Introduction

Currently, all screenees of the Dutch colorectal cancer (CRC) screening program with a positive faecal immunochemical test (FIT) undergo face-to-face counselling at an outpatient clinic. In order to reduce the burden for screenees and healthcare systems, we have developed a Digital Intake Tool (DIT) for the Dutch CRC screening population. A web-application that facilitates the entire pre-colonoscopy counselling process digitally, eliminating the need for a physician. In this study we evaluated whether the DIT could replace in-person counselling.

Aims & Methods

A prospective non-inferiority trial was conducted in seven centres, including academic and regional hospitals, and endoscopy centres. All participants received DIT-counselling. The DIT guided participants through the counselling process, which included spoken animated videos for patient education, a medical questionnaire for health assessment, and the collection of pre-procedural informed consent. For screenees in who no additional information was required, colonoscopy was scheduled without an in-person visit. The primary outcome was the proportion of participants achieving adequate bowel preparation, defined as a Boston Bowel reparation Scale (BBPS) score of ≥ 6. BBPS scores were compared to patients that received in-person counselling. To assess whether the DIT could replace the ‘human touch’ of in-person counselling, we evaluated patient-reported outcomes related to anxiety, psychological distress and satisfaction as secondary outcomes.

Results

Between October 2021 and September 2023, 1000 (58.8%) out of 1690 approached patients were included. Median age was 64.0 years with 45% being female. DIT-counselling achieved a BBPS of ≥ 6 in 96.5% of the participants, compared to 97.6% after in-person counselling, demonstrating non-inferiority (-1.1%, 95% CI -2.64 – 0.444, non-inferiority margin -8%). A significant reduction in outpatient visits was established, with only 3.4% requiring face-to-face consultations, and 40.9% of the participants could be scheduled for colonoscopy solely via DIT-counselling. After digital counselling, a significant decrease in distress was reported on a 11-point Likert scale (Z = -6.136 p<0.001). Also anxiety levels, measured by the STAI-6, decreased (Z = -3.210 p =0.001). Nearly all participants (98.9%), were satisfied with the information provided, mean score of 8.5 (SD 1.0) and 88.9% would choose the DIT again, while 5.3% preferred face-to-face counselling.

Conclusion

This study showed that digital counselling can replace in-person counselling for FIT-positive screenees of the CRC screening program. An adequate bowel preparation was achieved in >96% of the participants, meeting the 90% requirement of the CRC screening program. A substantial reduction in in-person outpatient visits was established, and patients reported highly positive experiences after digital counselling. Implementing this home-based approach will decrease the burden for patients and healthcare systems. Patients can receive care at the comfort of their own home at their own time, reducing travel and carbon emissions, while healthcare systems increase their outpatient capacity.

Disclosure

This study received a PPP-allowance provided by Health-Holland, Top Sector Life Sciences & Health, to stimulate public-private partnerships.

Introduction

The treatment of symptomatic hemorrhoidal disease (HD) in patients with bleeding disorders (BD) is challenging. This vulnerable group benefits the most from less invasive office-based procedures associated with low bleeding complications, namely polidocanol foam sclerotherapy (PFS).

Aims & Methods

The present study aimed to compare the efficacy and safety of polidocanol foam sclerotherapy (PFS) in the treatment of hemorrhoidal disease (HD) in patients with and without bleeding disorders (BD).
This was a prospective, multicentric, cohort study that enrolled patients with symptomatic internal HD grades I-III with BD (group B) and without BD (group A) following a 18-months period. HD baseline severity was assessed using the Goligher classification, the hemorrhoidal disease bleeding grade (HDBG) and the Sodergren hemorrhoid symptom severity (SHSS) scoring system. Both groups were treated with PFS prepared according to the Tessari´s technique. Patients with congenital BD did not perform prior bleeding prophylaxis and patients with acquired BD due to antithrombotic drugs did not discontinue therapy. The efficacy outcomes included therapeutic success (defined by an improvement of HDBG and SHSS score over baseline) and recurrence of HD (defined by HDBG and SHSS score greater than at the end of the intervention period) during a 12-months follow-up period. The safety outcomes comprised the rate and severity of complications related to PFS.

Results

The study included 228 patients (Group A: 155; Group B: 73). At baseline, the group B presented higher HDBG (p<0.001) and SHSS (p=0.019). The overall therapeutic success rate was 93.4% with an average number of sessions of 1.51±0.74, significantly higher for group B (1.68±0.86 vs 1.43±0.65, p=0.013). A 11.4% complications rate was reported, the majority were mild (96.2%); bleeding complications occurred in 4.8% of the patients. No significant differences were reported between the two groups concerning therapeutic success, recurrence rate, and complications rate.

Conclusion

Patients with BD may present with more symptomatic HD at baseline. Nevertheless, PFS decreased hemorrhoidal bleeding and symptom severity with low incidence of complications in these patients, demonstrating similar effectiveness and safety comparing to patients without BD. Notably, performing PFS did not expose patients with BD to an increased thrombotic risk.

Introduction

Anal wounds resulting from hemorrhoidectomy cause severe pain, with the possibility of postoperative bleeding. Therefore, the recovery rate of anal wounds is closely associated with the degree of patient recovery and, furthermore, quality of life. By accelerating cell migration and proliferation, hyaluronic acid (HA) stimulates tissue regeneration and accelerates wound healing.

Aims & Methods

This study aimed to investigate differences in wound healing rate and completeness of recovery of perianal wounds topically treated with HA-soaked cotton in rat model animals.
Forty-eight, 8-week-old Sprague-Dawley rats with perianal wounds created using a biopsy punch were divided into 2 groups: simple dressing with gauze (control); and topical dressing with HA-soaked cotton. A single application of HA-soaked cotton was performed following surgery. The wound healing rate and completeness of recovery were evaluated by measuring the healed area and histological analyses.

Results

The time required for complete wound healing in the HA-cotton group was shorter than in the control group (13.9 vs 16.4 days; p=0.031). The difference in wound healing area between the two groups was the largest on postoperative day 2 (51.6% vs 28.8%; p<0.001). Upon complete wound healing, fewer cases of granulation tissue (2 vs 5 cases) or redness (0 vs 3 cases) were observed in the HA-cotton group. Compared with the control group, the HA-cotton group exhibited histologically accelerated re-epithelialization, rapid shift to lymphocyte-dominant inflammation, enhanced fibroblast proliferation, and greater collagen deposition.

Conclusion

In a rat model study, HA-soaked cotton topically applied to perianal wounds resulted in an accelerated wound healing rate, especially in the initial stage, and the completeness of recovery improved. These results suggest that the topical application of HA-soaked cotton to hemorrhoidectomy wounds in human patients may improve the wound recovery rate.

Disclosure

This work was supported by grant no. 02-2021-0002 from the SNUBH Research Fund.

Introduction

The current gold standard for diagnosis of Inflammatory bowel disease (IBD) is based on clinical and endoscopic evaluation as well as histologic and radiologic evaluation. However, endoscopic evaluation can be uncomfortable and carry some risks, especially in the pediatric population that requires general anesthesia in order to perform the procedure.

Aims & Methods

Our aim was to investigate whether serum biomarkers can differentiate between pediatric patients with and without IBD. Secondary aims were to determine whether there are biomarkers that can differentiate between Crohn's disease (CD) and Ulcerative colitis (UC), and whether we can predict progression to biologic treatment within one year from diagnosis using these biomarkers.
Pediatric patients undergoing a first diagnostic colonoscopy at British Columbia Children's Hospital (BCCH) between December 2019 and June 2022 were invited to participate in the study. A 2 ml blood sample was taken from each participant at the time of colonoscopy. Demographic and clinical data were collected from each patient. Blood samples were analyzed using the Legendplex^TM flow cytometry kits investigating which included 50 different inflammatory cytokines and chemokines associated with IBD. A prediction model was built via a supervised learning method to determine how well we can predict the different groups.

Results

One hundred pediatric patients participated in the initial study. Five were excluded from the analysis due to uncertain diagnosis. Median age was 13.36 years, 39 were females (41%) and 54 (56.84%) were diagnosed with IBD, with 35 (64.81%) diagnosed with Crohn's disease. On a univariate analysis and Volcano plot 6 biomarkers were found to be strongly associated with the diagnosis of IBD: IL22, IL8, TARC, GROA, MIG, and IL18. The cross-validated AUROC was 0.70. Using SPLS-DA the classification accuracy was improved to 0.84, and MIG was found to be the key biomarker to discriminate between pediatric IBD patients and non-IBD patients.
On a univariate analysis only TSLP was found statistically significant as a predictor of CD, and RANTES and TARC were found as negative predictors for initiating biologic treatment within one year of diagnosis. However, the prediction model did not predict well the subclasses nor progression to biologic treatment.

Conclusion

Using serum biomarkers can predict the diagnosis of Pediatric IBD. MIG was found to be the key biomarker in the prediction model.

Introduction

Colorectal neuroendocrine tumors (NETs) and polyps have similar endoscopic manifestations and are easily misidentified. Due to the low incidence of NETs, it is difficult to obtain adequate images to fit deep-learning models. This study introduced a few-shot learning (FSL) model for the ternary classification of NETs and polyps on endoscopic images.

Aims & Methods

Three classes of endoscopic images (56 serrated lesions and polyps [SLPs], 86 traditional adenomas and 53 NETs) were collected from three datasets. First, three images from each class were randomly selected for Support Set (SS), while others for Query Set (QS). Second, ResNet50 V2 was pretrained based on ImageNet and then on esophageal endoscopic images Third, imaging eigenvectors were extracted based on a dual-pretrained model. Fourth, the Euclidean distances to the nine SS images were calculated for each QS image. Finally, a k-nearest neighbor classifier was used for classification based on Euclidean distances. The proposed FSL model was tested in three rounds.

Results

The performance of the FSL model (macro-area under the curve [AUC], 0.731; macro F1-score, 0.674; Matthews Correlation Coefficient [MCC], 0.526; Kappa, 0.523) was better than that of the traditional ResNet50 V2, junior endoscopist, and senior endoscopist. When identifying NETs, the proposed FSL model achieved the highest accuracy 0.823, sensitivity 0.653, precision 0.673 and F1-score 0.659, whereas the senior endoscopist achieved the highest specificity 0.904.

Conclusion

This study presented a FSL method based on transfer learning and metric learning to distinguish between SLPs, adenoma, and NETs on endoscopic images. This suggests that FSL might be an effective method for computer-aided diagnosis of rare diseases.

Introduction

Gastric adenoma is recognized as a premalignant lesion.¹Much of the literature lumps all adenomas together with different classifications. These are few western reports regarding the prevalence, associated risk factors and outcomes of endoscopic management of different subtypes of gastric adenoma.

Aims & Methods

Aims: The aim of this study is to determine the prevalence, potential predictors, and outcomes of endoscopic management of the different subtypes of gastric adenoma.
Methods: Of 162 consecutive patients who underwent endoscopic resection for gastric lesions between 2017 and 2022 at our center, 79 patients were enrolled. All the hyperplastic polyps (n=37) and subepithelial lesions (n=46) were excluded. The patient clinical characteristics, endoscopic and histopathological features of gastric lesions were retrospectively collected. Patients were divided according to the histological types of gastric adenoma into 4 groups: intestinal group (n= 49), foveolar group (n= 23),pyloric group (n= 6) and oxyntic group (n=1). We statistically compared the clinical and endoscopic features of the three groups. In addition to the analysis of the outcomes of endoscopic resection of gastric adenomas.

Results

Of the 79 patients with a mean follow-up of 2622 months, 51 patients were males (65 %) and 28 patients were females (35%). Forty-nine patients (49/79,62%) had intestinal adenoma, 23 patients (29%) showed foveolar adenoma, 6 patients (8%) developed pyloric adenoma and only 1 patient (1%) had oxyntic adenoma. The mean age was significantly older in the intestinal group (71 ± 13 years vs. 64 ± 16 years vs. 58 ± 18 years, p = 0.03). Intestinal adenomas were significantly associated with family history of gastric adenocarcinoma (14% vs. 4% vs. 0%, p = 0.01) and history of statin intake (39% vs. 26% vs. 0%, p = 0.04).Foveolar adenomas were significantly associated with multiple lesions (≥3 lesions) (p < 0.001) and 0-IIa+IIc Paris classification (6/23, 26%). the size of largest polyp was significantly higher among pyloric group (28 ±15, p= 0.00). Among intestinal group, 33/49 patients (67%) had atrophic gastritis. 82% of the adenomas were resected by ESD with histologically complete resection (R0) in 72/79 patients (91%). Although the difference was not statistically significant (p = 0.4), adenocarcinoma was most frequently encountered among the intestinal adenoma group (17/49, 35%). The post endoscopic resection outcome was comparable among 3 groups with overall recurrence rate (group1:8% vs. group 2:17% vs group 3:17%, P = 0.07) with a comparable mean time to recurrence among three groups (21 ± 17 months vs. 20±17months vs. 14 months, p=0.8). Family history of gastric adenocarcinoma (HR=1.33, p< 0.001) and active helicobacter pylori infection (HR=1.14, p < 0.001) were identified as independent predictors of recurrence after endoscopic resection of different gastric adenoma. Among baseline endoscopic characteristics, polyp size ³ 30mm(HR= 2.04, p< 0.001), more than 3 polyps (HR=1.51, p<0.001), lesser curvature as lesion location (HR=1.72, p< 0.001) and morphology as Paris classification IIc are potential predictors of post resection recurrence. In addition to specimen size ³ 15mm (HR=2.19, p< 0.001) and T1b as lesion histology (HR=2.07, p< 0.001), in the histopathological examination.

Conclusion

The present study clarifies the endoscopic and histopathological characteristics of different gastric adenomas, in addition to the potential predictive factors for each subtype. Potential predictors of recurrence after endoscopic resection emphazie the importance of endoscopic follow up.

References

1. Fujiwara, Y. et al. Diagnosis of borderline adenomas of the stomach by endoscopic mucosal resection. Endoscopy 28, 425–430 (1996).