bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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 &gt;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 &gt;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

Abstract

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

Abstract

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

Abstract

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

Abstract

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&lt;0.001) and age (&lt;65: 15%, &gt;=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

Abstract

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

Abstract

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

Abstract

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

Abstract

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.