Substratifying the risk of covert malignancy in significant rectal polyps: Outcomes from a specialist multidisciplinary team (MDT).

Aim: A treatment strategy for patients with a significant polyp or early colon cancer (SPECC) of the rectum presents a challenge due to the significant rate of covert malignancy and lack of standardized assessment. For this reason, NICE recommends multidisciplinary meetings to improve outcomes. The primary aim of the present study was to report the performance of our specialist early rectal cancer (SERC) multidisciplinary team (MDT) in correctly substratifying the risk of cancer and to discuss the limitations of staging investigations in those patients with "poor outcomes".

Outcomes and adverse factors for endoscopic mucosal resection (EMR) of colorectal polyps in elderly patients.

Introduction: Endoscopic mucosal resection (EMR) is an invaluable technique, however it is associated with significant risks. In the elderly in particular, the long-term survival benefits of polyp resection with EMR are unknown. The aim of this study was to determine the long-term outcomes in elderly patients who had undergone EMR and to identify any adverse factors.

Volatile organic compounds emitted from faeces as a biomarker for colorectal cancer.

Background: Colorectal cancer remains a leading cause of mortality and morbidity. The UK Bowel Cancer Screening Programme (BCSP) has demonstrated that detection of colorectal cancer at an earlier stage and identification of advanced pre-malignant adenomas reduces mortality and morbidity.

Aim: To assess the utility of volatile organic compounds as a biomarker for colorectal neoplasia.

Dual-focus Magnification, High-Definition Endoscopy Improves Pathology Detection in Direct-to-Test Diagnostic Upper Gastrointestinal Endoscopy.

Background: In the UK, the majority of diagnostic upper gastrointestinal (UGI) endoscopies are a result of direct-to-test referral from the primary care physician. The diagnostic yield of these tests is relatively low, and the burden high on endoscopy services. Dual-focus magnification, high-definition endoscopy is expected to improve detection and classification of UGI mucosal lesions and also help minimize biopsies by allowing better targeting.

Evaluation and long-term outcomes of the different modalities used in colonic endoscopic mucosal resection.

Endoscopic mucosal resection (EMR) has been used in western countries to remove colonic polyps for at least the last two decades. Significant experience has been accumulated and the efficacy of the method has recently been evaluated in a large meta-analysis. A number of variations to modify the technique, including knife-assisted, cap-assisted, ligation devices, and underwater EMR, have been developed in an attempt to improve outcomes.

New-Generation High-Definition Colonoscopes Increase Adenoma Detection when Screening a Moderate-Risk Population for Colorectal Cancer.

Background And Aim: Adenoma detection rate (ADR) is the most important quality indicator for screening colonoscopy, due to its association with colorectal cancer outcomes. As a result, a number of techniques and technologies have been proposed that have the potential to improve ADR. The aim of this study was to assess the potential impact of new-generation high-definition (HD) colonoscopy on ADR within the Bowel Cancer Screening Programme (BCSP).

Colonoscopy performance is stable during the course of an extended three-session working day.

Background: Three-session days were introduced in our endoscopy unit to accommodate the increased demand resulting from the introduction of the National Health Service Bowel Cancer Screening Programme (BCSP). Cecal intubation rate (CIR) and adenoma detection rate (ADR) may decline with time during a standard working day, but data are lacking for an extended three-session day. We assessed colonoscopy performance in an extended three-session day.

New technologies and techniques to improve adenoma detection in colonoscopy.

Adenoma detection rate (ADR) is a key component of colonoscopy quality assessment, with a direct link between itself and future mortality from colorectal cancer. There are a number of potential factors, both modifiable and non-modifiable that can impact upon ADR. As methods, understanding and technologies advance, so should our ability to improve ADRs, and thus, reduce colorectal cancer mortality.

National survey to determine current practices, training and attitudes towards advanced polypectomy in the UK.

Objective: Developments in advanced polypectomy technique provide an alternative to surgery in the management of large and complex colorectal polyps. These endoscopic techniques require expertise and can potentially incur high complication rates. This survey evaluates current UK practice, attitudes and training in advanced polypectomy.

Incidence of post-ERCP pancreatitis from direct pancreatic juice collection in hereditary pancreatitis and familial pancreatic cancer before and after the introduction of prophylactic pancreatic stents and rectal diclofenac.

Objectives: Individuals from hereditary pancreatitis (HP) and familial pancreatic cancer (FPC) kindreds are at increased risk of developing pancreatic cancer. Premalignant molecular changes may be detected in pancreatic juice collected by endoscopic retrograde cholangiopancreatography (ERCP). The objective was to determine the risk of post-ERCP pancreatitis (PEP).

Endoscopic balloon dilatation of Crohn's disease strictures: results from a large United kingdom series.

Introduction: Stricturing is a common complication of Crohn's disease. Endoscopic balloon dilatation (EBD) offers a valuable alternative to surgical intervention, but there are limited data on factors influencing its safety and efficacy.

Methods: A multicenter retrospective audit across 4 U.

Colonic stenting: a practical update.

Colonic stenting is part of the UK service provision guidelines for colorectal cancer. However, there are issues about availability and expertise within the UK, and controversies remain regarding various clinical and technical aspects of the technique. Based on the current evidence, this article will provide a practical update on the indications, the clinical and technical considerations and the remaining unanswered questions regarding colonic stenting.

Evaluation of a new anaesthetist-led propofol sedation service for endoscopy within a UK day-case setting.

Introduction: The use of propofol in endoscopy is becoming more prevalent both in Europe and North America. Potential advantages over conscious sedation include controlled deep sedation for therapeutic endoscopy and improved patient satisfaction. A new anaesthetist-led propofol-based day-case sedation service was introduced within the endoscopy unit at the Royal Liverpool University Hospital in April 2011.

A multicentre study to determine the incidence, demographics, aetiology and outcomes of 6-day emergency readmission following day-case endoscopy.

Background: Emergency readmission after elective procedures is a quality indicator of healthcare delivery, but data for endoscopy are limited.

Objectives: Using hospital episode statistics (HES) registration systems and a multicentre audit to describe outcomes of emergency readmission following elective endoscopy.

Methods: Emergency readmissions (April 2008-2009) within 6 days of an elective day-case upper-GI endoscopy (UE) and lower GI endoscopy (LE) were subjected to a multicentre retrospective audit (north-west of England) following the identification of cases from routinely coded hospital administrative data from HES.

The effect of high quality assurance measures in bowel cancer screening on patient satisfaction of colonoscopy.

Background: To ensure patient safety, rigorous quality assurance (QA) measures for colonoscopy were introduced for the Bowel Cancer Screening Programme (BCSP) in England. The impact of these high QA measures on patient experience and satisfaction is unknown.

Aims: To determine the impact of this high-level QA of colonoscopy on patient satisfaction.

Improved clinical outcomes and efficacy with a nurse-led colonoscopy surveillance service.

Background: A nurse practitioner-led colonoscopy surveillance service was introduced to improve appropriateness, validation and compliance with the National Patient Safety Agency safety alert and British Society of Gastroenterology consensus guidance for bowel cleansing agents.

Objective: To determine the clinical outcomes and efficacy of this new service.

Design And Patients: A 4-month prospective audit of patients due to attend for surveillance colonoscopy.

All-cause mortality after first ERCP in England: clinically guided analysis of hospital episode statistics with linkage to registry of death.

Background: All-cause death within 30 days of ERCP is a candidate indicator of care, but institutional-level statistics require careful interpretation. National-scale, population-based outcome studies of unselected patients undergoing ERCP are needed to define expected levels of real-world mortality risk and the case-mix factors that predict poor outcome.

Objective: To develop methods for analyzing administrative data for English hospitals with linkage to death registration to study all-cause mortality after first ERCPs and explore predictors of death and institutional variation.

An unusual presentation of fistulating Crohn's disease: Ascites.

Whilst ascites is a common presenting complaint in patients with decompensated chronic liver disease and disseminated malignancy, in Crohn's disease however, it is exceptionally rare. We describe a patient with no prior history of inflammatory bowel or liver disease, presenting with rapid onset gross ascites and scrotal swelling. Further investigations revealed severe hypoalbuminemia and transudative ascitic fluid with normal other liver function tests and a negative liver screen.

Safer sedation practice may not translate into improvements in endoscopic outcomes.

Introduction: Although the literature surrounding sedation practice and endoscopic outcomes remains sparse and controversial, there have been a number of stringent guidelines issued regarding sedation use in endoscopy.

Aims: To assess the impact of changes to enhance safer sedation practice on endoscopic outcomes.

Methods: Sedation practice was audited in 7234 consecutive gastrointestinal endoscopic procedures in 2004 and protocols for enhancing safer sedation practice were introduced.

Neurophysiologic assessment of esophageal sensory processing in noncardiac chest pain.

Background & Aims: Esophageal hypersensitivity is thought to be important in the generation and maintenance of symptoms in noncardiac chest pain (NCCP). In this study, we explored the neurophysiologic basis of esophageal hypersensitivity in a cohort of NCCP patients.

Methods: We studied 12 healthy controls (9 women; mean age, 37.

Patients with chest pain and occult gastroesophageal reflux demonstrate visceral pain hypersensitivity which may be partially responsive to acid suppression.

Objectives: Mechanisms of chest pain in gastroesophageal reflux disease (GERD) are poorly understood. The recent demonstration in healthy subjects that lower esophageal acid exposure induces pain hypersensitivity within the non-acid-exposed upper esophagus (secondary allodynia) raises the possibility that an increase in spinal neuronal excitability (i.e.

Development of esophageal hypersensitivity following experimental duodenal acidification.

Objectives: As visceral afferents from different regions of the gastrointestinal tract converge at the level of the spinal cord, we hypothesized that sensitization of one gut organ would induce visceral hypersensitivity in another gut organ, remote to the sensitizing stimulus.

Methods: Protocol 1: Eight healthy male volunteers, age 30 +/- 8.2 yr, underwent three studies on different days.

Psychological responses to episodic chest pain.

Patients with chronic musculo-skeletal pain have been profiled as "dysfunctional", "interpersonally distressed" or "adaptive copers". The relevance of these for episodic visceral pain is unknown. Our aim was to replicate conceptually the taxonomy in patients with episodic visceral pain.

The prostaglandin E2 receptor-1 (EP-1) mediates acid-induced visceral pain hypersensitivity in humans.

Background & Aims: Central sensitization, an activity-dependent increase in spinal cord neuronal excitability, has been shown to contribute to esophageal pain hypersensitivity. Prostaglandin E2 (PGE(2)) is a mediator in both peripheral and central sensitization, in part via the prostaglandin E2 receptor-1 (EP-1), and may be a potential target for treating visceral pain. The purpose of this study was to determine whether acid-induced pain hypersensitivity within the non-acid-exposed esophagus (secondary hyperalgesia) is mediated by PGE(2) activation of the EP-1 receptor.

Cortical processing of human gut sensation: an evoked potential study.

The rectum has a unique physiological role as a sensory organ and differs in its afferent innervation from other gut organs that do not normally mediate conscious sensation. We compared the central processing of human esophageal, duodenal, and rectal sensation using cortical evoked potentials (CEP) in 10 healthy volunteers (age range 21-34 yr). Esophageal and duodenal CEP had similar morphology in all subjects, whereas rectal CEP had two different but reproducible morphologies.