Background. Transanal irrigation (TAI) can successfully treat neurogenic bowel dysfunction (NBD), but patient perception of its use in chronic idiopathic constipation (CIC) is unknown. Objective. To evaluate patient perceptions of the efficacy and safety of TAI for CIC and whether there are predictive factors of perceived treatment response. Methods. Prospective data collection of baseline physiology and symptom severity; retrospective evaluation of efficacy and safety perceptions using a snapshot survey. All patients fulfilling the Rome III criteria for functional constipation with chronic idiopathic aetiology were included. The main outcome measure was the duration of patients' usage of TAI. Results. 102 patients reported 21,476 irrigations over 119 patient years, with a mean duration of therapy use of 60.5 weeks [SD 73.2 : SE 7.3]. Overall symptom improvement included general well-being (65%), rectal clearance (63%), bloating (49%), abdominal pain (48%), and bowel frequency (42%). 68 patients (67%) were “moderately better” or “very much better” on a satisfaction question. Reported complications were minor. No correlation was demonstrated between duration of therapy use and baseline measures. Conclusion. A significant proportion of CIC sufferers use TAI as a long-term or bridging therapy and perceive it as safe. This therapy demands a prospective investigation of efficacy and safety.

ObjectivesSacral nerve stimulation (SNS) may provide long-term symptom relief to patients suffering chronic constipation. Patients are currently selected for SNS using a 2week peripheral nerve evaluation (PNE) comprising stimulation via temporary leads. However, only 40% of test responders receive long-term benefit from treatment meaning that healthcare costs per successfully treated patient are too high. The primary objective was to assess tined-lead testing to predict benefit from SNS for chronic constipation. MethodsA randomised double-blind sham-controlled cross-over design evaluated enhanced PNE (ePNE) using tined quadripolar electrode leads over 6 weeks. The design differentiated between patients with discriminate and indiscriminate responses to testing. A score improvement of 25% or more was considered to be a positive response within a stimulation period. The primary outcome was the proportion of patients demonstrating a reduction ≥ 0.5 in constipation symptom score (PAC-SYM) at 6 months. ResultsA total of 45 patients were randomised, of whom 29 (64.4%) were test-phase responders. Of these, 27 were implanted providing permanent SNS. During ePNE, 7 (18%) were discriminate responders, 22 (56%) were indiscriminate responders and 10 (26%) were non-responders. Six patients were withdrawn during the test phase due to infection or non-compliance. At 6 months, there was no significant difference in primary outcome between discriminate and indiscriminate responders (60% vs 57%, p=0.76). The study was terminated prematurely due to a persistent infection rate of 10 (22%) during ePNE of which 9 (20%) were severe. ConclusionsePNE is a poor predictor of treatment response at 6 months. This suggests a strong and persistent placebo response during both SNS PNE and treatment. An extended 6 week PNE poses a high risk of infection.

Background: Healthcare workers (HCW) are a crucial part of the workforce but are also at potentially at increased risk of infection from SARS-CoV-2. Emerging evidence has suggested specific groups of HCW are at further increased risk particularly those from Black, Asian and Minority Ethnic (BAME) groups. Previous reports have not examined risk factors associated with contracting the virus and were reported prior to the pandemic peak in the UK. Methods: Staff testing in our facility commenced on the 1st April and all individuals were entered into a database. Repeat testing was used for the first 3 weeks for those initially testing negative. Demographics including age, sex, occupation and ethnicity were recorded. Occupation was divided into acute frontline (e.g. ITU), frontline, clinical support staff and non-clinical staff. Final testing status was analysed using univariate and multivariable analysis to determine independent associations with age, sex, occupation and ethnicity. Findings: 991 individuals (mean age 42.6 years, 145 males) were tested over a 4 week period and overall 440/991 (43.4%) tested positive for SARS-CoV-2. SARS-CoV-2 RNA detection rates were significantly higher in the first week of testing (59.0%) compared to week 2 (odds ratio 0.59), week 3 (odds ratio 0.32) and week 4 (odds ratio 0.23)(all p <0.001). Multivariable analysis showed no increased risk SARS-CoV-2 RNA detection with age (odds ratio 1.01, 95% confidence interval 0.99 - 1.03, p = 0.22), male sex (OR 1.03, 95% CI 0.59 - 1.79, p = 0.92), acute frontline work (OR 0.79, 95% CI 0.53 - 1.17, p = 0.23) or BAME status (OR 1.08, 95% CI 0.56 - 2.07, p = 0.84). Interpretation: A robust healthcare worker testing strategy is a crucial component of managing the workforce during the SARS-CoV-2 pandemic. No specific variables were identified that altered the risk of SARS-CoV-2 RNA detection including age, sex, occupation and ethnicity.

Hyperbaric oxygen therapy has improved pudendal nerve function and continence in this group of patients. The cause for this improvement in latencies is unclear at present but may be because of a direct effect on the nerve or an improvement in blood flow to the nerve through angiogenesis. However, these results are good enough to schedule further trials.

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).