Journal of the Canadian Association of Gastroenterology最新文献

Background and aim: Accurate measurement of resected colorectal polyps is essential for clinical management, research, and the development of artificial intelligence-based size estimation systems. Despite widespread use of caliper-based measurement for specimen sizing, formal validation against a reference standard is lacking. This study aimed to validate caliper-based measurement of resected small and diminutive colorectal polyps against high-resolution digital microscopy, a previously validated reference method.

Methods: At the Centre hospitalier de l'Université de Montréal, 143 polyps from 92 patients were measured immediately after resection using vernier digital calipers in the endoscopy suite. Independent measurements were subsequently obtained using high-resolution digital microscopy under blinded conditions. Agreement between methods was assessed using bias analysis, Bland-Altman limits of agreement, intraclass correlation coefficient (ICC), and categorical size concordance.

Results: Caliper-based measurements demonstrated a mean bias of -0.22 mm (95% CI: -0.34 to -0.11; P < .001) relative to the reference standard. The noninferiority hypothesis with a 0.5-mm margin was not rejected (lower 95% CI > -0.5 mm). Bland-Altman's limits of agreement were -1.57 to 1.12 mm, and the ICC was 0.88 (95% CI: 0.82-0.92). Correct categorical classification occurred in 94.4% of cases (95% CI: 0.89-0.97; κ = 0.81).

Conclusion: Caliper-based measurement provides accurate and reproducible estimates of polyp size when compared with digital microscopy, supporting its use for clinical and research applications requiring direct specimen measurement.

Background: Music therapy is a low-cost and low-risk intervention that has been shown to improve patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in various areas of medicine including gastrointestinal (GI) endoscopy. A scoping review was performed to answer the following research question: What is known from the existing literature about the effect of music therapy used in adult GI endoscopy on PROMs (eg pain, anxiety) and PREMs (eg satisfaction, willingness to repeat procedure)?

Methods: Guided by the methodologic framework proposed by Arksey and O'Malley, 3 medical databases were queried for articles pertinent to the research question and published between January 2005 and December 2024. Studies were selected for inclusion based on established criteria and summarized in a comprehensive data table as well as accompanying figures.

Results: A total of 30 original research articles were selected for inclusion. The most reported outcomes were pain (N = 21), anxiety (N = 21), and satisfaction (N = 14). Significant improvements following music therapy were described most commonly for anxiety (N = 15, 71% of 21) and satisfaction (N = 10, 71% of 14) and less commonly for pain (N = 11, 52% of 21). Reductions in pain and anxiety were more consistent for music interventions performed in the pre-endoscopy period.

Conclusions: Music therapy appears to be an effective means of improving anxiety and satisfaction in patients undergoing GI endoscopy. Endoscopists should consider music therapy as a non-pharmacologic adjunct to improve the patient experience in endoscopy.

Background: Small bowel bleeding accounts for about 5%-8% of all cases of gastrointestinal bleeding. Suspected small bowel bleeding (SSBB) can be classified into occult, inactive overt, and overt. Most patients with SSBB will undergo balloon-assisted enteroscopy (BAE) for diagnosis and treatment. There are currently no recommendations from practice guidelines on what is the best approach and limited information about diagnostic and therapeutic yields for each subtype of SSBB.

Aims and methods: We aimed to investigate the diagnostic and therapeutic yields of BAE in the 3 subtypes of patients with SSBB by performing a retrospective analysis of all patients that underwent BAE for this diagnosis at the University of Alberta Hospital in a 5-year period. We also aimed to identify other factors that could influence diagnostic and therapeutic yields.

Results: The overall diagnostic and therapeutic yields of BAE for SSBB were 66% and 51%, respectively. When stratified by subtypes of SSBB, the diagnostic yield for occult, inactive overt, and active overt SSBB were reported to be 61%, 67%, and 95% (P < .05), respectively. BAE performed within 72 hours of presentation and patients requiring transfusion within the past 12 months had a significantly higher diagnostic yield.

Conclusions: Our data showed the clinical differences between the 3 subtypes of patients with SSBB and the usefulness of an appropriate and timely approach to maximize the diagnostic and therapeutic yields.

Background: Telemedicine offers a promising approach to reduce the carbon footprint of healthcare delivery by minimizing travel-related greenhouse gas emissions. In this study, we quantified the carbon emissions savings from shifting gastroenterology clinic visits from in-person to telemedicine in a single gastroenterologist's clinic in a major urban Canadian centre that serves a mixed urban and rural Canadian population.

Methods: A cross-sectional analysis was conducted on 5690 telemedicine encounters from March 2020 to March 2022 at a tertiary-care gastroenterology clinic in Winnipeg, Manitoba, for a single gastroenterologist. Carbon emissions related to travel from home to clinic were estimated. The values are presented as CO2e, a standardized measure used to compare and aggregate the impact of different greenhouse gases on global warming. Travel distances were estimated using driving routes or flights for non-drivable locations. Clinic operational emissions were also estimated to assess total potential savings.

Results: The total potential travel distance avoided was 880 336 km. Rural patients accounted for 92.7% of this distance. The average CO2e emissions saved per encounter was 42.9 kg, with rural encounters averaging 106.7 kg and urban encounters 4.6 kg. Clinic operational emissions were minimal at 0.06 kg of CO2e per encounter, compared to travel-related emissions. Over the 2 years, telemedicine visits saved approximately 244 079 kg of CO2e, underscoring the significant environmental benefit of virtual care.

Conclusion: Telemedicine reduces the carbon footprint of gastroenterology outpatient care by minimizing patient travel, especially for rural populations. Incorporating telemedicine into routine practice can promote environmental sustainability within healthcare systems.

Background and aims: This study explores the effectiveness of vedolizumab dose escalation among patients with ulcerative colitis or Crohn's disease who experienced a suboptimal or loss of clinical response in a Canadian real-world cohort.

Methods: Patients with moderately to severely active ulcerative colitis or Crohn's disease treated with vedolizumab were prospectively followed in a patient support program in Canada from 2015 to 2023. In patients who dose escalated to every 4 weeks from every 8 weeks intravenous maintenance dosing, Harvey-Bradshaw Index and Partial Mayo Scores were assessed 12 and 52 weeks after dose escalation. Clinical remission was defined as Harvey-Bradshaw Index < 5 or Partial Mayo Score < 3.

Results: This study included 924 patients with Crohn's disease (45% bio-naïve) and 1816 patients with ulcerative colitis (71% bio-naïve). Of patients with Crohn's disease, 39% bio-naïve and 54% bio-experienced dose-escalated within the first 2 years. Of patients with ulcerative colitis, 39% bio-naïve and 50% bio-experienced dose escalated within the first 2 years. For Crohn's disease patients receiving every 8 weekly intravenous maintenance dosing who were not in clinical remission, 50% bio-naïve and 23% bio-experienced patients were in clinical remission 12 weeks after dose escalation, while for ulcerative colitis, 43% bio-naïve and 35% bio-experienced patients were in clinical remission 12 weeks after dose escalation, which was sustained through 52 weeks.

Conclusions: For patients who experienced a suboptimal or loss of clinical response to vedolizumab, this study supports the real-world effectiveness of intravenous vedolizumab dose escalation in improving clinical response and clinical remission rates among patients with ulcerative colitis or Crohn's disease.

Background: As inflammatory bowel disease (IBD) becomes increasingly common worldwide, optimizing service delivery is critical to ensuring timely access to high-quality IBD care. We conducted a scoping review to understand the extent and type of evidence related to models of outpatient IBD care.

Methods: We searched MEDLINE, EMBASE, CINAHL, and PsycINFO from inception to April 29, 2025 to identify English-language studies describing or evaluating models of care delivery for individuals with IBD in outpatient settings. Eligible peer-reviewed articles included publications of any type (primary studies, reviews, perspectives) focusing on any age group, timepoints in care (eg, transition from pediatric to adult care), and context (eg, remote delivery).

Results: Of the 14,202 records searched, 243 met the inclusion criteria, including 89 studies evaluating models of care, 141 studies describing models of care without formal evaluation, and 13 consensus statements/guidelines. Models discussed included value-based multidisciplinary teams (with either biomedical or biopsychosocial approaches), care provided by nurses and other allied healthcare professionals (HCPs), remote monitoring and healthcare delivery, and rapid access clinics. Models increased patient satisfaction, enhanced collaboration between patients and HCPs, reduced health services utilization (eg, emergency department visits, hospitalizations), and improved patient outcomes (ie, disease activity, mental health, quality of life). Gastroenterologists, IBD nurses, and allied HCPs were consistently identified as key team members.

Conclusions: Innovative outpatient models of IBD care have been proposed and evaluated. These models of care can guide modifications to IBD care globally to help address the rising demand of IBD on healthcare systems, increasing the efficiency of care.

Background: Evaluating small bowel Crohn's disease (SBCD) often relies on cross-sectional imaging (eg, computed tomography enterography [CTE]) and small bowel endoscopy (eg, balloon-assisted enteroscopy [BAE]). The accuracy of CTE for evaluating SBCD compared to BAE remains unclear and is assessed in this study.

Methods: This single-centre retrospective study included patients with SBCD who underwent both CTE and BAE within 6 months. Findings of active inflammation, long-segment disease, skip-segments, and presence of both strictures and high-grade strictures (HGS) were extracted from CTE and BAE reports and analyzed using BAE as the reference standard.

Results: Sixty-three CTE and BAE pairings were identified. CTE was sensitive for assessing active inflammation (80.0%) and all strictures (92.1%) and specific for long-segment inflammation (95.0%) and HGS (87.2%). Sensitivity was low for HGS (60.9%) and long-segment inflammation (50.0%), with poor specificity for all strictures (68.4%). In surgically naïve bowel, accuracy improved for active inflammation (sensitivity: 83.3%, specificity: 100%) and worsened for HGS (sensitivity: 42.9%, specificity: 84.2%). In postsurgical bowel, CTE sensitivity for HGS improved to 68.8%.

Conclusion: Computed tomography enterography accurately detected active inflammation and fibrostenotic disease but may not be sufficient to rule out clinically significant findings such as HGS. The accuracy of CTE varied between surgically naïve and postsurgical bowel. CTE remains an important modality for evaluation of SBCD and should be used in combination with BAE when clinical discrepancy arises.

Background: Access to inflammatory bowel diseases (IBD) specialist care is a predictor of health outcomes. We sought to characterize the impact of the pandemic on patterns of IBD healthcare delivery and whether it compromised overall access to care.

Methods: We identified adults with an IBD diagnosis residing in Ontario between 2016 and 2021 using administrative data at ICES. We determined quarterly rates of in-person and virtual IBD specialist visits and stratified that by regions with high and low access to IBD specialists. We stratified our analyses into 3 periods: pre-COVID, immediate COVID, and maintenance COVID. We performed interrupted time series analysis to assess for time trends.

Results: During the immediate COVID phase, there was a 69% relative quarterly decline in in-person IBD specialist visits with a concurrent 591% relative quarterly rise in rates of virtual visits. Entering the COVID maintenance phase, there was a 7% quarterly relative decline in the rate of in-person visits, and a 7% and 4% quarterly relative increases in the rates of virtual and total IBD specialist visits, respectively. Pre-pandemic, IBD patients residing in regions with high specialist access had a 16% higher rate of visits than those in low-access regions. During the COVID maintenance phase, the disparity was reduced to 12%.

Conclusions: During the COVID-19 pandemic, the rapid transition from in-person to virtual IBD specialist care led to a slight increase in overall IBD visits. There was also a small decrease in the gap in rates of IBD specialist visits between high- and low-access regions.

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus that effects both pediatrics and adult patients in Canada and is increasing in prevalence. No Canadian focused best practice recommendations currently exist to guide clinical practice.

Methods: The study used a modified Delphi technique to develop evidence and expert opinion-based recommendations for providing care for patients with EoE. The Delphi process consisted of 3 rounds of quantitative surveys and qualitative consensus meetings. Experts were included in the Delphi if they had experience caring for EoE patients in Canada within one of the following professional groups: allergist, adult gastroenterologists, pathologists, pediatric gastroenterologists, and dieticians.

Results: Delphi rounds were completed between May 1, 2024, and June 30, 2024. A total of 31 experts in EoE care from across Canada were recruited to participate in the Delphi consensus process. All participants completed all 3 rounds of Delphi surveys. The final statement includes 38 recommendations for the care of patients with EoE organized into 3 sections: definition, diagnosis, and management. A table of research gaps is provided to stimulate further knowledge development on this topic.

Conclusion: This consensus statement includes actionable recommendations to support quality care of patients with EoE at any age across Canada. We encourage EoE centres in Canada to come together in a multidisciplinary form to not only provide clinical care but also do much needed research on Canadian specific topics and gaps in EoE care.