Nikolaos Kyriakos

Evaluation of four time-saving methods of reading capsule endoscopy videos.

Objective Review of wireless capsule endoscopy recordings is time consuming. The aim of this study was to evaluate four time-saving methods offered with Rapid Software. Methods A total of 100 wireless capsule endoscopy videos with abnormal findings were evaluated using five different ways of viewing: (a) manual mode at a speed of 10 frames per second (fps), (b) manual mode at a speed of 20 fps, (c) manual mode with a simultaneous display of two images at a speed of 20 fps, (d) automatic mode at a speed of 10 fps, and (e) quickview mode at a speed of 3 fps. Then, we calculated the concordance of abnormal findings between each one of the four time-saving methods using method A. Results The mean reading time with time-saving methods was significantly shorter than with method A (method A: 59.8 min, method B: 30 min, method C: 30.2 min, method D: 32.2 min, method E: 16.3 min). The agreement in finding abnormal lesions between method A and the four evaluated methods was excellent and almost perfect (&kgr;>0.8), except for quickview in recognizing polyps. Diagnostic miss rate was 1% for method D, 2% for B and C, and 12% for E. No tumors and cases of celiac or Crohn’s disease were lost by all four methods. Conclusion We conclude that manual mode/20 fps, the simultaneous projection of two images/20 fps, and automatic mode/10 fps have minimal diagnostic miss rates and can safely replace slower modes in clinical practice. The quickview mode is a safe diagnostic tool only when larger or diffuse lesions are suspected, such as Crohn’s or celiac disease.

A study comparing an endoscopy nurse and an endoscopy physician in capsule endoscopy interpretation

Objective Complete review of wireless capsule endoscopy (WCE) recordings by a physician is time-consuming and laborious and may be perceived as a limitation to perform WCE. The aim of this study was to evaluate the efficacy of a nurse in interpreting WCE. Methods A total of 102 WCE videos were evaluated by a single gastroenterologist and a nurse experienced as an assistant in diagnostic and interventional endoscopy and trained in WCE. After independently reviewing WCE videos, the two readers discussed their findings and came to a consensus. Results The mean capsule reading time was significantly longer for the nurse compared with the gastroenterologist (117.3±24.8 vs. 63.8±8.5 min, P<0.001). No statistical differences were observed regarding the correct recognition of first gastric, duodenal and caecal images between the two readers. For the gastroenterologist, both sensitivity and specificity in detecting abnormal findings were 100% except for angiodysplasia [sensitivity 88.5%, 95% confidence interval (CI): 70–97.4]. For the nurse, the lowest sensitivity rates were in detecting polyps (70%, 95% CI: 34.9–92.3) and angiodysplasias (92.3%, 95% CI: 74.8–98.9). The interobserver agreement as determined by Cohens &kgr; coefficient was excellent except for polyps (k=0.71, 95% CI: 0.46–0.96). Conclusion A trained nurse is highly accurate in detecting abnormal findings and interpreting WCE recordings. Physicians role could be limited to consider and confirm thumbnails created by a nurse.

Inflammatory polypoid mass treated with Infliximab in a Crohn's disease patient.

Dear Sir, It has been proven that anti-Tumor Necrosis Factor-a (TNF-a) monoclonal antibody (Infliximab) causes immunosuppression-induced clinical remission in Crohns Disease (CD) patients that can also be accompanied by extensive, rapid and complete bowel mucosa healing1, which in turn can be associated with a better prognosis2. Systematic 8-weekly treatment with infliximab has been shown to induce complete mucosal healing in nearly half of treated patients3. Endoscopic remission is not precisely defined in the literature, with some authors suggesting to be the totally normal appearance of mucosa, while others the absence of mucosal ulceration3. In the presence of an inflammatory mass or pseudopolyp, definition of mucosal healing …

P402 Faecal calprotectin but not serum CRP predicts post-operative endoscopic recurrence of Crohn's disease

median age was 48 and median disease follow up was 6.5 years. Seventeen percent of were not on treatment; 36% on 5 ASA and 47% of patients were on effective immunosuppression. These included patients on thiopurines 40.3% (19), Methotrexate 4.2% (2) Infliximab 10.6% (5), Thiopurines +Infliximab 23.3% (11), Methotreaxte+Infliximab 2.1% (1), Adalimumab 4.2% (n = 2), Adalimumab+Thiopurines 2.1% (n = 1), Glucocorticoids 8.4% (4) and Infliximab + Prednisolone 4.2% (2). Immunization history was taken in 20% of the patients. Chest radiographs were performed in 42.5% (20) of patients, 25.5% were tested for Hepatitis B, 25.5% for Hepatitis C, 10.6% for HIV and 8.5% were tested for varicella titres. Cervical smears were performed in 19.2% (9) women. Of the patients on immunosuppressant 40.4% had no screening tests. Immunisation was carried out in 57.4% for Influenza, tetanus (38.3%), diphtheria (27.6%), pneumococcal (19.1%), meningococcus (10.6%), Hepatitis B (6.3%), HPV (6.3%) and MMR (17%). Twenty three percent of patients on immunosuppressants had no vaccinations. Conclusions: Our current practice was not in line with ECCO recommendations. IBD physicians must work in collaboration with primary care providers to ensure appropriate screening and vaccination in this vulnerable group. We have taken appropriate steps to ensure prompt screening of patients through a newly designed proforma.

Su1393 Primary Non Response to Infliximab in Patients With Inflammatory Bowel Disease

Background & Aim: Patients with Crohns disease (CD) or ulcerative colitis (UC) who fail to respond to induction therapy with infliximab (IFX) are considered as primary non responders (PNR). We aimed at investigating the prevalence, prediction and management of PNR to IFX in patients with CD or UC. Patients & Methods: Retrospective analysis of prospectively acquired data at a single-center which included PNRs to induction therapy with 5 mg/kg IFX at weeks 0, 2 and 6. PNR was defined as no improvement or worsening of clinical symptoms through week 14 after starting IFX as judged by the CDAI and physician global assessment. Using RFLP or allele-specific PCR, single nucleotide polymorphisms in the promoter region of the TNF gene (-238 G/A, -308 G/A, and -857 C/T) and the -158 V/F polymorphism of the FcγRΙΙΙa gene were determined in 79 patients. In 48 patients, the HLA class II DRB1 and DQB1 alleles were also determined using the complement-dependent lymphocytotoxicity (CDC) and where available the sequence-specificoligonucleotide (SSO) and primer (SSP) HLA typing methods. Antinuclear antibodies and perinuclear anti-neutrophil cytoplasmic antibodies at baseline were also evaluated in 104 and 87 patients, respectively. Results: Between 1/7/2007 and 31/8/2012, of 160 IFX-treated patients [107 CD, 53 with UC, 94 males, median age at diagnosis 23 years (IQR 17-32)], 26 (16.3%) were PNRs [8/107 (7.5%) NC vs 18/53 (34%) UC, p<0.001]. Differences between CD and UC in PNR rates may be due to inclusion of patients with severe UC treated with IFX rescue therapy. CD/PNRs to IFX received adalimumab (ADA, n=4), azathioprine (AZA, n=1), methotrexate (MTX, n=1) or surgical treatment (n=2); 2 of these 4 ADA-treated CD patients developed also PNR to ADA but the other two achieved sustained clinical response (n=1) or remission (n=1) after escalation of ADA dose to 40mg weekly. UC/PNRs to IFX were mainly treated surgically (n=12); one of whom received ADA after surgery for refractory pouchitis, and 6 patients received AZA. Univariate and multivariate analysis (including variables with p<0.2) did not reveal any clinical, serological, demographical or genetic factors as predictors of PNR to IFX. PNR to IFX was the only predictor of PNR to ADA [ΟR=8.889 (95% CI: 2.30234.316), p=0,032] as at the end of the study, only one more patient [with secondary loss of response (SLR) to IFX] of the total 43 who were switched to ADA (of the initial pool of the 160 patients), due to PNR (n=5), SLR (n=21), intolerance (n=9), or adverse events (n= 8) to IFX, developed also PNR to ADA. Conclusion: This study which mirrors real life experience indicates that PNR to IFX in UC is more frequent than in CD; PNR to IFX predisposes to PNR to ADA. Larger prospective studies are needed to identify any predictive factors for PNR to anti-TNF therapy and the ideal management of this phenomenon.

Long term safety and efficacy of H1N1 vaccine in a single-center cohort of IBD patients treated with immunomodulators and/or anti-TNFα biologics.

Dear Sir, Long term efficacy and safety data on influenza A (H1N1) virus vaccination are lacking in patients with Crohns disease (CD) and/or ulcerative colitis (UC) who are treated with immmunomodulators (IMM) and/or anti-TNFα biologics. This report summarizes our prospectively collected data on this topic in IBD patients who were in deep remission on IMM and/or anti-TNFα biologics who received the H1N1 vaccine (Focetria®) between November 2009 and April 2010 and were followed for one year. The activity of CD and UC were …

P401 Long term effect of anti-TNFβ agents on the lipidemic profile of IBD patients

median age was 48 and median disease follow up was 6.5 years. Seventeen percent of were not on treatment; 36% on 5 ASA and 47% of patients were on effective immunosuppression. These included patients on thiopurines 40.3% (19), Methotrexate 4.2% (2) Infliximab 10.6% (5), Thiopurines +Infliximab 23.3% (11), Methotreaxte+Infliximab 2.1% (1), Adalimumab 4.2% (n = 2), Adalimumab+Thiopurines 2.1% (n = 1), Glucocorticoids 8.4% (4) and Infliximab + Prednisolone 4.2% (2). Immunization history was taken in 20% of the patients. Chest radiographs were performed in 42.5% (20) of patients, 25.5% were tested for Hepatitis B, 25.5% for Hepatitis C, 10.6% for HIV and 8.5% were tested for varicella titres. Cervical smears were performed in 19.2% (9) women. Of the patients on immunosuppressant 40.4% had no screening tests. Immunisation was carried out in 57.4% for Influenza, tetanus (38.3%), diphtheria (27.6%), pneumococcal (19.1%), meningococcus (10.6%), Hepatitis B (6.3%), HPV (6.3%) and MMR (17%). Twenty three percent of patients on immunosuppressants had no vaccinations. Conclusions: Our current practice was not in line with ECCO recommendations. IBD physicians must work in collaboration with primary care providers to ensure appropriate screening and vaccination in this vulnerable group. We have taken appropriate steps to ensure prompt screening of patients through a newly designed proforma.