Knowledge Hub @ Bedfordshire Hospitals NHS FT
The Knowledge Hub, managed by the Danielle Freedman Library is a digital repository - a central location for Bedfordshire Hospitals NHS Foundation Trust's research, quality improvement, education and academic output - published and unpublished.
The Knowledge Hub replaces the academic report previously published by Research & Development.
Some items are added to the repository automatically by the library team, if you do not find your item or you would like more information about submitting your work to the Knowledge Hub please contact library@besdft.nhs.uk
Recent Submissions
Item Laparoscopic Retrieval of a Retained Video Endoscopy Capsule: Case Report and Review of Literature.(2023)Video-Capsule-Endoscopy (VCE) is a non-invasive method and a useful tool in determining the aetiology of obscure gastrointestinal bleeding and in the diagnosis of Crohn’s disease. Despite its proven utility, VCE carries risks, primarily capsule retention (CR). This refers to the failure of the capsule passing by day 14. CR may suggest underlying pathology, but in the process can lead to several sequelae including obstruction. We report the case of a 28-year-old patient with suspected Crohn’s disease requiring laparoscopic bowel-resection and retrieval of the capsule. The patient presented in 2019 with bloating, crampy abdominal pain and altered bowel habits. Initial endoscopic and blood investigations were unremarkable, however subsequent tests revealed raised calprotectin and anaemia. OGD and colonoscopy remained negative. In April 2021, he underwent VCE, demonstrating an inflamed distal ileum with structuring. However, the capsule failed to pass. After a period of watchful waiting and multidisciplinary discussion resulting in a trial of infliximab and steroid therapy, the capsule remained in-situ as confirmed by sequential X-rays and CTs. In March 2022, he underwent uncomplicated 3-port laparoscopic small bowel resection and retrieval of the retained capsule and was discharged 2 days later. Our case demonstrates an optimal approach in the management of CR. An initial conservative trial with medical therapy was attempted. MDT discussion ensured both gastroenterologists and surgeons were involved in the decision-making. Finally, our literature review demonstrated a lack of concise guidelines. Thus, based on the latest evidence we developed an algorithmic flow chart for the management of retained VCE.Item Beware of superficial thrombophlebitis mimicking a foreign body.(2023)A 37 year old woman was admitted with diabetic ketoacidosis. She later complained of pain, swelling, and a rash at a previous venous catheter site. The patient was afebrile, with an erythematous, oedematous, tender right forearm without any fluctuant areas. Ultrasound identified an irregular 4 cm echogenic material (A) within the right cephalic vein, occupying part of the lumen that was partially compressible (B). This was reported as an intravenous foreign body and may have represented a retained cannula catheter. The vascular multidisciplinary team disagreed and concluded this was superficial thrombophlebitis. The patient was treated with non-steroidal anti-inflammatory drugs and recovered well.Item Role of fit and CT abdomen-pelvis prioritising diagnostic colonoscopy for colorectal cancer.(2022)Introduction: COVID-19 has resulted in many new challenges for healthcare services. Colonoscopy, which is the gold standard investigation for diagnosis of colorectal cancer (CRC), has been significantly impacted with cessation of services during peak corona virus outbreaks with significant backlog. Several strategies have been proposed to address this. One of the main approaches is to risk stratify patients using a quantitative faecal immunochemical test (qFIT) alone or in combination with CT scan. Our study assessed the adherence of Bedford Hospital NHS Foundation Trust in performing both qFIT and CTAP with Iv contrast prior to colonoscopy referral. This study also evaluated the sensitivity of qFIT and CTAP both individually and in combination of missing a cancer when used as a triage service for prioritisation of colonoscopy. Methodology: Data was collected retrospectively from all colonoscopies performed in Bedford hospital, from June to August 2020, totalling 470 patients. Results: Average patient age was 59.9 years, with an age range of 19 to 90 years old. 55% were males and 45% were females. 45% (210) patients had a FIT performed pre colonoscopy. 129 patients had positive FIT. Overall, 35% (164) of patients underwent CTAP prior to colonoscopy. 125 patients underwent both FIT and CTAP prior to colonoscopy. Individually, FIT had a positive predictive value (PPV) and negative predictive value (NPV) of 6.2% and 98.7% with respect to diagnosing CRC. CTAP had a PPV and NPV of 42.9% and 100%. Performing FIT and CTAP in combination had a PPV and NPV of 28.6% and 100% respectively. Conclusion: Sensitivity of single qFIT is low and can miss cancers if used alone. Therefore, it should not be utilised as a single test for triage in community for prioritising colonoscopy in symptomatic patients. The risk of missing a cancer can be reduced by CTAP with Iv contrast as an add on test with negative predictive value of 100%.
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