Endoscopy Unit Research Articles

A93 IMPROVING INPATIENT ENDOSCOPY PROCEDURAL THROUGHPUT: A QUALITY IMPROVEMENT INITIATIVE AT AN ACADEMIC MEDICAL CENTER

Abstract Background Currently, due to pandemic-related supply and personnel constraints, increased strain is being placed on inpatient endoscopic services. At our academic center, inpatient procedural throughput/efficiency is only 65%, which is leading to excess procedures being completed on-call or on weekends. Purpose Our quality improvement study attempted to improve throughput of the inpatient endoscopy suite by 1 additional procedure completed per day, over a period of 12 months of study. Method An interprofessional team of gastroenterology fellows, attending physicians, nurses and nurse managers was created to investigate throughput concerns. Baseline data was collected via direct observation and completion of a time study over a period of 1-2 months. Subsequently, a process flow diagram was completed. A combination of root cause analysis tools (ie. Stakeholder interviews, Pareto chart and Driver Diagram were then utilized to identify areas for improvement. A delay in procedural start time was identified as a strong culprit for reduced patient throughput. Potential interventions proposed included: early physician handover start time, constructing a standardized patient procedure list, and improving timeliness of patient transfer to the endoscopy suite. Result(s) Stakeholder Interview(s): Completed via Anonymous Survey/Google Forms: See https://docs.google.com/forms/d/e/1FAIpQLSe-PDL31ClU8g-BChdBoBYhPoBhGBZVmlToTTZJnYKlEHz-GQ/viewform?usp=sf_link Concerns: - Inpatient procedure list not consistently being completed prior to starting endoscopy - Physician handover in the morning can cause significant delays in starting inpatient endoscopy - Concern patient/porter transfer related delays Conclusion(s) Our current data identifies that the most effective intervention included developing a standardized procedure list and mandating the first case is an EGD, minimizing delay due to inadequate bowel preparation. Concordantly, arranging timely patient transfer to the endoscopy suite, thereby minimizing delays due to patient portering services, was also found to be effective. Our average procedural time for completion of an EGD and associated recovery is approximately 25-30 minutes. After multiple interventions/PDSA cycles we obtained a more optimized procedural suite start time of 08:22 am, on average, which resulted in the completion of an additional procedure and increased the throughput of our endoscopy unit. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

The Roth Net at 40 years: celebrating the spirit of innovation

The Roth Net at 40 years: celebrating the spirit of innovation

Endoscopic management of buried bumper syndrome using the Balloon Dilation Pull (BDP) technique: a multicenter analysis.

Buried bumper syndrome (BBS) may complicate percutaneous endoscopic gastrostomy placement. In these patients, endoscopic treatment ought to be considered. Various approaches have been published, ranging from dissectionbased techniques to novel dedicated devices, although the evidence supporting the use of the Balloon Dilation Pull (BDP) technique has been limited to single case reports. The aim of this paper is to assess the feasibility, efficacy and safety of the systematic use of the BDPtechnique for the endoscopic treatment of BBS. We performed a retrospective multicenter analysis of prospectively collected data from all patients treated with the BDP-technique between January 2011 and November 2021. In total, 26 patients were identified (median age 72 (SD ± 13) years, 74% male, 84.6% underlying neurological disease). Technical success was achieved in 92.3%, with a median procedure time of 17.5 minutes (range 5-27). Adverse events were identified in 3.8% of patients (N=1, aspiration, ASGE lexicon severity grade: moderate). Our experience suggests that the BDP-technique is highly efficacious and safe, using accessories readily available in every endoscopic unit. Given the limited procedure time and tools required, this procedure has the potential to further optimize patient care in the context of BBS.

WEO Newsletter.

WEO Newsletter.

Endoscope reprocessing: Retrospective analysis of 90,311 samples

Background and study aims The contamination level of ready-to-use endoscopes published in the literature varies from 0.4 % to 49.0 %. Unfortunately, the comparison and the interpretation of these results are quite impossible, given the limited number of samples and sites included and the differences observed between sampling, culturing methods, and interpretation criteria. Methods The objective of this retrospective study was to analyze the results of 90,311 endoscope samples collected between 2004 and 2021 in 490 private or public hospitals in France. Results Through the full test period, the mean ratio of endoscopes at the action level was 12.6 % (19.5 % including alert level). Of the endoscopy units, 23.0 % had a ratio of compliant endoscopes ≤ 70.0 %. The overall microbial quality of gastroscopes, duodenoscopes, and colonoscopes is improving year by year, whereas an opposite trend is observed for ultrasound endoscopes and bronchoscopes. In 2021, following French guidelines, 13.0 % of the endoscopes should have been quarantined and 8.1 % were at the alert level, meaning that the contamination level of 21.1 % of the endoscopes exceeded what was defined as a maximum acceptable value. Conclusions This study demonstrates that additional efforts, including implementation of microbial surveillance strategies using a standardized sampling method and periodic observational audits, must be made to improve the overall microbiological quality of endoscopes and reduce the risk associated with their use.

Spray coagulation as an alternative to argon plasma coagulation for bleeding portal hypertensive gastropathy

Spray coagulation as an alternative to argon plasma coagulation for bleeding portal hypertensive gastropathy

Endoscopic retrograde cholangiopancreatography-oriented surgery for accomplished treatment of Mirizzi syndrome: a single-center experience.

Mirizzi syndrome is a gallstone disease characterized by compression of extrahepatic biliary duct with an impacted stone. Our aim is to identify and describe the incidence, clinical presentation, operative details and the association postoperative complication of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). The ERCP procedures were held in Gastroenterology Endoscopy Unit and retrospectively evaluated. The patients were divided into two groups, the cholelithiasis + common bile duct (CBD) stone group and the Mirizzi syndrome group. These groups were compared with the demographic characteristics, ERCP procedures, types of Mirizzi syndrome and surgical technique. A total of 1018 consecutive patients who underwent ERCP were scanned retrospectively. Of the 515 patients fulfilling the criteria for ERCP, 12 had Mirizzi syndrome and 503 had cholelithiasis and CBD stones. Half of the Mirizzi syndrome patients were diagnosed with pre-ERCP ultrasonography. The mean diameter of choledoc was found to be 10 mm in ERCP. ERCP-related complication rates (pancreatitis, bleeding and perforation) were the same in the two groups; 66.6% of the Mirizzi syndrome patients applied cholecystectomy and placement of T-tube surgical procedures, and there were no postoperative complications. Surgery is the definitive treatment of Mirizzi syndrome. Thus patients should have a correct preoperative diagnosis for an appropriate and safe surgery. We think that ERCP could be the best guide for this. Also, we believe that intraoperative cholangiography with ERCP and hybrid procedures for guiding surgical treatment may become an advanced treatment option in the future.

A comparison of the behavioral effects of ketamine and propofol sedation in the pediatric endoscopy unit

Introduction: Hospitalization and anesthesia can have a harmful psychological impact on children, leading to behavioral abnormalities. Using the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) version of the Post Hospitalization Behavior Questionnaire for daycase patients, the objective of this study is to assess the differences between ketamine and propofol and propofol alone use following anesthesia. Materials and methods: After receiving approval from the ethics committee, 84 children ages 2 to 18 who would undergo sedation surgery at the pediatric endoscopy-colonoscopy unit at Ankara City Hospital were enrolled in the study. Group K consisted of 27 patients sedated with ketamine and propofol, while group P consisted of 57 children sedated with propofol. To detect postoperative behavioral alterations in these youngsters, a questionnaire (POBQ-AS) was administered soon prior to the procedure and on the third day following it. Results: Pre-procedural Behavior Assessment Questionnaire Total scores were comparable for both groups. The measures on the third day following the surgery were also comparable. The Post-procedure Behavior Evaluation Questionnaire Total Score increased significantly (p 0.05) in both groups compared to the pre-procedure score. In Group K, the answers to the questions "Is he disconnected to his environment?" and "Does he become depressed when left alone?" increased significantly more than in the other group (p 0.05). Conclusion: Pediatric perioperative behavioral problem may be common. On the third postoperative day, sedative applications involving ketamine and propofol induce detrimental behavioral alterations, according to this study. In our patient group selected from the endoscopy unit to exclude factors such as mask induction, muscle relaxants, inhalation anesthetics, and surgical incision pain, we believe that only the negative behavioral changes of the intravenous anesthetics ketamine and propofol, as well as factors such as inflammation, surgical stress, and neurotoxicity, should be the focus of future research.

Integrating Ergonomics into Endoscopy Training: A Guide for Faculty and Fellows

Endoscopic procedures are physically demanding. Endoscopy-related musculoskeletal injuries (ERIs) can stem from repetitive high-force movements, especially when coupled with nonneutral body positions. 1 Shergill A.K. McQuaid K.R. Rempel D. Ergonomics and GI endoscopy. Gastrointest Endosc. 2009; 70: 145-153 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar ,2 Pawa S. Banerjee P. Kothari S. et al. Are all endoscopy-related musculoskeletal injuries created equal? Results of a national gender-based survey. Am J Gastroenterol. 2021; 116: 530-538 Crossref PubMed Scopus (12) Google Scholar Despite trainees commonly reporting ERIs and expressing interest in ergonomics-specific training, endoscopy ergonomics is not routinely taught during fellowship. 3 Villa E. Attar B. Trick W. et al. Endoscopy-related musculoskeletal injuries in gastroenterology fellows. Endosc Int Open. 2019; 7: E808-E812 Crossref PubMed Google Scholar ,4 Ruan W. Walsh C.M. Pawa S. et al. Musculoskeletal injury and ergonomics in pediatric gastrointestinal endoscopic practice. Surg Endosc. 2023; 37: 248-254 Crossref PubMed Scopus (1) Google Scholar This gap represents an opportunity. We present an approach for teaching ergonomics during endoscopy training and outline key ergonomic principles to promote development of safe and effective technique at the start of endoscopists’ careers, enhance endoscopy safety, and help extend career lifespans. Additional system-wide considerations, such as endoscopy case volume, endoscope and endoscopy unit design, and alternatives to endoscopy, are beyond the scope of this trainee-focused perspective.

The Role of an Artificial Intelligence Method of Improving the Diagnosis of Neoplasms by Colonoscopy

Colorectal cancer (CRC) is the third most common cancer worldwide. Colonoscopy is the gold standard examination that reduces the morbidity and mortality of CRC. Artificial intelligence (AI) could be useful in reducing the errors of the specialist and in drawing attention to the suspicious area. A prospective single-center randomized controlled study was conducted in an outpatient endoscopy unit with the aim of evaluating the usefulness of AI-assisted colonoscopy in PDR and ADR during the day time. It is important to understand how already available CADe systems improve the detection of polyps and adenomas in order to make a decision about their routine use in practice. In the period from October 2021 to February 2022, 400 examinations (patients) were included in the study. One hundred and ninety-four patients were examined using the ENDO-AID CADe artificial intelligence device (study group), and 206 patients were examined without the artificial intelligence (control group). None of the analyzed indicators (PDR and ADR during morning and afternoon colonoscopies) showed differences between the study and control groups. There was an increase in PDR during afternoon colonoscopies, as well as ADR during morning and afternoon colonoscopies. Based on our results, the use of AI systems in colonoscopies is recommended, especially in circumstances of an increase of examinations. Additional studies with larger groups of patients at night are needed to confirm the already available data.

Diagnostic yield of esophagogastroduodenoscopy in upper gastrointestinal bleeding in pediatrics: a cross-sectional study at a tertiary center

BackgroundEsophagogastroduodenoscopy (EGD) is currently considered the first-line diagnostic procedure of choice for upper gastrointestinal bleeding (UGIB); however, the etiology of bleeding remains unknown in a subset of patients. This study aimed to evaluate the diagnostic yield of EGD in UGIB in pediatrics and determine the clinical predictors for positive endoscopic diagnosis.MethodsA cross-sectional study was conducted at the pediatrics endoscopy unit, Ain Shams University, Cairo, Egypt, where 100 children were included. They were referred for EGD due to overt UGIB in the form of hematemesis and/or melena. Full medical history, thorough physical examination, laboratory investigations, and endoscopic and histopathologic findings were documented.ResultsForty-seven males and 54 females were included. Their ages ranged from 3 months to 15 years, with a median age of 4 years. Sixty-five percent presented with hematemesis only, 7% presented with melena only, and 28% presented with hematemesis and melena. An endoscopic diagnosis could be reached in 62% of cases, with Helicobacter pylori (H. pylori) gastritis (23%) and reflux esophagitis (11%) as the most common endoscopic diagnoses, with the former being the most common in children above 4 years and the latter for younger ones. Other diagnoses included non-specific gastritis (8%) and esophageal varices (4%). Presentation with melena only was a negative predictor to reach a diagnosis by EGD, while splenomegaly and thrombocytopenia were independent predictors of variceal bleeding.ConclusionEGD is the investigation of choice in children suffering from hematemesis especially in older age groups. Clinical and laboratory parameters might help in the prediction of the underlying etiology.

SG-APSIC1058: Microbiological surveillance of endoscopes in a Singapore tertiary-care academic hospital: A retrospective study from 2018 to 2021

Objectives: Improper reprocessing of endoscopes may result in healthcare-associated infections. Regular microbiological surveillance is an important means of evaluating the quality of endoscope reprocessing. We evaluated the effectiveness of reprocessing endoscopes (including the protocols on steps to be taken in the event of any positive microbiological results) in a sterile supply unit (SSU) and an endoscopy unit in a Singapore tertiary-care academic hospital. Methods: Singapore General Hospital (SGH) is a 1,750-bed, tertiary-care, academic medical center in Singapore with 2 main SSUs: 1 inpatient endoscopy unit and 1 outpatient endoscopy unit. We reviewed microbiological surveillance results from endoscopes following reprocessing from January 2018 to December 2021. In total, 160 endoscopes (27 bronchoscopes, 58 gastroscopes, 52 colonoscopes, 6 duodenoscopes, 5 echoscopes, 5 cystoscopes, 5 rhinolaryngoscopes, and 5 enteroscopes) and 15 automated endoscope reprocessors (AERs) were evaluated for the presence of microorganisms. Samples were obtained by swabbing the tip of the scope and the biopsy channel. Fluid was flushed from the biopsy channel after reprocessing, and this water from the AERs was sampled after waterline disinfection. Results: Of the 15,783 samples collected, 15,667 (99.3%) yielded no growth; 36 (0.2%) were positive for gut and environmental flora; and 80 (0.5%) were positive for low-concern organisms such as skin flora. Conclusions: Microbiological surveillance yielded a high percentage of negative results confirming the effectiveness of endoscope reprocessing. This quality-assurance process is necessary and beneficial in achieving patient safety.

Patients’ readiness before undergoing gastrointestinal endoscopy: a descriptive study

To analyse patients' anxiety related to endoscopy. The descriptive study was conducted from July 23 to September 14, 2020, at the Endoscopy Unit of Dr Abdoer Rahem Situbondo General Region Hospital, Dr Koesnadi Bondowoso General Region Hospital and Ibnu Sina Gresik General Region Hospital, East Java, Indonesia. The sample comprised endoscopy patients of either gender aged >20 years. Data was collected using the Endoscopy Confidence Questionnaire. Of the 50 patients, 28(56%) were males and 22(44%) were females. The largest age group was 41-50 years 17(34%), followed by 31-40 years 13(26%). Overall, 48(96%) subjects were married. Abdominal pain was most common indication for the procedure 10(20%). Esophagogastroduodenoscopy was the procedure in 29(58%) patients, 42(84%) had no history of endoscopy, and 41(82%) were reluctant to undergo the procedure. Patients' anxiety rises before endoscopy. Nurses need to provide complete and clear information related to the procedure, including the less pleasant elements.

Designing the Endoscopy Lab to Optimize Training

The endoscopy suite is the epicenter of hands-on training for gastroenterologists. There is a paucity of literature on the physical and intangible set up of the endoscopy laboratory to optimize education. Although no single design can optimize every aspect of training, there are general principles that may allow for the planning of an environment to prioritize training. This Editor and Trainees Perspectives article discusses key considerations of endoscopy unit design to facilitate trainee education by allowing for trainee preparation for endoscopy, learning during procedures, feedback from trainers, and reflection. We present this by using the following considerations: preparation spaces, sightlining within rooms, optimization of in-room communication, feedback rooms, in situ simulation, and education resource spaces to present a structure to allow fellowship leadership and endoscopy managers to support a safe, efficient, and cohesive learning environment for all levels of training.

P556 Surgery in high-risk paediatric Crohn’s Disease treated with up-front anti-TNF agents and long-standing biologic therapy

Abstract Background High-risk (HR) Crohn’s Disease (CD) is associated with high surgical and progression rates. Therefore, recent ESPGHAN guidelines (GL) suggest starting an early anti-TNFα treatment to modify the natural history of the disease. The aim of our study was to evaluate the surgical rate in a population of HR-CD paediatric patients treated with up-front anti-TNFα agents and long-standing biologic therapy Methods This is a retrospective, observational, single-center study conducted at the Paediatric Gastroenterology, Hepatology, and Endoscopy Unit at Policlinico Umberto I Hospital – Sapienza University of Rome. We collected data from all patients diagnosed with CD under 18 years, with a minimum follow-up of 12 months. between June 2008 to July 2022. Patients were then stratified at the diagnosis into HR and LR, based on ESPGHAN GL criteria. Demographic, clinical, laboratory, endoscopic, and imaging data were collected at 6, 12, 24, 36, 48, and 60 months Results 130 patients were enrolled, 76 HR (58%) and 54 LR (42%) [median age 12.5 (IQR) yrs, female 45 (35%), medium follow-up 54±24 months]. The HR group included 39 patients (51%) with panenteric disease, 15 (20%) with a structuring behavior (B2), 3 (4%) with structuring/penetrating disease (B2-B3), and 26 (34%) with perianal involvement (p). Early anti-TNFα agents were started in 80% of patients <6 months from the diagnosis, while 15 (20%) started biological therapy between 6 and 12 months from the diagnosis. All patients continued biologic therapy throughout the study follow-up: 20 (26%) optimized anti-TNF, 25% switched biologic, 11% added an immunomodulator, and 4% combined 2 biological drugs. The surgical rate at 5 years was 29% (n=22) and 29% n=16) in HR and LR groups respectively (p-value 1,0). Eleven % (n=8) of HR patients needed surgical resection, while perianal surgery (seton drainage, fistulotomy, fistulectomy) was performed in 18% (n=14), with no significant difference with LR group [(intestinal resection 18% (10/55), perianal surgery 11% (6/55), p > 0.05]. Perianal disease resulted positively associated with surgical risk (p 0.002, OR 5.62 CI 1.84-17.15) while small bowel imaging at the diagnosis was a protective factor for surgery (p 0.017, OR 0.23 CI 0.07-0.77). No significant difference was found in the interval free from surgery between HR and LR, although HR children mainly needed surgery in the first 12 months after the diagnosis. Conclusion Our data suggest that paediatric patients with HR-CD treated with early anti-TNF agents and long-standing biologic therapy have a similar disease course and surgical risk to those with LR disease. At a 5-year follow-up, one-third of patients needed surgery, mainly in the first year after the diagnosis

P442 Endoscopic resection of visible precancerous lesions in patients with colonic Inflammatory Bowel Disease

Abstract Background IBD patients have an increased risk of reporting a colorectal cancer. According to SCENIC, endoscopic resection (ER) should be preferred to biopsies for visible precancerous lesions in absence of stigmata of invasive cancer or submucosal fibrosis. However, the evidence is still lacking on specific outcomes of ER for the management of dysplastic lesions in IBD. Aim of this study was to evaluate the effectiveness and safety of ER of visible precancerous lesions in IBD patients. Methods In this retrospective study, we included consecutive IBD patients referred to an Endoscopy Unit (2016-2022) to undergo a ER, including endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and hybrid EMR-ESD (hESD), of visible precancerous lesions. The primary outcome was the assessment of rates of en bloc resection, R0 resection and adverse events (AEs). The secondary outcome was the rate of post-ER surgery and surgery for refractory IBD. En bloc resection was defined as excision of the targeted lesion in a single specimen. R0 resection was defined as resection with lateral and deep margins free of dysplasia/neoplasia on histopathology. Among AEs, we considered bleeding and perforation. Results A total of 67 visible lesions (64.18% non-polypoid, 53.73% left-side colon, median size 25 mm±20 mm, 65.67% neoplastic pit-pattern) in 67 patients with colonic IBD (56.72% male, median age 58 yrs±15 yrs, 68.66% ulcerative colitis, median disease duration 160 months±98 months, 58.21% active disease) were included. ESD, hESD, and EMR was performed in 20.9%, 6%, and 73.1% of cases. The final histopathological diagnoses after ER were inflammatory polyp in 32.84%, SSL in 8.96%, LGD in 40.30%, HGD in 13.42%, adenocarcinoma in 2.99%, and squamous cell carcinoma in 1.49% of cases. Excluding inflammatory polyps, en bloc resection was achieved in 14/14(100%), 3/4(75%), and 15/27(55%) lesions in case of ESD, hESD, and EMR (ESD+hESD vs EMR p<0.05). R0 resection was achieved in 12/14(86%), 3/4(75%), and 15/27(55%) lesions in case of ESD, hESD, and EMR (ESD+hESD vs EMR p=0.05). AEs occurred in 21% (2 bleedings and 1 perforation), 0%, and 3% (1 perforation) of patients treated by ESD, hESD and EMR (ESD+hESD vs EMR p=N.S.). Post-ER surgery rate was 21%, 25%, and 3% for patients treated by ESD, hESD, and EMR. Surgery for refractory IBD rate was 7%, 0%, and 18% for patients treated by ESD, hESD, and EMR. Conclusion Our findings showed that ER (including ESD, hESD, and EMR) of visible precancerous lesions performed in a tertiary center might be considered feasible, safe and effective in IBD patients, despite the presence of submucosal fibrosis. These data should be confirmed in a wider IBD population referring from different specialized Endoscopy Units.

P190 Delayed IBD diagnosis leads to worse outcomes over years, with multiple implications on service delivery

Abstract Background Delays in diagnosis can be patient and health-system related. Such delays have been reported to increase overall complications in Inflammatory Bowel Diseases (IBD). The aim of our study was to report on the impact of delays on IBD-related adverse outcomes (AOs), as hospitals currently face challenges with long waiting lists in the post-COVID-19 era. Methods New patients referred for suspected IBD to a single tertiary care centre between Jan 2013 to Dec 2017 were identified using EMR. A cut-off time was set for each delay-type based on best average hospital waiting times. Reasons for delays until start of treatment and data on pre-defined AOs (steroid & other rescue therapies, hospitalisations, surgery) were recorded for each patient until end of June 2021. Data was analysed using multiple Pearson correlations and Cox proportional Hazard model to determine if there was a difference in survival without AOs between patients with and without delay. Results 105 patients were identified using strict criteria (M=58; median age=32y) with a median follow-up of 55 months. The most frequent presenting complaints were abdominal pain (44, 41.9%), loose stools (40, 38.1%), bloody diarrhoea (37, 35.2%) and bleeding per-rectum (33, 31.4%). 65, 27 and 13 patients had a final diagnosis of Ulcerative colitis, Crohn’s disease and Unclassified colitis respectively, and were analysed jointly. The longest delay-types noted: patients seeking medical attention (median=4 months; range 1 to 84 months); arranging gastroenterology clinic review after GP referral (median=5 weeks; 1 to 30 weeks); and waiting for index endoscopy (median=3 weeks; 1 to 36 weeks). Patient stratification based on delay-type, using specific cut-off times for each showed a statistically significant difference in survival without AOs for all (when comparing delay vs no delay). - delay in seeking medical attention (cut-off=1m; p=0.004) (Fig 1A) - delay in GP referral to specialty review (cut-off=1w; p=0.048) - delay in index endoscopy (cut-off=4w; p=0.01) (Fig 1B) - delay in starting treatment (cut-off=4w; p=0.03) Fig 1A-Time to seek medical attention (survival without AOs; p=0.004) Fig 1B-Time from clinic review to index endoscopy (survival without AOs; p=0.01) Conclusion Several bottlenecks of delays increase AOs in IBD over the follow-up period. A delay as short as a week, between GP referral to specialty review, is significant in determining AOs, relevant for specialist IBD centres particularly in the post-Covid period. Endoscopy units should prioritise suspected IBD patients to reduce AOs, which is likely to have implications on service delivery and planning. Long delays observed in patients seeking medical attention highlights the need for better patient education in the community.

Impact of the COVID-19 pandemic in colorectal cancer diagnosis and presentation

Background and objectiveThe COVID-19 pandemic has been associated with a decrease in the colorectal cancer (CRC) incidence, due to the disruption of screening programmes and a downscaling of endoscopic activity. The endpoint of this study is to evaluate if the pandemic has led to a change in CRC diagnostic rate and presentation in our population. MethodsMulticenter retrospective study of all public hospitals of the Aragon region, attending a population of 1,329,391 inhabitants. We have analyzed all CRC cases detected and endoscopic units workload the year before the pandemic onset (1 March 2019–14 March 2020) and the first year of the COVID-19 pandemic (15 March 2020–28 February 2021). ResultsThe diagnosis of CRC cases dropped a 38.9% (888 pre-pandemic vs 542 pandemic cases). Also, there were 30.3% less colonoscopies performed (24,860 vs 17,337). During the pandemic, CRC cases were diagnosed in older patients (72.4±12.2 vs 71.2±12.1 years, p=0.021), and had more frequently severe complications at diagnosis (14.6% vs 10.4%, p=0.019). Moreover, most CRC cases were diagnosed in symptomatic patients (81.4%). No significant difference was found in CRC stage at diagnosis, although stage IV was more frequent (20.1% vs 16.1%). Most hospitals reported a lower workload of endoscopic activity. ConclusionCRC diagnostic rate was lower after the onset of the pandemic. CRC was diagnosed in older patients and was more frequently associated with complications. After the onset of the pandemic, the endoscopic units did not reach the workload performed previously.

Airborne transmission of SARS-Cov2: What consequences for digestive endoscopy?

The SARS-Cov-2 disease disrupted essential hospital procedures, such as gastrointestinal (GI) endoscopy, due to concerns about air transmission and the risk of exposing health care workers. With the spread of the pandemic, air transmission was considered as the main source of SARS-Cov2 transmission. This raised the problem of transmission by aerosolization of viral particles in operating rooms as well as endoscopy units. This is in line with the known airborne transmission of many other respiratory viruses. The risk of SARS-Cov-2 transmission during GI endoscopy was initially reduced by controlled measures, involving personal protections (mask…), restricted access to endoscopy rooms, and detection of infected patients. Gastrointestinal endoscopy generates aerosols, which may carry viruses. In addition, the endoscopy system may facilitate the diffusion of virus particles or fomites considering the forced-air cooling system used to maintain a stable temperature inside the box (25°C). The volume of air that goes through the light source box is high (240-300m3 for a 1-h period). Moreover, the light system contains an air pump to inflate air inside the gut lumen. In order to isolate people from hazard, different levels of protection and solutions to avoid airborne transmission of microorganisms should be proposed, such as the reinforcement of personal protective equipment, the change in the way people work and engineering control of the risk.

Effects of COVID-19 Pandemic and Post-Vaccination Period on Gastroenterology Practice in Turkey.

The sudden and intense burden due to the novel coronavirus (coronavirus disease 2019) pandemic has changed the priority of many health services. The highly contagious new variants and vaccination services have greatly impacted the daily practice of gastroenterologists. In the present study, we tried to evaluate the change in the daily practice of Turkish gastroenterologists in the coronavirus disease 2019 pandemic and the post-vaccination periods. A questionnaire was prepared using Google forms and sent online to 214 gastroenterologists registered with the Turkish Gastroenterology Association. Approximately half of the gastroenterologists moved their endoscopy unit or gastroenterology clinic to another location in the hospital during the pandemic and about one-third of the endoscopy units were completely closed. About 56% of the respondents reported the interruption of endoscopic procedures and inpatient services. In total, 85% of gastroenterologists thought that follow-up and treatment of chronic patients were disrupted due to patients obtaining their medicine directly from pharmacies. After the first case in Turkey, 74% of gastroenterologists worked in coronavirus disease 2019 patient care services, 28% of gastroenterologists were infected with coronavirus disease 2019, and 3% believed they had a cross-infected patient(s). A total of 78% of gastroenterologists reported that patient management became difficult due to the change in the priority of other departments, and 60% of gastroenterologists confirmed that they experienced a decrease in income. In the post-vaccination period, 70% of gastroenterologists returned to their pre-pandemic working schedule and 31% noticed an increase in endoscopic cancer detection. Prolongation of the pandemic has seriously damaged the practice of gastroenterology and multidisciplinary patient management.