bluuebunny/crossref_metadata_2025 huggingface dataset:
A112 THE EDMONTON PANCREATICOBILIARY INFLAMMATION AND CANCER (EPIC) PROGRAM – A NEW MULTIDISCIPLINARY COORDINATION OF CARE INITIATIVE
Authors: Sandha G S , Abdulhussain H , Krahn T , Timmermans M , Buchanan G , Bereznicki E , Mathura P , Kwan A , Perryman S , Veldhuyzen van Zanten S
Published: February 2024

Background

Pancreaticobiliary (PB) cancer is associated with a poor prognosis. A timely diagnosis and a coordinated, multidisciplinary effort may improve outcomes as patients navigate the healthcare system for investigations and treatment.

Aims

To establish and pilot a multidisciplinary (gastroenterology [GI], hepatopancreatic biliary [HPB] surgery, radiology, oncology, palliative medicine, and nutrition) collaborative care pathway (CCP) to coordinate timely referral and access to management for patients with PB cancer.

Methods

With multidisciplinary expert input, a CCP for PB cancer patients was developed. A donation to our hospital foundation facilitated the hiring of a nurse navigator (NN) to coordinate this process. The EPIC program was initiated as a 6-month pilot project on 01/07/23 for all consecutive patients referred to the University of Alberta Hospital with suspected PB cancer. Referrals were triaged by GI and HPB surgery into resectable, borderline resectable, or unresectable arms of the CCP. EUS biopsy and/or ERCP for stent were performed as needed. A referral to medical oncology was made after a diagnosis was established. Descriptive statistics were completed.

Results

At 3 months, 64 patients (39 M, 25 F), mean age 67±12 years (range 19-95 years), were referred to EPIC. Presenting symptoms were abdominal pain (73%), weight loss (40%), jaundice (27%), nausea/vomiting (21%), itching (8%), and new-onset diabetes (5%). Site of cancer was pancreas (77%, 49/64), bile duct (20%, 13/64), and ampulla (3%, 2/64). Timelines to care access were compared with a similar pre-CCP patient cohort as shown in Table.

Conclusions

The role of the NN is to reduce variability and coordinate timely referral, scheduling, and follow-up based on the care pathway, and to serve as a point of contact for ongoing patient issues. The EPIC program pilot is on track to meet the timelines set forth in the care pathway. Primary care outreach to increase awareness of symptoms and for prompt investigation may further improve access to care in these patients.

Note: negative numbers indicate days where the GI/HPB review occurred before the CT/MRI, or intervention before GI/HPB review

EPIC COLLABORATIVE CARE PATHWAY

Funding Agencies

None
A114 IMPROVING THE QUALITY OF PARACENTESIS PRACTICES IN PEOPLE WITH ADVANCED CIRRHOSIS IN AN AMBULATORY CARE SETTING
Authors: Sedarous M , Lee E , Verma A , Quinn K , Hirschfield G
Published: February 2024

Background

Spontaneous bacterial peritonitis (SBP) is a lethal complication of decompensated cirrhosis carrying a 90% mortality rate when left untreated. Despite AASLD recommendations, there is a practice gap regarding fluid cell count (FCC) collection during paracentesis.

Aims

We initiated prospective quality improvement (QI) project to improve FCC collection in an ambulatory care setting from a baseline of 78% to a goal of 100% compliance between September 11, 2022 and April 17, 2023.

Methods

We examined the effects of a quality improvement initiative in 233 adult patient encounters with cirrhosis undergoing paracentesis in an ambulatory setting located within a quaternary care centre in Toronto, Canada within the study timeframe. Using a multidisciplinary approach, the quality improvement initiatives included focused groups, education regarding AASLD guidelines, development of a paracentesis bundle, and streamlining workflow process. Descriptive statistics were collected. Statistical analysis using run charts and p-charts were conducted using QI Macros. Approval was obtained from the QI Review Committee at the institution where this QI initiative took place.

Results

Baseline adherence for collecting ascitic FCC per paracentesis procedure was 78%. Inconsistencies during process mapping such as variations in documentation, printing FCC labels and consistency in FCC collection were identified as root causes. Thus, bedside paracentesis bundles were introduced to standardize process and improve workflow. Post-intervention, the FCC rate increased marginally to 79.6% with no special cause variation identified (Figure 1). Subgroup analysis demonstrated FCC collection rates of 100% amongst registered nurse (RN) and nurse practitioners (NP), 97% amongst resident physicians, and 92% amongst attending physicians. Subsequently, another subgroup analysis was completed demonstrating 97% FCC collection rate amongst general hepatology group, while 40% FCC rate amongst specialty hepatology group. Overall rate of SBP was 1.62% (N=3).

Conclusions

This prospective QI study revealed a gap in guidance pertaining to the role of ascitic fluid cell count collection in patients with cirrhosis undergoing paracentesis in ambulatory settings. Further studies ascertaining rationale for not sending FCC may be helpful in elucidating why there is a gap in clinical practice. Additionally conducting studies in ambulatory settings to assess FCC collection's impact on morbidity and mortality will provide vital evidence and clarity for the role of FCC in this vulnerable patient group.

Figure 1: P-chart demonstrating percentage FCC Collection per week from September 11, 2022 to April 17, 2023. UCL indicates upper control limit; CL, center line; LCL, lower Control Limit.

Funding Agencies

Toronto Centre for Liver Disease funded the MSc QI program for Mary Sedarous (writer) who completed this study as her MSc QI project.
A115 EVALUATING THE CONTENT AND FACE VALIDITY OF LOW-COST GEL POLYPS FOR POLYPECTOMY SKILLS TRAINING IN NOVICE ENDOSCOPISTS
Authors: Tham D , Zhao A , Gimpaya N , Khalaf K , Mokhtar A , Na C , Lisondra J , Scaffidi M , Khan R , Walsh C , Fecso A , Grover S
Published: February 2024

Background

Polypectomy is an essential endoscopic skill involving the removal of potentially premalignant lesions during colonoscopy. The ad hoc nature of polyp encounters is a significant barrier to polypectomy training, as this limits the ability to deliberately practice the skill. Effective and accessible polypectomy simulators may improve global implementation of polypectomy curricula.

Aims

To determine the face and content validity of a novel low-cost gel polyp simulator for use in endoscopic training programs.

Methods

A novel gel polyp simulator with multiple polyp morphologies based on the Paris classification was developed and used with a commercially available colonic phantom (Koken Lower GI Endoscopy Simulator Type II LM-107, Koken CO.LTD, Japan) in an endoscopy simulation-based training course (July, 2023). Feedback based on previous prototypes of the simulator were implemented into the simulator utilized in the present study. Novice (ampersand:003C25 procedures) and expert (ampersand:003E1000 procedures) endoscopists performed simulated procedures with the gel polyps. Using a five-point Likert scale (“strongly agree” to “strongly disagree”), a post-training survey based on previously published surveys used to determine the face and content validity of low-cost physical colonic simulators was administered. A section for additional comments was placed at the end of the survey.

Results

The face and content validity survey was completed by 3 experts and 21 novices. The median score for all face validity questions was 5 (IQR 5-5) from experts and 5 (IQR 5-5) from novices. The median score for all content validity questions was 5 (IQR 5-4) from experts and 5 (IQR 5-5) from novices. In the additional comments section of the survey, one expert commented that future iterations of the gel polyps should be made thicker so that trainees could practice using endoscopic clips. The gel polyp simulator cost $0.61 CAD/polyp including the cost of materials and 3D printed molds.

Conclusions

The gel polyp simulator appears to be a feasible modality for polypectomy training that is reproducible using accessible and low cost materials.

Face and Content Validity Survey (questions and median survey score)

Funding Agencies

None
A119 ACUTE COLONOC PSEUDO-OBSTRUCTION AFTER ENDOSCOPIC RESECTION OF A FULLY CIRCUMFERENTIAL LARGE NON-PEDUNCULATED COLORECTAL POLYP
Authors: Zarrin A , Jiang S X , Gilhotra R , Shahidi N
Published: February 2024

Background

Complex large non-pedunculated colorectal polyps (LNPCPs), including those involving the full circumference of the bowel, are now readily managed by minimally invasive endoscopic resection techniques. Established procedure-related adverse events include sedation related adverse events, deep mural injury, clinically significant post-resection bleeding, delayed perforation and serositis. An appreciation for potential procedure-related adverse events is critical to the effective implementation of these techniques.

Aims

To describe a case of acute colonic pseudo-obstruction after endoscopic resection of a fully circumferential LNPCP.

Methods

Case report and review of the literature

Results

A 91-year-old male with a history of atrial fibrillation, chronic kidney disease and suspected McKittrick-Wheelock syndrome underwent successful endoscopic mucosal resection (EMR) of a 100mm fully circumferential LNPCP in the sigmoid colon. Histopathology diagnosed a tubulovillous adenoma with high-grade dysplasia. After elective admission, he suffered from clinically significant post-EMR bleeding requiring 2 units of packed red blood cells. On post-operative day 1 he began to suffer from nausea, abdominal pain and obstipation. On examination, he was visibly distended. Abdominal X-ray revealed extensive gas-filled loops of small and large bowel with the absence of gas in the rectum. He was managed conservatively with nasogastric tube decompression. Total duration of hospital stay was 9 days.

Conclusions

Critical to the continued expansion of minimally invasive endoscopic resection techniques is an awareness for potential procedure-related adverse events. To our knowledge this is the first description of acute colonic pseudo-obstruction after endoscopic resection

Funding Agencies

None
A120 A HUMAN-CENTERED DESIGN APPROACH TO THE DEVELOPMENT OF A VACCINE IMPLEMENTATION STRATEGY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Authors: Zhou F , Robar J , Stewart M , Jones J
Published: February 2024

Background

Vaccination uptake amongst patients with inflammatory bowel disease (IBD) remains suboptimal. Our previous study assessed perceived barriers and solutions related to implementation of evidence-based guidelines for vaccine preventable illness (VPI). Barriers included limited time, lack of access to a family physician, and incomplete understandings of coverage/access to vaccines.

Aims

The aim of this study was to use human-centered design (HCD) to design a vaccine implementation program in patients with IBD.

Methods

The HCD approach consisted of multiple phases. Phase 1 (discovery and define) consisted of semi-structured interviews of healthcare providers. Phase 1 also included the development of a context-specific patient journey map of the processes involved in accessing vaccines. This map was developed in collaboration with a multidisciplinary IBD team. Phase 2 involved identifying common barriers and facilitators through thematic analysis and journey mapping. In Phase 3, these analyses were used to design an implementation strategy for evidence-based management of VPI in the local health system context.

Results

Twelve interviews (including 11 gastroenterologists and one IBD nurse practicing in Nova Scotia and New Brunswick) were conducted. Mean participant age was 45.1 years, with 63.6% identifying practice in an urban/academic setting compared to a rural/community setting (36.4%). Lack of access to a family physician, limited time, vaccine hesitancy, and incomplete understanding of coverage/access to vaccines were among the barriers identified. Using facilitator themes as well as the journey mapping process, a proposal for an early implementation strategy prototype was designed. Prototype development involved collaborative partnership with a third-party patient support program to overcome various barriers identified in our surveys.

Conclusions

Barriers to implementation of evidence-based guidelines for management of VPI are well documented. The use of HCD to design an effective implementation strategy that is sensitive to the local healthcare context holds potential to increase access to and uptake of high quality, evidence-based VPI management. In future studies, the implementation-effectiveness of the implementation strategy (model prototype) will be evaluated and compared to standard of care.

Funding Agencies

None
A122 INTEROBSERVER AGREEMENT FOR THE PARIS CLASSIFICATION OF COLORECTAL POLYPS AMONGST SURGEONS, GASTROENTEROLOGISTS, TRAINEES AND EXPERTS: A VIDEO-BASED STUDY
Authors: Alj A , Djinbachian R , Pioche M , Saito Y , Sethi A , Chiu P , Marks J , Sebajang H , Pawlak K , Chennouf A , Benard F , Ide Y , Dang F , von Renteln D
Published: February 2024

Background

Colonic polyps are described based on their macroscopic shape, according to the Paris classification. This represents a useful tool to communicate polyp morphology between endoscopists, however, the agreement between endoscopists on polyp morphology evaluation has not been demonstrated in the literature. We were interested in evaluating endoscopist agreement using the Paris classification.

Aims

The aim of this study was to evaluate endoscopist agreement using the Paris classification.

Methods

We conducted a prospective video-based study evaluating endoscopist assessment of polyp morphology. An international group of endoscopists including surgeons, gastroenterologists, experts and trainees were included. Primary outcome was overall inter-observer agreement for the Paris classification. Secondary outcomes were inter-observer agreement stratified by endoscopist characteristics.

Results

11 endoscopists were included in the analysis with 1320 morphologic assessments of 120 individual polyps. There was low overall inter-observer agreement for the Paris classification with an overall Light’s Kappa of 0.19. Agreement remained low for men (Κ=0.25), women (Κ=0.25), gastroenterologists (K=0.23), surgeons (K=0.11), trainees (K=0.33), and experts (K=0.29). Endoscopists who have received training on lesion evaluation in Asia had higher inter-observer agreement when using the Paris classification compared to endoscopists in the west (K= 0.50 vs 0.26).

Conclusions

Agreement when using the Paris classification was low amongst a varied international group of surgeons, gastroenterologists, trainees and experts. Training in the east where higher emphasis is placed on lesion characterization was associated with the highest inter-observer agreement.

Funding Agencies

None
A123 THE EFFECTS OF INFLAMMATORY BOWEL DISEASE ON THE MANAGEMENT AND OUTCOMES OF COMPLEX POLYPS IN PATIENTS UNDERGOING SURVEILLANCE COLONOSCOPY: A RETROSPECTIVE COHORT STUDY
Authors: AlRamdan R , Almudaires A , Son S , Sey M , Gregor J , Yan B
Published: February 2024

Background

The influence of inflammatory bowel disease (IBD) on the outcomes of complex polyps remains an area of uncertainty.

Aims

To investigate the impact of IBD on the management and outcomes of complex polyps during surveillance colonoscopy.

Methods

This retrospective cohort study utilized a prospectively collected database, involving patients who underwent surveillance colonoscopy for colorectal cancer or IBD surveillance who were identified to have complex polyps between February 2019 and December 2020 in Southwestern Ontario. Patient demographics, disease characteristics, medication history, polyp description and management were analyzed. The data were summarized in median and interquartile range for continuous variable and frequency and percentage for categorical variables. Characteristics between IBD and non-IBD were compared using the Wilcoxon rank sum test and Fisher’s exact test, as appropriate.

Results

383 patients were included in the study, of which 27 individuals had IBD (5 Crohn's disease, 13 ulcerative colitis, and 9 indeterminate colitis). Patients with IBD were generally younger than their non-IBD counterparts (median age 61 vs 67 respectively). No significant differences were identified in terms of rates of complete polyp removal (17.70 % vs 22.22 %, pampersand:003C0.602), residual polyps after resection (76.97% vs 70.37%, pampersand:003C0.476), repeat removal attempts (84.27% vs 74.07%, pampersand:003C0.179), or surgical intervention (88.76% vs 88.89%, pampersand:003C0.99). A higher proportion of IBD patients were managed by gastroenterologists vs other endoscopists (81.48% vs. 40.17%, p ampersand:003C 0.001). No significant differences in complex polyp characteristics were observed, except in difficult locations of complex polyps were more common in the non-IBD cohort (55.34% vs 25.93%, pampersand:003C0.004).

Conclusions

In this retrospective cohort study, IBD does not appear to influence the management or outcome of complex polyps. Larger studies are required given the small IBD cohort size in this study.

Funding Agencies

None
A125 DIAGNOSTIC ACCURACY OF ARTIFICIAL INTELLIGENCE IN THE DIAGNOSIS OF INTESTINAL METAPLASIA AND DYSPLASIA IN PATIENTS WITH BARRETT'S ESOPHAGUS: A DIAGNOSTIC TEST ACCURACY META-ANALYSIS
Authors: Dadgar K , Mais L , Sangar S , Yaghoobi M
Published: February 2024

Background

Diagnosing dysplasia in patients with Barrett’s Esophagus is crucial in preventing esophageal cancer but challenging in clinical practice. Artificial Intelligence (AI) could potentially be utilized during endoscopy to provide better diagnostic accuracy.

Aims

The primary aim of this systematic review is to determine the diagnostic accuracy of AI in detecting intestinal metaplasia and dysplasia in adults with Barrett's esophagus using gastroscopy images.

Methods

A comprehensive electronic search was conducted of cross-sectional studies examining the accuracy of AI in diagnosing intestinal metaplasia or dysplasia using endoscopic images. Study selection, data extraction and quality assessment were completed by two authors independently. When a study used several models, the model with the highest sensitivity was used in meta-analysis. The Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool was used to assess risk of bias and applicability. Meta-analysis was performed using a bivariate model to obtain summary estimates of sensitivity, specificity, and diagnostic odds ratio.

Results

Of the 1479 articles reviewed, 23 were included. The diagnosis of dysplasia by AI per endoscopic image obtained had a sensitivity of 0.92 (CI 0.85-0.96), specificity of 0.84 (CI 0.78-0.88) and diagnostic odds ratio (DOR) of 59 (CI 22-161). The diagnosis of dysplasia in volumetric laser endomicroscopy images interpreted by AI had an overall sensitivity of 0.83 (CI 0.70-0.91), specificity of 0.77 (0.67-0.85) and a DOR of 16 (CI 2-30). Subgroup analysis did not show a statistically significant difference when comparing studies conducted in Europe to those outside of Europe or studies published before 2020 to those published after 2020. A sensitivity analysis by removing the largest studies did not change the overall accuracy of AI.

Conclusions

AI algorithms seem to be accurate at detecting the presence of intestinal metaplasia and dysplasia. Further research into using artificial intelligence should be carried out to evaluate its use in combination with endoscopist’s opinion as a clinical decision-making tool to target areas of dysplasia for biopsies.

Funding Agencies

None
A128 OPTIMIZED COMPUTER ASSISTED TECHNIQUE FOR INCREASING ADENOMA DETECTION DURING COLONOSCOPY: A RANDOMIZED CONTROLLED TRIAL
Authors: Djinbachian R , Taghiakbari M , Barkun A , Medawar E , Panzini B , Sidani S , Liu J , von Renteln D
Published: February 2024

Background

Efforts to improve colonoscopy have recently focused on improving adenoma detection interventions such as artificial intelligence (CADe) that have demonstrated improvements in Adenoma Detection Rates (ADR). Although studies have focused on implementation of one intervention at a time.

Aims

We evaluated an optimized computer assisted technique (CADopt) versus standard colonoscopy to improve ADR during colonosocopy.

Methods

A prospective randomized controlled trial was conducted enrolling adults (45–80 years) undergoing elective colonoscopy. Participants were randomized (1:1) to the intervention group (CADopt, and control group. In the CADopt group, endoscopists used a computer aided polyp detection combined with linked colour imaging, water exchange colonoscopy, and cecal retroflexion. In the control group, standard colonoscopy was performed. Primary outcome was Adenoma Detection Rate (ADR) in the intervention and control groups. Secondary outcomes included advanced ADR (AADR) and sessile serrated lesion detection rates (SDR).

Results

A total of 467 patients were recruited and randomized (CADopt group 229 patients, 50.2% female vs 238 patients, 48.3% female in the control group). ADR was 49.3% (95%CI 42.7-56.0) for the CADopt group vs 38.2% (95%CI 32.0-44.7) for the control group (p=0.016). AADR and SDR were 13.1% (95%CI 9.0-18.2) and 6.6% (95%CI 3.7-10.6) for the CADopt group versus 8.0% (95%CI 4.9-12.2), and 7.1% (95%CI 4.2-11.1) for the control group, respectively.

Conclusions

Using an optimized computer assisted technique led to significant improvements in ADR and a trend towards AADR improvements.

Funding Agencies

Fujifilm
A129 OUTCOMES FOLLOWING ENDOSCOPIC SUBMUCOSAL DISSECTION OF SUPERFICIAL GASTROINTESTINAL TRACT NEOPLASTIC LESIONS FROM A TERTIARY-CARE ACADEMIC CENTRE
Authors: Gupta S , Dang F , Fujiyoshi Y , Li S , Khalaf K , May G , Mosko J , Teshima C
Published: February 2024

Background

Endoscopic submucosal dissection (ESD) is an advanced luminal resection technique for dysplastic and early cancerous gastrointestinal (GI) tract neoplasms. By removing lesions en bloc, this method provides more accurate histopathologic evaluation of resection margins in comparison to endoscopic mucosal resection (EMR). Superior curative resection and lower recurrence rates over EMR have been shown in addition to the benefit of reduced morbidity and mortality compared to surgery. While ESD has become well-established in Asia and Europe, its adoption in North America – and in particular Canada – has been slowed by multiple technical and economic factors including a scarcity of infrastructure, institutional support, and standardized training. Additionally, reproduced Canadian data corroborating its known global efficacy is currently lacking.

Aims

Our aim was to evaluate clinical and technical outcomes in patients who underwent ESD of superficial GI tract neoplasms at a tertiary-care academic centre.

Methods

We conducted a retrospective single-centre cohort study at The Centre for Advanced Therapeutic Endoscopy & Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada. Consecutive adults (age ampersand:003E 18) who underwent ESD of any superficial GI tract neoplasm from October 2017 to December 2022 were included in the study. Primary outcomes were rates of en bloc, complete (R0), and curative resections. Secondary outcomes were rates of recurrence and adverse events. Data was collected through electronic chart review.

Results

ESD was performed in a total of 308 lesions with a mean size of 2.5 cm (range, 1-7 cm). Gastric ESD was the most common (n=130), followed by esophageal (n=91), rectal (n=62), and colonic (n=22). Three patients underwent duodenal ESD. En bloc, R0, and curative resection rates were 89.2%, 84.7%, and 71.8%, respectively. 64.3% of lesions were cancerous on pathology (n=198), of which 48 had at least submucosal invasion. Rates of delayed bleeding and deep mural injury (DMI) requiring surgical intervention were 3.9% and 1.3%, respectively. Overall recurrence at the first surveillance endoscopy (SE1) was 3.6%.

Conclusions

En bloc, R0, and curative resection rates reported from this largest single-centre Canadian ESD cohort are comparable to existing North American data. Low rates of early recurrence and an adequate safety profile have been demonstrated with this emerging oncologic method of resection. Additional investigation is warranted to optimize lesion selection and determine long-term clinical outcomes to further establish this technique in the management of superficial GI tract neoplasms.

Table I. Procedural characteristics, outcomes, and adverse events for patients who underwent ESD of superficial GI tract neoplasms.

Funding Agencies

None
A131 OUTCOMES AND COMPLICATIONS OF THERAPEUTIC ERCP IN DIFFERENT AGE GROUPS
Authors: Hazan E , Na C , Zarrin A , Mokhtar A , Khalaf K , Gimpaya N , Meleka M , Tham D , Abal S P , Mhalawi W , Chopra D , Gupta S , Jugnundan S , Calo N , Teshima C , Mosko J , May G , Grover S
Published: February 2024

Background

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a vital procedure for hepatobiliary disease management. Though it boasts high overall success rates, the impact of patient age on outcomes remains uncertain, especially amongst elderly patients. With an aging population, it is crucial to determine the efficacy and safety of ERCP in different age groups.

Aims

This study assesses ERCP success and complication rates across age groups. Our objective is to investigate whether ERCP remains a reliable and safe procedure for patients of all ages, particularly the elderly.

Methods

A database with retrospective data from consecutive patients undergoing ERCP at a Canadian tertiary care centre between 2011 and 2020 was utilized. Baseline patient characteristics and indications for ERCP were collected. Outcomes included procedural success, complications, and procedure duration. Patients were categorized into four age groups: ampersand:003C40, 40-65, 65-80, and ampersand:003E80, with a specific sub-analysis for patients ampersand:003C80 and ampersand:003E80.

Results

This study included 6132 patients. Significant disparities were observed in comorbid conditions (pampersand:003C0.0001), ASA status (pampersand:003C0.0001), and the use of anticoagulants or antiplatelet agents (pampersand:003C0.0001). The most common indications for ERCP were gallstones (45.1%), jaundice (19.2%), and ductal lesions (12.8%), with no significant variation among the age groups (p=0.5983). There was a significant difference in procedural success (p=0.0005), with declining success in older age groups (ampersand:003C40 = 91.3%, 40-65 = 87.4%, 65-80 = 86.2%, ampersand:003E80 = 84.9%), and this difference remained significant in the ampersand:003C80 and ampersand:003E80 sub-analysis (p=0.0133). While mean procedure duration was longer in older age groups (pampersand:003C0.0001), incidence of complications did not vary across all groups (p values [EH1] = 0.1532-0.7622) or patients ampersand:003C80 and ampersand:003E80 (p= 0.0769-0.7128).

Conclusions

ERCP maintains a high success rate and safety profile across all age groups; however, success rates decline and procedure times increase significantly in older patients.

ERCP outcomes across age groups

Funding Agencies

None
A134 ENDOSCOPIC RESECTION IS EFFECTIVE FOR COMPLEX LARGE NON-PEDUNCULATED COLORECTAL POLYPS
Authors: Jiang S X , Zarrin A , Walia A , Galorport C , Xiong W , Enns R , Lam E , Shahidi N
Published: February 2024

Background

Endoscopic resection is preferred for most large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs) due to superior efficacy, safety, and cost-efficiency compared to surgery. However, endoscopic resection can be challenging due to anatomical location, lesion characteristics, and concomitant colonic disease; these complex LNPCPs (C-LNPCPs) historically have suboptimal outcomes compared to uncomplicated LNPCPs (UC-LNPCPs).

Aims

To compare the outcomes of C-LNPCPs to UC-LNPCPs following endoscopic resection.

Methods

Consecutive patients ampersand:003E 18 years of age who underwent endoscopic resection of a LNPCP were enrolled in a prospective single center observation cohort study (clinicaltrials.gov ID: NCT05402696). C-LNPCP were defined by at least one of the following criteria: involvement of the appendiceal orifice, ileocecal valve, or anorectal junction; previous resection attempt; ≥ 90% circumferential involvement; concomitant inflammatory bowel disease. All other lesions were classified as UC-LNPCPs. Performance was evaluated by technical success (all neoplastic tissue removed at index procedure), procedure-related adverse events (intra-procedural perforation, clinically significant post-endoscopic resection bleeding (CSPEB), delayed perforation, serositis), referral to surgery, and recurrence at first surveillance colonoscopy (SC1).

Results

From 06/2022-09/2023, 350 LNPCPs were referred for endoscopic resection and 335 were attempted (91 C-LNPCPs, 244 UC-LNPCPs). Median age was 68 years (IQR 62-74 years) and 144 (54.1%) were male. Median size was 30mm (IQR 20-40mm). Most lesions were adenomatous (63.7% C-LNPCPs, 64.8% UC-LNPCPs), with cancer identified in 3.3% and 4.9% of C-LNPCPs and UC-LNPCPs, respectively. EMR was the most common resection modality (62.6% C-LNPCPs vs. 64.8% UC-LNPCPs) with C-LNPCPs undergoing more ESD (17.6% vs. 7.0%) and less CSR (19.8% vs. 28.3%; p=0.011). Auxiliary modalities were more frequently used in C-LNPCPs (6.6% vs. 1.2% UC-LNPCPs; p=0.004). Technical success was 95.6% in C-LNPCPs compared to 99.2% in UC-LNPCPs (p=0.049). There was no significant difference between groups in the frequencies of adverse events. 17 LNPCPs (5.1%; 4 C-LNPCP, 13 UC-LNPCPs) underwent surgery (p=1.000). Of those LNPCPs assessed at SC1, there was 1 recurrence (1.0%) in the UC-LNPCP subgroup.

Conclusions

With site-specific technical modifications and mitigating strategies for procedural-related adverse events, endoscopic resection outcomes for C-LNPCPs are comparable to UC-LNPCPs.

Funding Agencies

None
A135 DEEPLY EMBEDDED ESOPHAGEAL FISHBONE REMOVED BY ENDOSCOPIC MUCOSAL DISSECTION: CASE REPORT AND LITERATURE REVIEW
Authors: Jugnundan S , Gupta S , Teshima C
Published: February 2024

Background

Foreign body ingestion is frequently encountered in gastroenterology clinical practice. While most objects pass spontaneously, sharp objects, most commonly bony fragments in adults, have a tendency to become lodged in the esophagus. The European and American Society of Gastrointestinal Endoscopy both recommend emergent endoscopy for sharp objects or bones impacted in the esophagus. However, there is little guidance regarding management of deeply embedded foreign bodies, that may not be visible intra-luminally or that may have penetrated the submucosa or muscularis propria.

Aims

In this case report, we describe successful endoscopic retrieval of a deeply embedded fishbone in the distal esophagus. A literature review was also conducted to evaluate the current evidence surrounding the use of endoscopic ultrasound (EUS) and submucosal dissection (ESD) to localize and remove deeply embedded foreign bodies.

Methods

A literature search on EUS and ESD use in foreign body retrieval was performed via MEDLINE/PubMed (September 2023) using relevant keywords and MeSH terms.

Results

CASE DESCRIPTION

A 50-year-old man presented to hospital with several hours of dysphagia after consuming fish. A fishbone deeply embedded through the submucosa into the muscularis propria was identified on CT scan and EUS. ESD was employed to free the bone and a fully covered metal stent was deployed to close the defect. The patient had no immediate complications and recovered well post-procedure.

Our literature search revealed a total of 6 case reports detailing endoscopic management of penetrating foreign bodies. One case used EUS to localize an object which was subsequently removed surgically. The remaining 5 cases all used ESD to remove submucosal objects without any short or long-term complications.

Conclusions

Clinical history is critical to prompt diagnosis of foreign body ingestion, and it is crucial to be familiar with the radiologic characteristics of the suspected object. Fishbones are frequently encountered and are most commonly radiolucent on plain films. CT scans should be obtained in these patients. Rarely, these objects will be found to be deeply penetrating. There are emerging case reports supporting the use of EUS in the localization of some of these objects, particularly when they cannot be seen intraluminally. Upon review of the literature, there is a paucity of reports describing their removal. This case report adds to the sparse literature demonstrating that ESD has an emerging role in the management of deeply penetrating foreign bodies. Following multidisciplinary discussion and consultation with the appropriate surgical service, ESD may prevent the need for otherwise invasive and potentially morbid surgical intervention.

Fishbone embedded in the distal esophagus. Removed by ESD, defect closed with metal stent.

Funding Agencies

None
A136 EXPLORING ENDOSCOPIST PERCEPTIONS OF ARTIFICIAL INTELLIGENCE-AIDED COLONOSCOPY: A QUALITATIVE ANALYSIS
Authors: Lee C , Parker C H , Liu L W , Salim M , Jeyalingam T
Published: February 2024

Background

Artificial intelligence (AI) is gaining recognition as a promising adjunct in healthcare including gastrointestinal endoscopy. Randomized controlled trials have demonstrated improved polyp detection with computer-aided detection (CADe) systems in colonoscopy. Despite the foreseeable translation of CADe systems into the endoscopy suite, no study to date has explored how introducing this novel technology influences endoscopist perceptions and cognitive processes.

Aims

To explore how AI assistance impacts endoscopists’ perceptions of and cognitive processes during colonoscopy.

Methods

Faculty in gastroenterology and general surgery at the University Health Network (Toronto, Canada) were interviewed in April 2023 to explore their baseline perceptions of AI before the planned installation of the Medtronic GI GeniusTM Intelligent Endoscopy Module, an AI polyp detection tool, at Toronto Western Hospital in May 2023. After performing a minimum of 10 colonoscopies using GI GeniusTM, participants were re-interviewed to discuss their perceptions of AI-assisted colonoscopy and how it influenced their cognition during the procedure. Analysis was informed by constructivist grounded theory, whereby interview data were transcribed and coded iteratively using constant comparison to generate themes.

Results

In this interim constant comparative analysis, 9 participants (6 gastroenterologists and 3 general surgeons) were interviewed to generate 16 interview transcripts (9 pre-exposure and 7 post-exposure; 1 interview pending, 1 participant on leave). Participants held the view that: (1) AI will inevitably become the standard of care in colonoscopy, where clinicians and AI function symbiotically and in partnership; (2) CADe systems may facilitate standardization of practice and reduce inter-endoscopist variability by improving detection of specific types of lesions (e.g., sessile serrated polyps); (3) CADe assistance provides a “second set of eyes” that interacts with, but does not replace, endoscopists’ cognitive processes; and (4) trainees should gain familiarity with AI systems, despite mixed opinions regarding AI’s specific role in training.

Conclusions

We found that study participants conceptualize AI as an essential component of colonoscopy practice and training, with endoscopist thought processes and CADe systems appearing to function symbiotically. Elucidating the specific ways in which AI and endoscopist cognition interact will facilitate the future refinement of these tools.

Funding Agencies

None
A138 ENDOSCOPIC SUBMUCOSAL DISSECTION OUTCOMES IN T1B COLORECTAL CANCER: A SINGLE CENTER EXPERIENCE
Authors: Milne F , Bechara R
Published: February 2024

Background

Endoscopic submucosal dissection (ESD) has transformed the approach to gastrointestinal neoplasms, particularly in managing T1 colorectal cancer(CRC) with superficial submucosal invasion (SMI), which is considered curative when other high-risk features are absent.

Aims

The aim of this study is to describe a single center’s experience with safety, and technical and clinical outcomes for patients undergoing ESD with T1b CRC, as well as explore differences in outcomes depending on depth of SMI.

Methods

This is a retrospective, single center study of patients who underwent ESD for suspected CRC at the Kingston Health Sciences Center, Ontario, Canada between October 2016 and April 2023. Patients with T1b CRC on their final pathology were included. We analyzed patient demographics, tumor characteristics, and technical outcomes. Patients were followed to determine cancer-free survival and tumor recurrence. Patients were stratified and compared by depth of SMI on their final pathology.

Results

A total of 32 patients with 33 T1b CRCs were included. 19 lesions had superficial SMI, and 14 had deep SMI on final specimens. Two procedures were aborted due to suspected deep invasion or fibrosis limiting ESD. The mean procedure time was 74.5 minutes and the mean efficiency was 12.3 min/cm3. ESD had high en-bloc (90.9%) and R0 (78.7%) resection rates, and there was no significant difference regardless of depth of SMI (p=0.08 and 0.372, respectively). 24 of 33 lesions had biopsy prior to ESD, and 22 of 24 lesions with previous histology (91.7%) had upgrade in pathology on their final ESD specimen. 2 patients had adverse events, and both were managed supportively.

A total of 9 patients (27%) went on to have surgery. Those with deep SMI were more likely to have surgery (5% vs 57%, pampersand:003C0.005). The most common reason was lymphovascular invasion (44%). However, in the 7 patients who had complete ESD procedure and subsequent surgery, none had residual cancer on their surgical specimens, or malignant lymph nodes.

The follow-up period for all patients ranged from 1 to 43 months with a mean follow-up time of 14.9 months. Of those who did not have surgery, all were cancer free at a mean follow up time of 16.2 months. Within the group of patients who had surgery, all were cancer free at a mean follow up time of 11.6 months. 5 patients died during the follow up period. None were from procedural related complications or disease recurrence.

Conclusions

ESD for T1b CRC is safe with high en-bloc and R0 resection rates. Patients with deep SMI were more likely to go on to have surgery, though this was frequently due to an additional high risk feature. Recurrence rates were low, but studies with longer follow up are needed.

Funding Agencies

None
A139 EARLY VIDEO CAPSULE ENDOSCOPY VERSUS COLONOSCOPY FOLLOWING NEGATIVE ESOPHAGOGASTRODUDENOSCOPY IN PATIENTS WITH SUSPECTED UPPER GASTROINTESTINAL BLEEDING: PRELIMINARY DATA FROM A RANDOMIZED CONTROLLED TRIAL
Authors: Patel K , Yang D , Krahn T , Wesilenko S , Halloran B , Zepeda-Gomez S
Published: February 2024

Background

Esophagogastroduodenoscopy (EGD) is recommended for initial endoscopic evaluation of patients with suspected upper gastrointestinal bleeding (UGIB). When this is negative, the standard recommendation is to perform a colonoscopy, despite low diagnostic yield of less than 5%. In these patients, the question remains as to whether small bowel investigations would be of higher yield prior to colonoscopy.

Aims

To compare the diagnostic yield between early video capsule endoscopy (VCE) versus colonoscopy after a negative EGD in patients with suspected UGIB.

Methods

This is preliminary data from a prospective randomized control trial (RCT) of adult patients with suspected UGIB (melena and hemoglobin drop of more than 20 g/L within 48 hours of admission). Patients at a single centre were enrolled prior to initial EGD; those with negative EGD were included and randomized to either colonoscopy (next day) or early VCE (immediately after EGD). Patients with a confirmed source of bleeding in their group required no further testing, but those without underwent further testing with the alternative (VCE or colonoscopy). We evaluated patient outcomes, including bleeding localization time, hospitalization duration, procedure count, complications and rebleeding rates.

Results

A total of 19 adult patients have been enrolled, of which 12 had negative EGD and were randomized to either VCE or colonoscopy, with six patients in each arm (Figure 1). In the VCE group, 100% (6/6) of patients had bleeding sources detected by early VCE, with 50% (3/6) of them undergoing endoscopic treatment. In the colonoscopy group, only one patient had a positive finding (1/6), the rest underwent subsequent VCE. The VCE identified the bleeding source in 80% (4/5) of patients with negative colonoscopy. Patient are outlined in Table 1.

Conclusions

Based on our preliminary data, the diagnostic yield of early and subsequent VCE was higher when compared to colonoscopy after initial negative EGD in patients with suspected UGIB.

Table 1. Summary of findings and patient outcomes

Funding Agencies

Medtronic Canada (Brampton, ON, CA) will provide the video capsule in the treatment group. This is the only equipment funding required in this study.
A141 RISK OF TOTAL METACHRONOUS ADVANCED NEOPLASIA AFTER DETECTION OF PROXIMAL HYPERPLASTIC POLYPS, ADENOMAS, AND THEIR COMBINATION
Authors: Safih W , von Renteln D , Popescu Crainic I , Haumesser C , Noyon B , Mubaid F , Rekkabi C , Marques P , Li Y , Djinbachian R
Published: February 2024

Background

Recent research findings have identified an association between proximal sessile serrated lesions (SSL) and a greater risk of advanced metachronous neoplasia, without significant impact of distal SSL.

Aims

The principal aim of this study was to assess the risk of total metachronous advanced neoplasia (T-MAN) at the follow-up (fu) colonoscopy after detection of proximal hyperplastic polyps (HP), adenomas and their combination at the initial colonoscopy.

Methods

Medical records for patients aged 45 to 74 who underwent colonoscopies in both 2014 and 2015 were reviewed. The primary outcome was the presence of T-MAN (comprising advanced adenomas or high-risk SL) during the follow-up colonoscopy depending on the presence of proximal HP, adenoma, or their combination at index colonoscopy. Secondary outcomes included assessing the risk of T-MAN at follow-up depending on index findings characteristics.

Results

2014 patients were screened and 764 were included in the final analysis (44.1% male vs 55.9% female; mean age, 63y; median follow-up, 3.46 years). Patients with both proximal hyperplastic polyps and colonic adenomas during their initial colonoscopy had a significantly higher risk of developing T-MAN than patients with a combination of adenomas and distal HP or with only adenomas at index colonoscopy (30.5% vs 19%) [Hazard-ratio (HR)=1.95 (95% confidence interval (CI)1.3-2.9)]. A combination of proximal hyperplastic polyps and colonic adenomas is associated with a higher risk of T-MAN during follow-up than proximal HP alone (30.5% vs 13.9%) [HR=3.4 (95% CI 1.3-8.7)]. No statistically significant evidence was found to identify an increased risk of developing T-MAN at follow-up in patients presenting adenomas alone vs those with only proximal HP (19.1% vs 13.9%) [HR=1.9 (95% CI 0.75-4.7)].

Conclusions

Patients with proximal hyperplastic polyps have an increased risk of presenting a T-MAN at the follow-up colonoscopy. Presenting a combination of hyperplastic polyps and adenomas indicates a higher risk of developing T-MAN than presenting an HP or adenoma alone.

Funding Agencies

Daniel von Renteln is supported by a "Fonds de Recherche du Québec Santé" career development award. He has also received research funding from ERBE Elektromedizin GmbH, Ventage, Pendopharm, Fujifilm and Pentax, and has received consultant or speaker fees from Boston Scientific Inc., ERBE Elektromedizin GmbH, and Pendopharm. Roupen Djinbachian is supported by a “Fonds de Recherche du Québec Santé/Ministère de la Santé et des Services Sociaux” clinical research award. The remaining authors declare that they have no conflict of interest.
A142 PROGNOSTICATING FACTORS AND OUTCOMES OF EARLY ENDOSCOPIC EVALUATION IN ACUTE UPPER GASTROINTESTINAL BLEEDING
Authors: Saunders M , Melchiorre H , Schmanda L , Savage D , Zezos P
Published: February 2024

Background

Current guidelines recommend esophagogastroduodenal endoscopy (EGD) early (ampersand:003C24 hours after presentation) for all suspected acute upper gastrointestinal bleeds (AUGIB). Among referral centers providing advanced tiers of care to large regions, treatment is often delayed secondary to geographic constraints. Metropolitan centers meet early EGD recommendations in up to 87.5% of patients. Some centers limit endoscopy to the ICU setting outside of normal hospital operational times. There is currently no data assessing Canadian referral center endoscopic timing, including factors delaying AUGIB endoscopy and outcomes.

Aims

The aim of this study was to report the prevalence of early EGD in AUGIB at a Northern Ontario referral center. Factors associated with delayed EGD and poor outcomes associated with AUGIB were also evaluated.

Methods

Of 441 patients retrospectively identified with an ICD-10 discharge diagnosis of gastrointestinal hemorrhage from 2016–22, 327 patients met inclusion criteria. Patients were excluded if they were below the age of 18 years at the time of presentation, had chronic UGIB, or lower gastrointestinal hemorrhage.

Results

Pre-endoscopic risk stratification via GBS and clinical Rockall score was high at 10 and 3, respectively. There were 279 patients who received early EGD for AUGIB, of which 56% were male. The median (IQR) time to endoscopy was 27.4 (29.3) hours with early EGD achieved in 46% of presentations. A significantly greater proportion of patients presenting to hospital on the weekend (n=105) had delayed EGD (pampersand:003C0.0001; Phi effect size 0.45). Patients presenting at times when EGD was unavailable (n=157) also experienced delayed EGD (pampersand:003C0.05). regional patients did not experience a greater proportion of delayed EGD. In multivariate analysis, presentation on the weekend, higher CCI, absence of pre-existing evidence of liver cirrhosis, and absence of major stigmata of recent hemorrhage on EGD were independent predictors of delayed EGD (Nagelkerke R2 = 0.379, pampersand:003C0.0001). The odds ratio for receiving late EGD was 8.9 times greater (95% CI 3.7–21.3) for patients presenting on the weekend (pampersand:003C0.0001). Longer endoscopy wait time was significant correlated with higher pre-EGD blood transfusions and longer length of stay (pampersand:003C0.001). Delayed EGD did not increase all-cause 30-day mortality.

Conclusions

Prevalence of delayed EGD in AUGIB was markedly elevated and associated with hospital presentation during times of limited endoscopic capabilities. Outcomes of delayed GED included increased length of stay and higher blood transfusion rates.

Funding Agencies

NOAMA