The Endoscopy News Podcast

UEG Week 2020

The annual UEG Week has gone virtual

UEG Week - Artificial intelligence

Artificial Intelligence (AI) will soon be touching all areas of medicine. The first is already affecting lesion detection and characterisation.  Hot on the heels of radiology and histopathology comes endoscopy ... 

Effect of Covid on Endoscopy and more Endoscopy news

Today we are reviewing 15 recent endoscopy publications ranging from the effect of Covid on our endoscopy service and training, a Delphi review of water immersion vs exchange, AI and scoring colitis, adrenaline and pancreatitis.  We are asking if gastric GIST’s are not better removed laparoscopically after all. Finally, a reminder about the new WHO criteria for the diagnosis of SSPS.

1. Rutter M. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis. GUT 2020, July 20 (http://dx.doi.org/10.1136/gutjnl-2020-322179 )
2. Lantinga MA. Impact of the COVID-19 pandemic on gastrointestinal endoscopy in the Netherlands: analysis of a prospective endoscopy database. Endoscopy 2020, Oct 20
3. Clarke K. Impact of COVID-19 Pandemic on Training: Global Perceptions of Gastroenterology and Hepatology Fellows in the USA. Digestive Diseases & Sciences.  2020 Oct 19
4. Sonnenberg A. Digestive Diseases & Sciences. 2020 Oct 21 (https://doi.org/10.1007/s10620-020-06661-0)
5. Maclean W. Adoption of Faecal Immunochemical Testing for two-week wait colorectal patients during the COVID-19 pandemic: An observational cohort study reporting a new service at a regional centre. Colorectal Disease. 2020 Oct 17
6. McSorley ST. Yield of colorectal cancer at colonoscopy according to faecal haemoglobin concentration in symptomatic patients referred from primary care. Colorectal Disease.  2020 Oct 16
7. Pin-Vieito N. Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test. World Journal of Gastroenterology 2020 26(1):70-85, 2020
8. Ebigbo A. Cost-effectiveness analysis of SARS-CoV-2 infection-prevention strategies including pre-endoscopic virus testing and use of high-risk personal protective equipment.. Endoscopy.  2020 Oct 20
9. Cadoni S. Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations. Gastrointestinal Endoscopy. 2020 Oct 15.
10. Bhambhvani HP. Deep learning enabled classification of Mayo endoscopic subscore in patients with ulcerative colitis. European Journal of Gastroenterology & Hepatology.  2020 Oct 16
11. Luo H. Rectal Indomethacin and Spraying of Duodenal Papilla with Epinephrine Increases Risk of Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography. Clinical Gastroenterology & Hepatology. 17(8):1597-1606.e5, 2019 07
12. Dong X. Laparoscopic resection is better than endoscopic dissection for gastric gastrointestinal stromal tumor between 2 and 5 cm in size: a case-matched study in a gastrointestinal center. Surgical Endoscopy. 34(11):5098-5106, 2020 Nov
13. Ezaz G. Association Between Endoscopist Personality and Rate of Adenoma Detection. Clinical Gastroenterology & Hepatology. 17(8):1571-1579.e7, 2019 07
14. Lee JY. Association Between Cigarette Smoking and Alcohol Consumption and Sessile Serrated Polyps in Subjects 30 to 49 Years Old. Clinical Gastroenterology & Hepatology. 17(8):1551-1560.e1, 2019 07
15. Dekker E. Update on the World Health Organization Criteria for Diagnosis of Serrated Polyposis Syndrome. Gastroenterology 2020, January 23 (https://doi.org/10.1053/j.gastro.2019.11.310)

Our obsession with ADR and PCCRC

Today I am talking to Dr Nick Burr, one of our Rising Stars in Gastroenterology, working in Leeds.  You may recognise his name from some of the most influential papers written on the topic of ADR and PCCRC in the recent past.  I’ve decided to ambush him with some difficult questions about our unhealthy obsession with ADR and see if I can convince him that the PCRCR rate is irrelevant to individual colonoscopists.  

I am armed with the references below to support my argument ! 

1. Karminski MF. Quality Indicators for Colonoscopy and the Risk of Interval Cancer. NEJM 2010;362:1795-803
2. Eide T. Risk of CRC in adenoma bearing individuals. Intern J Cancer 1986;38;173–6
3. Stryker S. Natural history of untreated colonic polyps. Gastroenterology 1987;93:1009–13
4. Pickhart PJ. Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history.  Lancet Oncol. 2013;14(8):711–20
5. Kuntz KM.  A Systematic Comparison of Microsimulation Models of Colorectal Cancer: The Role of Assumptions about Adenoma Progression.  Medical Decision making 2011;31(4):530-9 https://doi.org/10.1177/0272989X11408730
6. Djinbachian R. Rates of Incomplete Resection of 1- to 20-mm Colorectal Polyps: A Systematic Review and Meta-Analysis.  Gastroenterology 2020;159(3):904-14   https://doi.org/10.1053/j.gastro.2020.05.018

News on the aetiology of achalasia and Sheffield changes its mind on Coeliac !

Today we are reporting on the 'FLIP device' and give you an update on the likely aetiology of achalasia. 

There have been studies on 'motorised spiral enteroscopy'. Is a motor really a good thing inside the small bowel? 

We are surprised to see a complete turnaround in the recommendations from Sheffield on how to diagnose Coeliac disease ! 

Sadly, surveillance in patients with MUTyH related polyposis doesn't seem to save lives. 

Should we all start doing 'full thickness' colonic resections?  I urge caution!  

Finally, there have been some good news and some bad news on the topic of emergency GI bleeding ...

References:

1. Savarino E. T Use of the Functional Lumen Imaging Probe.  American Journal of Gastroenterology 2020;115(11):1786-96
2. Campagna RAJ. Intraoperative assessment of oesophageal motility using FLIP during myotomy for achalasia.  Surgical Endoscopy 2020;34(6):2593-2600
3. Ikebuchi Y. microRNAs in biopsy samples of lower oesophageal sphincter muscle during peroral endoscopic myotomy for oesophageal achalasia.  Digestive Endoscopy. 2020;32(1):136-42
4. Ramchandani M. Diagnostic yield and therapeutic impact of novel motorized spiral enteroscopy in small-bowel disorders: a single-center, real-world experience from a tertiary care hospital.  Gastrointestinal Endoscopy.  2020 Jul 12.
5. Beyna T. Total motorized spiral enteroscopy: first prospective clinical feasibility trial.  Gastrointestinal Endoscopy.  2020 Oct 31.
6. Penny HA. Accuracy of a no-biopsy approach for the diagnosis of coeliac disease across different adult cohorts. Gut 2020 Nov 02.
7. Guz-Mark A. High rates of serology testing for coeliac disease, and low rates of endoscopy in serologically positive children and adults in Israel: lessons from a large real-world database.  European Journal of Gastroenterology & Hepatology. 2020;32(3):329-34
8. Thomas LE.  Duodenal adenomas and cancer in MUTYH-associated polyposis: an international cohort study.  Gastroenterology.  2020 Oct 29.
9. Patel R.  MUTYH-associated polyposis - colorectal phenotype and management.  Colorectal Disease 2020;22(10):1271-78
10. Yeh JH.  Long-term Outcomes of Primary Endoscopic Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis.  Clinical Gastroenterology & Hepatology. 2020;18(12):2813-23
11. Boger P.  Endoscopic full thickness resection in the colo-rectum: outcomes from the UK Registry. European Journal of Gastroenterology & Hepatology.  2020 Oct 29.
12. Zwager LW.  Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry.  Endoscopy. 2020;52(11):1014-23
13. Lee HS.  Comparison of conventional and modified endoscopic mucosal resection methods for the treatment of rectal neuroendocrine tumors.  Surgical Endoscopy.  2020 Oct 22.
14. Kherad O. Systematic review with meta-analysis: limited benefits from early colonoscopy in acute lower gastrointestinal bleeding. [Review] Alimentary Pharmacology & Therapeutics. 52(5):774-88, 2020 09.
15. Alzoubadi D. Outcomes from an international multicenter registry of patients with acute gastrointestinal bleeding undergoing endoscopic treatment with Hemospray.  Digestive Endoscopy. 2020;32(1):96-110

The UK 'National Endoscopy Database' - the most ambitious in the World !

The UK 'National Endoscopy Database' (NED)  is set to be the largest Endoscopy Dataset in the World.  In theory, it should capture information on every single endoscopy carried out in the UK, providing detailed, up-to-the minute information.  Matt Rutter has been there from the start and tells us about it's origins, current challenges and future hopes. 

Promises and Pitfalls of sending your patient for an EUS-BD

Arguably, the most exciting thing which has happen in ERCP, in the last 50 years, is EUS and the development of easy to place, 'lumen apposing metal stents' (LAMS).  It's transforming ERCP for the benefits of patients who no longer need to put up with painful PTC's.  Ideally, every region should offer this service but who should be referred for EUS-guided biliary drainage (EUS-BD) and what risks should you quote to your patients?  Monz Ahmed poses some probing questions to Bharat Paranandi and Aaron On in Leeds. 

Leeds Endoscopy Christmas Quiz 2020

 

Jamal Al-Asiry (Wakefield), Mo Thoufeeq (Sheffield), Pradeep Mundre (Bradford) and Nick Burr, (Endoscopy Fellow at Leeds) Battle it out at this Years Leeds Endoscopy Christmas Quiz !  Ten Questions, 3 answer options and 1 correct answer. 

Can we predict the risk of cancer in colitis?

There have been some recent developments shedding welcome light on the issue of cancer in colitis.  We take a closer look at the papers and have a chat with Lauranne Derikx about her recent GIE publication.  To my surprise, I find that my long lamented 'cancer field theory' is very much alive !  

References 
■ Derikx LAAP, Kievit W, Drenth JPH et.al. Prior Colorectal Neoplasia Is Associated With Increased Risk of Ileoanal Pouch Neoplasia in IBD. Gastroenterology 2014;146:119-28.

■ de Jong ME, van Tilburg SB, Nissen LHC et.al. Long-term Risk of advanced Neoplasia after finding LGD in pts with IBD - A Nationwide Cohort Study. Journal of Crohn's and Colitis 2019;1485-91.

■ de Jong ME, Kanne H, Nissen LHC et.al. Increased risk of HGD and CRC in IBD patients with recurrent LGD. GIE 2020;91:1334-42.
■ Wijnands AM, de Jong ME, Lutgens MWMD. Prognostic factors for advanced colorectal neoplasia in inflammatory bowel disease: systematic review and meta-analysis. Gastroenterology 2020; 22 December

The pitfalls and problems which trips you up managing Gastric NET's

Professor Mark Pritchard, has a simple plea; when you are dealing with gastric NET's, make sure that you know what you are doing!  In this Podcast he highlights the pitfalls and provides us with Endoscopy Gold !!!