SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 2 | 40 SAGES CONGRESS 2022 ABSTRACTS Conflict of interests This study was funded by Austell Laboratories. Ayodeji Idowu, Hafeez Mohamed and Priyamvada Pradeep are employees of Radogani Research Unit at Austell Laboratories. THE CHANGING PRESCRIBING PATTERNS FOR BIOLOGICAL AGENTS FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE. Author Dr Desiree Moodley 1 , Prof Ernst Fredericks 1 Tygerberg Hospital Background Biologic therapy has been shown to be effective in inflammatory bowel disease. Until the end of 2019 TNF- antagonists were the only agents available for the treatment of IBD refractory to conventional therapy. With the onset of newer classes of biological agents, prescribing habits for these agents have changed. METHODS We utilized the SAGES biologic database to review the prescription patterns of gastroenterologists since their introduction into the South African market. The period under review was from January 2020 to May 2022. Patients and treating doctors signed consent for the use of their data. RESULTS A total of 542 requests for induction of biologic therapy was received during the stated period. Gender distribution was equal with 54% males. Sixty percent of the applications were for Crohn’s disease. CD UC Total % Total % 323 59.6 219 40.4 Adalimumab 155 79 Infliximab 56 62 Total 211 67.8 141 64.4 Ustekinumab 88 16 Vedolizumab 24 62 Total 112 34.6 78 35.6 Currently the ratio for anti-TNF to newer agents was 2:1 for induction of remission in IBD. For CD, vedolizumab was used for induction in 78.5% of patients, while for UC 79.4% of patients received vedolizumab. Tofacitinib was not included in this analysis as there were less than new cases of induction with it. CONCLUSION There is steady increase in the use of newer biological agents in IBD. Cost withstanding, the ratio of 2;1 compared to established anti-TNF agents will soon be equalized and overtaken. TRENDS IN PROCEDURAL OUTCOMES AT ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY. Author Doctor Sayuri Naidu 1 , Doctor Frank Anderson 1 1 IALCH Introduction Endoscopic retrograde cholangiopancreatography (ERCP) has evolved largely into use for therapeutic purposes. This has been assisted by advancement in other diagnostic modalities viz MRI and Endoscopic Ultrasound. Failures at ERCP may be due to an inaccessible ampulla of Vater, failure to cannulate the ducts or in the intended therapy (viz failure to extract stones or deploy stents). There may be normal findings or an unnecessary procedure. Unnecessary ERCP should be limited as the complications of acute pancreatitis, perforation and bleeding may be fatal. Methods A retrospective review of electronic records of ERCP performed by a surgical team on a single day in week from 2011 to 2017 was performed. Demographic information, indications for ERCP, success and failure rates and non- therapeutic procedures were analyzed. Ethical approval was obtained from the UKZN ethics committee. Results All patients were referred from six regional hospitals. Six hundred and fifty procedures were reviewed from 2011 to 2017. The mean age in this population was 55 years with a standard deviation of 17 years. There were 191 (29.9%) males and 447 (70.1%) females. Gallstones, 295(45%), bile duct stricture, 167(26%), periampullary mass, 72(11%) and pseudocyst, 22(3%) were the commonest indications. The average cannulation rate over the period was 88.5% which improved to 92% when a pre-cut papillotomy was performed. There was failure to achieve therapeutic intent in an average 12(13%) and success in 67(72%) of patients. In an average 14(15%%) of patients there was no pathology at the time pf ERCP. Complications of ERCP were not analyzed as patients were repatriated to their referring institutions and these were not routinely evaluated. Conclusion The cannulation rate when the ampulla was identified was similar to other studies. However, greater than 10% of procedures which were unnecessary at the time of ERCP and these should be further evaluated and limited. TUBERCULOUS LIVER ABSCESS. Author Dr Yonela Qubekile 1 1 Department of Gastroenterology, Nelson Mandela school of medicine, University of Kwa-Zulu Natal, Inkosi Albert Luthuli Central Hospital Introduction Tuberculosis (TB) is common in South Africa but tuberculous liver abscess (TLA) is extremely rare with a prevalence of 0.35%. Focal TB of the liver can be manifested by single or multiple tuberculous abscesses. These occur more frequently in immunocompromised SAGES CONGRESS 2022 ABSTRACT eji l NF- eatment nset of its for the eir d atients eir py ribution ications 40.4 64.4 35.6 2:1 for was 79.4% t cases cal pared d and TRENDS IN PROCEDUR L OUTCOMES AT ENDOSCOPIC RETROGRADE CHOLANGIO ANCREATOGRAPHY. Author Doctor Sayuri Naidu 1 , Doctor Frank Anderson 1 1 IALCH Introduction Endoscopic retrograde cholangiopancreatography (ERCP) has evolved largely into use for therapeutic purposes. This has been assisted by advancement in other diagnostic modalities viz MRI and Endoscopic Ultrasound. Failures at ERCP may be due to an inaccessible ampulla of Vater, failure to cannulate the ducts or in the intended therapy (viz failure to extract stones or deploy st nts). There may be normal fin ngs or a unn c ssary procedure. Unnece sary ERCP should be limited as the complicatio s of acute pancreatitis, p rf ration and bleeding may be fatal. M thods A retrospective review of electronic records of ERCP performed by a surgical team on a single day in week from 2011 to 2017 was performed. Demographic information, indica s for ERCP, success and failure rates and non- therapeutic proc dures were a alyzed. Et ical approval was obtained from the UKZN ethics committee. Results All patients were referred from six regional hospitals. Six hundred and fifty procedures were reviewed from 2011 to 2017. The mean age in this population was 55 ye rs with standar dev ation of 17 years. There wer 191 (29.9%) males nd 447 (70.1%) females. Galls ones, 295(45%), bile duct stricture, 167(26%), periampullary mass, 72(11%) and pseudocyst, 22(3%) were the commonest indications. The average cannulation rate over the period was 88.5% which improved to 92% when a pre-cut papillotomy was performed. There was failure to achieve therapeutic intent in an average 12(13%) and success in 67(72%) of patients. In an average 14(15%%) of patients there was no pathology at the time pf ERCP. Complications of ERCP were not analyzed as patients were repatriated to their referring institutions and these were not routinely evaluated. Conclusion The cannulation rate when the ampulla was identified was imilar to other studies. However, greater than 10% of procedures which were unnecessary at the time of ERCP and these should be further evaluated and limited. TUBERCULOUS LIVER ABSCESS. Author Dr Yonela Qubekile 1 1 Department of Gastroenterol gy, N lson Mandela school of medicine, University of Kwa-Z lu Natal, Inkosi Al ert Luthuli Central Hospital Introduction Tuberculosis (TB) is common in South Africa but tuberculous liver abscess (TLA) is extremely rare with a prevalence of 0.35%. Focal TB of the liver can be manifested by single or multiple tuberculous abscesses. These occur more frequently in immunocompromised