bluuebunny/crossref_metadata_2025_split huggingface dataset:
136 Usefulness of Magnifying Narrow-Band Imaging Endoscopy for the Diagnosis of Sessile Serrated Adenoma/Polyp With Dysplasia/Carcinoma
Authors: Murakami Takashi , Sakamoto Naoto , Fukushima Hirofumi , Ueyama Hiroya , Shibuya Tomoyoshi , Nagahara Akihito 
Published: October 2019

INTRODUCTION:
Sessile serrated adenoma/polyp (SSA/P) is an early precursor lesion in the serrated neoplasia pathway, which results in BRAF-mutated colorectal carcinomas with high levels of microsatellite instability. Therefore, accurate diagnosis of SSA/P and its dysplastic components is endoscopically important. However, the usefulness of magnifying narrow-band imaging (NBI) endoscopy for SSA/Ps with dysplastic change has not yet been fully elucidated. The aim of this study was to verify the usefulness of magnifying NBI endoscopy for the diagnosis of SSA/P with dysplasia/carcinoma.

METHODS:
Among 939 endoscopically or surgically resected lesions pathologically diagnosed as SSA/P with or without dysplasia/carcinoma at Juntendo University Hospital (Tokyo, Japan) between 2011 and 2018, a total of 709 lesions had images available. These SSA/P lesions included 647 with no dysplasia (ND), 37 with low-grade dysplasia (LGD), 15 with high-grade dysplasia (HGD), and 10 with submucosal invasive carcinoma (SIC). We retrospectively evaluated magnifying NBI endoscopic findings using the Japan NBI Expert Team (JNET) system.

RESULTS:
The clinicopathological and endoscopic characteristics of the studied lesions are summarized in Table 1. The HGD and SIC lesions were associated with advanced age. All the lesions were more frequently located in the proximal colon. The SIC lesions were significantly larger than the ND and LGD lesions. All the lesions frequently exhibited endoscopic findings characteristic of SSA/P, such as mucus cap and Type II-Open pit pattern. As for the JNET classification of magnifying NBI endoscopy findings, all 709 lesions were type 1. Six hundred and eighteen (96%) ND lesions exhibited type 1 only, whereas 52 (84%) SSA/P with dysplasia/carcinoma lesions had a combination of type 1 and types 2A, 2B, or 3, corresponding to SSA/P and dysplasia/carcinoma, respectively (Figures 1 and 2). Furthermore, the JNET classification had high sensitivity (84%) and specificity (96%) for diagnosing SSA/P with dysplasia/carcinoma.

CONCLUSION:
Recently, the JNET was established and has proposed a universal NBI magnifying endoscopic classification of colorectal tumors. Our findings suggest that the use of magnifying NBI endoscopy using the JNET classification might be useful for the diagnosis of not only conventional colorectal tumors, but also SSA/P with dysplasia/carcinoma. This increased awareness may also improve the recognition of SSA/Ps with dysplasia or invasive carcinoma.
137 Diverticular Paradox: Increasing Odds of Diverticulitis in Diverticular Disease With Younger Age
Authors: Gboluaje Temitayo , Gwengi Martha , Olanipekun Titilope , Ajose Taiwo , Simien Melvin 
Published: October 2019

INTRODUCTION:
Diverticula disease historically has been known to be a disease of the elderly with estimated prevalence greater than 50% in people ages 60 and above. The healthcare costs associated with impact of diverticular disease is estimated at $3 billion per year. Diverticular disease is one of the commonest reasons for gastroenterology visit yearly. Acute diverticulitis is one of the most feared morbidity conferring complications of diverticular disease. Recent studies have reported an increasing incidence of acute diverticulitis in hospitalized individual younger than the age of 50. However, not much is known about the age-specific odds of having acute diverticulitis in diverticular disease.

METHODS:
We performed a retrospective cohort study of 1197 patients with diverticular disease at Grady Memorial Hospital. We evaluated association between age and diverticulitis, while adjusting for gender, race, BMI, HIV, COPD, hemorrhoids, and hypertension. A multivariate logistic regression model was used to compare diverticulitis and diverticulosis.

RESULTS:
Of the 1197 patients, 732 were females and 465 males. The average age of this patient sample was 58.14, with frequency of diverticulitis and diverticulosis in age group 23–29 years: 5 and 13, 30–44 years: 45 and 98, 45–59 years: 246 and 265, 60–74 years: 243 and 146, >75 years: 98 and 36 respectively. Primary diagnosis was diverticulosis in 637 of the patients and diverticulitis in 558 of the patients. Age group 23–44 was strongly associated with diverticulitis. The odds of diverticulitis increased with reduced age: 23–29 years (OR, 7.08; 95% CI, 2.36 to 21.26), 30–44 years (OR, 5.93; 95% CI, 3.52 to 9.97), 45–59 years (OR, 2.93; 95% CI, 1.93 to 4.46), 60 – 74 years (OR, 1.64; 95% CI, 1.06 to 2.52). In the multivariate logistic regression, age group 23–44 was strongly associated with diverticulitis, while hypertension was only marginally statistically significant (P-value = 0.05). In contrast BMI, HIV status, and COPD were not associated with diverticulitis, and neither was the interaction term: HIV, COPD, hypertension.

CONCLUSION:
Our study demonstrated that even though patients older than 45 had the highest number of diverticular disease cases, the odds of diverticulitis was highest in the younger age groups less that 45 years. More research should be done to evaluate this trend and clinicians should be aware of the high potential of diverticulitis in patients younger than 45 years old.
139 Is Smoking Associated With an Increased Risk of Diverticulitis?
Authors: Maddika Srikanth , Then Eric O. , John Febin , Aloreidi Khalil , Gayam Vijay , Are Vijay S. , Culliford Andrea , Gaduputi Vinaya 
Published: October 2019

INTRODUCTION:
Diverticulitis is inflammation of a previously existing diverticulum. Complicated diverticulitis is characterized by the formation of phlegmon, abscess, obstruction or perforation. Recent meta-analysis proved a positive association between tobacco and diverticulosis, but there is a lack of robust data on the effect of tobacco smoking on diverticulitis.

METHODS:
We retrospectively analyzed patients hospitalized with diverticulitis (via ICD-9 codes) in 2016 using the Nationwide Inpatient Sample (NIS) Database. Our primary end point was to establish a relationship between patients diagnosed with diverticulitis and tobacco smokers. We also analyzed the relationship between smoking and the presence of complicated versus non-complicated diverticulitis. Finally we analyzed the relationship between the presence of diverticulitis with race and gender. Univariate and multivariate logistic regression models were developed using STATA software version 15.

RESULTS:
A total of 331,999 patients with diverticulitis were included in our study population. We found that patients with diverticulitis were 35% more likely to be tobacco smokers than non-smokers (OR: 1.359; CI: 1.329–1.389; P-value: 0.000). This relationship was stronger in patients with complicated diverticulitis where 49% were more likely to be tobacco smokers than non-smokers (OR: 1.495; CI: 1.451–1.540; P-value: 0.000). In addition patients with complicated diverticulitis presented at a younger age in tobacco smokers than in non-smokers (mean age: 59.23 vs 61.55; P-value: 0.0001). On multivariate analysis adjusting for possible confounding factors we found that smoking (OR: 1.30; CI: 1.27–1.33; P-value: 0.00), Caucasian race (OR: 1.731; CI: 1.596–1.878; P-value: 0.000), female gender (OR: 1.09; CI: 1.07–1.11; P-value: 0.00), and colon cancer (OR: 1.07; CI: 1.01–1.15; P-value: 0.02) were all associated with an increased likelihood of diverticulitis. In contrast, diverticulitis was 14% less likely to occur in black patients (OR: 0.865; CI: 0.793–0.944; P-value: 0.001).

CONCLUSION:
We conclude there is a positive association between tobacco smoking and diverticulitis. Smoking increases the risk of complicated diverticulitis and this tends to occur at a younger age compared to non-smokers. Incidence of diverticulitis is more common in whites and least common among blacks when compared to other races. Given these findings more robust measures should be implemented to help young adults quit smoking tobacco.
144 Efficacy and Safety of NER1006 Versus Standard Bowel Preparations: A Meta-Analysis of Randomized Phase 3 Clinical Trials
Authors: Maida Marcello , Macaluso Fabio Salvatore , Sinagra Emanuele , Ventimiglia Marco 
Published: October 2019

INTRODUCTION:
The efficacy of bowel cleansing is essential for a quality colonoscopy, especially in the setting of colorectal cancer screening. Unfortunately, suboptimal bowel preparation is still observed in 25% of procedures. Recently, a very low-volume 1L PEG solution (NER1006) has been introduced on the evidence of three phase 3 randomized controlled trials. We conducted a meta-analysis to explore cleansing success, adenoma detection rate (ADR), and safety profile of NER1006 versus standard bowel preparations.

METHODS:
PubMed/Medline and Embase were systematically searched through April 2019 by two independent reviewers (M.M. and F.S.M.) for randomized phase 3 clinical trials comparing the effectiveness of NER1006 versus standard bowel preparations.

RESULTS:
Three RCTs (four arms, 2151 participants) met the inclusion criteria and were included in the meta-analysis (Table 1). The analysis showed a significant higher overall cleansing success for patients receiving NER1006 compared with standard preparations both using the Harefield Cleansing Scale (HCS) (OR 1.29; 95% CI 1.02–1.61; P = 0.031, I2 = 0%, 2151 participants) and the Boston Bowel Preparation Scale (BBPS) (OR 1.43; 95% CI 1.15–1.78; P = 0.001, I2 = 0%, 2151 participants) (Figure 1a,b), as well as a significant greater high-quality cleansing of the right colon both when assessed with the HCS (OR 2.26; 95% CI 1.44–3.54; P < 0.001, I2 = 70%, 2151 participants) and with the BBPS (OR 1.74; 95% CI 1.09–2.79; P = 0.021, I2 = 66%, 2151 participants) (Figure 1c,d). The pooled estimate of the NER1006 effect on ADR showed no significant difference in terms of overall ADR (OR 1.03; 95% CI 0.85–1.24; P = 0.773, I2 = 0%, 2151 participants), and a higher, although not significant, ADR of the right colon (OR 1.24; 95% CI 0.85–1.79; P = 0.262, I2 = 38%, 2151 participants) (Figure 2a,b). When considering the impact of NER1006 on mild to moderate treatment-emergent adverse events (TEAEs), we observed a significant pooled estimate of number of TEAEs (OR 2.25; 95% CI 1.81–2.80; P < 0.001, I2 = 0%, 2060 participants) and of patients with TEAEs (OR 1.80; 95% CI 1.36–2.38; P < 0.001, I2 = 0%, 2060 participants) (Figure 2c,d). No serious adverse events occurred.

CONCLUSION:
Compared with standard bowel preparations, NER1006 showed a higher overall cleansing success, a greater high-quality cleansing of the right colon and a higher, although not significant, ADR of the right colon. NER1006 showed a higher incidence of mild to moderate TEAEs, in the absence of serious adverse events.
147 Colorectal Mucosal Schwann Cell Hamartomas in a Community Gastroenterology Practice
Authors: Sadiq Bitaal , Nunez Matthew , Sannapaneni Shilpa , Hoelscher Amanda , Lager Donna J. , Jain Rajeev , Fourment Chris , Ritter Timothy E. 
Published: October 2019

INTRODUCTION:
Mucosal Schwann cell hamartoma (MSCH) is a benign mucosal lesion composed of spindle cells surrounding colonic crypts that can arise anywhere in the colon; usually in the rectosigmoid. Most reports of colonic MSCH are limited to case reports and two case series from tertiary-care academic settings involving 20 and 26 patients. Our retrospective study is the first to describe the characteristics of colorectal MSCH in a community gastroenterology practice.

METHODS:
We retrospectively identified patients with colorectal MSCH from the pathology database of a large, community gastroenterology practice of 157 physicians in Texas and Louisiana working at 24 outpatient centers. Data were collected from consecutive patients diagnosed with MSCH from 2015–2019. MSCH were confirmed by positive immunohistochemical staining for S-100. Historical data recorded included the endoscopic size and appearance of the polyps, location, indication(s) for colonoscopy, and patient age, sex, and race.

RESULTS:
184 colorectal MSCH from 179 patients were identified out of a total of 335,635 colon specimens. The median age of 59 years (range, 40–84). Sixty percent were female, 67% were White, and 25% were Black. The most common indications for colonoscopy were screening (55%), polyp surveillance (35%) and diagnostic (35%), which often overlapped. The polyps were described as sessile (65%), pedunculated (2%), mixed sessile/pedunculated (1.6%), and not specified (32%). The average size was 3.8 mm (range, 1–15 mm), and most were in the distal colon and rectum (77%) followed by transverse (11%) and proximal colon (10%). One MSCH was at an anastomosis and in one, the site was not specified.

CONCLUSION:
This large retrospective series is the first to describe colorectal MSCH in a community gastroenterology practice. Additionally, the large number of patients provides a better description of MSCH characteristics in comparison to prior small case series. MSCH were most commonly found during screening and surveillance colonoscopies in patients who were older, female and white. Most were located in the distal colon and rectum. Colorectal MSCHs are found infrequently at an approximate rate of 1 every 4 years by a community gastroenterologist, or 0.05% of colonoscopy biopsies.
150 Abdominal Tuberculosis in the 21st Century in Peru: A Description of 22 Cases
Authors: Torres Luis , Macalupú Juan Carlos , Bellido Alvaro , Pinto Jose , Espinoza-Ríos Jorge 
Published: October 2019

INTRODUCTION:
The diagnosis of abdominal tuberculosis (AT) remains complicated, although it's a common pathology in developing countries. A high degree of clinical suspicion is always needed in order to ensure its rapid detection. We aimed to describe and analyze the epidemiological, clinical and radiological features of patients diagnosed with abdominal tuberculosis: tuberculous lymphadenopathy, gastrointestinal, visceral and peritoneal tuberculosis (TB).

METHODS:
A prospective study was conducted between 2015 and 2016 and patients diagnosed with AT based on clinical, endoscopic and histopathologic features were collected. The clinical, epidemiological and radiological features were described by frequencies and percentages and then analyzed in Stata 12 to evaluate the associations between them.

RESULTS:
A total of 22 patients were included: 17 males (77%) with a mean age of 38.6 years. Twelve patients (55%) had only one type of AT and 10 patients (45%) had more than one. The most common diagnosis was gastrointestinal TB (14 cases, 64%), followed by peritoneal TB (10 cases, 45%), tuberculous lymphadenopathy (8 cases, 36%) and visceral TB (2 cases, 9%). The former showed 6 presentations: ileocecal (8 cases, 57%), colorectal (7 cases, 50%), duodenal (3 cases, 21%), gastric (2 cases, 14%), esophageal (1 case, 7%) and jejunal (1 case, 7%). The most important antecedents were HIV infection (11 cases, 52%), TB contact (9 cases, 43%) and pulmonary TB and alcoholism (7 cases, 33% each one). The most common symptoms were abdominal pain and weight loss (19 cases, 90% each one), anorexia (17 cases, 81%), fever (15 cases, 71%), nocturnal sweating (13 cases, 62%), chronic diarrhea (12 cases, 57%), cough (11 cases, 52%) and abdominal distension (11 cases, 52%). The physical findings were ascites (8 cases, 38%) and hepatosplenomegaly (5 cases, 24%), and the principal complication was lower gastrointestinal bleeding (5 cases, 24%). Radiological findings consistent with pulmonary tuberculosis were also common (13 cases, 62%). Only abdominal distention and ascites showed statistical association with peritoneal tuberculosis (Fisher's exact = 0.0001 and 0.008 respectively).

CONCLUSION:
Abdominal pain, B symptoms and chronic diarrhea are the most important manifestations of AT. Hence attention must be paid in patients with this symptoms, especially if they are immunocompromised. In these subjects abdominal distension and ascites seem to suggest the diagnosis of peritoneal TB.
153 Clinical Features of Radiotherapy-Related Proctocolitis
Authors: Abu-Sbeih Hamzah , Tang Tenglong , Tran Cynthia N. , Wang Yinghong 
Published: October 2019

INTRODUCTION:
Radiotherapy is an effective treatment for various malignancies. Especially when used in close proximity to GI tract, it carries risk for causing proctocolitis. We aimed to characterize radiotherapy-induced proctocolitis (RiPC) in a tertiary cancer center.

METHODS:
This is a retrospective cohort study of cancer patients who suffered RiPC between January 2010 and December 2018. Logistic regression analyses were used to assess factors associated with RiPC bleeding and treatment requirement.

RESULTS:
Of 61399 patients who received radiotherapy to the abdomen and pelvis, 7185 among them had endoscopy evaluation; among them, 135 (2%) had confirmed RiPC. Median age was 60 years. Half patients were males. Most patients were of white race (85%). Prostate cancer was the most common malignancy (39%), followed by rectosigmoid and anal cancers (21% and 20%, respectively). Most patients received external beam radiotherapy. The median dose of radiotherapy was 55 Gy for a median of 30 sessions (IQR, 27–35). Median time from first radiotherapy to RiPC is 15 days (IQR, 9–22). Diarrhea was the most common symptom (44%) followed by blood per rectum (39%). Median duration of RiPC symptoms is 28 (10–90) days. Eighty patients received antimotility agents, 36 received enema or suppository corticosteroids, and 13 received intravenous fluids. Twelve patients required hospitalization and 2 needed ICU-level care. Thirty-five patients had recurrence of RiPC after a median of 18 months. Mucosal bleeding occurred in 30% of patients, ulcerations in 16%, and strictures in 6% (Table 1). Thirty-five patients received endoscopic treatment with APC; among them, 15 needed a repeat treatment. Higher doses of radiotherapy, longer durations, and intensity modulated radiotherapy were associated with increased risk of bleeding (P < 0.05). Other factors associated with risk of bleeding from RiPC are listed in Table 2. Older male patients who received chemotherapy known to cause GI toxicity or higher doses or longer duration of radiotherapy were more likely to receive medical treatment for RiPC (P < 0.05). Inflammation of rectum was associated with less frequent complications compared with inflammation of the rest of the colon (Table 3).

CONCLUSION:
RiPC is a rare but devastating toxicity of radiotherapy that might recur in 26% of cases. Endoscopy is a useful tool for the diagnosis and treatment of RiPC. Colonic involvement was associated with RiPC complications.
154 Short-Term Efficacy of the Vaginal Bowel-Control Device in Improving Fecal Incontinence in Women: A Meta-Analysis of Prospective Studies
Authors: Zhang Allison , Doherty Bryan , Guss Debra , Notar-Francesco Vincent 
Published: October 2019

INTRODUCTION:
The vaginal bowel-control system (VBCS) is a novel design consisting of a reversible dynamic vaginal balloon insert that mimics the continence mechanism in the rectum to help control fecal incontinence (FI) in women. We performed a meta-analysis using data from four prospective open-label trials that investigated the efficacy and safety of this novel device at 1- or 3-month intervals.

METHODS:
PubMed, EMBASE and Cochrane Library databases were searched by two independent investigators using the terms fecal incontinence and vaginal bowel control, vaginal control, vaginal device, or vaginal. Only studies where a VBCS was used and where the response in FI was followed for 1 month or longer were included. Case reports were excluded and there were no case series or randomized controlled trials found. Meta-analysis using the fixed-effect model was performed to illustrate the pooled estimates.

RESULTS:
Four prospective open-label proof of concept clinical trials were identified. All patients were above 18 years of age and the size of the studies ranged from 5 to 63 patients. Patients were followed for 3 months in three studies and for 1 month in one study (n = 9). A response in FI was defined as a >50% improvement in the number of incontinent episodes compared to baseline in 3 out of the 4 studies, with the fourth study (n = 5) defining clinical improvement as a subjective qualitative improvement experienced by the patients. There was little heterogeneity across the studies. The overall estimated proportion of patients experiencing a response in FI was 85%, with a 95% confidence interval (CI) of 0.77 to 0.90. The overall adverse event rate was 18% with a 95% CI of 0.11 to 0.26. No patients experienced severe adverse events in any of the studies. Patient satisfaction was 89% with a 95% CI of 0.82 to 0.94.

CONCLUSION:
While recognizing that the number and quality of the studies available on the VBCS to treat FI are limited, the current analysis provides preliminary evidence that the VBCS may be considered a non-invasive, reversible, safe, and efficacious tool to control symptoms of FI in women in the short term, while achieving adequate patient satisfaction. Further validation on the practicality of this device can only be attained through long-term, large controlled studies, preferably randomized controlled trials.
157 Clinical Burden of Recurrent Clostridioides difficile Infection: A Real-World Data Analysis
Authors: Stong Laura , Nelson Winnie W. , Feuerstadt Paul , Boules Mena , Sacks Naomi , Portelli Alexandria , Healey Bridget , Lang Kathleen , Dahdal David N. 
Published: October 2019

INTRODUCTION:

Clostridioides difficile infection (CDI), especially recurrent CDI (rCDI), is associated with high morbidity and resource utilization, imposing significant burden on the US healthcare system. This study evaluated the association of rCDI with medical procedures, complications, and medication use after an index CDI episode.

METHODS:
We performed a retrospective analysis of commercial claims data from the IQVIA PharMetrics Plus™ database for patients aged 18–64 years with CDI episodes requiring inpatient stay with CDI diagnosis code (ICD-9-CM 008.45; ICD-10-CM A04.7, A04.71, A04.72) or an outpatient medical claim for CDI plus a CDI treatment. We considered index CDI episodes from 1/1/2010 to 6/30/2017, including only those patients who were observable 6 months a priori and 12 months after the index episode. Each CDI episode was followed by a 14-day claim-free period after the end of treatment to distinguish rCDI from continuous CDI. rCDI was defined as another CDI episode within an 8-week window immediately after the claim-free period. Medication use, procedures, and complications were calculated over 12 months and stratified by number of rCDI episodes.

RESULTS:
46,571 patients with an index CDI episode were included, of whom 3,129 (6.7%) experienced 1 rCDI, 472 (1.0%) experienced 2 rCDI, and 134 (0.3%) had 3 or more rCDI episodes. Mean (SD) age was 47.4 (12.7) years, and 62.4% were female (similar across rCDI groups; Table 1). Mean baseline Charlson Comorbidity Index (CCI) scores were 1.15, 1.54, 1.83, and 2.29 for those with no rCDI, 1 rCDI, 2 rCDI, and 3+ rCDI episodes, respectively. Vancomycin was the most commonly prescribed antibiotic during follow-up (Table 2). Follow-up prescription rates of metronidazole decreased with increasing rCDI episodes. In the 12-month follow up, sepsis occurred in 16.5% of patients with no rCDI, 27.3% with 1 rCDI, 33.1% with 2 rCDI, and 43.3% with 3+ rCDI episodes; subtotal colectomy or diverting loop ileostomy was performed as a follow-up procedure for 4.6%, 7.3%, 8.9%, and 10.4% of patients, respectively, in the four study groups (Figure 1).

CONCLUSION:
There appears to be a stepwise increase in number of rCDI episodes associated with increasing baseline CCI score. During the 12 months after index CDI episode, the frequency of sepsis and colectomy increased in parallel to the number of CDI recurrences. Prevention of rCDI is an important step to reduce the burden of such complications.