The Endoscopy News Podcast

We can now offer patients procedures which, 20 yrs ago were unthinkable. Procedures which improves health, reduces morbidity and saves lives. But, these procedures are longer and more uncomfortable and therefore patients require deeper sedation than before. Unfortunately, at the same time, patients are older and with more comorbidities. This dual problem of frail patients requiring deeper sedation for longer procedures, has narrowed our ‘sedation window’. The old way of monitoring patients, with a nurse and an oxygen saturation monitor, is no longer enough. It's for this reason that the Academy of Medical Royal Colleges in February 2021, updated their guidelines on Safe Sedation practises. Now they recommend that patients requiring 'moderate sedation' should be monitored more closely, not only by a dedicated nurse and oxygen saturation monitor but also with ECG, BP and Capnography. Of course, this is a huge change for endoscopy units. Our staff are now asked to do three things at the same time; maintain the airway, listen to the pitch of the oxygen saturation monitor and interpret that ECG and Capnography traces. Dr Martin Lees , Clinical Director of Cardiac Anaesthesia and Perioperative Medicine at St Barts Heart Centre in London and Nurse Specialist Andreia Trigo with SedateUK, discuss the new guidelines and the implications it has for endoscopy units around the World.

COVID never posed an existential threat but nevertheless had a devastating impact, including on our Endoscopy services. Now we do have an existential threat which Endoscopy is actively driving us towards. Endoscopy is the third greatest hospital contributor to Global Warming !!! You may be tempted to 'cop out', deciding that you can do nothing, but you would be wrong. There are 3 things which you can do; Reduce Reuse and Recycle. Listen to the suggestions, read the NHS Net Zero document and join By Hayee at Kings College as a 'Green Endoscopists'. By the way, we have had statements from all the main Endoscopy organisations on COVID but apart from BSG and the World Gastroenterology Organisation, very little on 'future sustainability'. Isn't it about time that we all 'Look UP'?

Topics included artificial intelligence, an overview of bariatric endoscopy, the less than straightforward management of early rectal cancer, how safe is spiral enteroscopy?, should we place a duodenal or a hot Axios stent in gastric outlet obstruction and why would you take papillary biopsies in FAP? What would you say to a patient, with a germline E-cadherin mutation, who decline a prophylactic gastrectomy? As usual, the most interesting findings are hidden in the details. For example, did you know that the introduction of colonic cancer screening doesn't appear to have had any impact on mortality rates ...

Post colonoscopy colorectal cancer is arguable one of the 'hardest' quality measures in colonoscopy. Until now, it has been difficult to identify cases often presenting several years after their colonoscopy and sometimes to a different institution. From September, NHS endoscopy units will have access to a bespoke online resource identifying cases of PCCRC. From September, this online tool will be used to audit the 1400 PCCRC cases which we see in the NHS every year. Roland Valori explains the idea behind the audit.

This week, Prof Marco Bruno, Department of Gastroenterology and Hepatology at the Erasmus University Medical Centre in Rotterdam is explaining about the problem we have with scope contamination. Last year his department published a Nationwide Study of bacterial colonization of endoscopes. The study included 74 Dutch Centres and reported that 17% of duodenoscopes and 13% of EUS scopes were contaminated! What can we do about this? With Marco, I discuss the current situation and possible solutions, like new endoscope designs, continuous monitoring and culturing of scopes and the training for reprocessing colleagues.

Bjorn's trawl of newsworthy Endoscopy papers currently in press includes; Which patients don't heal well after RFA, Chances of successfully removing a 45mm polyp is only 75% in the Netherlands, What is 'tip-In EMR?, Tumour biology is important in UC-related PCCRC, We should be doing more TIPS (and presumably therefore, less emergency band ligation) and finally musculoskeletal injury is rife amongst endoscopists!

This time our Podcast is full of both important and interesting studies. We present new evidence on how to treat pancreatic pseudocysts with hydrogen peroxide, the benefit of PPI's on EoE, an large study of endoscopic treatment of appendicitis, and find that our trusty indigo carmine dye spray is still going strong! Then we have an interesting paper on the appalling effect of mountain sickness on the stomach, transplantation on the risk of polyps and when to stop Barrett's surveillance. Thanks to our Partners at Pentax medical for your Support ! References reviewed includes;

Bjorn has reviewed the upcoming 'in-press' endoscopy related manuscripts and provides his usual opinionated and patronising feedback to the brave authors of 14 manuscripts. Of course, you may agree or disagree with his comments and could even find yourself fired up to read some of the articles yourself! But then again you don't need to, as everything is covered in his Podcast ! References are listed on the website: www.friendsofendoscopy.org Don't forget to say Thank You, next time you see someone from Pentax Medical because this wouldn't be possible without them !!!

Dr Andreia Albuguerque from Lisbon discusses her paper on the neglected topic of anal cancer recently published in Lancet Gastroenterology and Hepatology 2021;6:327-34. As larger endoscopy units should find 4-5 early anal cancers every year, I have a terrible suspicion that many of these lesions go undetected.

In this podcast we discuss Serrated Polyps with Professor Neil Shepherd. There is much more to these lesions than Size and Number! Did you know that there may be two distinct syndromes and it's the Site of the lesions which distinguishes the two? That is just the start. It gets weirder! We cover a huge amount of ground and headings include (in chronological order):

Srisha Hebbar and Peter Siersema challenge my prejudices and suggest that endoscopy can help patients with colonic lipomas and local recurrence after chemo-radiotherapy, two relatively uncommon conditions. They both make convincing arguments! Srisha has also uploaded a video to explain how to safely deal with colonic lipomas. Of course, the video and references are available on the website

This week Nick Burr and Bjorn Rembacken are discussing the bright new world of molecular screening for occult cancers as the NHS starts screening for more than 50 cancers. This summer the “Galleri blood test”, developed by an American company called ‘GRAIL’ will be piloted on 140.000 healthy people in the UK. Naturally, Bjorn remains sceptical, and after an unsuccessful search for the ‘study aims’, asks if getting a positive result always mean that the cancer is treatable? Furthermore, how do you tell the difference between a true positive and a false positive? Surprisingly, we are also standing up for the effectiveness of CTC and wonder why an American study reports such shockingly poor results.

The BSG Campus 2021 was a great success with nine half days of Gastroenterology news, 700 abstracts and 1400 delegates taking part. The podcasts gives you a 30 minute update on Endoscopy related news and research from the Campus meeting. A transcript and full list of references will be published on the www.friendsofendoscopy.org website

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 !!!

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

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.

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.

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.

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:

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 ! https://doi.org/10.1177/0272989X11408730https://doi.org/10.1053/j.gastro.2020.05.018