Journal of the Canadian Association of Gastroenterology最新文献

{"title":"Correction to: Quality of life, clinical outcomes and cost utilization of endoscopic therapy in patients with Barrett's esophagus and early esophageal cancer-an 8-year Canadian experience.","authors":"","doi":"10.1093/jcag/gwae026","DOIUrl":"https://doi.org/10.1093/jcag/gwae026","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/jcag/gwae018.].</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 5","pages":"393"},"PeriodicalIF":0.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11477983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended flexible sigmoidoscopy using water exchange facilitates a complete colon examination without sedation in participants undergoing average risk colorectal cancer screening: results from a randomized trial.","authors":"Adrian Bak, Brent Parker, Rafael Perini, Arshbir Aulakh, Caio Oliveira, Wes Richardson, Peter Hirschkorn, Barry Sullivan, Magda Recsky, Tess Orlando, Felix Leung","doi":"10.1093/jcag/gwae024","DOIUrl":"10.1093/jcag/gwae024","url":null,"abstract":"","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 6","pages":"403-410"},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An incidental choledochoduodenal fistula discovered during gastroscopy","authors":"Andrea M Kulyk, Justin Flood, Jennifer Jin","doi":"10.1093/jcag/gwae023","DOIUrl":"https://doi.org/10.1093/jcag/gwae023","url":null,"abstract":"","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"35 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141805349","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":"The usefulness of head computed tomography in patients with known cirrhosis presenting to emergency department with suspected hepatic encephalopathy.","authors":"David Yi Yang, Joel Bowron, Mohammed Ahmed, Juan G Abraldes, Sander Veldhuyzen van Zanten","doi":"10.1093/jcag/gwae022","DOIUrl":"https://doi.org/10.1093/jcag/gwae022","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography of the head (CT head) is frequently used for patients with cirrhosis presenting with suspected hepatic encephalopathy (HE).</p><p><strong>Aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 5","pages":"346-351"},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11477969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life, clinical outcomes and cost utilization of endoscopic therapy in patients with Barrett's esophagus and early esophageal cancer-an 8-year Canadian experience.","authors":"Joel David, Matthew Woo, Stephen Congly, Christopher N Andrews, Thurarshen Jeyalingam, Paul J Belletrutti, Milli Gupta","doi":"10.1093/jcag/gwae018","DOIUrl":"https://doi.org/10.1093/jcag/gwae018","url":null,"abstract":"<p><strong>Background and aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 5","pages":"368-375"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11477975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of large gastric polyp as an adenoid cystic carcinoma metastasis.","authors":"Kosuke Suzuki, Hiroaki Saito, Kimihiro Igarashi","doi":"10.1093/jcag/gwae019","DOIUrl":"10.1093/jcag/gwae019","url":null,"abstract":"","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"8 4","pages":"115-116"},"PeriodicalIF":2.7,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of patients admitted with acute, severe ulcerative colitis on biologic therapy: a retrospective analysis from a tertiary referral hospital.","authors":"Nasruddin Sabrie, Manisha Jogendran, Rohit Jogendran, Laura E Targownik","doi":"10.1093/jcag/gwae017","DOIUrl":"10.1093/jcag/gwae017","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 <i>P</i> = .52) or in-hospital colectomy rates between the 2 groups. Patients on BST had higher rates of surgical consultation (36.8% vs 8.3% <i>P</i> < .01) and 90-day readmission rates (26.3% vs 13.8% <i>P</i> = .03).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 4","pages":"306-311"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical guidance for managing patients with moderate-to-severe ulcerative colitis using small molecule therapies.","authors":"Vipul Jairath, Waqqas Afif, Brian Bressler, Janet E Pope, Daniel Selchen, Laura E Targownik, Remo Panaccione","doi":"10.1093/jcag/gwae013","DOIUrl":"10.1093/jcag/gwae013","url":null,"abstract":"<p><p>Ulcerative colitis (UC) is a severe and debilitating illness that affects the quality of life and physical health of many Canadians. Given the dynamic and progressive nature of the disease, advanced therapies are required to support its long-term management. The emergence of small molecule therapies offers novel treatment options that target mechanisms central to the immunopathology of UC. Sphingosine-1-phosphate (S1P) receptor modulators and Janus-activated kinase inhibitors are 2 classes of therapies that target unique pathways to attenuate inflammation and modulate the immune response characteristic of UC. This review aims to provide practical guidance on how these therapeutic options can best be used to optimize treatment management and highlight the emerging role of small molecule therapies as a treatment strategy for UC.</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 4","pages":"282-289"},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indication for endoscopic retrograde cholangiopancreatography and development of hemorrhage: a systematic review and meta-analysis.","authors":"Michael K Parvizian, Mitchell V Edwards, Prem Bhoey, Melanie C Zhang, Lawrence C Hookey, David M Rodrigues","doi":"10.1093/jcag/gwae014","DOIUrl":"https://doi.org/10.1093/jcag/gwae014","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhage is a common complication associated with endoscopic retrograde cholangiopancreatography (ERCP), usually following sphincterotomy. Studies investigating risk factors for hemorrhage including ERCP indication have been conflicting. Therefore, we conducted a systematic review and meta-analysis to characterize the association between the ERCP indication and hemorrhage.</p><p><strong>Methods: </strong>Database searches of MEDLINE, EMBASE, and CENTRAL were conducted to identify articles up to December 12, 2022. Randomized trials or observational studies of adult patients undergoing ERCP were included. Quality assessment using the Cochrane Risk of Bias 2.0 and Newcastle-Ottawa Scales for randomized trials and observational studies respectively was conducted. A random effects meta-analysis generating pooled odds ratios with 95% confidence intervals was conducted.</p><p><strong>Results: </strong>A total of 1323 articles were identified of which 26 were included with up to 25 121 subjects in each meta-analysis. Rates of sphincterotomy (median 96.1%; IQR 60.5-100), biliary stent placement (median 17.2%; IQR 10.6-34.4), antiplatelet use (median 6.0%; IQR 0-10.1), and anticoagulant use (median 1.9%; IQR 0%-3.2%) varied among included studies. No specific indication was associated with hemorrhage in the meta-analyses including cholangitis (OR 1.50; 95% CI 0.97-2.32), choledocholithiasis/biliary stone (OR 1.28; 95% CI 0.95-1.73), malignancy (OR 0.97; 95% CI 0.66-1.42), sphincter of Oddi dysfunction (OR 1.32; 95% CI 0.72-2.40), and acute pancreatitis (OR 0.81; 95% CI 0.44-1.49).</p><p><strong>Conclusions: </strong>Overall, no indication was significantly associated with increased hemorrhage following ERCP. However, given limitations in the included studies (ie, significant heterogeneity between studies), additional research to better characterize these associations is needed.</p><p><strong>Protocol registration number: </strong>PROSPERO (CRD42021283978).</p>","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":"7 5","pages":"352-367"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11477979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship among vedolizumab drug concentrations, biomarkers of inflammation, and clinical outcomes in a Canadian real-world study","authors":"C. H. Seow, J. K. Marshall, Stewart Erin, Christopher Pettengell, Ryan Ward, W. Afif","doi":"10.1093/jcag/gwae010","DOIUrl":"https://doi.org/10.1093/jcag/gwae010","url":null,"abstract":"\u0000 \u0000 \u0000 Therapeutic drug monitoring is used to optimize anti-tumour necrosis factor biologic effectiveness in inflammatory bowel disease, but its role with other biological classes is unclear. This study explores relationships between post-induction vedolizumab trough concentrations and biochemical outcomes in a real-world study of individuals with inflammatory bowel disease.\u0000 \u0000 \u0000 \u0000 This retrospective analysis of data from a national patient support program between 2018 and 2020, included 436 individuals with Crohn’s disease or ulcerative colitis receiving vedolizumab. Optimal vedolizumab concentration thresholds (at weeks 6 and 14) were determined based on their ability to predict biochemical normalization (week 30 faecal calprotectin [<250 µg/g], C-reactive protein [<5 mg/l]). Thresholds best associated with each outcome were evaluated in multivariate analyses.\u0000 \u0000 \u0000 \u0000 Among patients with Crohn’s disease, week 6 serum vedolizumab concentrations (>41.65 µg/ml) predicted normalization defined by C-reactive protein: Spearman correlation coefficient [ρ] = −0.26, P = 0.002 and multivariate analysis (MVA)—OR: 3.22, 95% CI: 1.32–7.87, P = 0.01, and at week 14 (>22.25 µg/ml): ρ = −0.38, P < 0.0001, and MVA—OR: 3.21, 95% CI: 1.26–8.17 but not faecal calprotectin. Similarly, among patients with ulcerative colitis, week 6 vedolizumab concentrations (>39.65 g/ml) predicted normalization defined by C-reactive protein: ρ = −0.26, P = 0.005 and MVA—OR: 4.03, 95% CI: 1.30–12.52, P = 0.016, and at week 14 (>17.35 µg/ml): ρ = −0.39, P = 0.0001 and MVA—OR: 6.95, 95% CI: 1.81–26.77, P = 0.005, but not faecal calprotectin.\u0000 \u0000 \u0000 \u0000 Induction and post-induction serum vedolizumab were not consistently associated with biochemical normalization. As such, proactive therapeutic drug monitoring for vedolizumab should not be routinely incorporated in a treat to target strategy for inflammatory bowel disease.\u0000 \u0000 \u0000 \u0000 NCT04567628.\u0000","PeriodicalId":17263,"journal":{"name":"Journal of the Canadian Association of Gastroenterology","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140385366","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}