Many clinicians have anecdotally observed patients opting out of colonoscopies due to unpleasantness related to the procedure, and within Inflammatory Bowel Disease (IBD) populations a number of factors have been implicated in non-adherence, including logistics, health perceptions, stress and procedure problems (including discomfort) [1].
Prior studies have demonstrated patient preferences for propofol sedation over midazolam and fentanyl sedation for outpatient colonoscopy in general [2]. Furthermore, propofol has been shown to be safe, without severe adverse events or accidents [3], and nurse-administered propofol has specifically proven to be an efficient means of sedation for endoscopy in low-risk patients [4]. Nevertheless, this area has yet to be explored in the specific cohort of IBD patients.
Modern management of IBD requires the employment of ileocolonoscopy for diagnosis, as well as for the surveillance and guidance of future management. The investigators here looked to fill the aforementioned knowledge gap through design of a trial investigating the effectiveness of deep nurse-administered propofol sedation (NAPS), versus moderate midazolam and fentanyl sedation, as a means of improving patient satisfaction and future attitude towards colonoscopies.
For very well-known pandemic reasons, we twice had to postpone the first Y-ECCO Mentorship Forum. Our third appointment with ECCO History proved to be the right one: in June 2022 we finally succeeded in completing our first Y-ECCO Mentorship Forum. Thanks to very active Y-ECCO participants and a stellar ECCO Faculty (Ailsa Hart, Peter Irving, Charlie Lees, Janneke Van der Woude and Johan Burisch), this networking and educational event was a great success. .
I hope you have all had time to re-charge over the summer! ECCO'23 abstract submission is currently open, with a deadline of November 21. Basic science abstracts can be considered for an Oral Presentation during the 9th Y-ECCO Basic Science Workshop, which will be held on Wednesday, March 1, 2023, between 13:05 and 15:30 CET – please tick the box if you are a Y-ECCO Member and would like to be part of this great interactive session.
The past 6 months of 2022 have seen the publication of two important papers, one by F. Magro et al. (“The ECCO position on harmonisation of Crohn’s disease mucosal histopathology” [1]) and the other by I.O. Gordon et al. (“International consensus to standardise histopathological scoring for small bowel strictures in Crohn’s disease” [2]).
Over the past two decades, significant progress has been made in the understanding of the role of genetics in the pathogenesis of Inflammatory Bowel Disease (IBD): On the one hand, adult IBD studies have identified more than 250 single nucleotide polymorphisms that increase the risk of disease, though their individual and overall effect on the risk of developing IBD is small [1]. On the other hand, the expanding use of next-generation sequencing (NGS) platforms has resulted in the identification of more than 100 different rare monogenic disorders that directly cause IBD [2]. Given the central role of immune cells in sustaining immune tolerance in the gut, it is not surprising that in many cases monogenic disorders causing IBD result from pathogenic variants in genes involved in essential immune or epithelial pathways. Some patients with such disorders present with a clear immunodeficiency phenotype (e.g. chronic granulomatous disease, Wiskott-Aldrich syndrome), but in others IBD is the sole manifestation [3].
Optimisation is the action of making the best or most effective use of a situation or resource (Oxford Dictionary) but in the medical world it is preparing the patient (and the surgeon) for surgery and postoperative recovery.
The goal of “optimising” patients’ health prior to surgery is to minimise the risk of postoperative complications, decrease the length of hospital stay, reduce unplanned re-admissions and enhance overall health and surgical experience.
It has long been acknowledged that Inflammatory Bowel Disease (IBD) carries a risk of malnutrition, leading to fatigue, infection, poor wound healing and poor health-related quality of life [1]. Historically, most attention has been devoted to undernutrition; however, there is now evidence that overnutrition in the form of visceral fat is associated with raised tumour necrosis factor (TNF) and poorer responses to anti-TNF agents [2], indicating that central adiposity can be just as detrimental to disease outcomes as undernutrition. Furthermore, under- and overnutrition are not mutually exclusive and nutrient deficiencies and excesses often co-exist. In the last few years, there has been a shift away from the historical approach of using rudimentary markers of malnutrition, such as weight or body mass index (BMI), which can often be misleading as assessment tools in that they may falsely detect abnormalities or miss them completely, towards more detailed body composition measures of muscle and fat mass, which reflect nutritional abnormalities more sensitively. Indeed, GLIM (Global Leadership Initiative on Malnutrition) recognises the importance of body composition in the diagnosis of malnutrition [3]. The key question now is how should we best assess our IBD patients for nutritional status in order to identify risk of poor clinical outcomes?
It is the time of year when we write to you with great pleasure to tell you about the N-ECCO Activities planned for the ECCO’23 Congress, to be held in Copenhagen on March 1–4, 2023. As in previous years, the N-ECCO Committee has worked hard to put together a wide range of activities covering clinical, educational and research topics.
In 2023 the Educational Programme at the ECCO Congress will again include two combined workshops devoted to the imaging of Inflammatory Bowel Diseases (IBD). The first will be centered on basic endoscopy, ultrasound and MRI while the second will focus on advancements in intestinal ultrasound. Both workshops will be possible thanks to the extensive cooperation of gastroenterologists with experience in intestinal imaging from ECCO and our partner societies, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and the International Bowel Ultrasound (IBUS) group.
The 4th ECCO Basic Imaging Workshop in collaboration with ESGAR and IBUS will educate attendees in how to make a precise diagnosis and how to better direct the therapeutic management of IBD patients using the latest imaging technologies. It is designed for gastroenterologists, endoscopists, surgeons, paediatricians, pathologists and other interdisciplinary medical experts interested in diagnostic imaging and endoscopy of IBD. The course has been highly successful and much requested over the past few years, and we have decided to run it twice on the same day this year to enable more participants to attend.
The 21st ECCO IBD Intensive Course for Trainees, Copenhagen 2023
The IBD Intensive Course for Trainees will take place over one day on Wednesday, March 1, 2023, prior to the start of the main ECCO Congress.
The ECCO IBD Intensive Course for Trainees has become a tradition. It is the oldest ECCO Educational Initiative, having been conceived back in 2003 before the launch of the ECCO Congress, and is the cornerstone of the Educational Committee’s activities. I remember attending the “2nd Intensive Clinical Course for Residents, Fellows and Junior Faculty”, delivered as an affiliated course during the 140th Falk Symposium in Dubrovnik, Croatia, in 2004. This was perhaps the most comprehensive IBD course that I had ever attended as a trainee and it inspired me to further in-depth engagement with IBD.
Bram Verstockt
Charlotte Hedin
Gert de Hertogh
Dror Shouval
Emma Halmos
W. Czuber-Dochan
Miriam Ganon
Ana Ibarra
