bluuebunny/crossref_metadata_2025_split huggingface dataset:
A125 TANDEM STUDY DESIGN IS LESS LIKELY TO DEMONSTRATE IMPROVED ADENOMA DETECTION RATE THAN PARALLEL STUDY DESIGN IN THE ASSESSMENT OF ARTIFICIAL INTELLIGENCE-ASSISTED COLONOSCOPY
Authors: Lee M C , Jeyalingam T , Parker C H , Liu L W 
Published: March 2023

Abstract

Background
Randomized controlled trials have reported that artificial intelligence (AI) improves adenoma detection rate (ADR). Different methodologies, namely parallel and tandem study designs, have been employed to evaluate the efficacy of AI-assisted colonoscopy in randomized controlled trials. In systematic reviews and meta-analyses, a pooled effect that includes both study designs have been reported. However, it is unclear whether there are inconsistencies in the reported results of these two designs.

Purpose
To determine if there are differences in ADR using AI-aided technologies during colonoscopy between parallel and tandem study designs

Method
A systematic search of Ovid MEDLINE (1946 to October 2022) and EMBASE (1947 to October 2022) for randomized controlled trials comparing AI-assisted colonoscopy with routine high-definition colonoscopy in polyp detection was conducted. Reference lists of systematic reviews were searched for additional studies. The publications were divided based on trial design: parallel vs. tandem. Analysis was conducted using Review Manager 5.4.1 using a random effects model.

Result(s)
The search identified 540 articles. After screening the title and abstract for relevance, 19 randomized controlled trials involving a total of 14 657 patients were included for full-text review. Fourteen were parallel studies (14 136 patients) and 5 were tandem studies (521 patients). ADR was reported in 17 studies, and there was overall improvement in ADR with AI-assisted colonoscopy (risk ratio [RR] 1.33, 95% CI 1.22-1.44; p&lt;.0001). Based on a separate pooled analyses of 13 parallel studies and 4 tandem studies, ADR significantly improved with AI assistance compared to routine colonoscopy, regardless of study design (RR 1.35, 95% CI 1.24-1.47 and p&lt;.0001; RR 1.15, 95% CI 1.03-1.28; p=0.02, respectively). A significant increase in ADR with AI assistance were found in 84.6% (11/13) of parallel design studies, but in only 25% (1/4) of tandem studies.

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Conclusion(s)
AI assistance during colonoscopy significantly increased ADR in both parallel and tandem studies; however, improvement in ADR was less likely to be seen in tandem compared to parallel studies. It remains unclear why this difference exists, but some hypotheses include smaller sample sizes in the tandem studies, significant heterogeneity in the tandem design, and differences in operator bias depending on study design. Better understanding the differences in these study designs will inform future studies of new endoscopic technologies.

Disclosure of Interest
None Declared
A128 GLOBAL TRENDS IN TRAINING AND CREDENTIALING GUIDELINES FOR GASTROINTESTINAL (GI) ENDOSCOPY: A SYSTEMATIC REVIEW
Authors: Sabrie N , Seleq S , Homsi H , Khan R , Gimpaya N , Bansal R , Scaffidi M , Lightfoot D , Grover S 
Published: March 2023

Abstract

Background
Credentialing in GI endoscopy is not a universally standardized process. National guidelines may provide a framework for local training, however in certain settings, training committees set minimal competency requirements that must be met before a clinician can be accredited to practice independently. There is a paucity of literature assessing the inter-societal and geographic variability in guidelines and training requirements in endoscopy.

Purpose
To systematically review the available credentialing guidelines proposed by different GI endoscopy societies and affiliated training committees internationally.

Method
We conducted a systematic review according to the PRISMA guidelines. A comprehensive literature search was performed for credentialing guidelines for GI endoscopy from inception until January 2022. Two reviewers screened and one reviewer abstracted data using a pre-defined data collection form.

Result(s)
From the 653 records obtained from our search, 20 credentialing guidelines from 12 different GI societies were ultimately included in the review. These guidelines encompassed the following procedures and outlined the following key-performance indicators; a) Colonoscopy: the recommended minimum number of procedures performed ranged from 150-275 with a minimum cecal intubation and adenoma detection rate of 85-90% and 20-30% respectively; b) EGD: the minimum number of procedures prior to credentialing ranged from 130-1000, the minimum duodenal intubation rate ranged from 95-100%, and the range for minimum number of upper GI bleeds managed was 20-45 (in addition to other procedural KPIs); c) ERCP: the recommended minimum number of procedures prior to credentialing ranged from 100-300 cases with a minimum selective duct cannulation rate of 80-90%. Guidelines for flexible sigmoidoscopy, EUS and capsule endoscopy were also obtained.

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Conclusion(s)
There is a general concordance amongst the various international GI societies with regards to minimum procedural volume and performance in key procedural tasks prior to credentialing, however the use of validated education assessment tools was lacking in the majority of guidelines. Additional KPI’s need to be explored for less routinely performed procedures such as EUS and capsule endoscopy.

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None

Disclosure of Interest
None Declared
A197 INVESTIGATING THE PROTON-PUMP INHIBITOR USE PRECEDING AND POST AN INFLAMMATORY BOWEL DISEASE DIAGNOSIS
Authors: Singh N , Nugent Z , Singh H , Shaffer S , Bernstein C 
Published: March 2023

Abstract

Background
Proton-pump inhibitors (PPI) have an impact on gut microbiome. The use of PPI has increased since the late 1980s and between 2007-2017, there were nearly 59 million PPIs dispensed annually in France.1 Considering that inflammatory bowel disease (IBD) affects persons of all races, a disease trigger for IBD may be a factor that can directly alter the intestinal immune response, or indirectly through changes in the gut microbiome. This raises the possibility that the advent use of PPI may be associated with the worldwide rise in IBD.

Purpose
We investigated whether increased use of PPI was associated with a diagnosis of IBD.

Method
The University of Manitoba IBD Epidemiology Database includes all Manitobans diagnosed with IBD between 1984 to 2018 with age, sex and geography-matched controls and comprehensive prescription drug data from April 1995. Subjects were considered to be users if they received 2 prescriptions of PPI. We assessed PPI prescriptions pre-diagnosis and for 3-years post-diagnosis of IBD. The absolute and relative rates were calculated and compared for PPI use pre- and post-IBD diagnosis.

Result(s)
A retrospective analysis was completed by analyzing 5920 subjects that were diagnosed with IBD after April 1996. Rates of PPI use in controls increased gradually from 1.5 to 6.5% over 15-years. Persons with IBD have a higher rate of PPI use peaking up to 17% within 1-year of IBD diagnosis with a rate ratio (RR) of 3.1 [95% CI 2.9 – 3.3]. Furthermore, persons with Crohn’s disease (CD) [RR= 4.2; 95% CI 3.7 – 4.6] were more likely to have been PPI users pre-diagnosis than persons with ulcerative colitis [RR= 2.4; 95% CI 2.2 – 2.7]. Important predictors of increased PPI use were older age, year of data collection and CD diagnosis.

Conclusion(s)
This retrospective analysis showed an increase in PPI use over the past 20-years among all Manitobans. Persons with IBD have higher PPI use within 1-year of their IBD diagnosis. It is possible that persons with IBD have an increase in acid peptic diseases or alternatively, the use of a PPI alters the gut microbiome increasing the risk for IBD diagnosis, or that some IBD symptoms are treated with PPI whether warranted or not. Future studies are needed to delineate whether the indication for ongoing PPI use is appropriate.
References:
1Lassalle M, Le Tri T, Bardou M, et al. Use of proton pump inhibitors in adults in France: a nationwide drug utilization study. Eur J Clin Pharmacol. 2020;76(3):449-457.

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None

Disclosure of Interest
None Declared
A211 CAN AN EXPERIMENTAL MOUSE MODEL BE USED TO CHARACTERIZE BEHAVIOURAL COMORBIDITIES ASSOCIATED WITH INFLAMMATORY BOWEL DISEASES?
Authors: Josephson J , Barnett J , Chiang H , Gibson D 
Published: March 2023

Abstract

Background
Inflammatory Bowel Diseases (IBD) are increasing globally with westernized countries experiencing a dramatic increase in cases of ulcerative colitis and Crohn’s disease. The corresponding rise in the comorbidities of anxiety and depression are linked to inflammation and microbiome dysbiosis; impacting the gut-brain axis (GBA). Another facet of the GBA are the tryptophan metabolites serotonin (5HT) and kynurenine (Kyn). 5HT and Kyn are metabolites implicated in anxious behaviours and memory deficiencies with dysbiosis influencing metabolite production. In inflammatory conditions, upregulation of Kyn impacts brain homeostasis as Kyn has both positive and negative brain metabolites. As disease outcomes are tied to the severity of depression/anxiety, characterization of the behavioural and tryptophan metabolite profile of an IBD model can allow us to develop better IBD therapies.

Purpose
To characterize the anxiety and memory phenotype with corresponding assessment of tryptophan metabolites 5HT and Kyn across tissues of interest in an spontaneous colitis model.

Method
Mucin 2 knockout mice (Muc2-/-) lack the protective mucin 2 layer in the distal colon, allowing for direct contact between the gut contents and the gut epithelial layer. Over time this contact results in the development of spontaneous colitis. Muc2-/- n=12 per sex were compared to C57Bl/6 mice for behaviour and tryptophan metabolites across brain, colon and serum. Open Field Test and Light/Dark tests were used to assess anxiety levels, Novel Object and Radial Arm maze were performed to assess memory deficits. Mice underwent one anxiety and one memory test and were euthanized following their last maze. Enzyme-linked immunosorbent assay (ELISA) assessment of 5HT and Kyn were performed on brain, colon and serum samples. T-tests were performed and graphs created using PRISM (v9.4.1).

Result(s)
Muc2-/- mice had decreased anxiety (p=0.0113) compared to C57Bl/6 wild type mice in the light/dark maze. Muc2-/- displayed no significant differences in novel object preferences or the number of memory errors in novel object recognition test and radial arm maze respectively. Serum kynurenine was found to be significantly elevated (p=0.0444) in Muc2-/- mice. The sex factor has to be mentioned here in the results not in the conclusions.

Conclusion(s)
IBD is increasing globally and problems with mental health is often comorbid. Within our model we were able to show that behavioural and biochemical differences do exist between our Muc2-/-and wild-type mice with depressed anxiety responses and heightened serum kynurenine, however the implications of these findings require further investigation. Understanding how inflammation is driving behavioural alterations can provide pathways to ameliorate the behavioural comorbidities in IBD patients suffering from anxiety of memory deficits.

Disclosure of Interest
None Declared
A234 PARASITIC INFECTION MIMICKING CROHN'S DISEASE: AN UNUSUAL PRESENTATION OF LOWER GASTROINTESTINAL SCHISTOSOMIASIS
Authors: Vantomme E , Jin J 
Published: March 2023

Abstract

Background
Chronic intestinal schistosomiasis (CIS) is a disease caused in humans by infection with one of seven schistosome species. These species are predominantly found in Africa, South America, and East Asia. Symptoms of CIS include abdominal pain, anorexia, weight loss and diarrhea. In cases of large parasitic burden, overt gastrointestinal bleeding can occur. To our knowledge there are only three other cases of CIS mimicking Crohn's Disease that have been published in the literature. In each of these cases, this was associated with ileal disease, perianal fistulas, or both.

Purpose
We present the first case of CIS in North America that mimicked Crohn's Disease on imaging with no associated ileal or visible perianal disease.

Method
Case report of a patient presenting to a tertiary care hospital in Edmonton, Alberta.

Result(s)
A 47 year old man who recently immigrated from Eritrea presented to the emergency department in June 2020 with red blood per rectum. Digital rectum exam revealed small external hemorrhoids. He was discharged with a plan for outpatient abdominal CT scan and colonoscopy. He presented again to the emegency department in January 2021 where he complained of back pain exacerbated by bowel movements productive for small, hard stool. He also began seeing white discharge mixed with his stool. His back pain, white discharge, and blood-streaked bowel movements persisted for over a year, and he developed perianal pain that was exacerbated by valsalva. A CT scan of the abdomen/pelvis revealed extensive soft tissue swelling in the anorectal region, extraluminal gas, and a 15mm fluid collection adjacent to the coccyx. A diagnosis of fistulizing Crohn's Disease was suspected. A digital rectal exam and colonoscopy were performed September 19, 2022 which revealed small hemorrhoids but otherwise endoscopically normal colonic and ileal mucosa. Biopsies from the rectum revealed eosinophilic granulomas associated with parasitic ova; a diagnosis of schistosomiasis was made.

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Conclusion(s)
CIS is a rare diagnosis in North America. It is unusual for this disease entity to present is a mimic of fistulizing Crohn's Disease. This case report reminds the clinician that a high index of suspicion in patients presenting from endemic regions is required to make this diagnosis.

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None

Disclosure of Interest
None Declared
A236 ENDOSCOPIC MANAGEMENT OF RARE JEJUNAL SOLITARY PEUTZ-JEGHERS-TYPE POLYP IN AN ELDERLY PATIENT WITHOUT A POLYPOSIS SYNDROME: A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Alenezi T , Bessissow T , Marcus V 
Published: March 2023

Abstract

Background
Solitary Peutz-Jeghers-type polyp (SPJP) is a rare hamartomatous lesion. It is considered as a different entity from Peutz-Jeghers syndrome despite similar histopathological findings. It can be found in the GI tract but rarely in the jejunum. Jejunal SPJP are susceptible to necrosis, ulceration, and intussusception, resulting in GI bleeding or small bowel obstruction.

Purpose
We describe a case of subacute gastrointestinal bleeding secondary to jejunal SPJP to share our approach to this challenging case using therapeutic endoscopy

Method
An 81-year-old male patient with a history of atrial fibrillation on warfarin with stable therapeutic INR levels, who presented with 1-week history of melena, generalized fatigue and shortness of breath on exertion and was found to have profound iron deficiency anemia. Esophageal gastroduodenoscopy and colonoscopy failed to identify the source of bleeding; however, double balloon enteroscopy detected a 4 cm polyp with stalk in the proximal jejunum. Endoscopic polypectomy was performed and the whole polyp was removed. Histopathological examination was consistent with Peutz-Jeghers polyp. The oropharyngeal and skin examination was negative for mucocutaneous hyperpigmented macules and the genetic analysis was negative for STK11 mutation. Follow up magnetic resonance enterography and video capsule endoscopy did not reveal any other polypoid lesion in the GI tract. The patient’s symptoms resolved gradually, and his hemoglobin level returned back to normal levels within 6 months.

Result(s)
To our knowledge this is the first case of endoscopic polypectomy during balloon-assisted enteroscopy for jejunal SPJP.

Conclusion(s)
Conclusion
Solitary Peutz-Jeghers hamartomas are a rare occurrence but should be part of the differential diagnosis for abdominal pain from intussusception, or small bowel bleeding even in elderly patient. Balloon assisted enteroscopy is a valuable technique for the management of solitary small bowel lesions.

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None

Disclosure of Interest
None Declared
LIVER AND BILIARY DISEASE
A263 MODULATION OF THE GUT MICROBIOTA TO PREVENT LOCAL ANASTOMOTIC TUMORS AND DISTANT METASTASIS IN COLORECTAL CANCER SURGERY
Authors: Hajjar R , Ajayi A S , Oliero M , Fragoso G , Alaoui A A , Cuisiniere T , Gerkins C , Calvé A , Vennin Rendos H , Richard C , Santos M M 
Published: March 2023

Abstract

Background
Colorectal cancer (CRC) recurrence is a leading cause of mortality worldwide. It has been suggested that poor anastomotic healing and leakage (AL) after surgery allows cancer cells to implant at the anastomotic site thereby increasing the risk of local cancer recurrence and metastatic spread in the peritoneum and to extraintestinal organs. We have previously showed that inulin, a well-known prebiotic, improves anastomotic healing and strengthens the gut barrier.

Purpose
The objective of the this study was to investigate the relationship between the promotion of postoperative intestinal healing using inulin and local and distant cancer recurrence.

Method
A 10-years' retrospective review of AL and non-AL cases after CRC surgery was performed in our institution. The effect of dietary supplementation with inulin on the occurrence of local anastomotic tumors was assessed in a mouse model inoculated with tumor cells directly in the gut lumen after colonic surgery. We also investigated in mice whether inulin may prevent metastatic spread and growth of tumor cells in the liver by transplanting CRC cells surgically into the spleen.

Result(s)
Patients experiencing AL displayed significantly lower overall survival and more cancer recurrence and progression compared to non-AL patients. Poor anastomotic healing in mice led to larger anastomotic tumors and peritoneal cancer dissemination. Inulin supplementation significantly inhibited local tumor implantation at the anastomotic site, and metastatic spread to the peritoneum and liver. Inulin increased the production of beneficial short-chain fatty acids, reinforced the gut barrier function and alleviated systemic inflammation in mice.

Conclusion(s)
Anastomotic leak was associated with worse oncological outcomes in patients and mice. Inulin was shown to reinforce the gut barrier, decrease the implantation of cancer cells at the anastomosis, and to prevent tumor dissemination and progression of liver metastasis. This paves the way toward future clinical trials in which such supplementation may be used to promote better oncological outcomes.

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CIHR, Other

Please indicate your source of funding;
CRS, FRQS

Disclosure of Interest
None Declared
A278 SEX DIFFERENCES IN THE EFFECT OF THE MICROBIOTA FROM IRRITABLE BOWEL SYNDROME PATIENTS ON ABDOMINAL PAIN
Authors: Bennett A , Baker C , Guzman-Rodriguez M , Jimenez-Vargas N , Vanner S , Reed D , Lomax A 
Published: March 2023

Abstract

Background
Irritable bowel syndrome (IBS) is a chronic abdominal pain disorder that affects women twice as often as men. The gut microbiota has been implicated as a key player in the modulation of abdominal pain in IBS. Given this, we hypothesised that the production of pro-nociceptive mediators within the gut lumen are increased in females, and this contributes to the female predominance of IBS.

Purpose
Compare the effects of FS from male and female IBS patients on abdominal pain pathways and identify the impact of female mouse estrous cycle on abdominal pain.

Method
Fecal supernatants (FS) were perfused through murine colonic preparations while performing extracellular colonic afferent nerve recordings to measure changes in action potential frequency in response to colonic distension. Phase of estrous cycle in female mice was determined through vaginal swabs. FS from male and female IBS patients reporting low, moderate, and high levels of abdominal pain were used.

Result(s)
FS from female IBS patients (N=6) increased afferent nerve discharge (p &lt; 0.05) whereas FS from male IBS patients has no effect (N=4). However, single unit analysis of nociceptive axons revealed that male IBS FS increased nociceptor activity in female mice taken during the proestrus/estrus stage (p &lt; 0.05), but not female mice taken during the metestrus/diestrus stage or male mice. Further investigation found that IBS FS from female patients with high abdominal pain (N=6), but not patients with moderate (N=5) or low pain (N=3), increased visceral afferent nerve discharge by 70%. Single unit analysis of nociceptive axons showed that their activation was increased by almost 50% following FS perfusion from high abdominal pain patients only (p &lt; 0.05). Histamine concentrations and proteolytic activity are increased in FS from female IBS patients with high abdominal pain compared to male IBS patients.

Conclusion(s)
This work suggests that luminal mediators that impact abdominal pain are increased in female IBS patients compared to male IBS patients, and females appear to be more sensitive to their pro-nociceptive effects. Together, these sex differences may contribute to the female predominance of IBS.

Disclosure of Interest
None Declared