bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP5.11 A systematic review of participant descriptors reported in studies of small bowel obstruction
Authors: Rashid Adil , Kumar Mithun , Lee Matt J 
Published: August 2023

Abstract

Aim
Reporting of participant descriptors in studies of small bowel obstruction (SBO) can help identify characteristics associated with favourable outcomes and allow comparison with other studies and real-world clinical populations. The aim was to identify the pattern of participant descriptors reported in studies assessing interventions for SBO.

Method
This systematic review was registered with PROSPERO (CRD42021281031) and reported in line with the PRISMA checklist. Systematic searches of Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were undertaken to identify studies assessing operative and non-operative interventions for adults with SBO. Studies were dual screened for inclusion. Descriptors were categorised into conceptual domains by the research team.

Results
Searches identified 2648 studies, of which 85 were included. A total of 168 unique descriptors were identified. On average, studies reported 12 descriptors. The most frequently reported descriptors were sex, age, SBO aetiology, history of abdominal surgery, BMI and ASA classification. The highest number of descriptors in a single study was 34, compared to the lowest number of descriptors which was one. Pathway factors were the least frequently described domain. Overall, 43 descriptors were reported in just one study.

Conclusion
There is a lack of consistency in participant descriptors reported in studies of SBO. Furthermore, a significant proportion of the descriptors were used infrequently. This makes it challenging to assess whether study participants are representative of the wider population. Further work is required to develop a Core Descriptor Set to standardise the reporting of patient characteristics and reduce heterogeneity between studies.
SP6.1 Short-term and long-term remission of Type 2 diabetes mellitus after Sleeve Gastrectomy (SG) vs One-Anastomosis Gastric Bypass (OAGB) vs Roux-en-Y Gastric Bypass (RYGB): A Narrative Literature Review
Authors: Balasubaramaniam Vignesh 
Published: August 2023

Abstract

Aim
The three most widely performed bariatric surgeries are RYGB, SG, and OAGB. Aside from the benefits of weight loss, current findings suggest that these procedures can also induce remission of T2DM. There are limited data that directly compare these three procedures. This study aims to compare the short-term and long-term remission of T2DM after RYGB, SG, and OAGB.

Methods
Three databases (Embase, PubMed, and Cochrane) were searched for randomised controlled trials, systematic reviews, meta-analyses, retrospective studies, and literature reviews that compared the effects of RYGB, SG, and OAGB on T2DM remission. The studies were published over a ten-year period (2012 - 2022). Only patients with T2DM and who had primary bariatric surgery were included.

Results
After applying the inclusion and exclusion criteria, six articles were included in the review. It was found that OAGB had superior T2DM remission and weight loss in the short-term and long-term follow-up. RYGB was noted to have the highest complication rate when compared to SG and OAGB. Moreover, in one of the studies, patients who were not taking insulin had a higher remission rate than those taking insulin.

Conclusion
This narrative literature review confirms the existing data that all three bariatric surgeries induce remission of T2DM. With the limited studies available that compared all three procedures, OAGB was found to be the superior procedure in terms of weight loss and inducing remission of T2DM. It is also worth noting that there are other independent predictive factors that have an impact on T2DM remission.
SP6.2 The Prognostic Impact of Pre-Treatment Cachexia in Patients Undergoing Resectional Surgery for Oesophagogastric Malignancy: A Systematic Review, Meta-Analysis & Meta-Regression
Authors: Brown Leo R , Sayers Judith , Yule Michael , Drake Thomas M. , Wigmore Stephen J. , Skipworth Richard J.E. 
Published: August 2023

Abstract

Background
Cancer cachexia is not purely an end-stage phenomenon and even influences the outcome of patients with potentially curative malignancies. This review aims to examine the effect of pre-treatment cachexia on survival in patients undergoing resection of an oesophagogastric malignancy.

Methods
A systematic literature search of MEDLINE, EMBASE and Cochrane Library databases was conducted, from January 2000 to May 2022, to identify studies reporting the influence of pre-treatment weight loss or cachexia on patients undergoing an oesophagogastric resection for cancer with curative intent. Meta-analyses of the primary (overall survival) and secondary (disease-free survival and postoperative mortality) outcomes were performed using random-effects modelling. Meta-regression was used to examine disease stage as a potential confounder.

Results
Ten non-randomised studies, comprising 7186 patients, were eligible for inclusion. The prevalence of pre-treatment cachexia was 35% (95% CI: 24-47%). Pooled adjusted hazard ratios found cachexia to be associated with decreased overall survival (HR 1.46, 95% CI: 1.31-1.60, p&lt;0.001). Meta-analysis of proportions confirmed decreased overall survival at 1-, 3- and 5-years in weight-losing cohorts. Pre-treatment cachexia was not a predictor of disease-free survival and further data are required to establish its influence on postoperative mortality. The proportion of patients with T3/4 tumours was a significant moderator of between-study heterogeneity (p=0.018). Cachexia appeared to have a greater effect on overall survival in studies with a higher proportion of locally advanced tumours.

Conclusions
Pre-treatment cachexia adversely influences overall survival following resection of an oesophagogastric malignancy. Consideration of weight loss, during the shared decision-making process, may improve risk-stratification and facilitate targeted interventions.
SP6.4 Economic cost-utility analysis of stage-directed oesophageal cancer treatment
Authors: Herbert Geraint , Barlow Emma , Eley Catherine , Robinson David , Powell Arfon , Lewis Wyn 
Published: August 2023

Abstract

Aims
Oesophageal Cancer (OC) treatment levies substantial financial burden on health services with potentially curative surgery with or without neoadjuvant offered to patients with locoregional disease. This study aimed to examine treatment costs related to Quality Adjusted Life-Years (QALYs) gained in patients that have potentially curative treatment (oesophagectomy) and those receiving best supportive care (BSC).

Methods
Consecutive 365 patients undergoing potentially curative treatment (median age 64.5 years, 308 male, 57 female, 331 adeno ca, 32 squamous cell ca, 2 high grade dysplasia, 263 neoadjuvant therapy) were studied. The cost of one-year’s treatment from referral was calculated based on current management standards within a regional cancer network and primary outcome was overall survival.

Results
QALY-adjusted survival for stage I was 48 months, stage II 30.6 months, stage III 23.0 months, and stage IV 13.0 months, with cost per QALY of £6038, £13412, £14606, and £20002 respectively. QALY-adjusted survival for patients receiving BSC was 2.24 months, with a cost per QALY of £60225. This gives an Incremental Cost-Effectiveness Ratio (ICER) per QALY for stages I to IV of £3385, £9714, £8740 and £17763 respectively.

Conclusion
Cost per QALY of potentially curative OC treatment for each stage was below national thresholds of readiness to pay per QALY, while BSC likely exceeds this. Regarding ICER-defined cost effectiveness, treatment of stage I was five-fold cheaper than stage IV OC, supporting early diagnosis as being most cost-effective.
SP6.5 Outcomes in Oesophagogastric Cancer up to 18 months following the COVID-19 pandemic
Authors: Khan Khurram , Gall Lewis , McCollum Catherine , Sundarraj Jeeva , McGovern Josh , Forshaw Matthew 
Published: August 2023

Abstract

Aims
COVID-19 has negatively influenced oesophago-gastric (OG) cancer prognosis with stage migration described during the first six months of the pandemic. This study investigated the medium term effect of the national lockdown on diagnosis, management and outcomes.

Methods
A retrospective cohort study of all newly diagnosed OG cancers in a single regional MDT between 1 October 2019 and 30 September 2021. Patients were divided into four 6-month period based upon date of first MDT discussion in relation to the first UK national lockdown: pre-lockdown, 0-6, 6-12 and 12-18 months post-lockdown. Electronic health records were reviewed and results compared.

Result
664 patients with OG cancers were included. Median age was 71 years (62-77) and 445 (67%) were male. 502 (76%) had adenocarcinoma. Compared with pre-lockdown, patients in the 0-6-months group were significantly older (p&lt;0.05), symptomatic (p&lt;0.05), and had stage migration with increased metastatic disease (p&lt;0.05), palliative treatment intent (p&lt;0.001) and reduced survival (p&lt;0.05).
Compared with pre-lockdown, there was no difference in patients presenting in the 12-18 months group in terms of age (p=0.927), sex (p=0.461), performance status (p=0.666), presence of metastatic disease (p=0.971) and treatment intent (p=0.123). However, more patients in this group were symptomatic (p=0.025), presented as emergencies (p=0.032) and had a poorer overall survival (p&lt;0.05).

Conclusion
Patients presenting 12-18 months after the initial lockdown are still experiencing poorer overall survival than those pre-pandemic. Identification and addressment of the factors contributing to the continued poor outcomes following COVID-19 is urgently required to return overall patient survival to the pre-pandemic level.
SP6.7 Variation in UK anti-reflux surgery practice - A Collaborative Multicentre National Audit (ARROW study)
Authors: Pipe Michelle , Walker Robert , Currie Andrew , Wiggins Tom , Hollyman Marianne , Collaborators ARROW 
Published: August 2023

Abstract

Aims
There is significant variation in the work-up of patients for anti-reflux surgery. This study describes the current variation in UK work up and perioperative management for anti-reflux surgery (ARS), and adherence to clinical guidelines.

Methods
A 12-month UK-wide multicentre prospective national audit was undertaken using a secure online platform. Data collection included demographics, symptoms, pre-operative investigations, intraoperative details, and postoperative outcomes within 90 days. Audit standards (AS) were taken from BSG, ICARUS and AUGIS guidelines.

Results
630 patients from 38 centres were analysed. Patients had a median age 58 years (18-92, F:M 384:245), median ASA 2, and median BMI 29kg/m2.
Oesophageal manometry was performed in 332 patients (54%, AS 100%). Twenty-four-hour pH monitoring was performed in 319 patients (53%, AS 100%). Endoscopy was performed in 520 patients (83%, AS 100%). Laparoscopic or robotic surgery was recorded in 506 and 63 patients, respectively (99%, AS 95%). Two patients underwent open surgery and four laparoscopic cases converted to open. Only 3% (22) patients were day-cases.
Overall, 45 patients were re-admitted (7%, AS &lt;10%); three units had a &gt;10% readmission rate which corresponded with high day-case rates. Less than one percent of patients had an unplanned re-operation. Of those with recorded follow up (60%), 94% had recorded full/partial resolution of symptoms; 86% having nil further requirement for PPI.

Conclusions
There is wide variation in practice, especially regarding preoperative work up, adherence to existing guidelines and low day-case rates. More work is required to assess how the variation in practice affects patient outcomes.
SP6.8 A systematic review and meta-analysis of bag extraction versus direct extraction for retrieval of gallbladder in laparoscopic cholecystectomy: Is it necessary to use?
Authors: Wuheb Ali , Mohamed Hussam , Albendary Mohamed , Mohamedahmed Ali Yasen , Elshikhawoda Mohamed 
Published: August 2023

Abstract

Aims
To evaluate comparative outcomes of gallbladder extraction with bag versus direct extraction in laparoscopic cholecystectomy.

Methods
A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing endo-bag versus direct extraction of gallbladder in laparoscopic cholecystectomy were included. Outcomes were surgical site infection (SSI), extension of fascial defect to extract the gallbladder, intra-abdominal collection, bile spillage and port-site hernia. Revman 5.4 was used for the data analysis.

Results
Eight studies were eligible to be included in this review with total number of 1805 patients divided between endo-bag [n=835] and direct extraction [n=970]. Four of the included studies were randomized-controlled trials while the rest were observational studies. The rates of SSI and bile spillage were significantly higher with direct extraction compared to bag extraction [odd ratio (OR)=2.50, P=0.006] and [OR=2.83, P=0.01], respectively. Conversely, extension of fascial defect was higher in endo-bag group [OR=0.22, P=0.00001]. Comparable results were observed regarding intra-abdominal collection [OR=0.01, P=0.51], and port-site hernia rate [OR-0.70, P=0.55] between the two groups.

Conclusion
Extraction of gallbladder with Endo-bag provides lower rates of SSI and bile spillage with no notable impact on postoperative abdominal collection. Despite the increased need to extend the fascial defect with Endo-bag, the rate of port-site hernia remains similar between both groups.
SP6.9 Presentation and Outcomes of Gallbladder Cancer: A Twenty-Year Experience from a Tertiary UK Centre
Authors: Bodla Ahmed Salman , Xiang Jinpo , Athwal Tejinderjit , Cheruvu Chandra 
Published: August 2023

Abstract

Aims
This retrospective observational study from a tertiary hepatobiliary centre sought to establish patterns in presentation and subsequent stage-dependent management and survival outcomes of gallbladder cancer (GBC) over a 20-year period. We also looked at recurrence rates and utilisation of chemotherapy in the adjuvant and palliative settings.

Methods
All cases of GBC between 2001 and 2021 were identified through clincial coding and locally maintained database. Relevant demographic, staging, management and outcomes information was gathered via electronic records. Patients with incomplete data were excluded.

Results

Conclusion
Out study provides a detailed picture of GBC incidence, management, and prognosis in England. GBC suffers from dismal survival outcomes due to advanced stage at presentation. T-stage has the strongest impact on survival since it determines the treatment offered. A significant proportion of patients are neither suitable for surgery due to locally advanced or mestatic disease, nor chemotherapy mostly due to poor performance status. R1 resection and post-operative recurrence pose additional problems in terms of long-term survival.
SP6.10 Preoperative antibiotic prophylaxis in acute cholecystectomy: a systematic review and meta-analysis of randomised controlled trials
Authors: Kaur Mandeep , Singh Anurag , Sains Parv , Swaminathan Christi , Singh Krishna , Sajid Muhammad 
Published: August 2023

Abstract

Objective
Laparoscopic cholecystectomy in patients admitted with acute cholecystitis is considered preferred, feasible and safe mode of managing gallstone disease. The objective of this study is to evaluate the role of single dose pre-operative prophylactic antibiotics in these patients undergoing acute cholecystectomy.

Materials and methods
All RCTs reporting the use of single dose pre-operative prophylactic antibiotics in patients undergoing acute cholecystectomy were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.

Results
Standard medical databases search produced only 3 RCTs on 781 patients undergoing acute cholecystectomy. There were 384 patients in single dose pre-operative antibiotics group whereas 397 patients were recruited in the no-antibiotics group. In the random effects model analysis, use of single does preoperative prophylactic antibiotics in patients undergoing acute cholecystectomy for mild to moderate cholecystitis failed to demonstrate any extra advantage of reducing the risk of [risk ratio 0.69, 95%, CI (0.46, 1.03), Z = 1.80, P=0.70] infective complications. There was no heterogeneity (Tau2 = 0; Chi2 = 1.74, df = 2 (P = 0.42; I2 = 0 %) among included studies.

Conclusion
Preoperative single dose of prophylactic antibiotics in patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis does not offer extra benefit to reduce infective complications.
SP6.11 Histological Findings in Routine Gallbladder Specimen for Benign Disease
Authors: Telfah Muwaffaq 
Published: August 2023

Abstract

Aim
Gallbladder is one of the most frequently analysed specimens in pathology departments. Non-selective approach is followed by most surgeons with its associated cost and time implications. This study aims to highlight the incidence of histological abnormalities that can be found in the specimen sent following cholecystectomy for benign pathology.

Methods
Retrospective review of histology reports over 10 years period (2010-2019) in district general hospital performed. Non-selective approach used by our surgeons to send specimen following cholecystectomy. Emergency and elective cholecystectomy in adult patients included. Any suspicious diagnosis preoperatively excluded. Histological diagnosis using SNOMED coding from pathology department used.

Results
6020 Histology reports reviewed. Chronic cholecystitis reported in 4113 case (68%), acute cholecystitis seen in 1587 cases (30%). Only 120 reports (2%) described abnormal histology which includes neoplastic and non-neoplastic lesions. Neoplastic lesions found in 90 cases: cancer=10 cases (0.16%) and dysplasia in 80 cases: high grade= 4 cases (0.06%), low grade= 73 (1.2%) and metaplasia in 3 cases (0.04%). Non-neoplastic lesions seen in 30 cases: adenoma= 7 (0.11%), polyp= 13 (0.21%), lipoma=2 (0.03%), cysts=2 (0.03%) and granulomatous cholecystitis in 6 cases (0.09%).

Conclusion
This study demonstrates the frequency of abnormal histology seen in routing specimen. This is an important information to quote during the consent process and also may help in adopting a selective approach for cholecystectomy performed for benign disease.
SP7.3 Development of a Patient Reported Outcome measure for GastroIntestinal recovery: The PRO-diGI study
Authors: Lee Matthew ,   PRODIGI STEERING GROUP
Published: August 2023

Abstract

Background
Patients undergoing abdominal surgery often experience gastrointestinal dysfunction. Recovery of gastrointestinal function is poorly measured. There is a need for a patient reported outcome measure to assess gastrointestinal recovery. The first stage of development requires qualitative work to identify key concepts.

Methods
The PRO-diGI study consisted of three phases:
Phase 1: Qualitative interviews of patients admitted to hospital for major gastrointestinal, gynaecological, or urological surgery, or with intestinal obstruction.
Phase 2: Development of questionnaire and face validity testing with patients as in Phase 1, and expert clinicians internationally.
Phase 3: The questionnaire was distributed to eligible patients. Participants completed the questionnaire as soon after surgery as they were able. Exploratory factor analysis was performed to confirm the structure of the questionnaire and reduce the number of items.

Results
Phase 1: 29 patients were interviewed, and reported 26 key symptoms or experiences across 6 themes including impact on life, mental health, and general physical wellbeing, diet and appetite, abdominal symptoms, nausea and vomiting, and bowel function.
Phase 2: 18 patients and 15 clinicians assessed a 44-item questionnaire, confirming good face validity.
Phase 3: 297 participants were recruited. Factor analysis identified 20 questions related to enjoyment of food, ability to eat and drink, bowel function, nausea and vomiting, and general wellbeing, for inclusion in the final tool. The final tool shows correlation with self-rating of gut function, GI-2, and operative approach.

Discussion
This study has developed a multi-dimensional patient reported outcome measure which can be used in studies of gastrointestinal recovery.
SP7.6 Do we need Routine Histopathological Examination of Gall Bladder Specimens after Cholecystectomy?
Authors: Rauf Fatima , Asif Hira , Zafar Nowera , Rauf Sidra 
Published: August 2023

Abstract

Aims
Gall bladder diseases usually manifest as gall stones, inflammation of gall bladder and gall bladder cancer. There had been a constant debate over the years regarding selective vs. routine histopathological assessment of all gall bladder specimens. This study was aimed to assess the safety of adopting the policy of selective histopathological examination of those gall bladder specimens with pre-operative and/or intra-operative suspicion of malignancy without risking patient safety.

Methodology
A descriptive, cross-sectional study was conducted. All 1285 cases of gall bladder biopsies done after elective cholecystectomies, during a period of 2 years from 1st January, 2018 to 31st December 2019, were reviewed retrospectively.

Results
During the study period, a total of 1285 gall bladder specimens were submitted for histopathological analysis. Chronic cholecystitis was found in 1020 (79.3%) patients, acute cholecystitis in 198 (15.4%), gangrenous gall bladder in 19 (1.47%) patients and gall bladder carcinoma (GBC) in 26 (2.02%) patients. Pre-operative or intraoperative diagnosis of GBC was made in 22/26 patients. The remaining 4 patients had either stage Tis or T1 stage carcinoma and did not require revision surgery.

Conclusion
In areas with low incidence of gall bladder carcinoma, a selective approach of histopathological examination of gall bladder specimens may be considered safe. Such selective approach is more economical and reduces the work burden of pathologists without risking patient safety.
SP7.7 Evaluation of predictive models of common bile duct stones and the use of biliary investigations
Authors: Albendary Mohamed , Mirza-Davies Anastasia , Malik Jasmin , Pankan Bibi , Ong Ling , Bhandari Santosh 
Published: August 2023

Abstract

Aims
This study identifies clinical, biochemical and radiological factors that may predict CBD stones prior to cholecystectomy to reduce costs and delays of non-indicated biliary imaging.

Method
Retrospective data of patients underwent cholecystectomy over 6 months was collected, including first presentations, liver function tests (LFTs), and imaging. Data was tested against guidelines from European Society of Gastrointestinal Endoscopy (ESGE, 2019), American Society of Gastrointestinal Endoscopy (ASGE, 2019) and literature models (Gurusamy-2015, Isherwood-2014).

Results
322 included patients had LFTs and US scans in first presentations with symptomatic gall stones. 52 of them had repeated biliary imaging (US, MRCP or CT) without showing any new findings in 92% of cases.
118 patients had MRCP prior to cholecystectomy, with only 22 cases of confirmed CBD stones. After applying the above-mentioned guidelines and predictive values, new criteria, combining cut-off values of 30 µmol/L for bilirubin and 180 IU/L for Alkaline phosphatase, showed the highest sensitivity (72.73%) and specificity (81.25%), while maintaining high positive predictive value (PPV) (46.99%) and accuracy (79.66%). (Table 1)

Conclusion
Using clinical and radiological findings to guide the need for definitive biliary imaging, commonly MRCP, can reduce unnecessary radiological investigations and costs. Our new suggested combined cut-off values of Bilirubin and ALP can complement the clinical judgement.