bluuebunny/crossref_metadata_2025_split huggingface dataset:
A63 TRENDS AND OUTCOMES OF LIVER DISEASE HOSPITALIZATIONS DURING THE CORONAVIRUS PANDEMIC IN THE UNITED STATES: A NATIONWIDE POPULATION-LEVEL ANALYSIS
Authors: Sedarous M , Youssef M , Adekunle A D , Babajide O , Rubens M , Okafor P N 
Published: March 2023

Abstract

Background
The impact of the Coronavirus disease-2019 (COVID-19) pandemic on patients with liver disease is not well described at the population level in the United States.

Purpose
We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years.

Method
Using the National Inpatient Sample (2018-2020), we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality for liver-related indications including compensated cirrhosis, decompensated cirrhosis, alcohol-associated liver disease (ALD), alcohol-associated hepatitis (AH), hepatocellular carcinoma (HCC), and variceal upper gastrointestinal bleeding (VUGIB) using regression modeling. We also looked at the impact of the COVID-19 pandemic on liver transplantation rates. A p-value &lt;0.05 was considered statistically significant.

Result(s)
Hospitalizations for both compensated and decompensated cirrhosis decreased in 2020 compared to 2019 (relative change [RC] of 1.5%, p &lt;0.001, Table 1). Interestingly, hospitalizations for ALD and AH increased in 2020 compared to pre-pandemic years (ALD RC=15.5% and AH RC 17.0%; p&lt;0.001). Despite the decrease in cirrhosis hospitalizations in 2020, all-cause inpatient mortality among patients with compensated cirrhosis increased from 30,135 in 2019 to 35,220 in 2020 (p&lt;0.001) and from 22,850 in 2019 to 26,390 in 2020 among patients with decompensated cirrhosis (p&lt;0.001). This was accompanied by a 27.8% increase in mortality for ALD (p=0.004) in comparison to pre-pandemic years. Corresponding to the peaks of the pandemic, we observed the fewest cirrhosis hospitalizations in April and December 2020 (Table 2), however, these months had the highest observed mortality rates (p-trend ≤ 0.004). Reassuringly, liver transplantation rates were not significantly impacted by the COVID-19 pandemic (p=0.51).

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Conclusion(s)
Cirrhosis hospitalizations, in general, decreased in 2020 compared to pre-pandemic years but were associated with higher all-cause mortality rates particularly in the peak months of the COVID-19 pandemic (April and December 2020) possibly reflecting COVID-19 specific mortality. Alcoholic liver disease admissions also increased during the pandemic while liver transplantation rates were not significant impacted.

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None

Disclosure of Interest
None Declared
A72 LOCAL RECURRENCE RATES AFTER RESECTION OF LARGE COLORECTAL SERRATED LESIONS WITH OR WITHOUT MARGIN ABLATION
Authors: Amar L , Djinbachian R , von Renteln D 
Published: March 2023

Abstract

Background
Endoscopic mucosal resection (EMR) has become the mainstay of therapy with regard to larger polyps. Serrated lesions (SLs) including traditional serrated adenomas (TSA), large hyperplastic polyps (HP) and sessile serrated lesions (SSLs) have been associated with high rates of incomplete resection. There has been an increasing role of margin ablation combined to EMR to reduce local recurrence.

Purpose
Our aim was to evaluate local recurrence rates (LRR) after resection of large colorectal SLs and the use of margin ablation in preventing recurrence

Method
Adult patients who underwent resection colorectal SSL, TSA, or HP polyps ≥ 15 mm from 2010-2019 with a colonoscopy follow-up within 18 months were identified through pathology database and electronic medical records search. Hereditary CRC syndromes, follow-ups longer than 18 months or no follow-up, surgical resection were excluded. The primary outcome was LRRs (either histologic or visual) during the first 18-month follow-up. Secondary outcomes were LRRs for polyps 15-19 mm and ≥20 mm, LRR after margin ablation for polyps ≥20mm.

Result(s)
Polyp resection was performed on 125 polyps in 112 patients (54.1 %women; mean age, 62.9 years). The mean size of polyps was 22.9 mm, with 58.4% ≥20mm. 76.0% of polyps were resected via EMR and 33.3% of polyps ≥20 mm received margin ablation. First surveillance colonoscopy was on average 8.4 months later and the resection scar was seen in 54.4% of lesions. Overall LRR for the first 18-months was 16% [95% confidence interval (CI) 10.5-23.6] (13% for polyps 15-19mm, 18% for ≥20mm, 22% for ≥30 mm). LRR for ≥20mm SLs was significantly lower after margin ablation (5.0% vs 24.0%; p=0.048).

Conclusion(s)
The local recurrence rate for SLs ≥15 mm is high with 16% overall recurrence, and increases with polyp size. Thermal ablation of the margins is superior to no ablation in reducing LRRs for ≥ 20mm SSLs.

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None

Disclosure of Interest
None Declared
A76 PHYSICIANS PERCEIVED VALUE OF COMPUTED TOMOGRAPHY SCANS FOR INFLAMMATORY BOWEL DISEASE PATIENTS IN THE EMERGENCY DEPARTMENT: A SURVEY OF CANADIAN PHYSICIANS
Authors: Roda C , Stiell I , Dube C , Macdonald B , Moloo H , DeBuck A , McCurdy J 
Published: March 2023

Abstract

Background
Despite concerns regarding the risks of ionizing radiation from computed tomography (CT) imaging, the rates of abdominal pelvic CT (APCT) utilization in the emergency department (ED) continues to increase for patients with inflammatory bowel disease (IBD).

Purpose
To determine the factors that drive decisions on when to perform APCT imaging in the ED for patients with IBD and to determine if differences exist between physician specialties.

Method
We performed a quantitative, web-based survey between November 2021 and August 2022. Structured questions for Crohn’s disease (CD) and ulcerative colitis (UC) were developed with input from stakeholders in gastroenterology, surgery, and emergency medicine. Surveys were disseminated to Canadian physicians in each of the three specialities through personal emails, and by newsletter from national specialty organizations. Between specialty comparisons were performed by Chi-squared and Fisher exact tests where appropriate.

Result(s)
A total of 208 participants responded to our survey: median age 44 years (IQR 37-50), 132 (63%) male, and 141 (68%) in an academic practice. Survey participants included 81 (39%) gastroenterologists, 35 (17%) surgeons and 92 (44%) emergency physicians.
There were significant differences between specialties in the perceived rates of positive findings from APCT imaging. In UC, gastroenterologists felt inflammation alone was more common than emergency physicians and bowel obstruction and septic complications less common than surgeons and emergency physicians. In CD, surgeons felt bowel obstructions, septic complications and bowel perforations were more common compared with gastroenterologists and emergency physicians.
There were significant differences between specialties in the types of clinical presentations that drove decisions to arrange APCT imaging (Figure 1a&b). In UC, gastroenterologists were less likely to order APCT imaging for diarrhea with rectal bleeding, abdominal pain without peritoneal findings and fever than surgeons and emergency physicians. In CD, there were similar practice patterns between specialities except gastroenterologists were less likely to order APCT imaging for diarrhea with rectal bleeding than surgeons.

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Conclusion(s)
Our survey identified key differences between physician specialties in the perceived rates of positive findings from APCT imaging and practice patterns of CT utilization. These findings will help to guide the development of future multidisciplinary consensus guidelines for the appropriateness of CT imaging in the ED for patients with IBD.

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None

Disclosure of Interest
None Declared
A78 BILIARY STENT USE IN ERCP: A QUALITY ASSURANCE STUDY ASSESSING ADHERENCE TO CLINICAL GUIDELINES AND COST OUTCOMES
Authors: Decanini A , Alhaidari S I S , Alzahrani I , Alhanaee M , Mohamed M , Zepeda-Gomez S , Mathura P , Zhang J , Sandha G 
Published: March 2023

Abstract

Background
A perceived increase in the use of biliary stents during endoscopic retrograde cholangiopancreatography (ERCP) was observed by our nursing team leader and brought to the attention of the Director of Endoscopy.

Purpose
To assess a) biliary stent utilization during ERCP, b) the adherence for stent placement based on published guidelines, and c) the associated cost.

Method
A chart review of all consecutive patients that underwent ERCP for one year (January 2020 to 2021) at the University of Alberta Hospital (UAH) was performed. The need for biliary stent placement was assessed independently by two blinded reviewers and compared with published guidelines. Costs were calculated using Alberta Health Services fee codes.

Result(s)
A total of 598 patients (316 F) with mean age of 60±19 years (range 3-99 years) underwent 842 ERCPs. Clinical indications for the initial ERCP were common bile duct (CBD) stones (376, 63%), malignant stricture (84, 14%), benign stricture (49, 8%), bile leak (27, 5%), stent removal (15, 3%), and others (47, 8%). Of the 244 patients that had a follow-up ERCP, the most common indications were stent removal (126, 52%), stent replacement (61, 25%), stent placement (28, 11%), and stone extraction (8, 3%). A total of 296 biliary stents were inserted, of which 223 stents (114 plastic, 109 metal) were inserted during the first ERCP (223/598, 37%) and 73 stents (43 plastic, 30 metal) during follow-up ERCP (73/244, 30%).
Of the 296 stents, 79 (27%) were inserted for indications not in accordance with published guidelines (63/223 initial ERCP, and 16/73 follow-up ERCP, kappa=0.62). Most of these were placed in CBD stone cases (61/63 initial ERCP, 6/16 follow-up ERCP). In the subgroup of 376 patients with CBD stones, 61 (16%) underwent stent placement not in accordance with published guidelines. The added cost of such stent insertions and follow-up ERCPs for stent removal was $130,000.

Conclusion(s)
Stent insertion not in accordance with published guidelines was identified in some patients with CBD stones presenting for ERCP. To reduce unnecessary follow-up procedures and healthcare resource utilization, ERCP stent insertion education based on published guidelines, as well as regular practice audit and feedback are required.

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None

Disclosure of Interest
None Declared
A85 ASSESSING THE IMPACT OF A DEDICATED RAPID INTERDISCIPLINARY IBD CLINIC ON PATIENT WAIT TIMES, REPORTED OUTCOMES, AND SATISFACTION OF CARE
Authors: Mathiyalagan G , Broni E , Jogendran R , O'Connor K , Kennedy E , Steiman A , Maxwell C , Omar A , Piguet V , Alavi A , Weizman A , Huang V 
Published: March 2023

Abstract

Background
Inflammatory bowel disease (IBD) is a chronic fluctuating condition where patients can experience periods of active disease and remission. Timely access to care has been shown to be impactful on important disease outcomes. In January 2020, we implemented a rapid assessment IBD program consisting of expedited access to interdisciplinary care and close monitoring of patients.

Purpose
To assess the impact of the rapid assessment program on access to care, disease activity, and patient satisfaction.

Method
Once informed consent was obtained, patients were enrolled into the RAPID IBD program. This program consisted of four close monitoring time points at baseline, 1, 2, and 3 months, as well as two follow up time points at 6 and 12 months. At each timepoint patients completed questionnaires that evaluated disease activity, using the Modified Harvey Bradshaw Index (mHBI) for Crohn’s disease (CD), partial Mayo (pMayo) score and Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis patients. At baseline, 3, 6, and 12 months, patients were also assessed on mental health, using the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7), and satisfaction of care, using the CACHE questionnaire.

Result(s)
Between January 2020 – August 2021, 216 patients were referred to the RAPID IBD program. The mean time from referral to clinical assessment was 8.1 days. Of those referred, 143 (71 CD, 62 UC, 6 IBDU, and 4 Query IBD) patients consented to and completed the 12-month RAPID IBD study. 34.9% of patients who had active disease at baseline achieved remission by 3 months (Table 1). At baseline 44.8% and 28.4% of patients experienced moderate to severe depression and anxiety, respectively. The greatest improvement in mental health was seen at 2 months where the proportion of patients experiencing moderate to severe depression and anxiety decreased to 27.5% and 18.3%, respectively (Table 2). Patient satisfaction, specific to clinical care, improved from a baseline score of 69.1% to 74.1% at 3 months (Table 3).

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Conclusion(s)
Implementation of a dedicated RAPID IBD clinic program reveals shorter wait times to be seen in clinic. By three months of enrollment, patients demonstrate improvements in clinical response, mental health, and satisfaction of care.

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Other

Please indicate your source of funding;
AMO Innovation Funding

Disclosure of Interest
None Declared
A93 IMPROVING INPATIENT ENDOSCOPY PROCEDURAL THROUGHPUT: A QUALITY IMPROVEMENT INITIATIVE AT AN ACADEMIC MEDICAL CENTER
Authors: Alsager M , Hudson D , hindi Z , Lavalle C , Iablokov V , Alajmi A , khanna N , qumosani K , brahmania M 
Published: March 2023

Abstract

Background
Currently, due to pandemic-related supply and personnel constraints, increased strain is being placed on inpatient endoscopic services. At our academic center, inpatient procedural throughput/efficiency is only 65%, which is leading to excess procedures being completed on-call or on weekends.

Purpose
Our quality improvement study attempted to improve throughput of the inpatient endoscopy suite by 1 additional procedure completed per day, over a period of 12 months of study.

Method
An interprofessional team of gastroenterology fellows, attending physicians, nurses and nurse managers was created to investigate throughput concerns. Baseline data was collected via direct observation and completion of a time study over a period of 1-2 months.
Subsequently, a process flow diagram was completed. A combination of root cause analysis tools (ie. Stakeholder interviews, Pareto chart and Driver Diagram were then utilized to identify areas for improvement. A delay in procedural start time was identified as a strong culprit for reduced patient throughput. Potential interventions proposed included: early physician handover start time, constructing a standardized patient procedure list, and improving timeliness of patient transfer to the endoscopy suite.

Result(s)
Stakeholder Interview(s): Completed via Anonymous Survey/Google Forms:

See
https://docs.google.com/forms/d/e/1FAIpQLSe-PDL31ClU8g-BChdBoBYhPoBhGBZVmlToTTZJnYKlEHz-GQ/viewform?usp=sf_link
Concerns:
- Inpatient procedure list not consistently being completed prior to starting endoscopy
- Physician handover in the morning can cause significant delays in starting inpatient endoscopy
- Concern patient/porter transfer related delays

Conclusion(s)
Our current data identifies that the most effective intervention included developing a standardized procedure list and mandating the first case is an EGD, minimizing delay due to inadequate bowel preparation. Concordantly, arranging timely patient transfer to the endoscopy suite, thereby minimizing delays due to patient portering services, was also found to be effective. Our average procedural time for completion of an EGD and associated recovery is approximately 25-30 minutes. After multiple interventions/PDSA cycles we obtained a more optimized procedural suite start time of 08:22 am, on average, which resulted in the completion of an additional procedure and increased the throughput of our endoscopy unit.

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None

Disclosure of Interest
None Declared
A102 INTERDISCIPLINARY TELEHEALTH REFERRAL PATHWAY AND CONSULTATIONS TO IMPROVE OUTCOMES AMONG CANADIAN OLDER ADULTS WITH LIVER CIRRHOSIS
Authors: Zhu J , Carr F , Tian P , McLeod M , MacFarlane M , De Coutere S , Sun M , Peltekian K 
Published: March 2023

Abstract

Background
Telehealth and telemedicine have become indispensable healthcare delivery tools during the COVID-19 pandemic. Older individuals with cirrhosis have complex medical needs that are currently unmet due to the growing disease burden and decreased access to care. Delivering timely specialist care virtually to older adults with cirrhosis will likely be beneficial and acceptable to such patients; however, this has not yet been prospectively evaluated.

Purpose
The primary goal is to pilot the delivery of dual specialist care from a hepatologist and geriatrician, delivered virtually, for older adults living with liver cirrhosis who are at high risk of geriatric syndromes (age &gt;/= 65 with frailty, undifferentiated cognitive impairment from dementia or hepatic encephalopathy, recurrent falls, risk factors for polypharmacy and moderate to severe malnutrition). Care is delivered using a dedicated hepatology-geriatric referral pathway. Primary objectives include evaluating the impact of this approach on emergency care and inpatient utilization, along with patient attitude and satisfaction to the virtual interdisciplinary care delivery model.

Method
This pilot quality improvement study was conducted in Halifax, Nova Scotia. Ethics approval was obtained from the Nova Scotia Health Research Ethics Board and the University of Alberta Research Ethics Board. Fifty to one hundred participants (age 65 years or older with at least one geriatric syndrome; diagnosis of liver cirrhosis by liver elastography or liver biopsy, or Fibrosis-4 Index for Liver Fibrosis greater than three and having radiological features of cirrhosis and/or portal hypertension) were recruited between September 2022 to December 2022 at the time of their hepatology consultation. After consent and screening, each patient underwent a telehealth appointment by zoom with a geriatrician within four weeks of their initial hepatology assessment. Follow-up by telephone using a standardized survey regarding ease of access and quality of their telehealth experience then occurred at 3-4 weeks, 3 months and 6 months for emergency room visits and hospital admission status.

Result(s)
Pending

Conclusion(s)
Pending

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Other

Please indicate your source of funding;
Pfizer Canada

Disclosure of Interest
J. Zhu Grant / Research support from: Pfizer Canada, F. Carr Grant / Research support from: Pfizer Canada, P. Tian: None Declared, M. McLeod: None Declared, M. MacFarlane: None Declared, S. De Coutere: None Declared, M. Sun: None Declared, K. Peltekian: None Declared
A142 APPROPRIATENESS OF POST-ENDOSCOPY CARE IN PATIENTS PRESENTING WITH FOOD BOLUS IMPACTIONS OVERNIGHT: A POPULATION-BASED MULTICENTER COHORT STUDY
Authors: Guo H , Hamilton P , Enns E , Gupta M , Andrews C , Nasser Y , Bredenoord A , Dellon E , Ma C 
Published: March 2023

Abstract

Background
Appropriate management of esophageal food bolus impactions includes endoscopic evaluation and follow-up for potential underlying esophageal pathology. Patients who present with impactions at night may not receive optimal long-term post-endoscopy care due to patient-, physician-, or system-related factors.

Purpose
We aimed to evaluate the appropriateness of care for patients who present with food bolus impactions after regular daytime hours.

Method
We conducted a retrospective, population-based, multi-center cohort study of adult patients undergoing endoscopy for food impaction between 19:00-06:59 from 2016-2018 in the Calgary Health Zone, Canada. Appropriate post-endoscopy care was defined by a composite of a follow-up clinic visit, repeat endoscopy, other appropriate investigations (e.g., manometry), or appropriate medical treatment (e.g., proton pump inhibitor). Predictors of inappropriate care were assessed using multivariable logistic regression, expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Result(s)
A total of 323 patients underwent an after-hours or overnight endoscopy for food bolus impaction. 25.4% (82/323) of patients did not receive appropriate post-endoscopy care. Predictors of inappropriate care included rural residence (aOR 2.66 [95% CI: 1.18-6.01], p=0.02), first food bolus presentation (aOR 2.38 [95% CI: 1.04-5.44], p=0.04), and absence of a specific pathology during the index procedure (aOR 3.01 [95% CI: 0.97-9.29], p=0.05), suggesting a potential association with clinician cognitive bias. Among patients who were followed, 18.9% (35/185) had a change in the original diagnosis.

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Conclusion(s)
One quarter of patients presenting with a food bolus impaction at night do not receive appropriate post-endoscopy care. System-based interventions should target this high-risk population as the diagnosis and management may change with follow-up.

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None

Disclosure of Interest
None Declared
A161 SYMPTOMATIC GASTRIC SCHWANNOMA DIAGNOSED WITH ENDOSCOPIC ULTRASOUND AND FINE NEEDLE BIOPSY: A CASE REPORT
Authors: Wang D , Stallwood C 
Published: March 2023

Abstract

Background
Gastric schwannomas are exceedingly rare neoplasms that account for 0.2% of all gastric masses. They belong to a group of peripheral nerve sheath tumors, which are typically slow-growing, benign lesions that also include neurofibromas and perineuriomas. These neoplasms are often found incidentally on endoscopy as subepithelial lesions.

Purpose
We aim to outline the presentation and differential diagnosis of gastric peripheral nerve sheath tumors.

Method
We present the case of a 44 year old female with heartburn and dyspepsia who was referred for esophagogastroduodenoscopy, which incidentally found a subepithelial lesion on the greater curve of the stomach. She was then referred for EUS-guided fine needle biopsy of the mass, and the pathology was initially reported as a neurofibroma. Eventually, the lesion was surgically removed with the final pathology report stating that this was a gastric Schwannoma. Both specimens had immunostains positive for S-100 and negative for CD34, desmin, DOG1 and cKit.

Result(s)
While gastric schwannomas are typically benign, they can still cause abdominal pain, gastrointestinal bleeding, and even gastric outlet obstruction and intussusception. The differential diagnosis of gastric schwannoma includes other peripheral nerve sheath tumors, as well as malignant subepithelial lesions such as gastrointestinal stromal tumors or gastric lymphoma.

Conclusion(s)
Gastric schwannoma should always be considered when evaluating subepithelial gastric lesions, and EUS with histologic sampling should be pursued to diagnose and guide the management of these lesions.

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None

Disclosure of Interest
None Declared