bluuebunny/crossref_metadata_2025_split huggingface dataset:
A89 LIVER TRANSPLANT REFERRAL PATTERNS FROM THE ATLANTIC CANADIAN PROVINCES
Authors: Harper C , Allen S , Zhu J 
Published: February 2024

Abstract

Background
End-stage liver disease (ESLD) is one of the leading causes of deaths in Canada. Liver transplantation (LT) is the ultimate treatment option for patients with ESLD. A variety of factors may influence patient outcomes before a liver transplant is offered. There have been no studies looking at the characteristics of patients referred for LT in Atlantic Canada at the prelisting and wait-listing stages.

Aims
To examine various patient characteristics, including age, sex, MELD score, BMI, rural vs. urban residency, and diagnosis that may be important to the LT work up process. To better understand referral patterns and potential barriers to LT in Atlantic Canada including geographic factors, the COVID-19 pandemic, and the evolution of underlying liver disease.

Methods
This is a retrospective cohort study using Multiorgan Transplant (MOTP) database to identify all active referrals sent to the Atlantic liver transplant program from four Atlantic Canadian provinces between January 1, 2017 and September 30, 2023.

Results
There were 533 LT referrals to the MOTP in the observation period. From the listed patients (217), 60% were transplanted and 25% died on the waiting list. Of the patients that did not progress to being listed (56%), 197 (37%) of the referrals were withdrawn and 99 (18.6%) died prior to being listed.
There was no significant difference in mean BMI, age, listing MELD-Na, or diagnosis (p=0.35) among active referrals between pre-COVID-19 (Jan.1 2017-Mar.30 2020) and COVID-19 periods (Apr.1 2020-Sept.30 2023). There was 6% reduction in referral number from all Atlantic provinces in COVID vs. pre-COVID period, and 25% reduction in referrals for hepatocellular carcinoma (HCC) in COVID.
The ratio of patients ampersand:003C 65 yrs to ampersand:003E/= 65 yrs decreased during COVID (2.88) compared to pre-COVID (3.57). For pre and post COVID period, there were similar numbers of patients withdrawn/died prior to listing (54.7%, 54.8%). There were less patients listed (43.0%, 38.2%) and a decrease in patients transplanted (32%, 28%) pre and post COVID.
We analyzed the number of referrals from urban and rural areas. Overall, 33% of referrals were urban and 67% of referrals were rural based on patient residence. The ratio of rural to urban area referrals was 1.80 pre COVID and 2.24 during Covid, indicating an increasing number of referrals from rural centers post-COVID.

Conclusions
Although there was a robust number of LT referrals during the pandemic, there was a decrease in number of referrals and transplants after COVID. There is a notable decrease in referrals for HCC after COVID. One plausible reason is reduced HCC surveillance during the pandemic. There was an increase in referrals from rural areas during COVID. Further analysis will be needed to determine any factors that affect LT referral patterns., with the goal of identifying reasons for this change and making appropriate recommendations to the MOTP.

Funding Agencies
None
A91 PYOGENIC LIVER ABSCESSES DUE TO FUSOBACTERIUM NUCLEATUM ARE ASSOCIATED WITH SEVERE INFLAMMATORY RESPONSE AND ACUTE LIVER FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Hossein-Javaheri N , Cloutier M , Dennis C , Ramesh M , Singh I , Aijaz A , Gohil H , Miranda C J 
Published: February 2024

Abstract

Background
Pyogenic liver abscesses (PLAs) are uncommon entities with potentially devastating consequences requiring early diagnosis and treatment. Fusobacterium nucleatum is an anaerobic, gram-negative bacterium that is a rare cause of liver abscesses. F. nucleatum initiates a severe pro-inflammatory cascade that promotes abscess formation through the gut-liver axis especially when the gastrointestinal (GI) barrier is compromised.

Aims
In this study, we explore the characteristics of PLAs due to F.nucleatum, including the duration and mode of therapy. This may inform clinical decisions when treating persons with suspected F.nucleatum PLAs and improve mortality.

Methods
A systematic literature search was conducted in MEDLINE, PubMed, and the Cochrane Library, from 1977 to September 2023. We included full-text abstracts and articles written in English that reported patients with F.nucleatum PLA aged ampersand:003E18. Demographics, history of GI diseases, pertinent laboratory markers, abscess characteristics, and the approaches taken to treat the abscess were collected. Pooled data were assessed qualitatively and reported as mean±SEM when appropriate.

Results
We included 32 studies. The mean patient age was 52±20 years with 71% being male. In total, 47% of patients had a recent history of GI disease: sigmoid diverticulosis (n=6), colonic adenomas (n=5), duodenitis (n=2), appendicitis (n=1) and ulcerative colitis (n=1). On presentation, only 53% (n=17) reported abdominal pain. Labs were significant for leukocytosis at 22±2 K/µL, C-reactive protein 199±37 mg/L, aspartate transferase (AST) 128±24 U/L, alanine aminotransferase (ALT) 116±16 U/L, Alkaline phosphatase (ALP) 275±35 IU/L, and bilirubin 11±3 mg/dL suggestive of severe inflammatory response and cholestatic liver injury. The average abscess size was approximately 10.2±0.7 cm, 28% of which had loculations (n=9) requiring multiple drainages (n=7) or laparoscopy (n=2). The initial antibiotic of choice was piperacillin/tazobactam (Zosyn) (n=12), ceftriaxone + metronidazole (n=7), Ampicillin/Sulbactam (Unasyn) (n=5), followed by Meropenem, Metronidazole, and Ciprofloxacin. The estimated length of stay was 23±4 days with a need for long-term antibiotic therapy (54±10 days) upon discharge. The majority of patients were discharged on Metronidazole (n=11), or Amoxicillin/Clavulanic acid (Augmentin) (n=6). With appropriate source control, the estimated survival was 91% (n=29).

Conclusions
Our findings suggest that PLAs due to F.nucleatum are associated with large abscesses, a severe inflammatory response, cholestatic liver injury, and prolonged hospitalization. Multiple drainages with targeted gram-negative coverage may be required for adequate source control and favorable outcomes.

Funding Agencies
None
A113 COVID-19 VACCINATIONS IN IBD PATIENTS: PATIENT KNOWLEDGE AND PERCEPTIONS
Authors: Saunders A , Hill L , Armstrong D , Marshall J , Narula N , Pai N , Chauhan U 
Published: February 2024

Abstract

Background
The IBD population has historically suffered from a below average uptake of vaccinations which raises concern for COVID-19 vaccine acceptance in this population. Patients report IBD-specific reasons for COVID-19 vaccine hesitancy including fear of vaccine-related IBD flare up, a desire for IBD-specific data regarding COVID-19 vaccine safety and efficacy, and worry about current drugs affecting vaccine efficacy. Additionally, IBD patients tend to report greater fear of COVID-19, concern about the impact of their medications on COVID-19 disease, and overall need for COVID-19 information.

Aims
To explore patients’ education, knowledge, and perceptions of COVID-19 vaccination with the aim of lowering COVID-19 vaccine hesitancy, improving knowledge of COVID-19 vaccines, and identifying outstanding barriers to COVID-19 vaccination uptake.

Methods
Study participants are patients diagnosed with IBD recruited from the Adult IBD Clinic at McMaster University Medical Centre between June 2022 and May 2023. Quantitative questionnaires were distributed to participants following receipt of informed consent at routine clinics and were offered in paper format. To describe the study population, the following descriptive statistics were performed: means and standard deviation for continuous variables, distributions (n, %) for dichotomous and categorical variables.

Results
In total, 236 participants were surveyed. The sample is predominantly female (61%) and most participants are diagnosed with Crohn’s disease (63.9%). The vast majority of patients have received at minimum 1 dose of a COVID-19 vaccine (92.1%). Reported reasons for vaccination included COVID-19 vaccine being available free of cost (52.3%), recommendation from a healthcare professional (51.9%), and feeling as though the benefit of the vaccine outweighs the risks (51.6%). Most patients reported having heard of negative vaccine experiences online (75.8%) including mild (27.6%) and severe (30.8%) adverse reactions. Despite this, participants viewed vaccines as effective (83%), protective towards the individual (75.5%), and safe (68.1%). Healthcare providers were regarded as a very significant influence in terms of COVID-19 vaccine information (65.6%) and were overwhelmingly viewed as a more reliable source than mass media (91.3%). Participants did not perceive an increased risk of COVID-19 infection, COVID-19 related serious illness, or COVID-19 vaccine related adverse effects due to their IBD or IBD treatments. Participants also did not show reluctance to vaccinate due to their IBD or IBD treatments.

Conclusions
The present study provides insight into the perceptions and knowledge of Canadian IBD patients as it relates to COVID-19 vaccines. Importantly, the results highlight the crucial role of the healthcare provider on vaccination uptake and acceptance.

Funding Agencies
None
A118 THE IMPACT OF HOMELESSNESS ON ENDOSCOPY UTILIZATION, SURGICAL TREATMENT, AND POST-OPERATIVE COMPLICATIONS AMONG HOSPITALIZED PATIENTS WITH CROHN’S DISEASE
Authors: Youssef M , Mungle T , Charu V , Okafor P 
Published: February 2024

Abstract

Background
Homelessness is an important public health issue with a prevalence around 4.2% in the United States. Homelessness has been associated with lack of access to healthcare services, poor quality of care, and negative health outcomes. However, there is limited data on clinical outcomes among homeless individuals with Crohn’s disease (CD).

Aims
In this study, we examine inpatient outcomes including endoscopy utilization, surgical treatment, and post-operative complications among homeless patients with CD.

Methods
The Healthcare Utilization Project (HCUP) State Inpatient Databases from New York, Arizona, Massachusetts and Florida for 2013 and 2014 were used to identify adults ≥18 years admitted with CD identified by International Classification of Diseases, Ninth Revision codes. Homeless patients were then identified, and propensity score matched using a one-to-ten greedy nearest-neighbor approach to non-homeless patients to balance the distribution of baseline covariates. Differences in outcomes including endoscopy utilization, surgical treatment and post-operative complications were reported as odds ratios (ORs) and 95% confidence intervals (CI).

Results
A total of 70,457 CD hospitalizations were identified, of which 469 (0.6%) were associated with homelessness. We matched 440 homeless patients with 4,400 housed patients with CD. Homeless individuals had a higher proportion of males (p=0.002), tended to be older (p=0.035), and had more comorbidities than non-homeless individuals. There was no difference in mortality between non-homeless and homeless patients (OR 1.6, 95% CI 0.72-3.57). Endoscopy utilization was comparable between non-homeless and homeless patients with CD including gastroscopy (OR 0.71, 95% CI 0.40-1.18), colonoscopy (OR 0.80, 95% CI 0.31-1.69), and sigmoidoscopy (OR 0.37, 95% CI 0.02-1.74) [Figure 1]. Surgical treatment was also comparable, except for lower rates of bowel resection among homeless patients (OR 0.55, 95% CI: 0.29-0.93). The two groups also had similar rates of post-operative complications including pulmonary, cardiovascular, gastrointestinal, and infectious complications (Figure 1).

Conclusions
Homeless patients with CD have comparable endoscopy utilization and surgical treatment as non-homeless patients, except for lower bowel resection rates. Postoperative complications are also similar between the two groups. Future studies are needed to better understand the impact of homelessness on health outcomes and healthcare service utilization among patients with CD.

Figure 1. Endoscopy utilization, surgical treatment, and post-operative complications among homeless and non-homeless individuals using 1:10 propensity matching

Funding Agencies
None
A121 CROSS-SECTIONAL STUDY OF RESIDENT PHYSICIAN KNOWLEDGE AND PERCEPTIONS REGARDING NON-ALCOHOLIC FATTY LIVER DISEASE IN CANADA
Authors: Zhu K , Jogendran M , Zhang Y , Hussaini T , Chahal D , Yoshida E 
Published: February 2024

Abstract

Background
Non-alcoholic Fatty Liver Disease (NAFLD) is a prevalent condition affecting approximately 25% of the Canadian population and is projected to continue increasing. Given the increasing prevalence and complications of NAFLD, it is imperative for future primary care physicians to possess a thorough understanding of NAFLD to enhance patient care.

Aims
To assess the knowledge and perceptions of primary care resident physicians in Canada concerning NAFLD.

Methods
We conducted a nationwide cross-sectional survey of resident physicians in primary care specialties to assess their knowledge of NAFLD. Additionally, we evaluated resident perceptions regarding the importance of NAFLD and their exposure and familiarity with the condition. "Reasonable knowledge" was defined as correctly answering more than 50% of the questions. We assessed associations using χ2 testing and multiple logistic regression analysis.

Results
We received 413 responses, with 252 (61%) from family medicine residents and 161 (39%) from internal medicine residents. Among the respondents, 90% considered NAFLD an important public health issue, but only 7% felt they had adequate exposure to the condition, and 94% expressed a need for more teaching. 59% indicated that they were only slightly familiar or unfamiliar with NAFLD. The majority of respondents correctly identified diabetes (90%), dyslipidemia (96%), and obesity (97%) as risk factors for NAFLD, while fewer recognized obstructive sleep apnea (53%), hypothyroidism (27%) and hypopituitarism (14%) as risk factors. Cardiovascular disease and cirrhosis were reported as the most common causes of mortality from NAFLD by 37% and 35% of respondents, respectively. Up to 59% of respondents reported that non-alcoholic steatohepatitis can be diagnosed through imaging or a blood test. Respondents demonstrated a strong understanding of nonpharmacologic therapies, but only 11% recognized that there are no approved medications for NAFLD.
Overall, 35% of the respondents displayed a reasonable knowledge of NAFLD. In univariate analysis, factors associated with greater NAFLD knowledge included internal medicine residency (P=0.001), higher post-graduate year (P=0.003), prior GI or hepatology rotations (P=0.003), and subjective familiarity with NAFLD (Pampersand:003C0.001). However, only higher post-graduate year (P=0.048) and subjective familiarity (P=0.003) remained statistically significant in multivariate analysis.

Conclusions
Resident physicians perceive NAFLD as an important health issue but significantly lack exposure and knowledge about the condition. Further emphasis and education are needed to bridge these knowledge gaps and improve patient outcomes.

Funding Agencies
None
Endoscopy, Technology & Imaging
A140 DELAYED BLEEDING POST-ENDOSCOPIC AMPULLECTOMY FOR AMPULLARY ADENOMAS: INCIDENCE, RISK FACTORS AND MANAGEMENT OF DELAYED BLEEDING
Authors: Pawlak K , Khalaf K , Gupta S , Tham D , Mosko J , May G , Calo N 
Published: February 2024

Abstract

Background
The duodenal tumors of major papilla account 10% of all peri-ampullary lesions, and the majority represent adenomas, carrying malignant potential through the well-known adenoma–carcinoma sequence ([i]). Historically, surgical resection was the standard of care, but it is associated with significant risk of complications (44.7%) ([ii]). Hence, endoscopic ampullectomy became the treatment modality for selected cases. Despite the significantly lower rate of adverse events, pancreatitis and bleeding occurs in up to 25% of patients ([iii]). The rate of bleeding may be even higher, depending on periampullary lesion size and type. Factors related to delayed bleeding are poorly understood.

Aims
The aim of our study was to determine predicting factors for delayed post-ampullectomy bleeding.

Methods
We conducted a single-center retrospective study over 13 years (2010-2023). All patients who underwent an endoscopic ampullectomy were analyzed. The primary endpoint was the incidence of delayed bleeding, which was defined as a post-procedural bleeding that necessitated either a blood transfusion, ICU admission or re-intervention. Secondary outcomes included risk factors for delayed bleeding, management, and other adverse events.

Results
113 patients underwent endoscopic papillectomy [mean age 66.2 ± 12.2 years; male gender 51 (45.1%)]. Mean lesion size was 27.0 ± 14.3 mm and mean procedure duration was 62.8 ± 35.6 minutes.
There were 24 cases of delayed bleeding (21.2%). Of these, 6 (25%) required repeat endoscopic intervention. The average length of hospital was longer in those experiencing a delayed bleed (8.6 ± 4.9 vs 4.8 ± 2.4 days, Pampersand:003C0.001).
By univariable logistic regression, the odds of delayed bleeding were greater in those with hypertension (OR 3.8, 95%CI 1.4-10.3, P=0.008) or an INR ≥ 1.2 (OR 13.3, 95%CI 3.0-58.3, P=0.001). A multivariable logistic regression analysis revealed that INR≥ 1.2 predicted delayed bleeding, with an OR of 16.1 (95%CI 3.0-85.4, P=0.001). Other adverse events included perforation (n=7, 6.3%) and pancreatitis (n=19, 16.8%). There were no deaths.

Conclusions
Post-ampullectomy bleeding is a common adverse event in patients undergoing ampullectomy leading to more prolonged hospital stay. History of hypertension and elevated INR above 1.2 might be related to delayed post-ampullectomy bleeding. Additional strategies to reduce post-ampullectomy bleeding should be explored.

Funding Agencies
None
A143 PATIENT POSITION AND ENDOSCOPIC CHOLANGIOPANCREATOGRAPHY (ERCP) TECHNICAL SUCCESS AMONG PATIENTS WITH SURGICALLY ALTERED FOREGUT ANATOMY: A RETROSPECTIVE ANALYSIS
Authors: Scaffidi M , Khalaf K , Pawlak K , Chopra D , Tham D , Malipatil S B , Gimpaya N , Chan B , Yeung E , Forbes N , Calo N , Mokhtar A , Na C , Mosko J , May G , Grover S 
Published: February 2024

Abstract

Background
Patients with surgically altered gastrointestinal anatomy undergoing endoscopic retrograde cholangiopancreatography (ERCP) pose challenges due to anatomical distortions. Factors such as patient positioning, endoscopist experience, and choice of endoscope may influence procedural success. It is unclear how these factors may impact the technical success of ERCP among patients with altered anatomy.

Aims
We primarily aimed to determine the impact of patient positioning (prone versus left lateral decubitus [LLD]) on technical success of ERCP among patients with surgically altered anatomy. Our secondary aim was to determine the impact of patient positioning on procedural time and immediate bleeding.

Methods
We conducted a retrospective single-centre study using data from 2010 to 2020 that included patients with hepaticojejunostomy, Roux-en-Y anastomosis, Billroth-1, or Billroth-2 anatomy. The primary outcome was technical success of the ERCP, which we comprehensively defined as of successful navigation to the papilla or surgical anastomosis, selective cannulation and cholangiography, and the realization of the intended therapeutic goals. The secondary outcomes were the presence of immediate bleeding and procedural time. Statistical analysis involved descriptive statistics using mean and standard deviation (SD) and Fisher exact test with relative risk (RR) and 95% confidence interval (95% CI). All statistical tests were two-tailed and considered significant at Pampersand:003C0.05.

Results
Among 205 patients, there were 179 (87.3%) in the LLD group, and 26 (12.6%) in the prone group. There were no statistically significant differences between the two groups in terms of patient sex, age, type of altered anatomy, or American Society of Anesthesiologist (ASA) classification. We found that there was no significant differences between the two groups in terms of procedural success (RR 1.1, 95% CI: 0.8-1.5), immediate bleeding (RR 1.7, 95% CI: 0.2-14.8), and procedural time (P=0.808).

Conclusions
We did not find that patient positioning had a significant impact on technical success in ERCP among patients with surgically altered anatomy. The choice of positioning should be tailored to individual patient and endoscopist factors, with a focus on optimizing outcomes in this complex patient subset.

Funding Agencies
None
A149 SAFETY AND EFFICACY OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGOGASTRIC NEOPLASMS IN A CANADIAN SETTING
Authors: AlDarwish A , Bechara R 
Published: February 2024

Abstract

Background
Endoscopic submucosal dissection (ESD) is a technique that has been developed in Japan and is increasingly being adopted by western countries for treatment of superficial gastrointestinal neoplasms.

Aims
In this study, we aim to present the safety and efficacy of ESD for esophageal and gastric neoplasms in a Canadian setting, given the limited data regarding the outcomes of ESD in North America

Methods
Data of 100 patients with superficial upper GI neoplasms (esophageal and gastric) who underwent ESD between 2016 and 2022 in Kingston Health Sciences Centre, a tertiary hospital in Kingston, Ontario, were retrospectively reviewed. Demographics and lesion characteristics, ESD technique, and outcomes in terms of efficacy and safety were analyzed.

Results
100 patients were included in the study. 67% of the lesions were esophageal. The median diameter was 4.6cm and median area was 11.94cm2. Outcomes were favorable with technical success 98%, en bloc resection 96%, R0 resection 89% and curative resection 80%. Upstage in pathology from index biopsy was seen in 42% of the lesions. Adverse events were infrequently encountered (8%) and included delayed bleeding, aspiration, and pain.

Conclusions
ESD is a safe and effective modality for accurately diagnosing and treating early and superficial esophagogastric neoplasms when performed by trained endoscopists. Further research is required, however, to increase the adoption of this technique across Canada.
Procedural Details

Funding Agencies
None