Introduction

Sexual function is an important determinant of quality of life (QoL) and may be affected in patients with perianal fistulizing Crohn’s disease (pCD). However, the literature on this topic is limited in patients with pCD. ​

Aims & Methods

Aims: This study aimed to evaluate the sexual function, the correlation between sexual function and quality of life and to identify potential risk factors for SD in patients with active pCD in a national prospective multicenter cohort study.
Methods: Patients with active pCD were identified from a prospective multicenter cohort study in 41 Dutch hospitals. Respondents on the sexual function (FSFI [female patients] or IIEF-5 [male patients]) and HR-QoL questionnaires (CAF-QoL scale and sIBDQ) were included in this study. Primary outcome was the prevalence of SD (FSFI<26.55, IIEF-5<22). Correlation for SD with HR-QoL was assessed with Spearman’s correlation test. Potential risk factors for SD were identified using multivariable logistic regression.

Results

214 patients with active pCD were included. Median age of the study cohort at inclusion was 37 years (IQR 30 – 51) and 52% of the patients were female. The median CD duration and median pCD duration comprised 8 years (3 – 17) and 4 years (2 – 8). The median FSFI and the median IIEF-5 scores were 19 (IQR 3.0 – 27) and 19 (IQR 9 – 24). Overall SD was reported by 69% of the patients and was more prevalent in female patients (75%) as compared to male patients (63%) without reaching significance (p=0.07). A significant higher CAF-QoL score (i.e. decreased pCD-related QoL)(median score 54 points vs. 35 points, p<0.01) and significant lower sIBDQ (i.e. decreased IBD-related QoL)(median score 46 points vs. 52 points, p<0.01) were observed in patients with SD. In addition, SD patients reported significantly more depressive symptoms (49% vs. 27%, p<0.01) as compared to patients with no SD. Higher rates of fatigue were reported in patients with SD, but did not reach significance. A weak correlation of SD with the CAF-QoL scale (r=0.25) and sIBDQ (r=-0.24) was observed. Multivariable analysis identified an older age (aOR 1.0; 95% CI 1.0 – 1.1), a longer pCD duration (aOR 0.9; 95% CI 0.8 – 0.9) and a decreased pCD-related QoL)(aOR 1.0; 95% CI 1.0 – 1.1) were independently associated with SD (Table 1).

Table 1. Multivariable logistic regression

Conclusion

Sexual dysfunction is highly prevalent in both male and female patients with pCD. A weak correlation between HR-QoL and SD was observed. An older age and a decreased pCD-related QoL were identified as risk factors for SD. Reversely, a longer pCD duration was identified as protective factor. Due to the high prevalence, the sexual function should be evaluated routinely by the treating team. When necessary, a referral to an expert may be considered.

Introduction

Faecal incontinence (FI) is a common problem, affecting about 9% of Western populations. However, only a few patients seek consultation and the number of such patients reaching hospital care is unknown. Current treatment pathways are poorly evidence based and are thought to vary greatly between different countries.

Aims & Methods

Background: The aim of this study was to evaluate the incidence of fecal incontinence (FI) in patients attending colorectal clinics in a global setting, treatment choices and accessibility to diagnostic and treatment tools.

Methods: An international, multi-center snapshot audit was performed in an 8-week period between January 9, 2023 and March 28, 2023. All eligible cross-sectional data was recorded. Data was entered and saved in a REDCap secured database. Two physician- and center-level surveys were filled for current practice evaluation.

Results

1,813 outpatients with FI from 110 hospitals, from 35 countries were included in this audit. Majority of patients with FI were females, parous, and in age range 50-70. Patients most commonly waited 1 to 3 years until seen in outpatient clinic. Etiology skewed toward anal injury and rectal prolapse. Stress incontinence was diagnosed more common than urge incontinence (36% vs 23% respectively). Majority of patients received previous treatment (n=222 (61%)), which mostly included pelvic floor physiotherapy (n=149), bowel retraining with biofeedback (n=114), and nurse-led continence support (n=90). Sacral nerve stimulation was the most commonly performed procedure (n=114/395) for FI in outpatient clinics, followed by sphincterocplastty (n=87/395). Endoanal ultrasound (n=206/1,226) as well as anorectal manometry (n=185/1,1226) are the basic diagnostic tools used to diagnose FI in outpatient settings. More than a half (56%) of clincs have access to pelvic floor MDT. The majority of physicians offer surgical treatment (colostomy or sphincter repair) for FI.

Conclusion

Patients FI wait 1-3 years until attending colorectal clinics. Anal injury and rectal prolapse are the main causes of FI. FI treatment consists of conservative and surgical treatment, and there has not been a single best treatment option.

Introduction

The incidence of caustic ingestion has remained stable in recent years due to its difficult prevention and limited changes in its management.

Aims & Methods

Aims:
1. To explore changes in the epidemiological and clinical characteristics of caustic ingestion over the last decades
2. To identify epidemiological risk factors of adverse outcomes.
Methods: We present data from an observational study that prospectively collected caustic ingestions in our centre since 1995 and included all adult patients whose acute episode was evaluated in the emergency department. Epidemiological data and variables related to the type of ingestion, prognostic risk factors and the adverse outcomes, defined as the need for admission to the intensive care unit, emergency surgery, patient death and oesophageal or gastric stricture development, were analysed; the results were compared for the periods 1995-2009 and 2010-2024.

Results

A total of 582 episodes of caustic ingestion were included, 305 during the first period and 277 during the second.
Epidemiological characteristics and type of ingestion were overall similar in both periods, as were the clinical, analytical, endoscopic and radiologic indicators of severity.
Adverse outcomes were also similar in the two time periods, both in the short term (comparable frequency of intensive care unit admission, need for surgery and death) and in the long term (stricture development).
The main risk groups for severe ingestions were patients older than 45 years (OR 4.3; 95%CI: 2.3-7.9) and psychiatric comorbidity (OR 5.2; 95%CI: 3.0-9.1), especially depressive syndrome (OR 7.2; 95%CI: 4.2-12.4).
Recurrent ingestions were more frequent in men (OR 1.9; 95%CI: 1.0-3.5) and psychiatric illness (OR 7.6; 95%CI: 3.5-16.5), mainly personality disorder (OR 11.0; 95%CI: 5.5-21.9).

	1995-2009	2010-2024	p value
Women	164 (53,8)	133 (48,0)	0,192
Age	44 (30)	50 (30)	0,193
Voluntary intake	154 (50,5)	121 (44,0)	0,139
pH of caustic Strong acid Weak acid Weak alkali Strong alkali	50 (16,9) 17 (5,8) 215 (72,9) 13 (4,4)	40 (14,7) 25 (9,2) 200 (73,3) 8 (2,9)	0,318
Psychiatric illness Depression Bipolar disorder Personality disorder Psychotic disorder Alcohol/toxic substances consumption	155 (50,8) 112 (36,7) 5 (1,6) 28 (9,2) 16 (5,2) 23 (7,5)	119 (43,0) 75 (27,1) 11 (4,0) 20 (7,2) 13 (4,7) 26 (9,4)	0,007 0,016 0,143 0,479 0,908 0,515
Intensive care unit admission	40 (13,1)	29 (10,5)	0,391
Emergency surgery	8 (2,6)	10 (3,6)	0,655
Death	15 (4,9)	19 (6,9)	0,412
Stricture formation	11 (5,1)	8 (3,7)	0,624

Conclusion

No relevant changes were identified in the epidemiological and clinical characteristics of caustic ingestions over the last decades, nor in their evolution. The most vulnerable groups to prioritise prevention measures would be patients with psychiatric cormobility.

Introduction

Endoscopic submucosal dissection (ESD) is widely implemented in Asia. Experience from the western world is still limited, so the evidence on the description of a learning curve (LC) is sparse.

Aims & Methods

The aim of this study is to evaluate the LC for ESD of gastric lesions using accepted proficiency benchmarks (PB).
Retrospective analysis with a prospectively maintained database of all patients undergoing ESD at a Western tertiary center from June 2016 to December 2022.
Inclusion criteria: ESD of gastric lesions performed by a single operator.
Primary endpoint: a LC to estimate the number of ESDs required to achieve PB (>90% for en bloc resection, >80% for histologic margin-negative (R0) resection and resection speeds (RS) >9cm2/hr), using the CUSUM method.

Results

Of 477 ESD performed, a total of 235 ESD met the inclusion criteria.
The en bloc resection rate was 100%. The R0 resection rate was 97% so no statistically significant differences were found, since it was always within PB.
Using the CUSUM method, the LC was divided into learning periods [Phase I - learning phase (cases 1-48); Phase II - adaptation phase (49-72), Phase III - consolidation (from case 73 on).
Globally, after reaching the level of 9cm2/h and after resection 73, the cumulative moving average remains above this speed for all following resections.
Several locations reach moving average proficiency levels at different number of interventions (antrum: from the beginning, body: 134th).

Conclusion

The PB regarding the en bloc and R0 resection were achieved from the beginning.
The PB regarding de RS was achieved from the beginning for the antrum.
The PB regarding de RS, globally, has a clinically significant first learning inflection at ESD number 49 and at ESD number 73 achieved sustained PB for RS.

Disclosure

There are no conflict of interest.