Journal of the Canadian Association of Gastroenterology最新文献

Background: Accurate and consistent documentation during colonoscopy is essential for optimal patient care and therapeutic decisions. Traditional manual documentation is time-consuming and subject to variability. Artificial intelligence (AI)-assisted tools offer potential improvements by standardizing report generation in real-time. We developed a novel AI-driven, voice-guided reporting platform that uses natural language processing (NLP) and real-time image capture for endoscopy documentation.

Methods: This prospective pilot study was conducted at the Centre Hospitalier de l'Université de Montréal between October 2023 and May 2024. A total of 95 patients undergoing elective endoscopy were recruited, with 57 procedures included in the final analysis. Endoscopists provided real-time verbal dictations during procedures, which the AI-assisted report generation tool transcribed and linked to captured images. The system's performance was evaluated based on documentation completeness, transcription accuracy, and user engagement.

Results: The AI-assisted report generation tool successfully documented key procedural parameters when verbal annotations were provided, achieving an 87.5% detection rate for ileocecal valve identification, and 100% detection rate for procedure indication, Boston Bowel Preparation Score, withdrawal time, and polyp characterization. However, the transcription word error was 10.07%, with errors primarily in medical terminology. User engagement varied, with some procedures lacking dictated annotations.

Conclusion: Our AI-assisted report generation tool demonstrates potential in standardizing colonoscopy documentation through AI-assisted, real-time NLP for generating reports. While effective, its performance depends on endoscopist engagement. Future improvements in NLP capabilities and structured reporting prompts can enhance completeness and usability, contributing to more efficient and accurate endoscopy documentation.

Background: Individuals with inflammatory bowel diseases (IBD) are at increased risk of repeated disease-related hospital admissions, some of which may be preventable with targeted outpatient interventions. We assessed population-level trends in the rates of IBD-specific hospital readmission within 30 and 90 days of index hospitalization among those with Crohn's disease (CD) and ulcerative colitis (UC) during a period marked by major changes to IBD management.

Methods: We accessed Ontario health administrative datasets to study CD (2002-2017) and UC (2004-2020) patients hospitalized for IBD-specific indications. We compared IBD-specific 30-day and 90-day hospital readmission rates across 4 (UC) and 5 (CD) year time periods using multivariable logistic regression, controlling for age, sex, comorbidities, residential setting, household income, hospital type, and clustering of admissions within patients.

Results: Among CD patients, 30-day readmission rates decreased from 9.7% to 7.4%, and 90-day rates decreased from 16.0% to 14.1% between 2002-2007 and 2012-2017 periods. There was a higher likelihood of 30-day readmission during 2002-2007 (adjusted odds ratio [aOR] 1.32; 95% CI, 1.16-1.50) and 2007-2012 (aOR 1.15; 95% CI, 1.01-1.32), and of 90-day readmission during 2002-2007 (aOR 1.14; 95% CI, 1.03-1.26), as compared to 2012-2017. Among UC patients, readmission rates remained stable across time periods.

Conclusion: Inflammatory bowel disease-related early rehospitalization risk has declined over time among individuals with CD but not among individuals with UC.

Background: Inflammatory bowel disease-related psychological distress (IBD-PD) refers to the emotional impact of IBD and has been shown to be associated with increased disease severity, comorbid mental health disorders, and increased mortality.

Aims: This study aims to identify the facilitators for accessing evidence-based interventions for IBD-PD to inform the design and implementation of patient-centred models for IBD mental health support in the future.

Methods: This was a qualitative research study in which a semistructured interview script was developed by a multidisciplinary team guided by the domains of the COM-B Behaviour Change Wheel framework. Using thematic analysis, codes were generated to identify themes using an inductive approach.

Results: Fourteen participants were successfully recruited (n = 14). Thematic analyses identified the following major themes: (1) mental health should be treated as an integrated component of specialty IBD care; (2) use of self-help strategies alongside existing supports is feasible, acceptable, and accessible; (3) accessing support for IBD-PD through virtual care is often acceptable; and (4) flexible, multifaceted delivery models for IBD-PD are needed. All participants felt that mental health should be discussed at IBD clinic visits. Preferences for hybrid formats for IBD-PD care were clear. Most participants felt that it was important for psychological support persons to also have IBD knowledge. Participants felt strongly that a more qualified psychologist, even in the absence of IBD knowledge, was their top priority.

Conclusions: Some key facilitators identified from this study include healthcare professionals discussing IBD-PD directly with their patients, offering hybrid formats for IBD-PD, and integrating self-help strategies into care.

Objective: Proton pump inhibitors (PPIs) are widely prescribed but inappropriate indications and concerns over long-term side effects have led to recommendations to deprescribe PPIs in certain patients. We previously found a 4-fold increase in PPI deprescription in patients with esophageal strictures. This study aims to assess the PPI deprescription rate in patients with upper gastrointestinal bleeding (UGIB).

Methods: All patients from 2 gastroenterology practices who received endoscopic treatment for UGIB during the years of 2015-2022 were identified using physician billing codes. We defined PPI deprescription as either a 50% dose reduction, frequency reduction, or complete medication discontinuation at the time of endoscopic intervention compared to the established PPI therapy from the 3 months prior. We compared the rate of PPI deprescription between 2 time periods 2015-2018 (group 1) and 2019-2022 (group 2).

Results: Three hundred one UGIB managed with endoscopy were analyzed. Patients in group 2 had a significantly higher rate of PPI deprescription than group 1 (15% vs 4%; P < .002). Patients with peptic ulcer disease (PUD) had a significantly higher PPI deprescription during the second time period (16% vs 0%; P = .028). Among patients with repeat UGIB, 10% had their PPI deprescribed.

Conclusions: Proton pump inhibitor deprescription in patients with UGIB treated with endoscopic intervention was more common in the second time period. This corresponds to when PPI deprescription guidelines were distributed. Physicians should ensure the appropriate application of PPI deprescription guidelines and continuation of PPI therapy for patients with strong indications.

Background: Literature from procedural specialties reveals gender differences amongst trainees regarding work-life balance, career goals, and workplace discrimination.

Purpose: To determine the impact of gender on gastroenterology resident experiences.

Methods: A 70-question cross-sectional survey was electronically disseminated to gastroenterology trainees across Canada. Survey questions addressed personal, professional, financial, and training characteristics. Comparisons were made between self-identified men and women. Wilcoxon test was used for continuous variables. Chi-squared test and Fisher's exact test were applied for categorical variables. Qualitative thematic analysis was applied for short answer responses with 2 independent reviewers.

Results: Forty-four trainees were surveyed, with 41% women. At work, women were more likely to have their clinical competency challenged than men (35% vs 8%, P = .024) and report difficult relationships with support staff (35% vs 0%, P = .001). Most trainees planned to complete further gastroenterology training (86%), but males were more likely to choose therapeutics (36% vs 0%, P = .033). Women more commonly were the predominant caregiver for children (67% vs 8%, P = .012) and felt that having children would slow their career advancement (77% vs 33%, P = .046). Men were more likely to prefer having children during residency (50% vs 7%, P = .036). No statistical difference was found between genders regarding desire for advanced subspecialty training, leadership aspirations, or academic pursuits.

Conclusion: Gender-related differences exist amongst Canadian gastroenterology trainees regarding work-life balance and career advancement. Women may benefit from supports to allow them to meet career goals which are similar to their male peers.

Purpose: Primary sclerosing cholangitis (PSC) is a cholestatic liver disease that frequently coexists with inflammatory bowel disease (IBD). The risk of infections in patients with concurrent PSC-IBD remains unclear. The aim of this study was to identify the event rate of infections and associated risk factors in PSC-IBD patients.

Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 12, 2024 for studies examining event rate or risk factors for infection in patients with PSC-IBD. The primary outcome was the event rate of all-cause and site-specific infections as well as infection-related mortality. The secondary outcome was risk factors for infection. Random-effects models were used to calculate pooled odds ratios (OR) with 95% confidence intervals (CI) comparing the event rate of all-cause infections in PSC-IBD patients to those with just PSC and just IBD. I ² values more than 50% suggested substantial heterogeneity.

Results: Eighty-one studies were included. The pooled event rate of all-cause infections in patients with PSC-IBD was 25.1% (95% CI, 17.0%-33.2%, I ² = 99.2%). PSC-IBD patients had significantly increased odds of all-cause infection (OR 3.67, 95% CI, 2.07-6.52, I ² = 41.9%), sepsis (OR 3.35, 95% CI, 2.29-4.91, I ² = 9.1%), and infection-related mortality (OR 11.25, 95% CI, 2.03-62.37, I ² = 0) compared to those with IBD but not those with PSC.

Conclusion: Patients with PSC-IBD appear to be at increased risk of all-cause infection, sepsis, and mortality compared to those with IBD alone.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is valuable in management of primary sclerosing cholangitis (PSC). Herein, we characterize individuals with PSC who underwent ERCP on-demand at a high-volume quaternary centre, with evaluation of pathology results and short-term postprocedural outcomes.

Methods: This retrospective cohort study evaluated patients with PSC who underwent ERCP at St Michael's Hospital between April 2011 and July 2021. Chart review was conducted to collect clinical, procedural, and pathology data, and reported post-ERCP complications within 90 days. Logistic regression analyses were conducted to evaluate factors associated with post-ERCP complications and placement of a biliary stent.

Results: One hundred and sixty-seven patients with PSC underwent 464 ERCPs (69% males, median age 45 years). The median duration of PSC diagnosis prior to ERCP was 6.7 years and 42% of procedures were in patients with cirrhosis. Symptoms pre-ERCP included jaundice, abdominal pain, subjective fevers, and pruritus. Stent insertion at procedure was associated with presentations with jaundice or elevated bilirubin, prior stent insertion, and/or concern for malignancy. Stent insertion was also associated with post-ERCP complications within 90 days. Neoplastic pathology was identified in 20% of cytology samples and 27% of biliary biopsies. There were no significant differences in symptomology at presentation between patients with and without neoplastic pathology.

Conclusion: Primary sclerosing cholangitis patients undergoing ERCP have high symptom burden and rates of neoplastic pathology, with high rates of recurrent obstruction post-ERCP. Stent insertion is associated with a sicker PSC phenotype and higher risk of post-ERCP complications. Future studies are needed to further explore the role of ERCP in management of PSC.

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.