bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP1.2.2CT Colonography (CTC) Should be the ‘Gold Standard’ in Suspected Colonic Malignancy: Results of a Retrospective Cohort Study
Authors: Bailey Kimberley , Aldoori Joanna , Avery Ged , Hunter Iain Andrew 
Published: October 2021

Abstract

Aim
Colonoscopy is the ‘gold’ standard with CT Colonography (CTC) being an alternative to investigate symptoms of colorectal cancer (CRC). Colonoscopy is invasive and can be embarrassing and distressing for patients. This retrospective cohort study aimed to investigate the validity of CTC in patients with suspected CRC.

Methods
We retrospectively reviewed 815 electronic patient records for those undergoing CTC in a large teaching hospital, between 2013 and 2015. Demographic data in addition to specific data on indication for CTC, endoscopic evaluation and further radiological imaging was collected until 2018.

Results
Mean age of the cohort was 67 (21 - 93 years). 326 (40%) patients underwent lower GI endoscopy in the three months preceding CTC, whilst 90 (11%) patients underwent endoscopy in the year following CTC. 37 patients had a CT Colonography Reporting Data System score (C-RADS) of C4 suggesting a colonic malignancy. Of these 21 (57%) were confirmed CRC, others demonstrated benign pathology (32%) or were unit or lost to follow up (11%). 56 (7%) had C-RADS of E4 suggesting significant extracolonic findings, 6 (11%) of which were renal cell carcinomas. Only 2 patients went on to develop a colorectal malignancy within our follow up period.

Conclusions
This large retrospective cohort study demonstrates that CTC is a reliable and valid tool. The authors propose that CTC should be the first line investigation with endoscopy reserved for use as an adjunct for diagnosis.Despite the limitations of a retrospective review, we were able to generate large patient numbers in order to establish our outcomes.
TP1.2.4The incidence, implications and risk factors for extracolonic findings at CT colonography in a bowel screening population
Authors: Di Rollo Domenic , McMillan Donald , Horgan Paul , Mansouri David 
Published: October 2021

Abstract

Aim
CT virtual colonoscopy (CTC) is increasingly relied upon in bowel screening programmes. Concern remains regarding the prevalence of incidental extra-colonic findings (ECF). The present study reports on the prevalence and implications of ECF as part of a UK bowel screening programme.

Methods
Reports for 400 consecutive CTCs carried out as part of the Scottish Bowel Screening Programme were examined. Intra and extracolonic findings were recorded using the CT Colonography Reporting and Data System (C-RADS). Medical records pertaining to ECF follow-up were examined. Cost analysis was performed.

Results
394 patients were included. 146 (37%) were males. Median age was 65 years, median follow-up was 72 months (Range 32-110). 92 (23%) patients had CTC as their primary investigation, 302 (77%) patients underwent CTC due to failed colonoscopy. Overall, 244/394 (62%) patients had ECF with only 45/394 (11%) found to have colonic pathology. 65/394 (16%) had moderately or highly significant ECF, (C-RADS E3-4). Of the 244 patients with ECF, 59 (24%) underwent further investigation, estimated cost £17,589. The majority, 37/59 (63%) were found to have benign disease after follow-up.

Conclusion
ECF at CTC are more frequent than colonic findings. The majority of ECF investigated are found to be benign yet a quarter of ECF are further investigated at a cost to the health service and the patient. Clinicians should be judicial when ordering and consenting patients with regards ECF and its implications if CTC is considered. Particularly when the test is part of a public funded and voluntary screening programme.
TP1.2.5Colonoscopic Surveillance Versus Surgical Resection After Polypectomy for Colorectal Polyp Cancers: Are We Overtreating Malignant Colorectal Polyps?
Authors: Jethwa Kishan , Pal Atanu 
Published: October 2021

Abstract

Aims
Colorectal polyp cancers are increasingly detected in the era of screening. This raises the dilemma regarding management by colonoscopic surveillance or surgical segmental resection. The evidence base remains relatively limited and guidelines are still evolving to balance the risk of overtreatment and unnecessary surgical resection or undertreatment and cancer recurrence. In this study we investigate the management of polyp cancers in our centre.

Methods
This single centre retrospective study in a university teaching hospital included all patients with malignant colorectal polyps found endoscopically and over a 15-month period. All patients were discussed at the colorectal MDT. The threshold for incomplete endoscopic excision was 1mm. Data from endoscopy reports, histopathology reports and operation notes was collected to determine rate of surgical resection and of residual disease.

Results
70 patients with colorectal polyps, classified as at least high-grade dysplasia, were included. 22/70 polyp cancers (31%) patients had surgical resection. Residual adenocarcinoma was identified in 1/22 (4%) and one further patient had lymph node metastases. Two individual patients developed post-operative ileus and pancreatitis resulting from surgery.

Conclusions
Of those patients undergoing surgical resection only 8% patients had malignancy in the postoperative specimen, raising the possibility of overtreatment under current guidelines. This highlights a need to update clinical guidelines to avoid overtreatment without compromising oncological outcomes.
TP1.2.6Functional Outcomes of Organ Preservation Strategies - Local Excision Procedures and 'Watchful-Waiting' In Management of Low Rectal Cancers - A Systematic Review
Authors: Ramesh V , Aspari A R , Narayanasamy S N , Kumar G , Gumber A O , Thomas P F 
Published: October 2021

Abstract

Objective
To evaluate functional outcomes and quality of life (QOL) associated with `wait-and-watch’ (WW) strategy and local-excision (LE) of rectal tumours after neo-adjuvant therapy, in comparison to the standard practice of total-mesorectal-excision (TME) for locally-advanced-rectal-cancers.

Data Sources
Medline, EMBASE, PubMed databases, and sources of Grey literature.

Study Selection
Randomised and non-randomised prospective studies, and retrospective studies with propensity-score-matched analyses analysing outcomes of WW and LE procedures for rectal cancer.

Data Extraction and Synthesis
Risk of bias assessments and data extraction were carried out independently by two reviewers. A narrative synthesis of data was presented keeping with the 27-item PRISMA checklist.

Main Outcomes
The outcomes of interest were those of faecal-incontinence (FI), bowel and rectal-evacuatory function, sexual-function, stoma-free-survival, and quality-of-life scores, which were assessed in comparison to those associated with radical surgeries.

Results
7 studies reported functional outcomes. Faecal-incontinence, bowel, and rectal-evacuatory-function assessed by various scoring systems were found to be least affected among patients on WW strategy, followed by those undergoing local excision and most in patients undergoing TME. These reflected on the quality of life assessments (FIQOL and FACT-C questionnaires). Sexual dysfunction was not higher among patients who underwent LE compared to TME. Advantage of stoma-free-survival with organ preservation strategies was realised for up to 2 years after treatment.

Conclusions
Organ-preservation strategies appear to have a favourable functional outcome compared to the gold standard of TME for up to 2 years after the commencement of treatment. Further research is warranted to provide stronger levels of evidence regarding the same.
TP5.2.3 Quality improvement project to reduce turn-around times to improve vascular theatre efficiency
Authors: Gambhir Raghvinder , Carr James , Walter Ben , Little Jessica 
Published: October 2021

Abstract

Aim
One of the factors influencing theatre efficiency is turn-around time (TAT). The aim of this QIP was to reduce turnaround times by 25% thereby reducing financial implications of theatre idle time.

Methods
Baseline data was obtained from electronic theatre record system ‘Galaxy’ for the period October 2019 to February 2020. TAT (Time from the last patient going to recovery and the next one coming into the theatre) was measured and a period average was established. This QIP mapped processes and conducted interviews, to identify issues contributing to longer turnaround times. Interventions were then constructed and implemented over 6 weeks.

Results
One of preventable causes of delay identified from staff interviews and personal observations was inadequate patient preparation by the ward. Preintervention percentage theatre utilisation was 86% and turnaround times was 51.7 minutes. A PDSA cycle was initiated focusing on advanced warning (30 minutes prior to the end of the previous surgery) from theatres to wards and advanced preparation from wards, using a newly designed ward-based checklist. After the first PDSA cycle there has been an improvement in TAT to 42.8 minutes, a decrease of 18.2%. Whilst this did not meet our goal of a 25% reduction, this remains significant. Unfortunately due to COVID -19 the second cycle has been delayed.

Conclusions
Affordable and sustainable improvements will be needed in post COVID-19 recovery phase to tackle the backlog of surgeries. This project has demonstrated that advanced warning system can decrease turnaround times.
TP5.2.6 Use of objective assessment criteria to assess symptom severity and clinical effectiveness following deep venous stenting
Authors: Ghulam Mustafa , Lodhia Krishan , Carter Jemima , Saratzis Athanasios , Saha Prakash 
Published: October 2021

Abstract

Aims
This review aimed to identify measures that assess symptom severity in patients prior to deep venous intervention, and outcomes used to evaluate its clinical effectiveness.

Methods
MEDLINE was searched for studies of stent placement for treatment of iliofemoral venous disease using relevant key words (April 2019). Data were extracted and validated by three authors.

Results
6,356 patients with venous stents were identified from 93 studies. 1,300 patients (20%) were treated for acute thrombosis and 5,056 patients for chronic venous insufficiency (CVI), due to non-thrombotic lesions (2,200 patients, 35%) or post-thrombotic disease (2,856 patients, 45%). The Clinical-Etiological-Anatomical-Physiological classification (CEAP) was reported in 3,233/5,056 CVI patients (64%) pre-intervention (C0:2%; C1:2%; C2:7%; C3:46%; C4:21%; C5:6%; C6:16%). Stent patency was reported in all studies, with variable follow-up (six months – five years). Primary patency was 81% in 3,365 patients and secondary patency 95% in 4,700 patients at one year. 655 patients had active ulceration, of which 397 (61%) healed post-intervention. Venous Clinical Severity Score (VCSS) or revised VCSS was reported in 849 patients (13%). Average VCSS/rVCSS was eight pre-intervention and three post-intervention. Villalta scores were reported in 768 patients (12%) pre-intervention vs. 1,111 patients (17%) post-intervention. Average Villalta scores were 20 pre-intervention vs. five post-intervention.

Conclusions
Few studies use objective measures to quantify the clinical effectiveness of deep venous stenting; consensus is lacking on which is the most appropriate tool to use. More research is needed on ideal assessment measures to identify suitable patients for these interventions and to quantify clinical effectiveness.
TP5.2.7 COVAS: Assessing the impact of Covid-19 On VAscular Surgery: A Single Centre Experience
Authors: Michel Martin , Stocco Fabio , Khaliq Farihah , Sahl Abdullah Bin , Stachan Annabel , Parry Duncan 
Published: October 2021

Abstract

Aims
To quantify the impact Covid-19 has had on vascular surgery during the pandemic at our unit compared to previous operating activity levels at a single vascular centre.

Methods
Retrospective analysis of all vascular operations undertaken in the department dating from 11th March 2020 to 16th November 2020. Historical average data (HD) from the previous five years (2015-2019) over the same timeframe were then collected for comparison.

Results
During the Covid-19 pandemic 237 vascular operations were performed which represented a 48% operative reduction compared to average HD (454). 57 elective day-case procedures (varicose veins/temporal artery biopsies/renal access) were performed compared to a median of 259 from HD. Varicose vein surgery had an 79% reduction (37 vs 180). Renal access surgery was unaffected (15 vs 9). Major limb revascularisation procedures were reduced by 41% (36 vs 61) however this did not equate to any increase in amputation rates (79 vs 84). There was no reduction in carotid procedures performed during the pandemic (26 vs 30). There was a 60% (14 vs 35) reduction in all types of aneurysm procedures.

Conclusion
The Covid-19 pandemic has dramatically affected vascular surgery at our unit. In terms of arterial work the largest disparities compared to previous years was major revascularisation and aneurysm surgery. In respect to elective day case procedures, venous work has unsurprisingly been hardest hit which, once resources allow, will require significant provision to overcome the shortfall. This quantitative study can direct future service delivery and prepare for the post-pandemic recovery.
TP5.2.9 Mortality following major lower extremity amputation in people with and without diabetes in Scotland 2004-2013
Authors: Murgitroyd Ellen , Yao Xuehan , Kerssens Jan , Walker Jeremy , Wild Sarah 
Published: October 2021

Abstract

Aim
To describe short and longer-term mortality following major lower extremity amputation (LEA) by diabetes status over two time periods.

Methods
A retrospective cohort study of patients who underwent major LEA between 2004 and 2013 was conducted based on linkage of national population-based hospital records and a register of people with diagnosed diabetes. Post-operative mortality was estimated at 30 days, one year and where available, five years. Using logistic regression models, we estimated the odds of death associated with diabetes adjusted for age, sex and socio-economic status within these time points compared to the non-diabetic population stratified by type of diabetes and five-year calendar periods.

Results
There were a total of 5436 people who received an amputation during the study period of whom approximately 40% had diabetes. Overall mortality for the 2004-8 and 2009-13 cohorts respectively was not significantly different at 7.9% and 7.3% at 30 days and 31% and 27% at one year. Almost 64% of the 2004-8 cohort were dead within five years. The only statistically significantly associations between diabetes and mortality were observed within five year follow-up of the 2004-8 cohort with odds ratios (95% CI) compared to the non-diabetic population of 1.62 (1.17, 2.26) for type 1 diabetes and 1.38 (1.14, 1.66) for type 2 diabetes.

Conclusions
An adverse association between diabetes and mortality after LEA only became apparent in longer term follow-up.
TP5.2.11 Intervention for mesenteric arterial insufficiency in octogenarians
Authors: Shenoy Sachin , Daly Kevin , Stuart Wesley , Meldrum Alan , Hussey Keith 
Published: October 2021

Abstract

Introduction
Mesenteric ischaemia is associated with significant morbidity and mortality. The poor prognosis associated with mesenteric ischaemia may prejudice decision-making, particularly for an older patient group. We have explored outcomes following intervention for mesenteric ischaemia in patients aged over 80-years old.

Methods
This was a retrospective analysis of a database of intervention for mesenteric ischaemia from 2010 to 2020 from a regional vascular unit covering two Health Boards in Scotland. Patients aged 80-years and over were identified and patterns of intervention and outcome described.

Results
There were 23 procedures performed – there were 17 patients aged 80-years or over. There were 8 patients with acute presentations, 6 had isolated superior mesenteric artery occlusion and thromboembolectomy was the most common procedure (n = 4). Laparotomy was performed in all cases and bowel resection required in 3. At 30-days 4 patients had died, but patients who survived the index admission were still alive at 1-year and symptom free.
Elective was performed on 9 patients. An endovascular approach was favoured (n = 7) with the superior mesenteric artery the preferred target. At 30-days 2 had died, but at 1-year there had only been 1 further death. Three patients experienced recurrent symptoms. The remaining patients were symptom free.

Conclusion
It is appropriate to consider mesenteric intervention for older patients with both acute and chronic mesenteric ischaemia. Meaningful survival can be achieved with good relief of symptoms and return to meaningful quality of life.
TP5.2.16 Organ donation education in schools significantly increases organ donor registration, knowledge, and family discussion
Authors: Byrne Matthew , Mayes Jonathan , Mogg Jasper , Symington Matthew , Hu Lisi , Brathwaite-Shirley Charlotte 
Published: October 2021

Abstract

Aim
Over Six-thousand patients are on the transplant waiting list in the UK and two die each day due to a lack of donors. We aimed to assess the effectiveness of a national organ donation educational intervention in schools at increasing organ donor register (ODR) sign-up, knowledge, and family discussion.

Methods
A fifteen-minute non-biased presentation about organ donation was delivered at secondary schools across the UK by individuals from four centres from July 2018 to July 2019. An optional questionnaire was distributed to students.

Results
1616 students from 25 schools completed the questionnaire. The mean age of students was 14 (SD = 2) years. Following the educational intervention, the number of students who were on or intended to join the ODR significantly increased from 8% to 44% (p &lt; 0.0001), knowledge of organ donation significantly increased from 43% to 79% (p &lt; 0.0002), and planned family discussion significantly increased from 19% to 42% (p &lt; 0.0001). These findings were not influenced by location.

Conclusions
Organ donation educational interventions delivered to school students significantly increases planned ODR sign-up, knowledge, and family discussion.
TP6.1.1 Interventional radiology cholecystostomy in a four year period in our trust
Authors: Ahmed Elmurtada , Al-Robaie Basim 
Published: October 2021

Abstract

Aims
to look in detail at the cases who underwent interventional radiology cholecystostomy in term of male to female ratio, age, was the tube spigoted before removal, did the patient have a tubo-gram prior to removal and when & where was the tube removed, so that we can produce firm guidelines on how to deal with these tubes.

Methods
We looked into the electronic records paper notes in our trust & found that 57 patients have undergone the procedure in the four years between June 2015 & July 2019, at a rate at roughly one patient per month.

Results
Procedure done under local anaesthesia in radiology department either under ultrasound or CT guidance , male to female ratio is 1:1 , two thirds of patients are in the 7th& 8th& 9th decade , the tube was spigeoted in only 10% of patients , the drain was removed in the surgical ward in 65% of patients ,in a few patients it was removed in the clinic , radiology department or other place ,the median time for removal was three weeks (57%) of patients , the drain fell in 23% of patients, a tubo-gram was peformed in 23% of patients at a median time of fourteen days.

Conclusions
There is a degree of inter-unit variation of cholecystostomy drain management so we are trying to produce a practical guide for junior doctors on this issue, we also noticed that the drain fell in 23% (high percentage compared to other centres ) of patients therefore we contacted radiology colleagues & informed them.
TP6.1.2 Laparoscopic subtotal cholecystectomy; change in practice over a 10-year period
Authors: Boyd Kirsten , Bradley Nicholas , Cannings Elizabeth , Wadhawan Himanshu , Wilson Michael , Crumley Andrew 
Published: October 2021

Abstract

Aim
Laparoscopic subtotal cholecystectomy is a safe strategy to avoid bile duct injury when a critical view of safety cannot be obtained. This technique may result in fewer open conversions and was introduced in our DGH in 2013. This study describes the change in practice at our centre following introduction of subtotal cholecystectomy.

Method
Retrospective case series included consecutive cholecystectomies over a ten-year period in a single institution. Cases were divided into subgroups based on operation date; 2009-2012 (Group A) and 2013-2019 (Group B). These groups represent pre- (Group A) and post- (Group B) introduction of laparoscopic subtotal cholecystectomy. Primary outcome was the proportion of patients undergoing laparoscopic total cholecystectomy, laparoscopic sub-total and lap-converted to open cholecystectomy. Secondary outcomes included incidence of bile leak, complication rate, return to theatre, and length of stay.

Results
There were 4248 cases; 1387 in Group A, and 2861 in Group B. The rate of open conversions was higher in Group A than Group B (4.7% vs. 2.8%, p = 0.003). The rate of laparoscopic total cholecystectomy was higher in Group A than Group B (95.3% vs. 92.8%, p = 0.013). In the subtotal group (n = 114, 3.9% of Group B); 14 (12.3%) patients had bile leak requiring ERCP, 6 (5.3%) underwent re-laparoscopy for inadequate biliary drainage, and median LOS was 2 days.

Conclusion
Laparoscopic subtotal cholecystectomy has proven to be a safe technique at our centre, reducing the rate of open conversion and length of stay, with a low rate of reintervention for bile leak.
TP6.1.4 Risk factors for post-cholecystectomy bile duct injuries: Systematic review and meta-analysis
Authors: Burns Rowan , Connor Katie , Sherif Ahmed , Wigmore Stephen 
Published: October 2021

Abstract

Aims
Bile duct injury (BDI) is a major complication of cholecystectomy resulting in long-term consequences. The relatively low incidence (0.23% – 1.5%) of BDI makes the identification of risk factors challenging. The aim of this study was to systematically analyse available literature on BDI post-cholecystectomy to provide an update on the incidence and determine current risk factors.

Methods
The study was pre-registered on PROSPERO (CRD42020177318). A search was conducted of MEDLINE, EMBASE, Scopus, Cochrane Central, Web of Science databases and the grey literature from inception to February 2020. 1583 unique papers were identified and screened for eligibility. English language, retrospective and prospective studies were included where the population age was &gt; 16 and underwent cholecystectomy.

Results
Outcomes analysed were incidence of BDI and risk estimates for possible risk factors. 30 studies (6,420,667 patients) were included in the meta-analysis. Gender, BMI&gt;30, acute cholecystitis (AC), emergent surgery, the operative approach, intraoperative cholangiography (IOC) and the impact of surgeon’s experience were analysed. Male gender and AC were determined to be statistically significant risk factors (OR 1.25 (1.13-1.39)) and 1.74 (1.27-2.39) respectively). Furthermore, IOC use was found to be significantly associated with BDI risk (OR 1.27 (1.17 – 1.37), while BMI&gt;30, open surgical approach, emergent surgery and surgeon’s experience were not statistically significant; however, significant heterogeneity among included studies limited the interpretation of these factors.

Conclusion
Male gender and AC were found to be predictors of BDI, while better quality evidence is needed to show the effect of other factors.