Journal of the Canadian Association of Gastroenterology最新文献

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.].

Background: Computed tomography of the head (CT head) is frequently used for patients with cirrhosis presenting with suspected hepatic encephalopathy (HE).

Aims: The primary aims of this study were to assess the frequency of CT head usage in this patient population and to determine whether these scans yielded significant findings. Our secondary aims were to identify factors associated with the decision to order CTs and whether patients who received CTs had different outcomes.

Methods: A single-centre, retrospective chart review was performed. Patients presenting to the University of Alberta Hospital with cirrhosis and common liver disease aetiologies over a 27-month period were identified via discharge diagnosis codes. Charts of patients with suspected HE were manually identified. The use of a CT head was documented, as were patient demographics, cirrhosis aetiology, MELD, and outcomes. Comparisons were made between patients with and without CT head.

Results: A total of 119 encounters from 100 patients met our inclusion criteria. In 57% of encounters, a CT scan was performed on presentation. None of these CT scans had significant findings. Patient factors associated with the decision to order CT included older age, more preserved liver function, and longer length of time between patient's current and previous presentations. Patients who did not receive CT head had higher in-hospital mortality, which was likely reflective of more severe underlying liver dysfunction in this group.

Conclusions: The frequency of CT head usage in the studied patient population was high while the yield was low. This calls into question the usefulness of CT head in this population.

Background and aims: Endoscopic treatment is a definitive and cost-effective management strategy for early neoplasia in Barrett's oesophagus (BE). However, little is known of its impact on quality of life (QoL). This study reports outcomes of endoscopic eradication treatment (EET), focusing on QoL and costs in a Canadian tertiary referral centre.

Methods: A retrospective cohort study using a prospectively maintained clinical database captured validated QoL metrics during and at the end of EET, risk factors for BE, treatment response, complications, costs, and follow-up response of all treated Barrett patients in Calgary and Southern Alberta, Canada.

Results: A total of 147 BE patients were treated from 2013 to 2021. All patients showed significant improvement in almost all QoL parameters except depression. There was significant improvement in 7 of the 8 QoL metrics in those who achieved complete eradication of intestinal metaplasia (CEIM). EET was successful in achieving complete eradication of dysplasia (CED) and CEIM in 93.4% and 74.3% of patients, respectively, with a median of 3 radio frequency ablation treatments. Longer circumferential segments of BE (Cx) predicted a lower likelihood of achieving CEIM. The average total cost to achieve CED and CEIM were $10 414.58 and $9347.93CAD, respectively (compared to oesophagectomy estimated at $58 332.30 CAD).

Conclusion: This Canadian cohort reports significant post-treatment improvement in QoL parameters in patients treated to CEIM or CED over an 8-year period. EET for BE eradication is cost-effective compared to oesophagectomy. There was a low rate of complications and recurrence post-CEIM.

Background: In steroid-refractory acute, severe, ulcerative colitis (ASUC), salvage medical therapy with infliximab is recommended to reduce the risk of colectomy. However, the evidence supporting this practice is based on cohorts naïve to biologics. Consequently, the management of patients on biologic or small molecule therapy (BST) with ASUC is not well defined.

Methods: We conducted a retrospective chart review of patients admitted with ASUC to Mount Sinai Hospital (MSH) in Toronto, Ontario from January 2018 until January 2022. Included subjects were considered to be on BST if they had received a dose of these agents within 56 days prior to admission. Our outcomes of interest included the mean difference in hospital length of stay (HLOS), rates of surgical consultation, rates of inpatient colectomies, and 90-day readmission rates between the 2 groups.

Results: Of the 185 admissions for ASUC, 76 were on BST prior to admission and 109 were not. Baseline characteristics were similar between the 2 groups. There were no significant differences in hospital length of stay (7.46 days vs 7.45 days P = .52) or in-hospital colectomy rates between the 2 groups. Patients on BST had higher rates of surgical consultation (36.8% vs 8.3% P < .01) and 90-day readmission rates (26.3% vs 13.8% P = .03).

Conclusions: We did not identify significant differences in the majority of our outcomes between the 2 groups. However, patients on BST were more likely to receive a surgical consultation during their admission and had higher rates of readmission at 90 days. Further studies evaluating the underlying factors that contribute to readmission in patients on BST in hospitals are needed.