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This is the first national audit of colonoscopy that has successfully captured the majority of adult colonoscopies performed across an entire nation during a defined time period. The data confirm that there has been a significant improvement in the performance of colonoscopy in the UK since the last study reported seven years ago (CIR 76.9%) and that performance is above the required national standards.

Ann R Coll Surg Engl 2010; 92: 279-281 279The phenomenon of gallstone ileus was first described in 1654 by Dr Erasmus Bartholin, a Danish physician and mathematician, on a patient he examined at autopsy. 1 The pathogenesis of gallstone ileus involves adhesions forming between the inflamed gallbladder and an adjacent part of the gastrointestinal tract. Subsequently, large stones within the gallbladder cause pressure necrosis, resulting in formation of a cholecyst-enteric fistula, which allows gallstones direct access to the gut.2 Most fistulas involve the duodenum, but fistulas to the stomach and colon have been described. 3 In the last 350 years, gallstone ileus has remained an uncommon, but intriguing, entity. Whilst resolving the obstruction can usually be achieved by simple enterotomy and gallstone removal, the dilemma of how to deal with the fistula from the gallbladder to the intestine is less easy to resolve. Standard surgical texts have conflicting advice: The New Aird's surgical textbook advocates a one-stage procedure consisting of an enterotomy, closed transversely, and managing the fistula by either stapling or suturing across it, followed by cholecystectomy.2 However, it also states that in the presence of severe inflammation and adhesions, simply relieving obstruction by removal of the stone and leaving the fistula and gallbladder untouched may be more appropriate, particularly in an elderly patient.2 Similarly, Sabiston's textbook of surgery suggests a one-stage procedure to prevent attacks of recurrent cholecystitis and cholangitis, but also suggests that, in the event of a severe inflammatory process in the right upper quadrant and in an unstable patient, a second laparotomy should be performed to deal with the fistula. This short review looks at the evidence available on which to base surgical planning. Materials and MethodsPublished articles were identified from the medical literature Gallstone ileus is an uncommon entity, which accounts for 1-4% of all presentations to hospital with small bowel obstruction and for up to 25% of all cases in patients over 65 years of age. Despite medical advances over the last 350 years, gallstone ileus is still associated with high rates of morbidity and mortality. The management of gallstone ileus remains controversial. Whilst open surgery has been the mainstay of treatment, more recently other approaches have been employed, including laparoscopic surgery and lithotripsy. However, controversy persists primarily in relation to the extent of surgery performed. MATERIALS AND METHODS A literature review was performed in an attempt to discover the optimal surgical treatment of gallstone ileus, particularly the timing of biliary surgery. Published articles were identified from the medical literature by electronic searches of Pubmed and Ovid Medline databases, using the search terms 'gallstone ileus', 'gallstone/intestinal obstruction' and 'gallstone/bowel obstruction'. The related articles function of the search engines was also used to maximise the number of articl...