The Impact of SARS-COV-2 on two Colorectal Cancer screening centres.

BowelScreen paused activity in March 2020 to prioritise the response to the COVID-19 pandemic. The aim of this study was to examine the impact of this delay. Cases affected by the pause and subsequently completed were compared to the same period in 2019. Endoscopy and histology data were obtained from the BowelScreen database and patient records. One-hundred and seven colonoscopies were performed during the study period. This compared with 224 colonoscopies during the same period in 2019. Median lead time to colonoscopy in 2020 was 74 days compared to 34 days in 2019. Adenoma detection rate was 59% for both periods. Advanced adenoma and cancer detection rates were similar in both periods. While there was a marked reduction in activity and significant delays for BowelScreen patients during the first wave of the COVID-19 pandemic, this does not appear to have impacted on clinical outcomes for patients who attended for screening colonoscopy.

REDUCED SEROLOGICAL RESPONSE TO COVID-19 VACCINES IN PATIENTS WITH IBD IS FURTHER DIMINISHED BY TNF INHIBITOR THERAPY;EARLY RESULTS OF THE VARIATION STUDY (VARIABILITY IN RESPONSE IN IBD AGAINST SARS-COV2-IMMUNISATION)

Objective: Patients with inflammatory bowel disease (IBD) have attenuated responses to current vaccinations. There is a limited body of evidence suggesting patients with IBD receiving TNF antagonists have an attenuated response to vaccination against COVID-19. We sought to determine the impact of IBD and various medications for the treatment of IBD on antibody responses to vaccination against COVID-19. Design: Patients with IBD (n=270) and healthy controls (HC, n=116) were recruited prospectively and quantitative antibody responses assessed following COVID-19 vaccination. The impact of IBD and medications for treatment of IBD on vaccine response rates was investigated. Results: All HC seroconvert post complete vaccination with two vaccine doses [100%]. A small proportion of patients with IBD failed to seroconvert [2%]. Median anti-spike protein (SP) immunoglobulin (Ig)G levels post one vaccination and complete vaccination in our IBD cohort was significantly lower than HC [2,613 AU/mL versus 6,871 AU/mL, p=<0.001] [Figure 1]. A diagnosis of IBD was independently associated with lower anti-SP IgG levels [β coefficient -0.2, p = 0.001] whereas use of mRNA vaccines was independently associated with higher anti-SP IgG levels [β coefficient 0.25, p = < 0.001]. Patients with IBD receiving anti-TNF therapy had significantly lower anti-SP IgG levels [2444.6 AU/mL] than IBD patients not receiving these agents [3867.6 AU/mL] [p = < 0.001]. Patients with IBD not receiving TNF inhibitors still showed attenuated responses compared to HC receiving a similar vaccine [p = 0.001] [Figure 2]. 58 patients had an additional follow-up serology sample at a median of 12 weeks to complete vaccination to allow assessment of the durability of the response after their initial post-vaccination IgG level. There was a significant drop in IgG levels from 3952.85 AU/mL at the first timepoint checked post-complete vaccination to 921.1 AU/mL (343.1 – 2102.7) on follow-up sampling (p = <0.001). Median anti-SP IgG levels were numerically lower in our cohort receiving anti-TNF therapy (794.8 AU/mL) compared to those not receiving anti-TNF therapy (3136.9 AU/mL) on final follow-up samples (p =0.28). HC participants with previous COVID-19 infection (n= 5) had significantly higher anti-SP IgG levels post complete vaccination (20,719.6 AU/mL) compared to IBD patients (n=4) with prior infection (3,938.2 AU/mL) (p = < 0.001). Conclusions: Patients with IBD have attenuated serological responses to SARS-CoV-2 vaccination. Patients with IBD who do not seroconvert post-vaccination against COVID-19 are a particularly vulnerable cohort. Use of anti-TNF therapy negatively impacts anti-SP IgG levels. Impaired responses to vaccination in our study highlights the importance of booster vaccination programmes for patients with IBD. (Figure Presented) Differences in median IgG levels across three time points (Figure Presented) Differences in median anti-SP Levels dependent on medication for treatment of IBD.

Development of a young person clinic for 16-24-year-olds with Inflammatory Bowel Disease (IBD), using a multidisciplinary team (MDT) approach

Background: In Ireland, the transition process is ad hoc with no formal guidelines on how to conduct transition clinics. This nurse-led project, aimed to develop a specific young person clinic for adolescents and provide information to adolescents and their families on the service they were joining, before their first clinic visit, subsequently reducing anxiety and improving outcomes. Providing the right care for young people with IBD, in the right place, at the right time, where the patient is a priority, is the end goal. Methods: The successful implementation of this project is due to the collaborative work of a multidisciplinary team using the Health Service Executive (HSE), Peoples Needs Defining Change Guide (2018). This change model provides clear definitive steps to Define, Design and Deliver innovative projects. The model was applied as follows: Define Raise awareness of the need for adolescent clinic Activate a core change team Develop a vision in line with the organisational culture Design Propose a care pathway for adolescents including transition. Design an informative 'Welcome Booklet' Arrange Virtual Meet and Greet (due to Covid restrictions) Deliver Open communication with all relevant stakeholders Determine a time suitable for recurring adolescent clinic Seek input from patients, colleagues and communication team to develop an informative 'Welcome Booklet' Results: The CIPP evaluation model, Context, Input, Process and Product, complimented this change model as formative evaluation throughout. This ensured the change process was streamlined with the values and vision of all stakeholders involved. Context -SWOT analyses was undertaken, and Goals defined Input - Strategy was defined and stakeholder analyses Process -Monthly MDT meetings, design model of care, welcome booklet. Plan virtual introductory meetings due to Covid unable to meet face to face in the paediatric hospital Product - Dedicated recurring clinic time for 16-24-year-olds with IBD to include transition clinics. 100% of parents and 80% of adolescents found the welcome booklet informative and useful. 100% both adolescents and parents found the introductory WebEx meeting beneficial. Commenced RCT to look at best format for transition clinics going forward Conclusion: (HSE), Peoples Needs Defining Change Guide (2018) provided the essential toolkit to ensure leadership, teamwork, the importance of stakeholders while keeping the patient central to all decisions made in developing young person's clinics for 16-24-year-olds with IBD.

The impact of sars-cov-2 on the irish national colorectal cancer screening programme: A report from two high-volume endoscopy centres

Aims The Irish National BowelScreen programme paused activities in March 2020 to prioritise the emergency response tothe SARS-CoV-2 pandemic. As a result, patients with positive fecal immunochemical test (FIT) results that had already beenreturned, experienced delays in time to colonoscopy. The standard lead time in BowelScreen is 20 working days. The aim ofthis study was to examine the impact of this delay on time to colonoscopy for index FIT positive cases in two tertiaryendoscopy units. Methods Index cases affected by the pause which were subsequently completed (up to July 2020) were analyzed andcompared to the same period in 2019. All colonoscopy's were performed by a BowelScreen accredited consultantendoscopist. Endoscopy and histology data was obtained from the BowelScreen database and patient records. Results In total, 111 colonoscopies were performed during the study period. During the same period in 2019, 226 indexcolonoscopies were completed. The median lead time in 2020 was 38 working days, or almost double the recommendedlead time. The median age in 2020 was 66.5 years (IQR 60-70) and in 2019 63 years (IQR 60-70). Men accounted for 55 %of patients in 2020 and 66 % in 2019. A total of 191 polyps were detected in the 2020 group, 16 % of which were advanced adenomas (adenoma ≥ 10mm). There were 394 polyps identified in the 2019 group, 16 % of which were advancedadenomas. The majority of these advanced adenomas (77 % in 2020 and 90 % in 2019) were left sided. High gradedysplasia was detected in one polyp in 2020 and in five in 2019. There were 3 cancers detected in 2020 and 11 in 2019. Conclusions There was a significant delay in lead time to index colonoscopy for FIT positive patients in BowelScreen.Despite this, the two groups had comparable advanced adenoma and cancer pathology detection rates.