bluuebunny/crossref_metadata_2025_split huggingface dataset:
A64 THE DIETARY FIBRE RHAMNOGALACTURONAN PROMOTES INTESTINAL EPITHELIAL CELL MIGRATION THROUGH THE NF-κB SIGNALING PATHWAY
Authors: Baggio C H , Shang J , Nascimento A , Cipriani T , MacNaughton W 
Published: February 2022

Abstract

Background
Damaged intestinal epithelial barrier is characteristic of inflammatory bowel diseases (IBD) and mucosal healing is the primary goal for IBD treatment. We previously showed the direct beneficial effects of rhamnogalacturonan (RGal), a polysaccharide isolated from the plant Acmella oleracea, on intestinal epithelial barrier function with participation of TLR4 and PKC activation. We also observed that RGal accelerates wound healing in human colonic epithelial Caco-2 cells. RNAseq data and pathway analysis have indicated the involvement of the canonical nuclear factor kB (NF-kB) signaling pathway.

Aims
We hypothesize that RGal increases intestinal epithelial wound healing through NF-kB signaling pathway.

Methods
Caco-2 cells monolayers were scratched and treated with vehicle (media or 0.5% DMSO in media) or RGal (1000 mg/ml) for 48 h. Wound healing was assessed using the IncuCyte live cell imaging system. Proliferation and apoptosis of cells were evaluated using EdU and TUNEL assays, respectively. Inhibitors were added at the same time (transcription inhibitor Actinomycin D, 5 mg/ml) or 1 h (NF-kB inhibitors Bay 11–7082 and JSH-23, 10 and 20 mM, respectively, or COX-2 inhibitor NS-398, 20 mM) before RGal treatment. Unwounded Caco-2 monolayers treated with RGal (1000 mg/ml) were collected for Western blotting for COX-2 protein.

Results
In the wound healing assay, RGal at a concentration of 1000 µg/ml enhanced wound healing by 12.5% at 48 h compared to control group, under 10% serum conditions. Neither proliferation nor apoptosis were involved in the RGal effect on wound healing, suggesting the response was due solely to cell migration. Actinomycin D (5 mg/ml), Bay 11–7082 (10 mM) or JSH-23 (20 mM) treatment significantly reversed the effect of RGal on wound healing, showing that the response was transcriptionally dependent and involved NF-kB signaling. Treatment of cells with NS-398 (20 mM) also reversed the effect of RGal on wound healing. COX-2 protein expression was significantly increased at 6 and 12 h after RGal addition to Caco-2 monolayers.

Conclusions
These data suggest that the plant-based polysaccharide RGal increases intestinal epithelial cell wound healing by increasing cell migration. The RGal effect is dependent on the activation of the transcription factor NF-kB and downstream COX-2 protein expression and activity. Our findings show a novel mechanism of action of RGal in wound healing that could help in the resolution of intestinal inflammation and mucosal healing.

Funding Agencies
NSERC
A82 DELIVERY OF AMBULATORY CARE DURING THE COVID-19 PANDEMIC IN THE DIVISION OF DIGESTIVE CARE & ENDOSCOPY, HALIFAX, NS
Authors: Francheville J , Koto P , Peltekian K 
Published: February 2022

Abstract

Background
The COVID-19 pandemic has placed the Canadian healthcare system under substantial strain requiring rapid and systemic changes to healthcare delivery in gastroenterology ambulatory care, including a shift to providing synchronous clinical visits virtually. It is important to describe and evaluate the impact of this care delivery change on patients, providers and the healthcare system in order to improve the quality of virtual care in the future.

Aims
As part of a larger quality improvement initiative, the aim of this project was to better understand the health system impact of the shift from in-person to virtual care delivery in the Division of Digestive Care & Endoscopy in Halifax, NS.

Methods
Using a before-and-after observational study design, outpatient encounters from January-March 2020 (Pre-COVID) were compared to encounters after the pandemic restrictions began April-June 2020 (COVID-Impacted). The primary objective was to compare the proportion of synchronous clinic encounters in the gastroenterology ambulatory space conducted virtually before versus after pandemic restrictions were implemented. Secondary objectives were to determine whether patient, disease, or provider-specific factors were associated with virtual care visits or changed with the implementation of pandemic restrictions. Endoscopic encounters were excluded. Descriptive statistics were used to compare patient and encounter characteristics in the Pre-COVID and COVID-Impacted periods. Multiple logistic regression modeling was used to evaluate the association between patient and provider characteristics and use of virtual care delivery. Unadjusted and adjusted odds ratio with associated 95% CI were estimated.

Results
A total of 4,923 unique patients (60.1% Pre-COVID and 39.9% in the COVID-Impacted period) and 6,659 encounters were identified. The proportion of synchronous clinical visits conducted virtually increased after February 2020, increasing from 25% (Pre-COVID) to 91% (COVID-Impacted). The Pre-COVID versus COVID-Impacted periods also differed with respect to median patient age (56 vs. 59, P = 0.000), mean proximity to the hospital (40km vs. 48km, P = 0.007) and proportion of new consults deemed urgent (9.8% vs. 20.0%, P = 0.000). Patients with family physicians, return visits, and patient age greater than 65 years were associated with the use of synchronous virtual care visits.

Conclusions
This project details the abrupt and significant disruption in in-person ambulatory, non-endoscopic digestive care and the dramatic uptake in virtual care delivery as a result of COVID-19 restrictions in Halifax, NS. Future research will explore virtual care use as pandemic restrictions ease to inform how virtual care is integrated into post-pandemic practice to guide new standards of care.

Funding Agencies
None
A83 BEST PRACTICES FOR THE PROVISION OF VIRTUAL CARE IN IBD AND BEYOND: A SYSTEMATIC REVIEW OF CURRENT GUIDELINES
Authors: Anvari S , Neumark S , Jangra R , Sandre A , Pasumarthi K , Xenodemetropoulos T 
Published: February 2022

Abstract

Background
Telemedicine has emerged as a feasible adjunct to in-person care in multiple clinical contexts, including inflammatory bowel disease (IBD), and its role has expanded in the context of the COVID-19 pandemic. However, there exists a general paucity of information surrounding best practice recommendations for conducting specialty or disease-specific virtual care.

Aims
The purpose of this study was to systematically review existing best practice guidelines for conducting telemedicine encounters, both in general and specific to patients with IBD.

Methods
A systematic review of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) of existing guidelines for the provision of virtual care was performed. Data was synthesized using the Synthesis Without Meta-Analysis (SWiM) guideline, and the AGREE II tool was used to evaluate quality of evidence

Results
A total of 60 studies providing guidance for virtual care encounters were included; 52% of these were published during the COVID-19 pandemic. No gastroenterology-specific guidelines were found. The majority (95%) of provider guidelines specified a type of virtual encounter to which their guidelines applied. Of included studies, 65% provided guidance regarding confidentiality/security, 58% discussed technology/setup, and 56% commented on patient consent. 31 studies also provided guidance to patients or caregivers. Overall guideline quality was poor.

Conclusions
General best practices for successful telemedicine encounters include ensuring confidentiality and consent, preparation prior to a visit, and clear patient communication. Future studies should aim to objectively assess the efficacy of existing clinician practices in order to further optimize the provision of virtual care for specific populations, such as patients with IBD.

Funding Agencies
None
A86 COST-EFFECTIVE ANALYSIS OF PRELIMINARY SINGLE-OPERATOR CHOLANGIOSCOPY IN MANAGEMENT OF DIFFICULT STONES
Authors: Sljivic I , Trasolini R , Donnellan F 
Published: February 2022

Abstract

Background
Single-operator peroral cholangioscopy (POC) is a therapeutic modality for difficult biliary stone disease. Given its high success rate and increasing availability, analysis of the economic impact of early POC utilization is critical for clinical decision-making.

Aims
We aim to compare the cost-effectiveness of different first and second-line endoscopic modalities for difficult-to-treat choledocholithiasis.

Methods
A decision tree model with a 1-year time horizon and a hypothetical cohort of 200 patients was used to analyze the cost-effectiveness of POC for first, second and third-line intervention in presumed difficult biliary stones. We adopted the perspective of a Canadian tertiary hospital, omitting complications and recurrence rates associated with ERCP. Effectiveness estimates were obtained from updated meta-analyses. One-way sensitivity analyses and probabilistic sensitivity analyses were also performed to assess how changes in key parameters affected model conclusions.

Results
First and second-line POC achieved comparable clinical efficacy from 95.5% to 96.5% stone clearance. The least expensive strategy is third-line POC (POC-3: $769,151). Performing POC during the second ERCP was marginally more expensive (POC-2: $770,832) but 9% more effective. The strategy of first-line POC incurred the highest hospital expenditures (POC-1: $848,141) but decreased total procedures performed by 13.4% when compared with POC-2. Sensitivity analysis was robust in showing POC-2 as the most optimal approach.

Conclusions
Second-line POC was superior to first and third-line POC for treatment of difficult biliary stones. When based on meta-analysis of non-heterogeneous trials, POC-2 is more cost-effective and cost-efficient. Our study warrants a larger pragmatic effectiveness trial.

Funding Agencies
None
A100 A PROVINCIAL APPROACH TO ASSESSING ENDOSCOPY PATIENT EXPERIENCE ENHANCES SITE PARTICIPATION AND CANADA-GLOBAL RATING SCALE COMPLIANCE
Authors: Oilund C , Morrin L , Moysey B , Jelinski S , Snider J , Underwood F , Spankie C , Nemecek N , Greenaway M 
Published: February 2022

Abstract

Background
The Canada-Global Rating Scale (C-GRS) is a web-based, patient centered endoscopy quality improvement tool. It assesses the quality of services a unit provides in two dimensions: clinical quality and patient experience. Endoscopy units submit results to the Canadian Association of Gastroenterology twice a year. In Alberta, units receive an A, B, C or D grade for each of the 12 C-GRS Items and a C-GRS score.
The C-GRS promotes that patient feedback is sought annually. Patient feedback is important because it informs practice improvement opportunities. However, survey creation, distribution, analysis and reporting can be time consuming and costly for an endoscopy unit and is a potential barrier to participation.

Aims
The purpose of this quality improvement project is to demonstrate how a provincial infrastructure, which includes coordination, management and reporting of an endoscopy patient satisfaction survey, can enhance provincial endoscopy unit survey participation and facilitate C-GRS compliance.

Methods
The Digestive Health Strategic Clinical Network (DHSCN), the Alberta Colorectal Cancer Screening Program and Primary Data Support (PDS) collaborated on the Provincial Endoscopy Patient Experience Survey (PEPES) in 2019. An existing paper survey was adapted to meet the needs of the 50 endoscopy units in AB with the addition of an electronic version. Education about the PEPES process was provided via a webinar and site visits. Each unit was responsible for distribution of the surveys to their patients. PDS coordinated the paper survey process and the DHSCN managed the electronic survey submissions. Paper survey results were merged with electronic PEPES data. A summary report was provided to units and shared with each AHS Zone Endoscopy Executive Leadership Team.

Results
Provincially coordinated implementation of the PEPES fosters compliance with C-GRS criteria. Participating endoscopy units were able to achieve at minimum 9 C-GRS descriptors and improve their C-GRS score in the following 7 of the 12 C-GRS Items: consent, comfort, equality, booking, privacy, aftercare and feedback.
Initial enrollment in the PEPES increased with the onset of provincial coordination (Figure 1). However, subsequent participation was negatively impacted by COVID-19 as many endoscopy units in AB were required to decrease their capacity and redeploy staff.

Conclusions
A provincially coordinated approach to the management of an endoscopy patient experience survey is an effective way to enhance site participation and improve C-GRS scores. Units can focus on actioning survey results, rather than the burden of survey administration. Future work includes comparison of results across sites allowing for potential provincial equity issues to be addressed.

Funding Agencies
None
A108 A RETROSPECTIVE REVIEW OF COMPLEX POLYP MANAGEMENT IN THE CHAMPLAIN REGION, ONTARIO
Authors: Monod A , Rostom A , Dube C 
Published: February 2022

Abstract

Background
Advanced endoscopic techniques have enabled the removal of polyps which, due to their size, location, or morphology, would otherwise have been removed surgically. Patients with such complex polyps should be referred promptly to expert centres for adjudication and management.

Aims
To review patterns of referral and initial management of complex polyps at The Ottawa Hospital (TOH), to identify gaps in care and to identify strategies to address those gaps.

Methods
We performed a retrospective chart review of cases where large (&gt;3cm) colonic polyps were evaluated at TOH, from March 2019-March 2021. Cases were identified using Canadian Institute of Health Information codes. Descriptive statistics were analyzed, and were compared using Mann-Whitney U tests where appropriate.

Results
94 consecutive patients with large polyps (mean age 68; 56.4% male) were included. The average polyp size was 4.7(4.4–5.1)cm. 45 patients were referred for a known complex polyp while the rest were referred for FIT/FOBT+ (n=20), symptoms or anemia (n=17), surveillance (n=9), or abnormal imaging (n=3). 32 patients were referred from &gt;50km from Ottawa (travelling), and 62 were referred from &lt;50km from Ottawa (local). Of the 45 referrals for known polyp, 20 (44.4%) included photodocumentation of the lesion; 33 (73.3%) had a prior biopsy, and 8 (17.8%) were partially removed. Key statistics are summarized in Table 1. All 8 patients referred with a partially removed polyp eventually had a successful endoscopic polypectomy. 10/94 (10.6%) patients required surgical resection: 7 for malignant pathology, and 3 for endoscopic failure. Overall, 3 patients had post-polypectomy bleeding, and 1 patient sustained a full-thickness perforation. As of October 2021, 26/78 (33.3%) patients eligible for a 4–6 month recheck and 36/48 (75%) patients eligible for a 12-month follow-up colonoscopy were overdue.

Conclusions
This retrospective review highlights significant differences in the management of complex polyps based on patient geography and the need to develop strategies to improve access for patients referred from outside of Ottawa. As expected, COVID had a significant impact on the time to complete removal of polyps, and affected the timely endoscopic follow up of these high-risk patients. Strategies to ensure timely endoscopic follow up of patients after complex polyp removal are needed.

Funding Agencies
None
A109 PATIENTS’ DESCRIPTIONS OF THEIR LAST BOWEL MOVEMENT BEFORE COLONOSCOPY CORRELATES STRONGLY WITH THEIR BOSTON BOWEL PREPARATION SCALE (BBPS) SCORE WHEN ASSESSED USING A STANDARDIZED METHOD
Authors: Akman O , Gregor J C , Singh H 
Published: February 2022

Abstract

Background
Predicting bowel prep quality prior to colonoscopy may help improve colonoscopy prep quality by instituting adjunct measures before colonoscopy. This will in turn reduce repeat procedures, complications, and costs.

Aims
We determined the utility of a standardized method to obtain information from patients on the characteristics of their last bowel movement before colonoscopy by correlating the obtained information to BBPS. We compared this approach to informal/usual descriptions attained by nurses.

Methods
This is a cross-sectional study with data collected at two tertiary care hospitals. On the day of their colonoscopy, outpatients were asked by an assistant to describe their last bowel movement using a standardized method. The same patients had previously been asked by endoscopy nurses to describe their last bowel movement; the assistant was blind to previous descriptions. Descriptions were assigned a score (Table 1).
Following colonoscopy, total and segmental BBPS scores were recorded by the gastroenterologist performing the procedure; the gastroenterologist was blind to the descriptions.
Bivariate Pearson’s Correlation was used to separately assess the correlation between descriptions and BBPS. Cohen’s Kappa was used to assess agreement between the two descriptions.

Results
121 patients (ages 17–86; 55% Female) with 11% BBPS&lt; 6 were included.
For descriptions attained by the assistant, there was a strong correlation with total BBPS score (r = 0.738; p &lt; 0.001); correlation to segmental BBPS was moderate-to-strong (r=0.70, 0.63 and 0.67 right, transverse and left colon respectively).
For descriptions attained by endoscopy nurses, there was a moderate correlation with total BBPS score (r = 0.525; p &lt; 0.001); correlation to segmental BBPS was weak-to-moderate (r=0.52, 0.49 and 0.44 right, transverse and left colon respectively).
There was weak agreement (K = 0.525) between description attained by assistant and nurses.

Conclusions
When asked using a standardized method, a patient’s description of their last bowel movement correlates strongly with their total and segmental BBPS score; the correlation is weaker for non-standardized descriptions attained by endoscopy nurses. A standardized questionnaire, including assessing consistency, is valuable in assessing the bowel movement before colonoscopy.

Funding Agencies
None
A111 A RECTUM-SPECIFIC SELECTIVE RESECTION ALGORITHM OPTIMIZES ONCOLOGIC OUTCOMES FOR LARGE NON-PEDUNCULATED RECTAL POLYPS
Authors: Shahidi N C , Vosko S , Gupta S , Whitfield A , Cronin O , O’Sullivan T , van Hattem W , Sidhu M , Tate D , Lee E , Burgess N , Williams S , Bourke M 
Published: February 2022

Abstract

Background
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are complementary techniques for large (≥ 20mm) non-pedunculated rectal polyps (LNPRPs). A mechanism for appropriate technique selection has not been described.

Aims
To evaluate whether a selective resection algorithm using EMR and ESD, based on real-time optical evaluation, optimizes oncologic outcomes for LNPRPs

Methods
We evaluated the performance of a selective resection algorithm (SRA; 08/2017-04/2021) compared to a universal EMR algorithm (UEA; 07/2008-07/2017) for LNPRPs within a prospective observational study. In the SRA, LNPRPs with features of superficial submucosal invasive cancer (SMIC &lt; 1000μm; S-SMIC; Kudo pit pattern Vi), or with an increased risk of SMIC (Paris 0-Is or 0-IIa+Is non-granular, 0-IIa+Is granular with a dominant nodule ≥ 10mm) underwent ESD. The remaining LNPRPs underwent EMR. Algorithm performance was evaluated by SMIC identified after EMR, curative oncologic resection (R0 resection, S-SMIC, absence of negative histologic features), technical success, adverse events, and recurrence at first surveillance colonoscopy.

Results
480 LNPRPs were evaluated (290 UEA, 190 SRA). Median lesion size was 40mm (IQR 30-60mm). In the SRA, 103 (54.2%) and 87 (45.8%) LNPRPs underwent EMR and ESD, respectively. SMIC was identified in 56 (11.7%) LNPRPs. Significant differences in SMIC after EMR (SRA 1 (1.0%) vs. UEA 35 (12.1%); p = 0.001), curative oncologic resection (SRA 7 (33.3%) vs. UEA 2 (5.7%); p = 0.010), and recurrence (SRA 2 (1.6%) vs. UEA 40 (17.2%); p &lt; 0.001) were identified. No significant differences in technical success or adverse events were identified (all p &gt; 0.137). Among potentially curable malignant LNPRPs which underwent ESD, 100% (7/7) were cured.

Conclusions
A SRA optimizes oncologic outcomes for LNPRPs and mitigates the risk of piecemeal resection of cancers.

Funding Agencies
The Cancer Institute of New South Wales provided funding for a research nurse and data manager to assist with the administration of the study. Neal Shahidi was supported by the University of British Columbia Clinician Investigator Program. There was no influence from either institution regarding study design or conduct, data collection, management, analysis, interpretation, preparation, review, or approval of the manuscript.
A118 UPPER GASTROINTESTINAL HEMORRHAGE SECONDARY TO SUPERIOR MESENTERIC ARTERY PSEUDOANEURYSM: CASE REPORT AND REVIEW OF LITERATURE
Authors: Guo H , Stach J , Panaccione R , Belletrutti P J 
Published: February 2022

Abstract

Background
Visceral artery pseudoaneurysms (VAPAs) are rare with an estimated incidence of 0.1%-0.2%. Due to various etiologies, a tear occurs in the vessel wall with subsequent formation of a peri-artery hematoma. A ruptured VAPA is a clinical emergency due to life-threatening hemorrhage and is associated with mortality rates of 25%-75%.

Aims
We report a case of upper gastrointestinal (GI) hemorrhage secondary to a ruptured superior mesenteric artery (SMA) pseudoaneurysm. A review of the literature regarding management of VAPAs and SMA pseudoaneurysms was performed using relevant medical subject headings on PubMed.

Methods
A 66-year-old woman presented to hospital with sudden large volume hematemesis and melena. Her daily medications included Aspirin and Atorvastatin. She had no prior history of peptic ulcers or chronic liver disease. She was found to be tachycardic and hypotensive. Initial investigations demonstrated a hemoglobin of 42g/L and a blood urea nitrogen of 17.5mmol/L. She was resuscitated and referred for an emergent upper endoscopy. On endoscopy, in the third portion of the duodenum, a 4cm solid-appearing subepithelial lesion with central umbilication and an apparent visible vessel was identified. Upon inspection of the lesion, the umbilicated area spontaneously began spurting blood (Image 1). A hemoclip was immediately placed next to the lesion for localization, then hemostatic powder was applied to the area. An immediate computerized tomography (CT) angiography of the abdomen revealed a 3.9 x 2.1 cm pseudoaneurysm arising from the superior mesenteric artery impressing upon the duodenum.

Results
Transcathether arterial embolization of the SMA pseudoaneurysm was performed, during which two Nester coils were deposited in the ileocolic outflow vessel. A covered endovascular stent was also deployed across the culprit arterial branch to exclude the pseudoaneurysm. Following the procedure, the patient stabilized and had no further GI bleeding. Traditionally, visceral angiography has been the gold standard diagnostic test for VAPAs, but has now been supplanted by CT angiography. Treatment strategies of VAPAs can be broadly separated into endovascular methods (coils, vascular plugs, stents, liquid embolic agents) and surgical methods (aneurysmectomy with patching, end-to-end anastomosis, bypass grafting).

Conclusions
SMA pseudoaneurysms are a rare yet life-threatening cause of GI bleeding. Endoscopically, they resemble solid subepithelial masses, such as GI stromal tumor, nerve sheath tumor or a lipoma, which may lead to inappropriate attempts to biopsy the lesion or apply direct endoscopic therapy. Prompt diagnosis with imaging, such as CT angiography, is paramount with a view to definitive treatment of the pseudoaneurysm via endovascular methods.

Actively hemorrhagic SMA pseudoaneurysm

Funding Agencies
None