Video Capsule Endoscopycapsule endoscopy (VCE) has emerged as a minimally invasive diagnostic tool for detecting and monitoring small bowel involvement in polyposis syndromes. VCE is included in the surveillance guidelines of Peutz-Jeghers syndrome. In the remaining familial polyposis syndromes, VCE may facilitate the early detection of polyps, when indicated, particularly in areas beyond the reach of conventional endoscopy, thereby aiding timely detection. Colon capsule endoscopy has been studied in symptomatic, screening and polyp surveillance populations and the second-generation colon capsule has demonstrated excellent detection rates for advanced neoplasia, however its role in colonic polyposis requires further research. The role of the panenteric capsule has not been explored in polyposis syndromes as a panintestinal examination. Despite its advantages, VCE has notable limitations; it may miss small, flat, or hidden lesions and lacks the capability for tissue sampling or therapeutic intervention. In the future, advances in imaging technology, extended battery life, and the integration of artificial intelligence (AI) are expected to further enhance the utility of VCE. Our review aims to focus on the applications of VCE in polyposis syndromes and future perspectives.

Patients diagnosed with Crohn's disease are increasingly subjected to repeat colonoscopic and radiological examinations to assess the extent of the disease severity and the effects of treatment. Pillcam (TM) Crohn's video capsule, a modified colon capsule, was developed to generate a minimally invasive mouth to rectum video of the gastrointestinal tract. The capsule provides a wide-angle panoramic mucosal view to assess inflammation, ulceration, stenosis, disease extent, and effect of treatment. This review summarizes the evidence of its utility in both adult and paediatric Crohn's disease and reviews the scoring systems used to quantify findings. The literature survey indicates that the Pillcam (TM) Crohn's capsule offers high sensitivity and specificity for the detection of inflammatory lesions and the extent and distribution of disease, and it could be considered a reliable imaging modality in both adults and childhood with Crohn's disease.

Background: Video capsule can illuminate the entire gastrointestinal mucosa. Upper gastrointestinal capsule endoscopy (UGICE) has the potential to survey for oesophageal, gastric and duodenal pathology and determine whether biopsy or intervention is indicated. Aims: This review traces the evolution of foregut video capsule endoscopy. Methods: A broad literature research was performed independently by two investigators. Extracted articles were organized and evaluated to interpret all current data.Results: In contrast to small bowel capsule, UGICE required sequential innovations to deal with rapid oesophageal transit, the irregular shape of the stomach and unpredictable gastric peristalsis. Oesophageal capsule endoscopy required the development of a two-camera device operating at a high frame rate, and postural change was developed to improve image capture, especially at the level of the Z-line, thus providing good imaging of Barrett's oesophagus, erosive oesophagitis and oesophageal varices, with optimal patients' tolerance. UGICE in patients presenting to the emergency room with acute bleeding has demonstrated accuracy when deciding on the need for emergency intervention. The latest development of a high frame rate UGICE, designed to image the oesophagus, stomach and duodenum has overtaken dedicated oesophageal capsule development. Capsule control is possible by exposing a magnetised capsule to an external magnetic field, and early reports indicate high accuracy in the oesophagus and stomach with high levels of patient acceptability. There is little information on cost-benefit.Conclusions: Capsule endoscopy offers gastroenterologists a new device to investigate the upper gastrointestinal tract with promising future potential.(c) 2021 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Purpose: To investigate whether the prokinetic prucalopride increases the completion rate of colon capsule endoscopy (CCE). Secondary outcomes included demographic distribution, polyp detection rate (PDR), distribution of Leighton-Rex grade, and adverse events. Patients and Methods: In a nested cohort within the CareForColon2015 trial, a subgroup of 406 individuals underwent CCE in 2021. The first half (control) received the standard bowel preparation and the second half (prucalopride) was supplemented with 2 mg of prucalopride. Transit times and bowel preparations were analyzed and completion rates calculated as those having timely transit and acceptable bowel cleanliness. Major adverse events were recorded continuously and minor adverse events were quantified from questionnaires. Results: The group demographics were homogenous. The prevalence ratio for complete CCE was 1.32 (CI 95% 1.15; 1.53) in the prucalopride group compared to the control group. Completion rate was 74.9% in the prucalopride group and 56.7% in the control group. The proportions of acceptable bowel preparation and complete transits were higher in the prucalopride group. The mean CCE transit time was 2 hours and 8 minutes faster in the prucalopride group. The PDR was higher in the intervention group with 55.7% compared to 36.0% in the control group for polyps greater than 9 mm, whereas the groups' PDRs were similar for small and diminutive polyps. In all, 589 polyps (mean 2.9) were found in the prucalopride group compared to 522 polyps (mean 2.6) in the control group. Conclusion: Prucalopride led to an increase in CCE completion rates. The proportions of complete transits and acceptable bowel preparations were higher in the prucalopride group. The PDR was higher in the prucalopride group compared to the control group. No major adverse events were identified. Nausea, diarrhea, headache and fatigue were more commonly reported in the prucalopride group.

The COVID-19 pandemic has caused considerable disruption in healthcare services and has had a substantial impact on the care of patients with chronic diseases, such as inflammatory bowel disease. Endoscopy services were significantly restricted, resulting in long waiting lists. There has been a growing interest in the use of capsule endoscopy in the diagnostic pathway and management of these patients. This review explores the published literature on the role of colon capsule endoscopy in ulcerative colitis and Crohn’s disease as a method for mucosal assessment of extent, severity, and response to treatment. Colon capsule preparation regimens and scoring systems are reported. The studies indicate that, despite inherent limitations of minimally invasive capsule endoscopy, there is increasing evidence to support the use of the second-generation colon capsule in inflammatory bowel disease evaluation, providing an additional pathway to expedite investigation of appropriate patients especially during and after the pandemic.

BACKGROUND & AIMS: The population prevalence of gastrointestinal (GI) disease is unclear and difficult to assess in an asymptomatic population. The aim of this study was to determine prevalence of GI lesions in a largely asymptomatic population undergoing colon capsule endoscopy (CCE). METHODS: Participants aged between 50-75 years were retrieved from the Rotterdam Study, a longitudinal epidemiological study, between 2017-2019. Participants received CCE with bowel preparation. Abnormalities defined as clinically relevant were Barrett segment >3cm, severe ulceration, polyp >10 mm or >= 3 polyps in small bowel (SB) or colon, and cancer. RESULTS: Of 2800 invited subjects, 462 (16.5%) participants (mean age 66.8 years, female 53.5%) ingested the colon capsule. A total of 451 videos were analyzed, and in 94.7% the capsule reached the descending colon. At least 1 abnormal finding was seen in 448 (99.3%) participants. The prevalence of abnormalities per GI segment, and the most common type of abnormality, were as follows: Esophageal 14.8% (Barrett's esophagus <3 cm in 8.3%), gastric 27.9% (fundic gland polyps in 18.1%), SB abnormalities 33.9% (erosions in 23.8%), colon 93.3% (diverticula in 81.2%). A total of 54 participants (12%) had clinically relevant abnormalities, 3 (0.7%) in esophagus/stomach (reflux esophagitis grade D, Mallory Weiss lesion and severe gastritis), 5 (1.1%) in SB (polyps > 10 mm; n = 4, severe ulcer n = 1,) and 46 (10.2%) in colon (polyp > 10 mm or >= 3 polyps n = 46, colorectal cancer n = 1). CONCLUSIONS: GI lesions are very common in a mostly asymptomatic Western population, and clinically relevant lesions were found in 12% at CCE. These findings provide a frame of reference for the prevalence rates of GI lesions in the general population.

Purpose: To investigate whether the prokinetic prucalopride increases the completion rate of colon capsule endoscopy (CCE). Secondary outcomes included demographic distribution, polyp detection rate (PDR), distribution of Leighton–Rex grade, and adverse events. Patients and Methods: In a nested cohort within the CareForColon2015 trial, a subgroup of 406 individuals underwent CCE in 2021. The first half (control) received the standard bowel preparation and the second half (prucalopride) was supplemented with 2 mg of prucalopride. Transit times and bowel preparations were analyzed and completion rates calculated as those having timely transit and acceptable bowel cleanliness. Major adverse events were recorded continuously and minor adverse events were quantified from questionnaires. Results: The group demographics were homogenous. The prevalence ratio for complete CCE was 1.32 (CI 95% 1.15; 1.53) in the prucalopride group compared to the control group. Completion rate was 74.9% in the prucalopride group and 56.7% in the control group. The proportions of acceptable bowel preparation and complete transits were higher in the prucalopride group. The mean CCE transit time was 2 hours and 8 minutes faster in the prucalopride group. The PDR was higher in the intervention group with 55.7% compared to 36.0% in the control group for polyps greater than 9 mm, whereas the groups’ PDRs were similar for small and diminutive polyps. In all, 589 polyps (mean 2.9) were found in the prucalopride group compared to 522 polyps (mean 2.6) in the control group. Conclusion: Prucalopride led to an increase in CCE completion rates. The proportions of complete transits and acceptable bowel preparations were higher in the prucalopride group. The PDR was higher in the prucalopride group compared to the control group. No major adverse events were identified. Nausea, diarrhea, headache and fatigue were more commonly reported in the prucalopride group.

Colon screening programs have reduced colon cancer mortality. Population screening should be minimally invasive, safe, acceptably sensitive, cost-effective, and scalable. The range of screening modalities include guaiac or immunochemical fecal occult blood testing and CT colonography and colonoscopy. A number of carefully controlled studies concur that second-generation capsule endoscopy has excellent sensitivity for polyp detection and a high negative predictive value. Colon capsules fulfill the screening expectation of safety, high sensitivity for polyp detection, and patient acceptance, and appear to straddle the divide between occult blood testing and colonoscopy. While meeting these criteria, there remains the challenges of scaling, capsule practitioner training, resource allocation, and implementing change of practice. Like CT colonography, capsule screening presents the clinician with a decision on the threshold for colonoscopy referral. Overall, colon capsules are an invaluable tool in polyp detection and colon screening and offer a filter that determines “who needs a colonoscopy?”.

Aims Although gastrointestinal (GI) diseases are common, prevalence rates of lesions in the GI tract in an asymptomatic population are difficult to assess. Colon capsule endoscopy (CCE) is a safe, minimally invasive tool that images the entire GI tract. The aim of this study is to assess prevalence of lesions in the entire GI tract in an asymptomatic population by CCE.

Since its introduction to clinical practice nearly 20 years ago, wireless capsule endoscopy has revolutionized the landscape in the diagnosis and management of small bowel diseases. Over the past 10 years, capsule endoscopy has evolved beyond the small intestine and a range of capsules are now available to examine the esophagus, stomach and colon. Because of its ease of use, tolerability, paucity of complications and ability to visualize the entire gastrointestinal tract, capsule endoscopy has entered the mainstream of clinical practice. This review of the literature summarizes the current state of capsule training and highlights the limited data available to assess reader competence and standards expected of an independent practitioner. There are neither standardized teaching strategies nor national or international metrics for accreditation of physicians and non-physicians interested in mastering this examination. Summating the few publications, there appears to be consensus that diagnostic expertise improves with experience, and that trainees should be fully supervised for at least 20 full case studies. Formative and summative assessment is advisable and the number of taught cases should not be the sole determinant of competence. The review also highlights differences in recommendations from major national gastroenterology societies. Finally, the authors discuss areas of unmet needs in teaching and learning for capsule endoscopy.

Background Less invasive alternatives to optical colonoscopy (OC) may improve patient compliance with investigation, but study of patient preference is limited. Objectives The aims of this study were to determine patient tolerance and acceptability of OC, computed tomography colonography (CTC) and colon capsule endoscopy (CCE) and also to determine the choice of investigation made by fully informed members of the lay public. Patients and methods Patients assigned a Gloucester Comfort Score (GCS, 1–5; as did endoscopists), an overall test experience score (visual analogue scale, 0–10) and completed a ‘Friends and Family Test’ following OC, CTC or CCE. In the second part of the study, members of the public were given information detailing the nature, tolerance, acceptability, risks and outcomes and invited to choose which test they would prefer in the event that one was needed. Results Assessed by endoscopist and patient, respectively, 24.2 and 49.3% (P<0.005) of symptomatic and 27.3 and 22.1% (P=0.4) of Bowel Cancer Screening Programme patients suffered moderate to severe discomfort (GCS: 4–5) [GCS (mean±SEM): 3.32±0.085, 1.96±0.083 and 1.30±0.088 (P<0.001); overall experience: 5.43, 2.35 and 3.80 (P<0.001)]. In all, 93.6, 96.1 and 85.7% of OC, CTC and CCE patients, respectively, were willing to undergo the same test under the same circumstances. The lay public (n=100) chose a noninvasive test (CTC or CCE) in 55% of the cases to investigate symptoms and chose a Bowel Cancer Screening Programme test in 29% of the cases (P<0.001). Conclusion Patient tolerance and experience favours CTC and CCE over OC and informed about all aspects of each procedure; a noninvasive option is commonly chosen by the lay public.

Small bowel capsule endoscopy is a minimally-invasive endoscopic investigation that is often used in clinical practice to investigate overt or occult gastrointestinal (GI) bleeding among other clinical indications. International guidance recommends small bowel capsule endoscopy as a first-line investigation to detect abnormalities in the small bowel, when gastroscopy and colonoscopy fail to identify a cause of GI bleeding. It can diagnose with accuracy abnormalities in the small bowel. However, there has been increasing evidence indicating that small bowel capsule endoscopy may also detect lesions outside the small intestine that are within the reach of conventional endoscopy and have been probably missed during prior endoscopic investigations. Such lesions vary from vascular deformities to malignancy and their detection often alters patient management, leading to further endoscopic and/or surgical interventions. The current study attempts to review all available studies in the literature and summarise their relevant findings.

Background Gastric electric stimulation (GES) is a treatment approach to refractory gastroparesis, possibly acting centrally via afferent vagus nerve stimulation (VNS). Non-invasive VNS (nVNS) is a potential alternative to GES that could eliminate the safety risks of or identify likely responders to implantable neurostimulators.& para;& para;Objective This open-label proof-of-concept study assessed the effects of nVNS in patients with severe drug-refractory gastroparesis.& para;& para;Methods Patients used the Gastroparesis Cardinal Symptom Index (GCSI) to grade symptoms in diaries daily for 2 weeks before treatment (baseline) and during >= 3 weeks of nVNS therapy. Adverse events (AEs) were also diarised. Treatment was self-administered using an nVNS device (gammaCore, electroCore) and consisted of 120 s stimulations to the vagus nerve in the neck (two stimulations to each side three times daily during weeks 1 and 2; three stimulations to each side three times daily during week 3 and beyond). Response was defined as a >= 1 point decrease from baseline in GCSI score.& para;& para;Results Thirty-five patients enrolled; 23 were compliant with study procedures and were included in the analysis; 7 continued treatment beyond 3 weeks. Response rates were 35% (8/ 23) at 3 weeks and 43% (10/23) for the duration of therapy (3-6 weeks). For the entire cohort and the 10 responders, improvements from baseline were noted for mean total GCSI and GCSI subscale scores (nausea/vomiting, postprandial fullness/early satiety, bloating). No serious AEs were reported.& para;& para;Conclusions These preliminary results provide a signal that nVNS may be useful for treating refractory gastroparesis. Larger controlled studies are warranted.

IntroductionPoor tolerance of laxatives may be associated with inadequate bowel cleansing and reduced pathology detection. [1] Colonoscopy (CS), the gold standard, is uncomfortable, may require sedation and is not without risk. [2] CT colonography (CTC) is less invasive, requires less laxatives, but involves irradiation. Colon capsule endoscopy (CCE) is non-invasive, directly visualises the mucosa, but requires a more vigorous laxative regimen. [3] In this study, patient tolerance of each was compared.MethodSplit dose Kleenprep (4L) was used for CS and gastrografin (3 × 30 ml) and rectal insufflation for CTC. The regimen for CCE was either (STH) split dose Kleenprep (4L) plus two phosphosoda ‘boosters’ or (RFH) split dose Moviprep (2L) with phosphosoda/gastrografin ‘boosters’. A bisacodyl suppository was used to promote capsule excretion if needed. Patients graded severity of laxative-related symptoms and recorded a Gloucester Comfort Score (GCS) for each procedure. They scored their overall experience (of bowel preparation and procedure combined) on a visual analogue scale (VAS 0–10: no-intolerable).ResultsCS was performed in 153 patients (86M, mn age 58.6±1.2). Prior failed CS, or refusal to have CS, occurred in 30.1% and 18.4%, respectively, of CTC patients (n=103; 36M, mn age 69.5±1.1), and 22.6% and 9.7% of CCE patients (n=31; 8M, mn age 42.9±3.6). CTC and CCE patients were predominantly female (p=0.003 cf. CS cohort, Kruskal Wallis). Moderate to severe laxative-related symptoms prior to CS, CTC and CCE (respectively) were nausea (12.4%, 2.9%, 29.1%; p<0.001), vomiting (2.6%, 3.9%, 8.7%; p=0.004), bloating (11.8%, 1.0%, 16.1%; p<0.001), pain (4.6%, 1.0% and 12.9%; p<0.001), headache (4.6%, 3.9% and 19.4%; p=0.019). GCS scores of moderate to severe discomfort occurred in 40.1%, 7.8% and 0% (p<0.001) and mean VAS scores for the overall experience were 4.9, 2.5 and 3.4 (p<0.001) respectively. Overall CS experience was worse than both CTC (p<0.001, Mann Whitney) and CCE (p=0.01) which yielded similar results.ConclusionLaxatives may cause distress and the less used, the better. However, procedural discomfort accounts for the overall poorer experience of CS patients compared to CTC and CCE, even though the latter cohorts contain more patients at risk of poorer tolerance (prior failed colonoscopy, refusal of colonoscopy and female predominance.[4] Investigation should be tailored according to the likely diagnoses and patient preference.References. Holt EW, et al., J Gastrointest Liver Dis 2014;23:135–40. . Standards of practice committee of the ASGE. Gastrointest Endosc 2011;74:745–752. . Spada C, et al., Gut 2015;64:272–281. . Ojidu H, McAlindon ME. Gut2016;65(1):A61.Disclosure of InterestNone Declared

Introduction Informed consent requires information about the nature, the risks, the benefits of the investigation proposed and the alternatives. [Brooks et al., Endoscopy 2005] Optical colonoscopy (OC) is widely accepted as the gold standard colonic investigative modality, but it is uncomfortable, incurs the risks of intubation and sedation and diagnostic yield is only 10% in symptomatic patients. [Gavin et al., Gut 2013] Alternatives include CT colonography (CTC) and colon capsule endoscopy (CCE) which are better tolerated and safer. The aim of this study was to determine the choices made by a cohort randomly selected from the population when provided with information about all three tests. Method Members of the public were invited to take part in the study outside a local shopping centre. They were provided with written literature explaining the nature, and a summary table of the advantages and disadvantages, of each test and were free to ask questions of the research team. Patient tolerance and acceptability data was obtained from earlier studies of our patient population. [Ojidu et al., submitted to BSG 2017] The risk of serious complications (perforation, bleeding and radiation exposure), diagnostic yield and expected incidence of incidental pathology (polyps or extraluminal findings on CTC) were derived from published literature and patients were advised of the possible need for OC (if a non-invasive test identified a polyp or tumour) or further investigation if CTC identified extraluminal pathology, which they were told may or may not be important. They were asked to choose which test they would prefer for the investigation of two clinical scenarios: new symptoms and a positive faecal occult blood test in the bowel cancer screening programme (BCSP). Results 100 subjects (median age (range) 42.5 years (19-92), 38% male) chose OC, CTC and CCE in 45%, 37% and 18% respectively to investigate new symptoms and 71%, 22% and 7% for the BCSP. Thus 55% of patients having symptoms investigated preferred an alternative to OC compared to 29% of those undergoing screening (p Conclusion Over half of a non-select cohort of the lay public prefer non-invasive colonic investigation of symptoms when fully informed about the modalities available, which should therefore be offered in clinical practice. Almost one third would prefer the same approach in the BCSP, which should be considered if compliance is to be optimised. Disclosure of Interest None Declared

BACKGROUND:Abnormal liver enzymes are frequently encountered in inflammatory bowel disease (IBD) patients. Infliximab has been implicated in inducing drug-induced liver injury, autoimmune hepatitis or reactivation of hepatitis B virus. We aimed to clarify the role of infliximab in liver impairment in an IBD cohort.STUDY:A total of 305 patients with IBD, without evidence of chronic liver disease, were included in the study and retrospectively evaluated. Laboratory and clinical data were retrieved from a prospectively acquired database. In all, 176 consecutive patients treated with infliximab during the last 5 years were compared with a matched population of 129 patients who did not receive any antitumour necrosis factor treatment.RESULTS:Elevation of alanine transaminase (ALT) was frequent in the entire population (36.4%) and it was not significantly associated with the use of infliximab (P=0.284). Elevations more than 3 upper limit of normal were observed in 7.9% and these resolved spontaneously in 83%. The use of immunomodulators was the only factor that was significantly associated with liver enzyme abnormalities in multivariate analysis [odds ratio (OR) 2.666, 95% confidence interval (CI) 1.576-4.511, P<0.005]. Overall, 39% of patients on infliximab had elevated liver enzymes and this was associated with increased ALT before starting infliximab (OR 3.854, 95% CI 1.800-8.251, P=0.001) and with longer duration of infliximab treatment (OR 1.030, 95% CI 1.013-1.047, P=0.001).CONCLUSION:Elevated liver enzymes are frequently found in IBD patients and they usually resolve spontaneously. The use of immunomodulators was independently associated with increased ALT. Infliximab is relatively safe in terms of liver impairment and discontinuation of treatment is rarely required in the setting of modest elevations of ALT.

Introduction In most UK hospitals, clinical episodes are recorded with a letter sent to the referring general practitioners (GPs). This requires dictation, typing, proof-reading, correction, printing, sign-off and posting. We have used a mind map template to record the patient journey. We evaluated the GP responses to these Easy View Care Maps (EVCMs) and the cost comparison with the traditional GP letter. Methods An EVCM was prepared by a secretary using information available from the GP referral. The draft EVCM was available for the clinician to complete during the consultation with the patient. Three completed EVCMs were printed: one to be incorporated into the patient's notes; the second to be given to the patient; and a third copy posted to the GP. At follow-up, the EVCM was modified to reflect results. GP responses to EVCMs were sought by a postal questionnaire sent to 266 GPs. A comparative cost analysis was performed. Results Over 10 months, 568 EVCMs were used as the sole source of information recorded for the hospital file, patient and GP. The mean turnaround time for a dictated letter is 5.2 days while EVCM generation is immediate. Ninety per cent of GPs reported that they received the necessary information with 71% indicating acceptance as an alternative to the traditional letter. Net annual departmental saving was £31 344. Conclusions EVCMs offer a new visual representation of the patient's journey. They are easy to follow and expose the clinician's thought processes. They provide an intuitive record at low cost.

Introduction Successful colon capsule endoscopy (CCE) requires high capsule excretion rates and high quality bowel cleansing. Cleansing regimens are based on polyethylene glycol (PEG) supplemented with a booster of NaP to accelerate transit time. Because preparation with NaP is rarely associated with renal toxicity, we have piloted two novel CCE cleansing regimens in patients at low risk of NaP nephrotoxicity. Method Prep 1was designed as a NaP free regimen comprising 2L split dose PEG+Ascorbate (PEG+A) with an additional 1L booster after capsule ingestion. Prep 2comprised identical split dose 2L PEG+A, but the post capsule ingestion booster comprised of low dose NaP (30–45 ml) and gastrografin (50–100 ml).34 CCEs were reviewed, 17 from each group. Oro-caecal, caeco-rectal transit times and capsule excretion rates were measured. Quality of bowel cleansing was assessed by two independent observers, using a modified small bowel cleansing scale grading from the first caecal image and every 15 mins until the end of the study. At each time point the assessors graded each of the two static images recorded by the CCE cameras. The proportion of visualised mucosa was graded as M3 (>75% of mucosal surface visualised), M2 (50–75%), M1 (25–49%) and M0 ( 50%). If capsule remained stationary >15 mins, the time was extended to the frame 15 mins following onward movement of capsule. Results Mean oro-caecal and caeco-rectal transit times and excretion times (h:mm) were 4:06,2:59 and 6:31 for Prep 1 and 3:06, 2:07 and 5:17 for Prep 2. Excretion rates for Prep 1and Prep 2 were 35.3% and 88.2% respectively. Table 1indicates the percentage of the examined frames for each score for mucosal surface visualisation and for obscuration. Conclusion Prep 1 assessed whether a PEG+A booster could produce a “tsunami” prokinetic and cleansing effect and Prep 2 examined boosting with a combination of gastrografin and low dose NaP. Failure of capsule excretion occurred in almost two thirds of Prep 1 patients, whilst with Prep 2the 88.2% completion rate was similar to that expected in standard colonoscopy. In Prep1 group 55% of frames examined scored M2/M3 for mucosal visualisation and 43% O2/O3 for obscuration, in Prep 2group 82% of frames scored M2/M3 and 72% O2/O3. PEG+A is an ineffective booster and fails to achieve adequate cleansing whilst the booster combination of gastrografin and low dose NaP appears to offer excellent excretion rates and enhanced bowel cleansing. Disclosure of interest None Declared.

Recent advancements in virtual reality graphics and models have allowed virtual reality simulators to be incorporated into a variety of endoscopic training programmes. Use of virtual reality simulators in training programmes is thought to improve skill acquisition amongst trainees which is reflected in improved patient comfort and safety. Several studies have already been carried out to ascertain the impact that usage of virtual reality simulators may have upon trainee learning curves and how this may translate to patient comfort. This article reviews the available literature in this area of medical education which is particularly relevant to all parties involved in endoscopy training and curriculum development. Assessment of the available evidence for an optimal exposure time with virtual reality simula-tors and the long-term benefits of their use are also discussed.

The ward round (WR) is a complex task and medical teachers are often faced with the challenge of finding a balance between service provision and clinical development of learners. The educational value of WRs is an under-researched area. This short communication aims to evaluate the educational role of WRs for junior trainees and provides insight into current practices. It also identifies obstacles to effective teaching/training in this setting and provides suggestions for improving the quality of WR teaching.