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Chien S, Glen P, Penman I, Bryce G, Cruickshank N, Miller M, Crumley A, Fletcher J, Phull P, Gunjaca I, Robertson K, Apollos J, Fullarton G. National adoption of an esophageal cell collection device for Barrett's esophagus surveillance: impact on delay to investigation and pathological findings. Dis Esophagus 2024; 37:doae002. [PMID: 38267082 DOI: 10.1093/dote/doae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/30/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024]
Abstract
High quality Barrett's esophagus surveillance is crucial to detect early neoplastic changes. An esophageal cell collection device (OCCD) was introduced as a triage tool for Barrett's surveillance. This study aims to evaluate whether the Scottish OCCD program (CytoSCOT) has reduced delays to Barrett's surveillance, and whether delayed surveillance negatively impacts endoscopic pathology. All patients undergoing OCCD testing for Barrett's surveillance across 11 Scottish health boards between 14/9/2020 and 13/9/2022 were identified. Patients were dichotomised into two groups (Year 1 vs. Year 2), with individual records interrogated to record demographics, recommended surveillance interval, time from last endoscopy to OCCD test, and OCCD result. Patients were deemed high-risk if the OCCD demonstrated atypia and/or p53 positivity. Further analysis was performed on patients who underwent endoscopy within 12 months of OCCD testing. A total of 3223 OCCD tests were included in the analysis (1478 in Year 1; 1745 in Year 2). In Year 1 versus Year 2, there was a longer median delay to surveillance (9 vs. 5 months; P < 0.001), increased proportion of patients with delayed surveillance (72.6% vs. 57.0%; P < 0.001), and more high-risk patients (12.0% vs. 5.3%; P < 0.001). 425/3223 patients (13.2%) were further investigated with upper gastrointestinal endoscopy, 57.9% of which were high-risk. As surveillance delay increased beyond 24 months, high-risk patients were significantly more likely to develop dysplasia or malignancy (P = 0.004). Delayed Barrett's esophagus surveillance beyond 24 months is associated with increased risk of pre-cancerous pathology. The CytoSCOT program has reduced delays in surveillance, promoting earlier detection of dysplasia and reducing burden on endoscopy services.
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Affiliation(s)
- Siobhan Chien
- Centre for Sustainable Delivery, Golden Jubilee National Hospital, Clydebank, Glasgow G81 4DN, UK
- School of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, UK
| | - Paul Glen
- Department of General Surgery, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Ian Penman
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Gavin Bryce
- Department of General Surgery, University Hospital Wishaw, Wishaw ML2 0DP, UK
| | - Neil Cruickshank
- Department of General Surgery, Victoria Hospital, Kirkcaldy KY2 5AH, UK
| | - Michael Miller
- Department of Gastroenterology, Ninewells Hospital, Dundee DD2 1SG, UK
| | - Andrew Crumley
- Department of General Surgery, Forth Valley Royal Hospital, Larbert FK5 4WR, UK
| | - Jonathan Fletcher
- Department of Gastroenterology, Borders General Hospital, Melrose TD6 9BS, UK
| | - Perminder Phull
- Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Ivan Gunjaca
- Department of Gastroenterology, Raigmore Hospital, Inverness IV2 3UJ, UK
| | - Kevin Robertson
- Department of General Surgery, University Hospital Crosshouse, Kilmarnock KA2 0BE, UK
| | - Jeyakumar Apollos
- Department of General Surgery, Dumfries & Galloway Royal Infirmary, Dumfries DG2 8RX, UK
| | - Grant Fullarton
- Centre for Sustainable Delivery, Golden Jubilee National Hospital, Clydebank, Glasgow G81 4DN, UK
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Stone TC, Ward V, Hogan A, Alexander Ho KM, Wilson A, McBain H, Duku M, Wolfson P, Cheung S, Rosenfeld A, Lovat LB. Using saliva epigenetic data to develop and validate a multivariable predictor of esophageal cancer status. Epigenomics 2024; 16:109-125. [PMID: 38226541 PMCID: PMC10825730 DOI: 10.2217/epi-2023-0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024] Open
Abstract
Background: Salivary epigenetic biomarkers may detect esophageal cancer. Methods: A total of 256 saliva samples from esophageal adenocarcinoma patients and matched volunteers were analyzed with Illumina EPIC methylation arrays. Three datasets were created, using 64% for discovery, 16% for testing and 20% for validation. Modules of gene-based methylation probes were created using weighted gene coexpression network analysis. Module significance to disease and gene importance to module were determined and a random forest classifier generated using best-scoring gene-related epigenetic probes. A cost-sensitive wrapper algorithm maximized cancer diagnosis. Results: Using age, sex and seven probes, esophageal adenocarcinoma was detected with area under the curve of 0.72 in discovery, 0.73 in testing and 0.75 in validation datasets. Cancer sensitivity was 88% with specificity of 31%. Conclusion: We have demonstrated a potentially clinically viable classifier of esophageal cancer based on saliva methylation.
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Affiliation(s)
- Timothy C Stone
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Vanessa Ward
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Aine Hogan
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Kai Man Alexander Ho
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Ash Wilson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Hazel McBain
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Margaret Duku
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Paul Wolfson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Sharon Cheung
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Avi Rosenfeld
- Department of Computer Science, Jerusalem College of Technology, Havaad Haleumi 21, Givat Mordechai, 91160, Jerusalem, Israel
| | - Laurence B Lovat
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
- Department of Gastrointestinal Services, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
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Lemanska A, Andrews C, Fisher L, Bacon S, Frampton AE, Mehrkar A, Inglesby P, Davy S, Roberts K, Patalay P, Goldacre B, MacKenna B, Walker AJ. Healthcare in England was affected by the COVID-19 pandemic across the pancreatic cancer pathway: A cohort study using OpenSAFELY-TPP. eLife 2023; 12:e85332. [PMID: 37561116 PMCID: PMC10414967 DOI: 10.7554/elife.85332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/14/2023] [Indexed: 08/11/2023] Open
Abstract
Background Healthcare across all sectors, in the UK and globally, was negatively affected by the COVID-19 pandemic. We analysed healthcare services delivered to people with pancreatic cancer from January 2015 to March 2023 to investigate the effect of the COVID-19 pandemic. Methods With the approval of NHS England, and drawing from a nationally representative OpenSAFELY-TPP dataset of 24 million patients (over 40% of the English population), we undertook a cohort study of people diagnosed with pancreatic cancer. We queried electronic healthcare records for information on the provision of healthcare services across the pancreatic cancer pathway. To estimate the effect of the COVID-19 pandemic, we predicted the rates of healthcare services if the pandemic had not happened. We used generalised linear models and the pre-pandemic data from January 2015 to February 2020 to predict rates in March 2020 to March 2023. The 95% confidence intervals of the predicted values were used to estimate the significance of the difference between the predicted and observed rates. Results The rate of pancreatic cancer and diabetes diagnoses in the cohort was not affected by the pandemic. There were 26,840 people diagnosed with pancreatic cancer from January 2015 to March 2023. The mean age at diagnosis was 72 (±11 SD), 48% of people were female, 95% were of White ethnicity, and 40% were diagnosed with diabetes. We found a reduction in surgical resections by 25-28% during the pandemic. In addition, 20%, 10%, and 4% fewer people received body mass index, glycated haemoglobin, and liver function tests, respectively, before they were diagnosed with pancreatic cancer. There was no impact of the pandemic on the number of people making contact with primary care, but the number of contacts increased on average by 1-2 per person amongst those who made contact. Reporting of jaundice decreased by 28%, but recovered within 12 months into the pandemic. Emergency department visits, hospital admissions, and deaths were not affected. Conclusions The pandemic affected healthcare in England across the pancreatic cancer pathway. Positive lessons could be learnt from the services that were resilient and those that recovered quickly. The reductions in healthcare experienced by people with cancer have the potential to lead to worse outcomes. Current efforts should focus on addressing the unmet needs of people with cancer. Funding This work was jointly funded by the Wellcome Trust (222097/Z/20/Z); MRC (MR/V015757/1, MC_PC-20059, MR/W016729/1); NIHR (NIHR135559, COV-LT2-0073), and Health Data Research UK (HDRUK2021.000, 2021.0157). This work was funded by Medical Research Council (MRC) grant reference MR/W021390/1 as part of the postdoctoral fellowship awarded to AL and undertaken at the Bennett Institute, University of Oxford. The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, UK Health Security Agency (UKHSA), or the Department of Health and Social Care. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
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Affiliation(s)
- Agnieszka Lemanska
- Faculty of Health and Medical Sciences, University of SurreyGuildfordUnited Kingdom
| | - Colm Andrews
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Seb Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Adam E Frampton
- Faculty of Health and Medical Sciences, University of SurreyGuildfordUnited Kingdom
- HPB Surgical Unit, Royal Surrey NHS Foundation TrustGuildfordUnited Kingdom
- Oncology Section, Surrey Cancer Research Institute, Department of Clinical and Experimental Medicine, University of SurreyGuildfordUnited Kingdom
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Peter Inglesby
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Simon Davy
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Keith Roberts
- Institute of Immunology and Immunotherapy, University of BirminghamBirminghamUnited Kingdom
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing and Centre for Longitudinal Studies, University College LondonLondonUnited Kingdom
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
| | - Alex J Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of OxfordOxfordUnited Kingdom
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Poh SS, Tan BF, Yong FY, Fong KW, Wee JTS, Tan TWK, Chua MLK, Sommat K, Wang FQ, Soong YL. The impact of the COVID-19 pandemic on nasopharyngeal carcinoma patients - a national cancer centre experience. Holist Integr Oncol 2023; 2:17. [PMID: 37520028 PMCID: PMC10244848 DOI: 10.1007/s44178-023-00041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/30/2023] [Indexed: 08/01/2023]
Abstract
Purpose or objective The COVID-19 pandemic has resulted in significant healthcare implications, with care for cancer patients compromised due to resource diversion towards battling the pandemic. We aim to investigate the impact of the peak wave of the pandemic in 2020 on the delivery of cancer care in Singapore, specifically via our nasopharyngeal carcinoma (NPC) treatment data. This study applies real world numbers to the impact of COVID-19 on cancer care delivery in Singapore. The choice of nasopharyngeal cancer allows a good direct estimate of common treatment measures such as time to biopsy, time to staging scans, time to treatment commencement, due to its clear protocol and algorithms for staging and treatment; thus serving as an excellent surrogate for the effectiveness and timeliness of the different aspects of cancer care delivery. Materials and methods In this retrospective study, we included all patients with newly diagnosed NPC from 1st January to 31st May from 2017 to 2020 at our centre. This time period was chosen as it coincided with the period in 2020 during the COVID-19 pandemic where there was the most strain on healthcare resources and the most restrictions on population movement within Singapore, which may impact on healthcare seeking behaviour. Narrowing down the time period to the first 5 months of the 4 respective years also allowed us to reduce the effect of annual seasonal variation in patient numbers seen as a result of holidays and festive periods such as the Lunar New Year and scheduled school holidays. Electronic medical records (EMR) were accessed. Only newly diagnosed NPC cases were included in our analysis. Patients with second synchronous primary malignancies or NPC disease recurrence were excluded. Data analysis was carried out using a combination of SPSS and Microsoft Excel. Results Significantly, there was a reduction of 37-46.3% in newly diagnosed NPC cases during the peak of the COVID-19 pandemic from January to end May 2020 compared to the preceding three years. Despite the reduction in numbers of newly diagnosed NPC, there was no statistically significant differences in delay from biopsy to the first radiation oncology visit and from biopsy to the first day of treatment in 2020 compared to the preceding years. All the patients treated in our centre also received the standard NPC treatment for their disease stage as per international guidelines. Conclusion We recommend a heightened awareness of the dangers of delaying cancer presentation and care in healthcare policies and resource allocation and at the same time, encourage patient's confidence in their ability to seek care. With the resurgence of new COVID-19 variants and case numbers worldwide and in Singapore, this study focuses upon the need to be aware of the exigencies of other clinical groups in resource utilization. It would be instructive to compare this study with future long term follow up to investigate the trajectory of our cancer care delivery, as well as survival outcomes.
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Affiliation(s)
- Sharon S. Poh
- Division of Radiation Oncology, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Oncology Academic Clinical Programme, Singapore, Singapore
| | - Boon Fei Tan
- Division of Radiation Oncology, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore, Singapore
| | - Fang Yue Yong
- Division of Radiation Oncology, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore, Singapore
| | - Kam Weng Fong
- Division of Radiation Oncology, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Oncology Academic Clinical Programme, Singapore, Singapore
| | - Joseph T. S. Wee
- Division of Radiation Oncology, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Oncology Academic Clinical Programme, Singapore, Singapore
| | - Terence W. K. Tan
- Division of Radiation Oncology, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Oncology Academic Clinical Programme, Singapore, Singapore
| | - Melvin L. K. Chua
- Division of Radiation Oncology, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Oncology Academic Clinical Programme, Singapore, Singapore
| | - Kiattisa Sommat
- Division of Radiation Oncology, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Oncology Academic Clinical Programme, Singapore, Singapore
| | - Fu Qiang Wang
- Division of Radiation Oncology, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Oncology Academic Clinical Programme, Singapore, Singapore
| | - Yoke Lim Soong
- Division of Radiation Oncology, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Graduate Medical School, Oncology Academic Clinical Programme, Singapore, Singapore
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Jurkevičiūtė D, Mauravičiūtė S, Dulskas A, Kildušienė I, Stratilatovas E, Jarmalaitė S. Changes of Colorectal Cancer Diagnostics and Hospitalizations during First Wave of COVID-19 Pandemic in Lithuania. Acta Med Litu 2023; 30:39-44. [PMID: 37575381 PMCID: PMC10417012 DOI: 10.15388/amed.2023.30.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
Purpose Our aim was to see the possible effect of the first COVID pandemic wave in Lithuania on colorectal cancer (CRC) preventive, diagnostic and treatment procedures. Methods A retrospective analysis was performed using the database of the National Cancer Institute, Lithuania. We have divided patients into two groups: group 1 - patients treated during the nonpandemic period (2019 January 1 to 2019 July 31) and group 2 - the pandemic period (2020 January 1 to 2020 July 31). We analyzed numbers of screening, therapeutic colonoscopies performed, and treated patients for CRC during two periods. Results In general, 1318 lower gastrointestinal endoscopic procedures were performed in the first group and 862 procedures in the second group, which was 34.6% less compared to the first group. The first group included 672 (51%) colonoscopies, 172 (13%) day surgeries and 474 (36%) CRC screening programmes. In group 2, 456 (34.6%) less patients underwent CRC diagnostics and treatment: 141 (21%) less colonoscopies, 93 (54%) less day surgeries, 222 (47%) less CRC screening programmes, and 26 (13%) less patients were hospitalized for surgical treatment (196 vs 170). Conclusion Our study reveals worrying changes in the timely access to diagnostic procedures during the COVID-19 pandemic that possibly provoked rise in cases with the advanced stage CRC. However, despite numerical difference between groups existed, the difference between groups do not reach statistical significant level.
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Affiliation(s)
- Dignė Jurkevičiūtė
- Faculty of Medicine, Vilnius University, 21 M. K. Ciurlionio Str., LT-03101, Vilnius, Lithuania
| | - Sandra Mauravičiūtė
- Faculty of Medicine, Vilnius University, 21 M. K. Ciurlionio Str., LT-03101, Vilnius, Lithuania
| | - Audrius Dulskas
- Faculty of Medicine, Vilnius University, 21 M. K. Ciurlionio Str., LT-03101, Vilnius, Lithuania
- National Cancer Institute, 1 Santariskiu Str., LT-08406, Vilnius, Lithuania
- SMK, University of Applied Social Sciences, 137E Kalvariju Str., LT-08211, Vilnius, Lithuania
| | - Inga Kildušienė
- National Cancer Institute, 1 Santariskiu Str., LT-08406, Vilnius, Lithuania
| | | | - Sonata Jarmalaitė
- National Cancer Institute, 1 Santariskiu Str., LT-08406, Vilnius, Lithuania
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Rees C, Penman I. Has the COVID-19 pandemic changed endoscopy in the UK forever? Lancet Gastroenterol Hepatol 2023; 8:6-8. [PMID: 36495910 PMCID: PMC9729001 DOI: 10.1016/s2468-1253(22)00387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Colin Rees
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK.
| | - Ian Penman
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
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Leung F. Insights Into Water Exchange Colonoscopy. Gastroenterol Hepatol (N Y) 2022; 18:664-666. [PMID: 36866032 PMCID: PMC9972667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Lee K, Suh M, Jun JK, Choi KS. Impact of the COVID-19 Pandemic on Gastric Cancer Screening in South Korea: Results From the Korean National Cancer Screening Survey (2017-2021). J Gastric Cancer 2022; 22:264-272. [PMID: 36316105 PMCID: PMC9633925 DOI: 10.5230/jgc.2022.22.e36] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted cancer screening services worldwide. We aimed to measure the impact of COVID-19 on gastric cancer screening rates based on age, sex, household income, and residential area. MATERIALS AND METHODS We analyzed data from the Korean National Cancer Screening Survey from 2017 to 2021 for adults aged 40-74 years. We evaluated the gastric cancer screening rate within two years in accordance with the National Cancer Screening Program protocol recommendations and that within the previous year. We compared the trends in the pre- and post-COVID-19 outbreak periods. RESULTS Before the COVID-19 outbreak, there was little change in the gastric cancer screening rates until 2019. After the COVID-19 outbreak, the screening rate as per recommendation decreased from 70.8% in 2019 to 68.9% in 2020 and that for one year decreased from 32.7% in 2019 to 27.2% in 2020. However, as the COVID-19 pandemic continued after 2020, both gastric cancer screening rates as per recommendations and for one year rebounded. Although a similar trend was observed for the upper endoscopy screening rate, the upper gastrointestinal series screening rate decreased from 7.8% in 2020 to 3.1% in 2021. During the pandemic, the screening rate decreased among younger adults (40-49), those residing in metropolitan regions, and those with high incomes. CONCLUSIONS Despite a decline in gastric cancer screening rate during the COVID-19 pandemic, the rate surged in 2021. Further studies are needed to estimate the impact of cancer screening delays on future cancer-related mortalities.
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Affiliation(s)
- Kyeongmin Lee
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Center, National Cancer Control Institute, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Center, National Cancer Control Institute, Goyang, Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,National Cancer Center, National Cancer Control Institute, Goyang, Korea
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Leung FW, Cadoni S, Koo M, Yen AW, Siau K, Hsieh YH, Ishaq S, Cheng CL, Ramirez FC, Bak AW, Karnes W, Bayupurnama P, Leung JW, de Groen PC. A survey of colonoscopists with and without in-depth knowledge of water-aided colonoscopy. J Gastroenterol Hepatol 2022; 37:1785-1791. [PMID: 35613903 DOI: 10.1111/jgh.15896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Endoscopy featured water-aided colonoscopy (WAC) as novel in the Innovation Forum in 2011. Gastrointestinal Endoscopy published a modified Delphi consensus review (MDCR) that supports WAC for clinical practice in 2021. We tested the hypothesis that experience was an important predictor of WAC use, either as water immersion (WI), water exchange (WE), or a combination of WI and WE. METHODS A questionnaire was sent by email to the MDCR authors with an in-depth knowledge of WAC. They responded and also invited colleagues and trainees without in-depth knowledge to respond. Logistic regression analysis was used with the reasons for WAC use treated as the primary outcome. Reports related to WAC post MDCR were identified. RESULTS Of 100 respondents, > 80% indicated willingness to adopt and modify practice to accommodate WAC. Higher adenoma detection rate (ADR) incentivized WE use. Procedure time slots ≤ 30 and > 30 min significantly predicted WI and WE use, respectively. Co-authors of the MDCR were significantly more likely to perform WAC (odds ratio [OR] = 7.5, P = 0.037). Unfamiliarity with (OR = 0.11, P = 0.02) and absence of good experience (OR = 0.019, P = 0.002) were associated with colonoscopists less likely to perform WAC. Reports related to WAC post MDCR revealed overall and right colon WE outcomes continued to improve. Network meta-analyses showed that WE was superior to Cap and Endocuff. On-demand sedation with WE shortened nursing recovery time. CONCLUSIONS An important predictor of WAC use was experience. Superior outcomes continued to be reported with WE.
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Affiliation(s)
- Felix W Leung
- Sepulveda Ambulatory Care Center, VAGLAHS; David Geffen School of Medicine at UCLA, Medicine, North Hills, California, USA
| | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
| | - Malcolm Koo
- Graduate Institution of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Andrew W Yen
- Sacramento Veterans Affairs Medical Center, VANCHCS, Division of Gastroenterology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Keith Siau
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK
| | - Yu-Hsi Hsieh
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sauid Ishaq
- The Dudley Group of Hospitals NHS Trust, Visiting Professor of Medicine and Gastroenterology, Birmingham City University, Birmingham, UK
| | - Chi-Liang Cheng
- Division of Gastroenterology, Department of Internal Medicine, Evergreen General Hospital, Taoyuan, Taiwan
| | - Francisco C Ramirez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Adrian W Bak
- Division of Gastroenterology, Department of Medicine, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - William Karnes
- Digestive Health Institute, University of California Irvine Medical Center, Irvine, California, USA
| | - Putut Bayupurnama
- Division of Gastroenterology and Hepatology, Internal Medicine Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Joseph W Leung
- Sacramento Veterans Affairs Medical Center, VANCHCS, Division of Gastroenterology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Piet C de Groen
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
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Ravindran S, Thomas-Gibson S, Bano M, Robinson E, Jenkins A, Marshall S, Ashrafian H, Darzi A, Coleman M, Healey C. The national census of UK endoscopy services 2021. Future Healthc J 2022; 9:16-17. [PMID: 36310960 PMCID: PMC9601067 DOI: 10.7861/fhj.9-2-s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Ara Darzi
- DImperial College London, London, UK
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11
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Conlon C, Campion J, Mehigan Farrelly N, Ring E, Dunne T, Gorman D, Murphy S, Kelleher B, Stewart S, Leyden J, Lahiff C. Endoscopy training through the COVID-19 pandemic: maintaining procedural volumes and key performance standards. Frontline Gastroenterol 2022; 14:38-44. [PMID: 36540618 PMCID: PMC9271842 DOI: 10.1136/flgastro-2021-102069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Endoscopy departments have experienced considerable challenges in the provision of endoscopy services since the start of the COVID-19 pandemic. Several studies have reported a reduction of procedures performed by trainee endoscopists during the pandemic. The aim of this study was to assess the impact on colonoscopy training and quality in an academic centre throughout successive waves of the pandemic. METHODS This was a single-centre, retrospective, observational study comparing colonoscopies performed at a tertiary endoscopy centre in Ireland at different stages of the pandemic with those performed during a similar time frame prepandemic. Data were collected using electronic patient records. Primary outcomes were procedure volumes, adenoma detection rate and mean adenoma per procedure. RESULTS In the prepandemic period, 798 colonoscopies were performed. During the same period in 2020, 172 colonoscopies were performed. In 2021, during the third wave of the pandemic, 538 colonoscopies were performed. Percentages of colonoscopies performed by trainees were 46.0% (n=367) in 2019, 25.6% (n=44) in 2020 and 45.2% (n=243) in 2021. Adenoma detection rate was 21.3% in 2019, 38.6% in 2020 and 23.9% in 2021. Mean adenoma per procedure was 0.45 in 2019, 0.86 in 2020 and 0.49 in 2021. Caecal intubation rate was 90.74% in 2019, 90.9% in 2020 and 95.88% in 2021. CONCLUSION The COVID-19 pandemic initially had a negative impact on overall colonoscopy volumes and training. Despite a reduction in procedural volume, key performance standards were maintained by trainees. Maintenance of hands-on training is essential to allow trainees achieve and retain competency in endoscopy.
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Affiliation(s)
- Caroline Conlon
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John Campion
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Eabha Ring
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Talulla Dunne
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Dora Gorman
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Suzanne Murphy
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Barry Kelleher
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Stephen Stewart
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Jan Leyden
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Conor Lahiff
- Gastrointestinal Unit, Mater Misericordiae University Hospital, Dublin, Ireland,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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12
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Ravindran S, Thomas-Gibson S, Bano M, Robinson E, Jenkins A, Marshall S, Ashrafian H, Darzi A, Coleman M, Healey C. National census of UK endoscopy services 2021. Frontline Gastroenterol 2022; 13:463-470. [PMID: 36250173 PMCID: PMC9555135 DOI: 10.1136/flgastro-2022-102157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/18/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The Joint Advisory Group on Gastrointestinal (GI) Endoscopy (JAG) biennial census provides a unique view of UK endoscopy. The 2021 census was conducted to understand the impact of ongoing pressures, highlighted in the previous census, as well as COVID-19. METHODS The census was sent to all JAG-registered services in April 2021. Data were analysed across the domains of activity, waiting time targets, workforce, COVID-19, safety, GI bleeding, anaesthetic support, equipment and decontamination. Statistical methods were used to determine associations between domain-specific outcome variables and core demographic data. RESULTS 321 services completed the census (79.2% response rate). In the first 3 months of 2021, 57.9% of NHS services met urgent cancer waits, 17.9% met routine waits and 13.4% met surveillance waits. Workforce redeployment was the predominant reason cited for not meeting targets. There were significant regional differences in the proportion of patients waiting 6 or more weeks (p=0.001). During the pandemic, 64.8% of NHS services had staff redeployed and there was a mean sickness rate of 8.5%. Services were, on average, at 79.3% activity compared with 2 years ago. JAG-accredited services are more likely to meet urgent cancer waits, with a lower proportion of patient waiting 6 weeks or more (p=0.03). Over 10% of services stated that equipment shortage interfered with service delivery. CONCLUSIONS Services are adapting to continued pressure and there are signs of a focused response to demand at a time of ongoing uncertainty. This census' findings will inform ongoing guidance from JAG and relevant stakeholders.
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Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Siwan Thomas-Gibson
- Wolfson Endoscopy Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Madeline Bano
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - Emma Robinson
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - Anna Jenkins
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - Sarah Marshall
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,St. Mark’s Bowel Cancer Screening Centre, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mark Coleman
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Chris Healey
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Department of Gastroenterology, Airedale General Hospital, Keighley, UK
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13
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Pausawasdi N, Manomaiwong E, Kaosombatwattana U, Karaketklang K, Charatcharoenwitthaya P. The Effects of COVID-19 on Clinical Outcomes of Non-COVID-19 Patients Hospitalized for Upper Gastrointestinal Bleeding during the Pandemic. J Clin Med 2022; 11:jcm11092461. [PMID: 35566587 PMCID: PMC9102445 DOI: 10.3390/jcm11092461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022] Open
Abstract
This study aims to investigate the effects of COVID-19 on clinical outcomes of non-COVID-19 patients hospitalized for upper gastrointestinal bleeding (UGIB) during the pandemic. A retrospective review is conducted. We recruited patients with UGIB admitted during the pandemic’s first wave (April 2020 to June 2020), and the year before the pandemic. The outcomes between the two groups were compared using propensity score matching (PSM). In total, 60 patients (pandemic group) and 460 patients (prepandemic group) are included. Patients admitted during the pandemic (mean age of 67 ± 14 years) had a mean Glasgow−Blatchford score of 10.8 ± 3.9. They were older (p = 0.045) with more underlying malignancies (p = 0.028), had less history of NSAID use (p = 0.010), had a lower platelet count (p = 0.007), and had lower serum albumin levels (p = 0.047) compared to those admitted before the pandemic. Esophagogastroduodenoscopy (EGD) was performed less frequently during the pandemic (43.3% vs. 95.4%, p < 0.001). Furthermore, the procedure was less likely to be performed within 24 h after admission (p < 0.001). After PSM, admissions during the pandemic were significantly associated with decreased chances of receiving an endoscopy (adjusted odds Ratio (OR), 0.02; 95% CI, 0.003−0.06, p < 0.001) and longer hospital stay (adjusted OR, 2.17; 95% CI, 1.13−3.20, p < 0.001). Additionally, there was a slight increase in 30-day mortality without statistical significance (adjusted OR, 1.92; 95% CI, 0.71−5.19, p = 0.199) and a marginally higher rebleeding rate (adjusted OR, 1.34; 95% CI, 0.44−4.03, p = 0.605). During the pandemic, the number of EGDs performed in non-COVID-19 patients with UGIB decreased with a subsequent prolonged hospitalization and potentially increased 30-day mortality and rebleeding rate.
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Affiliation(s)
- Nonthalee Pausawasdi
- Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.P.); (U.K.)
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (E.M.); (K.K.)
| | - Ekawat Manomaiwong
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (E.M.); (K.K.)
| | - Uayporn Kaosombatwattana
- Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.P.); (U.K.)
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (E.M.); (K.K.)
| | - Khemajira Karaketklang
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (E.M.); (K.K.)
| | - Phunchai Charatcharoenwitthaya
- Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (N.P.); (U.K.)
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (E.M.); (K.K.)
- Correspondence: ; Tel.: +66-2-419-7282; Fax: +66-2-411-5013
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14
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Smith PJ, Critchley L, Storey D, Gregg B, Stenson J, Kneebone A, Rimmer T, Burke S, Hussain S, Yi Teoh W, Vazeille S, Serna S, Steel A, Derbyshire E, Collins P, Dibb M, Flanagan P, Probert C, Verma AM, Subramanian S. Efficacy and Safety of Elective Switching from Intravenous to Subcutaneous Infliximab [CT-P13]: A Multicentre Cohort Study. J Crohns Colitis 2022; 16:1436-1446. [PMID: 35390141 PMCID: PMC9455786 DOI: 10.1093/ecco-jcc/jjac053] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/20/2022] [Accepted: 03/31/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Intravenous [IV] infliximab is a well-established therapy for inflammatory bowel diseases [IBD] patients. A subcutaneous [SC] formulation of infliximab [CT-P13] has recently been shown to be as effective as IV infliximab after two doses of IV induction in a randomised trial, but there are no data to support elective switching of patients on maintenance IV infliximab therapy. We aimed to assess the effectiveness of an elective switching programme to SC CT-P13 in patients treated with IV infliximab. METHODS Patients on established maintenance IV infliximab, who switched to SC CT-P13, were included in this retrospective multicentre cohort study. Disease activity was monitored serially with the Harvey-Bradshaw Index [HBI] for Crohn's disease [CD] and the Simple Clinical Colitis Activity Index [SCCAI] for ulcerative colitis (UC) for up to 12 months at months 3, 6, and 12. Faecal calprotectin [FC] and C-reactive protein [CRP] were recorded at baseline and follow-up, if available. Infliximab trough levels were measured prior to switch and at months 3, 6, and 12 following switch. The primary outcome measure was treatment persistence at latest follow-up. Secondary outcome measures included infliximab pharmacokinetics [PK], safety, need for corticosteroid rescue therapy, and need for surgery. RESULTS We included 181 patients, of whom 115 [63.5%] had CD. The majority [72.4%] were on 8-weekly dosing of intravenous infliximab prior to switching, and more than half [59.1%] were on concomitant immunomodulatory therapy. The majority of patients (CD: 106, 92.2%; UC: 46, 76.7%; and IBD unclassified [IBD-U]: 5, 83.3%) were in clinical remission. Treatment persistence rate was high [n = 167, 92.3%] and only 14 patients [7.7%] stopped treatment during the follow-up period. There was no significant difference between baseline and repeat measurements at 3, 6, or 12 months for HBI, SCCAI, CRP, or FC. Of the total cohort, 25 patients (13.8%) had perianal CD. Of these, only two patients [8%] had worsening of perianal CD and required antibiotic therapy and further examination under anaesthesia [EUA]. Both these patients also switched back to intravenous infliximab. Median infliximab level increased from a baseline of 8.9 µg/dl [range 0.4-16] to 16.0 µg/dl [range 2.3-16, p <0.001] at 3 months. Serum levels stayed stable at 6 months [median 16 µg/dl, range 0.3-17.2] and 12 months [median 16 µg/dl, range 0.3-19.1, both p <0.001 compared with baseline]. Among the variables examined, only antibodies to infliximab [ATI] was associated with infliximab levels (odds ratio [OR] -13.369, 95% CI -15.405, -11.333, p <0.001]. A total of 14 patients [7.7%] developed ATI; of these, nine [64.3%] were on concomitant immunomodulatory therapy. Immunomodulatory therapy was not significantly associated with development of ATI [p = 0.15]. In a subset of patients receiving escalated IV infliximab dosing frequency prior to switching, no difference in treatment persistence was observed in patients receiving weekly versus alternate weekly SC CT-P13. Patient acceptance and satisfaction rates with SC CT-P13 were very high. CONCLUSIONS Among patients on IV infliximab maintenance therapy switched to SC CT-P13, we observed high treatment persistence rates and low rates of immunogenicity, with no change in clinical disease activity indices or biomarkers. Infliximab levels increased after switch to SC CT-P13, and only ATI was associated with serum infliximab levels. Patient acceptance and satisfaction rates were high with SC CT-P13.
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Affiliation(s)
- Philip J Smith
- Corresponding author: Dr Philip J. Smith, Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L7 8XP, UK.
| | - Lisa Critchley
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel Storey
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Belle Gregg
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - June Stenson
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Andrew Kneebone
- Department of Gastroenterology, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Tracy Rimmer
- Department of Gastroenterology, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stevena Burke
- Department of Gastroenterology, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Shamas Hussain
- Liverpool School of Medicine, University of Liverpool, Liverpool, UK
| | - Wan Yi Teoh
- Liverpool School of Medicine, University of Liverpool, Liverpool, UK
| | - Stephan Vazeille
- Liverpool School of Medicine, University of Liverpool, Liverpool, UK
| | - Solange Serna
- Department of Digestive Diseases, Kettering General Hospital, Kettering, UK
| | - Alan Steel
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Edmund Derbyshire
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Paul Collins
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Martyn Dibb
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Paul Flanagan
- Department of Gastroenterology, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Christopher Probert
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK,Molecular and Cellular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ajay M Verma
- Department of Digestive Diseases, Kettering General Hospital, Kettering, UK
| | - Sreedhar Subramanian
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK,Department of Gastroenterology, Addenbrookes Hospital, Cambridge, UK
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15
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Guilabert L, Aparicio JR, Medina-prado L, Rodríguez-díaz JC, Gomis ML, Chico-sánchez P, Sánchez-payá J, Jover R. Coronavirus Disease Transmission Prevented in an Endoscopy Unit with Universal Protective Measures and No Systematic Preprocedural Testing. J Clin Med 2022; 11:1681. [PMID: 35330006 PMCID: PMC8955929 DOI: 10.3390/jcm11061681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background and aims: Even after two years of pandemic, there are still uncertainties on how to proceed when we schedule endoscopic procedures. During the COVID-19 pandemic, some scientific societies recommended universal preprocedural testing for all patients. However, other societies recommended against and considered enough to maintain strict infection control strategies. Our aim was to evaluate this approach in order to see if it was safe for both patients and healthcare workers to proceed with the endoscopies without performing a systematic PCR on all patients. Methods: Retrospective chart review of all patients undergoing endoscopy without preprocedural COVID testing at our center from March 2020 to May 2021. PCR tests performed in the patients receiving an endoscopic procedure were analyzed, and patients who tested positive between 14 days before and after the endoscopic procedure were selected. The registry of the endoscopy unit members participating in these procedures was also analyzed. Results: A total of 10,132 procedures were performed in the unit with 26 patients infected with SARS-CoV-2. Nineteen of these procedures were performed in patients with unknown SARS-CoV-2 carrier status. In 23 (88.5%) cases, transmission occurred through social or familial contact, and in 3 (11.5%), transmission occurred in the hospital. Four health care workers became infected during this period and none of them were related to the endoscopic procedures performed in patients with COVID-19. Conclusions: SARS-CoV-2 positive testing in asymptomatic ambulatory patients is rare and the adequate use of individual protective measures emerges as the main way to control the spread of COVID-19 infection in endoscopy centers.
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16
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Lui RN, Tang RSY, Chiu PWY. Endoscopy After the COVID-19 Pandemic—What Will Be Different? Curr Treat Options Gastro 2022; 20:46-59. [PMID: 35095262 PMCID: PMC8789548 DOI: 10.1007/s11938-022-00370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 10/26/2022]
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17
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Raju SA, Harris R, Cook C, Harvey P, Ratcliffe E. UK-wide study of the opinions of gastroenterology trainees: COVID-19, Shape of Training and the future workforce. Frontline Gastroenterol 2021; 13:386-391. [PMID: 36042778 PMCID: PMC8694934 DOI: 10.1136/flgastro-2021-101965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/21/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has disrupted training. Gastroenterology higher specialty training is soon to be reduced from 5 years to 4. The British Society of Gastroenterology Trainees Section biennial survey aims to delineate the impact of COVID-19 on training and the opinions on changes to training. METHODS An electronic survey allowing for anonymised responses at the point of completion was distributed to all gastroenterology trainees from September to November 2020. RESULTS During the first wave of the COVID-19 pandemic, 71.0% of the respondents stated that more than 50% of their clinical time was mostly within general internal medicine. Trainees reported a significant impact on all aspects of their gastroenterology training due to lost training opportunities and increasing service commitments. During the first wave, 88.5% of the respondents reported no access to endoscopy training lists. Since this time, 66.2% of the respondents stated that their endoscopy training lists had restarted. This has resulted in fewer respondents achieving endoscopy accreditation. The COVID-19 pandemic has caused 42.2% of the respondents to consider extending their training to obtain the skills required to complete training. Furthermore, 10.0% of the respondents reported concerns of a delay to completion of training. The majority of respondents (84.2%) reported that they would not feel ready to be a consultant after 4 years of training. CONCLUSIONS Reductions in all aspects of gastroenterology training were reported. This is mirrored in anticipated concerns about completion of training in a shorter training programme as proposed in the new curriculum. Work is now required to ensure training is restored following the pandemic.
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Affiliation(s)
- Suneil A Raju
- Gastroenterology and Liver Unit, The University of Sheffield, Sheffield, UK
| | - Rebecca Harris
- Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Charlotte Cook
- Department of Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Philip Harvey
- Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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18
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Hayee B, Bhandari P, Rees CJ, Penman I. COVID-19 transmission following outpatient endoscopy during pandemic acceleration phase involving SARS-CoV-2 VOC 202012/01 variant in UK. Gut 2021; 70:2227-2229. [PMID: 33762432 PMCID: PMC7992382 DOI: 10.1136/gutjnl-2021-324354] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Bu'Hussain Hayee
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - Pradeep Bhandari
- Gastroenterology, Queen Alexandra Hospital, Portsmouth, Portsmouth, UK
| | - Colin J Rees
- Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, South Tyneside, UK
| | - Ian Penman
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
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19
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Jayasena H, Abeynayake D, De Silva A, Niriella M, de Silva HJ. The use of personal protective equipment in endoscopy: what should the endoscopist wear during a pandemic? Expert Rev Gastroenterol Hepatol 2021; 15:1349-1359. [PMID: 34821190 DOI: 10.1080/17474124.2021.2011213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endoscopists are at high risk of exposure and nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) when performing endoscopic procedures due to the highly aerosol generating nature of these procedures. At present, there is still no consensus among endoscopists with regards to the type of protective equipment to be worn by healthcare workers, when performing endoscopy during the coronavirus 2019 (COVID-19) pandemic. This review encompasses a summary of currently published guidelines related to the use of personal protective equipment (PPE) when performing endoscopic procedures during the COVID-19 pandemic. With increasing calls to rationalize the use of PPE due to shortages in global supply chains, the review offers a concise summary on the most appropriate and adequate use of PPE when performing endoscopy during the pandemic. It is expected that these adaptations in the use of PPE during the pandemic will help to improve standards of care and safety of healthcare workers.
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Affiliation(s)
- Hiruni Jayasena
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Clinical Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
| | | | - Arjuna De Silva
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Madunil Niriella
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - H Janaka de Silva
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Gadour E, Agu O, Musharaf M, Dixon M, Askar A, Hafeez S, Shafiq Y, Arabiyat A, Moradi J. Success Rate of Wire Control-Assisted ERCP Sphincterotomy Versus Non-assisted ERCP Cannulation of Common Bile Duct in a Secondary Care Unit During the First COVID-19 Peak: A Retrospective Observational Study of 281 Patients. Cureus 2021; 13:e17861. [PMID: 34522563 PMCID: PMC8429881 DOI: 10.7759/cureus.17861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background The British Society of Gastroenterology (BSG) recommended that during the COVID-19 pandemic, endoscopy units perform endoscopic retrograde cholangiopancreatography (ERCP) for obstructive biliary pathologies in an emergency. We assessed the local performance of ERCP during the first wave of COVID-19 at our local endoscopy center, in particular the technique to common bile duct (CBD) cannulation. Methodology All ERCP procedures performed from January to June 2020 were retrospectively assessed and compared with procedures performed between January and June 2019 at the Royal Lancaster Infirmary. The indications for ERCP, success rate, and complications were studied separately. Correlation analysis was conducted using Spearman's rank correlation coefficient. The binary logistic regression model was used to compute the factors associated with successful ERCP. Significance was established when the two-sided P-value < 0.05. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 25 for Windows (SPSS Inc., Chicago, IL, USA, 2017). Results A total of 281 ERCP were included in this study, with 169 and 112 performed during the first six months of 2019 and 2020, respectively. A statistically significant (0.0087) higher proportion of cases with liver dysfunction presented for ERCP before the COVID-19 outbreak (152, 89.94%). All patients before COVID-19 underwent wire control-assisted ERCP, while 82 (73.21%) received assisted ERCP during the first wave (P < 0.001). There was no statistically significant difference (P = 0.10) in the number of patients who underwent sphincterotomy before and during the first wave of COVID-19, with 97 (57.39%) and 76 (67.85%), respectively. The success rate of ERCP before COVID-19 was relatively high, accounting for 146 (86.39%) patients in contrast to 87 (77.67%) patients during the first wave (P = 0.074). Sphincterotomy (β = 2.800, P = 0.028) and stent insertion (β = 0.852, P = 0.046) were statistically significant predictors of ERCP outcomes. There was no statistically significant impact of cholangitis on the success of ERCP (β = 1.672, P = 0.109). Conclusion The first wave of COVID-19 had a statistically proven negative impact on the expected standards of ERCP performance. Although the complication rate was significantly higher during the first wave case difficulty, the American Society of Anesthesia (ASA) status was not assessed on an individual basis. Both ASA status and case difficulty are now included in our endoscopy selection process. We recommend adding the complexity of cases and ASA to the local and national recording databases. This is a rare study on UK-based hospitals.
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Affiliation(s)
- Eyad Gadour
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Okwudili Agu
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Mutwakil Musharaf
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Megan Dixon
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Amr Askar
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Siddrah Hafeez
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Yousuf Shafiq
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Abdalla Arabiyat
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
| | - Julia Moradi
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
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21
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Abstract
Dysphagia is a common presentation in gastroenterology practice and the diagnosis and management requires a comprehensive knowledge of diverse range of aetiologies, with a systematic approach for assessment of symptoms, selection of investigations and appropriate treatment to relieve symptoms. In this curriculum review, the suggested diagnostic approach highlights the importance of thorough clinical assessment in order to guide the selection of investigations. This article discusses the utility of endoscopic, histopathology, fluoroscopic and motility investigations for dysphagia, and their interpretation, in order to guide targeted treatments ranging from dietary, pharmacological, endoscopic and surgical interventions.
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Affiliation(s)
- Gaurav B Nigam
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK,National Institute of Health Research, Oxford, UK
| | - Dipesh Harshvadan Vasant
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK,Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, UK
| | - Anjan Dhar
- Gastroenterology, Darlington Memorial Hospital, Darlington, UK,School of Health and Life Sciences, Teesside University, Middlesborough, UK
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22
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McSorley ST, Digby J, Clyde D, Cruickshank N, Burton P, Barker L, Strachan JA, Fraser CG, Smith K, Mowat C, Winter J, Steele RJC. Yield of colorectal cancer at colonoscopy according to faecal haemoglobin concentration in symptomatic patients referred from primary care. Colorectal Dis 2021; 23:1615-1621. [PMID: 33064898 DOI: 10.1111/codi.15405] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/16/2020] [Accepted: 10/03/2020] [Indexed: 12/13/2022]
Abstract
AIM Lower gastrointestinal (GI) symptoms are poor predictors of colorectal cancer (CRC). The aim of this study was to examine the diagnostic yield of colonoscopy by faecal haemoglobin (f-Hb) concentration in symptomatic patients assessed in primary care by faecal immunochemical testing (FIT). METHOD In three Scottish NHS Boards, FIT kits (HM-JACKarc, Hitachi Chemical Diagnostics Systems Co., Ltd, Tokyo, Japan) were used by general practitioners to guide referrals for patients with lower GI symptoms (laboratory data studied for 12 months from December 2015 onwards in Tayside, 18 months from June 2018 onwards in Fife and 5 months from September 2018 onwards in Greater Glasgow and Clyde). Cases of CRC diagnosed at colonoscopy were ascertained from colonoscopy and pathology records. RESULTS Four thousand eight hundred and forty one symptomatic patients who underwent colonoscopy after FIT submission were included. Of the 2166 patients (44.7%) with f-Hb <10 µg Hb/g faeces (µg/g), 14 (0.6%) were diagnosed with CRC, with a number needed to scope (NNS) of 155. Of the 2675 patients (55.3%) with f-Hb ≥10 µg/g, 252 were diagnosed with CRC (9.4%) with a NNS of 11. Of the 705 patients with f-Hb ≥400 µg/g, 158 (22.4%) were diagnosed with CRC with a NNS of 5. Over half of those diagnosed with CRC with f-Hb <10 µg/g had coexisting anaemia. CONCLUSION Symptomatic patients with f-Hb ≥10 µg/g should undergo further investigation for CRC, while higher f-Hb concentrations could be used to triage for urgency during the COVID-19 recovery phase. Patients with f-Hb <10 µg/g and without anaemia are very unlikely to be diagnosed with CRC and the majority need no further investigation.
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Affiliation(s)
- Stephen T McSorley
- Academic Unit of Surgery, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Jayne Digby
- Centre for Research into Cancer Prevention and Screening, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Danielle Clyde
- Department of Surgery, NHS Fife, Victoria Hospital, Kirkcaldy, UK
| | - Neil Cruickshank
- Department of Surgery, NHS Fife, Victoria Hospital, Kirkcaldy, UK
| | - Paul Burton
- eHealth, Corporate Services, Business Intelligence, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Louise Barker
- Department of Surgery, NHS Fife, Victoria Hospital, Kirkcaldy, UK
| | - Judith A Strachan
- Department of Blood Sciences, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Karen Smith
- Department of Clinical Biochemistry, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, UK
| | - Craig Mowat
- Department of Gastroenterology, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - Jack Winter
- Department of Gastroenterology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Robert J C Steele
- Centre for Research into Cancer Prevention and Screening, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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23
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Gimeno-García AZ, Hernández A, Hernández-Bustabad A, Amaral C, Reygosa C, Morales-Arraez D, Jimenez A, Nicolás-Pérez D, Hernández-Guerra M. Usefulness of prioritization systems during the resumption of gastrointestinal endoscopy activity during the COVID-19 pandemic. Endoscopy 2021; 53:662-663. [PMID: 33902113 DOI: 10.1055/a-1453-0206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Antonio Z Gimeno-García
- Gastroenterology and Hepatology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain.,Instituto Universitario de Tecnologías Biomédicas CIBICAN, Departamento de Medicina Interna, Psiquiatría y Dermatología, Universidad de La Laguna, Tenerife, Spain
| | - Anjara Hernández
- Gastroenterology and Hepatology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Alberto Hernández-Bustabad
- Gastroenterology and Hepatology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Carla Amaral
- Gastroenterology and Hepatology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Cristina Reygosa
- Gastroenterology and Hepatology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Dalia Morales-Arraez
- Gastroenterology and Hepatology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Alejandro Jimenez
- Research Unit, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - David Nicolás-Pérez
- Gastroenterology and Hepatology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Manuel Hernández-Guerra
- Gastroenterology and Hepatology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain.,Instituto Universitario de Tecnologías Biomédicas CIBICAN, Departamento de Medicina Interna, Psiquiatría y Dermatología, Universidad de La Laguna, Tenerife, Spain
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24
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Cordie A, Gaber Y, AbdAllah M, Vergori A, Kharono B, Omran S, Afify S, Karkouri M, Chakroun M, Musa S, Moorhouse M, Esmat G. Gastrointestinal manifestations of human immunodeficiency virus and coronavirus disease 2019: Understanding the intersecting regions between the two epidemics. Arab J Gastroenterol 2021; 22:75-87. [PMID: 34120849 PMCID: PMC8149211 DOI: 10.1016/j.ajg.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/07/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023]
Abstract
In March 2020, the World Health Organization declared coronavirus disease (COVID-19) a pandemic. As of February 2021, there were 107 million COVID-19 cases worldwide. As a comparison, there are approximately 38 million people living with human immunodeficiency virus (PLHIV) worldwide. The coexistence of both epidemics, and the syndemic effect of both viruses could lead to a delirious impact both at individual and community levels. Many intersecting points were found between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19, and HIV; among which, gastrointestinal (GI) manifestations are the most notable. GI manifestations represent a common clinical presentation in both HIV and SARS-CoV-2. The emergence of GI symptoms as a result of SARS-CoV-2 infection provides a new dynamic to COVID-19 diagnosis, management, and infection control measures, and adds an additional diagnostic challenge in case of coinfection with HIV. The presence of GI manifestations in PLHIV during the COVID-19 pandemic could be referred to HIV enteropathy, presence of opportunistic infection, adverse effect of antiretrovirals, or coinfection with COVID-19. Thus, it is important to exclude SARS-CoV-2 in patients who present with new-onset GI manifestations, especially in PLHIV, to avoid the risk of disease transmission during endoscopic interventions. Structural similarities between both viruses adds a valuable intersecting point, which has mutual benefits in the management of both viruses. These similarities led to the hypothesis that antiretrovirals such as lopinavir/Rironavir have a role in the management of COVID-19, which was the target of our search strategy using the available evidence. These similarities may also facilitate the development of an efficient HIV vaccine in the future using the advances in COVID-19 vaccine development.
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Affiliation(s)
- Ahmed Cordie
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Yasmine Gaber
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Mohamed AbdAllah
- Medical Research Division, National Research Center, Giza, Egypt
| | - Alessandra Vergori
- HIV/AIDS Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy.
| | | | - Salma Omran
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shimaa Afify
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mehdi Karkouri
- Association de Lutte Contre le Sida/Coalition Plus, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Morocco
| | - Mohamed Chakroun
- Infectious Diseases Department, University Hospital of Monastir, Tunisia
| | - Sherief Musa
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | - Gamal Esmat
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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25
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Turkington RC, Lavery A, Donnelly D, Cairnduff V, McManus DT, Coleman HG. The Impact of the COVID-19 Pandemic on Barrett's Esophagus and Esophagogastric Cancer. Gastroenterology 2021; 160:2169-2171.e1. [PMID: 33513406 PMCID: PMC7837162 DOI: 10.1053/j.gastro.2021.01.208] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Richard C Turkington
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland.
| | - Anita Lavery
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
| | - David Donnelly
- The Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - Victoria Cairnduff
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Damian T McManus
- Department of Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Helen G Coleman
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland; The Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, Northern Ireland; Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
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26
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Hayee B, East J, Rees CJ, Penman I. Multicentre prospective study of COVID-19 transmission following outpatient GI endoscopy in the UK. Gut 2021; 70:825-828. [PMID: 32928914 PMCID: PMC7490915 DOI: 10.1136/gutjnl-2020-322730] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Bu'Hussain Hayee
- King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| | - James East
- Translational Gastroenterology Unit, John Radcliffe Hospital Department of Gastroenterology, Oxford, Oxfordshire, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Colin J Rees
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Ian Penman
- Royal Infirmary of Edinburgh, Edinburgh, UK
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27
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Din S, Gaya D, Kammermeier J, Lamb CA, Macdonald J, Moran G, Parkes G, Pollok R, Sebastian S, Segal J, Selinger C, Smith PJ, Steed H, Arnott ID. Inflammatory bowel disease clinical service recovery during the COVID-19 pandemic. Frontline Gastroenterol 2021; 13:77-81. [PMID: 34966535 PMCID: PMC8666864 DOI: 10.1136/flgastro-2021-101805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/12/2021] [Accepted: 03/26/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Shahida Din
- Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
| | - Daniel Gaya
- Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Jochen Kammermeier
- Pediatric Gastroenterology, Evelina London Children's Hospital, London, UK
| | - Christopher A Lamb
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK,Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Jonathan Macdonald
- Department of Gastroenterology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Gordon Moran
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK,Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - Gareth Parkes
- Department of Gastroenterology, Royal London Hospital, London, UK
| | | | - Shaji Sebastian
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Jonathan Segal
- Department of Gastroenterology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Christian Selinger
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK
| | - Philip J Smith
- Department of Hepatology and Liver Transplantation, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Helen Steed
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Ian D Arnott
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
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28
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Antonelli G, Karstensen JG, Bhat P, Ijoma U, Osuagwu C, Desalegn H, Abera H, Guy C, Vilmann P, Dinis-Ribeiro M, Ponchon T, Sabbagh LC, Pausawasdi N, Makharia G, Hassan C, Veitch A, Aabakken L, Ebigbo A. Resuming endoscopy during COVID-19 pandemic: ESGE, WEO and WGO Joint Cascade Guideline for Resource Limited Settings. Endosc Int Open 2021; 9:E543-E551. [PMID: 33816775 PMCID: PMC7969134 DOI: 10.1055/a-1400-9135] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Giulio Antonelli
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy,Department of Translational and Precision Medicine, “Sapienza” University of Rome, Italy,Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli (N.O.C.), Rome, Italy
| | - John Gásdal Karstensen
- Gastro Unit, Hvidovre Hospital, Hvidovre, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Purnima Bhat
- ANU Medical School/Canberra Hospital -Gastroenterology, Garran, Australia
| | - Uchenna Ijoma
- III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
| | - Chukwuemeka Osuagwu
- Gastroenterology Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Hailemichael Desalegn
- Department of Internal Medicine, St. Paulʼs Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Hanna Abera
- III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
| | - Claire Guy
- European Society of Gastrointestinal Endoscopy – Munich, Germany
| | - Peter Vilmann
- Gastro Unit, Copenhagen University Hospital Herlev – Herlev, Denmark
| | | | - Thierry Ponchon
- Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Luis Carlos Sabbagh
- Department of Gastroenterology, Reina Sofia and Colombia University Clinics, Bogota, Colombia
| | | | | | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Andrew Veitch
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, UK
| | - Lars Aabakken
- Department of Transplantation Medicine, Faculty of Medicine, Oslo University Hospital – Rikshospitalet, Oslo, Norway
| | - Alanna Ebigbo
- III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
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29
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Bailey SER, Abel GA, Atkins A, Byford R, Davies SJ, Mays J, McDonald TJ, Miller J, Neck C, Renninson J, Thomas P, Walter FM, Warren S, Hamilton W. Diagnostic performance of a faecal immunochemical test for patients with low-risk symptoms of colorectal cancer in primary care: an evaluation in the South West of England. Br J Cancer 2021; 124:1231-6. [PMID: 33462361 DOI: 10.1038/s41416-020-01221-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The faecal immunochemical test (FIT) was introduced to triage patients with low-risk symptoms of possible colorectal cancer in English primary care in 2017, underpinned by little primary care evidence. METHODS All healthcare providers in the South West of England (population 4 million) participated in this evaluation. 3890 patients aged ≥50 years presenting in primary care with low-risk symptoms of colorectal cancer had a FIT from 01/06/2018 to 31/12/2018. A threshold of 10 μg Hb/g faeces defined a positive test. RESULTS Six hundred and eighteen (15.9%) patients tested positive; 458 (74.1%) had an urgent referral to specialist lower gastrointestinal (GI) services within three months. Forty-three were diagnosed with colorectal cancer within 12 months. 3272 tested negative; 324 (9.9%) had an urgent referral within three months. Eight were diagnosed with colorectal cancer within 12 months. Positive predictive value was 7.0% (95% CI 5.1-9.3%). Negative predictive value was 99.8% (CI 99.5-99.9%). Sensitivity was 84.3% (CI 71.4-93.0%), specificity 85.0% (CI 83.8-86.1%). The area under the ROC curve was 0.92 (CI 0.86-0.96). A threshold of 37 μg Hb/g faeces would identify patients with an individual 3% risk of cancer. CONCLUSIONS FIT performs exceptionally well to triage patients with low-risk symptoms of colorectal cancer in primary care; a higher threshold may be appropriate in the wake of the COVID-19 crisis.
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30
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James T, Nicholson BD, Marr R, Paddon M, East JE, Justice S, Oke JL, Shine B. Faecal immunochemical testing (FIT): sources of result variation based on three years of routine testing of symptomatic patients in English primary care. Br J Biomed Sci 2021; 78:211-217. [PMID: 33627037 DOI: 10.1080/09674845.2021.1896204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: We aimed to determine the analytical capabilities of a commonly used faecal immunochemical test (FIT) to detect faecal haemoglobin (Hb) in symptomatic people attending primary care in the context of the English NICE DG30 guidance.Materials and Methods: Data obtained from independent verification studies and clinical testing of the HM-JACKarc FIT method in routine primary care practice were analysed to derive performance characteristics.Results: Detection capabilities for the FIT method were 0.5 µg/g (limit of blank), 1.3 µg/g (limit of detection) and 3.0 µg/g (limit of quantitation). Of 33 non-homogenized specimens, 31 (93.9%) analysed in triplicate were consistently categorized relative to 10 µg/g, compared to all 33 (100%) homogenized specimens. Imprecision was higher (median 27.8%, (range 20.5% to 48.6%)) in non-homogenized specimens than in homogenized specimens (10.2%, (7.0 to 13.5%)). Considerable variation was observed in sequential clinical specimens from individual patients but no positive or negative trend in specimen degradation was observed over time (p = 0.26).Discussion: The FIT immunoassay evaluated is capable of detecting faecal Hb at concentrations well below the DG30 threshold of 10 µg/g and is suitable for application in this context. The greatest practical challenge to FIT performance is reproducible sampling, the pre-analytical step associated with most variability. Further research should focus on reducing sampling variability, particularly as post-COVID-19 guidance recommends greater FIT utilization.
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Affiliation(s)
- T James
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - B D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R Marr
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - M Paddon
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - J E East
- Translational Gastroenterology Unit, and Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - S Justice
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - J L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - B Shine
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
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31
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Jones CM, Lyles A, Foley KG. A national cross-sectional survey investigating the use of endoscopic ultrasound in the diagnosis and treatment of oesophageal cancer in the UK. Clin Radiol 2021; 76:458-464. [PMID: 33752881 DOI: 10.1016/j.crad.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/17/2021] [Indexed: 01/01/2023]
Abstract
AIM To evaluate variation in the pre-pandemic use of endoscopic ultrasound (EUS) for oesophageal cancer diagnosis and treatment planning up to 2019, and which factors contributed to this. MATERIALS AND METHODS A UK-wide online survey of oesophagogastric multidisciplinary team lead clinicians was undertaken to determine perceptions towards, and the use of, EUS to aid staging and treatment planning in oesophageal cancer. RESULTS Thirty-five responses were received, representing 97 UK National Health Service Trusts/Health Boards. A majority of centres (n=21, 60%) did not have formal written guidance for EUS use. Although all respondents had access to EUS, a perceived lack of utility (n=7) and concerns about delaying treatment start dates (n=8) each restricted EUS use for a fifth of respondents. For most centres (n=24, 68.6%), EUS use is case-specific, whereas for 10 (28.6%) EUS is used for all patients with potentially curable disease. A majority of centres use diagnostic positron-emission tomography for radiotherapy target volume delineation (TVD), whereas 22 (62.9%) use EUS. The factors contributing to decisions to use EUS for staging, TVD and surgical planning varied between centres. The proportion of centre respondents who would request EUS in each of six clinical scenarios varied considerably. CONCLUSION There were substantial differences in the patient and disease characteristics that are perceived to be indications for EUS use for both staging and treatment planning. Research to clarify in which patients with oesophageal cancer EUS affords benefit is required, as is urgent standardisation of its role in the diagnostic pathway.
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Affiliation(s)
- C M Jones
- Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Radiotherapy Research Group, Faculty of Medicine & Health, University of Leeds, Leeds, UK.
| | - A Lyles
- Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K G Foley
- Department of Clinical Radiology, Velindre Cancer Centre, Cardiff, UK
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Ho KMA, Banerjee A, Lawler M, Rutter MD, Lovat LB. Predicting endoscopic activity recovery in England after COVID-19: a national analysis. Lancet Gastroenterol Hepatol 2021; 6:381-390. [PMID: 33713606 PMCID: PMC7946568 DOI: 10.1016/s2468-1253(21)00058-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 12/25/2022]
Abstract
Background The COVID-19 pandemic has led to a substantial reduction in gastrointestinal endoscopies, creating a backlog of procedures. We aimed to quantify this backlog nationally for England and assess how various interventions might mitigate the backlog. Methods We did a national analysis of data for colonoscopies, flexible sigmoidoscopies, and gastroscopies from National Health Service (NHS) trusts in NHS England's Monthly Diagnostic Waiting Times and Activity dataset. Trusts were excluded if monthly data were incomplete. To estimate the potential backlog, we used linear logistic regression to project the cumulative deficit between actual procedures performed and expected procedures, based on historical pre-pandemic trends. We then made further estimations of the change to the backlog under three scenarios: recovery to a set level of capacity, ranging from 90% to 130%; further disruption to activity (eg, second pandemic wave); or introduction of faecal immunochemical testing (FIT) triaging. Findings We included data from Jan 1, 2018, to Oct 31, 2020, from 125 NHS trusts. 10 476 endoscopy procedures were done in April, 2020, representing 9·5% of those done in April, 2019 (n=110 584), before recovering to 105 716 by October, 2020 (84·5% of those done in October, 2019 [n=125 072]). Recovering to 100% capacity on the current trajectory would lead to a projected backlog of 162 735 (95% CI 143 775–181 695) colonoscopies, 119 025 (107 398–130 651) flexible sigmoidoscopies, and 194 087 (172 564–215 611) gastroscopies in January, 2021, attributable to the pandemic. Increasing capacity to 130% would still take up to June, 2022, to eliminate the backlog. A further 2-month interruption would add an extra 15·4%, a 4-month interruption would add an extra 43·8%, and a 6-month interruption would add an extra 82·5% to the potential backlog. FIT triaging of cases that are found to have greater than 10 μg haemoglobin per g would reduce colonoscopy referrals to around 75% of usual levels, with the backlog cleared in early 2022. Interpretation Our work highlights the impact of the pandemic on endoscopy services nationally. Even with mitigation measures, it could take much longer than a year to eliminate the pandemic-related backlog. Urgent action is required by key stakeholders (ie, individual NHS trusts, Clinical Commissioning Groups, British Society of Gastroenterology, and NHS England) to tackle the backlog and prevent delays to patient management. Funding Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) at University College London, National Institute for Health Research University College London Hospitals Biomedical Research Centre, and DATA-CAN, Health Data Research UK.
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Affiliation(s)
- Kai Man Alexander Ho
- Division of Surgery and Interventional Science, University College London, London, UK.
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK; DATA-CAN, Health Data Research Hub for Cancer, London, UK
| | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK; Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Laurence B Lovat
- Division of Surgery and Interventional Science, University College London, London, UK; Gastrointestinal Services Division, University College London Hospitals NHS Foundation Trust, London, UK
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Hampton JS, Sharp L, Craig D, Rees CJ. Colorectal Cancer Screening and Surveillance for Non-Hereditary High-Risk Groups—Is It Time for a Re-Think? Curr Treat Options Gastro 2021; 19:48-67. [PMID: 33424223 PMCID: PMC7781649 DOI: 10.1007/s11938-020-00317-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 12/24/2022]
Abstract
Purpose of review Colorectal cancer (CRC) is the second most common cause of cancer death worldwide, killing approximately 900,000 people each year. An individual’s risk of developing CRC is multi-factorial with known risk factors including increasing age, male sex, family history of CRC and raised body mass index. Population-based screening programmes for CRC exist in many countries, and in the United Kingdom (UK), screening is performed through the NHS Bowel Cancer Screening Programme (BCSP). Screening programmes offer a population-based approach for those at “average risk”, and do not typically offer enhanced screening for groups at increased risk. In the UK, such patients are managed via non-screening symptomatic services but in a non-systematic way. Recent findings There is growing evidence that conditions such as cystic fibrosis and a history of childhood cancer are associated with higher risk of CRC, and surveillance of these groups is advocated by some organizations; however, national recommendations do not exist in most countries. Summary We review the evidence for screening “high risk” groups not covered within most guidelines and discuss health economic issues requiring consideration acknowledging that the demand on colonoscopy services is already overwhelming.
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Rutter MD, Brookes M, Lee TJ, Rogers P, Sharp L. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis. Gut 2021; 70:537-543. [PMID: 32690602 PMCID: PMC7385747 DOI: 10.1136/gutjnl-2020-322179] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has had a major global impact on endoscopic services. This reduced capacity, along with public reluctance to undergo endoscopy during the pandemic, might result in excess mortality from delayed cancer diagnosis. Using the UK's National Endoscopy Database (NED), we performed the first national analysis of the impact of the pandemic on endoscopy services and endoscopic cancer diagnosis. DESIGN We developed a NED COVID-19 module incorporating procedure-level data on all endoscopic procedures. Three periods were designated: pre-COVID (6 January 2020 to 15 March), transition (16-22 March) and COVID-impacted (23 March-31 May). National, regional and procedure-specific analyses were performed. The average weekly number of cancers, proportion of missing cancers and cancer detection rates were calculated. RESULTS A weekly average of 35 478 endoscopy procedures were performed in the pre-COVID period. Activity in the COVID-impacted period reduced to 12% of pre-COVID levels; at its low point, activity was only 5%, recovering to 20% of pre-COVID activity by study end. Although more selective vetting significantly increased the per-procedure cancer detection rate (pre-COVID 1.91%; COVID-impacted 6.61%; p<0.001), the weekly number of cancers detected decreased by 58%. The proportion of missing cancers ranged from 19% (pancreatobiliary) to 72% (colorectal). CONCLUSION This national analysis demonstrates the remarkable impact that the pandemic has had on endoscopic services, which has resulted in a substantial and concerning reduction in cancer detection. Major, urgent efforts are required to restore endoscopy capacity to prevent an impending cancer healthcare crisis.
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Affiliation(s)
- Matthew D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Brookes
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
- Research Institute in Healthcare Science (RIHS), University of Wolverhampton, Wolverhampton, UK
| | - Thomas J Lee
- Gastroenterology Research, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Khorrami Minaei S, Garrido Durán C, García Hernández M, García Amengual I, Mena Ribas A. POOR AGREEMENT BETWEEN CLINICAL SCREENING AND UNIVERSAL PRE-PROCEDURE SARS-CoV-2 PCR TESTING PRIOR TO ENDOSCOPY. Rev Esp Enferm Dig 2021; 113:649-655. [DOI: 10.17235/reed.2021.7612/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is still wreaking havoc in many parts of the world and poses a great burden to healthcare systems worldwide. Mitigation and suppression strategies have been implemented globally but the disease has proven to be difficult to contain. Initially many elective gastrointestinal endoscopies were cancelled to reduce the risk of infection and conserve personal protective equipment, but many endoscopy units are now faced with the dilemma of resuming endoscopy service during the pandemic as indefinitely postponing diagnostic procedures may lead to a delay in the diagnosis and treatment of malignancies. Further concerns are surfacing as COVID-19 is now known to affect the gastrointestinal tract and may potentially be spread via the fecal-oral route. Until more effective drugs and vaccines are available, it is unlikely that the pandemic will wind down in the near future. Maintaining a balance between protecting healthcare workers and patients from being infected on the one hand and providing timely and effective clinical care on the other will become increasingly important as the pandemic persists. In this narrative review, the risk of COVID-19 infection for healthcare workers and patients undergoing endoscopy, and recommendations on maintaining safe, high-quality endoscopy practice will be discussed.
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Pinto-Sanchez MI, Silvester JA, Lebwohl B, Leffler DA, Anderson RP, Therrien A, Kelly CP, Verdu EF. Society for the Study of Celiac Disease position statement on gaps and opportunities in coeliac disease. Nat Rev Gastroenterol Hepatol 2021; 18:875-84. [PMID: 34526700 DOI: 10.1038/s41575-021-00511-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 02/08/2023]
Abstract
Progress has been made in understanding coeliac disease, a relatively frequent and underappreciated immune-mediated condition that occurs in genetically predisposed individuals. However, several gaps remain in knowledge related to diagnosis and management. The gluten-free diet, currently the only available management, is not curative or universally effective (some adherent patients have ongoing duodenal injury). Unprecedented numbers of emerging therapies, including some with novel tolerogenic mechanisms, are currently being investigated in clinical trials. In March 2020, the Celiac Disease Foundation and the Society for the Study of Celiac Disease convened a consensus workshop to identify high-yield areas of research that should be prioritized. Workshop participants included leading experts in clinical practice, academia, government and pharmaceutical development, as well as representatives from patient support groups in North America. This Roadmap summarizes key advances in the field of coeliac disease and provides information on important discussions from the consensus approach to address gaps and opportunities related to the pathogenesis, diagnosis and management of coeliac disease. The morbidity of coeliac disease is often underestimated, which has led to an unmet need to improve the management of these patients. Expanded research funding is needed as coeliac disease is a potentially curable disease.
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Esmaily S, Yau CC, Dwarakanath D, Hancock J, Mitra V. Impact of COVID-19 pandemic on key performance indicators in pancreatobiliary endoscopy: prioritise, minimise risk, keep scoping and training. Frontline Gastroenterol 2020; 12:288-292. [PMID: 34249313 PMCID: PMC8231416 DOI: 10.1136/flgastro-2020-101701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has profoundly affected endoscopy services including pancreatobiliary (PB) endoscopy across the UK. The British Society of Gastroenterology and Joint Advisory Group have issued guidance for managing endoscopy services safely throughout this period. There have been perceived concerns among the PB endoscopists that wearing full personal protective equipment might have an adverse impact on key performance indicators (KPIs) in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) procedures leading to non-compliance with the national guidelines. The aim of the study was to assess the impact of COVID-19 pandemic on KPIs in ERCP and EUS and ascertain the risk of procedure-related complications. METHODS A retrospective audit of a prospectively maintained endoscopy database was carried out between 18 March and 31 July 2020. RESULTS 146 ERCP procedures (common bile duct (CBD) cannulation rate of naïve papilla 89.2%, complete CBD stone extraction rate at first ERCP 88.2%, biliary stricture decompression rate 91%) and 87 EUS procedures (diagnostic accuracy of EUS-fine needle aspiration 92%) were carried out during this period. ERCP-related complications included pancreatitis (4.8%), bleeding (0.68%) and cholangitis (0.68%). 30-day ERCP procedure-related mortality was 0.68%. There were no complications or procedure-related mortality in the EUS group. CONCLUSION This is the first study looking at the impact of COVID-19 on KPIs and procedure-related complications in ERCP and EUS in the literature. Our study confirms that a high-quality PB endoscopy service can be delivered safely and effectively during the COVID-19 pandemic.
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Affiliation(s)
- Shiran Esmaily
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Chia Chuin Yau
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Deepak Dwarakanath
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - John Hancock
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Vikramjit Mitra
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
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Phull PS. Urgent upper gastrointestinal endoscopy referrals cancelled due to the COVID-19 pandemic. Clin Med (Lond) 2020; 20:e278. [PMID: 33199340 DOI: 10.7861/clinmed.let.20.6.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Crawford SM, Evans C, Edwards H, Zoltowski A. Requests from primary care for chest X-ray and CA125 measurements during the COVID-19 emergency: An observational study. Clin Med (Lond) 2020; 21:e45-e47. [PMID: 33188011 DOI: 10.7861/clinmed.2020-0638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
During the first 3 months of 2020, as the COVID-19 pandemic developed, it was noticed that requests from primary care for investigations were decreasing, including those that form part of the diagnostic process for cancers. We therefore obtained data on the requests from primary care for chest X-rays (CXRs) and CA125 measurement our hospital received in the first half of 2020 and compared them with 2019. The number of CXRs declined by 93% in April 2020 compared with 2019, with the decline being greater for patient living in outlying areas. Requests from the emergency department also declined. Requests for CA125 measurement similarly fell by 77% from all areas. The requests increased in June, CA125 more than CXR. If this phenomenon is widespread it may have an impact on diagnosis of major conditions, particularly cancers and tuberculosis.
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Karampekos G, Gkolfakis P, Tziatzios G, Apostolopoulos P, Vlachogiannakos J, Thomopoulos K, Protopapas A, Kofokotsios A, Oikonomou M, Mela M, Samonakis D, Christodoulou D, Triantafyllou K. Differences between fellows and fellowship program directors in their perception of the impact of the COVID-19 pandemic on gastroenterology training: results from a nationwide survey in Greece. Ann Gastroenterol 2020; 33:680-686. [PMID: 33162746 PMCID: PMC7599356 DOI: 10.20524/aog.2020.0546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background Lockdown measures applied during the SARS-CoV-2 outbreak caused a significant disturbance to hospital routine. We assessed trainees' and fellowship directors' perceptions regarding the impact of the pandemic on gastroenterology fellowship training. Methods A web-based survey was anonymously disseminated to all Greek gastroenterology fellows and fellowship program directors. Participants completed electronically a questionnaire comprised of 5 domains that assessed participants' perception of: 1) overall impact on training; 2) impact on training in gastroenterology-specific fields (endoscopy, inflammatory bowel disease, hepatology); 3) impact on different aspects of endoscopy training; 4) impact on academic training; and 5) training perspectives for the post-pandemic era. Results A total of 77/128 fellows (60.1%) and 18/28 fellowship program directors (64.3%) responded. More fellows reported that the COVID-19 pandemic would have an adverse impact on fellowship training compared to their fellowship program directors (81.8% vs. 55.6%, P=0.038). This concern was mainly focused on endoscopy training (83.1% vs. 27.8%, P<0.001), with no difference regarding training in gastroenterology's other specific fields. The difference was consistent for technical skills (79.2% vs. 38.9%, P=0.001), and for the performance of basic diagnostic (70.1% vs. 22.2%, P<0.001) and emergency (48.1% vs. 11.1%, P=0.004) procedures. Fellows and fellowship program directors identified the unknown timeframe of measure implementation and the postponement of scheduled endoscopic procedures as the main factors that negatively affected training. Extension of the fellowship training program was deemed the optimal option by fellows for addressing the training decrement in the post-pandemic era, while fellowship program directors favored an increase in workload. Conclusion Fellows and their fellowship program directors do not share the same concerns about the impact of COVID-19 pandemic on training programs and they propose different measures to remedy its effects.
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Affiliation(s)
- George Karampekos
- Department of Gastroenterology, "Evangelismos-Ophthalmiatreion Athinon - Polykliniki" General Hospital of Athens, Greece (George Karampekos, Maria Mela)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (Paraskevas Gkolfakis)
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Georgios Tziatzios, Konstantinos Triantafyllou)
| | | | - Jiannis Vlachogiannakos
- Academic Department of Gastroenterology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Jiannis Vlachogiannakos)
| | - Konstantinos Thomopoulos
- Department of Gastroenterology, University General Hospital of Patras, Patras, Greece (Konstantinos Thomopoulos)
| | - Andreas Protopapas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (Andreas Protopapas)
| | - Alexandros Kofokotsios
- Department of Interventional Gastroenterology, "Euromedica Geniki Kliniki" General Hospital, Thessaloniki, Greece (Alexandros Kofokotsios)
| | - Michalis Oikonomou
- Gastroenterology Private Practice Facility, Athens, Greece (Michalis Oikonomou)
| | - Maria Mela
- Department of Gastroenterology, "Evangelismos-Ophthalmiatreion Athinon - Polykliniki" General Hospital of Athens, Greece (George Karampekos, Maria Mela)
| | - Dimitrios Samonakis
- Department of Gastroenterology, University Hospital of Heraklion, Crete, Greece (Dimitrios Samonakis)
| | - Dimitrios Christodoulou
- Division of Gastroenterology, University Hospital & Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Dimitrios Christodoulou)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Georgios Tziatzios, Konstantinos Triantafyllou)
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Phillips G, Jones M, Dagg K. Restarting training and examinations in the era of COVID-19: a perspective from the Federation of Royal Colleges of Physicians UK. Clin Med (Lond) 2020; 20:e248-e252. [PMID: 32912965 PMCID: PMC7687339 DOI: 10.7861/clinmed.2020-0481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
COVID-19 has proven to be a potent disruptor of postgraduate training, assessment and learning. In so doing, it has equally proved to be a potent catalyst and has driven innovation. Here we discuss the response of the Federation of the three UK Royal Colleges of Physicians to the challenges presented in these areas by the COVID-19 pandemic.
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Affiliation(s)
| | - Mike Jones
- Joint Royal Colleges of Physicians Training Board
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Hunt RH, East JE, Lanas A, Malfertheiner P, Satsangi J, Scarpignato C, Webb GJ. COVID-19 and Gastrointestinal Disease: Implications for the Gastroenterologist. Dig Dis 2020; 39:119-139. [PMID: 33040064 PMCID: PMC7705947 DOI: 10.1159/000512152] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND COVID-19 was initially considered a respiratory disease but the SARS-CoV-2 virus can lead to serious systemic consequences affecting major organs including the digestive system. SUMMARY This review brings new clinically important information for the gastroenterologist. This includes: the mechanisms of tissue damage seen with the SARS-CoV-2 virus; the consequences of immunosuppression in patients with inflammatory bowel disease (IBD) and chronic liver disease with the additional risks of decompensation in patients with cirrhosis; the impact of COVID-19 on gastrointestinal emergencies, on gastrointestinal endoscopy, diagnosis and treatments. These highlight the need to understand the clinical pharmacology, toxicology and therapeutic implications of drugs commonly used by gastroenterologists and their links with COVID-19. Key Messages: Any part of the digestive system may be affected by the SARS-CoV-2 virus, and those with pre-existing disease are at greatest risk of adverse outcomes. The risk for drug-drug interactions is considerable in patients seriously ill with COVID-19 who often require mechanical ventilation and life support. Some repurposed drugs used against SARS-CoV-2 can cause or aggravate some of the COVID-19-related gastrointestinal symptoms and can also induce liver injury. Ongoing clinical studies will hopefully identify effective drugs with a more favourable risk-benefit ratio than many initially tried treatments.
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Affiliation(s)
- Richard H. Hunt
- Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada,*Richard H. Hunt, Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, McMaster University Health Sciences Centre, Hamilton, ON L8S 4L8 (Canada),
| | - James E. East
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Angel Lanas
- University Hospital Lozano Blesa, IIS Aragón, CIBER Enfermedades Hepáticas y Digestivas (CIBERehd) Digestive Diseases, Universidad de Zaragoza, Zaragoza, Spain
| | - Peter Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Magdeburg, Germany,Med. Klinik und Poliklinik II, Klinikum der Universität, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jack Satsangi
- Consultant Physician, Oxford University NHS Trust and Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom,Department of Gastroenterology, University of Edinburgh, Edinburgh, United Kingdom
| | - Carmelo Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta,Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Gwilym J. Webb
- Oxford Liver Unit, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom
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Tham TC, Douds AC, Ransford R. Challenges and opportunities of COVID-19 for gastroenterology and hepatology services. Frontline Gastroenterol 2020; 12:342-344. [PMID: 34249321 PMCID: PMC8231418 DOI: 10.1136/flgastro-2020-101611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Tony C Tham
- Immediate past Chair, British Society of Gastroenterology Clinical Services and Standards Committee, London, UK,Division of Gastroenterology, Ulster Hospital, Belfast, Northern Ireland, UK
| | - Andrew C Douds
- Department of Gastroenterology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK,Chair, British Society of Gastroenterology Clinical Services and Standards Committee, London, UK
| | - Rupert Ransford
- Department of Gastroenterology, Hereford County Hospital, Hereford, UK,Deputy Chair, British Society of Gsatroenterology Clinical Services and Standards Committee, London, UK
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Rees CJ, Rutter MD, Sharp L, Hayee B, East JE, Bhandari P, Penman I. COVID-19 as a barrier to attending for gastrointestinal endoscopy: weighing up the risks. Lancet Gastroenterol Hepatol 2020; 5:960-2. [PMID: 32888412 DOI: 10.1016/S2468-1253(20)30268-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
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FitzPatrick M, Clough J, Harvey P, Ratcliffe E. How can gastroenterology training thrive in a post-COVID world? Frontline Gastroenterol 2020; 12:338-341. [PMID: 34249320 PMCID: PMC8231417 DOI: 10.1136/flgastro-2020-101601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Michael FitzPatrick
- Translational Gastroenterology Unit, Oxford University, Oxford, Oxfordshire, UK
| | - Jennifer Clough
- Gastroenterology, Guy’s and St Thomas’ NHS Trust, London, UK
| | - Philip Harvey
- Gastroenterology, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK
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Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, Rachet B, Aggarwal A. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol 2020. [PMID: 32702310 DOI: 10.1016/s1470-2045(20)30388-0/attachment/52c550ca-e7e3-475d-8b04-14d4edc4444d/mmc1.pdf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Since a national lockdown was introduced across the UK in March, 2020, in response to the COVID-19 pandemic, cancer screening has been suspended, routine diagnostic work deferred, and only urgent symptomatic cases prioritised for diagnostic intervention. In this study, we estimated the impact of delays in diagnosis on cancer survival outcomes in four major tumour types. METHODS In this national population-based modelling study, we used linked English National Health Service (NHS) cancer registration and hospital administrative datasets for patients aged 15-84 years, diagnosed with breast, colorectal, and oesophageal cancer between Jan 1, 2010, and Dec 31, 2010, with follow-up data until Dec 31, 2014, and diagnosed with lung cancer between Jan 1, 2012, and Dec 31, 2012, with follow-up data until Dec 31, 2015. We use a routes-to-diagnosis framework to estimate the impact of diagnostic delays over a 12-month period from the commencement of physical distancing measures, on March 16, 2020, up to 1, 3, and 5 years after diagnosis. To model the subsequent impact of diagnostic delays on survival, we reallocated patients who were on screening and routine referral pathways to urgent and emergency pathways that are associated with more advanced stage of disease at diagnosis. We considered three reallocation scenarios representing the best to worst case scenarios and reflect actual changes in the diagnostic pathway being seen in the NHS, as of March 16, 2020, and estimated the impact on net survival at 1, 3, and 5 years after diagnosis to calculate the additional deaths that can be attributed to cancer, and the total years of life lost (YLLs) compared with pre-pandemic data. FINDINGS We collected data for 32 583 patients with breast cancer, 24 975 with colorectal cancer, 6744 with oesophageal cancer, and 29 305 with lung cancer. Across the three different scenarios, compared with pre-pandemic figures, we estimate a 7·9-9·6% increase in the number of deaths due to breast cancer up to year 5 after diagnosis, corresponding to between 281 (95% CI 266-295) and 344 (329-358) additional deaths. For colorectal cancer, we estimate 1445 (1392-1591) to 1563 (1534-1592) additional deaths, a 15·3-16·6% increase; for lung cancer, 1235 (1220-1254) to 1372 (1343-1401) additional deaths, a 4·8-5·3% increase; and for oesophageal cancer, 330 (324-335) to 342 (336-348) additional deaths, 5·8-6·0% increase up to 5 years after diagnosis. For these four tumour types, these data correspond with 3291-3621 additional deaths across the scenarios within 5 years. The total additional YLLs across these cancers is estimated to be 59 204-63 229 years. INTERPRETATION Substantial increases in the number of avoidable cancer deaths in England are to be expected as a result of diagnostic delays due to the COVID-19 pandemic in the UK. Urgent policy interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the COVID-19 pandemic on patients with cancer. FUNDING UK Research and Innovation Economic and Social Research Council.
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Affiliation(s)
- Camille Maringe
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - James Spicer
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Melanie Morris
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK; Institute of Cancer Policy, King's College London, London, UK; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bernard Rachet
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Institute of Cancer Policy, King's College London, London, UK; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Emmanuel A. When routine bites hard…. Clin Med (Lond) 2020; 20:349. [DOI: 10.7861/clinmed.ed.20.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tack J, Schol J, Geeraerts A, Huang I, Mori H, Scarpellini E, Sinonquel P, Carbone F, Colomier E, Geysen H, Jandee S, Moonen A, Pannemans J, Timmermans L, Van den Houte K, Verbeure W, Wauters L, Bisschops R, Hoffman I, Roelandt P, Rommel N, Simren M, Suzuki H, Tornblom H, Verbeke K, Vanuytsel T. A survey on the impact of the COVID-19 pandemic on motility and functional investigations in Europe and considerations for recommencing activities in the early recovery phase. Neurogastroenterol Motil 2020; 32:e13926. [PMID: 32478910 PMCID: PMC7300498 DOI: 10.1111/nmo.13926] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The COVID-19 pandemic, declared by WHO on March 13, 2020, had a major global impact on the healthcare system and services. In the acute phase, the presence of the SARS-CoV-2 virus in the aerodigestive tract limited activities in the gastroenterology clinic and procedures to emergencies only. Motility and function testing was interrupted and as we enter the recovery phase, restarting these procedures requires a safety-focused approach with adequate infection prevention for patients and healthcare professionals. METHODS We summarized knowledge on the presence of the SARS-CoV-2 virus in the aerodigestive tract and the risk of spread with motility and functional testing. We surveyed 39 European centers documenting how the pandemic affected activities and which measures they are considering for restarting these measurements. We propose recommendations based on current knowledge as applied in our center. RESULTS Positioning of catheters for gastrointestinal motility tests carries a concern for aerosol-borne infection of healthcare workers. The risk is low with breath tests. The surveyed centers stopped almost all motility and function tests from the second half of March. The speed of restarting and the safety measures taken varied highly. CONCLUSIONS AND INFERENCES Based on these findings, we provided recommendations and practical relevant information for motility and function test procedures in the COVID-19 pandemic era, to guarantee a high-quality patient care with adequate infection prevention.
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Affiliation(s)
- Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium,Division of Gastroenterology and HepatologyLeuven University HospitalsLeuvenBelgium,Department of Internal Medicine & Clinical NutritionInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Jolien Schol
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Annelies Geeraerts
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - I‐Hsuan Huang
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Hideki Mori
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Emidio Scarpellini
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Pieter Sinonquel
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Florencia Carbone
- Division of Gastroenterology and HepatologyLeuven University HospitalsLeuvenBelgium
| | - Esther Colomier
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Hannelore Geysen
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Sawangpong Jandee
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - An Moonen
- Division of Gastroenterology and HepatologyLeuven University HospitalsLeuvenBelgium
| | - Jasper Pannemans
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Lien Timmermans
- Division of Gastroenterology and HepatologyLeuven University HospitalsLeuvenBelgium
| | - Karen Van den Houte
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Wout Verbeure
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Lucas Wauters
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Raf Bisschops
- Division of Gastroenterology and HepatologyLeuven University HospitalsLeuvenBelgium
| | - Ilse Hoffman
- Division of Gastroenterology and HepatologyLeuven University HospitalsLeuvenBelgium
| | - Philip Roelandt
- Division of Gastroenterology and HepatologyLeuven University HospitalsLeuvenBelgium
| | - Nathalie Rommel
- Division of Gastroenterology and HepatologyLeuven University HospitalsLeuvenBelgium
| | - Magnus Simren
- Department of Internal Medicine & Clinical NutritionInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Hidekazu Suzuki
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineSchool of MedicineTokai UniversityIseharaKanagawaJapan
| | - Hans Tornblom
- Department of Internal Medicine & Clinical NutritionInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Kristin Verbeke
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium
| | - Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disorders (TARGID)Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)KU LeuvenLeuvenBelgium,Division of Gastroenterology and HepatologyLeuven University HospitalsLeuvenBelgium
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