BSG cross-sectional survey on impact of COVID-19 recovery on workforce, workload and well-being.

Objective: The aim of this survey was to understand the impact of the COVID-19 pandemic and recovery phase on workload, well-being and workforce attrition in UK gastroenterology and hepatology. Design/method: A cross-sectional survey of British Society of Gastroenterology physician and trainee members was conducted between August and October 2021. Multivariable binary logistic regression and qualitative analyses were performed. Results: The response rate was 28.8% (180/624 of opened email invites). 38.2% (n=21/55) of those who contracted COVID-19 felt pressured to return to work before they felt ready. 43.8% (71/162) had a regular increase in out-of-hours working. This disproportionately affected newly appointed consultants (OR 5.8), those working full-time (OR 11.6), those who developed COVID-19 (OR 4.1) and those planning early retirement (OR 4.0). 92% (150/164) believe the workforce is inadequate to manage the service backlog with new consultants expressing the highest levels of anxiety over this. 49.1% (80/163) felt isolated due to remote working and 65.9% (108/164) felt reduced face-to-face patient contact made their job less fulfilling. 34.0% (55/162) planned to work more flexibly and 54.3% (75/138) of consultants planned to retire early in the aftermath of the pandemic. Early retirement was independently associated with male gender (OR 2.5), feeling isolated from the department (OR 2.3) and increased anxiety over service backlog (OR 1.02). Conclusion: The pandemic has placed an additional burden on work-life balance, well-being and workforce retention within gastroenterology and hepatology. Increased aspirations for early retirement and flexible working need to be explicitly addressed in future workforce planning.

Switching to subcutaneous vedolizumab in inflammatory bowel disease during COVID-19 pandemic – County Durham experience

IntroductionThe COVID-19 pandemic resulted in the need for significant adaptations to an intravenous biologics infusion service. Patients were reluctant to come to a Biologics Infusion Unit in an acute hospital due to the fear of exposure to SARS-CoV-2 virus and also due to the UK governmental advice on strict isolation and shielding. Based on the VISIBLE-1 and -2 Study data, we decided to switch our IBD patients from IV Vedolizumab to SC vedolizumab in a phased manner. We report on our experience and short term outcomes.MethodsDuring the COVID-19 pandemic, we decided to switch patients with Ulcerative colitis and Crohn’s disease from IV Vedolizumab to Subcutaneous Vedolizumab in a phased manner. In the first Phase (July – Sep 2020) all patients with Ulcerative colitis (UC) in clinical remission of their disease beyond 16 weeks of Vedolizumab treatment were invited to switch. In phase 2 (October –Dec 2020) additional UC and Crohn’s Disease (CD) patients on maintenance were switched and in Phase 3, new patients with UC and CD entering the Vedolizumab treatment programme were included for IV induction followed by SC maintenance. 6 month outcomes were assessed for clinical response, faecal calprotectin, and for short term patient experience.ResultsA total of 31 patients were switched in the 6 month period of COVID-19 adaptation. 19 patients had UC (13 pancolitis, 6 distal colitis) and 12 patients had CD (1 Crohn’s colitis, 5 ileocolonic, 5 small bowel and 1 complex). Over the 6month period, 1 patient flared on SC Vedo and switched back to escalated IV, 1 developed abnormal LFTs and switched out of class. All remaining patients were doing well, and had mean SCAI score of 0, HBI score of 1. Mean FCP in UC patients was 197 ug/g (range 25-561), and in CD patients was 248ug/g (range 213-283). Patient experience indicated that all patients on SC Vedo felt that they were safer during the pandemic.ConclusionA COVID-19 adaptation of managed switching of patients with ulcerative colitis and Crohn’s disease from IV to SC Vedolizumab is safe and does not result in any adverse outcomes. Long term data on maintenance of remission and endoscopic healing is awaited.

The impact of COVID-19 pandemic on Upper GI and Hepato-pancreato-biliary cancers – diagnosis and staging

IntroductionCancer Charities and the BSG Endoscopic Section predict an increased GI cancer related mortality arising from reduced endoscopic activity and delays to cancer diagnosis during the COVID-19 pandemic. Initial modelling reports suggest up to a 58% reduction in weekly GI cancer detection. A real world analysis of the adverse impact of COVID-19 on Upper GI and hepato-pancreato-biliary (HPB) cancers has not been reported so far.Aims and MethodsPatients with a new diagnosis of upper GI (oesophageal and gastric) or HPB cancer at County Durham over two 4-month periods of June-September 2019 (pre-COVID) and 2020 (peri-COVID) were selected for this analysis. Data collected from electronic patient notes and Somerset Cancer MDT electronic database included: 1) patient demographics and co-morbidities;2) Pathway parameters - duration of symptoms prior to presentation, 2WW timeframes, interval between referral and endoscopy, performance status, elective vs emergency presentation, and 3) Tumour parameters - cancer site, TNM staging. 90-day mortality, where available was also recorded.Results163 patients were included – 82 patients in pre-COVID (2019) and 81 in peri-COVID (2020) cohorts. In the pre-COVID group, 25 were oesophageal cancers, 8 gastric, 21 pancreatic, and 26 liver cancers. In the peri-COVID group, 31 were oesophageal cancers, 13 gastric, 17 pancreatic, and 18 liver cancers. An absolute increase of 17.5% was seen in emergency presentation of UGI cancers to A&E in 2020 (35.8% v 18.3%). In the peri-COVID group, 87.1% of patients had advanced (TNM staging of T3/4, N2 or M1) oesophageal and gastric cancer, 7.1% more than in pre-COVID group. A similar increase of 6.4% was identified in metastatic pancreatic cancers (58.8% in 2020 v 52.4% in 2019). There was a significant reduction in the number of endoscopies performed within 3 weeks of referral - 56.8% pre-COVID, compared with only 20% peri-COVID. There was no significant difference between 60-day mortality (pre-COVID 25.61% and peri-COVID group 25.91%) and 90-day mortality (34.15% and 32.10% respectively), between the two groups.ConclusionAlthough the impact of COVID-19 on endoscopy activity resulted in a 17.5% increase in emergency presentations of UGI and HPB cancers and nearly 10% increase in advanced cancer diagnosis with a 37% reduction in endoscopy activity in County Durham, we were unable to show a significant increase in short term cancer related mortality. We believe a similar phenomenon is occurring across the NHS leading to an indirect increase in COVID-19 related cancer diagnosis. Measures to mitigate this are urgently needed.

GI and Non-GI manifestations of COVID-19 during first wave of the pandemic at Darlington, UK

Anjan Dhar1,2, Alexander Newman2, Vikki Rand2Department of Gastroenterology1, Darlington Memorial Hospital and School of Health and Life Sciences2, Teesside University, UKGastrointestinal (GI) manifestations of COVID-19 have been increasingly reported from many centres but it is not clear as to whether the presence of GI manifestations influences the outcomes of COVID-19. The data from the UK is still emerging and there is significant variability between the North of England and the rest of the UK.Aim of this studyDarCoVE was a single centre epidemiological study initiated over a 3 week period during the peak of the first wave of the COVID-19 pandemic in the United Kingdom. This prospective cohort analysis evaluated the GI and non-GI manifestations of the disease and produced a multi-variate analysis of prognosticators for COVID-19.MethodsConsecutive patients admitted with fever, cough or shortness of breath to the Acute Medical Admissions Service of Darlington Memorial Hospital between 26 March 2020 – 12 April 2020 were recruited to an electronic database, and divided into two cohorts: RT-PCR positive for SARS-CoV-2 (COVID+) and negative (COVID-). Demographic parameters, underlying co-morbidities, GI and non-GI symptoms, BMI, haematological and biochemical laboratory parameters, chest radiology, need for supplemental oxygen, need for high dependency and intensive care treatment, length of hospital stay and mortality were recorded. Univariate survival analysis was performed by Cox proportional hazard model in R, multi variate analysis was done by forward selection model, cumulative survival by Kaplan-Meier method using log-rank test.Results275 patients formed the dataset for analysis, 130 COVID+. Median age of COVID+ was 70(range 23-95yrs), 63% were over age 65yrs, M:F=1.28. 73% had at least one co-morbidity, diabetes commonest. Median BMI 29.7 (range 13.9-44.9). 60.8% patients had a BMI>30, compared to UK average of 10.9% (p<0.001). GI manifestations included: diarrhoea in 10.1%, vomiting 13%, abdominal discomfort 9.4%, loss of appetite 5.7%, abnormal liver functions 37%, mean ALT 52.4 IU/L, ALT >150 in 5.1%. Of 43 clinical and biochemical factors investigated for prognostic value, 9 factors were associated with outcome at p<0.05 with cough and diarrhoea associated with lower risk of death compared to the other 7 factors. On multivariate analysis, high frailty score > 5, worst oxygenation SpO2 < 93%, platelets < 100 x 109/L and immunocompromised were poor prognosticators. None of the GI manifestations co-related with risk of death in this analysis, with a trend for ALT >150 to be associated with higher mortality. Overall mortality was 30.8% compared to UK national mortality of 26%, with ITU mortality higher at 37%.ConclusionThis study has shown a regional variation in the outcome of COVID-19, with slightly different prognosticators. GI manifestations continue to be significant in COVID-19, with a trend seen with high ALT. The data from this analysis will help management in future pandemics.

SARS-CoV-2 vaccination for patients with inflammatory bowel disease: a British Society of Gastroenterology Inflammatory Bowel Disease section and IBD Clinical Research Group position statement.

SARS-CoV-2 has caused a global health crisis and mass vaccination programmes provide the best opportunity for controlling transmission and protecting populations. Despite the impressive clinical trial results of the BNT162b2 (Pfizer/BioNTech), ChAdOx1 nCoV-19 (Oxford/AstraZeneca), and mRNA-1273 (Moderna) vaccines, important unanswered questions remain, especially in patients with pre-existing conditions. In this position statement endorsed by the British Society of Gastroenterology Inflammatory Bowel Disease (IBD) section and IBD Clinical Research Group, we consider SARS-CoV-2 vaccination strategy in patients with IBD. The risks of SARS-CoV-2 vaccination are anticipated to be very low, and we strongly support SARS-CoV-2 vaccination in patients with IBD. Based on data from previous studies with other vaccines, there are conceptual concerns that protective immune responses to SARS-CoV-2 vaccination may be diminished in some patients with IBD, such as those taking anti-TNF drugs. However, the benefits of vaccination, even in patients treated with anti-TNF drugs, are likely to outweigh these theoretical concerns. Key areas for further research are discussed, including vaccine hesitancy and its effect in the IBD community, the effect of immunosuppression on vaccine efficacy, and the search for predictive biomarkers of vaccine success.