Objective To evaluate the influence of socioeconomic deprivation and rurality on colon capsule endoscopy (CCE) performance and downstream management in a remote National Health Service (NHS) population.Methods We performed a secondary analysis of 2480 patients undergoing CCE within NHS Highland between 2019 and 2024 using data from the ScotCap registry. Primary outcomes were bowel preparation adequacy and CCE completion. The secondary outcome was follow-up pathway (endoscopic vs non-endoscopic). Predictor variables included age, sex, Scottish Index of Multiple Deprivation (SIMD) quintile and Urban–Rural Classification (URC). Multivariable logistic regression was used to estimate ORs with 95% CIs.Results The mean age was 59.3 years (SD 12.4) and 1379/2480 (55.6%) patients were female. Adequate bowel preparation was achieved in 1787/2480 (72.1%) patients, CCE was completed in 1669/2480 (67.3%), and endoscopic follow-up occurred in 1421/2480 (57.3%). Neither SIMD nor URC was associated with bowel preparation adequacy, CCE completion or follow-up pathway (all p>0.05). Female sex was independently associated with inadequate bowel preparation (OR 1.70, 95% CI 1.42 to 2.04; p<0.001) and CCE incompletion (OR 1.62, 95% CI 1.36 to 1.93; p<0.001). Increasing age was associated with reduced odds of non-endoscopic follow-up (OR 0.99, 95% CI 0.98 to 1.00; p=0.01). Inadequate bowel preparation was strongly associated with subsequent endoscopic investigation (OR 0.18, 95% CI 0.12 to 0.27; p<0.001).Conclusions This is the largest study evaluating socioeconomic deprivation and rurality in CCE. Neither influenced CCE performance or downstream management. Instead, patient factors, including sex, age and bowel preparation quality, were the primary determinants of outcomes. These findings support CCE as an equitable diagnostic modality across diverse populations and support the expansion of community and home-based services.
Introduction Pseudomyxoma peritonei (PMP) is a rare malignancy usually originating from a perforated appendix tumour. Potentially curative treatment involves cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy, commonly mitomycin-C (MMC). Different regimens of MMC are used across the world, with little convincing evidence for which regimen best balances favourable clinical outcomes against side effects and cost. The aim of this trial is to compare two dosing regimens of MMC during CRS.Methods and analysis The HIPEC-PMP trial is an individually randomised, parallel group, single-blind, non-inferiority trial that will randomise patients (1:1) with PMP who are amenable to complete cytoreduction to one of two established regimens, either low-dose MMC (10 mg/m2 for 60 min) or high-dose MMC (35 mg/m2 for 90 min) to test the non-inferiority of low-dose MMC. A Bayesian design is used to incorporate prior information on each dose, with a principled approach to discount historical data if it is markedly different from the trial data. Participants must have a clinical and/or radiological diagnosis of PMP from a primary mucinous epithelial tumour of the appendix that is amenable to complete cytoreduction and will be recruited from a single specialist centre. Participants will be followed up for a minimum of 2 years. The primary endpoint is disease-free survival at 2 years, and secondary endpoints are overall survival, adverse events, quality of life and cost-effectiveness. A Bayesian analysis will be used to determine the probability that 2-year recurrence rates are within 10% to determine non-inferiority. The trial has a target sample size of 176.Ethics and dissemination The study is sponsored by the University of Southampton, coordinated by the Cancer Research UK Southampton Clinical Trials Unit, and open to recruitment at the Peritoneal Malignancy Unit at the Hampshire Hospitals Foundation Trust. The trial protocol has received the favourable opinion of the London-Westminster Research Ethics Committee (REC 24/LO/0692), as well as the necessary approvals from the Medicines and Healthcare products Regulatory Agency and NHS Health Research Authority. Informed consent is required before any trial specific procedures are undertaken. It is intended that the results of the study will be disseminated via publication in peer-reviewed scientific journals, conference presentations and submission to regulatory authorities.Trial registration number NCT06513065.
Objective Type 2 diabetes mellitus (T2DM) is a risk factor for acute pancreatitis (AP), severe AP (SAP) and chronic pancreatitis (CP). Metformin has anti-inflammatory and metabolic effects. We aimed to evaluate the effects of metformin on pancreatitis risk in patients with T2DM.Methods Retrospective cohort study using the US subset of the TriNetX network database. Subjects ≥18 years with T2DM, no prior pancreatitis and ≥12 months of metformin exposure were compared with a cohort with T2DM not on medication. The first AP event was recorded, SAP was defined using validated surrogates and CP was included if diagnosed ≥3 years after the first AP event. 1:1 propensity score matching was performed, and outcomes were compared using relative risk (RR).Results After matching, there were 74 930 subjects in each cohort. AP incidence was significantly lower among metformin users (268 (0.36%)) compared with non-users (420 (0.56%); RR 1.57, 95% CI 1.35 to 1.83; p<0.001). SAP occurred in 4664 (6.22%) metformin users versus 8399 non-users (RR 1.90, 95% CI 1.83 to 1.97; p<0.001). CP was less frequent in metformin users (98 (0.13%) vs 153 (0.23%); RR 1.56, 95% CI 1.21 to 2.01; p<0.001). Thirty-day mortality was significantly reduced in the SAP cohort (1.02% vs 2.02%; RR 2.00, 95% CI 1.84 to 2.19; p<0.0001), as was length of stay (6.09±12.72 vs 6.57±11.16 days; p<0.001), with no differences for AP or CP.Conclusion Metformin was associated with lower risks of AP, SAP and CP in subjects with T2DM, with a reduction in mortality and hospitalisation in patients with SAP. Metformin use may be a disease modifier in pancreatitis. Prospective studies are warranted to validate these observations, clarify dose–response relationships and explore mechanistic pathways.
Objective To explore National Health Service (NHS) staff and patients’ perceptions of the safety, cost-effectiveness, environmental impact, benefits and challenges of single-use and reusable endoscopes in upper gastrointestinal (GI) procedures.Methods This qualitative study was conducted across four NHS hospital sites in England and Wales. Participants included patients who had undergone upper GI endoscopy and staff involved across the endoscopy pathway. Data were collected between December 2024 and September 2025 and analysed using reflexive thematic analysis.Results Eighteen patients and 21 NHS staff participated. Five themes were identified: (1) information about reusability not relevant to patients, with patients prioritising understanding the procedure rather than technical details of the endoscope; (2) deference to NHS decision-making, with patients and staff generally perceiving both reusable and disposable endoscopes as safe and appropriate, while favouring reusable scopes based on familiarity and perceived cost-effectiveness; (3) potential use of disposable endoscopes for managing contagious patients, with staff viewing disposable scopes as particularly appropriate for high-risk or emergency cases; (4) greener endoscopy through more targeted use, with staff suggesting that more targeted use of procedures and selective use of disposable scopes could be potential opportunities to reduce environmental impact and (5) reusable scopes working well but variable in quality, with staff reporting generally good performance but some concerns regarding variation in image quality and wear and tear.Conclusion Neither staff nor patients strongly preferred reusable or disposable endoscopes when quality and safety standards were met. Decisions should therefore prioritise cost-effectiveness and environmental sustainability.
