Background Emerging evidence suggests ethnic minorities are disproportionately affected by COVID-19. Detailed clinical analyses of multi-cultural hospitalized patient cohorts remain largely undescribed. Methods We performed regression, survival and cumulative competing risk analyses to evaluate factors associated with mortality in patients admitted for COVID-19 in three large London hospitals between February 25 and April 5, censored as of May 1, 2020. Results Of 614 patients (median age 69 years, (IQR 25) and 62% male), 381 (62%) had been discharged alive, 178 (29%) died and 55 (9%) remained hospitalized at censoring. Severe hypoxemia (aOR 4.25, 95%CI 2.36-7.64), leukocytosis (aOR 2.35, 95%CI 1.35-4.11), thrombocytopenia (aOR 1.01, 95%CI 1.00-1.01, increase per 10x9 decrease), severe renal impairment (aOR 5.14, 95%CI 2.65-9.97), and low albumin (aOR 1.06, 95%CI 1.02-1.09, increase per g decrease) were associated with death. Forty percent (244) were from black, Asian and other minority ethnic (BAME) groups, 38% (235) white and for 22% (135) ethnicity was unknown. BAME patients were younger and had fewer comorbidities. Whilst the unadjusted odds of death did not differ by ethnicity, when adjusting for age, sex and comorbidities, black patients were at higher odds of death compared to whites (aOR 1.69, 95%CI 1.00-2.86). This association was stronger when further adjusting for admission severity (aOR 1.85 95% CI 1.06-3.24). Conclusions BAME patients were over-represented in our cohort and, when accounting for demographic and clinical profile of admission, black patients were at increased odds of death. Further research is needed into biologic drivers of differences in COVID-19 outcomes by ethnicity.

Endoscopic submucosal dissection (ESD) is a minimally invasive therapeutic procedure to remove larger polyps or early non-metastatic lesions. It has long been used in Asia, but is now fast growing in popularity in the West. There are multiple challenges faced by ESD practitioners. While the practice of ESD in gastric lesions is relatively well established, the oesophagus with its narrow lumen and challenging workspace, and the colon with its tortuous course and folds are more challenging frontiers. The nature of performing a procedure endoscopically means that conventional methods offer no mechanism for providing counter-traction while performing dissection, impeding visibility and increasing the rate of complications. There are a multitude of tools available to those performing ESD for the different stages of the procedure. This article reviews the accessories currently used in regular ESD practice including the knives used to cut and dissect lesions, the cap and hood devices used to improve visibility and safety, injection fluids to lift the submucosal plane, haemostatic devices, generators, and finally, emerging traction apparatus. There is some evidence behind the use of these tools, however, ESD remains the domain of a small number of practitioners and the practice relies heavily on expert experience. Evolution of the ESD toolbox will make the procedure more accessible to more endoscopists, which in turn will drive the development of a more substantial evidence base to evaluate efficacy and safety of the multitude of tools.

Aim Colorectal cancer (CRC) is diagnosed in approximately 45 000 people annually in the UK, and it is estimated that Lynch syndrome (LS) accounts for 3.1% of these cases. In February 2017, National Institute for Health and Care Excellence (NICE guideline DG27 recommended universal testing of new cases of CRC for mismatch repair (MMR) status. The aim of this study was to implement universal testing for LS in CRC patients in a secondary care setting.Method We prospectively collected data on consecutive newly diagnosed CRC patients at our centre from November 2016 to August 2018, including evidence of MMR status determined by immunohistochemistry. We recorded clinicopathological data including age at diagnosis, stage, tumour site, reported histological findings and MMR tumour status. Statistical analysis was performed using the chi-square test and the twotailed t-test for binary and continuous variables, respectively.Results A cohort of 203 consecutive patients were diagnosed with CRC during this period. Universal MMR testing was performed for the 198 CRC patients in whom a diagnosis of adenocarcinoma was confirmed, with colonoscopic biopsy used as the source material in 68.6% of cases. Twenty-three CRCs (11.6%) were MMR deficient (dMMR). Most dMMR CRCs (21/23) were early stage tumours (Dukes A or B, P = 0.002). In 39 Dukes B CRCs in patients under 70 years of age, the result of MMR testing influenced decision-making about personalized treatment with 5-fluorouracil based chemotherapy.Conclusion Our results demonstrate that universal testing of all new cases of CRC for features suggestive of LS is feasible and effective in the UK. Our data also indicate the importance of genetic testing and personalized oncological care.