The safety and efficacy of adalimumab in patients with Crohn's disease: the experience of a single Canadian tertiary care centre

Abstract Background The most feared complication of videocapsule endoscopy (VCE) is retention in the intestine. It is estimated to occur in 1.4% of cases but the risk factors are not well known. Aims To determine the prevalence of VCE retention at a tertiary care centre as well the associated risk factors. Methods Retrospective study between 2016 and 2019. All patients at a tertiary care centre undergoing VCE were recruited. The patients with an incomplete endoscopy report or who were unable to complete VCE were excluded. Clinical and endoscopic information was compiled from patients’ medical charts as well as the indications and results of the endoscopic procedure. VCE retention, evaluated by radiography or CT scan, was defined as persistence of the videocapsule in the gastrointestinal tract for ≥14 days or the need for an intervention for removal. Results In total, 126 patients underwent VCE (average age: 66±16, 52% female). There was 6% of patients with Crohn’s disease, and 40% of patients had a previous abdominal surgery. The indications for endoscopy were: iron deficient anemia (48%), gastrointestinal bleeding (32%), suspicion/follow up of IBD (10%), and other (11%). The VCE findings (n=146) were: angiodysplasia (30%), inflammation (30%), normal (20%), polyp (5%), and other (15%). 77% of results were not previously found by conventional endoscopy or imaging. The prevalence of VCE retention was 1.6%. The patient risk factors for retention were Crohn’s disease (OR 19.67; 95CI 1.09–354.11; p<0.05) and corticosteroid use in the previous 2 weeks (OR 19.67; 95CI 1.09–354.11; p<0.05). There was no risk of retention associated with ulcerative colitis, sex, abdominal surgery, or opioid use. The finding of stenosis on VCE was associated with an increased risk of retention (OR 123; 95% CI 4.11-3683.43; p<0.01). Conclusions VCE retention remains a rare complication. There is increased risk of retention in patients with known Crohn’s disease or recent use of corticosteroids. Funding Agencies None

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The safety and efficacy of gastric fundal variceal obliteration using N-butyl-2-cyanoacrylate; the experience of a single canadian tertiary care centre

Saudi Journal of Gastroenterology ◽

10.4103/1319-3767.114508 ◽

2013 ◽

Vol 19 (4) ◽

pp. 152 ◽

Cited By ~ 5

Author(s):

Paul Marotta ◽

Bandar Aljudaibi ◽

MahmoudH Mosli ◽

Majid Almadi

Keyword(s):

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Safety And Efficacy

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Safety and efficacy of concomitant use of newer and older antiepileptic drugs in tertiary care centre of North India: A prospective cohort study

Journal of Pharmacological and Toxicological Methods ◽

10.1016/j.vascn.2009.04.107 ◽

2009 ◽

Vol 60 (2) ◽

pp. 234

Author(s):

A. Prakash ◽

D. Bansal ◽

B. Medhi

Keyword(s):

Cohort Study ◽

Antiepileptic Drugs ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Tertiary Care ◽

North India ◽

Care Centre ◽

Tertiary Care Centre ◽

Safety And Efficacy

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Safety and Efficacy of Intra-caesarean IUCD: A Prospective Study at a Tertiary Care Centre

The Journal of Obstetrics and Gynecology of India ◽

10.1007/s13224-019-01242-2 ◽

2019 ◽

Vol 69 (4) ◽

pp. 325-329 ◽

Cited By ~ 1

Author(s):

Rekha Jakhar ◽

Ganesh Singhal

Keyword(s):

Prospective Study ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Safety And Efficacy ◽

A Prospective Study

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P158 Semi-automated detection of qualitative features of Crohn’s disease activity found on CT-enterography using machine learning

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.287 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S217-S218

Author(s):

R Stidham ◽

B Enchakalody ◽

A Waljee ◽

G Su ◽

M Al-Hawary ◽

...

Keyword(s):

Machine Learning ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Tertiary Care ◽

Support Vector ◽

Ct Enterography ◽

Excellent Performance ◽

Tertiary Care Centre ◽

Normal Bowel ◽

Bowel Segments

Abstract Background Imaging is essential in the assessment of Crohn’s disease (CD) severity, phenotype, and therapeutic response. However, qualitative findings can be limited by interobserver variation and ambiguous feature definitions. Our aim was to evaluate computational approaches for identifying qualitative disease features using CT-enterography (CTE). Methods CD subjects with ileal CD and CTE imaging between 2009 and 2017 were retrospective identified at a single tertiary care centre. CTE scans were reviewed by two fellowship-trained abdominal radiologists who labelled diseased and normal bowel transitions agreeing on definitions of qualitative findings prior to labelling. Computed intestinal features were used by machine learning methods (k-nearest neighbour, support vector machines, random forest) to model regions of diseased bowel and predict qualitative findings with 5-fold cross validation. Cohen’s kappa with quadratic weighting was used to assess agreement between radiologists and model predictions. Results In 206 unique patients, 548 small bowel segments underwent paired radiologist review for qualitative imaging findings. Automated localisation of diseased vs. normal bowel segments had excellent performance, with an AUC, PPV, and NPV of 0.922, 0.924, and 0.918, respectively (Figure 1). Radiologist-to-Radiologist and Radiologist-to-automated prediction agreement on qualitative findings are shown in Table 1. Agreement on the degree of mural enhancement between radiologists was very good (k = 0.75,95% CI 0.68–0.82), with nearly identical agreement (k = 0.75, 95% CI 0.72–0.79) between radiologists and automated grading models. Conclusion Computer vision methods have excellent performance for automatically distinguishing diseased from normal ileum and show potential for qualitative disease assessments of Crohn’s disease on CTEs.

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Clinicopathological and Molecular Characterisation of Crohn’s Disease-associated Small Bowel Adenocarcinomas

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz135 ◽

2019 ◽

Vol 14 (3) ◽

pp. 287-294 ◽

Cited By ~ 1

Author(s):

Xiaoyan Liao ◽

Guangyuan Li ◽

Russel McBride ◽

Jane Houldsworth ◽

Noam Harpaz ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Tertiary Care ◽

Growth Patterns ◽

Molecular Entity ◽

Low Grade ◽

Small Bowel Adenocarcinoma ◽

Tertiary Care Centre ◽

Molecular Features

Abstract Background and Aims Small bowel adenocarcinoma [SBA] is a recognised complication of Crohn’s disease [CD], but its low absolute prevalence limits opportunities for clinicopathological characterisation. Methods We compared the clinical, pathological, and molecular features of 48 SBA from patients with CD [CDSBA] and 29 SBAs from patients without CD [NSBA] who underwent treatment at our tertiary care centre between 2000 and 2018. Results Patients with CDSBA were younger than those with NSBA [mean age, 56 vs 64; p = 0.02]. Males predominated in both groups. Most CDSBA [69%] occurred in the ileum, whereas most NSBA occurred in the duodenum [38%] and jejunum [31%; p < 0.001]. Stage I tumours were more prevalent in the CDSBA [33% vs 3%; p = 0.002], although the rates of Stage IV disease and disease-specific mortality were similar in both groups. CDSBA were less likely to present a discrete mass [35% vs 93%; p < 0.001] and were more often stricturing or fistulising [75% vs 10%, respectively, p < 0.001] than NSBA. Microscopically, CDSBA were relatively heterogeneous, exhibiting at least three distinct growth patterns in 39% compared with 1% of NSBA [p = 0.01]. Low-grade tubuloglandular adenocarcinoma was the predominant pattern in 19% of CDSBA compared with 0% of NSBA [p = 0.003]. CDSBA were more frequently DNA mismatch repair proficient [90% vs 62%; p = 0.04] and exhibited profiles of frequently mutated genes similar to those of NSBA, except for IDH1 [18%] and SMAD4 [12%] mutations that occurred uniquely in CDSBA. Conclusions These observations, based on the largest single-centre series described hitherto, establish that CDSBA is a distinct clinical, pathological, and molecular entity.

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