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This article discusses the feasibility, safety, and outcomes of endoscopic submucosal dissection (ESD) for early gastrointestinal neoplasia in the UK. The study collected data from 451 UGI ESD cases between August 2016 and August 2023. The majority of cases were performed in the esophagus, with a high technical success rate and low complication rates. The study found that deep submucosal invasion was a predictor of poor R0 rate. Overall, the study demonstrates the feasibility and safety of UGI ESD in a Western population. [Extracted from the article]

This article discusses a study comparing two commercially available artificial intelligence (AI) systems for predicting the histology and size of colorectal polyps during colonoscopy. The study found that both AI systems had similar sensitivity to experts in diagnosing adenomatous polyps, but lower specificity. The AI systems also had similar performance in sizing polyps compared to experts. The study suggests that using these AI systems for strategies like resect and discard may result in slightly more hyperplastic polyps being resected compared to relying solely on expert diagnosis. [Extracted from the article]

This article discusses the use of Artificial Intelligence (AI) in endoscopy for the detection of neoplasia in patients with inflammatory bowel disease (IBD). The study evaluated the efficacy of a novel Computer Aided Detection (CADe) algorithm called CADe-IBD. The algorithm was used in conjunction with standard care during colonoscopies, and its effectiveness was assessed by comparing its results to those of expert endoscopists. The CADe-IBD algorithm demonstrated a high sensitivity for lesion detection, with a low miss rate for true neoplasia. The findings suggest that CADe-IBD has the potential to replace current chromoendoscopy-based surveillance practices. [Extracted from the article]

This article discusses the feasibility, safety, and outcomes of endoscopic submucosal dissection (ESD) for early gastrointestinal neoplasia in the UK. The study collected data from 568 colorectal ESDs performed between August 2016 and August 2023 at six large tertiary referral centers. The results showed that ESD was technically successful in 97.7% of cases, with an en-bloc resection rate of 83.1%. Adverse events, such as perforation and bleeding, were managed endoscopically in most cases. The study also found that the majority of resected lesions were adenomatous neoplasia, with varying rates of dysplasia. The authors conclude that ESD is feasible, safe, and effective in the Western setting, but improvements are needed to optimize the R0 resection rate. [Extracted from the article]

The current standard of treating early Barrett's neoplasia is resection of visible lesions using endoscopic mucosal resection (EMR) followed by ablative therapy to the Barrett’s segment. There is increasing evidence to support the use of endoscopic submucosal dissection (ESD) where en-bloc resection and lower recurrence rates may be achieved. However, ESD is associated with deep submucosal dissection when compared to EMR. This may increase the risk of complications including stricture formation with subsequent radiofrequency ablation (RFA) therapy. The aim of this study is to compare the safety and efficacy of RFA following EMR and ESD as well as when RFA was used without prior endoscopic resection. The primary outcome measure was complication rates. Clearance of dysplasia (CRD) and clearance of intestinal metaplasia (CRIM) were secondary outcomes. A retrospective analysis of a cohort of 91 patients referred for RFA from a single academic tertiary center was performed. The choice of endoscopic resection method was tailored according to the lesion type and morphology. Focal and circumferential ablation was performed after initial follow up endoscopy postresection. Patients proceeded straight to RFA in the absence of any visible lesions. In this study, the ESD group had a higher proportion of cancers compared to the EMR cohort (74.1% vs. 30.2%, P < 0.01) prior to RFA. All complications post RFA occurred in the groups with previous endoscopic resection. There was no significant difference in the total complication rate (7.4% vs. 9.3%, P = 0.78) and stricture formation rate (3.7% vs. 9.3%, P = 0.38) between the ESD and EMR groups. CRD was achieved in 96.3% in the ESD group, 88.4% in the EMR group and all patients in the RFA alone group. CRIM rates were similar in the EMR and ESD groups (81.4% vs. 85.2%) but higher in the RFA alone group (90.5%). In conclusion, RFA following ESD is very effective and not associated with an increased risk of complications compared to EMR. This supports the application of RFA in the treatment algorithm of patients undergoing ESD for Barrett's neoplasia. [ABSTRACT FROM AUTHOR]

Background and study aims: Acetic acid reacts with Barrett's mucosa to produce acetowhitening which disappears with time. The clinical significance of this is unknown. We aimed to quantify the acetowhitening time, developing an objective tool for diagnosis of neoplasia in Barrett's esophagus. Patients and methods: Prospective cohort study in a tertiary referral center, enrolling patients undergoing surveillance of Barrett's metaplasia or referred with suspected neoplasia. Acetic acid 2.5% was applied to the mucosa via a spray catheter. Acetowhitening was observed and time to disappearance recorded. Targeted biopsies of any neoplasia and quadrantic 2-cm biopsies of residual Barrett's area were then taken. Histological findings were investigated in relation to duration of acetowhitening. Results: 132 patients were examined. A receiver operating characteristic (ROC) curve was produced for identifying high risk neoplasia according to acetowhitening duration. The area under the curve (AUC) was 0.93 (0.89-0.97). Using a threshold of 142 seconds yielded a sensitivity for neoplasia of 98% (95% confidence interval [95% CI] 89%-100%) and specificity of 84% (74%- 91%). The ROC curve for mucosal neoplasia (high grade dysplasia or intramucosal carcinoma) versus deep invasive cancer showed an AUC of 0.786 (0.61-0.96); a cutoff of 20 seconds yielded a sensitivity and specificity for invasive cancer of 67% (35%-90%) and 85% (69%-95%), respectively. Conclusion: The time to disappearance of acetowhitening can serve as a simple but very sensitive tool for the diagnosis of high risk neoplasia in Barrett's esophagus. It can be used to distinguish mucosal neoplasia from deep invasive cancer. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 30-year-old woman with swallowing difficulties or dysphagia. It stresses that through gastroscopy, the patient depicted almost complete obstruction of the oesophagus at 35 centimeter. It states that the patient undergone surgery and the utilization of Merendino jejunal transposition was required to allow effective swallowing.

The article presents a case study of a 16-year-old male who was admitted due to loss of vision. The patient was reported bilateral visual disturbance while sitting in bed together with breathlessness, chest discomfort and dizziness but had not had palpitation. The article discusses the routine transthoracic echocardiography demonstrated Ebstein's anomaly with an associated atrial septal defect and small membranous ventricular septal defect.

Introduction In recent years the resolution of endoscopes has been increasing. Modern Fujinon colonoscopes have a CCD pixel density of 850 000 pixels compared to a standard definition 410 000 pixel CCD. However, acquiring high definition (HD) scopes represents a significant capital investment and their clinical value remains uncertain. This study aims to investigate the impact of high resolution endoscopy on the in-vivo histology prediction of colonic polyps Methods Procedures were performed using Fujinon colonoscopes and EPX 4400 processor. Fujinon standard definition (SD) EC 530 and high resolution (HD) EC530 and EC 590 colonoscopes were used. Polyps <10 mm were assessed using white light (WLI), FICE and indigo carmine (IC) spray, with the predicted diagnosis recorded with each modality of imaging. In each case the kind of colonoscope (SD or HD) was recorded. Polyps were removed and sent for histological analysis, with the pathologist blinded to the diagnosis made by the endoscopist. The predicted diagnosis for WLI FICE and IC were compared to the true histology to calculate the accuracy, sensitivity and specificity of in vivo assessment using either SD or HD scopes. McNemar's test was used for the statistical comparison of modalities of imaging. Results 232 polyps <10 mm were examined, 89 polyps with standard definition endoscopes and 143 polyps high definition endoscopes. The true histology consisted of 155 neoplastic and 77 hyperplastic polyps. HD endoscopes significantly improved the ability of the endoscopist to make an in vivo diagnosis using FICE but had no effect on the WLI or IC predicted diagnosis. See . OC-092 Diagnostic accuracy for adenomas Conclusion In-vivo diagnosis of small polyps is very important for the correct management of patients. W can conclude from our work that: In-vivo prediction of polyp histology is poor with WLI and this does not improve with HD scopes. In-vivo prediction of polyp histology is good with FICE and improves significantly with HD scopes. In-vivo prediction of polyp histology with IC is very good and is unaffected by HD scopes. [ABSTRACT FROM PUBLISHER]

Introduction Conventional bowel preparation for afternoon colonoscopy involves the use of an oral agent the day prior to the procedure, with further preparation on the morning of the procedure. We hypothesise that for afternoon lists same day bowel prep would be more effective, avoiding a wasted day taking bowel prep and could lead to a cleaner bowel. Methods Using nationally accepted criteria we compared the recorded quality of bowel preparation. All procedures were performed by the same endoscopist on an afternoon list. Group A consisted of patients prepared with three sachets of picolax, given at 12:00 and 17:00 the day before, and at 8:00 on the morning of the procedure. Group B consisted of patients given two sachets of picolax on the morning of the procedure at 07:00 and 10:00. A Fisher's exact test was performed to test for a significant difference in mucosal visibility between the regimes. Polyp detection, sedation levels and patient comfort was compared between the groups. Patients completed a quality of life (QOL) questionnaire investigating complications, including faecal incontinence, interruption to sleep, headaches, vomiting, abdominal pain, impact on work and social activities and preference of regime. Results There were 214 patients, 82 in group A and 132 in group B. 70% were male, median age 65 (range 60–71). 66% had polyps. There was no difference in sedation or discomfort between the groups. Same day preparation produced better mucosal visibility than the split dose regimen (p = 0.0046). See . Polyp detection in the same day regimen was numerically better (71% vs 62%) but the study was not powered to show statistical difference (p = 0.2). OC-083 Quality of mucosal cleansing by bowel preparation regimen QOL questionnaires were completed by 92 patients. There was less faecal incontinence, interruption to sleep, headaches, vomiting or abdominal pain with same day prep (P = 0.0001). Patients in the same day regimen reported less impact on ADLs compared to split dose prep. For the whole cohort patients favoured choice for preparation was for the same day regimen (p = 0.037). Amongst the split dose patients 40% favoured split dose, 48% same day prep with 12% unsure (P = 0.57). Amongst the same day prep patients 14% favoured split dose, 83% favoured same day prep with 3% unsure (p = 0.0001). The difference between the groups was significant (P = 0.004). Conclusion We found that afternoon colonoscopy with same day bowel preparation is feasible, safe and more effective than the conventional split dose regime. Patients preferred the same day regimen and it has less impact on QOL with less adverse effects. We believe same day bowel prep should become a new standard for afternoon colonoscopy. [ABSTRACT FROM PUBLISHER]

Introduction Barrett's dysplasia is difficult to visualise on routine endoscopy. When assessing patients with suspected dysplasia standard practice is to take protocol guided quadrantic biopsies, with each biopsy sent in a separate cassette in an attempt to localise the dysplasia. Acetic acid chromoendoscopy is a method for visualising dysplastic areas and perform targeted therapies like biopsy or EMR. We examine the efficacy of this technique in detection of neoplasia and the potential cost implications. Methods We reviewed all patients referred with suspected early neoplasia between 2005 and 2010. Procedures were performed on a dedicated list with high resolution fujinon gastroscopes and EPX4400 processor. A thorough inspection of Barrett's was performed with white light (WLI) and visible neoplasia noted. This was followed by acetic acid (AA) chromoendoscopy. Additional neoplastic areas were noted and targeted biopsies performed. This was followed by quadrantic biopsies of the remaining Barrett's. Cases where acetic acid failed to identify the dysplastic areas were noted. The cost of each biopsy cassette for histological evaluation was £58.90. By looking at the average length of Barrett's the cost per area of dysplasia located by Seattle and Cleveland clinic protocol biopsies was compared to targeted histology. Results 263 procedures were examined. High risk Neoplasia was found on 143 procedures. Using acetic acid it was correctly identified in 96% of the cases. With white light this was possible in 55% of cases. In 5 of 143 procedures additional dysplasia was picked up on quadrantic biopsy. The cost of histological evaluation in this cohort by Seattle protocol, Cleveland Protocol and acetic acid targeted biopsy protocols are shown in . A potential cost saving of £269,292.80 could be achieved in a population with suspected dysplasia. OC-065 Evaluation of histopathology costs by biopsy protocol Conclusion Acetic acid chromoendoscopy helps localise dysplasia in the majority of patients and is superior to WLI evaluation. This strategy could potentially represent a significant cost saving in patients with suspected dysplasia. We believe that AA chromoendoscopy should become a standard practice in the evaluation of dysplasia. [ABSTRACT FROM PUBLISHER]

Introduction The histological evaluation of diminutive polyps is time consuming and expensive. Recent developments in endoscopic techniques have enabled the prediction of histology in vivo using vascular enhancement techniques and dye sprays. This study aims to evaluate the cost effectiveness of in vivo histology prediction using white light (WLI) FICE and indigo carmine (IC) dye spray in the bowel cancer screening programme. Methods Patients undergoing screening on the national bowel cancer screening programme (BCSP) were prospectively evaluated. Polyps were examined using WLI, FICE and IC prior to removal and histological examination. The accuracy of the in vivo histology prediction was calculated. Using a histology cost of £58.90 per polyp the cost of histological analysis for the cohort was calculated. Cost savings for sending neoplastic polyps (Portsmouth protocol) or just polyp cancers (modified Portsmouth protocol) was then calculated. Finally the cost per missed adenoma was assessed for WLI, FICE and IC dye spray. Results 141 patients were examined, with 305 diminutive polyps <10 mm found in 106 patients (mean 2.9 polyps per patient). When using HD endoscopes a sensitivity for adenomas of 76% with WLI, 93% with FICE and 94% with IC was achieved. This is in keeping with similar results from the DISCARD study using narrow band imaging. No polyp cancers were mis-diagnosed. Rescope interval as determined by BSG guidelines would have been correct in 97% of cases using either FICE or IC for in vivo histology prediction. The potential costs for each strategy are shown in . Based on our data a potential cost saving of £109 per person undergoing screening colonoscopy could be made. Within the national BCSP 12153 colonoscopies are performed per annum with 11,619 benign polyps <10 mm removed per year. Using this data we have calculated that in vivo diagnosis could represent a potential saving of £684,339.47 per annum for histology related costs. OC-060 Evaluation of histopathology costs by biopsy protocol Conclusion (1) In vivo diagnosis of polyps and retrieving and sending only adenomas can lead to a 1.5–2-fold reduction in pathology costs. (2) In vivo diagnosis where only diminutive cancers are sent for histology can lead to an 75–113-fold reduction in pathology costs. (3) A simple change in practice (after appropriate training) with in vivo polyp diagnosis can significantly reduce the work load for extremely stretched and busy endoscopy and pathology departments. [ABSTRACT FROM PUBLISHER]

Introduction The current paradigm for the management of colonic polyps is to remove all lesions and send for histopathological evaluation, which dictates the surveillance interval. However, this is expensive and can result in a delay in arranging the surveillance interval for the patient. Studies using vital stains with zoom endoscopes have suggested that in vivo histology prediction is possible but has been perceived as too messy and impractical for every day use. This study aims to evaluate the accuracy of FICE and indigo carmine dye spray in the prediction of in vivo histology for diminutive polyps (<10 mm). Methods Procedures were performed using fujinon colonoscopes and EPX 4400 processor. Polyps <10 mm were assessed using white light (WLI) followed by FICE, followed by indigo carmine spray, with the predicted diagnosis recorded with each modality of imaging. Finally, the polyps were removed and sent for histological analysis, with the pathologist blinded to the diagnosis made by the endoscopist. The predicted diagnosis for WLI, FICE and IC were compared to the true histology to calculate the accuracy, sensitivity and specificity of in vivo assessment. Mcnemear's test was used for the statistical comparison of modalities of imaging. Results A total of 232 polyps <10 mm in size were examined, consisting of 2 polyp cancers, 153 adenomas and 77 hyperplastic polyps. FICE and IC significantly improved the accuracy of the in vivo diagnosis of polyps as compared to WLI endoscopy (see ). In vivo prediction of polyp histology allowed us to set the correct surveillance interval in 83% of cases using WLI alone and in 97% of cases using either FICE or IC based on BSG guidelines. OC-006 In-vivo diagnosis of neoplasia by endoscopic modality Conclusion FICE and indigo carmine significantly improves the in vivo diagnosis of diminutive colonic polyps. This has the potential to improve the management of polyps and setting the accurate surveillance interval at the time of the procedure, with a significant impact on the cost and quality of care. [ABSTRACT FROM PUBLISHER]

Introduction The traditional approach to the management of large colonic polyps has been surgery. Endoscopic mucosal resection (EMR) is an emerging technique for the removal of large colorectal lesions. Most of the published literature comes from Japan, with limited data regarding safety, efficacy and outcome in the west. We aim to assess the feasibility and safety of EMR in the colon in a western setting. Methods A prospective review of patients undergoing EMR of colonic neoplasia >2 cm in size was performed. All patients were tertiary referrals from experienced consultants. The polyps were considered technically challenging due to size, difficult lesion access (peri-diverticular, peri-appendicular, touching the dentate line), or recurrences on previous EMR scars. They were referred to our service prior to surgical referral. Lesions were assessed using indigocarmine chromoendoscopy, and lesions with features suggestive of invasive malignancy were excluded. Completeness of resection was recorded by the endoscopist. Patients were followed up endoscopically where appropriate to assess for incomplete resection or recurrence. Results 214 patients with 214 polyps underwent EMR. The mean size was 43 mm (range 20–150). 180 were flat and 46 were on the right side of the colon. Primary reason for referral was the size in 91 cases, lesion access in 107 cases and a previous failed resection in 16 cases. Endoscopic clearance at first attempt was achieved in 92% of cases. Residual or recurrent disease was seen at the first endoscopic follow-up in 17% cases requiring further endoscopic resection. Overall endoscopic cure has been achieved in 95% of patients. Three patients went to surgery due to failed endoscopic resection. There were procedure related complications in 15/214 (7%) of cases. This consisted of delayed bleeding in nine patients, immediate bleeding in two cases and four post polypectomy syndrome. The risk of complications was independent of size or location. There were 13 cancers (7 > sm1 invasion) in flat polyps and 4 pedunculated polyp cancers (1 > Haggitt 2). 13 of these cases underwent surgery. Taking the cost of surgery as £12,000 and the cost of EMR as £561 this represents a potential cost saving of £2,231,946 for the cohort. Conclusion This is the largest UK series demonstrating that EMR is a safe and effective treatment for large difficult polyps with an overall complication rate of 7%. It avoided surgery in 93% of cases with substantial cost savings. We believe that EMR of large and difficult benign polyps should be the new standard of care. [ABSTRACT FROM PUBLISHER]

Introduction The introduction of the bowel cancer screening programme has resulted in a rise in the number of large polyps being encountered during endoscopy. The exact frequency and management of these polyps remains unclear. This study aims to assess the incidence of large polyps and their management in the BCSP and to extrapolate this to the national scenario within the programme. Methods The bowel cancer screening database was interrogated to identify all cases over the last 3 years where lesions greater than 2 cm were identified. In each case the polyp morphology and histology was noted. The case files were retrieved and the treatment given to the patient recorded. Results The Solent BCSP covers a catchment population of 763 000.In total 1573 colonoscopies were performed over a 3 year period. Polyp burden There were 2454 polyps in total (1072 per million per annum). 193 polyps >2 cm were seen during this period. This amounts to 84 per million per annum and represents 7.9% of the total polyp burden. 122/193 were pedunculated polyps (53 per million per annum) and 71/193 were flat polyps >2 cm (31 per million per annum) representing 2.9% of all polyps. It is flat lesions >3 cm which we believe are very challenging. The frequency of these was 32/193 (14 per million per annum), just 1.3% of the polyps encountered. Polyp cancers The overall risk of cancer in polyps >2 cm was 13%. Size did not correlate to risk of malignancy. Polyp management 24/193 polyps were not resected endoscopically. 17 were referred to surgery due to suspected malignancy and were found to have cancer at surgery. 7 benign adenomas were sent to surgery. 4 benign polyps were referred to surgery due to technical inability of the endoscopist, 1 due to coexisting cancer, 1 due to co-existing ulcerative colitis and 1 due to patient choice. Conclusion (1) The majority of polyps in the BCSP are small (2) Flat adenomas >2 cm are infrequent and those >3 cm are rare, representing 1.3% of the total polyp burden (3) The management of most of the large lesions in this series was endoscopic, due in part to a strong local EMR service within the Solent area (4) Our data shows that the number of patients with large and flat lesions in the BCS programme is low and a good outcome can be achieved in a specialist centre. [ABSTRACT FROM PUBLISHER]

Introduction Endoscopic resection (ER) is an accepted treatment of early upper gastrointestinal neoplasia in Europe, but surgery remains the gold standard in the UK due to lack of data. We started an upper gastrointestinal ER service in 2005 and are reporting our 6 year outcome data. We serve six different regional cancer centres. Methods We analysed our database of all upper gastrointestinal (UGI) endoscopic resection procedures performed at our centre for the period 2005–2010. All procedures were carried out by a single skilled endoscopist. Demographic data, histology, procedure success, long-term outcome and complications were assessed. Results We have performed 160 UGI ER procedures (108 oesophageal (O), 29 gastric (G), 33 duodenal/ampullary (D)) in 127 patients (O=75, G=25, D=27). Mean age was 65.9 years (range 25–94). A mean of 1.32 UGI ER procedures were performed per patient (range 1–5). All neoplastic cases were diagnosed as high grade dysplasia or intramucosal cancer prior to EMR. Overall complication rate was 5.0%. Specific complications were four procedural bleeds and two delayed bleeds (all controlled endoscopically) one full thickness perforation clipped endoscopically and one episode of pancreatitis. There were no cases of procedure related mortality. 25 patients (19.7%) were upstaged, having been found to have sm1 invasion or deeper on histological examination of the initial ER specimen. This group were considered for radical treatment if fit, or conservative management if unfit or through patient choice. 16 patients (O=11, G=4, D=1) proceeded to radical surgery, of which 2 patients died of postoperative complications and 2 patients died of local recurrence; the other 12 remain well. 2 patients received chemo/radiotherapy; 1 died of advanced oesophageal cancer, the other remains well. Of the remaining 102 patients complete local remission was achieved in 79.4% of cases following a single ER procedure, and in 97.1% overall. After a mean 2.57 years follow-up; 4% of all patients are known to have recurrence or metachronous disease and are awaiting further ER. Development of our service has potentially led to a cost saving of £91 270 per year, plus 170 bed days saved per year through reduced requirement for radical surgery. Conclusion Our data demonstrates the long-term feasibility, efficacy and safety of an innovative ER service. It provides valuable information about the number and type of patients requiring this service helping inform future planning and commissioning. Our data demonstrates significant cost savings for the NHS. [ABSTRACT FROM PUBLISHER]

Introduction Japanese endoscopists have been using pit pattern recognition in early colorectal neoplasia for many years. It has a key role in the decision to endoscopically resect or defer to surgery. We have been training in Kudo's pit pattern recognition as part of an endoscopy fellow programme studying EMR, and optical diagnosis. We aimed to evaluate our accuracy in pathological prediction relative to: 3 experienced untrained peers; a specialist UK consultant endoscopist; and a specialist Japanese consultant endoscopist. We aimed to assess 2 separate training interventions; an untrained endoscopist undergoing a 1 h training session in pit pattern assessment and pathological prediction; an endoscopy fellow undertaking a 4 week visit to a specialist centre in Japan. Methods 111 pictures of polyps seen by white light (38), chromoendoscopy (35), and magnification chromoendoscopy (38) were studied by all participants. Prediction of pathology was made, and compared to actual pathology; 37 hyperplastic, 43 adenomatous and 31 cancer polyps. All participants were blinded until the study was completed. 60 pictures were assessed by all fellows and untrained peers prior to intervention, with one peer further assessed after a 1 h teaching session using a GIE supplement for illustration. Six weeks after the initial assessment the same 60 pictures and a further 51 not seen before were assessed by all. Results were compared to results achieved by the UK and Japanese consultant endoscopists from a separate study using the same polyp library. Results Endoscopy fellows achieved a mean accuracy higher than the untrained peers, 72% versus 64%. Additional training in Japan showed no significant increase in diagnostic accuracy, 72% versus 73%. The specialist UK endoscopist achieved 87% accuracy. This was not statistically different to the specialist Japanese endoscopist at 93%. Fellows achieved an overall accuracy of 72%, with highest accuracy in their area of interest (metaplastic polyps 84%, polyp cancer 79%). Overall accuracy improved from 60% to 65% after 1 h teaching, and was 63% at 6 weeks. The sensitivity in diagnosing polyp cancer rose from 69% to 75%, and finally 94% at 6 weeks. Conclusion Training as a specialist endoscopist increases skill in lesion recognition compared to untrained peers. Additional training in Japan does not necessarily increase lesion recognition skills above that gained from UK training. A simple 1 h intervention in an untrained endoscopist increased accuracy in lesion recognition, and improved polyp cancer recognition. Mastery of lesion recognition to the level of specialist Japanese endoscopists is possible, but requires ongoing study and assessment. [ABSTRACT FROM PUBLISHER]

Introduction: Rheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct an evaluation of a task-sharing approach to echocardiographic active case finding for early detection and management of RHD in high-risk settings in Australia and Timor-Leste., Methods and Analysis: Echocardiograms will be obtained by trained local staff using hand-held echocardiographic devices employing the 'Single Parasternal Long Axis view with a Sweep of the Heart' (SPLASH) technique and interpreted by experts remote from the site of acquisition. Approximately 1500 children and pregnant women will be screened across high-risk communities in Australia and Timor-Leste over an 18-month period. The study will use a type II effectiveness-implementation hybrid design. A tailored package of implementation strategies will be co-designed with communities and health services and mapped onto a Theory of Change framework. The clinical effectiveness will be assessed as the change in the proportion of the target population that are prescribed secondary prophylaxis for RHD by the end of the study compared with baseline. The implementation will be assessed as the adoption, penetration, sustainability, fidelity and cost of the programme with a mixed-methods theory-based and economic evaluation. Data will include numbers of normal, abnormal and uninterpretable SPLASH echocardiograms obtained, numbers of participants progressing through the cascade of care, interviews with staff and programme costs., Ethics and Dissemination: Ethical approval has been obtained from the Human Research Ethics Committee of the NT Department of Health and Menzies School of Health Research, Darwin (HREC-2022-4479), the Western Australian Aboriginal Health Ethics Committee (HREC-1237) and the Instituto Nasional Saude Publika Timor-Leste Ethics and Technical Committee (03-UEPD/INSP-TL/V/2023). Informed consent is required to be enrolled. Study findings will be disseminated in the communities involved and submitted for publication., Trial Registration Number: NCT06002243., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objective: To assess health-related quality of life (HRQOL) and global quality of life (QOL) in children and adolescents with Fontan physiology and identify key predictors influencing these outcomes., Study Design: Cross-sectional analysis of 73 children and adolescents enrolled in the Australia and New Zealand Fontan Registry aged 6-17 years, at least 12 months post-Fontan operation. Assessments included the Pediatric Quality of Life Inventory (PedsQL) for HRQOL and a developmentally-tailored visual analogue scale (0-10) for global QOL, along with validated sociodemographic, clinical, psychological, relational, and parental measures. Clinical data were provided by the Australia and New Zealand Fontan Registry., Results: Participants (mean age: 11.5 ± 2.6 years, 62% male) reported lower overall HRQOL (P < .001), and lower scores across all HRQOL domains (all P < .0001), compared with normative data. Median global QOL score was 7.0 (IQR 5.8-8.0), with most participants (79%) rating their global QOL ≥6. Anxiety and depressive symptoms requiring clinical assessment were reported by 21% and 26% of participants, respectively. Age, sex, and perceived seriousness of congenital heart disease explained 15% of the variation in HRQOL scores, while depressive symptoms and treatment-related anxiety explained an additional 37% (final model: 52% of variance explained). For global QOL, sociodemographic and clinical factors explained 13% of the variance in scores, while depressive symptoms explained a further 25% (final model: 38% of variance explained). Parental factors were not associated with child QOL outcomes., Conclusions: Children and adolescents with Fontan physiology experience lower HRQOL than community-based norms, despite reporting fair overall QOL. Psychological factors predominantly influenced QOL outcomes, indicating strategies to bolster psychological health could improve QOL in this population., Competing Interests: Declaration of Competing Interest This work was supported by HeartKids Australia and Australian National Health and Medical Research Council (NHMRC) Project (APP1065794) and Partnership (APP1076849) Grants. The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The World Heart Federation (WHF) published the first evidence-based guidelines on the echocardiographic diagnosis of rheumatic heart disease (RHD) in 2012. These guidelines have since been applied internationally in research and clinical practice. Substantial research has assessed the utility of the 2012 WHF criteria, including its applicability in low-resource settings. This article summarises the evidence regarding the performance of the guidelines., Methods: A scoping review assessing the performance of the guidelines was performed. Cochrane, Embase, Medline, PubMed Lilacs, Sielo, and Portal BVS databases were searched for studies on the performance of the guidelines between January 2012-March 2023, and 4047 manuscripts met the search criteria, of which 34 were included. This included papers assessing the specificity, inter-rater reliability, application using hand-carried ultrasound, and modification of the criteria for simplicity. The review followed the PRISMA Extension for Scoping Reviews guideline., Results: The WHF 2012 criteria were 100% specific for definite RHD when applied in low-prevalence populations. The criteria demonstrated substantial and moderate inter-rater reliability for detecting definite and borderline RHD, respectively. The inter-rater reliability for morphological features was lower than for valvular regurgitation. When applied to hand-carried ultrasound performed by an expert, modified versions of the criteria demonstrated a sensitivity and specificity range of 79-90% and 87-93% respectively for detecting any RHD, performing best for definite RHD. The sensitivity and the specificity were reduced when performed in task-sharing but remains moderately accurate., Conclusion: The WHF 2012 criteria provide clear guidance for the echocardiographic diagnosis of RHD that is reproducible and applicable to a range of echocardiographic technology. Furthermore, the criteria are highly specific and particularly accurate for detecting definite RHD. There are limitations in applying all aspects of the criteria in specific settings, including task-sharing. This summary of evidence can inform the updated version of the WHF guidelines to ensure improved applicability in all RHD endemic regions., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Barrett's oesophagus is the only known precursor to oesophageal adenocarcinoma, a cancer with very poor prognosis. The main risk factors for Barrett's oesophagus are a history of gastro-oesophageal acid reflux symptoms and obesity. Men, smokers and those with a family history are also at increased risk. Progression from Barrett's oesophagus to cancer occurs via an intermediate stage, known as dysplasia. However, dysplasia and early cancer usually develop without any clinical signs, often in individuals whose symptoms are well controlled by acid suppressant medications; therefore, endoscopic surveillance is recommended to allow for early diagnosis and timely clinical intervention. Individuals with Barrett's oesophagus need to be fully informed about the implications of this diagnosis and the benefits and risks of monitoring strategies. Pharmacological treatments are recommended for control of symptoms, but not for chemoprevention. Dysplasia and stage 1 oesophageal adenocarcinoma have excellent prognoses, since they can be cured with endoscopic or surgical therapies. Endoscopic resection is the most accurate staging technique for early Barrett's-related oesophageal adenocarcinoma. Endoscopic ablation is effective and indicated to eradicate Barrett's oesophagus in patients with dysplasia. Future research should focus on improved accuracy for dysplasia detection via new technologies and providing more robust evidence to support pathways for follow-up and treatment., Competing Interests: Competing interests: MdP participated in the BEST3 screening trial and received consultant fees from Medtronic. JNP was chair of the trial Steering committee of the AspECT trial. NJT participated in the AspECT trial., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)