Journal of the Canadian Association of Gastroenterology最新文献

{"title":"Contemporary epidemiology of hepatocellular carcinoma: understanding risk factors and surveillance strategies","authors":"F. Jaber, G. Cholankeril, H. El‐Serag","doi":"10.1093/jcag/gwae025","DOIUrl":"https://doi.org/10.1093/jcag/gwae025","url":null,"abstract":"\u0000 The contemporary epidemiology of hepatocellular carcinoma (HCC) shows a shift in the main etiological risk factors from less common but highly virulent (eg, hepatitis C and B) to more common but weak risk factors (eg, alcohol and metabolic syndrome). Therefore, we are in a seemingly paradoxical state of declining overall incidence rates of HCC-related to improved prevention and treatment of viral hepatitis but burgeoning number of people at an elevated risk of HCC. Several geographic regions have reported an increase in HCC attributable to alcoholic liver disease and metabolic dysfunction associated with steatotic liver disease (MASLD). The importance of risk stratification is increasing to allow for targeted prevention and early detection of HCC. Most risk factors predispose HCC through the formation of cirrhosis, which has served as the main risk stratifying factor. However, this scheme is showing cracks at both ends of the spectrum. On one hand, the risk of developing HCC varies widely among patients with contemporary advanced fibrosis or cirrhosis, and on the other hand up to one-third of MASLD-related HCC occurs among patients with no clear evidence of cirrhosis. The use of multidimensional (eg, clinical, epidemiological, and biochemical) predictive algorithms may improve risk stratification efforts. The shift in HCC risk factors also further heightened the importance and limitations of current surveillance practices (eg, reduced performance of ultrasound in MASLD). Therefore, exploring advanced imaging methods, new biomarkers but also existing combinations of biomarkers augmented by clinical factors for HCC early detection is crucial.","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"14 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141925007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and prioritization of patient-centred strategies to enhance IBD-related care for older adults: a modified Delphi approach","authors":"N. Rohatinsky, Natasha Tooke, S. Fowler, Christian Rueda-Clausen, Dirk Morrison, Judith Winchester, J. Peña-Sánchez","doi":"10.1093/jcag/gwae021","DOIUrl":"https://doi.org/10.1093/jcag/gwae021","url":null,"abstract":"\u0000 \u0000 \u0000 The older adult age group makes up one of the fastest-growing groups of individuals with inflammatory bowel disease (IBD). It is important to hear the perspectives of older adults living with IBD about care experiences and managing their illness. The purpose of this patient-oriented study was to identify and prioritize patient-centred strategies that have the potential to enhance IBD-related care for older adults in Saskatchewan.\u0000 \u0000 \u0000 \u0000 The interprofessional research team, consisting of older adult individuals living with IBD, gastroenterology providers, and researchers specializing in IBD or older adult education used a modified Delphi approach to identify and prioritize strategies that may enhance IBD-related care for older adults. Thirty-one older adults with IBD participated in ranking, revising, and prioritizing statements related to their chronic illness care. Nine statements were developed that highlighted strategies for older adult IBD care.\u0000 \u0000 \u0000 \u0000 Through the consensus process, 6 statements were retained. Co-creating a treatment plan with the IBD provider was ranked as the top priority statement for older adults with IBD.\u0000 \u0000 \u0000 \u0000 Facilitating collaborative relationships and understanding individual priorities for IBD-related care for older adults has the potential to enhance positive health outcomes and quality of life for these individuals.\u0000","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141672690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rectal varices treated by retrograde transvenous obliteration","authors":"L. Rioux, Laurence Dubé, Lauren Said","doi":"10.1093/jcag/gwae016","DOIUrl":"https://doi.org/10.1093/jcag/gwae016","url":null,"abstract":"","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140993941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian colorectal cancer screening programs: How do they measure up using the International Agency for Research on Cancer criteria for organized screening?","authors":"Cindy C Y Law, Li Zhang, A. L. Carvalho, Linda Rabeneck, Alan N. Barkun, Anja Nied-Kutterer, David Armstrong, Clarence K Wong, Diane Lamothe, Donald Macintosh, Catherine Dubé, E. Kilfoil, Jennifer Telford, Nancy N. Baxter, Eshwar Kumar, H. Singh, J. Mcgrath, Laura Coulter, Daniel C Sadowski, Karen Efthimiou, Hendrik DuPlessis, Kelly Bunzeluk, L. Gentile, M. Guertin, B. McCurdy, Michael Kohle, Michael Stewart, Ross Stimpson, S. Antle, Shelley Polos, S. Heitman, Tong Zhu, Simbi Ebenuwah, Judy Kosloski, Melissa Mok, Partha Basu, J. Tinmouth","doi":"10.1093/jcag/gwae015","DOIUrl":"https://doi.org/10.1093/jcag/gwae015","url":null,"abstract":"\u0000 \u0000 \u0000 Canada has one of the highest incidences of colorectal cancer (CRC) worldwide. CRC screening improves CRC outcomes and is cost-effective. This study compares Canadian CRC screening programs using essential elements of an organized screening program outlined by the International Agency for Research on Cancer (IARC).\u0000 \u0000 \u0000 \u0000 We collaborated with the Cancer Screening in 5 continents (CanScreen5) program, an initiative of IARC. Standardized data collection forms were sent to representatives of provincial and territorial CRC screening programs. Twenty-five questions were selected to reflect IARC’s essential elements of an organized screening program. We performed a qualitative analysis of Canada’s CRC screening programs and compared programs within Canada and internationally.\u0000 \u0000 \u0000 \u0000 CRC screening programs exist in 10 provinces and 2 territories. None of the programs in Canada met all the essential criteria of an organized screening program outlined by IARC. Three programs do not send invitations to participate in screening. Among those that do, 4 programs do not include a stool test kit in the invitations. While all provinces met the essential elements for leadership, governance, finance, and access to essential services, there was more heterogeneity in the domains of service delivery as well as information systems and quality assurance.\u0000 \u0000 \u0000 \u0000 There is considerable heterogeneity in the design of CRC screening programs in Canada and worldwide. Programs should strive to meet all the essential IARC criteria for organized screening if local resources allow, such as issuing invitations and implementing systems to track and compare outcomes to maximize screening program quality, effectiveness, and impact.\u0000","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141053957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A88 ADVERSE EVENTS ASSOCIATED WITH ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A SYSTEMATIC REVIEW AND META-ANALYSIS","authors":"H. Guo, K. Bishay, Z. Meng, Y. Ruan, D. Brenner, N. Forbes","doi":"10.1093/jcag/gwad061.088","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.088","url":null,"abstract":"Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is a widely utilized procedure for diagnosing and managing various biliary and pancreatic disorders. Despite its established effectiveness, ERCP is associated with a total adverse event (AE) rate exceeding 10%. However, existing literature lacks a comprehensive synthesis of incidence rates pertaining to specific or overall AEs following ERCP procedures. Aims We performed separate systematic reviews and meta-analyses of (1) data from randomized controlled trials (RCTs) and (2) data from observational studies to evaluate the incidence of AEs following ERCPs in adult patients. Methods Two separate systematic literature searches were conducted to identify ERCP AE rates in RCTs and observational studies published between 2000 and 2021, inclusive. Abstracts underwent independent assessment to identify studies for full-text review and subsequent data extraction. DerSimonian and Laird random effects meta-analyses were applied to determine pooled incidence rates of individual post-ERCP AEs, accompanied by 95% confidence intervals (CIs). The Newcastle-Ottawa Scale (NOS) and Risk of Bias 2 (ROB2) tool were used for quality assessment of observational studies and RCTs respectively. Results Our analysis incorporated 242 RCTs and 143 observational studies. Among RCTs, the pooled incidences of post-ERCP pancreatitis (PEP) in patients with native and non-native papillae were 6.9% (CI 6.2% to 7.6%) and 6.1% (CI 5.3% to 7.1%), respectively. In observational studies, the pooled PEP incidences were 5.0% (CI 4.0% to 6.1%) for patients with native papillae and 4.2% (CI 3.6% to 4.8%) for patients with non-native papillae. The incidences of bleeding for patients with native papillae were 1.6% (CI 1.3% to 2.0%) and 2.2% (CI 1.2% to 3.9%) in RCTs and observational studies, respectively. The incidences of perforation for patients with native papillae were 0.3% (CI 0.2% to 0.4%) in RCTs and 0.5% (CI 0.3% to 0.7%) in observational studies. The incidence of cholangitis was 1.4% (CI 1.1% to 1.9%) in RCTs and 1.1% (CI 0.7% to 1.7%) in observational studies. Conclusions This meta-analysis offers comprehensive insights into the incidence of ERCP-associated AEs from 2000 to 2021, both in idealized study settings where procedures are performed by experts, and in ‘real world’ settings. More precise estimates of ERCP-related AEs can help facilitate patient consent, manage appropriate patient expectations, and enhance peri-procedural care. Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"22 2","pages":"62 - 63"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139777627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A272 EFFECTS OF EMPAGLIFLOZIN ON CHEMICALLY INDUCED COLITIS IN A MOUSE MODEL ARE MODULATED BY SEX AND DIETARY INTERACTIONS","authors":"K. Madsen, B. Villaflor, N. Hotte, A. Thiesen, C Cheng, T. Omeltchenko","doi":"10.1093/jcag/gwad061.272","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.272","url":null,"abstract":"Abstract Background High sugar diets have been shown to dramatically increase disease severity in mouse models of colitis. Empagliflozin (EMPA) is a highly selective sodium glucose cotransporter-2 (SGLT2) inhibitor that is used therapeutically as an antihyperglycemic agent in the management of type 2 diabetes. In human trials EMPA treatment exerts potent anti-inflammatory effects independently of glycemic control. Further, we have previously demonstrated in a genetic mouse model of colitis that EMPA treatment was highly effective in improving colonic inflammation. Based on these findings, we hypothesized that EMPA treatment may also be effective in mitigating disease severity in chemically induced colitis in mice fed a high sugar diet. Aims The aim of this study was to examine the effects of treatment with EMPA on chemically induced colitis in mice fed a high sugar diet Methods At 6-8 weeks of age, wild-type 129/SvEv mice were placed on chow (CH) or high sugar diet (HS) (50% sucrose: AIN76A) ± EMPA (10mg/kg). After two days on the diet, mice were administered dextran sodium sulfate (DSS) for 5 days in drinking water followed by water alone for 2 days (n=4-6 mice for all groups). Disease activity index (DAI) was calculated daily from animal weight change, stool consistency, and stool hemoccult. As a measurement of degree of healing, colonic tissues were evaluated at day 9 for histological changes, weight-to-length ratio, and cytokine levels by ELISA. As a measure of EMPA functionality, urinary and blood glucose levels were measured. Results Mice on the HS diet demonstrated increased susceptibility to colitis compared with chow fed mice with increased colonic levels of IL-1β, weight loss, and DAI. Significant interactions between sex and diet were seen in responses to EMPA treatment. EMPA treatment did not alter severity of colitis but did significantly delay healing in male mice on both the HS and chow diets as evidenced by increased DAI and increased enterocyte injury with increased levels of lamina propria neutrophils and lymphocytes. EMPA treatment did not increase disease severity in females on either diet. No differences were seen in colonic TNFα, IL-10, IL-12p70, or IL-22 between any of the groups. Urinary glucose levels were elevated in mice receiving EMPA and significantly higher in males compared with females (pampersand:003C0.05). EMPA treatment did not alter fasting blood glucose levels. Conclusions A high sugar diet strongly exacerbates disease severity in a sex-dependent manner in a chemically induced model of colitis. Further, contrary to our hypothesis, EMPA treatment did not improve colitis in females and worsened disease in males suggesting that the documented anti-inflammatory effects of EMPA may be condition dependent. Funding Agencies CCC","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"33 8","pages":"219 - 219"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139778295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A184 HCPE CONTRIBUTES TO THE HOST INFLAMMATORY RESPONSE TO HELICOBACTER PYLORI","authors":"C. Creuzenet, N. Salloum, J. Lester, J. M. Takougoum, D. Carroll, K Patel, C. Atanassov, C. Bodet, C. Burucoa","doi":"10.1093/jcag/gwad061.184","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.184","url":null,"abstract":"Abstract Background Helicobacter pylori (HP) colonizes chronically 50% of the world population, leading to gastric ulcers or cancers in 2-10 % of infections. Due to rising antibiotic resistance, curtailing HP-induced diseases requires the identification of new anti-HP molecules that can reduce HP viability or its ability to elicit inflammation. Amongst HP’s virulence factors are the Helicobacter Cysteine-rich Proteins (Hcp) that are secreted outside the bacteria and contain Sel-Like Repeats (SLR) which support protein / protein interactions involved in signal transduction across kingdoms. Several SLR-containing bacterial proteins including HcpA are involved in bacteria / host interactions. Thus, Hcps may affect HP’s virulence via interaction of their SLRs with host proteins. Aims We aim to elucidate the role of Hcps in HP’s virulence. Hcps were considered as immune decoys since anti-Hcp antibodies made in infected patients are unable to clear the infection. However, recent data suggest that Hcps interact with host components and may modulate the function of immune cells. However, their effects on gastric cells remain unknown and functional differences between Hcps remain to be explored. Methods This work uses knockout mutagenesis, interactions with gastric cells, transcriptomics, and microscopy. Results We focus on HcpE, the largest Hcp that may interact with many host proteins via its 9 SLRs motifs. We showed that HcpE is secreted outside HP in 2 lab strains and that ~ 30% of secreted HcpE was comprised in outer membrane vesicles that may deliver HcpE into eukaryotic cells by membrane fusion. We also showed that the DiSulfide Bond forming protein DsbK is essential for HcpE production and secretion. Here, we demonstrate the production and secretion of HcpE by clinical isolates in vitro, and its production in situ in infected patients. Using our HcpE and DsbK knockout mutants, we investigate the role of HcpE and other Hcps in interactions with human gastric cells in vitro and in ex vivo gastric explants, showing a role in inflammation activation. Finally, we demonstrate their role in murine gastric colonization and in murine splenocytes activation. Overall, our data show a role of Hcps in host / pathogen interactions largely due to immuno-modulatory functions and a role in gastric colonization, with a predominant role of HcpE over other Hcps. Conclusions The findings open up possibilities to use Hcps or the gate keeper DsbK that controls their production as novel therapeutic targets to alleviate the burden of HP-associated disease.This could benefit the ~6 million patients who develop gastric ulcers or cancers each year worldwide due to HP infection, also saving billions of annual health care costs. Funding Agencies Western University","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"45 3","pages":"144 - 145"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139778387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A59 EXPLORING THE ROLE OF ARID1A IN COLONIC HOMEOSTASIS AND REGENERATION","authors":"D. Lei, A. Loe, T Kim","doi":"10.1093/jcag/gwad061.059","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.059","url":null,"abstract":"Abstract Background Recent advances in cancer genome analysis have revealed frequently mutated epigenetic regulators as a novel feature in cancer development. Within this context, the Arid1a (AT-rich interactive domain-containing protein 1A) gene, a subunit of the BAF chromatin remodeling complex, has emerged as a frequently mutated gene in many cancers. Additionally, repeated colonic injury caused by diseases such as inflammatory bowel disease (IBD), is also a major risk factor leading to colorectal cancer. Therefore, understanding the connection between colonic epigenetic regulation and its role in response to injury is particularly important for understanding the pathobiology of colorectal cancer. Aims Aim 1: Exploring the role of Arid1a during colonic homeostasis. Mouse model with Arid1a conditionally knocked out in the colon will be analysed at different time points to test whether Arid1a is required during colonic homeostasis. Aim 2: Determining the role of Arid1a during colonic injury and regeneration. Mice will be exposed to a known colitis model to induce colonic injury. Arid1a will be deleted after injury to find out its role during regeneration and recovery from the injury. Methods To examine the effect of Arid1a loss on colonic homeostasis, mice between 6-10 weeks old were injected with 2mg/20g tamoxifen for three days to induce Arid1a knockout using the VilCreERT2; Arid1afl/fl mousseline. Mice were then euthanised using CO2 chamber and analysed 10 days, 3 weeks, and 8 weeks post Arid1a deletion. Histological analysis was performed to examine morphological changes in the colon. To examine the effect of Arid1a on injury caused by colitis, mice were treated with dextran sulfate sodium (DSS) to cause colitis-like injury. Then, Arid1a is deleted by injecting 2mg/20g tamoxifen. Changes in histology and specific cell types will be examined both in the short- and long-term. Results To test whether Arid1a loss alone causes morphological changes in the colon, I compared the crypt lengths between VilCreERT2; Arid1afl/fl mutant mice with their littermate controls and saw that there was no difference in both morphology and length of the crypts. My results show that Arid1a loss in the colon after injury resulted in impaired regeneration characterized by the prolonged loss of goblet cells and cryptal structure in the distal colon. In the long term, Arid1a loss before or after DSS treatment both lead to tumor formation, suggesting that Arid1a is required for colonic regeneration and repair while suppressing tumorigenesis. Conclusions Based on my results, I conclude that Arid1a deletion alone does not cause significant morphological changes in the colon, but this loss affects colonic regeneration and recovery compared to colons with Arid1a intact. In the long term, the dysregulated colonic regeneration may lead to tumorigenesis. Funding Agencies University of Toronto Department of Molecular Genetics","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"65 38","pages":"38 - 39"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139778832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A97 INTERNAL MEDICINE RESIDENT AND STAFF PERCEPTIONS OF GASTROENTEROLOGY ROTATION","authors":"N. K. Klemm, S. Jayakumar","doi":"10.1093/jcag/gwad061.097","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.097","url":null,"abstract":"Abstract Background The choice of subspecialty by internal medicine residents is partially influenced by their experience with that service. Challenges exist between internal medicine and the high acuity, procedurally-heavy, gastroenterology (GI) service. Negative perceptions may limit the number of residents rotating through a gastroenterology elective, impacting knowledge and comfort managing common GI conditions. Aims To identify misperceptions of the GI service at a tertiary hospital, and evaluate resident and new staff comfort in managing common GI conditions. Methods Twenty-question survey sent to internal medicine residents during 2022-2023 and 13-question survey sent to staff that completed training from 2020-2022; both anonymous, and using Qualtrics software. Results The survey was completed by 18% (30/166) of residents and 20% (13/65) of staff. Most staff (62%) practiced in a community setting. Both cohorts cited overnight cross-coverage consults during (56%) and negative word-of mouth (38%), as reasons they avoided a GI elective. Most participants reported a little (33%) or moderate (47%) amount of GI teaching on medicine service and were unaware of formal lectures (79%) during a GI rotation. Residents and staff were most comfortable managing pancreatitis (98%) and ALF (74%). Staff wished for more experience managing pancreatic and liver masses and outpatient IBD flares; however both groups (86%) were unaware of the ambulatory week during the GI rotation. Conclusions Misperception and unawareness of a GI elective persist amongst internal medicine residents and has implications for new staff managing GI conditions. This study has led to action items that address these concerns. Table 1: Resident & staff awareness, perceptions & knowledge of GI Resident Staff Reasons for not completing a GI rotation n=30 (%) n=9 (%) I had adequate experience completing GI consults overnight as Cross-Coverage 15 (50) 7 (78) GI service was too busy during the day 10 (33) 1 (11) I heard from other residents that is was not a good rotation 10 (33) 5 (56) I had not had a good experience with GI when on medicine service 7 (23) 2 (22) Aware of ambulatory week n=30 (%) n=12 (%) No 25 (83) 11 (92) Aware of formal lectures n=30 (%) n=12 (%) No 24 (80) 9 (75) Amount of teaching on GI conditions during medicine service n=30 (%) n=13 (%) None at all 2 (7) 0 A little 12 (40) 2 (15) A moderate amount 10 (33) 10 (77) A lot 6 (20) 0 A great deal 0 1 (8) During my first year as staff, I felt residency prepared me to manage the following GI issues n=13 (%) ALF or ACLF 11 (84) Liver Mass 5 (38) IBD flare - inpatient 3 (23) IBD flare - outpatient 0 Pancreatic mass 6 (46) Pancreatitis & complications 11 (84) Funding Agencies None","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"222 ","pages":"69 - 71"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139836474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A141 RISK OF TOTAL METACHRONOUS ADVANCED NEOPLASIA AFTER DETECTION OF PROXIMAL HYPERPLASTIC POLYPS, ADENOMAS, AND THEIR COMBINATION","authors":"W. Safih, D. von Renteln, I. Popescu Crainic, C. Haumesser, B. Noyon, F. Mubaid, C. Rekkabi, P. Marques, Y Li, R. Djinbachian","doi":"10.1093/jcag/gwad061.141","DOIUrl":"https://doi.org/10.1093/jcag/gwad061.141","url":null,"abstract":"Abstract Background Recent research findings have identified an association between proximal sessile serrated lesions (SSL) and a greater risk of advanced metachronous neoplasia, without significant impact of distal SSL. Aims The principal aim of this study was to assess the risk of total metachronous advanced neoplasia (T-MAN) at the follow-up (fu) colonoscopy after detection of proximal hyperplastic polyps (HP), adenomas and their combination at the initial colonoscopy. Methods Medical records for patients aged 45 to 74 who underwent colonoscopies in both 2014 and 2015 were reviewed. The primary outcome was the presence of T-MAN (comprising advanced adenomas or high-risk SL) during the follow-up colonoscopy depending on the presence of proximal HP, adenoma, or their combination at index colonoscopy. Secondary outcomes included assessing the risk of T-MAN at follow-up depending on index findings characteristics. Results 2014 patients were screened and 764 were included in the final analysis (44.1% male vs 55.9% female; mean age, 63y; median follow-up, 3.46 years). Patients with both proximal hyperplastic polyps and colonic adenomas during their initial colonoscopy had a significantly higher risk of developing T-MAN than patients with a combination of adenomas and distal HP or with only adenomas at index colonoscopy (30.5% vs 19%) [Hazard-ratio (HR)=1.95 (95% confidence interval (CI)1.3-2.9)]. A combination of proximal hyperplastic polyps and colonic adenomas is associated with a higher risk of T-MAN during follow-up than proximal HP alone (30.5% vs 13.9%) [HR=3.4 (95% CI 1.3-8.7)]. No statistically significant evidence was found to identify an increased risk of developing T-MAN at follow-up in patients presenting adenomas alone vs those with only proximal HP (19.1% vs 13.9%) [HR=1.9 (95% CI 0.75-4.7)]. Conclusions Patients with proximal hyperplastic polyps have an increased risk of presenting a T-MAN at the follow-up colonoscopy. Presenting a combination of hyperplastic polyps and adenomas indicates a higher risk of developing T-MAN than presenting an HP or adenoma alone. Funding Agencies Daniel von Renteln is supported by a \"Fonds de Recherche du Québec Santé\" career development award. He has also received research funding from ERBE Elektromedizin GmbH, Ventage, Pendopharm, Fujifilm and Pentax, and has received consultant or speaker fees from Boston Scientific Inc., ERBE Elektromedizin GmbH, and Pendopharm. Roupen Djinbachian is supported by a “Fonds de Recherche du Québec Santé/Ministère de la Santé et des Services Sociaux” clinical research award. The remaining authors declare that they have no conflict of interest.","PeriodicalId":508018,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"126 ","pages":"108 - 109"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139836492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}