This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles, and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

No abstract

In this study, there was no difference between the pressures at which gastric and oesophageal varices bled. Rebleeding and mortality rates were similar in the two groups. TIPS is equally effective in the treatment of both oesophageal and gastric variceal haemorrhage.

Objectives The UK National Health Service Bowel Cancer Screening Programme (BCSP) is based on a strategy of biennial faecal occult blood (FOB) testing. Positive results are classified as ‘abnormal’ or ‘weak positive’ based on the number of positive windows per kit or need for repeat testing. Colonoscopy is offered to both groups. We evaluate the relationship between FOB test positivity and clinical outcome in the BCSP. Setting The South of Tyne and Tees (UK) Bowel Cancer Screening Centres. Methods Data were collected prospectively on all individuals who were offered FOB testing and colonoscopy between February 2007 and February 2009. Univariable and multivariable analyses were performed to investigate the relationship between FOB test positivity and clinical outcome. Results Following FOB testing, 1524 individuals underwent colonoscopy, 1259 (83%) after a ‘weak positive’ and 265 (17%) an ‘abnormal’ result. Cancer was detected in 180 (11.8%) and adenomas in 758 (49.7%). Individuals with an ‘abnormal’ result were more likely to have cancer or be ‘high risk’ for the development of future adenomas (110/265, 41.5%) than those with ‘weak positive’ results, (236/1259, 18.7%, P < 0.0001). Those with Dukes stage B, C or D cancers or cancers proximal to the splenic flexure were more likely to have an ‘abnormal’ result. Conclusions The majority of colonoscopies were performed following ‘weak positive’ FOB results. Those with an ‘abnormal’ result were more likely to be diagnosed with cancer. The high yield of pathology in both the ‘abnormal’ and ‘weak positive’ groups justifies the need for colonoscopy in both.

The development of a SIBDQ for patients with ulcerative colitis did not reveal any clear advantage over the original version of the SIBDQ. Further studies are required to determine the role of the SIBDQ in routine clinical practice.

Objective The NHS Bowel Cancer Screening Programme (BCSP) began roll-out in 2006 aiming to reduce cancer mortality through detection at an earlier stage. We report results from the prevalent round of screening at two fi rst wave centres and compare with the UK pilot study. Design This is a service evaluation study. Data were collected prospectively for all individuals undergoing faecal occult blood testing (FOBt) and colonoscopy including: uptake and outcomes of FOBt, colonoscopic performance, fi ndings, histological data and complications. Continuous data were compared using a two-tailed test of two proportions.

Evaluation of swallowing following stroke has previously concentrated on the oropharyngeal phase. We have studied whether there is esophageal dysmotility during the early phase following stroke in patients with no clinical evidence of oropharyngeal dysfunction. Twenty-five patients with a clinical diagnosis of stroke, and CT scan confirmation, without swallowing abnormalities at bedside evaluation were studied. Each subject had two esophageal manometric studies, one between days 3-5 after the stroke and the second during the third week after the stroke. Mean percentage (+/-SE) of completed peristaltic events increased from 57.8 +/- 5.9 (days 3-5) to 77.3 +/- 3.9 (week 3) (P = 0.005). Mean propagation of peristalsis (+/-SE) between 10 and 5 cm above the lower esophageal sphincter increased from 2.9 +/- 0.2 cm/sec (days 3-5) to 3.7 +/- 0.3 cm/sec (week 3) (P = 0.003). We have demonstrated subclinical peristaltic dysfunction in the smooth muscle segment of the esophagus in stroke patients with relatively preserved oropharyngeal function.