bluuebunny/crossref_metadata_2025_split huggingface dataset:
542 Gastroenterologist Sentiment Toward Artificial Intelligence (AI) in Endoscopic Practice: A Nationwide Survey
Authors: Wadhwa Vaibhav , Alagappan Muthuraman , Gonzalez Adalberto , Chandnani Madhuri , Berzin Tyler M. 
Published: October 2019

INTRODUCTION:
Application of artificial intelligence (AI) in gastroenterology has been shown to improve the performance of endoscopists in several tasks including colonic polyp detection. However, little is known about how gastroenterologists perceive AI, especially with respect to its costs, ease of use, and efficacy. This nationwide survey is amongst the first to describe how practicing gastroenterologists view this emerging technology

METHODS:
In this cross-sectional observational study, an online survey was sent to practicing gastroenterology physicians and fellows across the US. This included questions about physician background as well as questions about physician understanding and perception of AI. Descriptive statistics were utilized to summarize physician sentiment toward AI. Chi-square test or Fisher's exact test were utilized to assess whether background information about physicians was correlated to their sentiment towards AI. Finally, a multivariate regression model was created to determine which physician factors were most correlated to physician sentiment

RESULTS:
Online surveys were sent by email to 330 gastroenterologists nationwide representing a variety of practice settings and experience levels out of which 124 physicians completed the survey and were included in the analysis. 86% of physicians reported interest in AI-assisted colonoscopy and 84.7% agreed that computer assisted polyp detection (CAPD) would improve their endoscopic performance. Univariate analysis showed that physicians practicing in academic centers versus private practices (P = 0.025) and physicians with less than 15 years post-fellowship experience versus physicians with more than 15 years of post-fellowship experience (P = .006) had a greater expectation of AI improving endoscopic performance. Multivariate analysis showed that post-fellowship experience of less than 15 years was the most important factor in determining whether a physician was likely to believe that CAPD would improve endoscopic performance (OR = 4.03; P = .04). The most common concerns about implementation of AI in endoscopic procedures were cost (75.2%) and development of operator dependence (62.8%)

CONCLUSION:
Gastroenterologists nationwide have an interest in the application of artificial intelligence to endoscopic procedures in gastroenterology, and many believe that this technology would improve their clinical performance. Further studies are needed to determine if AI applications in gastroenterology are cost-saving and time neutral.
545 Converting Inpatient Consults to Directly Scheduled Outpatient Procedures
Authors: Brodsky Tamara , Rubin Moshe , Karaptis John , Hussain Syed , Kim Sang 
Published: October 2019

INTRODUCTION:
Hospitalized patients undergo many tests which can reveal medical issues unrelated to their primary reason for hospitalization. This can lead to consultant evaluations which are necessary, although often not urgent. We evaluated one institution's practice of hospitalized patients requiring non-urgent gastroenterology (GI) procedures. The standard was for patients to either have an inpatient procedure or follow up in clinic after discharge to be scheduled for a procedure, often weeks to months after the initial hospitalization. We instituted a new protocol for scheduling hospitalized patients directly for outpatient procedures within two weeks of discharge.

METHODS:
A protocol was developed for GI fellows consulting on inpatients with incidentally discovered heme positive stool or non-life threatening anemia at New York-Presbyterian Queens Hospital to evaluate the urgency of a GI procedure. If non-urgent, the fellow notified the patient navigators who then reviewed the pre-procedure instructions with the patient and scheduled the procedure for within two weeks of discharge. Patients returned for their procedure and subsequently were seen in the clinic for follow up.

RESULTS:
17 patients were included with 6 procedures completed. Of the 11 patients whose procedures were not completed, 7 were “no shows”, 3 had medical contraindications and 1 insurance authorization was not obtained. On average, each inpatient procedure directly costs the hospital $1,200. Conversely, each outpatient procedure yields $800. In sum, this protocol resulted in approximately $25,200 in total savings/credit for the institution.

CONCLUSION:
Incidental medical problems discovered during a patient's hospitalization can have downstream effects including additional procedures. Without a system to timely complete these procedures outpatient, there is pressure to do so inpatient. This can decrease patient satisfaction, increase length of stay, strain the endoscopy unit, and cause financial loss. We instituted a protocol to ensure hospitalized patients requiring non-urgent GI procedures were directly scheduled for that procedure within two weeks of discharge without the delay of a clinic visit before scheduling. This lead to 17 procedures avoided in the hospital, a direct hospital savings of over $25,000. Hurdles included patients lost to follow up and delays with insurance pre-authorization. With continued refinement, we hope to improve this process to create a better system for patients, providers, and the hospital.
549 Efficacy and Safety of Non-Elevated Piecemeal Polypectomy Using Hot Snare
Authors: Sharma Sahil , Sharma Akhil , Khokhotva Vladislav 
Published: October 2019

INTRODUCTION:
Piecemeal polypectomy refers to the removal of large sessile colonic polyps by means of multiple snarings and is commonly performed after submucosal injection of a liquid, typically normal saline. Some reports suggest submucosal injection may not be benign, due to concerns of needle tracking of neoplastic cells, and difficulty in removal of recurrences due to scarring after injection. There is a paucity of recent literature describing polypectomy without submucosal injection. Historically, non-elevated piecemeal polypectomy has been criticized for concerns regarding bleeding and perforation. The purpose of this study was to describe a retrospective review of colonic polyps removed using non-elevated piecemeal polypectomy and associated outcomes.

METHODS:
An outpatient endoscopy center database was searched for patients who had large (≥3.0) sessile polyps excised using non-elevated piecemeal polypectomy technique between December 2012 and December 2018. All polyps with invasive cancer were excluded (n = 3). Chart review was carried out to extract demographic data, outcomes and adverse events. Details of all subsequent colonoscopies, including recurrences, residual tissue, or need for surgery were recorded.

RESULTS:
During the study period, 73 patients underwent 78 non-elevated piecemeal polypectomies for polyps ≥3 cm. There were 27 (37%) female patients and 46 (63%) male patients. Most common polyp sizes were between 3.5 cm to 3.9 cm (48.7%) or ≥4 cm (52.6%). Tubulovillous adenoma was the most frequent histological subtype (48.7%). Most polypectomies occurred in the right colon (54.4%). There were zero events of perforation. Ten (12.6%) patients had intraprocedural bleeding controlled endoscopically. Four patients (5.1%) had post-procedural bleeding, 3 required colonoscopy and clip hemostasis. There were 10 recurrences (12.8%), nine were found at the first endoscopic follow up and controlled by means of non-elevated hot snare polypectomy. One patient had a persistent recurrence and required subsequent surgical management for an adenocarcinoma.

CONCLUSION:
Non-elevated piecemeal polypectomy with hot snare is a safe and effective technique for the removal of large sessile (≥3 cm) colonic polyps. Perforation and bleeding are uncommon. Recurrences are easily controlled by additional hot snare resection.
554 Continuous Intravenous Fluid versus On-Demand Fluid Therapy During Elective Endoscopy
Authors: Jilani Omar , Kim Pamela , Dhawan Annika , Brignone Emily , Shields Kelly , Dhawan Manish 
Published: October 2019

INTRODUCTION:
Colonoscopy and esophagogastroduodenoscopy (EGD) are commonly performed under sedation with close hemodynamic monitoring. Given the risk of intra-procedural hypotension, it is common practice to start intravenous fluids (IVF) routinely during these procedures despite a lack of evidence for reduction in morbidity. This study aims to compare routine IVF administration versus on-demand IVF administration on patient outcomes after routine endoscopy in an ambulatory surgical center.

METHODS:
An IRB approved retrospective chart review of 100 patients was completed. Of the 100 patients, 50 patients received routine IVFs during endoscopy and the remaining 50 patients did not. Data collected included age, gender, body mass index, and American Society of Anesthesiologists (ASA) score, duration of the procedure, time spent in the recovery room post procedure, quantity of IVFs used and hemodynamics. Adverse patient effects such as dizziness, nausea, emesis, or shortness of breath were documented.

RESULTS:
The routine IVF group and the on-demand IVF group had similar demographics (Table 1). About 75% of the patients in both groups met criteria for ASA class 2. About one-third of the patients in both groups had a BMI over 30. There was no significant difference in the preoperative, intraoperative and postoperative hemodynamics between the two groups. The average preoperative and postoperative blood pressure in both groups was 137/83 and 116/66, respectively. The on-demand group received an average 15 milliliters of fluids, likely as KVO (Keep Vein Open) while the routine IVF group received an average of 423 milliliters of fluid (Table 2). Although 84% of patients in the routine IVF group received fluids postoperatively there was no reported change in hemodynamics to warrant this fluid. There was a significant difference in the post-procedure recovery time between the two groups, 49.9 minutes for the IVF group and 41.7 minutes for the on-demand IVF group (P < 0.002). Only one patient (from the IVF group) required vasopressor intraoperatively for hypotension.

CONCLUSION:
The lack of routine intravenous fluids did not result in adverse outcomes or any detrimental change in hemodynamics. Prospective studies can reveal more insight into the utility of routine IVF use during these procedures and any improvement in safety and quality to justify the increased cost.
558 Accuracy of Endoscopists in Predicting Colorectal Polyps
Authors: Fahim Peter , Ali Birmaji , Kindel Robert , Steinbrunner Jenni 
Published: October 2019

INTRODUCTION:
Colonoscopy is the gold standard for the identification of colorectal cancer and polyps. The majority of colorectal polyps found at screening colonoscopy are diminutive (≤5 mm) and have a low prevalence for advanced histological features and rarely harbor cancer. Precise endoscopic determination of the histology of polyps at the time of colonoscopy could prevent unnecessary polypectomies. The ASGE PIVI statement on this topic proposes to leave a suspected recto-sigmoid hyperplastic polyp ≤5 mm, there should be ≤90% negative predictive value (when used with high confidence) for adenomatous histology. The study purpose is to assess the accuracy of experienced endoscopists in predicting histological types of polyps resected at standard screening colonoscopy using white light.

METHODS:
Patients undergoing screening colonoscopy were enrolled into this prospective study. The study was conducted at two sites – a tertiary community teaching hospital and an outpatient endoscopy unit. Screening colonoscopy was defined as the first colonoscopy performed in an adequately prepped asymptomatic patient between the age of 50-80 with no risk factors. Six endoscopists were asked to complete a form at the end of the procedure, which included their pathology prediction and level of confidence of each resected polyp. Classifications for prediction pathology were adenoma (tubular, villous, tubulovillous), serrated (hyperplastic, sessile serrated adenoma, traditional serrated adenoma), cancer and others. Analysis was conducted to determine the accuracy of predictions.

RESULTS:
Among the 158 patients eligible for the study, endoscopist predictions were made on 336 resected polyps. The majority of polyps (82%) were <5 mm. Predictive accuracy of all polyp types with high confidence was 84%. The accuracy in predicting adenomatous histology with high confidence was 89%. Negative predictive value of polyps <5 mm located in the recto-sigmoid predicted with high confidence was 90%. When comparing endoscopists, there was not significant variability for predicting polyp type or adenoma classification. Out of the 42 polyps predicted to be hyperplastic with high confidence, 30 (71%) were correctly predicted, 7 (17%), 3 (7%) and 2 (5%) were diagnosed as tubular adenoma, sessile serrated adenoma, and other respectively.

CONCLUSION:
Our study have met the negative predicative value threshold for adenomatous poly histology, supporting a “diagnose- and- leave” strategy for diminutive predicted polyps in the rectosigmoid.
563 High Rate of Discordant Pain Levels Reported by Patients and Physicians During Gastrointestinal Endoscopy
Authors: Yip Benjamin , Lewis Justin , Crain Tyler , Ho Nancy 
Published: October 2019

INTRODUCTION:
Procedural sedation is given to reduce patient anxiety, discomfort, pain and to improve outcomes in endoscopy. Data are limited regarding patient satisfaction with endoscopy. Our goal was to evaluate physician perceptions of patient pain and anxiety before and after endoscopy and factors associated with their correlation.

METHODS:
We performed a prospective study of 233 consecutive patients who received procedural sedation during endoscopy from August to November 2018 at the Portland VA Medical Center. Patients were given a pre-endoscopy survey to assess expectations and a post-endoscopy survey to assess procedural satisfaction, and physician were given a post-endoscopy survey only. Outcomes included expected and actual pain, anxiety, and sedation level during endoscopy and was reported on a scale from 0 to 5.

RESULTS:
Upper endoscopy, colonoscopy, and bi-directional endoscopy were performed in 30%, 60%, and 10% of cases, with an average procedural time of 19.1 minutes. Midazolam and fentanyl were most commonly used for sedation with an average dose of 4.0 ±0.1 mg and 102.5 ± 2.7 mcg, respectively. A minority of patients reported alcohol, marijuana, non-opiate pain medication, and opiate use (39%, 15%, 19%, and 16%, respectively). Pre-procedural anxiety and expected level of pain significantly improved with patient's post-procedural assessment (Tables 1 and 2). The average difference of anxiety and pain levels pre-endoscopy and post-endoscopy was 0.48 and 0.41, respectively. There was poor concordance between the physician's perceived patient pain and patient reported pain level during endoscopy (61%) with an overall Cohen's kappa of 0.258. Several factors associated with reduced patient and physician pain correlation included the presence of mental health disorders and use of benzodiazepines, SSRI, or SNRI (Table 3). Despite the discordance, the majority of patients reported satisfaction in pain control and would return for a repeat procedure (85% and 95%, respectively).

CONCLUSION:
Patients reported higher levels of pre-procedure anxiety and expected pain than actual anxiety and pain post-procedure. Physicians have poor concordance with patients with respect to pain levels, especially with more severe pain scores and in the presence of mental health disorders. Patients at high risk for discordance may benefit from more thorough pre-procedural counseling and a lower threshold for escalating doses of sedation during endoscopy.
564 Prevalence, Risk Factors, and Global Impact of Musculoskeletal Injuries Among Endoscopists in Portugal
Authors: Morais Rui , Vilas-Boas Filipe , Lopes Pedro , Simões Carolina , Dantas Eduardo , Cunha Inês , Roseira Joana , Cortez-Pinto João , Silva João , Lage Jorge , Caine Mafalda , Rocha Manuel , Flor de Lima Margarida , Santos Maria Pia , Garrido Mónica , Sousa Paula , Marcos Pedro , Azevedo Richard , Castro Rui , Gonçalves Tiago Cúrdia , Leal Tiago , Magno-Ferreira Vítor , Ramalho Rosa , Rodrigues-Pinto Eduardo , Macedo Guilherme 
Published: October 2019

INTRODUCTION:
The performance of endoscopy is characterized by frequent and repetitive activities. Endoscopists often report musculoskeletal injuries (MI). The widespread use of endoscopy and the execution of more technically challenging procedures may lead to higher rates of repetitive stress injuries. Despite previous American and Asian reports, little evidence has come from Europe. We aimed to determine the prevalence, risk factors and impact of MI among Portuguese endoscopists.

METHODS:
A 48-question electronic survey was developed by a multidisciplinary group. The electronic survey was sent to all members of Portuguese Society of Gastroenterology (SPG, n = 705) during May 2019. Study data were collected and managed using REDCap electronic data capture tools hosted at SPG–CEREGA.

RESULTS:
The survey was completed by 171 endoscopists (response rate of 24.3%), 55.0% female, with a median age of 36 years (31-50). The majority of the respondents were consultants (77.8%; trainees 22.2%), with 97.7% currently performing endoscopy. The median time of endoscopic practice was 9 years (5-22). Regarding practice setting, 52.0% worked in academic centers, 41.5% in community centers and 63.9% in private practice. The median weekly-working time was 50 hours (45-60), 50% (37.5-62.5%) performing endoscopy. The prevalence of reported MI was 69.6% (n = 119). The median time for MI development was 6 years (3-16). The most common sites of injury were neck (42.9%) and thumb (42.0%). In 45.4%, the pain was evident both in work and daily activities and 22.7% referred pain even at rest. In the respondents with MI, 34.5% changed practice and/or reduced working activity and 33.6% reduced work-unrelated physical activity. Missing work was reported by 10.1% [median 30 days (4-45)]. The most common treatments were NSAIDs (57.1%) and physiotherapy (30.3%) but surgery was required in 1.7%. In the multivariate logistic regression, endoscopic practice >15 years (OR 3.514, P = 0.004), female gender (OR 2.443, P = 0.018) and higher percentage of time performing upper endoscopy (OR 0.974, P = 0.026) were independently associated with MI.

CONCLUSION:
Musculoskeletal injuries were reported by over two thirds of the portuguese endoscopists that completed our survey. These injuries had a significant impact on regular and professional activities. Female endoscopists and those with a minimum of 15 years of practice are at higher risk. The identification of these risk factors may result in practice changes to reduce the burden of the injuries.
565 Prophylactic Antibiotics for PEG Tube Placement: An Updated Meta-Analysis of Randomized Controlled Trials
Authors: Mandal Amrendra , Kesar Varun , Gonzalez Zorisadday , Roy Neel P. , Kanth Rajan , Roy Praveen K. 
Published: October 2019

INTRODUCTION:
Percutaneous endoscopic gastrostomy (PEG) tube placement is associated with a risk of infection. It is currently a standard of practice to administer prophylactic antibiotics with PEG tubeplacement. However, several recent studies have reported mixed results. We performed an updated meta-analysis to assess the efficacy of prophylactic antibiotics for PEG tube placement.

METHODS:
MEDLINE, Google scholar, Embase PubMed, Cochrane Database, and abstracts from gastroenterology scientific meetings were searched. Only randomized controlled trials (RCTs) of adult subjects comparing prophylactic antibiotics to no prophylactic antibiotics for PEG tube placement were included. Study quality was accessed by assigning a quality score. Two independent reviewers used standard forms to extract data and the differences were resolved by mutual agreement. Meta-analysis for the effects of prophylactic antibiotics was analyzed by calculating pooled risk or odds ratio for peristomal infections, systemic infections, and mortality using both fixed and random effects models. Heterogeneity among studies was assessed by calculating I2 measure of inconsistency. Publication bias was also assessed.

RESULTS:
Thirteen RCTs (636 controls/764 treatment arm) met the inclusion criteria. All trials were published between 1985 and 2016. Eight trials predominantly used cephalosporins and 5 trials used penicillins. Eleven trials reported the technique of PEG tube placement: 8 used pull technique, 1 push technique, 1 both and 1 used the introducer method. In the treatment arm 1.07% of the patients got peristomal infection and in the control arm it was 2.55%. Prophylactic antibiotics with PEG tube placement resulted in a significant reduction in the risk of peristomal infection (RR 0.49, 95% CI: 0.39–0.63, P < 0.001, NNT = 8) and systemic infection. On subgroup analysis, both cephaloporins and penicillin based prophylaxis resulted in statistically significant reduction in risk of infections. Both single dose and multiple doses of antibiotics resulted in a reduction in the risk of infection. No significant difference was noted for mortality. Heterogeneity among studies was not significant. Funnel plots revealed no significant publication bias. Majority of the studies received a high score for quality.

CONCLUSION:
Current evidence supports the administration of prophylactic antibiotics prior to PEG tube placement. Further studies need to explore different PEG tube placement techniques that might obviate the need for antibiotics.
569 Music During Colonoscopy: A Meta-Analysis of Randomized Controlled Trials
Authors: Heath Ryan , Parsa Nasim , Matteson-Kome Michelle , Samiullah Sami , Nguyen Douglas , Puli Srinivas , Bechtold Matthew 
Published: October 2019

INTRODUCTION:
Music seems to be beneficial in multiple clinical areas. Colonoscopy is a stressful event for patients, especially with conscious sedation. Music during colonoscopy has been evaluated in multiple randomized controlled trials (RCTs) with varied results. Even meta-analyses on the subject over the years have yielded inconsistent conclusions. Therefore, we conducted an up-to-date meta-analysis on music during colonoscopy.

METHODS:
Multiple large databases were aggressively searched (November 2018). Only RCTs on adult subjects that compared music versus no music during colonoscopy were included. Standard forms were used to extract data by two independent reviewers. Meta-analysis for the effect of music on patients undergoing colonoscopy was analyzed by calculating pooled estimates of total procedure time, dose of sedative medications (midazolam and mepiridine), and patients' pain scores, experience, and willingness to repeat same procedure in the future using odds ratio (OR) and mean difference (MD) with random effects model. Heterogeneity and publication bias were assessed.

RESULTS:
11 studies (N=988) met the inclusion criteria. Music during colonoscopy demonstrated a statistically significant reduction in procedure times (MD -2.3 minutes; 95% CI: -4.13 to -0.47; P = 0.01) and patients' pain (MD -1.26; 95% CI: -2.28 to -0.24; P = 0.02) while improving patients' experience (MD -1.11; 95% CI: -1.7 to -0.53; P < 0.01) as compared to no music. No statistically significant differences were observed between music and no music during colonoscopy for midazolam (MD -0.4; 95% CI: -0.9-0.09; P =0.11), meperidine (MD -3.06; 95% CI: -10.79-4.67; P = 0.44), or patients' willingness to repeat the procedure (OR 3.89; 95% CI: 0.76-19.97; P = 0.1).

CONCLUSION:
Music appears to improve overall patient experience while reducing procedure times and patient pain. Therefore, music, being a non-invasive intervention, should be strongly considered during colonoscopy.