Pub Date : 2023-12-16DOI: 10.1136/flgastro-2023-102503
Bruno Augusto Alves Martins, Amira Shamsiddinova, Manal Mubarak Alquaimi, Guy Worley, Phil Tozer, Kapil Sahnan, Zarah Perry-Woodford, Ailsa Hart, Naila Arebi, Manmeet Matharoo, Janindra Warusavitarne, Omar Faiz
Background Total proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the most established restorative operative approach for patients with ulcerative colitis. It has associated morbidity and the potential for major repercussions on quality of life. As such, patient selection is crucial to its success. The main aim of this paper is to present an institutional preoperative checklist to support clinical risk assessment and patient selection in those considering IPAA. Methods A literature review was performed to identify the risk factors associated with surgical complications, decreased functional outcomes/quality of life, and pouch failure after IPAA. Based on this, a preliminary checklist was devised and modified through an iterative process. This was then evaluated by a consensus group comprising the pouch multidisciplinary team (MDT) core members. Results The final preoperative checklist includes assessment for risk factors such as gender, advanced age, obesity, comorbidities, sphincteric impairment, Crohn’s disease and pelvic radiation therapy. In addition, essential steps in the decision-making process, such as pouch nurse counselling and discussion regarding surgical alternatives, are also included. The last step of the checklist is discussion at a dedicated pouch-MDT. Discussion A preoperative checklist may support clinicians with the selection of patients that are suitable for pouch surgery. It also serves as a useful tool to inform the discussion of cases at the MDT meeting. No data are available.
{"title":"Creation of an institutional preoperative checklist to support clinical risk assessment in patients with ulcerative colitis (UC) considering ileoanal pouch surgery","authors":"Bruno Augusto Alves Martins, Amira Shamsiddinova, Manal Mubarak Alquaimi, Guy Worley, Phil Tozer, Kapil Sahnan, Zarah Perry-Woodford, Ailsa Hart, Naila Arebi, Manmeet Matharoo, Janindra Warusavitarne, Omar Faiz","doi":"10.1136/flgastro-2023-102503","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102503","url":null,"abstract":"Background Total proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the most established restorative operative approach for patients with ulcerative colitis. It has associated morbidity and the potential for major repercussions on quality of life. As such, patient selection is crucial to its success. The main aim of this paper is to present an institutional preoperative checklist to support clinical risk assessment and patient selection in those considering IPAA. Methods A literature review was performed to identify the risk factors associated with surgical complications, decreased functional outcomes/quality of life, and pouch failure after IPAA. Based on this, a preliminary checklist was devised and modified through an iterative process. This was then evaluated by a consensus group comprising the pouch multidisciplinary team (MDT) core members. Results The final preoperative checklist includes assessment for risk factors such as gender, advanced age, obesity, comorbidities, sphincteric impairment, Crohn’s disease and pelvic radiation therapy. In addition, essential steps in the decision-making process, such as pouch nurse counselling and discussion regarding surgical alternatives, are also included. The last step of the checklist is discussion at a dedicated pouch-MDT. Discussion A preoperative checklist may support clinicians with the selection of patients that are suitable for pouch surgery. It also serves as a useful tool to inform the discussion of cases at the MDT meeting. No data are available.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"105 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138686399","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 : 2023-12-12DOI: 10.1136/flgastro-2023-102550
Ann J Archer, Jennifer Phillips, Robbie Adamson, Francesca Neuberger, Christy Burden, Kushala WM Abeysekera, Andrew J Portal
The recently published European Association for the Study of the Liver (EASL) clinical practice guideline (CPG) on the management of liver diseases in pregnancy encompasses the management of gestational liver diseases as well as acute and chronic liver disease occurring coincidentally in pregnancy. This review will address the latter, given the broad scope of the CPG and the comprehensive Frontline Gastroenterology curriculum review of gestational liver disease.
{"title":"Guideline review: EASL clinical practice guidelines on the management of liver diseases in pregnancy","authors":"Ann J Archer, Jennifer Phillips, Robbie Adamson, Francesca Neuberger, Christy Burden, Kushala WM Abeysekera, Andrew J Portal","doi":"10.1136/flgastro-2023-102550","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102550","url":null,"abstract":"The recently published European Association for the Study of the Liver (EASL) clinical practice guideline (CPG) on the management of liver diseases in pregnancy encompasses the management of gestational liver diseases as well as acute and chronic liver disease occurring coincidentally in pregnancy. This review will address the latter, given the broad scope of the CPG and the comprehensive Frontline Gastroenterology curriculum review of gestational liver disease.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"92 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138580017","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 : 2023-12-09DOI: 10.1136/flgastro-2023-102555
Khalid Bashir, Iosif Beintaris, Linda Sharp, Julia Newton, Katherine Elliott, Jon Rees, Peter Rogers, Matt Rutter
Introduction Gastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An FIT-based diagnostic pathway may lead to more effective resource utilisation. We aimed to use National Endoscopy Database (NED) data to create a new colonoscopy performance measure, cancer detection rate (CDR) to assess the appropriate identification of target populations for colonoscopy; then to use CDR to assess the impact of implementing an FIT-based referral pathway locally. Methods NED data were analysed to compare local diagnostic colonoscopic CDR in 2019 (prepathway revision) and 2021 (postpathway revision), benchmarked against overall national CDR for the same time frames. Results 1, 123, 624 NED diagnostic colonoscopies were analysed. Locally, there was a significant increase in CDR between 2019 and 2021, from 3.01% (2.45%–3.47%) to 4.32% (3.69%–4.95%), p=0.003. The CDR increase was due to both a 10% increase in the number of CRCs detected and a 25% reduction in the number of diagnostic colonoscopies performed. Nationally, there was a smaller, but significant, increase in CDR from 2.02% (1.99%–2.07%) to 2.33% (2.29%–2.37%), p<0.001. The rate of increase in CDR% between 2019 and 2021 was significantly different locally compared with nationally. Conclusion Our study indicates that the introduction of a robustly vetted FIT-based algorithm to determine whether diagnostic colonoscopy is required, is effective in increasing the colonoscopic CDR. Moreover, CDR appears to be a meaningful performance metric that can be automatically calculated through NED, enabling monitoring of the quality of referral and vetting pathways. All data relevant to the study are included in the article or uploaded as online supplemental information.
{"title":"Colonoscopic cancer detection rate: a new performance measure – is it FIT for purpose?","authors":"Khalid Bashir, Iosif Beintaris, Linda Sharp, Julia Newton, Katherine Elliott, Jon Rees, Peter Rogers, Matt Rutter","doi":"10.1136/flgastro-2023-102555","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102555","url":null,"abstract":"Introduction Gastrointestinal symptoms correlate poorly with cancer diagnosis. A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. An FIT-based diagnostic pathway may lead to more effective resource utilisation. We aimed to use National Endoscopy Database (NED) data to create a new colonoscopy performance measure, cancer detection rate (CDR) to assess the appropriate identification of target populations for colonoscopy; then to use CDR to assess the impact of implementing an FIT-based referral pathway locally. Methods NED data were analysed to compare local diagnostic colonoscopic CDR in 2019 (prepathway revision) and 2021 (postpathway revision), benchmarked against overall national CDR for the same time frames. Results 1, 123, 624 NED diagnostic colonoscopies were analysed. Locally, there was a significant increase in CDR between 2019 and 2021, from 3.01% (2.45%–3.47%) to 4.32% (3.69%–4.95%), p=0.003. The CDR increase was due to both a 10% increase in the number of CRCs detected and a 25% reduction in the number of diagnostic colonoscopies performed. Nationally, there was a smaller, but significant, increase in CDR from 2.02% (1.99%–2.07%) to 2.33% (2.29%–2.37%), p<0.001. The rate of increase in CDR% between 2019 and 2021 was significantly different locally compared with nationally. Conclusion Our study indicates that the introduction of a robustly vetted FIT-based algorithm to determine whether diagnostic colonoscopy is required, is effective in increasing the colonoscopic CDR. Moreover, CDR appears to be a meaningful performance metric that can be automatically calculated through NED, enabling monitoring of the quality of referral and vetting pathways. All data relevant to the study are included in the article or uploaded as online supplemental information.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"72 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138560489","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 : 2023-12-09DOI: 10.1136/flgastro-2023-102515
Gaurav B Nigam, Laween Meran, Ishita Bhatnagar, Sarah Evans, Reem Malik, Nicole Cianci, Julia Pakpoor, Charis Manganis, Brian Shine, Tim James, Brian D Nicholson, James E East, Rebecca M Palmer
Background Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID-19 pandemic, FIT was used to triage patients referred with urgent 2-week wait (2ww) cancer referrals instead of a direct-to-test strategy. FIT-negative patients were assessed and safety netted in a FIT negative clinic. Methods We reviewed case notes for 622 patients referred on a 2ww pathway and seen in a FIT negative clinic between June 2020 and April 2021 in a tertiary care hospital. We collected information on demographics, indication for referral, dates for referral, clinic visit, investigations and long-term outcomes. Results The average age of the patients was 71.5 years with 54% female, and a median follow-up of 2.5 years. Indications for referrals included: anaemia (11%), iron deficiency (24%), weight loss (9%), bleeding per rectum (5%) and change in bowel habits (61%). Of the cases, 28% (95% CI 24% to 31%) had endoscopic (15%, 95% CI 12% to 18%) and/or radiological (20%, 95% CI 17% to 23%) investigations requested after clinic review, and among those investigated, malignancy rate was 1.7%, with rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma. Conclusion A FIT negative clinic provides a safety net for patients with unexplained symptoms but low risk of colorectal cancer. These real-world data demonstrate significantly reduced demand on endoscopy and radiology services for FIT-negative patients referred via the 2ww pathway. Data are available upon reasonable request.
背景 国家健康与护理优化研究所（National Institute for Health and Care Excellence）建议使用粪便免疫化学检验（FIT）对有不明症状但不符合疑似下消化道癌症路径标准的无症状初级保健患者进行分流。在 COVID-19 大流行期间，FIT 被用于对紧急转诊的 2 周等待（2ww）癌症患者进行分流，而不是采用直接检测策略。对 FIT 阴性患者进行评估，并在 FIT 阴性诊所进行安全防护。方法 我们回顾了一家三甲医院在 2020 年 6 月至 2021 年 4 月期间通过 2 周等待途径转诊并在 FIT 阴性门诊就诊的 622 名患者的病例记录。我们收集了有关人口统计学、转诊指征、转诊日期、门诊就诊、检查和长期结果的信息。结果 患者平均年龄为 71.5 岁，54% 为女性，中位随访时间为 2.5 年。转诊原因包括：贫血（11%）、缺铁（24%）、体重减轻（9%）、直肠出血（5%）和排便习惯改变（61%）。在这些病例中，28%（95% CI 24% 至 31%）在门诊复查后要求进行内窥镜检查（15%，95% CI 12% 至 18%）和/或放射学检查（20%，95% CI 17% 至 23%），其中恶性肿瘤的发生率为 1.7%，包括直肠乙状结肠神经内分泌肿瘤、食道癌和肺腺癌。结论 FIT 阴性诊所为症状不明但罹患结直肠癌风险较低的患者提供了一个安全网。这些实际数据表明，通过 2ww 途径转诊的 FIT 阴性患者对内镜检查和放射科服务的需求明显减少。如有合理要求，可提供相关数据。
{"title":"FIT negative clinic as a safety net for low-risk patients with colorectal cancer: impact on endoscopy and radiology utilisation–a retrospective cohort study","authors":"Gaurav B Nigam, Laween Meran, Ishita Bhatnagar, Sarah Evans, Reem Malik, Nicole Cianci, Julia Pakpoor, Charis Manganis, Brian Shine, Tim James, Brian D Nicholson, James E East, Rebecca M Palmer","doi":"10.1136/flgastro-2023-102515","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102515","url":null,"abstract":"Background Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID-19 pandemic, FIT was used to triage patients referred with urgent 2-week wait (2ww) cancer referrals instead of a direct-to-test strategy. FIT-negative patients were assessed and safety netted in a FIT negative clinic. Methods We reviewed case notes for 622 patients referred on a 2ww pathway and seen in a FIT negative clinic between June 2020 and April 2021 in a tertiary care hospital. We collected information on demographics, indication for referral, dates for referral, clinic visit, investigations and long-term outcomes. Results The average age of the patients was 71.5 years with 54% female, and a median follow-up of 2.5 years. Indications for referrals included: anaemia (11%), iron deficiency (24%), weight loss (9%), bleeding per rectum (5%) and change in bowel habits (61%). Of the cases, 28% (95% CI 24% to 31%) had endoscopic (15%, 95% CI 12% to 18%) and/or radiological (20%, 95% CI 17% to 23%) investigations requested after clinic review, and among those investigated, malignancy rate was 1.7%, with rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma. Conclusion A FIT negative clinic provides a safety net for patients with unexplained symptoms but low risk of colorectal cancer. These real-world data demonstrate significantly reduced demand on endoscopy and radiology services for FIT-negative patients referred via the 2ww pathway. Data are available upon reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"50 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138561032","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 : 2023-11-29DOI: 10.1136/flgastro-2023-102461
Jamal Ahmed, Priyanka Prakash, Gney Mehta, Tessa M Davies, Yin Yin Lim, Nicholas D Cross, Marek Alexander Czajkowski, Miles Clifford Allison
Objective Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for most patients with common bile duct stones (CBDS). Duct clearance at initial ERCP may not be achieved in a third of patients, many of whom may be elderly with multiple comorbidities rendering them at potentially high risk for further procedures. We aimed to quantify the rate of biliary sequelae and mortality among a large cohort undergoing a single ERCP with sphincterotomy and stent insertion without having undergone complete ductal clearance (permanent stent insertion, PSI), and to examine factors that may predispose to adverse outcomes. Design/method Outcomes of all ERCPs undertaken on the intact papilla between February 2010 and January 2020 were distilled to identify a cohort who had undergone PSI for initially irretrievable CBDS. These were subjected to retrospective follow-up until the development of biliary sequelae, death or survival into 2023. Results There were 2175 index ERCPs for CBDS, of whom 114 met the PSI criteria. Eleven did not survive their index hospitalisation, leaving 103 for follow-up. Of these, 25 (24%) developed late biliary sequelae, 19 (18%) required at least one further ERCP and 8 (8%) died from biliary sequelae. Adverse outcomes were found to be more common among those who had undergone cholecystectomy prior to ERCP, and those with periampullary diverticula. Conclusions Long-term biliary stenting following sphincterotomy remains a valid option for selected patients with initially irretrievable bile duct stones who could be at high risk from repeat procedures. Data are available upon reasonable request.
{"title":"Outcome of long-term biliary stenting for stones in the 2010s: beware the cholecystectomised!","authors":"Jamal Ahmed, Priyanka Prakash, Gney Mehta, Tessa M Davies, Yin Yin Lim, Nicholas D Cross, Marek Alexander Czajkowski, Miles Clifford Allison","doi":"10.1136/flgastro-2023-102461","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102461","url":null,"abstract":"Objective Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for most patients with common bile duct stones (CBDS). Duct clearance at initial ERCP may not be achieved in a third of patients, many of whom may be elderly with multiple comorbidities rendering them at potentially high risk for further procedures. We aimed to quantify the rate of biliary sequelae and mortality among a large cohort undergoing a single ERCP with sphincterotomy and stent insertion without having undergone complete ductal clearance (permanent stent insertion, PSI), and to examine factors that may predispose to adverse outcomes. Design/method Outcomes of all ERCPs undertaken on the intact papilla between February 2010 and January 2020 were distilled to identify a cohort who had undergone PSI for initially irretrievable CBDS. These were subjected to retrospective follow-up until the development of biliary sequelae, death or survival into 2023. Results There were 2175 index ERCPs for CBDS, of whom 114 met the PSI criteria. Eleven did not survive their index hospitalisation, leaving 103 for follow-up. Of these, 25 (24%) developed late biliary sequelae, 19 (18%) required at least one further ERCP and 8 (8%) died from biliary sequelae. Adverse outcomes were found to be more common among those who had undergone cholecystectomy prior to ERCP, and those with periampullary diverticula. Conclusions Long-term biliary stenting following sphincterotomy remains a valid option for selected patients with initially irretrievable bile duct stones who could be at high risk from repeat procedures. Data are available upon reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"45 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138520427","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 : 2023-11-23DOI: 10.1136/flgastro-2023-102475
Helen Griffiths
Endoscopy is known to be a high generator of waste in healthcare. It also poses an infection risk to patients, both from their own endogenous flora and from exogenous micro-organisms. Increases in infection, as seen during the pandemic, result in increased use of single-use equipment, personal protective equipment, packaging and harmful chemicals. With the significant risk of a further pandemic within the next 5 years, both climate change and the risk of infections should be considered as health emergencies, as they create a revolving door scenario. This article reviews some of the endoscopic and non-endoscopic infection risks and practical ways in which we can improve our environmental footprint while maintaining infection prevention and control.
{"title":"Infection control and environmental sustainability: focus on practice","authors":"Helen Griffiths","doi":"10.1136/flgastro-2023-102475","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102475","url":null,"abstract":"Endoscopy is known to be a high generator of waste in healthcare. It also poses an infection risk to patients, both from their own endogenous flora and from exogenous micro-organisms. Increases in infection, as seen during the pandemic, result in increased use of single-use equipment, personal protective equipment, packaging and harmful chemicals. With the significant risk of a further pandemic within the next 5 years, both climate change and the risk of infections should be considered as health emergencies, as they create a revolving door scenario. This article reviews some of the endoscopic and non-endoscopic infection risks and practical ways in which we can improve our environmental footprint while maintaining infection prevention and control.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138520428","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 : 2023-11-22DOI: 10.1136/flgastro-2023-102566
Keith Pohl, Ashwin Dhanda
Malnutrition is a concern for all inpatients; however, those with cirrhosis are particularly at risk. Current guidelines recommend standardised nutritional assessment of all inpatients with advanced chronic liver disease (eg, Malnutrition Universal Screening Tool (MUST)) followed by specialist dietician review within 24 hours to commence nutritional support.1 Such nutritional optimisation has been shown to improve symptoms, quality of life, morbidity and mortality.2 Severn and Peninsula Research in Gastroenterology is a trainee research network. The Evaluation of NutRItion in CirrHosis is a trainee-led retrospective regional service evaluation of dietetic provision to inpatients with cirrhosis in the South West of England against current guidelines from the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver.1 3 The aim was to evaluate the nutritional management of inpatients with cirrhosis to inform improvements in current services. The objectives were to determine the proportion of inpatients receiving nutritional assessment, referral to dietetics and/or the proportion appropriately commenced on nutritional support. Data was collected from admissions in …
{"title":"Nutritional assessment of patients with cirrhosis in the South West requires improvement: results of the Evaluation of NutRItion in CirrHosis (ENRICH) Study","authors":"Keith Pohl, Ashwin Dhanda","doi":"10.1136/flgastro-2023-102566","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102566","url":null,"abstract":"Malnutrition is a concern for all inpatients; however, those with cirrhosis are particularly at risk. Current guidelines recommend standardised nutritional assessment of all inpatients with advanced chronic liver disease (eg, Malnutrition Universal Screening Tool (MUST)) followed by specialist dietician review within 24 hours to commence nutritional support.1 Such nutritional optimisation has been shown to improve symptoms, quality of life, morbidity and mortality.2 Severn and Peninsula Research in Gastroenterology is a trainee research network. The Evaluation of NutRItion in CirrHosis is a trainee-led retrospective regional service evaluation of dietetic provision to inpatients with cirrhosis in the South West of England against current guidelines from the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver.1 3 The aim was to evaluate the nutritional management of inpatients with cirrhosis to inform improvements in current services. The objectives were to determine the proportion of inpatients receiving nutritional assessment, referral to dietetics and/or the proportion appropriately commenced on nutritional support. Data was collected from admissions in …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"9 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138520425","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 : 2023-11-22DOI: 10.1136/flgastro-2023-102497
Oliver Tavabie, Jennifer Clough, Jonathan King, Victoria Nicholas, Aditi Kumar
Trainee research networks are a collaborative effort to enable high-quality multicentre audits or research that is more widely accessible to trainees. Such networks lead, design and deliver research at a far higher scale than could be achieved locally and are carried out solely by trainees. There is an increasing focus on delivering research that is not only environmentally sustainable but also focuses on areas that can reduce the carbon footprint of service provision in gastroenterology and hepatology. In this manuscript, we performed a scoping review to understand the current evidence base of the impact of gastroenterology and hepatology services on the environment as well as exploring any association between pollution and climate change with gastrointestinal and liver disease. We further discuss the barriers that researchers face in delivering environmentally sustainable research, the limitation in clinical guidelines related to practicing environmentally sustainable gastroenterology and hepatology and how the trainee research networks are ideally placed to initiate change by developing, disseminating and implementing best practice in ‘green Gastroenterology’.
{"title":"Challenges of developing a green gastroenterology evidence base and how trainee research networks can fill the gaps","authors":"Oliver Tavabie, Jennifer Clough, Jonathan King, Victoria Nicholas, Aditi Kumar","doi":"10.1136/flgastro-2023-102497","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102497","url":null,"abstract":"Trainee research networks are a collaborative effort to enable high-quality multicentre audits or research that is more widely accessible to trainees. Such networks lead, design and deliver research at a far higher scale than could be achieved locally and are carried out solely by trainees. There is an increasing focus on delivering research that is not only environmentally sustainable but also focuses on areas that can reduce the carbon footprint of service provision in gastroenterology and hepatology. In this manuscript, we performed a scoping review to understand the current evidence base of the impact of gastroenterology and hepatology services on the environment as well as exploring any association between pollution and climate change with gastrointestinal and liver disease. We further discuss the barriers that researchers face in delivering environmentally sustainable research, the limitation in clinical guidelines related to practicing environmentally sustainable gastroenterology and hepatology and how the trainee research networks are ideally placed to initiate change by developing, disseminating and implementing best practice in ‘green Gastroenterology’.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"5 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138520423","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 : 2023-11-20DOI: 10.1136/flgastro-2023-102438
Pauline Reid, Kev Patterson, Emma McCulloch, Laura Walsh, Amal Murshid, William Kinsella, Andrew Moore, Thomas Skouras, Philip J Smith
The most significant and common cause of anaemia is iron deficiency, which occurs when iron absorption cannot meet the body’s demands due to growth, pregnancy, poor nutrition, malabsorption or blood loss. It is estimated that in the UK 11% of the adult population have iron-deficiency anaemia (IDA) and investigation is essential to exclude significant pathology as the underlying cause. It has been shown that IDA is responsible for 57 000 hospital admissions in the UK, and at least 10% of gastroenterology referrals per annum. IDA is a major red flag symptom for gastrointestinal cancer. At the Royal Liverpool University Hospital, a dedicated nurse-led IDA service was developed in 2005 to help alleviate the clinical pressures created by the two week suspected cancer referral pathway. With the success of this service, investigation and management of IDA has been extended to referrals from accident and emergency, with the aim of reducing hospital admissions and to investigating and optimising iron replacement therapy in preoperative patients. Delivering this as a nurse consultant-led service was proposed by the gastroenterology medical team who felt that, as a clinical problem with well established, published investigative algorithms, IDA would be suitable for management in a dedicated nurse-led clinic. This article will focus on the strategies employed to achieve sufficient resources and clinic capacity to run this service effectively, develop strong nurse education and training, and the development of agreed investigation pathways. A robust results review process, with rapid management of abnormal results, was established with timely discharge for those patients with normal results. Optimisation of iron replacement therapy and verification of sustained haematological response was prioritised as this was identified as being poorly managed across all specialties. A process for ongoing audit of results was included to show the success of the service and highlight areas for redesign. Here, we demonstrate the effectiveness of our nurse-led IDA service and suggest it as the basis for other IDA services in the UK and beyond.
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