Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy.

GI endoscopy is highly resource-intensive with a significant contribution to greenhouse gas (GHG) emissions and waste generation. Sustainable endoscopy in the context of climate change is now the focus of mainstream discussions between endoscopy providers, units and professional societies. In addition to broader global challenges, there are some specific measures relevant to endoscopy units and their practices, which could significantly reduce environmental impact. Awareness of these issues and guidance on practical interventions to mitigate the carbon footprint of GI endoscopy are lacking. In this consensus, we discuss practical measures to reduce the impact of endoscopy on the environment applicable to endoscopy units and practitioners. Adoption of these measures will facilitate and promote new practices and the evolution of a more sustainable specialty.

Clinical presentation and ECG changes--how good is it in diagnosing troponin positive acute coronary syndrome.

UNLABELLED: To study the relation between troponin positive acute coronary syndrome (ACS) and electrocardiogram (ECG) changes on admission. METHODS: It was a prospective cohort study looking at patients admitted to the Heart Assessment Center over a period of a month, who were suspected to have an ACS. There were 126 patients in the cohort. The groups were classified depending on the number of cardiovascular risk factors: 0, 1, 2, 3, 4 and >4. The history and ECG changes during presentation were analyzed and the cardiac enzymes (12-hour troponin) were done. The final diagnosis was based on the expert opinion of the Consultant Cardiologist in combination with troponin positive results, and they were only further studied. RESULTS: Of the 126 patients that were analyzed 31(25%) were diagnosed as ACS of which 26(21%) were troponin positive ACS. Among them, 13(50%) had ECG changes during admission, and 13(50%) did not have any noticeable ECG changes. CONCLUSION: Certain elements of the chest pain history and ECG changes are associated with increased or decreased likelihood of a diagnosis of ACS, none of them alone or in combination identify a group of patients that can be safely discharged without further diagnostic testing.

Biodegradable esophageal stents in benign and malignant strictures - a single center experience.

BACKGROUND AND STUDY AIMS: Biodegradable (BD) esophageal stents were recently developed mainly for refractory benign strictures, but experience and available literature are limited. PATIENTS AND METHODS: This was a retrospective observational study. All patients who had BD stents inserted due to refractory benign esophageal strictures or malignant strictures, or were awaiting radical radiotherapy/chemotherapy or neo-adjuvant therapy and esophagectomy between March 2011 and July 2015 were included. RESULTS: Stent placement was successful in all patients. Ten patients with benign strictures (3 male, median age 80.5 years, IQR: 68.75 - 89.5) were followed-up for a median of 171.5 weeks (IQR: 24 - 177.25). The interval between dilatations prior to the first BD stent placement (median: 34.25 days, IQR: 23.06 - 48.29) was significantly shorter than the interval between the first BD stent placement and the first intervention required (median: 149.5 days, IQR: 94.25 - 209.5) and this difference was statistically significant (P = 0.012). Ten patients with esophageal cancer (8 male, median age: 69 years, IQR: 59.25 - 80.75) were included and they were followed up for a median of 36 weeks (IQR: 26 - 58). Only 1 completed radical radiotherapy successfully, but developed refractory post-radiotherapy stricture. No one proceeded to esophagectomy and 50 % required a self-expanding metal stent (SEMS) at a median of 134 days (IQR: 100 - 263) following stent placement. CONCLUSIONS: BD stents were successfully deployed in both benign and malignant strictures. They offered a prolonged dilatation-free interval in benign strictures, yet in the majority of patients, strictures recurred. In malignant strictures, stent patency was similar to that of benign strictures, which suggests a potential value in ensuring adequate oral intake during oncologic therapy. In our cohort, however, use of stents did not contribute to improved outcome.