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Sharif K, de Santiago ER, David P, Afek A, Gralnek IM, Ben-Horin S, Lahat A. Ecogastroenterology: cultivating sustainable clinical excellence in an environmentally conscious landscape. Lancet Gastroenterol Hepatol 2024; 9:550-563. [PMID: 38554732 DOI: 10.1016/s2468-1253(23)00414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 04/02/2024]
Abstract
Gastrointestinal practices, especially endoscopy, have a substantial environmental impact, marked by notable greenhouse gas emissions and waste generation. As the world struggles with climate change, there emerges a pressing need to re-evaluate and reform the environmental footprint within gastrointestinal medicine. The challenge lies in finding a harmonious balance between ensuring clinical effectiveness and upholding environmental responsibility. This task involves recognising that the most significant reduction in the carbon footprint of endoscopy is achieved by avoiding unnecessary procedures; addressing the use of single-use endoscopes and accessories; and extending beyond the procedural suites to include clinics, virtual care, and conferences, among other aspects of gastrointestinal practice. The emerging digital realm in health care is crucial, given the potential environmental advantages of virtual gastroenterological care. Through an in-depth analysis, this review presents a path towards sustainable gastrointestinal practices, emphasising integrated strategies that prioritise both patient care and environmental stewardship.
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Affiliation(s)
- Kassem Sharif
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Enrique Rodriguez de Santiago
- Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERehd, ISCIII, Madrid, Spain
| | - Paula David
- Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel
| | - Arnon Afek
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Centre, Afula, Israel; Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Beaton DR, Sharp L, Lu L, Trudgill NJ, Thoufeeq M, Nicholson BD, Rogers P, Docherty J, Jenkins A, Morris AJ, Rösch T, Rutter MD. Diagnostic yield from symptomatic gastroscopy in the UK: British Society of Gastroenterology analysis using data from the National Endoscopy Database. Gut 2024:gutjnl-2024-332071. [PMID: 38697772 DOI: 10.1136/gutjnl-2024-332071] [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: 01/29/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE This national analysis aimed to calculate the diagnostic yield from gastroscopy for common symptoms, guiding improved resource utilisation. DESIGN A cross-sectional study was conducted of diagnostic gastroscopies between 1 March 2019 and 29 February 2020 using the UK National Endoscopy Database. Mixed-effect logistic regression models were used, incorporating random (endoscopist) and fixed (symptoms, age and sex) effects on two dependent variables (endoscopic cancer; Barrett's oesophagus (BO) diagnosis). Adjusted positive predictive values (aPPVs) were calculated. RESULTS 382 370 diagnostic gastroscopies were analysed; 30.4% were performed in patients aged <50 and 57.7% on female patients. The overall unadjusted PPV for cancer was 1.0% (males 1.7%; females 0.6%, p<0.01). Other major pathology was found in 9.1% of procedures, whereas 89.9% reported only normal findings or minor pathology (92.5% in females; 94.6% in patients <50).Highest cancer aPPVs were reached in the over 50s (1.3%), in those with dysphagia (3.0%) or weight loss plus another symptom (1.4%). Cancer aPPVs for all other symptoms were below 1%, and for those under 50, remained below 1% regardless of symptom. Overall, 73.7% of gastroscopies were carried out in patient groups where aPPV cancer was <1%.The overall unadjusted PPV for BO was 4.1% (males 6.1%; females 2.7%, p<0.01). The aPPV for BO for reflux was 5.8% and ranged from 3.2% to 4.0% for other symptoms. CONCLUSIONS Cancer yield was highest in elderly male patients, and those over 50 with dysphagia. Three-quarters of all gastroscopies were performed on patients whose cancer risk was <1%, suggesting inefficient resource utilisation.
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Affiliation(s)
- David Robert Beaton
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Mo Thoufeeq
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Brian D Nicholson
- University of Oxford Department of Primary Care Health Sciences, Oxford, UK
| | | | | | | | | | - Thomas Rösch
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf Department of Interdisciplinary Endoscopy, Hamburg, Germany
| | - Matthew D Rutter
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
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Beaton D, Sharp L, Lu L, Trudgill N, Thoufeeq M, Nicholson B, Rogers P, Docherty J, Jenkins A, Morris AJ, Rösch T, Rutter M. Diagnostic yield from symptomatic lower gastrointestinal endoscopy in the UK: A British Society of Gastroenterology analysis using data from the National Endoscopy Database. Aliment Pharmacol Ther 2024. [PMID: 38634291 DOI: 10.1111/apt.18003] [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: 01/11/2024] [Revised: 04/07/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The value of lower gastrointestinal endoscopy (LGIE; colonoscopy or sigmoidoscopy) relates to its ability to detect clinically relevant findings, predominantly cancers, preneoplastic polyps or inflammatory bowel disease. There are concerns that many LGIEs are performed on low-risk patients with limited benefit. AIMS To determine the diagnostic outcomes of LGIE for common symptoms. METHODS We performed a cross-sectional study of diagnostic LGIE between March 2019 and February 2020 using the UK National Endoscopy Database. We used mixed-effects logistic regression models, incorporating random (endoscopist) and fixed (symptoms, patient age, and sex) effects upon two dependent variables (large polyp [≥10 mm] and cancer diagnosis). Adjusted positive predictive values (aPPVs) were calculated. RESULTS We analysed 384,510 LGIEs; 33.2% were performed on patients aged under 50 and 53.6% on women. Regarding colonoscopies, the unadjusted PPV for cancer was 1.5% (95% CI: 1.4-1.5); higher for men than women (1.9% vs. 1.1%, p < 0.01). The PPV for large polyps was 3.2% (95% CI: 3.1-3.2). The highest colonoscopy cancer aPPVs were in the over 50s (1.9%) and in those with rectal bleeding (2.5%) or anaemia (2.1%). Cancer aPPVs for other symptoms were <1% despite representing 54.3% of activity. In patients under 50, aPPVs were 0.4% for cancer and 1.6% for large polyps. Results were similar for sigmoidoscopy. CONCLUSIONS Most colonoscopies were performed on patients with low-risk symptoms, where cancer risk was similar to the general population. Cancer and large polyp yield was highest in elderly patients with rectal bleeding or anaemia, although still fell short of FIT-based screening yields.
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Affiliation(s)
- David Beaton
- Northumbria NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Mo Thoufeeq
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Brian Nicholson
- NIHR Clinical Lecturer, Nuffield Department of Primary Care Health Services, University of Oxford, Oxford, UK
| | | | | | - Anna Jenkins
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - A John Morris
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Matthew Rutter
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, UK
- North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
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Lu L, Catlow J, Rutter MD, Sharp L. Initiatives to increase colonoscopy capacity - is there an impact on polyp detection? A UK National Endoscopy Database analysis. Endoscopy 2024; 56:302-310. [PMID: 37989199 PMCID: PMC10978102 DOI: 10.1055/a-2214-9840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND To address mismatch between routine endoscopy capacity and demand, centers often implement initiatives to increase capacity, such as weekend working or using locums/agency staff (insourcing). However, there are concerns that such initiatives may negatively impact quality. We investigated polyp detection for weekend vs. weekday and insourced vs. standard procedures using data from the UK National Endoscopy Database. METHODS We conducted a national, retrospective, cross-sectional study of diagnostic colonoscopies performed during 01/01-04/04/2019. The primary outcome was mean number of polyps (MNP) and the secondary outcome was polyp detection rate (PDR). Multi-level mixed-effect regression, fitting endoscopist as a random effect, was used to examine associations between procedure day (weekend/weekday) and type (insourced/standard) and these outcomes, adjusting for patient age, sex, and indication. RESULTS 92 879 colonoscopies (weekends: 19 977 [21.5 %]; insourced: 9909 [10.7 %]) were performed by 2496 endoscopists. For weekend colonoscopies, patients were less often male or undergoing screening-related procedures; for insourced colonoscopies, patients were younger and less often undergoing screening-related procedures (all P < 0.05). Fully adjusted MNP was significantly lower for weekend vs. weekday (incidence rate ratio [IRR] 0.86 [95 %CI 0.83-0.89]) and for insourced vs. standard procedures (IRR 0.91 [95 %CI 0.87-0.95]). MNP was highest for weekday standard procedures and lowest for weekend insourced procedures; there was no interaction between procedure day and type. Similar associations were found for PDR. CONCLUSIONS Strategies to increase colonoscopy capacity may negatively impact polyp detection and should be monitored for quality. Reasons for this unwarranted variation require investigation.
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Affiliation(s)
- Liya Lu
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Jamie Catlow
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom
- Gastroenterology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Matthew D. Rutter
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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Farkas N, O’Brien JW, Palyvos L, Maclean W, Benton S, Rockall T, Jourdan I. The increasing burden of the 2-week wait colorectal cancer pathway in a single centre: the impact of faecal immunochemical tests. Ann R Coll Surg Engl 2024; 106:338-343. [PMID: 36688865 PMCID: PMC10981981 DOI: 10.1308/rcsann.2022.0138] [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] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Two-week wait (TWW) volume and colorectal cancer (CRC) detection pose an increasing challenge for NHS cancer services. Primary aims were to assess the introduction of faecal immunochemical tests (FIT) into clinical practice at our centre, the impact on TWW referral volume and CRC diagnoses, and to provide an update to previously published work. A secondary aim was to correlate FIT value and investigation. METHODS TWW CRC data following incorporation of FIT into clinical practice were analysed (1 June 2019-31 July 2021). Parameters assessed were monthly referral volume, CRC detection, primary care FIT volume and secondary care investigations. Referrals and CRC detection rates were compared with previously published data (2009-2019). Data relating to primary care FIT were collated from Berkshire and Surrey Pathology Services. RESULTS TWW referrals increased 360% (2009-2020). CRC incidence decreased from 8.87% to 3.24%. Following incorporation into clinical practice, primary care FIT requests have increased to >450/month and accompanied 1,722/4,796 referrals. CRC incidence is static (3-4%). Patients with FIT <10µg Hb/g faeces undergo radiological imaging more commonly, whereas FIT-positive patients are more likely to undergo endoscopy, although the difference is not statistically significant. CONCLUSIONS No significant change in CRC diagnosis was observed, despite increasing TWW referrals. Increasing utilisation of FIT in both primary and secondary care has helped maintain CRC detection while avoiding diagnostic delay. This study supports growing evidence highlighting the value of FIT in triage, referral and TWW investigation. FIT appears increasingly important for allocating secondary care resources (endoscopy), while guiding primary care referral. Additional low-cost strategies to determine prioritisation or reassurance (e.g. repeat FIT) require further evaluation.
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Affiliation(s)
- N Farkas
- Royal Surrey NHS Foundation Trust, UK
| | | | - L Palyvos
- Royal Surrey NHS Foundation Trust, UK
| | - W Maclean
- Royal Surrey NHS Foundation Trust, UK
| | - S Benton
- Royal Surrey NHS Foundation Trust, UK
| | - T Rockall
- Royal Surrey NHS Foundation Trust, UK
| | - I Jourdan
- Royal Surrey NHS Foundation Trust, UK
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Nurminen N, Järvinen T, Robinson E, Zhou N, Salo S, Räsänen J, Kytö V, Ilonen I. Upper gastrointestinal endoscopy procedure volume trends, perioperative mortality, and malpractice claims: Population-based analysis. Endosc Int Open 2024; 12:E385-E393. [PMID: 38504745 PMCID: PMC10948266 DOI: 10.1055/a-2265-8757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/26/2024] [Indexed: 03/21/2024] Open
Abstract
Background and study aims Upper gastrointestinal endoscopy (EGD) is one of the most common diagnostic procedures done to examine the foregut, but it can also be used for therapeutic interventions. The main objectives of this study were to investigate trends in EGD utilization and mortality related to it in a national low-threshold healthcare system, assess perioperative safety, and identify and describe patient-reported malpractice claims from the national database. Patients and methods We retrospectively identified patients from the Finnish Patient Care Registry who underwent diagnostic or procedural EGD between 2010 and 2018. In addition, patient-reported claims for malpractice were analyzed from the National Patient Insurance Center (PIC) database. Patient survival data were gathered collectively from the National Death Registry from Statistics Finland. Results During the study period, 409,153 EGDs were performed in Finland for 298,082 patients, with an annual rate of 9.30 procedures per 1,000 inhabitants, with an annual increase of 2.6%. Thirty-day all-cause mortality was 1.70% and 90-day mortality was 3.84%. For every 1,000 patients treated, 0.23 malpractice claims were filed. Conclusions The annual rate of EGD increased by 2.6% during the study, while the rate of interventional procedures remained constant. Also, while the 30-day mortality rate declined over the study period, it is an unsuitable quality metric for EGDs in comprehensive centers because a patient's underlying disease plays a larger role than the procedure in perioperative mortality. Finally, there were few malpractice claims, with self-evident causes prevailing.
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Affiliation(s)
- Nelli Nurminen
- Department of General Thoracic and Esophageal surgery, Heart and Lung Center, HUS Helsingin yliopistollisen sairaala, Helsinki, Finland
| | - Tommi Järvinen
- Department of General Thoracic and Esophageal surgery, Heart and Lung Center, HUS Helsingin yliopistollisen sairaala, Helsinki, Finland
| | - Eric Robinson
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Nanruoyi Zhou
- Department of Surgery, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Silja Salo
- Department of Gastrointestinal Surgery, Abdominal Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Jari Räsänen
- Department of General Thoracic and Esophageal surgery, Heart and Lung Center, HUS Helsingin yliopistollisen sairaala, Helsinki, Finland
| | - Ville Kytö
- Heart Center, TYKS Turku University Hospital, Turku, Finland
- Clinical Research Center, TYKS Turku University Hospital, Turku, Finland
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Ilkka Ilonen
- Department of General Thoracic and Esophageal surgery, Heart and Lung Center, HUS Helsingin yliopistollisen sairaala, Helsinki, Finland
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Churchhouse AM, Moffat VE, Selinger CP, Lamb CA, Thornton MJ, Penman I, Din S. British Society of Gastroenterology interim framework for addressing the COVID-19-related backlog in inflammatory bowel disease colorectal cancer surveillance. Gut 2023; 72:1631-1634. [PMID: 37549983 PMCID: PMC10423467 DOI: 10.1136/gutjnl-2022-328309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/10/2022] [Indexed: 08/09/2023]
Affiliation(s)
| | - Victoria El Moffat
- Edinburgh IBD Unit, Western General Hospital, NHS Lothian, Edinburgh, UK
| | | | - Christopher A Lamb
- Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Ian Penman
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Shahida Din
- Edinburgh IBD Unit, Western General Hospital, NHS Lothian, Edinburgh, UK
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Stack R, Doherty J, O'Moráin N, Nolan B, Sheridan J, Cullen G, Mulcahy H, Buckley M, Horgan G, Hamed M, McDermott E, Doherty G. Implementation of BSG/ACPGBI/PHE polypectomy surveillance guidelines safely reduces the burden of surveillance in a screening cohort: a virtual model study. BMJ Open Gastroenterol 2023; 10:e001160. [PMID: 37699732 PMCID: PMC10503359 DOI: 10.1136/bmjgast-2023-001160] [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: 04/13/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE To evaluate the impact of British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE) 2019 polypectomy surveillance guidelines within a national faecal immunochemical test-based bowel cancer screening (BS) cohort on surveillance activity and detection of pathology by retrospective virtual application. DESIGN A retrospective review of BS colonoscopies performed in 2015-2016 with 5 years prospective follow-up in single institution. Index colonoscopies were selected. Incomplete colonoscopies were excluded. Histology of all resected polyps was reviewed. Surveillance intervals were calculated according to BSG/ACPGBI/PHE 2019 guidelines and compared with pre-existing 'European Guidelines for Quality Assurance in Colorectal Cancer Screening and Diagnosis' (EUQA 2013). Total number of colonoscopies deferred by virtual implementation of BSG/ACPGBI/PHE 2019 guidelines were calculated. Pathology identified on procedures that would have been deferred was reviewed. RESULTS Total number of index BS colonoscopies performed in 2015-2016 inclusive was 890. 115 were excluded (22 no caecal intubation, 51 inadequate bowel preparation, 56 incomplete polyp clearance). N=509 colonoscopies were scheduled within a 5-year interval following index colonoscopy surveillance rounds based on EUQA guidelines. Overall, volume of surveillance was significantly reduced with retrospective application of BSG/ACPGBI/PHE 2019 guidelines (n=221, p<0.0001). No cancers were detected within the 'potentially deferred' procedures who attended for follow-up (n=330) with high-risk findings found in<10% (n=30) of colonoscopies within the BSG/ACPGBI/PHE cohort. CONCLUSION BSG/ACPGBI/PHE 2019 guidelines safely reduce the burden of colonoscopy demand with acceptable pathology findings on deferred colonoscopies.
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Affiliation(s)
- Roisin Stack
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jayne Doherty
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Neil O'Moráin
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Blathnaid Nolan
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Juliette Sheridan
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Garret Cullen
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Hugh Mulcahy
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Maire Buckley
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Gareth Horgan
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Mohamed Hamed
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Edel McDermott
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Glen Doherty
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Ravindran S, Matharoo M, Marshall S, Robinson E, Bano M, Bassett P, Coleman M, Rutter M, Ashrafian H, Darzi A, Healey C, Thomas-Gibson S. Development, validation, and results of a national endoscopy safety attitudes questionnaire (Endo-SAQ). Endosc Int Open 2023; 11:E679-E689. [PMID: 37502673 PMCID: PMC10370487 DOI: 10.1055/a-2112-5105] [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: 05/27/2022] [Accepted: 06/13/2023] [Indexed: 07/29/2023] Open
Abstract
Background and study aims Safety attitudes are linked to patient outcomes. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) identifies the need to improve our understanding of safety culture in endoscopy. We describe the development and validation of the Endo-SAQ (endoscopy safety attitudes questionnaire) and the results of a national survey of staff attitudes. Methods Questions from the original SAQ were adapted to reflect endoscopy-specific content. This was refined by an expert group, followed by a pilot study to assess acceptability. The refined Endo-SAQ (comprising 35 questions across six domains) was disseminated to endoscopy staff across the UK and Ireland. Outcomes were domain scores and the percentage of positive responses (score ≥75/100) per domain. Descriptive and comparative analyses were performed. Binary logistic regression identified staff and service factors associated with positive scores. Validity and reliability of Endo-SAQ were assessed through psychometric analysis. Results After expert review, four questions in the preliminary Endo-SAQ were adjusted. Sixty-one participants undertook the pilot study with good acceptability. A total of 453 participants completed the refined Endo-SAQ. There were positive responses in teamwork, safety climate, job satisfaction, and working conditions domains. Endoscopists had significantly more positive responses to stress recognition and working conditions than nursing staff. JAG accreditation was associated with positive scores in safety climate and job satisfaction domains. Endo-SAQ met thresholds of construct validity and reliability. Conclusions Endoscopy staff had largely positive safety attitudes scores but there were significant differences across domains and staff. There is evidence for the validity and reliability of Endo-SAQ. Endo-SAQ could complement current measures of patient safety in endoscopy and be used in evaluation and research.
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Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Manmeet Matharoo
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
| | - Sarah Marshall
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
| | - Emma Robinson
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
| | - Madeline Bano
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
| | - Paul Bassett
- Statistics, Statsconsultancy Ltd, Amersham, United Kingdom of Great Britain and Northern Ireland
| | - Mark Coleman
- Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom of Great Britain and Northern Ireland
| | - Matt Rutter
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom of Great Britain and Northern Ireland
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom of Great Britain and Northern Ireland
| | - Hutan Ashrafian
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ara Darzi
- Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Chris Healey
- Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, United Kingdom of Great Britain and Northern Ireland
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Harrow, United Kingdom of Great Britain and Northern Ireland
- Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
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Gil N, Su H, Kaur K, Barnett M, Murray A, Duffy S, von Wagner C, Kerrison RS. Patient experience and satisfaction with symptomatic faecal immunochemical testing: an explanatory sequential mixed-methods evaluation. Br J Gen Pract 2023; 73:e104-14. [PMID: 36702594 DOI: 10.3399/BJGP.2022.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/06/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Recent evidence suggests that faecal immunochemical testing (FIT) can rule out colorectal cancer (CRC) in symptomatic adults. To date, there has been little research exploring experiences of FIT for this population. AIM To explore patient experience and satisfaction with FIT in an 'early adopter' site in England. DESIGN Explanatory sequential mixed-methods approach combining mailed quantitative surveys with semi-structured telephone interviews. METHOD Multivariate logistic regression was used to analyse quantitative data. Thematic analysis was used to assess qualitative transcripts. RESULTS The survey had 260 responders, and it found that satisfaction with FIT was high (88.7%). Compared with test satisfaction, the proportion of responders satisfied with their GP consultation and how they received their results was lower (74.4% and 76.2%, respectively). Multivariate analysis showed that increased area-level deprivation and not receiving an explanation of the purpose of the test were associated with lower satisfaction with the GP consultation (both P-values <0.05), while increased area-level deprivation and not receiving results from the GP were associated with lower satisfaction with receiving results (both P-values <0.05). Interviews with responders (n = 20) helped explain the quantitative results. They revealed that 'not knowing the purpose of the test' caused 'anxiety' and 'confusion', which led to dissatisfaction. 'Not receiving results from GP' was considered 'unacceptable', as this left patients with a 'niggling doubt' and lack of diagnosis or assurance that they did not have cancer. CONCLUSION Patient satisfaction with symptomatic FIT is high. Efforts to improve satisfaction should focus on ensuring that patients understand the purpose of the test and always receive their test results.
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11
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Vales A, Coyle C, Plehhova K, Hobson A, Woodland P. Randomised clinical trial: the use of alginates during preinvestigation proton pump inhibitor wash-out and their impact on compliance and symptom burden. BMJ Open Gastroenterol 2023; 10:bmjgast-2022-001026. [PMID: 36627148 PMCID: PMC9835863 DOI: 10.1136/bmjgast-2022-001026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/17/2022] [Accepted: 11/18/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND/AIMS Investigation of gastro-oesophageal reflux disease is usually performed off proton pump inhibitors (PPIs). This can exacerbate symptoms, potentially impacting investigation accuracy if patients circumvent the preinvestigation instructions. There are no standard recommendations on how to manage PPI withdrawal. We aimed to assess the impact of structured alginate use on symptom burden. METHODS Participants were already established on ≥4 weeks of PPI therapy and being referred for manometry and 24-hour pH/impedance testing. Preinvestigation instructions involved stopping PPIs and H2 receptor antagonists for 1 week, but antacids and alginates were allowed until the night before. Participants were randomised to follow these standard instructions (control group), or the same instructions with the provision of Gaviscon Advance to be taken four times daily (treatment group). The primary outcome assessed change in Gastro-Oesophageal Reflux Disease Health-Related Quality of Life Score. KEY RESULTS Data for 48 patients were available for primary outcome assessment. While patients in the control group had a significant increase in symptoms (median difference 6.5, 95% CI (1 to 7), p=0.04), no change occurred in the treatment arm (median difference -1.5, 95% CI (-2, 3.5), p=0.54). There were no serious adverse events. CONCLUSIONS Structured alginate use prevents symptom exacerbation during preinvestigation PPI wash-out. These findings are limited to the 1-week wash-out period but can benefit thousands of patients undergoing investigation for gastro-oesophageal reflux each year. Further research is required to assess this effect in other settings, such as sustained PPI deprescription. The trial was funded by Reckitt Benckiser. TRIAL REGISTRATION NUMBER EudraCT registration 2019-004561-41.
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12
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Sebastian S, Dhar A, Baddeley R, Donnelly L, Haddock R, Arasaradnam R, Coulter A, Disney BR, Griffiths H, Healey C, Hillson R, Steinbach I, Marshall S, Rajendran A, Rochford A, Thomas-Gibson S, Siddhi S, Stableforth W, Wesley E, Brett B, Morris AJ, Douds A, Coleman MG, Veitch AM, Hayee B. Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy. Gut 2023; 72:12-26. [PMID: 36229172 PMCID: PMC9763195 DOI: 10.1136/gutjnl-2022-328460] [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: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 12/08/2022]
Abstract
GI endoscopy is highly resource-intensive with a significant contribution to greenhouse gas (GHG) emissions and waste generation. Sustainable endoscopy in the context of climate change is now the focus of mainstream discussions between endoscopy providers, units and professional societies. In addition to broader global challenges, there are some specific measures relevant to endoscopy units and their practices, which could significantly reduce environmental impact. Awareness of these issues and guidance on practical interventions to mitigate the carbon footprint of GI endoscopy are lacking. In this consensus, we discuss practical measures to reduce the impact of endoscopy on the environment applicable to endoscopy units and practitioners. Adoption of these measures will facilitate and promote new practices and the evolution of a more sustainable specialty.
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Affiliation(s)
- Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, East Riding of Yorkshire, UK .,Clinical Sciences Centre, Hull York Medical School, Hull, UK
| | - Anjan Dhar
- Department of Gastroenterology, Darlington Memorial Hospital, Darlington, UK,School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Robin Baddeley
- Institute for Therapeutic Endoscopy, King's College Hospital, London, UK,Department of Gastroenterology, St Mark's National Bowel Hospital & Academic Institute, London, UK
| | - Leigh Donnelly
- Department of Gastroenterology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Rosemary Haddock
- Department of Gastroenterology, Ninewells Hospital & Medical School, Dundee, UK
| | - Ramesh Arasaradnam
- Applied Biological and Experimental Sciences, Coventry University, Coventry, UK,Department of Gastroenterology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Archibald Coulter
- Department of Gastroenterology, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Benjamin Robert Disney
- Department of Gastroenterology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Helen Griffiths
- Department of Gastroenterology, Brecon War Memorial Hospital, Brecon, UK
| | - Christopher Healey
- Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, UK
| | | | | | - Sarah Marshall
- Bowel Cancer Screening & Endoscopy, London North West University Healthcare NHS Trust, Harrow, UK,Joint Advisory Group on GI Endoscopy, London, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Andrew Rochford
- Department of Gastroenterology, Royal Free Hospitals, London, UK
| | - Siwan Thomas-Gibson
- Department of Gastroenterology, St Mark's National Bowel Hospital & Academic Institute, London, UK
| | - Sandeep Siddhi
- Department of Gastroenterology, NHS Grampian, Aberdeen, UK
| | - William Stableforth
- Departments of Gastroenterology & Endoscopy, Royal Cornwall Hospital, Truro, UK
| | - Emma Wesley
- Departments of Gastroenterology & Endoscopy, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Bernard Brett
- Department of Gastroenterology, Norfolk and Norwich Hospitals NHS Trust, Norwich, UK
| | | | - Andrew Douds
- Department of Gastroenterology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Mark Giles Coleman
- Joint Advisory Group on GI Endoscopy, London, UK,Department of Colorectal Surgery, Plymouth University Hospitals Trust, Plymouth, UK
| | - Andrew M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Bu'Hussain Hayee
- King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
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13
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Xin L, Gao Y, Wang TJ, Meng QQ, Jin ZD, Fu ZJ, Wang YL, Lin H, Li ZS, Wang LW. EUS development in China: Results from national surveys in 2013 and 2020. Endosc Ultrasound 2023; 12:90-95. [PMID: 36861507 PMCID: PMC10134942 DOI: 10.4103/eus-d-22-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/21/2021] [Accepted: 04/24/2022] [Indexed: 03/03/2023] Open
Abstract
Background and Objectives EUS has recently gained attraction in mainland China. This study aimed to evaluate the development of EUS from results of two national surveys. Methods EUS-related information, including infrastructure, personnel, volume, and quality indicator, was extracted from the Chinese Digestive Endoscopy Census. Data from 2012 and 2019 were compared, and differences among various hospitals and regions were analyzed. The EUS rates (EUS annual volume per 100,000 inhabitants) between China and developed countries were also compared. Results The number of hospitals performing EUS in mainland China increased from 531 to 1236 (2.33-fold), and 4025 endoscopists performed EUS in 2019. The volumes of all EUS and interventional EUS increased from 207,166 to 464,182 (2.24-fold) and 10,737 to 15,334 (1.43-fold), respectively. The EUS rate in China was lower than that in developed countries but showed a higher growth rate. EUS rate varied substantially among different provincial regions (in 2019: 4.9-152.0 per 100,000 inhabitants) and showed significant positive association with gross domestic product per capita (in 2019: r = 0.559, P = 0.001). The EUS-FNA-positive rate in 2019 was comparable between hospitals in terms of annual volume (≥50 or < 50: 79.9% vs. 71.6%, P = 0.704) and practice duration (starting EUS-FNA before or after 2012: 78.7% vs. 72.6%, P = 0.565). Conclusion EUS has developed considerably in China in recent years but still needs substantial improvement. More resources are in demand for hospitals in less-developed regions and with low EUS volume.
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Affiliation(s)
- Lei Xin
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Ye Gao
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Tian-Jiao Wang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Qian-Qian Meng
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Zhen-Dong Jin
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Zeng-Jun Fu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Yi-Lin Wang
- Georgetown Preparatory School, North Bethesda, Maryland, USA
| | - Han Lin
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
| | - Luo-Wei Wang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai, China
- National Digestive Endoscopy Improvement System, Shanghai, China
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Waddingham W, Kamran U, Kumar B, Trudgill NJ, Tsiamoulos ZP, Banks M. Complications of diagnostic upper Gastrointestinal endoscopy: common and rare - recognition, assessment and management. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000688. [PMID: 36572454 PMCID: PMC9806027 DOI: 10.1136/bmjgast-2021-000688] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/14/2022] [Accepted: 11/26/2022] [Indexed: 12/27/2022] Open
Abstract
A clear understanding of the potential complications or adverse events (AEs) of diagnostic endoscopy is an essential component of being an endoscopist. Creating a culture of safety and prevention of AEs should be part of routine endoscopy practice. Appropriate patient selection for procedures, informed consent, periprocedure risk assessments and a team approach, all contribute to reducing AEs. Early recognition, prompt management and transparent communication with patients are essential for the holistic and optimal management of AEs. In this review, we discuss the complications of diagnostic upper gastrointestinal endoscopy, including their recognition, treatment and prevention.
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Affiliation(s)
- William Waddingham
- Gastro-intestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Umair Kamran
- Department of gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Bhaskar Kumar
- Department of Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Nigel J Trudgill
- Department of gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Matthew Banks
- Gastro-intestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
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15
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Yong KK, He Y, Cheung HCA, Sriskandarajah R, Jenkins W, Goldin R, Beg S. Rationalising the use of specimen pots following colorectal polypectomy: a small step towards greener endoscopy. Frontline Gastroenterol 2022; 14:295-299. [PMID: 37409340 DOI: 10.1136/flgastro-2022-102231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/27/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Aims In this study, we aim to determine whether combining multiple small colorectal polyps within a single specimen pot can reduce carbon footprint, without an associated deleterious clinical impact. Methods This was a retrospective observational study of colorectal polyps resected during 2019, within the Imperial College Healthcare Trust. The numbers of pots for polypectomy specimens were calculated and corresponding histology results were extracted. We modelled the potential reduction in carbon footprint if all less than 10 mm polyps were sent together and the number of advanced lesions we would not be able to locate if we adopted this strategy. Carbon footprint was estimated based on previous study using a life-cycle assessment, at 0.28 kgCO2e per pot. Results A total of 11 781 lower gastrointestinal endoscopies were performed. There were 5125 polyps removed and 4192 pots used, equating to a carbon footprint of 1174 kgCO2e. There were 4563 (89%) polyps measuring 0-10 mm. 6 (0.1%) of these polyps were cancers, while 12 (0.2%) demonstrated high-grade dysplasia. If we combined all small polyps in a single pot, total pot usage could be reduced by one-third (n=2779). Conclusion A change in practice by placing small polyps collectively in one pot would have resulted in reduction in carbon footprint equivalent to 396 kgCO2e (emissions from 982 miles driven by an average passenger car). The reduction in carbon footprint from judicious use of specimen pots would be amplified with a change in practice on a national level.
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Affiliation(s)
- Karl King Yong
- Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Yun He
- School of Medicine, Imperial College School of Medicine, London, UK
| | | | | | - William Jenkins
- School of Medicine, Imperial College School of Medicine, London, UK
| | - Robert Goldin
- Division of Digestive Diseases, Imperial College School of Medicine, London, UK
| | - Sabina Beg
- Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
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16
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Henriksson A, Thakrar S. Anaesthesia and sedation for endoscopic retrograde cholangiopancreatography. BJA Educ 2022; 22:372-375. [PMID: 36132880 PMCID: PMC9482865 DOI: 10.1016/j.bjae.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- A.M. Henriksson
- Chelsea and Westminster Hospital, Chelsea and Westminster NHS Trust, London, UK
| | - S.V. Thakrar
- Hammersmith Hospital, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare Trust, London, UK
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17
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Winters C, Subramanian V, Valdastri P. Robotic, self-propelled, self-steerable, and disposable colonoscopes: Reality or pipe dream? A state of the art review. World J Gastroenterol 2022; 28:5093-5110. [PMID: 36188716 PMCID: PMC9516669 DOI: 10.3748/wjg.v28.i35.5093] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/21/2022] [Accepted: 09/01/2022] [Indexed: 02/06/2023] Open
Abstract
Robotic colonoscopes could potentially provide a comfortable, less painful and safer alternative to standard colonoscopy. Recent exciting developments in this field are pushing the boundaries to what is possible in the future. This article provides a comprehensive review of the current work in robotic colonoscopes including self-propelled, steerable and disposable endoscopes that could be alternatives to standard colonoscopy. We discuss the advantages and disadvantages of these systems currently in development and highlight the technical readiness of each system to help the reader understand where and when such systems may be available for routine clinical use and get an idea of where and in which situation they can best be deployed.
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Affiliation(s)
- Conchubhair Winters
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Venkataraman Subramanian
- Leeds Institute of Medical Research, University of Leeds, St. James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Pietro Valdastri
- School of Electronic and Electrical Engineering, University of Leeds, Leeds LS2 9JT, United Kingdom
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18
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Lewis J, Askari A, Mehta A, Razak Y, Patel P, Misra R, Tilney H, Ahmed T, Ahmed M, Syeed A, Camilleri-brennan J, Nicholls RJ, Kinross JM. A novel digital rectoscope for the triage of lower gastrointestinal symptoms in primary care: a prospective multicentre feasibility study. BJGP Open 2022; 6:BJGPO.2022.0036. [PMID: 35728817 PMCID: PMC9680743 DOI: 10.3399/bjgpo.2022.0036] [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: 03/23/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background Access to community rectoscopy might help to ease the burden on hospital services and reduce costs for the NHS. To assess this, a prospective multicentre observational phase I feasibility study of a novel digital rectoscope and telestration software for the triage of lower gastrointestinal (GI) symptoms was undertaken. Aim To determine if digital rectoscopy is feasible, acceptable, and clinically safe. Design & setting Evaluation of clinician case reports and patient questionnaires from patients recruited from five primary care centres. Method Adults meeting 2-week wait (2WW) criteria for suspected lower GI cancer, suspected new diagnosis, or flare-up of inflammatory bowel disease (IBD) were enrolled. Examinations were performed by primary care practitioners using the LumenEye rectoscope. The CHiP platform allowed immediate remote review by secondary care. A prospective analysis was performed of patient and clinician experiences, diagnostic accuracy, and cost. Results A total of 114 patients were recruited and 110 underwent the procedure (46 [42%] females and 64 [58%] males). No serious adverse events were reported. Eighty-two (74.5%) patients reported that examination was more comfortable than expected, while 104 (94.5%) felt the intervention was most convenient if delivered in the community. Clinicians were confident of their assessment in 100 (87.7%) examinations. Forty-eight (42.1%) patients subsequently underwent colonoscopy, flexible sigmoidoscopy, or computed tomography virtual colonoscopy (CTVC). The overall sensitivity and specificity of LumenEye in identifying rectal pathology was 90.0% and 88.9%. It was 100% and 100% for cancer, and 83.3% and 97.8% for polyps. Following LumenEye examination, 19 (17.3%) patients were discharged, with projected savings of 11 305 GBP. Conclusion Digital rectoscopy in primary care is safe, acceptable, and can reduce referrals. A phase III randomised controlled trial is indicated to define its utility in reducing the burden on hospital diagnostic services.
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Xin L, Gao Y, Cheng Z, Wang T, Lin H, Pang Y, Sun C, Fu Z, Li Z, Ma X, Wang L. Utilization and quality assessment of digestive endoscopy in China: results from 5-year consecutive nationwide surveys. Chin Med J (Engl) 2022; 135:2003-2010. [PMID: 36070457 PMCID: PMC9746725 DOI: 10.1097/cm9.0000000000002366] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Worldwide, the volume and availability of digestive endoscopy have undergone dramatic development in recent years, with increasing attention on quality assurance. We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions. METHODS We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually. The questionnaires included the personnel, annual volume, and quality indicators of endoscopy. An endoscopy quality index (EQI) was developed based on recorded quality indicators using principal component analysis to determine the relative weight. RESULTS From 2015 to 2019, 806, 1412, 2644, 2468, and 2541 hospitals were respectively enrolled in this study. The average annual volume of endoscopy increased from 12,445 to 16,206 (1.30-fold) and from 2938 to 4255 (1.45-fold) in tertiary and secondary hospitals, respectively. The most obvious growth was observed in diagnostic colonoscopy (1.44-fold for all hospitals after standardization). The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3% (55,210/448,861) to 17.7% (85,429/482,647) and from 11.4% (69,411/608,866) to 16.9% (107,192/634,235), respectively. The adenoma detection rate of diagnostic colonoscopy increased from 14.9% (2,118,123/14,215,592) to 19.3% (3,943,203/20,431,104). The EQI model included 12 quality indicators, incorporating 64.9% (7.792/12) of the total variance into one comprehensive index. According to the EQI measurements, the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals. CONCLUSIONS Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality. The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.
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Affiliation(s)
- Lei Xin
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Ye Gao
- Graduate School, Naval Medical University, Shanghai 200433, China
| | - Zhiyuan Cheng
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200240, China
| | - Tianjiao Wang
- National Digestive Endoscopy Improvement System, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Han Lin
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Yanan Pang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Chang Sun
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Zengjun Fu
- National Digestive Endoscopy Improvement System, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Zhaoshen Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
- National Digestive Endoscopy Improvement System, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Xudong Ma
- Department of Medical Quality, Medical and Health Administration, National Health Commission of China, Beijing 100044, China
| | - Luowei Wang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
- National Digestive Endoscopy Improvement System, Changhai Hospital, Naval Medical University, Shanghai 200433, China
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Beg S, Jegatheeswaran L, Abdul-Aema B, Franklin J, Ragunath K. Polyps seen but not removed during index colonoscopy: an underestimated inefficiency in endoscopy practice. Gastrointest Endosc 2022; 96:291-297.e1. [PMID: 35217017 DOI: 10.1016/j.gie.2022.02.021] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/09/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS In the United Kingdom endoscopists are certified for independent practice once competent in the removal of polyps up to 20 mm in size. Where polyps are detected but not removed during the index colonoscopy, a repeat procedure is required. The aim of this study was to identify the proportion of polyps <20 mm that were not removed at the time of diagnosis. METHODS Polyps identified at colonoscopy during a 12-month period in a single institution were included in this study. All polyps were categorized according to the reported size and complexity per the size, morphology, site, access (SMSA) classification. In cases where polyps ≤20 mm were not removed, patient records and endoscopy reports were interrogated to ascertain the reasons for this. RESULTS Across 1444 patients, 2442 polyps <20 mm in size were diagnosed. Removal at the time of the index procedure occurred in 1158 patients (80.2%). Nonremoval for a predefined acceptable reason, such as concomitant anticoagulation therapy, accounted for 174 cases (12.0%). Nonremoval without contraindication was noted in 112 cases (7.8%). The mean polypectomy complexity as determined by the SMSA score of these polyps was lower than level 2, denoting low complexity. The requirement for unnecessary repeat procedures equated to 9.3 days of endoscopy capacity per year. CONCLUSIONS This study demonstrates that a small but significant proportion of small colorectal polyps are not removed at the time of diagnosis. This practice has implications for both patients and service provision.
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Affiliation(s)
- Sabina Beg
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Lavandan Jegatheeswaran
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Buraq Abdul-Aema
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - James Franklin
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Krish Ragunath
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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Oka P, McAlindon M, Sidhu R. Capsule endoscopy - a non-invasive modality to investigate the GI tract: out with the old and in with the new? Expert Rev Gastroenterol Hepatol 2022; 16:591-599. [PMID: 35695266 DOI: 10.1080/17474124.2022.2089113] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Capsule endoscopy has had significant development since it was introduced into the field of medicine in 2000. It is non-invasive, well tolerated, does not require sedation and is a first-line small bowel investigative modality. As it transits through the entire gastrointestinal (GI) tract, it has the potential to provide a pan-enteric examination. AREAS COVERED In this review we will discuss the new diagnostic modalities along with traditional methods which have been used for examination of the gastro intestinal (GI) tract. The main focus of this review will be on the use of capsule endoscopy for pan-enteric examination. EXPERT OPINION Capsule endoscopy is an accepted first-line investigation for the small bowel. Diagnostic sensitivity of the colon capsule is comparable to colonoscopy in controlled trials and is being evaluated in high-risk patients in routine clinical practice in national programs. Preliminary data suggest that a magnetic-controlled examination of the upper GI tract could be developed to enable a complete upper GI examination.
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Affiliation(s)
- Priya Oka
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Mark McAlindon
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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22
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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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23
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Penman ID. National endoscopy services: reflections on the impact of COVID-19. Frontline Gastroenterol 2022; 13:461-462. [PMID: 36250167 PMCID: PMC9555138 DOI: 10.1136/flgastro-2022-102202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Ian D Penman
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
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24
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Kamel F, Zulfiqar S, Penfold WI, Weatherell S, Madani R, Nisar P, Bearn P. The use of the faecal immunochemical test during the COVID-19 pandemic to triage urgent colorectal cancer referrals. Colorectal Dis 2022; 24:727-736. [PMID: 35297169 PMCID: PMC9111478 DOI: 10.1111/codi.16120] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/31/2022] [Accepted: 03/06/2022] [Indexed: 02/08/2023]
Abstract
AIM During the first wave of the COVID-19 pandemic in 2020, elective gastrointestinal endoscopy services were abbreviated for fear of viral transmission. However, urgent suspected colorectal cancer (CRC) referrals continued. Serendipitously, a national study suggested that a new faecal immunochemical test (FIT) might be helpful in triaging patients with colorectal alarm symptoms. METHODS This was a single centre observational study of patients referred using NG12 criteria between March and August 2020. Patients were triaged to the urgent cancer pathway for FIT ≥ 10 μg/g and investigated using the latest National Health Service England guidance. Demographic data, method of investigations, cancer and polyp detection rates were compared to patients referred in the 6 months prior to the use of FIT as a triage tool. RESULTS In all, 1192 patients (median age 70) were referred using NG12 guidelines during the pandemic period, compared with 1592 patients (median age 72) in the previous 6 months. CRC detection was similar in both groups (n = 45, 2.8% vs. n = 38, 3.5%; P = 0.248). Two patients with a negative FIT (0.36%) had CRC. Using FIT as a triage tool resulted in a significant reduction in the use of endoscopy (n = 477, 43.6% vs. n = 1186, 74.5%; P > 0.001) with a significant increase in CT scanning (n = 696, 63.6% vs. n = 750, 47.1%; P < 0.001). CONCLUSION The use of FIT in NG12 patients triaged during the first wave of the COVID-19 pandemic reduced endoscopy but not CT scanning and did not compromise CRC detection rates. It is a safe method that aids in reducing the burden on services greatly. A negative FIT test does not absolutely exclude CRC.
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Affiliation(s)
- Faddy Kamel
- Department of colorectal surgeryAshford and St Peter's NHS TrustChertseyUK
| | - Saadia Zulfiqar
- Department of colorectal surgeryAshford and St Peter's NHS TrustChertseyUK
| | - WIlliam Penfold
- Department of colorectal surgeryAshford and St Peter's NHS TrustChertseyUK
| | | | - Rana Madani
- Department of colorectal surgeryAshford and St Peter's NHS TrustChertseyUK
| | - Pasha Nisar
- Department of colorectal surgeryAshford and St Peter's NHS TrustChertseyUK
| | - Philip Bearn
- Department of colorectal surgeryAshford and St Peter's NHS TrustChertseyUK
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25
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Lim S, Haboubi HN, Anderson SHC, Dawson P, Machado AP, Mangsat E, Santos S, Wong T, Zeki S, Dunn J. Transnasal endoscopy: moving from endoscopy to the clinical outpatient-blue sky thinking in oesophageal testing. Frontline Gastroenterol 2022; 13:e65-e71. [PMID: 35812036 PMCID: PMC9234731 DOI: 10.1136/flgastro-2022-102129] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND COVID-19 has severely affected UK endoscopy services with an estimate 86% loss of activity during the first wave. Subsequent delays in diagnostic and surveillance procedures highlight the need for novel solutions to tackle the resultant backlog. Transnasal endoscopy (TNE) provides an attractive option compared with conventional upper gastrointestinal endoscopy given its limited use of space, no sedation and reduced nursing resources. OUR EXPERIENCE We describe piloting and then establishing an outpatient model TNE service in the pandemic era and the implications on resource allocation, training and workforce. We also discuss our experiences and outline ways in which services can evolve to undertake more complex endoscopic diagnostic and therapeutic work. Over 90% of patients describe no discomfort and those who have previously experienced conventional transoral endoscopy preferred the transnasal approach. We describe a low complication rate (0.8%) comprising two episodes of mild epistaxis. The average procedure duration was reasonable (9.9±5.0 min) with full adherence to Joint Advisory Group quality standards. All biopsies assessed were deemed sufficient for diagnosis including those for surveillance procedures. DISCUSSION TNE can offer a safe, tolerable, high-quality service outside of a conventional endoscopy setting. Expanding procedural capacity without impacting on the current endoscopy footprint has great potential in recovering endoscopy services following the COVID-19 pandemic. Looking forward, TNE has potential to be used both within the endoscopy suite as part of therapeutic procedures, or outside of the endoscopy unit in outpatient clinics, community hospitals, or mobile units and to achieve this in a more sustainable and environmentally friendly way.
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Affiliation(s)
- Samuel Lim
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hasan Nadim Haboubi
- Gastroenterology, University Hospital Llandough, Cardiff, UK,Institute of Life Sciences, Swansea University, Swansea, UK
| | - Simon H C Anderson
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Patrick Dawson
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ana Paula Machado
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Edna Mangsat
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sara Santos
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Terry Wong
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sebastian Zeki
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK,Comprehensive Cancer Centre, King's College London, London, UK
| | - Jason Dunn
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK,Comprehensive Cancer Centre, King's College London, London, UK
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26
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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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27
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Sneyd J. Developments in procedural sedation for adults. BJA Educ 2022; 22:258-264. [DOI: 10.1016/j.bjae.2022.02.006] [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] [Accepted: 02/22/2022] [Indexed: 12/01/2022] Open
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28
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Walker JT, Bak A, Marsden G, Spencer W, Griffiths H, Stanton GA, Williams C, White LJ, Ross E, Sjogren G, Bradley CW, Garvey M. Final rinse water quality for flexible endoscopy to minimise the risk of post-endoscopic infection. Report from Healthcare Infection Society Working Party. J Hosp Infect 2022; 124:79-96. [PMID: 35276281 DOI: 10.1016/j.jhin.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/02/2022] [Indexed: 01/10/2023]
Affiliation(s)
- James T Walker
- Central Sterilising Club, UK; Healthcare Infection Society, London, UK
| | - Aggie Bak
- Healthcare Infection Society, London, UK.
| | | | - Wayne Spencer
- Authorising Engineer, Spencer Nickson Ltd, Frodsham, UK
| | - Helen Griffiths
- Decontamination and TSE advisor, British Society of Gastroenterology, London, UK
| | | | - Craig Williams
- Healthcare Infection Society, London, UK; Consultant Microbiologist, University Hospitals of Morecambe Bay, UK
| | - Leila J White
- Healthcare Infection Society, London, UK; Lancashire Teaching Hospitals NHS Foundation Trusts, UK
| | - Elaine Ross
- Healthcare Infection Society, London, UK; Infection Prevention Society, Seafield, UK
| | - Geoff Sjogren
- Western Sussex Hospitals NHS Foundation Trust (retired), UK
| | - Christina W Bradley
- Healthcare Infection Society, London, UK; University Hospitals Birmingham NHS Foundation Trust, UK
| | - Mark Garvey
- Healthcare Infection Society, London, UK; University Hospitals Birmingham NHS Foundation Trust, UK
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29
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Ratcliffe E, Britton J, Hamdy S, McLaughlin J, Ang Y. Developing patient-orientated Barrett's oesophagus services: the role of dedicated services. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000829. [PMID: 35193888 PMCID: PMC8867250 DOI: 10.1136/bmjgast-2021-000829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/11/2021] [Accepted: 01/09/2022] [Indexed: 11/03/2022] Open
Abstract
Introduction Barrett’s oesophagus (BO) is common and is a precursor to oesophageal adenocarcinoma with a 0.33% per annum risk of progression. Surveillance and follow-up services for BO have been shown to be lacking, with studies showing inadequate adherence to guidelines and patients reporting a need for greater disease-specific knowledge. This review explores the emerging role of dedicated services for patients with BO. Methods A literature search of PubMed, MEDLINE, Embase, Emcare, HMIC, BNI, CiNAHL, AMED and PsycINFO in regard to dedicated BO care pathways was undertaken. Results Prospective multicentre and randomised trials were lacking. Published cohort data are encouraging with improvements in guideline adherence with dedicated services, with one published study showing significant improvements in dysplasia detection rates. Accuracy of allocation to surveillance endoscopy has been shown to hold cost savings, and a study of a dedicated clinic showed increased discharges from unnecessary surveillance. Training modalities for BO surveillance and dysplasia detection exist, which could be used to educate a BO workforce. Qualitative and quantitative studies have shown patients report high levels of cancer worry and poor disease-specific knowledge, but few studies have explored follow-up care models despite being a patient and clinician priority for research. Conclusions Cost–benefit analysis for dedicated services, considering both financial and environmental impacts, and more robust clinical data must be obtained to support this model of care in the wider health service. Greater understanding is needed of the root causes for poor guideline adherence, and disease-specific models of care should be designed around clinical and patient-reported outcomes to address the unmet needs of patients with BO.
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Affiliation(s)
- Elizabeth Ratcliffe
- Gastroenterology, Wrightington Wigan and Leigh NHS Foundation Trust, Leigh, UK .,School of Medical Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - James Britton
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Shaheen Hamdy
- School of Medical Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK.,Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - John McLaughlin
- School of Medical Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK.,Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Yeng Ang
- School of Medical Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK.,Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
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30
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Grant RK, Brindle WM, Robertson AR, Kalla R, Plevris JN. Unsedated Transnasal Endoscopy: A Safe, Well-Tolerated and Accurate Alternative to Standard Diagnostic Peroral Endoscopy. Dig Dis Sci 2022; 67:1937-1947. [PMID: 35239094 PMCID: PMC8893049 DOI: 10.1007/s10620-022-07432-9] [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: 10/15/2021] [Accepted: 01/30/2022] [Indexed: 12/23/2022]
Abstract
Diagnostic unsedated transnasal endoscopy (uTNE) has been proven to be a safe and well-tolerated procedure. Although its utilization in the United Kingdom (UK) is increasing, it is currently available in only a few centers. Through consideration of recent studies, we aimed to perform an updated review of the technological advances in uTNE, consider their impact on diagnostic accuracy, and to determine the role of uTNE in the COVID-19 era. Current literature has shown that the diagnostic accuracy of uTNE for identification of esophageal pathology is equivalent to conventional esophagogastroduodenoscopy (cEGD). Concerns regarding suction and biopsy size have been addressed by the introduction of TNE scopes with working channels of 2.4 mm. Advances in imaging have improved detection of early gastric cancers. The procedure is associated with less cardiac stress and reduced aerosol production; when combined with no need for sedation and improved rates of patient turnover, uTNE is an efficient and safe alternative to cEGD in the COVID-19 era. We conclude that advances in technology have improved the diagnostic accuracy of uTNE to the point where it could be considered the first line diagnostic endoscopic investigation in the majority of patients. It could also play a central role in the recovery of diagnostic endoscopic services during the COVID-19 pandemic.
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Affiliation(s)
- Rebecca K. Grant
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William M. Brindle
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Rahul Kalla
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - John N. Plevris
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
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31
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Kumar B, Lam S, Adam M, Gilroy R, Pallen MJ. The oesophageal microbiome and cancer: hope or hype? Trends Microbiol 2021:S0966-842X(21)00192-X. [PMID: 34493428 DOI: 10.1016/j.tim.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
Abstract
The human oesophagus is home to a complex microbial community, the oesophageal microbiome. Despite decades of work, we still have only a poor, low-resolution view of this community, which makes it hard to distinguish hope from hype when it comes to assessing links between the oesophageal microbiome and cancer. Here we review the potential importance of this microbiome and discuss new approaches, including culturomics, metagenomics, and recovery of whole-genome sequences, that bring renewed hope for an in-depth characterisation of this community that could deliver translational impact.
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32
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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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33
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Onaizah O, Koszowska Z, Winters C, Subramanian V, Jayne D, Arezzo A, Obstein KL, Valdastri P. Guidelines for Robotic Flexible Endoscopy at the Time of COVID-19. Front Robot AI 2021; 8:612852. [PMID: 33718439 PMCID: PMC7947201 DOI: 10.3389/frobt.2021.612852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/20/2021] [Indexed: 12/22/2022] Open
Abstract
Flexible endoscopy involves the insertion of a long narrow flexible tube into the body for diagnostic and therapeutic procedures. In the gastrointestinal (GI) tract, flexible endoscopy plays a major role in cancer screening, surveillance, and treatment programs. As a result of gas insufflation during the procedure, both upper and lower GI endoscopy procedures have been classified as aerosol generating by the guidelines issued by the respective societies during the COVID-19 pandemic-although no quantifiable data on aerosol generation currently exists. Due to the risk of COVID-19 transmission to healthcare workers, most societies halted non-emergency and diagnostic procedures during the lockdown. The long-term implications of stoppage in cancer diagnoses and treatment is predicted to lead to a large increase in preventable deaths. Robotics may play a major role in this field by allowing healthcare operators to control the flexible endoscope from a safe distance and pave a path for protecting healthcare workers through minimizing the risk of virus transmission without reducing diagnostic and therapeutic capacities. This review focuses on the needs and challenges associated with the design of robotic flexible endoscopes for use during a pandemic. The authors propose that a few minor changes to existing platforms or considerations for platforms in development could lead to significant benefits for use during infection control scenarios.
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Affiliation(s)
- Onaizah Onaizah
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Zaneta Koszowska
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Conchubhair Winters
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | | | - David Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Keith L. Obstein
- Department of Gastroenterology, Hepatology, Nutrition, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, United States
| | - Pietro Valdastri
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
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34
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Ravindran S, Munday J, Veitch AM, Broughton R, Thomas-Gibson S, Penman ID, McKinlay A, Fearnhead NS, Coleman M, Logan R. Bowel cancer screening workforce survey: developing the endoscopy workforce for 2025 and beyond. Frontline Gastroenterol 2021; 13:12-19. [PMID: 34970428 PMCID: PMC8666856 DOI: 10.1136/flgastro-2021-101790] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 02/04/2023] Open
Abstract
AIM The demand for bowel cancer screening (BCS) is expected to increase significantly within the next decade. Little is known about the intentions of the workforce required to meet this demand. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG), the British Society of Gastroenterology (BSG) and Association of Coloproctology of Great Britain and Ireland (ACPGBI) developed the first BCS workforce survey. The aim was to assess endoscopist career intentions to aid in future workforce planning to meet the anticipated increase in BCS colonoscopy. METHODS A survey was developed by JAG, BSG and ACPGBI and disseminated to consultant, clinical and trainee endoscopists between February and April 2020. Descriptive and comparative analyses were undertaken, supported with BCS data. RESULTS There were 578 respondents. Screening consultants have a median of one programmed activity (PA) per week for screening, accounting for 40% of their current endoscopy workload. 38% of current screening consultants are considering giving up colonoscopy in the next 2-5 years. Retirement (58%) and pension issues (23%) are the principle reasons for this. Consultants would increase their screening PAs by 70% if able to do so. The top three activities that endoscopists would relinquish to further support screening were outpatient clinics, acute medical/surgical on call and ward cover. An extra 155 colonoscopists would be needed to fulfil increased demand and planned retirement at current PAs. CONCLUSION This survey has identified a serious potential shortfall in screening colonoscopists in the next 5-10 years due to an ageing workforce and job plan pressures of aspirant BCS colonoscopists. We have outlined potential mitigations including reviewing job plans, improving workforce resources and supporting accreditation and training.
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Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Surgery and Cancer, Imperial College London, London, UK
| | | | - Andrew M Veitch
- Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK,Bowel Screening Advisory Committee, Public Health England, London, UK
| | - Raphael Broughton
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, 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
| | - Ian D Penman
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK,British Society of Gastroenterology, London, UK
| | - Alistair McKinlay
- British Society of Gastroenterology, London, UK,Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Nicola S Fearnhead
- Colorectal Surgery, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK,Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, 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
| | - Robert Logan
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK,NHS England and NHS Improvement London, London, UK
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Ravindran S, Bassett P, Shaw T, Dron M, Broughton R, Griffiths H, Keen D, Wood E, Healey CJ, Green J, Ashrafian H, Darzi A, Coleman M, Thomas-Gibson S. Improving safety and reducing error in endoscopy (ISREE): a survey of UK services. Frontline Gastroenterol 2020; 12:593-600. [PMID: 34917317 PMCID: PMC8640393 DOI: 10.1136/flgastro-2020-101561] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) 'Improving Safety and Reducing Error in Endoscopy' (ISREE) strategy was developed in 2018. In line with the strategy, a survey was conducted within the JAG census in 2019 to gain further insights and understanding of key safety-related areas within UK endoscopy. METHODS Questions were developed using the ISREE strategy as a guide and adapted by key JAG stakeholders. They were incorporated into the 2019 JAG census of UK endoscopy services. Quantitative and qualitative statistical methods were employed to analyse the results. RESULTS There was a 68% response rate. There was regional variability in the provision of out-of-hours GIB services (p<0.001). Across 1 month, 1535 incidents were reported across all services. There was a significantly higher proportion of reported incidents in acute services compared with others (p<0.001). Technical and training incidents were likely to be reported significantly differently to all other incident types. 74% of services have an endoscopy-specific sedation policy and 42% have a named sedation or anaesthetic lead for endoscopy. Services highlighted a desire for more anaesthetic-supported lists. Only 66% of services stated they have an effective strategy for supporting upskilling of endoscopists. Across acute services, 56% have access to human factors and endoscopic non-technical skills (ENTS) training. Patient feedback is used in several ways to improve services, develop training and promote shared learning among endoscopy users. CONCLUSIONS The census provides a benchmark for key safety-related characteristics of endoscopy services. These results have highlighted key areas to develop, guided by the ISREE strategy.
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Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Surgery and Cancer, Imperial College London, London, London, UK
| | | | - Tim Shaw
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, London, UK
| | - Michael Dron
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, London, UK
| | - Raphael Broughton
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, London, UK
| | - Helen Griffiths
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - Dimple Keen
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - Eleanor Wood
- Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, London, UK,Simulation Centre, Homerton University Hospital NHS Foundation Trust, London, London, UK
| | - Chris J Healey
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Gastroenterology and Hepatology Services, Airedale NHS Foundation Trust, Keighley, West Yorkshire, UK
| | - John Green
- Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, Cardiff, UK
| | - Hutan Ashrafian
- Surgery and Cancer, Imperial College London, London, London, UK
| | - Ara Darzi
- Surgery and Cancer, Imperial College London, 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, Plymouth, UK
| | - Siwan Thomas-Gibson
- Surgery and Cancer, Imperial College London, London, London, UK,Wolfson Endoscopy Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
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