bluuebunny/crossref_metadata_2025_split huggingface dataset:
O-BN08 Quality of Life 21 Years Following Gastric Pacing/ Gastric Electrical Stimulation for Gastroparesis – A real life data
Authors: Kadirkamanathan Sritharan , Kordzadek Ali , Yazaki Etsuro , Askari Alan , Siriwardana Priyantha , Qamruddin Mohammad 
Published: December 2021

Abstract

Background
Gastroparesis is defined as delayed emptying of the stomach in the absence of mechanical obstruction. Gastroparesis symptoms ranging from nausea, vomiting, bloating and abdominal pain with significant impact on overall quality of life (QALY). Gastric electrical stimulation (GES) for gastroparesis has been used in clinical practice since 1998 and was initially licensed as a “humanitarian” treatment when all else had failed. In the last two decades, it has been increasingly used in the treatment of refractory gastroparesis. We have been performing GES for refractory Gastroparesis since 2000 and we present our data on symptoms, quality of life and resource utilization

Methods
A prospective consecutive cohort study at a single center from December 2000 to July 2021 has been conducted. Data on patient demographics (gender and age), comorbidities, aetiology, the method of surgery, pre and post hospital stay, pre and post-operative SF-36 questionnaire (QALY) and symptom score (Likert Score), adjunct intervention, feeding regimen, mortality and morbidity were collated and subjected to student t-test for parametric data, the Wilcoxon test for non-parametric data, and McNemar’s test for binomial data

Results
A total of 162 patients underwent GES. There were 118 females. The median age was 36.5 years (range 6-80). Ninety-two patients were Idiopathic, 63 were Diabetic and 7 Post-Surgical. Overall QALY improved from a mean of 190/500 to 415/500(p = &lt;0.001) with significant improvement in nausea (p = &lt;0.001), abdominal pain (p = 0.005) and bloating (p = 0.001) severity score prior and following surgery. Number of hospital admissions (median) reduced post GES insertion from six to zero per year (p = 0.002). The median length of stay was 3 days (range 1-45) and follow up was up to 129 months (6-252). There was no mortality from the procedure.

Conclusions
This is one of a few long-term studies looking at the outcome following GES for Gastroparesis. Our data shows that GES is a safe procedure with very little morbidity and no mortality. It improves symptoms and quality of life. It also reduces the health care utilization for these patients. The effects of GES are also very durable and hence should be considered as a mainstream treatment for patients with refractory gastroparesis.
O-EGS08 Endoluminal Vacuum Therapy (EVT) for leaks in the upper gastrointestinal (UGI) tract; 10-years’ experience in a specialist Oesphagogastric centre
Authors: Afzal Zeeshan , Gourgiotis Stavros , Hardwick Richard , Safranek Peter , Sujendran Vijayendran , Bennett John , O'Neill Robert , Noorani Ayesha , Hindmarsh Andrew 
Published: December 2021

Abstract

Background
Endoluminal vacuum therapy (EVT) is an emerging treatment strategy for UGI leaks. When compared to traditional treatments strategies EVT is reported to reduce morbidity and mortality, especially in patients with delayed presentation and established sepsis. We report the outcomes for patients with UGI leaks and perforations treated with EVT using an ad-hoc endoluminal vacuum device (EVD) in a tertiary UK hospital over a 10-year period.

Methods
Sixty-seven patients with UGI leaks from disparate causes were treated with EVT between April 2011 and July 2021. The ad-hoc EVD was constructed using a piece of open cell foam sutured around the distal end of a nasogastric tube, and placed endoscopically either through the perforation and into the extra-luminal leak cavity OR intraluminally depending on the morphology of the leak cavity. Continuous negative pressure (125mmHg) was applied. Endoscopic re-evaluation of the leak cavity with change of EVD was performed every 48-120 hours depending on the patients clinical condition. Information related to treatment and outcome was recorded prospectively.

Results
Patients had a median age of 66 years (range 23-92), and median Apache II score of 21 (range 4-36) at presentation. Fifty-two leaks were oesophageal (78%), 12 gastric (18%), 2 duodenal (3%), and 1 pharangeal (1%). The leak cause was anastomotic in 26 (39%), iatrogenic in 20 (30%), spontaneous in 19 (28%), and traumatic in 2 (3%). The median number of EVD changes required to heal the leak was 6 (range 1-27), and median length of hospital stay was 42 days (range 1-182). Successful resolution of the leak was achieved in 59 patients (88%). Eight (12%) patients died during treatment. There were no complications related to insertion of the EVD.

Conclusions
EVT is an effective treatment for UGI leaks which can be delivered safely in a tertiary oesophagogastric centre, and used to treat a wide range of leak causes in critically unwell patients. Further studies are required to develop a standardized procedure to improve the ease with which EVT can be delivered. This will enable broader adoption of EVT for this group of patients.
O-OGC06 Genomic analysis of response to neoadjuvant chemotherapy in oesophageal adenocarcinoma
Authors: Breininger Stella , Izadi Fereshteh , Sharpe Benjamin , Secrier Maria , Gibson Jane , Walker Robert , Rahman Saqib , Devonshire Ginny , Lloyd Megan , Walters Zoë , Fitzgerald Rebecca , Rose-Zerilli Matthew , Underwood Tim 
Published: December 2021

Abstract

Background
Oesophageal adenocarcinoma (OAC) is the ninth most common cancer worldwide, with an estimated mortality of over 500,000 deaths yearly. Neoadjuvant chemotherapy (NAC) followed by surgery is the standard of care (SOC) for locally advanced OAC. Although almost all patients receive chemotherapy as SOC, fewer than 20% obtain a clinically meaningful response and benefit before surgery. The OAC genome is complex and heterogeneous between patients, and it is not yet understood whether specific mutational patterns may result in chemotherapy sensitivity or resistance.

Methods
To identify associations between genomic events and response to NAC in OAC, a comparative genomic analysis was performed in 65 patients using whole-genome sequencing.  We defined response to NAC using Mandard Tumour Regression Grade (TRG), with responders classified as TRG1-2 (n = 27) and non-responders classified as TRG4-5 (n = 38).

Results
We report a higher non-synonymous mutation burden in responders (median 2.08/Mb vs 1.70/Mb, P = 0.036) and elevated copy number variation (CNV) in non-responders (282 vs 136/patient, P&lt;0.001). We identified CNVs unique to each group, with cell cycle (CDKN2A, CCND1), c-Myc (MYC), RTK/PIK3 (KRAS, EGFR) and gastrointestinal differentiation (GATA6) pathway genes being specifically altered in non-responders. Of particular interest was the identification of the Neuron Navigator-3 (NAV3), a known tumour suppressor downstream of EGFR, which was mutated exclusively in non-responders with a frequency of 22%.

Conclusions
Our work characterises genetic features and mutations that are uniquely associated with response to NAC. We envision a treatment pipeline that incorporates driver mutation profiling in OAC, combining response prediction with targeted therapies to enhance response to NAC and improve survival outcomes.
O-OGC07 Endoscopically derived oesophageal adenocarcinoma organoids to assess potential response to neo-adjuvant therapy and virotherapy
Authors: Rayner Charles , Wooldridge Tyler , Bagwan Izhar , Preston Shaun , Pandha Hardev , Annels Nicola , Abbassi-Ghadi Nima 
Published: December 2021

Abstract

Background
Organoids are 3D models that retain the architecture and function of the organ from which they are derived. Culture of oesophageal adenocarcinoma organoids from individual’s standard endoscopic biopsies to assess response to therapy could dramatically alter the neo-adjuvant treatment paradigm, giving clarity over who will benefit from therapy, including novel treatment methodologies. Immune checkpoint blockade (ICB) has been shown to be effective in oesophageal adenocarcinoma. Combining Oncolytic Virotherapy with ICB could enhance the action of ICB alone, through selective infection of tumour cells accompanied by immunogenic cell death, with release of neo-tumour antigens and alteration of the tumour microenvironment.

Methods
This study uses organoids derived from endoscopic biopsies to assess the viability of an oncolytic herpes simplex virus in the treatment of oesophageal adenocarcinoma. Samples were taken at staging endoscopy using standard biopsy forceps. Tissue specimens were dissociated using the Miltenyi tumour dissociation kit before being suspended in Matrigel in conditioned media. Media was changed every 48 hours with domes being split every 7-10 days. After &gt;6 passages organoids were incubated with an oncolytic herpes simplex virus lacking ICP 34.5 and 47. Growth was monitored, and green fluorescence protein expression measured using the Incucyte SX5 Live Cell Analysis system.

Results
Organoids were successfully established and cultured beyond 6 passages for patients with oesophageal adenocarcinoma. Organoids incubated with an oncolytic herpes simplex virus demonstrated significantly reduced growth compared to untreated organoids with increased expression of green fluorescence protein indicating viral infection.

Conclusions
We have demonstrated a successful methodology to culture Oesophageal adenocarcinoma organoids from endoscopic biopsies. Further work to determine their responses to standard chemotherapy used in the perioperative phase will help to assess their potential for providing bespoke therapy in the future. Oncolytic herpes simplex virus is able to infect and cause lysis of OAC organoids supporting its potential use in driving an increased inflammatory tumour microenvironment which could be combined with immune checkpoint blockade to induce durable responses for patients.
O-P01 Potential Utility of Intraoperative Fluid Amylase Measurement During Pancreaticoduodenectomy
Authors: Joshi K , Abradelo M , Chatzizacharias N , Bartlett D , Dasari B , Isaac J , Marudanayagam R , Mirza DF , Roberts K , Sutcliffe RP 
Published: December 2021

Abstract

Background
Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a source of major morbidity and mortality. Early diagnosis and treatment of POPF is mandatory to improve patient outcomes, and clinical risk scores may be combined with postoperative drain fluid amylase (DFA) values to stratify patients.
The aim of this study was to determine if intraoperative fluid amylase values (IFA) correlate with DFA1 and POPF.

Methods
In consecutive patients undergoing PD between February and November 2020, intraoperative samples of intra-abdominal fluid adjacent to the pancreatic anastomosis were taken and sent for fluid amylase measurement prior to abdominal closure. Data regarding patient demographics, postoperative DFA values, complications and mortality were prospectively collected.

Results
Patient Demographics: Data was obtained for 52 patients with a median alternative Fistula Risk Score (aFRS) of 9.4. Postoperative complications occurred in 20 patients (38%), including five Clavien grade 3+. There were eight POPFs and two patients died (pneumonia/sepsis). There was significant correlation between IFA and DFA1 (Pearson’s correlation: R2=0.713; p &lt; 0.001) and DFA3 (p &lt; 0.001), and median IFA was higher in patients with POPF than patients without (1232.5 vs. 122; p = 0.0003). IFA&gt;260 U/l predicted POPF with sensitivity, specificity, PPV and NPV of 88%, 75%, 39% and 97%, respectively. The incidence of POPF was 43% in high risk (high aFRS/IFA) and 0% in low risk patients (low aFRS/IFA).
Complications:

Conclusions
Intraoperative fluid amylase closely correlated with postoperative pancreatic fistula, and may be a useful adjunct to clinical risk scores to stratify patients during pancreatico-duodenectomy, allowing targeted intervention to reduce the clinical impact of pancreatic fistula.It is possible to detect fluid amylase adjacent to the completed pancreatic anastomosis in patients undergoing PD. Presence of IFA correlates with postoperative DFA and POPF.
IFA increases the accuracy of the alternate Fistula Risk Score in predicting POPF. Low risk patients with a low IFA may be suitable for a ‘no drain’ strategy, whilst patients with a high IFA may benefit from intraoperative mitigation strategies to reduce the incidence and/or severity of a postoperative pancreatic fistula.
O-P08 Optimising design of national collaborative studies in surgery: national availability of electronic data in the NHS
Authors: Thorne Thomas , Hall Lewis , McKay Siobhan C , Wilkin Richard W , Harvey Phillip , Layton Georgia , Roberts Keith J ,   RICOCHET Study on behalf of WMRC
Published: December 2021

Abstract

Background
Clinical trials are constrained in part by cost and limited funding opportunities. Trainee-led collaborative, multi-centre research models have become increasingly popular, enabling clinicians to undertake impactful national and international practice-changing studies with limited funding. However, ensuring equitable and efficient data collection from participating centres requires understanding data accessibility. Here, we reflect upon our strategies in designing and delivering collaborative research (The RICOCHET Study). Specifically, we consider the availability of data sources for UK hospitals, to enable effective design of study case report forms to ensure study success.

Methods
RICOCHET was a National trainee-led audit of UK hospitals treating patients with pancreatic cancer. All registered hospitals were asked to complete a site-survey at point of registration. The site survey was completed by the lead consultant (surgeon or gastroenterologist) or the lead trainee at each site. The site-survey detailed hospital demographics, including size, availability of services and availability of patient data electronically. The survey was completed online via REDCap. Sites lacking full reporting were excluded from the analyses.

Results
98 UK sites registered for RICOCHET, and 94 completed the site-survey (26 specialist pancreatic sites; 68 non-specialist sites). 100% sites had electronic radiology reports. However, electronic ward-round notes were available at only 19% (5/26, 19.2% specialist vs. 13/68, 19.1% non-specialist; p = 0.99). Furthermore, sources such as external letters were low (29%; 11/26 42.3% specialist vs. 16/68, 23.5% non-specialist; p = 0.072). Although electronic interventional radiology reports were broadly available at 79% sites, this was significantly lower at non-specialist sites (49/68 72.1% vs. 25/26 96.2%; p = 0.011).

Conclusions
Availability of electronic data is not consistent across sites managing pancreatic cancer patients. Significant disparity exists between specialist and non-specialist centres, highlighted by lack of availability of interventional radiology reports. To ensure success in trainee-led cohort studies we recommend designing concise case report forms that can be easily completed from electronic data sources. Until this report, there was no data available for the availability of electronic data across the NHS. This represents the most comprehensive report of such data sources, and will guide future study design of national studies at both specialist and non-specialist pancreatic centres in the UK.
P-BN14 Differences in rate of complications between emergency and elective laparoscopic cholecystectomy at district general hospital
Authors: Belhasan Anas , Wookey Rebecca , Atkinson Adam , Albirnawi Hatim , Gupta Ajay 
Published: December 2021

Abstract

Background
Current NICE guidelines recommend healthy low risk patients who present with acute biliary disease should be offered laparoscopic cholecystectomy on the same index admission. The increased complexity of the acute operations may impact on the operative complication rates; hence the aim of this study is to evaluate and compare the operative complication rates between elective and emergency laparoscopic cholecystectomies and additionally to assess the difference in surgical techniques comparing complete cholecystectomy versus subtotal versus open procedures.

Methods
Retrospectively, data was collected from emergency and elective Laparoscopic Cholecystectomies completed in the period 01/01/2021-01/06/2021 at the Queen Elizabeth Hospital Gateshead. The data set was gathered from an electronic theatre database and the individual cases were sub-analyzed further by delving into the electronic patient records database. Statistical analysis done by using Excel 2010.

Results
The average age of both groups was 50 years. There wasn’t a statistical significance on the rate of complication between the elective Vs emergency cholecystectomies (Elective 2%, Emergency 9% P = 0.17).
Out of 42 Elective procedures, 4 had Sub-total cholecystectomy Vs 3 out of 42 patients on the emergency group who had Subtotal cholecystectomy (9% Vs 7%), implying there was no significant difference noted between the two groups. Average hospital stays was 5.6 days for the acute presentation with biliary disease Vs 0.14 days on the planned elective group.
2% of the elective group were noted to have a surgical drain inserted during the operation; whilst the emergency cohort had a slightly higher rate at 5%.

Conclusions
Overall there was no significant difference noted between the surgical complications arising in emergency cholecystectomy compared to planned surgeries. In addition to this the data also suggests that there is negligible difference in the rates of sub-total cholecystectomies in both cohorts.
P-BN17 Laparoscopic subtotal cholecystectomy is a safe and effective treatment for gallstone disease
Authors: Leivers Emily , Toumi Zaher 
Published: December 2021

Abstract

Background
Laparoscopic cholecystectomy is the gold standard treatment of gallstones in fit patients with symptomatic gallbladder disease. If the critical view of safety cannot be achieved intra-operatively, there are few options, one of which is laparoscopic subtotal cholecystectomy. This study aims to ascertain the outcomes of subtotal cholecystectomy.

Methods
Retrospective review of all patients who underwent laparoscopic subtotal cholecystectomy by a single surgeon over a 5 year period.

Results
37 consecutive patients who underwent subtotal cholecystectomy were included in this study; seventeen of which were males (49%); the median age was 69, and 18 were emergencies (49%).The most common reasons for conversion to laparoscopic subtotal cholecystectomy were adhesions (57%) and fibrotic Calot’s triangle (22%). One patient required ERCP and biliary stenting for ongoing bile leak and another returned to theatre for post operative bleeding during index admission. 6 patients (16%) required further hospital admissions for gallstone disease (1 for biliary colic, two for cholecystitis and three for CBD stones). 3 patients required ERCP. None required further gallbladder surgery.

Conclusions
Laparoscopic subtotal cholecystectomy is a safe and effective alternative to total cholecystectomy when the critical view of safety cannot be achieved. In our experience, only a small proportion of patients have recurrent biliary problems.
P-BN20 An evaluation of the accuracy of sonography for the measurements of gallbladder polyps across 3 UK hospital trusts: should the surveillance guidelines be revised?
Authors: Claxton Harry , Strong Catherine , Nevins Edward 
Published: December 2021

Abstract

Background
Transabdominal ultrasound scan (USS) is recommended for surveillance of gallbladder polyps (GBP), this is to stratify risk for premalignant potential. European Society of Gastrointestinal and Abdominal Radiology make recommendations based on increases of as small 2mm during sequential USS surveillance. Our aim is to determine the accuracy of USS in diagnosis and measurement of GBP.

Methods
Measurement data for all GBPs were gathered for three hospital trusts across a 12 year period and retrospectively reviewed. USS findings (diagnosis of GBP and GBP size) were compared with histological diagnosis and measurements, when both reports were available, in those patients who had underwent cholecystectomy at the time of data collection.

Results
For the first two hospital trusts, 778 USS were reviewed which identified patients with GBP. 78 patients had undergone cholecystectomy at time of data collection. Only 17/78 of patients had histological evidence of GBP. Of those without GBP, 37/61 had gallstones.
For the third hospital trust, 41 GBP histological reports were identified, 20 could be directly compared with USS. Collectively 29 USS reports were directly compared with GBP histology reports. Only, 31% had results which were in agreement to within 1mm. The mean measurement discrepancy between both modalities was 5.41mm.

Conclusions
USS does not provide an accurate diagnosis of GBP, it is likely that USS misdiagnoses gallstones as GBP. Moreover, when comparing USS measurements with histological data, there is 31% accuracy of measurement to within 1mm in this cohort. Current guidelines recommend cholecystectomy if there is an interval change of 2mm or more; this data shows a measurement error of more than this.
P-BN22 The use of virtual clinics in gallbladder polyp surveillance
Authors: Young John , Belhasan Anas , Kansal Nisheeth , Taribagil Sanjay 
Published: December 2021

Abstract

Background
Gallbladder polyps are common findings on ultrasound with a prevalence between 0.3-9.5%. Their significance is not clear but are theorised to have potential risk of transformation into gallbladder malignancy which have poor prognosis if not caught early. Current guidelines recommend surveillance of polyps and that laparoscopic cholecystectomy should be offered if certain criteria are met. Most patients are asymptomatic and regular reviews in clinic is time consuming for patients and adds to strain on services. This study looks at the use of virtual clinics in gallbladder polyp surveillance.

Methods
Since January 2019 patients identified with gallbladder polyps have been added to virtual clinic. Each patient is added to a database which is maintained by one upper GI surgeon. Current guidelines are followed: laparoscopic cholecystectomy is offered if polyps are greater than 1cm, there is an increase greater than 2mm between scans, and in high-risk groups or in symptomatic patients. All other patients are offered interval scans as per guidelines and a template letter is generated informing patients of their scan results and date of their follow up scan.

Results
Since January 2019, 70 patients have been identified to have gallbladder polyps. Of these 48 patients so far have benefitted from involvement from follow up in virtual clinic to date, this has resulted in 88 clinic appointments being saved. 12 patients have undergone laparoscopic cholecystectomy due to increase in size of their gallbladder polyps or secondary to symptoms. 7 patients have been lost to follow up, 2 discharged due to the gallbladder polyps disappearing and the other 49 remain under surveillance in the virtual clinic.

Conclusions
Long term polyp surveillance can be time consuming for both the patient and clinician. This model of a virtual clinic maintains clear communication with patients about their scan findings, the risks associated and plans for future scans. This is an efficient method of monitoring these patients that has good compliance and identifies patients appropriate for surgery.