bluuebunny/crossref_metadata_2025_split huggingface dataset:
TU1.6 Endoscopic Management of Broncho-Oesophageal Fistula Caused by Impacted Denture
Authors: Elnabil-Mortada Ahmed , Afonso Matias Mariana Rita 
Published: November 2022

Abstract

Background
Oesophageal foreign body impaction in adults is fairly common. Although, dentures being often accidentally ingested among the elderly, it is very unusual to develop a broncho-oesophageal fistula (BOF) secondary to a retained denture. The few cases reported in the literature were mostly managed with thoracotomy.
We present a clinical case of a BOF successfully treated by endoscopic approach following a combined assessment and planning between intervention radiology, general and cardiothoracic surgery.

Case Report
A 60-year-old male was transferred from neighbouring DGH to our centre due to worsening of dysphagia. Patient reported that he had swallowed a denture 6 month earlier. The CT scan showed the denture along with a left BOF. Imaging was further reviewed and discussed amongst interventional radiology, cardiothoracic, and upper gastrointestinal surgeons. Endoscopic retrieval of impacted denture plate was successful, followed by the insertion of left bronchial stent, and percutaneous gastrostomy tube. The left bronchial stent was removed after three months with successful closure of the fistula.

Conclusion
Our clinical case highlights that multidisciplinary team discussion is crucial in the management of complex surgical cases in order to achieve the best outcome possible. Additionally, endoscopic management of BOF is a safe alternative option to thoracotomy when the required resources are available.
TU1.8 Laparoscopic partial gastrectomy as day-case surgery: Our 12-month experience
Authors: Peristeri Dimitra , Jaunoo Shameen 
Published: November 2022

Abstract

Aim
Procedures performed in ambulatory surgical centers (ASC) can provide several advantages over hospital-based surgery. We present our experience in same-day discharge after laparoscopic partial gastrectomy (LPG) in 19 consecutive patients during 2021. Our aim was to review our outcomes and assess the safety and efficacy of outpatient LPG over 12 months to determine if this procedure can be safely performed in the ambulatory setting.

Methods
Retrospective review of all consecutive patients who underwent ambulatory LPG from January 2021 to December 2021. Patient age, social circumstances, and other demographics were recorded as well as any comorbidities and ASA score. All patients were discharged home the same day after surgery without an overnight stay at the hospital. Incidence of complications and re-admission to the hospital after discharge were reviewed up to 30 days from surgery.

Results
From January 2021 to December 2021, 19 consecutive patients underwent LPG. The mean age was 47 years (range, 23–74 yr). 17 patients (89%) had gastric GIST tumor resected. Mean recovery room time was 131 minutes (30–385 min). No patients (0%) were readmitted within 30 days. There were no complications and no open conversions or deaths occurred in the series.

Conclusion
With stringent patient selection and utilization of enhanced recovery pathways, our study indicates that LPG may be suitable for the outpatient setting. Our low overall readmission and complication rate portends to the feasibility of laparoscopic PG as a safe outpatient procedure.
TU1.9 Oesophageal manometry and ambulatory pH monitoring prior to laparoscopic anti-reflux surgery – is it a necessity? An evaluation of a newly established anti-reflux surgery service at a district general hospital
Authors: Slim Naim , Shamali Awad , Williamson James 
Published: November 2022

Abstract

Background
Laparoscopic fundoplication is an effective surgical option for patients with symptoms of reflux refractory to proton-pump inhibitor (PPI) use. Oesophageal manometry and ambulatory pH monitoring are typically advocated as part of the evaluation of gastro-oesophgeal reflux disease, when anti-reflux surgery is considered. However, the requirement for these as a mandatory procedure remains controversial, particularly in the context of large hiatus hernia or presence of endoscopic reflux oesophagitis.

Methods
A retrospective review of all cases performed since the inception of the anti-reflux service at a single-centre district general hospital was undertaken. All patients who underwent an elective laparoscopic anti-reflux operation were included. Data pertaining to preoperative symptoms, preoperative investigations and postoperative outcomes (resolution of symptoms and PPI cessation) was collected.

Results
Over the three-year period, 22 anti-reflux operations were performed, of which 17 were followed up. The mean length of follow-up was 9.5 months. Most patients (91%) had typical reflux symptoms with a large hiatus hernia or endoscopic reflux oesophagitis. Only 4 (18.2%) patients underwent oesophageal manometry and ambulatory pH monitoring—each of these had either a normal preoperative OGD or barium swallow, or atypical symptoms. Alleviation of symptoms was achieved in 14 (82.3%) patients; 9 (52.9%) of which achieved complete resolution. PPI cessation was achieved in 12 (70.1%) patients, comparable with current literature.

Conclusion
Anti-reflux surgery can safely be performed without routine oesophageal manometry and ambulatory pH monitoring in the context of typical symptoms, a large hiatal defect or evidence of endoscopic reflux oesophagitis, as exemplified in our newly established anti-reflux service.
TU1.11 Patients’ views on laparoscopic cholecystectomy consent process: Consent in clinic improves quality of informed consent and patient satisfaction
Authors: Yang Peiming 
Published: November 2022

Abstract

Aims
Informed consent for elective laparoscopic cholecystectomy should begin at first clinic consultation. Due to clinic time pressures, informed consent is often obtained on the morning of surgery for the first time. This study aims to assess whether consent quality and patients’ consent satisfaction are better in clinic compared to day of surgery.

Methods
Retrospective review of all elective laparoscopic surgeries between April and June 2021. Self-administered questionnaire was also completed by the same cohort to ascertain consent satisfaction.

Results
38 patients in total during study period. 16(42.1%) were consented in clinic, and 22 were first consented on day of surgery. 25/38(65.8%) patients prefer to be consented in clinic, 13(34.2%) prefer consent on day of surgery. Significantly higher proportion of consent forms from clinic had full documentation of risks and benefits of cholecystectomy (P&lt;0.001) compared to consents from day of surgery. Significantly higher proportion of patients consented in clinic felt adequately informed of procedure, had alternative options explained to them, were informed regarding recovery process, and felt there was adequate time for consent (P&lt;0.05). Insignificantly higher proportion of patients consented in clinic received information leaflet about procedure.
Overall consent satisfaction was significantly higher in patients consented in clinic (77% versus 55%, P=0.048%)

Conclusions
Consent quality and patient satisfaction levels for elective cholecystectomy were statistically significantly higher when consent was carried out in clinic prior to surgery compared to on the day of surgery. We recommend that all elective cholecystectomy consent is performed formally in clinic prior to surgery.
TU2.1 Colonoscopic Polyp Tattooing: To Tattoo or Not to Tattoo?
Authors: Jeilani Milad , Mosoneke Michael , Riad Mahmud , Hassan Mohamed , Abdelsaid Kirolos 
Published: November 2022

Abstract

Aims
Colorectal cancer is often investigated with colonoscopy, where tattooing is performed to identify the location of potentially tumorous polyps to aid surgery and colonic surveillance. BSG guidelines state that polyps ≥20mm in size should be tattooed, except those in the rectum/caecum. Tattoos should be recorded and local policy should be in place. At our trust, St Mark's protocol is used which advises all suspicious lesions be tattooed except those in the rectum/caecum, and 3 tattoos be placed circumferentially. Here, we audit adherence to these guidelines.

Methods
Retrospective analysis of data collected from Endobase for endoscopies revealing polyps during 2020 at DGH.

Results
325 polyps were found in 255 patients (70% male). Sessile and pedunculated polyps were most common, accounting for 77%. Smaller polyps (15–19mm) were most prevalent (52%). Tattooing of smaller polyps (15–19mm) remains low (30%), whereas tattooing of larger polyps has improved (85%). Tattooing of rectal/caecal polyps remains prevalent (19%). Only 30% of tattooed polyps had 3 tattoos. Tattoo information was recorded well in certain sections of Endobase (83% in ‘conclusion’) but poorly in others (61% in ‘therapeutic’).

Conclusions
There has been an increase in male predominance, and in smaller and pedunculated polyps. These demographic changes are useful to be aware of. Teaching and clearer display of guidelines is required to improve tattooing of smaller polyps, and reduce tattooing of rectal/caecal polyps. However, clearer trust guidelines should accommodate operative variability. Recording tattoo information in Endobase is technically challenging and requires improvement to avoid loss of data.
TU2.2 Endo-Sponge Carries Good Outcome for Low Rectal Anastomotic Leak; Case Series study
Authors: Ahmed Salma , Abbakar Malaz , Hassan Karim , Mohammed Mohammed , Magee Conor , Wilson Jeremy 
Published: November 2022

Abstract

Introduction
Rate of anastomotic leak is considered rare, and the low rectal ones are approximately 10% of all leaks. Management of anastomotic leak is variable and could be challenging. ENDO-SPONGE is advised by experts to be considered given some criteria to be met but in general, ENDO-SPONGE is thought to improve patients’ life quality and maintains the possibility of stoma reversal after resolution of the leak.

Objective
To assess the management of anastomotic leak using ENDO-SPONGE in our hospital and to compare our practice with the international published data.

Methods
Case study of patients diagnosed with anastomotic leak and treated with ENDO-SPONGE. All cases from 2016 to 2021 were included. Concordance with the NICE briefing and recommendation which was published in 2019 was studied. All data were collected in a Microsoft forms then transcribed into an Excel sheet.

Results
13 patients treated with ENDO-SPONGE were identified – median age is 66. Guidelines suggest that ENDO-SPONGE changes should occur within 24–72 hours and the compliance from the trust was only 25%. However the compliance with the number of changes, place of insertion, and the outcome was 100%. 99% of the ENDO-SPONGE replacement took place in the theatre, only one patient's ENDO-SPONGE was replaced in endoscopy department. Complete resolution of the leak occurred in 11 of the 13 patients and only 2 required open drainage. 5/13 were eventually reversed.

Conclusions
More Compliance with timing of replacement of ENDO_SPONGE should be improved but overall ENDO_SPONGE carried a good outcome with complete resolution in nearly 85% of patients.
TU2.3 Flexible sigmoidoscopy after management of CT proven uncomplicated acute diverticulitis: a closed loop audit of local practice at tertiary care centre
Authors: Ahsan Amiya , Ma Jenifer , Krasicka Dominica , Ray Kausik , Swaminathan Christi , Sajid Muhammad S 
Published: November 2022

Abstract

Background
Routine practice of offering a flexible sigmoidoscopy after patients undergoing medical management of CT proven uncomplicated acute diverticulitis (UAD) has been revisited recently and is not required in the absence of red flag symptoms as per the recommendations of the World Society of Emergency Surgery (WSES). The aim of this audit project is to evaluate whether local practice in requesting flexible sigmoidoscopy after the medical management of UAD is in line with WSES guidelines.

Methods
The data of all patients undergoing medical management of CT proven UAD for 19 months (2019–2021) was collected and analysed as per guidelines provided by the WSES.

Results
The study cohort included the subjects treated both as in-patients as well as out-patients in the ambulatory care unit. Out of 115 admissions with acute diverticulitis during first loop of the audit, there were 80 (69.5%) patients diagnosed with CT proven UAD. Thirty-nine patients (48/8%) with UAD were booked to undergo flexible sigmoidoscopy and only 10 patients (25.64%) were diagnosed with sub-centimetre colonic polyps. Second loop included 49 patients, of which 34 patients were diagnosed with UAD and 10 (29.4%) patients underwent flexible sigmoidoscopy showing polyps in 3 (8.8%) patients.

Conclusion
This audit project successfully has shown reduced booking rate of flexible sigmoidoscopy following the medical management of UAD. Given the low rate of positive findings, the high rate of outpatient request for sigmoidoscopy in the uncomplicated group appeared unjustified.
TU2.6 Pre-Operative Optimisation of Elective IBD Patients: Are we meeting the standard?
Authors: Allan Jennifer , Craig Sarah , Wallace William 
Published: November 2022

Abstract

Aim
Inflammatory bowel disease represents a significant healthcare burden. Management requires a multi-disciplinary approach and a combination of both surgical and medical considerations. The aim of this study was to compare current practice within our colorectal unit for pre-operative optimisation of IBD patients with ACPGBI recommendations, with the view of introducing a proforma for these patients to ensure pre-operative optimisation standards are met.

Methods
This was a retrospective study identifying patients undergoing elective surgery for IBD in our unit between January 2019-October 2020. Data was collected on pre-operative management and compared to the broad principles of optimisation outlined by ACPGBI in their 2018 guidelines. Clavien-Dindo classification was used to define post-operative complications.

Results
94 patients were identified, 67 in 2019 and 27 patients in 2020. 4.3% had active intra-abdominal sepsis. No patients had a clearly documented comprehensive nutritional assessment. 15.6% patients were on oral steroids pre-operatively (Dose ≤30mg). 43.8% were on biologic therapy. Mean length of stay was 11.3days. 39.7% of patients experienced post-operative complications. However, only 12.8% of patients had a Clavien-Dindo score of ≥3. There was no mortality.

Conclusion
ACPGBI guidelines highlight key areas for adequate pre-operative optimisation. Our study highlighted that our morbidity following IBD surgery was comparable to those in literature. However, key areas of improvement were identified including comprehensive nutritional assessment. Current work involves creating a pre-operative proforma to encompass this and will be followed by a re-audit.
TU2.9 Under-investigation of iron deficiency anaemia in QFIT-negative suspected colorectal cancer patients
Authors: Bajomo Oreoluwa , Omassoli Jessica , Alsadoun Lara , Lascelles Simon 
Published: November 2022

Abstract

Introduction
QFIT (Quantitative faecal immunochemical testing) has become the first-line screening tool for suspected colorectal cancer due to a lower risk profile, higher sensitivity and specificity than routine colonoscopy and faecal occult blood testing.
Patients with QFIT measurements &lt;10micrograms/ml are considered unlikely to have colorectal cancer and may be discharged from the 2-week wait (2WW) pathway without further investigations, in the absence of other concerning features including iron deficiency anaemia (IDA). We present our findings on the under-investigation of IDA in a cohort of QFIT-negative patients.

Method
We collected data on 100 patients in a district general hospital, referred via the 2WW suspected colorectal cancer pathway with QFIT measured as &lt;10 micrograms/ml, over a 2-month period. Our data-points included whether iron, ferritin and haemoglobin were measured in the 6months preceding QFIT measurement.

Results
Our patients included 67 females and 33 males, with a median age of 67.5. 32 out of 100 patients underwent neither iron nor ferritin blood tests; 21 of which did not have their haemoglobin measured either. 25 out of 100 patients underwent iron, ferritin and haemoglobin blood tests in the specified time period.

Discussion
Failure to investigate IDA in QFIT-negative suspected colorectal cancer patients increases the risk of missed pathology. Studies have found patients with right sided colon cancer sometimes have false negative QFIT results but often present with IDA. We propose that mandatory investigation of IDA is incorporated into existing 2WW suspected colorectal cancer pathways, alongside QFIT measurement, to mitigate this risk.
TU2.11 Adherence to post-polypectomy surveillance guidelines in a district general hospital
Authors: Myintmo Aye , Butler Daniel , Flashman Harriet , Bethune Robert 
Published: November 2022

Abstract

Aims
National guidelines instruct clinical decision making around post-polypectomy surveillance. The current polyp surveillance guidelines were jointly published by the British Society of Gastroenterologists (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE) in 2019, updating the 2010 surveillance guidelines. Adherence to polyp surveillance guidelines is historically poor, both in the UK and globally.
This audit set out to establish the adherence rate of clinicians to the 2019 polyp surveillance guidelines in a district general hospital and to compare this to the adherence rate to the 2010 surveillance guidelines.

Methods
We aimed to collect 300 patients who had been treated under the 2010 or 2019 polyp surveillance guidelines. After exclusion criteria were applied we collected 152 and 133 patients who had respectively been treated under the 2010 and 2019 guidelines. Each patient record was analysed and it was determined by our team whether the chosen polyp surveillance was adherent to the respective guidelines or not.

Results
Of 152 patients treated under the 2010 guidelines, 41.4% (63) of patients were adherent. Of 133 patients treated under the 2019 guidelines, 66.2% (88) of patients were adherent. This represents a score difference of 24.7% (95% confidence interval of 13.5% to 35.9%, p&lt;0.0001).

Conclusions
Our results show that following the introduction of the 2019 guidelines, adherence to polyp surveillance guidelines increased. Increased adherence to guidelines has significant implications for improving patient safety, financial savings and protecting endoscopy capacity.
TU2.12 Experience of Elective Colorectal Cancer Surgery at District General Hospital (DGH): Single centre study
Authors: Elzaafarany Ahmed , Tawfik Ahmed , Day Andrew 
Published: November 2022

Abstract

Background
Elective colorectal resection surgery is one of the most common surgical procedures performed for bowel cancer treatment. This study evaluates the whole practice of colorectal cancer surgery in a DGH in England.

Aims
The primary outcome is to measure postoperative length of stay (LOS), with secondary outcomes including approach of surgical operation and conversion rate, R0 resection, VTE prophylaxis and its compliance with NICE guidelines, postoperative DVT over a period of one year, readmission rate within 30 days of discharge and reasons for readmission.

Methods
A single centre, retrospective, observational study was performed over a period of a year from January 2018 –January 2019. Patients were eligible for study inclusion if they had undergone planned surgical resection for colorectal cancer after being discussed in the local colorectal cancer MDT.

Results
A total of 123 patients were included. Mean length of stay was 7.97 days. 74.7% of the procedures were performed by laparoscopic approach with conversion rate of 6.5%. R0 resection was achieved in 95.1%. 96.7% of patients who underwent surgery for colorectal cancer received extended VTE prophylaxis as per NICE guidelines. Six patients had developed post-operative DVT and one inpatient death recorded. 13.8% of patients that underwent colorectal surgery for cancer were readmitted within 30 days of discharge. SBO, abdominal/pelvic collection, wound dehiscence and SSI as the most common reasons for readmission.

Conclusion
Laparoscopic approach is the preferred method for elective colorectal resection surgeries with acceptable measures of patient outcome including R0 resection, postoperative length of stay, DVT and readmission rate.
TU2.13 Laparoscopic/robotic restorative proctectomy in the District General Hospital setting
Authors: Patel Maitreyi , Aguayo Xavier , Robinson Christine , Banerjee Saswata , Hanson Matthew , Rajendran Nirooshun 
Published: November 2022

Abstract

Aims
Ileal pouch anal anastomosis/restorative proctectomy is a standard surgical treatment for ulcerative colitis performed in a few specialist centres. We report the evolution of the service at our trust which originally carried out open pouch surgery but has moved practice towards laparoscopic and robotic-assisted pouch surgery. The aim of this study was to assess the surgical and functional outcomes of patients undergoing laparoscopic/robotic-assisted IPAA.

Methods
Data were prospectively collected from consecutive laparoscopic/robotic IPAA cases from 2014 to 2021. Patient demographics, operative details, postoperative complications, functional outcomes were collected. Patients were selected by IBD specialized surgeons and reviewed by a pouch nurse. Follow-up consisted of clinical examination and assessment of pouch function.

Results
18 patients underwent laparoscopic or robotic IPAA during the study period, 13 (72.23%) were males. Median age was 28 years. Indication for surgery was ulcerative colitis. Median duration of surgery was 7 hours. Four patients (22.23%) developed postoperative intra-abdominal collection, managed conservatively in all except one, who required laparoscopic washout. The median duration of stay was 8 days. The rate of severe complications, Grade 3 and 4 on Clavien-Dindo classification was 11.12%. During a median follow up of 75 months, there were no pouch failures. The median stool frequency was 6 daily.

Conclusion
Our data suggests that with good patient selection and guidance from an experienced pouch nurse, laparoscopic/robotic IPAA is safe and feasible. Good perioperative outcomes and acceptable pouch function can be achieved in a DGH setting with a team to ensure consistent care of patients.