ABSTRACT
Introduction: More than 2.5 million people in Europe are diagnosed with inflammatory bowel diseases (IBD). IBD affects the quality of life, but also has important consequences for health systems. It remains unknown if variations in IBD care and education differs across Europe and to help address this question, we conducted this European Variation In IBD PracticE suRvey (VIPER) to study potential differences. Aims & Methods: This trainee-initiated survey, run through SurveyMonkey ®, consisted of 47 questions inquiring basic demographics, IBD training and clinical care. The survey was distributed through social media and national GI societies from December 2020 - January 2021. Results were compared according to GDP per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). Differences between groups were calculated using the chi2 statistic. Results: The online survey was completed by 1268 participants from 39 European countries. Most of the participants are specialists (65.3 %), followed by fellows in training (>/< 3 years, 19.1%, 15.6 %). Majority of the responders are working in academic institutions (50.4 %), others in public/ district hospitals (33.3 %) or private practices (16.3 %). Despite significant differences in access to IBD-specific training between high (56.4%) and low (38.5%) GDP countries (p<0.001), majority of clinicians feels comfortable in treating IBD (77.2% vs 72.0%, p=0.04). GDP was not a factor that dictated confidence in treating patients. IBD patients seen per week, IBD boards and especially IBD specific training were factors increasing confidence in managing IBD patients. Interestingly, a difference in availability of dedicated IBD units could be observed (58.5% vs 39.7%, p<0.001), as well as an inequality in multidisciplinary meetings (72.6% vs 40.2%, p<0.001), which often take place on a weekly basis (53.0%). In high GDP countries, IBD nurses are more common (86.2%) than in low GDP countries (36.0%, p<0.001), which is mirrored by differences in nurse-led IBD clinics (40.6% vs 13.8%, p<0.001). IBD dieticians (32.4% vs 16.6%) and psychologists (16.7% vs 7.5%) are mainly present in high GDP countries (p<0.001). In the current COVID era, telemedicine is available in 58.4% vs 21.4% of the high/low GDP countries respectively (p<0.001), as well as urgent flare clinics (58.6% vs 38.7%, p<0.001) and endoscopy within 24 hours if needed (83.0% vs 86.7% p=0.1). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. Almost all (94.7%) use faecal calprotectin for routine monitoring, whereas half also use intestinal ultrasound (47.9%). Conclusion: A lot of variability in IBD practice exists across Europe, with marked differences between high vs low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardise IBD care across Europe.
ABSTRACT
Aims In March 2020, COVID-19 has been declared as a pandemic, resulting in modulation of endoscopic activity andenhancement of personal protective equipment (PPE) when performing colonoscopy. Recently, it has been shown that suchPPE interferes with visual and auditory perception. Our aim was to evaluate if PPE may negatively impact colonoscopyquality. Methods Cross-sectional retrospective study comparing colonoscopy quality indicators between elective outpatient non-therapeutic colonoscopies performed between April and May 2019 and 2020 (lockdown period). We included patients aged > 50 years old and excluded patients with inflammatory bowel disease, history of colon surgery or cancer (CRC). 300colonoscopies were randomly and evenly selected from the two groups. Cecal intubation rate (CIR), adenoma detection rate(ADR), mean number of polyps, adenomas and serrated sessile lesions (SSL) per colonoscopy were assessed andcompared. Results Groups were similar regarding gender, mean age and exam indication. Indications for colonoscopy were classifiedas screening (25 % vs 22 %), diagnosis (41 % vs 48 %) and post-polypectomy surveillance (33 % vs 29 %). There was nosignificant difference in CIR (90 % vs 88 %), adequate bowel preparation (70.5 % vs 70.6 %, p = 0.970) and procedureduration. Polyp, adenoma and SSL detection rates were similar in both groups (66.7 % vs 66.7 %, p = 0.999;57.4 % vs 51.4 %, p = 0.609;5.5 % vs 9.5 %, p 0.173). There was no difference in the mean number of polyps and adenomas. For polyps < 5 mm the mean number was lower in 2020 (1.59 vs 1.09, p = 0,028). There was no difference in high-risk patients (19.3 %vs 21.1 % (p = 0.143) and CRC (4.7 % vs 2 %, p = 0.335). The ADR difference remained non-significant, after adjusting(multivariate analysis) for bowel preparation, intubation detection rate, endoscopist and exam duration. Conclusions In our study, the use of PPE did not influence key performance measures of colonoscopy quality.