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- Crossing barriers: the burden of inflammatory bowel disease across Western EuropePublication . Kumar, Aditi; Yassin, Nuha; Marley, Alexandra; Bellato, Vittoria; Foppa, Caterina; Pellino, Gianluca; Myrelid, Pär; Millan, Monica; Gros, Beatriz; Avellaneda, Nicolas; Catalan-Serra, Ignacio; El-Hussuna, Alaa; Cunha Neves, João A.; Roseira, Joana; Cunha, Miguel F.; Verstockt, Bram; Bettenworth, Dominik; Mege, Diane; Brookes, Matthew J.An estimated 2.5-3 million individuals (0.4%) in Europe are affected by inflammatory bowel disease (IBD). Whilst incidence rates for IBD are stabilising across Europe, the prevalence is rising and subsequently resulting in a significant cost to the healthcare system of an estimated 4.6-5.6 billion euros per year. Hospitalisation and surgical resection rates are generally on a downward trend, which is contrary to the rising cost of novel medication. This signifies a large part of healthcare cost and burden. Despite publicly funded healthcare systems in most European countries, there is still wide variation in how patients receive and/or pay for biologic medication. This review will provide an overview and discuss the different healthcare systems within Western Europe and the barriers that affect overall management of a changing IBD landscape, including differences to hospitalisation and surgical rates, access to medication and clinical trial participation and recruitment. This review will also discuss the importance of standardising IBD management to attain high-quality care for all patients with IBD.
- Towards a greener endoscopy: considerations on the strategies to improve sustainabilityPublication . Neves, Joao; Roseira, Joana; Cunha, Miguel F.; Pellino, Gianluca; Sampietro, Gianluca M.; Rodríguez de Santiago, EnriqueClimate crisis is dramatically changing life on earth. Environmental sustainability and waste management are rapidly gaining centrality in quality improvement strategies of healthcare, especially in procedure- dominant fields such as gastroenterology and digestive endoscopy. Therefore, healthcare interventions and endoscopic procedures must be evaluated through the ‘triple bottom line’ of financial, social, and environmental impact. The purpose of the paper is to provide information on the carbon footprint of gas- troenterology and digestive endoscopy and outline a set of measures that the sector can take to reduce the emission of greenhouse gases while improving patient outcomes. Scientific societies, hospital execu- tives, single endoscopic units can structure health policies and investment to build a “green endoscopy”. The AIGO study group reinforces the role of gastrointestinal endoscopy professionals as advocates of sus- tainability in digestive endoscopy. The “green endoscopy” can shape a more sustainable health service and lead to an equitable, climate-smart, and healthier future.
- Green surgery: a systematic review of the environmental impact of laparotomy, laparoscopy, and roboticsPublication . Cunha, Miguel F.; Neves, João Cunha; Roseira, Joana; Pellino, Gianluca; Castelo-Branco, PedroSurgery is the most energy-intensive healthcare sector, but data on the environmental impact of abdominal surgical techniques are limited. This systematic review aims to identify the most sustainable approach among open, laparoscopic, and robotic surgeries. We searched MEDLINE, Cochrane, and Web of Science databases (inception to March 2024) for studies on the carbon footprint of abdominal surgery, focusing on carbon dioxide equivalents (CO2e) or CO2 emissions. The Joanna Briggs Institute checklist was used to assess bias. (PROSPERO: 298486). Of 2155 records, eight cohort studies were included, showing low to moderate risk of bias but high heterogeneity. Two studies on hysterectomy found robotic surgery had the highest carbon footprint (12.0-40.3 kgCO2e) compared to laparoscopic (10.7-29.2 kgCO2e) and open surgery (7.1-22.7 kgCO2e). Another study found laparoscopic prostatectomy produced more emissions than robotic surgery (59.7 vs. 47.3 kgCO2e) due to higher disposable devices, surgery time and length of stay. Single-use devices in laparoscopic cholecystectomy emitted more CO2e than hybrid devices (7.194 vs. 1.756 kgCO2e). CO2 used in minimally invasive surgery had negligible environmental effects (0.9 kgCO2e). Qualitative subgroup analyses revealed significant differences between surgery types and measurement methodologies, contributing to data heterogeneity. Minimally invasive surgeries often have higher carbon footprints due to disposable tools and waste. However, one study showed robotic surgery may reduce the overall environmental impact by shortening hospital stays. Due to methodological heterogeneity across studies, definitive conclusions remain limited. Standardized life-cycle assessment methodologies and inclusion of clinical outcomes in future studies are urgently needed to clarify the environmental sustainability of surgical practices.
- Assessing the role of CT imaging in identifying candidates for neoadjuvant chemotherapy in right colon cancer: a critical analysisPublication . Lopes, João Leão; Soares, Ana Sofia S.; Mendes, Beatriz; Tomada, Elisa Paoluzzi; Cunha, Miguel F.; Melina Fernandez, Laura; Amorim, Edgar; Azevedo, José; Parvaiz, AmjadBackground and purpose Standard treatment for localized right colon cancer is radical surgery, followed by adjuvant chemotherapy for stage III or intermediate MSS and high-risk stage II tumours. Recent studies suggest a benefit from neoadjuvant chemotherapy (NAC), particularly for T4b and/or N+tumours. Patient selection for NAC relies on CT-based clinical staging, but the accuracy of CT in detecting high-risk features is variable, raising concerns about potential overtreatment. The study aims to demonstrate the accuracy of CT staging of the right colon with the purpose of indicating neoadjuvant CT. Methods Patients undergoing curative right hemicolectomy between 2013 and 2023 at two Portuguese institutions were included. All had preoperative CT; those receiving NAC were excluded. Sensitivity, specificity, positive predictive value, and negative predictive value of CT in identifying T4b and N+tumours were calculated by comparing clinical (cTNM) and pathological (pTNM) staging. Results Among 165 patients (48% male, mean age 70.5 years), CT showed low sensitivity (26%) but high specificity (91%) for pT4b tumours, with a tendency toward understaging. For nodal disease, sensitivity was 87% and specificity 41%. Only 57% of cT4b and/or cN+cases confirmed at least one unfavorable pathological factor, implying potential overtreatment in 43% of patients if NAC were applied solely based on CT findings. Conclusion CT remains the standard for clinical staging but demonstrates limited accuracy in identifying high-risk right colon cancers. NAC decisions should integrate additional criteria beyond CT findings to avoid overtreatment.