Publications by authors named "Siwan Thomas-Gibson"

85 Publications

When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement.

Clin Gastroenterol Hepatol 2021 May 22;19(5):1038-1050. Epub 2021 Jan 22.

Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain. Electronic address:

Background & Aims: There is a lack of clinical studies to establish indications and methodology for tattooing, therefore technique and practice of tattooing is very variable. We aimed to establish a consensus on the indications and appropriate techniques for colonic tattoo through a modified Delphi process.

Methods: The baseline questionnaire was classified into 3 areas: where tattooing should not be used (1 domain, 6 questions), where tattooing should be used (4 domains, 20 questions), and how to perform tattooing (1 domain 20 questions). A total of 29 experts participated in the 3 rounds of the Delphi process.

Results: A total of 15 statements were approved. The statements that achieved the highest agreement were as follows: tattooing should always be used after endoscopic resection of a lesion with suspicion of submucosal invasion (agreement score, 4.59; degree of consensus, 97%). For a colorectal lesion that is left in situ but considered suitable for endoscopic resection, tattooing may be used if the lesion is considered difficult to detect at a subsequent endoscopy (agreement score, 4.62; degree of consensus, 100%). A tattoo should never be injected directly into or underneath a lesion that might be removed endoscopically at a later point in time (agreement score, 4.79; degree of consensus, 97%). Details of the tattoo injection should be stated clearly in the endoscopy report (agreement score, 4.76; degree of consensus, 100%).

Conclusions: This expert consensus has developed different statements about where tattooing should not be used, when it should be used, and how that should be done.
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http://dx.doi.org/10.1016/j.cgh.2021.01.024DOI Listing
May 2021

Management of inflammatory bowel disease associated colonic dysplasia: factors predictive of patient choice and satisfaction.

Colorectal Dis 2021 Apr 19;23(4):882-893. Epub 2020 Dec 19.

Imperial College London, London, UK.

Aim: In cases of prognostic uncertainty and equipoise as to the best management (prophylactic colectomy vs. surveillance) for dysplasia in inflammatory bowel disease (IBD), individualized discussion with the patient is required. Further understanding of patients' preferences is needed.

Methods: A nationwide cross-sectional survey was distributed to adult IBD patients who had never been diagnosed with dysplasia (dysplasia-naïve) and those who had (dysplasia-experienced). Risk perceptions and factors that influence management choices were explored.

Results: There were 123 respondents. A substantial proportion (29%) of the dysplasia-experienced respondents did not feel well informed about the associated cancer risk and/or its management by their clinical team. Contributing themes included contradictory advice and lack of personalized information regarding their cancer risk, alternative management options and impact on long-term quality of life. Decisional regret and health-related quality of life amongst those who chose either surveillance or surgery were comparable, but cancer-related worry scores were elevated in the surveillance group. The dysplasia-naïve respondents reported that they would only consider having a prophylactic colectomy if they had on average a 50% or even higher risk of developing cancer. On multivariable logistic regression analyses, predictors of colectomy or surveillance preference included ethnicity, personality traits such as health locus of control (whether health status is influenced by luck) and differences in perception of what a low risk of cancer is.

Conclusions: This study identifies predictive factors that can influence decision-making and satisfaction with the counselling process when IBD dysplasia is diagnosed. Further qualitative exploration of cultural themes would be informative.
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http://dx.doi.org/10.1111/codi.15460DOI Listing
April 2021

Feedback interventions in colonoscopy: Good, but can we do better?

Gastrointest Endosc 2020 11;92(5):1041-1043

Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK.

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http://dx.doi.org/10.1016/j.gie.2020.06.044DOI Listing
November 2020

Endoscopic full thickness resection in the colo-rectum: outcomes from the UK Registry.

Eur J Gastroenterol Hepatol 2021 Jun;33(6):852-858

Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust.

Background: Endoscopic full-thickness resection (eFTR) of the colon using the full-thickness resection device (FTRD) is a novel method for removing lesions involving, or tethered to, deeper layers of the colonic wall. The UK FTRD Registry collected data from multiple centres performing this procedure. We describe the technical feasibility, safety and early outcomes of this technique in the UK.

Methods: Data were collected and analysed on 68 patients who underwent eFTR at 11 UK centres from April 2015 to June 2019. Outcome measures were technical success, procedural time, specimen size, R0 resection, endoscopic clearance, and adverse events. Reported technical difficulties were collated.

Results: Indications for eFTR included non-lifting polyps (29 cases), T1 tumour resection (13), subepithelial tumour (9), and polyps at the appendix base or diverticulum (17). Target lesion resection was achieved in 60/68 (88.2%). Median specimen size was 21.7 mm (10-35 mm). Histologically confirmed R0 resection was achieved in 43/56 (76.8%) with full-thickness resection in 52/56 (92.9%). Technical difficulties occurred in 17/68 (25%) and complications in 3/68 (5.9%) patients.

Conclusion: eFTR is a useful technique with a high success rate in treating lesions not previously amenable to endoscopic therapy. Whilst technical difficulties may arise, complication rates are low and outcomes are acceptable, making eFTR a viable alternative to surgery for some specific lesions.
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http://dx.doi.org/10.1097/MEG.0000000000001987DOI Listing
June 2021

Diagnostic ileocolonoscopy: getting the basics right.

Frontline Gastroenterol 2020 Oct 27;11(6):484-490. Epub 2020 Mar 27.

Wolfson Endoscopy Unit, St Marks Hospital, Harrow, UK.

Proficient colonoscopy technique that optimises patient comfort while simultaneously enhancing the timely detection of pathology and subsequent therapy is an aspirational and achievable goal for every endoscopist. This article aims to provide strategies to improve colonoscopy quality for both endoscopists and patients.
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http://dx.doi.org/10.1136/flgastro-2019-101266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569527PMC
October 2020

Lower gastrointestinal polypectomy competencies in the United Kingdom: a retrospective analysis of Directly Observed Polypectomy Skills (DOPyS).

Endoscopy 2020 Aug 6. Epub 2020 Aug 6.

The Wolfson Unit of Endoscopy, St Mark's Hospital and Academic Institute, Harrow, London, UK.

Background:  Polypectomy is often the most hazardous part of colonoscopy. There is significant variability in polypectomy training and assessment internationally. DOPyS (Directly Observed Polypectomy Skills) is a validated assessment tool and is used to demonstrate polypectomy competency in the UK. This study aimed to describe the learning curve for polypectomy competency in UK trainees.

Methods:  Retrospective DOPyS data (January 2009 to September 2015) were obtained from the UK Joint Advisory Group (JAG) for intestinal endoscopy training system (JETS) national database. The number of lower gastrointestinal (LGI) procedures, overall cecal intubation rate (CIR), procedure intensity, and time in days to the first DOPyS assessment were recorded, and time to JAG certification was calculated.

Results:  4965 DOPyS assessments from 336 trainees were analyzed. Within the study period, 124 and 53 trainees achieved provisional and full colonoscopy certification, respectively. Trainees started formative assessment of polypectomy after > 130 LGI procedures and with a CIR of > 70 %. Within 3 years from the first DOPyS assessment, 94 % of trainees achieved provisional certification, and 50 % full certification. Higher procedure intensity at baseline DOPyS assessment was associated with a higher likelihood of obtaining certification sooner.

Conclusion:  There is a significant variation in time to competency, and this potentially reflects the time necessary to acquire polypectomy skills. There is a need to start polypectomy training earlier, once sufficient skills, such as tip control, have been achieved to shorten the time to competency. Overall, the CIR could be used as a guide for such technical skills. Increasing exposure to training lists also potentially reduces the time to polypectomy competency.
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http://dx.doi.org/10.1055/a-1234-8233DOI Listing
August 2020

Teamworking in endoscopy: a human factors toolkit for the COVID-19 era.

Endoscopy 2020 10 22;52(10):879-883. Epub 2020 Jun 22.

Department of Surgery and Cancer, Imperial College London, United Kingdom.

Background: Endoscopy services have had to rapidly adapt their working practices in response to COVID-19. As recovery of endoscopy services proceeds, our workforce faces numerous challenges that can impair effective teamworking. We designed and developed a novel toolkit to support teamworking in endoscopy during the pandemic.

Methods: A human factors model was developed to understand the impact of COVID-19 on endoscopy teams. From this, we identified a set of key teamworking goals, which informed the development of a toolkit to support several team processes. The toolkit was refined following expert input and refinement over a 6-week period.

Results: The toolkit consists of four cognitive aids that can be used to support team huddles, briefings, and debriefs, alongside techniques to optimize endoscopic nontechnical skills across the patient-procedure pathway. We describe the processes that local endoscopy units can employ to implement this toolkit.

Conclusion: A toolkit of cognitive aids, based on human factors principles, may be useful in supporting teams, helping them adapt to working safely in the era of COVID-19.
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http://dx.doi.org/10.1055/a-1204-5212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516366PMC
October 2020

Systematic review with meta-analysis: IBD-associated colonic dysplasia prognosis in the videoendoscopic era (1990 to present).

Aliment Pharmacol Ther 2020 07 20;52(1):5-19. Epub 2020 May 20.

St Mark's Hospital, Harrow, UK.

Introduction: The prognosis of dysplasia in patients with IBD is largely determined from observational studies from the pre-videoendoscopic era (pre-1990s) that does not reflect recent advances in endoscopic imaging and resection.

Aims: To better understand the risk of synchronous colorectal cancer and metachronous advanced neoplasia (ie high-grade dysplasia or cancer) associated with dysplasia diagnosed in the videoendoscopic era, and to stratify risk according to a lesion's morphology, endoscopic resection status or whether it was incidentally detected on biopsy of macroscopically normal colonic mucosa (ie invisible).

Methods: A systematic search of original articles published between 1990 and February 2020 was performed. Eligible studies reported on incidence of advanced neoplasia at follow-up colectomy or colonoscopy for IBD-dysplasia patients. Quantitative and qualitative analyses were performed.

Results: Thirty-three studies were eligible for qualitative analysis (five for the meta-analysis). Pooled estimated proportions of incidental synchronous cancers found at colectomy performed for a pre-operative diagnosis of visible high-grade dysplasia, invisible high-grade dysplasia, visible low-grade dysplasia and invisible low-grade dysplasia were 13.7% (95% CI 0.0-54.1), 11.4% (95% CI 4.6-20.3), 2.7% (95% CI 0.0-7.1) and 2.4% (95% CI 0.0-8.5) respectively. The lowest incidences of metachronous advanced neoplasia, for dysplasia not managed with immediate colectomy but followed up with surveillance, tended to be reported by the studies where high definition imaging and/or chromoendoscopy was used and endoscopic resection of visible dysplasia was histologically confirmed.

Conclusions: The prognosis of IBD-dysplasia diagnosed in the videoendoscopic era appears to have been improved but the quality of evidence remains low. Larger, prospective studies are needed to guide management. PROSPERO registration no: CRD42019105736.
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http://dx.doi.org/10.1111/apt.15778DOI Listing
July 2020

Curriculum review: serrated lesions of the colorectum.

Frontline Gastroenterol 2020 5;11(3):243-248. Epub 2019 Jun 5.

Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK.

Colorectal cancer (CRC) is the second leading cause of death from cancer in the UK. Sporadic CRC evolves by the cumulative effect of genetic and epigenetic alterations. Typically, over the course of several years, this leads to the transformation of normal colonic epithelium to benign adenomatous polyp, low-grade to high-grade dysplasia and finally cancer-the adenoma-carcinoma sequence. Over the last decade, the serrated neoplasia pathway which progresses by methylation of tumour suppressing genes has been increasingly recognised as an important alternative pathway accounting for up to 30% of CRC cases. Endoscopists should be aware of the unique features of serrated lesions so that their early detection, appropriate resection and surveillance interval can be optimised.
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http://dx.doi.org/10.1136/flgastro-2018-101153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223468PMC
June 2019

Ring-fitted caps: A welcome addition to the endoscopist's tool belt?

Gastrointest Endosc 2020 01;91(1):121-123

Wolfson Unit for Endoscopy, St Mark's Hospital, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK.

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http://dx.doi.org/10.1016/j.gie.2019.08.030DOI Listing
January 2020

Post-colonoscopy colorectal cancer: patients can be reassured that UK endoscopy is already engaged in quality assessment and continual improvement.

BMJ 2019 12 10;367:l6910. Epub 2019 Dec 10.

Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London NW1 4LE, UK.

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http://dx.doi.org/10.1136/bmj.l6910DOI Listing
December 2019

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines.

Gut 2020 02 27;69(2):201-223. Epub 2019 Nov 27.

Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.

These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped? two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); five or more premalignant polyps The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG's guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); five or more premalignant polyps The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise :two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); five or more premalignant polyps This cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.
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http://dx.doi.org/10.1136/gutjnl-2019-319858DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984062PMC
February 2020

National survey of UK endoscopists showing variation in diathermy practice for colonic polypectomy: a JAG perspective.

Frontline Gastroenterol 2019 Oct 9;10(4):444-445. Epub 2019 Jan 9.

Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, London, UK.

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http://dx.doi.org/10.1136/flgastro-2018-101133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788133PMC
October 2019

Impact of the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) on endoscopy services in the UK and beyond.

Frontline Gastroenterol 2019 Apr 13;10(2):93-106. Epub 2018 Nov 13.

Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.

The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) was initially established in 1994 to standardise endoscopy training across specialties. Over the last two decades, the position of JAG has evolved to meet its current role of quality assuring all aspects of endoscopy in the UK to provide the highest quality, patient-centred care. Drivers such as changes to healthcare agenda, national audits, advances in research and technology and the advent of population-based cancer screening have underpinned this shift in priority. Over this period, JAG has spearheaded various quality assurance initiatives with support from national stakeholders. These have led to the achievement of notable milestones in endoscopy quality assurance, particularly in the three major areas of: (1) endoscopy training, (2) accreditation of endoscopy services (including the Global Rating Scale), and (3) accreditation of screening endoscopists. These developments have changed the landscape of UK practice, serving as a model to promote excellence in endoscopy. This review provides a summary of JAG initiatives and assesses the impact of JAG on training and endoscopy services within the UK and beyond.
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http://dx.doi.org/10.1136/flgastro-2018-100969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540274PMC
April 2019

Improving safety and reducing error in endoscopy: simulation training in human factors.

Frontline Gastroenterol 2019 Apr 9;10(2):160-166. Epub 2019 Jan 9.

Department of Gastroenterology, Homerton University Hospital, London, UK.

Patient safety incidents occur throughout healthcare and early reports have exposed how deficiencies in 'human factors' have contributed to mortality in endoscopy. Recognising this, in the UK, the Joint Advisory Group for Gastrointestinal Endoscopy have implemented a number of initiatives including the 'Improving Safety and Reducing Error in Endoscopy' (ISREE) strategy. Within this, simulation training in human factors and Endoscopic Non-Technical Skills (ENTS) is being developed. Across healthcare, simulation training has been shown to improve team skills and patient outcomes. Although the literature is sparse, integrated and in situ simulation modalities have shown promise in endoscopy. Outcomes demonstrate improved individual and team performance and development of skills that aid clinical practice. Additionally, the use of simulation training to detect latent errors in the working environment is of significant value in reducing error and preventing harm. Implementation of simulation training at local and regional levels can be successfully achieved with collaboration between organisational, educational and clinical leads. Nationally, simulation strategies are a key aspect of the ISREE strategy to improve ENTS training. These may include integration of simulation into current training or development of novel simulation-based curricula. However used, it is evident that simulation training is an important tool in developing safer endoscopy.
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http://dx.doi.org/10.1136/flgastro-2018-101078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540271PMC
April 2019

Deep sedation and anaesthesia in complex gastrointestinal endoscopy: a joint position statement endorsed by the British Society of Gastroenterology (BSG), Joint Advisory Group (JAG) and Royal College of Anaesthetists (RCoA).

Frontline Gastroenterol 2019 Apr 9;10(2):141-147. Epub 2019 Jan 9.

Department of Gastroenterology, University College London Hospital NHS Foundation Trust, London, UK.

In the UK, more than 2.5 million endoscopic procedures are carried out each year. Most are performed under conscious sedation with benzodiazepines and opioids administered by the endoscopist. However, in prolonged and complex procedures, this form of sedation may provide inadequate patient comfort or result in oversedation. As a result, this may have a negative impact on procedural success and patient outcome. In addition, there have been safety concerns on the high doses of benzodiazepines and opioids used particularly in prolonged and complex procedures such as endoscopic retrograde cholangiopancreatography. Diagnostic and therapeutic endoscopy has evolved rapidly over the past 5 years with advances in technical skills and equipment allowing interventions and procedural capabilities that are moving closer to minimally invasive endoscopic surgery. It is vital that safe and appropriate sedation practices follow the inevitable expansion of this portfolio to accommodate safe and high-quality clinical outcomes. This position statement outlines the current use of sedation in the UK and highlights the role for anaesthetist-led deep sedation practice with a focus on propofol sedation although the choice of sedative or anaesthetic agent is ultimately the choice of the anaesthetist. It outlines the indication for deep sedation and anaesthesia, patient selection and assessment and procedural details. It considers the setup for a deep sedation and anaesthesia list, including the equipment required, the environment, staffing and monitoring requirements. Considerations for different endoscopic procedures in both emergency and elective setting are also detailed. The role for training, audit, compliance and future developments are discussed.
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http://dx.doi.org/10.1136/flgastro-2018-101145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540268PMC
April 2019

Patient position change in colonoscopy: Dogmatic or pragmatic?

Gastrointest Endosc 2019 06;89(6):1202-1203

The Wolfson Unit for Endoscopy, St. Mark's Hospital, London, Untied Kingdom.

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http://dx.doi.org/10.1016/j.gie.2019.02.029DOI Listing
June 2019

Certification of UK gastrointestinal endoscopists and variations between trainee specialties: results from the JETS e-portfolio.

Endosc Int Open 2019 Apr 4;7(4):E551-E560. Epub 2019 Apr 4.

Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.

In the UK, endoscopy certification is administered by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG). Since 2011, certification for upper and lower gastrointestinal endoscopy has been awarded via a national (JETS) e-portfolio to the main training specialties of: gastroenterology, gastrointestinal surgeons (GS) and non-medical endoscopists (NME). Trends in endoscopy certification and differences between trainee specialties were analyzed. This prospective UK-wide observational study identified trainees awarded gastroscopy, sigmoidoscopy, colonoscopy (provisional and full) certification between June 2011 - 2017. Trends in certification, procedures and time-to-certification, and key performance indicators (KPIs) in the 3-month pre- and post-certification period were compared between the three main training specialties. Three thousand one hundred fifty-seven endoscopy-related certifications were awarded to 1928 trainees from gastroenterology (52.3 %), GS (28.4 %) and NME (16.5  %) specialties. During the study period, certification numbers increased for all modalities and specialties, particularly NME trainees. For gastroscopy and colonoscopy, procedures-to-certification were lowest for GS (  < 0.001), whereas time-to-certification was consistently shortest in NMEs (  < 0.001). A post-certification reduction in mean cecal intubation rate (95.2 % to 93.8 %,  < 0.001) was observed in colonoscopy, and D2 intubation (97.6 % to 96.2 %,  < 0.001) and J-maneuver (97.3 % to 95.8 %,  < 0.001) in gastroscopy. Overall, average pre- and post-certification KPIs still exceeded national minimum standards. There was an increase in PDR for NMEs after provisional colonoscopy certification but a decrease in PDR for GS trainees after sigmoidoscopy and full colonoscopy certification. Despite variations among trainee specialties, average pre- and post-certification KPIs for certified trainees met national standards, suggesting that JAG certification is a transparent benchmark which adequately safeguards competency in endoscopy training.
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http://dx.doi.org/10.1055/a-0839-4476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6449159PMC
April 2019

Optimum colonoscopy withdrawal: Is time everything?

Gastrointest Endosc 2019 03;89(3):531-532

Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, United Kingdom.

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http://dx.doi.org/10.1016/j.gie.2018.10.045DOI Listing
March 2019

Results of the British Society of Gastroenterology supporting women in gastroenterology mentoring scheme pilot.

Frontline Gastroenterol 2019 Jan 4;10(1):50-55. Epub 2018 Aug 4.

Department of Gastroenterology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.

Introduction: Mentorship has long been recognised as beneficial in the business world and has more recently been endorsed by medical and academic professional bodies. Recruitment of women into gastroenterology and leadership roles has traditionally been difficult. The Supporting Women in Gastroenterology network developed this pilot scheme for female gastroenterologists 5 years either side of the Completion Certificate of Specialist Training (CCST) to examine the role that mentorship could play in improving this discrepancy.

Method: Female gastroenterology trainees and consultant gastroenterologists within 5 years either side of CCST were invited to participate as mentees. Consultant gastroenterologists of both genders were invited to become mentors. 35 pairs of mentor:mentees were matched and completed the scheme over 1 year. Training was provided.

Results: The majority of the mentees found the sessions useful (82%) and enjoyable (77%), with the benefit of having time and space to discuss professional or personal challenges with a gastroenterologist who is not a colleague. In the longitudinal study of job satisfaction, work engagement, burnout, resilience, self-efficacy, self-compassion and work-life balance, burnout scale showed a small but non significant improvement over the year (probably an effect of small sample size). Personal accomplishment improved significantly. The main challenges were geography, available time to meet and pair matching. The majority of mentors surveyed found the scheme effective, satisfying, mutually beneficial (70%) and enjoyable (78%).

Conclusion: Mentorship is shown to be beneficial despite the challenges and is likely to improve the recruitment and retention of women into gastroenterology and leadership roles, but is likely to benefit gastroenterologists of both genders.
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http://dx.doi.org/10.1136/flgastro-2018-100971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319152PMC
January 2019

Endoscopy in 2017: a national survey of practice in the UK.

Frontline Gastroenterol 2019 Jan 24;10(1):7-15. Epub 2018 Apr 24.

Department of Gastroenterology, University Hospital Llandough, Penarth, UK.

Introduction: The Joint Advisory Group on Gastrointestinal Endoscopy (JAG), hosted by the Royal College of Physicians, London, oversees the quality assurance of endoscopy services across the UK. Additional questions focusing on the pressures faced by endoscopy units to meet targets were added to the 2017 annual Global Rating Scale (GRS) return. This provides a unique insight into endoscopy services across all nations of the UK involving the acute and non-acute Nation Health Service sector as well as the independent sector.

Methods: All 508 services who are registered with JAG were asked to complete every field of the survey online in order to submit their completed April 2017 GRS return.

Results: A number of services reported difficulty in meeting national waiting time targets with a national average of only 55% of units meeting urgent cancer wait targets. Many services were insourcing or outsourcing patients to external providers to improve waiting times. Services are striving hard to increase capacity by backfilling lists and working weekends. Data collection was done in most units to reflect productivity but not to look at demand and capacity. Some of the units did not have an agreed capacity plan. The Did Not Attend rates for patients in the bowel cancer screening programme were much lower compared with standard lists.

Conclusion: This review highlights the increased pressure endoscopy services are under and the 'just about coping' situation. This is the first published overview of different aspects of UK-wide endoscopy services and the future challenges.
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http://dx.doi.org/10.1136/flgastro-2018-100970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319153PMC
January 2019

Gender differences in leadership, workforce and scholarly presentation within a national society: a gastroenterology perspective.

Frontline Gastroenterol 2019 Jan 7;10(1):2-6. Epub 2018 Aug 7.

Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.

In the UK, gastroenterology has been a male predominant medical speciality. Data regarding gender within workforce, academia and leadership at a national level are lacking. Data regarding scholarly presentation at the following annual conferences were collected and analysed; British Society of Gastroenterology (BSG) 2013, 2014, and Digestive Diseases Federation (DDF) in 2015. Data from the 2013-2015 BSG annual workforce reports were examined. In 2015, female higher specialty trainees (STs) made up 39% (328/848) of the trainee workforce, versus 37% and 35% in 2014 and 2013. From 2013 to 2015, less than a fifth of all consultant gastroenterologists were women. Female consultant (18%), ST (39%), associate (86%) and student attendance (47%) at DDF 2015 did not change significantly from 2013 to 2014. Female speakers (trainees and consultants) were significantly lower at DDF 2015 compared with BSG 2014; 43/331 (13%) versus 56/212 (26.4%) (p=0.0001) and BSG 2013 63/231 (27%) (p=0.0001). The number of female chairs, delivery of the named lectures and prizes awarded to women did not differ across the 3-year period. Female leadership via representation at Council and Executive at BSG was 4/30 (13%) in 2015 and did not differ in 2013/2014, with no elected council members since 2008 and one female president in 1973. The proportion of female gastroenterology trainees and consultants is increasing, but remains lower than across all medical specialties and is reflected in attendance and scholarly contributions. Action within the BSG is underway to address female under-representation in leadership roles.
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http://dx.doi.org/10.1136/flgastro-2018-100981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319156PMC
January 2019

Whole-colon investigation vs. flexible sigmoidoscopy for suspected colorectal cancer based on presenting symptoms and signs: a multicentre cohort study.

Br J Cancer 2019 01 19;120(2):154-164. Epub 2018 Dec 19.

Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.

Background: Patients with suspected colorectal cancer (CRC) usually undergo colonoscopy. Flexible sigmoidoscopy (FS) may be preferred if proximal cancer risk is low. We investigated which patients could undergo FS alone.

Methods: Cohort study of 7375 patients (≥55 years) referred with suspected CRC to 21 English hospitals (2004-2007), followed using hospital records and cancer registries. We calculated yields and number of needed whole-colon examinations (NNE) to diagnose one cancer by symptoms/signs and subsite. We considered narrow (haemoglobin <11 g/dL men; <10 g/dL women) and broad (<13 g/dL men; <12 g/dL women) anaemia definitions and iron-deficiency anaemia (IDA).

Results: One hundred and twenty-seven proximal and 429 distal CRCs were diagnosed. A broad anaemia definition identified 80% of proximal cancers; a narrow definition with IDA identified 39%. In patients with broad definition anaemia and/or abdominal mass, proximal cancer yield and NNE were 4.8% (97/2022) and 21. In patients without broad definition anaemia and/or abdominal mass, with rectal bleeding or increased stool frequency (41% of cohort), proximal cancer yield and NNE were 0.4% (13/3031) and 234.

Conclusion: Most proximal cancers are accompanied by broad definition anaemia. In patients without broad definition anaemia and/or abdominal mass, with rectal bleeding or increased stool frequency, proximal cancer is rare and FS should suffice.
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http://dx.doi.org/10.1038/s41416-018-0335-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342953PMC
January 2019

Managing underperformance in endoscopy: a pragmatic approach.

Gastrointest Endosc 2018 10 6;88(4):737-744.e1. Epub 2018 Jul 6.

Department of Gastroenterology, South Tyneside District Hospital, South Shields, Tyne and Wear, United Kingdom.

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http://dx.doi.org/10.1016/j.gie.2018.06.029DOI Listing
October 2018

Commentary: Accrediting colonoscopy services and colonoscopists for screening makes a difference.

Colorectal Dis 2018 09;20(9):O283-O285

St Mark's Hospital London, Imperial College London, London, UK.

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http://dx.doi.org/10.1111/codi.14374DOI Listing
September 2018

Correction: Changes in scoring of Direct Observation of Procedural Skills (DOPS) forms and the impact on competence assessment.

Endoscopy 2018 08 26;50(8):C9. Epub 2018 Jul 26.

Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom.

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http://dx.doi.org/10.1055/a-0658-2732DOI Listing
August 2018

Use of intravenous hyoscine butylbromide (Buscopan) during gastrointestinal endoscopy.

Frontline Gastroenterol 2018 Jul 18;9(3):183-184. Epub 2017 Aug 18.

Northern Region Endoscopy Group (NREG), Newcastle, UK.

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http://dx.doi.org/10.1136/flgastro-2017-100877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056080PMC
July 2018

The impact of chromoendoscopy for surveillance of the duodenum in patients with MUTYH-associated polyposis and familial adenomatous polyposis.

Gastrointest Endosc 2018 10 24;88(4):665-673. Epub 2018 Apr 24.

Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK; Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.

Background And Aims: Duodenal polyposis and cancer have become a key issue for patients with familial adenomatous polyposis (FAP) and MUTYH-associated polyposis (MAP). Almost all patients with FAP will develop duodenal adenomas, and 5% will develop cancer. The incidence of duodenal adenomas in MAP appears to be lower than in FAP, but the limited available data suggest a comparable increase in the relative risk and lifetime risk of duodenal cancer. Current surveillance recommendations, however, are the same for FAP and MAP, using the Spigelman score (incorporating polyp number, size, dysplasia, and histology) for risk stratification and determination of surveillance intervals. Previous studies have demonstrated a benefit of enhanced detection rates of adenomas by use of chromoendoscopy both in sporadic colorectal disease and in groups at high risk of colorectal cancer. We aimed to assess the effect of chromoendoscopy on duodenal adenoma detection, to determine the impact on Spigelman stage and to compare this in individuals with known pathogenic mutations in order to determine the difference in duodenal involvement between MAP and FAP.

Methods: A prospective study examined the impact of chromoendoscopy on the assessment of the duodenum in 51 consecutive patients with MAP and FAP in 2 academic centers in the United Kingdom (University Hospital Llandough, Cardiff, and St Mark's Hospital, London) from 2011 to 2014.

Results: Enhanced adenoma detection of 3 times the number of adenomas after chromoendoscopy was demonstrated in both MAP (P = .013) and FAP (P = .002), but did not affect adenoma size. In both conditions, there was a significant increase in Spigelman stage after chromoendoscopy compared with endoscopy without dye spray. Spigelman scores and overall adenoma detection was significantly lower in MAP compared with FAP.

Conclusions: Chromoendoscopy improved the diagnostic yield of anomas in MAP and FAP 3-fold, and in both MAP and FAP this resulted in a clinically significant upstaging in Spigelman score. Further studies are required to determine the impact of improved adenoma detection on the management and outcome of duodenal polyposis.
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http://dx.doi.org/10.1016/j.gie.2018.04.2347DOI Listing
October 2018

Factors associated with delayed bleeding after resection of large nonpedunculated colorectal polyps.

Endoscopy 2018 08 6;50(8):790-799. Epub 2018 Apr 6.

Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, London, United Kingdom.

Background: Delayed bleeding is the most common significant complication after piecemeal endoscopic mucosal resection (p-EMR) of large nonpedunculated colorectal polyps (NPCPs). Risk factors for delayed bleeding are incompletely defined. We aimed to determine risk factors for delayed bleeding following p-EMR.

Methods: Data were analyzed from a prospective tertiary center audit of patients with NPCPs ≥ 20 mm who underwent p-EMR between 2010 and 2012. Patient, polyp, and procedure-related data were collected. Four post p-EMR defect factors were evaluated for interobserver agreement and included in analysis. Delayed bleeding severity was reported in accordance with guidelines. Predictors of bleeding were identified.

Results: Delayed bleeding requiring hospitalization occurred after 22 of 330 procedures (6.7 %). A total of 11 patients required blood transfusion; of these, 4 underwent urgent colonoscopy, 1 underwent radiological embolization, and 1 required surgery. Interobserver agreement for identification of the four post p-EMR defect factors was moderate (kappa range 0.52 - 0.57). Factors associated with delayed bleeding were visible muscle fibers ( = 0.03) and the presence of a "cherry red spot" ( = 0.05) in the post p-EMR defect. Factors not associated with delayed bleeding were American Association of Anesthesiologists class, aspirin use, polyp size, site, and use of argon plasma coagulation.

Conclusions: Visible muscle fibers and the presence of a "cherry red spot" in the resection defect were associated with delayed bleeding after p-EMR. These findings suggest evaluation and photodocumentation of the post p-EMR defect is important and, when considered alongside other patient and procedural factors, may help to reduce the incidence and severity of delayed bleeding.
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http://dx.doi.org/10.1055/a-0577-3206DOI Listing
August 2018