Is early bowel resection better than medical therapy for ileocolonic Crohn's disease? A systematic review and meta-analysis.

AIM: There is emerging evidence supporting early bowel resection (EBR) for ileocaecal Crohn's disease (CD) as an alternative to conventional escalation of medical therapy (MT). Here, we present a systematic review and meta-analysis of studies comparing the outcomes of EBR with those of MT in ileocolonic CD, with a focus on ileocaecal disease. METHODOLOGY: The MEDLINE, Embase, CINAHL and Cochrane Central Register of Controlled Trials databases were searched for studies reporting the outcomes of EBR versus MT for ileocolonic CD. The Cochrane tools for assessment of risk of bias were used to assess the methodological quality of studies. RESULTS: Nine records (from 8 studies, with a total of 1867 patients) were included in the analysis. Six studies were observational and two were randomised controlled trials. There was a reduced need for drug therapy in the EBR arm. The rate of intestinal resection at 5 years was 7.8% in the EBR arm and 25.4% in the MT group with a pooled OR of 0.32 (95% CI 0.19, 0.54; p < 0.0001). The EBR group had a longer resection-free survival (HR 0.56, 95% CI 0.38, 0.83; p = 0.004). These outcomes were consistent in a subgroup analysis of patients with ileocaecal disease. Morbidity and quality of life scores were similar across the two groups. CONCLUSION: EBR is associated with a more stable remission compared to initial MT for ileocolonic Crohn's disease. There is enough evidence to support EBR as an alternative to escalation of MT in selected patients with limited ileocaecal disease.

Patient experience of virtual urogynaecology services during Covid-19 pandemic.

INTRODUCTION AND HYPOTHESIS: Due to increasing burden on outpatient services, there is a drive from NHS policy makers to utilise virtual clinics to help curb unsustainable demand. During the COVID-19 pandemic, urogynaecology clinics were converted to telephone consultation (TC). We used this opportunity to evaluate patient perspective and identify which patients may be best suited to TC. METHODS: Postal questionnaires were sent to patients following urogynaecology TCs in May to June 2020. Clinical outcome data were obtained from electronic records. The survey combined three validated tools: QQ-10, Patient Enablement Index (PEI) and NHS Friends and Family Test (NHS-FFT). Qualitative and quantitative data were analysed. RESULTS: Of the 308 patients contacted, 165 responded (54%). Eighty-six percent of patients described their experience of TC as "very good" or "good" (NHS-FFT). Positive themes included convenience, thoroughness and feeling at ease in terms of communicating intimate symptoms. QQ-10 results demonstrated a mean value score of 77 and a mean burden score of 17 (range 0-100); 72% of patients "strongly" or "mostly" agreed to repeat TC. Following TC, 22% of patients were discharged, 72% required follow-up and 37% needed face-to-face (F2F) consultation. Post-operative patients and those with lower urinary tract symptoms benefited most, whereas many prolapse patients required F2F consultation. CONCLUSIONS: We report the largest qualitative and quantitative study of patient experience of TC in urogynaecology. TC is a convenient, acceptable and effective medium for conducting patient care. TC can support patients in communicating intimate symptoms with health professionals.