Clinical Service Line 02 - UGI & Bariatric, Colorectal, Gastro & Endo, Surgery wards

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    Efficacy and safety of bariatric surgery during the Covid-19 pandemic –a retrospective cohort study from a UK unit
    (2022) Ebrahim, S; Arahi, C; AlHabsa, O; Zalin, A; Rashid, F; Jain, V; Jambulingham, P; Munasinghe, A; Mamidanna, R; Whitelaw, D; Al Taan, O; Adil, Md T
    N/A
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    Resolution of comorbidities and outcomes after revision of sleeve gastrectomy to duodenal switch for patients with body mass index more than 60 kg/m2
    (2022) Ghosh, A.; Hussein, A.; Askari, A.; Jain, V.; Adil, M.T.
    Abstract Aim Patients with body mass index (BMI) more than 60 kg/m2 pose unique challenges in management and their ability to lose significant weight after a single-stage bariatric procedure is debatable. The aim of this study is to explore resolution of comorbidities and report quality of life (QoL) in patients who have a laparoscopic sleeve gastrectomy (LSG) revised to duodenal switch (DS). Methods Patients who completed two-stage DS from 1 January 2011 to 31 December 2017 were analysed for excess weight loss (EWL), total weight loss (TWL), resolution of comorbidities and QoL. Validated questionnaires were used to assess QoL. Results A total of 9/1975 bariatric patients underwent two-stage DS during the study period, all of whom had had a previous LSG. The median preoperative weight before the first stage was 207.0 kg [interquartile range (IQR) 175.3-278.9 kg] and the median BMI was 75.0 kg/m2 (IQR 65.1-92.0 kg/m2). Length of hospital stay following the first stage (ie, LSG) was a median of 1 day (IQR 1-2 days) and 2 days (IQR 1-3 days) after revision to DS. The median EWL following LSG was 58.0% (IQR 33.3%-100.8%) and the median TWL was 16.1% (IQR 13.7%-25.2%). Following DS, the median EWL was 57.1% (IQR 47.1%-60.8%) and the median TWL was 21.2% (IQR 19.5%-26.7%). Significant improvement in obesity-related comorbidities were observed. QoL improved in overall feeling, physical activity, social life, work and approach to food. No immediate postoperative complications were observed. Long-term outcome of all patients was rated to be ‘very good’, ‘good’ or ‘fair’. Conclusions Two-stage DS leads to sustained weight loss, resolution of comorbidities and improvement in QoL in carefully selected patients with BMI more than 60 kg/m2.
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    P278 Pan-enteric capsule to assess treatment effects of vedolizumab in IBD patients: A 1 year proof of concept study
    (2022) Thakor, A; Johnson, M; Wye, j
    Abstract Background Pan-enteric capsule (PEC) endoscopy may be an acceptable alternative to more invasive endoscopy in the assessment of patients with IBD. These patients require endoscopic assessment of disease extent and severity to guide both initiation and continuation of biological therapy. There are many potential benefits including: increased patient comfort, lower complication risk, no sedation related risks and greater convenience for the patient. Vedolizumab is an effective biological agent for both UC and Crohn’s disease. Previous studies largely concentrated their endoscopic analysis on improvements seen within the colonic mucosa. However, less is known about the effects of Vedolizumab on the small bowel Crohn’s disease. Using a pan-enteric capsule (PillCam Crohn’s Capsule, Medtronic, USA), we evaluated the symptomatic, clinical and endoscopic improvements seen in a group of IBD patients over a 1 year treatment course of Vedolizumab. We also assessed any patient preference for PEC as opposed to colonoscopy. Methods A group of 10 patients starting Vedolizumab were evaluated at 0, 6 and 12 months via PEC, rather than colonoscopy +/- small bowel capsule/MRI. Biochemical and clinical evaluation used ESR, Calprotectin and symptomatic scores (HBI or mUCDAI). The extent and severity of the underlying Crohn’s disease was assessed using the Eliakim score, which has shown strong inter-reader reliability and moderate-to-strong correlation with the Lewis score. Questionnaires were completed post procedure to determine patient acceptability. Results We found the average ESR reduced from 30 (range 7–81) to 12.1 (2–31) after 1 year of Vedolizumab. Likewise, the average faecal calprotectin dropped from 1263.6 (189->1800) to 440.1 (30–1460). The modified UCDI score and modified HBI reduced from 5 to 0, and 7.5 to 3.5, respectively. The average small bowel PillCam Crohn’s Capsule Score reduced from 5 to 2.8, whilst the Eliakim Score dropped from 13.6 (6–30) to 5.2 (0–22). The comfort score for PEC was on average 9.5/10, with all 10 patients reporting a preference to continue with PEC evaluation in the future. Conclusion PEC provides an excellent evaluation of the pan-intestinal extent and severity of IBD, and the effects of a treatment regime. We feel PEC should be considered as a 1st line assessment tool when evaluating the effectiveness of biological therapy in IBD patients, especially those with small bowel Crohn’s disease. Whilst Vedolizumab has already been shown to be beneficial in the treatment of colonic inflammation, this proof of concept study also demonstrated its beneficial effect in reducing inflammation across all 3 segments of the small bowel in those with Crohn’s disease. Topic: magnetic resonance imaginginflammationpatient evaluationcolonoscopycrohn's diseaseinflammatory bowel diseaseendoscopybiological productsbiological therapyfecesintestine, smallintestinescolonirritable bowel syndromesedation procedurepatient preferencesleukocyte l1 antigen complexcolonic mucous membranevedolizumabassessment scalespatient comfortproof of concept studies Issue Section: POSTER PRESENTATIONS > Clinical: Diagnosis and outcome
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    Current guidelines in the surgical management of hereditary colorectal cancers
    (2022) Kudchadkar, S.; Ahmed, S.; Mukherjee, T.; Sagar, J.
    Abstract Incidence of colorectal cancer (CRC) is on rise. While approximately 70% of all CRC cases are sporadic in nature, 20%-25% have familial aggregation and only < 5% is hereditary in origin. Identification of individuals with hereditary predilection for CRC is critical, as it has an impact on their overall surgical management including surgical timing, approach & technique and determines the role of prophylactic surgery and outcome. This review highlights the concept of hereditary CRC, provides insight into its molecular basis, possibility of its application into clinical practice and emphasizes the current treatment strategies with surgical management, based on the available international guidelines. Keywords: Colorectal cancer; Familial adenomatosis polyposis; Immunohistochemistry; Lynch syndrome; Metachronous colon cancer. ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. PubMed Disclaimer Conflict of interest statement Conflict-of-interest statement: The authors declare that they have no conflict of interest. Similar articles Hereditary colorectal cancer syndromes: familial adenomatous polyposis and lynch syndrome. Al-Sukhni W, Aronson M, Gallinger S. Surg Clin North Am. 2008 Aug;88(4):819-44, vii. doi: 10.1016/j.suc.2008.04.012. PMID: 18672142 Review. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2016 for the Clinical Practice of Hereditary Colorectal Cancer (Translated Version). Ishida H, Yamaguchi T, Tanakaya K, Akagi K, Inoue Y, Kumamoto K, Shimodaira H, Sekine S, Tanaka T, Chino A, Tomita N, Nakajima T, Hasegawa H, Hinoi T, Hirasawa A, Miyakura Y, Murakami Y, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, Hamaguchi T, Ishiguro M, Ishihara S, Kanemitsu Y, Kawano H, Kinugasa Y, Kokudo N, Murofushi K, Nakajima T, Oka S, Sakai Y, Tsuji A, Uehara K, Ueno H, Yamazaki K, Yoshida M, Yoshino T, Boku N, Fujimori T, Itabashi M, Koinuma N, Morita T, Nishimura G, Sakata Y, Shimada Y, Takahashi K, Tanaka S, Tsuruta O, Yamaguchi T, Sugihara K, Watanabe T; Japanese Society for Cancer of the Colon and Rectum. J Anus Rectum Colon. 2018 May 25;2(Suppl I):S1-S51. doi: 10.23922/jarc.2017-028. eCollection 2018. PMID: 31773066 Free PMC article. Review. Surgical management of hereditary colorectal cancer: surgery based on molecular analysis and family history. Perea J, Justo I, Alvaro E, Lomas M, Tasende JD, Marín JC, Franco A, Colina F, Rodríguez Y, Martínez J, Robles L, Urioste M, Hidalgo M. Rev Esp Enferm Dig. 2009 Aug;101(8):536-40. doi: 10.4321/s1130-01082009000800003. PMID: 19785492 Role of surgery in familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer (Lynch syndrome). Smith KD, Rodriguez-Bigas MA. Surg Oncol Clin N Am. 2009 Oct;18(4):705-15. doi: 10.1016/j.soc.2009.07.006. PMID: 19793576 Review. Practical genetics of colorectal cancer. Lynch HT, Shaw TG. Chin Clin Oncol. 2013 Jun;2(2):12. doi: 10.3978/j.issn.2304-3865.2013.03.04. PMID: 25841492 See all similar articles Cited by Recent Advancements, Limitations, and Future Perspectives of the use of Personalized Medicine in Treatment of Colon Cancer. Dey A, Mitra A, Pathak S, Prasad S, Zhang AS, Zhang H, Sun XF, Banerjee A. Technol Cancer Res Treat. 2023 Jan-Dec;22:15330338231178403. doi: 10.1177/15330338231178403. PMID: 37248615 Free PMC article. Review. Proteomic analysis of the chemosensitizing effect of curcumin on CRC cells treated with 5-FU. Yang J, He C, Liu N. Front Med (Lausanne). 2022 Nov 24;9:1032256. doi: 10.3389/fmed.2022.1032256. eCollection 2022. PMID: 36507511 Free PMC article. c-MYC Protein Stability Is Sustained by MAPKs in Colorectal Cancer. Lepore Signorile M, Grossi V, Fasano C, Forte G, Disciglio V, Sanese P, De Marco K, La Rocca F, Armentano R, Valentini AM, Giannelli G, Simone C. Cancers (Basel). 2022 Oct 4;14(19):4840. doi: 10.3390/cancers14194840. PMID: 36230763 Free PMC article. References Perea J, Justo I, Alvaro E, Lomas M, Tasende JD, Marín JC, Franco A, Colina F, Rodríguez Y, Martínez J, Robles L, Urioste M, Hidalgo M. Surgical management of hereditary colorectal cancer: surgery based on molecular analysis and family history. Rev Esp Enferm Dig. 2009;101:536–540. - PubMed Kennelly RP, Gryfe R, Winter DC. Familial colorectal cancer: Patient assessment, surveillance and surgical management. Eur J Surg Oncol. 2017;43:294–302. - PubMed Ambe PC, Möslein G. Surgical management of hereditary colorectal cancer. Mini-invasive Surg. 2018;2:37. Monahan KJ, Bradshaw N, Dolwani S, Desouza B, Dunlop MG, East JE, Ilyas M, Kaur A, Lalloo F, Latchford A, Rutter MD, Tomlinson I, Thomas HJW, Hill J Hereditary CRC guidelines eDelphi consensus group. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG) Gut. 2020;69:411–444. - PMC - PubMed Stoffel EM, Mangu PB, Gruber SB, Hamilton SR, Kalady MF, Lau MW, Lu KH, Roach N, Limburg PJ American Society of Clinical Oncology; European Society of Clinical Oncology. Hereditary colorectal cancer syndromes: American Society of Clinical Oncology Clinical Practice Guideline endorsement of the familial risk-colorectal cancer: European Society for Medical Oncology Clinical Practice Guidelines. J Clin Oncol. 2015;33:209–217. - PMC - PubMed
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    BS O06 The burden of bariatric-related emergency interventions at a tertiary bariatric centre: The Luton and Anglian Experience
    (2022) Aly, M; Ahmed , S; Perera , H.M; Arhi , C; Jain , V; Adil , T; Whitelaw , D; Al Taan, O; Jambulingam, P; Munasinghe, A
    Abstract Background Bariatric surgery is becoming more prevalent worldwide due to increasing rates of obesity. British patients can access bariatric surgical services through established NHS services, or privately via British hospitals or abroad. Post-operatively, patients might require urgent surgical admission for analgesia, nutritional evaluation and even emergency surgery. Few publications have addressed the rates of late endoscopic or surgical re-intervention in British bariatric patients. This study investigated the burden of emergency bariatric-related surgery at an established high volume bariatric centre. Methods All bariatric-related procedures were selected from a prospectively maintained emergency surgery database. Patients who underwent unplanned, endoscopic or surgical procedures between September 2018 and September 2021 were included. Patients who had bariatric surgery at our institution and returned to theatre within their inpatient stay were excluded. Primary outcomes were the location of the index procedure (local, other institutions within the UK, or abroad), type of the index bariatric procedure, length of stay (LOS), admission to intensive care, and mortality. Results During the study period, 87 patients underwent 102procedures. Index procedures were roux-en-Y gastric bypass 32 (37%), gastric banding 28 (32%), balloon insertion 12 (14%), sleeve gastrectomy 7 (8%), one-anastomosis gastric bypass 4 (5%) and band-to-sleeve gastrectomy revision 3 (3%). 34 (39%) patients had their initial procedure at our unit, 36 (41%) at another British centre and 17 (20%) abroad. The commonest index procedure to require emergency reintervention of those who had surgery at our hospital was the roux-en-Ygastric bypass (26%). Amongst those who had surgery at another UK hospital, it was the gastric band (28%), and intragastric balloons (6%) in the abroad group. The most common emergency procedures performed for patients from our centre were OGD 11 (11%) and redo jejuno-jejunostomy 7 (7%). Patients from other UK centres required removal of gastric bands 25 (25%) and removal of intragastric balloons 4 (4%). Patients who underwent surgery abroad required OGD 5 (5%), removal of gastric balloons 5 (5%) or gastric bandremoval 4 (4%). Median length of stay was 4 days (IQR 3.9–12.7). There were 9 (9%) admissions to ITU. There were two mortalities (2%), one patient from our hospital and onepatient from another British centre. Conclusions Our centre experiences a high volume of bariatric surgical emergencies that are promptly managed surgically and endoscopically with increased demand from patients who underwent bariatric surgery abroad. More than a third of patients are from other British centres reflecting the importance of established regional networks for the specialised care of these patients, while a fifth underwent surgery abroad. Further work should involve exploring factors affecting patients decision to seek private bariatric surgery, within the UK or abroad, and a consideration of the cost-burden to the NHS. Topic: obesityballoon dilatationendoscopygastrectomyanastomosis, surgicalgastric balloonsgastric bypassinpatientsintensive careintensive care unitcreation of jejunostomylength of staysurgical procedures, operativepain managementanalgesia (pain absence)mortalitybypassgastric band placementbariatric surgerygastric bypass, roux-en-ysleeve gastrectomy, laparoscopic emergency surgical procedurenational health service (uk)primary outcome measure Issue Section: Abstracts