ABSTRACT
Introduction: The COVID-19 pandemic led to the suspension of all faceto- face teaching for gastroenterology trainees in the UK. From June 2020, we organised and delivered a weekly webinar, mapped to the UK higher speciality training (HST) gastroenterology curriculum, comprising a 40-minute lecture, delivered by an international multi-disciplinary faculty, followed by 10-20 minutes of moderated discussion via Microsoft Teams. Webinars were coordinated and moderated live by East Midlands Gastroenterology trainees and made available on demand for attendees to view in between commitments. Any professional in Gastroenterology, including trainees, consultants and allied health professionals, not limited to geographical location, was allowed to request access to the platform. Aims & Methods: We aimed to perform a multi-modal evaluation of the webinar series. First, we reviewed participants' demographics and weekly webinar attendance data. Second, we conducted a curriculum-mapping exercise of the programme to identify the breadth of topics covered. Third, we conducted two web-based feedback surveys in June 2021 and April 2022 to assess participants' satisfaction with the webinar series. Finally, since the webinar series has substituted face-to-face training for East Midlands trainees, we performed a projected calculation of CO2 emission saving based on the cessation of face-to-face teaching within the East Midlands region. Result(s): Between June 2020 and April 2022, a total of 84 webinars were delivered by 68 consultants, 13 senior trainees and two allied health care professionals. 47.6% of the speakers were from outside East Midlands. A total of 746 participants were registered on the online platform, of whom 85.6% were from the UK and 14.4% were from abroad. Live attendance data were available for 33 sessions (mean 55 +/- 13 attendees). The webinar series has, so far, covered over 80% of the UK HST gastroenterology curriculum. Fifty-nine participants and 20 participants completed the first and second feedback surveys, respectively. 98% of the first survey respondents felt that the webinars fulfilled their educational goals and 100% rated the programme's quality as good/very good. This positive feedback was sustained during the second survey with 100% reporting that the webinars fulfilled their educational goals and 90% rating the programme's quality as good/very good. 97% of the first survey respondents and 100% of the second survey respondents wanted the webinar series to continue, even when face-to-face teaching resumes. Using the East Midlands region as an example, we estimate a saving of >2.9 metric tons in CO2 emission/region, equivalent to the recycling of one ton of waste/year from the replacement of face-to-face with web-based teaching. Conclusion(s): We have demonstrated that the East Midlands Gastroenterology webinar series is a greener, highly valued, and sustainable trainee-led innovation, bringing together an international community of gastroenterology practitioners. A significant proportion of the UK HST curriculum can be delivered online. Future evaluations should aim to evaluate the scalability of such innovation across different programmes in different settings.
ABSTRACT
Introduction: Percutaneous endoscopic gastrostomy (PEG) is a relatively easy and safe procedure that provides long-term enteral feeding for selected patients with dysphagia. Amid the COVID-19 pandemic, the European society of gastrointestinal endoscopy (ESGE) classified PEG insertion as a high priority procedure and advised to maintain services without disruption. Aims & Methods: This is a retrospective study of all consecutive adult patients who underwent PEG insertion between January 2019 and December 2020 at a district general hospital in the UK. The main aims were to assess the impact of COVID-19 on PEG insertion service and the clinical outcomes post PEG insertion in comparative cohorts. Data regarding patients' demographics, co-morbidities, laboratory findings and indications for PEG insertion were collected. 30-, 60- and 90-days post-PEG mortality data were assessed. Data of all procedures performed in 2020 (pandemic cohort) were compared with those in 2019 (pre-pandemic cohort). Continuous variables were compared using unpaired t-test, categorical variables were assessed using chi-square test or Fisher's exact test and factors associated with mortality were identified using multivariate logistic regression. Kaplan-Meier curves and log-rank tests were used to estimate mortality rates and compare survival post PEG insertion. Results: A total of 145 patients underwent PEG insertion using the pulltechnique (61.3% men, median age 68 years [IQR 59.5-77.5]). 60% of patients had WHO performance status 3 or 4 and 36.5% had two or more significant co-morbidities. The main indications for PEG were head and neck cancer (n= 64, 44.1%), cerebrovascular disease (n= 40, 27.5%) and neurological disorders (n= 27, 18.6%). There was a marked decline in PEG insertion in 2020 (n=55) compared to 2019 (n=90), mainly due to a 47.6% decline in prophylactic PEG insertion for head and neck cancer patients. There were no differences in patients' characteristics, co-morbidities and indications for PEG between the two study periods. Patients had longer hospital admissions in 2020 compared to 2019 (p=0.04). However, mortality rates were similar (p=0.11). 40/55 patients were screened for COVID-19, none of whom tested positive after two weeks of PEG insertion. The overall mortality was 7.5% at 30 days, 14.4% at 60 days and 18.6% at 90 days. Causes of death were sepsis (40.7%), pneumonia (37%) and COVID-19 (14.8%). Mortality was significantly higher for inpatient PEG insertion compared to outpatient (p<0.0001), but there was no procedurerelated mortality. At multivariate analysis, low serum albumin was independently associated with mortality (OR 1.2, 95% CI 1.07-1.37, p=0.002). 23/145 (15.8%) patients were successfully weaned off PEG in a mean period of 259 days (SD 170), the majority were head and neck cancer patients 19/23 (82.6%). Conclusion: PEG insertion during the COVID-19 pandemic was safe with a low risk of COVID-19 transmission and no significant difference in mortality compared to the pre-pandemic cohort. The decline in PEG insertion numbers was attributable to a significant reduction in elective cancer treatment.