bluuebunny/crossref_metadata_2025_split huggingface dataset:
1129 Increased Risk of Sessile Serrated Adenomas on Initial Screening Colonoscopy in Post-Bariatric Surgery Patients
Authors: Fakhreddine Ali Y. , Lee Joy A. , Gupta Nealansh , Magavi Pooja R. , Takata Mark , Konijeti Gauree G. 
Published: October 2019

INTRODUCTION:
An increased standardized incidence ratio of colorectal cancer (CRC) with longer follow-up intervals after bariatric surgery has been suggested in a large retrospective Swedish cohort study. By impacting epigenetic modifications versus de novo chromosomal mutations, the complex physiologic changes following bariatric surgery may preferentially modulate CRC risk via the sessile serrated adenomas (SSAs) pathway or conventional adenoma-carcinoma sequence, respectively. Our aim was to examine the risk of CRC precursors in post-bariatric surgery patients as compared to the general population.

METHODS:
We conducted a single center retrospective case-control study of patients age 40 to 50 at time of bariatric surgery between 2007-2019 with subsequent documented initial screening colonoscopy and pathology. Diagnostic colonoscopy or patients with a family history of CRC (1st-degree relative age< 60 years, or two 1st-degree relatives) were excluded. 88 patients met both inclusion and exclusion criteria. Cases were matched 1:1 by age ± 2 years and gender to controls with BMI ≥ 25 undergoing average-risk screening colonoscopy during the same time period.

RESULTS:
Among cases, bariatric procedures consisted of Roux-en-Y (51%), laparoscopic gastric band placement (28%), and vertical sleeve gastrectomy (20%). Mean BMI pre-surgery was 42 kg/m2 compared to 33 kg/m2 at their initial screening colonoscopy (Table 1). Average time from surgery to colonoscopy was 4.5 years (SD 2.5 years), with 45% undergoing colonoscopy ≥ 5 years post-surgery. There was no significant difference in adenoma detection rate or BMI at time of colonoscopy between surgical and control groups. SSA detection rate was significantly higher in post-surgery patients (9.1%) compared to controls (3.9%, P < 0.01). Of all detected adenomas, SSA proportion was significantly higher in surgical (15%) vs. control patients (8.2%, P = 0.03). Rectal adenomas were more common in the surgical vs. control groups (12.3% vs 3.0%, P < 0.01), but otherwise we observed no difference in the proportion of adenomas by anatomic location or advanced adenomas. Neither group had high-grade dysplasia or CRC.

CONCLUSION:
SSAs are more common among average-risk post-bariatric surgery patients compared to average-risk non-surgical controls. By anatomic location, adenomas are more common in the rectum compared to non-surgical controls, but the overall distribution of adenomas was similar. Further studies are needed to understand the risk of CRC following bariatric surgery.
1131 A Multifaceted Weight Loss Program for Management of Obesity Related Gastrointestinal Disorders in a Community Based Gastroenterology Practice
Authors: Hawa Fadi , Gladshteyn Mark , Zolotarevsky Mitchelle , Berger Stephen H. , Corsello Paul M. , Fine Michael R. , Peters Stevany L. , Walsh John W. , Velarde Mark J. , Duda Jill E. , Gunaratnam Naresh T. 
Published: October 2019

INTRODUCTION:
Obesity related gastrointestinal disorders including Non-Alcoholic Fatty Liver Disease (NAFLD) and Gastroesophageal Reflux Disease (GERD) are more frequent and usually present earlier than diabetes mellitus type 2 and cardiovascular disorders. This provides an opportunity for the gastroenterologist to intervene early with an effective weight loss therapy. We evaluated the outcomes of a gastroenterologist supervised weight loss program aimed at achieving a 10% total body weight (TBW) loss at 3 months, a known correlation with NAFLD and GERD regression.

METHODS:
Patients with NAFLD and GERD seen at the clinic between May, 2017 to January, 2019 were offered participation in a medically supervised weight loss program comprised of a calorie restricted (800 Kcal/day) meal replacement diet, supervised medical fitness program, and weekly behavioral support groups for 3 months. This was followed by monthly follow up visits with slow reintroduction of whole food plant-based or Mediterranean diet. Two-sample t-Test assuming equal variances was used for statistical analysis.

RESULTS:
One hundred and fifty-three patients presented for their baseline office visit, 56 patients dropped out within 12 weeks of enrollment, and 97 patients with NAFLD (64 patients had both NAFLD and GERD) continue to participate in the program to date. At baseline, the 97 participants (68 Females), had a mean age of 56 years, and a mean BMI of 38 kg/m2. Average percentage weight loss was (4.1% ± 3.5%), (10.5% ± 4.7%), and (13.3% ± 6.5%) at 1 month, 3 months, and 6 months follow up respectively. At 3 months, 63% of patients had lost at least 10% of TBW. Furthermore, patients who attended > 50% of the offered behavioral support groups lost 11.9% TBW at 3 months compared to 10.9% and 9.5% TBW loss for those who attended 10 - 50% and < 10% respectively. Attending > 50% of behavioral support groups was associated with a statistically significant higher TBW loss at 3 months when compared to no attendance (11.9% versus 10%, P-value = 0.042).

CONCLUSION:
Over 60% of patients who completed a 3 month follow up in a multifaceted, community based, gastroenterologist supervised, weight loss program have achieved a clinically significant TBW loss of at least 10%. Our results also suggest that incorporating weekly behavioral support groups into the program might be a useful adjunct to achieving a clinically significant weight loss in this patient population. Studies are ongoing to determine the sustainability of this weight loss over 1 year.
1138 Intragastric Balloon on Blood Pressure Reduction in a Gastroenterology Practice in Eastern Northern Carolina: A Retrospective Review
Authors: Samuel Gbeminiyi O. , Lambert Karissa , Asagbra Oghale O. , Ibegbu Eric 
Published: October 2019

INTRODUCTION:
Obesity is a global pandemic and a major health concern contributing to cardiovascular disease (CVD). Cardiovascular disease (CVD) causes nearly 18 million deaths yearly. Amongst the CVD risk factors, hypertension remains the leading cause of excessive premature mortality and morbidity. The consequences of hypertension are of momentous impact on public health. It is estimated that nearly 1.5 billion adults in the world will have hypertension in the decade ahead. If this trend is not reversed, the ramifications do not bode well for the pandemic of CVD. The highest CVD hospitalization rates are clustered primarily in rural Eastern North Carolina (ENC), a pattern similar to that of all CVD death rates. Also, the prevalence of obesity and HTN in ENC are comparable. Bariatric surgery is the most effective weight (wt.) reduction intervention with short- and long-term health improvements. However, little is known about endoscopic bariatric therapy, such as intragastric balloon therapy (IGBT) on HTN improvement.

METHODS:
Retrospective chart review between January 1, 2016, and January 31, 2019, of adults who received IGBT in a GI practice in ENC. Data collection comprised patient demographics. The primary outcome was wt. reduction, expressed as kilograms lost, and % wt. loss at 3 and 6 months after IGB. The secondary outcome was the impact of weight reduction on hypertension (cut off SBP/DBP: 140/90) post-implantation at 6 months. Logistic regression analyses were performed to determine the association between weight and hypertension at 6- months post-implantation. Statistical analysis was done using STATA 14.

RESULTS:
See Table 1 for baseline demographics. Wt. was found to be a significant factor in determining SBP given the JNC 8 guidelines (β = 0.0140, P < 0.000). These results indicate that for every increase in wt., the log odds of SBP will increase by 1.4%. These results indicate that for every increase in wt, the log odds of hypertension will increase by 1.2%. No association was shown between wt. and DBP. 11 patients requested early removal (IGB removal in the first two weeks to one-month post-implantation). Of the 11, 10 patients reported intolerable side effects, such as intractable nausea, vomiting, diarrhea, and abdominal pain; and one patient reported a sensation of a foreign body.

CONCLUSION:
There was a statistically significant wt reduction post-implantation. Statistically significant correlation was found between wt reduction and changes in SBP at 6 months post-implantation.
1139 High Prevalence of Non-Alcoholic Steatohepatitis in Veterans With Non Alcoholic Fatty Liver Disease Undergoing Sleeve Gastrectomy
Authors: Rabiee Atoosa , Pavle Alexis , Paal Edina , Brody Fredrick , Papademetriou Marianna 
Published: October 2019

INTRODUCTION:
Sleeve gastrectomy leads to significant weight loss and improves features of metabolic syndrome. The prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population undergoing bariatric surgery is reported at 84% -95%. Prevalence of Non Alcoholic Steatohepatitis (NASH) in this population is 25%- 50%. Around 10% of these patients have advanced fibrosis at the time of surgery. The prevalence of NAFLD/NASH or advanced fibrosis in the veteran population undergoing sleeve gastrectomy has not been previously reported. NASH may be underrecognized prior to time of surgery, particularly if there are no associated laboratory abnormalities. This study aims to assess the prevalence of NASH and advanced fibrosis in veterans undergoing sleeve gastrectomy.

METHODS:
This is a retrospective study of 39 patients who underwent sleeve gastrectomy between January 1, 2018- April 30, 2019 at a Veterans Affairs Hospital. Patients with known alcohol use, cirrhosis or without liver biopsy at the time of surgery were excluded. A single pathologist reviewed the liver biopsies and provided a NASH Activity Score (NAS) for each sample. A Fib 4 score and NAFLD fibrosis score were calculated. Summary statistics was used to determine the prevalence of NAFLD at time of surgery.

RESULTS:
Patients baseline characteristics are outlined in Table 1. Only 13% of patients had an abnormal ALT at the time of surgery. There was no evidence of liver synthetic dysfunction with normal INR, bilirubin and albumin. Median NAFLD fibrosis score was -0.8 and median FIB-4 was 0.9 which rules out advance fibrosis. 59% of patients had NAFLD and 61% of these patients had evidence of NASH on pathologic exam. Advanced fibrosis was seen in 8% of patients. 70% of patients had NAS score of 4 or below. Percentage of steatosis, inflammation, ballooning and fibrosis score have been summarized in Table 2.

CONCLUSION:
More than half of our NAFLD patients had characteristics features of NASH on biopsy. This is higher than reported in the general population and close to what has been reported in diabetic patients. However, prevalence of diabetes in the NAFLD patients was only 26%, which would not explain the high number of NASH patients. Advanced fibrosis was only seen in 8% of patients at the time of surgery, which is similar to previous studies. This is the first study to our knowledge to report high prevalence of NASH in a VA population undergoing surgery in the absence of high rate of concomitant diabetes.
1144 A Prospective Study on PPI Response in Children With Eosinophilic Esophagitis
Authors: Bose Paroma , Albright Eric , Idrees Muhammad T. , Sawyers Cindy L. , Perkins Anthony , Gupta Sandeep , Hon Emily 
Published: October 2019

INTRODUCTION:
Proton pump inhibitors (PPIs) are now considered a treatment option for eosinophilic esophagitis (EoE). High-dose PPI (HDPPI) response rates are 23-63% in pediatric studies. Our primary aim was to determine PPI response rate in children with EoE. Secondary aim was to determine clinical, endoscopic, or histologic characteristics that impact this PPI response.

METHODS:
A prospective cohort study of children was conducted. Demographics, clinical history, child and parent-proxy Pediatric EoE Symptom Scores version 2 (PEESSv2.0), EoE endoscopic reference scores (EREFS), and histology scores were collected at endoscopies before and after at least 8 weeks of HDPPI. EoE was defined as ≥ 15 eosinophils/high powered field (eos/hpf) on biopsy from any level of the esophagus on initial endoscopy with symptoms of esophageal dysfunction. Children with < 15 eos/hpf on repeat endoscopy were classified as PPI-responsive (PPI-R) EoE, and ≥ 15 eos/hpf were classified as PPI-nonresponsive (PPI-NR) EoE.

RESULTS:
72 children were enrolled from 2015 to 2018 (58% male; mean 9.4 years). 40 children (56%) met criteria for EoE, and 25 had endoscopies before and after HDPPI. 11 refused HDPPI, and 4 were lost to follow-up. 32% (8/25) of children had PPI-R EoE. Baseline demographics, clinical history, child and parent-proxy PEESSv2.0 scores, parent-proxy dysphagia subdomain scores, EREFS, and histology scores were similar in PPI-R and PPI-NR EoE patients. Baseline child dysphagia scores were worse in PPI-NR EoE patients than in PPI-R EoE patients (17.8 v 11.0, P = 0.012). Parent-proxy PEESSv2.0 scores improved in PPI-R and PPI-NR EoE groups after HDPPI (P = 0.046, P = 0.005). Child PEESSv2.0 scores, and parent-proxy and child dysphagia scores improved significantly in the PPI-NR group after HDPPI (33.2 to 19.1, P = 0.006; 18.9 to 8.9, P = 0.004; 17.8 to 9.2, P < 0.001). EREFS improved in PPI-R and PPI-NR EoE groups (P < 0.001, P = 0.030), but had more improvement in the PPI-R group (P = 0.017). Children in the PPI-R group had improvement in degranulation and basal cell hyperplasia compared to the PPI-NR group (P = 0.016, P = 0.008).

CONCLUSION:
32% of children with EoE responded to HDPPI therapy. No characteristics predicted PPI response. As anticipated, endoscopic and histologic features of EoE improved more in the PPI-R group. We did not expect to find that child and parent-proxy symptom scores would improve significantly in the PPI-NR group. The value of these symptom scores and their role in EoE management should be further studied.
1145 Are There Predictors of Eosinophilic Esophagitis in Children Undergoing Initial Endoscopy for Esophageal Dysfunction?
Authors: Bose Paroma , Albright Eric , Idrees Muhammad T. , Sawyers Cindy L. , Perkins Anthony , Gupta Sandeep , Hon Emily 
Published: October 2019

INTRODUCTION:
Eosinophilic esophagitis (EoE) is a clinicopathologic disease that requires endoscopy for evaluation. At this time, we do not have non-invasive methods to differentiate between EoE and non-EoE causes of esophageal dysfunction. The Pediatric Eosinophilic Esophagitis Symptom Score version 2 (PEESSv2.0) is an EoE-specific validated outcome metric for use by children and parents/caregivers, but its use has not been explored outside of EoE. Our primary aim was to determine if demographics, clinical history, or PEESSv2.0 scores can differentiate between EoE and non-EoE patients in children undergoing initial esophagogastroduodenoscopy (EGD) for esophageal dysfunction.

METHODS:
A prospective cohort study of pediatric patients was conducted at our center after IRB approval. Children ages 1-18 undergoing initial EGD for esophageal dysfunction were enrolled. Demographics, clinical history, and child self-report and parent-proxy report PEESSv2.0 symptom scores were collected at the time of endoscopy. Esophageal biopsies were reviewed by two blinded pathologists. EoE was defined as ≥ 15 eos/hpf seen in any level of the esophagus on biopsy with symptoms of esophageal dysfunction. Non-EoE was defined as < 15 eos/hpf.

RESULTS:
72 children were enrolled in the study from 2015 to 2018 [58% (42/72) males; mean age 9.4 years; age range 1-17 years]. 56% (40/72) had ≥15 eos/hpf on esophageal biopsy and met criteria for EoE. 43% (31/72) had <15 eos/hpf and were labeled non-EoE. Children with EoE trended towards being older than non-EoE patients (mean age 10.4 vs 8.3 years, P = 0.070). Children with EoE were more likely to be male than non-EoE patients (70% vs 45.2%; P = 0.051). Presence of personal or family history of atopy did not differ between these groups. Non-EoE children and their parents had higher (worse) mean PEESSv2.0 total scores than those with EoE (P = 0.001 for child-report and P = 0.049 for parent-proxy). PEESSv2.0 dysphagia subdomain scores (child and parent-proxy) did not differ between EoE and non-EoE groups.

CONCLUSION:
Children with EoE tended to be older and of male gender than non-EoE patients. Personal or family history of atopy did not increase likelihood of diagnosing EoE. Interestingly, the total PEESSv2.0 scores were worse in non-EoE group compared to EoE group. We plan to explore this unexpected finding by analyzing PEESSv2.0 subdomains and compare PEESSv2.0 with other EoE outcome metrics. These data may help stratify likelihood of EoE prior to subjecting a child to initial endoscopy.
1148 Radiation Exposure in Pediatric Population During Endoscopic Retrograde Cholangiopancreaticography (ERCP)
Authors: Ramireddy Srinivas , Subramanian Sruthi K. , Patil Prithvi , Davee Tomas , Badillo Ricardo , Thosani Nirav 
Published: October 2019

INTRODUCTION:
Radiation exposure during ERCP has been well studied in adult population but not specifically in the pediatric population. Use of fluoroscopy during ERCP exposes patients to ionizing radiation with potential for deleterious health consequences including risk of malignancy in future. Based on recent studies, fluoroscopy time (FT) is considered as an imperfect measure of radiation exposure. There are other factors like DAP (dose area product), effective dose (ED), Radiation dosage (RD), which need to be considered in assessing the radiation exposure to patients. The primary aim of this study is to assess the overall radiation exposure to pediatric population during ERCP and to determine if there is a difference between the dose received between adult population and pediatric population.

METHODS:
All procedures performed at our center between 2015 and 2017 were included in this study. Most of the ERCP’s were performed by one high volume endoscopist performing >200 ERCP’s per year in adult population. All ERCPs were performed in the same fluoroscopy unit equipped with an undercouch x- ray tube, collimator, an overcouch image intensifier and image receiver, and a digital image system allowing automatic brightness/exposure control and last image hold. ERCP-associated radiation data are automatically recorded in preinstalled manufacturer-provided software in an operator console unit. This unit automatically records FT (minutes), total radiation dose (TRD) (mGy), and DAP (Gy-cm2). DAP provides an easily measurable estimate of the total radiation delivered to patients undergoing ERCP. Fluoroscopy equipment was entirely operated by the endoscopist.

RESULTS:
Total of 143 pediatric patients were included in the study (n = 143). Mean age was 15.2. The overall median FT was 1.4 minutes. The overall median TRD was 25.375 mGy. The overall median DAP was 6.077 Gy-cm2. The overall ED received by patients during ERCPs was 1.58002 mSv. Age group < =10 appeared to have received less ED and TRD compared to age group 11-18. When compared to adult population, pediatric age population are exposed to more ED and DAP.

CONCLUSION:
Radiation exposure during ERCP should be kept to minimum and there is a strong need to create more awareness among endoscopists about how to use to different settings (by selecting a low frame rate and magnification setting, by using collimation, etc) with newer fluoroscopy machines which can decrease the overall radiation exposure.
1150 Safety, Feasibility, and Cost-Effectiveness of Pediatric Gastrointestinal Procedures at an Outpatient Endoscopy Center
Authors: Kunde Sachin , Chopra Sana , Arora Monica , Hutzenbuhler Megan , Saini Angelie , Sachdeva Neeraj K. 
Published: October 2019

INTRODUCTION:
Pediatric endoscopic procedures are traditionally performed in hospital-based endoscopy centers or operating rooms due to safety concerns. However, the healthcare costs of these pediatric procedures are significantly higher in the hospital setting. Current healthcare environment necessitates safe, effective, and a cost-effective approach for pediatric endoscopic procedures. We implemented specific patient selection criteria for pediatric gastrointestinal procedures at our ambulatory endoscopy center. We report 15-month data on the safety and feasibility of performing pediatric gastrointestinal procedures at an outpatient endoscopy center. We also evaluated the cost of these procedures at our center compared to the hospital-based endoscopy centers.

METHODS:
We conducted a retrospective chart analysis of pediatric endoscopic procedures performed at our ambulatory center over the last 15 months (February 2018 to May 2019). Sedation was provided by certified registered nurse anesthetists using propofol. We used inclusion and exclusion criteria as defined by our QA committee. In addition to standard adult criteria for endoscopy, pediatric-specific criteria included: age >6 years, weight > 22kg, avoidance of documented anaphylactic reaction to soy or egg, and inclusion of ASA I or II only. Adverse events were defined as cardio-respiratory distress indicated by use of the bag and mask ventilation, airway intubation or transfer to a hospital due to respiratory distress. Cost analysis data were obtained from the NC Blue Cross Blue Shield treatment cost estimator tool which is based on historical BCBSNC claims data.

RESULTS:
Overall 316 pediatric patients underwent procedures at our endoscopy center, of which 271 underwent upper endoscopy and 90 underwent colonoscopy. The average patient age was 13 years (range 6-20 years) and 44% were males. 38% of patients met ASA I criteria. None of the patients experienced any adverse events. The average cost of upper endoscopy with biopsy at our center was $750 (+/-100) compared to $4000 (+/-500V) at the hospital. The average cost of colonoscopy with biopsy at our center was $1250 (+/-50) compared to $5000 (+/-500) at the hospital-based endoscopy center.

CONCLUSION:
Performing pediatric gastrointestinal endoscopic procedures at an ambulatory center is feasible and safe, as long as appropriate patient selection criteria are used. Performing pediatric procedures at an ambulatory center is highly cost-effective compared to performing procedures at a hospital.