2021–2022 The end of September 2021 was a very special time for me when Evangelos Xynos handed over his Presidency at the Annual Meeting of the European Society of Coloproctology (ESCP). The virtual nature of the meeting reminded us all that he and the Executive Board had steered the Society safely and successfully through turbulent times. The COVID pandemic, with its restrictions on in-person meeting, had imposed unprecedented challenges to our Society, whose focus had been its annual meeting. With the end of my 2021–2022 term as President, it is now time to share some reflections. It has been a very interesting journey, one full of novel experiences and new insights. Our Society's mission is to promote and advance the science and practice of coloproctology in Europe and beyond. Although over the years several research and educational activities have been launched at multiple occasions throughout the year, the main vehicle of engagement was the annual meeting. The COVID era threatened the fulfilment of the Society's mission. Even its economic viability could be prone to risk. The need for transformation of the classic model of a society centred around one annual meeting became obvious. The years 2019–2020 and 2020–2021 were more about amelioration of the immediate consequences of COVID; the period since September 2021 has been focused on how to position the Society in a changing environment with different needs and demands. While addressing easy access to high quality information, the Society must also take into account changing expectations and attitudes of its members (e.g., a broadened acceptance of online learning, an increasingly competitive field of educational offerings, a growing awareness of the environmental consequences of air travel, and an increased desire to address and fulfil the principle of diversity). This all took place in a time of high uncertainty: COVID'S course remained (and remains) unpredictable. The only certainty is that the evolution of events will lead to something new, something different from what we were used to, something to which we have to adapt and learn to understand. The terrible Ukraine war, collectively deeply concerning and appalling the Trustees and Executive Board, has added to the level of uncertainty. The ESCP is multinational and multicultural, united by each member's common interest in the field of coloproctology. It is inclusive and diverse, a home to a network of experts and learners, and strives for easy and broad access to the highest-quality content. Over the last year these assets were evidenced in multiple activities clearly aiming to transform ESCP into one of the leading platforms of knowledge exchange and multinational research in our field of coloproctology and to reach beyond the boundaries reflected by our ‘European’ designation. Ongoing activities were accelerated, others initiated. In the end, the collective effort, expertise and experience of our active members contributed to considerable progress in diversifying the offers of the Society by multiple activities and an impressive output of the ESCP committees (Communication, Education, Guidelines, Membership, Programme, Research) and the programme of our annual meeting. The Communication Committee's role is central to the ESCP. With cross-representation from every other committee, it is instrumental not only in disseminating their content but also in generating a crucial connection with external partners in publishing and in producing highly relevant contemporary content. It was very active throughout the year: #operationequalaccess, launched in June, had 55 494 video impressions, 144 posts, 862 774 impressions; and a new platform on WeChat was created. The social media subcommittee (SoMe) was strengthened: they commissioned a new member app; they presented the ESCP Collecting Opinions on Sustainable Surgery global survey at ESCP 2021, Association of Surgeons of Great Britain and Ireland (ASGBI) 2022, Association of Coloproctology of Great Britain and Ireland 2022; and further publicized the survey in an ASGBI webinar on Diversity and Inclusion. A constant increase of followers on Twitter and Instagram is a testament to the success of the Communication Committee. In an environment heavily based on communication, its future importance to ESCP cannot be overstated. Under the Education Committee's umbrella multiple activities took place throughout the year, all aiming to enhance the Society's offerings in education and training: fellowships, masterclasses, hands-on courses, activities of the European School of Coloproctology (ESC) and the contribution of an ‘educational stream’ to the annual meeting. Because of the pandemic the number of fellowships, masterclasses and hands-on courses had to be reduced. Six fellowships for robotics and two for function and the pelvic floor were awarded; new host centres for observerships, fellowships and skill based observerships were recruited. In line with our global outreach, these are not only within Europe. ESCP-sponsored fellowships were suspended but will resume in the coming years. By the end of 2022, in 10 years the impressive number of 97 trainees from 36 different countries will have had the opportunity to be hosted as fellows in 42 institutions in 14 countries. The Education Committee has started collaborating with overseas organizations to ensure fellowships and observerships for European fellows in the USA and the Australasian region. These additions will certainly add to the success of the programme. COVID also had a negative impact on the masterclasses. Only one, the 10th ESCP Regional (Winter) Masterclass, ‘Anal Cancer: from Dysplasia to Invasive Cancer’, took place in Paris in conjunction with the Annual Meeting of the Société Française de ColoProctologie and was run in a hybrid format in November 2021. The new format of a ‘beyond Europe masterclass’ was introduced, with the first one in Cairo, the 1st ESCP Beyond Europe Masterclass ‘Colorectal Surgery for a Modern Age’ in conjunction with the Annual Conference of the Egyptian Society of Colon and Rectal Surgeons in August 2022. Hands-on courses were limited to a successful course on transanal minimally invasive surgery in November 2021. Its new hybrid format, with a centralized theoretical part and a practical part taking place at various locations in Europe, helped to overcome some of the COVID restrictions. This also signalled a potential means to increase outreach by adopting new modes of content delivery. The ESC delivered a series of webinars on robotic colorectal surgery: ‘Implementation of a colorectal robotic programme: recipe for success’, November 2021; ‘Colorectal Robotic Grand Round: Interactive Forum’, December 2021; ‘An update on inflammatory bowel disease and the role of robots’, April 2022; ‘Staying out of trouble—non-technical skills in robotic surgery’, June 2022; a series of three webinars focused on rectopexy ‘The three I's: indications, investigations, intervention’, July 2022; ‘Ins and outs of ventral mesh rectopexy, how to do it?’, August 2022; ‘Avoiding problems’, September 2022; and in collaboration with the European Hereditary Tumour Group (EHTG) the ‘Microsatellite instability: what every surgeon needs to know, but never dared to ask’ webinar took place in July 2022. All were well attended, not only by Europeans but by a worldwide audience as well. The long-awaited modular training programme for robotic colorectal surgery was launched, and the first trainees were included in February 2022. As the first training programme independently developed by a surgical society and supported by a grant from the Intuitive Foundation, it represents a paradigm shift in how novel technology is taught and implemented. Further new educational offerings under the ESC, such as ‘Operating Days’ with elements of both remote access and interactivity, are on their way. The resource library of the ESCP, which offers exhaustive information covering the entire spectrum of coloproctology, continues to be updated and expanded regularly—as in past years. ‘ESCP Essentials’, a video series on anal fistula treatment, was popular and is available on the ESCP website. The collaboration with CREST (run by the American Society of Colon and Rectal Surgeons, ASCRS) has now ceased. However, a collaboration with the ASCRS-U, the new state-of-the-art ASCRS education programme with a contemporary easy-to-use platform, is being explored with the purpose of making it available to all ESCP members. The traditionally strong link with the European Union of Medical Specialists (UEMS) European Board of Surgical Qualification continues. A hybrid examination ensured that candidates were able to sit the examination in March 2022 at a convenient location, with the viva-based sections via teleconferencing: 84% of 25 candidates from 11 countries examined by 18 examiners from six countries received the diploma. The examination is now established as the norm for the young generation of colorectal surgeons to certify their specialization. With the increased relevance and popularity of the diploma, a growing number of senior role models are also taking the examination—underscoring the importance of this European Certification. The Guidelines Committee continued its impressive output with great drive. It intensified its collaborative activities with other committees in the ESCP and with multiple international societies, for example United European Gastroenterology (UEG), European Association for Endoscopic Surgery (EAES), European Society of Neurogastroenterology and Motility (ESNM), European Society for Primary Care Gastroenterology (ESPCG), EHTG, European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA), European Association for Gastroenterology, Endoscopy and Nutrition (EAGEN), European Society of Gastrointestinal and Abdominal Radiology (ESGAR). Two webinars, ‘Mesh in the pelvis’, January 2022, and ‘UEG webinar faecal incontinence’, January 2022, were well attended. Two guidelines were completed and published in 2021–2022: the Joint European Clinical Practice Guideline for Faecal Incontinence UEG, ESNM, ESPCG and ESCP (supported by a UEG grant); and the European Society of Coloproctology Guidance on the Use of Mesh in the Pelvis in Colorectal Surgery. Work is in progress for the Guideline on the Diagnosis and Treatment of Cryptoglandular Perianal Fistula, Robotic Guidelines, Familial Adenomatous Polyposis (FAP) Guideline (collaboration EHTG-ESCP) and Social Media Guideline. All are to be presented at the ESCP Annual Meeting in Dublin. Further guidelines are being conceptualized and developed, and funding has been secured: Surgical Site Infection Guideline (a collaboration between ESCP, EAES and UEG; financially supported by the UEG grant) and Pilonidal Sinus (supported by the British Journal of Surgery). Grant applications have been submitted for the T1 Colorectal Cancer Guideline, How to Develop Clinical Guidelines: Planning, Realization, Implementation (ESCP, EAES, UEG collaboration) and Obstructed Defaecation Syndrome (joint ESGENA, UEG, EAGEN and ESGAR guideline). Membership stabilized with a slight increase since 2021. However, the negative impact of the COVID pandemic is not yet fully resolved. There is hope that, with the return to an in-person annual meeting and with the year-round offers of various activities, the membership will recover to pre-COVID levels. After approval by the AGM, new membership types and rates will be established beginning in October 2022. To facilitate access of global members to ESCP, the concept of national block membership was developed by the Membership Committee together with the Global Reach Working Group and several countries have agreed. Despite considerable uncertainty at the time, the decision to host the annual meeting as primarily face-to-face was taken in spring 2022. A virtual component was added to allow participation of a broader audience unable to travel to Dublin and to provide a backup option in the case of an unavoidable cancellation. Venue and cost constraints required a restructuring for this first ESCP hybrid meeting; the Programme Committee redesigned the programme structure. It now offers four parallel sessions. New formats aim to increase audience and participant engagement. Opportunities for abstract and video presentations are substantially increased. Significant effort has been made to improve gender balance. The committees on programme, education, research, guidelines and Young-ESCP, in addition to associated societies (European Crohn's and Colitis Organisation [ECCO], EAES), have contributed to the content. Workshops (Endoanal ultrasound, OASIS, Training village) add to the programme. To further develop and improve our annual meeting in the coming years, the acceptance and success of the implemented changes will be monitored and adapted accordingly. The Research Committee, one of the most diverse in the ESCP, continued to offer a broad and impressive portfolio of options for active engagement: clinical trials, cohort studies, snapshots. Over the years this approach has increased awareness of the ESCP, attracted new members, and created strong links with industry partners interested in targeting specific issues. The work of the Research Committee has been instrumental in increasing ESCP's footprint—globally also. Strong links with the Global Reach subgroup have created productive synergies. After a period of challenges owing to COVID, several activities regained strong momentum: the first global randomized controlled trial ‘EAGLE’ (ESCP Safe Anastomosis Programme in Colorectal Surgery), which already included more than 3000 patients from 371 hospitals in 67 countries, is expanding and establishing new networks in South America. The DAMASCuS study on diverticular disease, including 628 patients from 43 centres, is close to publication; its 2-year follow-up is now financially secured; and a follow-up study (East of DAMASCuS) is planned to improve our understanding of the differences between predominantly right- and left-sided diverticular disease. The MASC (Management of Acute Severe Ulcerative Colitis) study, including 699 patients from 32 countries, is close to submission for publication. Two robotic cohort studies (RESET and MIRCAST) are also back on track. The prospective PROPHER study aiming to gain insight into the current management of parastomal hernia and introducing a digital data acquisition platform for patient-reported longitudinal outcome has been launched. A new global snapshot audit addressing issues around the diagnosis and treatment of faecal incontinence will commence later this year. The output of the Research Committee remains an impressive manifestation that the ESCP network and the methodologies developed and established by this committee over the years offer unique opportunities for those interested in the field of coloproctology—nationally, multinationally, globally. The Global Reach subgroup, closely linked to the Research Committee, will be formally recognized as a committee in 2022 when after a prolonged process the new rules of our Society will be ratified. Multiple contributions of this subgroup aim to publicize research and educational activities, establish worldwide partnerships, widen the outreach of ESCP, and spark the interest and engagement of funding partners. The Global Symposium has been established for the annual meeting, now with easy virtual access. The Global Reach subgroup was key in the recruitment for the EAGLE trial and its expansion to South America, as well as in the launch of the above mentioned DAMASCuS study. Over the last year they delivered three webinars (Bridging Global Research and Practice, December 2021; Developments in Care for Colorectal Cancer, March 2022; Global Challenges in Proctology, June 2022) and chose an innovative mode of presentation adapted to different time zones to allow convenient access in different continents. As mentioned above, together with the membership committee a block membership model has been developed for countries outside Europe. All these efforts are very much appreciated, not only by the ESCP but also by our global colleagues and partners. Young-ESCP is often considered to represent the future of our Society but is already today an integral, innovative and vibrant part. At least one member of the Young-ESCP is actively involved in each committee. The SoMe Working Group (subcommittee of the ESCP Communication Committee) is entirely composed of Young-ESCP members and, with its global members, serves as another role model for inclusivity and diversity. Young-ESCP SoMe installed well-established social media outlets, managed by the young members (Twitter: @YouESCP Instagram: @escp_insta). Using a broad spectrum of channels to disseminate information, they have worked on campaigns such as that to raise concern about equal access to surgery. Young-ESCP activities reach beyond the boundaries of the ESCP: some SoMe members are on the editorial board of Colorectal Disease, mutually benefitting the ESCP and its official journal. Collaboration and interaction with other young groups of international scientific societies are considered vital by Young-ESCP. An example is the fruitful interaction with the UEG Society, and in particular with its Friends of Young Talent group. Congratulations go to Gianluca Pellino, Chair of the Young-ESCP, who has been awarded the UEG Rising Star 2021. The recognition of Young-ESCP as an official Committee of the ESCP, reflecting its importance, will finally happen in 2022 with the ratification of the new rules of our Society. With the increasing number of in-person meetings after a long 2 years, the established external relationships and traditions with other societies were revitalized during my term: for example, reciprocal invitations were extended to the ESCP and ASCRS presidents to each society's annual meeting; Korean Society of Coloproctology/Japan Society of Coloproctology and ASCRS travelling fellowships recommenced and were awarded as previously agreed; and ECCO and EAES are represented with a symposium at our annual meeting. The collaboration with UEG was intensified, especially by projects driven by the Guidelines Committee, which also pushed to connect with other societies. ESCP members were represented on various committees of the UEG. New connections were built, such as ESCP's joining the initiative European Cancer Organisation/American Society of Clinical Oncology special network on the impact of the war in Ukraine on cancer. Existing relations were redefined: after years as one member of the European branch of the Tripartite group, ESCP became a full individual partner of the group's members—the American Society of Colon and Rectal Surgeons, the Association of Coloproctology of Great Britain and Ireland, the Royal Australasian College of Surgeons Colon and Rectal Surgery, and the Section of Coloproctology Royal Society and Medicine. ESCP will host the Tripartite meeting in Paris in conjunction with its own annual meeting in September 2025. Colorectal Disease, under the renewed leadership of Editor-in-Chief Neil Smart, currently remains the official journal of the ESCP. Its 2-year impact factor increased to 3.917 for 2021. The investment of our industry partners throughout the year in research and training programmes designed, developed and delivered by our Society and their support at our annual meeting is acknowledged with deep appreciation. We are especially fortunate to have partners who not only trust our expertise with established modes but who also share our vision for the new and promising (the EAGLE study and the robotic training programme being the most prominent examples to date). By listening to and learning from each other, the working relationship with our secretariat and PCO MCI Group grew over the year, even with all the COVID challenges and the demands arising from our efforts not only to recover to the pre-COVID business level but also to restructure and grow our Society. I wish to thank all who were and are involved in the Society. Their dedication, enthusiasm and knowledge have made the Society what it represents today. Those contributing to the various committees and functions are too numerous to be mentioned individually here (please see www.escp.eu.com). Instead, I wish to thank those Executive Members who, as Chairs, represent their committees (including their working groups) and the other Executive Board members. All have been instrumental in the constructive development of our Society over my year as President: Eloy Espin Basany (President Elect), Richard Brady and Erman Aytac (Chair and Assistant Chair, Communication Committee), Stephanie Breukink (Chair, Guidelines Committee), Charles Knowles and Tom Pickney (Chair and Assistant Chair, Research Committee), Gabriela Möslein (Chair, Programme Committee), Dion Morton and Simon Ng (Co-Chairs, Global Reach Subgroup), Gianluca Pellino (Chair, Young-ESCP), Roland Scherer and Frederic Ris (Chair and Assistant Chair, Membership Committee), Baljit Singh (Journal Representative), Janindra Wasrusavitarne (Chair, Education Committee), Evangelos Xynos (Immediate Past President), David Zimmerman (UEMS Representative), Oded Zmora (President in Waiting). Special thanks go to Miguel Pera (Treasurer) for his mindful, insightful and prudent handling of the finances in exceptional times and to Antonino Spinelli (Secretary) for his remarkable efforts to coordinate what has evolved to be a complex, multilayered organization. My successor Eloy Espin Basany and this great team with the administrative support of the MCI Group will lead the Society into an exciting year full of new developments and offers to our members, reflecting the spirit of our Society as an open and inclusive place to engage. It has been a great honour to have served the members of ESCP as President for this past year.
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