bluuebunny/crossref_metadata_2025_split huggingface dataset:
A120 NO EVIDENCE OF A FRIDAY EFFECT ON COLONOSCOPY QUALITY OUTCOMES
Authors: Hindi Z , Guizzetti L , cocco S , Brahmania M , Wilson A , Yan B , Jairath V , Sey M 
Published: March 2021

Abstract

Background
Colonoscopy quality may be influenced by operator fatigue. Prior studies have shown lower adenoma detection rates for procedures performed at the end of the day. However, it is unknown if colonoscopy quality is impaired at the end of the work week.

Aims
We investigated whether colonoscopy quality-related metrics differ at the end of the work week using the South West Ontario Colonoscopy Cohort.

Methods
Between April 2017 to February 2018, 45,510 consecutive colonoscopies from 20 academic and community hospitals in our health region were captured to form the cohort. In Canada, outpatient endoscopies are generally performed between Monday to Friday, taking Friday, or the last business day, as the last day of the work week compared to the rest of the work week. When a statutory holiday occurred on a Friday, Thursday was designated the last day of the work week. The primary outcome was adenoma detection rate (ADR), and secondary outcomes were sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), and failed cecal intubation. Outcomes were presented as unadjusted and adjusted risk ratios derived from modified Poisson regression and adjusting for physician-level clustering, and characteristics of the patient (age, sex, severity), procedure (hospital setting, trainee presence, indication, sedation, bowel preparation quality) and physician (experience and specialty).

Results
During the observation period, 9,132 colonoscopies were performed on the last day of the work week compared to 36,378 procedures during the rest of the work week. No significant difference was observed for ADR (26.4% vs. 26.6%, p=0.75), ssPDR (4.5% vs. 5.0%, p=0.12), PDR (44.1% vs. 43.1%, p=0.081), or failed cecal intubation (2.8% vs. 2.9%, p=0.51) for colonoscopies performed on the last day of the work week compared to the rest of the week, respectively. After adjusting for potential confounders, there were no significant differences in the ADR (RR 1.01, 95% CI [0.88, 1.15], p=0.94), ssPDR (RR 0.90, 95% CI [0.70, 1.14], p=0.38), PDR (RR 1.00, 95% CI [0.92, 1.09], p=0.94), or failed cecal intubation (RR 0.92, 95% CI [0.72, 1.18], p=0.51) for colonoscopies performed on the last day of the work week compared to the rest of week, respectively.

Conclusions
Colonoscopy quality metrics, including ADR, ssPDR, PDR, and failed cecal intubation are not significantly different at the end of the week.

Funding Agencies
None
A121 UNDERWATER EMR FOR NON-LIFTING SESSILE COLORECTAL LESIONS
Authors: Galts C , Barclay R , Percy D 
Published: March 2021

Abstract

Background
Sessile colorectal lesions which do not elevate with submucosal injection — “non-lifting” lesions — are considered poor candidates for EMR due to concerns of possible invasive cancer and increased procedural risk. However, a non-lifting sign is an unreliable predictor of malignancy, relegating many benign lesions to surgical resection. Underwater EMR (UEMR), which obviates submucosal injection, is effective for sessile colorectal polyps but has not been evaluated specifically for non-lifting lesions.

Aims
The aim of this study was to assess the efficacy of UEMR for “non-lifting” large sessile colorectal lesions with the hypothesis that UEMR may have a clinical role in managing complex lesions.

Methods
We reviewed our database from 2016 to 2019 for patients referred for large (≥ 20 mm) non-lifting colorectal lesions without overt signs of invasive cancer, who subsequently underwent UEMR.

Results
Thirty-two cases were successfully treated with single session UEMR. 18 (56%) were de novo lesions whereas the remainder had undergone previous attempt(s) at conventional EMR. The mean lesion size was 37 ± 17 mm. 4 cases (13%) were resected en bloc; the remainder piecemeal. Final pathology was T1 adenocarcinoma, N=3 (9%); tubulovillous adenoma, N=15 (47%); tubular adenoma, N=8 (25%); sessile serrated, N=6 (19%); high-grade dysplasia, N=2 (6%). One patient with cancer underwent surgical resection (T1N0); the remainder had endoscopic follow-up over 8 ± 3 months with benign recurrent/residual lesions in 8%, all amenable to UEMR. There were no procedural complications.

Conclusions
In this series of large sessile non-lifting colorectal lesions, UEMR was effective for both de novo and previously treated lesions, obviating surgery in the majority of cases.

Funding Agencies
None
A126 GIST – GLUE IN STROMAL TUMOR
Authors: Kundapur P , Ilnyckyj A 
Published: March 2021

Abstract

Background
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and typically located in the stomach. Gastrointestinal bleeding is a frequent complication of GISTs with surgery being the treatment of choice. Managing GIST bleeding endoscopically can be challenging by an underlying friable neovascularization. The use of cyanoacrylate basis glue has well-established utility in the endoscopic management of variceal bleeding. However, the role of cyanoacrylate basis glue in the management of GIST bleeding is exceptionally rare.

Aims
We present a case of a bleeding GIST that was successfully managed through the utilization of cyanoacrylate basis glue allowing for elective surgical resection.

Methods
A chart review was undertaken. Also, a literature review of the topic was also conducted using the terms “GIST, Cyanoacrylate Glue, Bleeding”

Results
A 75-year-old male presented with a four week history of exertional chest pain. He had noticed persistent black stools for the previous two weeks. His past medical history was relevant for coronary artery disease; two years earlier he had drug eluting stents placed. His medications included ASA 81mg PO OD and Pantoprazole 40mg OD. Physical examination revealed stable vital signs, a soft abdomen and melena on rectal examination. Laboratory investigations showed a hemoglobin of 75 g/L, and 2 weeks prior his hemoglobin had been 120 g/L. Platelets were 149. His liver enzymes and liver function tests were unremarkable. His BUN was 9.9 mmol/L and creatinine of 96.0 umol/L. An esophagogastroduodenoscopy (EGD) revealed a 5cm smooth mass with a central deep depression, in the antrum, that was actively bleeding. Attempts to clip were unsuccessful due to the width of the central depression which was the source of bleeding. (See image 1). The endoscopist chose to inject 1cc of cyanoacrylate basis glue directly into the bleeding site. A subsequent CT scan revealed a 5.2cm polypoid mass in the gastric antrum, favored to be a GIST with no evidence of metastatic disease. Surgery and Cardiology were involved in the care of this patient, and emergency surgery was delayed due to the patient having an intercurrent acute coronary syndrome. Post EGD, the patient underwent an angiogram and the culprit coronary artery was stented and patient was started on dual antiplatelet therapy. Patient then successfully underwent a laparoscopic gastric wedge resection for his GIST, this was completed 1 week after EGD. The pathology of the resected area was in keeping with a GIST. Of note, the patient’s hemoglobin had been stable from the time of EGD until surgical intervention.

Conclusions
Managing GIST bleeding endoscopically can be challenging, and surgical resection is the recommended treatment modality. In situations where surgical intervention is contraindicated, endoscopic therapy with cyanoacrylate basis glue can be considered to achieve hemostasis in GIST bleeding.

Funding Agencies
None
A127 ASSOCIATION OF TRANSABDOMINAL BOWEL ULTRASOUND FINDINGS AND SEVERITY OF INFLAMMATORY BOWEL DISEASE IN PEDIATRIC PATIENTS
Authors: Ma H , Migliarese Isaac D , Petrova A , Parsons D , Anna K , Carroll M W , Wine E , Huynh H Q 
Published: March 2021

Abstract

Background
Previous research has shown that transabdominal bowel ultrasound (TABUS) can detect disease in inflammatory bowel disease (IBD) patients.

Aims
Our aim is to determine the parameters of bowel ultrasound findings that are associated with disease severity at time of diagnosis.

Methods
This prospective study was conducted at the Stollery Children’s Hospital in Edmonton, Alberta. Patients with suspect IBD were enrolled. Each patient underwent a baseline ultrasound, Physicians performed TABUS to visualize the small and large intestine (except rectum). Other investigations including blood work, MRI, and endoscopy. Disease severity in was categorised into mild, moderate and severe using the weighted pediatric Crohn’s disease activity index (wPCDAI), simple endoscopic score for CD (SES-CD), pediatric ulcerative colitis disease activity index (PUCAI), and Mayo score in UC. The severity of disease was compared to 7 ultrasound parameters (fat proliferation, hyperemia, bowel wall thickness (BWT), free intra- abdominal fluid, &gt; 4 lymph nodes (LN) in an area, presence of stricture, and BW stratification. Data was analyzed using SPSS. Anova and Chi square were used to determine parameters for TABUS that were associated with disease severity, with p &lt;0.05 considered significant.

Results
This prospective study was conducted at the Stollery Children’s Hospital in Edmonton, Alberta. Patients with suspect IBD were enrolled. Each patient underwent a baseline ultrasound, Physicians performed TABUS to visualize the small and large intestine (except rectum). Other investigations including blood work, MRI, and endoscopy. Disease severity in was categorised into mild, moderate and severe using the weighted pediatric Crohn’s disease activity index (wPCDAI), simple endoscopic score for CD (SES-CD), pediatric ulcerative colitis disease activity index (PUCAI), and Mayo score in UC. The severity of disease was compared to 7 ultrasound parameters (fat proliferation, hyperemia, bowel wall thickness (BWT), free intra- abdominal fluid, &gt; 4 lymph nodes (LN) in an area, presence of stricture, and BW stratification. Data was analyzed using SPSS. Anova and Chi square were used to determine parameters for TABUS that were associated with disease severity, with p &lt;0.05 considered significance.

Conclusions
Fat proliferation was found to be associated with severity of Crohn’s disease based on disease activity score while BWT was associated with endoscopic severity. Lack of association in UC is likely due to the low number of patients recruited.

Funding Agencies
WCHRI Capacity Grant
A132 ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTEROSTOMY USING A NOVEL DOUBLE BALLOON DEVICE IN THE MANAGEMENT OF MALIGNANT GASTRIC OUTLET OBSTRUCTION
Authors: Marino A , Bessissow A , Valenti D , Boucher L , Miller C , Forbes N , Chaudhury P , Martel M , Chen Y 
Published: March 2021

Abstract

Background
EUS-gastroenterostomy (EUS-GE) is a novel modality in the management of malignant gastric outlet obstruction (MGOO). It is, however, technically challenging limiting its widespread application. To facilitate EUS-GE, a double balloon catheter has been developed in Japan. While this tool is not available outside of Asia, we have conceived a similar device using a widely available vascular balloon catheter. We aim to determine the clinical efficacy and safety of EUS-GE using this double balloon device (DBD).

Aims
We aim to determine the clinical efficacy and safety of EUS-GE using this double balloon device (DBD).

Methods
This is a single-centre, retrospective study of consecutive patients who underwent DBD assisted EUS-GE for MGOO from January 2019-June 2020 (IRB approved). The DBD consists of two 60 mm vascular balloons (Coda, Cook Medical, USA) fashioned together with the balloons 10 cm apart (Figure 1). It is inserted across the obstruction over a wire to the ligaments of Treitz. Both balloons are then inflated followed by saline and contrast infusion into the occluded small bowel segment to facilitate EUS-guided insertion of a 15 mm cautery assisted lumen apposing metal stent (AxiosTM, Boston Scientific Inc, USA). The primary endpoint is the rate of technical success defined as adequate deployment of the stent. Secondary endpoints include rate of clinical success and adverse events.

Results
A total of 11 patients were included in this study. 45% were female with a mean age of 64.9 ± 8.6 years old. The etiology of MGOO was 73% pancreatic cancer, 9% gastric cancer, 9% duodenal cancer, and 9% metastatic cervical cancer. Procedures were performed under general anesthesia and conscious sedation in 82% and 18%, of patients respectively. The mean procedure time was 64.8 ± 25.8 minutes. Technical and clinical success (intention to treat) was 91%. The only technical failure was due to poor patient tolerance of the procedure under conscious sedation. There was one adverse event (9%) due to stent migration rated as severe. Two patients (18%) required re-intervention for stent obstruction secondary to food impaction associated with non-compliance to a low-residue diet. Following re-enforced instructions, no further obstruction occurred.
All patients started a clear liquid diet within 1 day of the procedure with a mean time to a low residue diet of 3.25 days ± 2.5. The median length of hospital stay following the procedure was 5 days ± 13. The median follow-up time was 84 days (IQR 152).

Conclusions
DBD assisted EUS-GE is clinically effective and safe. This balloon device may greatly facilitate the technical aspect of EUS-GE while potential enhancing its safety and clinical use. Larger studies are needed to validate this approach to EUS-GE.

Funding Agencies
None
A134 A MULTI-CENTRE RANDOMIZED CONTROLLED TRIAL TO COMPARE TWO BOWEL CLEANSING REGIMENS AFTER A COLONOSCOPY WITH INADEQUATE BOWEL PREPARATION
Authors: Sey M , von Renteln D , Sultanian R , McDonald C , Martel M , Bouin M , Chande N , Sandhu A , Yan B , Barkun A N 
Published: March 2021

Abstract

Aims
Failed bowel preparation is common during colonoscopy, yet the optimal purgative regimen to use for the next attempt is unknown. The objective of this study was to compare the efficacy, tolerability, and safety of two regimens at supratherapeutic doses for use after failed bowel preparation.

Methods
A multi-centre phase III endoscopist blinded randomized controlled trial (NCT02976805) was conducted in patients who failed bowel preparation, using the US Multi-Society Task Force (USMSTF) definition of inability to exclude polyps &gt;5 mm in size and requiring a shortened interval to next colonoscopy. Regimen A consisted of 15 mg of bisacodyl and 2 + 2 L of split dose polyethylene glycol electrolyte solution (PEG) and Regimen B consisted of 15 mg of bisacodyl and 4 + 2 L of split dose PEG. The primary outcome was adequate bowel preparation, defined as a Boston Bowel Preparation Scale (BBPS) total score ≥ 6 with all segment scores ≥ 2. Secondary outcomes were adequate bowel preparation using the USMSTF definition, median BBPS, adenoma detection (ADR), advanced adenoma detection (aADR), sessile serrated polyp detection (SSPDR), and cecal intubation (CIR). Adverse events were assessed at the time of the colonoscopy and 14 days later.

Results
Between February 2017 and December 2019, 250 subjects were screened at four academic centres in Canada, of which 195 were randomized: 96 to Regimen A and 99 to Regimen B. The mean (SD) age was 60.6 (11.4) years, 87 (45.1%) were female, and the median (IQR) total BBPS score at previous failed colonoscopy was 3 (1,4). Regimen B was not superior to Regimen A in achieving adequate bowel preparation using the BBPS definition (87.6% vs. 91.1%, p=0.45) or the USMSTF definition (85.4% vs 91.1%, p=0.24), nor was it superior with respect to the median BBPS score (7 vs 7, p=0.50), mean ADR (31.5% vs 37.8%, p=0.37), aADR (11.2% vs 18.9%, p=0.15), SSPDR (5.6% vs 8.9%, p=0.40) or CIR (92.1% vs 96.7%, p=0.19). Regimen A had a higher adherence rate (88.2% vs. 74.7%, p=0.02) and greater willingness to undergo the bowel preparation again (91.2% vs. 66.2%, p&lt;0.001). The only serious adverse event occurred in a patient randomized to Regimen B who was admitted to hospital for vomiting after colonoscopy.

Conclusions
Split dose 4L PEG with 15mg of bisacodyl is highly efficacious, well tolerated, and can be used for patients who previously failed first line bowel preparations. The additional 2L of PEG in Regimen B did not improve bowel preparation and was not as well tolerated.

Funding Agencies
AMOSO Opportunities Grant, Pharmascence Inc.
A136 LIVING ON THE EDGE: EUS-DIRECTED TRANSGASTRIC ERCP (EDGE) IN PATIENTS WITH ROUX-EN-Y GASTRIC BYPASS ANATOMY
Authors: Jain A , Barclay R , Donnellan F 
Published: March 2021

Abstract

Background
Roux-en-Y gastric bypass (RYGB) surgery imposes anatomic barriers to endoscopic retrograde cholangiopancreatography (ERCP). Potential options for biliary access in these patients include laparoscopic-assisted ERCP or balloon enteroscopy. However, these approaches require specialized equipment and/or operating room personnel and are associated with high rates of failure and adverse events compared to conventional ERCP. A recently described technique, EUS-directed transgastric ERCP (EDGE), is an entirely endoscopic approach which involves accessing the excluded stomach to facilitate conventional ERCP.

Objectives
To describe the results of EDGE procedures performed in two centres in British Columbia.

Aims
To describe the results of EDGE procedures performed in two centres in British Columbia.

Methods
Data were collected from five patient cases who had undergone an EDGE procedure at Victoria General Hospital (4) or Vancouver General Hospital (1) in British Columbia from 2019 to 2020. All patients had a history of RYGB bariatric surgery. In each of the procedures, a 20 mm diameter lumen-apposing metal stent (LAMS) was deployed under EUS-guidance to allow access from the gastric remnant or proximal jejunum to the excluded stomach. Subsequently, during a separate procedure 4 to 28 days later, a duodenoscope was passed through the LAMS to perform ERCP. Following ERCP, the LAMS was removed 0 to 38 days later and replaced with a double pigtail stent to facilitate controlled closure of the gastro-jejunal or gastro-gastric fistula.

Results
Of the five cases included in the case series, 4 patients underwent EDGE for treatment of choledocholithiasis and one patient underwent the procedure for gallstone pancreatitis. The technical success rate of the EDGE procedure in the five cases was 100%. Clinical success, defined by normalization of bilirubin and symptomatic relief, was observed in all of the cases. There were no adverse events related to the EDGE procedure in these five cases.

Conclusions
The results of this series support EDGE as a safe and minimally invasive approach to biliary access and therapy in patients with previous RYGB surgery.

Funding Agencies
None
A139 IMPROVED QUALITY OF LIFE AFTER ENDOSCOPIC THERAPY FOR BARRETT’S ESOPHAGUS AND EARLY ESOPHAGEAL CANCER IN SOUTHERN ALBERTA
Authors: Jeyalingam T , Woo M , Congly S E , David J , Belletrutti P J , Gupta M 
Published: March 2021

Abstract

Background
In patients with Barrett’s esophagus (BE), endoscopic therapy reduces the risk of progression to invasive esophageal adenocarcinoma (EAC). Data on the impact of endoscopic therapy on patient quality of life (QoL) is limited.

Aims
We aimed to assess: (1) change in QoL during the course of endoscopic therapy for BE, (2) factors which predict this change, (3) whether achieving complete remission of dysplasia (CRD) or intestinal metaplasia (CRIM) affect the degree of change.

Methods
We conducted a retrospective observational study using a prospectively maintained database of BE patients treated in Calgary, Alberta from 2013–2020 containing data on demographics, BE disease characteristics and therapeutics, QoL, and follow-up. QoL was determined prior to initiation of therapy and after each treatment session using a validated questionnaire. Descriptive statistics were calculated and change in QoL was compared using a Wilcoxon signed ranks test. Backwards multiple linear regression analysis was performed to determine predictors of change in QoL.

Results
Of 130 BE patients, 112 (86.1%) were male and 104 (80%) had dysplastic histology or intramucosal carcinoma on index endoscopy. Mean (SD) age was 65.6 (12.0) years. At time of analysis, 76 patients (58.5%) had completed endoscopic therapy, of whom 69 (90.8%) achieved CRIM; 54 patients (41.5%) were still undergoing treatment. There was significant improvement in all QoL measures during the treatment course except for “depression” (Table 1). Patients with CRIM or CRD had reductions in “sleep difficulty” and “negative impact on life” to a significantly greater degree vs patients not achieving CRIM (Δ sleep -0.45 vs 0.0, P=0.002; Δ negative impact -0.4 vs -0.05, P=0.014) or CRD (Δ sleep -0.40 vs +0.60, P=0.002; Δ negative impact -0.40 vs +0.20, P=0.04). Multiple linear regression revealed older age (B=-0.03, P=0.008) and fewer number of EMR sessions (B=0.254, P=0.008) were correlated with greater improvement in QoL.

Conclusions
Endoscopic therapy improves QoL in BE patients, especially in those achieving CRIM/CRD. Older age and fewer EMRs are correlated with greater improvement in QoL. These results further reinforce the role of endoscopic therapy as the first line treatment of BE and early EAC.

Funding Agencies
None