bluuebunny/crossref_metadata_2025_split huggingface dataset:
A124 PERORAL ENDOSCOPIC MYOTOMY IS THE PREFERRED TREATMENT FOR PATIENTS WITH SYMPTOMATIC ZENKER’S DIVERTICULUM
Authors: Hasan M , Buduhan G , Liu R , Tan L , Srinathan S , Kidane B 
Published: March 2023

Abstract

Background
Zenker’s diverticulum (ZD) is a mucosal herniation at the pharyngoesophageal junction presenting with dysphagia, regurgitation and aspiration. While open surgical myotomy (OSM) is the conventional treatment option, select patients can undergo myotomy using endoscopic techniques.

Purpose
Evidence on third-space flexible endoscopy with myotomy is lacking, especially in North America. We aimed to assess the safety and efficacy of peroral endoscopic myotomy (POEM) for symptomatic ZD.

Method
Retrospective cohort study was performed of consecutive patients undergoing OSM and POEM completed in a tertiary hospital from 2010-2020. Only patients with accessible electronic medical records and at least 3 months of follow-up were included in this study. Data collected included: demographics, comorbidities, ZD characteristics, clinical and patient-reported outcomes.

Result(s)
14 patients underwent OSM and 18 patients underwent POEM. 10 of the patients undergoing POEM were considered for but were not able to get stapled endoscopic myotomy, the most common reasons were related to the technical limitations (ZD size too small, unable to hyper-extend neck, unable to position suspension laryngoscope). There were no significant differences between groups in age (p=0.35), BMI (p=0.38), Charlson comorbidity index (p=0.26) and size of ZD (p=0.92). Length of stay was significantly lower for POEM (0.4 vs. 3.1, p&lt;0.01). Complications were more common and severe with OSM (36%, n=5) versus POEM (11%, n=2). The only complications post-POEM were contained esophageal perforations. Complications post-OSM included esophageal perforations requiring open cervical drainage, surgical site infections, recurrent laryngeal nerve injury/paresis, esophageal strictures requiring multiple dilatations. All patients undergoing POEM had 100% technical success with post-treatment barium esophagogram showing 100% resolution of obstruction/hang-up. The median follow-up time post-POEM was 11 months. Over the follow-up period there was a significant improvement of patient-reported outcomes, with a mean decrease of Eckardt score (4.7 to 1.1, p&lt;0.001) and mean increase of Dakkak-Watson score (20.7 to 41, p&lt;0.001). Only one patient had persistent ongoing symptoms of dysphagia post-POEM and was subsequently diagnosed with ineffective esophageal motility on high resolution manometry.

Conclusion(s)
POEM is a minimally invasive treatment option for ZD with high treatment success as well as reduced length of stay and complications. It is less invasive than OSM, more versatile than stapled endoscopic myotomy and is less prone to technical limitations.

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None

Disclosure of Interest
None Declared
A130 ENDOSCOPIC ULTRASOUND GUIDED THROMBIN INJECTION: A NOVEL TECHNIQUE IN THE MANAGEMENT OF RECURRENT UPPER GASTROINTESTINAL BLEEDING CAUSED BY GASTRODUODENAL ARTERY PSEUDOANEURYSMS
Authors: Chin Koon Siw K , Kundra A , Chatterjee A 
Published: March 2023

Abstract

Background
Gastroduodenal artery (GDA) aneurysm is a rare vascular condition that is potentially life-threatening. It is associated with significant morbidity and mortality and most often encountered in patients with chronic pancreatitis. Other etiologies including atherosclerosis, peptic ulcer disease, alcohol abuse, cholecystectomy and absence of celiac axis, have been reported. False and true GDA aneurysms account for about 1.5% of all visceral artery aneurysms however are associated with a risk of rupturing and hemorrhage up to 75%. Mainstay of GDA aneurysm management involves aneurysm repair with open surgery with vessel ligation or endovascular repair with coil embolization or stent placement, depending on the patient’s comorbidities and overall hemodynamic stability. The use of percutaneous thrombin injection via computed tomography (CT) and ultrasound has also been described in the literature and is being increasingly used to promote clot formation and pseudoaneurysm occlusion as a less invasive option.

Purpose
To present a case of endoscopic ultrasound guided thrombin injection as an effective and safe management strategy for GDA pseudoaneurysms.

Method
At this time, there are limited data in the literature on endoscopic ultrasound guided thrombin injection for pseudoaneurysms. To our knowledge, this is the first case report describing a patient with recurrent gastrointestinal bleeding from a duodenal ulcer, who had undergone multiple endoscopic and angiographic procedures, with subsequent development of a gastroduodenal pseudoaneurysm unrelated to pancreatitis which was successfully managed by occluding the pseudoaneurysm with thrombin injection under endoscopic ultrasound guidance. EUS guided thrombin injection is a viable alternative to traditional interventional radiology guided thrombin injection for management of pseudoaneurysms.

Result(s)
In clinic follow-up three weeks after thrombin injection, our patient continued to do clinically well, without abdominal pain or symptoms. Repeat CT angiogram demonstrated the GDA pseudoaneurysm had remained thrombosed, indicating successful endoscopic obliteration. He had no further signs of gastrointestinal bleeding.

Conclusion(s)
EUS guided thrombin injection is a novel approach that has been presented as an option in the management of bleeding gastroduodenal pseudoaneurysms, especially when radiology guided or surgical options are higher risk or have previously failed. The paucity of available data highlights the need for ongoing clinical studies comparing the different therapeutic strategies that can effectively and safely manage these rare but life-threatening vascular entities.

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None

Disclosure of Interest
None Declared
A139 ONE OF THESE THINGS IS NOT LIKE THE OTHER: A CURIOUS CASE OF DISCORDANT ENDOSCOPIC OPTICAL EVALUATION
Authors: Aboalfaraj N T , Shahidi N , Tomaszewski M , Jiang S , Xiong W 
Published: March 2023

Abstract

Background
Optical evaluation has become the cornerstone of early gastrointestinal neoplasia management as it informs therapeutic decisions between minimally invasive endoscopic resection techniques and surgery.

Purpose
We report an unusual case of a subepithelial gastric inlet patch (GIP) with optical evaluation mimicking early squamous neoplasia

Method
Case Presentation:
A 74-year-old male was referred for epigastric discomfort. On esophagogastroduodenoscopy, a 10-mm GIP was identified at 23cm from the incisors. Furthermore, a 15-mm polypoid lesion was identified at 25cm from the incisors on the contralateral wall. On optical evaluation, it was believed to be atypical but suspicious for squamous neoplasia (Figure 1). Histopathology of the lesion revealed a stratified squamous epithelium with an underlying focus on glandular mucosa. After a multidisciplinary team review, endoscopic submucosal dissection was performed, given the atypical optical characteristics of the lesion.

Result(s)
Histopathology of the lesion identified subepithelial gastric cardia-type mucosa with focal extension into the muscularis mucosae, most consistent with a subepithelial GIP. No neoplasia was identified.

Image

Conclusion(s)
We describe an unusual case of subepithelial GIP. With the widespread availability of high-definition endoscopes equipped with image-enhanced endoscopy, this case highlights the optical characteristics of this likely underappreciated endoscopic finding.

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None

Disclosure of Interest
None Declared
A151 OSEPHAGEAL VARICEAL RECURRENCE 4 YEARS BEYOND ENDOSCOPIC BAND LIGATION IN HEPATITIS C PATIENTS WHO ACHIEVED SUSTAINED VIROLOGICAL RESPONSE WITH ORAL DIRECT ACTING ANTIVIRAL THERAPIES
Authors: Abdel-Samiee M , Abdelsameea E , Badran A 
Published: March 2023

Abstract
NOT PUBLISHED AT AUTHOR’S REQUEST

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None

Disclosure of Interest
None Declared
GASTROINTESTINAL ONCOLOGY
A153 PYCRL LACTYLATION AS A POTENTIAL REGULATOR OF CANCER STEM CELL METABOLISM IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA (ESCC)
Authors: Douchin J , Nogueira de Almeida L G , Gonneaud A , Boisvert F -M , Dufour A , Giroux V 
Published: March 2023

Abstract

Background
Patients with esophageal malignancy have a 5-year survival rate of only 14% in Canada. This high mortality rate is due to three factors: late diagnosis, difficulty in surgically removing the tumor because of its localization, and treatment resistance. Resistance can be developed after prolonged exposure to anti-cancer drugs and/or radiation. Indeed 30% of patients will not respond to treatment or will relapse. Resistance has been mainly ascribed to the presence of cancer stem cells (CSCs) inside the tumor. However, no treatment specifically directed against CSCs is available to patients.

Purpose
Thus, targeting CSCs is a promising strategy to improve the survival of patients with esophageal squamous cell carcinoma (ESCC), the most common type of esophageal cancer worldwide. Therefore, a better understanding of the molecular mechanisms occurring during long-term exposure to cancer treatments is imperative.

Method
Herein, we developed an unbiased approach to identify new players in chemotherapy and radiotherapy resistance development in ESCC. We established radio- (R), chemo- (C), and radiochemo-resistant (RC) human ESCC cell lines using prolonged exposure to radiation and/or chemotherapeutic agent 5-FU, respectively.

Result(s)
The enrichment in CSCs in all treated cell lines was demonstrated by an increase of ALDH1high cells and CD24high/CD44high cells in flow cytometry. We then used a proteomic approach to identify new players in treatment resistance. Interestingly, pathway analysis pointed out to alterations in energy metabolism as well as amino acid metabolism. Seahorse assays showed that resistant cell lines have a lower respiration rate than control cells, while glycolysis remains unchanged. To further characterize these metabolic changes, we performed an unbiased metabolomic study and confirmed a decrease in amino acid levels such as proline, in resistant cell lines. Recently, metabolic regulation has been linked to a new post-translational modification, lactylation. Proteomic data were re-analyzed looking for lactylated protein and found, amongst others, PYCRL, an enzyme implicated in proline biosynthesis, as one of the most differentially lactylated proteins in treated cell lines compared to control. PYCRL lactylation was confirmed using immuno-fluorescence colocalization and immuno-precipitation. Lastly, using AlphaFold, preliminary results point toward the importance of PYCRL lactylation impairing PYCRL homomultimerization.

Conclusion(s)
To conclude, our results suggest an important role of proline metabolism following long-term treatment in ESCC. This study is a first step toward the identification of new targets to fight treatment resistance in ESCC patients.

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CAG, CIHR, Other

Please indicate your source of funding;
FRQ

Disclosure of Interest
None Declared
A163 INFECTION WITH HYMENOLEPIS DIMINUTA ELICITS A TH2 IMMUNITY AND ALLEVIATES DNBS-COLITIS IN A MOUSE MODEL WITH MINIMAL INTESTINAL MICROBIOTA
Authors: Li S , Wang A , McKay D M 
Published: March 2023

Abstract

Background
Immunocompetent mice infected with the rat tapeworm Hymenolepis diminuta are protected from dinitrobenzene sulphonic-acid (DNBS)-induced colitis that was accompanied by the increased relative abundance of short-chain fatty acid (SCFA)-producing bacteria and fecal SCFA levels at 8 days post-infection (dpi). These changes were not observed in antibiotic-treated BALB/c mice or germ-free mice. To further characterize the host-parasite-microbiota interaction in the control of colitis, experiments have been conducted in a reductionist system in which the H. diminuta anti-colitic response was tested in mice colonized with 12 commensal bacteria representing the major five phyla of the mouse gut.

Purpose
To identify key bacterial species and microbe-derived mediators involved in the H. diminuta-induced protection from DNBS-induced colitis.

Method
OligoMM12 (Oligo-Mouse-Microbiota) mice (n=4-8/group) were infected with 10 viable antibiotic-treated H. diminuta cysticercoids eight days prior to challenge with DNBS (3mg, i.r.). Mice were monitored daily and necropsied 72h post-DNBS. Disease was assessed by a macroscopic disease activity score, colon length and histopathology on H&E sections of mid-colon. Production of IL-4, -5, -10 and -13 by concanavalin-A treated spleen cells by ELISA was used as an index of successful helminth infection.

Result(s)
OligoMM12 mice treated with DNBS developed acute colitis, with 3/8 mice requiring humane euthanization, while all mice infected with H. diminuta survived the DNBS challenge. Successful infection was confirmed by statistically significant increases in splenic output of the Th2-cytokines in response to mitogenic stimulation and efficient expulsion of the worms burden by 11 dpi. The severity of DNBS-induced colitis was reduced in H. diminuta-infected mice (n=4), although additional experiments are required to confirm the statistical significance of these data.

Conclusion(s)
Reproducible DNBS-induced colitis in mice with the simplified OligoMM12 consortium of bacteria and reduced disease in H. diminuta-infected mice has created a model by which the participation of exact bacterial groups or species in H. diminuta-induced suppression of colitis can be tested. This is of translational value, since the failure of helminth therapy in IBD could be predicated by dysbiosis in the patient, and therefore potentially overcome by combination therapy of ‘probiotic’ and helminth.

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CIHR, Other

Please indicate your source of funding;
NSERC-CGS D, Eyes High doctoral Recruitment Scholarship

Disclosure of Interest
None Declared
A171 INTESTINAL INTERFERON-LAMBDA RECEPTOR 1 EXPRESSION AND RESPONSES ARE SIGNIFICANTLY DECREASED IN PEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS
Authors: Ogungbola O , Mahmood R , Bittorf K , Nguyen N , El-Matary W , Wine E , Tyrrell L , Armstrong H , Santer D 
Published: March 2023

Abstract

Background
While interferon-lambdas (IFN-λs) were initially discovered for their role in antiviral immunity at mucosal barriers such as the lung and gut, there are many unanswered questions for how IFN-λs uniquely dampen inflammatory immune responses. In mouse colitis models, IFN-λs were shown to play a significant role in promoting epithelial barrier integrity and mucosal healing. Microbes present in the gut naturally induce IFN-λs, but how chronic inflammation, such as in patients with inflammatory bowel diseases (IBD), affects IFN-λ biology has not been well studied, especially in humans.

Purpose
Here, we tested the hypothesis that children with active, more severe IBD would present with lower intestinal IFN-λR levels and IFN-λ responses which could contribute to IBD pathology through exacerbated inflammation, decreased mucosal healing and impaired barrier function.

Method
We screened 14 novel antibodies to find the optimal clone that accurately stains the unique IFN-λ receptor subunit (IFN-λR1) protein in human intestinal tissue and IFN-λR1 levels were quantified by immunohistochemistry and flow cytometry in biopsy samples from children without IBD, Crohn’s disease, or ulcerative colitis (n=35 total). Fresh patient biopsies (ascending colon or terminal ileum) were also treated in media +/- IFN-λ for 24hrs using our novel ex vivo biopsy assay and changes in gene expression were quantified by RT-qPCR. Intestinal washes were also collected and microbes profiled by shotgun metagenomics.

Result(s)
We identified 2 new antibodies that accurately stained human cell lines and immune cells known to express IFN-λR1 protein (gut epithelial cells and B cells). We found that IFN-λ receptor (IFN-λR) levels are significantly reduced in gut epithelial and immune cells within pediatric IBD intestinal tissue, even at non-inflamed sites (p&lt;0.01, 30-50% reduction) and this was even more pronounced when comparing moderate/severe disease compared to children with no disease activity. This led to lower IFN-λ responsiveness in IBD compared to non-IBD biopsies when investigating IFN-stimulated gene expression (p&lt;0.05, up to 7-fold reduction). Paired patient gut microbe analyses identified specific species that correlated with changes in IFN-λ receptor expression.

Conclusion(s)
Together, our findings demonstrate pediatric IBD patients may be less able to induce critical IFN-λ-mediated antimicrobial responses and protective anti-inflammatory pathways. This work supports the goal to restore and promote IFN-λ responses as a novel therapeutic strategy for pediatric IBD.

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Other

Please indicate your source of funding;
Children's Hospital Research Institute of Manitoba

Disclosure of Interest
None Declared
A194 IMPACT OF SUPPRESSOR OF CYTOKINE SIGNALING 1 (SOCS1) EXPRESSION IN INTESTINAL EPITHELIAL CELLS ON THE GUT MICROBIOTA
Authors: Leon L M , Marrero Cofino G , Delannoy A , Placet M , Geha S , Verdú E F , Fortier L -C , Menendez A , Saucier C 
Published: March 2023

Abstract
NOT PUBLISHED AT AUTHOR’S REQUEST

Disclosure of Interest
None Declared
A208 REAL WORLD EVIDENCE ANALYSIS WITH ADALIMUMAB BIOSIMILAR, MSB 11022, REPORTED WITH PATIENT CARE PROGRAM
Authors: Cheung S , Heidari P , Truong D 
Published: March 2023

Abstract

Background
Injection site reactions (ISR), including injection site pain (ISP) are common adverse events reported with drugs administrated via subcutaneous injections. In clinical trials, the rates of ISR of adalimumab and adalimumab biosimilars range from 3% to 22.8% with citrate-buffer formulations, and from 1.7% to 16.6% with acetate-buffered and other formulations.

Purpose
The objective of this study is to evaluate ISR of adalimumab biosimilar, MSB 11022, in real world setting.

Method
Patients with immune mediated inflammatory diseases (IMIDs) enrolled with patient care program (PSP), and received at least one dose of adalimumab biosimilar, MSB 11022, were followed up. Incidences of injection site reactions, including injection site pain, burning sensation, bruise, erythema, hemorrhage, pruritus, and/or swelling were documented through unsolicited and solicited (outgoing following up calls with patients after their first injection through PSP contacts) reports. The data were collected between April 2021 and July 2022, and the rates of ISRs were assessed.

Result(s)
There were 2812 patients that met criteria through data collection period, with 219 cases of ISR. More than 99% of case reports were through solicited contacts, i.e., through case-manager follow up calls. Overall, rate of injection site reaction is 7.8% in patients with IMIDs treated with adalimumab biosimilar, MSB 11022. The rates of ISRs reported by disease are as follows: 6.8% of patients with Crohn's disease, 8.7% with ulcerative colitis, 8.8% with rheumatoid arthritis, 6.5% with psoriatic arthritis, 7.8% ankylosing spondylitis, 6.1% uveitis, 8.3% with hidradenitis suppurativa, and 11.1% of juvenile rheumatoid arthritis.

Conclusion(s)
Real world data provided evidence that ISR rate of adalimumab biosimilar, MSB 11022, is within the ranges of clinical trial data of adalimumab with citrate-buffer, and other formulations. As far as we know, this is the first real world evidence reported for ISR among adalimumab biosimilars with IMID patients.

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None

Disclosure of Interest
None Declared
A232 RISK OF TOTAL METACHRONOUS ADVANCED NEOPLASIA AT SURVEILLANCE COLONOSCOPY AFTER DETECTION OF SERRATED LESIONS: A MATCHED COHORT STUDY
Authors: Djinbachian R , Lafontaine M -L , Anderson J C , Pohl H , Dufault T , Boivin M , Bouin M , von Renteln D 
Published: March 2023

Abstract

Background
Serrated lesions (SLs), including sessile serrated lesions (SSL) and traditional serrated adenomas (TSA) have become subject of increased interest for their role as CRC precursors.

Purpose
Study aim was to evaluate the risk to develop total metachronous advanced neoplasia (T-MAN) at follow-up in patients with index SL compared to a matched cohort without SL.

Method
Patients 45-74y with SLs were identified through pathology database search. SL patients were matched 2:1 by sex; age; synchronous polyps (high-risk adenoma [HRA], low-risk adenoma [LRA], no-adenoma); timing of index, to patients without SL. Primary outcome was risk of T-MAN (advanced adenoma or high-risk SL) at follow-up. Secondary outcomes included risk of T-MAN stratified by synchronous polyps and SL characteristics.

Result(s)
1425 patients were included (475 patients, 642 SLs; 950 controls (mean follow-up 2.9 vs 3.9y). The SL group had greater risk of T-MAN compared to the non-SL group [Hazard-ratio (HR)=6.12 (95%confidence-interval (CI)3.91-9.58)]. Patients with SL+HRA had higher risk of T-MAN compared to HRA alone [HR=2.62 (95%CI 1.45-4.71)], as well as patients with SL+LRA compared to LRA alone [HR=7.03 (95%CI 2.78-18.44)], and SL without adenoma compared to no-adenoma [HR=14.87 (95%CI 6.51-33.95)]. Presence of proximal SSL (HR=9.30), large SSL (HR=17.87) and proximal large SSL (HR=24.99), but not distal SSL, was associated with greater risk for T-MAN.

Conclusion(s)
Patients with SLs are at greater risk for developing T-MAN regardless of synchronous adenomas. Patients with SL and HRA, and those with large or proximal SSLs appear to be at greatest risk for T-MAN.

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Other

Please indicate your source of funding;
ACG

Disclosure of Interest
R. Djinbachian Grant / Research support from: Grant from the American College of Gastroenterology for the conduction of this project, M.-L. Lafontaine: None Declared, J. Anderson: None Declared, H. Pohl: None Declared, T. Dufault: None Declared, M. Boivin: None Declared, M. Bouin: None Declared, D. von Renteln Grant / Research support from: Daniel von Renteln is supported by a “Fonds de Recherche du Québec Santé” (FRQS) career development award and has received research funding from ERBE, Ventage, Pendopharm, Fujifilm, and Pentax., Consultant of: Boston Scientific and Pendopharm,