British Society Of Gastroenterology Research Articles

Compliance with BSG/BASL decompensated cirrhosis care bundle

Background: This audit focuses on Compliance with the British Societyof Gastroenterology (BSG) and British Association for the Study of theLiver (BASL) Decompensated Cirrhosis Care Bundle as decompensatedliver cirrhosis is becoming a burden on the current NHS.Objectives: The study aims to ensure that future admissions with decompensatedcirrhosis adhere to the care bundle, identify areas of poor compliance,and pinpoint areas for improvement.Methodology: Over the course of 6 months, a sample of 29 patients, rangingin age from 29 to 77, were evaluated at Hinchingbrooke Hospital.Presentations and compliance were examined using manual medical takeclerking searches.Findings: Common presentations included jaundice, ascites, and varicealbleeding. In-hospital mortality stood at 31%. While basic investigationswere generally compliant, there were significant non-compliance rates forseptic screen (38%), ascitic tap (37%), and USS abdomen (24%). Partialcompliance was noted in recording alcohol intake (87%) and prescribingIV Pabrinex (89%), with non-compliance for CIWA (74%). Varicealbleeding management showed non-compliance in prophylactic antibiotics(60%), terlipressin (70%), and vitamin K (43%), while adequate lactulosedosing in encephalopathy was non-compliant in 71% of cases. VTEprophylaxis prescribing showed high compliance at 92% in appropriatecases.Conclusion: The audit highlights the need to adhere to the use of decompensatedcirrhosis care bundle. It shows gaps in compliance which can beareas for improvement and education.

Is there any difference between Eastern and Western clinical practice guidelines in management of gastric cancer?

Gastric cancer (GC) has been known as one of the most common causes of cancer mortality both in Western and Eastern countries. However, there might be differences between how it is managed in different countries. Thus, we aimed to investigate these differences. The most well-known clinical guidelines in field of GC management including Korean GC Association (KGCA), Japanese GC Association (JGCA), National Comprehensive Cancer Network (NCCN), European Society for Medical Oncology (ESMO), British Society of Gastroenterology (BSG), and National Institute for health and Care Excellence (NICE) have been reviewed. The contents of these guidelines were categorized under eight headings including (1) genetic predisposition, (2) prevention, (3) management of gastric polyp, atrophy, dysplasia and metaplasia, (4) diagnosis, (5) pathology and molecular biology, (6) treatment, (7) supportive and palliative care, and (8) follow up. Difference in each section was discussed. Considering KGCA and JGCA as Eastern and NCCN, ESMO, BSG, and NICE as Western guidelines, it is revealed that both sets of guidelines share common practices such as prioritizing comprehensive diagnostic evaluations, personalizing treatment plans, and palliative care. However, main differences can be seen in treatment regimens, the adoption of newer therapies like immunotherapy, and the utilization of emerging techniques such as HIPEC. These differences reflect the diverse clinical landscapes, research focuses, and healthcare systems within these regions.

Prevalence of the Oral Corticosteroid Exposure and Excessive Use in Patients with Inflammatory Bowel Disease: Data from Four French Referral Centers of the International DICE Study.

Background: Corticosteroids used to induce a response in Crohn's disease (CD) and ulcerative colitis (UC) may cause adverse reactions. The DICE study aimed to quantify and investigate factors associated with their use. Methods: This cross-sectional, non-interventional study conducted in seven countries allowed us to collect data on oral corticosteroid exposure and excessive use (cf. British Society of Gastroenterology) over the past 12 months in adult patients with CD or UC for more than a year. The factors associated with these practices were investigated using marginal logistic models. We present the results from the four participating French expert centers. Results: Corticosteroid exposure over the past 12 months was observed in 20.1% of 324 CD patients and 30.2% of 205 UC patients. Excessive use was reported in 13.3% and 17.1% of patients, respectively. Corticosteroid exposure and excessive use were less frequently observed in CD than in UC (OR: 0.56, p < 0.0001, and 0.69, p = 0.0042). A disease activity assessment at patient's last visit was the main factor (p < 0.01) associated with the risk of corticosteroid exposure and excessive use in CD (OR: 3.41 and 3.44) and UC (OR: 7.29 and 6.90). Conclusions: Corticosteroid exposure and excessive use continue to be frequently observed in CD and UC in France.

The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridioides difficile infection and other potential indications: second edition of joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines

The first British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS)-endorsed faecal microbiota transplant (FMT) guidelines were published in 2018. Over the past 5 years, there has been considerable growth in the evidence base (including publication of outcomes from large national FMT registries), necessitating an updated critical review of the literature and a second edition of the BSG/HIS FMT guidelines. These have been produced in accordance with National Institute for Health and Care Excellence-accredited methodology, thus have particular relevance for UK-based clinicians, but are intended to be of pertinence internationally. This second edition of the guidelines have been divided into recommendations, good practice points and recommendations against certain practices. With respect to FMT for Clostridioides difficile infection (CDI), key focus areas centred around timing of administration, increasing clinical experience of encapsulated FMT preparations and optimising donor screening. The latter topic is of particular relevance given the COVID-19 pandemic, and cases of patient morbidity and mortality resulting from FMT-related pathogen transmission. The guidelines also considered emergent literature on the use of FMT in non-CDI settings (including both gastrointestinal and non-gastrointestinal indications), reviewing relevant randomised controlled trials. Recommendations are provided regarding special areas (including compassionate FMT use), and considerations regarding the evolving landscape of FMT and microbiome therapeutics.

External Validation of the Oakland Score for Predicting Safe Discharge in Patients Presenting With Lower Gastrointestinal Bleeding at the William Harvey Hospital in the United Kingdom.

Introduction Lower gastrointestinal bleeds (LGIB) are defined by having a bleeding point in the gastrointestinal tract beyond the ligament of Treitz. The most common causes include diverticular bleeds, tumours, and colitis. There are noNational Institute for Health and Care Excellence (NICE) guidelines regarding safe discharge of patients with LGIB. The aim of this study was to investigate the effectiveness and safety of the Oakland score, as suggested by the British Society of Gastroenterology (BSG) guidelines, in patients presenting with LGIB at William Harvey Hospital. Methods Patients with LGIB who presented to Accident & Emergency or inpatient referral from January to December 2023 were included in this retrospective study. Data was extracted from patients' Sunrise documentation. The Oakland score for each patient was calculated. Those with a score of ≤8 were deemed safe for discharge; those with a higher score were deemed unsuitable. Patients' admission, discharges, and adverse outcomes, such as representation, blood transfusion, or further intervention, were investigated. Patients with no adverse outcomes were deemed to have had a safe discharge. The area under the receiver-operating characteristic curve (AUROC) for the Oakland score and adverse outcome (and therefore safe discharge) were calculated. Results A total of 123 patients were included. These led to a total of 144 LGIB presentations to the hospital. Twenty-nine patients had an Oakland score of ≤8; 21 (72.4%)cases were initiallydischarged with four representations (19.0%) and eight (27.6%) were admitted although none of these suffered from any adverse outcomes. For those who scored ≤8, 25 (86.2%) were therefore deemed to have had a safe discharge. A total of 115 had a score >8; 43 (37.4%) were initiallydischarged, 72 (62.6%) admitted and 41 (35.7%) experienced at least one adverse outcome including 16 (13.9%) representations, 21 (18.3%) blood transfusions, three (2.6%) surgical interventions and one (0.9%) endoscopic haemostasis. Out of the 115 cases which scored >8, 74 (64.3%) were deemed to have had a safe discharge. The AUROC for safe discharge was 0.84. Conclusion The Oakland score seems to be a safe and reliable tool for identifying LGIB patients who could be safely discharged home without hospital intervention. However, further research is required to assess whether a score of >8 could be used as many patients with a higher score did not experience adverse outcomes.

Challenges and Clinical Relevance of Modern Breast Pathology Reporting: Your Questions Answered

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Breast pathology reporting, especially for breast cancer, has evolved through the years, from terse succinct diagnostic conclusions with scant histological details to the current comprehensive reporting guidelines issued by major pathology colleges and bodies, including the International Collaboration on Cancer Reporting. Pathology elements included in reporting guidelines are evidence based and contribute significantly to individualised and personalised patient management. &lt;b&gt;&lt;i&gt;Summary:&lt;/i&gt;&lt;/b&gt; This article is based on the lively interactive question and answer session that followed the breast pathology segment in the symposium jointly organised by the British Association of Urological Pathology, British Association of Gynaecological Pathologists, British Society of Gastroenterology and the Association of Breast Pathology, in November 2022, titled “Personalised histopathology reporting for personalised medicine.” &lt;b&gt;&lt;i&gt;Key Messages:&lt;/i&gt;&lt;/b&gt; The breast pathology session emphasised the clinical utility of breast pathology data items, incorporating a case-based approach by highlighting the relevance of pathology information in various clinical scenarios. This review included clinico-pathological discussion points on florid lobular carcinoma in situ, atypical apocrine adenosis, post-neoadjuvant chemotherapy reporting, atypical ductal hyperplasia presenting at the margin, flat epithelial atypia versus columnar cell change, papilloma on core needle biopsy, margin status, mucocele-like lesion, total duct excision/microdochectomy specimen, and anterior and nipple margins in skin-sparing mastectomy. Effective communication and regular involvement of pathologists in breast multidisciplinary tumour boards are crucial.

Position statement on how can we can implement the Greendeal in our gastrointestinal and gastrointestinal endoscopy department in Belgium.

The importance to reach the target to be carbon net zero by 2050, as presented by the European Commission in the European Green Deal, cannot be overestimated. In a current endoscopy world, where single use has found its place and techniques are constantly evolving, it will be a challenge to reach these goals. How can we reconcile this evolution to a carbon neutral status by 2050 without compromising patients care, clinical standards and training needs? The European Society of Gastrointestinal Endoscopy (ESGE) together with the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) recently published a position statement (1) whereas in the UK there is the work from the green endoscopy group (2) in line with the strategy of the British Society of Gastroenterology (BSG) on sustainability (3). In Flanders, a project called "greendeal in duurzame zorg" had its kick off in March 2023 (4) so it is about time that we in Belgium, as gastroenterologists, start with tangible actions to a more sustainable daily practice. We wrote this position statement in cooperation with the Vlaamse Vereniging voor Gastro-Enterologie (VVGE), the Société royale belge de Gastro-entérologie (SRBGE) and the Belgian Society of Gastrointestinal Endoscopy (BSGIE). We will also work together in the coming years to continue to motivate our members to work on these initiatives and to co-opt new projects within the framework of the greendeal.

P815 Infliximab drug monitoring: proactive or reactive: a North West England NHS 3 trust retrospective study

Abstract Background Therapeutic drug monitoring (TDM) plays a vital role in the management of patients on Infliximab. (1) The British Society of Gastroenterology (BSG) recommends TDM assessment ideally takes place 2-4 weeks after the initial loading doses, however the European Crohns and Colitis Organisation (ECCO) do not make particular proactive or reactive recommendations for TDM. (1,2,3) Methods Three North West England NHS trusts retrospectively collected data on 75 patients who had Infliximab trough and antibody levels done within a 12 month time frame. The aim was to establish if collectively TDM was done proactively or reactively and the overall outcomes from the monitoring. Results The demographic profile gave us 37 females and 38 males with the disease distribution predominantly Crohns disease ( N=53). There were more participants in the 18-50 age range (N=53) with 22 patients being 31-40 years of age, less participants in the 51-70+ age range ( N=22). Dual therapy with either Mercaptopurine or Azathioprine accounted for 49 out of the 75 participants with a majority favouring Azathioprine. Clinical management and routine use of TDM was seen in 40.5% ( N= 54) of patients indicating proactive use of monitoring in this study. TDM was undertaken after induction and annually in 48 patients whilst the remaining 27 patients received monitoring as ‘maintenance’, this is similar to the BSG recommendations and in a study by Sagar et al in 2021 ( 4). Conclusion Although the three participating trusts may use differing assays for the TDM, the outcomes show that it is used proactively for the majority of patients after induction and annually in keeping with BSG recommendations (3). From the data collected a further examination of results regarding subcutaneous versus intravenous TDM outcomes is proposed as the trusts move towards providing patients with both modes of administration of Infliximab.

2010 The scope of CT in investigating iron deficiency anaemia in the context of frailty

Abstract Introduction Iron Deficiency Anaemia (IDA) is a highly prevalent co-morbidity in older patients with advanced frailty. It’s associated with adverse outcomes and heightened all-cause mortality. IDA is frequently multifactorial and can stem from various gastrointestinal causes. The British Society of Gastroenterology and National Institute for Health and Care Excellence advocate a combination of endoscopy and computerised tomography (CT) as the gold standard investigations for IDA. The aim of this review was to evaluate oesophagogastroduodenoscopy (OGD) findings and management outcomes of clinically frail patients with IDA. Methods We review notes for patients referred for OGD to investigate IDA without additional symptoms over a six-month period. The inclusion criteria were IDA, age of 65 years or greater and a clinical frailty score of 5 or greater. Results 53 patients met the inclusion criteria. A single case (1.8%) UGI malignancy using OGD was identified prior to CT. Thus, demonstrating low yield of OGD in malignancy. 35.6% of patients underwent CT scanning 3 months prior to OGD. Approximately 90% of OGD findings were benign. 23% of patients died within 90 days of OGD. No significant adverse events during OGD or significant complications were recorded in our cohort. It is therefore highly unlikely that the undergoing of an OGD had a direct impact on mortality. Conclusion This review shows there is a low yield of UGI malignancy on OGD following a negative CT. Benign upper GI condition is the most common finding. Thus, CT imaging alone may be an adequate investigation to rule out UGI malignancy in this group. Considering there is a high mortality rate in older patients with frailty, following an OGD, we suggest considering starting empirical treatment with PPI and iron replacement as a suitable and less invasive alternative to OGD after a negative CT in frail patients.

There is a long way from current clinical practice in Denmark compared to recent published English guideline on management of children with eosinophilic oesophagitis

BackgroundA low incidence of eosinophilic esophagitis (EoE) in children in the North Denmark Region (NDR) were measured in 2007–2017. Few of the children diagnosed before 2017 were treated to remission suggesting a lack of awareness. While there currently are no guidelines for treating EoE in Denmark, a new English guideline was published in 2022 renewing focus on the disease.ObjectiveThe aim of this study was to measure the difference of current Danish clinical practice for treatment and follow-up of EoE children in the NDR with the new English guideline from the British Society of Gastroenterology (BSG) and the British Society of Pediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN).MethodsThis retrospective, register-based DanEoE cohort study included 31 children diagnosed with EoE between 2007 and 2021 in NDR. Medical records were reviewed and information about treatment and follow-up were collected.ResultsIn 32% of the children with EoE in the NDR, first-line treatment corresponded with the new English guideline. One in 6 children were never started on any treatment even though treatment always is recommended. Histologic evaluation within 12 weeks as recommended was performed in 13% of the children.ConclusionsIn Denmark focus on improving EoE treatment and follow-up for children is needed, as there is a significant difference between current clinical practice and the recommendations in the new English guideline.

Lower GI bleed audit

Abstract Introduction In the UK, Lower GI Bleeding is common emergency presentation and accounts for 3% of emergency surgical referrals. The most common cause is Diverticular Bleeds. Other frequent causes are the benign anorectal conditions. 23% of patients admitted to Hospital with LGIB in the UK are discharged without diagnosis. Most LGIB resolves on its own but may require further interventions. Aim To describe current local practice of risk stratification with Shock Index and Oakland’s Score in comparison with existing national guidelines by the British Society of Gastroenterology (BSG). Method Retrospective Analysis of 36 patients who presented to the local A&amp;E with lower GI bleed between Sept 2021 – Nov 2021. Result Male:Female 18:18. Median age 56 years (3months – 95years). Haemorrhoids (9, 25%) accounted for most of the presentation. 1 patient (3%) had their shock index documented. 2 patients (6%) needed a CT angiogram. 16 patients (44%) were admitted under the EGS team. Out of these 16 patients, 7 (44%) needed inpatient endoscopy, while 3 (19%) required transfusion. Discussion There was a consistent finding of no documented shock index in the patients notes, likely because there is easy access to EWS that allow clinicians to interpret this in real time. The Oakland score was rarely used to determine if a patient could safely be discharged. Other specialties, endoscopy/gastroenterology or the emergency department, likely have different guidelines for the assessment of lower GI bleed. This could account for poor uptake, locally, of risk stratification as proposed by the BSG.

EGS P09 Audit of Management of Acute Upper Gastrointestinal Bleeding against National Standard

Abstract Background Acute upper gastrointestinal bleeding (AUGIB) remains a common gastrointestinal emergency with varying standards of care, management practices, patient outcomes and high mortality rates in the United Kingdom. National strategic initiatives have been implemented in response to this, the most recent and definitive one being the AUGIB care bundle released by the British Society of Gastroenterology (BSG) led multisociety consensus in 2019. We audited our performance against BSG AUGIB care bundle. Methods This was a retrospective cohort study conducted in a single surgical unit on all consecutive adult inpatients who received emergency oesophago-gastro-duodenoscopy (OGD) from September 2021 to September 2022. Patients who were scoped for indications other than AUGIB were excluded. Patient demographics, inpatient hospital notes, laboratory multisociety consensus results, NCEPOD data and endoscopy reports were studied and analysed. These findings were then compared against recommendations as described by the BSG multiconsensus care bundle. The compliance target for each step was 100%. This study was registered with Clinical Quality Project (LanQIP 14739). Results 150 OGDs were included; 79 (58.7%) were male and median age was 63 years (IQR 52.5-75.5). Median length of stay was 3.7 days (IQR 1.9-7.8). Melaena was the commonest presenting symptom (n=95, 63.3%). 54 (36%) presented with NEWS &amp;gt;2 and 12 (8.0%) in shock. Offending medications was the primary risk factor in 66 patients (44%). All OGDs had consultant supervision. 85 (56.7%) were performed in-hours. 55 (36.7%) had gastritis and 20 (13.3%) had oesophageal varices. 10 (6.7%) were re-admitted within 3 months. 30-day mortality was 8.0%. Our audit outcomes were as follow (Table 1): Conclusions Whilst senior clinician involvement was strong in our unit, there was a significant gap in concordance with BSG measures in applying the care bundle, GBS risk scoring and the resuscitation and medical management of acute bleeders. Formally implementing the AUGIB bundle from the emergency department into the admission unit will provide a framework for junior doctors to safely and systematically assess and resuscitate of patients with AUGIB, and guide timely planning for endoscopic intervention and follow-up by the senior clinical decision-maker. This should be continually re-audited to ensure improvement in performance together with outcome measures to ensure real change.

Cost-benefits and environmental impact of the no-biopsy approach for the diagnosis of coeliac disease in adults

ObjectiveRecent evidence suggests that adult patients with IgA tissue transglutaminase levels of ≥10× the upper limit of normal could be accurately diagnosed with coeliac disease without undergoing endoscopy and biopsy....

946 A Complete Cycle Audit of the Appropriate Management of Stable Patients Presenting Acutely with a Lower GI Bleed Using the Oakland Score Risk Stratification Tool in Order to Avoid Unnecessary Admissions

Abstract Aim The use of risk stratification tools such as the Oakland Score (OS) to identify patients with low risk of adverse outcomes (scale 0-35, safe discharge threshold ≤8) who present acutely with a Lower Gastrointestinal Bleed (LGIB) in order to avoid unnecessary admissions, in accordance with British Society of Gastroenterology (BSG) guidance. Method At a District General Hospital, data was collected retrospectively over six months. Patients who acutely presented with a LGIB were identified using patient handover lists and e-documentation was reviewed for a documented Oakland Score (OS). A departmental survey was conducted to ascertain knowledge of OS and LGIB assessment. Tailored teaching was subsequently delivered, including a summary sheet with a link to an e-calculator. A re-audit was conducted over three months to measure change of practice. Results Prior to intervention, 6/63 (10%) had a documented Oakland score (OS). Three patients had an OS &amp;lt;8 and were inappropriately admitted. A survey was completed by 11 members of the General Surgical team. Prior to intervention, 27% (3/11) were aware of OS and only 9% (1/11) reported using it practice. Following intervention, 16/38 (42%) had a documented OS. All patients (8/8) with an OS ≤8 were appropriately discharged. Conclusions The use of numerical risk stratification tools such as the Oakland Score, in compliance with BSG guidance, improved patient management and avoidance of inappropriate admissions. Targeted educative measures should be delivered to the department on a regular basis, to account for continual rotating of doctors and ensuring updated knowledge to further improve outcomes.

656 Improving Practice in Acute Pancreatitis Management at a District General Hospital

Abstract Aim Appropriate management of acute pancreatitis is essential, as this condition is associated with a high mortality rate. This clinical audit aimed to improve the initial management of acute pancreatitis in patients presenting to University Hospital Wishaw in line with current guidelines between June 2021 and August 2022. Method A retrospective cohort analysis was performed for acute pancreatitis patients discharged between 01/06/21 and 01/12/21. Management was compared against NICE, British Society of Gastroenterology and Royal College of Surgeon’s audit standards which encompass risk stratification, investigation, and management. To improve and standardise care amongst staff, departmental teaching and a management pro-forma were implemented in April 2022. Repeat prospective data collection was performed from May to August 2022. Results There were a total of 73 patients included in Cycle 1, and 44 patients in Cycle 2. There was an improvement in all ten audit standards measured. Appropriate investigation into pancreatitis aetiology improved from 25% to 50%, with an 83% reduction in clinicians assuming alcohol-induced pancreatitis without suitable investigation of alternate causes. Initial risk stratification of patients improved from 36% to 52% and severity assessment increased from 4% to 36%. The provision of nutritional support to appropriate patients improved by 35%. Comparison of sub-cohorts revealed that adherence with the pro-forma showed measurably better compliance with standards. Conclusions The implementation of teaching and a management pro-forma demonstrated an improvement in standardisation of care. Specifically, use of a visual aid has been shown to better standards. Future cycles could focus on improvement of the pro-forma, and increased compliance.

National study of NAFLD management identifies variation in delivery of care in the UK between 2019 to 2022

Non-alcoholic fatty liver disease (NAFLD) is associated with liver and cardiovascular morbidity and mortality. Recently published NAFLD Quality Standards include 11 key performance indicators (KPIs) of good clinical care. This national study, endorsed by British Association for the Study of the Liver (BASL) and British Society of Gastroenterology (BSG), aimed to benchmark NAFLD care in UK hospitals against these KPIs. This study included all new patients with NAFLD reviewed in the outpatient clinic in the months of March 2019 and March 2022. Participating UK hospitals self-registered for the study through BASL/BSG. KPI outcomes were compared using Fisher's exact or Chi-square tests. Data from 776 patients with NAFLD attending 34 hospitals (England [25], Scotland [four], Wales [three], Northern Ireland [two]) were collected. A total of 85.3% of hospitals reported established local liver disease assessment pathways, yet only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment documented at the point of referral to secondary care. In secondary care, 79.1% of patients had fibrosis assessment. Assessment of cardiometabolic risk factors including obesity, type 2 diabetes, hypertension, and smoking were conducted in 73.2%, 33.0%, 19.3%, and 54.9% of all patients, respectively. There was limited documentation of diet (35.7%) and exercise advice (55.1%). Excluding those on statins, only 9.1% of patients with NAFLD at increased cardiovascular risk (T2DM and/or QRISK-3 >10%) had documented discussion of statin treatment. Significant KPI improvements from 2019 to 2022 were evident in use of non-invasive fibrosis assessment before secondary care referral, statin recommendations, and diet and exercise recommendations. This national study identified substantial variation in NAFLD management in the UK with clear areas for improvement, particularly fibrosis risk assessment before secondary care referral and management of associated cardiometabolic risk factors. This study identified significant variation in the management of NAFLD in the UK. Only 27.9% of patients with suspected NAFLD had non-invasive fibrosis assessment performed to identify those at greater risk of advanced liver disease before specialist referral. Greater emphasis is needed on the management of associated cardiometabolic risk factors in individuals with NAFLD. Hospitals with multidisciplinary NAFLD service provision had higher rates of fibrosis evaluation and assessment and management of cardiometabolic risk than hospitals without multidisciplinary services. Further work is needed to align guideline recommendations and real-world practice in NAFLD care.

Exploring changing attitudes to non-invasive liver fibrosis tests in secondary care pathways: comparison of two national surveys

IntroductionThe increasing availability of non-invasive tests (NITs) has created the opportunity to explore their use in improving risk stratification of advanced liver disease. The study aimed to determine the attitudes...

Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revision

The risk of developing metachronous advanced neoplasia is associated with the presence of polyps in index colonoscopy. Therefore, it is essential to establish the optimal colonoscopy surveillance period following polypectomy. In the 2020s, international guidelines published by the US Multi-Society Task Force, European Society of Gastrointestinal Endoscopy, and British Society of Gastroenterology were revised. In 2022, the Korean postpolypectomy colonoscopic surveillance guidelines were revised to recommend surveillance for adenoma size ≥ 10 mm, ≥ 3 adenomas, tubulovillous or villous adenoma, adenoma with high-grade dysplasia, traditional serrated adenoma, sessile serrated lesion (SSL) with dysplasia, serrated polyp with size ≥ 10 mm, and ≥ 3 SSLs.

Risk stratification for the detection of metachronous polyps after bowel screening polypectomy: clinical outcomes from the Integrated Technologies for Improved Polyp Surveillance (INCISE) study cohort.

After colorectal polypectomy, 20-50 per cent of patients develop metachronous polyps and some have increased colorectal cancer risk. British Society of Gastroenterology (BSG) 2020 guidelines recommend surveillance colonoscopy for high-risk patients based on index pathology. The aim of this study was to evaluate metachronous lesion outcome using BSG 2020 criteria. A retrospective, multicentred study was conducted including patients who had polypectomy during screening colonoscopy (2009-2016) followed by surveillance. Demographics, index pathology, and BSG 2020 risk criteria were compared with regard to metachronous lesion pathology (non-advanced versus advanced lesions) and timing of detection (early versus late). Advanced lesions were defined as adenomas/serrated polyps greater than or equal to 10 mm, high-grade dysplasia, serrated polyps with dysplasia, or colorectal cancer, and late lesions those detected greater than 2 years after the index procedure. Of 3090 eligible patients, 2643 were included. Among these, retrospective BSG 2020 application would have excluded 51.5 per cent from surveillance. After a median of 36 months, the advanced polyp/colorectal cancer rate in BSG 2020 high-risk patients was 16.3 versus 13.0 per cent in low-risk patients. Older age (P = 0.008) correlated with advanced metachronous lesions. Male sex, greater than five polyps, and BSG 2020 high-risk criteria correlated with non-advanced and advanced lesions (P < 0.001). Older age (P < 0.001), villous features (P = 0.006), advanced index polyp (P = 0.020), and greater than five polyps (P < 0.001) correlated with early metachronous lesions. Male sex and BSG 2020 high-risk criteria correlated with early and late lesions (P < 0.001). On multivariable regression, increased polyp number (odds ratio (OR) 1.15 (95 per cent c.i. 1.07 to 1.25); P < 0.001) and villous features (OR 1.49 (95 per cent c.i. 1.05 to 2.10); P = 0.025) independently correlated with early advanced lesions. The rate of non-advanced and advanced metachronous polyps was higher in BSG 2020 high- versus low-risk patients (44.4 versus 35.4 per cent for non-advanced and 15.7 versus 11.8 per cent for advanced; P < 0.001), but the colorectal cancer rate was similar (0.6 versus 1.2 per cent). However, when examining only lesions detected greater than 2 years after the index colonoscopy in high- versus low-risk patients, no significant differences were observed (P = 0.140). BSG 2020 criteria correlated with metachronous polyps, but did not differentiate advanced and non-advanced lesions and were not predictive of late lesions.

Gender differences of authors of major Hepatology society guidelines during the past 15 years.

Recent studies have shown that women are underrepresented as authors of medical research and clinical practice guidelines. This study aimed to evaluate gender disparities of authors of major hepatology guidelines. We reviewed the hepatology guidelines published by the following major gastroenterology societies from January 2008 to September 2022: the American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), American Association for the Study of Liver Diseases (AASLD), Asian-Pacific Association for the Study of the Liver (APASL), British Society of Gastroenterology (BSG), European Association for the Study of the Liver (EASL) and Korean Association for the Study of the Liver (KASL). We determined the topic and the gender of all authors of each guideline. The numbers of men authors, women authors and total authors were collected. The trends of women first authors, women senior authors and total women authors were assessed. A logistic regression analysis was performed to analyse the relationship between the gender of the first or senior author and related factors. We identified 103 hepatology guidelines published between January 2008 and September 2022 published by the AGA, ACG, AASLD, APASL, BSG, EASL, and KASL. The gender of 1096 of 1100 (99.6%) authors was determined. Therefore, a total of 1096 authors were included: 223 (20.3%) authors were women and 873 (79.7%) authors were men. Women comprised 14.6% of all first authors, and 20.4% of all senior authors were women. Only the AASLD had writing committees comprising more than 30% total women authors. The proportions of women senior authors and total women authors increased significantly during the study period (p < .05). Women first authors and women senior authors were more likely to publish guidelines with more women authors. Women first authors were less likely to be co-authors with men authors. Over the course of the past decade, the proportion of women authors of major hepatology guidelines has been low; however, this gender gap appears to be closing.