Introduction

The highest risk factor of inflammatory bowel disease (IBD) is having a first-degree relative (FDR) with IBD. Although the prevalence of IBD in Norway is among the highest in the world, its incidence has remained steady throughout the 21st century.

Aims & Methods

In this era of stable incidence, we wanted to explore the role of a positive family history of IBD. The rate of having at least one FDR with IBD in the adult IBD population was estimated in two population-based IBD incidence cohorts conducted in South-Eastern Norway. One in 1990-1994 (IBSEN) (0.9 M inhabitants in 1992) and the second 30 years later, in 2017-2019 (IBSEN III) (2.95 M inhabitants in 2017). We compared the phenotype of IBD, age at diagnosis (AAD) with standard deviation, the distribution of disease and severity of IBD, between sporadic and familial cases of IBD in the two cohorts. Severe disease was defined as extensive colitis in Ulcerative colitis (UC), and the presence of perianal, stricturing, or penetrating disease in Crohn`s disease (CD). Further, those who reported more than one FDR with IBD in the IBSEN III cohort were invited to participate in a multiplex-family IBD study. In this multiplex-family cohort, we explored the generational differences in AAD, the severity of disease, and the association between the length of shared household and the phenotype of IBD. Chi-square and t-test were used for categorical and continuous variables, respectively. Tests of equal proportions were performed to compare the rate of familial IBD in the IBSEN and IBSEN III cohorts.

Results

Overall 785 adults aged >18 years were included in the IBSEN cohort (1990-1994) and 1561 in the IBSEN III cohort (2017-2019), of whom 7.3 % (57) and 10.9% (170) reported a positive family history of IBD, respectively. The rate of familial IBD increased by 49.3% (p=0.008) over 30 years.
In the IBSEN III cohort, there were no significant differences in mean AAD between familial, 38.7 (14.5) and sporadic cases, 39.1 (15.0) of IBD (p=0.739), nor between mean AAD in familial CD, 39.4 (14.0) and UC, 38.4 (14.7) (p=0.664), compared to sporadic CD, 40.4 (15.8) (p=0.678) and UC, 39.2 (15.0) (p=0.587).

Among familial and sporadic cases of IBD, 45/170 (26.5%) and 449/1391 (32.3%) had severe disease, respectively (p=0.124). Of familial IBD with severe disease, 10/55 (18.2%) and 35/115 (30.4%) suffered from CD and UC, respectively (p=0.090).
Among sporadic cases of IBD, 87/451 (19.3%) with CD and 362/ 940 (38.5%) with UC suffered from severe disease (p< 0.001). In the multiplex IBD cohort, we included 30 children and 18 parents with familial IBD. The mean AAD was 25.1 years (13.0) among the children and 33.3 years (16.5) among the parents (p=0.063). Eight of twenty-six children (30.8%) and 9/16 (56.3%) among the parents reported severe disease (p=0.102). The length of shared households within multiplex families from the initial IBD diagnosis among FDRs to subsequent diagnoses of CD or UC in others, was 11.78 years and 17.14 years, respectively (p=0.026).

Conclusion

The rate of a positive family history of IBD has increased substantially over thirty years, underscoring the importance of shared environmental factors for the development of the IBD diagnosis. Severe disease was associated with UC among familial cases as well as among sporadic cases of IBD. Shorter time of shared household was significantly associated with development of familial CD.

Disclosure

Vendel A. Kristensen has reported advisory boards from Takeda and Tillotts Pharma, consultant fees from Janssen Cilag, Takeda, and speaker fees from Thermo Fischer Scientific.
Marte Lie Høivik has reported investigator-initiated research grants from Takeda, Pfizer, Tilllotts, Ferring and Janssen, speaker honoraria from Takeda, Tillotts, Ferring, AbbVie, Galapagos, MSD and Meda and Advisory board Takeda, Galapagos, MSD, Lilly, Janssen, Pfizer and AbbVie.
The other authors of this abstract have no Conflict of Interest.

Introduction

Plastic biliary stents that have not been removed for more than 12 months are considered forgotten stents. In this study, we sought to evaluate which factors are associated with forgetting biliary stents and their consequences.

Aims & Methods

Retrospective analysis, in a high-volume ERCP unit, of patients who underwent ERCP between 2016 and 2023 with placement of plastic biliary stents. Procedures in which the patient died or the prosthesis was surgically removed less than 1 year after its placement were excluded.

Results

A total of 555 procedures in 425 patients (49% female, age 68.9±16.8 years) were included. The reasons for placement were: malignant stenosis 29.2% (n=162); choledocholithiasis 23.8% (n=132); benign stenosis 22.7% (n=126); bile leak 7.2% (n=40); acute cholangitis 6.7% (n=37); Mirizzi syndrome 4.7% (n=26); gallstones 4.3% (n=24); post-sphincterectomy bleeding 0.9% (n=5); intrahepatic lithiasis 0.5% (n=3).
Thirty-four procedures (6.1%) with forgotten stents were identified in 34 patients (35.3% female, age 64.4±17.3 years). The most frequent reasons for non-removal were: non-referral after cholecystectomy (n=15) or after hospital discharge (n=11). Among the indications for placement, gallstones (OR 9.71, p &lt; 0.001) and Mirizzi syndrome (OR 3.02, p = 0.049) were associated with an increased risk of forgetting the device.
In 10 patients, extraction was endoscopic, 2 had spontaneous migration, 1 had surgical extraction, and 7 patients died for unrelated reasons. The rest (n=14) were recruited for removal during this study. A total of 9 patients of this group responded to the call and it was confirmed the spontaneous migration of the plastic stent in na abdominal radiography.
8 patients (23.5%) presented complications: acute cholangitis (n=4), jaundice (n=2), abdominal pain (n=1) and liver abscess with septic shock (n=1).

Conclusion

Forgotten stents constitute a rare event but with a significant risk of complications. Following this analysis, we created a database in order to improve the timing until the extraction of stents and reduce related adverse events.