bluuebunny/crossref_metadata_2025_split huggingface dataset:
EGS SO18 - Entero-enteric intussusception secondary to a capillary haemangioma of the small bowel: A case of a diagnostic conundrum
Authors: Asour Amani , Massella Virginia , Azad Mohd , Raza Mehdi 
Published: November 2024

Abstract

Background
This is a case of a 50 year-old female who presented with acute on chronic abdominal pain, and she was intra-operatively diagnosed with entero-enteric intussusception secondary to a large small bowel tumour . The video demonstrates the findings during the diagnostic laparoscopy. The lead point appeared to be a tumour and histopathology confirmed it is a benign capillary haemangioma. The patient had a long standing history of abdominal pain that was previously investigated on multiple occasions, but without a definitive diagnosis.

Method
This is an interesting case of a challenging diagnosis of a rare disease. The patient has been suffering for four years with unexplained upper abdominal pain not associated with weight loss, rectal bleed, or change in bowel habit, but had occasional anaemia. The patient had a normal abdominal US, multiple CTs where she was found to have a right renal stone and an OGD that showed gastritis and positive CLO test initially. A repeat OGD and colonoscopy were negative. While the patient was awaiting further investigations for profound iron deficiency anaemia she presented with acute abdomen and required emergency surgery.

Results
The patient presented to ED with excruciating colicky pain for one day, one episode of melena and nausea. She was haemodynamically stable, peritonitic with increased inflammatory markers, hb 86 g/dL and lactate of 2 mmol/L. The CT abdomen and pelvis showed small bowel intussusception with possible ischemia, therefore the patient underwent an emergency operation.The laparoscopy showed small bowel intussusception and the patient underwent mini laparotomy. The intussusception was reduced, the small bowel was viable and the lead point was a large size tumour.The patient underwent small bowel resection and primary anastomosis, and made good post operative recovery.

Conclusion
Rare conditions are hard to diagnose. Small bowel intussusception is rare and in adults is usually linked to serious underlying pathology. Capillary haemangioma of the small bowel is very rare too. The patient's symptoms and occassional anaemia can now be explained. Although the patient went through an appropriate work up at the time, her symptoms remained unexplained to some extent or they were linked to other potential causes. Only when the anaemia became profound the patient warranted further investigations. In retrospect, capsule endoscopy would have been inevitable, however the patient became acutely unwell and required an emergency surgery.
EGS SO24 - Endoscopic Vacuum Therapy for Oesophageal Perforation and Anastomotic Leaks
Authors: Alam Mushfique , Raychaudhury Arun , D’Souza Joel , Bird Nick , Rao Rohith , Gunasekera Rohan , Howes Nathan , Stephens Nathan , Dexter Eloise 
Published: November 2024

Abstract

Background
Oesophageal perforations and oesophago-gastric (OG) anastomotic leaks are challenging conditions, associated with significant morbidity and mortality. In recent years, endoscopic vacuum (EndoVac) therapy has emerged as a novel, alternative intervention for source control and to promote healing. Introduced to our unit in 2019, this cohort study presents our experience with EndoVac management of both post operative OG anastomotic leaks and primary oesophageal ruptures.

Method
Retrospective analysis of patient electronic records was conducted for all patients who received EndoVac management between the study period of October 2019 to June 2023. Pertinent outcome variables included length of vacuum therapy, number of changes, length of admission, in hospital and 90 day mortality rates.

Results
37 patients were identified within the study period. The average age of this study cohort was 68 years with a mode ASA of III. The most common indication for EndoVac therapy was anastomotic leak (56%), followed by oesophageal perforation (31%). Defect resolution was achieved in 72% of patients. The median duration of treatment was 26 days (range 2-157), whilst the median number of changes was 7 (range 2-31). The overall in hospital complication (Clavien Dindo I-V) rate was 34%. The 90-day mortality rate was 22% whilst the morbidity rate was 13% in the form of anastomotic stricturing requiring serial dilatations.

Conclusion
EndoVac therapy is an effective minimally invasive treatment for post operative OG anastomotic leaks and oesophageal ruptures. With ongoing expansion in it’s use in our unit and throughout the UK, further work is required to assess the long-term outcomes and develop guidelines around its use in both oesophageal leaks and perorations.
OGC SO09 - Embracing change: Reproducible protocol for enhanced recovery after esophagectomy
Authors: Hassn Ahmed , Bahery Mohamed , Saad Reda 
Published: November 2024

Abstract

Background
Esophagectomy for cancer of the oesophagus is a complex surgery with significant morbidity. Protocols have been proposed to enhance recovery and reduce morbidities after this surgery.
A decade ago, we have introduced major changes to the traditional perioperative management of esophagectomy patients and have been able to introduce these changes and reproduce the same results in three different countries.

Method
While working in the NHS, the main author has introduced many changes in the perioperative management of esophagectomy patients.
The major changes included: 1- Injection of 200 units of Botox into the pylorus in the week prior to surgery. 2- No use of thoracic epidural and use of intercostal block instead. 3- Hybrid minimally invasive esophagectomy(HMIO) (Laparoscopic abdominal part and right thoracotomy). 4- Use of Heimlich valve instead of under-water seal bottle. 5- Avoidance of Opiate use and walking the patient on day 1 postoperatively.
These changes were introduced in two other countries namely; Egypt and Dubai.

Results
We studied 151 consequtive cases of esophagectomy from January 2014 till April 2024 (102 cases were performed in NHS Wales and 49 cases were performed in Egypt and Dubai).
Median age was 69 and range of 38 - 83 years. 94% had adenocarcinoma and 88% were stage 2b -3b. Neoadjuvant chemotherapy were given to 91% of patients.
All patients had the described changes applied.
Overall complication rate is 17.2% with Clavien-Dindo score of ≥ 3a in 8%. Anastomotic leak and 90-day mortality were 2.6%. Median hospital length of stay is 5 days.
There were no difference of outcomes in the three countries.

Conclusion
Preoperative injection of Botox into the pylorus, use of Heimlich valve instead of under-water seal bottle, use of intercostal block instead of thoracic epidural and avoidance of Opiate use when applied to HMIO significantly improve the short-term outcomes after esophagectomy.
These changes and outcomes are reproducible.
OGC SO17 - Right lateral approach to left gastric pedicle and Usage of articulated Signia Tri-stapler in Laparoscopic abdominal phase of a 2-stage Oesophagectomy
Authors: Loh Yong Yang Danielle , Kwan Xin Yi , Pua Qiao Ying , Viswanath Yirupaiahgari K S 
Published: November 2024

Abstract

Background
Advancements in oesophagectomy surgery over the past decade has seen an increase in minimally invasive oesophagectomies (MIE) being performed. Studies showed MIE had considerable advantages over open oesophagectomy by reducing intraoperative blood loss and post-operative complications while maintaining similar oncological outcomes1. In the abdominal phase of the Ivor-Lewis 2-stage oesophagectomy, a posterior approach is commonly used to dissect posterior gastric and left gastric vessels2.

Method
A 40-year-old patient with early malignant lesion underwent laparoscopic 2-stage oesophagectomy. In this video, we demonstrate using a right lateral approach to access and divide the left gastric vein and artery. Lymphadenectomy of stations 7 and 8a was also completed. A pyloroplasty is performed along with fashioning a gastric conduit using an articulated Signia tri-stapler, a smart stapler that adapts in real-time to tissue variability.

Results
The right lateral approach is superior to the more commonly used posterior lesser sac approach as it provides visuals of key vessel structures and spleen thereby reducing the risk of injury and bleeding. In the second stage, the Signia tri-stapler allows precise manoeuvres with fully powered articulation, rotation, and clamping, resulting in consistent staple lines and stronger staple lines.

Conclusion
Oesophagectomies remain a highly technical surgery with varied practices across centres and we would like to propose using a right lateral approach and articulated tri-stapler as a better technique that would reduce risk of bleeding and leaks.
OGC SO21 - Role of Staging Laparoscopy on oesophageal and junctional cancer management
Authors: Tokhi Ashraf , Reid Eleanor , North Samuel , Clarke Simone , Vohra Ravinder , Parsons Simon 
Published: November 2024

Abstract

Background
Staging laparoscopy and peritoneal cytology is currently recommended as a staging tool required for oesophageal and gastro-oesophageal junction (OGJ) adenocarcinomas. However, evidence is variable regarding the utility of this investigation, leading to heterogenous practice in the UK. With improved staging sensitivity of CT and PET imaging and inclusion of routine MDT discussion for upper GI cancer patients, staging laparoscopy may not be necessary for all patients with oesophago-gastric cancer, and in fact may delay their treatment. We thus aimed to assess the impact of staging laparoscopy on the treatment algorithm of patients with oesophago-gastric cancer.

Method
All staging laparoscopies undertaken between January 2022 and March 2024 were identified from our surgical database. Patients were included if they had oesophago-gastric adenocarcinoma, with a plan for curative treatment. Data collected included age, gender, location of primary tumour, CT/PET staging, laparoscopy findings, impact on treatment intention, neoadjuvant treatment, and final histology. Primary outcome was incidence of positive microscopic or macroscopic peritoneal disease for oesophageal and OGJ malignancy.

Results
127 patients were identified - 69 (55%) oesophageal, 25 (20%) GOJ, and 32 (24.4%) gastric cancer. 1/70 (1.4%) patient diagnosed endoscopically with oesophageal cancer had positive peritoneal disease, which was suspected due to pre-operative imaging findings of ascites and suspicions of linitis plastica. Of patients diagnosed with GOJ cancer, 4/25 patients (16%) had peritoneal disease present. None of the 39 patients with oesophageal/junctional tumours with clinical T1-2 disease were found to have peritoneal disease on staging laparoscopy. 6/32 (19%) patients with gastric cancer were found to have unexpected peritoneal disease present.

Conclusion
This study found minimal impact staging laparoscopy has on the management of primary oesophageal cancers. Consideration can be made of limiting staging in oesophageal cancer to patients with suspicious findings on CT/PET imaging. For GOJ tumours, there may be a role for limiting staging laparoscopy for Siewert 1 tumours to T3/4 tumours based on CT/PET findings. Importantly, accurate identification on primary endoscopy of the location of the tumour in relation to the gastro-oesophageal junction is necessary to help guide ongoing management.
OGC SO31 - Treatment of cachexia in gastric cancer: A literature review exploring the use of natural anti-inflammatory products and their derivatives
Authors: Loyala Jerocin , Down Billy , Wong Enoch , Tan Benjamin 
Published: November 2024

Abstract

Background
Gastric cancer is a major cause of global cancer-related mortality, with 5-year survival rates of 7% in advanced disease. Cancer cachexia, characterised by irreversible skeletal muscle loss driven by systemic inflammation, contributes to approximately 20% of cancer-related deaths. Cachexia differs from malnutrition in that it cannot be fully reversed with nutritional support alone. Current treatments that focus on nutritional support, psychological counselling and anti-inflammatory medication are lacking in efficacy. Natural dietary supplements and their derivatives such as fatty acids, probiotics, amino acids, curcumin, ginger and resveratrol, may offer additional therapeutic benefits in managing gastric cancer cachexia.

Method
A comprehensive literature review was conducted to evaluate the efficacy of natural anti-inflammatory products in managing gastric cancer cachexia. The review focused on widely studied compounds including omega-3 fatty acids, probiotics, amino acids, curcumin, fucoidan, epigallocatechin-3-gallate (EGCG), resveratrol and ginger, assessing their impact on inflammation, muscle mass preservation, and overall patient outcomes.

Results
Natural anti-inflammatory compounds demonstrate efficacy in mitigating cancer cachexia by reducing systemic inflammation and muscle wasting. Essential fatty acids from nuts, seeds, and fish oil decrease pro-inflammatory cytokines and improve chemotherapy tolerance. Probiotics reduce gut dysbiosis and may enhance chemotherapy tolerance. Essential amino acids may promote muscle anabolism and reduce catabolism. Curcumin, fucoidan, EGCG and ginger exhibit anti-inflammatory properties, with some improving appetite and reducing nausea. While promising, these compounds need further clinical trials to validate their efficacy and safety in cancer cachexia management.

Conclusion
Natural anti-inflammatory products hold promise as adjunctive therapies in management of gastric cancer cachexia. While preclinical evidence is encouraging, robust clinical trials are essential to confirm their efficacy and safety. Integrating these compounds with conventional treatments may offer a comprehensive approach to addressing the complex metabolic and inflammatory challenges of cancer cachexia, potentially improving patient outcomes. Future research should focus on understanding mechanisms, optimising dosages, and overcoming bioavailability challenges.
OGC SO32 - Propensity score analysis of the impact of deprivation and the COVID-19 pandemic on Upper Gastro Intestinal (UGI) cancer surgery outcomes
Authors: Herbert Geraint L , Abdelrahman Tarig , Powell Arfon , Witherspoon Jolene , Foliaki Antonio , Blackshaw Guy , Khalid Usman , Lewis Wyn G 
Published: November 2024

Abstract

Background
Deprivation is a complex, multifaceted concept, not synonymous with poverty, but with the potential to widen health inequalities. This study aimed to explore demographic disparities in patients undergoing UGI cancer surgery in a UK regional cancer network during the COVID-19 pandemic.

Method
Consecutive 881 patients were studied prospectively (median age 67 (24 - 89) yr., 703 m, 178 f; 518 oesophageal, 363 gastric; 837 Adeno-, 44 SCC) over 13 years. The COVID-19 pandemic was defined as the 24-month period from February 1, 2020 to January 31, 2022, during which 118 patients were treated. The demographic profile of the pandemic cohort was compared with that of the 763 patients treated outside this period incorporating a propensity score analysis. Primary outcomes were operative morbidity, mortality, and one-year survival. Wales’ Index of Multiple Deprivation was used to assess deprivation disparity.

Results
A 24% reduction in the number of cancer operations was observed during the first pandemic year. No difference was observed in age, gender, histology, tumour site, ASA grade, or oncological treatment. During COVID-19 the proportion of patients from the two most deprived quartiles receiving potentially curative surgery fell from 53.2% to 40.7% (p=0.012). No difference was observed in severe morbidity (Clavien-Dindo &gt;3, 22.2% vs. 19.8%, p=0.897), 30-day mortality (2.5% vs. 2.4%, p=0.886), or one-year survival (82.4% vs. 78.8%, p=0.374).

Conclusion
UGI cancer surgery safely continued during COVID-19, but patients from areas of high deprivation were over 20% less likely to access curative surgical treatment compared with before and after COVID-19. This emphasises the need for bespoke strategies to mitigate the disproportionate impact of any future pandemic on patients living in deprived geographical areas.
OGC SO37 - Pyloric drainage interventions for delayed gastric conduit emptying after oesophagectomy: A single centre analysis
Authors: James Eleanor , Santoro Giovanni , D’Souza Joel , Alam Mushfique , Bird Nicholas , Rao Rohith , Stephens Nathan , Gunasekera Rohan , Howes Nathan 
Published: November 2024

Abstract

Background
Oesophagectomy in combination with perioperative multimodal therapy is the cornerstone of modern curative treatment for resectable oesophageal cancer. Delayed gastric emptying (DGE) is a common postoperative complication that results from the anatomical and physiological changes in the gastric conduit after an oesophageal resection. It is associated with an increased risk of pneumonia, anastomotic leak and prolonged hospital stay. Although several prophylactic pyloric drainage interventions have been postulated to mitigate the risk of DGE, the optimal modality remains debatable. This study aimed to define the incidence, evaluate prognostic factors, and characterise the management of DGE following oesophagectomy.

Method
Consecutive patients who underwent an oesophagectomy for oesophageal cancer between January 2022 and March 2024 were retrospectively identified from a hospital database. Pyloric drainage procedures consisted of expectant management, endoscopic/open pyloric Botox and pyloroplasty. Univariable and multivariable analyses were performed to define the incidence of DGE after each pyloric drainage modality, evaluate prognostic factors for DGE, and characterise the need for subsequent intervention in the management of DGE.

Results
The study cohort comprised 137 patients – mean age 66 years, male 78%. The incidence of DGE was 31%. Pyloroplasty had the lowest incidence of DGE (16%) followed by endoscopic botox (21%). Intra-operative pyloric drainage reduced the risk of DGE (p=0.03). The modality of prophylactic pyloric drainage used significantly influenced the risk of developing DGE (p=0.028). No significant differences were identified between patient demographics, operative approach, and oncological variables in the development of DGE. On multivariable analysis, pyloroplasty was associated with a reduced risk of DGE (OR 0.27, 95% CI 0.09 – 0.71). DGE did not influence overall survival.

Conclusion
DGE is a common postoperative complication which affects up to 39% of patients undergoing oesophagectomy. Patients who did not undergo a prophylactic pyloric drainage procedure during the index oesophagectomy were at an increased risk of developing DGE. Most patients with DGE (71%) require further intervention via endoscopy and botox injection. Pyloroplasty as a prophylactic drainage modality significantly reduced the risk of developing DGE compared to endoscopic botox. Further prospective randomised controlled trials are required to validate these findings.
OGC SO45 - Effect of anastomotic technique on leak rates in two-stage robotic-assisted subtotal oesophagectomy
Authors: Cross Andrea , Brown Joshua , Phillips Alexander , Wahed Shajahan , Immanuel Arul 
Published: November 2024

Abstract

Background
Introduction of new surgical techniques requires constant monitoring and real time audit. In our unit the introduction of the thoracic component of our robotic oesophagectomy program resulted in an increase in the anastomotic leak rate which was recognised in real time. This prompted a decision to change from a circular to a linear stapled technique. The aim of this study was to evaluate the impact of this change in technique on the anastomotic leak rate.

Method
A database was used to identify all cases of patients undergoing two stage subtotal oesophagectomy where the thoracic phase was performed robotically-assisted. Demographic, operative, pathological and complications data were extracted. An anastomotic leak was defined as radiological or endoscopic disruption of the oesophagogastric anastomosis or where a clinician had documented the presence of a leak in the clinical notes. Leaks were then graded by severity according to the classification by Low et al into type 1: localised defect treated with medical therapy or observation; Type 2: localised defect requiring intervention but not surgery, and; Type 3: localised defects requiring surgery.

Results
Fifty-seven patients were identified. The first 25 cases were reconstructed with a circular-stapled and the subsequent 32 with a linear-stapled anastomosis. There were no differences in baseline demographics. There were no differences in thoracic operating time nor blood loss, intraoperative complications and pathological variables such as lymph node yield. Overall, 11/57 patients (19%) had an anastomotic leak, of which 7 (28%) had a circular stapled anastomosis and 4 (12%) had a linear stapled anastomosis. This difference was not statistically significant (p=0.2384). However, CUSUM analysis after the change in anastomotic technique showed an ongoing and diminished anastomotic leak rate.

Conclusion
In our unit changing from a circular to a linear stapled anastomotic technique resulted in a reduction in the anastomotic leak rate from 24% to 12%. While this was not statistically significant, this is a clinically appreciable result and this benefit was confirmed on CUSUM analysis.
BN SO03 - "Stuck in the Middle: A Case of SMA Syndrome on a 68/Male"
Authors: Alicer John Felix , Barnuevo Teodulfo 
Published: November 2024

Abstract

Background
A case is a 68-year-old male presenting with 1 year history of bilious vomiting, abdominal pain, weight loss and early satiety. Intraoperatively, the stomach, 1st and 2nd part of the duodenum were dilated, while the 3rd part of the duodenum was identified to be compressed by the superior mesenteric artery, distal duodenum and was noted to be collapsed, and a side-side duodenojejunostomy was performed. Post-operatively, the patient’s course in the ward was unremarkable. On 1-month follow up, the patient wasclinically well with no recurrence of symptoms, able to tolerate regular solid full diet and has gained weight since the procedure.

Method
N/A
CASE REPORT

Results
N/A
CASE REPORT

Conclusion
N/A
CASE REPORT
BN SO25 - Laparoscopic Management of Achalasia and Iatrogenic Mucosal Perforation in a Patient with Severe Reflux Following Multiple Therapeutic Dilatations
Authors: Pua Qiao Ying , Gada Parth , Kwan Yi Xin , Loh Danielle , Viswanath Y K S 
Published: November 2024

Abstract

Background
Laparoscopic Heller's cardiomyotomy (LHC) is the gold standard intervention for achalasia. Owing to its well-established complications of reflux symptoms, some surgeons perform an additional fundoplication surgery, although the consensus regarding the clinical benefits of this approach remains unclear.1 A meta-analysis showed that posterior fundoplication has proven to be superior to anterior fundoplication in controlling reflux symptoms.2

Method
A gentleman in his 60s reported ongoing severe reflux symptoms following multiple Rigiflex ballon dilatations for achalasia, on manometry and pH studies showed features of pathological acid reflux, incomplete lower oesophageal sphincter relaxation and defective peristalsis. As shown in the video, type 1 sliding hiatus hernia, submucosal fibrosis and peri-oesophagitis were seen intraoperatively. A short cardiomyotomy was performed, which was complicated by iatrogenic oesophageal perforation. Anterior fundoplication with mucosal closure was performed.

Results
Following the surgery, no leak was observed on the swallow test and the patient reported a massive improvement in reflux symptoms. The addition of fundoplication to LHC in patients with achalasia and reflux symptoms has improved clinical outcomes.

Conclusion
Concomitant LHC and anti-reflux surgery should be considered in patients presenting with achalasia and gastro-oesophageal reflux symptoms.