bluuebunny/crossref_metadata_2025_split huggingface dataset:
AHP SO03 - The role of the specialist upper gastrointestinal (UGI) benign dietitian in the management of benign UGI disorders – a review of the outpatient referral base
Authors: Jarvis Emma , Orla Evans 
Published: November 2024

Abstract

Background
Benign UGI disorders can negatively affect patients’ nutritional status by impacting on oral intake and/or through malabsorption. GSTT performs a high volume of benign UGI surgeries and is a tertiary referral centre for oesophageal reconstructions and complex hernias. The role of the dedicated specialist UGI benign dietitian was established in 2019 to provide dietetic expertise to the UGI multidisciplinary team (MDT). It supports patients before and after surgery with the aim of reducing post-operative complications, length of hospital stay, re-admissions and improving patient experience and quality of life.

Method
Outpatient referrals to the UGI benign dietetic service between 02/02/2024 and 06/06/2024 were reviewed for source of referral, reason for dietetic referral and UGI diagnosis.

Results
Twenty-five new referrals were received from a variety of clinical specialities (table 1). The primary UGI disorders of referrals are outlined in table 2, with complex hernia repair being the most common. Table 3 outlines the broad range referral reasons. Nutrition support referrals were received for the following disorders: achalasia, oesophageal stricture and following oesophageal perforation, hiatus hernia repair, cholecystectomy and oesophagectomy. All weight management referrals were for complex hernia repair patients. Referrals for the side-effects of UGI surgery included dietetic support with pancreatic exocrine insufficiency (pancreatectomy; distal gastrectomy), dumping syndrome (hiatus hernia repair) and delayed gastric emptying (oesophagectomy).

Conclusion
The role of the benign UGI dietitian requires skills and expertise in a broad range of dietetic interventions. The service is well utilised by surgical and non-surgical colleagues. Next steps for service development would be to review the impact of interventions on surgical and patient reported outcomes, and explore feasibility of patient groups to deliver dietetic advice (for example weight reduction prior to surgery) to improve capacity within the service.
EDI&S SO05 Barriers to delivering a net zero NHS: An evaluation of Sustainability in Surgery across the Midlands
Authors: Kanani Trisha , Al Saoudi Tareq , Holden Angela , Sharrod-Cole Hayley , Orrock Emma , Isherwood John , Dennison Ashley 
Published: November 2024

Abstract

Background
The healthcare sector is under increasing scrutiny for contributing approximately 4.6% of the UK’s total carbon footprint and 25% of the public sector’s carbon footprint. With support from the UK Health Alliance on Climate Change, the NHS aims to reach a net zero carbon target by 2045 through its Greener NHS campaign. This study aimed to identify key barriers to implementing sustainable practices in the surgical environment. It involved reviewing Green Plans published by Integrated Care Systems (ICSs) in the Midlands, conducting a thematic analysis of relevant literature, and surveying key stakeholders within NHS Trusts in the Midlands.

Method
Between June and September 2023, Green Plans from 11 ICSs across the Midlands were evaluated by two reviewers for the inclusion of the "key areas of focus" outlined by the NHS Green Plan Guidance. Additionally, three computerised searches were conducted using Ovid MEDLINE and Embase to retrieve abstracts published before May 2023 on reusable surgical gowns, re-sterilisation of surgical energy devices, and operating theatre waste management. Three reviewers screened the abstracts to identify barriers to implementing change. Based on these findings, a framework was developed for the “Supporting a Greener NHS Survey” and disseminated to key stakeholders in the Midlands.

Results
A heat map was created to assess compliance of each Green Plan with NHS England guidance (Figure 1). The literature search yielded 82 abstracts and key barriers to sustainability were identified as infection control, cost implications, instrument damage, and waste management practices. The survey received 89 responses; 45% did not use reusable drapes at their Trust, 35% did not use reusable gowns, 46% did not use reusable laparoscopic ports, and 59% didn’t know whether their energy devices were recyclable. Key barriers to implementing sustainable change included surgeon preference, financial constraints, and infection control concerns.

Conclusion
The literature analysis and survey of stakeholders in the Midlands identified several barriers to implementing sustainable changes. With national, regional and local organisational impetus coupled with clinical leadership commitment to sustainability, these barriers can be overcome with multi-disciplinary involvement. By investing in comprehensive training programmes and implementing rigorous quality control measures with input from infection prevention and control teams, clinical leaders and clinicians are best placed to help overcome these barriers and promote sustainability in the surgical environment.
BS SO07 - NHS Tertiary Centre Experience with Bariatric Tourism; A Call for National Registry
Authors: Alnagar Amr , Askar Mohab , White Emma , Wadley Martin , Robinson Steven , Perry Anthony , Noormohamed Mohamed Saleem 
Published: November 2024

Abstract

Background
Bariatric surgery has demonstrated notable efficacy and is becoming an increasingly popular practice. Nonetheless, patients often opt for bariatric tourism due to the unaffordability of bariatric procedures or the lengthy waiting lists. The postoperative care for such patients not only imposes financial burdens on a different health system, necessitating costly interventions for complex cases but also affects the allocation of resources for patients receiving care in the public health services. A national guidance platform and registry are required to measure the impact of bariatric tourism on the modern NHS and plan future resource allocation.

Method
This is a retrospective review of patients referred to one of the bariatric units in the United Kingdom for complications following bariatric procedures abroad. Patient demographics, bariatric intervention, presenting complications, length of hospital stay and management received were recorded.

Results
Between 2022 and 2024, our unit admitted nine patients. Eight had sleeve gastrectomy in Turkey, and one had a gastric balloon in Thailand. In the sleeve group, five patients had intractable vomiting, one had small bowel ischemia, one leaked, and one had reactive hypoglycemia. The patient with the gastric balloon had vomiting and abdominal pain, leading to balloon removal. Three sleeve patients had a conversion to Roux-en-Y bypass, one is under investigation, and one is awaiting bypass surgery, one required three surgeries for small bowel ischemia, and one with a leak was treated with a pigtail and gastric stent.

Conclusion
Medical tourism for bariatric procedures is an appealing option for obese patients due to its affordability and shorter wait times. Patients typically receive brief pre-operative preparation and education in addition to a limited post-operative care. However, managing complex bariatric cases is expensive, necessitates extended hospital stays and nutritional and emotional support, and can only be done in specialised centres. It's important to create a national bariatric surgery guidance platform providing recognised centre details internationally and a national registry of bariatric tourism patients to assess the impact on the healthcare system and to plan for future resource allocation.
BS SO12 - Long-term impacts of emergency presentations following bariatric health tourism on patients and health services: A UK perspective
Authors: Iqbal Mohd Javaid , Alabdellat Osama , Nimeh Baraa Abu , Alwani Omneya , Alkhaffaf Bilal 
Published: November 2024

Abstract

Background
Bariatric surgery is an effective treatment for obesity. Whilst short-term complication rates are low, little is known about the longer-term impacts on patients and health services. Even less is known about the true impact of the increasing trend of Health Tourism (HT) in this field. This study aimed to explore this topic further to quantify the impact of HT on UK healthcare services and to subsequently inform future service planning.

Method
This was a retrospective study of consecutive emergency inpatient episodes related to bariatric surgery (presenting to ED or transferred from other hospitals) at a regional bariatric centre. The study included patients between January 2018- April 2023. Data on index procedure (type, time to presentation, location), complications (and associated management), and subsequent readmissions, diagnostic investigations, and interventions (surgical, radiological, endoscopic) following first discharge from our centre was collected.

Results
308 patients (489 episodes) were included (188 patients had surgery in the UK, 77 HT, 43 unknown origin). Gastric band (50%) and gastric sleeve (39%) were the commonest causes for admission in UK and HT patients, respectively. 86 surgical interventions post discharge were required. An average of 2.0 diagnostic investigations were undertaken following discharge per patient (UK 2.3 vs HT 1.9). Following discharge, similar average rates of further readmissions (UK 0.6 v HT 0.6), surgical (UK 0.3 v HT 0.4), radiological (UK 0.2 v HT 0.2) and endoscopic interventions (UK 0.6 v HT 0.6) were seen between cohorts.

Conclusion
Patients presenting with emergencies following bariatric surgery require significant ongoing investigation and management following discharge from hospital. This ongoing burden is often overlooked in health services research. In our study, this demand was significantly increased by bariatric health tourism. This highlights the critical need to recognise this additional burden, improve service planning to accommodate increased service demand, and address underlying factors contributing to health tourism.
EGS SO04 - Gastrodoudenal Artery Pseudoaneurysm Secondary to blunt abdominal trauma: A rare case report
Authors: Mansour Mohamed , Thambi Prem , Fadhl Yousif 
Published: November 2024

Abstract

Background
Visceral artery pseudoaneurysms (VAPAs) are rare, potentially life-threatning aneurysms found in the celiac, superior, or inferior mesenteric arteries. They are most common in the splenic artery (60-70%), followed by hepatic arteries (20%) and celiac or mesenteric arteries (10%). Usually asymptomatic, VAPAs are often discovered incidentally during abdominal imaging. They pose a high risk of rupture and haemorrhage. Risk factors include iatrogenic injury and abdominal trauma. Traumatic VAPAs are extremely rare with unclear management guidelines. Treatment options vary from observation to endovascular therapy or surgical repair. This report presents a case of a gastoduodenal artery psuedoaneurysm due to blunt abdominal trauma.

Method
A case report: a 68-year-old male with a high BMI and atrial fibrillation managed with edoxaban, presented with severe upper abdominal pain following a fall. Initial examination and laboratory results suggested acute pancreatitis or cholecystitis, but a CT angiography revealed a GDA pseudoaneurysm with active extravasation. The patient was referred for urgent therapeutic embolization; however, the pseudoaneurysm had spontaneously thrombosed, precluding the need for embolization. The patient was managed conservatively, with close monitoring in the high dependency unit (HDU), analgesics, proton pump inhibitors, and mechanical venous thromboembolism prophylaxis. He remained hemodynamically stable and was discharged with instructions for follow-up care.

Results
GDA pseudoaneurysms are rare, accounting for 0.01-1% of all visceral artery aneurysms, with trauma being an exceptionally infrequent cause. The management of VAPAs, particularly in hemodynamically stable patients, can range from conservative observation to endovascular interventions. This case underscores the importance of a multidisciplinary approach involving surgery, interventional radiology, and vascular teams for optimal management.

Conclusion
Gastroduodenal artery pseudoaneurysms secondary to blunt abdominal trauma can be effectively managed conservatively in stable patients. Comprehensive history-taking, appropriate imaging, and multidisciplinary discussions are crucial for successful outcomes. Continued monitoring is essential to ensure patient safety and address potential complications.
EGS SO17 - Foreign body management - Time for improvement
Authors: Karagiannidis Georgios , Pervez Aneeka , Gunasekera Githmi , Sinclair Martin 
Published: November 2024

Abstract

Background
The management of foreign bodies (FBs) in clinical practice presents significant challenges across various medical specialties. FBs can be ingested, inhaled, inserted, or result from trauma, necessitating a comprehensive understanding of their management to prevent complications. The prevalence of FB incidents varies by age, with children being particularly susceptible to ingestion and inhalation, while adults often encounter FBs through trauma or occupational hazards. Effective management strategies are crucial to minimize morbidity and mortality associated with FB incidents.

Method
This study retrospectively reviewed cases of FB management over eight years (2015-2023), encompassing various specialties including gastroenterology, upper gastrointestinal and colorectal surgery. Data were collected on patient demographics, type and location of FB, method of removal, complications, and outcomes. Imaging techniques, such as X-rays, CT scans, and endoscopic evaluations, were analysed for their efficacy in FB detection. Different removal techniques, including endoscopic, surgical, and non-invasive methods, were evaluated for success rates and associated complications.

Results
Of the 153 FB incidents,47% involved male patients and 53% involved female patients.The paediatric group accounted for 36% of incidents.Non-invasive management was successful in 62% of cases,while 37% required invasive procedures.Among invasive interventions,70% required operative intervention,10% endoscopic intervention and 20% other minimally invasive options.The time to intervention for invasive procedures varied with more than 50% taking place after 24 hours.For operative interventions,64% occurred over 24 hours after presentation,21% within less than 24 hours, and 14% within 12 hours.All endoscopic interventions were performed within 12 hours.Outcomes showed that 96% of cases were managed without further complications.There were no reported mortalities.

Conclusion
Effective management of FBs requires a timely and appropriate intervention strategy tailored to the patient’s age and the type of FB. Non-invasive methods successfully managed most cases, while invasive procedures were necessary for a significant proportion. Prompt intervention, particularly endoscopic and other minimally invasive techniques, was associated with favorable outcomes and minimal complications. No mortalities were reported, underscoring the efficacy of current management protocols. Further research is needed to optimize these protocols and improve outcomes across diverse patient populations.
OGC SO01 - Patients undergoing major upper gastrointestinal resection admitted to an enhanced peri-operative care facility: Two years of outcomes
Authors: Schofield Matthew , Hackett Stephen 
Published: November 2024

Abstract

Background
The Author's Trust has set up an Enhanced Peri-Operative Care facility (EPOC) to provide a higher level of monitoring in the immediate postoperative period, for certain patients undergoing elective major surgical procedures. Patients receive a nursing ratio of 2:1, invasive blood pressure monitoring, and epidural and peripheral vasopressor infusions if required, for one day before being discharged to the ward. This service, in carefully selected patients, can remove the need for critical care admission, which patients undergoing major upper gastrointestinal (UGI) resection previously required. We believe this to be a novel pathway in the UK for major UGI resections.

Method
Between November 2021 to November 2023, 170 major UGI resections (oesophagectomies and gastrectomies [including total and subtotal]) were performed. 82 of these cases (48%) were admitted to EPOC, instead of the Critical Care Department (CCD). The primary project outcome consisted of the proportion of EPOC cases being successfully discharged to the ward by the end of day one. Patients failing to meet the requirements for safe EPOC discharge were transferred to the CCD. Secondary outcomes included total admission length, need for escalation to critical care after discharge from EPOC and patient deaths.

Results
78% of cases admitted to EPOC after major UGI resection were able to be discharged to the ward by the end of day one. The total admission length of these cases was 11.5 days. 4.6% of patients discharged to the ward from EPOC later developed complications and needed to be transferred to the CCD. 96% of patients were discharged home. Three patients died.

Conclusion
The Trust has been sending major UGI resection cases to EPOC for over two years. This is the first project looking at the combined outcomes. The first year was audited in 2022 and results were used to support pathway expansion, with an increased number of patients admitted in year two. The results support the notion that when patients are selected correctly they can be cared for safely in an EPOC setting, relieving pressure on the CCD and reducing the likelihood of cancellation due to critical care capacity, improving the efficiency of the UGI surgical service.
OGC SO11 - Impact Evaluation of Endoscopic Mucosal Resection in the Foregut in a Tertiary Centre in the United Kingdom (UK)
Authors: Kwan Yi Xin , Pua Qiao Ying , Loh Danielle , Viswanath Y K S 
Published: November 2024

Abstract

Background
Endoscopic mucosal resection (EMR) has emerged as a crucial technique for managing early-stage lesions in the oesophagus and stomach, encompassing precancerous and cancerous conditions.1 With fewer complications and excellent 5-year survival rates, EMR has shown potential as a less-invasive alternative to surgical resections.1 EMR achieves higher accuracy with its ability to obtain more profound and better quality tissue samples compared to conventional biopsies, which facilitates multidisciplinary team (MDT) discussions regarding treatment decisions.1 This study aims to evaluate the impact of EMR performed in an Oesophago-Gastric Cancer tertiary centre in the UK.

Method
This is a retrospective service evaluation of patients who underwent EMR from March 2021 to March 2024. A sample size of 73 EM (n=73) is identified. Data were collected from medical and endoscopic records, which includes patient’s demographics, American Society of Anaesthesiologists (ASA) grade, EMR indication, histology report and MDT outcome. EMRs performed were categorised into oesophageal, gastric and duodenal. Three main referral indications were identified; ‘polyp’, ‘dysplastic nodule in Barrett’s oesophagus’ and ‘possible early malignancy’. MDT outcomes were analysed thematically.

Results
Of the seventy-three patients identified, 78% is male and mean age at 71 years. Most patients (81%) are classified as ASA Grade 2. Polyp is identified in 37 patients (51%), making up the most common referral indication. 49% of the EMR were gastric, with remaining being oesophageal (41%) and duodenal (11%). 26% of histology results showed benign disease, 40% dysplastic disease, and 34% malignant. From histology reports, 47% of the EMRs achieved complete clearance margins. 28 patients (38%) were discharged with no further interventions and 12 patients (16%) received repeat EMR. 4 main themes were identified from MDT outcomes, with 43.8% patients needing surveillance endoscopy, 16.7% patients recommended for surgical intervention and repeated EMR each.

Conclusion
EMR has shown to be effective as a reference for further treatment decisions, especially for MDT discussions. It has been proven that EMR can be therapeutic in providing complete resection, particularly for benign and early dysplastic diseases.
OGC SO14 - Management of Anastomotic Leaks after oesophagectomy for oesophageal cancer in the era of Endoscopic Vacuum Therapy
Authors: Peristeri Dimitra , Ibrahim Ahmed , Powell Arfon , Farooq Naheed , Alkhaffaf Bilal 
Published: November 2024

Abstract

Background
Anastomotic leak (AL) is a serious complication following oesophagectomy that occurs in 10-15% of patients. Endoscopic vacuum therapy (EVT) is a novel non-operative approach to managing AL that has become increasingly popular recently. However, little is known about EVT’s effectiveness in managing ALs compared to more established approaches.

Method
This was a retrospective review of consecutive AL management in a regional oesophageal cancer centre during two distinct time periods: prior to (group 1, 2014-2018) and following (group 2, 2018-2023) the introduction of EVT. 66 patients met the inclusion criteria. Patients were further classified according to size and type of leak, degree of mediastinal soiling and degree of sepsis. Primary endpoints were treatment success, 90-day mortality, and long-term preservation of gastrointestinal continuity. Secondary endpoints were the length of hospital stay (LOS) and re-interventions during the first postoperative year.

Results
80.3% of patients (14 in group 1, 40 in group 2) had less than 1cm AL defect with present sepsis and a small mediastinal cavity. In group 1, 12 were treated successfully conservatively, and 2 (14.2%) had T-tube insertion. In group 2, 20 (50%) had conservative management and 19 (47.5%) had Esosponge insertion. The success rate was 95% and 94.7%, respectively. In bigger ALs (&gt;1cm defect with severe sepsis), all patients in group I were treated with thoracotomy with a success rate of 75%, whereas in group 2, 60% were treated with Esosponge insertion with a success rate of 83.3%.

Conclusion
EVT is a safe and feasible therapy option. It appears to improve outcomes in septic patients with small ALs and potentially reduces the need for high-risk revisional operations.