Introduction. Upper gastrointestinal (UGI) video capsule endoscopy (VCE) provides a possible alternative to conventional oesophago-gastro-duodenoscopy (OGD). In Ireland, the COVID-19 pandemic led to unprecedented change in endoscopy services, accelerating the need for UGI VCE to help reduce patient exposure but allow the continuation of endoscopy services. We report on using UGI VCE as an alternative to OGD throughout all phases of COVID-related endoscopy adjustments. Aims/Background. Prospective observational study to assess identification of relevant UGI anatomical landmarks on UGI VCE as defined in the British Society of Gastroenterology. Method. Inclusion criteria were: patients with dyspepsia under 40 years of age with no alarm symptoms; known cirrhosis for variceal screening; UGI bleeds with the Blatchford $\text{score}\le 2$ . A protocol for preparation and a series of positional movements were adapted for the procedure. Landmarks and pathology detection were evaluated by two independent endoscopists. Results. 127 UGI VCE was performed from June 2020 to December 2021, of which 22 required further evaluation with OGD. The most common indications were dyspepsia and abdominal pain, 71% and 19%, respectively. With the use of the dual-facing camera, clear views of the OGJ in 100% of cases, cardia 100%, fundus 97%, greater curve 99%, lesser curve 98%, incisura angularis 95%, antrum 95%, pylorus 94%, D1/bulb 83%, and D2 82% were obtained. The main findings at UGI VCE were reflux oesophagitis and gastritis, with normal mucosa observed in 48% of cases. Findings suggesting a neoplastic lesion at the OG junction were detected in 1 case. Conclusion. Since June 2020, 81% ( $N=103$ ) of a selected cohort of patients referred for UGI endoscopy avoided invasive traditional endoscopy and were successfully managed by VCE, thus reducing endoscopy waiting lists. UGI VCE may serve as a clinical diagnostic tool, used alongside OGD in appropriate cases, to help improve patient services and care delivery.

Introduction: High-resolution ano-rectal manometry (HRAM), part of the investigative process to diagnose disorders of recto-anal co-ordination, is currently performed in the left-lateral position (LLP). This may seem unnatural for patients and recent data suggest that the seated, squatted position (SP) may improve rectal drive and recto-anal pressure gradients, raising the question as to whether defaecatory dyssenergia (DD) is over-diagnosed when the test is carried out in the LLP. Aim/method: A single centre study was carried out in patients with faecal incontinence and/or constipation to evaluate the effect of SP versus LLP on HRAM analysis and resultant manometric diagnosis of DD. Positioning was consecutive and the order was randomised for each patient. The HRAM protocol was carried out in accordance with the manufacturer’s guidelines (Manoscan). Data analysis and interpretation were blinded with a consensus reached for each test position. Data (mean ± SEM) were analysed using an unpaired t-test and Chi-square test. Results: In total, 40 patients completed the study, including 33 females with a median age of 56 (IQR 48–63). The mean rectal drive was significantly higher in the SP vs. LLP (82.6 ± 5.3 mmHg vs. 44.1 ± 3.9 mmHg, respectively, p < 0.0001). No difference in the anal sphincter relaxation pressure (66.7 ± 5.7 mmHg vs. 70.9 ± 5.5 mmHg, p = 0.9535) was detected. The manometric diagnoses of abnormal ano-rectal co-ordination were significantly higher in the LLP, when p = 0.013. Patients reported a significant preference for the seated position, when p = 0.0001. Conclusion: These data show that HRAM in the seated position improves rectal drive, which reduces manometric diagnoses of abnormal ano-rectal coordination. These findings may have important implications for practice and may inform future guidelines.