Visualization Of Mucosa Research Articles

Spectrum aided vision enhancer enhances mucosal visualization by hyperspectral imaging in capsule endoscopy.

Narrow-band imaging (NBI) is more efficient in detecting early gastrointestinal cancer than white light imaging (WLI). NBI technology is available only in conventional endoscopy, but unavailable in magnetic-assisted capsule endoscopy (MACE) systems due to MACE's small size and obstacles in image processing issues. MACE is an easy, safe, and convenient tool for both patients and physicians to avoid the disadvantages of conventional endoscopy. Enabling NBI technology in MACE is mandatory. We developed a novel method to improve mucosal visualization using hyperspectral imaging (HSI) known as Spectrum Aided Visual Enhancer (SAVE, Transfer N,Hitspectra Intelligent Technology Co., Kaohsiung, Taiwan). The technique was developed by converting the WLI image captured by MACE to enhance SAVE images. The structural similarity index metric (SSIM) between the WLI MACE images and the enhanced SAVE images was 91%, while the entropy difference between the WLI MACE images and the enhanced SAVE images was only 0.47%. SAVE algorithm can identify the mucosal break on the esophagogastric junction in patients with gastroesophageal reflux disorder. We successfully developed a novel image-enhancing technique, SAVE, in the MACE system, showing close similarity to the NBI from the conventional endoscopy system. The future application of this novel technology in the MACE system can be promising.

The Gastroscopy RAte of Cleanliness Evaluation (GRACE) Scale: an international reliability and validation study.

mucosal visualization during upper gastrointestinal (UGI) endoscopy can be impaired by the presence of foam, bubbles, and mucus. Some UGI endoscopy visibility scales were proposed but without a multicenter validation. This study aimed to develop and validate the Gastroscopy RAte of Cleanliness Evaluation (GRACE) scale. a multicenter international cross-sectional study was conducted. The GRACE scale is based on a score from 0-worst to 3-excellent of esophagus, stomach, and duodenum, for a total ranging from 0 to 9. In the first phase, four expert endoscopists evaluated 60 selected images twice with a two-week interval; in the second phase, the same 60 images were scored twice by one expert and one non-expert endoscopist from 27 different Endoscopy Departments worldwide. For reproducibility assessment and clinical validation, a real-time scale application was performed on consecutive patients undergoing gastroscopy in each center. in the internal validation, the interobserver agreement was 0.81 (95%CI[0.73-0.87]) and 0.80 (95%CI[0.72-0.86]), with a reliability of 0.73 (95%CI[0.63-0.82]) and 0.72 (95%CI[0.63-0.81]), in the two rounds, respectively. In the external validation, the overall interobserver agreement was 0.85 (95%CI[0.82-0.88]) with a reliability of 0.79 (95%CI[0.73-0.84]). In the real-time evaluation phase, the overall percentage of correct classifications was 0.80 (95%CI[0.77-0.82]). the GRACE scale showed good interobserver agreement and reliability and good validity. The spread of this scale could enhance the quality and standardize the cleanliness of the mucosa assessment during UGI endoscopy, pushing endoscopists to obtain excellent visibility and reducing the risk of missing lesions.

Novel ultrasound capsule endoscopy for gastrointestinal scanning: An in vivo animal study.

EUS is an important modality for diagnosis and assessment of gastrointestinal (GI) subepithelial lesions. However, EUS is invasive and operator-dependent and requires sedation in most cases. The newly developed ultrasound capsule endoscopy (USCE) system, with both white-light and ultrasound imaging modalities, is a minimally invasive method for superficial and submucosal imaging of the esophagus. This animal study aimed to evaluate the feasibility and efficacy of the USCE system for upper GI tract and small bowel scanning. Three Bama miniature pigs were selected to scan their esophagus, stomach, small bowel, and simulated submucosal lesions. USCE was performed first, followed by EUS. The feasibility of USCE was measured by obtaining ultrasound images of normal GI walls and submucosal lesions under the guidance of optical viewing. The efficacy of USCE was evaluated by comparing tissue structures and lesion features shown on ultrasound images obtained with both instruments. Under the optical mode of USCE, the GI tract was well visualized, and all simulated lesions were located. Clear ultrasound images of normal GI tract and submucosal lesions were acquired. Ultrasound images of the esophagus, stomach, and small bowel were characterized by differentiated multilayer structures on USCE, which was consistent with the structures displayed on EUS. And the visualization of submucosal lesions, using both USCE and EUS, was characterized by a hypoechoic and well-demarcated mass in the layer of submucosa. This animal study indicated the feasibility and potential clinical efficacy of this USCE for simultaneous optical mucosal visualization and transmural ultrasound imaging of upper GI tract and small bowel, providing possibility of using this technology for a wider range of GI tract.

Effectiveness of a Mobile Health Application for Educating Outpatients about Bowel Preparation.

Colonoscopy is an essential method for diagnosing and treating colorectal cancer, relying on effective bowel preparation to thoroughly examine the large intestinal mucosa. Traditional education involves printed instructions and verbal explanations but does not guarantee clear patient understanding. Poor bowel preparation can obscure mucosal visibility, delaying cancer diagnosis and treatment. A mobile medical model using Android devices for bowel preparation education was tested in a single-blind, randomized trial. This trial enrolled outpatients undergoing colonoscopy at the Endoscopy Center for Diagnostic and Treatment between 27 October 2021 and 31 December 2022. This study introduced the ColonClean app alongside traditional methods. After examination, endoscopists rated the preparation quality using the Aronchick scale. A data analysis was conducted using SPSS 25.0 to determine if there was a significant improvement in bowel preparation quality between the control group (traditional method) and the experimental group (traditional method plus the ColonClean app). Forty patients were recruited in each group. In the experimental group, all ratings were "fair", with 75% receiving an "excellent" or "good" rating, showing statistical significance (p = 0.016). The ColonClean app improves bowel preparation quality more effectively than traditional care instructions.

Management of colorectal neoplasia in IBD patients: current practice and future perspectives.

Inflammatory bowel disease (IBD) patients are at increased risk of developing colorectal neoplasia (CRN). In this review, we aim to provide an up-to-date overview and future perspectives on CRN management in IBD. Advances in endoscopic surveillance and resection techniques have resulted in a shift towards endoscopic management of neoplastic lesions in place of surgery. Endoscopic treatment is recommended for all CRN if complete resection is feasible. Standard (cold snare) polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection should be performed depending on lesion complexity (size, delineation, morphology, surface architecture, submucosal fibrosis/invasion) to maximize the likelihood of complete resection. If complete resection is not feasible, surgical treatment options should be discussed by a multidisciplinary team. While (sub)total and proctocolectomy play an important role in management of endoscopically unresectable CRN, partial colectomy may be considered in a subgroup of patients in endoscopic remission with limited disease extent without other CRN risk factors. High synchronous and metachronous CRN rates warrant careful mucosal visualization with shortened intervals for at least 5 years after treatment of CRN.

Effects of glucagon-like peptide-1 receptor agonists on gastric mucosal visibility and retained gastric contents during EGD

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used in diabetes and obesity management. Although GLP-1RAs delay gastric emptying, their impact on visibility during EGD remains uncertain. A 1:1 matched case-control study was conducted. Individuals undergoing EGD who were taking GLP-1RAs were matched to nonusers based on demographic characteristics and diabetes status. A validated scale (POLPREP) was used to determine gastric mucosal visibility scores. A total of 84 pairs (N= 168) were included. GLP-1RA users had significantly lower visibility scores, with a 2.42 times higher likelihood of lower scores compared with nonusers. In addition, GLP-1RA users had a higher incidence of retained gastric contents (13.1% vs 4.8%; adjusted odds ratio, 4.62; P= .025) and aborted procedures due to this issue. No anesthesia-related adverse events were observed. GLP-1RA use at the time of endoscopy exhibited higher odds of lower gastric mucosal visibility scores, retained contents, and aborted procedures. Further research is warranted.

Intravenous metoclopramide for increasing endoscopic mucosal visualization in patients with acute upper gastrointestinal bleeding: a multicenter, randomized, double-blind, controlled trial

Acute upper gastrointestinal hemorrhage (UGIH) is the most common emergency condition that requires rapid endoscopic treatment. This study aimed to evaluate the effects of pre-endoscopic intravenous metoclopramide on endoscopic mucosal visualization (EMV) in patients with acute UGIH. This was a multicenter, randomized, double-blind controlled trial of participants diagnosed with acute UGIH. All participants underwent esophagogastroduodenoscopy within 24 h. Participants were assigned to either the metoclopramide or placebo group. Modified Avgerinos scores were evaluated during endoscopy. In total, 284 out of 300 patients completed the per-protocol procedure. The mean age was 62.8 ± 14.3 years, and 67.6% were men. Metoclopramide group achieved a higher total EMV and gastric body EMV score than the other group (7.34 ± 1.1 vs 6.94 ± 1.6; P = 0.017 and 1.80 ± 0.4 vs 1.64 ± 0.6; P = 0.006, respectively). Success in identifying lesions was not different between the groups (96.5% in metoclopramide and 93.6% in placebo group; P = 0.26). In the metoclopramide group, those with active variceal bleeding compared with the control group demonstrated substantial improvements in gastric EMV (1.83 ± 0.4 vs 1.28 ± 0.8, P = 0.004), antral EMV (1.96 ± 0.2 vs 1.56 ± 0.6, P = 0.003), and total EMV score (7.48 ± 1.1 vs 6.2 ± 2.3, P = 0.02). Pre-endoscopic intravenous metoclopramide improved the quality of EMV in variceal etiologies of UGIH, which was especially prominent in those who had signs of active bleeding based on nasogastric tube assessment.Trial Registration: Trial was registered in Clinical Trials: TCTR 20210708004 (08/07/2021).

Reading of small bowel capsule endoscopy after frame reduction using an artificial intelligence algorithm

ObjectivesPoorly visualized images that appear during small bowel capsule endoscopy (SBCE) can confuse the interpretation of small bowel lesions and increase the physician’s workload. Using a validated artificial intelligence (AI) algorithm that can evaluate the mucosal visualization, we aimed to assess whether SBCE reading after the removal of poorly visualized images could affect the diagnosis of SBCE.MethodsA study was conducted to analyze 90 SBCE cases in which a small bowel examination was completed. Two experienced endoscopists alternately performed two types of readings. They used the AI algorithm to remove poorly visualized images for the frame reduction reading (AI user group) and conducted whole frame reading without AI (AI non-user group) for the same patient. A poorly visualized image was defined as an image with < 50% mucosal visualization. The study outcomes were diagnostic concordance and reading time between the two groups. The SBCE diagnosis was classified as Crohn’s disease, bleeding, polyp, angiodysplasia, and nonspecific finding.ResultsThe final SBCE diagnoses between the two groups showed statistically significant diagnostic concordance (k = 0.954, p < 0.001). The mean number of lesion images was 3008.5 ± 9964.9 in the AI non-user group and 1401.7 ± 4811.3 in the AI user group. There were no cases in which lesions were completely removed. Compared with the AI non-user group (120.9 min), the reading time was reduced by 35.6% in the AI user group (77.9 min).ConclusionsSBCE reading after reducing poorly visualized frames using the AI algorithm did not have a negative effect on the final diagnosis. SBCE reading method integrated with frame reduction and mucosal visualization evaluation will help improve AI-assisted SBCE interpretation.

Use of N-acetylcysteine plus simethicone to improve mucosal visibility in upper digestive endoscopy via systematic alphanumeric-coded endoscopy: a randomized, double-blind controlled trial.

The use of antifoaming and mucolytic agents prior to upper gastrointestinal (GI) endoscopy and a thorough systematic review are essential to optimize lesion detection. This study evaluated the effect of simethicone and N-acetylcysteine on the adequate mucosal visibility (AMV) of the upper GI tract by an innovative systematic method. This randomized, double-blind controlled trial included consecutive patients who underwent diagnostic upper GI endoscopy for screening for early neoplasms between August 2019 and December 2019. The upper GI tract was systematically assessed by systematic alphanumeric-coded endoscopy. Patients were divided into 4 groups: 1) water; 2) only simethicone; 3) N-acetylcysteine + simethicone; and 4) only N-acetylcysteine. The following parameters were assessed in each group: age, sex, body mass index, level of adequate mucosal visibility, and side-effects. A total of 4564 images from upper GI areas were obtained for evaluation. The mean AMV in the 4 groups was 93.98±7.36%. The N-acetylcysteine + simethicone group had a higher cleaning percentage compared with the other groups (P=0.001). There was no significant difference among the remaining groups, but several areas had better cleaning when a mucolytic or antifoam alone was used. No side-effects were found in any group. The combination of N-acetylcysteine plus simethicone optimizes the visibility of the mucosa of the upper GI tract, which could potentially increase diagnostic yield.

Comparison of adenoma miss rate and adenoma detection rate between conventional colonoscopy and colonoscopy with second-generation distal attachment cuff: a multicenter, randomized, back-to-back trial

Endocuff VisionTM has been designed to enhance mucosal visualization thereby improving detection of (pre-)malignant colorectal lesions. This multicenter, international, back-to-back, randomized colonoscopy trial compared adenoma detection rate (ADR) and adenoma miss rate (AMR) between Endocuff Vision-assisted colonoscopy (EVC) and conventional colonoscopy (CC). Patients aged 40-75 years referred for non-immunochemical fecal occult blood test-based screening, surveillance, or diagnostic colonoscopy were included at ten hospitals and randomized into four groups: Group 1; 2xCC, Group 2; CC followed by EVC, Group 3; EVC followed CC and Group 4; 2xEVC. Primary outcomes included ADR and AMR. A total of 717 patients were randomized of which 661 patients (92.2%) had one and 646 (90.1%) patients had two completed back-to-back colonoscopies. EVC did not significantly improve ADR compared to CC (41.1% [95%-CI;36.1-46.3] versus 35.5% [95%-CI;30.7-40.6], respectively, P=0.125), but EVC did reduced AMR by 11.7% (29.6% [95%-CI;23.6-36.5] versus 17.9% [95%-CI;12.5-23.5], respectively, P=0.049). AMR of 2xCC compared to 2xEVC was also not significantly different (25.9% [95%-CI;19.3-33.9] versus 18.8% [95%-CI;13.9-24.8], respectively, P=0.172). Only 3.7% of the polyps missed during the first procedures had advanced pathologic features. Factors affecting risk of missing adenomas were age (P=0.002), Boston Bowel Preparation Scale (P=0.008) and region where colonoscopy was performed (P<0.001). Our trial shows that EVC reduces the risk of missing adenomas but does not lead to a significant improved ADR. Remarkably, 25% of adenomas are still missed during conventional colonoscopies, which is not different from miss rates reported 25 years ago; reassuringly, advanced features were only found in 3.7% of these missed lesions. NCT03418948.

Pre-medication with simethicone and N-acetyl cysteine for improving mucosal visibility during upper gastrointestinal endoscopy: A randomized controlled trial.

Diagnostic performance of esophagogastroduodenoscopy (EGD) may be compromized due to adherent mucus and foam. In this study, we aimed at assessing the impact of premedication on mucosal visibility during endoscopy. This is a double-blinded (patient and investigator), randomized trial conducted at a tertiary care centre. Patients were randomized into four groups: A (water), B (simethicone [S]), C (N-acetyl cysteine [NAC]), D (S + NAC). Premedication solutions were administered 10-30minutes before endoscopy and mucosal visibility graded from 1(best) to 4(worst) (1 best, 4 worst). Total mucosal visibility scores (TMVS) from six sites ranged from 6 (best) to 24 (worst) points. The primary outcome of study was comparison of TMVS between simethicone and combination (S + NAC) premedication groups. Secondary outcomes were adverse events and impact of endoscopy timing on TMVS. Total 800 patients (39years, 68.8% males) were randomized into four groups. Median TMVS were significantly lower in groups B (7 [6-8]) and D (8 [6-9]) as compared to A (11 [9-13]) and C (10 [8-12]). Proportion of cases with adequate gastric mucosal visibility (score < 7) was 26% in group A, 71% in group B, 36% in group C and 79% in group D. There was no difference in TMVS in groups A and C (p = 0.137). TMVS were significantly lower in late (> 20-30minutes) vs. early (10-20minutes) endoscopy sub-group (8 [7-11] vs, 9 ([7-11], p = 0.001). However, TMVS were similar between group B and group D in early endoscopy group (p = 0.451). There was no significant difference in the lesion detection rate among the different premedication drugs (p > 0.05). Premedication with simethicone or combination (simethicone and NAC) significantly improves mucosal visibility during EGD. If early endoscopy is indicated, simethicone provides similar mucosal visibility and may be an effective alternative to combined premedication. NCT05951712.

Optimal timing of simethicone administration prior to upper endoscopy: A multicenter, single-blind, randomized controlled trial.

Background and study aims Simethicone is useful as premedication for upper endoscopy because of its antifoaming effects. We aimed to evaluate the effect of timing of simethicone administration on mucosal visibility. Patients and methods In this multicenter, randomized, endoscopist-blinded study, patients scheduled for upper endoscopy were randomized to receive 40 mg simethicone at the following time points prior to the procedure: 20 to 30 minutes (early group), 0 to 10 minutes (late group) or 20 mg simethicone at both time points (split-dose group). Images were taken from nine predefined locations in the esophagus, stomach, and duodenum before endoscopic flushing. Each image was scored on mucosal visibility by three independent endoscopists on a 4-point scale (lower scores indicating better visibility), with adequate mucosal visibility defined as a score ≤ 2. Primary outcome was the percentage of patients with adequate total mucosal visibility (TMV), reached if all median subscores for each location were ≤ 2. Results A total of 386 patients were included (early group: 132; late group: 128; split-dose group: 126). Percentages of adequate TMV were 55%, 42%, and 61% in the early, late, and split-dose group, respectively ( P < 0.01). Adequate TMV was significantly higher in the split-dose group compared to the late group ( P < 0.01), but not compared to the early group ( P = 0.29). Differences between groups were largest in the stomach, where percentages of adequate mucosal visibility were higher in the early (68% vs 53%, P = 0.03) and split-dose group (69% vs 53%, P = 0.02) compared to the late group. Conclusions Mucosal visibility can be optimized with early simethicone administration, either as a single administration or in a split-dose regimen.

Update on Endoscopic Dysplasia Surveillance in IBD.

As medical management of inflammatory bowel disease (IBD) makes great advances, most patients with IBD will have long life expectancies without need for total colectomy. With prolonged disease duration, however, there is increased risk of dysplasia leading to colorectal cancer (CRC). Multiple consensus and guideline documents have been published over the last decade with recommendations to optimize early detection and management of dysplastic lesions. Endoscopic technology has improved tremendously, even over the last few years. Previously invisible dysplasia has become visible in most cases with advanced imaging technologies that now allow for much clearer and more detailed mucosal inspection. New tools to facilitate endoscopic resection of visible lesions has also enabled patients to avoid colectomy, with resulting need to continue colon surveillance. There are limited or conflicting data leading to inconsistent recommendations regarding the need for random biopsies, the preferred endoscopic imaging technique and surveillance intervals after resection of dysplasia. Similarly, there remains significant variability in the application of guidelines into daily practice and availability of and training with advanced imaging technologies. Here, we present a narrative review of which patients are at highest risk for dysplasia, the current guidelines on surveillance colonoscopy, factors affecting optimal mucosal visualization, enhanced imaging techniques, standardized reporting terminologies for surveillance colonoscopy, endoscopic management of dysplasia, indications for colectomy, and briefly on future potential technologies to assist in dysplasia detection.

Comparison of the efficacy and safety of an oral sulfate solution and 3-L polyethylene glycol on bowel preparation before colonoscopy: a phase III multicenter randomized controlled trial

Adequate bowel preparation is crucial for clear mucosal visualization during colonoscopy. We aimed to comprehensively compare oral sulfate solution (OSS) and 3-L split-dose polyethylene glycol (PEG) for bowel preparation before colonoscopy. This randomized, active-controlled, noninferiority study was performed in 10 medical centers. Eligible subjects were enrolled to receive OSS or 3-L PEG in a split-dose regimen. The quality of bowel preparation, adverse reactions, and acceptability were evaluated. The quality of bowel preparation was evaluated using the Boston Bowel Preparation Scale. Safety was evaluated by adverse reactions. The study population was divided into the full analysis set (FAS), the safety set, the modified FAS (mFAS), and the per-protocol set (PPS). Three hundred forty-eight potentially eligible subjects were enrolled. Three hundred forty-four subjects were included in the FAS and safety set, 340 subjects were included in the mFAS, and 328 subjects were included in the PPS. Adequate bowel preparation of the OSS was not inferior to 3-L PEG in the mFAS (98.22% vs 97.66%) and the PPS (98.17% vs 98.78%). There was no significant difference in acceptability between the 2 groups (94.74% vs 94.80%, P= .9798). Overall adverse reactions were similar (50.88% vs 44.51%, P= .2370) between the 2 groups. The split-dose OSS regimen was not inferior to the split-dose 3-L PEG regimen for the quality of bowel preparation in a Chinese adult population. The safety and acceptability of the 2 groups were similar. (Clinical trial registration number: NCT05465889.).

Dual-Energy CT Evaluation of Gastrointestinal Bleeding

Gastrointestinal (GI) bleeding is a potentially life-threatening condition accounting for more than 300 000 annual hospitalizations. Multidetector abdominopelvic CT angiography is commonly used in the evaluation of patients with GI bleeding. Given that many patients with severe overt GI bleeding are unlikely to tolerate bowel preparation, and inpatient colonoscopy is frequently limited by suboptimal preparation obscuring mucosal visibility, CT angiography is recommended as a first-line diagnostic test in patients with severe hematochezia to localize a source of bleeding. Assessment of these patients with conventional single-energy CT systems typically requires the performance of a noncontrast series followed by imaging during multiple postcontrast phases. Dual-energy CT (DECT) offers several potential advantages for performing these examinations. DECT may eliminate the need for a noncontrast acquisition by allowing the creation of virtual noncontrast (VNC) images from contrast-enhanced data, affording significant radiation dose reduction while maintaining diagnostic accuracy. VNC images can help radiologists to differentiate active bleeding, hyperattenuating enteric contents, hematomas, and enhancing masses. Additional postprocessing techniques such as low-kiloelectron voltage virtual monoenergetic images, iodine maps, and iodine overlay images can increase the conspicuity of contrast material extravasation and improve the visibility of subtle causes of GI bleeding, thereby increasing diagnostic confidence and assisting with problem solving. GI bleeding can also be diagnosed with routine single-phase DECT scans by constructing VNC images and iodine maps. Radiologists should also be aware of the potential pitfalls and limitations of DECT. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.

Quality in colonoscopy: time to ensure national standards are implemented?

BackgroundHigh-quality colonoscopy is crucial to ensure complete mucosal visualisation and to maximise detection of pathology. Previous audits showing variable quality have prompted national and international colonoscopy improvement programmes, including the...

Small bowel cleansing for capsule endoscopy, systematic review and meta- analysis: Timing is the real issue.

The optimal small bowel preparation modality before capsule endoscopy (SBCE) is still uncertain, regarding preparation type, dose and timing of administration. The aim of the study is to evaluate the small bowel cleansing in patients undergoing small bowel capsule endoscopy after fasting alone or active treatment with purgative solutions. We searched 4 major scientific databases from inception to December 2021 for studies evaluating small bowel preparation before SBCE. Different preparation efficacy was compared using fasting as reference. Main variables evaluated in the current study were: preparation type, administration schedule and timing. 17 studies (27 treatment arms) with 2372 patients (male 47,4%) were included, mean age 54 years. Fasting alone VS overall purgative preparations pooled rate difference (RD) was 0.15 I2=81.5% p: 0.000. Sub-analysis for preparation schedule (day-before, split and same-day) and the time lapse showed that administration of PEG after the ingestion of capsule had the highest rate of adequate small bowel cleansing with a RD 0.33, administration between 1 and 6h before SBCE had a RD 0.28, 6 to 12h had a RD 0.21 and ≥12h had a RD 0.05. Timing of ingestion was found to be critical for bowel cleansing; the shorter time laps between the ingestion last dose of laxative and SBCE, the better was the mucosal visualization.

Quality indicators in the endoscopic detection of gastric cancer

Gastroscopy is the reference standard for the diagnosis of gastric cancer, but it is operator-dependent and associated with missed gastric cancer. The proliferation of gastroscopic examinations, increasingly for the screening and detection of subtle premalignant lesions, has motivated scrutiny of quality in gastroscopy. The concept of a high-quality endoscopic examination for the detection of superficial gastric neoplasia has been defined by expert guidelines to improve mucosal visualization, engender a systematic examination process and detect superficial neoplasia. This review discusses the evidence supporting the components of a high-quality diagnostic gastroscopic examination in relation to the detection of gastric cancer, and their potential role as procedural quality indicators to drive a structured improvement in clinically meaningful outcomes.

A113 DIAGNOSTIC ACCURACY OF COMPUTED TOMOGRAPHY ENTEROGRAPHY COMPARED TO BALLOON ASSISTED ENDOSCOPY IN CROHN’S DISEASE

Abstract Background Crohn’s disease (CD) is a chronic inflammatory condition which can affect the entire gastrointestinal tract with a wide variety of potential complications which may require endoscopic or surgical interventions. Small bowel CD beyond the reach of standard endoscopy poses a diagnostic obstacle and relies on cross sectional imaging ─ such as computed tomography enterography (CTE) ─ and balloon assisted endoscopy (BAE). BAE is the current diagnostic gold standard allowing for direct mucosal visualization as well as therapeutic capabilities; however, remains limited by access, cost, and requires specialized training. Alternatively, CTE in small bowel in CD is widely available, and less invasive than BAE. The diagnostic accuracy of CTE against the gold standard of BAE remains unclear. Purpose We aim to assess the sensitivity and specificity of CTE vs BAE in the diagnosis and evaluation of small bowel CD. Method Patients with an established diagnosis of Crohn’s disease who underwent a CTE and a BAE within 6 months between 2011 and 2018 were reviewed. Relevant findings of active inflammation (defined by mural hyperenhancement and thickening), long-segment disease (≥ 15 cm active disease), skip-segments, number of strictures, and presence of high-grade strictures (defined on BAE as inability to traverse with scope prior to dilation and on CTE as prestenotic luminal dilation ≥3cm and fecalization) were extracted from both reports and images of CTE and BAE by two independent reviewers. Sensitivity and specificity for each finding on CTE was calculated using BAE as the gold-standard diagnostic test. Result(s) A total of 42 patients with 65 corresponding CTE and BAE were identified between 2011 and 2018. CTE was found to be most sensitive for assessing presence of active inflammation and number of strictures at 75.6% [95% CI, 60.5-87.1%] and 71.4% [95% CI, 55.4-84.3], respectively. CTE was highly specific for findings of long-segment inflammation, skip lesions, number of strictures, and high-grade stricture with a specificity of 89.3% [95% CI, 78.1-96.0], 74.1% [95%, 67.2-94.7], 100% [97.5% CI, 73.5-100], and 84.4% [95% CI, 67.2-94.7] respectively. CTE showed poor specificity for active inflammation 45.0% [23.1-68.5%], and poor sensitivity for high grade strictures 54.5% [36.4-71.9] and skip lesions 54.5% [23.4-83.3] Image Conclusion(s) CTE is relatively sensitive in detecting active inflammation and number of strictures compared to BAE, but showed suboptimal sensitivity in detecting long segment inflammation, skip lesions, and high-grade strictures. CTE showed high specificity in identification of long segment inflammation, number of strictures, and high-grade strictures, but not active inflammation overall. CTE and BAE are complementary to one another and based utilized in combination to improve diagnostic accuracy. Future directions include prospective validation prospective studies to validate the results of this study looking at a broader population of Crohn’s disease patients. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Bowel cleansing efficacy of 1L NER1006versus macrogol and 3L polyethylene glycol using split-dose administration.

Colonoscopies are an important diagnostic technique in the detection of colorectal cancer and colonic disease. Adequate examination is dependent on the degree of mucosal visibility, with poor cleansing impeding the detection of neoplasms. These patients require shorter colonoscopy surveillance intervals, longer hospital stays, and increased healthcare costs-rendering a screening colonoscopy cost-ineffective. In Australia and the Gold Coast Hospital and Health Service (GCHHS), macrogol and 3L of polyethylene glycol are the preferred regimen given its safety profile and efficacy. Yet, little is known locally about the use of the new low-volume bowel preparation NER1006 (Plenvu) given its recent registration with the Therapeutic Goods of Australia (TGA). The primary outcome assessed the bowel cleansing efficacy of NER1006 compared with 7 days of macrogol and 3L of polyethylene glycol using the Boston Bowel Preparation Scale (BBPS), while also assessing the influence of notable patient characteristics such as age, gender, body mass index (BMI), and the patients Charlson comorbidity index (CCI). Secondary outcomes assessed the polyp detection rate and procedural factors including cecal intubation, scope withdrawal time, and rebooking rates. Data from all patients who underwent an outpatient colonoscopy procedure at GCHHS between 1 July 2020 and 30 September 2020 were analyzed. Patients were aged 50-74 years of age and were referred for a screening colonoscopy due to a positive fecal occult blood test (FOBT) result from the National Bowel Cancer Screening Program. Of the 238 patients who met the inclusion criteria, 108 patients received NER1006 and 130 patients received macrogol and 3L polyethylene glycol. NER1006 achieved superior overall (P< 0.001) and right-sided colon cleansing (P= 0.016). There was an even distribution of males and females (P= 0.118), the mean age of both cohorts was <65 years of age. The macrogol and 3L polyethylene glycol group had a statistically higher BMI (P< 0.001) and CCI (P< 0.001). Cecal intubation success was achieved in both cohorts (≥95%) and scope withdrawal time was ≥6min, polyp detection was non-superior (P= 0.824), but superior in NER1006 when BBPS ≥6 (P= 0.002). Rebooking rates were significantly lower in the NER1006 group (P= 0.013). This study demonstrated that NER1006 was superior in terms of overall and right-sided bowel cleansing as a primary endpoint. Patient factors demonstrated to be independent predictors of inadequate bowel preparation. Future studies should aim to explore the safety and tolerability of NER1006 while also assessing the bowel cleansing effectiveness in patients with a high BMI and comorbidity index.