bluuebunny/crossref_metadata_2025 huggingface dataset:
EGS SO26 - Back Under the Knife: Unveiling the Fate of non-trauma Patients Returning to the Emergency Theatre
Authors: Isswiasi Sanad , Hammad Mustafa , Anwaar Muhammadhasan , Vysotskyi Artur , Abbas Minaam , Kanya Miriam , Hirosue Shoko , Sunny Sanisha , Afzal Barza , Esawi Ahmed
Published: November 2024

Background

Offering a planned or unplanned second operation in emergency general surgery is not uncommon. However, there is a scarcity of data in this context. This study aims to evaluate the outcomes of patients who were offered two emergency operations to those who required one operation, focusing on complications, increased level of care at discharge and mortality rates.

Method

We identified those patients who underwent planned and unplanned revisits to the emergency theatre between July 2020 and July 2023. Inclusion criteria were consistent with the established UK National Emergency Laparotomy Audit (NELA at our centre over three years.. We examined demographics, ASA (American Society of Anesthesiologists) classification, indications and outcomes in terms of complications, increased post-operative care levels and mortality rates.

Results

390 patients (89.3%) required one operation (1OP) and 47 (10.7%)patients underwent two operations (2OP) . The median age was 70 years for 1OP and 71 years for 2OP, with a male-to-female ratio of 192:198 in 1OPG and 22:25 in 2OP. The median ASA score (2 vs. 3), median frailty score (3 vs. 4) and the median Clavien-Dindo classification (2 vs. 4), and length of stay in days (12 vs. 21) were significantly higher for the 2OP. The increase in the level of care at discharge (30.6% vs. 59%) and the mortality (7.4% vs. 32%) were higher in the 2OP.

Conclusion

Our study shows that non-trauma patients requiring a second emergency operation face significantly worse outcomes compared to those undergoing only one surgery. Specifically, the group needing two operations experienced higher rates of complications, increased levels of post-operative care, and significantly higher mortality rates. These findings underscore the critical need for close monitoring and a multidisciplinary approach perioperatively. Moreover, these insights can help provide patients and their families with informed decision-making regarding the potential risks and benefits of additional surgical interventions. A prospective multicentre study would be valuable in providing further insights into this subgroup of patients.
EGS SO27 - Removable covered stent as an alternative to traditional methods in management of Oesophageal Perforation in unfit surgical patients: A Tertiary Care Hospital Experience
Authors: Bhatti Khalid , Laulloo Sufia , Lilley Jaiesh , Subramaniam Sheena , Ward Jeremy , Pursnani Kish , Turner Paul , Sarantitis Ioannis , Nandi Sumit , Ball Christopher , Shetty Vinutha Daya
Published: November 2024

Background

Oesophageal perforation in elderly and frail patients carries a significantly higher mortality rate. Traditionally, management involves surgery for patients who are fit for surgery, or a conservative approach for those with minimal contamination. Endoscopy, with procedures such as endoscopic washout of mediastinal collections and placement of covered removable stents, sometimes in conjunction with chest drain insertion, is emerging as a minimally invasive option for a selected group of patients who are not suitable for traditional methods. This technique aims to seal perforations, promote healing, and facilitate early restoration of oral intake.

Method

This retrospective study was conducted at a tertiary care hospital. Data were collected over a 10-year period starting from 2012. The study enrolled all patients aged 18 and older, admitted with oesophageal perforation and underwent oesophageal stent insertion. SX-ELLA Danis-seal stents (30-25-30 × 135mm) were used for benign perforations, while permanent covered metal stents were used for patients with underlying malignancy. Variables analyzed included age, gender, Charlson Comorbidity Index (CCI), WHO performance status, location and size of esophageal perforation, type and dimensions of stent used, length of hospital stay, and mortality rates. Data analysis was conducted using SPSS version 25.

Results

During study period, 11 out of 78 patients with esophageal perforation underwent stent insertion (M:F=7:4, median age-71 (range 48-85) years, median CCI -5). Causes included spontaneous perforation (n=3,27.3%), iatrogenic (n=4,36.4%), and malignancy (n=4,36.4%). Distal esophageal perforation was observed in 7 patients (63.6%). Oral intake was commenced within 72 hours post-insertion. A single procedure sufficed for 10(90%) patients. Stents used for non-malignant perforations were removed endoscopically after an average of 12 weeks. No major complications; minor complications included stent migration (n=1, 9.1%), failed placement (n=1, 9.1%), and loss to follow-up (n=1, 9.1%). The 90-day mortality rate was 45.5% (n=5/11).

Conclusion

Endoscopy with mediastinal cavity washout and insertion of a covered metal stent in unfit surgical patients provides an alternative and improves outcomes. It could also be considered in patients with non-healing perforations to facilitate early resumption of oral intake.
EGS SO28 - Management of oesophageal diverticulitis in a 71-year-old female: Case report and review of management approaches
Authors: Down Billy , Marlow Neale , Toor Kavanbir , Ierodiakonou Vrettos , Owen Richard , Magro Tania , Loyala Jerocin
Published: November 2024

Background

Oesophageal diverticulitis is a rare condition with fewer than ten reports in the literature. We present a case of oesophageal diverticulitis in a 71-year-old female with a history of COPD, TIA, and known oesophageal diverticulum. She was managed conservatively with NBM, total parenteral nutrition and intravenous antibiotics requiring a 16-day inpatient stay. The rarity of this condition poses challenges in its diagnosis and management, necessitating a thorough understanding of both conservative and surgical interventions. This case highlights the complexity involved in treating oesophageal diverticulitis, especially in patients with significant comorbidities.

Method

Patient presented with a 6-day history of upper abdominal pain and sepsis (elevated inflammatory markers; CRP 320, WCC 11.1, temperature 38.0, pulse 104). Abdomen was soft with upper abdominal tenderness. Imaging was consistent with diverticulitis of a 5.9cm lower oesophageal diverticulum without perforation. Initial management included making the patient nil by mouth, total parenteral nutrition, and intravenous antibiotics (vancomycin and metronidazole). The patient’s condition was closely monitored with serial blood tests and clinical assessments. Opinion was sought from a tertiary upper GI centre. Discharge was planned once the patient safely transitioned to oral diet and was apyrexial for 48 hours.

Results

Inflammatory markers improved over five days (CRP from 320 to 51, WCC from 11.1 to 9). She remained intermittently pyrexial until day 8 of admission. Clinical improvement allowed transition from intravenous to oral therapy, and she was discharged on day 16 with double dose oral PPI therapy. Patient has been followed up by tertiary upper GI services with plans for consideration of surgical resection of the oesophageal diverticulum. The patient’s successful discharge without surgical intervention during the acute phase underscores the effectiveness of a conservative management approach initially, with a plan for definitive surgical treatment in a stable outpatient setting.

Conclusion

Oesophageal diverticulitis, though rare, requires a nuanced approach to management, especially in patients with significant comorbidities. This case demonstrates the importance of an awareness of thorough history taking and review of previous examinations to prevent delayed diagnosis of a rare pathology not demonstrated on a CT abdomen and pelvis. This approach highlights the importance of individualised treatment plans and the potential for conservative management to provide stabilisation, followed by elective surgical management. The paucity of cases of oesophageal diverticulitis has prevented development of evidence based guidelines, underscoring the importance of seeking advice from tertiary centers when managing rare presentations.
EGS SO34 - Idiopathic pancreatitis - a myth or a reality?
Authors: Karagiannidis Georgios , Abdallah Mohamed , Atwal Amit , Babunashvili Tamara , Sinclair Martin
Published: November 2024

Background

Acute pancreatitis is characterized by frequent episodes of inflammation in the pancreas.The most common causes are alcohol abuse and gallstones but approximately 30% of cases are defined as idiopathic because initial evaluation fails to detect the aetiology.This study aims to investigate the aetiology and the reasons for the incorrect labelling of patients with pancreatitis as idiopathic.

Method

This is a retrospective study and included patients with a diagnosis of idiopathic pancreatitis (IP) between 1 May 2019 and 31 April 2023.Cases were eligible for inclusion if they had been discharged as IP. Data were collected following review of patient notes into Microsoft Excel.

Results

A total of 129 patients were identified of whom the majority of patients did not find to have gallstones (88%), did not report alcohol use (91%), and did not experience trauma (87%). However, MRCP and EUS were not performed in all patients before they are labelled as idiopathic. Ultrasound was the most commonly performed diagnostic procedure (98%), while MRCP (40%) and EUS (8%) were less frequently utilized. Surprisingly, a quarter of patients underwent a laparoscopic cholecystectomy. Nutritional referrals were lacking in a significant portion of cases and the readmission rates were high (65%).

Conclusion

The most surprising elements in the data include the high incidence of unperformed diagnostic procedures to exclude the common causes of pancreatitis.Also,the underutilization of nutritional referrals and the high readmission rates suggest potential areas for improvement in the diagnostic workup and management of IP, as well as raising questions about the current clinical practices and their efficacy in this cohort.
OGC SO07 - A retrospective service evaluation of the impact of a dedicated oesophago-gastric cancer (OGC) dietitian in the OG surgical oncology team
Authors: Smith Louise , Tucker Olga , Nijjar Rajwinder , Hossain Tanvir
Published: November 2024

Background

Patients with OGC frequently present with malnutrition. Oncological care pathways advocate for dietitian’s to be essential member’s of the multi-disciplinary team (MDT), as it is well-established that malnutrition significantly increases rates of post-operative complications, length-of-stay (LoS) and mortality. However, due to financial constraints, specialist OGC dietetic support is not always resourced. To reduce the potential for nutrition related incidents, a dedicated OGC dietitian’s post was funded to support the pre-operative nutritional optimisation of OGC patients. The aim of this service evaluation was to evaluate the OGC dietitian’s impact on dietetic and surgical outcomes in a tertiary referral centre.

Method

The OGC dietitian reviewed all potentially curative patients at or within 48 hours of their first OGC surgical clinic; compared to >8 weeks pre-dietitian, with some patients not even reviewed before surgery. Weekly telephone or face-to-face dietetic-led clinics enabled more functional assessments (hand-grip strength (HGS)). Attendance to MDT was mandatory. Dietetic and surgical outcome data was collected for curative patients between July 2022 and April 2023 (pre-dietitian) (n=25) and July 2023 and April 2024 (OGC dietitian in-post) (n=19). Patient reported experience measures (PREMs) were collected. Data was analysed on excel. Ethical approval was not needed for this retrospective service evaluation.

Results

Pre-dietitian, 28% (n=7) experienced >5% (clinically significant) pre-operative weight loss compared to 11% (n=2) post-dietitian. 58% (n=12) patient’s post-dietitian gained weight from first dietetic contact up until date of surgery, compared to 44% (n=11) pre-dietitian. Mean HGS increased by 1.3kg (SD 2.77) from pre-operative to post-operative dietetic assessments in patients with OGC dietitian. More patient’s pre-dietitian experienced post-operative complications (42%) compared to post-dietitian at 31%. Average post-operative LoS was 19 days pre-dietitian versus 15 days post. 100% positive feedback was received from completed PREMs regarding OGC dietitian, with themes including consistent and timely communication, in-depth knowledge and empathy and compassion.

Conclusion

Mandatory inclusion of dietitians within the OGC pathway can support the pre-operative optimisation of patients, and impact positively on patient surgical outcomes. This service evaluation demonstrates that with increased dietetic contact, patients experience less clinically important weight loss, whilst feeling empowered and confident in their nutritional care. More research in a larger cohort of patients is required to provide an adequately powered study.
OGC SO08 - Optimising Analgesia in Sub-total Oesophagectomy: A Dose of Success
Authors: Moudhgalya Shyam , Browell Christopher , de Pennington Jane , Bailey Jake Charles
Published: November 2024

Background

Sub-total oesophagectomy (STO) is a complex and major surgery with significant associated burdens for our patients. Our centre in North-East England completes 70-80 STOs annually. In the peri-operative period, good analgesia management and delivery is key. Analgesia strategy has evolved across the UK over the past decade, influenced by multi-modal analgesia, progressing surgical approaches towards minimally invasive operations alongside the ongoing drive for enhanced recovery programmes endorsing early mobilisation. Surgical approach in our patient cohort now comprises a combination of Open-Open, combined Open-Minimally invasive and entirely minimally invasive techniques. Our analgesia strategy combines single shot intrathecal diamorphine and regional anaesthesia.

Method

We engaged our multi-professional (Acute Pain Specialist Nurses, Anaesthesia Consultants and Surgical Consultants) team in a PDSA cycle. A guidance analgesia package was agreed after review of retrospective cases.

This package was delivered to our baseline group of 10 patients. We used subjective patient reported abdominal and thorax pain scores on a 0-10 scale, recorded by our pain team each day for post-operative days 1-5.

Following analysis, we implemented a single change to Intrathecal diamorphine dosing - changing from uniform delivery of 1000micrograms intrathecal diamorphine to a dose calculated on Ideal Body Weight of 15-20micrograms/kg up to 1500micrograms maximum dose

Results

Our baseline group of 10 patients all received 1000micrograms of intrathecal diamorphine - mean dose 15.9mcg/kg. Our intervention group of 12 patients received doses based upon their ideal body weight - mean dose 18.9mcg/kg.

Overall, there was a trend of reduced pain scores following our intervention. Thoracic reported overall pain scores were significantly lower (p=0.04) following the intervention. No significant difference was demonstrated specifically in the first 24 or 48hours in overall, abdominal or thoracic pain scores.

Importantly, there were no reported adverse events related to our higher dosing regime and no recorded side effects such as pruritis or nausea.

Conclusion

There is little evidence with regards the use of higher dose intrathecal diamorphine in the literature. The sample sizes in our groups are small but overall reduction in patient reported pain scores appear to be associated with use of the higher dose of intrathecal diamorphine, based upon ideal body weight and importantly without any adverse effect. Continued evolution of our analgesia strategies is essential alongside that of surgical techniques. The next iterations of our guidance and PDSA cycle will consider our regional techniques to identify if further advances can be made.
OGC SO27 - Management of oesophageal defects with Microtech VAC stents (MVS): A single centre case series
Authors: White Michael , Fernandes Shriya , Snook Rhea , McDonnell Declan , Kynes Larissa , Underwood Tim , Byrne James , Noble Fergus , Kelly Jamie
Published: November 2024

Background

Oesophageal defects following cancer resection, dilatation or Boerhaave’s syndrome are increasingly managed with endoscopic approaches. Surgical management is associated with high morbidity and mortality. Pigtails stents (PS), oesophageal stents and negative pressure therapy (eso-sponge) have all been described with variation in efficacy. Microtech VAC stents (MVS) have emerged as a means of providing an oesophageal luminal stent and negative pressure to the mediastinum.

Method

Between June 2023 to June 2024, 19 MVS have been used in four patients with transmural oesophageal defects. Two patients had anastomotic leak (one was a quaternary referral) following Ivor Lewis Oesophagectomy. One patient had a perforation from a dilatation of a gastro-jejunostomy anastomotic stricture post-gastric bypass at another centre, then admitted as an emergency. One patient had Boerhaave’s syndrome.

Results

Four patients were treated with MVS. In two patients, one post dilatation perforation and one with Boerhaave’s, one MVS was sufficient to resolve the mucosal defect after seven and 11 days respectively. The other two patients with anastomotic leak required seven and 10 MVS respectively. In these patients MVS and antibiotics controlled mediastinitis, but did not completely resolve the mucosal defect. For chronic leak management MVS were exchanged for PS to enable ambulatory care. No complications with MVS changes within seven days. One patient had ingrowth of mucosa into the MVS after 11 days, but was successfully removed.

Conclusion

MVS therapy has been demonstrated to be safe and feasible in the management of oesophago-gastric perforations in a UK centre. Exchange of VS every 5-7 days does have additional burden to a busy endoscopy unit. No adverse events were observed.
OGC SO29 - Patient perceptions survey on the best timed oesophago-gastric dietetic pathway
Authors: Osborne Laura , Ford Kate , Owen Kellie
Published: November 2024

Background

It is well established that patients with oesophago-gastric (OG) cancer often present with malnutrition and impact symptoms such as anorexia, dysphagia and abdominal symptoms. Dietetic input is imperative in assessing and managing these symptoms early to improve outcome measures such as nutritional status, clinical outcomes and quality of life. A service evaluation was conducted to explore patient perceptions of early dietetic intervention in the Greater Manchester OG two week wait (TWW) pathway. There is no known prior research exploring the aims of this project. The results provide a novel insight into patient perceptions.

Method

A mixed methods survey using Microsoft Forms including open and close-ended questions was completed using transcription of responses via telephone consultation for 8 participants. For multiple choice responses, quantitative analysis was undertaken utilising Microsoft Forms analytics. Thematic analysis was completed with the use of computer assisted qualitative data analysis software (CAQDAS).

Results

100% of respondents strongly agreed that receiving information about eating and drinking during investigations was important to them. 100% of respondents disagreed that dietetic advice was difficult to understand and follow. 75% of respondents felt dietetic input to be helpful in managing nutritional impact symptoms. 25% of participants responded neutrally. 100% of respondents felt their individual needs and concerns were addressed and would recommend the service to friends/family (88% strongly agreed; 12% agreed respectively).

Conclusion

Dietetic input was viewed positively by service users undergoing the OG TWW pathway. Patients reported feeling reassured, and valued communication, accessibility, and a personal approach. Some patients experienced delays in receiving prescribed nutritional supplements. Consistency of nutritional information requires improvement across the multidisciplinary team. Unfamiliarity with dietetic input limits the ability of participants to provide perspectives on service improvement. These findings suggest that specialist nutritional assessment and advice is beneficial to patients. Future research should be conducted to explore the long-term impact of early dietetic interventions on health outcomes in OG cancer patients.
OGC SO33 - Resection Margins in Gastrectomy Patients – Are Current Guidelines Fit for Purpose? An Observational Study from a Tertiary Centre
Authors: Ashan Dassanayake D M , Choh Clarisa T P , Gillies Richard S
Published: November 2024

Background

Positive resection margins in cancer surgery are associated with higher likelihood of locoregional recurrence and poor outcomes. The Association of Upper GI Surgeons (AUGIS) outlined a target of less than 5% margin positivity for gastric resections, a goal not met in repeated national audits (NOGCA). Our study aimed to evaluate the positive resection margin rate after a gastrectomy in a tertiary centre and identify associated factors to assess the current guideline's suitability. Our hypothesis is that positive longitudinal margins are more related to tumour factors, such as proximity to the intended margin, rather than poor surgical technique.

Method

All records of patients who underwent gastrectomy from June 2015 to September 2021 were retrospectively reviewed. Data collection included demographic details, type of gastrectomy, exposure to neoadjuvant chemotherapy, and post operative histopathological information such as tumour differentiation, presence of signet ring (SR) morphology and linitis-plastica (LP), and resection margin(RM) status. Chi square tests of association were utilised to determine associations between the resection margin status and the potential determinant factors.

Results

Our study included 144 subjects (100 males, mean age 66, range 27-87). Types of gastrectomy were subtotal (38.9%), proximal (4.2%), total (29.2%), extended total (ETG) (27.8%). Positive RMs were found in 13.2%, with 8.3% having positive longitudinal margins and 6.3% positive circumferential margins. Neoadjuvant-chemotherapy was completed by 73% of subjects. Poor tumour differentiation was seen in 59.7%, SR presence in 12.5%, and LP in 3.5%. Significant associations were noted between positive margins and LP (80%, p<0.001) and age (<65: 15%, >=65: 4%, p=0.028). ETGs had double the rate of positive margins (12.5%) than that of other gastrectomies (6.7%,p=0.314).

Conclusion

The overall positive longitudinal margin rate was higher than the national guideline, replicating NOGCA audits. Our hypothesis was not proved: although the longitudinal positive margin rate in ETGs was almost double that of other gastrectomies, this did not reach statistical significance. Positive margin rates were higher in younger patients, and those with LP. Further large-scale audit is urgently required to determine if the recommended margin rate is appropriate or whether it should be adjusted for factors such as tumour location, presence of LP and age when the risk of a positive margin is higher.
OGC SO35 - Capsule-sponge assessment of long segment Barrett's Oesophagus
Authors: Hasan Mahmudul , Razzak Saad , Ghorpade Ashwini , McDonald Claire , Megson Tyler , Olejnik Hannah , Saha Arin
Published: November 2024

Background

Capsule-sponge technology is increasingly utilised in assessment of reflux, though NICE still recommends its usage for surveillance of Barrett's Oesophagus to be conducted carefully. Our hospital has utilised capsule-sponge technology for two years in the surveillance of Barrett's Oesophagus, whilst adhering to strict guidance and recommendations from national bodies. This study aimed to assess the performance and effectiveness of capsule-sponge assessment of long segment Barrett's Oesophagus.

Method

From September 2022 to June 2024, 379 patients received capsule-sponge assessment of their Barrett's Oesophagus using the CytospongeTM device. All patients were entered onto a prospectively maintained database and those with a previously identified long segment with no p53 positivity or atypia on initial sponge analysis were brought forward for endoscopic assessment at 12 months, rather than the current standard of 18 to 24 months. Endoscopy results were recorded and patients assessed for development of inter-test malignancy.

Results

14 patients who had a Cytosponge (4%) were identified with a previously measured long-segment of Barrett's Oesophagus. The range of Prague Classification was C (6-12cm) M (6-13cm) and none of the patients had previously had dysplasia. All patients were offered surveillance endoscopy at 12 months. One patient refused endoscopy due to discomfort, though she did agree to continued capsule-sponge testing.

Of the remaining 12 patients, all had successful endoscopy and Barrett's mapping. None had developed inter-test malignancy and all had persisting long segment Barrett's oesophagus. There were no other concerning findings at endoscopy.

Conclusion

Capsule sponge assessment of long segment Barrett's Oesophagus is safe and well tolerated. Patient feedback universally favoured capsule sponge over endoscopic assessment, particularly because of the increased length of time required for mapping of long segment disease. Poor tolerance of endoscopy led to refusal to have endoscopic surveillance in at least one patient in this series. By increasing frequency of capsule sponge assessment, even patients with long segment Barrett's Oesophagus may be suitable for regular surveillance without endoscopy.
OGC SO36 - Complications of palliative oesophageal cancer stent insertion: Audit for a five year period
Authors: Xiang Jinpo , Irons Wendy , Rehman Jameel , Smajer Bohdan
Published: November 2024

Background

Oesophageal stents are commonly used for the palliative treatment of inoperable oesophageal malignancy[1]. Stenting of the oesophagus may provide safe and quickly effective management for late-stage disease symptoms. However, there are common complications associated with the oesophageal stents. This audit looks at the types of early and delayed complications from oesophageal stenting, specifically for malignancy. We aim to stratify the types of complication, association between complications and the type of stent used, and the frequency of repeat stenting or repositioning. This will provide patients with better expectations of the complications and compare our practice against published international standards

Method

All fluoroscopy guided stent insertions between 1/1/2019 and 31/12/2023 for oesophageal malignancy were requested from the hospital radiology department. 101 patients were included for analysis. Their basic demographics were obtained, as well as a disease profile including tumour histology, staging and whether they underwent radiotherapy or chemotherapy. Complications of the stent insertion were then logged. The number of times stents were replaced or repositioned were noted. The type of stent, size parameters, features such as covering, antimigration device and anti-reflux valve were also assessed. In addition, any hospital admissions related to stent complications were also recorded.

Results

Of 101 patients, the median age was 75, with a higher proportion of male patients ( 71%). After stent fitting there was a median survival length of 94 days. 45% of patients had complications related to the stent. Stent migration was the most frequent complication, 14% of patients experienced stent migration into the stomach, which required repositioning or restenting. Both middle and lower oesophagus stents had equal complication rate. 25% of patients were reported to have overgrowth of tumour affecting the stent, and there was no significant difference in those fitted with a covered stent, meant to reduce overgrowth complications.

Conclusion

The complications directly resulting from oesophageal stents may adversely affect the palliation of oesophageal cancer patients. In this cohort, the most commonly occurring complications were migration of the stent, immediate symptoms after insertion, and overgrowth of the tumour. Although overgrowth of tumour is part of the disease progression, in many cases it made retrieval of the existing stent or reinsertion more difficult. Our results found no significant difference for complication rates between the different stents, nor the inclusion of antimigration devices. There were no deaths directly due to the stent and no oesophageal perforations reported.
OGC SO39 - The OUTLIVE Study - Oesophageal and JUncTional Cancer ELectIVE Surgery Morbidity and Mortality at 90-Day: A TUGS Multinational Audit
Authors: Scarano Pereira Juan Pablo , Boddy Alex , Donohoe Claire , Marques Cláudia , Martinino Alessandro , Mahawar Kamal , Viswanath Y K S , Gada Parth
Published: November 2024

Background

Oesophageal cancers are among the most common types of cancer and have a high mortality rate. Todate, oesophagectomy remains the gold standard treatment. However, considerable heterogeneity in the literature fails to generate a truly representative picture of short-term outcomes associated with these procedures.

Method

This multinational global audit includes all consecutive adults with clinically documented primary oesophageal malignancy undergoing elective surgery with curative intent. The study'sstudy's primary objective was to assess the 90-day mortality and morbidity rates in this population. Data was collected through a standardised dataset, and a descriptive analysis was employed. For analysis purposes, the patients were classified depending on the surgical procedure they underwent (laparoscopic, open, hybrid, converted and robotic surgery).

Results

A total of 622 individuals were analysed, most male [462 (74%)], with a mean Charlson Comorbidity Index of 4.30. The most common procedure was laparoscopic surgery [222 (35.7%)], followed by open surgery [198 (31.83%)]. 31 (5%) of the procedures reported an intraoperative complication, but more common in open procedures [11 (5.6%)].

318 (51%) patients suffered postoperative complications within 90 days of surgery. The reoperation rate was 9.3%. McKeown staged procedure, compared to Ivor Lewis, had more infective complications [19% vs 11%, p=0.007] and a higher conversion to open procedures [69 (11.1%)]. 34 (11%) patients died because of a surgical complication.

Conclusion

No significant differences were found between the number of patients with at least one complication and the surgical approach. Nevertheless, robotic-assisted minimally invasive oesophagectomy (RAMIE) presented with the lowest complication, reoperation, and mortality rates. McKeown three-stage surgery also presented with worse clinical outcomes compared to Ivor Lewis procedures. Further studies and randomised control trials comparing different procedures in the field of elective oesophagectomy are needed to expand our knowledge in this field and guarantee the best outcomes for our patients.
OGC SO40 - Oesophageal Stents with fixation device for anastomotic leaks after oesophagectomy: Our initial experience
Authors: Sira Sukhbir , Osilli Dixon , Gupta Abhinav , Mukherjee Dipankar , Mukherjee Samrat
Published: November 2024

Background

Anastomotic leaks following oesophagectomy are associated with significant morbidity and mortality. The management of these leaks also presents significant clinical and nutritional challenges. The role of endoscopic interventions such as endoluminal vacuum therapy and endoscopic stents in management of these leaks has increased over the past decade. We present our experience in the use of endoscopic stents with a stent fixation device over the last 4 years.

Method

Detailed patient records were retrospectively reviewed to assess the indications, procedural success, complications and overall clinical outcomes for patients with anastomotic leaks following Ivor-Lewis oesophago-gastrectomy (ILO) at our institution from January 2021 to June 2024 treated endoscopically with fully-covered self-expanding metal stents using stent fixation devices.

Results

5 patients had post-ILO anastomotic leaks treated with endoscopic stents. The stents were fixed to the proximal oesophagus using a stent fixation device (Stentfix clip). 1of the 5 patients continued to leak despite the stent, leading to prolonged recovery. The remaining 4 achieved leak resolution after stent insertion without needing further intervention. No stent-related procedural complications were noted. The patients progressed on to oral diet/nasogastric feeding within a median of 8 days (Range: 1-18). The median hospital stay following stenting was 29 days (range 7-39). The stents remained in situ for 3 months and were succcesfully removed endoscopically thereafter.

Conclusion

Endoscopic stenting with a fully covered stent and a stent fixation device (alongside pleural drainage) is a highly effective and safe intervention for managing anastomotic leaks after ILO. It does not entail multiple procedure and oral feeding can be commenced relative quickly. It potentially minimizing the need for more complex procedures and reduces overall hospital stay and costs in the management of anaestomotic leaks.
OGC SO42 - A comparison of body composition changes between neoadjuvant FLOT and MAGIC regimes in patients with locally advanced oesophageal cancer
Authors: Daley Andrew , Wong Enoch , Tan Benjamin
Published: November 2024

Background

Several studies have documented the changes in body composition that can occur between pre and post neoadjuvant chemotherapy for locally advanced OGA. However, none have compared the changes between different neoadjuvant regimes following the shift in practice from MAGIC to FLOT neoadjuvant chemotherapy. Specifically, given that the FLOT regimen has been thought to be more toxic than MAGIC regimen, it is unclear whether this toxicity is measurable and clinically significant with regards to body composition. This study aims to compare the changes in body composition between these two regimens in patients with locally advanced oesophageal cancer.

Method

We conducted a retrospective cohort study comparing changes in body composition between patients receiving either MAGIC or FLOT neoadjuvant chemotherapy. 115 patients treated with FLOT (n = 61) or MAGIC (n = 54) who underwent an oesophagectomy for OGA between 2008 and 2020 at Queen Elizabeth Hospital, Birmingham, UK were ultimately enrolled in the study. Changes in body composition between pre- and post-neo-adjuvant chemotherapy were determined by analysis of computed tomography (CT) imaging. Slice-O-Matic is a software tool allowing segmentation of body tissues into different classes Including skeletal muscle and fat based on the Hounsfield units.

Results

Our findings showed a statistically significant difference in the weight loss of participants enrolled the MAGIC group compared to FLOT (FLOT -0.6 ±6.9 vs MAGIC -3.4 ±1.2, p=0.034) which was therefore also reflected in BMI differential before and after neoadjuvant chemotherapy (FLOT -0.2 ± 2.2 vs MAGIC -1.2 ± 2.7, p=0.024). However, there was no statistically significant difference in the L3 skeletal muscle index in both regimes (FLOT -2.8 ± 4.1 vs MAGIC -2.9 ± 4.1; p=0.93). Finally, changes in L3 fat index between the two cohorts did not demonstrate statistically significant difference in our study (FLOT -0.9 ± 22.6 vs MAGIC -5.6 ± 24.8; p=0.29).

Conclusion

Our study suggests that a large proportion of patients with locally-advanced OGA were sarcopenic prior to starting chemotherapy and this proportion increased post treatment. There was no statistically significant loss of muscle mass or fat during treatment with either MAGIC or FLOT. Despite this, weight loss and decreases in BMI were greater in the MAGIC group compared to FLOT, suggesting FLOT may have a more favourable toxicity profile with regard to body composition. Overall, our findings support the safety profile of FLOT chemotherapy with regard to body composition changes and illustrates a superior pathological response to FLOT therapy for OGA.
BN SO01 - Fluorescent Precision: Advancing Laparoscopic Cholecystectomy with Indocyanine Green ( ICG )
Authors: Manasseh Mina , Bowling Kirk
Published: November 2024

Background

Laparoscopic cholecystectomy represents a significant advancement in surgical techniques for gallbladder disease. However, challenges persist in accurately identifying critical structures such as the bile ducts, leading to complications. Indocyanine Green (ICG), a fluorescent dye with unique properties, has emerged as a promising tool to enhance precision and safety in laparoscopic cholecystectomy. Originally developed for infrared photography, ICG's fluorescence capabilities have been harnessed in various medical applications, including ophthalmology and surgical procedures. Its ability to provide real-time visualization of the biliary anatomy facilitates better surgical navigation, reducing the risk of inadvertent injury and improving overall outcomes.

Method

Comprehensive review of existing literature and research on laparoscopic cholecystectomy, with a focus on the role of Indocyanine Green (ICG) in enhancing surgical precision and safety. Relevant articles, clinical trials, and meta-analyses were identified through databases such as PubMed, Google Scholar, and Scopus. Search terms included "laparoscopic cholecystectomy," "Indocyanine Green," "fluorescence imaging," and related terms.

Results

The results of this study highlight the significant role of Indocyanine Green (ICG) in laparoscopic cholecystectomy. Through a comprehensive review of existing literature and research, it was found that ICG integration enhances surgical precision and safety by providing real-time visualization of the biliary anatomy. The use of ICG reduces the risk of inadvertent injury and improves overall surgical outcomes. Despite challenges such as technical complexities and safety considerations, the evidence strongly supports the transformative potential of ICG in modern surgery.

Conclusion

In conclusion, the integration of Indocyanine Green (ICG) into laparoscopic cholecystectomy represents a pivotal advancement in surgical practice. The findings of this study underscore the importance of cautious navigation and collaboration in maximizing the benefits of ICG. By addressing challenges through innovation and evidence-based guidelines, ICG has the potential to revolutionize the landscape of minimally invasive surgery, offering patients safer procedures and better outcomes. As research continues to evolve, the journey of ICG in laparoscopic cholecystectomy holds promise for a future where precision and safety converge, ultimately shaping the standard of surgical excellence.
BN SO02 - Cholecystectomy HRG Coding Audit
Authors: Muscat Neil , Soxibova Firuza , Alam Imran , Kandil Ahmed , Rehman Urwah
Published: November 2024

Background

Incorrect coding practices for elective surgical procedures carry significant financial implications at Trust level. In this project, we aimed to audit the current coding practices pertaining to laparoscopic cholecystectomies performed within the NHS WWL Foundation Trust during November 2021-October 2022 and calculate the financial burden resulting from this.

Method

A list of 194 patients undergoing a cholecystectomy and their allocated HRG coding at time of discharge was compiled by the coding department. A comorbidity and complication index (CCI) for each of these patients was calculated using the operation note together with hospital and GP records. With this information, the correct HRG coding for each patient was calculated and compared to their allocated coding at discharge to calculate the difference in tariffs generated.

Results

69.23% of 194 procedures carried out during the reported time period were coded incorrectly.

This amounted to a financial burden of £72,232 lost in potential tariffs, equating to £372.33 per cholecystectomy performed.

Commonest CCI of 3 in 29% of patients with corresponding HRG code GA10J

Commonest incorrectly allocated coding GA10K denotes a presumed CCI of 0

Conclusion

High percentage of incorrectly coded procedures with significant financial implications at Trust level

Currenty coding practice often incorrectly presumes a CCI index of 0 with subsequent incorrect GA10K coding.

However, the appropriate coding for the vast majority of patients undergoing a laparoscopic cholecystectomy was GA10J.

Education and awareness is underway to make improvements at a Trust level before re-auditing of data can commence.
BN SO05 - Risk Factors associated with Complications Post-Laparoscopic Common Bile Duct Exploration: A Comprehensive Literature Review
Authors: Manasseh Mina , Elsmalouty Islam , San ChoNu , Kostalas Marcos
Published: November 2024

Background

Gallstone-related diseases, particularly common bile duct (CBD) stones, present a significant global health issue. The adoption of laparoscopic common bile duct exploration (LCBDE) has revolutionized the management of these conditions by providing a minimally invasive alternative to open surgery. This literature review aims to identify and analyze the risk factors associated with complications in LCBDE, thereby offering insights to improve patient care and outcomes.

Method

comprehensive search for primary research studies, systematic reviews, and meta-analyses pertaining to risk factors for complications following LCBDE. The search was conducted on PubMed, focusing on English-language articles published within the last 20 years and encompassing all age groups. Peer-reviewed journal articles were prioritized. All relevant studies reporting complications after LCBDE were eligible for inclusion if available as full texts, structured abstracts, or conference reports. The initial search yielded 826 articles. Exclusion criteria : open surgery, non-English articles, lacking full-text. A total of 29 records were identified by the literature search.

Results

Laparoscopic common bile duct exploration (LCBDE) is generally safe and effective, with complication rates influenced by patient and procedural factors. Older age, comorbidities, previous abdominal surgeries, high BMI, narrow common bile ducts, and difficult stones increase risks. Experienced surgeons and shorter operative times reduce complications. The transcystic approach and primary suture closure have fewer complications compared to the transductal route and T-tube drainage, respectively. Intraoperative imaging significantly reduces risks by ensuring complete stone clearance and identifying anatomical variations. Tailoring surgical approaches to patient-specific factors and leveraging surgical expertise are crucial for minimizing complications in LCBDE.

Conclusion

LCBDE emerges as a safe and effective therapeutic modality for addressing conditions impacting the bile ducts (31). The success and utility of LCBDE can be significantly enhanced through the meticulous optimization of patient-related, surgeon-related, and procedure-related factors. By addressing and fine-tuning these key elements, the occurrence of complications associated with LCBDE can be mitigated, thereby reinforcing its potential as a primary choice for managing various bile duct conditions. This strategic approach not only underscores the clinical efficacy of LCBDE but also advocates for its expanded utilization as a frontline intervention in the comprehensive management of bile duct disorders.
BN SO15 - Post Cholecystectomy Syndrome: Definition, Aetiology, Investigation & Management – A Systematic Review
Authors: Kobetic Matthew , Britton Emily , Rees Jonathan , Potter Shelley , Hinchliffe Robert
Published: November 2024

Background

Post-cholecystectomy syndrome (PCS) is a term commonly used to refer to the persistence of abdominal symptoms following cholecystectomy, or de-novo symptoms that develop post operatively. Despite the common use of the term, there is no widely agreed upon consensus definition. PCS is reported to affect between 5-40% of patients that undergo cholecystectomy representing a large populational burden. Despite this, there are no guidelines or protocols in place for the routine investigation and management of this large heterogenous patient group. In this study we systematically review the literature describing definition, aetiology, investigation and up-to-date management of PCS.

Method

An updated systematic search of the Medline, EMBASE and Cochrane databases was undertaken to identify studies where patients underwent cholecystectomy and subsequently were diagnosed with PCS. Included papers were published between 2016-2024, had a minimum of 10 cases of PCS following laparoscopic or open cholecystectomy. Excluded studies were case reports, narrative and systematic reviews, paediatric patient population or papers unavailable in the English language. Paper characteristics were extracted and where present, the definition of PCS, aetiology, investigations and management of these patients was both extracted and analysed.

Results

145 papers were identified of which 13 were included after title, abstract and full text screening. Definition of PCS, where present, was highly heterogenous between papers. Aetiology was often divided into biliary and non-biliary causes, with some papers claiming early-PCS and late-PCS as distinct clinical phenomena. In such papers, early-PCS was most commonly attributed to gastro-oesophageal pathologies and late-PCS to biliary pathologies. Investigation strategy is sparingly reported and without guideline or protocol. Most frequently used tests include LFTs, USS, MRCP, CT, ERCP and OGD. Some studies also used 99m Tc-Mebrofenin Hepatobiliary Scintigraphy, sphincter manometry and colonoscopy.

Conclusion

PCS has a widely reported prevalence in the published literature. This is potentially due to the heterogeneity of definitions used to cover the syndrome. The effective management of such patients depends on both the accurate diagnosis of the underlying cause, as well as exclusion of procedure related complications. There are currently no guidelines or protocols available for the investigation and management of patients presenting with symptoms post cholecystectomy despite the large populational burden. Further studies should aim to provide a consensus definition of PCS, and work towards guidelines for the investigation and management of this patient group.