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Background Inflammatory Bowel Disease (IBD) is a chronic, debilitating collection of diseases with significant impairment to patient quality of life and hospital burden. Patients with acute flare of their disease are managed with IV corticosteroids and ultimately transitioned to an oral equivalent. Despite no formal guideline recommendation, some patients remain in hospital on oral corticosteroids, primarily for observation. Given that each day spent in hospital carries significant costs, examining this observatory period is warranted. The utility of the observatory period for patients recently switched to oral corticosteroids has not yet been studied and may be unnecessarily increasing hospital stays and costs to the Canadian medical system. Purpose - Analyse the efficacy of the in-hospital period for patients on oral corticosteroids after an acute IBD flare in preventing recurrence in the 14 and 28 days post discharge. - Assess the relationship between length of the in-hospital “observatory” period with future hospital burden. Method - This retrospective cohort study identified patients with known IBD who were admitted to Royal Columbian Hospital under the Gastroenterology service primarily for acute flare of their disease from June 1, 2020 to June 30th, 2022. Patients were identified through the clinic EMR (Plexia) and hospital information was accessed via the Fraser Health Health Records Department. This study acheived ethics approval by the Fraser Health Research Ethics Board (Event: 2022376). - Inclusion criteria are as follows: - Age > 18 years old - Prior diagnosis of IBD as per CAG guidelines - Acute IBD flare is primary reason for hospitalization - Hospital management includes IV corticosteroids and discharge medications include a tapering course of oral corticosteroid. - Exclusion criteria are as follows: - Patients found to be non-compliant on outpatient medication regimen (i.e tapering dose of PO prednisone). - Patients with a complicated course in management (concurrent illness that impacted hospital stay). Result(s) -20 patients were identified, with 60 total hospital admissions. -35 visits included an observatory period, with 6 less than 24hr (1 hospital re-presentation), and 29 greater than 24hr (3 hospital re-presentations). -25 visits did not have an observatory period. -The relative risk of patients without an observatory period returning to hospital within 14 and 28 days compared to those with an observatory period was 4.2 and 1.75, respectively. Conclusion(s) These preliminary results suggest an increased relative risk for those without an in-hospital observatory period for short term re-hospitalization. However, we hypothesize this will significantly change once we have broadened our date range and increased our total number of hospitalizations, which is planned prior to the poster presentation date. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Background The human gut microbiome is a complex, dynamic community that has been shown to impact gastrointestinal (GI) diseases, including inflammatory bowel disease (IBD). Particularly, changes in diet quality and composition can influence the composition and function of the gut microbiome, leading to an inappropriate response to inflammation, increasing risk for IBD flare. Currently, our understanding of diet modulation largely revolves around changes in bacterial composition and diversity, despite our knowledge of neighbouring eukaryotes, viruses, and archaea within the GI tract. This literature review serves to bolster our understanding of diet modulation on viral and fungal communities, in an effort to support non-pharmacological therapies in IBD. Purpose To assess current literature investigating the effect of diet modulation on the gut microbiota, with interest in viral and fungal communities. Method We performed a MEDLINE and EMBASE literature review with the following search terms: "microbiome / microbiota / microbe" and "fungi / fungal" or "virus / viral / virome" and "diet composition" or "high fiber/re diet" or "diet therapy" or "diet." Exclusion criteria: - Abstracts - Articles not in English - Expert Review articles - Articles investigating bacterial microbiota communities exclusively Result(s) Our EMBASE and MEDLINE search identified 418 and 343 articles, respectively. After applying our exclusion criteria and removing duplicates, 13 articles were included (5 - fungal communities exclusively, 4 - viral communities exclusively, 4 - both). Novel research directly investigating the impact of diet modulation on fungal and viral communities in the gut microbiota are exceedingly rare. Despite this, both communities in animal and human models showed increases in diversity in response to diet modulation, independent of changes in bacterial composition. Fungal communities in animal studies showed a four-fold increase in diversity with changes in diet composition (standard chow to high-grain/ high fibre /low fat) as soon as 28 days post dietary commencement. In human studies, fungal communities changed in response to short term diet changes, not long-term. Candida was positively correlated with carbohydrate ingestion, while Aspergillus was negatively correlated with short chain fatty acid ingestion. Viral communities in animal models showed a similar increase in diversity in response to diet modulation (standard chow to high-grain/high-fibre). In human studies, virome response to diet increased most significantly in those with lower initial viral diversity. However, viral diversity was impacted most by interpersonal variation, not diet modulation. Conclusion(s) Diet modulation remains a key player in altering the gut microbiome, extending to fungal and viral communities. Further studies are required to elucidate the magnitude and temporal effect on these lesser studied microbial communities, given recent studies showing the importance of fungal/viral microbes in IBD. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared NEUROGASTROENTEROLOGY & MOTILITY

Background Iatrogenic perforation is arguably the most feared adverse event associated with endoscopy. Current American Society for Gastrointestinal Endoscopy (ASGE) and European Society of Gastroenterology Endoscopy (ESGE) guidelines recommend endoscopic closure as the first-line treatment strategy. Historically, this has been achieved using through-the-scope clips (TTSC). Given the emergence of alternative endoscopic closure techniques including over-the-scope clips (OTSC) and endoscopic suturing, we sought to provide an updated review of the literature. Purpose To review endoscopic closure techniques following iatrogenic perforation during screening or therapeutic endoscopy. Method Based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, an electronic search of MEDLINE and EMBASE from June 1st, 1946 – Oct 10th, 2022 was performed. Inclusion criteria was limited to English full-text original citations, with case reports, and cohorts with < 3 patients excluded. Our primary objective was to assess complete defect closure after attempted endoscopic treatment. Outcomes were stratified by modality (TTSC, OTSC, endoscopic suturing) and chronologically based on a previous well received systematic review. Result(s) A total of 2549 citations were identified in our electronic search, of which 34 were included representing 830 perforations. Overall, successful endoscopic closure was achieved in 763 cases (91.9%). When stratified by endoscopic closure techniques, range estimates for successful endoscopic closure was 71% – 100%, 57% - 100%, and 100% for TTSC, OTSC and endoscopic suturing respectively. When stratifying chronologically, an improvement in TTSC closure was identified. Conclusion(s) Endoscopic defect closure, including TTSC, OTSC and endoscopic suturing, are effective in the management of iatrogenic perforations with increasing TTSC performance over time. It remains the primary treatment strategy for iatrogenic perforation. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Background Primary sclerosing cholangitis (PSC) is a rare autoimmune fibroinflammatory disease that is associated with inflammatory bowel disease (IBD) and can progress to end-stage liver disease (ESLD) requiring liver transplantation (LT). Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a highly aggressive and rare hematologic malignancy (HM) that usually affects elderly males. High-dose chemotherapy followed by allogenic stem cell transplantation (SCT) offers the best chance of long-term remission in BPDCN. While it is well described that there is an increased risk of de-novo cancer development after solid organ transplantation (SOT), these are less commonly HMs. There are currently no documented cases of BPDCN in post-SOT patients in the literature. Aims To describe one of the first cases of BPDCN in a patient post-SOT, and subsequent clinical resolution of UC post SCT. Methods Case Report Results A 19-year-old previously healthy male initially presented with cholangitis and was diagnosed with PSC. Two years after the diagnosis of PSC, he progressed to ESLD and underwent live donor LT in India. He subsequently presented with episodes of bloody diarrhea and a colonoscopy then revealed diffuse mucosal edema, erosions, and spontaneous bleeding, with scattered inflammatory polyps throughout the colon. UC was diagnosed and Infliximab therapy was started. He later presented with a UC flare and Vedolizumab therapy was initiated. A liver biopsy showed recurrent sclerosing cholangitis and ultimately the patient required a second liver transplant. After the second LT he developed weight loss, arthralgias, and progressive splenomegaly following which BPCDN was diagnosed. His Vedolizumab was subsequently stopped. He received induction chemotherapy followed by a single antigen mismatched allogenic SCT. Whilst he had numerous complications associated with his chemotherapy induction, his UC appeared to be in clinical remission. No repeat colonoscopies were completed, however, on follow-up assessments, he denied abdominal pain and reported having formed, non-bloody stools. Unfortunately, he suffered an aggressive relapse of his BPCDN, and he was palliated. Conclusions The development of de-novo cancers after LT is common, and patients with PSC are at particularly high risk. PSC-LT patients have also been found to have the highest rate of hematological malignancies post LT; however, these are most commonly post-transplant lymphoproliferative disorder. Additionally, there have been a few reports of complete resolution of IBD after allogenic mismatched SCT. Here we describe one of the first cases of BPCDN post-LT in a PSC-UC patient and display another example of UC clinical remission post allogenic SCT. These findings emphasize that close follow-up of these patients after LT is imperative. Funding Agencies None

Background Crohn’s disease (CD), a form of inflammatory bowel disease (IBD) is a chronic, immune mediated condition characterized by gastrointestinal inflammation. Approximately 25% of CD patients have pharmacologically refractory disease, in which stem cell therapy has been shown to play a role. Aims A case series was performed to analyze the efficacy of autologous bone marrow transplantation (ABMT) for refractory CD in British Columbia(B.C). Methods A chart review was conducted on patients who had undergone ABMT for treatment refractory CD between 2001 to 2021 in B.C. Demographic, clinical, laboratory and endoscopic data was collected. Results Case details are summarized in Table 1. 3 patients(2 female and one male) were included. All patients failed conventional therapies prior to ABMT. 2 patients underwent surgical intervention (colectomy with ileostomy) prior to ABMT. Average time from diagnosis to ABMT was 8.83 + 6.6 years. All 3 patients received standard myeloablative therapy. There were no intestinal complications post ABMT. 6 months post-ABMT transplant, all 3 patients showed significant improvement, with CDAI scores Conclusions Despite medical and surgical therapeutic advances, a subset of CD patients develop refractive disease associated with significant morbidity and mortality. In this population, there is increasing evidence in support of stem cell therapy as a treatment modality, with acute mortality less than 5% for patients with malignancy driven primarily by infectious complications and treatment-related toxicity. Clinical trials are currently underway to evaluate ABMT in CD. This case series presents the only Canadian data to date on the use of ABMT for refractory CDs and their subsequent follow up. Funding Agencies None

BACKGROUND: Although several etiologies exist, gastrointestinal bleeding is widely considered to be responsible for Iron Deficiency Anemia (IDA). Currently, there is debate regarding the most appropriate course of investigation following negative bidirectional endoscopy. Computed Tomographic Enterography (CTE) has emerged as a prospective diagnostic tool but limited studies have outlined its role, specifically for investigation of IDA. AIMS: To evaluate the efficacy of CTE through diagnostic yield for patients with IDA. Furthermore, to outline etiologies of gastrointestinal bleeding, predictive symptoms, and changes in management for true positive cases. METHODS: Patients were identified by CTE requisition orders at the Royal Columbian Hospital Centre consecutively between Jan 1, 2013 and June 1, 2017. Only patients diagnosed with Iron Deficiency Anemia, or who had experienced obscure occult gastrointestinal bleeding were included. To determine the diagnostic yield of CTE, patients’ charts were retrospectively studied. Negative endoscopy or lack of further small bowel investigation following a negative CTE was defined as a True Negative. Positive endoscopy for small bowel carcinomas matching the description of a prior CTE was defined as a True Positive. RESULTS: 937 CTE results were reviewed and 223 patients matched our inclusion criteria. 7 positive CTE results were identified, 3 of which were false positives. 216 negative CTE results were identified, none of which were false negatives. Follow-up Capsule Endoscopy (CE) was used in 13 negative cases, of which 3 identified non-malignant sources of GI bleeding. The diagnostic yield of CTE was 1.8%, with 100% sensitivity and 98.6% specificity. The etiologies of the 4 positive cases included a GIST tumor, a small bowel spindle cell neoplasm, and two moderately differentiated adenocarcinomas. Further investigation included an imaging technique (Colonoscopy or Laparoscopy) followed by surgical small bowel resection. In one case, CE was used to localize the tumor within the small bowel following positive CTE. None of the symptoms exhibited by the patients of the four positive cases were atypical of diagnostic symptoms of IDA. CONCLUSIONS: CTE has high sensitivity and specificity in investigating IDA. Only 1.8% of patients had a change in management based on CTE but all were significant. The four lesions identified by CTE required further imaging, including CE, before surgical resection. Given that CE has a higher diagnostic yield than CTE, it may be a better choice for IDA if no contraindication to CE exists, as opposed to CTE followed by CE. FUNDING AGENCIES: None