Journal of the Canadian Association of Gastroenterology最新文献

Background: Button battery ingestions pose a serious threat to paediatric health and are on the rise worldwide. Little is known about Canadian data. This study described the type of button battery ingestions Canadian paediatric physicians have observed, including treatment and complications.

Methods: A Canadian Paediatric Surveillance Program (CPSP) survey was sent to paediatricians and paediatric subspecialists. The questions were developed through a literature review and consultation with 19 CPSP members, before piloting with 5 paediatric physicians. Descriptive analyses were conducted.

Results: The response rate was 39% (n = 1067/2716). Few were aware of treatment options with honey (n = 189/1067, 18%) and sucralfate (n = 118/1067, 11%). Two hundred and ninety-nine physicians (28%) had been involved in a case in the past 1 year (n = 132 case details). Children < 3 years were most affected (n = 67/132, 51%). In unwitnessed ingestions (n = 41/132, 31%), the most common symptoms were dysphagia (n = 14/41, 34%) and coughing (n = 10/41, 24%). When it was known where the child found the battery, it was most commonly loose in the environment (n = 34/132, 26%). Seventy per cent of patients (n = 92/132) presented within 6 h following the ingestion. Six per cent (n = 8/132) reported the battery eroding into important adjacent structures (eg, aorta and trachea).

Interpretation: A high degree of suspicion for button battery ingestion is needed in young children presenting with dysphagia and coughing. Prevention efforts should be aimed at battery disposal and security. There is a need for dissemination of guidelines to physicians caring for paediatric patients, since modifiable patient factors, such as honey and/or sucralfate administration while awaiting definitive treatment, can improve outcomes.

Introduction: Unequal female representation in the field of advanced therapeutic endoscopy (ATE) has been recently highlighted in the United States. Previous attempts to determine the barriers to entry into the career have reported a lack of mentorship, patriarchy, inflexible hours/calls and exposure to fluoroscopy. Canadian trainee exposure to ATE and differences in experience between men and women is unknown.

Objectives: We sought to determine the barriers to pursuing a career in ATE, specifically focussing on the perspectives of Canadian female gastroenterology fellows.

Methods: An online survey was developed and distributed to Canadian gastroenterology fellows enrolled in Royal College-accredited programs in 2021-2022.

Results: Responses were received from gastroenterology fellows at 12 of the 14 Canadian programs. The response rate was 46% (n = 42, 16 female respondents and 26 male respondents). An equal proportion of male (42%, n = 11) and female (38%, n = 6) trainees indicated interest in a career in ATE. Thirty-eight per cent (n = 6) of female trainees felt that they had inadequate mentorship opportunities/role models within ATE, in comparison to 4% (n = 1) of males (P = .004). Furthermore, 19% (n = 3) of females felt that this lack of mentorship/role models was a primary deterrent from pursuing ATE as a career, in comparison to 0% of males (P = .02). There was equal self-perceived competency surrounding ATE knowledge between both men and women.

Conclusions: Female gastroenterology fellows in Canada lack mentorship and role models in ATE, which seems to be a primary deterrent from pursuing it as a career when compared to their male counterparts. Recognizing and addressing the lack of female leadership and visibility is necessary to improve parity and encourage women to train in the male-dominated field of ATE.

Background: Digital health monitoring may help facilitate self-management strategies when caring for patients with inflammatory bowel disease (IBD).

Aims: This study investigated the feasibility of implementing the MyGut health application when caring for patients with IBD and evaluated whether its use improved health outcomes.

Methods: We conducted a prospective trial in 2 Canadian hospitals from 2020 to 2023. Patients with IBD were recruited from gastroenterology clinics, and the MyGut application was installed onto their mobile devices. Metrics such as acceptability, satisfaction, feasibility, quality-of-life scores (measured through the short IBD questionnaire [SIBDQ]), and resource utilization were collected throughout the 1-year follow-up period.

Results: Of the 84 patients enrolled, 58 patients (69%) continued to use the app until the study completion. At recruitment, all 84 patients (100%) were willing to use the MyGut application after a brief tutorial. There was a significant improvement in the SIBDQ scores after 1 year of MyGut use (mean = 56.0, SD 8.85 vs 52.0, SD 9.84) (P = .012). However, only 42.9% (21/49) of the patients were willing to continue using the application after 1 year, a significant decrease compared with the 71.4% (35/49) who were willing to continue after 2 months (P = .001). No differences were observed in the number of emergency room visits/hospitalizations (P = .78) before and after 1 year of MyGut use.

Conclusions: This study demonstrates that patients are willing to use digital health monitoring platforms and this may lead to improved quality of life. However, sustained efforts must be made to optimize its long-term feasibility.

Background: ERCP is a technically demanding procedure that carries a high cumulative adverse event (AE) rate of >10%. Identifying risk factors for adverse events is paramount. Procedure timing, as a surrogate for endoscopist fatigue, has been shown to influence key quality metrics in colonoscopy, but data on this relationship in ERCP is sparse.

Methods: We conducted a retrospective cohort study of ERCP procedures performed by 5 experienced staff endoscopists, with or without advanced endoscopy fellow (AEF) involvement, from January 1, 2010 to December 1, 2020 at St Michael's Hospital, Toronto, Ontario, a regional referral center for therapeutic endoscopy. The primary outcome was the difference in rate of selective deep, duct canulation between AM and PM procedures.

Results: A total of 5672 ERCP procedures were eligible for inclusion. 2793 (49.2%) procedures were performed in the AM and 2879 procedures (50.8%) were performed in the PM. We found no significant difference in the rate of selective ductal cannulation between AM and PM procedures in the unadjusted (82.8% AM vs. 83.1% P-value = .79) or adjusted (OR = 0.98, 95% CI, 0.85-1.12, P-value = .72) analyses. We found no significant difference in the mean procedural duration or rate of perforation between AM and PM procedures. The rate of immediate bleeding was slightly higher in the AM cohort.

Conclusion: In our single-center retrospective study, ERCP quality, including selective cannulation rates and immediate adverse events were not significantly different in procedures performed in the morning compared to those performed in the afternoon.

Background: Complementary and alternative medicine (CAM) use is common in inflammatory bowel disease (IBD) patients and impacts compliance with conventional treatment. Gastroenterologists should understand the motivational factors of CAM use-factors that push patients away from standard therapy or pull towards CAM. Our study describes the motivations behind CAM use for IBD and evaluates differences between Crohn's disease (CD) and ulcerative colitis (UC) patients.

Methods: Retrospective cohort survey of patients over 18 years old with IBD, evaluated by gastroenterologists at a tertiary care referral centre from January 1 to December 31, 2019. Only patients who reported CAM use were included. Chi-square and independent t-tests were performed and P-value <0.05 was significant.

Results: Of the 230 completed surveys, 193 reported CAM use (CD: 57.5% vs UC: 42.5%). Demographics, disease duration, and hospitalizations were similar, but CD patients had lower SIBDQ scores (CD: 48.1 vs UC: 53.5, P < 0.001). Both groups were largely influenced by their social network to use CAM (CD: 33% vs UC: 31.3%) and did not feel well informed about CAM (87.4%). CD and UC patients had similar push and pull factors. Push factors included lack of improvement (39%) and side effects (20%) with conventional treatment. Pull factors included the desire for a holistic approach (21%) and to improve mood (35%). UC patients wanted a natural approach to treat their IBD, which nearly reached significance (P = 0.049). Most patients hoped fatigue 62.7%, and diarrhoea 61.7% would improve with CAM, but more CD patients wanted to improve their appetite (P = 0.043).

Conclusion: Despite differences in QoL, push and pull motivations for CAM use did not differ between CD and UC patients. Most users do not feel well informed of CAM and ongoing dialogue is important for patient-centred care.

[This corrects the article DOI: 10.1093/jcag/gwae018.].