bluuebunny/crossref_metadata_2025_split huggingface dataset:
A33 DIAGNOSTIC YIELD AND QUALITY OF EUS-GUIDED LIVER BIOPSIES IN A 142-PATIENT COHORT - THE KELOWNA EXPERIENCE
Authors: Jowhari F , Neong S , Berg K 
Published: February 2025

Abstract

Background
EUS-guided liver biopsy (EUS-LB) is a safe & effective technique, consistently yielding diagnostic accuracy with adequate tissue samples. However, most studies are limited by small sample sizes, leaving gaps in data. Despite growing international evidence, a comprehensive Canadian experience remains unreported. To address this, we present our institutional data on EUS-LB, emphasizing diagnostic yield, safety & procedural benefits.

Aims
To evaluate the diagnostic yield, safety & procedural efficacy of EUS-guided liver biopsies in a large cohort of patients from a Canadian healthcare setting.

Methods
This is a retrospective analysis of patients who underwent EUS-LB over a 4 year period. All procedures were performed with a linear echoendoscope using a 1-2 pass,selective-actuation,wet suction technique & a 19-G Franseen-tip needle using our own institutional protocol. All patients received either conscious or deep sedation. Specimen adequacy was assessed by a GI histopathologist evaluating key parameters including the number of complete portal tracts (CPT),length of longest intact core (LIC),total specimen length (TSL) & degree of fragmentation, using guideline specific cutoffs where applicable. Comprehensive demographic, clinical & procedural data were also collected for detailed analyses.

Results
A total of 142 consecutive patients underwent EUS-LB at Kelowna General Hospital, British Columbia, from April 2020 to October 2024. The median age was 62 years (IQR 52–70), with 109 women (77%) and 33 men (23%). The median BMI was 27 kg/m2 (IQR 24–32). The diagnostic yield was 99.3%, with all but one specimen being diagnostic. Adequate histological specimens were obtained in 136 patients (95.7%), and a conclusive diagnosis was reached in 141 patients (99.3%). The most common diagnosis was metabolic dysfunction-associated steatohepatitis (MASH) in 42 patients (29%), followed by drug-induced liver injury (14.5 %), autoimmune hepatitis (13.1%), and primary biliary cholangitis (PBC) (10.3%). At the time of this submission, detailed histopathologic analyses were available for a subset of patients. The median total specimen length (TSL) was 4.4 cm (IQR 3.3–5.2), the median number of complete portal tracts (CPTs) was 13 (IQR 11.5–23.5), and the median longest intact core was 1.3 cm (IQR 1.1–1.7). No major adverse events were observed.

Conclusions
Our study reinforces the evolving role of EUS-guided liver biopsy in liver diagnostics, demonstrating its safety, efficacy, and high diagnostic yield. This technique not only ensures procedural success but also enhances the autonomy of gastroenterologists, promoting more timely and integrated patient care. As the largest study of EUS-guided liver biopsies conducted in a Canadian healthcare setting, it addresses a critical gap in the literature and further validates the role of EUS-LB in modern hepatology practice.

Gross intact core EUS-LB specimens collected in formalin.

Funding Agencies
None
A35 ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) OUTCOMES IN GASTROINTESTINAL SUBMUCOSAL TUMORS (SMT): A RETROSPECTIVE STUDY
Authors: Youssef M , Ching Hui Yee C , Bechara R 
Published: February 2025

Abstract

Background
Gastrointestinal submucosal tumors (SMTs) range from benign entities to malignant tumors that require surveillence or resection. The role of ESD in management of SMTs remains unclear.

Aims
We aim to evaluate the clinical and technical outcomes of ESD in the management of SMTs.

Methods
This study included patients with SMTs who underwent ESD at the Kingston Health Sciences Center (KHSC) between May 2017 to September 2024. Data was collected on patient demographics and tumor characteristics including size, pathology, differentiation, depth, and lymphovascular invasion (LVI). Technical outcomes were analyzed with respect to procedure time (min), technical efficiency (min/cm2), en-bloc and R0 resection rates. En-bloc resection was defined as resection of the lesion piecemeal and R0 indicated negative margins on microscopic examination. We also reported clinical outcomes including length of stay, perioperative adverse events (e.g. bleeding or perforation), strictures, and tumor recurrence rates at the time of follow-up. Descriptive analysis was used to summarize the data.

Results
This case series included 22 patients (7 males, 15 females) with SMTs (6 esophageal, 16 gastric). 40.1% of patients (9/22) had endoscopic biopsy prior to ESD. The median specimen area was 3.8 cm2 (min-max range 0.38-18.2 cm2). Procedure times ranged between 5-138 mins with a mean time of 49.6 mins (SD= 33.1 mins) and mean efficiency of 13.7 min/cm2. 100% of patients had en-bloc resections and 86.3% (19/22) had R0 resections. There were no perioperative adverse events and most patients (21/22) were discharged the same day with the exception of one patient who stayed for 6 days postoperatively for (chronic) pain management. The pathology of the six esophageal tumors showed 3 leiomyomas, 2 Granular Cell Tumors (GCT), and 1 lipoma. Of the sixteen gastric lesions, 6 were Gastrointestinal Stromal Tumors (GIST), 6 were neuroendocrine tumors (NET), 1 leiomyoma, 1 lipoma, 1 inflammatory fibroid polyp, and 1 heterotopic pancreatic tissue. In both GIST and NET tumors, 5/6 lesions were Grade 1 (well-differentiated) and 1/6 was Grade 2 (moderately differentiated). The depth of the lesions was into the submucosa and there was no lymphovascular invasion (LVI). With regards to the esophageal tumors that required endoscopic follow-up (n= 4), the mean follow-up time was 8.5 months and there was no tumor recurrence. Of the gastric lesions that required endoscopic follow-up (n= 14), the mean follow-up time was 26.2 months and there was no tumor recurrence. There were no strictures observed on endoscopic follow-up for any of the lesions.

Conclusions
ESD for SMTs is a safe procedure with high en-bloc and R0 resection rates, along with low recurrence rates on follow-up. Larger scale studies are needed to further explore the efficacy and safety of ESD in the management of SMTs.

Funding Agencies
None
A47 VIRTUAL REALITY SIMULATION TRAINING IN GASTROINTESTINAL ENDOSCOPY: A COCHRANE REVIEW
Authors: Khan R , Sabrie N , Plahouras J , Johnston B , Scaffidi M , Grover S , Walsh C 
Published: February 2025

Abstract

Background
Training with virtual reality (VR) simulation is increasingly used for health professions training to allow novices to practice in a learner-centered, risk-free environment. This review was performed to evaluate the effectiveness of VR simulation training in gastrointestinal endoscopy.

Aims
To determine whether virtual reality simulation training can supplement and/or replace early conventional endoscopy training in diagnostic endoscopy for health professions trainees with limited or no prior endoscopic experience.

Methods
We searched 17 databases from inception until October 18, 2023. We included randomised and quasi-randomised trials that compared VR simulation training with no training, conventional training, another form of simulation training, or an alternative method of VR training. We screened and abstracted data through Cochrane methodology. The primary outcome was composite score of competency. Secondary outcomes were procedure completion, procedure time, adverse events, patient discomfort, global rating of competency, and mucosal visualization. We calculated risk ratio for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) for continuous outcomes with 95% CI. We used GRADE to assess the certainty of evidence.

Results
We included 20 trials (500 participants; 3975 endoscopic procedures). There was insufficient evidence to determine the effect of VR training on composite score of competency compared to no training or conventional training. VR training was advantageous over no training based for independent procedure completion (RR 1.62, 95% CI 1.15 to 2.26; moderate certainty evidence), overall rating of performance (mean difference [MD] 0.45, 95 %CI 0.15 - 0.75, very low certainty evidence), and mucosal visualization (MD 0.60, 95 %CI 0.20 - 1.00, very low certainty evidence). VR training resulted in fewer independent procedure completions compared to conventional training (RR = 0.45, 95 %CI 0.27 - 0.74, low certainty evidence). We found no differences between VR training and no training or conventional training for other outcomes. Based on qualitative analysis, we found no significant differences between VR training and other forms of simulation training. VR curricula based in educational theory provided benefit with respect to composite score of competency, compared with unstructured curricula. Based on qualitative analysis, we found no significant differences between VR training and other forms of simulation training. VR curricula based in educational theory provided benefit with respect to composite score of competency, compared with unstructured curricula.

Conclusions
VR simulation training in endoscopy can supplement conventional endoscopy training and provides benefit compared to no training.

Risk of bias summary

Funding Agencies
None
A48 PATIENT OUTCOMES OF A COMPLEX POLYP ASSESSEMNT COMMITTEE IMPLEMENTATION
Authors: Gallagher P , Petropolis H , Stewart M , Patel S , Farina D , Kohansal A 
Published: February 2025

Abstract

Background
Over the past two decades, the endoscopic approach to managing complex colonic polyps has shifted from surgery to advanced endoscopic techniques, including endoscopic mucosal resection (EMR) and Endoscopic Submucosal Dissection. Endoscopic methods are less invasive than surgery, reducing morbidity, mortality, and cost, but require additional time, training, and expertise. Despite guidelines recommending EMR as the first line option, surgical resection for complex non-invasive polyps remains common in Canada. A 2019 retrospective study revealed that 12.5% of large non-malignant polyps in Nova Scotia were treated with surgical resection. Subsequently, a Complex Polyp Assessment Committee (CxPAC) was established to assess polyps suitable for endoscopic resection, aiming to reduce unnecessary surgical procedures.

Aims
The project aims to examine the early outcomes of programmatic assessment and management of complex colorectal polyps though CxPAC.

Methods
A retrospective chart review was completed on all patients referred to Nova Scotia’s CxPAC between January 2022 and February 2024. Descriptive statics were calculated.

Results
In a 24-month study period, 99 patients were referred to the CxPAC, with 88 suitable for complex polypectomy. Among the 10 patients not deemed appropriate for the procedure, 7 were directed to surgery prior to any endoscopic intervention. The referral indication was polyp size (65.7%), size with challenging position (16.2%), challenging position alone (6.1%), residual/recurrent polyp (7.1%), and scarring/poor lift (5.1%). The mean patient age was 66 (SD, 12), and the mean polyp size was 37mm (SD, 17). There were 18 patients referred for surgical management: 2 based on referral image review, 10 after endoscopic or post-resection pathology appearance positive for invasive carcinoma, 1 after perforation, and 5 after incomplete resection. Follow-up endoscopies have been performed on 61 patients. Among the 40 patients deemed clear during follow-up endoscopy, 8 did not have a biopsy at the polypectomy site. Of the 32 patients who did undergo biopsies, 20 exhibited normal mucosa, 8 showed reactive changes/scarring post-polypectomy, 2 were diagnosed with tubular adenomas, 1 with a sessile serrated adenoma, and 1 with a hyperplastic polyp. There were 9 instances of severe adverse events related to complex polypectomy: 5 cases of post-polypectomy bleeding, 2 perforations, and 2 emergency department visits due to abdominal pain.

Conclusions
The CxPAC has been effective for assessing and managing complex non-malignant colonic polyps, with 88.6% of patients able to avoid surgery. While endoscopic resection of complex polyps is a safer alternative to surgery, procedural risks remain, highlighting the importance of additional training on the part of the endoscopists and a detailed discussion and consent process with the patients.

Funding Agencies
None
A52 OVERNUTRITION IN TREATED CELIAC DISEASE (CED) PATIENTS: THE NEED FOR PERSONALIZED NUTRITIONAL ASSESSMENT TO MANAGE THE METABOLIC SEQUELAE OF A GLUTEN-FREE DIET (GFD)
Authors: Verma A K , Khaouli M , Abdi F , Blom J , Echagüe F J , Alessa F , Aman A , Armstrong D , pinto-sanchez M 
Published: February 2025

Abstract

Background
Overnutrition, leading to overweight and obesity, is increasingly prevalent in celiac disease (CeD). A nutritionally imbalanced diet may contribute to overnutrition and the development of Metabolic Syndrome (MS) and Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD).

Aims
To investigate the factors contributing to the metabolic shift in treated CeD.

Methods
We enrolled patients with biopsy-proven CeD on a GFD and non-CeD (Inflammatory Bowel Disease and Irritable Bowel Syndrome) attending a tertiary care center adult Nutrition Assessment Clinic. We collected data on nutritional assessment (SGA), energy requirements determined by resting energy expenditure (REE: indirect calorimetry, QNRG, COSMED, US) and activity factor (IPAQ), body composition (3D scanner; Styku CA, US) and obesity risk (EOSS: Edmonton Obesity Staging System) to assess risk based on metabolic comorbidities such as diabetes, fatty liver, and cardiovascular disease. SPSS (version 22, US) was used for statistical analysis. Data are reported as median (IQR); Mann-U-Whitney was used for comparison between groups.

Results
From November 2021 to October 2024, 124 CeD [Female: 76%; Age: 45 (27) yr; time since diagnosis: 5 (6) yr] and 96 non-CeD [F:74%; 48 (27) yr] patients were enrolled. Nutritional assessment identified undernutrition (BMI&lt;19) in 8% vs 20%, overweight (BMI 26-30) in 24% vs 14%, and obesity (BMI&gt;30) in 49% vs 34% of CeD vs non-CeD (p&lt;0.001). REE adjusted for weight was significantly lower in obese CeD compared with non-obese CeD [17 (3) vs 22 (4) kcal/kg/day; p&lt;0.001]. Fat mass was significantly greater [19 (7) vs 40 (10) kg; p&lt;0.001], and fat-free mass was significantly reduced [FFM:43 (11) vs 54 (10) kg; p=0.005] in CeD with overweight/obesity compared to normal BMI. FFM was positively correlated with REE (r=0.71; p&lt;0.001). Metabolic comorbidities occurred in 26% of obese-CeD patients. MASLD was more frequent in CeD with overweight and obesity compared to normal BMI (81% vs 43%; p=0.04).

Conclusions
The high rate of overnutrition and reduced muscle mass in treated CeD patients is concerning, as this is associated with metabolic comorbidities. Personalized nutrition assessment with accurate measurements is crucial for nutritional guidance and will likely improve health in CeD.
Funding Agencies:
A66 MICROSCOPIC COLITIS: AN EPIDEMIOLOGICAL ANALYSIS OF MANITOBA’S POPULATION
Authors: Shah P , Al-Bayati K , Parkinson K , Fischer G , Singh H , Bernstein C N , Shaffer S 
Published: February 2025

Abstract

Background
Microscopic colitis (MC) is an inflammatory disease of the colon, causing chronic diarrhea, with 2 histologic sub-types, collagenous colitis and lymphocytic colitis. It tends to affect older individuals, with a female predominance. MC is diagnosed in 10% of patients across all age groups, and in 20% in those over the age of 70 among persons undergoing colonoscopy for chronic watery diarrhea. However, there is a paucity of data in Canadian populations, thus we performed a population-based study in Manitoba to assess the prevalence of MC.

Aims
Determine of the prevalence of MC in Manitoba from 2006 - 2018.

Methods
Pathology reports which mentioned MC (or one of the histologic sub-types) were obtained from the Shared Health Pathology Database, which includes a portion of the pathology reports issued in Manitoba for the years 2006 to 2018. These pathology reports were then examined manually to detect true cases of MC. Patient demographics including age, year of diagnosis, and histologic sub-type (collagenous versus lymphocytic) were obtained. Continuous variables were analyzed using means.

Results
9377 pathology reports were initially identified. Of these, 916 people (9.8%) were identified with MC, with 74 having had more than 1 colonoscopy during this time period. Of the 916 cases of MC, 53.5% (490) had collagenous colitis, 44.8% (410) had lymphocytic colitis, and 1.7% (16) did not have a specified sub-type reported. There was a female predominance: collagenous colitis at 83.9%, lymphocytic colitis at 77.1%, and unspecified subtype at 81.3%. The mean age of diagnosis for collagenous colitis, lymphocytic colitis, and unspecified, was 62.0 years old (SD 13.2), 59.8 years old (SD 14.6) and 60.5 years ols (SD 15.6,), respectively. The age range of diagnoses was 18 to 91.
Of the 70 people who had more than 1 colonoscopy during this time period, 4 people initially had a diagnosis of collagenous colitis which was later switched to lymphocytic colitis, 7 had an initial diagnosis of lymphocytic colitis which was later switched to collagenous colitis, and 1 patient had an initial diagnosis of lymphocytic colitis, then switched to collagenous colitis, and later switched back to lymphocytic colitis.

Conclusions
In Manitoba over a 13 year time-period, 916 (9.8% of those where MC was considered) were diagnosed from colonic biopsy. Collagenous colitis was more common than lymphocytic colitis, with a similar age at the time of colonoscopy, along with both having a female predominance. Further research is needed to understand whether the clinical courses of collagenous and lymphocytic colitis differ, and how each sub-type responds to conventional treatment.

Funding Agencies
None
A80 TIME-RESTRICTED FEEDING IMPROVES INFLAMMATORY AND METABOLIC BIOMARKERS IN CROHN’S DISEASE WITH OVERWEIGHT: A RANDOMIZED, PLACEBO-CONTROLLED PILOT TRIAL
Authors: Haskey N , Lewis A G , Lavallee C , Yousuf M , Taylor L , Jilani S , Gold S , Lu C , Ghosh S , Panaccione R , Raman M 
Published: February 2025

Abstract

Background
Time-restricted feeding (TRF), a form of intermittent fasting (IF), has shown promise for weight loss and metabolic health. Up to 40% of patients with Crohn’s disease (CD) have a BMI &gt;25, which together with increased visceral adipose tissue (VAT) are independent risk factors for increased hospitalizations, early surgical interventions, and reduced responsiveness to pharmacotherapy. Effects of IF regarding metabolic and inflammatory biomarkers in CD remain limited.

Aims
To assess whether a TRF, compared to standard management (SM), affects inflammatory and metabolic biomarkers in CD patients with a BMI &gt;25.

Methods
We conducted a 12-week (12W) pilot randomized controlled trial, recruiting patients with CD and overweight from Calgary/Kelowna. Participants were randomly assigned in a 1:1 ratio to either TRF or SM. The TRF group fasted for 16 hours daily and ate within an 8-hour window (16:8) for 6 days per week, without altering their habitual diet. The SM group continued their habitual diet.

Results
35 patients completed the protocol (TRF=20; SM=15). Baseline characteristics were similar between groups, with a median BMI 28.0 kg/m2 [IQR:26-33.1]; median age 49 years [IQR:37-60]; 63% female with a median fecal calprotectin (FCP) 115 mcg/g [IQR:42-543]. There were no significant differences between groups in terms of diet, clinical disease activity or inflammatory and metabolic biomarkers at baseline. At 12W, the TRF group experienced a significant reduction in BMI (-0.9 kg/m2, P=0.007) and VAT (-194 cm3, P=0.008) while the SM group saw an increase in BMI (+0.2 kg/m2) and VAT (+78 cm3). FCP levels were either maintained or reduced (P=0.046), serum amyloid A significantly decreased (P&lt;0.0001), with a trend toward improvement in the Harvey Bradshaw Index (P=0.061) in the TRF group, whereas in the SM group FCP, serum amyloid A, and the Harvey Bradshaw Index increased over the 12W. Serum markers leptin (P=0.002), adipsin (P=0.023), and plasminogen activator inhibitor-1 (P=0.045), significantly decreased in the TRF group. These changes were not observed in the SM group; the SM group saw an increase in IL-6 levels over the 12 weeks (P=0.001).

Conclusions
TRF led to significant improvements in BMI, VAT, and key metabolic markers, as well as decreases in systemic and gut inflammation, not observed in the SM group. These results highlight the potential of TRF as a complementary strategy for improving metabolic health and reducing inflammation in CD patients, warranting further investigation in larger studies. (NCT05230160).

Funding Agencies
Crohn’s & Colitis Foundation
A106 PATIENTS’ BARRIERS TO OPTIMIZING DIETARY INTERVENTIONS IN INFLAMMATORY BOWEL DISEASE (IBD): A DESCRIPTIVE QUALITATIVE STUDY
Authors: Noejovich V , Verma R , Miranda P M , Szeto J , Verdu E , Armstrong D 
Published: February 2025

Abstract

Background
Diet is a key influence on symptoms and disease activity in IBD patients, but effective dietary intervention relies on patient adherence, which is often sub-optimal in clinical practice and research. Adherence is shaped by individual barriers, beliefs and behaviours that must be addressed when recommending personalized dietary interventions, but these barriers are not well understood for IBD patients.

Aims
To identify IBD patients’ self-identified barriers to dietary modification and to understand their experiences and expectations for dietary interventions.

Methods
Adult patients with confirmed IBD attending a tertiary care centre IBD Clinic were invited to join heterogeneous focus group sessions with 2-6 participants or individual interviews moderated by a psychologist over a video communication platform (Zoom). Participants completed a demographics survey (REDCap). Audio files for all sessions were transcribed, de-identified and reviewed for accuracy by two reviewers, followed by thematic analysis (NVIVO).

Results
Between May 2022 and May 2023, 47 IBD patients were enrolled; 38 took part in 11 focus groups and 9 in individual interviews. Most participants (mean age 42 yrs; 60% female) were Caucasian (87%); 42% had a self-reported history of mental health disorders. Mean IBD duration was 16 yrs (0.5–44 yrs); 73% were in remission, and 68% had Crohn’s disease. Participants identified multiple barriers, which were consolidated using thematic analysis into 4 key themes, which encompassed 12 subthemes and related barriers (Table). Some patients (n= 30) reported adjusting their diet when diagnosed with IBD without following a specific diet, while some reported that diet was not discussed with their doctors (n=30).

Conclusions
IBD patients report multiple barriers to modifying their diet, highlighting the need to integrate specialized dietary advice into their healthcare. These findings could be used to develop screening questionnaires to guide personalized dietary interventions that address individuals’ barriers to dietary adoption

Funding Agencies
None