bluuebunny/crossref_metadata_2025 huggingface dataset:
A68 DISTAL MIGRATION OF A PERCUTANEOUS GASTROJEJUNAL DUODOPA INFUSION TUBE DUE TO BEZOAR FORMATION AT THE JEJUNAL TUBE TIP
Authors: Akman O , Duerksen D
Published: March 2021

Background

Continuous intestinal infusion of levodopa/carbidopa intestinal gel (LCIG) for the treatment of advanced Parkinson’s Disease (PD) leads to less variability in plasma drug levels and improved symptom control. Percutaneous Gastrojejunostomy (PEG-J) tube placement has a high placement success rate; however, delayed tube malfunctions occur in approximately 58% of cases within two years. A rare complication is bezoar formation at the jejunal tube tip.

Aims

To present a case of bezoar formation at the jejunal tip of a PEG-J tube that caused distal migration of the tube with gastroduodenal ulceration and required surgical extraction.

Methods

Full chart review was conducted including clinical notes, laboratory results, radiographic imaging, endoscopy reports, and surgical reports. A relevant literature review was conducted.

Results

A 57-year-old male with severe PD underwent endoscopic guided PEG-J tube insertion for continuous infusion of LCIG; intestinal administration was effective for symptom control. Two years later, he noted that the gastric tube had retracted approximately 15 cm into the stoma without external manipulation of the apparatus. Attempts to externally pull the tube back into position were unsuccessful.

The patient underwent Gastroscopy (EGD) with fluoroscopy. Contrast was used to confirm placement of the jejunal tip within the jejunum, but also showed migration of the gastric tip into the duodenum. A gastroscope was used to reposition the gastric tube in the stomach; the jejunal tube was visualized to be under traction. The bumper on the apparatus was re-positioned and external tape was used to further secure the apparatus and prevent migration.

A month later the tube had migrated again; repeat EGD showed the jejunal tube to be under traction with some resultant ulceration of the pyloric channel and duodenal bulb where the tube had been pressing against the mucosa. The jejunal tube could not be pulled back and appeared to be fixed distally. A CT scan was obtained to assess for complications and a coiled tip was seen in the proximal jejunum.

Surgical extraction of the malfunctioning tube was required. At laparotomy, the coiled tip of the feeding tube was successfully removed via enterotomy. The tube tip had coiled around itself and was encased with food materials, creating a large bezoar that was being pulled distally by peristalsis. The patient subsequently underwent insertion of a new GJ tube for ongoing administration of LCIG and has been doing well since.

Conclusions

Bezoar formation at the jejunal tip of LCIG PEG-J tubes is a rare complication and can lead to distal migration and traction related gastroduodenal ulceration. Surgical removal may be required.

Funding Agencies

None
A70 PREVALENCE OF SELF-PUBLICATION AMONG EDITORIAL BOARD MEMBERS OF GASTROENTEROLOGY JOURNALS
Authors: Verma Y , Scaffidi M A , Gimpaya N , Panjwani A , Bansal R , Li J , Elsolh K , Khan R , Grover S C
Published: March 2021

Background

Editorial self-publication refers to the practice wherein editors publish research in journals to which they serve as editorial board members. The International Committee of Medical Journal Editors (ICMJE) has detailed recommendations against the practice of self-publication. There is evidence to suggest that editorial board membership may influence the decision to publish academic papers, which may contribute to publication bias. Despite this, there have been few attempts to characterize this practice in gastroenterology journals.

Aims

To determine the prevalence of original gastroenterology research articles published by editorial board members in their own journal.

Methods

We conducted a cross-sectional study to determine the prevalence of editorial board members publishing within their own journals. A list of the top 25 highest impact factor gastroenterology journals was created through InCites Journal reports. Journals were screened to determine eligibility based on whether their primary focus included gastroenterology research and whether archives with the names and affiliations of editorial board members were available. 10 journals were selected based on these criteria. For each journal, we extracted all original research articles published in 2019 using Web of Science (Clarivate Analytics ©). Articles classified as editorial material, meeting abstracts, reviews, and clinical practice guidelines were excluded. We cross-referenced the affiliations of all authors found in each publication with affiliations of editors disclosed on the journal website. For each editorial board member, we determined the number of publications within their own journal.

Results

We identified 844 editorial board members in the 10 journals included. Overall, 337 (39.9%) of the editors had a publication in their own journal, of which, 152 (18.0%) had more than one publication. Across all journals, the median number of editors with self-publication is 27 (IQR=20.3–49.8). The median number of editors with more than one self-publication is 16 (IQR=10.0–25.3). In total, 507 (60.1%) of all editors had no publications within their respective journals.

Conclusions

Despite recommendations against this practice, our results show a high number of research publications authored by editorial board members. These results demonstrate a potential risk for publication bias. However, this study was limited by the inability to investigate beyond the prevalence of self-publication. Furthermore, the explicit implications of our results remain unclear. Further research is required to evaluate factors such as disclosures and the review process associated with increased rates of self-publication as well as its impact on publication bias.

Funding Agencies

None
A75 IMPLEMENTING A CIRRHOSIS ORDER SET: A QUALITATIVE ANALYSIS OF PROVIDER-IDENTIFIED BARRIERS AND FACILITATORS
Authors: Johnson E , Carbonneau M , Campbell-Scherer D , Tandon P , Hyde A
Published: March 2021

Background

Cirrhosis is the leading cause of mortality and morbidity in individuals with gastrointestinal disease. Multiple care gaps exist for hospitalized patients with cirrhosis, resulting in high rates of re-hospitalization (e.g. 44% at 90 days in Alberta). The Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial with an aim to reduce acute-care utilization by implementing an electronic order set and supporting education across eight hospital sites in Alberta.

Aims

As part of the pre-implementation evaluation, this qualitative study analyzed data from provider focus groups to identify barriers and facilitators to implementation.

Methods

We conducted focus groups at eight hospital sites with a total of 54 healthcare providers (3–12 per site). A semi-structured interview guide based upon constructs of the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory (NPT) frameworks was used to guide the focus groups. Focus groups were recorded and transcribed verbatim. Data was analyzed thematically and inductively.

Results

Five major themes emerged across all eight sites: (i) understanding past implementation experiences, (ii) resource challenges, (iii) competing priorities among healthcare providers, (iv) system challenges, and (v) urban versus rural differences. Site-specific barriers included perceived lack of patient flow, time restraints, and concerns about the quality and quantity of past implementation interventions. Facilitators included passionate project champions, and an ample feedback process.

Conclusions

Focus groups were useful for identifying pre-implementation barriers and facilitators of an electronic orders set. Findings from this study are being refined to address the influence of COVID-19, and the data will be used to inform the intervention roll-out at each of the sites.

Funding Agencies

Alberta Innovates
A77 A REUSABLE POLYCARBONATE BOX TO DECREASE DROPLET CONTAMINATION DURING UPPER ENDOSCOPY: A SIMULATION-BASED STUDY FOR THE COVID-19 PANDEMIC
Authors: Gimpaya N , Khan R , Gallinger Z R , Scaffidi M A , Al Abdulqader A K , Ahmed M , Gholami R , Ramkissoon A , James P D , Mosko J , Griller N , Bansal R , Grover S C
Published: March 2021

Background

Upper gastrointestinal (GI) endoscopic procedures are aerosol-generating, increasing the risk of healthcare workers (HCW) contracting Coronavirus disease 2019 (COVID-19).

Aims

To present a polycarbonate box (EndoBox) designed for use in upper GI endoscopy and evaluate its impact on the contamination of endoscopy staff during simulated procedures.

Methods

Simulated gastroscopies were performed using an upper body simulator placed in left lateral decubitus (LLD) and supine positions. The endoscopist and assistant wore personal protective equipment. Droplet exposure was measured using fluorescent abiotic surrogate particles. Two blinded observers independently viewed images from each scenario to qualitatively evaluate contamination levels. The primary outcome was the level of HCW contamination by droplets generated from a simulated cough with and without the EndoBox on the upper body simulator. The endoscopist’s ergonomic behaviour was also assessed using the Rapid Upper Limb Assessment (RULA) tool.

Results

Without the EndoBox, there was a higher level of contamination on the endoscopist when the upper body simulator is in the LLD position. A higher level of contamination was observed on the assistant when the simulator is in supine position. With the EndoBox, the contamination levels on the endoscopy staff were lower in both LLD and supine scenarios. The endoscopist’s ergonomics were rated 2 to 3 on the RULA tool when using the EndoBox.

Conclusions

The EndoBox reduces macroscopic droplet contamination during simulated gastroscopy. The endoscopist’s risk of musculoskeletal injury remained in the low risk categories as assessed by the RULA tool. Another advantage of the EndoBox design is the arch extending from the bottom that allows for removal of the box without withdrawing the endoscope. This enables rapid access to the patient’s airway if they experience respiratory distress. This study was limited by an inability to assess microscopic contamination and contamination at the level of the port or buttons when suction is applied. Within these limitations, the EndoBox may be a useful adjunct to traditional personal protective equipment.

Funding Agencies

SMHA AFP COVID-Related Innovation Funds
A81 BARRIERS AND FACILITATORS OF PEDIATRIC TO ADULT TRANSITION IN IBD: A PILOT STUDY EVALUATING THE STAKEHOLDER EXPERIENCE
Authors: Chis R , Jawaid N , Fu Y , Bollegala N
Published: March 2021

Background

Inflammatory bowel disease (IBD) is increasing in prevalence with up to 25% of IBD patients diagnosed before 18 years of age. These patients will require graduation from pediatric care to adult services. The transition of care from pediatric to adult gastroenterologists (GIs) is a purposeful transition that requires planning with involvement of all stakeholders to ensure proper transition and avoid interruption in care.

Aims

To identify the transition experiences of adult patients with pediatric diagnoses of IBD, their parents, pediatric and adult GIs and registered nurses (RNs) and identify barriers and facilitators to a successful transition.

Methods

Patients aged 18–25 diagnosed with pediatric-onset IBD were included. Semi-structured focus groups were held with 9 patients and separately with 4 parents. Questions focused on the patient transition experience, opportunities for improvement, and patient quality of life. Transition practices and expectations of 12 adult GIs, 7 pediatric GIs and 9 IBD nurses were also investigated in a series of provider specific focus groups. The groups were audio-recorded, transcribed and qualitative themes were noted.

Results

Patients: Facilitators included ease of access to adult providers outside of clinic time and parental presence in the early stages of transition. Barriers included abrupt transitions to adult care by age 18, lack of choice regarding adult GI and lack of adult nursing.

Parents: Facilitators included an extended transition period, availability of support groups/resources. Barriers related to exclusion from the transition process and lack of input on adult GI choice.

RNs: Facilitators include having champion IBD nurses on the pediatric and adult side during transition. Barriers included lack of educational tools for patients.

Pediatric GIs: Facilitators included effective communication between adult and pediatric GIs, having an emergency assessment protocol, involving families in the transition process and access to multidisciplinary resources. Barriers included prolonged wait time for transfer and lack of adult access to multidisciplinary support.

Adult GIs: Facilitators included succinct transfer summaries and formal transition programs for high risk patients. Barriers included a lack of multidisciplinary support, difficulty reaching rural areas, heavy case loads and prolonged wait time to transfer of care.

Conclusions

This study explores the stakeholder experience of pediatric to adult transition in IBD. Themes noted related to efficient communication between GIs, streamlining transfer summaries, ensuring a gradual transition process, involving parents and ensuring access to multidisciplinary resources. Identifying barriers and facilitators during the transition process can provide insight into creating a successful pediatric to adult transitions program in IBD.

Funding Agencies

None
A88 PATIENT AND PHYSICIAN PERSPECTIVE OF TELE-HEALTH IN GASTROENTEROLOGY
Authors: Tomaszewski M , Zhao B , Kim H , Enns R A , Bressler B , Moosavi S
Published: March 2021

Background

Given the social distancing measures employed to reduce the transmission of SARS-CoV-2, tele-health has rapidly expanded and is now routinely used in new patient encounters and in follow up appointments across Canada.

Aims

To determine the patient and physician perspective towards tele-health in a gastroenterology outpatient setting.

Methods

An anonymous voluntary online survey was distributed to patients who had previously undergone at least one tele-health visit in a tertiary care gastroenterology outpatient setting. A separate online survey was distributed to gastroenterologists practising across Canada.

Results

A total of 181 patients from British Columbia (59.8% female) completed the survey. The tele-health appointment was the first visit for 21.8% of patients. Appointments occurred by phone call alone (61.4%) or by video and audio software (38.6%) and started within 5 minutes of the scheduled time in 75% of visits. Patient satisfaction with the tele-health visit was high (8.54 on a scale of 0–10; 0 completely dissatisfied, 10 extremely satisfied; IQR 8–10). Most patients did not perceive a difference in likelihood of compliance compared to a non-tele-health visit (90.6%), were not concerned about the lack of physical exam during a tele-health visit (82.4%) and did not with-hold information they would have revealed in person (88.7%). After the COVID-19 pandemic, some patients would prefer tele-heath visits (39.2%), whereas others would prefer in office visits (28.5%) and the remainder were indifferent (32.3%). Post-pandemic, most patients would prefer tele-health for follow up visits (68.4%), over tele-health for all possible visits (27.9%) or no tele-health visits (3.8%).

A total of 25 Canadian gastroenterologists (28.0% female; 60% academic practice, 40% community practice) completed a separate survey. Regarding the lack of physical exam in tele-health, 44% of physicians believed this did not affect the quality of their assessment, whereas some physicians believed it had either minimally (48%) or greatly (8%) impaired the quality of their assessment. Almost all physicians (96%) perceived that patients either appreciate tele-health as much as or more than in office visits.

Post-pandemic, most physicians (96%) supported a hybrid model of both tele-health and in office visits. Appointments for follow up of benign endoscopic pathology results (96%), follow up visits (92%), consultations prior to endoscopy (76%) were deemed to be most appropriate for tele-health. Follow up of malignant pathology results (24%) and consultations for new patients (32%) were thought to be less appropriate for tele-health visits.

Conclusions

Patient and physician satisfaction with tele-health in a Canadian outpatient gastroenterology setting is high. Most patients and physicians wish for tele-health to remain available in the post-pandemic setting.

Funding Agencies

Gastrointestinal Research Institute, Vancouver, British Columbia
A92 PREVIOUS VIRTUAL CONSULTATION EXPERIENCE IS RELATED TO PRECEPTOR’S WILLINGNESS TO INVOLVE TRAINEES IN VIRTUAL CARE DURING THE COVID-19 PANDEMIC
Authors: Olayinka L , Kaplan G G , Reeb L , Panaccione R , Kroeker K
Published: March 2021

Background

The COVID-19 pandemic has accelerated the need for healthcare service reform in order to reduce the risk of transmission of SARS-CoV-2 infection between patients, healthcare providers and medical trainees. Gastroenterologists have been challenged to adopt to virtual consultations and accommodate medical trainees in their virtual clinics.

Aims

To assess the impact of virtual care on medical education during the COVID-19 pandemic

Methods

A REDCap survey was disseminated among gastroenterology providers via email. The subsection of the survey on medical education consisted of 4 questions pertaining to inclusion of trainees in virtual clinics, type of virtual clinic, observation method and an open-ended question for additional comments. Quantitative data was analyzed using IBM SPSS Statistics 27 and qualitative theme analysis was applied for short answer responses.

Results

Of the 24 respondents that completed the survey, only 6 (25%) had trainees involved in their clinics (Table 1). The type of clinic consultations conducted were telephone only (50%), a combination of telephone, video and hospital-base telehealth (33.3%) and hospital-based telehealth only (16.7%). There was an equal split between direct and indirect observations. Preceptors that had previous experience with virtual consultation prior to the pandemic, were more likely to include trainees in their virtual clinics (66.6% vs 33.4%; Fisher’s exact test, p=0.033). For preceptors who included trainees in their virtual clinics, their overall satisfaction averaged 0.51 points lower (95% CI: 0.19–0.84, p=0.004). Concerns identified were lack of trainee engagement, adequate remuneration for healthcare providers, and lack of training for trainee and preceptors on how to navigate virtual platforms.

Conclusions

This survey demonstrates that gastroenterologists with previous experience with virtual clinics are more likely to accommodate trainees in their virtual clinics. However, involving trainees seem to reduce preceptor’s satisfaction with virtual clinic. Our findings suggest that there is a need to provide telemedicine training for both educators and trainees, in order to alleviate concerns and promote its adoption as organizations seek to continue to provide high-quality medical education while providing virtual care.

Funding Agencies

None
A95 HOW ENDOSCOPY TEACHERS MAKE POLYPECTOMY ENTRUSTMENT DECISIONS IN CLINICAL AND SIMULATION-BASED SETTINGS
Authors: Jeyalingam T , Walsh C M , Tavares W , Mylopoulos M , Hodwitz K , Liu L W , Brydges R
Published: March 2021

Background

Entrustment, a central construct in competency-based medical education (CBME), represents the point at which clinical supervisors trust a trainee to perform a task independently. Many implementations of CBME involve assessing entrustment through observation of entrustable professional activities (EPAs). While EPAs are frequently assessed in both clinical and simulation-based settings, research has yet to clarify how faculty who teach endoscopy form judgments of entrustment across these two contexts.

Aims

We aimed to explore the features that endoscopy teachers report as influencing their entrustment decisions regarding polypectomy across clinical and simulation-based assessment settings.

Methods

We designed an interview-based, constructivist grounded theory-informed study involving endoscopy teachers and trainees in the University of Toronto gastroenterology residency program. Teachers completed separate EPA assessments of each trainee’s performance of an endoscopic polypectomy (colonic polyps < 1cm, Paris 0-Is or 0-Ip in morphology) in both settings. Teachers were interviewed after each assessment to explore how they made their entrustment decision within and across settings. Transcribed interview data were coded iteratively using constant comparison to generate themes.

Results

Based on 14 interviews with 7 endoscopy teachers, we found that they: (1) held multiple meanings of entrustment for polypectomy, both within and across participants, (2) expressed variability in how they justified their entrustment decisions, the related narrative, and numerical scoring, (3) held unique personal criteria for making decisions ‘comfortably,’ including authenticity of the task, variability in terms of polyp shape, location, and morphology, as well as the ability to assess trainee response to procedural complications (e.g., post-polypectomy bleeding), and (4) perceived a relative freedom when using simulation to make entrustment decisions due to the absence of a real patient.

Conclusions

We found that faculty who teach endoscopy defined polypectomy entrustment in a variety of ways, leading to variability in how they judged entrustment within and across trainees and assessment settings. The observed idiosyncrasies suggest gastroenterology competence committees cannot assume equivalence of EPA data obtained from different settings. Furthermore, educators designing faculty development for CBME will need to attend to the criteria that endoscopy teachers report they need to comfortably make entrustment decisions.

Funding Agencies

Royal College of Physicians and Surgeons of Canada
A96 GENDER DIFFERENCES IN GASTROENTEROLOGY AND HEPATOLOGY AUTHORSHIP AND EDITORIAL BOARDS
Authors: Jawaid N , Leung K , Bollegala N
Published: March 2021

Background

Women are numerically under-represented in the field of gastroenterology and hepatology.

Aims

To characterize the gender distribution of first and senior authors and editorial board members of the highest impact factor journals in gastroenterology and hepatology.

Methods

Using Clarivate Journal Citation Report 2019, the 28 highest ranked journals within gastroenterology and hepatology were selected for review, along with the Journal of the Canadian Association of Gastroenterology. Publications between January 1 to December 31, 2019 were included. Gender of board members and authors was identified using publicly available data. Spearman correlation coefficients were calculated using SPSS to assess for a relationship between editorial board, first author, and senior author gender as well as impact factor.

Results

Of 29 journals assessed with a median impact factor of 5.55 (IQR 3.72–9.10), 357 journal issues and 8036 articles were reviewed. Three journals were headed by female chief editors, constituting 7.7% of all editors-in-chief (3/39). In total, females made up 17.1% of editorial board members (n=584). Of 8036 first authors, 2547 (31.7%) were female. Of 7335 senior authors, 1390 (19.3%) were female. There were no statistically significant correlations between impact factor and gender. Chief editor gender did not significantly correlate with gender distribution of editorial boards, first or senior authors. There was a significant positive correlation between male-dominated editorial boards and male first and senior authorship, versus a significant negative correlation between male-dominated editorial boards and female first and senior authorship. A positive correlation exists for the same gender between first and senior authors.

Conclusions

Although gender distribution of female first and senior authorship approaches current distributions in the field of gastroenterology and hepatology, editor-in-chief positions and editorial board membership on journals continue to be occupied by men in higher proportions. Future endeavors such as diversity statements and mentorship may help to balance these distributions in the future.

Funding Agencies

None
A102 ADVERSE PREGNANCY-RELATED OUTCOMES IN WOMEN WITH INFLAMMATORY BOWEL DISEASE
Authors: Hanna Y , Tandon P , Huang V W
Published: March 2021

Background

Women with active inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes such as preeclampsia. Though aspirin prophylaxis is prescribed in the general population (prior to 16 weeks’ gestation) for those at high-risk of preeclampsia, its use in patients with IBD has not been established.

Aims

To determine the frequency of and risk factors for adverse pregnancy outcomes in women with IBD, and to evaluate the risk for preeclampsia and the use of aspirin for primary prevention.

Methods

All pregnant women with IBD (Crohns disease (CD), ulcerative colitis (UC) and IBD-unclassified (IBDU)) seen at Mount Sinai Hospital from 2016–2020 were retrospectively identified. Demographics, reproductive history, and IBD characteristics including therapy and activity during pregnancy were recorded. Adverse pregnancy outcomes were also identified. Active disease during pregnancy was defined as a fecal calprotectin > 250 ug/g and/or using clinical disease activity scores. Categorical variables were compared using the Chi-square (x2) test and continuous variables using the Mann-Whitney test. A two-sided p-value less than 0.05 was considered statistically significant.

Results

127 patients (66 with CD, 60 with UC, 1 with IBDU) were included with a median age of 32 years at conception. The majority were Caucasian (70.9%), married (82.7%), completed post-secondary education (69.3%), had no prior or current smoking (78.7%) or alcohol use history (67.7%), and had no other comorbidities (81.9%). 50.4% of women had a prior pregnancy. 3 had a history of preeclampsia and 15/127 were prescribed aspirin prophylaxis. 73.2% of women were in clinical remission at conception.

Compared to women with CD, women with UC were more likely to have infants with low birth weight (LBW) (p=0.031), small for gestational age (SGA) (p=0.002) and had higher rates of active IBD during pregnancy (p=0.005).

13 women with IBD developed preeclampsia (6 with UC and 7 with CD). IBD type (p=0.844) and disease activity (p=0.308) were not associated with preeclampsia. Married women (p=0.001) while those who had a preconception consultation (50/127) (p=0.009) had lower rates of preeclampsia while those with a prior history of preeclampsia had higher rates (p=0.002). Among women who developed preeclampsia, pregnancy outcomes were comparable to those who did not. Women on aspirin prophylaxis (5/13) had a higher rate of preeclampsia (p=0.012), although they were also more likely to have a history of preeclampsia (p=0.002). Aspirin use was not associated with subsequent disease activity in pregnancy (p=0.830).

Conclusions

Women receiving aspirin prophylaxis had higher rates of preeclampsia, likely owing to a higher baseline risk. Preeclampsia prevention with aspirin prophylaxis does not appear to result in disease flares but larger studies are needed to confirm this finding.

Funding Agencies

None
A104 PREVALENCE OF GHOST-AUTHORSHIP IN INDUSTRY-SPONSORED CLINICAL TRIALS
Authors: Li J , Hu M , Scaffidi M A , Gimpaya N , Bansal R , Verma Y , Elsolh K , Khan R , Grover S C
Published: March 2021

Background

Ghost-authorship involves the exclusion of individuals who have made substantial contributions to the article from the author byline. Previous studies have found that ghost-authorship is highly prevalent in industry-sponsored clinical trials. Its prevalence, however, has yet to be investigated in trials of biologics in the management of inflammatory bowel disease (IBD).

Aims

To determine the prevalence of ghost-authorship in IBD biologic industry-sponsored clinical randomized controlled trials (RCTs).

Methods

Biologic medications indicated for ulcerative colitis (UC) or for Crohn’s disease (CD) were identified using the Food and Drug Agency (FDA) database. We identified the clinical trials on clinicaltrials.gov corresponding to the data presented at the time of FDA approval. Specifically, we included the first publication for each trial to report study results for our analysis. Two authors independently identified the presence of ghost-authorship, which we defined as the exclusion on the author byline of the included RCT publication of any individuals who assisted in the writing of the trial manuscript and/or performed the data analyses.

Results

We identified a total of 28 relevant RCTs on biologic medications (10 for UC and 18 for CD), which were matched to 20 publications. We found ghost-authorship in 70% of publications (n=14); 40% (n=8) involved manuscript and protocol writing assistance from sponsor staff; 35% (n=7) involved medical writers from external companies; 15% (n=3) involved both sponsor staff and medical writers assisting in manuscript writing; and 20% (n=4) involved individuals performing data analysis or interpretation.

Conclusions

We found that ghost-authorship in industry-sponsored IBD biologic clinical trials has a moderately high prevalence, with the most common being manuscript or protocol writing assistance. A lack of transparency regarding sponsor-affiliated and/or external contributors may negatively affect the trust placed in medical research. One limitation is that data was only extracted from publications. Further evidence on ghost-authorship may be found in study protocols and registrations, which will be investigated in the future.

Funding Agencies

None
A122 WATER EXCHANGE FACILITATES HIGH CECAL INTUBATION RATE FOLLOWING INCOMPLETE COLONOSCOPY
Authors: Lin T , Tai T , Parker B , Taylor S A , Trasolini R , Perini R , Bak A W
Published: March 2021

Background

Incomplete colonoscopy is a complex problem that negatively affects the success of colon cancer screening programs. Failure to intubate the cecum is associated with a significant risk of missed colorectal cancer and increases costs through missed diagnoses and salvage investigations. Water exchange (WE) colonoscopy is associated with a high rate of patient comfort and cecal intubation (CI) and may be of value in preventing and following up on incomplete colonoscopy.

Aims

To estimate effectiveness of WE colonoscopy as initial salvage of incomplete colonoscopy.

Methods

All patients referred to the Kelowna Gastroenterology group for incomplete colonoscopy between Jan 2010 to Dec 2019 were included. Demographic, clinical, procedural, and pathological information were collected via retrospective chart review. Patients underwent WE colonoscopy by a single endoscopist. The outcomes evaluated were CI rate, sedation requirements, and adenoma detection.

Results

116 patients met study criteria and underwent WE colonoscopy after a previously failed or incomplete colonoscopy for technical reasons. The mean age was 66 years (range 21–89). 83 (72%) patients were female. 53 (46%) patients had previous abdominal surgery, and 42 (36%) had previous pelvic surgery. 65 (56%) patients had previous bowel disease. 81 (70%) patients had previously incomplete conventional air insufflation (AI) colonoscopy, 9 (8%) patients had previously incomplete WE colonoscopy, and 5 (4%) patients underwent unsuccessful combination of WE and AI colonoscopy. 17 (15%) patients had previously incomplete flexible sigmoidoscopy, and 4 (3%) patients had previously incomplete water immersion colonoscopy. The most common cause of unsuccessful CI was redundant colon (n=39, 34%) followed by strictures/angulations (n=16, 14%). 105 (91%) patients underwent repeat WE colonoscopy only, while 7 (6%) patients had combination WE and AI colonoscopy and 4 (3%) patients had concurrent gastroscopy. CI was successful in 114 (98%) patients and unsuccessful in 2 (2%) patients. 87 (75%) study patients received conscious sedation, 16 (14%) opted for no sedation, and 7 (6%) attempted no sedation then switched to conscious sedation. 5 patients (4%) required general anesthesia. CI was achieved in all 16 unsedated patients. 236 polyps were identified in 79 (68%) patients, 2 (1%) of which were malignant.

Conclusions

There is no standardized approach to incomplete colonoscopy. In this cohort of patients with previous failed attempt at colonoscopy, WE as a primary technique was associated with a high success rate with minimal need for general anesthesia and a high rate of polyp detection. A significant rate of colon cancer was identified, similar to that seen in general screening populations.

Funding Agencies

None
A123 DEFINING CROHN’S DISEASE STRICTURES USING INTESTINAL ULTRASOUND COMPARED TO HISTOPATHOLOGY
Authors: Cooper J , Koro K , Wilson S , Medellin A , Ma C , Novak K L , Seow C , Kaplan G G , Panaccione R , Lu C
Published: March 2021

Background

Fibrostenotic Crohn’s Disease (CD) is a challenging phenotype often leading to surgical resection. Diagnostic imaging is an invaluable tool to diagnose CD strictures. MRE (Magnetic Resonance Enterography) is the most widely used modality for evaluating strictures, but is limited by access and cost. The current definition of strictures is based only on MRE or CT (computed tomography). Strictures are defined as increased bowel wall thickness (BWT), narrowed luminal apposition, and pre-stenotic dilation > 3cm according to CONSTRICT MR/CT expert consensus criteria. However, this definition has not been studied in intestinal US (IUS). IUS is a cost-effective, easily repeatable, and well-tolerated tool shown to have equal accuracy to MRE in diagnosing and monitoring CD.

Aims

The objective of this study was to assess the utility of identifying strictures with IUS using CONSTRICT definition.

Methods

In this retrospective pilot study, 30 of 80 CD patients who underwent small bowel resection (gold standard for stricture diagnosis) between 2015–2019 with IUS within 6 months prior to surgery were randomly identified for chart review. IUS was performed in a fasted state without oral contrast. Data extracted included confirmed stricture on resection specimens defined as having fibrosis and prestenotic dilation. Fistulizing disease was excluded. Student’s t-tests, sensitivities, specificities, positive (PNV) and negative predictive values (NPV) were calculated for IUS in detecting strictures.

Results

Of the 30 CD patients evaluated, 20 patients had fibrostenosis on pathology and IUS reports. Only 40% (8/20) met CONSTRICT criteria for stricture diagnosis on IUS, despite having a stricture on pathology. All patients had elevated BWT and luminal narrowing, but 60% (12/20) did not have prestenotic dilation > 3cm. Mean dilation was 2.9 cm (SD 1.38) and was significantly different from the mean stricture diameter of 1.3cm (SD 0.59 cm, p=0.0001, 95% CI: 0.9–2.2). Mean BWT was 8.7 mm (SD: 2.5, range 5–15) where normal is < 3mm, and mean luminal apposition was 2.3 mm (SD 1.2, range 0.2–5.8mm). IUS has a sensitivity of 95.2% (95% CI: 76.2 - 99.9%), specificity of 66.7% (95% CI: 29.9 - 92.5%), PPV of 87.0% (95% CI: 72.5–94.4), and NPV of 85.7% (95% CI 45.6–97.7%) in detecting strictures when compared to gold standard.

Conclusions

CONSTRICT criteria for diagnosing fibrostenotic CD on CT/MR may not be applicable to IUS. In this study, only 40% of patients met criteria despite having histologic confirmed strictures. Thus, perhaps additional criteria of stricture diameter < 50% of prestenotic dilation size is most appropriate for IUS. This pilot study provides the initial data to delineate an IUS stricture definition for future validation and to inform both clinical practice and trial design.

Funding Agencies

None
A130 VIDEOCAPSULE ENDOSCOPY VERSUS DOUBLE-BALLOON ENTEROSCOPY: WHICH ONE WINS?
Authors: Li Fraine S , Langevin C , Mahdi N , Bouin M
Published: March 2021

Background

Videocapsule endoscopy (VCE) and double-balloon enteroscopy (DBE) are two endoscopic exams that permit the investigation of the small intestinal mucosa. There exists few studies that compare the diagnostic performance and results between these two diagnostic modalities.

Aims

To compare the diagnostic performance between VCE and DBE.

Methods

Retrospective study between 2016 and 2019. All patients at a tertiary care centre undergoing both VCE and DBE were recruited. Clinical and endoscopic information was compiled from patients’ medical charts as well as the indications and results of the two endoscopic exams. The patients with an incomplete endoscopy report or who were unable to complete both VCE and DBE were excluded. The results of both VCE and DBE were compared using univariate analysis.

Results

In total, 126 patients underwent VCE. Of those patients, 15 further underwent DBE (average age: 69±17, 53% female). In total, 11 patients underwent upper DBE, 3 patients underwent lower DBE, and one patient underwent both upper and lower DBE. The indications for endoscopy were: gastrointestinal bleeding (47%), iron deficient anemia (40%), and other (13%). The VCE findings were: angiodysplasia (35%), inflammation (35%), polyp/neoplasia (20%), and other (10%). The DBE findings were: angiodysplasia (41%), normal (35%), polyp/neoplasia (12%), stenosis (6%) and other (6%). In 53% of cases there was at least one finding concordant between VCE and DBE. In only 20% of cases, DBE found a new lesion that was not seen by VCE. In comparison, 33% of DBE exams were normal despite a positive findings by VCE. The discordance between exams was possibly due to the delay between both exams (average 125 days).

Conclusions

In over half of cases, there is at least one lesion consistent between both endoscopic modalities. DBE finds a new lesion that was not seen by VCE in only 20% of cases. Therefore, VCE should be the first choice in the investigation of the small intestine mucosa even though both exams seem to be complementary.

Funding Agencies

None
A150 INFLIXIMAB INDUCED EOSINOPHILIC PNEUMONITIS IN AN ADOLESCENT
Authors: Carrión-Jaramillo E , Chilvers M , Barker C
Published: March 2021

Background

Infliximab is used to induce and maintain remission of inflammatory bowel disease (IBD). Pulmonary abnormalities in IBD are rare, but comprise airway, parenchymal and interstitial lung complications. Pulmonary adverse effects reported after Infliximab include tuberculosis reactivation, invasive aspergillosis, interstitial pneumonitis, pulmonary oedema and alveolar hemorrhage.

Aims

Four cases previously reported associate Infliximab to eosinophilic pneumonitis. However, this is the first in pediatrics.

Methods

Case report of an adolescent female with IBD and a rare adverse reaction to Infliximab

Results

Our patient was diagnosed with ulcerative pancolitis, Mayo 2, initially treated with 5-ASA. Five months into therapy she was switched to azathioprine and Infliximab (10mg/kg every 8 weeks) due to worsening disease. She attained and maintained clinical and biochemical remission for the next 1.5 years. Azathioprine was stopped at the patient’s request. One month later, she presented with cough and nasal congestion but was afebrile. Peripheral eosinophilia was noted. Salbutamol and steroid inhalers were started, without improvement. She was admitted to hospital due to progressive cough, shortness of breath, and wheezing. Physical examination was otherwise unremarkable. Pulmonary function test showed FVC of 69%, FEV1 of 45% with bronchodilator effect of 12% and a FEV1/FVC of 59. Her blood work showed eosinophilia (4.42 x109/L) and an elevated IgE (4596 ug/L). Serum-specific IgE for Aspergillus was positive; but skin testing was negative. An X-ray showed marked bilateral interstitial thickening in the mid and lower zones. Chest CT showed extensive bronchiectasis with bronchial mucous plugging. A bronchoscopy with bronchoalveolar lavage (BAL) reported marked eosinophilia, negative for mycobacterium, bacterial and fungal growth. Other infectious and autoimmune etiologies were ruled out. She responded successfully to high-dose prednisone (50 mg/day). At discharge, symptoms had improved, and her pulmonary function tests were normal (FEV1 of 95% predicted and FEV1/FVC 84). Upon steroid taper, she relapsed in pulmonary symptoms, eosinophilia, as well as a flare of her IBD. Reinduction with steroids resolved her symptoms and eosinophilia. Due to her loss of response to Infliximab and pulmonary, she was switched to Vedolizumab with good response. After stopping Infliximab her lung function improved significantly (FVC of 96% predicted and FEV1 of 98% predicted) and has remained so. Peripheral eosinophilia dropped to 0.2 x109/L. Her IBD is currently in remission without any respiratory symptoms.

Conclusions

Eosinophilic pneumonitis can be a complication of Infliximab. Our patient had a delayed presentation of respiratory symptoms, 16 months after a satisfactory response to Infliximab. Although responsive to steroids, she ultimately needed to be switched to another immunosuppressive agent.

Funding Agencies

None
A155 REAL-WORLD USE OF CORTIMENT IN ULCERATIVE COLITIS: A POPULATION-BASED STUDY
Authors: Coward S , Martins K , Klarenbach S , Kroeker K , Ma C , Panaccione R , Richer L , Seow C , Targownik L E , Kaplan G G
Published: March 2021

Background

Ulcerative colitis (UC) is a relapsing and remitting disease with variable severity. BudesonideMMX (Cortiment®) was approved by Health Canada for the treatment of mild to moderate UC in July 2016. It offers the advantage of extensive first pass hepatic metabolism resulting in decreased systemic corticosteroid toxicity. Most public drug plans in Canada do not cover it, limiting its use to private insurance and self-pay.

Aims

To characterize the UC patients who use Cortiment® and explore prescribing patterns and short-term outcomes.

Methods

Population-based administrative data identified patients who were covered by the Alberta Health Care Insurance Plan and dispensed Cortiment® from August 1, 2016 to December 31, 2017. Analyses identified: age, sex, rural/urban status, Material [MDI] and Social Deprivation Indices [SDI], UC-related medications 6-months before and 10-weeks following Cortiment® dispensing, and disease exacerbation indicators (new dispense of corticosteroids, hospitalization with inflammatory bowel disease (IBD) as most responsible diagnosis, or IBD-related surgery).

Results

We identified 427 UC patients dispensed Cortiment®. The median age was 47 years (25th %: 35; 75th %: 59) and 57.4% were females. Most individuals (91.3%, n=390) resided in an urban setting, as compared to approximately 73% of all UC cases. Distribution of patients across SDI was consistent while the MDI had a higher proportion in the more well-off categories. 77.5% had a UC-related drug therapy in the 6 months prior to Cortiment® dispensing and 71.7% had a UC-related drug dispensed in the 10-weeks following. Approximately, 30% had a disease exacerbation indicators in the 10 weeks following dispensing: 24.8% new corticosteroid, 3.7% UC-related hospitalization, and <2.3% UC-related surgery.

Conclusions

Despite lack of public drug coverage, Cortiment® was dispensed across socioeconomic classes. The high dispensing within urban sites suggests that rural UC patients may have less access to Cortiment®. While a quarter of Cortiment® dispensings had a new concurrent dispensing of prednisone, <5% of these patients were admitted to hospital for a flare of UC.

Funding Agencies

Ferring Pharmaceuticals
A162 OBESITY IS A RISK FACTOR FOR THE DEVELOPMENT OF THE EXTRAINTESTINAL MANIFESTATIONS IN ULCERATIVE COLITIS, BUT NOT IN CROHN’S DISEASE
Authors: Lytvyak E , Fedorak R , Dieleman L A
Published: March 2021

Background

Several inflammatory markers have been associated with both obesity and the risk of adverse outcomes. Studies exploring obesity as a potential risk factor in extraintestinal manifestations (EIMs) development in patients with inflammatory bowel disease (IBD) are limited.

Aims

To describe the relationship between obesity and EIMs development, taking into consideration various confounding risk factors.

Methods

We performed a retrospective cohort study using data of 5,023 IBD patients diagnosed between 1954 and 2020. We collected data on demographics, clinical features, biochemistry, medications, smoking, weight status and EIMs (hepatobiliary, musculoskeletal, dermatological, urogenital, ophthalmological, and pulmonary). Obesity was defined as measured BMI≥30.00 kg/m2, prolonged steroid use – as using any corticosteroid formulations for at least 6 months. Rates were compared using Pearson’s chi-squared test with Bonferroni’s p-value adjustment. Univariate and multivariate logistic regression models were used to determine the association between obesity, potential contributing factors and EIMs.

Results

Data of 2,367 ulcerative colitis (UC) patients (47.8% females) and 2,656 Crohn’s disease (CD) patients (52.2% females), aged 18–97 (median 48.0, IQR 27.0) years, were analysed. Obesity was common among IBD patients (30.1%; 95% CI 28.7–31.6%) and the rate was higher than the Alberta’s population-based one (28.2%; 95% CI 28.17–28.23%); p=0.013. Obesity was less prevalent in the UC (28.5%; 95% CI 26.3–30.6%) vs CD cohort (31.4%; 95% CI 29.4–33.4%); p=0.049. In both cohorts, the EIMs prevalence tended to be slightly higher among IBD patients living with obesity compared to those without it (UC: 19.5% vs 16.1%, p=0.106; CD: 20.2% vs. 19.6%, p=0.767); the prevalence of specific EIMs subtypes and the proportion of IBD patients with over 2 or 3 EIMs also did not differ significantly. Among UC patients, obesity was proven to be a risk factor for EIMs development (OR 1.75, 95% CI 1.15–2.67; p=0.009), along with male sex (OR 1.90, 95% CI 1.25–2.89; p=0.02), and prolonged steroid use (OR 1.88, 95% CI 1.03–3.45; p=0.04). Among CD patients, logistic regression analysis showed that stricturing and penetrating disease behaviour (OR 1.69, 95% CI 1.04–2.75; p=0.033), iron deficiency (OR 1.55, 95% CI 1.16–2.07; p=0.003) and calcium deficiency (OR 2.43, 95% CI 1.36–4.36; p=0.003) were associated with EIMs development; obesity was not an independent or adjusted risk factor (Table).

Conclusions

In a large IBD cohort, obesity prevalence was found to be higher than in the general population. Interestingly, obesity was established as a risk factor for the EIMs development in UC, but not in CD. Our findings highlight the need for timely assessment and management of obesity in these disorders, which may help in preventing EIMs development.

Funding Agencies

AbbVie