Clinical Case Summary

Background: Crohn’s disease (CD) is a chronic inflammatory condition frequently managed with biologic therapies. While venous thromboembolism (VTE) is a recognized complication in inflammatory bowel disease (IBD), certain biologics, including JAK2 inhibitors, have been linked to increased thrombotic events. This case report describes a rare instance of recurrent, unprovoked pulmonary embolism (PE) in a CD patient receiving Vedolizumab (VDZ).
Case presentation: A 45-year-old male with a long-standing history of CD experienced recurrent disease flares. His medical history included an ileo-colonic resection and anastomotic revision, after which he developed a provoked PE requiring long-term anticoagulation. Previous treatments, including infliximab, Adalimumab, Ustekinumab, Methotrexate, and 6-MP, had failed before he was started on VDZ monotherapy, which effectively controlled his colitis. Despite intensified anticoagulation, he had four hospitalizations for unprovoked PE within a year. A comprehensive hematologic evaluation, reviewed by a consultant haematologist, ruled out any underlying thrombophilic disorders. Given concerns about a potential association between VDZ and recurrent VTE, the medication was discontinued, and the patient was transitioned to Risankizumab. After four months, no further VTE episodes were reported.
Discussion & conclusion: Emerging evidence, including a study by Cross et al. (2017), suggests that patients treated with VDZ have a higher risk of thrombotic complications. This case highlights a potential, yet rare, association between Vedolizumab and recurrent PE in CD patients. Clinicians should remain vigilant when prescribing VDZ, particularly in patients with a history of thromboembolic events. Further research is needed to explore this association and guide clinical decision-making.

References

https://www.researchgate.net/publication/316370555_The_Incidence_of_Cardiovascular_Events_in_Patients_with_Crohn's_Disease_Treated_with_Vedolizumab_and_Anti-TNF_Therapies

Disclosure

No Conflict of Interest

Introduction

Women have been historically underrepresented in gastrointestinal endoscopy research. Understanding the current patterns of female authorship is essential to assess progress and identify persistent gaps within this field.

Aims & Methods

This study aimed to evaluate the representation of women as first and senior (last) authors the three highest-impact journals in gastrointestinal endoscopy (Endoscopy, Gastrointestinal Endoscopy and Digestive Endoscopy) from 2015 to 2024. For each publication, we extracted bibliometric data of original articles, review articles and editorials, including the names of the first and senior authors, their primary country of affiliation, and the year of publication. Countries and territories were categorized by geographic region. Author gender was predicted using Genderize.io software (https://genderize.io), and only authors with ≥80% gender prediction accuracy were included.

Results

We analyzed 4,414 publications. Among first authors, 885 (20.15%) were women from 36 countries and 3,507 (79.85%) were men from 49 countries. Most female first authors were affiliated with institutions in North America (36.61%), while most male first authors were based in Asia (40.82%). The greatest gender disparity among first authors was observed in Asia (male-to-female ratio = 6.8), and the lowest in Europe (male-to-female ratio = 2.5). Among senior authors, 433 (11.51%) were women from 32 countries and 3,328 (88.49%) were men from 47 countries. Female senior authors were most frequently from Europe (38.57%), whereas male senior authors were again predominantly from Asia (41.12%). The largest disparity in senior authorship was in Oceania (male-to-female ratio = 44), and the lowest in Latin America (male-to-female ratio = 4.1). Notably, the odds of a woman being the first author nearly doubled when the senior author was also a woman. Overall, over the 10-year period, the male-to-female ratio among first authors improved from 4.46 (2015–2016) to 3.25 (2023–2024), and among senior authors from 9.10 to 6.43.

Conclusion

Women remain underrepresented in first and senior authorship positions in gastrointestinal endoscopy research. These disparities may be influenced by limited female representation and mentorship in the field. Although gender gaps have narrowed over the past decade, sustained and coordinated efforts are needed to promote equity in academic publishing.

Introduction

Artificial intelligence (AI) characterization (CADx) systems for colonic polyps exhibit high diagnostic accuracy. However, they may only support, not replace, clinical decision-making and little is known of this human-AI interaction – even less so with trainee endoscopists. This issue is difficult to explore, but data from a study investigating CADx-supported trainee endoscopists compared to AI-blinded experts could give insight.

Aims & Methods

This analysis draws on data from a prospective observational study comparing the diagnostic performance of CADx-supported trainee endoscopists (using GI Genius®, Medtronic) to expert endoscopists blinded to AI support. Two key scenarios were explored: (a) instances in which the CADx system produced a ‘no prediction’ output, and (b) cases where trainees actively overruled AI-generated diagnoses. These were assessed to examine the impact of AI absence and human-AI discordance on diagnostic accuracy.

Results

The baseline cohort included 11 trainees performing 225 colonoscopies, mean age 63.8 years (SD 12.7), 48.9% male patients. Baseline ADR was 57.8%. Of 630 resected lesions (median size 3 mm, IQR 2;4), 40.0% were in the rectosigmoid, and 53.6% were non-adenomatous. CADx failed to provide a prediction in 19.2% (n=121) of cases. These ‘no prediction’ polyps were smaller (median 3 mm, p=0.048) and more often located in the right colon (72% vs. 58%, p=0.005. In the absence of AI support, trainee diagnostic accuracy declined significantly by 12.8% (63.6% vs. 76.4%, p=0.007). Interestingly, expert endoscopists—despite being blinded to AI—also performed worse on these polyps (64.7% vs. 73.9%, p=0.045), suggesting an inherent difficulty in classifying these lesions.
Trainees overruled AI suggestion leading to discordant diagnoses in 9.0% (57/630) of polyps, comprised of 20 (35.1%) non-adenomatous, and 37 (64.9%) adenomatous lesions. Trainees incorrectly overruled AI in 59.6% (34/57), which mostly consisted of downgrading lesions to NICE 1. Discordant polyps did not differ in size (3 mm vs. 3 mm, p=0.413), but were more often located proximally (77.2% vs. 58.1%, p=0.005). The difference in false negative rate (FNR) between trainees and AI was 62.16% (81.07% vs. 18.92%, p<0.0001), demonstrating a risk of missed adenomas when trainees override AI. Blinded expert endoscopists achieved identical overall diagnostic accuracy in those polyps as the AI system (59.6%). However, their error profiles differed – In this subset, blinded experts and AI performed equally in overall accuracy (59.6%), although with differing error profiles: AI showed a numerically lower FNR (18.9% vs. 35.1%, Δ16.2%, p=0.17), offset by a higher false positive rate (80.0% vs. 50.0%).

Conclusion

CADx systems generate ‘no prediction’ outputs in a substantial proportion of polyps, significantly impairing trainee diagnostic performance. These cases may represent inherently more challenging lesions. Despite CADx’s high accuracy, trainees overrule AI in almost every tenth polyp, most often incorrectly downstaging polyps. Structured training on appropriate use of CADx, emphasizing both its capabilities and limitations, may enhance clinical effectiveness. Further research on human-AI interaction and trust is warranted, as these factors will be critical for successful integration of CADx into routine endoscopic practice.

Disclosure

The original study (AC-CADx) received technical support by Medtronic. Medtronic was not involved in the design of the study or analysis of the data, neither in the original study nor this exploratory analysis.