bluuebunny/crossref_metadata_2025_split huggingface dataset:
P267 Real-world artificial intelligence-aided colonoscopy does not improve adenoma detection rates in patients with Inflammatory Bowel Disease
Authors: Levartovsky A , Levy I , Bruckmayer L , Klang E , Ben-Horin S , Kopylov U 
Published: January 2023

Abstract

Background
Recently, the implementation of artificial intelligence-aided colonoscopy (AIAC) has resulted in improved performance of colorectal cancer (CRC) screening. The adenoma detection rate (ADR) is a key quality indicator in screening colonoscopies and achieving high ADRs is crucial for optimal prevention of CRC. Guidelines suggest that ADRs of 20% in women and 30% in males are indicative of adequate performance. Patients with inflammatory bowel disease (IBD) may be at increased risk for CRC based on disease extent and duration. However, ADR in patients with IBD can be generally lower than in average-risk patients, mainly due to an age gap and the presence of dysplasia associated lesions as opposed to sporadic adenomas. Indeed, there is no consensus for an accepted ADR target in these patients. In addition, the impact of AIAC on ADR in these patients has yet to be described. We aimed to explore the ADR of patients with IBD in a large-volume endoscopic center and evaluate the effect of AIAC on ADR.

Methods
This was a retrospective study conducted at a high-volume gastroenterology department where all endoscopy suites were equipped with an AIA device (GI Genius, Medtronic, Ireland) starting from July 1st 2021. Data was collected on all colonoscopies performed in the 11 months before the mentioned date and compared to a 15-month period afterwards. We excluded patients that performed colonoscopy due to evaluation of IBD severity, for known or suspected malignancy, therapeutic endoscopies, incomplete colonoscopies and colonoscopies with inadequate preparation. The primary outcome of the study was ADR.

Results
Our study included 996 colonoscopies (237 pre-AIAC, 759 AIAC). The groups were similar in age (median 43.8 years, interquartile ratio (IQR) 28.7-61.2 vs 44.5 years, IQR 30.7-59.1, p=0.76) and gender distribution (55.3% vs 54.3% males, p=0.82). In both groups, there were more Crohn’s disease (62.9% pre-AIAC, 57.2% AIAC, p=0.13) than ulcerative colitis patients. The ADR in the pre-AIAC group tended to be higher in comparison to AIAC (6.3% vs 4%, p=0.15); When limiting to experienced gastroenterologists only (≥ 5 years), ADR results were significant higher in the pre-AIAC group (7.6% vs 3.8%, p=0.035). In addition, total procedure time (considered the time from procedure start and end as recorded by the endoscopy nurse) was significantly shorter in the AIAC group (21 minutes, IQR 17-28 vs 25 minutes, IQR 19-37, p&lt;0.0001).

Conclusion
In a large-volume tertiary center cohort, the introduction of AIAC to real-world colonoscopies did not improve ADR in patients with IBD, questioning the integration of AIAC in routine practice.
P275 Anastomotic technique drives endoscopic recurrence in Postoperative Crohn's Disease: a systematic review and meta-analysis
Authors: Nardone O M , Luglio G , Calabrese G , Giglio M , Castiglione F , Ghosh S , Iacucci M 
Published: January 2023

Abstract

Background
Patients with Crohn's disease (CD) after Ileo-colic resection may develop an endoscopic postoperative recurrence (ePOR) that reaches approximately 70% of incidence within six months. ECCO guidelines favour a stapled side-to-side anastomosis. However, the advent of the Kono-S ileocolic anastomosis, a hand-sewn antimesenteric functional end-to-end anastomosis, seems to reduce clinical risk and ePOR. Whilst the majority of the studies have assessed the rate of ePOR individually, currently there is limited data comparing surgical techniques of the anastomosis. Hence, we aimed to assess the impact of different surgical techniques on ePOR in CD

Methods
We searched PubMed and Embase in October 2022 for eligible studies reporting the surgical types of anastomosis and, based on these, the rate of endoscopic recurrence at a minimum of six months. Studies were grouped by conventional anastomosis vs Kono, and comparisons were made between these groups. Pooled incidence rates of ePOR were computed using random-effect modelling. Meta-regression and subgroup analyses were performed to examine the impact of the type of anastomosis on the incidence of ePOR ≥ 6 months

Results
Thirteen studies, including 1816 patients who underwent ileocolic resection for CD, were included. Among these patients, 282 (15.5%) received a Kono-S anastomosis, while 1534 (84.4%) had a conventional anastomosis. ePOR at ≥≥ six months showed a pooled incidence of 31.8% (95% CI, 24.8 to 39.2), with significant heterogeneity among the studies (p&lt;0.01). Meta-regression analysis showed that Kono-S anastomosis was associated with a significant reduction in the ePOR at endoscopic follow-up (p=0.001). In detail, patients receiving a Kono-S anastomosis had a pooled incidence of ePOR of 12% (95% CI, 3.1 to 24.9), while patients receiving a conventional anastomosis had an ePOR of 38.2 (95% CI, 30 to 46.9%) [Figure1].

Funnel plot asymmetry [Figure 2] and Egger's regression test (p=0.118) indicated the absence of a publication bias

Conclusion
Kono-S anastomosis was associated with a significant reduction of ePOR at ≥ six months compared to the conventional anastomosis. Our findings highlight the need to standardize and implement the use of Kono-S anastomosis, particularly for difficult-to-treat patients with high risk for a post-operative recurrence
P278 Endoscopic scoring system utilization for Inflammatory Bowel Disease activity assessment: a multicenter real-world evidence study from Argentina (DARE study)
Authors: Lasa J , Martínez S , Smolarczuk A , Navar S , Espinosa F , Pereyra L , Rainero G , Meligrana N , Marturano V , Steinberg L , Reyes K , Giraudo F , Garbi L , Gullino L , Yantorno M , Correa G , Ponce C , Orellana D , Galvarini M , Caruso E , Olivera P 
Published: January 2023

Abstract

Background
The use of scores for the assessment of endoscopic activity in inflammatory bowel disease (IBD) patients is crucial for accurate and reproducible evaluation of mucosal healing, which is a relevant marker of prognosis. Frequency and patterns of their use in a real-life setting are not known. We aimed to describe the prevalence of adequate use of endoscopic scores in IBD patients who underwent colonoscopy in a real-life setting.

Methods
A multicenter observational study comprising six community hospitals in Argentina was undertaken. Patients with a diagnosis of Crohn’s disease or ulcerative colitis who underwent colonoscopy for endoscopic activity assessment between July 2018 and July 2022 were included. Colonoscopy reports of included subjects were manually reviewed to determine the proportion of colonoscopies that included an endoscopic score report. We compared the endoscopic findings to determine if there were differences in the score reported and the inflammatory activity described. Finally, we determined the proportion of colonoscopy reports that included all of the IBD colonoscopy report quality elements proposed by BRIDGe group. Endoscopist’s specialty, years of experience as well as expertise in IBD were assessed. Chi square test was used for the comparison of categorical variables; Student t test for the comparison of numerical variables. A multivariate analysis was performed using a logistic regression model. A p value of less than 0.05 was considered to be statistically significant.

Results
A total of 1206 patients were included for analysis (32.25% patients with Crohn’s disease). Mean age was 45.48±15.6. Endoscopic score reporting was found in only 34.45% of Crohn’s disease colonoscopies and in 52.87% of ulcerative colitis colonoscopies. Most frequently used scores were Mayo endoscopic score (90.56%) and SES-CD (56.03%).
We found discrepancies between the score reported and the findings described in colonoscopies in 10.92% of cases; only 26% of reports included all recommendations proposed by BRIDGe group. On multivariate analysis, surgeons as operators [OR 0.08 (0.03-0.18)], &gt;15 years of endoscopist experience [OR 0.24 (0.07-0.37)], IBD expertise [OR 2.86 (1.86-4.41)] and compliance of quality elements of reporting [OR 2.48 (1.24-3.76)] were significantly associated with endoscopic score reporting.

Conclusion
We identified a low prevalence of endoscopic activity score reporting in IBD patients’ colonoscopies. This finding is associated with operator-dependent characteristics. Educational interventions can be introduced to increase adequate score reporting.
P281 Conversion of the ileal pouch-anal anastomosis to a continent ileostomy – outcome and patient satisfaction
Authors: Hermanson M , Bengtson J , Block M 
Published: January 2023

Abstract

Background
This is a description of consecutive patients converted from ileal pouch-anal anastomosis (IPAA) to continent ileostomy (CI) at a tertiary centre, outcome after surgery and patient satisfaction after long time follow-up.

Methods
All consecutive patients operated with IPAA which later was converted to a CI at Sahlgrenska University Hospital, Gothenburg, Sweden, were included in the study. Demographic data was registered and a questionnaire regarding quality of life was sent to included patients.

Results
A total of 28 patients were included during the period of 1985-2022. The most common diagnosis was Ulcerative Colitis (UC) (n=23), other diagnoses included Crohn′s disease (n=2) and Familial Adenomatous Polyposis (n=1) (missing data n=2). IPAA was performed at a mean age of 30 (15-49) years and IPAA converted to CI at a mean age of 39 (22-62) years. At follow-up, three of the patients were diseased, not related to conversion surgery, and one had moved abroad. All of the remaining 24 patients completed the questionnaire. 20/28 (71%) patients still had their CI in function. 17/28 (61%) were converted due to fistula problems and the rest due to functional problems. 20/28 (71%) were converted using their IPAA-pouch and 4/28 (14%) had a new-constructed reservoir (missing data n=4). Totally, 18/20 (90% p&lt;0.001) were satisfied with the CI and 19/20 (95% p&lt;0.001) would choose it again if they were facing the same situation, even if most of the patients needed revision of the reservoir (mean 2 (0-5) surgeries). Four patients required excision of the CI. All excised patients had UC and was converted using their original IPAA. The main reason for conversion in the excised group was fistula with the inner meatus in the IPAA (three woman with anovaginal fistula and one man with perianal fistula).

Conclusion
A CI is an alternative that patients seem to be satisfied with, even after long follow-up time, when IPAA is no longer a suitable alternative. The majority of the patients in this study were converted from IPAA to CI using their IPAA-pouch.
P282 Isolated colonic Crohn’s disease and extensive ulcerative colitis: is there a reel difference?
Authors: Ben Safta N , Ben Mustpha N , Khemiri W , Serghini M , Laabidi S , Fekih M , Labidi A , Boubaker J 
Published: January 2023

Abstract

Background
The management of isolated colonic Crohn's disease (CDc) is often modeled on that of Ulcerative Colitis (UCc).
The aim of our study was to compare epidemiological and evolutive profiles of CDc and UCc.

Methods
We conducted a retrospective, descriptive and comparative study, including patients diagnosed with CDc as well as UCc, who were hospitalized in our department over a 9-year period [January 2011 - January 2020]. The group 1 included patients with CDc and group 2 included patients with UCc. Patients with less than 2 years of follow-up were excluded. Data were recorded and analyzed by SPSS software version 26.

Results
We included 130 patients with a sex ratio M/F= 0.68. The mean age at diagnosis was 34.85 years [6-68 years]. Sixty-three patients had CDc, while 67 patients had UCc. The two groups were comparable for age (p=0.56) and sex (p=0.54). The percentage of patients with smoking and alcoholism was also comparable between the two groups (p=0.4 and p=0.8 respectively). The presence of at least one autoimmune disease and a family history of Inflammatory Bowel Disease were more noted in patients in group 1 than in group 2 (p= 0.011 and p=0.046 respectively). The mean BMI at diagnosis was 22.28 kg/m² and was comparable between the 2 groups. The main phenotype was inflammatory (93.6%) in group 1. Twenty-five patients in group 1 (39.6%) and 22 patients (32.8%) in group 2 had associated extra-intestinal involvement (p=0.41), represented mainly by rheumatological involvement (n=39, 30%). The mean albumin level at diagnosis was 29.21 g/L and 30.96 g/L in groups 1 and 2 respectively. The occurrence of Severe Acute Colitis during follow-up was more frequent in group 2 than in group 1 (58.2% vs. 46%), although the difference was not significant (p=0.13). However, the rate of colectomy was significantly higher in group 2 (p=0.029). The use of anti-TNF therapy was significantly higher in group 1 (p=0.046). The maximum duration of hospitalization and the number of relapses were not statistically different between the 2 groups (p=0.81 and p=0.8 respectively). Finally, there was no significant difference between the 2 groups considering the use of corticosteroid or immunosuppressive therapy (p=0.88 and p=0.96 respectively). The main limit of our study is that it was conducted only in hospitalized patients who had relatively severe disease.

Conclusion
CDc is more prone to intensive medical treatment, whereas colectomy is more noted in UCc.
P286 Combined F18-FDG-PET-MRI-imaging: A promising tool for diagnostics of small bowel Crohn’s disease
Authors: Mattila J , Virtanen J , Nuutila P , Koffert J ,   CD-PET
Published: January 2023

Abstract

Background
Diagnostics of small bowel Crohn’s disease (CD) may be difficult. Combined PET-MRI has been documented to be a reliable tool for evaluating intestinal metabolism, but clinical use has been limited due to accessibility, costs and lack of standardized methods to quantify inflammation. Our study aims to prove that combined PET-MRI can be used to detect active CD inflammation in small bowel.

Methods
25 patients with suspected ileal CD in ileocolonoscopy were recruited from Turku University Hospital’s outpatient clinic. The patients’ endoscopic findings in ileum were graded according to SES-CD- score (Simple Endoscopic Score for Crohn’s disease). A static PET-MRI was obtained with [18F]-FDG (fluorodeoxyglucose) tracer and gadolinium contrast agent (Dotarem®). Hemoglobin (Hb), C-reactive protein (CRP), serum albumin (Alb) and fecal calprotectin (FC) were measured. After PET-MRI, a small bowel capsule endoscopy was done and the findings graded along the CECDAI-system (Capsule Endoscopy Crohn’s disease Activity Index). The patient’s symptoms were scored with a validated questionnaire. Medication data was also collected. The MR images with a small bowel protocol and diffusion weighted imaging (DWI) were analyzed and the degree of inflammation graded on a visual scale of 1-4, from none to severe by an experienced abdominal radiologist. SUVmax (standardized uptake value) was measured from PET-sequences for each patient from terminal ileum.

Results
Twenty (80%) of the patients diagnosed with small bowel CD had mean SUVmax 3.40 (±1.54), while the 20% without CD diagnosis had lower SUVmax 2.15 (± 0.93) (p=0.047). Patients who were later treated with immunomodulators or biologics had higher SUVmax than patients who didn’t need medication or were treated with oral budesonide only (3.71 (±1.49) vs 2.07 (±0.82), p=0.0093). There was a correlation with SUVmax and visual MRI grading, CECDAI-score, ileal SES-CD-score and FC (r=0.406, p=0.049; r=0.504, p=0.056; r=0.419, p=0.042 and r=0.49, p=0.014 respectively). SUVmax correlated negatively with Alb (r=0.599, p=0.0025) but not with Hb, CRP or the symptom score of the patients.

Conclusion
In this study we have shown that SUVmax measured from terminal ileum in combined PET-MRI could be used for prediction of patients CD progression. SUVmax also correlated with SES-CD-score, fecal calprotectin and serum albumin. These findings suggest that combined PET-MRI can be used in the future in diagnostics of small bowel CD. Further analyses are needed to define threshold values for small intestine CD.
P304 Leucine-rich alpha 2 glycoprotein reduces the necessity for endoscopic examination for activity evaluation
Authors: Hayashi Hayasix@0917 T , Takatori H , Yamashita T 
Published: January 2023

Abstract

Background
Leucine-rich alpha 2 glycoprotein (LRG) reflects mucosal healing in ulcerative colitis (UC) and is useful for assessing mucosal healing. In this study, we hypothesized that endoscopy for activity evaluation may be unnecessary depending on LRG levels, and investigated the relationship between LRG and endoscopic findings.

Methods
Patients who underwent endoscopy for UC from April 2021 to August 2022, when LRG measurement became available, and whose LRG was measured within a month, were included in the study. The relationship between Mayo endoscopic subscore (MES) and LRG was evaluated and symptoms were also reviewed to examine these relationships. Endoscopic remission was defined as MES 1 or less.

Results
The mean (range) LRG values per MES and the percentage of patients with a cutoff value of less than 16 μg/mL were MES 0 (n=86): 11.3±2.8 (6.0-24.2) μg/mL, 96.5%; MES 1 (n=56): 13.3±6.0 (7.7-43.8) μg/mL, 79.2%; MES 2(n=53): 21.7±11.5(8.1~65.1) μg/mL, 34.0%, MES 3(n=19): 26.4±9.3(12.3~42.9) μg/mL, 25.0%, and AUC 0.856 in ROC analysis, higher than other markers (CRP, Alb, WBC) LRG Even below the cutoff value, 15.0% (22/147) were in endoscopic non-remission. Even when patients have neither diarrhea 3 or more times a day nor bloody stool, 7.4% (9/122) were still in endoscopic non-remission. However, there were no cases in endoscopic non-remission when the LRG was below the cutoff value and there were no such symptoms. In multivariate analysis using binomial logistic regression analysis, LRG (p=0.028) was an independent predictor of endoscopic remission, in addition to diarrhea (p=0.003) and bloody stool (p&lt;0.001).

Conclusion
LRG was a useful tool for predicting endoscopic activity in ulcerative colitis, but LRG alone could not exclude non-remitting cases. However, LRG was considered to be an independent predictor of endoscopic remission, and all patients who had less than the LRG cutoff value and no diarrhea or bloody stool more than 3 times a day showed endoscopic remission, suggesting that endoscopy for activity evaluation may be unnecessary in such cases.
P311 Reliability of computed tomography enterography for evaluation of stricturing Crohn’s disease: Development of a Crohn’s disease stricture index
Authors: Rieder F , Ma C , Hanzel J , Fletcher J G , Baker M , Wang Z , Guizetti L , Patel M , Niu J , Shackelton L , Ottichilo R , Santillan C , Capozzi N , Taylor S A , Zhou G , Bruining D , Feagan B , Jairath V , Rimola J 
Published: January 2023

Abstract

Background
Computed tomography enterography (CTE) is frequently used to assess stricturing Crohn’s disease (CD). However, the reliability of CTE items used for assessment has not been established and there is no validated radiologic stricture severity index.

Methods
We conducted a retrospective study of 43 patients with symptomatic, terminal ileal stricturing CD. Four radiologists assessed a comprehensive list of pre-defined radiologic items potentially associated with stricture severity in 48 CTE scans in two separate rounds in random order. Reliability was quantified using the intraclass correlation coefficient (ICC). Items with at least moderate (ICC≥0.41) inter-rater reliability that were correlated with a visual analogue scale of overall stricture severity were candidate items for the development of a CTE stricture index.

Results
Inter-rater reliability was almost perfect for assessment of luminal diameter of pre-stenotic dilation (ICC 0.817 [95% confidence interval 0.703, 0.878]), substantial for stricture length (ICC 0.628 [0.419, 0.797]), and moderate for stricture wall thickness (0.482 [0.330, 0.601]). Intra-rater reliability was almost perfect (ICC ≥ 0.850) for all three items. A stricture severity index was derived and was well calibrated (optimism-adjusted calibration slope = 1.009), with scores calculated as the sum of stricture length (cm) + luminal diameter of pre-stenotic dilation (mm) + 5 x stricture wall thickness (mm).

Conclusion
Stricture length, prestenotic dilation, and stricture wall thickness can be reliably assessed, and are component items for a novel CTE stricture index (CTE-SI) of stricture severity for CD-related terminal ileal strictures. Additional external index validation for clinical and research contexts is required.
P314 Microscopic appendicitis in ulcerative colitis: Feasibility of ultrasonographic diagnosis
Authors: Reijntjes M , Pruijt M , Visser E , de Voogd F , d'Haens G R , Mookhoek A , Gecse K B , Buskens C J , Bemelman W A 
Published: January 2023

Abstract

Background
Increasing evidence suggests appendectomy as potential alternative treatment in patients with ulcerative colitis (UC), especially in those with histological appendiceal inflammation (AI). Intestinal ultrasound (IUS) is a non-invasive diagnostic modality that detects differences in the appendix between UC patients and healthy controls1. This study aimed to correlate appendiceal IUS and endoscopic findings to histopathological inflammation in resection specimens of UC patients undergoing appendectomy.

Methods
In this prospective cohort study, appendiceal IUS was performed in UC patients undergoing endoscopy and subsequent appendectomy between 2020 and 2022 in a trial for UC (NCT03912714). Primary outcome was the correlation between an increased maximal cross-sectional diameter (MCD, ≥ 6 mm) and AI in patients with a visible appendix on IUS. Presence of AI was assessed in pathology reports. Patients with fibrosis (F) were excluded from IUS analyses. Secondary outcomes included bowel wall thickness (BWT) on IUS and presence of endoscopic peri-appendiceal red patch (PARP) before appendectomy.

Results
In total, 32 UC patients who underwent laparoscopic appendectomy in study setting were included (84% female, median age 40 [IQR 27-50] years). The majority of patients demonstrated left sided disease (38%) and a mayo score ≥ 2 (88%) on baseline endoscopy. A median window between ultrasound and appendectomy of 1.2 (0.1-2.1) months was found. A total of eighteen (56%) patients were demonstrated to have AI in the resection specimen, and five (16%) patients demonstrated F. The appendix was visualised on IUS in 25 (78%) UC patients, with no difference in patients with AI (AI: 78%, no AI: 78%, p= 1.0). The overall median MCD and BWT were 5.6 [IQR 4.4-6.6] and 2.2 [1.6-2.5] mm, respectively. Patients with AI demonstrated a numerically higher median MCD (AI: [6.0 [4.2-6.8], no AI: 4.9 [4.4-5.8] mm, p= 0.3). Patients with an increased MCD were more likely to demonstrate pathologic AI, although not significant (OR: 6.0, CI 95%: 0.6-63.7, p=0.1). A minority of patients with AI demonstrated to have an endoscopic PARP: 5/18 (28%). The median MCD of patients with PARP was numerically higher (PARP: 6.0 [IQR 4.4-7.8] vs no PARP: 5.5 [4.0-6.6], p=0.5).

Conclusion
IUS is a feasible modality for assessment of the appendix. Although significance was not reached, patients with an increased MCD were more likely to demonstrate AI.
1Reijntjes MA, de Voogd FAE, et al. Intestinal ultrasound detects an increased diameter and submucosal layer thickness in the appendix of patients with ulcerative colitis compared to healthy controls - a prospective cohort study. Aliment Pharmacol Ther. 2022 Nov 1.