Pub Date : 2024-03-13DOI: 10.1136/flgastro-2023-102627
Manu Nayar, Kofi W Oppong, Pardeep Maheshwari, Sarah Johnson, Shiran Esmaily, Ruth Waller, John Leeds
Background The diagnostic performance of endoscopic retrograde cholangiopancreatography brush cytology for malignant strictures is modest. A novel larger more abrasive brush may have improved diagnostic performance. We compared the utility of the new biliary brush with a conventional brush. Methods The new brush was used in 51 consecutive patients (group 1) referred with a biliary stricture and matched to 102 patients who underwent sampling with a conventional brush (group 2). Demographic data, stricture characteristics, sensitivity, specificity, negative predictive values and positive predictive values were analysed and compared with final diagnosis. Analysis was performed using strict criteria (definite for cancer) and relaxed criteria (suspicious for cancer). All patients had a minimum follow-up of 12 months. Results There was no statistically significant difference in the age and sex distribution between the two groups. Malignancy was diagnosed in 74% in both groups. There was no significant difference in sensitivity between the groups using either strict criteria (sensitivity group 1 47.4% vs group 2 52%, p=0.69) or relaxed criteria (sensitivity group 1 71.1% vs group 2 71.2%, p=1.0). Conclusions Our data suggest that the novel brush design does not confer improved diagnostic performance in malignant biliary strictures when compared in a robust manner. This highlights the difficulties of intraductal brush sampling and the need to develop newer diagnostic techniques. Data are available upon reasonable request.
{"title":"Sequential comparison of two intraductal biliary brush cytology devices for suspected malignant biliary strictures","authors":"Manu Nayar, Kofi W Oppong, Pardeep Maheshwari, Sarah Johnson, Shiran Esmaily, Ruth Waller, John Leeds","doi":"10.1136/flgastro-2023-102627","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102627","url":null,"abstract":"Background The diagnostic performance of endoscopic retrograde cholangiopancreatography brush cytology for malignant strictures is modest. A novel larger more abrasive brush may have improved diagnostic performance. We compared the utility of the new biliary brush with a conventional brush. Methods The new brush was used in 51 consecutive patients (group 1) referred with a biliary stricture and matched to 102 patients who underwent sampling with a conventional brush (group 2). Demographic data, stricture characteristics, sensitivity, specificity, negative predictive values and positive predictive values were analysed and compared with final diagnosis. Analysis was performed using strict criteria (definite for cancer) and relaxed criteria (suspicious for cancer). All patients had a minimum follow-up of 12 months. Results There was no statistically significant difference in the age and sex distribution between the two groups. Malignancy was diagnosed in 74% in both groups. There was no significant difference in sensitivity between the groups using either strict criteria (sensitivity group 1 47.4% vs group 2 52%, p=0.69) or relaxed criteria (sensitivity group 1 71.1% vs group 2 71.2%, p=1.0). Conclusions Our data suggest that the novel brush design does not confer improved diagnostic performance in malignant biliary strictures when compared in a robust manner. This highlights the difficulties of intraductal brush sampling and the need to develop newer diagnostic techniques. Data are available upon reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"37 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140125934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-12DOI: 10.1136/flgastro-2023-102523
Peter Rimmer, Jonathan Cheesbrough, Jane Harris, Melanie Love, Samantha Tull, Asif Iqbal, Daniel Regan-Komito, Rachel Cooney, Karl Hazel, Naveen Sharma, Thomas Dietrich, Iain Chapple, Mohammad Nabil Quraishi, Tariq H Iqbal
Objective Diagnostic delays in inflammatory bowel disease (IBD) result in adverse outcomes. We report a bespoke diagnostic pathway to assess how best to combine clinical history and faecal calprotectin (FCP) for early diagnosis and efficient resource utilisation. Methods A rapid-access pathway was implemented for suspected IBD patients referred outside urgent ‘two-week wait’ criteria. Patients were triaged using symptoms and FCP. A 13-point symptom history was taken prediagnosis and clinical indices, including repeat FCP, collected prospectively. Results Of 767 patients (January 2021–August 2023), 423 were diagnosed with IBD (208 Crohn’s disease (CD), 215 ulcerative colitis (UC)). Most common symptoms in CD were abdominal pain (84%), looser stools (84%) and fatigue (79%) and in UC per-rectal bleeding (94%), urgency (82%) and looser stools (81%). Strongest IBD predictors were blood mixed with stools (CD OR 4.38; 95% CI 2.40–7.98, UC OR 33.68; 15.47–73.33) and weight loss (CD OR 3.39; 2.14–5.38, UC OR 2.33; 1.37–4.00). Repeat FCP testing showed reduction from baseline in non-IBD. Both measurements >100 µg/g (area under the curve (AUC) 0.800) and >200 µg/g (AUC 0.834) collectively predicted IBD. However, a second value ≥220 µg/g considered alone, regardless of the first result, was more accurate (Youden’s index 0.735, AUC 0.923). Modelling symptoms with FCP increased AUC to 0.947. Conclusion Serial FCP measurement prevents unnecessary colonoscopy. Two FCPs >200 µg/g could stream patients direct to colonoscopy, with two >100 µg/g prompting clinic review. A second result ≥220 µg/g was more accurate than dual-result thresholds. Coupling home FCP testing with key symptoms may form the basis of effective self-referral pathways. Data are available upon reasonable request.
{"title":"Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception study","authors":"Peter Rimmer, Jonathan Cheesbrough, Jane Harris, Melanie Love, Samantha Tull, Asif Iqbal, Daniel Regan-Komito, Rachel Cooney, Karl Hazel, Naveen Sharma, Thomas Dietrich, Iain Chapple, Mohammad Nabil Quraishi, Tariq H Iqbal","doi":"10.1136/flgastro-2023-102523","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102523","url":null,"abstract":"Objective Diagnostic delays in inflammatory bowel disease (IBD) result in adverse outcomes. We report a bespoke diagnostic pathway to assess how best to combine clinical history and faecal calprotectin (FCP) for early diagnosis and efficient resource utilisation. Methods A rapid-access pathway was implemented for suspected IBD patients referred outside urgent ‘two-week wait’ criteria. Patients were triaged using symptoms and FCP. A 13-point symptom history was taken prediagnosis and clinical indices, including repeat FCP, collected prospectively. Results Of 767 patients (January 2021–August 2023), 423 were diagnosed with IBD (208 Crohn’s disease (CD), 215 ulcerative colitis (UC)). Most common symptoms in CD were abdominal pain (84%), looser stools (84%) and fatigue (79%) and in UC per-rectal bleeding (94%), urgency (82%) and looser stools (81%). Strongest IBD predictors were blood mixed with stools (CD OR 4.38; 95% CI 2.40–7.98, UC OR 33.68; 15.47–73.33) and weight loss (CD OR 3.39; 2.14–5.38, UC OR 2.33; 1.37–4.00). Repeat FCP testing showed reduction from baseline in non-IBD. Both measurements >100 µg/g (area under the curve (AUC) 0.800) and >200 µg/g (AUC 0.834) collectively predicted IBD. However, a second value ≥220 µg/g considered alone, regardless of the first result, was more accurate (Youden’s index 0.735, AUC 0.923). Modelling symptoms with FCP increased AUC to 0.947. Conclusion Serial FCP measurement prevents unnecessary colonoscopy. Two FCPs >200 µg/g could stream patients direct to colonoscopy, with two >100 µg/g prompting clinic review. A second result ≥220 µg/g was more accurate than dual-result thresholds. Coupling home FCP testing with key symptoms may form the basis of effective self-referral pathways. Data are available upon reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"22 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140115140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-06DOI: 10.1136/flgastro-2023-102600
Thomas Ryan, Jonathan P Segal
Background The aims of this narrative review are to examine the impact of proctocolectomy on the liver in patients with primary sclerosing cholangitis and ulcerative colitis (PSC-UC), mainly focusing on graft loss, and to compare the different proctocolectomy techniques to help determine which is the best for PSC-UC patients. Methods A literature search was performed using the online databases MEDLINE and Embase. Studies found via the search were evaluated against both inclusion and exclusion criteria by two independent reviewers (TR and JS). Relevant studies were included in the review. Results Seven studies were deemed relevant through the literature search and review process and another one was included via other sources, therefore, eight studies were included in the final review. Conclusions Proctocolectomy does not appear to have a negative impact on the liver and ileostomy appears to have better outcomes in terms of graft loss compared with ileal pouch-anal anastomosis. However, more high-quality studies on this topic are required as the existing literature is limited, and therefore, the findings should not be overinterpreted. Data is available upon request.
{"title":"Liver outcomes following proctocolectomy in patients with primary sclerosing cholangitis and ulcerative colitis","authors":"Thomas Ryan, Jonathan P Segal","doi":"10.1136/flgastro-2023-102600","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102600","url":null,"abstract":"Background The aims of this narrative review are to examine the impact of proctocolectomy on the liver in patients with primary sclerosing cholangitis and ulcerative colitis (PSC-UC), mainly focusing on graft loss, and to compare the different proctocolectomy techniques to help determine which is the best for PSC-UC patients. Methods A literature search was performed using the online databases MEDLINE and Embase. Studies found via the search were evaluated against both inclusion and exclusion criteria by two independent reviewers (TR and JS). Relevant studies were included in the review. Results Seven studies were deemed relevant through the literature search and review process and another one was included via other sources, therefore, eight studies were included in the final review. Conclusions Proctocolectomy does not appear to have a negative impact on the liver and ileostomy appears to have better outcomes in terms of graft loss compared with ileal pouch-anal anastomosis. However, more high-quality studies on this topic are required as the existing literature is limited, and therefore, the findings should not be overinterpreted. Data is available upon request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"43 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140055336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-05DOI: 10.1136/flgastro-2023-102564
Isabel Carbery, Gauraang Bhatnagar, Rachel Cooney, Christian Selinger
The carbon footprint of the National Health Service (NHS) is estimated to be responsible for 5.9% of the total UK carbon footprint. The NHS has committed to reach carbon net zero by 2040, and therefore, all healthcare professionals have a role to play in identifying ways to help achieve this goal within their individual clinical areas. While specific research focusing on the carbon footprint of inflammatory bowel disease (IBD) care is limited, by combining principles of sustainable healthcare with work done in other healthcare areas, we can start to develop ideas to inspire our own sustainable IBD care. The aim of this review article is to examine each part of the IBD care pathway and consider where improvements in sustainability can be made or future research should be focused.
{"title":"How can we improve the carbon footprint of IBD clinical care?","authors":"Isabel Carbery, Gauraang Bhatnagar, Rachel Cooney, Christian Selinger","doi":"10.1136/flgastro-2023-102564","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102564","url":null,"abstract":"The carbon footprint of the National Health Service (NHS) is estimated to be responsible for 5.9% of the total UK carbon footprint. The NHS has committed to reach carbon net zero by 2040, and therefore, all healthcare professionals have a role to play in identifying ways to help achieve this goal within their individual clinical areas. While specific research focusing on the carbon footprint of inflammatory bowel disease (IBD) care is limited, by combining principles of sustainable healthcare with work done in other healthcare areas, we can start to develop ideas to inspire our own sustainable IBD care. The aim of this review article is to examine each part of the IBD care pathway and consider where improvements in sustainability can be made or future research should be focused.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140044722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1136/flgastro-2024-102659
R Mark Beattie
We (mostly) think of abnormal serum amylase as being elevated. In this issue, Jalal and colleagues report a systematic review of the conditions associated with low serum amylase. The authors found 19 studies reporting 15 097 patients. The main conditions associated with low serum amylase were diabetes mellitus, metabolic syndrome, chronic pancreatitis (CP), non-alcoholic fatty liver disease and obesity. Low serum amylase showed a high specificity (94%) with low sensitivity (38.7%–59%) in diagnosing CP. The clinical implications are of interest. The authors suggest low amylase can be part of a metabolic process making it a useful metabolic marker in cases like obesity, metabolic syndrome and diabetes mellitus. It can be used as an exocrine marker and trigger investigation for pancreatic exocrine insufficiency. (See page 153) Chronic abdominal pain is common in inflammatory bowel disease (IBD) and not always straightforward to manage. In this issue, Baille and colleagues present a practical guide. The authors start by reviewing pain pathways (see figure 1). It is important to …
{"title":"UpFront","authors":"R Mark Beattie","doi":"10.1136/flgastro-2024-102659","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102659","url":null,"abstract":"We (mostly) think of abnormal serum amylase as being elevated. In this issue, Jalal and colleagues report a systematic review of the conditions associated with low serum amylase. The authors found 19 studies reporting 15 097 patients. The main conditions associated with low serum amylase were diabetes mellitus, metabolic syndrome, chronic pancreatitis (CP), non-alcoholic fatty liver disease and obesity. Low serum amylase showed a high specificity (94%) with low sensitivity (38.7%–59%) in diagnosing CP. The clinical implications are of interest. The authors suggest low amylase can be part of a metabolic process making it a useful metabolic marker in cases like obesity, metabolic syndrome and diabetes mellitus. It can be used as an exocrine marker and trigger investigation for pancreatic exocrine insufficiency. (See page 153) Chronic abdominal pain is common in inflammatory bowel disease (IBD) and not always straightforward to manage. In this issue, Baille and colleagues present a practical guide. The authors start by reviewing pain pathways (see figure 1). It is important to …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"5 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1136/flgastro-2023-102482
Anjan Dhar, Hasan Haboubi, Christian Selinger, Ramesh Arasaradnam
While it is now well recognised that gastroenterology, hepatology and endoscopy are major contributors to climate change on account of the amount of greenhouse gases (GHGs) that are generated in these specialties, systematic research that measures the exact amount of GHGs generated by different aspects of clinical care in the specialty is lacking. Similarly, while there are a number of publications highlighting the potential strategies for the reduction of GHGs, interventional studies assessing the impact of change are only beginning to be carried out. As such, there are a number of unmet research needs in this field and this mini review is aimed at discussing some of these.
{"title":"Unmet research needs in sustainable luminal gastroenterology practice","authors":"Anjan Dhar, Hasan Haboubi, Christian Selinger, Ramesh Arasaradnam","doi":"10.1136/flgastro-2023-102482","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102482","url":null,"abstract":"While it is now well recognised that gastroenterology, hepatology and endoscopy are major contributors to climate change on account of the amount of greenhouse gases (GHGs) that are generated in these specialties, systematic research that measures the exact amount of GHGs generated by different aspects of clinical care in the specialty is lacking. Similarly, while there are a number of publications highlighting the potential strategies for the reduction of GHGs, interventional studies assessing the impact of change are only beginning to be carried out. As such, there are a number of unmet research needs in this field and this mini review is aimed at discussing some of these.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"213 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140016970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-26DOI: 10.1136/flgastro-2023-102617
Chien-Ming Chiang, Hsueh-Chien Chiang, Jui-Wen Kang
A 69-year-old man with diabetes mellitus (DM) visited the emergency department with chest pain for 4 days. He had suicidal history 6 months ago, using a knife to cut into his throat about 3 cm depth. An elevated body temperature (37.4°C) was detected. Electrocardiography showed sinus rhythm without ST or T wave changes, and chest computed tomography angiography (CTA) demonstrated no aortic dissection or pulmonary embolism. His blood test revealed mildly elevated C-reaction protein (CRP), without elevation …
{"title":"Chest pain in a patient with suicidal history","authors":"Chien-Ming Chiang, Hsueh-Chien Chiang, Jui-Wen Kang","doi":"10.1136/flgastro-2023-102617","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102617","url":null,"abstract":"A 69-year-old man with diabetes mellitus (DM) visited the emergency department with chest pain for 4 days. He had suicidal history 6 months ago, using a knife to cut into his throat about 3 cm depth. An elevated body temperature (37.4°C) was detected. Electrocardiography showed sinus rhythm without ST or T wave changes, and chest computed tomography angiography (CTA) demonstrated no aortic dissection or pulmonary embolism. His blood test revealed mildly elevated C-reaction protein (CRP), without elevation …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"27 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139979427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-26DOI: 10.1136/flgastro-2023-102586
Robert Logan, Charles Andrews
Based on evidence from patients with both high-risk and low-risk symptoms of colorectal cancer (CRC), National Institute of Clinical Excellence (NICE) NG56 (quantitative faecal immunochemical testing (FIT) to guide CRC referral in primary care) places FIT at the heart of CRC diagnosis in primary care.1 When fully implemented, it should improve the diagnosis of CRC by identifying those at increased risk and reduce the demand for unnecessary (low value) endoscopy in those at low risk. However, greater use of FIT as a triage tool in primary care will lead to two challenges: first, how to manage any increased demand arising from widespread use of FIT in patients outside of NG56 recommendations, and second, how to manage patients with symptoms but who are ‘FIT negative’ (and not anaemic) and who represent the vast majority of patients referred for suspected cancer. In their publication, Bashir et al provide reassuring real-world evidence from the north-east of England which validates the use of FIT and propose cancer detection rate (CDR) as a new …
国家临床优化研究所 (NICE) 的 NG56（定量粪便免疫化学检验 (FIT)，用于指导初级医疗机构的 CRC 转诊）基于高风险和低风险结直肠癌 (CRC) 症状患者的证据，将 FIT 作为初级医疗机构 CRC 诊断的核心1 。然而，在初级医疗中更多地使用 FIT 作为分诊工具将带来两个挑战：第一，如何管理因在 NG56 建议范围之外的患者中广泛使用 FIT 而增加的需求；第二，如何管理有症状但 FIT 为 "阴性"（且不贫血）的患者，这些患者占疑似癌症转诊患者的绝大多数。在他们的出版物中，Bashir 等人提供了来自英格兰东北部的令人欣慰的实际证据，证实了 FIT 的使用，并提出将癌症检出率 (CDR) 作为一种新的 ...
{"title":"FIT for the future","authors":"Robert Logan, Charles Andrews","doi":"10.1136/flgastro-2023-102586","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102586","url":null,"abstract":"Based on evidence from patients with both high-risk and low-risk symptoms of colorectal cancer (CRC), National Institute of Clinical Excellence (NICE) NG56 (quantitative faecal immunochemical testing (FIT) to guide CRC referral in primary care) places FIT at the heart of CRC diagnosis in primary care.1 When fully implemented, it should improve the diagnosis of CRC by identifying those at increased risk and reduce the demand for unnecessary (low value) endoscopy in those at low risk. However, greater use of FIT as a triage tool in primary care will lead to two challenges: first, how to manage any increased demand arising from widespread use of FIT in patients outside of NG56 recommendations, and second, how to manage patients with symptoms but who are ‘FIT negative’ (and not anaemic) and who represent the vast majority of patients referred for suspected cancer. In their publication, Bashir et al provide reassuring real-world evidence from the north-east of England which validates the use of FIT and propose cancer detection rate (CDR) as a new …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"32 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139979802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-26DOI: 10.1136/flgastro-2023-102565
Ioanna Parisi, Angelica Vania Hosea, Sandro Stoffel, Martin Nemec, Sohail Badat, Edward Seward, Aradhna Kaushal, Robert Kerrison, Christian Von Wagner
Objective The role of small bowel capsule endoscopy (SBCE) in diagnosing gastrointestinal diseases has long been established. Recently, colon CE (CCE) has been suggested as an alternative to colonoscopy. CE has been traditionally conducted at endoscopy units. However, during the COVID-19 pandemic, a switch was made to ‘at-home CE’ (ACE) which has continued to date. This study is an evaluation of ACE, focusing on safety, efficacy, feasibility and patient perceptions. Methods The study evaluated the performance of ACE in 105 consecutive patients, considering procedure outcomes, completion rates, complications and patient satisfaction. Self-report questionnaires were used to assess perceptions and preferences of 84 ACE patients and 43 in-hospital CE patients. ACE procedure involved preassessment calls, bowel preparation, equipment setup, virtual verbal consent, capsule ingestion, booster alerts and equipment collection. Descriptive statistics and tests of independence were used for data analysis. Results All 105 ACE patients were able to have CE at home, with completion rates for SBCE, CCE and panenteric (Crohn’s) CE at 98.3%, 75.9% and 55.6%, respectively. Patients reported low levels of pain (94.1%), embarrassment (98.8%) and anxiety (82.1%). ACE saved time and money, as 42.9% of patients were able to avoid work absence and 52.4% avoided transportation costs. ACE patients reported high satisfaction with the overall procedure (mean=8.5, SD=1.9), and 83.3% would prefer CE again at home. Conclusion This study demonstrates that at-home CEs are clinically effective and well received by patients, providing the opportunity to conduct the test in the comfort of patients’ homes. No data are available. Request for additional information about the data should be made to corresponding author.
{"title":"Evaluation of the safety, efficacy and feasibility of ‘at-home’ capsule endoscopy","authors":"Ioanna Parisi, Angelica Vania Hosea, Sandro Stoffel, Martin Nemec, Sohail Badat, Edward Seward, Aradhna Kaushal, Robert Kerrison, Christian Von Wagner","doi":"10.1136/flgastro-2023-102565","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102565","url":null,"abstract":"Objective The role of small bowel capsule endoscopy (SBCE) in diagnosing gastrointestinal diseases has long been established. Recently, colon CE (CCE) has been suggested as an alternative to colonoscopy. CE has been traditionally conducted at endoscopy units. However, during the COVID-19 pandemic, a switch was made to ‘at-home CE’ (ACE) which has continued to date. This study is an evaluation of ACE, focusing on safety, efficacy, feasibility and patient perceptions. Methods The study evaluated the performance of ACE in 105 consecutive patients, considering procedure outcomes, completion rates, complications and patient satisfaction. Self-report questionnaires were used to assess perceptions and preferences of 84 ACE patients and 43 in-hospital CE patients. ACE procedure involved preassessment calls, bowel preparation, equipment setup, virtual verbal consent, capsule ingestion, booster alerts and equipment collection. Descriptive statistics and tests of independence were used for data analysis. Results All 105 ACE patients were able to have CE at home, with completion rates for SBCE, CCE and panenteric (Crohn’s) CE at 98.3%, 75.9% and 55.6%, respectively. Patients reported low levels of pain (94.1%), embarrassment (98.8%) and anxiety (82.1%). ACE saved time and money, as 42.9% of patients were able to avoid work absence and 52.4% avoided transportation costs. ACE patients reported high satisfaction with the overall procedure (mean=8.5, SD=1.9), and 83.3% would prefer CE again at home. Conclusion This study demonstrates that at-home CEs are clinically effective and well received by patients, providing the opportunity to conduct the test in the comfort of patients’ homes. No data are available. Request for additional information about the data should be made to corresponding author.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"17 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139979065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-23DOI: 10.1136/flgastro-2023-102567
Desmond Leddin
Sustainable practice means living within our means and not compromising the health of the planet for future generations. We are not meeting this goal at present as evidenced by the breaking of several indicators of planetary health and ever-increasing global mean temperatures. The arguments in favour of environmental sustainability include our ethical obligations as healthcare providers not to harm patients. We know that the emissions from healthcare are damaging health, so it follows that we have an obligation to minimise them. There is also the issue of intergenerational justice, that is not living beyond our means and leaving the problems for the next generation to deal with. We have professional obligations of leadership and advocacy on this issue, and it makes good economic and management sense to reduce environmental damage. Finally, there is the question of self-interest. If we do not change the trajectory of global warming, we face an existential threat in the not-too-distant future. We currently lack data on how to most effectively reduce the environmental impact of digestive health practice and we even lack a clear vision of what sustainable care might look like. However, that is being remedied and in the meantime it should not stop us beginning to take action, which is urgently needed as the climate crisis continues to gather momentum.
{"title":"Should environmental sustainability be a priority for the gastroenterology community?","authors":"Desmond Leddin","doi":"10.1136/flgastro-2023-102567","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102567","url":null,"abstract":"Sustainable practice means living within our means and not compromising the health of the planet for future generations. We are not meeting this goal at present as evidenced by the breaking of several indicators of planetary health and ever-increasing global mean temperatures. The arguments in favour of environmental sustainability include our ethical obligations as healthcare providers not to harm patients. We know that the emissions from healthcare are damaging health, so it follows that we have an obligation to minimise them. There is also the issue of intergenerational justice, that is not living beyond our means and leaving the problems for the next generation to deal with. We have professional obligations of leadership and advocacy on this issue, and it makes good economic and management sense to reduce environmental damage. Finally, there is the question of self-interest. If we do not change the trajectory of global warming, we face an existential threat in the not-too-distant future. We currently lack data on how to most effectively reduce the environmental impact of digestive health practice and we even lack a clear vision of what sustainable care might look like. However, that is being remedied and in the meantime it should not stop us beginning to take action, which is urgently needed as the climate crisis continues to gather momentum.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"168 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139945540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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