Endoscopic Score for Crohn’s disease). A static PET-MRI was obtained with [18F]-FDG (fluorodeoxyglucose) tracer and gadolinium contrast agent (Dotarem®). Hemoglobin (Hb), C-reactive protein (CRP), serum albumin (Alb) and fecal calprotectin (FC) were measured. After PET-MRI, a small bowel capsule endoscopy was done and the findings graded along the CECDAI-system (Capsule Endoscopy Crohn’s disease Activity Index). The patient’s symptoms were scored with a validated questionnaire. Medication data was also collected. The MR images with a small bowel protocol and diffusion weighted imaging (DWI) were analyzed and the degree of inflammation graded on a visual scale of 1-4, from none to severe by an experienced abdominal radiologist. SUVmax (standardized uptake value) was measured from PET-sequences for each patient from terminal ileum.

Results

Twenty (80%) of the patients diagnosed with small bowel CD had mean SUVmax 3.40 (±1.54), while the 20% without CD diagnosis had lower SUVmax 2.15 (± 0.93) (p=0.047). Patients who were later treated with immunomodulators or biologics had higher SUVmax than patients who didn’t need medication or were treated with oral budesonide only (3.71 (±1.49) vs 2.07 (±0.82), p=0.0093). There was a correlation with SUVmax and visual MRI grading, CECDAI-score, ileal SES-CD-score and FC (r=0.406, p=0.049; r=0.504, p=0.056; r=0.419, p=0.042 and r=0.49, p=0.014 respectively). SUVmax correlated negatively with Alb (r=0.599, p=0.0025) but not with Hb, CRP or the symptom score of the patients.

Conclusion

In this study we have shown that SUVmax measured from terminal ileum in combined PET-MRI could be used for prediction of patients CD progression. SUVmax also correlated with SES-CD-score, fecal calprotectin and serum albumin. These findings suggest that combined PET-MRI can be used in the future in diagnostics of small bowel CD. Further analyses are needed to define threshold values for small intestine CD.
P304 Leucine-rich alpha 2 glycoprotein reduces the necessity for endoscopic examination for activity evaluation
Authors: Hayashi Hayasix@0917 T , Takatori H , Yamashita T
Published: January 2023

Background

Leucine-rich alpha 2 glycoprotein (LRG) reflects mucosal healing in ulcerative colitis (UC) and is useful for assessing mucosal healing. In this study, we hypothesized that endoscopy for activity evaluation may be unnecessary depending on LRG levels, and investigated the relationship between LRG and endoscopic findings.

Methods

Patients who underwent endoscopy for UC from April 2021 to August 2022, when LRG measurement became available, and whose LRG was measured within a month, were included in the study. The relationship between Mayo endoscopic subscore (MES) and LRG was evaluated and symptoms were also reviewed to examine these relationships. Endoscopic remission was defined as MES 1 or less.

Results

The mean (range) LRG values per MES and the percentage of patients with a cutoff value of less than 16 μg/mL were MES 0 (n=86): 11.3±2.8 (6.0-24.2) μg/mL, 96.5%; MES 1 (n=56): 13.3±6.0 (7.7-43.8) μg/mL, 79.2%; MES 2(n=53): 21.7±11.5(8.1~65.1) μg/mL, 34.0%, MES 3(n=19): 26.4±9.3(12.3~42.9) μg/mL, 25.0%, and AUC 0.856 in ROC analysis, higher than other markers (CRP, Alb, WBC) LRG Even below the cutoff value, 15.0% (22/147) were in endoscopic non-remission. Even when patients have neither diarrhea 3 or more times a day nor bloody stool, 7.4% (9/122) were still in endoscopic non-remission. However, there were no cases in endoscopic non-remission when the LRG was below the cutoff value and there were no such symptoms. In multivariate analysis using binomial logistic regression analysis, LRG (p=0.028) was an independent predictor of endoscopic remission, in addition to diarrhea (p=0.003) and bloody stool (p<0.001).

Conclusion

LRG was a useful tool for predicting endoscopic activity in ulcerative colitis, but LRG alone could not exclude non-remitting cases. However, LRG was considered to be an independent predictor of endoscopic remission, and all patients who had less than the LRG cutoff value and no diarrhea or bloody stool more than 3 times a day showed endoscopic remission, suggesting that endoscopy for activity evaluation may be unnecessary in such cases.
P311 Reliability of computed tomography enterography for evaluation of stricturing Crohn’s disease: Development of a Crohn’s disease stricture index
Authors: Rieder F , Ma C , Hanzel J , Fletcher J G , Baker M , Wang Z , Guizetti L , Patel M , Niu J , Shackelton L , Ottichilo R , Santillan C , Capozzi N , Taylor S A , Zhou G , Bruining D , Feagan B , Jairath V , Rimola J
Published: January 2023

Background

Computed tomography enterography (CTE) is frequently used to assess stricturing Crohn’s disease (CD). However, the reliability of CTE items used for assessment has not been established and there is no validated radiologic stricture severity index.

Methods

We conducted a retrospective study of 43 patients with symptomatic, terminal ileal stricturing CD. Four radiologists assessed a comprehensive list of pre-defined radiologic items potentially associated with stricture severity in 48 CTE scans in two separate rounds in random order. Reliability was quantified using the intraclass correlation coefficient (ICC). Items with at least moderate (ICC≥0.41) inter-rater reliability that were correlated with a visual analogue scale of overall stricture severity were candidate items for the development of a CTE stricture index.

Results

Inter-rater reliability was almost perfect for assessment of luminal diameter of pre-stenotic dilation (ICC 0.817 [95% confidence interval 0.703, 0.878]), substantial for stricture length (ICC 0.628 [0.419, 0.797]), and moderate for stricture wall thickness (0.482 [0.330, 0.601]). Intra-rater reliability was almost perfect (ICC ≥ 0.850) for all three items. A stricture severity index was derived and was well calibrated (optimism-adjusted calibration slope = 1.009), with scores calculated as the sum of stricture length (cm) + luminal diameter of pre-stenotic dilation (mm) + 5 x stricture wall thickness (mm).

Conclusion

Stricture length, prestenotic dilation, and stricture wall thickness can be reliably assessed, and are component items for a novel CTE stricture index (CTE-SI) of stricture severity for CD-related terminal ileal strictures. Additional external index validation for clinical and research contexts is required.
P314 Microscopic appendicitis in ulcerative colitis: Feasibility of ultrasonographic diagnosis
Authors: Reijntjes M , Pruijt M , Visser E , de Voogd F , d'Haens G R , Mookhoek A , Gecse K B , Buskens C J , Bemelman W A
Published: January 2023

Background

Increasing evidence suggests appendectomy as potential alternative treatment in patients with ulcerative colitis (UC), especially in those with histological appendiceal inflammation (AI). Intestinal ultrasound (IUS) is a non-invasive diagnostic modality that detects differences in the appendix between UC patients and healthy controls1. This study aimed to correlate appendiceal IUS and endoscopic findings to histopathological inflammation in resection specimens of UC patients undergoing appendectomy.

Methods

In this prospective cohort study, appendiceal IUS was performed in UC patients undergoing endoscopy and subsequent appendectomy between 2020 and 2022 in a trial for UC (NCT03912714). Primary outcome was the correlation between an increased maximal cross-sectional diameter (MCD, ≥ 6 mm) and AI in patients with a visible appendix on IUS. Presence of AI was assessed in pathology reports. Patients with fibrosis (F) were excluded from IUS analyses. Secondary outcomes included bowel wall thickness (BWT) on IUS and presence of endoscopic peri-appendiceal red patch (PARP) before appendectomy.

Results

In total, 32 UC patients who underwent laparoscopic appendectomy in study setting were included (84% female, median age 40 [IQR 27-50] years). The majority of patients demonstrated left sided disease (38%) and a mayo score ≥ 2 (88%) on baseline endoscopy. A median window between ultrasound and appendectomy of 1.2 (0.1-2.1) months was found. A total of eighteen (56%) patients were demonstrated to have AI in the resection specimen, and five (16%) patients demonstrated F. The appendix was visualised on IUS in 25 (78%) UC patients, with no difference in patients with AI (AI: 78%, no AI: 78%, p= 1.0). The overall median MCD and BWT were 5.6 [IQR 4.4-6.6] and 2.2 [1.6-2.5] mm, respectively. Patients with AI demonstrated a numerically higher median MCD (AI: [6.0 [4.2-6.8], no AI: 4.9 [4.4-5.8] mm, p= 0.3). Patients with an increased MCD were more likely to demonstrate pathologic AI, although not significant (OR: 6.0, CI 95%: 0.6-63.7, p=0.1). A minority of patients with AI demonstrated to have an endoscopic PARP: 5/18 (28%). The median MCD of patients with PARP was numerically higher (PARP: 6.0 [IQR 4.4-7.8] vs no PARP: 5.5 [4.0-6.6], p=0.5).

Conclusion

IUS is a feasible modality for assessment of the appendix. Although significance was not reached, patients with an increased MCD were more likely to demonstrate AI.

1Reijntjes MA, de Voogd FAE, et al. Intestinal ultrasound detects an increased diameter and submucosal layer thickness in the appendix of patients with ulcerative colitis compared to healthy controls - a prospective cohort study. Aliment Pharmacol Ther. 2022 Nov 1.
P321 Increased modified DUBLIN scores are associated with serious ulcerative colitis and treatment failure
Authors: Xie C , Su J , Liu L , Lin Y , Hu Y , Shi H
Published: January 2023

Background

Grading of endoscopic lesions is important for determining the severity of ulcerative colitis and developing treatment strategies, but the commonly used methods are not sufficient.This study aimed to investigate whether new endoscopic scoring systems incorporating lesions and disease extent are associated with clinical disease severity and maintainable remission.

Methods

This was a retrospective study. One hundred and ten patients with ulcerative colitis were included and eighty seven completed 12 months follow-up.Colonoscopy was performed within 1week before blood samples were taken. DUBLIN (Degree of ulcerative colitis burden of luminal inflammation) scores were calculated as the product of MES (Mayo endoscopic score) by disease extent and UCEIS (ulcerative colitis endoscopic index of severity) was used to replace MES when calculating modified DUBLIN scores.

Results

DUBLIN and modified DUBLIN scores were increased in the moderate and severe groups significantly (p<0.05). Both of increased scores contributed to the detection of serious diseases, and the clinical cut-off values of DUBLIN and modified DUBLIN were 3(AUC=0.809, p=0.001) and 7(AUC=0.815, p=0.001). They were with high sensitivity, but the specificity of DUBLIN was lower. Both scores were correlated to partial Mayo scores, CPR and ESR positively, and they were correlated to the albumin negatively (p<0.05). Higher modified DUBLIN scores (>7) were associated with an increase risk of treatment failure (HR=4.96, 95% CI 1.17-21.00, p=0.03), but there were no association between DUBLIN scores and long term remission (p>0.05).

Conclusion

Increased DUBLIN and modified DUBLIN scores were conducive to screening serious disease, but only modified DUBLIN scores had the potential to assist in making an upgraded therapeutic schedule.
P323 The Rate of and Risk of Dysplasia in Long Standing Ulcerative Colitis Patients Among Middle-Eastern Population
Authors: Altuwaijiri M , Alharbi O , Alruthia Y , Aljebreen A , Almadi M , Almalki Y , Alrashed A W , Alzahran S A , Almuhaya H , Alhowaish N , Alshehri K F , Alrushud S S , Alanazi W S , Azzam N
Published: January 2023

Background

Patients with long-standing Ulcerative Colitis (UC) are at high risk of getting colorectal cancer (CRC). Therefore, surveillance colonoscopy is recommended to minimize that risk.

Aim

To examine the rate of dysplasia alongside the clinical, biochemical and endoscopic variables associated with dysplasia among patients with long-standing UC in a university-affiliated tertiary care center.

Methods

This was a retrospective medical chart review was conducted. UC patients with a disease history of ≥ 8 years or had primary sclerosing cholangitis (PSC) and underwent colonoscopy surveillance between 2010 and 2021 were included. Patients’ endoscopic and histopathological characteristics as well as their adherence to annual surveillance colonoscopy were assessed.

Results

Two-hundred and sixty patients were included with a mean age and duration of illness of 45 years and 15 years, respectively. Most of the patients were females (55%) and did not adhere to the annual surveillance (56%). About 59% of the patients were in remission, and 48% of them had pancolitis, 35% had left-sided UC, and 17% had proctitis. The percentage of treated patients with monoclonal antibody (mAb) among those who adhered to the annual surveillance colonoscopy was twice that among those who did not adhere to the annual surveillance colonoscopy (34% vs. 17%). The odds of detecting dysplasia among those who adhered to regular annual colonoscopy was 78% lower in comparison to their counterparts who did not adhere to the annual colonoscopy (OR= 0.153, 95% CI= 0.026 – 0.90, p-value=0.0379) controlling for the presence of PSC, disease duration, history of colectomy, and baseline albumin level. On the other hand, patients with longer disease duration had higher odds of dysplasia detection in comparison to their counterparts with shorter disease duration (OR= 1.136, 95% CI= 1.038 – 1.243, p-value=0.0055).

5). .

Conclusion

Adherence to the annual colonoscopy among high-risk UC patients was associated with lower rates of dysplasia detection. However, the rates of dysplasia detection among patients with poor adherence to the annual colonoscopy were lower that the ones reported in the literature. Future studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.
P343 Eosinophilic inflammation as an indicator of the activity of the course of Inflammatory Bowel Diseases
Authors: Babayeva-Sadigova G , Asadova G , Quliyev F , Makhmudov U , Ismayilova K , Samedova T , Hasanova A , Mirzazada O , Mahammadaliyeva M , Abdulzada C , Musayev C , Iskenderov N ,   IBD
Published: January 2023

Background

Eosinophils have been identified as cells that promote immune cell infiltration in inflammatory bowel diseases (IBD). Activation of eosinophils causes degranulation, which can lead to tissue damage due to the release of toxic oxygen radicals, including eosinophilic cationic protein (ECP). The potential role of eosinophils in inflammation and fibrosis in patients with IBD remains relevant.

Purpose of the study

to study the effect of changes in the level of eosinophilic cationic protein on the activity of the course of inflammatory bowel diseases.

Methods

The study was conducted from January 2016 to April 2022, among 400 patients with IBD (MC 12 patients, women 8, men 4; UC 150 patients, women 71, men 79; CD 238 patients, women 120, men 118). Patients underwent endoscopy with biopsy sampling for pathomorphological examination, as well as laboratory blood tests (general blood count, h/s CRP, homocysteine, vitamin D, ANCA-parameters, α-THF and IL-1β, IL-4, IL -8, IL-10, IL-18, total protein, albumin, iron, ferritin, eosinophilic cationic protein (ECP), İgE; urinalysis and urinary albumin; fecal analysis and fecal calprotectin and lactoferrin.

Results

In 250 patients (62.5%) with a poor response to basic therapy, a study was conducted on ECP and in 69 cases (27.6%) the result was positive, the number of positive endoscopic manifestations was 190 (76%), the number of patients with a positive pathological conclusion for the presence of eosinophils in the biopsy material (more than 30-35 eosinophils per field of view) - 95 (38%), the number of patients with concomitant allergic diseases - 14 (5.6% / 20.2%). The level of EPC fluctuated within 29-228 ng/mL (N<24 ng/mL). Indicators for the studied parameters are presented in Table 1.

Table 1. Changes in activity in some laboratory, endoscopic and pathological parameters

During the follow-up in the group of patients with elevated levels of eosinophilic cationic protein for 6-24 months, some changes occurred: new cases of fibrosis appeared in patients with CD, as well as cases of non-response to basic therapy and, as an outcome, cases of surgical interventions in patients with ulcerative colitis (Diagram 1).

Diagram 1. Outcome of patients with elevated EPC levels

Conclusion

The increase in the level of ECP in the study group of patients was 27.6% and correlated with higher rates both in laboratory and in endoscopic and morphological activity of IBD. The study of the increase in ECP is of interest in the context of the “non-response” marker to basic therapy in IBD and in the search for new targets for treatment.
P346 Influence of diagnostic delay on ulcerative colitis characteristics at disease onset
Authors: Ramírez C , Barreiro-de Acosta M , Cabriada J L , Rodríguez-Lago I
Published: January 2023

Background

Diagnostic delay (DD) is defined as the time between the onset of the first symptoms and the definitive diagnosis of IBD. It is highly heterogeneous and it has a negative impact on the disease course. Our objective was to describe the main clinical and histological characteristics at diagnosis of UC according to the DD and its influence on clinical course.

Methods

A retrospective study compiled information from consecutive patients diagnosed with UC between January 2015 and December 2019 and included in the ENEIDA registry in our hospital. Patient and disease characteristics at diagnosis such as age, DD, disease extent, partial Mayo Score (PMS), extraintestinal manifestations (EIM), fecal calprotectin (FC), and histological characteristics at diagnosis were compiled. The role of DD was evaluated as both quantitative and dichotomous variable using Spearman correlation, chi-square and Mann-Whitney tests.

Results

A total of 146 patients (53% male; 47% former smokers; median age 46 years [IQR, 34-56]; 27% E2 and 35% E3; median FC of 289 mg/kg (IQR, 105-586) with a median DD of 2 months (IQR, 1 -4) were included. The median PMS at diagnosis was 2 points (IQR, 2-5), with higher scores in patients with shorter DD (≤2 months, median 3 points [IQR, 2-5] vs >2 months, median 2 points [IQR, 2-4]; p=0.002). Among them, 7% of patients presented at least one EIM, reported more frequently in patients with a DD >2 months (1.4% with DD≤2 vs 13.4% with DD>2 months; p=0.007; Figure A). During follow-up, 9% developed proximal disease extension.

The most frequent histological findings were cryptic abscesses (71%), with a predominantly chronic infiltrate with basal plasmacytosis (97%), epithelial irregularity (83%), decreased mucosecretion (46%), erosions (21%), and ulceration (12%). The presence of eosinophils was more frequent as DD increases (5.6% if DD≤2 vs 18% if DD>2 months; p=0.029; Figure B), whereas the degree of chronic infiltration is more severe in patients with shorter DD (94% if DD≤2 vs 82% if DD>2 months; p=0.029; Figure C).

Conclusion

DD in UC influences the severity of clinical disease activity and the rate of EIM at diagnosis. In addition, eosinophils are more frequent as DD increases, while the degree of chronic infiltrate was more pronounced in patients with shorter disease duration.
P351 Validation of anterior thigh ultrasound for screening of sarcopenia and elevated body fat in Inflammatory Bowel Disease
Authors: Mc Gettigan N , Saeidi R , Hanley M , Clarke M , O'Toole A , Morrin M , Boland K
Published: January 2023

Background

Sarcopenia (low muscle mass, strength and function) and visceral obesity are associated with adverse outcomes in inflammatory bowel disease (IBD). US measurement of thigh muscle thickness as a biomarker of muscle loss in IBD has not been validated to date. Our aim is to validate anterior thigh US for measurement of total muscle thickness (TMT) and fat thickness (FT) in IBD patients and to identify muscle thickness values associated with sarcopenia using bioelectrical impedance analysis (BIA).

Methods

A prospective study of muscle function and mass was carried out using handgrip strength testing, sit-to-stand test, B-mode US and bioelectrical impedance analysis (BIA) (SECA mBCA 525) in IBD patients attending outpatients in our centre. Sarcopenia was confirmed by ASM/H2. Stata was used for statistical analysis, p ≤ 0.05 denoted statistical significance.

Results

A total of 52 patients were included, 42% (n=22) were females with a mean age of 45.5 years. CD patients accounted for 75% (n=39). Mean BMI of females was 29.64 (SD 5.88) vs males 26.2 (SD 3.8), p=0.014. Sarcopenia was diagnosed in 16 patients (31%), 10/16 were female with a significantly lower TMT vs non-sarcopenic females (mean 3.56cm vs 4.32cm, p=0.05). ASM/H2 was lower in sarcopenic patients (mean 4.67 kg/h2 vs 8.97 kg/h2, p<0.001). Handgrip strength was lower in sarcopenic patients (mean 24.4 vs 32.1 kg, p=0.25), sit-to-stand did not differ significantly (mean 18.84 vs 13.13sec, p=0.027). Physical activity levels were insignificantly lower in the sarcopenia group (mean PAL 1.78 vs 1.85, p=0.089). TMT strongly correlated with ASM/H2 (r=0.385,p=0.005), skeletal muscle mass (mm) (r=0.368, p0.008), right leg MM (r=0.404, p0.003), handgrip strength (0.29, 0.035) and BMI (r=0.39, 0.005). FT strongly correlated with body fat (kg) (r=0.699, p<0.001), body fat % (r=0.76, p<0.001), body fat index (r=0.67, p<0.001), waist circumference (r=0.35,p0.01) and BMI (r=0.68, p<0.001). Of the sarcopenic patients, 62.5% had high body fat (n=10) which trended toward but did not reach statistical significance (p=0.08). Visceral fat was high overall with higher levels in men (3.6L vs 2.0L, p=0.009), it did not correlate with SF (r=-0.074, p=0.6). Finally, the intra-rater reliability for TMT and SF were both excellent (r=0.97, p<0.001 and 0.979 p<0.001 respectively).

Conclusion

Sarcopenia is prevalent in IBD patients. Anterior thigh US correlates with BIA and can be used as a screening tool for early loss of muscle mass in IBD patients in addition to screening for high visceral adiposity. The presence of increased visceral adiposity was high, which may have deleterious outcomes for CD patients, given its association with transmural inflammation and post-operative recurrence.
P354 Application of the clinical decision support tool to predict treatment outcomes in Crohn’s Disease patients treated with vedolizumab subcutaneous formulation
Authors: Dulai P , Lindner D , Agboton C , Alric H , Bamias G , Peyrin-Biroulet L
Published: January 2023

Background

There is a need to identify Crohn’s Disease (CD) patients who will obtain most clinical benefit from treatment with vedolizumab (VDZ), an anti-α4β7 integrin inhibitor for the treatment of ulcerative colitis and Crohn’s Disease (CD). Previously, a clinical decision support tool (CDST) has been developed and validated to guide treatment decisions in CD patients (pts) treated with intravenous VDZ.1 In this study, we aimed to test the ability of the CDST to predict clinical outcomes in CD pts receiving maintenance treatment with the subcutaneous (SC) formulation of VDZ.

Methods

Pts with moderate to severe CD receiving maintenance treatment with VDZ SC in the VISIBLE 2 study were categorized using the CDST into low (≤13 points), intermediate (>13 and ≤19 points) and high response probability groups (>19 points) based on the scoring system detailed in Table 1. Clinical outcomes evaluated included clinical remission: CD Activity Index (CDAI) ≤ 150 at Week 6, 14, 30, and 52, and enhanced clinical response: decrease from baseline in CDAI score ≥ 100 points at Week 52. All outcomes were evaluated as observed.

Results

There were 275 pts who completed induction treatment with VDZ 300 mg IV and continued into maintenance treatment with VDZ 108 mg SC until Week 52. Using the CDST, at baseline, 14 pts (5.1%) had a low, 98 (35.6%) had an intermediate, and 163 (59.3%) had a high probability of treatment response with VDZ. Due to the low number of pts in the low probability group, the low and intermediate groups were combined. At Week 6, 99 pts (61.1%) in the high probability group had achieved clinical remission vs 38 pts (33.9%) in the low/intermediate probability group (Fig 1). Rates of clinical remission in the high probability group continued to exceed those of the low/intermediate group through until Week 52 when 89 pts (86.4%) in the high probability group were in clinical remission vs 43 pts (79.6%) in the low/intermediate probability group (Fig 1). In the high probability group, 97 pts (94.2%) had an enhanced clinical response at Week 52 compared with 46 pts (85.2%) in the low/intermediate group.

Conclusion

Compared with the low/intermediate group, pts categorized by the CDST as having the highest probability of treatment response to VDZ achieved clinical remission sooner, as early as Week 6. These findings provide further confirmation of the CDST as a means of identifying pts with CD likely to benefit from treatment with VDZ in either IV or SC formulations.

References:

1. Dulai PS et al. (2018) Gastroenterology 155:687-695.e10.
P356 CRAB Score, An Indian Insight into in hospital and long-term Colectomy following Acute Severe Ulcerative Colitis (ASUC)
Authors: Varghese J
Published: January 2023

Background

Oxford and Swedish index were developed to predict in hospital colectomy in ASUC and not for long-term prediction say one to two years. Oxford index, Swedish index and other predictors of Colectomy are based on western Data. In hospital colectomy rates were also rapidly decreasing during the last two decades with the advent of rescue therapy like infliximab and cyclosporine but the colectomy rate within one or two years of ASUC is not significantly reduced. Study by Alice et al had shown that with advent of infliximab and cyclosporine rescue therapy oxford index no longer predicts in-hospital colectomy rates also in addition to its shortcoming in predicting long-term colectomy rates. Our study Aims to find out the predictors of in hospital and long-term colectomy in an Indian cohort of ASUC patients.

Methods

Prospective observational study conducted in department of Medical Gastroenterology medical college Trivandrum over a period of 5 years (2015-2020). ASUC is defined by Truelove Witts criteria Patients with ASUC were followed up for a period of 24 months to look for progression to colectomy.

Results

Total 81 patients were taken up for the study (47 males and 34 females). 15 patients progress to colectomy during the follow up period of 24 months (11 patients had colectomy done during the same hospital admission and 4 patients during the follow up period of 24 months). Among the variables analysed Albumin, CRP and Hb were significant in predicting colectomy in 24 months. On regression analysis CRP and Albumin were independent predictors of 24-month colectomy and coefficient of Beta was multiplied to albumin and CRP and total score was obtained and termed it as CRAB (CRP + Albumin) score (CRAB score = CRP*0.2 – Albumin*0.26). This score was plotted to AUROC and the score has AUROC of 0.923 and at a Score of >0.4 has sensitivity of 82 and specificity of 92% 24-month chance for colectomy following ASUC. The score was validated in a validation cohort of 31 patients and in validation cohort also at >0.4 the score has sensitivity of 83 and specificity of 96% in predicting colectomy. Those without pancolitis and those with a precipitating factor for colitis exacerbation won’t progress to Colectomy.

Conclusion

CRAB score is a simple prognostic score that can predict 24-month colectomy in ASUC patients with high sensitivity and specificity. Those without pancolitis and those with a precipitating factor for colitis exacerbation won’t progress to Colectomy.
P357 Intestinal ultrasound as a promising non-invasive monitoring tool in patients with Ulcerative Colitis
Authors: Morão B , Nascimento C , Revés J , Abreu B , Bravo A C , Saraiva S , Glória L , Torres J , Palmela C , Frias Gomes C
Published: January 2023

Background

Intestinal ultrasound (IUS) is an established non-invasive tool for monitoring disease activity in Crohn’s disease, however its value in ulcerative colitis (UC) is still less clear. Our goal was to correlate IUS features with well-established disease targets in UC.

Methods

Prospective study including patients with left-sided (E2) or extensive (E3) UC. Simple Clinical Colitis Activity Index (SCCAI), patient reported outcomes (PRO-2), C-reactive protein (CRP), fecal calprotectin (FCal) and endoscopic activity (Mayo endoscopic subscore - sMayo) were evaluated. IUS features included bowel wall thickness (BWT) and color Doppler flow (CDF), assessed by modified Limberg score. The most affected segment was selected for analysis. Clinical remission was defined by SCAAI ≤ 2, endoscopic remission by sMayo of 0 and IUS remission by BWT ≤ 3 mm and CDF=0.

Results

17 UC patients (59% males, median age 44 (20-68) years, 53% E3) were included and evaluated in 46 different time-points, with concomitant endoscopic assessment in 31 cases. Overall, 55% were in clinical remission, 30% in endoscopic remission and 22% in IUS remission. The sigmoid colon was the most affect segment by IUS (46%) and endoscopy (39%). Median BWT in the most affected segment was 4.28 (3.08-6.25) mm and 83% had a Limberg score ≥ 1. Median CRP was 0.41 (0.06-18.55) mg/dL and FCal 80 (3-8000) ug/g. There was a moderate agreement between IUS and endoscopy regarding the most affected segment (k=0.43, p<0.001). BWT showed a strong correlation with sMayo and CRP and a moderate correlation with FCal, SCCAI and PRO-2. CDF showed no significant correlations with clinical, biochemical and endoscopic features (Table 1). Patients with IUS remission presented higher rates of endoscopic remission (78% vs 10%, p<0.001) and lower sMayo scores (0 vs 2, p<0.001), together with lower FCal (21 vs 133 ug/g, p=0.01) and CRP levels (0.08 vs 0.54, p<0.01).

Conclusion

IUS features showed a significant correlation with endoscopic activity, clinical activity and biomarkers. IUS remission was associated with endoscopic remission and lower biomarker activity, suggesting that IUS is an accurate method to evaluate UC patients both with active disease and in remission.
P373 An Unusual Occurrence of Right-sided Colonic Neuroendocrine Carcinoma in Ulcerative Colitis – A case report
Authors: Alessa S , Aldraiweesh S , Albogami F
Published: January 2023

Background

It's estimated that inflammatory bowel disease (IBD) accounts for 1-2% of all colorectal cancer (CRC) cases. However, the mere presence of IBD increases the risk by 2 folds compared with the general population. It's been established that the most prevalent epithelial colonic malignancy linked to IBD is adenocarcinoma. Neuroendocrine neoplasms arising in the large intestines are extremely rare (rate <1%), even less common in association with IBD.(1)

Herein, we report a 49 years-old male with a longstanding history of ulcerative pancolitis, who was found to have a metastatic right-sided colorectal neuroendocrine carcinoma (NEC).

Methods

Case Presentation

A 49-years-old male patient, with a 13-years history of ulcerative pancolitis underwent a colonoscopy. It revealed a large ulcerated mass extending from the ileocecal valve into the proximal ascending colon highly suspicious for malignancy. Biopsy showed a large cell poorly differentiated NEC in the ascending colon. Tumor cells were positive for Synaptophysin and cytokeratin AE1/3, and a high Ki67. Serum Chromogranin A (CgA) and urine 5-hydroxyindoleacetic acid were high. Imaging was evident for a short segment circumferential wall thickening at the ascending colon and hepatic metastasis. The patient was planned to receive chemotherapy, but died before treatment.

Results

Discussion

Risk of CRC increments linearly approximately 7 years following diagnosis of IBD. After 30 years of colitis, the incidence is estimated to be around 18%. NECs in particular are not frequently encountered in association with IBD, much less right-sided.(1) Colonic NECs are usually aggressive with a Ki67 typically greater than 20%, often present with metastasis with absence of a characteristic hormonal secretion picture.(2, 3)

The incidence of NECs in association with Ulcerative Colitis (UC) is twice more frequent in males, with a mean age of 49.36, and development after a median of 15 years of UC first diagnosis. Majority of NECs were found in the left side of the colon, in the contrary to our patient. Prognosis was dismal in most cases, as most demonstrated a higher malignant potential compared to adenocarcinomas.(3)

Early diagnosis of gastrointestinal NECs poses a challenge since it lacks a specific clinical presentation. Serum CgA level correlates with the tumor burden and overall survival. Additionally, studies demonstrating the role of endoscopic surveillance in colonic NECs early detection is scarce.(1,4)

Conclusion

Thorough understanding of the condition and its risk factors is crucial for a timely diagnosis, which maximizes the likelihood of a favorable prognosis. By reporting this case, we emphasize the importance of considering NEC as a differential diagnosis of CRC in IBD, particularly in UC patients.