SUMMARYBackground: The current understanding of quality of life impairment in inflammatory bowel disease has largely been derived from selected populations and may not reflect the experience of patients in the community, where fewer than half are likely to be under specialist care. Aim: To describe the health-related quality of life in a community-based sample of patients with established inflammatory bowel disease and explore its association with the type and extent of disease, gender, age, material deprivation and other factors. Methods: Adults with established inflammatory bowel disease were identified systematically from the records of 23 family practices in north-east England. The healthrelated quality of life was assessed by self-completion of the UK Inflammatory Bowel Disease Questionnaire.

Background Colorectal cancer often presents with obstruction needing urgent, potentially life-saving decompression. The comparative efficacy and safety of endoluminal stenting versus emergency surgery as initial treatment for such patients is uncertain. Methods Patients with left-sided colonic obstruction and radiological features of carcinoma were randomized to endoluminal stenting using a combined endoscopic/fluoroscopic technique followed by elective surgery 1–4 weeks later, or surgical decompression with or without tumour resection. Treatment allocation was via a central randomization service using a minimization procedure stratified by curative intent, primary tumour site, and severity score (Acute Physiology And Chronic Health Evaluation). Co-primary outcome measures were duration of hospital stay and 30-day mortality. Secondary outcomes were stoma formation, stenting completion and complication rates, perioperative morbidity, 6-month survival, 3-year recurrence, resource use, adherence to chemotherapy, and quality of life. Analyses were undertaken by intention to treat. Results Between 23 April 2009 and 22 December 2014, 245 patients from 39 hospitals were randomized. Stenting was attempted in 119 of 123 allocated patients (96.7 per cent), achieving relief of obstruction in 98 of 119 (82.4 per cent). For the 89 per cent treated with curative intent, there were no significant differences in 30-day postoperative mortality (3.6 per cent (4 of 110) versus 5.6 per cent (6 of 107); P = 0.48), or duration of hospital stay (median 19 (i.q.r. 11–34) versus 18 (10–28) days; P = 0.94) between stenting followed by delayed elective surgery and emergency surgery. Among patients undergoing potentially curative treatment, stoma formation occurred less frequently in those allocated to stenting than those allocated to immediate surgery (47 of 99 (47.5 per cent) versus 72 of 106 (67.9 per cent); P = 0.003). There were no significant differences in perioperative morbidity, critical care use, quality of life, 3-year recurrence or mortality between treatment groups. Conclusion Stenting as a bridge to surgery reduces stoma formation without detrimental effects. Registration number: ISRCTN13846816 (http://www.controlled-trials.com).

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BackgroundThe COVID-19 pandemic has profoundly affected endoscopy services including pancreatobiliary (PB) endoscopy across the UK. The British Society of Gastroenterology and Joint Advisory Group have issued guidance for managing endoscopy services safely throughout this period. There have been perceived concerns among the PB endoscopists that wearing full personal protective equipment might have an adverse impact on key performance indicators (KPIs) in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) procedures leading to non-compliance with the national guidelines. The aim of the study was to assess the impact of COVID-19 pandemic on KPIs in ERCP and EUS and ascertain the risk of procedure-related complications.MethodsA retrospective audit of a prospectively maintained endoscopy database was carried out between 18 March and 31 July 2020.Results146 ERCP procedures (common bile duct (CBD) cannulation rate of naïve papilla 89.2%, complete CBD stone extraction rate at first ERCP 88.2%, biliary stricture decompression rate 91%) and 87 EUS procedures (diagnostic accuracy of EUS-fine needle aspiration 92%) were carried out during this period. ERCP-related complications included pancreatitis (4.8%), bleeding (0.68%) and cholangitis (0.68%). 30-day ERCP procedure-related mortality was 0.68%. There were no complications or procedure-related mortality in the EUS group.ConclusionThis is the first study looking at the impact of COVID-19 on KPIs and procedure-related complications in ERCP and EUS in the literature. Our study confirms that a high-quality PB endoscopy service can be delivered safely and effectively during the COVID-19 pandemic.

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