Journal of the Canadian Association of Gastroenterology最新文献

Introduction: Foreign body ingestions (FBI) are a common reason for emergency department (ED) visits in children. We hypothesized that increased time spent at home by children due to COVID-19 restrictions could contribute to a rise in FBI ingestion rate and severity. Our primary objective was to evaluate the number of FBI cases at a Canadian tertiary paediatric hospital in Montreal during the pandemic as compared to the two previous years.

Methods: Children assessed at CHU Sainte-Justine ED for FBI between March 2018-February 2020 (pre-pandemic) and March 2020-February 2021 (pandemic) were included. FBI ratio was calculated by dividing the number of FBI cases by the total number of ED visits. Differences between the two groups were analyzed by Student's t-test or Chi-square test.

Results: A total of 614 cases of FBI (median age, 3.5 years; 54% male) were included. The ratio of FBI doubled during the pandemic: 51.7 cases/10,000 ED visits vs 24.0 cases/10 000 visits in the pre-pandemic group (P = 0.0002). The overall number of cases increased significantly during the pandemic period from an average 15.5 cases per month to 20.2. Almost one-fourth of the cohort was hospitalized at similar rates during both observation periods.

Conclusions: The ratio of FBI cases increased significantly during the pandemic in comparison with the two previous years. The high hospitalization rates, although stable during the pandemic, underline the significant morbidity associated with paediatric FBI.

There is an urgent need for analgesics to treat pain that lacks the serious side effects of existing drugs, such as conventional opioids and nonsteroidal anti-inflammatory drugs. Most side effects arise from the non-selective actions of these drugs at sites where the pain is not generated because of the ubiquitous expression of the drug targets in the body regardless of the underlying disease. In this narrative review, we explore 2 mechanistic approaches focusing on visceral nociceptive neurons that have the potential to limit side effects while preserving efficacy. Strategy 1 demonstrates how mechanistic pain studies underlying a specific disorder, such as irritable bowel syndrome, can identify targets specifically upregulated in that condition. We discuss recent findings regarding 2 neuroactive mediators, histamine and proteases, including novel intestinal sources, signalling pathways, and intracellular synergistic actions that could serve as potential therapeutic targets. Strategy 2 examines how acidic microenvironments unique to the sites of inflammation where pain is generated, such as in inflammatory bowel disease, can be exploited. pH-sensitive analgesics have been developed that inhibit μ-opioid receptors at sites of inflammation where tissue pH is low, ie, 6.5, while showing no activity at other sites where tissue pH is normal, ie, 7.4. Collectively, these studies highlight the value of investigating the mechanisms underlying specific disorders, which can lead to novel biomarkers and therapeutic strategies that can enhance the specificity of the new therapies.

Background and study aims: Recent research has identified an association between proximal sessile serrated lesions (SSLs) and an increased risk of advanced metachronous neoplasia (TMAN), with no significant impact from distal SSL. This study aimed to assess the risk of TMAN at follow-up colonoscopy after detecting proximal hyperplastic polyps (HP), adenomas, or their combination at the initial colonoscopy.

Methods: Medical records from patients who underwent colonoscopies in 2014 and 2015 were reviewed. The primary outcome was the presence of TMAN (advanced adenomas or high-risk SSL) at follow-up, based on the presence of proximal HP, adenomas, or their combination during the index colonoscopy.

Results: Out of 2014 patients screened, 764 were included in the final analysis (44.1% male; mean age 63 years; median follow-up of 3.46 years). Patients with both proximal HPs and adenomas during the initial colonoscopy had a significantly higher risk of developing TMAN compared with patients with adenomas and distal HP or adenomas alone (30.5% vs 19%; HR = 1.87; 95% CI, 1.3-2.7). Additionally, a combination of proximal HPs and adenomas posed a higher risk of TMAN than proximal HP alone (30.5% vs 13.9%; HR = 3.6; 95% CI, 1.4-9.5). No significant difference in TMAN risk was observed between patients with adenomas alone versus proximal HP (19.1% vs 13.9%; HR = 1.8; 95% CI, 0.73-4.4).

Conclusion: The presence of both proximal HPs and adenomas significantly increases the risk of TMAN compared with adenomas or HPs alone, highlighting the need for further studies to evaluate the effect of these variables on postcolonoscopy CRC.

Introduction: Patients with surgically altered gastrointestinal anatomy undergoing endoscopic retrograde cholangiopancreatography (ERCP) pose challenges due to anatomical distortions. Various patient and endoscopic factors, such as sex and positioning, may impact procedural success. It is unclear how these factors may impact the technical success of ERCP among patients with altered anatomy.

Objective: We aimed to determine the patient and endoscopic factors that were associated with technical success of ERCP.

Methods: We conducted a retrospective single-centre study using data from 2010 to 2020 that included patients with hepaticojejunostomy, Roux-en-Y anastomosis, Billroth-1, or Billroth-2 anatomy at a single tertiary care centre in Toronto, Canada. We extracted data from a database. The primary outcome was technical success of the ERCP, defined as successful navigation to the papilla or surgical anastomosis, selective cannulation and cholangiography or pancreatography. Penalized logistic regression with elastic net regularization was used to identify significant predictors of technical success. Effect size was odds ratio with 95% confidence interval. The model was evaluated using the area under the curve (AUC) metric.

Results: Overall, there were 205 patients included in the analysis. In the multivariate analysis, the most significant contributors to predicting technical success of ERCP were expert endoscopic experience and non-Roux-en Y anatomy. The elastic net model demonstrated moderate predictive performance, with an AUC of 0.656.

Conclusions: The findings emphasize the importance of tailored procedural planning to optimize ERCP success in patients with altered anatomy.

Background and aims: Endoscopic mucosal resection (EMR) is not systematically taught during most training programs. The aim of this study was to evaluate the effectiveness and clinical utility of a 1-day didactic and simulation-based EMR curriculum for practicing endoscopists without prior formal training in advanced endoscopic tissue resection.

Methods: We designed a 1-day lecture and simulation-based EMR course. Twelve participants completed the course. Effectiveness and clinical utility were evaluated using sequential explanatory mixed methods. All participants completed a pre-course multiple choice question (MCQ) examination followed by a separate, post-course MCQ examination with a similar blueprint. A survey was also conducted to assess cognitive fatigue, perceived benefit, and potential for change in EMR practice. Finally, a delayed MCQ examination was administered 10-14 weeks later to assess knowledge retention and qualitative data were sequentially collected from 3 candidates via semi-structured interviews.

Results: The mean pre-course score was 47.8% (SD 12.4%). The mean post-course score was 75% (9.9%) and the mean delayed score was 70.8% (13.6%), both significantly higher than the mean pre-course score (P < .001; Cohen's d = 1.86 and P < .001; Cohen's d = 1.47, respectively). There was no significant difference between the mean post- and delayed-course test scores (P = .2). Three themes emerged from the interviews: (1) a need for EMR training, (2) improved knowledge evaluating polyps, and (3) changed or refined EMR technique after the course.

Conclusions: This study demonstrates significant knowledge acquisition and retention of cognitive skills and suggests a change in practice following a 1-day focused didactic and simulation-based EMR course.

Aims: Electrosurgical units (ESUs) are essential for tissue dissection hemostasis during ESD. The ERBE VIO 3, enables rapid setting changes, facilitating the swift application of vessel sealing current. Additionally, features such as PreciseSect mode allow dynamic modulation frequency adjustment, making it suitable for submucosal dissection and vessel management. Our comparison of the ERBE VIO3 and 300d aims to assess whether these functionalities enhance the ESD experience.

Methods: From 2021 to 2024, 88 patients undergoing ESD for colorectal lesions were identified from a prospectively maintained database. Lesions were categorized based on the ESU utilized.

Results: Eighty-eight procedures were identified. Forty-four (50.0%) procedures were performed using VIO 3 and 44 (50.0%) using VIO 300d. 40 (45.5%) lesions were colonic and 48 (54.5%) rectal. Median lesion diameter was 4.5 cm. Lesions in the VIO3 group were significantly larger (P = 0.027). All ESDs were completed en bloc. Use of the VIO3 resulted in a significantly fewer uses of coagulation graspers overall (28 vs 23, P < 0.001), fewer uses of coagulation graspers for arterial bleeding (1 vs 2, P < 0.001), fewer uses of coagulation graspers per cm² (0.17 vs 0.58, P < 0.001), and fewer uses of coagulation graspers per minute (0.011 vs 0.066, P < 0.001). This led to a non-significant trend in increased efficiency with use of the VIO3 (4.6 vs 5.1 min/cm², P = 0.667).

Conclusions: The VIO 3 significantly decreased reliance on coagulation graspers, particularly in addressing arterial bleeding. This holds the potential to enhance procedural efficiency, reduce bleeding, and lower costs associated with coagulation graspers usage.

Background: Acute severe ulcerative colitis (ASUC) is associated with significant morbidity. In patients with ulcerative colitis (UC), the estimated lifetime risk of developing severe colitis is 25%. Several gastrointestinal societies have provided recommendations on pathways of care for managing ASUC. The degree to which they are adhered to in different care settings remains unclear.

Methods: We conducted a retrospective review using data from 7 acute-care hospitals collected through the general medicine inpatient initiative (GEMINI), a hospital research collaborative that collects administrative and clinical data from hospital information systems. We identified all patients with the most responsible inpatient discharge diagnosis of ulcerative colitis between April 2015 and December 2019. The primary outcome was the difference in hospital length of stay of patients admitted with ASUC based on hospital-type; community, academic, or inflammatory bowel disease (IBD)-focussed sites.

Results: 765 eligible patients were identified between April 2015 and December 2019. The mean hospital length of stay was 9.21 days for the academic sites, 6.94 days for the community sites, and 8.03 for the IBD specialty centre (P = .094). Adverse events were uncommon overall. In our multiple logistic regression analysis, we identified that admission to an IBD-focussed centre compared to an academic centre, carried an odds ratio of 2.07 (95% CI, 1.16-3.78) for the outcome of inpatient-colectomy.

Conclusions: The processes of care for patients with ASUC varied on the basis of the type of hospital they were admitted to, with the IBD specialty centre providing the most guideline adherent care. Low-cost interventions should be utilized to promote adherence to clinical practice recommendations.

Objectives: Despite rapidly rising rates of pediatric inflammatory bowel disease (IBD), literature exploring the financial burden on families of children with IBD remains limited. This study sought to better understand the socioeconomic burden of pediatric IBD on families at our institution and compare IBD provider practices and perceptions across the country.

Methods: Two separate electronic surveys exploring demographics, financial impacts of an IBD diagnosis, and perceptions around IBD care were developed for patient families and IBD providers respectively. Descriptive statistics and regression analysis took place to assess survey responses. Thematic analysis was also undertaken to qualitatively assess family survey comments.

Results: Patient survey results (N = 69) indicated missed time off work and school and dietary therapy costs as considerable burdens on families. Nearly 60% of respondents also reported significant mental health impacts on the family. Provider data (N = 18) suggests some variability in clinical practice, allied health support, and financial support for families. However, providers almost universally recognize the financial, mental health, and employment impacts on families as significant socioeconomic burdens on families.

Conclusions: This is the first study in Canada to directly explore national provider practices and the socioeconomic burden on families of children with IBD. Results indicate a good correlation between provider awareness and the increased financial burden on families but suggest ongoing care gaps to address impacts on employment, mental health, and out-of-pocket costs. This data suggests that various quality improvement opportunities for research and advocacy exist to better support families, both locally and beyond.