bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGBN P23 Diagnosing and mapping Barrett's oesophagus: a need to be better
Authors: Asarbakhsh Mariam , Singh Gautam , McDonald Claire , Olejnik Hannah , Megson Tyler , Verma Harsh , Saha Arin 
Published: November 2023

Abstract

Background
The diagnosis of Barrett's oesophagus is made by endoscopic assessment of the oesophageal epithelium and histopathological confirmation of intestinal metaplasia on oesophageal biopsies. There are clear standards for the diagnosis of Barrett's oesophagus described by the British Society of Gastroenterologists (BSG). It is vital to maintain these standards to ensure accuracy of diagnosis (to prevent both over-diagnosis and under-diagnosis) and to ensure that conversion to dysplasia or neoplasia is not missed. This study aimed to assess the quality of Barrett's surveillance at our institution and implement changes in our service to improve diagnosis.

Methods
All patients who were due to have Barrett's surveillance endoscopy in 2022 were identified from our electronic hospital waiting lists. Initial endoscopy reports, where the Barrett's was diagnosed, were obtained and assessed for quality of adherence to BSG standards, such as image capture, number of biopsies, recording of Prague classification, use of high-definition screens and use of adjuncts (such as infacol or acetic acid). Histopathological reports were obtained and assessed for correlation with endoscopic findings.

Results
192 patients were identified for this study. All had Barrett's oesophagus diagnosed between 2016 and 2020, either on endoscopic grounds, histopathological suggestion of intestinal metaplasia, or both. A total of 29 different endoscopists (including consultant gastroenterologists, surgeons, trainees, nurse endoscopists and endoscopists from outsourcing companies) had performed the primary diagnostic scope in this cohort. 55 patients (29%) did not have any images captured and recorded on their endoscopy report. 36 patients (19%) did not have a Prague classification recorded. Only 127 patients (66%) had intestinal metaplasia on biopsies. p53 status was not recorded in any case.

Conclusions
This study highlights several deficiencies in the current practice of diagnosis of Barrett's oesophagus and these findings may be replicated in other units. These data have been used to develop a wide-ranging quality improvement programme for Barrett's surveillance, including dedicated Barrett's lists shared amongst a small number of experienced endoscopists, use of a high resolution scope and camera system, image capture and appropriate 'pointing' of procedures to allow enough time for accurate mapping and use of endoscopic adjuncts.
OGBN P24 Primary symptom indication can be a predictor of outcomes in revisional anti-reflux surgery
Authors: Krishnan Sailakshmi , Falk Gregory 
Published: November 2023

Abstract

Background
Symptom recurrence after primary hiatus hernia surgery is an established problem and revision anti-reflux surgery may be indicated in select cases of recurrence after primary surgery. Previous studies on this subject are of small number and often lack objective measures. Our aim is to assess the relationship between primary symptom indication and a variety of objective and subjective post operative outcomes.

Methods
A prospectively maintained single surgeon database of revisional hiatus hernia surgery from 1992 to 2022 was retrospectively evaluated. This was a consecutive cohort of adults greater than 18 years of age. The symptomatic, anatomical, and physiological indications for surgery were reviewed. The symptoms described by patients were grouped into four categories: typical reflux, volume, obstructive and gastric motility symptoms. The intraoperative findings and post operative outcomes were analysed. The dataset consisted of 379 patients, of whom 59% were female. The average age of this cohort at the time of primary revisional surgery was 59 years (range 19-91).

Results
Intraoperative findings of the revision operations found that 32% had a large hiatus hernia, 30% had a small hernia, 16% had a moderate hernia, 8% had a very large hernia. Patients who initially presented with volume symptoms appeared more likely to have two or more revision operations than patients who presented with no volume symptoms. Symptom score improvement was seen in reflux and dysphagia symptoms following revisional surgery. No significant improvement was seen in volume symptoms. Symptom focused questions in the GIQLI score demonstrated a statistically significant improvement in dysphagia symptoms 12 months post surgery (p=0.021).

Conclusions
Patients presenting initially with volume symptoms may be more likely to require multiple revision operations. This could be either due to an undiagnosed underlying motility disorder or advanced severity at presentation. Consideration of an alternative procedure such as roux-en-y gastric bypass could be entertained in this group.
OGBN P28 Accuracy of Barium Swallow and PH Manometry on Pre-operative Anti-reflux surgery
Authors: Nagarajan Ashitha , Goutham Meera , Jagtiani Minal , Pore Naresh , Sheth Hemant , Raje Durgesh 
Published: November 2023

Abstract

Background
Fundoplication is one of the common surgical procedures offered to patients who have not responded to medical or conservative treatment for Gastroesophageal-Reflux-Disease.Within our trust routine-PH manometry,barium swallow and OGD are preferred pre-op investigations.According to the guidelines set forth by SAGES(Society of American Gastrointestinal and Endoscopic Surgeons)-PH manometry and endoscopy are recommended as the preferred methods for pre-operative assessment.PH manometry is considered the gold standard for detecting reflux and dysmotility.Our objective is to evaluate and compare the local practice with published literature on identifying the accuracy of pre-operative barium swallow and ph manometry in diagnosing reflux and dysmotility.

Methods
A retrospective review of electronic medical records of patients who had Nissen fundoplication at Ealing Hospital between January2017-December2022 was included in the study. Among these, patients who had both pre-operative assessments - barium swallow and Ph manometry were included in the cohort. Initial data was retrieved from the Surgical operating service list and was further analyzed with the help of EPRO ( Electronic information provider) for information on Barium swallow, Ph manometry studies, and postoperative outcome.

Results
In a study of 54 Nissen Fundoplication patients (mean age M&F 58), 25 underwent pH manometry and barium swallow- Concordant positive results were found in 13 patients (52%), indicating reflux. Discordant results occurred in 11 patients (44%) with positive manometry but negative barium swallow, favoring pH manometry's sensitivity. Of the 25 patients analyzed, 20 (80%) had good symptom control, while 3 (12%) experienced symptom recurrence, and 2 (8%) missed follow-ups. Barium swallow missed 8 dysmotility cases, while pH manometry missed 4. Among 46 patients with detected hiatus hernia by OGD, only 26 (54%) were accurately diagnosed using barium swallow.

Conclusions
Our study demonstrated that Ph manometry is a reliable pre-operative assessment tool for anti-reflux surgery, achieving 100% accuracy in detecting reflux compared to only 55% accuracy with barium swallow. With dysmotility, Ph manometry showed better results of 67% whereas barium swallow identified only 33%. Barium swallow should be used as an additional investigation for failed pH studies and reflux-related dysphagia symptoms. It can also be valuable in post-operative cases to evaluate wrap position and potential complications due to tightness. These findings were presented at the local surgical audit meeting, and future cycles will focus on guideline compliance assessment.
OGBN P34 Telemedicine clinics are a safe and feasible alternative to preoperative face-to-face assessments for day case laparoscopic cholecystectomy surgery: a retrospective cohort study
Authors: Siraj Lakha Adil , Urbonas Tomas , King Emily , Pepes Sophia , Ceresa Carlo , Udupa Venkatesha , Soonawalla Zahir , Silva Michael A , Gordon-Weeks Alex , Reddy Srikanth 
Published: November 2023

Abstract

Background
The telemedicine clinic for follow ups after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to assess the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy.

Methods
We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates. Statistical analysis was done using JASP 0.16.2 software.

Results
We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 6.8% of patients had surgery cancelled on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal or higher than grade 3) were observed in 1% of patients. 30-day readmission rate was 11%.

Conclusions
Our series showed that it is feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, environmental impact, and healthcare economics to support its routine use in general surgery.
OGBN P42 Surgical innovation in the NHS: the role of local hospitals, NICE and the health research authority
Authors: Wallis Lucy , Cousins Sian , Blazeby Jane 
Published: November 2023

Abstract

Background
Innovation in surgery is key to advancing care. Innovation, however, may carry risk. Oversight of innovation therefore is needed to ensure transparent patient consent, learning from adverse events and efficient decision making for innovation scaling-up, non-adoption or abandonment. In the UK this may be regulated by an ethically approved research protocol or by committees in NHS local hospitals. The National Institute of Clinical Excellent (NICE) makes recommendations for appropriate oversight but little is known about interactions between local NHS hospital committees and NICE. We explored decision-making about surgical innovation in the local NHS committees in relation to NICE guidance.

Methods
A prospective study of five hospitals in England was undertaken between February 2022 and March 2023. Decisions made by the local new procedures committees and meeting minutes were all reviewed. Where NICE guidance was available this was compared to the local hospital decision about the new procedure. Where no guidance was available decisions were recorded and analysed based on available evidence and practice. Whether hospitals referred the innovation to NICE was also recorded.

Results
In the 12 month period 38 decisions about innovative surgical procedures were made (range 1 to 22 per hospital) in 30 meetings. For 16 innovations NICE guidance was thought to be available and implemented. Further analyses identified that two sets of guidance did not apply (e.g. application of laparoscopic to robotic procedures). 17 innovations were considered at meetings for which NICE guidance was not available. None were referred to NICE. 15 were approved to be undertaken in the hospital, 2 were recommended to seek research ethics approval and 1 was rejected.

Conclusions
Local hospital committees make important recommendations about the introduction of innovative surgical procedures in the NHS. NICE guidance was sometimes difficult to find and interpret and new procedures were generally not referred to NICE. Few were rejected or recommended for research ethics approval. This approach means that local hospitals have large governance responsibilities and there may be inconsistencies across organisations and patient risk. A national strategy is needed to make surgical innovation transparent and safe.
HPB P01 Evaluating quality of life outcomes following Total Pancreatectomy and Islet Autotransplant for Chronic Pancreatitis
Authors: Hughes Daniel , Pandirajan Kamashi , Fox Jennifer , Silva Michael 
Published: November 2023

Abstract

Background
Chronic Pancreatitis (CP) is a debilitating condition that is associated with significant patient morbidity. The disease is characterised by chronic abdominal pain that is recurring and relapsing, which subsequently has a significant impact on the patients’ quality of life. In addition to the stigma associated with the disease, patients often undergo social isolation and are unable to maintain functional status. Total Pancreatectomy and Islet Auto transplant for Chronic Pancreatitis (TPIAT) serves as opportunity to alleviate the pain whilst preserving endocrine function. Our aim was to evaluate whether TPIAT also improved patients quality of life.

Methods
A retrospective review of all patients referred to the TPIAT service in Oxford between 2019 -2022 was performed. Clinical information was recorded regarding patient demographics, aetiology and previous treatment of CP, intraoperative data (islet yield secured) and post operative complication rate. Long term endocrine function, analgesic use and quality of life was formally assessed.

Results
Of the 39 patients referred to the service, 23 (59%) were listed for TPIAT. TPIAT was successfully performed in 21 patients. The median age of this cohort was 22. Hereditary pancreatitis was the most frequent aetiology in 48%. The median length of stay post procedure was 12.5 days. During the last follow up, freestyle libre interrogation highlighted that 79% of patients had blood sugars within the target range. A significant reduction in analgesia use was noted (p=0.001), in addition to a marked reduction in opiate based analgesics (p=0.001). Resolution of pancreatic pain was also significantly apparent in the cohort (p=0.001).

Conclusions
TPIAT for CP serves as an effective treatment strategy as it provides symptomatic relief for patients, reduces long term narcotic use, permits glycaemic control and improves quality of life for patients.
HPB P06 The clinical and molecular landscape of early onset pancreatic cancer
Authors: Dreyer Stephan , Bryce Adam , Jamieson Nigel , Biankin Andrew , Chang David 
Published: November 2023

Abstract

Background
The incidence of Pancreatic ductal adenocarcinoma (PC) is rising in the western world. There is a particularly concerning trend in the rapid increase in incidence of early onset PC (EOPC). The reason for this, and the implications of EOPC is not well understood. The aim of this study was to investigate the clinical outcomes of patients with EOPC and the molecular heterogeneity between EOPC and late onset disease.

Methods
Clinical, pathological and survival outcome data was obtained from 2 large independent prospective cohorts curated by the Australian Pancreatic Genome Initiative (APGI) and the West of Scotland pancreatic unit (Glasgow Royal Infirmary). Patients were categorised into 2 age groups, &lt; 50 and &gt;50 years at time of diagnosis. Clinicopathological and outcome data were compared between groups. Molecular data was obtained from the APGI’s contribution to the International Cancer Genome Consortium, this included transcriptomic, genomic and immunohistochemical data. Molecular subtypes, gene expression signatures, mutational signatures, and tumour microenvironment data was compared between groups.

Results
N=851 patients were identified and n=71 (8%) were &lt; 50 years old. EOPC was associated with earlier recurrence (10.9 vs 14.2 months, P=0.011) and higher incidence of liver recurrence (50% vs 37%, P=0.031). There were no differences in validated clinicopathological variables. Despite an increased proportion of patients with EOPC receiving adjuvant chemotherapy (P=0.020), recurrence was earlier in those that completed &gt; 3 cycles (12.6 vs 16.0 months, P=0.022). There is enrichment of the poor prognostic squamous (basal) subtype (42% vs 28%) in EOPC. There were no differences in the incidence of germline mutations to account for the early onset of disease.

Conclusions
EOPC appears to be increasing in incidence and is associated with earlier recurrence and more aggressive disease pattern. This appears to be associated with resistance to adjuvant chemotherapy and more aggressive, adverse molecular pathology. The onset of early disease cannot be explained by inherited genomic aberrations. Ongoing mutation signature, gene expression and microenvironmental data analysis will be presented upon acceptance of this abstract.
HPB P08 Is Biliary Hyperkinesia a true Pathology? Should cholecystectomy be considered? A prequel towards Pilot study
Authors: Ali Kiren , Shahzad Khan Khurram 
Published: November 2023

Abstract

Background
Biliary Hyperkinesia (BH) is defined as a condition where gallbladder contracts and empties more rapidly than usual causing recurrent biliary colic with no evidence of gallstones on ultrasound or MRCP. Hepatobiliary iminodiacetic acid (HIDA) scan is the investigation of choice and shows gallbladder ejection fraction (EF) of &gt;80% in BH. A recent systematic review and meta-analysis suggested that laparoscopic cholecystectomy (LC) could alleviate the symptoms. Similar results have been highlighted in case reports published about this relatively new gallbladder dysmotility. This study investigates the number of patients with BH on HIDA scan who might qualify for LC.

Methods
This was a 7-year (2015 to 2022) retrospective cohort study of adult patients with biliary pain in the absence of gallstones who underwent HIDA scan. Patient with EF &gt;80% on HIDA scan were included in the study. Electronic case notes were reviewed for demographics, body mass index (BMI), smoking status, liver function tests, duration of symptoms, radiology investigations and endoscopy result including endoscopic ultrasound (EUS).

Results
225 patients had HIDA scan of which 37 (16.4%) patients had BH. Median age was 49 years (IQR 38-62) and 32 (86.4%) were female. Median BMI 28 (IQR 23.3-32.4) and 48.3% were smokers. 5 (13.5%) were referred for pH manometry and gastric emptying studies while 25 (67.5%) have been formally discharged from surgery clinic follow-up. 7 (18.9%) are still waiting for further review.
Only two patients had LC; one 3 years post HIDA when repeat ultrasound eventually showed gall stones and histopathology confirmed chronic cholecystitis. The second patient had sludge seen on EUS and histopathology confirmed chronic cholecystitis.

Conclusions
The hypothesis that overactive emptying of gallbladder represented by a high EF on HIDA scan leads to pain is somewhat convincing. High biliary pressure in a short circuit bounded by gallbladder/cystic duct junction and sphincter of Oddi causes gallbladder mucosal damage and cholecystitis. However, could there be missed stones or sludge is something that still needs to be considered. EUS might be of additional value before diagnosing patient with biliary hyperkinesia. Surgeons should consider LC in patients with BH once other pathologies have been ruled out. Further studies are needed to understand the outcome of cholecystectomy in BH.
HPB P17 Preoperative cardiovascular disease and outcomes ofpancreatoduodenectomy performed for malignancy
Authors: Hall Thomas , Kahar Nurul , Nadeem Nabeegh , Shah Nehal 
Published: November 2023

Abstract

Background
Despite improvements to morbidity and mortality rates in recent decades, pancreatoduodenectomy (PD) remains a high-risk operation. Patients with pre-existing cardiovascular disease (CVD) are known to be at increased risk of perioperative morbidity and mortality. Evidence is lacking on the impact of CVD on long-term outcomes. This study aimed to compare the outcomes of PD patients with preoperative CVD to those without.

Methods
Data was extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1484). Pre-existing CVD included any of the following: hypertension (HTN), atrial fibrillation (AF), other cardiac arrhythmia, ischaemic heart disease (IHD), previous cardiovascular surgery, heart failure, peripheral vascular disease (PVD), previous stroke, previous transient ischaemic attack (TIA), pulmonary HTN, deep vein thrombosis, valve disease, cardiomyopathy, subarachnoid haemorrhage, peri-/myocarditis and myocardial infarction. Several outcomes were compared: length of stay, 30-day readmission, 90-day mortality, unplanned return to theatre rate, and five-year survival.

Results
From 1484 cases, 590 patients (39.8%) had pre-existing CVD. HTN, AF, other cardiac arrhythmia, IHD, previous cardiovascular surgery, heart failure and PVD affected 33.0%, 3.6%, 1.0%, 5.3%, 1.9%, 1.3% and 1.5% of patients, respectively. Remaining pathologies surmounted to &lt;1%. 30-day readmission (10.5% vs 8.1%, p=0.1), 90-day mortality (4.4% vs 3.2%, p=0.3), unplanned return to theatre (5.2% vs 4.8%, p=0.7) and five-year survival (31.2% vs 32.1%, p=0.7) were similar between the patient groups, however, median LoS was significantly longer in those with CVD (14 vs 12 days, p&lt;0.0001). Similar results were obtained when hypertension was not classified as a cardiovascular comorbidity.

Conclusions
In our multicentre study of PD outcomes, patients with a preoperative cardiovascular comorbidity had longer length of stay than those who did not but the other studied outcomes were unaffected.
HPB P31 Delayed discharges in day-case cholecystectomies, a real issue?
Authors: Martinuzzi Michela , Kaur Sukham 
Published: November 2023

Abstract

Background
Elective cholecystectomies are a very common general surgical procedure accounting for approximately 66660 cases a year and costing large amounts of resources to the NHS with significant regional variations in day-case rates1. Initiatives such as Get it Right First Time (GIRFT) aimed at improving the treatment of NHS patients are currently pushing for an increase in day-case rate to at least 75% of all cases and a decrease in regional variations2. The aim of this project was to determine how many patients underwent a day-case elective cholecystectomy, the percentage of delayed discharges and any reasons for the delay.

Methods
Retrospective analysis for which all adult patients admitted for a cholecystectomy at a district general hospital, in six consecutive months were included. For all included patients, ASA score, average age, length of stay, diagnosis and reason for delayed discharge were recorded. Reported complications were also included in the analysis. All data was collected via screening of local electronic health records.

Results
217 patients were included in the analysis. 58% were discharged on the same day; of those not discharged on the same day non-elective operations and planned elective inpatients accounted for 28% and 17% of the total respectively. 75% of all included patients was female and all planned day-cases patients were either ASA1 or 2. Reasons for delayed discharge of planned day-cases included drain placement (18%), social issues (4%), nausea and pain (10%), not meeting discharge criteria such as inability of passing urine (14%) and for 24% of patients no reason was recorded.

Conclusions
Studies have shown that the combination of high ASA and increasing age reduce the likelihood of same day discharge.3 Our study found documentation to be often inaccurate and a potential for better pre-operative selection of patients in order to ensure high levels of safe day-case cholecystectomies.