bluuebunny/crossref_metadata_2025_split huggingface dataset:
A96 RAPID IMPLEMENTATION OF AN EVIDENCE-BASED, VIRTUAL COVID-19 VACCINE EDUCATION CLINIC AT NOVA SCOTIA COLLABORATIVE INFLAMMATORY DISEASE CLINIC (NSCIBD)
Authors: Komeylian H , Jones J , Stewart M , Heisler C , Phalen-Kelly K , Currie B 
Published: February 2022

Abstract

Background
Rapid adaptation of clinical management as well as policy decisions in relation to implementation of COVID-19 vaccination programs for persons living with IBD has been required throughout the pandemic.

Aims
To meet the need for public health-mandated COVID-19 vaccine education for patients living with IBD in Nova Scotia a novel, evidence-based, virtual COVID-19 vaccine educational intervention was developed, implemented, and evaluated.

Methods
An observational, cross sectional, implementation-effectiveness study was conducted at the NSCIBD program between April and July, 2021. The educational intervention consisted of a standardized evidence-based letter describing risks and benefits of COVID-19 vaccine emailed to patients in advance of a virtual clinic appointment. Virtual appointments were offered to all patients contacting the NSCIBD program with questions or concerns about vaccination. During these virtual visits standardized, evidence-based information was provided by a gastroenterologist (n=2) or IBD nurse practitioners (n=2) and patients were provided with an opportunity to address specific disease and treatment related concerns. Following the session, a link to an anonymous questionnaire was distributed via email to evaluate key implementation metrics including satisfaction, appropriateness, usefulness, perceived impact on knowledge and vaccine hesitancy, and recommendations for improvement. Data analysis was descriptive. Group means were expressed as proportions for categorical variables and means for numerical variables.

Results
A total of 298 patients participated in a virtual patient education session of which 265 provided a valid email address and invited to participate in the on-line survey. The response rate was 49% (131/265). Before the session, 48.9% (64/131) expressed vaccine hesitancy. Twenty-six percent (35/131) expressed concerns relating to risks versus benefits of COVID-19 vaccines. Ninety-one percent (119/131) of respondents found the education program helpful. The proportion of those willing to get vaccinated rose from 61% (pre) to 86.3% (post). Only 1.5% (2/131) indicated they would not get vaccinated. Seventy-seven percent (101/131) found the written and virtually administered educational content to be satisfactory. Eighty-eight percent (115/131) of respondents were willing to participate in similar types of virtual education offerings in the future.

Conclusions
Implementation of an evidence-based, multidisciplinary, virtual COVID-19 vaccination education intervention was perceived to be feasible, acceptable, and effective by IBD patients. Further research on innovative, evidence-based, multidisciplinary educational interventions and the impact of these interventions on IBD clinical outcomes are needed.

Funding Agencies
None
A113 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PATIENTS WITH SURGICALLY ALTERED ANATOMY IN A CANADIAN TERTIARY REFERRAL CENTRE
Authors: Motomura D , Gan S , Byrne M , Donnellan F 
Published: February 2022

Abstract

Background
Endoscopic retrograde cholangiopancreatography (ERCP) has become a mainstay of diagnosis and treatment of pancreatobiliary conditions. Surgically altered anatomy presents unique challenges in the procedure, necessitating creative solutions such as different types of endoscopes and tools. Distinct from regular anatomy, forward viewing scopes are often required for successful cannulation and therapy of the pancreaticobiliary system. To our knowledge, there is limited data on the practice of ERCP in altered anatomy in Canada.

Aims
Our aim is to present outcomes from a large series of patients with surgically altered anatomy who underwent ERCP at a large Canadian referral centre.

Methods
All ERCP procedures at a tertiary referral centre in Vancouver, Canada from Oct 2020 to Oct 2021 were reviewed retrospectively. Inclusion criteria required surgically altered anatomy and attempted ERCP. Liver transplant patients with duct-to-duct anastomosis were not included in the series. Patients with incomplete procedure documentation were excluded. Demographic, procedural and outcome data were collected. Results are presented descriptively and as median + IQR for quantitative data. Procedural success was defined as cannulation and performance of a cholangiogram and/or pancreatogram

Results
A total of 34 procedures met the inclusion criteria during the study period. Twenty-four procedures were on male patients (71%). Nineteen patients (56%) had had previous ERCP. Sixteen patients (47%) had choledocholithasis as the indication for the procedure, 9 patients (26%) had cholangitis and 5 patients (15%) had concerns of neoplasia. Some patients had multiple indications. Seventeen patients (50%) had roux-en-Y anatomy, 8 patients (24%) were post Whipple’s and 6 patients (18%) had Billroth II type anatomy. Other altered anatomy included duodenal switch, and post gastrojejunostomy bypass. The most commonly used endoscope was the adult or pediatric colonoscope (74% of cases). Single balloon enteroscope was used in 5 cases (15%). Overall success rate was 74%. The breakdown of success rate by anatomy is shown in Table 1. One (3%) complication was noted in the form of mild cholangitis, requiring only outpatient antibiotics.

Conclusions
Experience in ERCP in patients with altered anatomy is becoming more pertinent in tertiary care. Cannulation and therapy is more difficult in this cohort, but still successful in the majority of cases. Adverse events remain uncommon. Knowledge of forward viewing ERCP techniques is critical in surgically altered anatomy. Future studies will aim to expand the retrospective cohort for more quantitative analysis.

Funding Agencies
None
A117 MANAGEMENT OF VARICEAL BLEEDING WITH ENDOSCOPIC INJECTION OF N-BUTYL-2-CYANOACRYLATE IN PREGNANCY
Authors: Vukovic S , Gallinger Z 
Published: February 2022

Abstract

Background
Although variceal bleeding is rare in pregnancy, pregnant woman with non-cirrhotic portal hypertension are at greater risk of variceal hemorrhage due to increased splanchnic blood flow. Variceal hemorrhage is associated with increased risk of maternal and fetal mortality. Most documented cases of variceal bleeding in pregnancy report the use of elastic ligation for hemostatic management. Histoacryl glue has become increasingly utilized in the acute management and secondary prophylaxis of gastric and ectopic varices in the general population.

Aims
Evidence surrounding the use of Histoacryl glue in pregnancy is limited. We report two cases of variceal bleeding during pregnancy managed successfully with glue.

Methods
Varices were confirmed endoscopically. Images were obtained and reviewed. Aliquots of injected glue were recorded. Maternal and fetal outcomes were monitored during pregnancy and post-partum.

Results
Case 1: A 39-year-old G4P3L0, presented at 20 weeks gestation following several episodes of hematemesis. Urgent esophagogastroduodenoscopy (EGD) revealed hyperemia and portal hypertensive gastropathy in the fundus. A gastric varix with high-risk stigmata was injected with a total of 9mL of 50/50 Histoacryl/Lipodol and bleeding stopped. The patient returned to the hospital two weeks following discharge with melena. Repeat EGD showed mild portal hypertensive gastropathy with a clot at the site of the previous bleeding. No further intervention was required, and the patient delivered at 37 weeks via elective caesarian-section.
Case 2: A 41-year-old G2P0L1 presented at 26 weeks gestation with severe anemia refractory to five units of blood transfusion. Urgent EGD showed a large gastric varix with recent stigmata of hemorrhage, but no active bleed. A total of 13 mL of 75/50 Histoacryl/Lipidol was injected into the varix with no further bleeding. She delivered by elective caesarian-section at 37 weeks gestation. Repeat EGD performed following delivery showed a larger varix with fresh clot at the inferior portion of the fundus. Due to concern for re-bleeding, a total of 4 mL of 50/50 Histoacryl/Lipidol was injected at the site. CT scan post-partum showed prominent gastric varices with glue visualized within the peripheral branches of the portal vein (Figure 1).

Conclusions
Our cases highlight the successful management of gastric varices using Histoacryl glue in pregnancy. Risks associated with Histoacryl glue include glue embolization, local venous thrombosis, as well as extrusion of glue and ulceration. The general complication rate is quoted between 0.5%-5%. One of the two cases was associated with a maternal complication, with evidence of new portal vein thrombosis following injection. The safety of sclerotherapy in pregnancy with cyanoacrylate remains unclear, and further evaluation of the management of gastric varices in this unique population are required.

Funding Agencies
None
A128 PATIENT CHARACTERIZATION AND ASSESSMENT OF REMISSION RATES IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS AFTER INITIAL TREATMENT AND 1-YEAR POST-DIAGNOSIS
Authors: Da Silva S , Bortolin K , Afzal N , Marcon P , Hulst J 
Published: February 2022

Abstract

Background
Eosinophilic esophagitis (EoE) is a chronic immune- or antigen-mediated esophageal disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. With incidence rates rapidly increasing, EoE is the leading cause of food bolus impaction and the second leading cause of chronic esophagitis. The treatment of EoE includes both induction and maintenance therapy to prevent complications including esophageal fibrosis and strictures. Despite significant advances in the diagnosis and treatment of EoE, the natural history and long-term management of the disease remains poorly understood.

Aims
To describe the clinical characterization of children with EoE, and to assess remission rates after initial treatment and 1-year post-diagnosis.

Methods
In this ongoing, single-center retrospective study, the electronic medical charts of children newly diagnosed with EoE between January 2017-March 2021 participating in the EoE-AHEAD Registry study were reviewed. Children aged 6 months-18 years with a confirmed diagnosis of EoE based on consensus guidelines and receiving outpatient care at the SickKids EoE clinic were included.

Results
A total of 37 children with a median age of 11 years (IQR: 4.5, 12.5) were included, the majority of which were male (86.5%). Demographic and clinical characteristics are shown in Table 1. On initial treatment, 2.7% of children were on an elemental diet, 18.9% on a food elimination diet, 40.5% on proton-pump inhibitor (PPI) therapy, 16.2% on topical steroids, 8.1% on systemic steroids, and 13.5% on a combination therapy. Of the 30 children with a second endoscopy (mean interval since diagnosis of 6.1 months (3.9)), 30% achieved histological remission after the initial treatment (see Figure 1). Of the 14 children with a one-year follow-up endoscopy, 14.2% were in remission, 3 of which had relapsed. No significant differences in treatment modality were found between those who achieved remission and those who did not.

Conclusions
This is the first Canadian registry study to examine the longitudinal outcomes of EoE in a pediatric setting. Our preliminary results show that only 30% of children achieved histological remission following first-line treatment. The choice of initial therapy varied, although the majority of patients (62.2%) were prescribed a PPI and/or a topical steroid. Our findings highlight the importance of identifying different disease phenotypes to develop personalized therapeutic approaches for the management of EoE.

Funding Agencies
SickKids start-up funds (JM Hulst) and the Comprehensive Research Experience for Medical Students (CREMS) Program
A131 ESOPHAGEAL MUCOSAL BIOPSIES FOR THE DIAGNOSIS OF NON-EROSIVE REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Rodrigues D , Kataria J , Rivera D 
Published: February 2022

Abstract

Background
Non-erosive reflux disease (NERD) accounts for over half of all cases of gastroesophageal reflux disease (GERD). It is characterized by symptoms of GERD with pathologic acid exposure on ambulatory pH monitoring and no evidence of erosive esophagitis on upper endoscopy. Symptoms and negative endoscopy alone are insufficient to diagnose NERD. Ambulatory pH monitoring is limited due to availability and patient tolerance. Conventional histologic analysis of mucosal esophageal biopsies has been studied in this context but there is no clear guidance as to its utility in diagnosing NERD.

Aims
The purpose of this study was to conduct a systematic review and meta-analysis to determine the sensitivity and specificity of esophageal biopsy histology in diagnosing NERD.

Methods
Data were obtained from Embase (1947- April 2021) and Ovid MEDLINE (1946 – April 2021). We included all studies where esophageal mucosal biopsies were taken and light microscopy was used to analyze histopathology in symptomatic adult NERD patients (i.e., no evidence of erosive esophagitis and ambulatory pH testing confirmed the presence of pathologic acid exposure). Papers were sorted in duplicate. Relevant data was extracted from papers meeting inclusion criteria, including histologic abnormalities and the location of the biopsy. Sensitivities and specificities were calculated from raw data and pooled using RevMan 5.4 software, using asymptomatic patients with no significant esophageal acid exposure and/or patients with functional heartburn (i.e., symptoms but no elevated acid exposure on ambulatory pH testing) as controls.

Results
The search yielded 2871 studies after the removal of duplicates, of which 158 were eligible for full text review. In total, 12 papers met our stringent inclusion criteria and contained raw data that allowed for sensitivity calculations. Histological abnormalities that were commonly reported included gross morphological scores, papillary elongation, basal cell hyperplasia and dilated intraepithelial spaces. Biopsies were taken at &lt;3cm in 5 studies, ≥3cm in 5 studies, and at multiple sites in 2 studies, and all were reviewed by a blinded pathologist. When assessing for the presence of any abnormality in the histological analysis, biopsies taken at &lt;3cm had a pooled sensitivity of 0.70 (95% CI 0.64 – 0.75) and specificity of 0.72 (95% CI 0.63 – 0.77). Biopsies taken at ≥3cm revealed a pooled sensitivity of 0.39 (95% CI 0.32 – 0.47) and specificity of 0.63 (95% CI 0.51 – 0.74).

Conclusions
Esophageal mucosal biopsies have poor sensitivity and specificity at diagnosing non-erosive gastroesophageal reflux disease. Biopsies taken below 3cm appear to have a higher sensitivity and specificity than those taken more proximally.

Funding Agencies
None
A139 EQUITY IN ACCESS TO COLORECTAL CANCER SCREENING IN NOVA SCOTIA
Authors: Sullivan R , Jones J , Williams C , Kilfoil E , MacIntosh D , Stewart M J 
Published: February 2022

Abstract

Background
Population-based colorectal cancer (CRC) screening programs aim to minimize inequities in participation through universal access, however, there remain disparities associated with low education, socio-economic status, and population centre. In the United States racialized groups have lower screening participation, and Black and Indigenous adults have higher CRC mortality. There is no Canadian data on racialized group participation in CRC screening because racial and ethnic data is not routinely collected. The Nova Scotia Colon Cancer Prevention Program (NSCCPP) mails fecal immunochemical tests (FIT) biennially to all residents aged 50–74 and allows for optional self-identified race and ethnicity.

Aims
To determine whether participation rates in the NSCCPP differ on the basis of race/ethnicity, age, sex, or population centre. In this preliminary analysis we report screening participation on the basis of race/ethnicity.

Methods
A retrospective cohort study was performed using the NSCCPP database to identify screen-eligible adults who returned a FIT to the program (i.e. participated) from 2011 to 2021. Racialized groups were identified based on self-identification form results allowing for multiple category selections. Race/Ethnicity was categorized as White, Black/African Canadian, Indigenous, Asian, Middle Eastern. The 2016 Canadian census was used to estimate the screen-eligible population (age 50–74) and race/ethnicity group population sizes. Unique participants were identified as individuals who returned one or more FITs in the study period. Unique participants were compared to the screen-eligible population to estimate participation over the 10-year study period.

Results
508,533 FITs were returned over 10 years by 208,702 unique participants. The number of annual FITs returned ranged from 14,066 in 2011 to 65,746 in 2019. Participants were 56% female, 44% male, with a mean age 62.8 (± 7.0). FIT status was 89% negative, 7% positive, and 4% indeterminate. 96% (n=490,398) of participants provided self-identification data. Table 1 provides the screen-eligible population, unique participants, and FIT participation over the 10-year study period all characterized by race/ethnicity. Over 10 years, 59% of the eligible population participated in CRC screening by returning at least one FIT.

Conclusions
CRC screening participation by race/ethnicity in Canada is unknown. This analysis of the NSCCPP suggests that participation by racialized individuals including Black/African Canadian, Asian, and Indigenous, are lower relative to White individuals. Further analyses will explore race/ethnicity and gender in terms of temporal and geographic trends.
Table 1.

Funding Agencies
None
A143 SAFETY OF BIOLOGICAL THERAPIES IN ELDERLY IBD: A SYSTEMATIC REVIEW
Authors: Golovics P , Drügg Hahn G , Wetwittayakhlang P , Wild G , Afif W , Bitton A , Bessissow T , Lakatos P L 
Published: February 2022

Abstract

Background
There was a significant progress in the medical therapy of inflammatory bowel disease(IBD) with the advent of biological compounds, yet patients may experience adverse events(AE): infusion reactions, serious infections and malignancies, understudied in vulnerable patient populations (e.g. elderly).

Aims
Our aim was to perform a systematic review to assess the safety of the biologic therapies in the elderly IBD population.

Methods
Medline databases and conferences proceedings were searched between January 1, 2010, and June 1, 2021. Two reviewers independently evaluated the collected studies based on inclusion and exclusion criteria. Search was focused on IBD/CD/UC, any biological therapy, and adverse events in the elderly. The methodological quality of the included studies was assessed using the Newcastle– Ottawa Scale (NOS). This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA).

Results
Our search identified 2885 articles and 12 congress abstracts trough the data base search, finally 14 peer reviewed papers and 3 abstracts met the inclusion criteria. The majority of the studies were retrospective, merging IBD patients, with an age limit of 60 or 65 years for elderly, from Europe or North America. The gender ratio was equal except in the USA veteran database. The identified studies collected safety data on anti-TNF therapy, vedolizumab and ustekinumab. We selected studies with at least 1 year follow-up period. Ranges of AE rates(infliximab/adalimumab 6–39/100patient-years (PY), vedolizumab 6–26/100 PY and ustekinumab 6–18.2/100 PY), infection rates (anti TNF 2.5–31/100PY, vedolizumab 2.6–77/100 PY and ustekinumab 5.2–35.7/100 PY) or infusion/injection reactions (anti TNF 0–14/100PY, vedolizumab 0.9–5/100 PY and ustekinumab 0–2.6/100 PY), were not different among the biological medication.

Conclusions
We report for the first time the comparative safety of biological therapies in elderly IBD patients. Ranges of adverse events or infections were wide but not different among the medications. Current data are insufficient to suggest prioritizing among biologicals in the elderly based on the safety, larger studies in elderly IBD patients are warranted.

Funding Agencies
None
A146 THE EFFECTIVENESS OF USTEKINUMAB DOSE ESCALATION IN PATIENTS WITH ULCERATIVE COLITIS
Authors: Albino L , Rosentreter R , Lu C , Siffledeen J , Dieleman L A , Ma C , Baugmart D C , Du L , Halloran B , Kroeker K , Peerani F , Wong K 
Published: February 2022

Abstract

Background
Ustekinumab (UST), an IgG1 antibody that targets IL-12/23, is an effective and safe treatment option for patients with inflammatory bowel disease (IBD). Cohort studies have shown that dose escalation is an effective strategy for reinducing and maintaining remission in Crohn’s disease patients who do not respond or lose response to standard dosing of UST. There are currently no published studies evaluating effectiveness of UST dose escalation in ulcerative colitis (UC) patients.

Aims
To assess the effectiveness of UST dose escalation in patients with moderate-to-severe UC who have not responded to or lost responsiveness to standard maintenance dosing (90mg SC every 8 weeks).

Methods
A retrospective cohort study was conducted at three centers. Consecutive patients with moderate-to-severe UC initiated on ustekinumab were enrolled.

Results
Data on 43 patients (26 males) are reported (to date, patients from 1 of 3 centres have been reviewed). Mean age was 40.2 years (±15.6). Mean duration of disease was 8.5 years (±5.8). Mean duration of follow up while on UST was 8.8 months (±7.2). In total, 28% (12) of patients underwent dose escalation: 8% (1) by way of IV reinduction, 58% (7) through interval shortening (every 4 weeks), and 33% (4) by both interval shortening and IV reinduction. Mean time to first dose escalation was 6.2 months (±4.1). Mean time to second dose escalation was 5.1 months (±1.2). Seven percent (3) of patients discontinued UST, with the mean timeframe being 5.3 months (±2.9). Three patients discontinued UST due to primary non-response with one proceeding onto surgery.
Time to normalization of CRP and FCP after initiation of UST is shown in Table 1.

Conclusions
Preliminary data demonstrates that 28% of patients in this cohort required UST dose escalation, with 33% requiring a second dose escalation. Only 7% of patients discontinued UST at 9 months of follow up. Longer term follow up of this cohort would determine if dose escalation is an effective strategy to extend durability of ustekinumab.
Table 1. Normalization of CRP and FCP

Funding Agencies
None