bluuebunny/crossref_metadata_2025 huggingface dataset:
2794 Subtotal Cholecystectomy Outcomes
Authors: Chum Christopher , Mun Michael , Bernstein Michael , Trillo John , Chaudhury Samiran Roy , Choudhry Mohammad K. , Rasheed Ahmed Daniyaal
Published: October 2019

INTRODUCTION:

Subtotal cholecystectomies have become a viable alternative to converting laparoscopic cholecystectomies to open cholecystectomies in complicated gallbladder etiologies. There are two subtypes of subtotal cholecystectomies: fenestrating and reconstituting. Fenestrating subtotal cholecystectomy requires an internal suture of the cystic duct with removal of most of the gallbladder. Reconstituting subtotal cholecystectomy creates a gallbladder remnant. Bile leak is a common adverse outcome of subtotal cholecystectomies. ERCP is the standard intervention for high output bile leaks.

METHODS:

This was a retrospective analysis of patients at Coney Island Hospital who underwent any cholecystectomy during January 2010 to December 2018. The inclusion criterion was patients who underwent subtotal cholecystectomy. The exclusion criteria was any patient who underwent prior ERCP or sphincterotomy. We reviewed patient’s age, initial WBC, alkaline phosphatase, total bilirubin, AST, ALT, total output of JP drain, duration of JP drain, and hospitalization length. Data was analyzed using XTabs, ANOVA, and T-test using Prism and SAS software.

RESULTS:

1423 cholecystectomies performed at Coney Island Hospital during this period. Of these, 106 were subtotal cholecystectomies: 11 were reconstituting and 96 were fenestrating. 34 subtotal cholecystectomies required ERCP intervention. Fenestrating subtotal cholecystectomies were associated with higher total bile output from JP drain and longer duration of JP drain. Cases requiring ERCP intervention were associated with larger bile output from JP drain, higher total bilirubin, and longer hospitalization duration. 68 of the fenestrated subtypes were left with an open cystic duct without internal closure.

CONCLUSION:

ERCP has been demonstrated to be an effective intervention in treating post operative bile leaks in cases showing large JP drain output and increased total bilirubin on initial presentation. However, a majority of subtotal cholecystectomies can be managed without intervention. We noted that 68 of the 96 fenestrating subtotal cholecystectomies had the cystic ducts remain open instead of the traditional internal suture. Cystic duct obliteration or severe inflammation may impede suturing. Regardless, close monitoring of JP drain output is recommended. Our research concludes that there are better outcomes with reconstituting subtotal cholecystectomies and fenestrating subtotal cholecystectomies in which there was an internal suture placed at the cystic duct.
2798 Meta-Analysis and Systematic Review of Initial Endoscopic Therapy for Cholangitis
Authors: Lee Alice A. , Buitrago Carlos A. , Chang Patrick , Hiramoto Brent , Hilson Liam , Kankotia Ravi J. , Yeh Jeffrey , Nguyen Stefan , Schilperoort Hannah M. , Wani Sachin , Buxbaum James L.
Published: October 2019

INTRODUCTION:

The initial endoscopic treatment of ascending cholangitis is controversial. It has been proposed that management should be limited to decompression alone while the alternative is to additionally perform sphincterotomy and/or stone removal to address the underlying etiology. Our aim was to compare the effectiveness and safety of endoscopic decompression alone to decompression combined with other endotherapy for ascending cholangitis.

METHODS:

We systematically searched Embase, Medline, the Cochrane Library, and ClinicalTrials.gov from inception to April 22, 2019. Studies were screened by two independent reviewers using Covidence software and standardized extraction forms. We included trials that compared endoscopic decompression and decompression combined with other endotherapy. Our primary outcome was the odds of effective decompression by decompression alone versus combined with other endotherapy. Our secondary outcome was the odds of adverse events (post ERCP pancreatitis, hemorrhage, mortality). Pooled odds ratios and proportions were estimated using the random effects model for the two approaches.

RESULTS:

10,508 abstracts and 256 full text documents were reviewed. Six comparative reports of decompression alone versus decompression with other endotherapy were included in the meta-analysis. These studies capture the results for 462 patients; 205 underwent endoscopic (stent or nasobiliary) decompression alone and 257 decompression plus other endotherapy.

There was no difference in success of cholangitis therapy for decompression combined with sphincterotomy and other therapeutic maneuvers as opposed to decompression alone (OR 1.3 [95% CI 0.3-5.6]); there was also no difference in mortality (OR 0.4 [0.4-7.3]). There were more adverse events for decompression combined with sphincterotomy and other maneuvers (OR 2.5 [1.0-6.5]) driven by a higher rate of bleeding (OR 9.1 [2.4-34.7])(Figure 1); there was no difference in rates of post ERCP pancreatitis (OR 0.7 [0.2-2.1]).

CONCLUSION:

In cholangitic patients, the addition of therapeutic maneuvers including sphincterotomy to biliary decompression is associated with higher rates of adverse events and particularly bleeding compared to decompression alone. Nevertheless, the included studies did not account for adverse events during subsequent ERCP to remove biliary stones in those initially managed with decompression alone. In cholangitic patients who are coagulopathic or would not tolerate adverse events, decompression alone should be considered.
2805 Targeted Interventions Improving Compliance With Guideline-Based Care in Acute Pancreatitis
Authors: Sydor Michael , Roark Russell , Samuel Ronald , Chatila Ahmed , Nguyen Bao , Dayah Rawan , Marcondes Felippe O. , Khowaja Tehmina , Kaushik Chandni , Faruqi Jordana , Garza Rigoberto , Agarwal Mayank , Biggs Sarah , Tambra Sarah , Kline Kevin , Bilal Mohammad , Olino Kelly , Parupudi Sreeram , Sonstein Lindsay
Published: October 2019

INTRODUCTION:

Acute pancreatitis (AP) is the 3rd leading cause of GI related hospitalizations nationwide. In an effort to improve guideline-based care at our institution, we acquired retrospective data from 247 patients admitted to our institution between April 1, 2015 to September 30, 2017 with AP. We identified multiple areas in which to improve care based on the American College of Gastroenterology (ACG) Guidelines: intravenous fluid (IVF) resuscitation, right upper quadrant ultrasound (RUQ-US) use, and antibiotic stewardship in patients admitted with AP. We aimed to increase the percentage of AP patients who receive adequate IVF resuscitation in the first 24 hours from 6.4% to 50%, increase the RUQ-US rate from 59.5% to 80%, and decrease the rate of inappropriate antibiotic use from 24% to 10%, by April 1, 2019.

METHODS:

Within the internal medicine department, a quality improvement group was assembled. Barriers to implementing guideline-based care within our target areas were identified. We then implemented interventions aimed at improving performance in our three focus areas. The interventions included: house staff education, development and implementation of an AP admission order set within the electronic medical record (EMR), meeting with the emergency department to encourage early fluid resuscitation, distribution of a management flowsheet to house staff work rooms, and the antimicrobial stewardship program (ASP) including patients with AP who meet criteria for inappropriate use (on antibiotics for >48 hours without evidence of intrapancreatic or extrapancreatic infection) in their EMR based communication. We tracked our progress utilizing a real-time patient monitoring software.

RESULTS:

On April 1, 2019, a total of 35 patients were captured after the start of our interventions. Appropriate IVF resuscitation [defined as >250cc/hr of normal saline or lactated ringers (6L in the 1st 24 hours)] improved from 6.4% to 20%. RUQ-US obtained on admission improved from 59.5% to 71.4%. Inappropriate antibiotic use decreased from 24% to 11.4%.

CONCLUSION:

While improvements in appropriate IVF resuscitation, RUQ-US rate, and antibiotic stewardship were noted, we have not yet met our goals. We aim to build on this progress through increased utilization of the AP order set, and the ASP will continue to monitor and intervene for inappropriate antibiotic use in AP patients. We intend to evaluate pre and post intervention 30-day readmission rates and length of stay.
2806 Viral-Induced Acute Pancreatitis: A Systematic Review
Authors: Imam Zaid , Simons-Linares Roberto , Chahal Prabhleen
Published: October 2019

INTRODUCTION:

Infectious (viral, bacterial, and fungal) etiologies are rare causes of acute pancreatitis (AP). We sought to investigate the frequency of viral-induced AP (VIAP), describe its natural course, and clinical features.

METHODS:

A comprehensive review of PubMed’s database of English language from the time of its inception and until April 12th,2019 was performed using all relevant MeSH (medical subject headings) keywords. AP diagnosis and severity were defined as per the Revised Atlanta Classification (RAC). Viral infections were diagnosed by serology and/or histology. A diagnosis of viral infection, with a concurrent AP diagnosis, a temporal resolution of both entities and the attempt to exclude the most common etiologies of AP defined VIAP. Graft pancreatitis studies and non-English publications were excluded. Two independent blinded reviewers (Z.I, C.R.S.L.) reviewed the publications. Bias risk was assessed with the Murad tool derived from the Newcastle-Ottawa scale.

RESULTS:

209 cases were identified in 128 publications meeting criteria for VIAP and were reviewed (2 case control, 120 case reports, 6 case series) (Figure 1). Most studies 101 (78.3%) were at high risk of bias. Mean age was 38.9 ± 1.28 yrs for 170 patients. Male to female ratio was 2.2:1, and 52 (28.0%) of 186 patients were immunocompromised. Mean lipase was 1590 (range: 61-16879) and mean amylase was 1237 (range: 33-14800) in 103 and 156 patients. Viral hepatitis (A,B,C,D and E) was the most common virus and accounted for 34.4% of reported cases, followed by coxsackie and echoviruses at 14.8%, hemorrhagic fever viruses at 12.4%, CMV at 12.0%, VZV at 10.5%, mumps and measles at 3.8%, primary HIV infection at 3.8%, HSV at 1.9%, EBV at 1.9% and the remainder of cases (1.9%) attributed to adenovirus, influenza H1N1, and multiple viruses were implicated in 1% of cases. Severity of AP was: 43.1% mild, 11.7% moderately severe, 32.4% severe. Death was reported in 42 (20.1%) patients. Patient characteristics are summarized in Table 1.

CONCLUSION:

Although majority of patients were not immunocompromised (72%), a significant portion were immunocompromised (28.0%). Importantly, among those who died, 71.4% were immunocompromised. Mortality rate was higher than that reported for AP from other etiologies in the literature. Cholangiopathy and obstruction, direct acinar injury by viral replication are suggested pathogenesis mechanisms for virus attributed AP.
2823 Spleen Rupture Secondary Colonoscopy Is a Rising Epidemic
Authors: Ullah Waqas , Mehmood Asif , Rashid Mamoon Ur , Zafar Yousaf , Ahmed Ishtiaq , Hurairah Abu
Published: October 2019

INTRODUCTION:

Colonoscopy is a safe and routine procedure to evaluate large bowel for diagnostic and therapeutic purposes. Common post procedure complications include bleeding and perforation of gut but rarely splenic Injury.

METHODS:

A structured search on four databases was done and 68 articles were selected. Three reviewers extracted data into the excel sheet identifying the reason of colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcome of all patients with spleen injury.

RESULTS:

The mean age of all the patients was 62.7 SD 15.7 years, 36% male and 64% female. About 22% had a complete splenic rupture with colonoscopy while 63% had subcapsular hematoma, spleen laceration and spleen avulsion. The most common reason was screening colonoscopy (46%) followed by diagnostic colonoscopy (28%). About 87% patients presented with abdominal pain. Patients with spleen rupture mostly required splenectomy (47%). While minor spleen hematomas and lacerations were managed conservatively (38%). Interestingly, 6% patients were managed with proximal splenic artery splenic embolization (PSAE) and 4% were managed with laparoscopy. The overall mortality was about 10% while 77% had successful recovery. The reason of colonoscopy against presentation specifically abdominal pain showed no statistical significance P = 0.69. Spleen rupture and injury were the most common reason was screening colonoscopy followed by colonoscopy done for bleeding evaluation (not statistically significant). There was no significant association found between the reason of colonoscopy and type of spleen injury management (P 0.89). It is interesting to note that significantly high (74%) of the spleen rupture patients were managed with splenectomy while the rest were managed with conservative management in spleen injury group (P value 0.04) (Figure 1). The strength of association between the management and spleen injury was moderately strong at at a cramer’s V 0.34. The Fisher exact test for the type of spleen injury with the outcome was significant (P = 0.028) indicating a high mortality with spleen rupture.

CONCLUSION:

Spleen rupture due to colonoscopy is an increasing concern and should physicians should be aware of it as it has been associated with a high mortality. The management of the patients can be individualized based on clinical settings.
2841 Sex, Educational Status, and Compliance With Scheduled Out-Patient Screening Colonoscopy Among Under-Served Urban Blacks
Authors: Laiyemo Adeyinka , Kwagyan John , Williams Carla , McKie Charmaine , Castor Chimene , Brim Hassan , Lee Edward , Ashktorab Hassan
Published: October 2019

INTRODUCTION:

Black men suffer the highest burden from colorectal cancer in the United States. It is generally believed that women are more health conscious than men, but it is unknown if educational status influence compliance by sex among underserved minorities. Aim: To evaluate sex differences in compliance with scheduled screening colonoscopy appointments among underserved urban blacks and investigate the effect of the highest education attained.

METHODS:

Methods: A total of 399 black patients participated in a clinical trial (NCT02464618) designed to evaluate the efficacy of self-selected social contact person in improving compliance to scheduled outpatient screening colonoscopy. The primary outcome of our present study was compliance with the scheduled outpatient screening colonoscopy among attendees by sex and highest education attained. We used logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS:

There were 188 (47.1%) black men and 211 (52.9%) black women. Overall, there was no sex difference in compliance with the scheduled colonoscopy appointments (77.3% versus 77.1%; OR = 1.01; 95% CI: 0.63-1.61). However, participants with some college education were more compliant (84.1% versus 73.1%; OR = 1.95; 95% CI: 1.15-3.30). This improvement in compliance was more evident among men (Table 1).

CONCLUSION:

Conclusion: Efforts to improve general and cancer specific education of black men are needed to reduce the burden of colon cancer among this vulnerable population.
2843 Lack of Knowledge About Follow-Up Colonoscopy in Patients With Biopsy Proven Advanced Colorectal Polyps: A Major Clinical and Medicolegal Challenge
Authors: Rothschild Evin , Fiedler Benjamin , Fiedler Lawrence , DeDonno Michael , Fiedler Lawrence , Cruz Leonie de la , Fiedler Lawrence , Hennekens Charles H.
Published: October 2019

INTRODUCTION:

The most recent guidelines from the American College of Gastroenterology recommend that patients with biopsy proven advanced colorectal polyps undergo repeat surveillance colonoscopy at a minimum of three years following resection. The rationale is based on rates of recurrence and progression to colorectal cancer. In this report we quantitate the knowledge of patients with biopsy proven advanced colorectal polyps about if, and when, they need a repeat colonoscopy.

METHODS:

Methods: Written informed consents were obtained and brief telephone interviews conducted by trained interviewers among 84 patients with biopsy proven advanced colorectal polyps. In semi-structured questionnaires that included eleven questions the patients provided self-reports about their awareness of the need to have a repeat colonoscopy as well as the proper surveillance interval.

RESULTS:

Among the 84 patients, who ranged in age from 41-91 years, 24 (28.6%) were unaware of either the need for a repeat colonoscopy or the proper surveillance interval. These included 10 (12.0%) who were not even aware that they required a follow up colonoscopy and 14 (16.6%) who were unaware of the proper three year interval.

CONCLUSION:

Discussion: These data pose medical and legal challenges to clinicians to educate patients with biopsy proven advanced colorectal polyps about their need for repeat colonoscopy as well as the proper surveillance interval to reduce their risks of colorectal cancer. Specifically, without proper knowledge of the advanced colorectal polyp three year surveillance protocol, 28.6% of these high risk patients would have forgone or delayed the colonoscopy. With advances in technology and digitized medical records, clinicians may need to rely on a more objective and reproducible centralized database of past colonoscopy findings rather than self-reports. These clinical and medicolegal challenges may also be addressed, at least in part, by automated recalls that ensure there is a safety net to remind patients of their subsequent colonoscopy appointment. The success of these strategies will depend on meticulous attention by the clinician to ensure accurate data pertaining to guideline based appropriate surveillance intervals for colonoscopy. These strategies may also reduce any overutilization of colonoscopies. Of far greater import, the achievement of this goal may reduce morbidity and mortality from colorectal cancer in high risk patients with advanced colorectal polyps.
2849 An Initiative to Optimize Bowel Preparation Quality
Authors: Jacob Bobby , Cusano Elizabeth , Yeroushalmi Kevin , Karim Syed , Wankhade Charudatta , Khan Nausheer , Rizvon Kaleem , Mustacchia Paul
Published: October 2019

INTRODUCTION:

Colonoscopies are an imperfect screening tool with a miss rate of approximately 2-6% of pre-cancerous and/or cancerous lesion. Variations occur amongst endoscopists in performance of colonoscopies; therefore, quality indicators are established in order to provide consistent high quality health care. Bowel preparation quality affects the completeness of the examination, procedure duration and need to cancel or repeat procedures at earlier dates than would be otherwise be needed. Inadequate preparation is a major contributor of missed lesions leading to decreased adenoma detection rates (ADR) and medical costs.

METHODS:

We performed a retrospective review of all colonoscopies preformed from May 1, 2018 to September 30, 2018 to assess our baseline rates of poor bowel preparation quality using the Aronchick bowel preparation scale. An initiative to improve the quality of our bowel preparation rates through re-designing the educational material distributed to patients undergoing colonoscopies and implementing a two-day call reminder system. We then performed another retrospective analysis from October 1, 2018 to February 28, 2019 with the above changes to our practice. We then compared the rates of poor preparation before and after the implemented modifications of counseling patients, as well as the rates of adequate preparation in the subset of patients undergoing colonoscopy for the indication of screening for colorectal cancer.

RESULTS:

We assessed our baseline rates of adequate preparation of all colonoscopies to be 86% pre-intervention. Post-intervention with re-designed education material and two-day call reminder system has improved our adequate preparation rate to 93.3%. Of all the colonoscopies preformed with the indication as screening colonoscopies the pre-intervention adequate preparation rate was 84.3% and post-intervention adequate preparation rate was 86%.

CONCLUSION:

Healthcare professionals involved with colorectal cancer screening should focus on improving patients understanding and compliance with appropriate bowel preparation prior to screening colonoscopy through effective communication, phone call reminders and educational material, which can be easily comprehendible. Socioeconomic factors and language barriers in some patient populations may require increased educational efforts before the colonoscopy to achieve this level of success. Compliance with quality measures will allow for effective and safe CRC prevention, better patient outcomes and decreased medical costs.
2858 Effervescent Granules Are an Effective, and Cost-Saving Strategy in Acute Esophageal Food Impaction
Authors: Al-Jashaami Layth , Narang Aneesh T. , Baron Robert L. , Gerkin Richard D. , David Joseph
Published: October 2019

INTRODUCTION:

Acute esophageal food impactions (AEFI) are common. Effervescent granules (EG) consist of sodium bicarbonate and citric acid and create carbon dioxide (CO2) gas in the esophagus, which can raise the intraluminal pressure and force the bolus into the stomach. There are little published data describing EG in the treatment of AEFI. The primary purpose of this study was to evaluate the effectiveness and safety of EG in the emergency department (ED) setting in adult patients presenting with AEFI. Secondary objectives are to determine cost associated with EG, and to see if there are any patient characteristics that may predict successful response.

METHODS:

A prospective chart review of patients presenting to the ED with AEFI in a large tertiary referral teaching hospital, as well as from 2 sister community hospitals in the same metropolitan area from January 1, 2016 to December 31, 2018 was performed. Inclusion criteria were age 18 and older and clinical diagnosis of AEFI. Data collected included patient demographics, outcomes, cost and complications. Mann-Whitney testing was used to compare groups. Logistic regression was used to determine predictors of effectiveness. Successful response was defined as clearance of the food impaction avoiding the need for emergent endoscopy.

RESULTS:

Sixty AEFI presentations met inclusion criteria with mean age of 51.0 years (+/- 18.4) and mean BMI 29.1 kg/m2 (+/- 6.6). Other demographic variables are shown in Table 1. A total of 33 patients (55.0%) who received EG responded successfully. The median hospitalization cost associated with EG success was $1,743 (IQR $976-$2,427). For patients who failed to respond to EG, the median cost was $13,224 (IQR $10.563-$18,933) (P < 0.001). Of concern, there were 2 cases of esophageal perforation that both occurred in patients who failed to respond to EG but were only noted after EGD. One healed with conservative therapy (NPO, antibiotics) and the other with placement of a covered esophageal stent. Both made a full recovery.

CONCLUSION:

Effervescent granules are an effective and cost-saving initial strategy in the treatment of acute esophageal food impaction. Further study of the safety and effectiveness of effervescent granules is warranted.
2860 Safety of Esophageal Dilation in Patients With Eosinophilic Esophagitis in a Single Center Cohort
Authors: Zhao Weidan , Ali Asad , Rosenstengle Craig , Shan Kuangda , Dayan Yehudith Assouline
Published: October 2019

INTRODUCTION:

Eosinophilic esophagitis (EoE), a chronic immune-mediated disorder, is a leading cause of food impaction due to fibrotic formation of rings, narrowing, and strictures. Historically, esophageal dilation (ED) was reserved as second-line therapy for EoE after failure of medical management, due to concern of complications, mainly perforation. Now, ED is recognized as an effective treatment for symptomatic relief. The aim of this study is to assess the safety of ED in a large cohort of EoE cases in a single center.

METHODS:

A retrospective review of patients with biopsy confirmed EoE at University of Iowa Hospitals and Clinics between the years 2006 – 2018 was conducted. All subjects met diagnostic criteria for EoE; presence of esophageal dysfunction and mucosal eosinophilic infiltration (≥15 eos/hpf). Histologic and clinical features, ED characteristics and related complications, and self-reported symptomatic improvement were extracted via chart review. Descriptive statistic with univariate analysis was performed.

RESULTS:

A total of 160 patients were dilated 295 times, ranging from 1-12 dilations per patient, with an average of 1.91 dilations per patient. 67 patients (41.88%) required >1 dilation. Procedures were generally tolerated well, with no major bleeds or perforations. The overall complication rate was 6.1%, primarily due to post-procedural chest pain (4.8%). Three patients had sedation related complications: one aspiration pneumonia and two ICU admissions for respiratory distress. Clinical improvement was documented in 87% of dilations on follow up. Table 1 and Figure 1 and 2.

CONCLUSION:

The prevalence of EoE is increasing with rates of 0.5 – 1 cases per 1000 individuals, with 25-35% of these patients requiring ED for symptomatic management. In the early 2000s, many reports suggested an increased procedure-related risk, including esophageal perforation. Recent systematic review and meta-analysis have shown otherwise. Present published rate of perforation in dilation in EoE occurs in < 0.3% of procedures, which approximates that of dilation for other benign esophageal indications. Our study is consistent with current data. Taking the above safety data of ED into account along with the rising incidence of EoE, lends evidence to the acceptance of ED as a safe and effective treatment. ED should therefore be considered a safe procedure in EoE patients for symptomatic management in addition to dietary and pharmacological interventions.
2876 YouTube Videos on Irritable Bowel Disease: A Qualitative Analysis of Views and Content
Authors: Azawi Muaataz , Homsi Maher , Syed Umer , Walfish Aaron
Published: October 2019

INTRODUCTION:

IBS is a functional disorder of the GI tract. It accounts for 25-50% of all referrals to gastroenterologists in the US, ranking it as the second highest cause of work absenteeism. Patients tend to use the internet, and particularly social media sites, to learn more about their medical condition. YouTube being one of the largest search engines, has grown its popularity as a go-to health-related source of information. This study aims to evaluate the quality of material available for IBS patients.

METHODS:

Youtube.com main page was queried for the search term “Irritable Bowel Disease”. The resulting videos were evaluated for content, duration, source, and audience interaction: number of views, likes, and dislikes. Content was classified as useful, misleading or patient’s views/experience. Useful videos were further analyzed for content using the published DISCERN instrument with 16 questions each consists of 5-point scale for assessing the quality of health information.

RESULTS:

The search phrase “Irritable Bowel Disease” recaptured thousands of videos sorted by default filter of “relevance.” The top 20 videos were analyzed as these are the videos that patients were likely to view by visitor statistics. On average, videos had 5:41 minutes duration, 184892 views, 1471 likes, and 81 dislikes. 50% of videos were from health care professionals, 30% from health care organizations, 10% from individuals/patients, 5% clips from TV shows, and 5% non-professional educational groups. 60% of the videos were classified as useful. Wheres 25% were misleading, 10% were irrelevant, and 5% were patient experience. Useful videos scored an average of 2.8 out of 5 on the DISCERN scale indicating fair quality. 66% of the useful videos were from health care professionals with average DISCERN score of 2.6 out of 5. 33% were from health care organizations with an average score of 3.3 out of 5.

CONCLUSION:

Despite YouTube being the fastest growing shared videos website, it lacks qualitative videos about a very common disease such IBS. As one of the largest online references for many patients, healthcare organizations can utilize this platform to correct misconceptions about the disease. Although the majority of the top 20 videos were created by healthcare professionals, it is advisable to improve their content quality and given the prevalence of misleading videos, patients should exercise extra caution towards these information and verify it directly from a healthcare provider.
2878 Assessment of Mobile APP for Constipation and Incontinence: Randomized Crossover Study in Healthy Subjects
Authors: Yan Yun , Jimenez Enoe , Karunaratne Tennekoon , Sharma Amol , Parr Rachael , Herekar Anam , Eubanks Audrey , Sanku Amalesh , Rao Satish
Published: October 2019

INTRODUCTION:

An accurate history is important for diagnosis, treatment and clinical decision making but patients with bowel problems cannot accurately recall or quantify stool habit. We determined whether an electronic mobile phone APP can reliably and accurately records bowel symptoms of constipation and fecal incontinence (FI), when compared to paper form stool diary in healthy subjects.

METHODS:

Healthy subjects were randomly assigned to complete either a paper diary or 2 mobile phone APPs (separate for FI and constipation) for 2 weeks each, in a crossover study. The APP has approximately 10 questions each that assess severity of symptoms, bowel habit, stool consistency etc. Usability of APP versus paper form diary was assessed after 4 weeks. Intraclass correlation coefficients (ICC) assessed equivalence.

RESULTS:

Ten healthy subjects (34.7 ± 4.1 years, F/M = 6/4) participated. The number of BM, spontaneous (SBM), and complete spontaneous bowel movement (CSBM), over 2 weeks showed strong correlation between APP and paper form diaries, and for all questions related to either FI or constipation (ICC >0.79) (Table 1). Although mean stool consistency was strongly correlated with paper diary, the number of hard (BSFS1-2) and normal (BSFS3-4) stools were moderately significantly correlated with paper diary, possibly because of day to day variability in normal stool pattern. No leakage episodes were recorded in both FI APP and paper diary. The urgency of BM in FI APP was significantly associated with paper diary. The number of gas and bloating episodes ranged rom 0.8 to 2.5 in both APPs and paper diary. The VAS scores for functionality and usability for electronic APP were significantly higher (P < 0.027) compared to paper diary, and 90% of subjects preferred (P < 0/001) the APP (Table 2).

CONCLUSION:

The mobile APPs for FI and constipation were reliable, reproducible and useful and strongly correlated with paper diary. However they were strongly preferred by the subjects over paper form. These APPs could aid screening and assessment of bowel function in patients with FI and constipation but require validation for clinical or research use.
2885 Reducing Anxiety in Patients Undergoing First-Time Colonoscopy: A Pilot and Feasibility Study for a Randomized Controlled Trial
Authors: Albashir Siwar , Durepos Pamela , Causada-Calo Natalia S. , Mangat Ramandeep S. , Nowakowski Matilda E. , Kaasalanien Sharon , Anglin Rebecca , Moayyedi Paul , Armstrong David
Published: October 2019

INTRODUCTION:

Patients undergoing colonoscopy may experience pre-procedure anxiety, which is associated with increased pain and might affect the willingness to undergo subsequent studies. We hypothesised that a brief psychological intervention would reduce anxiety before colonoscopy. The aim of the pilot study was to evaluate the feasibility of conducting a randomized, controlled trial (RCT) of the efficacy of a psychological intervention (PsI) in reducing anxiety levels in adult patients undergoing first-time colonoscopy under conscious sedation.

METHODS:

We performed a mixed method, double-blinded RCT of adult patients undergoing first-time colonoscopy. Eligible patients were randomized to a PsI vs. sham PsI. The primary outcome was feasibility, with success defined a priori as recruitment rate >50%. All participants had an anxiety assessment pre- and post-intervention using State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) score.Pre- and post-intervention scores were compared within and between groups. Secondary outcomes included sedation dose, patient comfort, cecal intubation rate and willingness to repeat colonoscopy.

RESULTS:

In total, 130 patients were recruited from 180 eligible participants (72%). Eighty were randomized and completed the study (44%).Failure to randomize recruited patients was due to logistical scheduling issues after patient arrival (26/50: 52%). Baseline characteristics were similar among groups (Table 1). In the PsI group, pre- and post-intervention median STICSA scores were 29 and 24 (P < 0.001), respectively. In the sham group, pre and post median scores were 31 and 25 (P < 0.001), respectively. There were no significant differences between the groups for any other secondary outcomes (Table 2). Although not statistically significant, the PsI group had fewer patients unwilling to repeat a colonoscopy and a higher cecal intubation rate than the sham PsI group.

CONCLUSION:

We have shown that it is feasible to recruit patients to an RCT evaluating PsI in colonoscopy and identified potentially remediable administrative challenges that reduced study completion rates. In addition, anxiety scores in both groups improved following colonoscopy although we did not observe a significant difference between treatment arms. Both findings are key to adjust future study design (e.g. a third arm that receives usual care). Currently, a qualitative assessment is underway to evaluate participant and staff acceptance of the study design and intervention.
2886 A Quality Improvement Curriculum for First Year Gastroenterology Fellows Associated With Improved Efficiency in the Endoscopy Unit
Authors: Kaminsky Thomas J. , Bank Jeffrey S. , Gawron Andrew J. , Iriana Sentia , Voaklander Rebecca , Johnson Jessica , Byrne Kathryn R.
Published: October 2019

INTRODUCTION:

A teaching endoscopy unit is a dynamic setting, with many interrelated parts. Its fundamental mission is to provide quality care to patients while facilitating the development of physician learners. This requires that teaching cases be safe and effective, but also timely. We implemented a Quality Improvement (QI) curriculum in the Salt Lake City Veterans Affairs GI Endoscopy Unit with a focus on workflow efficiency.

METHODS:

We implemented a year-long quality improvement curriculum in the Endoscopy Unit. This was carried out by rotating first-year fellows and faculty mentors with input from technical and nursing staff. Initial efforts were aimed at identifying areas of inefficiency. Pre-intervention data was collected from fifty eight appointments over three months using recording sheets. Time points were noted as patients underwent each phase of their GI procedures with moderate sedation (e.g. appointment, check-in, intake, consent, in-room, scope in). Forty three appointments were analyzed, while fifteen were incomplete and were omitted. Our primary measure was patient check-in time to patient in-room time. Procedures were defined as “on-time,” only if this interval was thirty minutes or less. After data collection confirmed our perceived area of inefficiency, we made formal modifications to process inputs and quantified their effect over two months. A total of thirty six appointments were included in the post-intervention analysis. Eight appointments were incomplete and were omitted.

RESULTS:

At the time of initial data collection, a total of 14% of procedures began “on-time.” We considered multiple changes to workflow inputs. These included modifications to the check-in process, variations in the order and location of consent, utilization of workstations-on-wheels as well as novel communication methods between Unit staff. However, the chosen intervention was a formal posting which detailed the roles and responsibilities of each member of the Endoscopy Unit. This was communicated with the support of departmental leadership. Post-intervention, a total of 61% procedures began “on-time.” Overall, the initiative was associated with a 47% improvement over a five-month period.

CONCLUSION:

Increasing emphasis is being placed on healthcare efficiency and productivity, even in the academic setting. In this collaborative initiative, we demonstrate that implementation of a first year fellows QI curriculum is associated with a significant improvement in the timeliness of endoscopic procedures.
2903 Does Onset of Cancer Suppresses the Disease Activity in Patients With Pre-Existing Inflammatory Bowel Disease?
Authors: Dhaliwal Amaninder , Lamb Bernie , Cormier Ian , Sayles Harlan , Eichele Derrick , Young Renee , Hewlett Alexander
Published: October 2019

INTRODUCTION:

Limited data is available regarding the impact of cancer on the disease activity in patients with pre-existing inflammatory bowel disease (IBD) especially in relation to chemotherapy. The aim of our study was to see the effect of cancer and chemotherapy on the IBD activity in our patient population.

METHODS:

A retrospective chart review of the patients was conducted who had prior diagnosis of IBD (UC/Crohn's) followed by any cancer between 01/01/2010 to 09/30/2018. Exclusion criteria: Age < 19 years, patients who had total colectomy and pregnant patients. Primary outcome was to evaluate if onset of cancer had any overall impact on the UC/Crohn's activity. Secondary outcome was to evaluate whether chemotherapy or cancer related surgery had any impact on UC/Crohn's activity. Statistical analysis was conducted using McNemar's test.

RESULTS:

51 patients (UC 23/Crohn's 28) were included, 26 males: 25 females, mean age 61 years. 98% were Caucasians with mean BMI 28. The mean age at IBD diagnosis and duration of IBD before the diagnosis of cancer were 34 years and 20 years respectively. Overall, 30 patients who had active disease before the cancer, 57% remained active and 43% had remission after the onset of cancer as compared to 21 patients who were in remission before the cancer, only 5% developed active disease while 95% stayed in remission after the onset of cancer with P value = 0.002 (Table 1). In Crohn's group, out of 20 patients, who had active disease before the cancer, 55% remained active and 45% had remission after the onset of cancer as compared to 8 patients who were in remission before the cancer, only 12% developed active disease while 88% stayed in remission after the onset of cancer with p value = 0.02 (Table 2). In UC group, no statistical difference was noted in the overall disease activity in relation to the cancer. In the subgroup analysis, out of 22 patients who only had cancer related surgery, 32% remained active, 18% had remission and 50% stayed in remission as compared to 12 patients who only received cytotoxic drugs, 50% remained active, 42% had remission and 8% stayed in remission with p value = 0.04 (Table 3).

CONCLUSION:

Our limited study showed that onset of cancer suppressed the overall disease activity in patients with pre-existing IBD (P = 0.002). In the subgroup analysis, patients who had cancer related surgery had higher chance of going into or staying in remission as compared to patients who received cytotoxic drugs (P = 0.04).
2909 Vedolizumab Safety Profile in Treatment of Elderly IBD Patients
Authors: Marnoy Zachary , Grossberg Laurie , Hartwell Nathan
Published: October 2019

INTRODUCTION:

Vedolizumab is an anti-integrin therapy for IBD. It is a monoclonal antibody that selectively inhibits the interaction between the MAdCAM-1 receptor and α4β7 integrin in the gut. Vedolizumab, in comparison to other biologics, has a smaller pool of literature designating it's safety profile, specifically in the elderly (age >65 years of age) population of IBD patients. The GEMINI post-hoc trials have indicated an acceptable rate of infections, adverse reactions leading to hospitalization, and rate of malignancy in patients older than 55 years of age. The elderly subset of patients, designated as those 60-65 years of age or older by prior literature, is a growing population in need of effective and safe treatment of their IBD.

METHODS:

We searched the Epic database for Lahey patients with a diagnosis of inflammatory bowel disease, searching for patients who had been prescribed vedolizumab for this diagnosis. Of the compiled list of patients collected with these criteria, we searched the patient charts for the occurrence of flares, infections, development of malignancy, and death. Reasons for exclusion from the study include discontinuation of vedolizumab before completion of induction dosing, not being on vedolizumab, and lack of gastroenterology follow-up at Lahey Medical Center by a Lahey gastroenterologist.

RESULTS:

Of a total of 86 patients with IBD, ages ranging from 23-81 years of age, there was no significant difference found in the time to flare, time to remission from flare, incidence of infections, arthralgias, or malignancy in patients with IBD >65 after starting vedolizumab. Non-melanomatous skin cancer was the most common malignancy diagnosed after starting vedolizumab in both groups.

CONCLUSION:

Our data indicated no statistical difference between the adverse reactions leading to hospitalization, time to flare, and malignancy between the elderly and non-elderly IBD patients undergoing treatment with vedolizumab. However, our current data is primarily limited by small sample size and unequal study arm size. Also, our sample is primarily Caucasian, limiting our data's application to non-white IBD patient populations. We are currently working to combine our data with that of other hospital populations to overcome this limitation.
2916 Social Media and Inflammatory Bowel Disease
Authors: Chowdhary Tarika , Naqvi Syeda Fatima , Thompson Jesse M. , Gayam Swapna
Published: October 2019

INTRODUCTION:

Social media has become so prevalent in our society today and it has become more widely used in the healthcare community. Inflammatory bowel disease (IBD) patients are one of the many patient populations that benefit from social media use to obtain further information on their diseases. West Virginia (WV) is a rural state and we wanted to see what role social media played in the lives of those living there. We conducted a study in the state of WV to determine how IBD patients used social media, which sources they used, and their opinions on these resources.

METHODS:

Our patient population consisted of patients 18-65 years old who live in WV with a diagnosis of IBD. Surveys were sent to patients over a course of four weeks through an application called REDCap. Our survey included 17 questions and was sent to a total of 2131 patients. We used descriptive statistics to better understand social media use in our IBD population.

RESULTS:

We received 624 responses with a 30% response rate. When asked about using social media for medical purposes, 29.6% of patients noted that they used Facebook for information related to their IBD, while 4.3% used Instagram. All other sites were used by less than 2% of participants. The majority of patients ranked reliability of the information as neutral (44.9%) or reliable (39.3%). When comparing information obtained through social media versus from physicians, 92% of patients did not prefer information obtained through social media over their physicians and there was no difference among patients with different education levels regarding this preference (chi square P value >.05%). Most patients stated that social media had a neutral impact on their disease management (67%), while 30.3% believed it had a positive impact. Almost 55% of patients stated they wished their physician had a social media account for IBD. The most common topic of interest was treatment options.

CONCLUSION:

IBD patients in WV represent a rural population with more barriers to social media use, so it was interesting to see how social media was used specifically for IBD. Even in this population, patients have been able to use social media to be involved in support groups, obtain information about treatments, and hear other patient's stories. Many patients were neutral about the impact that social media had on their lives, but there were also many others that were positively affected. This stresses the importance of social media in today's world among all different populations and locations.
2918 Reader's Digestion: An Assessment of Health Literacy in IBD Patients on Biologic and Immunomodulator Therapies
Authors: Baumgartner Scott , Szvarca Daniel , Clarke Lindsay , Tabbara Nadeem , Borum Marie
Published: October 2019

INTRODUCTION:

Management of Inflammatory Bowel Disease (IBD) can include immunomodulators and biologics therapy. While these medications can have significant risks, patients may be inconsistently assessed for health literacy prior to initiating medications. Evaluation of health literacy is recommended to optimize patient understanding of clinical circumstances and management plans. This study assessed the rates of health literacy documentation in patients with IBD who are maintained on immunomodulators and biologics at a university medical center.

METHODS:

A retrospective chart review evaluating all IBD patients at a university medical center during a 5 year period was performed. Patient age, gender, IBD diagnosis, medication record (biologics, immunomodulators), and documented health literacy assessment with regard to medications and procedures were recorded. A database was generated using Microsoft Excel. Statistical analysis was performed using two-tailed Fisher's Exact Test with significance set at P < 0.05. The study was approved by the institutional IRB.

RESULTS:

Medical records of 392 IBD patients (175 men, 217 women) with mean age 44.3 (range 20-82; 259 <50 years old) were reviewed. 278 (70.9%) had ulcerative colitis, 96 (24.5%) Crohn's disease, 11 (2.8%) microscopic colitis and 7 (1.8%) with unspecified colitis. 295 were on immunomodulators (224 on immunomodulators alone, 31 also on a biologic). 78 were on biologics alone. Of those on biologics, 32 (41%) had documented health literacy assessment. Patients on biologics were more often assessed for health literacy compared to those not on biologics (P < 0.0001) or on immunomodulators alone (P = 0.0334). With respect to age, patients <50 were assessed for health literacy more frequently than patients >50 years (P = 0.0008).

CONCLUSION:

As physicians discuss therapeutic options with their IBD patients, it is important that physicians assess health literacy when initiating medications. This study demonstrates that there is insufficient documentation of health literacy in patients on biologic and other immunomodulatory therapies, especially in those older than 50. While this study was limited by retrospective design, small sample size and reliance on documentation, it identifies a potential opportunity for physicians to enhance quality of care and improve clinical outcomes in IBD patients.