bluuebunny/crossref_metadata_2025_split huggingface dataset:
AHP P05 Attendee perceptions of a support group for patients and carers following Oesophageal or Gastric resection
Authors: Dossou Vida , Murphy Amy 
Published: November 2023

Abstract

Background
The benefits of patient support groups are widely recognised, playing a vital role in cancer survivorship. Patients undergoing Oesophageal or gastric resection for cancer are presented with an array of unique post operative and life altering symptoms. Patients and carers alike can be profoundly affected as they live with their cancer diagnosis and the impact of the substantial surgery. The ‘Little and Often’ support group was established 16 years ago to support patients and carers in this regard, meetings are held monthly at a hospital site venue and combine informal conversation with Health care professional speakers.as requested by attendees.

Methods
A survey was conducted at the ‘Little and Often’ support group amongst attendees, patients and carers alike (n=17). The survey was a combination of open questions and rating scales and was submitted anonymously. Patients and carers were also asked to describe their feelings prior to attending the support group, and to describe how they felt after attending the support group to see if attendance had a bearing. The results were collated and reflected upon to inform the format of future support group meetings.

Results
The results tell us that most patients and carers find the ‘Little and Often’ support group valuable to their cancer journey and survivorship. Many affirmative aspects were identified that had a positive impact on patient experience, and 82% attendees stated there was nothing they did not like about the group. 100% attendees liked having a Health care professional present and accessible at the group. 100% of attendees either strongly agreed or agreed that the group had made an important difference in their life in a safe space that left them with hope for the future.

Conclusions
This survey reinforces the perceived benefits of patients and their carers attending the Little and Often support group. The format of having a health care professional speak alongside informal conversation was welcomed by the attendees. The group facilitates a patients transition from feeling alone and isolated at times to feeling hopeful, supported, and positive about the future. It would be prudent to repeat this survey on a larger cohort of patient across a longer time scale, a validated quality of life assessment tool can be utilised to monitor the impact of the Little and Often group on patients and carers.
EGS P03 Outcomes from 450 Endoluminal Vacuum Therapy (EVT) Procedures in the Management of Upper Gastrointestinal Leaks and Perforations
Authors: Alkhaffaf Bilal , Powell Arfon , Ibrahim Ahmed , Farooq Naheed 
Published: November 2023

Abstract

Background
Anastomotic leaks and perforations of the upper gastrointestinal (UGI) tract are life-threatening conditions which result in significant rates of morbidity. There is no consensus with respect to how these challenging cases should be optimally managed.
Endoluminal vacuum therapy (EVT) is a novel approach for the management of leaks and perforations in the UGI tract. Proponents highlight the benefits of its use particularly in cases where major invasive surgery or re-operation would otherwise usually be required. We present the outcomes from nearly 450 EVT related procedures during the last 5 years.

Methods
A retrospective analysis of all UGI leaks and perforations managed with EVT between September 2018 and June 2023 was undertaken. This included patients who had undergone cancer resections (oesophagectomy and gastrectomy), bariatric surgery (both within and out with our centre) and those presenting with benign disease (e.g. oesophageal perforation and iatrogenic injury). The setting was a regional tertiary oesophago-gastric and bariatric centre in the North-West of England serving a population of over 3.5 million people. Demographic data, patient and disease factors, nutrition-related data, and outcomes related to EVT were collected. Descriptive and statistical analysis was undertaken.

Results
59 patients (43 males; median age 61) underwent 446 EVT related procedures during the study period, of which 52 (88%) were alive at discharge. Median LOS was 43 days. 66% (39/59) cases related to post-operative leak (resection 28, bariatric surgery 11) vs 11/59 spontaneous and 8/59 iatrogenic perforations. Median number of procedures was 6 (IQR 3-11) over a median of 21 days (IQR 11-41). Successful healing was achieved in 86% (51/59) cases. There was no difference in success rate between pathologies (p=0.88), however, iatrogenic perforations required fewer EVT procedures before healing (p=0.00). No adverse events were directly attributable to EVT.

Conclusions
UGI leaks and perforations represent a heterogeneous group which pose a significant management challenge. Our study suggests that EVT is a safe and effective approach in managing a broad range of different UGI leaks and perforations. EVT opens the possibility of active treatment for patients unsuitable for more invasive surgical intervention. Further study is required to standardise nomenclature, indications and follow-up. Comparisons to other management approaches are required to further explore the benefits for patients, taking into consideration clinical efficacy, impacts on quality of life and cost-effectiveness.
EGS P08 The effect of socioeconomic status on traumatic liver injuries: A prospective multicentre study
Authors: Koh Amanda , Lewis-Lloyd Christopher , Blackburn Lauren , Adiamah Alfred , Brooks Adam ,   LIPTA Collaborators
Published: November 2023

Abstract

Background
Abdominal traumas only represent 10% of all trauma-related injuries but is associated with significant morbidity and mortality. This is especially true for liver and pancreatic injuries. There is a growing interest in understanding the complex relationships between socioeconomic deprivation and trauma in recent years. Evidence from the US demonstrates that social deprivation is strongly associated with violent traumas and more severe injuries. There is, however, a lack of research examining the relationship between socioeconomic deprivation and severe abdominal traumas. This prospective multicentre audit investigates the association between socioeconomic status and the mechanisms and outcomes of liver and pancreatic traumas.

Methods
This prospective, multicentre audit was conducted through the National Trauma Research and Innovation Collaborative at18 participating major trauma centres and units in the United Kingdom between 01/01/2021 and 01/10/2021. The differences in patient demographics, mechanism of injury, injury severity score, operative management, length of hospital stay, and mortality were compared between patients from the five socioeconomic groups. The socioeconomic status for each patient was determined using the Index of Multiple Deprivation (IMD) tool, which is a recognised and validated tool published by the UK government. Chi-squared, Fisher’s Exact, and Kruskal-Wallis tests were used to compare categorical variables as appropriate.

Results
Of the 232 patients included, 75% were male. There is an increasing trend of deprivation in males, with 82.9% of the most deprived patients being male compared to the 66.7% in the least deprived quintile. The most deprived group had a lower comorbidity burden and were younger with a median age of 26 (IQR 19-39) compared to the least deprived group (median age 42, IQR 28-61,p&lt;0.01). Penetrating injuries occurred more frequently in the 3 most deprived groups, although this was not significant (p=0.09). There were no differences in the management, length of stay, and mortality between the 5 socioeconomic groups.

Conclusions
The findings of this prospective study adds to the growing body of evidence associating socioeconomic deprivation and major trauma in the UK. Despite the differences in patient demographics across the socioeconomic groups, the definitive management and mortality did not differ. The planning and provision of preventative public health intervention should target areas of higher socioeconomic deprivation.
EGS P09 Audit of Management of Acute Upper Gastrointestinal Bleeding against National Standard
Authors: Ng Shou Kee , Namade Mitesh , Adeoti Olayiwola Moses , Khan Khurram Shahzad 
Published: November 2023

Abstract

Background
Acute upper gastrointestinal bleeding (AUGIB) remains a common gastrointestinal emergency with varying standards of care, management practices, patient outcomes and high mortality rates in the United Kingdom. National strategic initiatives have been implemented in response to this, the most recent and definitive one being the AUGIB care bundle released by the British Society of Gastroenterology (BSG) led multisociety consensus in 2019. We audited our performance against BSG AUGIB care bundle.

Methods
This was a retrospective cohort study conducted in a single surgical unit on all consecutive adult inpatients who received emergency oesophago-gastro-duodenoscopy (OGD) from September 2021 to September 2022. Patients who were scoped for indications other than AUGIB were excluded. Patient demographics, inpatient hospital notes, laboratory multisociety consensus results, NCEPOD data and endoscopy reports were studied and analysed. These findings were then compared against recommendations as described by the BSG multiconsensus care bundle. The compliance target for each step was 100%. This study was registered with Clinical Quality Project (LanQIP 14739).

Results
150 OGDs were included; 79 (58.7%) were male and median age was 63 years (IQR 52.5-75.5). Median length of stay was 3.7 days (IQR 1.9-7.8). Melaena was the commonest presenting symptom (n=95, 63.3%). 54 (36%) presented with NEWS &gt;2 and 12 (8.0%) in shock. Offending medications was the primary risk factor in 66 patients (44%).
All OGDs had consultant supervision. 85 (56.7%) were performed in-hours. 55 (36.7%) had gastritis and 20 (13.3%) had oesophageal varices. 10 (6.7%) were re-admitted within 3 months. 30-day mortality was 8.0%. Our audit outcomes were as follow (Table 1):

Conclusions
Whilst senior clinician involvement was strong in our unit, there was a significant gap in concordance with BSG measures in applying the care bundle, GBS risk scoring and the resuscitation and medical management of acute bleeders. Formally implementing the AUGIB bundle from the emergency department into the admission unit will provide a framework for junior doctors to safely and systematically assess and resuscitate of patients with AUGIB, and guide timely planning for endoscopic intervention and follow-up by the senior clinical decision-maker. This should be continually re-audited to ensure improvement in performance together with outcome measures to ensure real change.
EGS P12 To Perform Magnetic Resonance Cholangiopancreatography or Not in Gallstone Pancreatitis? – A Single Centre Retrospective Cohort Study
Authors: Ng Shou Kee , Stevenson Carla , Ansari Fraz , Khan Khurram Shahzad 
Published: November 2023

Abstract

Background
The management of gallstone pancreatitis (GSP) is well-described in guidelines from the Association of Upper Gastrointestinal Surgeons (AUGIS) and British Society of Gastroenterologists (BSG). Guidelines recommend laparoscopic cholecystectomy (LC) for mild GSP within 2 weeks of the admission, with endoscopic retrograde cholangiopancreatography (ERCP) as second-line for unfit patients. Magnetic resonance cholangiopancreatography (MRCP) plays a pivotal role in excluding choledocholithiasis. Our aim was to determine if MRCP is required to rule out choledocholithiasis in patients with GSP.

Methods
A retrospective cohort study of all consecutive adult patients who had MRCP for GSP in a single centre from September 2020 to September 2022 was conducted. Patient demographics, pre-MRCP peak liver function test (LFT) values and MRCP findings were analysed. Patients were risk-stratified based on modified AUGIS guidelines using the presence of hyperbilirubinaemia and the presence of biliary duct dilation on other imaging modalities. Patients with MRCP-proven choledocholithiasis were compared to those without. P-values were calculated using Fisher’s exact test. This study was registered with Clinical Quality Project (LanQIP 14738).

Results
138 patients were identified; median age was 61 years (IQR 45-73) and 95 (68.8%) were female. 20 (14.5%) patients were post-cholecystectomy. 115 (83.3%) had inpatient scans and 66 (47.8%) were urgent. Median waiting time for inpatient MRCPs was 1.1 days (IQR 0.8-1.9) and 22.9 days (IQR 13.4-28.0) for outpatient scans.
25 (78.1%) patients had raised alkaline phosphatase levels and 23 (71.9%) had hyperbilirubinaenia. 61.1% of abdominal ultrasounds and 38.5% of CT scans reported dilated bile ducts.
MRCP yielded 32 patients (23.2%) with choledocholithiasis, 3 of whom were post-cholecystectomy. Choledocholithiasis on MRCP was strongly correlated to higher risk stratification.

Conclusions
MRCP is useful imaging modality determining the presence of choledocholithiasis in high and moderate risk patients with GSP. We recommend that intraoperative cholangiography should still be performed during laparoscopic cholecystectomy where expertise is available.
EGS P19 Do Waiting Times for Inpatient Magnetic Resonance Cholangiopancreatography Affect Total Length of Stay? – A Single Centre Experience
Authors: Ng Shou Kee , Stevenson Carla , Ansari Fraz , Khan Khurram Shahzad 
Published: November 2023

Abstract

Background
Magnetic resonance cholangiopancreatography (MRCP) is an important imaging modality in ruling out choledocholithiasis and thus guide management of patients. However, access to MRI remains limited, which may lead to delays in discharge. Our aim was to analyse the waiting time for inpatient MRCP and its impact on total length-of-stay (LOS).

Methods
A retrospective cohort study of all consecutive adult inpatients who underwent MRCP in a single surgical unit was conducted from September 2020 to September 2022. Patients being investigated for non-biliary indications including hepato-pancreato-biliary malignancies were excluded.
Patient demographics, laboratory results, MRCP indications, results and timestamps from the hospital’s radiology information system were analysed. Peak liver function test (LFT) values before MRCP were used. P-values were calculated using Student T-test. This study was registered with Clinical Quality Project (LanQIP 14736).

Results
677 patient has inpatient MRCPs; 22 were excluded. Median age was 66 years (IQR 51-76) and 401 (59.2%) were female. 281 (41.5%) MRCPs were urgent requests. 128 (18.9%) patients were clinically jaundiced and 115 (17.0%) had gallstone pancreatitis. 228 (33.7%) patients had choledocholithiasis on MRCP, of which 192 (84.2%) were known to have gallstones pre-MRCP.
Median waiting time for urgent MRCPs from time of order was 1.0 days versus 1.3 for routine requests (p&lt;0.001). Overall, median LOS was 6.7 days (IQR 4.1-10.9). This was 6.1 days (IQR 3.7-10.1) for urgent scans and 7.0 (IQR 4.5-11.5) for routine scans (p=0.106).

Conclusions
Inpatient MRCP does not significantly delay discharge in our centre. Patients screened for high-risk features of choledocholithiasis should have MRCPs marked as urgent to expedite clinical decision-making and mitigate complications from biliary obstruction. Therefore, it remains useful in determining the need for endoscopic retrograde cholangiopancreatography and/or intra-operative cholangiogram in patients with gallstone disease.
EGS P23 A rare case of gallstone ileus post Roux-en-Y Gastric Bypass: Stone migration from large duodenal diverticulum
Authors: Iosif Evangelia , Beynon Victoria , Monkhouse Simon 
Published: November 2023

Abstract

Background
Small bowel obstruction following Roux-en-Y gastric bypass is common and is mainly attributed to adhesions or internal herniation. Intraluminal formation of stones, usually in areas of stasis due to the anatomical changes post-RYGB, and migration to the distal ileum to cause acute bowel obstruction is rare. Impacted stones at the duodenal diverticulum can trigger diverticular inflammation, back pressure to the common bile duct and pancreas resulting in abdominal pain, nausea and vomiting, intermittent derangement of liver enzymes and episodes of cholangitis and pancreatitis. The impaction at the distal ileum is an emergency requiring prompt diagnosis and intervention to prevent complications.

Methods
This is a case report of a 56-year-old female who presented at East Surrey Hospital in February 2023 with recurrent upper abdominal pain, nausea and vomiting. She previously underwent an open cholecystectomy for cholelithiasis and cholecystoduodenal fistula (2003) and a Roux-en-Y gastric bypass (2018). Her symptoms were initially thought to be secondary to inflammation and periduodenal abscess managed with antibiotics, but as time and scans (CT, MRCP, water-soluble contrast, gastroscopy) progressed without resolution of her symptoms it became evident that she had developed mechanical bowel obstruction. We described her case and the diagnostic challenges leading to the final surgical management.

Results
To investigate the patient’s symptoms, her intermittently raised inflammatory markers, deranged liver enzymes and amylase a series of radiological examinations was rperformed. Initial CT scan showed an inflamed large duodenal (D3) diverticulum and fluid filled proximal duodenum. Subsequent MRCP demonstrated dilated common bile duct and intrahepatic ducts without any ductal stone. Repeat CT scan two weeks later, confirmed small bowel obstruction due to a heterogenous bolus at the ileocecal valve with resolution of the duodenal inflammation and dilatation. The patient underwent a laparoscopic extraction of a stone impacted at the ileocecal valve causing small bowel obstruction and recovered well.

Conclusions
Even though small bowel obstruction due to stone aggregation is uncommon post-RYGB, a high index of suspicion for the diagnosis and a low threshold for early laparoscopic intervention can prevent further serious complications. Reporting these cases in literature offers a guidance for the workup and management of these unusual scenarios amongst surgical teams and improves patients’ outcomes.
EGS P24 Management of oesophageal denture impaction and complications - a case series
Authors: Doran Sophie L F , Mohammadi Borzoueh , Tamhankar Anand P 
Published: November 2023

Abstract

Background
Dentures are sometimes inadvertently ingested and can impact in the oesophagus. This can lead to complications such as mediastinitis, perforation and major vascular fistulae. In 1914, Chiari coined ‘aorto-oesophageal syndrome’ following foreign body ingestion. Usually diagnosed post-mortem, he described a triad of chest pain, haematemesis and cardiac arrest resulting from perforation and aortic fistula. Modern dentures are radiolucent, have complex configurations and commonly impact in the oesophagus at the level of the aortic arch. Early specialist intervention by experienced oesophago-gastric (OG) surgeons is crucial to the prognosis. We present our personal experience of managing oesophageal denture impaction and complications.

Methods
A retrospective review of electronic health records of the authors’ case series of patients with a diagnosis of oesophageal denture impaction over a 13-year period from 01/01/2010 to 31/12/2022 was performed. The inclusion criteria was adult patients with a clinical diagnosis of oesophageal denture/dental bridge impaction. Pathology and complications from impaction and mode of intervention was reviewed. Other outcome measures evaluated were treatment complications, length of stay and 90-day mortality.

Results
Seven patients (6 males) with median age 54 were reviewed. Dentures were impacted at or above the aortic arch in 6 patients. Attempted retrieval with ENT rigid scope in 3 caused migration of denture causing perforation. Attempted retrieval with flexible gastroscope was successful in 3 but led to opening up of a fistula in one. Five patients underwent surgical intervention (results summarised in tables 1 and 2). 90-day mortality was 0%. The median length of stay in the surgical intervention group was 30 days. Two patients who had aorto-oesophageal fistulae required additional input by cardiac surgery and vascular radiology teams.

Conclusions
This is a report of the authors’ experience of managing oesophageal denture impaction and it’s sequelae. A favourable 0% 90-day mortality rate despite complex presentations including aorto-oesophageal fistulae has been described. For patients presenting with haematemesis or prolonged history of denture impaction a triple phase CT scan should be performed prior to intervention. The variable complex configuration of dentures complicates their impaction or attempts at extraction. Attempts at extraction with a rigid endoscope can lead to oesophageal perforation. Successful management of these complex cases requires an effective multidisciplinary approach in a specialist OG surgery centre.
EGS P25 Patient outcomes after percutaneous cholecystostomy at Dorset County Hospital
Authors: English Camilla , Gavrila Ana , Rao Sudhindra , Chen Mengting , Abel Abel , Saberi Seena 
Published: November 2023

Abstract

Background
No guideline for percutaneous cholecystostomy exists at Dorset County Hospital, nor has an audit looking into patient outcomes after percutaneous cholecystostomy previously been carried out. This audit aims to identify the indications for cholecystostomy insertion, timing of insertion, complications thereafter, timing of any tubograms, and follow-up of patients after cholecystostomy. No universal management guidelines for percutaneous cholecystostomy currently exist, though studies have proposed treatment algorithms.

Methods
Retrospective cohort audit of all patients who underwent cholecystostomy insertion at Dorset County Hospital over 6 years from January 2017 – December 2022. Data was provided by the local radiology department of all abdominal drains inserted in this period, with further information collected from discharge summaries, clinic letters and tubogram data on local clinical systems. Data was inputted to and analysed on Microsoft excel.

Results
Between 2017 – 2022, 38 cholecystostomy drains were inserted. More men than women received drains, with a mean age of 71.8 at insertion. Inpatient stay varied from 2-71 days, with mean of 3 days between admission and drain insertion. 30 patients avoided cholecystectomy, whilst 34% of patients were re-admitted with drain-related or underlying pathology-associated complications.

Conclusions
Indications for drain insertion are in keeping with medical literature as a means of biliary sepsis control. Cholecystostomy was the definitive gallstone disease procedure for most patients. Most also had tubograms, yet tubogram timings varied significantly likely reflecting the lack of universally accepted management guidelines. This audit identified patients who have benefited from cholecystostomy insertion, allowing creation of a local management guideline for patients with biliary sepsis who undergo percutaneous cholecystostomy.