Keith Siau

Keith Siau
Royal Cornwall Hospitals NHS Trust · Department of Gastroenterology

About

184
Publications
24,381
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1,127
Citations
Introduction
Find me on Twitter for endoscopy related updates @drkeithsiau
Additional affiliations
February 2017 - present
The Dudley Group NHS Foundation Trust
Position
  • Fellow

Publications

Publications (184)
Article
Full-text available
Acute upper gastrointestinal bleed (AUGIB) is one of the most common medical emergencies in the UK, with roughly one presentation every 6 min. Despite advances in therapeutics and endoscopy provision, mortality following AUGIB over the last two decades has remained high, with over 9,000 deaths annually in the UK; consequently, several national bodi...
Article
Full-text available
Purpose of the review: Progress towards the goal of high-quality endoscopy across health economies has been founded on high-quality structured training programmes linked to credentialing practice and ongoing performance monitoring. This review appraises the recent literature on training interventions, which may benefit performance and competency ac...
Article
Full-text available
Background: Robust real-world performance data of newly independent colonoscopists are lacking. In the United Kingdom, provisional colonoscopy certification (PCC) marks the transition from training to newly independent practice. We aimed to assess changes in key performance indicators (KPIs) such as cecal intubation rate (CIR) in the periods pre- a...
Article
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Background Endoscopy within 24 h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24 h of admission). Methods This prospective multicentre audit enrolled patients admitted with AUGIB who underwent in...
Article
Full-text available
The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) was initially established in 1994 to standardise endoscopy training across specialties. Over the last two decades, the position of JAG has evolved to meet its current role of quality assuring all aspects of endoscopy in the UK to provide the highest quality, patient-centred care. Drivers...
Article
Introduction Water immersion (WI) and water exchange (WE) colonoscopy were described in 1984 and 2010, respectively; in 2021 a Delphi review of water-aided colonoscopy (WAC) reported 11 consensus statements on WI and WE. Determinants of WAC use are not well understood. Methods A questionnaire generated by IWATERS (International Water-Aided Techniq...
Article
Background and aims: Assessment of mucosal visualization during esophagogastroduodenoscopy (EGD) can be improved with a standardized scoring system. To address this gap, we created the Toronto Upper Gastrointestinal Cleaning Score (TUGCS). Methods: We developed the TUGCS using Delphi methodology, whereby an international group of endoscopy exper...
Article
Introduction: Endoscopy featured water-aided colonoscopy (WAC) as novel in the Innovation Forum in 2011. Gastrointestinal Endoscopy published a modified Delphi consensus review (MDCR) that supports WAC for clinical practice in 2021. We tested the hypothesis that experience was an important predictor of WAC use, either as water immersion (WI), wate...
Article
Full-text available
Background Advanced endoscopic technologies led to significant progress in the definition of endoscopic remission of ulcerative colitis (UC) and correlate better with histological changes, compared with standard endoscopy. However, while studies have assessed the diagnostic accuracy of endoscope technologies individually, there are currently limite...
Article
In academia, peer-review refers to a fundamental quality control process whereby external experts (reviewers) are invited to provide unbiased critique of a paper (or other submitted material) and advise on suitability for publication. The process must be robust and conducted with honor and integrity and to the highest professional standards. It is...
Article
Background High quality esophagogastroduodenoscopy (EGD) depends on the ability to appropriately visualize upper gastrointestinal (GI) mucosa pathology. Evaluation can be limited by the presence of mucus, foam, bubbles and solid materials. Currently, there is no standardized method to assess mucosal visualization for use in clinical or research set...
Article
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Introduction Training and quality assurance in oesophagogastroduodenoscopy (OGD) is important to ensure competent practice. A national evidence-based review was undertaken to update and develop standards and recommendations for OGD training and certification. Methods Under the oversight of the Joint Advisory Group (JAG), a modified Delphi process...
Article
Background Advanced endoscopic technologies led to significant progress in the definition of endoscopic remission of ulcerative colitis (UC), and correlate better with histological changes, compared to standard endoscopy. However, whilst studies have assessed the diagnostic accuracy of endoscope technologies individually, there is current limited d...
Article
Background Inflammatory bowel disease (IBD) increases colorectal cancer risk. To mitigate this patients undergo endoscopic surveillance to detect dysplasia. However, chronic inflammation alters mucosal and vascular colonic architecture, complicating lesion recognition. Endoscopic advances enhance our ability to accurately characterise these lesions...
Article
Full-text available
Background and study aims Despite the high-risk nature of endoscopic retrograde cholangiopancreatography (ERCP), a robust and standardized credentialing process to ensure competency before independent practice is lacking worldwide. On behalf of the Joint Advisory Group (JAG), we aimed to develop evidence-based recommendations to form the framework...
Article
Climate change is a global emergency. Increasing awareness has led to policy changes regarding global industry emissions. The healthcare industry carbon footprint is large and growing more and more. Gastroenterology, with its heavy reliance on industry, is a major contributor toward this growth. For a significant change toward reducing the field's...
Article
Full-text available
Delayed post-polypectomy bleeding (DPPB) is a potentially severe complication of therapeutic colonoscopy which can result in hospital readmission and re-intervention. Over the last decade, rates of DPPB reported in the literature have fallen from over 2% to 0.3–1.2%, largely due to improvements in resection technique, a shift towards cold snare pol...
Article
The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented disruptions in fellowship training programs worldwide. In gastroenterology, the strain in healthcare service provision and the emphasis on preventing viral transmission has adversely impacted hands-on training opportunities, with trainees facing the constant pressure to meet...
Conference Paper
Full-text available
Introduction Endoscopic retrograde cholagiopancreatography (ERCP) is a well-established technique for removal of common bile duct stones. However, stone(s) might pass out in the time lag between imaging and ERCP procedure, and the patient might become asymptomatic with improved biochemical markers. The primary outcome of this study was to look at e...
Conference Paper
Introduction The recently developed Horibe score was shown to be superior to the Glagow Blatchford Score (GBS) in predicting endoscopic therapy in acute upper gastrointestinal bleeding (AUGIB). However, this has not been validated in the UK. We aimed to compare the Horibe score [1] with other AUGIB risk assessment tools to identify the optimal risk...
Conference Paper
Introduction Despite the high-risk nature of endoscopic retrograde cholangiopancreatography (ERCP), a robust and standardised credentialing process to ensure competency before independent practice is lacking worldwide. On behalf of the Joint Advisory Group (JAG), we aimed to develop evidence-based recommendations to form the framework of ERCP train...
Article
The teaching of endoscopic procedures to trainees has radically changed from the previous "see one, do one, teach one" approach to the method termed "competency-based medical education" (CBME), which has transformed endoscopic training. Successful implementation of a CBME program requires learners to direct their own learning. Learners with a growt...
Article
Full-text available
Background: Although the efficacy of water-assisted colonoscopy is well established, the role of water immersion sigmoidoscopy (WIS) remains unclear. We compared WIS with carbon dioxide insufflation sigmoidoscopy (CO2S) on patient outcomes. Methods: We conducted an analysis of prospectively collected data from a single-center quality improvement...
Article
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Background: The COVID-19 pandemic has created unprecedented challenges in all fields of society with social, economic, and health-related consequences worldwide. In this context, gastroenterology patients and healthcare systems and professionals have seen their routines changed and were forced to adapt, adopting measures to minimize the risk of in...
Article
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Although barium swallow imaging is established in the investigation of Zenker’s diverticulum (ZD), no agreed measurement protocol exists. We developed a protocol for measuring ZD dimensions and aimed to correlate measurements with symptoms and post-operative outcomes. This prospective study included patients with confirmed ZD who underwent flexible...
Article
Each year, over 18 million endoscopy procedures are performed in the United States (US) alone. Endoscopy is the third highest generator of waste in healthcare, a sector with significant contributions to carbon emissions worldwide. Endoscopy carries a substantial carbon footprint owing to its resource-heavy decontamination processes, complex waste s...
Article
Underperformance can be defined as performance which persistently falls below a desired minimum standard considered acceptable for patient care. Within gastrointestinal endoscopy, underperformance may be multifactorial, related to an individual’s knowledge, skills, attitudes, health or external factors. If left unchecked, underperformance has the p...
Article
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Background and study aims Correct optical diagnosis of colorectal polyps is crucial to implement a resect and discard strategy. Training methods have been proposed to reach recommended optical diagnosis thresholds. The aim of our study was to present a systematic review and meta-analysis on optical diagnosis training. Methods PubMed/Medline and Coc...
Article
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Background Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) exposes staff and patients to potentially harmful ionizing radiation. We performed a UK survey to explore trainee and trainer attitudes to radiation protection and cholangiogram interpretation in ERCP. Methods An electronic 10-point survey was prospectively distrib...
Article
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Background The coronavirus disease 2019 (COVID-19) pandemic has impacted endoscopy services and education worldwide. This study aimed to characterize the impact of COVID-19 on gastroenterology trainees in Canada. Methods An analysis of Canadian respondents from the international EndoTrain survey, open from April 11 to May 2 2020 and distributed by...
Article
Background and aims: Since 2008, a plethora of research studies have compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among exper...
Article
Full-text available
Background Bowel preparation for colonoscopy is often poorly tolerated due to poor palatability and adverse effects. This can negatively impact on the patient experience and on the quality of bowel preparation. This systematic review and meta-analysis was carried out to assess whether adjuncts to bowel preparation affected palatability, tolerabilit...
Article
Full-text available
The global pandemic of coronavirus disease‐2019 (COVID‐19) has led to significant disruptions in care delivery. Patients with chronic liver diseases require a high level of care and are therefore particularly vulnerable to disruptions in medical services during COVID‐19. Recent data has also identified chronic liver disease as an independent risk f...
Article
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Background: The Joint Advisory Group on Gastrointestinal Endoscopy basic skills in colonoscopy (BSC) course was introduced in 2009 to improve colonoscopy training within the United Kingdom, but its impact on trainee performance is unknown. Aim: To assess whether attendance of the BSC could improve colonoscopy performance. Methods: Trainees awa...
Article
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Background and aims: Although coronavirus disease 2019 (COVID-19) has affected endoscopy services globally, the impact on trainees has not been evaluated. We aimed to assess the impact of COVID-19 on procedural volumes and on the emotional well-being of endoscopy trainees worldwide. Methods: An international survey was disseminated over a 3-week...
Article
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Background Structural disorders of the hypopharynx can lead to dysphagia‐related morbidity. Endoscopic therapy in this area, for example, myotomy for Zenker's diverticulum (ZD), has traditionally been performed under general anesthesia (GA). We have developed a two‐stage sedation process, which is used along with high‐flow nasal oxygen therapy (HFN...
Article
Objectives Flexible endoscopic septum division is an established treatment for Zenker’s diverticulum (ZD); however, long-term outcome data are lacking. We aimed to evaluate the long-term efficacy of flexible endoscopic septal division (FESD) using the stag beetle knife for ZD and identify predictors of symptom recurrence. Methods Patients undergoi...
Article
Full-text available
Medical care bundles improve standards of care and patient outcomes. Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency which has been consistently associated with suboptimal care. We aimed to develop a multisociety care bundle centred on the early management of AUGIB. Commissioned by the British Society of Gastroenterology...
Article
Full-text available
Background: Pre-clinical simulation-based training (SBT) in endoscopy has been shown to augment trainee performance in the short-term, but longer-term data are lacking. Aim: To assess the impact of a two-day gastroscopy induction course combining theory and SBT (Structured PRogramme of INduction and Training - SPRINT) on trainee outcomes over a...
Article
Full-text available
Introduction Competence in endoscopic haemostasis for acute upper gastrointestinal bleeding (AUGIB) is typically expected upon completion of gastroenterology training. However, training in haemostasis is currently variable without a structured training pathway. We conducted a national gastroenterology trainee survey on haemostasis exposure and on a...
Article
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Background Validated competency assessment tools and the data supporting milestone development during gastroscopy training are lacking. We aimed to assess the validity of the formative direct observation of procedural skills (DOPS) assessment tool in diagnostic gastroscopy and study competency development using DOPS. Methods This was a prospective...
Article
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The citation for Reference 22 should be replaced with: Kumar NL, Kugener G, Perencevich ML, et al (2018) The SAFE-T assessment tool: derivation and validation of a web-based application for point-of-care evaluation of gastroenterology fellow performance in colonoscopy. Gastrointest Endosc 87(1):262–269
Article
Full-text available
Introduction Gastroenterologists are typically expected to be competent in endoscopic haemostasis for acute upper gastrointestinal bleeding (AUGIB), with the Certificate of Completion of Training (CCT) often heralding the onset of participation in on-call AUGIB rotas. We analysed the volume of haemostasis experience recorded by gastroenterology CCT...