Browsing by Author "Hilsden, Robert Jay"

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    Outcomes of Endoscopic Retrograde Cholangiopancreatography in Patients with Underlying Mental Health Disorders
    (2024-10-15) Tepox Padron, Alejandra; Forbes, Nauzer; El-Gabalawy, Renée; Hilsden, Robert Jay
    Depression and anxiety are significant contributors to the global health burden. In Canada, the lifetime prevalences of depression and anxiety among adults are around 11% and 9%, respectively. These mental health disorders (MHDs) increase post-operative adverse events (AEs), worsen outcomes, and negatively impact healthcare correlates. In gastrointestinal endoscopy settings, pre-procedural anxiety reduces patient satisfaction and increases pain sensitivity and requirements for sedatives. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for managing certain pancreaticobiliary conditions. However, it is technically challenging and has the highest rates of AEs and unplanned hospital encounters (UHEs) among endoscopic procedures. There is a knowledge gap regarding the impact of MHDs on ERCP-related outcomes and patient-reported tolerability with conscious sedation. This thesis presents results from two studies seeking to examine the associations between pre-existing MHDs in adult patients undergoing ERCP and: 1) UHEs within 30 days of the procedure, including unplanned emergency department visits and/or admissions for somatic symptoms only without a clear explanatory diagnosis or AE (Study 1), 2) AEs within 30 days of the procedure (Study 1), and 3) patient-reported peri- and post-procedural tolerability (Study 2). Secondary analyses of multi-centre data were conducted using logistic regression while accounting for pertinent covariates. Study 1 found no significant associations between pre-existing MHDs and UHEs or AEs in 6,648 patients undergoing ERCP within 30 days, including visits or admissions for somatic symptoms alone. Conversely, Study 2 demonstrated a significant association between MHDs and poorer patient-reported tolerability of ERCP under conscious sedation. Among 3,714 patients, significantly more participants with MHDs reported increased intra-procedural awareness and discomfort, along with greater post-procedural abdominal pain, nausea, and distension. Using these data, clinicians performing ERCP can provide accurate information regarding MHDs and ERCP-related outcomes. Additionally, increased awareness of the reduced tolerability and worse patient-reported experience measures of ERCP under conscious sedation in patients with depression and/or anxiety can help endoscopists decrease potential patient morbidity and enhance satisfaction. Further study is needed to determine potential associations between more granular MHD-related exposures and post-ERCP outcomes.
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    Sessile serrated lesions in focus: Examining temporal trends, patient risk factors, and the role of the endoscopist in lesion detection
    (2023-09-22) Mazurek, Matthew; Brenner, Darren Michael RIehl; Heitman, Steven James; Hilsden, Robert Jay; Lee, Joon; Ferraz, Jose Geraldo P
    Serrated polyps of the colorectum have become increasingly recognized as an important clinical entity, as these precursor lesions are hypothesized to be responsible for up to 25% of sporadic cases of colorectal cancer. Much confusion exists regarding these polyps; particularly, their classification and associated malignant risk due to varied nomenclature, evolving pathological criteria, and ongoing research in prognostication. A specific subtype, sessile serrated lesions (SSLs), are of particular interest, as they are the most prevalent premalignant subtype and are over-represented in cases of interval cancers. Accurate identification and risk assessment remains a challenge owing to variable detection of clinically relevant serrated lesions by endoscopists, high inter-observer variability in diagnosis by pathologists, and an incomplete understanding of risk of future neoplasia. In this thesis, we analyze over 75,000 screening colonoscopies performed over a five-year period at a dedicated, large volume, high-efficiency screening centre to identify trends in the endoscopic detection of SSLs. The intent of this work is to better understand the temporal factors influencing SSL detection prevalence, the patient risk factors that are associated with these lesions, and how detection is related to procedural and endoscopist factors. The analysis includes consideration of traditional statistical methods as well as novel machine learning algorithms. We demonstrated a positive temporal trend in SSL detection over study period and identified several patient, procedural, and endoscopist factors associated with SSL detection. Machine learning models improved upon the predictive capabilities of traditional statistical models, yet a significant proportion of variability in risk remained unexplained, underscoring the complexity of accurately predicting SSLs. Endoscopic detection of SSLs demonstrates strong correlation with other detection metrics, notably adenoma detection rate, implying a shared underlying skillset requisite for the identification of these distinct polyp types. This connection highlights opportunities for enhancing detection through benchmarking and established quality improvement strategies.