Dedicated service for Barrett's oesophagus surveillance endoscopy yields higher dysplasia detection and guideline adherence in a non-tertiary setting in the UK: a 5-year comparative cohort study.

Objective: Barrett's oesophagus (BO) endoscopic surveillance is performed to varying quality, dedicated services may offer improved outcomes. This study compares a dedicated BO service to standard care, specifically dysplasia detection rate (DDR), guideline adherence and use of advanced imaging modalities in a non-tertiary setting. Design/method: 5-year retrospective comparative cohort study comparing a dedicated BO endoscopy service with surveillance performed on non-dedicated slots at a non-tertiary centre in the UK. All adult patients undergoing BO surveillance between 1 March 2016 and 1 March 2021 were reviewed and those who underwent endoscopy on a dedicated BO service run by endoscopists with training in BO was compared with patients receiving their BO surveillance on any other endoscopy list. Endoscopy reports, histology results and clinic letters were reviewed for DDR and British society of gastroenterology guideline adherence. Results: 921 BO procedures were included (678 patients). 574 (62%) endoscopies were on a dedicated BO list vs 348 (38%) on non-dedicated.DDR was significantly higher in the dedicated cohort 6.3% (36/568) vs 2.7% (9/337) (p=0.014). Significance was sustained when cases with indefinite for dysplasia were excluded: 4.9% 27/533 vs 0.9% 3/329 (p=0.002). Guideline adherence was significantly better on the dedicated endoscopy lists.Factors associated with dysplasia detection in regression analysis included visible lesion documentation (p=0.036), use of targeted biopsies (p=<0.001), number of biopsies obtained (p≤0.001). Conclusions: A dedicated Barrett's service showed higher DDR and guideline adherence than standard care and may be beneficial pending randomised trial data.

Barrett's oesophagus with indefinite for dysplasia shows high rates of prevalent and incident neoplasia in a UK multicentre cohort.

AIMS: Barrett's oesophagus with indefinite for dysplasia (IDD) carries a risk of prevalent and incident dysplasia and oesophageal adenocarcinoma. This study seeks to determine the risk of neoplasia in a multicentre prospective IDD cohort, along with determining adherence to British Society of Gastroenterology (BSG) guidelines for management and histology reporting. METHODS: This was a cohort study using prospectively collected data from pathology databases from two centres in the North West of England (UK). Cases with IDD were identified over a 10-year period. Data were obtained on patient demographics, Barrett's endoscopy findings and histology, outcomes and histological reporting. RESULTS: 102 biopsies with IDD diagnosis in 88 patients were identified. Endoscopy was repeated in 78/88 (88%) patients. 12/78 progressed to low-grade dysplasia (15% or 2.6 per 100 person years), 6/78 (7.7%, 1.3 per 100 person years) progressed to high-grade dysplasia and 6/78 (7.7%, 1.3 per 100 person years) progressed to oesophageal adenocarcinoma. The overall incidence rate for progression to any type of dysplasia was 5.1 per 100 person years. Cox regression analysis identified longer Barrett's segment, multifocal and persistent IDD as predictors of progression to dysplasia. Histology reporting did not meet 100% adherence to the BSG histology reporting minimum dataset prior to or after the introduction of the guidelines. CONCLUSIONS: IDD carries significant risk of progression to dysplasia or neoplasia. Therefore, careful diagnosis and management aided by clear histological reporting of these cases is required to diagnose prevalent and incident neoplasia.

Successful implementation of the CDC recommendations during the care of 2 patients with Candida auris in in-patient rehabilitation and intensive care settings.

Candida auris presents a unique challenge to practitioners and infection control teams worldwide because of its virulence, alarming resistance profile, environmental fitness, and risk of nosocomial transmission. We describe 2 cases of Candida auris infection managed with the CDC recommendations with no evidence of in-hospital transmission.

Use and Interpretation of Enteropathogen Multiplex Nucleic Acid Amplification Tests in Patients With Suspected Infectious Diarrhea.

Acute diarrheal illness due to gastrointestinal infection is a significant cause of morbidity and mortality in the United States and around the world. Determining the causative organism in a timely manner assists with patient care, identifying outbreaks, providing infection control, and administering antimicrobial therapy when indicated. Traditional diagnostic modalities based on culture and immunoassays are limited by their low sensitivity and long turnaround time. Nucleic acid amplification tests (NAATs) for enteric pathogens allow for the syndromic testing of stool for multiple pathogens simultaneously and have higher sensitivity with a shorter turnaround time. However, by not isolating the organism, NAATs do not provide drug susceptibility or confirmatory identification. Furthermore, NAATs cannot distinguish between true infection and carrier states. Nevertheless, several studies have demonstrated the cost-effectiveness of multiplex NAATs by reducing the length of hospital stay and cost of isolation. Five platforms are currently approved by the US Food and Drug Administration that can detect different bacteria, parasites, and viruses. The sensitivity and specificity of each platform depends on the targeted pathogens and whether the tests are performed on fresh stool, frozen stool, or in transport media. Overall, these tests have high sensitivity and specificity of more than 90% when used in symptomatic patients. Thus, multiplex NAAT gastrointestinal platforms offer several advantages compared to traditional methods. However, the interpretation of the results requires acknowledging the limitations of the tests and exercising clinical judgment. More studies are needed to establish the cost-effectiveness of multiplex NAATs and their impact on antibiotic stewardship and clinical outcomes.