Exabis Library

Educational objectives: 

1. To understand the role of anti TNF on postoperative infectious complications
2. To review the evidence for drug levels associated with postoperative complications
   3. To understand the role of anti interleukin and anti integrins on postoperative infectious complications
   4. To understand how biologics affects staging of IPAA

1. To understand adherence in a broad perspective
2. To review existing knowledge on adherence
3. To emphasise possible predictors for low or non-adherence
4. To provide with some tools to measure adherence

1. To understand adherence in a broad perspective
2. To review existing knowledge on adherence
3. To emphasize possible predictors for low adherence
4. To provide with some tools to measure adherence

Although characteristic findings within the mesentery have been described early on by Burrill Crohn himself, the role within Crohn’s disease has only partially been deciphered yet. Thus, this tandem talk will address the following three central points in the field:

1) Why this topic is of interest.

2) Reasons that suggest a protective role of the mesentery.

3) Reasons that suggest a disease-driving role of the mesentery.

This will be done by jointly discussing the available experimental, translational as well as surgical evidence. We will conclude by identifying the gaps in knowledge and by highlighting the ongoing clinical trials in the field.

1. to give a surgical point of view concerning adipose tissue and Crohn's disease

2. to present the reasons that underline a protective side of the mesentery, with the recent good results with KONO-S anastomosis (preservation of the mesentery) and stricturoplasty

3. to have an overview of the reasons that underline a disease-driven role of adipose tissue, with good results obtain with mesorectal resection during abdominoperineal resection for CD in Amsterdam and good preliminary results obtain by Coffey in Ireland with ileocecal resection with mesenteric resection for CD

4. to give an overview of the randomized trials in progress on mesenteric resection during ileocecal resection for Crohn's disease

Advanced endoscopic technologies led to significant progress in the definition of endoscopic remission of ulcerative colitis (UC), and correlate better with histological changes, compared to standard endoscopy. However, whilst studies have assessed the diagnostic accuracy of endoscope technologies individually, there is current limited data comparing between technologies. As such, we aimed to compare the correlations between endoscopy and histology disease activity scores across endoscope technologies

We searched PubMed and Embase in January 2021 for eligible studies reporting the correlation between endoscopy and histology activity scores in UC. Studies were grouped by endoscope technology as standard-definition white light (SD-WLE), high-definition white light (HD-WLE), or electronic virtual chromoendoscopy (VCE), and comparisons made between these groups

A total of N=27 studies were identified, of which N=12 were included in a meta-analysis of correlations between endoscopic and histological activity scores. Combining these returned a pooled correlation coefficient (rho) for the SD-WLE group of 0.61, which did not differ significantly from HD-WLE (rho: 0.79, p=0.140) or VCE (rho: 0.70, p=0.471) [Fig 1a]. In addition, N=4 studies reported the accuracy of endoscopic activity scores on WLE and VCE to diagnose histological remission. Pooling these found significantly higher accuracy for VCE, compared to WLE (risk ratio: 1.13, 95% CI: 1.07-1.19, p<0.001).[Fig 1b]

Activity scores assessed using endoscopy are strongly correlated with activity on histology. VCE appears to have better accuracy for the diagnosis of histological remission in UC, compared to WLE.

Marieke Barnhoorn discusses the work of the team at Leiden University Medical centre to report efficacy and safety data for patients 4 years after receipt of allogeneic bone marrow-derived mesenchymal stem cells for treatment of Crohn’s disease perianal fistulae.

Review the ACG guideline process with emphasis on pressure points and areas of improvement

Lihi Godny from the Rabin Medical Center, Petah-Tikva, Israel discusses her work linking fruit consumption to microbial diversity and reduced risk of pouchitis. This work generates possibly the first practical dietary advice for patients with an ileal pouch anal anastomosis.

Histological remission is increasingly regarded as an important and deep therapeutic target for ulcerative colitis (UC). Assessment and scoring of histological images is a tedious procedure, that can be imprecise and prone to inter- and intra-observer variability. Therefore, a need exists for an automated method that is accurate, reproducible and reliable. This study aimed to investigate whether an artificial intelligence (AI) system developed using image processing and machine learning algorithms could measure histological disease activity based on the Nancy index.

A total of 200 histological images of patients with UC from a database at University Hospital, Vandoeuvre-lès-Nancy, France were used for this study. The novel AI system was used to fully characterise histological images and automatically measure Nancy index. The in-house AI algorithm was developed using state-of-the-art image processing and machine learning algorithms based on deep learning and feature extraction. The cell regions of each image, followed by Nancy index, were manually annotated and measured independently by 3 histopathologists. Manual and AI-automated measurements of Nancy index score were done and assessed using the intraclass correlation coefficient (ICC).

The 200-image dataset was divided into 2 groups (80% was used for training and 20% for testing). ICC statistical analyses were performed to evaluate AI tool and used as a reference to calculate the accuracy (Table 1). The average ICC amongst the histopathologists was 89.33 and average ICC between histopathologists and AI tool was 87.20. Despite the small number of image data, the AI tool was found to be highly correlated with histopathologists.

The high correlation of performance of the AI method suggested promising potential for IBD clinical applications. A standardised and validated histological AI-driven scoring system can potentially be used in daily IBD practice to eliminate the subjectivity of the pathologists and assess the disease severity for treatment decision.

Educational objectives:
1. To understand the role of IL-12 and IL-23 in the development of IBD
2. To review the pivotal UNITI and UNIFI trials
3. To review the place of ustekinumab in IBD therapy
4. To have an overview on practical modalities of ustekinumab therapy
5. To get insight in the anti-IL23 drugs that are in development

Educational objectives:
1. To understand the role of IL-12 and IL-23 in the development of IBD
2. To review the pivotal UNITI and UNIFI trials
3. To review the place of ustekinumab in IBD therapy
4. To introduce specific IL-23 antibodies