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Background There is a small but measurable increased risk of lymphoma in inflammatory bowel disease (IBD), with a suggestion that primary intestinal lymphoma in IBD is associated with inflamed tissue and immunosuppressant use, mainly thiopurines. Methods This multicentre case series was supported by the European Crohn’s and Colitis Organisation (ECCO) and performed as part of the Collaborative Network of Exceptionally Rare case reports (CONFER) project. Clinical data were recorded in a standardized case report form. Results Fifteen patients with intestinal lymphoma from 8 centres were included [12 males, 11 patients with Crohn’s disease, mean age 47.8 (±16.4 SD, range 26-76) years at lymphoma diagnosis]. Lymphoma type was diffuse large B-cell lymphoma (DLBCL) in 8, Hodgkin’s disease in 2, MALT lymphoma in 3, and single cases of immunoblastic lymphoma and indolent T cell lymphoma. Lymphoma was located within the IBD affected area in 10 patients. At lymphoma diagnosis, 9 patients had a history of azathioprine or anti-TNF use. Lymphoma was diagnosed at a mean time of 10.4 (±7.07, 1-24) years after IBD diagnosis in 11 patients, prior to IBD in 2 and concurrently in 2. Sustained remission over a median follow-up time of 6.5 (1.5-20) years was achieved in 10 patients after treatment; 5 of them had started biologic therapy (including anti-TNFs, vedolizumab and ustekinumab) for active CD subsequent to their PIL treatment. Conclusion In this small case series, two thirds of patients developed lymphoma in the IBD-affected area, and almost two thirds had a history of thiopurine or anti-TNF use. Biologics were restarted without recurrence of lymphoma in half of the remitters.

Objective Aerosol generating procedures have become an important healthcare issue due to the COVID-19 pandemic, as the SARS-CoV-2 virus can be transmitted via aerosols. We aimed to characterise aerosol and droplet generation in gastrointestinal endoscopy, where there is little evidence. Design This prospective observational study included patients undergoing routine per-oral gastroscopy (POG, n=36), trans-nasal endoscopy (TNE, n=11) and lower gastrointestinal (LGI) endoscopy (n=48). Particle counters took measurements near the appropriate orifice (two models used, diameter ranges 0.3um-25um and 20um-3000um). Quantitative analysis was performed by recording specific events and subtracting the background particles. Results POG produced 2.06x the level of background particles (p<0.001), and 2.13x the number of particles compared to TNE. LGI procedures produce significant particle counts (p<0.001), with a rate of 8.8x106/min/m3 compared to 13.0x106/min/m3 for POG. Events significant relative to the noise floor of background particles were: POG- throat spray (112.3x, p<0.01), oesophageal extubation (36.7x, p<0.001), coughing/gagging (30.7x, p<0.01); TNE- nasal spray (32.8x, p<0.01), nasal extubation (25.6x, p<0.01), coughing/gagging (23.3x, p<0.01); LGI- rectal intubation (3.5x, p<0.05), rectal extubation (11.8x, p<0.01), application of abdominal pressure (4.9x, p<0.05). These all produced particle counts larger than or comparable to volitional cough. Conclusions Gastrointestinal endoscopy performed via the mouth, nose or rectum all generates significant quantities of aerosols and droplets. As the infectivity of procedures is not established, we therefore suggest adequate PPE is used for all GI endoscopy where there is a high population prevalence of COVID-19. Avoiding throat and nasal spray would significantly reduce particles generated from UGI procedures.