bluuebunny/crossref_metadata_2025_split huggingface dataset:
A82 A SURVEY OF TRAINING PATHWAYS AND PRACTICE TRENDS OF ENDOSCOPIC SUBMUCOSAL DISSECTION IN CANADA
Authors: Li S , Mosko J , May G , Teshima C 
Published: March 2021

Abstract

Background
Endoscopic submucosal dissection (ESD) has become the established standard for endoscopic removal of large gastrointestinal (GI) lesions and early GI malignancies, with improved outcomes compared to traditional endoscopic techniques and offers an alternative to surgery. However, ESD is technically challenging and requires significant healthcare infrastructure. As such, its adoption in Canada was slow relative to Asia and Europe. Thus far, the practice of ESD has been limited to a small number of tertiary centers. Currently, the availability and practice of ESD across Canada remains unclear.

Aims
To provide a descriptive overview of the training pathways and practice trends of endoscopists performing ESD in Canada.

Methods
ESD practitioners across Canada were identified from internal networks and by contacting respective endoscopy units. All endoscopists currently accepting ESD referrals were invited to participate in a cross-sectional survey that was distributed via SurveyMonkey.

Results
27 ESD practitioners were identified; current survey response rate was 44% although is expected to increase. Median years of independent ESD practice was 5 (IQR 2.75). All practitioners underwent international ESD training of some type. 92% attended short-term training courses. 50% pursued international ESD fellowship training. 92% received training on animal models. 58% and 33% performed hands-on human upper and lower GI ESD respectively prior to independent practice. In practice, 67% of practitioners noted an increase in number of ESD procedures performed per year from 2015 to 2019. 67% rated the awareness of appropriate ESD indications by referring physicians to be “not so aware” or lower. 75% of practitioners report a patient wait time for ESD of 1–3 months. 67% and 75% rated the difficulty of securing endoscopy time and anesthesia support for ESD respectively to be “difficult” or “very difficult”. 75% were “dissatisfied” or “very dissatisfied” with their institution’s healthcare infrastructure to support ESD. 25% perceived their institution as supportive in expanding the practice of ESD.

Conclusions
A number of challenges exist for the adoption of ESD in Canada. Training pathways are highly variable, with no set standards and most practitioners pursue international training. In practice, the majority of practitioners express dissatisfaction with their access to necessary infrastructure for performing ESD and feel poorly supported by their centers in expanding its practice. As ESD is becoming the accepted standard in allowing for the minimally invasive treatment of indicated GI lesions; greater collaboration between practitioners, institutions, and healthcare systems is crucial to standardize ESD training and to ensure improved patient access.

Funding Agencies
None
A108 ARE INPATIENTS STILL MORE LIKELY TO FAIL BOWEL PREPARATION IN THE SPLIT-DOSE ERA? FINDINGS FROM 47, 292 COLONOSCOPIES IN THE SOUTHWEST ONTARIO COLONOSCOPY COHORT
Authors: Sey M , Wong A , McDonald C , Liu E Y , Yan B 
Published: March 2021

Abstract

Background
Prior studies before the widespread use of split-dose bowel preparation have shown a high rate of inadequate bowel preparation in hospitalized patients. Whether this is still true in the era of split-dose bowel preparation is unknown.

Aims
To determine the impact of inpatient status on bowel preparation quality in the contemporary era of split-dose bowel preparation.

Methods
The Southwest Ontario Colonoscopy cohort consists of all inpatient and outpatient colonoscopies performed between April 2017 and Oct 2018 at 21 hospitals serving a large geographic health region. Procedures done in patients &lt; 18 years of age or by an endoscopist performing &lt;50 colonoscopies/year were excluded. Data were collected through a mandatory quality assurance form that was completed by the endoscopist after each procedure. Pathology reports were manually reviewed. The primary outcome was adequate bowel preparation, defined on an ordinal scale as “good” or “fair” rather than “poor”. Secondary outcomes included adenoma detection rate (ADR), sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), and cecal intubation rate (CIR).

Results
A total of 47,292 colonoscopies were performed by 75 physicians (36.2% by gastroenterologists, 60% by general surgeons, 4% others), of which 1,690 were inpatients (3.6%). Inpatients were older (mean 66.8 years vs 60.2 years, p&lt;0.0001), more co-morbid (≥ASA grade 3, 53.6% vs 23.7%, p&lt;0.0001), performed for symptomatic indications (95.7% vs 48.6%, p&lt; 0.0001), have trainee involvement (47% vs 11.6% p&lt;0.001), and less likely to receive split-dose bowel preparation (71.7% vs 91.6% p&lt;0.001). On crude analysis, inpatients were less likely to have adequate bowel preparation (86.2% vs 97.6% p&lt;0.001). On multi-variable analysis, inpatients had lower odds of achieving adequate bowel preparation (OR=0.41, 95% CI 0.33 - 0.50, p&lt;0.001), lower ADR (OR=0.47, 95% CI 0.40 - 0.55, p&lt;0.001), lower PDR (OR=0.54, 95% CI 0.47 - 0.61 p&lt;0.001) and lower CIR (OR = 0.43, 95% CI 0.35 - 0.54, p&lt;0.001).

Conclusions
In the era of split-dose bowel preparation, inpatient status is still an important predictor of inadequate bowel preparation with resultant lower quality outcome metrics.

Funding Agencies
None
A109 LINKING PRIMARY AND SPECIALTY CARE FOR THE MANAGEMENT OF DIGESTIVE HEALTH CONDITIONS: AN EVALUATION OF GUT LINK IMPLEMENTATION
Authors: Stewart M J , Heisler C , Kohansal A R , Patel S , Williams G , Williams S , Miles M , Zhu J , Kulai T , Peltekian K , Gruchy S E , Epstein I , Farina D , Jones J 
Published: March 2021

Abstract

Background
Severe restrictions on in-person encounters and endoscopic procedures for digestive care have occurred as a result of the COVID-19 pandemic. This has exacerbated pre-existing barriers in access to gastroenterology (GI) care across Nova Scotia (NS) for patients and primary healthcare providers (PHCPs). In response, a provincial PHCP-GI consultative service (GUT LINK) was implemented at a single tertiary care center with the goal of supporting PHCPs in the management of non-urgent GI referral conditions.

Aims
To implement and evaluate the acceptability, feasibility, appropriateness, and early effectiveness of the GUT LINK PHCP-GI consultation service.

Methods
This is an ongoing prospective observational cohort study. All referrals received through the EMR-based referral and triage management system between May and November 2020 that were deemed to be amenable to management within primary care with specialist support were returned to the PHCP with the suggestion to arrange a GUT LINK telephone consultation. GUT LINK appointments were scheduled through an administrative support telephone line with the PHCP and a GI specialist. A post-consultation e-questionnaire was distributed to PHCPs who consented to participate. Feasibility (number of and indication for referrals, PHCP participation rates), acceptability and appropriateness (satisfaction, future use, likelihood to recommend) metrics and outcomes (case resolution, re-referrals, proportion requiring endoscopic investigations) were recorded. Patient charts were reviewed to determine whether the patient ultimately required GI speciality care. Analyses were descriptive and expressed as frequencies, means (+/-SD), medians (+/-SE), and proportions (%).

Results
A total of 45 GUT LINK consultations were completed between May and November 2020. Of these, 20% required GI specialist care and 80% have remained within primary care, with a median follow-up of 101 (+/-9.1) days. The indications for GUT LINK consultation included lower GI symptoms (64%), abnormal imaging or investigations (17%), and upper GI symptoms (19%).
To date, 21 PHCP agreed to be contacted for the post-consultation survey and 10 have been completed. All PHCPs reported that GUT LINK consultation was easy to access, while 90% found the advice helpful and 80% reported that that it resolved the issue. Following the GUT LINK appointment, 80% felt they would not need to refer their patient to GI.

Conclusions
The implementation of GUT LINK was acceptable, feasible, and improved access to specialist support for management of undifferentiated GI symptoms. Future research will focus on comprehensive stakeholder engagement in order to design, implement, and evaluate GUT LINK PHCP care pathways.

Funding Agencies
CAG
A117 PROPOFOL SEDATION DOES NOT IMPROVE MEASURES OF COLONOSCOPY QUALITY – FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT
Authors: Sey M , Yan B , Hindi Z , Brahmania M , Gregor J C , Jairath V , Wilson A , Khanna N , McDonald C , cocco S , Chakraborti D , French K , ALasseger M , Siddiqi O , Blier M , makandey b , Al-obaid S , wong A , Siebring V , Brackstone M , Teriaky A , Vinden C , Guizzetti L 
Published: March 2021

Abstract

Background
The use of propofol during colonoscopy has gained increased popularity due to deeper anesthesia compared to conscious sedation. Prior studies examining the use of propofol sedation during colonoscopy have primarily focused on anesthesia outcomes. Whether propofol sedation is associated with improvements in colonoscopy outcomes is uncertain.

Aims
The primary outcome was adenoma detection rate (ADR). Secondary outcomes were the detection of any adenoma (conventional adenoma, sessile serrated polyp, and traditional serrated adenoma), sessile serrated polyp detection rate, polyp detection rate, cecal intubation rate, and perforation rate.

Methods
The Southwest Ontario Colonoscopy cohort consists of all patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 hospitals serving a large geographic area in Southwest Ontario. Procedures performed in patients less than 18 years of age or by endoscopist who perform &lt;50 colonoscopies/year were excluded. Data were collected through a mandatory quality assurance form that was completed by the endoscopist after each procedure. Pathology reports were manually reviewed.

Results
A total of 46,634 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others) of which 16,408 (35.2%) received propofol and 30,226 (64.8%) received conscious sedation (e.g. combination of a benzodiazepine and a narcotic). Patients who received propofol were likely to have a screening indication (49.2% vs 45.5%, p&lt;0.0001), not have a trainee endoscopist present and be performed at a non-academic centre (32.2% vs 44.6%, p&lt;0.0001). Compared to conscious sedation, use of propofol was associated with a lower ADR (24.6% vs. 27.0%, p&lt;0.0001) and detection of any adenoma (27.7% vs. 29.8%, p&lt;0.0001); no difference was observed in the detection ofsessile serrated polyps (5.0% vs. 4.7%, p=0.26), polyp detection rate (41.2% vs 41.2%, p=0.978), cecal intubation rate (97.1% vs. 96.8%, p=0.15) or perforation rate (0.04% vs. 0.06%,p=0.45). On multi-variable analysis, the use of propofol was not significantly associated with any improvement in ADR (RR=0.90, 95% CI 0.74–1.10, p=0.30), detection of any adenoma (RR=0.93, 95% CI 0.75–1.14, p=0.47), sessile serrated polyp detection rate (RR=1.20, 95%CI 0.90–1.60, p=0.22), polyp detection rate (RR=1.00, 95% CI 0.90–1.11, p=0.99), or cecal intubation rate (RR=1.00, 95%CI 0.80–1.26, p=0.99).

Conclusions
The use of propofol sedation does not improve colonoscopy quality metrics.

Funding Agencies
None
A125 SNARE TIP SPRAY COAGULATION FOR NON-CONTACT HEMOSTASIS: A SINGLE OPERATOR RETROSPECTIVE STUDY OF CLINICAL OUTCOMES.
Authors: Fetz A , Gan S 
Published: March 2021

Abstract

Background
An emerging non-contact endoscopic method for hemostasis is the use of spray coagulation (SC) using a polypectomy snare tip. Other non-contact options, such as argon plasma coagulation (APC), can be inconvenient and costly. Our current practice includes using SC where APC would be traditionally indicated.

Aims
The aim of this study was to characterize the clinical outcomes, including rates of successful hemostasis, rebleeding, and complications, for snare tip SC in hemostasis.

Methods
We conducted a retrospective chart review of all patients who underwent therapeutic endoscopy for hemostasis using snare tip SC by a single operator at a large Canadian tertiary care centre between January 2018 and September 2020.

Results
14 patients, including 10 males and 4 females, were included. 5 (35%) patients received SC during an EGD, 5 (35%) patients during a colonoscopy, and 4 (29%) patients during a small bowel enteroscopy. Mean age was 74.4 (±11). All patients were referred for work-up of gastrointestinal bleeding or anemia. 5 (35%) patients were treated for vascular lesions including AVMs or angioectasias, 4 (29%) patients for GAVE, 3 (21%) patients for radiation proctitis, and 2 (14%) patients for bleeding ulcers. Adequate hemostasis, defined by cessation of bleeding symptoms, lack of a 10g/L or more decrease in hemoglobin post-procedure, and no further endoscopic therapies in the subsequent 28 days, was achieved in 11 patients (79%). 2 of the 3 patients in which adequate hemostasis was not achieved had additional investigations in which a second source of bleeding was found and treated. 1 patient with colonic AVMs and 1 patient with radiation proctitis required a repeat treatment in 2 weeks and 6 months, respectively. There were no incidence of prolonged abdominal pain, perforations or deaths.

Conclusions
Snare tip spray coagulation appears to be a safe and effective modality for non-contact hemostasis. Larger studies will help solidify its use in daily practice.

Funding Agencies
None
A131 POINT OF CARE ULTRASOUND CHANGES THE NEEDLE INSERTION LOCATION FROM AN ANATOMICALLY LANDMARKED SITE DURING BEDSIDE PARACENTESIS.
Authors: Rodrigues D , Kundra A , Hookey L , Montague S 
Published: March 2021

Abstract

Background
Paracentesis is a bedside procedure to obtain ascitic fluid from the peritoneum. It is traditionally performed using anatomic landmarking and percussion to ascertain a safe drainage site. The serious complication rate has been reported as less than 2%. Point-of-care ultrasound (POCUS) has been adopted into education and clinical use and has been shown to improve the safety of certain procedures such as central line insertion and thoracentesis. However, the evidence supporting its use is limited.

Aims
We aimed to assess if POCUS would yield a user-preferred site for needle insertion compared to conventional landmarking, defined as a &gt;5cm change in location.

Methods
Adult patients under the care of gastroenterology or general internal medicine at Kingston Health Sciences Centre undergoing paracentesis were consecutively enrolled between January and September of 2020. Physicians performing the procedure were enrolled based on availability. An anatomic site was selected 4cm superiorly and 2-4cm medially to the anterior superior ileac spine and confirmed with dullness to percussion. POCUS was then employed to determine if there was an alternative user-preferred site. Patient and operator demographic data and procedure-related information were collected.

Results
A total of 30 individual patients and 24 operators were enrolled, comprising 45 unique procedure combinations. Operators were primarily in their PGY 1 and 2 years of training (33% and 31% respectively). Per procedure, patients mean age was 61, and most of the ascites was due to cirrhosis (84%) predominantly due to EtOH (47%) and NAFLD (34%). As per indication, 29% of procedures were for diagnostic purposes alone. In total, users primarily preferred the POCUS site which resulted in a change in needle insertion site &gt;5cm from the anatomic site in 69% of cases. The average depth of fluid was greater at the POCUS site vs. the anatomic site (5.4cm+/-2.8 vs 3.0cm+/-2.5, p&lt;0.005). On average, POCUS deflected the needle insertion site superiorly and laterally to the anatomic site. Operators listed that per procedure the POCUS site was chosen to avoid adjacent organs (38%), optimize fluid pocket (61%) and due to abdominal wall issues (primarily issues with pannus; 11.5%). Importantly 6 cases were aborted due to a lack of an appropriate fluid pocket, despite clinical and/or prior radiographic evidence of ascites.

Conclusions
Overall, POCUS changes the needle insertion site from the conventional anatomic site for most procedures, due to user-perceived safety concerns. POCUS also prevented an attempt at paracentesis in 6 cases that were deemed unsafe. Therefore, POCUS plays an important role in bedside paracentesis. This research supports the use of POCUS in paracentesis and argues for continued training with POCUS throughout medical school and residency.

Funding Agencies
None
A135 ASSESSING THE HISTOLOGICAL QUALITY OF ENDOSCOPIC BIOPSY SAMPLES OBTAINED USING NOVEL MULTIBITE FORCEPS FROM A PORCINE GASTRIC SPECIMEN
Authors: Anvari H , Rai M , Hussey A , Hurlbut D , Grin A , Hookey L 
Published: March 2021

Abstract

Background
Tissue sampling is often limited to acquisition of one to two biopsy samples during a single pass. The ability to obtain more than two biopsies during a single pass can improve diagnostic yield however is potentially limited by poor specimen quality and loss of specimens. The multibite forceps used in this study have a unique geometry with the ability to store up to six biopsy samples taken consecutively with easy removal of the samples when shaken in solution. If multiple biopsies can be taken during a single pass with preserved specimen quality then we can reduce procedure time, improve efficiency and sensitivity of biopsies.

Aims
To evaluate the histological quality of the first biopsy sample compared to the last (sixth) biopsy sample acquired consecutively with the multibite forcep during a single act.

Methods
A porcine stomach was coloured with surgical dye to create six separate segments. An experienced endoscopist used single use disposable MultiCROC multi-sampling biopsy forceps to acquire six consecutive biopsies. Biopsies were manually separated into the order of which they were acquired (biopsy one through six) and each sample was placed in formalin solution. A total of 35 sets of 6 biopsies were obtained producing a total of 210 samples. Samples were randomized and two independent pathologists who were blinded to the biopsy order assessed the histological quality of specimens. Specimens were evaluated for presence of full thickness mucosa, absence of fragmentation, crush artifact and diagnostic utility. Each pathologist then scored each specimen and the mean scores were used to compare the histological quality of the first biopsy vs. the sixth biopsy for each set.

Results
Our preliminary results include 12 of the 35 sets of biopsies. Using a paired sample t test, there was no significant difference between the mean score given to biopsy one and biopsy six for all twelve pairs [3.62 (SD 1.46) vs. 3.67 (SD 1.15), correlation factor=0.498 and p=.10). There was no significant difference between the first and sixth biopsy when comparing the presence of full thickness mucosa [0.59 (SD 0.49) vs. 0.59 (SD 0.44), p=.086], absence of fragmentation [0.50 (SD 0.50) vs. 0.73 (SD 0.34), p=0.06], absence of crush artifact [0.96 (SD 0.15) vs. 0.91 (SD 0.30), p=0.77), and specimen size [1.64 (SD 0.92) vs. 1.70 (SD 0.65), p=0.56).

Conclusions
No significant differences were found between the histological quality of the first biopsy and the sixth biopsy. Additional parameters such as specimen size, full thickness mucosa, absence of fragmentation and absence of crush artifact revealed no significant differences between the first and sixth biopsy. This preliminary data thus far shows that there is no difference between the histological quality when multiple biopsies are retrieved consecutively.

Funding Agencies
NoneNone
A137 LAPAROSCOPIC ENDOSCOPIC COOPERATIVE SURGERY FOR GASTROINTESTINAL STROMAL TUMOURS: EARLY EXPERIENCE IN A CANADIAN ACADEMIC CENTRE
Authors: Low D J , Fecso A , Chesney T , Mosko J 
Published: March 2021

Abstract

Background
Surgical resection with laparoscopic gastric wedge resection is commonly conducted for local management of gastrointestinal stromal tumours (GIST). However, resection margins are often difficult to appreciate for lesions with larger endophytic components. As a result, tumour margins may be compromised or excess tissue resected. Laparoscopic endoscopic cooperative surgery (LECS) was developed in Japan to overcome these technical challenges in the resection of subepithelial lesions, including GISTs. Here, we present a case report of an early Canadian experience utilizing LECS in the management of gastric GIST.

Aims
To describe a case report of an early Canadian experience of LECS for the resection of a gastric GIST.

Methods
We performed a review of the literature and describe a case of LECS.

Results
We present a 70-year-old female referred to our centre for endoscopic resection of a 2.5x2.5cm histologically confirmed gastric GIST (low mitotic index and no known metastases). Repeat endoscopic evaluation at our centre confirmed a 25-30mm subepithelial lesion with both exophytic (small) and endophytic (large) components. After tumour board review, we opted for a LECS approach. In the OR, the lesion was identified endoscopically and marked with a Dual J-Knife (Olympus). The margins were injected with a combination of Voluven, methylene blue, and dilute epinephrine. A circumferential incision was then completed using standard ESD technique. The lesion was subsequently identified laparoscopically, with endoscopic guidance, along the lesser curvature. The lesser omentum was mobilized for clear visualization of the serosa around the lesion. A full thickness incision was made endoscopically along the distal aspect of lesion. Full thickness resection was continued endoscopically for one third of the circumference of the lesion until gastric insufflation became compromised. Full thickness resection was completed laparoscopically under endoscopic guidance with grossly negative margins. The defect was closed with running laparoscopic sutures. Endoscopic leak test was performed which was negative. The specimen was retrieved and follow up pathology demonstrated a GIST with low mitotic index and negative margins without tumour rupture.

Conclusions
In a review of the literature, LECS appears to minimize tissue resection while maintaining R0 resection rates. This technique is especially useful for subepithelial lesions with larger endophytic and transmural components. It has an excellent safety profile with a less than 5% anastomotic leak rate. As such, the literature supports LECS as a suitable procedure for gastric subepithelial lesions &lt;50 mm. However, further studies are needed to compare it systematically to conventional laparoscopic wedge resection in addition to other innovative endoscopic techniques such as STER and EFTR.

Funding Agencies
None