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Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association logoLink to Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association
. 2022 Dec 1;28(Suppl 1):S1–S13.

SDDF Abstracts 2022

PMCID: PMC10116997
Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/01: GENDER BIAS IN THE EVALUATION OF POLYPECTOMY TECHNIQUE OF GASTROENTEROLOGY FELLOWS

Hanan M Alrammah 1, Turki AlAmeel 2, Majid A AlSahafi 3, Mohammed Alaskaran 1, Dimah Alaskar 1

Introduction: The majority of physicians in gastroenterology are men. Female physicians constitute less than 20%. As more women pursue careers in surgical fields, gender bias has been shown to negatively impact the evaluation of their technical skills. We aimed to assess whether gender bias existed in assessing endoscopic skills of fellows performing polypectomy.

Methodology: This was a cross sectional study of gastroenterology consultants in Saudi Arabia. Participants were shown a video of endoscopic polypectomy through a web based link. Participants were randomly assigned to either evaluate a hypothetical male or female fellow; both groups were shown the same video. The fellow's gender and level of training were included in the scenario. Evaluation was done using the standardised method known as the Direct Observation of Polypectomy skills (DOPyS). A scoring of 3 or more is considered desirable.

Results: Seventy six evaluators participated in the study. The majority (88.15%) were men. Three quarters (76%) were involved in training fellows in their practice. 47% were asked to evaluate female fellows. The overall median score was 3. Although the polypectomy video was the same, participants were more likely to give the higher score of 4 to the hypothetical male fellows than female fellows (7 vs 3) (P=0.29). The evaluater's gender or age had no impact on the way they evaluated trainees. Endoscopists performing more than 30 procedures per week were more likely to score trainees of both genders lower compared to those who performed less procedures (P=0.027).

Conclusion: Female trainees had numerically lower scores while performing the same procedure compared to their male counterparts. Although this was not statistically significant, it may have been related to the relatively small sample size. More studies are required to identify and address gender bias in gastroenterology.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/02: PHARMACOGENETICS OF THIOPURINE S-METHYLTRANSFERASE IN A MIDDLE EASTEREN POPULATION WITH DIGESTIVE DISORDERS: A RETROSPECTIVE STUDY

Hanine AlMubayedh 1, Mansoor Khazi 1, Zain Askar 1, Nabil Kamas 1, Dimah Alaskar 2, Turki Alameel 2

Background: Thiopurinemethyltransferase (TPMT) is a cytoplasmic enzyme that catalyzes the thiopurine S-methylation and plays a vital role in the pharmacokinetics of thiopurines. Inter subject variations in thiopurine metabolism, efficacy and toxicity are attributed to the genetic polymorphism in TPMT activity. In this study we aim to explore the pharmacogenetics of TPMT activity in our Middle Eastern population with digestive related disorders and demonstrate its relation to age, gender and underlying disease.

Methods: This is a seven-year retrospective (2015-2021) single center study, including patients with inflammatory bowel disease, autoimmune hepatitis and autoimmune pancreatitis who underwent erythrocyte TPMT testing prior to treatment with thiopurines. The association between patients' demographics and enzyme activity was measured using Pearson Chi-Square and one-way ANOVA tests.

Results: One hundred and forty patients were included in this study. The male-to-female ratio was relatively equal and the mean age of patients was 28.18 years. The most common diagnosis was inflammatory bowel disease (88.57%). The Shapiro-Wilk test confirmed the normal distribution of our data. Most patients had a normal TPMT enzyme activity (83.57%). Frequency distribution of TPMT level of activity was divided into four categories: low (12.14%), intermediate (3.57%), normal (83.57%) and hyperactive (0.71%). A significant inverse relationship was identified between the mean level of TPMT metabolites and enzyme activity (p<0.05). The association between the mean level of 6-methylmercaptopurine riboside (6-MMP-R) and age was also statistically significant (p<0.05).

Conclusion: TPMT enzyme activity showed genetic polymorphism in the studied Middle Eastern population. The data showed significant correlation with age but not gender or diagnosis. Further research is needed to measure the clinical outcomes associated with having abnormal TPMT enzyme activity.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/03: A 5-YEAR GASTRIC CANCER SCREENING PROGRAM IN CENTRAL SAUDI ARABIA

Moataz Daadour 1, Ahmed Albadrani 1, Georgios Zacharakis 1, Abdulaziz Almasoud 1,2, Omar Arahmaner 3, Ahmed Albadrani 1, Khaled Aldossary 4, Jamaan Alzahrani 4, Sameer Al-Ghamdi 4, Abdullah AlShehri 5, Pavlos Nikolaidis 6, Abdullah Bawazir 1, Talal Alfayez 1, Faisal Alslimah 1, Mohammed Altamimi 1, Sami Alshalawi 1

Background: According to Globocan 2020, the incidence rate of gastric cancer (GC) in Saudi Arabia (SA) is 2%, mortality 4%, and the 5-year prevalence (all ages) 3.21%, lower in comparison to the worldwide prevalence. GC has been ranked 14th among both men and women. However, there may be regional variations in the incidence of exposure to trigger factors.

Aims: We aimed to assess the incidence of GC, its clinopathological profiles and association with risk factors in Central Saudi Arabia.

Methods: The 5-year participation rate was 87% (1080/1242) for a period of five years (2017-2022) following a screening strategy combining gastric and colorectal cancer. This prospective study included asymptomatic Saudi patients with a high-sensitivity guaiac faecal occult blood test (HSgFOBT) and negative colonoscopy followed by gastroscopy.

Results: The 5-year prevalence (all ages) was 3.8% (41/1080) per 100000. The incidence rate was 3.5% (21/603), the mortality rate 4.2 % (20/477) and intestinal adenocarcinoma was the most frequent in occurrence at 77%), followed by malignant lymphoma 12%) and diffuse adenocarcinoma (11%). The Carcinoid and mucinous adenocarcinomas were rare (1.5% vs. 0.9%). The gastric antrum (non-cardia) was most commonly site in stomach (41%), followed by corpus (23%), the cardia (19%), and fundus (17%). Helicobacter pylori on associated positively with relative risk (RR):1.39 (1.1-3.3), obesity (BMI>30) 1.69 (3.3-24.8), smoking status 1.99 (2.1-9.1), nutrition salty preserved products 1.7 (4.6-18.9).

Conclusions: The incidence of GC is still low compared with that in other countries. GG is not one of the deadliest cancers in central SA; however, it has poor prognosis and is difficult to treat. HP eradication, normal body weight, smoking avoidance, and a healthy diet can reduce the risk of GC. Further epidemiological and pathological studies are required across the country.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/04: RELATIONSHIP BETWEEN BURNOUT SYNDROME AND IRRITABLE BOWEL SYNDROME AMONG MEDICAL HEALTH PROVIDERS AND MEDICAL STUDENTS OF SAUDI ARABIA

Saeed Alqarni 1

Background: Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. Emotional exhaustion and loss of a feeling of personal accomplishment were significantly associated with lower GI disorders. Besides, men with emotional exhaustion more frequently had symptoms from the upper and lower GI systems, compared to those without emotional exhaustion.

Aim: The current study aims to detect the presence and severity of IBS and burnout syndrome among medical health providers and medical students. It also aims to assess the relationship between burnout syndrome and irritable bowel syndrome among medical health providers and medical students in Saudi Arabia.

Methods: A correlational cross-sectional study was conducted in Saudi Arabia in the Year of 2021-2022, targeting health care providers and medical students in Southern Saudi Arabia. Data were collected based on an electronic questionnaire. The questionnaire covered the participant's age, job title, and work setting. Maslach Burnout Inventory-Student Survey (MBI-SS) was used to assess burnout among study participants. IBS criteria and severity assessment as well as GERD symptoms were used to assess irritable bowel syndrome. The approved questionnaire was then uploaded online using social media platforms by the researchers and their friends.

Results: There were a total of 1031 total responders out of which 931 were valid. This includes medical health providers and medical students, fulfilling the inclusion criteria who completed the study questionnaire. Participants' ages ranged from 18 to 59 years, with a mean age of 25.2-11.9 years old. The exact number of 402 (43.2%) participants were physicians and 256 (28.5%) were nurses, while medical students were 197 (21.2%) and 67 (7.2%) were paramedical. Occupational exhaustion was high among 413 (44.4%) participants, and low among 136 (14.6%). Considering depersonalization, it was high among 493 (53%) participants and low among 141 (15.1%). Considering personal accomplishment assessment, it was low among 684 (73.5%) participants and high among 87 (9.3%) participants. The exact of 359 (38.6%) of the study participants had no clinical proof for IBS. Mild IBS was detected among 238 (25.6%) participants, while 222 (23.8%) had moderate IBS and 112 (12%) had severe IBS.

Conclusion: In conclusion, the current study revealed that up to 85% of health care staff had high levels of burnout and IBS severity, especially physicians and nurses. Burnout syndrome is significantly associated with GI symptoms and IBS severity.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/05: STUDY OF THE EFFICACY AND SAFETY OF ARGON PLASMA COAGULATION FOR THE TREATMENT OF THE PELVIC RADIOTHERAPY-INDUCED RECTAL VASCULAR COMPLICATIONS

Ayman Mohamed Elehleh 1, Mohamed Abo Elfotoh Shehata 1, Anas Atef Abo-Omar 2, Ayman Ahmed Sakr 1

Introduction: Chronic radiation proctitis is a pelvic malignancy radiation induced-long term complication that leads to endothelial dysfunction, microvascular injury, ischemia, fibrosis, and the occurrence of neovascular lesions and hence mucosal damage. Various endoscopic therapeutic modalities have been used for treatment. Recently, Argon plasma coagulation (APC) is an innovative, effective, and non-touch electrocoagulation technique that has been used successfully for treatment of hemorrhagic radiation proctitis (HRP).

Aims: Study of the efficacy and safety of APC for the treatment of the pelvic radiotherapy-induced rectal vascular complications.

Patients and Methods: A prospective study done on 50 patients recruited from tertiary medical center over the period from December 2019 to October 2021 complaining of post-pelvic radiation complications especially bleeding per rectum (BPR). Colonoscopy was performed for all patients after good preparation to detect the presence of mucosal vascular complications; 32 patients had rectal angiodysplasias and 18 patients didn't have. The endoscopic score for HRP according to the consisted of 3 factors: Telangiectasia distribution, surface area involved, and presence of fresh blood; graded from A to C reported by Zinicola et al.[1] The severity of rectal bleeding before and after treatment was graded from 0 to 4, reported by Chutkan et al.[2] scoring system. Then, according to colonoscopic findings, patients were classified into 3 groups; group I: included 16 patients that had angiodysplasias associated with BPR, group II: included 16 patients with angiodysplasias without BPR and GIII: 18 patients had no rectal vascular complications. The severity of rectal bleeding before and after treatment was graded. Patients that had angiodysplasia with evidence of bleeding, oozing or not have been treated by APC (ERPE VIO 200D) with power settings 40 watts, interval 2 seconds, flow rate 1.5 - 2 l/min. Colonoscopy was done 1 and 6 months later to follow up the degree of response, efficacy, and safety of the treatment.

Results: 50 patients included (32 with and 18 without rectal angiodysplasia). The mean age of the studied patients was 59.3 years,78.1% were males. The mean duration from last radiotherapy session was 9.53 months. Cancer prostate constitutes 62.5% of the studied patients. APC was successful in reducing clinical symptoms in 16 (100%) patients with angiodysplasia and had healed mucosa after single APC session in GII and 14/16 in GI has improved clinical picture and healed rectal mucosa during follow up periods. In GI, 31.3%,62.5%&6.3% of patients required single, two and three sessions, respectively. While (93.8%) of patients in GII achieved treatment success after only one treatment session. Mean number of sessions were significantly higher in GI than GII (1.75±0.57) vs (1.06±0.25), respectively(P-0.001). APC-induced adverse events were minimal with only two patients had abdominal pain 6.3% and 3 patients had distension 9.3%. Moreover, significant positive correlation was detected between bleeding score and number of sessions required to control bleeding (r.0.85 &P value 0.017).

Conclusion: APC is an effective, safe, curative and easy technique with minor side effects for treatment of HRP. APC should be considered as a 1st line option for such complications.

References

  • 1.Zinicola R, Rutter MD, Falasco G, Brooker JC, Cennamo V, Contini S, et al. Haemorrhagic radiation proctitis: Endoscopic severity may be useful to guide therapy. Int J Colorectal Dis. 2003;18:439–44. doi: 10.1007/s00384-003-0487-y. [DOI] [PubMed] [Google Scholar]
  • 2.Chutkan R, Lipp A, Waye J. The argon plasma coagulator: A new and effective modality for treatment of radiation proctitis. GastrointestEndosc. 1997;45:AB27. [Google Scholar]
Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/06: THE EFFECT OF PROTON PUMP INHIBITORS ON ACUTE GASTROINTESTINAL BLEEDING PATIENTS: MULTICENTRE RETROSPECTIVE STUDY

Fahad M Alotaibi 1, Nasser F Alotaibi 1, Faisal F Alsubaie 1, Hussain A Ekhuraidah 1, Mohammad Koshan 1, Rayan H Al Zahrani 1, Hamdan Alghamdi 1, Abed Allehibi 1, Abdulrahman A Aljumah 1

Background: Proton Pump Inhibitors (PPI) are among the most widely used drug in gastroenterology. They are acid-suppressive medications that are used in cases of acid-related disorders such as gastroesophageal reflux syndrome (GERD), upper gastrointestinal bleeding (UGIB), certain dyspepsia subtypes, peptic ulcers, and erosive esophagitis (ERD).

Aim: To assess the effect of Proton Pump Inhibitors on acute gastrointestinal bleeding patients.

Method: Medical records of all patients were reviewed. Demographic data, vital signs, medical history, physical examinations, comorbidity, medications, laboratory investigations, radiological investigations, cause and stage of liver disease, management, and complications were recorded. Endoscopic findings and endoscopic management of the bleeding site were collected according to the presenting symptom. Data were collected initially on a case report form (CRF) individually, then transferred to excel sheets. Statistical analyses were performed by using SPSS version 25.0.

Results: A total of 760 patients (642 were from King Abdulaziz Medical City and 118 were from King Fahad Medical City) were included. The mean age was 62.69 years (SD 17.81. Males were 467 (61.4%). From the study population, 48.9% gave a history of using PPI which was used as protector or alone as a therapy for certain acid-related disorders. Among all upper GI bleeding cases, PPI users represent 54.8%, while among all lower GI bleeding the PPI users were 44.1%, and 41.1% of all upper/lower GI bleeding were PPI users. Most of the cases that suffered from bleeding under the use of PPI had upper GI bleeding which consists of 49.4% of the whole study population, while the cases of lower GI bleeding from the total cases used for PPI accounted for 47.2%. However, we found strongly associated benefits for PPI users and Esophagitis, gastritis, and peptic ulcer respectively, (OR 3.4, 2.2 and 1.8 respectively). Among all PPI users, subjects in their seventies were the most likely to have acute GI bleeding, constituting 54.5%, while the lowest were those in their thirties, representing 30.2% of the whole study population.

Conclusion: Proton pump inhibitors (PPIs) may increase the risk of GIB if they are used in conjunction with anticoagulants or nonsteroidal anti-inflammatory drugs. Multiple anticoagulants and older patient's age are at a higher risk of GIB.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/07: PREVALENCE, CLINICAL PRESENTATIONS AND RISK FACTORS OF GASTROINTESTINAL BLEEDING IN SAUDI ARABIA: A MULTICENTER RETROSPECTIVE STUDY

Abed Allehibi 1, Faisal F Alsubaie 1, Nasser F Alotaibi 1, Hussain A Ekhuraidah 1, Mohammad Koshan 1, Rayan H Al Zahrani 1, Fahad M Alotaibi 1, Hamdan Alghamdi 1, Abdulrahman A Aljumah 1

Background: Gastrointestinal (GI) Bleeding is a fairly common problem, which may happen according to its location as upper GI bleeding in 100 to 200 per 100000 persons each year or lower GI bleeding in 20.5 to 27 per 100000 persons each year. It may cause major and extensive bleeding that may lead to eventual death.

Aim: To assess the epidemiology and clinical presentation of gastrointestinal bleeding and its outcomes in Saudi patients.

Subject: Seven hundred and sixty patients (Male and female), older than 18 years old, Saudi and Non- Saudi, visited the Emergency department of two tertiary care centers in Riyadh region (King Abdulaziz Medical City (National Guard Health Affairs) Riyadh, and King Fahad Medical City, Riyadh), during the period between January of 2010 and January of 2020 with GI bleeding presentations. All subjects with gastrointestinal bleeding (Upper or Lower) regardless of the underlying cause, lifestyle, location of bleeding, health status, or medications used were included. Patients with no endoscopy record, who were younger than 18 years old or those who sought medical care before or after the mentioned period were excluded from the study.

Method: Medical records of all patients were reviewed. Demographic data, vital signs, medical history, physical examinations, comorbidity, medications, laboratory investigations, radiological investigations, cause and stage of liver disease, management, and complications were recorded. Endoscopic findings and endoscopic management of the bleeding site were collected according to the presenting symptom. Data were collected initially on a case report form (CRF) individually, then transferred to excel sheets. Statistical analyses were performed by using SPSS version 25.0.

Results: A total of 760 patients were available for final analysis from the two tertiary care hospitals (642 were from National Guard Hospital while 118 were from King Fahad Medical City). The mean age was 62.7 years ± 17.8, and 61.4% were males. The mean BMI was 27.9 ± 7.2 kg/m2. The majority of patients were of Saudi nationality (97.2%). The most common comorbidity on presentation were hypertension (54.1%), diabetes mellitus (51.2%), ischemic heart disease (18.2%), as well as other comorbidities at less frequencies. The origin of the bleeding was lower G.I in 51.8%, upper GI in 43.9%, while 3.8% had bleeding from upper and lower GI bleeding at the same time. Symptoms on presentation included melena (42.1%), abdominal pain (38.0%), hematochezia (32.1%), hematemesis (21.6%), vomiting (19.5%), coffee-ground vomiting (12.8%), and dizziness (12.8%). The mean duration of ICU stay was 12.7 ± 13 days (range from 2 to 79 days). The majority (71.9%) had no recurrence of bleeding after discharge. The in-hospital disease-specific mortality rate was 12.1%. Endoscopic findings for upper GI bleeding were esophageal varices (18.8%), gastritis (14.5%), peptic ulcer (12.8%), esophagitis (3.4%), benign tumors (2.9%), gastric varices (2%), portal hypertensive gastropathy (0.5%). Endoscopy was negative in 27.5% of the whole study population. The colonoscopy findings in lower GI bleeding were hemorrhoids (21.4%), polyps (11.1%), diverticular disease (8.8%), ulcers (7.6%), benign tumors (3.6%), malignant tumors (2.5%), angiodysplasia (1.7%), and varices (0.7%), while the other causes (4.9%). Colonoscopy was negative in (21.1%).

Conclusion: Lower GI bleeding was more common than upper G.I bleeding in our cohort. Hemorrhoids, polyps, diverticular disease, and colonic ulcers. Constitute the majority of lower G.I. bleeding. On the other hand, upper G. I. bleeding was predominantly due to; esophageal varices, gastritis, and peptic ulcer. The most common presentations were melena and abdominal pain. The in-hospital mortality and length of ICU stay were high among these patients.”

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/08: IMPACT OF ANTITHROMBOTIC THERAPY ON CLINICAL OUTCOMES OF GASTROINTESTINAL BLEEDING AMONG SAUDI PATIENTS: TWO CENTERS EXPERIENCE

Hamdan S AlGhamdi 1, Mohammad A Koshan 1, Nasser F AlOtaibi 1, Fahad M AlOtaibi 1, Faisal F Alsubaie 1, Hussain A Ekhuraidah 1, Rayan H Al Zahrani 1, Abed AlLehibi 1, Abdulrahman A AlJumah 1

Background: Patients receiving antithrombotic medications may present with severe hemorrhage. Gastrointestinal (GI) tract is a common place where bleeding diathesis can occur. Patients in general are considered at increased risk if they are known to have underlying GI mucosal or vascular lesions.

Aim: We aimed at assessing the impact of antithrombotic therapy on clinical outcome of gastrointestinal bleeding.

Methods: All consecutive patients presented with GI bleeding (GIB) between January 2010 - 2020 to endoscopy units at two tertiary care centers were enrolled. Baseline demographic data, vital signs, medical history, physical examinations, comorbidity, medications, laboratory, radiological and endoscopic findings were recorded.

Results: During the study period, a total 760 patients presented with GIB. Patient demography showed mean age of 62.29 years ±18.26, males in 61.45%, hypertension in 5.39% and diabetes mellitus in 51.06%. The prevalence of antithrombotic prescription was 46.44% (353/760). The type of antithrombotic prescription was 63.5% for antiplatelets,55.5% for heparin, 18.7% for warfarin in 18.7% and 7.9% for factor Xa inhibitors. In the antithrombotic users, GIB occurred with similar frequency 34.56%,32.86%, and 32.58% among anticoagulants only users, antiplatelet only users and combination respectively. The prevalence of upper GIB (UGIB) among anticoagulants and antiplatelets users was 50% and 37.93% respectively. The most common causes of UGIB were erosive gastroenteritis 27%, peptic ulcers 25.3%, and esophageal varices 22%. The prevalence of Lower GIB (LGIB) among anticoagulants and antiplatelets users was 44.26% and 56.03% respectively. The most common causes of LGIB were hemorrhoids 32%, polyps 19.5%, and diverticular18.3%. The mortality rate among antithrombotic users vs. non-users was 7.63% (58/760) vs 4.47% (34/760) respectively, P value = 0.0069.

Conclusion: The use of antithrombotic medications is associated with increased frequency of both upper and lower GI bleeding. This led to a significant increase in mortality rate among patients presenting with GI bleeding while on antithrombotic therapy.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/9: ROLE OF FECAL CALPROTECTIN IN DIAGNOSING INFLAMMATORY BOWEL DISEASE AND IN DETECTING THE DISEASE ACTIVITY

Effat A El-Fekhfakh 1, Mohamed O Khalifa 1, Ashraf M Albreedy 1, HossamEldin M Salem 1, Mohamed O El-Maraghy 1, Mohammed A Al-Sanabani 1

Objective: To clarify the role of fecal calprotectin in the diagnosis of inflammatory bowel disease and to identify the relation between the level of fecal calprotectin & the degree of activity and severity of inflammation in patients with inflammatory bowel disease.

Patients and Methods: Eighty patients were included in the study. 40 patients with IBD; 20 patients with active IBD and 20 patients with inactive IBD versus 20 patients with IBS in addition to 20 healthy persons as control. Full history taking, clinical examination, routine laboratory investigations, ESR and CRP, stool culture and sensitivity, abdominal ultrasound, fecal calprotectin, total colonoscopy with terminal ileum examination and biopsies with histopathological examination. Correlation of the fecal calprotectin and IBD (endoscopy, histopathology, scores of disease activities, and other laboratories) was done and statistically studied.

Results: Fecal calprotectin had sensitivity, specificity, PPV, NPV and accuracy of 87.5%, 95%, 97.2%, 79.2 and 90% respectively when measured at a cutoff level of 69μg/g to distinguish between IBD and IBS. Also, in order to differentiate active IBD from inactive disease, the fecal calprotectin at the level of 148μg/g had sensitivity, specificity, PPV, NPV and accuracy of 100%, 97.5%, 95.2%, 100 and 97.5% respectively.

Conclusion: Fecal calprotectin is sensitive, simple, and non-invasive marker that can be helpful for differentiating IBD from non-organic disease. Fecal calprotectin is also a useful guide to monitor disease activity in previously diagnosed IBD.”

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/10: GASTROINTESTINAL BASIDIOBOLOMYCOSIS AT A TERTIARY CARE CENTER IN KING ABDULLAH MEDICAL CITY, MAKKAH: CASE SERIES

Yaser Meeralam 1, Adnan Alzanbagi 1, Abdulaziz Tashkandi 1, Saleh Alzahrani 1, Saad Zahrani 1, Walaa AlHarthi 1, Mohammad Shariff 1

Background: Basidiobolusranrum causes one of the rare fungal diseases that infects mainly immunocompetent individuals. Gastrointestinal Basidiobolomycosis (GIB) is a rare and uncommon form of this fungal infection. It's still ambiguous how this fungus is reaching the gastrointestinal tract leading to Gastrointestinal Basidiobolomycosis.

Objective: To summarize the clinical features, imaging and histopathological of patients diagnosed with GIB in our institution Patients and methods: A series of five cases of patients who diagnosed by basidiobolomycosis in King Abdullah Medical City, Makkah, Saudi Arabia, which reviewed by latest literature related to diagnosis and treatment.

Results: Most of patients were externally evaluated and were initially misdiagnosed. Some of them were suspected of colonic malignancy, other presumed to have hepatic hemangioma and fistulizingcrohn's disease. The definitive diagnosis is often based on histopathological examination and fungal culture of the surgically resected mass. An optimum standardized treatment of basidiobolomycosis has not yet been established.

Conclusion: Deeper knowledge of clinical characteristics, diagnosis and treatment of basidiobolomycosis will allow us to early detect it and early initiating of treatment which Later on show positive impact on the patient, more study need to explore a definite treatment.”

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/11: LONG-TERM EFFICACY AND SAFETY OF TENOFOVIR DISOPROXIL FUMARATE AND ENTECAVIR IN PATIENTS WITH CHRONIC HEPATITIS B: A SINGLE-CENTER COHORT STUDY

Bader Alansari 1, Waleed Al-hamoudi 1, Mazen Hassanain 1, Ayman Abdo 1, Abdullah Khathlan 1, Weam Hussein 1, Maram Alkhammash 1, Esther Abigail Robles 1, Maram Alaqel 1, Rana Aljunidel 1, Khalid Alswat 1

Background: Long-term safety and efficacy of oral nucleotide and nucleoside analogues have been demonstrated in several countries. However, available local data about treatment effects in our region are scarce.

Objectives: To assess the safety and efficacy of Entecavir and Tenofovir in chronic HBV patients.

Methods: This is a retrospective cohort study of the prospectively collected database at King Saud University Medical City. It included all Chronic hepatitis B patients treated with entecavir (0.5 mg or 1 mg) or Tenofovir (245 mg) for more than five years. Data for demographic, biochemical, and viral markers were assessed at baseline, one year, and the last follow-up.

Results: We included 253 HBV patients, with cirrhosis diagnosis in 22 %, and most participants (90.5%) were treated with the entecavir. Viral load (VL) was successfully suppressed (HBV DNA< 60 IU/ML) in both treatment groups after one year and recent follow-up in both groups. Entecavir VL suppression was achieved in 64% in 1 year and 77% in a recent follow-up. On the other hand, tenofovir VL suppression reached 58% and 87.5% after one year of treatment and recent follow-up, respectively. There were a small number of HBsAg seroconversion in both treatment groups (3% in the entecavir group and 0% in the tenofovir group). The mean ALT markedly improved from baseline in both treatment groups (p-value = 0.000 and 0.030). Renal safety was observed in Entecavir and Tenofovir groups with no significant changes in creatinine (p-value = 0.142 and 0.742).

Conclusion: Entecavir and Tenofovir are effective and safe treatment options for patients with chronic HBV, with significant improvement in HBV viral load and serological and biochemical markers with few patients who cleared the virus.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/12: GENE SEQUENCING IN SAUDI PATIENTS WITH HEPATOCELLULAR CARCINOMA

Mazen Hassanain 1, Yang Liu 1, Weam Hussain 1, Albandri Binowayn 2, Ghaida Almasaad 1, Duna Barakah 1, Khalid AlSwat 1, Ayman Abdo 1, Waleed AlHamoudi 1, Faisal AlSaif 2, Maram Alaqel 1, Rana Aljunidel 1, Ehtehal Elsalom 3, Saleh Alqahtani 4, Robert Hoehndorf 1, Malak Abedalthagafi 2

Background: HCC is the third most common cancer in Saudi Arabia. HCC is the second most common cancer affecting Saudi males and the eighth most common cancer affecting females. Most of patients (90%) present at a more advanced stage when symptoms prevail. Given the high prevalence of HCC in the Kingdom. We used deep next generation sequencing in Saudi cohorts of HCC both Whole Genome Sequencing (WGS) and Customized Genomic Panel (CGP). We compared the validated predisposition variants from CGI with our germline variants for 16 patients in our discovery cohort, and two of them could be detected: rs152451 are present in three individuals (heterozygotes are in case 1 and case 6, homozygotes is in case 14). rs17217772 is present in one individual (heterozygote is in case 1). We analyzed the variants on genes of interest (DPYD, APOB, PIK3CA, MYC, MRC1, TP53, RB1, CTNNB1, ATR, LRP1B, SAC3D1, HNF1A, KEAP1, LRRIQ3, ALB, NFE2l2). We then tested if those 7 individuals (validation cohort) have any of rare nonsynonymous variant in the gene panel. All of the 7 samples carried a rare nonsynonymous variant in BRD7 and 5 individuals carried a nonsynonymous variant in APOB.

Objectives:

  • To identify the genomics characteristics of Saudi patients with HCC.

  • To identify the genomic makeup of the tumors of HCC patients with exceptional response to sorafenib compared to non-responders.

  • To analyze the functional consequences of genomic aberrations that occurred in the studied patients in order to correlate that with knowledge about the process of hepatocarcinogenesis and response to Sorafenib; the targeted cancer drug.

Methods: To further explore the contribution of rare nonsynonymous variants to HCC on function unit, we used PPI as prior knowledge to propagate information and detect important disease module for each individual. We obtained 714 significant genes from differential gene expression analysis and count the number of rare nonsynonymous variants on these genes, then we normalized the number by gene size. Finally, we performed PCST algorithm for these 16 individuals to detect the most import module. We compared the validated predisposition variants from CGI with our germline variants for 16 patients in our discovery cohort, and two of them could be detected: rs152451 are present in three individuals (heterozygotes are in case 1 and case 6, homozygotes is in case 14). rs17217772 is present in one individual (heterozygote is in case 1). We analyzed the variants on genes of interest (DPYD, APOB, PIK3CA, MYC, MRC1, TP53, RB1, CTNNB1, ATR, LRP1B, SAC3D1, HNF1A, KEAP1, LRRIQ3, ALB, NFE2l2). We then tested if those 7 individuals (validation cohort) have any of rare nonsynonymous variant in the gene panel. All of the 7 samples carried a rare nonsynonymous variant in BRD7 and 5 individuals carried a nonsynonymous variant in APOB.

Results: We obtained 714 significant genes from differential gene expression analysis and count the number of rare nonsynonymous variants on these genes, then we normalized the number by gene size. Finally, we performed PCST algorithm for these 16 individuals to detect the most import module. We obtained 437 genes and 572 interactions from 16 graph results. In these 437 genes, five are included in gene panel, TP53, PIK3CA, ETAA1, CTNNB1, CREBBP, 39 have been validated on DisGeNet with evidence. CD44 is a hyaluronic acid receptor. Expression of CD44 potentiates AKT activation to in- duce the phosphorylation and nuclear translocation of Mdm2, which terminates the p53 genomic surveillance response. This allows DNA damaged hepatocytes to escape p53-induced death. Nuclear factor-B (NF-B) is a master regulator of inflammation and cell death, who acts as a central link between hepatic injury, fibrosis and HCC, and that it may represent a target for the prevention or treatment of liver fibrosis and HCC Additional discoveries are novel. For example, KRT8 and KRT18 were detected in 15 and 16 individuals separately. Studies have shown that high Keratin 8/18 Ratio Predicts Aggressive Hepatocellular Cancer Phenotype. ADAM8 were also screened out in all of the 16 individuals. Researchers illustrate that expression levels of the metalloproteinase ADAM8 critically regulate proliferation, migration and malignant signaling events in hepatoma cells.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/13: PERIPANCREATIC FLUID COLLECTIONS, PLASTIC STENTS, AND DIFFERENT SUB-TYPES OF METAL STENTS: WHERE DOES THE EVIDENCE LAND?

Abed Al Lehibi 1, Abdullah Al Jabri 1, Shahem Abbarh 1, Areej Al Balkhi 1, Nawwaf Al Otaibi 1, Thamer Almasoudi 1, Abdullah Al Mtawa 1, Adel AlGhamdi 1, Abdullah AlKhathlan 1, Adel Qutub 1, Khalid Al Sayari 1, Shameem Ahmad 1

Background: Peripancreatic fluid collections (PFCs) are a frequent complication of acute pancreatitis. Symptomatic PFCs may need to be drained, and there are multiple endoscopic accessories that can facilitate the procedure. This paper aims to compare the success rate, number of procedures required for resolution and adverse events rate for PFCs EUS-guided drainage with plastic stents and lumen-apposing metal stents (LAMS).

Methods: This is a retrospective analysis of a consecutive sample of patients that was collected from 2013 - 2019. The medical records of these patients were reviewed, and the outcomes for each type of stent (plastic vs LAMS, and different subtypes of LAMS) were compared in terms of clinical success, number of re-interventions needed, and adverse events.

Results: A total of 33 patients (23 males) were treated for PFCs with EUS-guided drainage and stenting. The patients' ages ranged between 14 and 85 years (mean ± SD: 43.5 ± 19 years). Overall, there was no difference between plastic stents and LAMS in terms of symptomatic recovery (P = 0. 24), but metal stents had better results with regards to radiological resolution (P = 0.03), and were associated with a higher number of necrosectomies (P = 0.029). Adverse events occurred more frequently in patients who had plastic stents, but direct comparison between the two groups showed that the difference was not statistically significant (P = 0.2). Stratification for different LAMS subtypes showed no difference in terms of symptomatic or radiological resolution (P =0.49), number of rescue procedures (P = 0.41), and adverse events (P = 0.81).

Conclusion: Our study, along with the current available evidence, suggests a slight advantage of metal stents over plastic stents in terms of clinical success, need for rescue procedures, and incidence of adverse events. Furthermore, it provides empirical evidence that the different sub-types of LAMS perform similarly when compared against each other.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/14: PERORAL ENDOSCOPIC MYOTOMY FOR THE TREATMENT OF ACHALASIA: A MULTICENTER MIDDLE EASTERN EXPERIENCE

Abed Al Lehibi 1, Shaimaa ElKholy 1, Mohamed Gouda 1, Ammar Al Dabbagh 1, Areej Al Balkhi 1, Abdullah Almtawa 1, Nawwaf Al Otaibi 1, Mohammed El-Sherbiny 1, Kareem Essam 1, Mohammed Attieh Alzahrani 1, Ahmed Al Ghamdi 1, Adel Al Ghamdi 1, Ahmad AlEid 1, Adel Qutub 1, Abdulrahman Alamr 1, Shameem Ahmad 1, Khalid Al Sayari 1, Bashaar Al Ibrahim 1, Abdullah Al Khathlan 1

Background: Peroral endoscopic myotomy (POEM) was proposed in 2010 as a minimally invasive procedure for the treatment of achalasia. In this article, we describe the Middle Eastern experience with the procedure in terms of efficacy, length of admission, and short-and long-term complications.

Methods: A retrospective analysis of our prospectively collected data on patients who underwent a POEM procedure was conducted between March 2019 and May 2020. The primary outcome was clinical success rate, defined as a postprocedureEckardt score ≤3 at ≥3 months. Secondary outcomes included the length of hospital stay, presence of reflux symptoms or need for proton pump inhibitors (PPIs) ≥3 months, and adverse events.

Results: During the study period, 67 patients (35 females) underwent the procedure for achalasia. The participants' ages ranged from 11 to 80 years (mean 41 ± 18 years). Eckardt scores before the treatment ranged between 4 and 12 (mean 8.85 ± 1.75). Sixty-four patients (95.5%) achieved Eckardt scores of ≤3 at ≥3 months after the procedure (95% confidence interval [CI]: 91%-100%). The difference between pre- and post-procedural Eckardt scores averaged around -8 points (95% CI: -7.5 to -8.5 P < 0.0001). Adverse events were reported in 24 patients (35.8%) and included pneumoperitoneum (32.8%), reflux symptoms at 3 months (29.9%), and surgical emphysema (3%). Six patients had adverse events that led to prolongation of admission; 3% of whom had aspiration pneumonia, 3% had pneumoperitoneum, 1.5% had both, and 1.5% had an esophageal tear.

Conclusions: POEM is a promising procedure for the treatment of achalasia with a high clinical success rate, short hospital admission, and a reassuring safety profile.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/15: PREVALENCE OF EXTRAINTESTINAL MANIFESTATIONS AMONG INFLAMMATORY BOWEL DISEASE PATIENTS AT A TERTIARY CARE CENTER IN RIYADH, SAUDI ARABIA

Abdullah A Alotiabi 1, Abrar Alhubayshi 1, Abed AlLehibi 1, Abdullah Almtawa 1, Nawwaf Alotaibi 1, Adel Alghamdi 1, Saad Alrajhi 1, Adel AlQutub 1, Ahmad AlEid 1, Abdulrahman Alamr 1, Bashaar Ibrahim 1, Mohammed Alahmari 1, Hussam Alhamidi 1, Shameem Ahmad 1, Youssef Altannir 1, Hadeel Albayyat 1, Osama Alshaya 1, Alghamdi Ahmed 1

Background and Aims: The Inflammatory Bowel Diseases (IBDs), Crohn's Disease (CD) and Ulcerative Colitis (UC), are gastrointestinal autoimmune disorders with many Extraintestinal Manifestations (EIMs). Previously reported incidences of EIMs in IBD patients have ranged from 10% to 50%. The large variation in occurrence of EIMs has been linked to genetic predisposition. Correlations between individual EIMs are unclear. Therefore, we aim to estimate the incidence of EIMs among IBD patients, and to review the frequency, features, and treatment modalities of the major IBD-associated extraintestinal manifestations.

Patients and Methods: This study is a cross-sectional chart review that will involve reviewing patients' charts who visited Gastroenterology and Hepatology clinics at KFMC, using a computer database, data on demographics, disease characteristics, and EIMs were extracted and analyzed. Descriptive used to statistically analyze qualitative data. Student t- test and ANOVA were used to compare means for quantitative data when needed.

Results: We reviewed the electronic medical files of 571 patients with confirmed IBD, of which 312(54%) were males and 266(46%) females, the mean age was 32 (±11) years; 367 (63.5 %) patients had CD and 211 (36.5%) UC. The overall prevalence of EIMs was 32(11.2%), The most common EIM was PSC in 33 patients (5.2%) (p = 0.005), Followed by peripheral arthritis (2.5%), then Sacroiliitis in 11 (1.9%). Venous thromboembolism in 6 patients (1%). Spondylitis was in 5 (0.9%). While Aphthous ulcer in 4 patients (0.7%). Skin manifestations in 3 patients (0.5%) where Pyoderma Gangrenosum was the most common (0.3%). Primary Sclerosing Cholangitis (PSC) occurred in 16 males, 14 females, of a median age of 33 (5.2%) whereas it was more specific for UC (9.0%) in comparison to CD (3.0%).

Conclusion: Present of extraintestinal manifestations will affect the course of the disease and choice of treatment. Early and active surveillance of EIM is important, and A multidisciplinary assessment is recommended as part of IBD management to improve overall health outcomes.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/16: CHARACTERISTICS AND NATURAL HISTORY OF HEPATITIS B IN SAUDI ARABIA: DATA FROM THE SYSTEMATIC OBSERVATORY LIVER DISEASE REGISTRY

Khalid Alswat 1, Faisal Sanai 1, Waleed Al-hamoudi 1, Ayman Abdo 1, Abdullah Khathlan 1, Mona Ismail 2, Yaser Dahlan 1, Hamdan Saleh AlGhamdi 3,4, Ibrahim Altraif 3,4, Abdulrahman Aljumah 3,4, Abduljaleel Alalwan 3,4, Mohamed Babatin 5, Abdullah Alghamdi 5, Ali Albenmousa 6, Khalid Bzeizi 6, Saleh A Alqahtani 6,7

Introduction: Chronic hepatitis B (CHB) is still a major health problem in many countries, including Saudi Arabia. Several studies described the prevalence of CHB in the country; however, the disease characteristics and natural history have not been analyzed in a large cohort. This study aims to address this important knowledge gap by describing disease characteristics and natural history in a large database cohort.

Methods: Data from the SOLID (Saudi observatory liver disease) registry were collected for all CHB patients from January 2008 to December 2019. Information was analyzed regarding demographic, biochemical, virological, and fibrosis markers and compared between baseline and follow-up (FU) visits.

Results: A total of 1564 patients were analyzed, with 1218 (78%) patients having inactive disease and 346(22%) patients with active disease and offered treatment at baseline. The average age was 41 years; the male patients were 62.5%. The average BMI of this cohort was 28.4 kg/m2, and the majority of the cohort were HBeAg negative 1375 (87.9%). Cirrhosis was diagnosed in 100 (6.4%) patients and 19 (1.2%) with decompensated cirrhosis. The HBeAg negative group, when compared with HBeAg positive group, has older age, 41.6 (13.7) vs. 35.8(12.3) years (p=0.001), with significantly lower HBV DNA levels 3.1 × 107 (4.5 × 108) vs. 9.9 × 106(1.4 × 108) IU/ML, p=0.001). During a mean FU period of 45. 8 (36.1) months for a cohort of 741 patients, 90 patients had evidence of disease activity and changed status from inactive disease to active disease and were started on treatment, 38 (6%) patients lost HBsAg, and four cases of hepatocellular carcinoma were diagnosed. Among the inactive disease cohort, 609 patients had FU visits and data. At the FU time, the level of liver enzymes was stable, with a mean (SD); ALT in baseline group 42.1 (25.7) and ALT at FU 32.3 (17.6) IU/ML, p=0.001), No significant difference in HBV DNA mean levels between baseline and FU ((2.1 × 107 (4.2 × 108) vs. 7.7 × 106, respectively (p=0.402)) however, more patients with negative HBV DNA or HBV < 2000 IU/ML at FU time. FIB4 was significantly higher at FU time (baseline 0.4(0.6) vs. FU 0.8(0.5), p=0.001), APRI was similar at baseline and FU times, and no other hepatic complications were observed at FU. No significant predictors for HBsAg loss were observed.

Conclusions: This analysis showed that a significant proportion of CHB patients (quarter) in the country required treatment at the presentation time; however, few patients with confirmed inactive CHB had disease activity or progression during the FU period. More data analysis using noninvasive markers such as transient elastography is required to best assess disease progression, considering the impact of overweight and possible fatty liver in many patients.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/17: ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE ELDERLY SAUDI CHOLANGITIS PATIENTS: A RETROSPECTIVE STUDY

Abdulaziz Al Masoud 1, Abdulrahman Al-Robayan 1, Ebtissam Al-Meghaiseeb 1, Reem Al-Amro 1, Hadeel Ghazal 1, Nabih Alansari 1, Nawaf Bin Mugren 1, Musaad Albalood 1, Abdullah Alshablan 1, Abdulmajeed Alshalan 1, Amal Aldawish 1, Mohammed Almeshal 1, Ali Alduhayshi 1, Misbahul Arfi 1

Background and Aims: The aim of this study was to evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly Saudi patients.

Methods: The medical files of the cholangitis patients visiting the gastroenterology clinics of Prince Sultan Military Medical City (PSMMC) Riyadh from June 2015 to June 2022 were reviewed. ERCPs were performed on 363 cases aged 70 and more in our endoscopy division. Patients were classified into two groups namely 81-103 years (n= 164, M=120; F=46) as elderly and 70-80 years old (n=199, M=123; F=76) as controls. The patients' medical records were retrospectively searched for co-morbidities, laboratory data, and etiology of cholangitis (presence of biliary stones, biliary stricture and malignancy), details of the ERCP, ERCP-related complications and mortality. The demographics, American society of anesthesiologists (ASA) physical status classification score, indication for the use of the ERCP procedure, and clinical outcomes were recorded.

Results: The elder group (those ≥81years old) showed significantly more patients with ASA Classes III-IV than the control one (those≤80 years old). The frequency of co-morbidities like hypertension, chronic heart failure, cerebrovascular disease, arrhythmia, COPD/asthma/respiratory disease, and chronic renal failure was higher in the elderly group than the control group where as diabetes mellitus, malignancy; chronic liver disease was more in control group. There was no significant difference in the technical success rates or endoscopic procedure durations and frequency and type of ERCP-related complications between the two groups. The post-ERCP pancreatitis was higher in the control group than the elder one. The minor complications during the procedures or post-ERCP were independent of age or sex of the patients. No other surgical intervention or angiography was required in any of the cases with ERCP-related complications. There was no mortality during the observational period of 30 days in both the groups. Follow up data indicated that the geriatric assessment parameters like physical function, nutrition, other medical conditions, mental health, and extent of social support or independency were quite promising in our elderly patients.

Conclusion: ERCP is as safe in the Saudi elderly patients as it is in control group and emergency or elective ERCP can be performed safely even in elderly (≥81years old) cholangitis patients.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/18: THE UTILITY OF DIGITAL CHOLANGIOSCOPY (SPYGLASS DS) IN BILIARY AND PANCREATIC DISEASES: A CLINICAL FEASIBILITY STUDY AT TWO TERTIARY CARE CENTERS IN SAUDI ARABIA

Abed Al Lehibi 1, Emad Aljahdali 1, Areej Al Balkhi 1, Thamer Almasoudi 1, Ahmed Al Ghamdi 1, Khalid Al Sayari 1, Abdullah Al Khathlan 1, Adel Qutub 1, Ahmad AlEid 1, Shameem Ahmad 1, Nawwaf Al Otaibi 1, Abdullah Al Mtawa 1

Background and Study Aim: Since its inception in 2007, single-operator cholangioscopy (SOC) has gained popularity for many diagnostically and therapeutically challenging biliary and pancreatic conditions. Many studies have been published to evaluate the feasibility, usefulness, cost-effectiveness, and safety profile of the first generation. This paper is a descriptive study in which we aim to share the experience of two tertiary care centers with the novel version of SOC, SpyGlass DS.

Patients and Methods: We retrospectively reviewed the records of all the patients who went through the procedure from October 2015 - July 2019 to explore the scope of biliary and pancreatic conditions in which SOC was utilized. Technical success was defined as the ability to visualize the lesion and complete the procedure as planned, whereas clinical success was determined by the ability to achieve the desired diagnostic/therapeutic outcome.

Results: During the period of interest, 66 patients (34 males) went through 84 cholangioscopy procedures. Forty-four patients failed the conventional extraction methods and needed the intervention for the treatment of difficult stones, 24 patients needed a diagnostic evaluation of biliary strictures, and 3 needed an intervention to remove migrated stents. Technical success was achieved in 98.8% (83/84) of the procedures (95% CI: 96-100%). Regarding clinical success, stone breakdown and removal was achieved in 92% of the procedures (49/53; 95% CI: 85-100%). Tissue samples were successfully obtained in 95.8% (23/24) of patients with strictures (95% CI: 88-100%). The biopsy was appropriate to make a histological diagnosis in 83.3% of cases (20/24; 95% CI: 68-98%). The median number of sessions needed to achieve the deisred outcome was one (ranging between 1 and 6 sessions).

Conclusion: The new version of SOC, SpyGlass DS, provides a feasible and an effective option for the management of difficult cholelithiasis, as well as visually evaluating and obtaining histological samples for indeterminate biliary strictures. However, data from more extensive studies are needed to establish its non-inferiority to the fiberoptic version in terms of short- and long-term outcomes, cost-effectiveness, and complications.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/19: SEROPREVALENCE OF HEPATITIS B AMONG ADULT PATIENTS RECEIVING IMMUNOSUPPRESSIVE THERAPY AT A TERTIARY CARE CENTER IN SAUDI ARABIA

Abdulatif Alsuleimani 1, Yaseen Aswad 1, Abed AlLehibi 1, Abdullah Almtawa 1, Nawwaf Alotaibi 1, Adel Alghamdi 1, Saad Alrajhi 1, Adel AlQutub 1, Ahmad AlEid 1, Bashaar Ibrahim 1, Mohammed Alahmari 1, Hussam Alhamidi 1, Shameem Ahmad 1, Youssef Altannir 1, Ahmed Alghamdi 1, Abdulrahman Alamr 1

Background and Introduction: Hepatitis B (HB) is a threat to global health. Patients receiving immunosuppressive therapy are at high risk of HBV reactivation and diminished response to HBV vaccination. The HBV vaccination program in KSA dramatically decreased the prevalence of Hepatitis B Surface Antigen (HbsAg) over the last three decades to 1.3% in 2019. Our study aims to measure the seroprevalence of HB and evaluate the effect of the vaccination program among adult Saudi patients receiving immunosuppressive therapy at a tertiary care center in Saudi Arabia. In addition, we aim to measure the compliance with HBV screening.

Methods: We used the electronic medical record system (EPIC) to generate a list of patients (3 18 years old) who have received systemic immunosuppressive therapy from March 2021 to February 2022 at King Fahad Medical City, Riyadh, Saudi Arabia.

Results: A total of 2865 patients were enrolled. 422 patients (84.6%) were screened for HBV by the complete set of HBV profiles. We found that 1567 (54.8%) of our patients were not effectively immunized, 624 (21.8%) were effectively vaccinated, 211 (7.4%) have a resolved infection, and 21 (0.7%) are currently infected. Meanwhile, 439 (15.3%) patients have not been compliant with HBV screening. The patients were further subdivided into two groups: group 1 (> 32 years old) and group 2 (<32 years old). In group 1, 962 (52.2%) were nonimmune, 336 (18.2%) were effectively immune, 204 (11.1%) have had a resolved infection, and 21 (1.1%) are currently infected. In group 2, 605 (59.4%) were non-immune, 288 (28.3%) effectively vaccinated, and 7 (0.7%) have had a resolved infection. Unlike group 1, there is no active HBV infection among group 2 patients.

Conclusion: HBsAgseroprevalence in our study is lower than the general population in KSA. Since most of our patients are non-immune to HBV, the risk of acquiring the infection is high. In addition, immunosuppression therapy increases the risk of HBV reactivation in patients with a history of HB. We detected non-compliance with the complete HBV profile in 439 (15.3%) patients.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/20: NUDT15 GENE VARIANTS AND AZATHIOPRINE INDUCED LEUKOPENIA IN SAUDI PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Yaser Meeralam 1, Adnan Al Zanbagi 1, Mona Al Saadi 1, Mohammed Khan 1, Abdulrahman Basfar 1, Wafi Almutawa 1, Sayeda Al Belewi 1, Mohammed K Shariff 1

Background: Thiopurine induced myelosuppression is a well-recognized adverse event and is associated with genetic variants in nudix hydrolase 15 (NUDT15) gene. Loss-of-function alleles has been well characterized in different ethnic groups. However, the prevalence of these variants in Saudi patients with inflammatory bowel disease (IBD) has not been reported.

Aim: To investigate the prevalence of NUDT15 polymorphism in Saudi patients with IBD and its influence on myelosuppression in patients taking azathioprine.

Methods: Patients with a confirmed diagnosis of IBD from a tertiary referral center in Makkah who had NUDT15 genotyping done before initiating azathioprine were retrospectively evaluated for evidence of myelosuppression by checking complete blood count including hemoglobin, differential white cell count and platelet count.

Results: NUDT15 genotyping was done in 37 patients with a mean age of 29.8 years (SD 10.3) including eleven females (males = 26) and 27 patients with Crohn's disease (ulcerative colitis = 10). Thirty-four patients (92%) carried the wild type NUDT15 genotype and three (8%) variant alleles. Of these three variant NUDT15 mutation p.R139C (rs116855232, allele *3), two were homozygous (*3*3) and one heterozygous (*1*3). Four patients (11%) developed thiopurine-induced leucopenia (TIL). Only one patient (1/34, 3%) with wild type NUDT15 genotype developed TIL in comparison to all the patients with NUDT15 variant (3/3, 100%) with a sensitivity and specificity of 100% and 97.06% respectively.

Conclusion: This is the first study of its kind, in modest number of patients, to report on the prevalence of NUDT15 haplotypes in Saudi patients with IBD. Analyzed in a single tertiary center, 8% of this study population were carriers of NUDT15 variant and all these patients developed TIL, signifying the importance of genotyping prior to initiation of azathioprine.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/21: THIOPURINE METHYLTRANSFERASE GENOTYPING IN ADULT SAUDI PATIENTS WITH INFLAMMATORY BOWEL DISEASE: FREQUENCY AND IMPACT ON THIOPURINE INDUCED MYELOSUPPRESSION

Yaser Meeralam 1, Adnan Al Zanbagi 1, Mona Al Saadi 1, Mohammed Khan 1, Abdulrahman Basfar 1, Wafi Almutawa 1, Sayeda Al Belewi 1, Mohammed Shariff 1

Background: Thiopurine methyltransferase (TPMT) gene variants have been implicated in development of leucopenia leading to recommendations in dose adjustment of thiopurines according to the TPMT genotype. The frequency and role of TPMT polymorphism in Saudi patients with inflammatory bowel disease (IBD) has not been reported.

Aim: To evaluate the occurrence of TPMT haplotypes *2, *3A, *3B and *3C in Saudi patients with IBD.

Methods: TPMT screening was performed in 42 patients with IBD before initiating azathioprine at a single tertiary referral center in Makkah in the Kingdom of Saudi Arabia (KSA). Patient's electronic database was retrospectively reviewed for demographics and laboratory results. The coding exons of genes TPMT were enriched and sequenced on an illumine system by next generation sequencing.

Result: The mean age of the 42 patients was 29.36 ± years (Males: Females, 28:14) with 30 of them having Crohn's disease and 12 ulcerative colitis. TPMT genotyping identified 98% (41/42) as wild type (*1*1), 2% (1/42) as TPMT heterozygous {*1/*3C (c.719A>G)}, none were homozygous and none carried the haplotype *2, *3A, or *3B. Three patients (7%) developed azathioprine-induced leucopenia (AIL), all were detected in patients with wild type TPMT. The only patient who was heterozygous for TPMT did not manifest AIL.

Conclusion: For the first time we determined the frequency of the TPMT polymorphism in the Saudi patients with IBD. In this cohort of small number of patients, TPMT genotyping was not associated with AIL. Further studies with large population based screening in KSA is warranted to confirm the clinical relevance of TPMT genotyping in IBD.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/22: GASTROINTESTINAL BASIDIOBOLOMYCOSIS AT A TERTIARY CARE CENTER IN KING ABDULLAH MEDICAL CITY, MAKKAH: CASE SERIES

Yaser Meeralam 1, Adnan Alzanbagi 1, Abdulaziz Tashkandi 1, Saleh Alzahrani 1, Saad Zahrani 1, Walaa Alharthi 1, Mohammed K Shariff 1

Background: Basidiobolusranrum causes one of the rare fungal diseases that infects immunocompetent individuals. Gastrointestinal Basidiobolomycosis (GIB) is a rare and uncommon form of this fungal infection. It's still ambiguous how this fungus invades the gastrointestinal tract leading to Gastrointestinal Basidiobolomycosis.

Objective: To summarize the clinical features, imaging and histopathology of patients diagnosed with GIB in our institution.

Patients and Methods: A series of five cases of patients who were diagnosed with basidiobolomycosisin King Abdullah Medical City, Makkah, Saudi Arabia, were retrospectively searched and their electronic records reviewed for laboratory results, endoscopy, histopathology and imaging.

Results: Most of the patients were initially misdiagnosed and referred to our hospital for further evaluation. Case 1 – 25-year-old male referred with suspected colonic malignancy with history of bloody diarrhea and weight loss. CT scan of abdomen revealed ileocecal mass and colonoscopy showed a polypoidal cecal tumor. Biopsy from this lesion was described as inflammatory polyp. Patient later developed intestinal obstruction leading to right hemicolectomy and histology of this confirmed eosinophillicinflitration with fungal hyphae suggestive of GIB. Case 2 – 52year male referred as rectal malignancy with rectal bleeding. Colonoscopy showed a circumferential polypoidal lesion and a biopsy confirmed GIB as described above. Case 3 – 41-year-old male referred as hepatic malignancy with abdominal pain. CT scan of abdomen revealed a large lesion in left lobe. Hepatic resection and histology confirmed a diagnosis of hepatic basidiobolomycosis. Case 4 – 54-year-old male presented with large bowel obstruction with CT showing multiple mass lesion in the ascending and sigmoid colon leading to a total colectomy. The histology confirmed the diagnosis of GIB. Case 5 - 58-year-old male presented with non-bloody diarrhea with CT scan revealing inflammatory colonic thickening with multiple fistulae in mesentery and abdominal wall. He later required a extended right hemicolectomy due to colonic perforation and histology confirmed GIB.

Conclusion: Better understanding of clinical characteristics, diagnosis and treatment of basidiobolomycosis will allow us to detect the disease early and initiate prompt therapy avoiding complication and extensive surgery.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/23: IMPACT OF THE OPEN ACCESS THERAPEUTIC ERCP ON PATIENT SATISFACTION AND QUALITY OF LIFE: DATA FROM A TERTIARY HOSPITAL OF SAUDI ARABIA

Laeeque A Qureshi 1, Adnan Alzanbagi 1, Abdulaziz Tashkandi 1, Mohammed S Khan 1, Saad Zahrani 1, Fawaz S Baalaraj 1, Dyaa E Habeeb 1, Mohammed K Shariff 1

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced invasive procedure to diagnose and to treat a variety of pancreatico-biliary diseases. Due to a limited availability of facility and demand in western region of KSA, patients are facing longer waiting time. Hence, open access for therapeutic ERCP on day care basis was established. After the procedure, patients are transferred back to the referring hospital. This study investigates the impact of the open access for ERCP on patient's satisfaction and quality of life.

Methods: The data of all open access ERCP from Aug 2021 to Jun 2022 were reviewed from the hospital's electronic health record and the endoscopy database. Data were collected on a performa and patients were interviewed according to a predesigned questionnaire to assess the satisfaction and quality of life.

Results: A total 298 open access ERCPs were performed by Board-certified consultants. 128 patients were male and 170 were female. Mean age of the patients was 57 years. Deep CBD cannulation rate was 98.6%. The commonest indication was choledocolithiasis (180/298) followed by malignant biliary obstruction (55/298). Pre-procedure satisfaction in relation to staff cooperation, explanation ofprocedure and related complications and reply to patient's concerns were assessed and responded as (Strongly agree 225 (76%), agree 23 (8%), neutral 13 (4%), disagree 14 (5%) and strongly disagree 23(8%)). Procedural satisfaction was assessed in relation to the discomfort during or 2 hours post procedure (Strongly agree 257 (86%), agree 17 (6%), neutral 10 (3%), disagree 5 (2%) and strongly disagree 9 (3%)). Post procedure satisfaction was assessed in relation to explanation of findings and their management, any unfortunate event and its management and explanation of possible delayed complications and reply to the concerns (strongly agree 216 (72%), agree 51 (17%), neutral 14 (5%), disagree 8 (3%) and strongly disagree 9 (3%)). Hospitalized was required in 37/298 (12%), mostly for cholecystectomy or management of abdominal pain. Majority of the patients (199/298, 67%) regained their routine activities within 5 days of procedure. The positive overall impact of ERCP in relation to symptoms, social life, and psychology and performance status was reported 'Excellent' by 214 (71.81 %) patients, 'very good' by 41 (14%), 'good' by 15 (5%), 'bad' by 9 (3%) patients & 13 (4%) patients remain 'neutral'. Overall satisfaction by the open access ERCP was reported 'excellent' by 246 (82.55 %) patients, 'very good' by 30 (10.06 %) patients, 'good' by 9 (3.02 %) patients, and 'poor' by 4 (1.34 %) patients and 'very poor' by 9 (3.02 %) patients.

Conclusion: Practicing an open access ERCP with maintaining the safety of patient and quality of procedure is practical without adding the morbidity or mortality risk. This practice reduces the waiting time of procedure. A well-structured practice provides both, the patient's satisfaction and a positive impact on the overall quality of life.

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/24: SINGLE CENTER EXPERIENCE OF LOCOREGIONAL THERAPY IN UNRESECTABLE HEPATOCELLULAR CANCER

Adnan Al-Zanbagi 1, Abdulaziz Tashkandi 1, Zaffar Mahmoud 1, Noha H Guzaiz 1, Mohammed K Shariff 1

Background: Hepatocellular cancer (HCC) is a leading cause of liver related death in Kingdom of Saudi Arabia. Most cases present late and have limited curative options. Locoregional therapies have merged as minimally invasive approaches to manage patients with intermediate stage HCC. However, there is limited data on the outcome of these techniques in Kingdom of Saudi Arabia.

Aim: Evaluate the safety and efficacy of locoregional therapies in unresectable HCC.

Methods: Patients who underwent locoregional therapy at our tertiary referral center for HCC over the last five years were retrospectively searched for their demographics and outcome of therapy from electronic records.

Results: 46 patients had locoregional therapy with mean age of 70 ± 11 years (Males 37) including 43% (20) with Child-Pugh (CP) class A, 33% (15) class B and 24% (11) in class C. The main etiology was hepatitis B in 41% (19) and hepatitis C in 33% (15). Transarterial chemoembolization (TACE), transarterial radioembolization (TARE) and ablative therapy like radiofrequency and microwave were used with 33% (15) receiving combination therapy. Following the locoregional therapy, 26% (12) had complete response, 22% (10) partial response and 26% (12) stable disease. In 46% (21) HCC was progressive with 2 year survival rate of 39% (18). Adverse events were recorded in 61% (28) of patients with the most common being rise transaminase in 25% (7/28) and rise in bilirubin 17% (5/28).

Conclusion: Locoregional therapy in our center performed to international standards with acceptable efficacy and safety profile in patients with intermediate stage HCC.”

Saudi J Gastroenterol. 2022 Dec 1;28(Suppl 1):S1–S13.

SJG2022/25: TRANSARTERIAL CHEMOEMBOLIZATION OR RADIOEMBOLIZATION FOR PATIENTS WITH HEPATOCELLULAR CANCER – A RETROSPECTIVE COMPARISON OF OUTCOMES

Adnan Al-Zanbagi 1, Abdulaziz Tashkandi 1, Zaffar Mahmoud 1, Noha H Guzaiz 1, Mohammed K Shariff 1

Background: Hepatocellular cancer (HCC) is sixth most common cancer in Kingdom of Saudi Arabia (KSA). Transarterial chemoembolization (TACE) is the standard of care for intermediate stage HCC endorsed by the international societies. Transarterialradioembolization (TARE) has lately emerged as an alternative to TACE. However, there is limited data comparing these techniques in KSA.

Aim: Evaluate the safety and efficacy of TACE and TARE in unresectable HCC.

Methods: Information on patient demographics, clinical status, biochemical and radiological results for all the HCC cases who underwent TACE or TARE at our tertiary referral center for HCC over the last five years were retrospectively collected and analyzed from electronic records.

Results: The rate of complete response, partial response and stable disease between TACE and TARE was 6% vs 8% (p = 0.86), 6% vs 23% (p=0.10) and 13% vs 38% (p=0.048), respectively. HCC progression rate was 36% and 54% for TACE and TARE respectively (p=0.31). Two year survival rate was 34% and 23% for TACE and TARE, respectively (p=0.46). Adverse events were similar between techniques and included liver decompensation, rise in transaminase and abdominal pain.

Conclusion: Both the locoregional therapies were comparable in terms of efficacy and safety. Though numerically the survival rate was better in TACE, this did not reach statistical significance. Large studies are required to confirm these findings.

Articles from Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association are provided here courtesy of Wolters Kluwer -- Medknow Publications

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