MHRA alert regarding N-butyl-2-cyanoacrylate (Histoacryl)
The MHRA has issued an alert regarding N-butyl-2-cyanoacrylate (Histoacryl) after being notified about problems with batches that have failed to polymerise when deployed. They have also warned of potential supply problems in the near future. Cyanoacrylate is recommended in the BSG 2015 guidelines for the management of gastric variceal haemorrhage in cirrhotic patients (level 1a, grade A). Thrombin can also be considered, albeit with a weaker evidence base (level 4, grade C). Many units around the UK already use thrombin (FlosealTM) and Endoscopy Units may wish to consider having this available as an alternative to cyanoacrylate for patients with bleeding gastric varices until the situation is resolved.
The BSG does not routinely issue drug or device alerts but in this instance, all members should be aware of the problems with Histoacryl to allow forward planning, given the often life-threatening and emergency nature of gastric variceal haemorrhage.
Ian Penman, VP Endoscopy
John Dillon, VP Hepatology
Advanced Endoscopy Fellowships
As we continue to restart our service provision following the COVID-19 pandemic, one of the issues for the gastroenterology specialty will be the repercussions for endoscopy training.
To support our trainees, BSG is developing a central database of all advanced endoscopy fellowships in the UK & Ireland to be hosted on the BSG website. This will enable trainees to access information on a single portal, and plan their future careers in endoscopy.
View the latest endoscopy fellowships here
COVID-related endoscopy research studies and audits – are you interested?
COVID-19 has had a major impact on GI endoscopy. There are many challenges we face to establish sufficient endoscopy capacity going forwards. Solutions will involve new ways of working and utilising novel technologies. We have been overwhelmed (but not surprised) by the enthusiasm of colleagues with positive ideas and the range of diverse proposals from around the UK.
To address endoscopy in a COVID-19 world we have established a BSG Endoscopy COVID Research Group (as part of the existing Endoscopy CRG) which will oversee our strategy to ensure that whatever we do has a clear and strong evidence base – and where that does not exist- embed research or audit within any service changes.
We are very keen to make sure that good ideas and research work progress collaboratively and have the potential for maximal benefit for patients and service delivery. We wish to avoid duplication and ensure that groups are not reinventing the wheel and this programme of work will be inclusive and collaborative. We have established a series of Working Groups (WG). If you would like to be involved in any of this work or have ideas or suggestions, please contact as below:
- WG1 COVID screening / safety – email@example.com
- WG2 Pathways to care – (Upper and lower GI diagnostic) – firstname.lastname@example.org
- WG3 Patient experience – email@example.com
- WG4 Data – firstname.lastname@example.org
- WG5 Role of novel technologies – email@example.com
Colin Rees (Chair, BSG Endoscopy clinical Research Group)
Ian Penman (VP Endoscopy, BSG)
Latest Endoscopy Guidelines
2021 Update: Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: BSG & ESGE Guidelines Update
Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. BSG endorsed.
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