bluuebunny/crossref_metadata_2025_split huggingface dataset:
A93 A RETROSPECTIVE REVIEW OF FECAL DIVERSION SYSTEM USE IN A TERTIARY CARE INTENSIVE CARE UNIT
Authors: Monod A , Lin Z , Rostom A 
Published: February 2025

Abstract

Background
Fecal diversion systems (FDS) are frequently deployed in intensive care units (ICUs), although recommendations for their use are heterogeneous. Complications can include pain, bleeding, perforation, infection and death. Risk assessment prior to FDS use may reduce the incidence of complications.

Aims
We analyzed FDS usage in ICUs at The Ottawa Hospital (TOH), to determine complication rates and identify patients who may be at greatest risk.

Methods
We performed a retrospective chart review of FDS deployments in TOH ICUs, from July 2021-July 2023. Continuous variables were analyzed for mean and standard deviation, and significance was determined using unpaired t-tests. Categorical variables were recorded as counts and percentages, and significance determined using chi-squared tests.

Results
263 patients were included. 156 (59.3%) were male, and the mean age was 59.7. The most common admission diagnoses were sepsis (10.3%), COVID (7.6%), and respiratory failure (7.3%). The mean FDS duration was 11.6 days. FDS were most frequently deployed for diarrhea (85.0%), and perineal wounds (9.3%). Further patient characteristics are summarized in Table 1. 25(9.5%) patients developed new clinical bleeding after FDS placement, after a mean of 10.4 days. Post-FDS bleeding was associated with admissions for bowel ischemia (p&lt;0.01) or a prior episode of GI bleeding (p=0.02). 9(36.0%) patients with post-FDS bleeding were on anticoagulants or antiplatelet agents, compared to 99(41.6%) patients without (p=0.59). 17(68.0%) patients with post-FDS bleeding underwent endoscopy; 9(52.9%) had rectal ulcers and 3(17.6%) had rectal ischemia. The mean number of endoscopic procedures to achieve hemostasis was 1.9. The mean length of ICU stay among patients with post-FDS bleeding was 25 days, compared to 16.8 days for those without (p=0.25). 1 patient required surgery for bleeding, 1 sustained a perforation, and 5 required FDS discontinuation due to pain. 3 patients (1.1%) died after post-FDS bleeding.

Conclusions
In our cohort, post-FDS bleeding was seen in a substantial proportion of patients. Post-FDS bleeding was more likely in patients admitted to ICU for prior GI bleeding and ischemic colitis. Post-FDS bleeding resulted in longer ICU stays, though the difference was not statistically significant. Complications from FDS are difficult to predict, and FDS usage in ICUs should be minimized.
Characteristics of patients with and without post-FDS bleeding

Funding Agencies:
A96 WHICH IS THE BEST ENDOSCOPIC HEMOSTATIC THERAPY FOR DIEULAFOY’S LESIONS? A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Samnani S , Yuan Y , Leontiadis G , Barkun A , Laine L , Tse F 
Published: February 2025

Abstract

Background
Dieulafoy’s lesion (DL) is an uncommon but serious cause of significant gastrointestinal bleeding, typically treated with various endoscopic therapies.

Aims
This systematic review and meta-analysis is the first to evaluate the effectiveness and safety of endoscopic hemostatic therapies for treating DL, including endoscopic band ligation (EBL), endoscopic hemoclip placement (EHP), over-the-scope clips (OTSC), thermocoagulation, topical hemostatic agents (THA) and injection methods (epinephrine, sclerosant).

Methods
We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials up to March 2024, including randomized controlled trials (RCTs) and observational cohort studies comparing different endoscopic techniques for DL. Two authors conducted study selection, data extraction and quality assessment independently. The primary outcome was 7-day further bleeding. Further bleeding is a composite outcome of failure to achieve immediate hemostasis and rebleeding. Secondary outcomes included failure to achieve immediate hemostasis, rebleeding, overall mortality, adverse events, and additional hemostatic therapy. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using RevMan 5.4. Heterogeneity was assessed by Chi2 (P&lt;0.15) and I2 tests (&gt;25%). The GRADE approach was used to assess the certainty of evidence (CoE).

Results
We included 7 RCTs, 4 comparative cohort studies, and 27 single-arm cohort studies from 5501 citations. Meta-analyses of EBL compared to EHP showed RRs for 7-day further bleeding in RCTs and cohort studies of 0.66, 95%CI 0.09-5.03 and RR 0.22, 95% CI0.05-0.95, respectively (very low CoE). Additionally, RR for EBL compared to thermocoagulation for 7-day further bleeding in a cohort study was 0.15, 95%CI 0.01- 2.71 (very low CoE). RRs for epinephrine injection alone compared to EBL/EHP and thermocoagulation were 4.37, 95%CI 1.43-13.33 and 10.08, 95%CI 0.63-162.0, respectively (very low CoE). Table 1 shows the results of the standard meta-analyses and proportional meta-analyses.

Conclusions
Epinephrine should not be used as monotherapy for the treatment of DL. Mechanical endoscopic therapies, especially EBL, appear to be an effective option for DL. Further research is needed to assess the roles of OTSC and THA in managing DL and obtain more precise estimates of the effectiveness of EBL, EHP, and thermocoagulation.
Table: Outcomes in patients with DL treated with different endoscopic interventions.

Funding Agencies
None
A97 PHYSICIAN AND PATIENT PERCEPTIONS REGARDING LOW DOSE ASPIRIN FOR THE PREVENTION OF PREECLAMPSIA IN PREGNANT PEOPLE WITH INFLAMMATORY BOWEL DISEASE
Authors: Hothi H , Jogendran R , Hanna Y , Srikanth V , O’Connor K , Tandon P , Huang V 
Published: February 2025

Abstract

Background
Preeclampsia, characterized as high blood pressure and end organ dysfunction in pregnancy, is the second leading cause of maternal mortality worldwide. Patients with inflammatory bowel disease (IBD) are at increased risk of developing severe preeclampsia. While there is emerging evidence that prevention with low dose aspirin (LDA) is safe in pregnant patients with IBD, patient and physician perceptions of LDA use remain unclear.

Aims
To examine Canadian patient and physician perceptions on LDA use for the prevention of preeclampsia in pregnant people with IBD.

Methods
This is a cross-sectional study with a survey for patients with IBD and a second survey for Canadian healthcare providers (HCPs). We collected demographic information and Likert scale answers on perceptions of LDA use including perceived side effects, utility, and optimal prescribing practices. Bivariate assessments were performed using Chi-square analysis and Fischer’s Exact Test.

Results
125 patients and 46 HCPs responded. Patient median age was 35 and 60.8% were diagnosed with Crohn’s disease, 40% with Ulcerative Colitis, and 2.4% with indeterminate disease. 73.15% of patients did not consider Aspirin to pose significant risks such as increased gastrointestinal side effects, IBD flares, or fetal harm. 64.8% of patients agreed with being comfortable taking aspirin if prescribed for preeclampsia risk. There was no association between age, education level, income, or ethnicity and perceived comfort (all p &gt; 0.05). Among HCPs, 43% were gastroenterologists, 30% obstetricians, and 27% other (General Practitioners, General Internists, Nurse Practitioner, Rheumatologist, Midwife, Gynecologist). Respondents (38.0%) most commonly recommended that obstetricians should prescribe LDA. For dosages, 51% of HCPs indicated 162 mg daily and 16.3% indicated 81 mg daily should be prescribed if indicated, while 18.4% reported not knowing. There was no association between years in practice, setting (academic versus community),or volume of IBD or pregnant patients seen in clinic (i.e., scope of practice), with HCP reported comfort levels in managing pregnancy related care in IBD (all p &gt; 0.05). Scope of practice was also not associated with HCP perception that pregnant patients with IBD would develop pre-eclampsia or have worse outcomes than those without IBD.

Conclusions
Although IBD patient and HCP perceptions vary, LDA use is generally accepted for pre-eclampsia prophylaxis in pregnant patients with IBD. Future research should focus on targeted educational approaches to increase awareness and uptake of LDA therapy.

Funding Agencies
CAG
A98 PATIENT NAVIGATOR PROGRAMS FOR CHRONIC GASTROINTESTINAL DISORDERS: A SCOPING REVIEW
Authors: Souza Lira A P , Osei J , Sanderson R , McIlduff C D , Fowler S , Peña-Sánchez J 
Published: February 2025

Abstract

Background
Individuals living with chronic gastrointestinal disorders (CGIDs), including inflammatory bowel disease (IBD), diverticulitis (DI), gastroesophageal reflux disease (GERD), and undiagnosed gastrointestinal complaints (UGCs), could encounter healthcare barriers, such as delays in diagnosis, frequent hospital visits, complex treatment plans, financial concerns, transportation difficulties, among others. Patient navigator programs (PNPs) have emerged as a potential solution to enhance healthcare access and improve care for chronic diseases, including CGIDs.

Aims
To synthesize available literature on PNPs for CGIDs, describing their focus and impacts.

Methods
A scoping review was completed across seven databases: MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science, Global Health, and Public Health. Qualitative, quantitative, mixed-method studies and abstracts published between 2012 and 2022 were included in this review. Eligibility criteria included publications in English focused on PNPs for CGIDs. Two independent reviewers screened titles, abstracts, and available full texts. The included publications were classified and summarized.

Results
11 publications were included in the review; the majority were from the United States (n=5). There were two publications from Australia, two from Canada, one from Belgium, and one from Chile. There were nine full papers and two conference abstracts. By study design, there were four retrospective cohorts, three cross-sectionals, two case-control, one prospective cohort, and one study protocol for a randomized controlled trial. The 11 publications described 10 PNPs for CGIDs, which were implemented between 2008 and 2022 in urban areas, and all were linked to hospital clinics or tertiary referral centres. Nurses led ten PNPs, and eight programs were for IBD care. The other three programs were for persons with GERD, DI, or UGCs. These publications reported the positive impact of PNPs on multiple healthcare utilization and patient outcomes, including more timely access to appointments and diagnostic tests, decreased hospital admission rates, fewer emergency department visits, high user satisfaction levels, reductions in no-show rates for gastroenterology appointments and direct healthcare costs, and a reduced need for pain medications post-hospital discharge.

Conclusions
This scoping review identified 10 PNPs for CGIDs around the world; the majority of these PNPs were led by nurses and designed for IBD care. PNPs for CGIDs have evidence of multiple benefits for individuals and the healthcare system. Further research could explore the impact on patient outcomes of PNPs for CGIDs living in rural and remote locations, as well as their impact on individuals with CGIDs belonging to equity-deserving groups.

Funding Agencies
None
A99 INCREASING THE NUMBER OF PASSES FOR ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION BIOPSY OF SOLID MASS LESIONS – A QUALITY IMPROVEMENT INITIATIVE TO IMPROVE DIAGNOSTIC YIELD
Authors: Sandha G , Khan S , Mathura P , Puttagunta L , Girgis S , Thiesen A , Zhang J , Nilsson J , Wasilenko S , Zepeda-Gomez S 
Published: February 2025

Abstract

Background
A retrospective chart audit (01/2022-12/2022) of endoscopic ultrasound (EUS)-guided fine needle aspiration biopsy (FNAB) of solid mass lesions revealed a disappointing diagnostic yield of 56% with a single needle pass. To improve this, a quality improvement (QI) intervention where endoscopists (three) were encouraged to perform three needle passes per patient was developed and trialed.

Aims
To assess intervention impact on improving the diagnostic yield of EUS-FNAB of solid mass lesions over a 9-month study period.

Methods
A chart audit was completed quarterly for all patients undergoing EUS-FNAB of solid mass lesions from 01/2024-09/2024. Descriptive statistics were completed. Only a definite diagnosis, as confirmed on histological examination, was considered when calculating the diagnostic yield.

Results
A total of 183 patients (112 M, 71 F), mean age 63±13 years (range 12-88 years), underwent 198 EUS-FNABs by 3 endoscopists over 9 months. A single pass with an FNAB needle was undertaken in 36/198 cases (18%). The diagnostic yield was 20/36 (56%), similar to the pre-intervention year. The solid mass lesions targeted were pancreas (16), lymph nodes (12), subepithelial (3), rectal and retro-peritoneal (2 each), and ampulla (1). One endoscopist performed 25/36 cases (69%) whereas the other two performed 11/36 (31%) and 0/36 cases. Proximity to vasculature and technical difficulty were reasons provided in 11 and 1 case(s), respectively, whereas no reason was documented in 24 cases. There was no difference in these variables between the groups with a definite diagnosis (20/36) vs. those without (16/36). After the first quarter audit, the need to avoid a single needle-pass was reinforced. Figure 1 shows the trend of single vs. 3 or more needle passes for the pre-intervention vs. the post-intervention year. There is a trend towards performing fewer single needle passes (39 pre vs. 36 post) and increasing 3 or more needle passes (25 pre vs. 68 post). This was associated with an improvement in diagnostic yield in the pre (22/39 [56%] vs. 21/25 [84%]) vs. post groups (20/36 [56%] vs. 61/68 [90%]).

Conclusions
Education, regular audit, and continued reinforcement has demonstrated an improvement in the diagnostic yield of EUS-FNAB by increasing the number of needle passes to 3 or more for solid mass lesions.

Funding Agencies
None
A100 ADULT GASTROENTEROLOGIST PERSPECTIVES ON AN EDUCATIONAL PLATFORM TO SUPPORT YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE
Authors: Mohmand Z , Miatello A , Allemang2 B , Tausif A , Lawrence S , Deslandres C ,   C.Education Committee, Wang Y , de Guzman J , Lee K , Barwick M , Benchimol E I , Fu N , Bollegala N 
Published: February 2025

Abstract

Background
Adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) encounter challenges during the transition from pediatric to adult healthcare, where they must manage their care with increasing independence. The Transition Adolescent & Young Adults implementioN (IBD-TrAYN) is a randomized clinical trial (NCT05221281) of a program to address care gaps during this critical period. As part of the intervention arm, we developed an online educational platform with 19 modules to enhance disease knowledge and self-management skills among AYAs.

Aims
This quality improvement project aims to understand the perspectives of adult gastroenterologists (GIs) on the relevance of the module content for AYAs with IBD.

Methods
Adult GIs with experience treating AYAs (18-25y) with IBD in Canada were recruited using purposive and snowball sampling techniques. Three virtual focus groups were conducted to explore perceptions of module applicability and potential gaps in the curriculum. Content analysis was performed on the transcripts for emergent themes by two independent reviewers.

Results
Eleven GIs were recruited, who recognized the educational platform as a valuable tool for addressing critical gaps in care due to limited clinic time, allied health support, and varying patient knowledge and transition readiness levels. Modules identified as high-priority included disease self-management, mental health, and sexual health. Concerns about information overload led to suggestions for combining related topics, such as family planning and sexual health, and integrating features like searchability and interactive elements to make the content more engaging and personalized. Participants recommended the development of education modules to support parallel caregiver role transitions. Participants stressed the importance of a flexible, accessible approach that allows AYAs access to relevant information at their own pace.

Conclusions
Adult GIs endorsed the value of the platform and its relevance in addressing their clinical priorities and the needs of their AYA patients. The perspectives gathered will inform content refinement to prevent information overload and enhance the curriculum, ultimately contributing to enhanced knowledge and transition readiness for AYAs with IBD.

Funding Agencies
CCC
A101 SCALES EVALUATING THE CLEANLINESS AND MUCOSAL VISIBILITY OF THE UPPER GI TRACT: A SCOPING REVIEW
Authors: Tham D , Gimpaya N , Tran W , Ibrahim A , Verma Y , Grover S 
Published: February 2025

Abstract

Background
Esophagogastroduodenoscopy (EGD) requires clear mucosal visualization for detecting lesions in the upper gastrointestinal (UGI) tract. Historically, studies have evaluated UGI cleanliness using non-validated scales. The validation of scoring methods for UGI cleanliness is necessary to be able to document EGD quality in a standardized and reproducible manner. Recently, there have been multiple published studies which describe the development of novel cleanliness scales for EGD, and there is a need to synthesize the currently available data.

Aims
To summarize and compare novel UGI cleanliness scales for EGD.

Methods
A literature search of MEDLINE and Web of Sciences from inception to September 2024 identified randomized and cohort studies that used UGI cleanliness scoring systems. Two reviewers screened abstracts/articles and extracted data. Baseline study characteristics and information about cleanliness scales were extracted. The primary outcome was characteristics and validity evidence for UGI cleanliness scales.

Results
Of 1729 articles screened, 65 were analyzed (Figure 1). 53 studies developed scales for EGD and 11 for capsule endoscopy. 27 articles described novel scales that were not based on prior studies. The primary objectives of these studies were to develop or validate an UGI cleanliness scale (5), evaluate devices (5), or assess intervention efficacies (17). Table 1 summarizes studies that developed a UGI cleanliness scale as a primary aim.
Among the 38 studies which created or utilized UGI cleanliness scales based on other studies, the most highly cited scale (13) was proposed by Kuo et al. in 2002. This 4 point scale (1=optimal visibility, 4=poor visibility) evaluated the gastric antrum, lower body, upper body, and fundus. No validation studies were performed, but scores between multiple endoscopists showed a correlation with each other (r = 0.59-0.78, P &lt; 0.001).

Conclusions
In this review, we have synthesized the current body of literature on UGI scales, highlighting their testing and validity. Future studies should compare the scores from UGI scales with clinical outcomes to determine the utility of standardized scales in improving EGD quality.
Table 1: Summary of studies with UGI cleanliness scale validation/development as the primary outcome.

Funding Agencies
None
A103 GUTLINK SMARTPATH: AN ONLINE TOOL TO IMPROVE PATIENT CARE
Authors: Park G , Stewart M , Jones J , Willett N 
Published: February 2025

Abstract

Background
Lower gastrointestinal (GI) symptoms are common reasons patients present to primary healthcare providers (PHCP). It can be challenging for PHCPs to identify dietary and functional conditions versus serious illnesses that require specialty assessment. Unfortunately, access to GI care in Nova Scotia is limited with patients waiting well beyond published standards.
The Division of Digestive Care and Endoscopy (DDCE) at Dalhousie University has developed a referral management system to prioritize patients. Unfortunately, the lack of standardization in referral requirements creates challenges to implementing a robust and accurate referral management system.
To support the evaluation and management of patients with lower GI symptoms within primary care, we developed an adaptive clinical care pathway (SmartPath), delivered within an online platform, Virtual Hallway (VH). The SmartPath is an evidence-informed clinical support tool facilitating appropriate primary care investigations and management as well as specialist referrals, as required.

Aims
To evaluate the implementation and early effectiveness of the lower GI symptom SmartPath.

Methods
We conducted a cohort study of SmarthPaths initiated with primary care. Descriptive data was extracted from the Virtual Hallway platform, with results of a short survey PHCPs were asked to complete following completion of a SmartPath. To assess the quality of referrals facilited by SmartPath versus traditional referral pathways, a series of 20 consecutive referrals for 3 common lower GI complaints (diarrhea, constipation and rectal bleeding) were selected for comparison. Interim data is presented for Smartpaths initiated between October 2023 and August 2024.

Results
A total of 272 SmartPaths were initiated by 103 unique PCHPs, of which 179 (65.8%) led to a specific action, with the 93 (34.2%) remaining in process within primary care. Of the 37 DDCE referrals, 26 (62.1%) were accepted, 11 (29.7%) were declined or redirected to another service.
60 consecutive traditional lower GI symptoms referrals were analyzed, 27 (45%) of which were declined. 31 (51.7%) did not provide any investigations, 42 (70%) did not provide physical examinations, and 34 (56.7%) did not provide a past medical history.
Survey responses were provided by 57 PHCPs with mean scores (out of 5) of 4.2 for ease of use, 3.9 for overall satisfaction, and 4.2 for likelihood to use again.

Conclusions
An adaptive care pathway is effective for facilitaing investigation and management of common lower GI symptoms within primary care while facilitating access to specialized services, as required. Referrals received through smartpath had a higher acceptance rate.

Funding Agencies
None