Carlos Guarner-Argente

Adherence to surveillance recommendations for Barrett’s esophagus (BE) has been little studied. This study evaluated adherence to current guidelines in Spain, factors associated with deviations from recommendations, and the impact on progression. It was a prospective, observational, multicenter study of patients with BE between January 2016 and December 2022. 375 patients (80.5% males, age 55 ± 13 years) were followed for 50 (IQR 34–61) months and underwent 556 gastroscopies, 505(90.8%) for surveillance. Among these, only 206(40.8%) were performed within the recommended intervals and 254(50.3%) were early endoscopies. Risk factors for early endoscopy were short BE length (< 3 cm 59.5% vs. ≥ 3 cm 42.2%, OR 2.01(1.35–2.98)) and endoscopy referred by a surgeon (7.2% vs. 2.8%, OR 2.99(1.19–7.52)), whereas use of the Seattle protocol (68% vs 79.9%, OR 0.51(0.32–0.8)) was protective. BE progression was confirmed in 13 patients (3.4%): 7 low-grade dysplasia, 5 high-grade dysplasia or in-situ adenocarcinoma, and 1 invasive adenocarcinoma. The median time from BE diagnosis to progression was 48 months (IQR 28–59). Early endoscopy did not significantly increased detection of BE progression (3.1% vs 2%, p = 0.41). The only independent risk factor for progression was BE length (OR 9.39 (2.02–43.78)). In conclusion, adherence to BE surveillance guidelines in Spain is low and the tendency to early endoscopy is notable. Improving adherence could reduce unnecessary procedures without compromising patient outcomes.

Background Pancreatic cancer is the seventh leading cause of cancer-related mortality worldwide and the fifth in the United Kingdom (UK), with incidence rates nearly matching mortality. Methods We conducted a population-based cohort study using Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases including patients aged 18+ with at least one year of prior data, diagnosed between 2000 and 2021. We estimated incidence, period prevalence, and survival at one, five, and ten years, stratified by age, sex, and calendar year. Results A total of 10,116 (GOLD) and 20,127 (Aurum) patients were included (median age 73 years, 50% male). Crude incidence rose from 6.9 per 100,000 person-years in 2000 to 14.2 in 2021. Age-standardized rates were lower towards the end of the study. Period prevalence increased from 0.01% to 0.03% over the same period. Median survival was 0.38 (95% CI 0.36–0.39) years in GOLD and 0.39 (95% CI 0.38–0.40) in Aurum. One-, five-, and ten-year survival were 25.3–26.2%, 6.1–6.6%, and 3.8–4.0%, respectively, with no differences by sex. One-year survival improved from 22.5% (95% CI 20.2–25.1) in 2000–2004 to 28.4% (95% CI 26.5–30.5) in 2015–2019. Conclusions Pancreatic cancer incidence and prevalence are increasing in the UK. Rising incidence may partly reflect population aging. Survival remains poor, with only modest short-term improvements. Small improvements in survival highlight more research is needed to improve earlier diagnosis which will lead to better patient outcomes. KEY MESSAGES This study aimed to assess long-term trends in the incidence, prevalence, and survival of pancreatic cancer in the United Kingdom using two large primary care databases. We found that both incidence and prevalence of pancreatic cancer have increased between 2000 and 2021, while survival has remained poor, with only modest short-term improvements. These findings highlight the urgent need for strategies focused on early diagnosis and prevention, particularly considering population aging and the increasing burden of modifiable risk factors.

INTRODUCTION: The management of colorectal cancer (CRC) is evolving, with advances in screening and treatment. The purpose of this study was to leverage population-based data to generate up-to-date UK estimates of age-specific and sex-specific incidence and overall survival for the period 2000–2021. METHODS: We analyzed nationally representative primary care records from Clinical Practice Research Datalink GOLD and replicated in Clinical Practice Research Datalink Aurum. We calculated incidence rates, and short-term and long-term survival stratified by age, sex, and diagnosis year. RESULTS: Overall incidence was 67.4/100,000 person years, increasing in 2000–2011 to drop slightly in 2011–2014, and then plateauing. By contrast, early-onset CRC raised uninterruptedly throughout the study period, from 8.33 to 19.07/100,000 person-years. Overall survival was 78.3%, 51.4%, and 38.5% at 1, 5, and 10 years, respectively, lower in men compared with women. Modest improvements in survival were observed over the study period, particularly for 60–69-year-old patients. DISCUSSION: Although the overall incidence in the population has plateaued, a worrying increasing trend of early-onset CRC was observed. Moreover, the slight improvement in overall survival suggests that significant progress is still needed. These findings highlight the urgent need for continued research and resource allocation to improve the diagnosis and management of CRC.

Background The management of colorectal cancer (CRC) is evolving, with advances in screening and treatment. We leveraged population-based data to generate up-to-date UK estimates of age and sex-specific incidence and prevalence and overall survival for the period 2000-2021. Methods We analysed nationally representative primary care records from Clinical Practice Research Datalink (CPRD) GOLD, and replicated in CPRD Aurum. We calculated incidence rates, prevalence, and short- and long-term survival stratified by age, sex, and diagnosis year. Results Unadjusted prevalence increased in the study period, from 15.6 to 46.4/10,000. Overall incidence was 61.5/100,000 person years, increasing in 2000-2011 to drop slightly in 2011-2014, and then plateauing. In contrast, early-onset CRC raised uninterruptedly throughout the study period, from 8.33 to 19.07/100,000 person-years. Overall survival was 78.3%, 51.4% and 38.5% at 1-, 5-, and 10-years respectively, lower in men compared to women. Modest improvements in survival were observed over the study period, particularly for 60-69 year old patients. Conclusion The overall prevalence of CRC in the UK has tripled in the last 20 years, leading to increased healthcare resource needs and with slight survival improvements. A worrying increasing trend of early-onset CRC is observed, warranting further research into its diagnosis and management.

Purpose: The COVID-19 pandemic profoundly affected healthcare systems and patients. There is a need to comprehend the collateral effects of the pandemic on non-communicable diseases. We examined the impact of the pandemic on short-term survival for common solid tumours, including breast, colorectal, head and neck, liver, lung, oesophageal, pancreatic, prostate, and stomach cancer in the UK. Methods: This was a population-based cohort study of electronic health records from the UK primary care Clinical Practice Research Datalink GOLD database. In sum, 12,259,744 eligible patients aged ≥ 18 years with ≥ 1 year’s history identified from January 2000 to December 2022 were included. We estimated age-standardised incidence and short-term (one- and two-year) survival for several common cancers from 2000 to 2019 (in five-year strata) and compared these to 2020– 2022 using the Kaplan–Meier method. Results: Incidence decreased for most cancers in 2020 and recovered to different extents in 2021– 2022. Short-term survival improved for most cancers between 2000 and 2019, but then declined, albeit minimally, for those diagnosed in 2020– 2022. This was most pronounced for colorectal cancer, with one-year survival falling from 78.8% (95% CI 78%– 79.6%) in 2015– 2019 to 77% (95% CI 75.6– 78.3%) for those diagnosed in 2020– 2022. Conclusion: Short-term survival for many cancers was impacted, albeit minimally, by the pandemic in the UK, with reductions in survivorship from colorectal cancer equivalent to returning to the mortality seen in the first decade of the 2000s. While data on longer-term survival are needed to fully comprehend the impact of COVID-19 on cancer care, our findings illustrate the need for an urgent and substantial commitment from the UK National Health Service to address the existing backlog in cancer screening and diagnostic procedures to improve cancer care and mortality.

INTRODUCTION: Endoscopic vacuum therapy (EVT) is a novel technique for closing upper gastrointestinal (UGI) defects. Available literature includes single-center retrospective cohort studies with small sample sizes. Furthermore, evidence about factors associated with EVT failure is scarce. We aimed to assess the efficacy and safety of EVT for the resolution of UGI defects in a multicenter study and to investigate the factors associated with EVT failure and in-hospital mortality. METHODS: This is a prospective cohort study in which consecutive EVT procedures for the treatment of UGI defects from 19 Spanish hospitals were recorded in the national registry between November 2018 and March 2022. RESULTS: We included 102 patients: 89 with anastomotic leaks and 13 with perforations. Closure of the defect was achieved in 84 cases (82%). A total of 6 patients (5.9%) had adverse events related to the EVT. The in-hospital mortality rate was 12.7%. A total of 6 patients (5.9%) died because of EVT failure and 1 case (0.9%) due to a fatal adverse event. Time from diagnosis of the defect to initiation of EVT was the only independent predictor for EVT failure (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01–1.05, P = 0.005). EVT failure (OR 24.5, 95% CI 4.5–133, P = 0.001) and development of pneumonia after EVT (OR 246.97, 95% CI 11.15–5,472.58, P = 0.0001) were independent predictors of in-hospital mortality. DISCUSSION: EVT is safe and effective in cases of anastomotic leak and perforations of the upper digestive tract. The early use of EVT improves the efficacy of this technique.

Objectives: The COVID-19 pandemic profoundly affected healthcare systems and patients. There is a pressing need to comprehend the collateral effects of the pandemic on noncommunicable diseases. Here we examined the impact of the COVID-19 pandemic on shortterm cancer survival in the United Kingdom (UK). We hypothesised that short-term survival from nine cancers would be reduced during the pandemic, particularly cancers that benefit from screening and early detection (e.g., breast and colorectal cancer). Design: Population-based cohort study. Setting: Electronic health records from UK primary care Clinical Practice Research Datalink (CPRD) GOLD database. Participants: There were 12,259,744 eligible patients aged ≥18 years with ≥one year of prior history identified from January 2000 to December 2021. Main outcome measures: We estimated age-standardised incidence rates (IR) and short-term (one- and two-year) survival of several common cancers (breast, colorectal, head and neck, liver, lung, oesophagus, pancreatic, prostate, and stomach cancer) from 2000 to 2019 (in five-year strata) compared to 2020 to 2021 using the Kaplan-Meier method. Results: Apart from pancreatic cancer, IRs decreased for all cancers in 2020 and recovered to different extents in 2021. Short-term survival improved for most cancers between 2000 to 2019, but then declined for those diagnosed in 2020 to 2021.This was most pronounced for colorectal cancer, with one-year survival falling from 79.3% [95% confidence interval: 78.5%-80.1%] in 2015 to 2019 to 76.3% [74.6%-78.1%] for those diagnosed in 2020 to 2021. Conclusion: Short-term survival for many cancers was impacted by the management of the COVID-19 pandemic in the UK. This decline was most prominent for colorectal cancer, with reductions in survivorship equivalent to returning to mortality seen in the first decade of the 2000s. These results illustrate the need for an immediate and well-funded investment in resolving the current backlog in cancer screening and diagnostic procedures in the UK National Health Service to improve patient outcomes.

The Human Machine Interface (HMI) of intraluminal robots has a crucial impact on the clinician's performance. It increases or decreases the difficulty of the tasks, and is connected to the users' physical and mental stress. Objective: This article presents a framework to compare and evaluate different HMIs for robotic colonoscopy, with the objective of identifying the optimal HMI that minimises the clinician's effort and maximises the clinical outcomes. Methods: The framework comprises a 1) a virtual simulator (clinically validated), 2) wearable sensors measuring the cognitive load, 3) a data collection unit of metrics correlated to the clinical performance, and 4) questionnaires exploring the users' impressions and perceived stress. The framework was tested with 42 clinicians investigating the optimal device for tele-operated control of robotic colonoscopes. Two control devices were selected and compared: a haptic serial-kinematic device and a standard videogame joypad. Results: The haptic device was preferred by the endoscopists, but the joypad enabled better clinical performance and reduced cognitive and physical load. Conclusion: The framework can be used to evaluate different aspects of a HMI, both hardware and software, and determine the optimal HMI that can reduce the burden on clinicians while improving the clinical outcome. Significance: The findings of this study, and of future studies performed with this framework, can inform the design and development of HMIs for intraluminal robots, leading to improved clinical performance, reduced physical and mental stress for clinicians, and ultimately better patient outcomes.

Article published online: 28 November 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Background Removing lumen-apposing metal stents (LAMSs) may be difficult and even harmful, but these features have seldom been analyzed. We aimed to generate a comprehensive assessment of the feasibility and safety of LAMS retrieval procedures. Methods A prospective multicenter case series including all technically successfully deployed LAMSs between January 2019 and January 2020 that underwent endoscopic stent removal. All retrieval-related data were prospectively recorded using standardized telephone questionnaires as part of centralized follow-up that ended after stent removal had been performed. Multivariable logistic regression models assessed the potential risk factors for complex removal. Results For the 407 LAMSs included, removal was attempted in 158 (38.8 %) after an indwell time of 46.5 days (interquartile range [IQR] 31–70). The median (IQR) removal time was 2 (1–4) minutes. Removal was labelled as complex in 13 procedures (8.2 %), although advanced endoscopic maneuvers were required in only two (1.3 %). Complex removal risk factors were stent embedment (relative risk [RR] 5.84, 95 %CI 2.14–15.89; P = 0.001), over-the-wire deployment (RR 4.66, 95 %CI 1.60–13.56; P = 0.01), and longer indwell times (RR 1.14, 95 %CI 1.03–1.27; P = 0.01). Partial and complete embedment were observed in 14 (8.9 %) and five cases (3.2 %), respectively. The embedment rate during the first 6 weeks was 3.1 % (2/65), reaching 15.9 % (10/63) during the following 6 weeks (P = 0.02). The adverse event rate was 5.1 %, including seven gastrointestinal bleeds (5 mild, 2 moderate). Conclusions LAMS removal is a safe procedure, mostly requiring basic endoscopic techniques attainable in conventional endoscopy rooms. Referral to advanced endoscopy units should be considered for stents with known embedment or long indwell times, which may require more technically demanding procedures.