bluuebunny/crossref_metadata_2025_split huggingface dataset:
A115 EVALUATING THE CONTENT AND FACE VALIDITY OF LOW-COST GEL POLYPS FOR POLYPECTOMY SKILLS TRAINING IN NOVICE ENDOSCOPISTS
Authors: Tham D , Zhao A , Gimpaya N , Khalaf K , Mokhtar A , Na C , Lisondra J , Scaffidi M , Khan R , Walsh C , Fecso A , Grover S 
Published: February 2024

Abstract

Background
Polypectomy is an essential endoscopic skill involving the removal of potentially premalignant lesions during colonoscopy. The ad hoc nature of polyp encounters is a significant barrier to polypectomy training, as this limits the ability to deliberately practice the skill. Effective and accessible polypectomy simulators may improve global implementation of polypectomy curricula.

Aims
To determine the face and content validity of a novel low-cost gel polyp simulator for use in endoscopic training programs.

Methods
A novel gel polyp simulator with multiple polyp morphologies based on the Paris classification was developed and used with a commercially available colonic phantom (Koken Lower GI Endoscopy Simulator Type II LM-107, Koken CO.LTD, Japan) in an endoscopy simulation-based training course (July, 2023). Feedback based on previous prototypes of the simulator were implemented into the simulator utilized in the present study. Novice (ampersand:003C25 procedures) and expert (ampersand:003E1000 procedures) endoscopists performed simulated procedures with the gel polyps. Using a five-point Likert scale (“strongly agree” to “strongly disagree”), a post-training survey based on previously published surveys used to determine the face and content validity of low-cost physical colonic simulators was administered. A section for additional comments was placed at the end of the survey.

Results
The face and content validity survey was completed by 3 experts and 21 novices. The median score for all face validity questions was 5 (IQR 5-5) from experts and 5 (IQR 5-5) from novices. The median score for all content validity questions was 5 (IQR 5-4) from experts and 5 (IQR 5-5) from novices. In the additional comments section of the survey, one expert commented that future iterations of the gel polyps should be made thicker so that trainees could practice using endoscopic clips. The gel polyp simulator cost $0.61 CAD/polyp including the cost of materials and 3D printed molds.

Conclusions
The gel polyp simulator appears to be a feasible modality for polypectomy training that is reproducible using accessible and low cost materials.
Face and Content Validity Survey (questions and median survey score)

Funding Agencies
None
A119 ACUTE COLONOC PSEUDO-OBSTRUCTION AFTER ENDOSCOPIC RESECTION OF A FULLY CIRCUMFERENTIAL LARGE NON-PEDUNCULATED COLORECTAL POLYP
Authors: Zarrin A , Jiang S X , Gilhotra R , Shahidi N 
Published: February 2024

Abstract

Background
Complex large non-pedunculated colorectal polyps (LNPCPs), including those involving the full circumference of the bowel, are now readily managed by minimally invasive endoscopic resection techniques. Established procedure-related adverse events include sedation related adverse events, deep mural injury, clinically significant post-resection bleeding, delayed perforation and serositis. An appreciation for potential procedure-related adverse events is critical to the effective implementation of these techniques.

Aims
To describe a case of acute colonic pseudo-obstruction after endoscopic resection of a fully circumferential LNPCP.

Methods
Case report and review of the literature

Results
A 91-year-old male with a history of atrial fibrillation, chronic kidney disease and suspected McKittrick-Wheelock syndrome underwent successful endoscopic mucosal resection (EMR) of a 100mm fully circumferential LNPCP in the sigmoid colon. Histopathology diagnosed a tubulovillous adenoma with high-grade dysplasia. After elective admission, he suffered from clinically significant post-EMR bleeding requiring 2 units of packed red blood cells. On post-operative day 1 he began to suffer from nausea, abdominal pain and obstipation. On examination, he was visibly distended. Abdominal X-ray revealed extensive gas-filled loops of small and large bowel with the absence of gas in the rectum. He was managed conservatively with nasogastric tube decompression. Total duration of hospital stay was 9 days.

Conclusions
Critical to the continued expansion of minimally invasive endoscopic resection techniques is an awareness for potential procedure-related adverse events. To our knowledge this is the first description of acute colonic pseudo-obstruction after endoscopic resection

Funding Agencies
None
A120 A HUMAN-CENTERED DESIGN APPROACH TO THE DEVELOPMENT OF A VACCINE IMPLEMENTATION STRATEGY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Authors: Zhou F , Robar J , Stewart M , Jones J 
Published: February 2024

Abstract

Background
Vaccination uptake amongst patients with inflammatory bowel disease (IBD) remains suboptimal. Our previous study assessed perceived barriers and solutions related to implementation of evidence-based guidelines for vaccine preventable illness (VPI). Barriers included limited time, lack of access to a family physician, and incomplete understandings of coverage/access to vaccines.

Aims
The aim of this study was to use human-centered design (HCD) to design a vaccine implementation program in patients with IBD.

Methods
The HCD approach consisted of multiple phases. Phase 1 (discovery and define) consisted of semi-structured interviews of healthcare providers. Phase 1 also included the development of a context-specific patient journey map of the processes involved in accessing vaccines. This map was developed in collaboration with a multidisciplinary IBD team. Phase 2 involved identifying common barriers and facilitators through thematic analysis and journey mapping. In Phase 3, these analyses were used to design an implementation strategy for evidence-based management of VPI in the local health system context.

Results
Twelve interviews (including 11 gastroenterologists and one IBD nurse practicing in Nova Scotia and New Brunswick) were conducted. Mean participant age was 45.1 years, with 63.6% identifying practice in an urban/academic setting compared to a rural/community setting (36.4%). Lack of access to a family physician, limited time, vaccine hesitancy, and incomplete understanding of coverage/access to vaccines were among the barriers identified. Using facilitator themes as well as the journey mapping process, a proposal for an early implementation strategy prototype was designed. Prototype development involved collaborative partnership with a third-party patient support program to overcome various barriers identified in our surveys.

Conclusions
Barriers to implementation of evidence-based guidelines for management of VPI are well documented. The use of HCD to design an effective implementation strategy that is sensitive to the local healthcare context holds potential to increase access to and uptake of high quality, evidence-based VPI management. In future studies, the implementation-effectiveness of the implementation strategy (model prototype) will be evaluated and compared to standard of care.

Funding Agencies
None
A122 INTEROBSERVER AGREEMENT FOR THE PARIS CLASSIFICATION OF COLORECTAL POLYPS AMONGST SURGEONS, GASTROENTEROLOGISTS, TRAINEES AND EXPERTS: A VIDEO-BASED STUDY
Authors: Alj A , Djinbachian R , Pioche M , Saito Y , Sethi A , Chiu P , Marks J , Sebajang H , Pawlak K , Chennouf A , Benard F , Ide Y , Dang F , von Renteln D 
Published: February 2024

Abstract

Background
Colonic polyps are described based on their macroscopic shape, according to the Paris classification. This represents a useful tool to communicate polyp morphology between endoscopists, however, the agreement between endoscopists on polyp morphology evaluation has not been demonstrated in the literature. We were interested in evaluating endoscopist agreement using the Paris classification.

Aims
The aim of this study was to evaluate endoscopist agreement using the Paris classification.

Methods
We conducted a prospective video-based study evaluating endoscopist assessment of polyp morphology. An international group of endoscopists including surgeons, gastroenterologists, experts and trainees were included. Primary outcome was overall inter-observer agreement for the Paris classification. Secondary outcomes were inter-observer agreement stratified by endoscopist characteristics.

Results
11 endoscopists were included in the analysis with 1320 morphologic assessments of 120 individual polyps. There was low overall inter-observer agreement for the Paris classification with an overall Light’s Kappa of 0.19. Agreement remained low for men (Κ=0.25), women (Κ=0.25), gastroenterologists (K=0.23), surgeons (K=0.11), trainees (K=0.33), and experts (K=0.29). Endoscopists who have received training on lesion evaluation in Asia had higher inter-observer agreement when using the Paris classification compared to endoscopists in the west (K= 0.50 vs 0.26).

Conclusions
Agreement when using the Paris classification was low amongst a varied international group of surgeons, gastroenterologists, trainees and experts. Training in the east where higher emphasis is placed on lesion characterization was associated with the highest inter-observer agreement.

Funding Agencies
None
A123 THE EFFECTS OF INFLAMMATORY BOWEL DISEASE ON THE MANAGEMENT AND OUTCOMES OF COMPLEX POLYPS IN PATIENTS UNDERGOING SURVEILLANCE COLONOSCOPY: A RETROSPECTIVE COHORT STUDY
Authors: AlRamdan R , Almudaires A , Son S , Sey M , Gregor J , Yan B 
Published: February 2024

Abstract

Background
The influence of inflammatory bowel disease (IBD) on the outcomes of complex polyps remains an area of uncertainty.

Aims
To investigate the impact of IBD on the management and outcomes of complex polyps during surveillance colonoscopy.

Methods
This retrospective cohort study utilized a prospectively collected database, involving patients who underwent surveillance colonoscopy for colorectal cancer or IBD surveillance who were identified to have complex polyps between February 2019 and December 2020 in Southwestern Ontario. Patient demographics, disease characteristics, medication history, polyp description and management were analyzed. The data were summarized in median and interquartile range for continuous variable and frequency and percentage for categorical variables. Characteristics between IBD and non-IBD were compared using the Wilcoxon rank sum test and Fisher’s exact test, as appropriate.

Results
383 patients were included in the study, of which 27 individuals had IBD (5 Crohn's disease, 13 ulcerative colitis, and 9 indeterminate colitis). Patients with IBD were generally younger than their non-IBD counterparts (median age 61 vs 67 respectively). No significant differences were identified in terms of rates of complete polyp removal (17.70 % vs 22.22 %, pampersand:003C0.602), residual polyps after resection (76.97% vs 70.37%, pampersand:003C0.476), repeat removal attempts (84.27% vs 74.07%, pampersand:003C0.179), or surgical intervention (88.76% vs 88.89%, pampersand:003C0.99). A higher proportion of IBD patients were managed by gastroenterologists vs other endoscopists (81.48% vs. 40.17%, p ampersand:003C 0.001). No significant differences in complex polyp characteristics were observed, except in difficult locations of complex polyps were more common in the non-IBD cohort (55.34% vs 25.93%, pampersand:003C0.004).

Conclusions
In this retrospective cohort study, IBD does not appear to influence the management or outcome of complex polyps. Larger studies are required given the small IBD cohort size in this study.

Funding Agencies
None
A125 DIAGNOSTIC ACCURACY OF ARTIFICIAL INTELLIGENCE IN THE DIAGNOSIS OF INTESTINAL METAPLASIA AND DYSPLASIA IN PATIENTS WITH BARRETT'S ESOPHAGUS: A DIAGNOSTIC TEST ACCURACY META-ANALYSIS
Authors: Dadgar K , Mais L , Sangar S , Yaghoobi M 
Published: February 2024

Abstract

Background
Diagnosing dysplasia in patients with Barrett’s Esophagus is crucial in preventing esophageal cancer but challenging in clinical practice. Artificial Intelligence (AI) could potentially be utilized during endoscopy to provide better diagnostic accuracy.

Aims
The primary aim of this systematic review is to determine the diagnostic accuracy of AI in detecting intestinal metaplasia and dysplasia in adults with Barrett's esophagus using gastroscopy images.

Methods
A comprehensive electronic search was conducted of cross-sectional studies examining the accuracy of AI in diagnosing intestinal metaplasia or dysplasia using endoscopic images. Study selection, data extraction and quality assessment were completed by two authors independently. When a study used several models, the model with the highest sensitivity was used in meta-analysis. The Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool was used to assess risk of bias and applicability. Meta-analysis was performed using a bivariate model to obtain summary estimates of sensitivity, specificity, and diagnostic odds ratio.

Results
Of the 1479 articles reviewed, 23 were included. The diagnosis of dysplasia by AI per endoscopic image obtained had a sensitivity of 0.92 (CI 0.85-0.96), specificity of 0.84 (CI 0.78-0.88) and diagnostic odds ratio (DOR) of 59 (CI 22-161). The diagnosis of dysplasia in volumetric laser endomicroscopy images interpreted by AI had an overall sensitivity of 0.83 (CI 0.70-0.91), specificity of 0.77 (0.67-0.85) and a DOR of 16 (CI 2-30). Subgroup analysis did not show a statistically significant difference when comparing studies conducted in Europe to those outside of Europe or studies published before 2020 to those published after 2020. A sensitivity analysis by removing the largest studies did not change the overall accuracy of AI.

Conclusions
AI algorithms seem to be accurate at detecting the presence of intestinal metaplasia and dysplasia. Further research into using artificial intelligence should be carried out to evaluate its use in combination with endoscopist’s opinion as a clinical decision-making tool to target areas of dysplasia for biopsies.

Funding Agencies
None
A128 OPTIMIZED COMPUTER ASSISTED TECHNIQUE FOR INCREASING ADENOMA DETECTION DURING COLONOSCOPY: A RANDOMIZED CONTROLLED TRIAL
Authors: Djinbachian R , Taghiakbari M , Barkun A , Medawar E , Panzini B , Sidani S , Liu J , von Renteln D 
Published: February 2024

Abstract

Background
Efforts to improve colonoscopy have recently focused on improving adenoma detection interventions such as artificial intelligence (CADe) that have demonstrated improvements in Adenoma Detection Rates (ADR). Although studies have focused on implementation of one intervention at a time.

Aims
We evaluated an optimized computer assisted technique (CADopt) versus standard colonoscopy to improve ADR during colonosocopy.

Methods
A prospective randomized controlled trial was conducted enrolling adults (45–80 years) undergoing elective colonoscopy. Participants were randomized (1:1) to the intervention group (CADopt, and control group. In the CADopt group, endoscopists used a computer aided polyp detection combined with linked colour imaging, water exchange colonoscopy, and cecal retroflexion. In the control group, standard colonoscopy was performed. Primary outcome was Adenoma Detection Rate (ADR) in the intervention and control groups. Secondary outcomes included advanced ADR (AADR) and sessile serrated lesion detection rates (SDR).

Results
A total of 467 patients were recruited and randomized (CADopt group 229 patients, 50.2% female vs 238 patients, 48.3% female in the control group). ADR was 49.3% (95%CI 42.7-56.0) for the CADopt group vs 38.2% (95%CI 32.0-44.7) for the control group (p=0.016). AADR and SDR were 13.1% (95%CI 9.0-18.2) and 6.6% (95%CI 3.7-10.6) for the CADopt group versus 8.0% (95%CI 4.9-12.2), and 7.1% (95%CI 4.2-11.1) for the control group, respectively.

Conclusions
Using an optimized computer assisted technique led to significant improvements in ADR and a trend towards AADR improvements.

Funding Agencies
Fujifilm
A129 OUTCOMES FOLLOWING ENDOSCOPIC SUBMUCOSAL DISSECTION OF SUPERFICIAL GASTROINTESTINAL TRACT NEOPLASTIC LESIONS FROM A TERTIARY-CARE ACADEMIC CENTRE
Authors: Gupta S , Dang F , Fujiyoshi Y , Li S , Khalaf K , May G , Mosko J , Teshima C 
Published: February 2024

Abstract

Background
Endoscopic submucosal dissection (ESD) is an advanced luminal resection technique for dysplastic and early cancerous gastrointestinal (GI) tract neoplasms. By removing lesions en bloc, this method provides more accurate histopathologic evaluation of resection margins in comparison to endoscopic mucosal resection (EMR). Superior curative resection and lower recurrence rates over EMR have been shown in addition to the benefit of reduced morbidity and mortality compared to surgery. While ESD has become well-established in Asia and Europe, its adoption in North America – and in particular Canada – has been slowed by multiple technical and economic factors including a scarcity of infrastructure, institutional support, and standardized training. Additionally, reproduced Canadian data corroborating its known global efficacy is currently lacking.

Aims
Our aim was to evaluate clinical and technical outcomes in patients who underwent ESD of superficial GI tract neoplasms at a tertiary-care academic centre.

Methods
We conducted a retrospective single-centre cohort study at The Centre for Advanced Therapeutic Endoscopy & Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada. Consecutive adults (age ampersand:003E 18) who underwent ESD of any superficial GI tract neoplasm from October 2017 to December 2022 were included in the study. Primary outcomes were rates of en bloc, complete (R0), and curative resections. Secondary outcomes were rates of recurrence and adverse events. Data was collected through electronic chart review.

Results
ESD was performed in a total of 308 lesions with a mean size of 2.5 cm (range, 1-7 cm). Gastric ESD was the most common (n=130), followed by esophageal (n=91), rectal (n=62), and colonic (n=22). Three patients underwent duodenal ESD. En bloc, R0, and curative resection rates were 89.2%, 84.7%, and 71.8%, respectively. 64.3% of lesions were cancerous on pathology (n=198), of which 48 had at least submucosal invasion. Rates of delayed bleeding and deep mural injury (DMI) requiring surgical intervention were 3.9% and 1.3%, respectively. Overall recurrence at the first surveillance endoscopy (SE1) was 3.6%.

Conclusions
En bloc, R0, and curative resection rates reported from this largest single-centre Canadian ESD cohort are comparable to existing North American data. Low rates of early recurrence and an adequate safety profile have been demonstrated with this emerging oncologic method of resection. Additional investigation is warranted to optimize lesion selection and determine long-term clinical outcomes to further establish this technique in the management of superficial GI tract neoplasms.

Table I. Procedural characteristics, outcomes, and adverse events for patients who underwent ESD of superficial GI tract neoplasms.

Funding Agencies
None
A131 OUTCOMES AND COMPLICATIONS OF THERAPEUTIC ERCP IN DIFFERENT AGE GROUPS
Authors: Hazan E , Na C , Zarrin A , Mokhtar A , Khalaf K , Gimpaya N , Meleka M , Tham D , Abal S P , Mhalawi W , Chopra D , Gupta S , Jugnundan S , Calo N , Teshima C , Mosko J , May G , Grover S 
Published: February 2024

Abstract

Background
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a vital procedure for hepatobiliary disease management. Though it boasts high overall success rates, the impact of patient age on outcomes remains uncertain, especially amongst elderly patients. With an aging population, it is crucial to determine the efficacy and safety of ERCP in different age groups.

Aims
This study assesses ERCP success and complication rates across age groups. Our objective is to investigate whether ERCP remains a reliable and safe procedure for patients of all ages, particularly the elderly.

Methods
A database with retrospective data from consecutive patients undergoing ERCP at a Canadian tertiary care centre between 2011 and 2020 was utilized. Baseline patient characteristics and indications for ERCP were collected. Outcomes included procedural success, complications, and procedure duration. Patients were categorized into four age groups: ampersand:003C40, 40-65, 65-80, and ampersand:003E80, with a specific sub-analysis for patients ampersand:003C80 and ampersand:003E80.

Results
This study included 6132 patients. Significant disparities were observed in comorbid conditions (pampersand:003C0.0001), ASA status (pampersand:003C0.0001), and the use of anticoagulants or antiplatelet agents (pampersand:003C0.0001). The most common indications for ERCP were gallstones (45.1%), jaundice (19.2%), and ductal lesions (12.8%), with no significant variation among the age groups (p=0.5983). There was a significant difference in procedural success (p=0.0005), with declining success in older age groups (ampersand:003C40 = 91.3%, 40-65 = 87.4%, 65-80 = 86.2%, ampersand:003E80 = 84.9%), and this difference remained significant in the ampersand:003C80 and ampersand:003E80 sub-analysis (p=0.0133). While mean procedure duration was longer in older age groups (pampersand:003C0.0001), incidence of complications did not vary across all groups (p values [EH1] = 0.1532-0.7622) or patients ampersand:003C80 and ampersand:003E80 (p= 0.0769-0.7128).

Conclusions
ERCP maintains a high success rate and safety profile across all age groups; however, success rates decline and procedure times increase significantly in older patients.
ERCP outcomes across age groups

Funding Agencies
None