Large bowel obstruction can be caused by advanced colonic cancer, extracolonic obstruction or benign strictures. The technical success rate of colonic stents for the treatment of colorectal obstruction is about 87% with complications or technical failure at about 14%. Mortality associated with the procedure is <4% and perforation is 4.5%. This article will discuss who would benefit from colonic stents

Objective Small-bowel capsule endoscopy (SBCE) is being used with increasing frequency. It is important, however, to ensure that the frail elderly in particular are undergoing investigations which have a positive impact on their ongoing management. We aimed to determine the SBCE rate in the elderly, the clinical outcomes, and if clinical frailty may be used to tailor SBCE. Design/methods Patients aged

A 66-year-old man presented with a 20-year history of progressively worsening dysphagia and intermittent chest pain. The patient described a sensation of food ‘sticking’ in his lower chest which occurred with both solids and liquids, impacting his quality of life significantly. His medical history was otherwise unremarkable with no known allergies, prior surgeries or chronic conditions. During the

Achalasia is a rare oesophageal disease characterised by an unrelaxing lower oesophageal sphincter and abnormal peristalsis of the oesophageal body. Achalasia symptoms include dysphagia to solid and liquid, chest pain, regurgitation and weight loss. Achalasia diagnosis might be delayed for many years when atypical symptoms dominate. Significant progress has been made over the last two decades regarding

Background and aim Data on the effectiveness of polymeric exclusive enteral nutrition (EEN) in inducing biochemical remission in adults with active Crohn’s Disease (CD) is scarce. We aimed to assess the effectiveness of polymeric EEN in inducing biochemical remission in adults with active CD. Methods Single-centre retrospective study, from January 2018 to September 2022, of patients with active CD

A previously fit and well 36-year-old male presented with sudden-onset severe epigastric pain that woke him from sleep, fever and rigours. This was preceded by 1 month history of mild abdominal pain that was unrelated to eating. He reported reduced appetite and one stone weight loss over the past week. He denied any nausea or vomiting. He usually suffered with diarrhoea, but had not moved his bowels

Background The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) conducts a biennial census of UK endoscopy services. The 2023 census aimed to assess the current status of endoscopy services and compare them with pre-pandemic census benchmark data. Methods An electronic survey was sent to all JAG participating services in April 2023. Key domains included activity, waiting times, workforce and

Objective The National Health Service is a significant contributor to greenhouse gas emissions, with endoscopy ranking as the third highest contributor of waste in healthcare. We aimed to ascertain the endoscopy workforce attitudes towards sustainable practices, barriers to change and potential solutions towards achieving a more sustainable endoscopy practice. Methods A prospective cross-sectional

With increasing international travel and migration, tropical and infectious diseases once largely confined to specialist institutes now present more widely. Amoebiasis is a potentially dangerous example since it may closely mimic the presentation of inflammatory bowel disease. Misdiagnosis and treatment with immunosuppressants can result in fulminant amoebiasis and death. This review considers the

It is my great honour to take over from Professor Mark Beattie as Editor in Chief of Frontline Gastroenterology ( FG ). Over his tenure, he advanced the journal forwards on many fronts—from increasing the number of issues per year to six, to affiliating with British Association for Parenteral and Enteral Nutrition (BAPEN) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition

In 2014, the British Society of Gastroenterology (BSG) published a standards framework outlining key performance indicators for ERCP practitioners and services. In the last 10 years there have been numerous changes to clinical practice yet there remains considerable variation in service delivery in the UK. In 2021 the BSG commissioned an ERCP endoscopy quality improvement project (EQIP) comprising

Background and aims We aimed to analyse data from the UK National Endoscopy Database (NED) to investigate factors associated with endotherapy in patients with suspected upper gastrointestinal bleeding (UGIB) . Methods Analysis of oesophagogastroduodenoscopy (OGD) uploads to the NED from 1 March 2019 to 29 February 2020 was performed. UGIB was defined as procedures with indications of melaena and/or

Objective Describe clinical characteristics, treatment patterns, time to diagnosis and development of strictures in patients diagnosed with eosinophilic oesophagitis (EoE) between January 2014 and October 2020 in England. Design/Method Routinely collected data were sourced from three linked databases in England: Clinical Practice Research Datalink (CPRD) Aurum; Hospital Episode Statistics (HES); and

Objectives Remotely living Indigenous Australians have a disproportionate mortality from cirrhosis and hepatocellular cancer (HCC). However, there are no local population studies examining the prevalence of chronic liver disease (CLD) in remote communities. The main aims of this study were therefore to study a remote Indigenous population to determine the prevalence of CLD risk factors and the prevalence

Objective Sexual dysfunction is common in patients with inflammatory bowel disease (IBD). Data on IBD disease activity and IBD patients’ desire to seek specialist advice regarding sexual dysfunction are lacking. We aimed to identify sexual healthcare needs in patients with IBD. Design/method We conducted a cross-sectional survey of adult patients with IBD at a tertiary teaching hospital. Clinical disease

Objective Since approval in Crohn’s disease (CD) of risankizumab, there has been widespread use. Real-world data are, however, limited and our aim is to address that gap. Design/method We performed a retrospective, observational study of risankizumab use in patients with CD starting treatment between January 2021 and January 2023 at two UK centres. Clinical activity, biochemical and faecal biomarkers

Eosinophilic oesophagitis (EoE) is a chronic condition characterised by solid-food dysphagia and food bolus obstruction due to T-helper cell-driven eosinophilic infiltration of the oesophageal epithelium and submucosal fibrosis. Suboptimal management results in delayed diagnosis, repeated food bolus obstructions and hospital attendances, inappropriate referral and treatment, increased healthcare resource

Liver blood test (LBT) abnormalities are common in people with inflammatory bowel disease (IBD). The majority are self-limiting, with only 5% having clinically significant liver disease. Liver conditions most frequently associated with IBD include primary sclerosing cholangitis, metabolic dysfunction-associated steatotic liver disease and drug-induced liver injury (DILI). A combination of clinical

Background The transmission dynamics of hepatitis E in men who have sex with men (MSM) are poorly understood. We aimed to explore any factors observed in MSM with hepatitis E by systematically reviewing the literature. Methods We searched five databases (PubMed, Embase, CINAHL Plus, MEDLINE and Web of Science Core Collections). The primary author performed an initial screen of citations and abstracts

A 44-year-old man was referred to our hospital with a 2-week history of abdominal distention, nausea and recurrent vomiting. The past medical history disclosed peptic ulcer-related duodenal stenosis at the bulb for 3 years and cholecystolithiasis for 20 years. On examination, the abdomen was distended and soft with no tenderness. Blood laboratory tests showed leucocytosis (12.10×109/L, reference 3

A man in his 50s presented with painful lesions located on the anal margin. He was HIV positive since 1996. He was treated by a regimen of bictegravir, emtricitabine, tenofovir and alafenamide. The CD4+ lymphocyte count was more than 500 per x10ˆ9/L millimetre with a negative HIV viral load. He had been treated for low-grade human papillomavirus (HPV)-related lesions of the anus in 2018 and was subsequently

The patient is admitted to the hospital for a 5-day history of diffuse myalgias, cough, diarrhoea and fever peaking at 100.8°F (38.2°C). Medical history is significant for systemic lupus erythematosus (SLE), managed with hydroxychloroquine 400 mg daily, mycophenolate mofetil 500 mg two times a day and prednisone 5 mg daily. Laboratory tests are provided in table 1. View this table: Table 1 Laboratory

It is with great interest that we read the timely article by Tavabie and colleagues detailing the environmental impact of gastroenterology and hepatology services and outlining the unique position of trainee research networks to facilitate the sustainable transformation of endoscopy services and share best practice approaches between units.1 The recent COP28 summit and Global Tipping Points Report

We were delighted to see specific guidance on palliative care (PC) included in the recently published British Society of Gastroenterology (BSG) best practice guidance on the outpatient management of cirrhosis.1 Decompensated advanced chronic liver disease (dACLD) carries a significant, and seldom addressed, symptom burden.2 3 PC interventions demonstrably improve physical and psychological symptoms

Background Infliximab (IFX) effectiveness in inflammatory bowel disease (IBD) can be impaired by antidrug antibodies (ADA). Subcutaneous IFX has a different pharmacokinetic profile compared with intravenous administration, potentially affecting immunogenicity. Methods Retrospective audit of adult patients starting IFX between January 2019 and June 2022. All participants received induction with three

A 71-year-old woman with an ovarian cyst was referred to our hospital for bilateral leg oedema and dyspnoea on exertion. She had no significant medical history and no history of smoking or alcohol consumption. Physical examination showed bilateral oedema of the lower extremities. Laboratory tests revealed a haemoglobin level of 76 g/L (normal range: 111–151 g/L), calcium levels of 10.6 mg/dL (normal

Due to their increasing incidence, neuroendocrine neoplasms (NENs) are being detected more frequently by endoscopists while they are performing diagnostic upper or lower gastrointestinal (GI) endoscopies. These procedures are usually performed for unrelated indications or for screening, with the tumours often being detected incidentally. The most common scenario is of an endoscopist being surprised

Liver disease is now the second highest cause of years of working life lost in Europe, only surpassed by ischaemic heart disease.1 The April #FGDebate based on the recent paper entitled ‘Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study’2 aimed to facilitate discussion around this topic

There are ever-increasing therapeutic options for patients with ulcerative colitis, but licensing and availability for children and young people are often years behind those aged >18 years. In this issue, Ashton and colleagues review the evidence. This includes a comprehensive discussion of the standard ‘advanced’ therapies—infliximab and adalimumab. The authors review the ‘newer’ therapies including

The recently published European Association for the Study of the Liver (EASL) clinical practice guideline (CPG) on the management of liver diseases in pregnancy encompasses the management of gestational liver diseases as well as acute and chronic liver disease occurring coincidentally in pregnancy. This review will address the latter, given the broad scope of the CPG and the comprehensive Frontline

Objective Why about a quarter of patients with inflammatory bowel disease (IBD) suffer symptoms for more than a year before their diagnosis made is unclear. Low public awareness, embarrassment and the apprehension of invasive tests are cited. The anonymity of direct-to-public calprotectin testing may overcome these barriers. We sought to characterise what calprotectin testing is available directly

Objectives To evaluate the effectiveness of ustekinumab in treating Crohn’s disease (CD) in a UK real-world setting. Design This was a multicentre, retrospective observational study of patients (aged ≥18 years) with CD or inflammatory bowel disease of unclassified type (IBDU) starting ustekinumab between 11 November 2016 and 1 August 2020 across eight English hospitals. The primary objective was to

Objectives 1. Describe characteristics of patients with severe acute pancreatitis (SAP) requiring admission to Critical Care, including interventional management of pancreatic fluid collections. 2. Quantify whether patients requiring drainage of collections via a Lumen-Apposing Metal Stent (LAMS) have different patient experiences and demands on critical care and pancreatic services, compared with

Background Intestinal ultrasound (IUS), although less widely practiced in the UK, offers several advantages in inflammatory bowel disease (IBD), particularly with regard to the accessibility of the test and immediate availability of reports. Aims To assess the use of point-of-care IUS in influencing management change in IBD. Methods A retrospective service evaluation review of 3 years of a rapid access

Introduction Hepatocellular carcinoma (HCC) is increasing in incidence across the UK. Most patients have underlying cirrhosis, but a significant minority do not. Progression and outcomes of HCC in patients without cirrhosis remains unclear. This study aimed to establish the proportion and characteristics of patients with HCC occurring in those with and without cirrhosis in the West of Scotland. Methods

There are ever-increasing therapeutic options for patients with ulcerative colitis (UC), but licensing and availability for children and young people are often years behind those aged >18 years. ‘Advanced therapies’, including biologics and small molecules, now target numerous different inflammatory pathways but continue to have a therapeutic ceiling with only 30–60% of patients responding to initial

Developing new treatments that improve outcomes for patients with decompensated cirrhosis remains an unmet area of clinical need. The UK has a rich history of being on the forefront of clinical trials for this patient group. However, there have been challenges in achieving this goal in the past decade, with several negative studies as well as trials struggling to achieve recruitment. This has been

There has been greater societal awareness of differences in gender identity and sexual orientation in recent years. The rates of identifying as transgender or gender non-conforming (TGNC) are increasing and are known to be higher in the younger population and will therefore be over-represented in the inflammatory bowel disease (IBD) subpopulation. However, despite this there is very little in the literature

Introduction The antimicrobial treatment options for patients with intestinal spirochaetosis (caused by Brachyspira pilosicoli and Brachyspira aalborgi ) are not well defined. We aimed to systematically review the literature to explore antimicrobial treatment options to inform future clinical guidelines. Method We systematically searched three bibliographical databases (MEDLINE, EMBASE, SCOPUS and

Objective Giardia duodenalis causes enteritis and malabsorption and can be sexually transmissible in men who have sex with men (MSM). The aim of this study was to explore factors associated with MSM with G. duodenalis . Methods MEDLINE, Embase, Emcare, PubMed, Global Health and Web of Science were searched for manuscripts published up to February 2024. The primary author screened manuscript titles

The North West Endoscopy Academy is committed to ensuring endoscopy training is of a standardised high quality that is multidisciplinary. It seeks to address the historic lack of admin training by providing a core admin and clerical (A&C) skills in endoscopy course for all A&C staff. The competency framework used for this training is the first developed specifically for A&C staff in endoscopy and the

Tacrolimus is a calcineurin inhibitor rarely associated with gastrointestinal injury and reported only a handful of times in the literature. We present a case report demonstrating late-onset colitis in a patient taking tacrolimus for years, with typical histological features, associated with delayed mucosal healing. We hope this highlights the potential variability in both presentation and resolution

A 69-year-old man with diabetes mellitus (DM) visited the emergency department with chest pain for 4 days. He had suicidal history 6 months ago, using a knife to cut into his throat about 3 cm depth. An elevated body temperature (37.4°C) was detected. Electrocardiography showed sinus rhythm without ST or T wave changes, and chest computed tomography angiography (CTA) demonstrated no aortic dissection

A 39-year-old female patient presented to the upper gastrointestinal outpatient clinic with a protracted history of recurrent right upper quadrant pain. She was otherwise fit and well, with a body mass index of 30 and no previous operations. On physical examination, she was not clinically jaundiced and had abdominal tenderness in the right upper quadrant region on palpation. Liver function tests revealed

A previously well 43-year-old men was admitted with right upper quadrant and epigastric pain, fever and vomiting. His medical history included asymptomatic cholestatic liver function tests for which serial ultrasound (US), magnetic resonance cholangiopancreatography, fibroscan and a US-guided liver biopsy had proved unremarkable several years prior to this presentation. Physical examination revealed

A Rwandan man in his 40s underwent an upper gastrointestinal endoscopy for evaluation of solid-food dysphagia. Of note, the patient also reported a long-standing history of anaemia, which was originally diagnosed in 2000. He had required four transfusions since and noted that he had previously been prescribed tot’hema syrup (a form of iron supplementation) but was no longer taking it. Laboratory tests

Cold snare polypectomy (CSP) is the treatment of choice for polyps less than 10 mm in size and sessile serrated lesions.1 We present a 66-year-old woman with Crohn’s colitis. Inflammatory bowel disease (IBD) was in complete clinico-endoscopic remission and colonoscopy was performed for dysplasia surveillance. …

A 65-year-old woman with a medical history of cholecystectomy 20 years ago was referred to our hospital for recurrent colic pain in the upper abdomen with intermittent cholestatic liver enzyme abnormalities. She also experienced an episode of acute pancreatitis 2 weeks before the presentation. CT showed a dilated common bile duct with a hyperdense object of 10×4 mm in the distal common bile duct, suspecting

An asymptomatic 65-year-old woman was referred to our endoscopy unit after a screening positive faecal occult blood test. Colonoscopy revealed a pale, whitish colonic mucosa with yellowish specks (figure 1), congestive areas and foci of lymphoid follicular hyperplasia (figure 2). Sessile lesions (0-Is) with whitish speckling on their surface were also identified. Figure 1 Whitish colonic mucosa with

We are all aware that diagnostic delays in inflammatory bowel disease (IBD) result in adverse outcomes. In this issue, Rimmer and colleagues report the outcome of a bespoke diagnostic pathway to combine clinical history and faecal calprotectin for early diagnosis. Patients were triaged using symptoms and faecal calprotectin (including initial and repeat faecal calprotectin). 767 patients reported of

The European Crohn’s and Colitis Organisation has recently published the third version of the European Consensus on reproduction in inflammatory bowel disease. Here, we summarise their key recommendations.

Objective The role of small bowel capsule endoscopy (SBCE) in diagnosing gastrointestinal diseases has long been established. Recently, colon CE (CCE) has been suggested as an alternative to colonoscopy. CE has been traditionally conducted at endoscopy units. However, during the COVID-19 pandemic, a switch was made to ‘at-home CE’ (ACE) which has continued to date. This study is an evaluation of ACE

Objective Diagnostic delays in inflammatory bowel disease (IBD) result in adverse outcomes. We report a bespoke diagnostic pathway to assess how best to combine clinical history and faecal calprotectin (FCP) for early diagnosis and efficient resource utilisation. Methods A rapid-access pathway was implemented for suspected IBD patients referred outside urgent ‘two-week wait’ criteria. Patients were

Background The diagnostic performance of endoscopic retrograde cholangiopancreatography brush cytology for malignant strictures is modest. A novel larger more abrasive brush may have improved diagnostic performance. We compared the utility of the new biliary brush with a conventional brush. Methods The new brush was used in 51 consecutive patients (group 1) referred with a biliary stricture and matched

Background Upadacitinib is a Janus kinase inhibitor, which has recently been approved for treating Crohn’s disease. There are limited real-world studies on the outcomes of upadacitinib in Crohn’s disease. Objective Our aim was to evaluate the outcomes of upadacitinib in a real-world Crohn’s disease cohort. Methods We conducted a retrospective, multicentre, cohort study over a 2-year period across National

Background and aims Colonoscopy practice has evolved with a trend towards water-assisted insertion. A recent national survey suggests a hybrid approach to colonic distension during insertion, with water used predominately to the splenic flexure and carbon dioxide (CO2) with water used thereafter to the caecum, is commonly used. This contrasts with the water exchange technique where no CO2 is used.

Background The aims of this narrative review are to examine the impact of proctocolectomy on the liver in patients with primary sclerosing cholangitis and ulcerative colitis (PSC-UC), mainly focusing on graft loss, and to compare the different proctocolectomy techniques to help determine which is the best for PSC-UC patients. Methods A literature search was performed using the online databases MEDLINE

Objective Entamoeba histolytica is parasitic infection that can cause a proctocolitis (amoebiasis) and extraintestinal sequelae (eg, liver abscess) and can be sexually transmitted in men who have sex with men (MSM). We aimed to identify factors associated with E. histolytica in MSM to provide insight for future control strategies. Design/methods We searched MEDLINE, Embase, CINAHL and Web of Science

Orofacial symptoms are common in patients with inflammatory bowel disease (IBD). They may present as a primary manifestation of the disease in the oral cavity with oral Crohn’s disease, or as a secondary manifestation of the disease such as iron deficiency, or due to side effects to medications used in treatment. Orofacial manifestations of IBD may result in significant morbidity which can impact patients’

Metastatic oesophageal adenocarcinoma (OAC) is associated with a poor prognosis, but patients with a good performance status may be offered palliative oncological intervention. Oesophageal cryoablation is an emerging therapy for the palliation of malignant dysphagia that can be given over multiple sessions with relatively few side effects. Emerging evidence suggests that cryoablation may provide a