Bronze open access

A survey of the current state of training in inflammatory disease (IBD) surgery in the United Kingdom (UK) (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

Argyriou O.; *El-Sayed C.; Drami I.; Celentano V.; Reza L.

Citation:

Colorectal Disease. Conference: 20th Scientific and Annual Conference of the European Society of Coloproctology, ESCP 2025. Paris France. 27(Supplement 1) (no pagination), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Aim: Inflammatory Bowel Disease (IBD) surgery demands advanced technical skills due to the complexity and variability of procedures. High-quality training is essential, not only for the management of acute IBD-related emergencies but also for the development of a specialist IBD practice. This survey, developed by the Dukes' Club for UK colorectal surgery trainees and the IBD Subcommittee of the Association of Coloproctology of Great Britain and Ireland (ACPGBI), aims to evaluate the current state of IBD surgical training in the UK and to identify key areas and potential interventions for improvement. Method(s): An electronic survey was designed by members of the Dukes' Club executive committee and the ACPGBI IBD subcommittee, followed by dissemination via various professional networks, between September 2024 and April 2025.The survey investigated a number of key domains, including exposure to IBD procedures (routine/complex), participation in multidisciplinary team (MDT) meetings and joint surgical-gastroenterological clinics, career and fellowship intentions, as well as access to training resources. Result(s): The survey was completed by 103 participants (70% in training, 30% early years consultants).Senior trainees (ST6-ST8) represented 58.4% of the trainee participants.58.4% of trainees reported lack of exposure to IBD MDTs, with only 5.6% undertaking an active role in the MDT.Trainees reported minimal exposure to ileoanal pouch surgery and complex procedures such as strictureplasties and Kono-S anastomosis. In contrast, higher levels of exposure were noted for subtotal colectomies, ileo-caecal resections for Crohn's Disease, and IBD-related perianal fistula procedures. Conclusion(s): The survey demonstrated a lack of focus in IBD surgical training. Apart from high-quality educational activities that are delivered by the Dukes' Club and ACPGBI, a structured approach to ensure better exposure, through the training curriculum, is called for.

DOI: 10.1111/codi.70174

Link to full-text [no password required]

Incidence and Survival Outcomes of Primary Parotid Follicular Lymphoma (PPFL): a Seer-Based Retrospective Analysis (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

Backer G.; *Arunachalam J.

Citation:

HemaSphere. Conference: 30th Congress of theEuropean Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 1214-1215), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Primary malignant lymphomas of the parotid glands are rare, estimated to account for just 0.6% to 5% of all tumors of the parotid gland. Primary Parotid Follicular Lymphoma (PPFL) is a rare subtype of non-Hodgkin lymphoma (NHL) originating in the parotid gland, often associated with autoimmune disorders such as Sjogren's syndrome. Due to its low incidence, comprehensive population-based studies are scarce, limiting our understanding of epidemiological factors associated with PPFL and how they impact survival outcomes. Aims Using a large, population-based cancer registry, we aimed to evaluate the incidence trends and survival patterns of PPFL for the past 20 years in the US. Methods We conducted a retrospective population-based study utilizing data between 2000-2021 from the SEER (Surveillance, Epidemiology, and End Results) database. SEER is a program of the National Cancer Institute that collects epidemiological and survival data from cancer registries across the United States. We identified and extracted data from patients diagnosed with PPFL using ICD codes specific for primary tumors of the parotid gland (C07.9) and for follicular lymphoma (ICD codes 9690, 9691, 9695, 9698). Demographic data collected included year of diagnosis, age, sex, race, and area of residence. Incidence rates (IR) were calculated per 100,000 population and were age adjusted to the US standard population using SEER*stat 8.4.4. Using GraphPad Prism software, Kaplan-Meier survival analysis was done to calculate overall survival (OS) and cancer specific survival (CSS). Log rank (Mantel-Cox) test was used to compare survival outcomes between different groups. Results 793 patients with primary parotid follicular lymphoma were identified. 52% were male. 56% were older than 65 years at the time of diagnosis. 79% of patients were white, 10% were Hispanic, and 5% were black. 18% of patients had metastatic disease at initial presentation. IR was 0.050 (SE 0.002, 95% CI 0.045-0.055) for the years 2000-2010 and 0.036 (SE 0.002, 95% CI 0.032-0.040) from 2011 to 2021. Incidence was 29.7% higher in males compared to females with p = 0.0001(IR 0.048 vs 0.037, respectively). IR was 0.049 amongst white patients (SE 0.002, 95% CI 0.046 – 0.054), 0.021 amongst black patients (SE 0.003, 95% CI 0.015 – 0.029), and 0.031 amongst hispanic patients (SE 0.004, 95% CI 0.024-0.038). Patients between the ages of 75-79 years had the highest IR of 0.241 (SE 0.024, 95% CI 0.197- 0.293). Median overall survival (mOS) was 174 months. 5-year and 10-year CSS was 90% and 84%, respectively. mOS was 180 months in patients who received chemotherapy. mOS was 106 months in adults older than 65 years, compared to those younger (p<0.0001). White patients had the poorest mOS of 161 months (p=0.0042). There was no statistically significant difference in survival outcome based on gender. mOS was 109 months in patients residing in non metropolitan counties compared to mOS of 187 months in patients residing in metropolitan counties (p=0.0005). Summary/Conclusion PPFL primarily affects older adults, with high incidences in males and white patients. Though CSS rates are generally favorable, overall survival was found to be worse in white patients, adults aged > 65, and people residing in non metropolitan counties. These differences highlight potential disparities in disease outcomes and suggest the need for future research into factors influencing survival and access to care for patients with PPFL.

DOI: 10.1002/hem3.70152

Link to full-text [no password required]

Exploring Disparities in Survival Outcomes of Primary Cardiac Diffuse Large B-Cell Lymphoma (DLBCL): a Seer Database Analysis (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

Arvind S.; Shaikh G.; *Arunachalam J.; Naagendran M.S.; Meleveedu K.

Citation:

HemaSphere. Conference: 30th Congress of theEuropean Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 3452-3453), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Primary Cardiac Diffuse Large B-cell lymphoma (DLBCL) representing only 1.3% of cardiac tumors and 0.5% of extranodal lymphomas is an uncommon but aggressive malignancy that exclusively involves the heart or the pericardium. Favorable clinical outcomes depend on early detection and timely treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. Little research currently exists on the impact of healthcare access, socioeconomic and demographic factors on survival rates in primary cardiac DLBCL. Aims This study aims to provide an overview of survival outcomes of primary cardiac DLBCL and their association with demographic and clinical factors. Methods We collected data from SEER (Surveillance, Epidemiology, and End Results), which is a program of the National Cancer Institute (NCI) with statistical information on cancer incidence and survival in the United States. From the Research plus data (17 registries, 2000 – 2021), we extracted patients diagnosed with Diffuse large B-cell lymphoma (DLBCL) using the ICD code 9680/3 and having the primary cancer site as heart using code C38.0. Analysis was stratified based on age, sex, race, marital status, median household income and residency. Survival analysis was done with Graphpad Prism software, and survival outcomes were compared using the Log-rank test. Kaplan-Meier curves were used to visualize the data. Results 134 patients with cardiac DLBCL were identified. 64% of the patient population was 65 and older at diagnosis. 56% males and 44% females. 64% White, 14% Hispanic, 5% Black. 92% of patients lived in counties in metropolitan areas with a population ranging from 250,000 to 1 million. The marital status distribution at the time of diagnosis was as follows: 18% were single (never married), 16% were widowed, 4% were divorced, 2% were separated, 0.75% were in a domestic partnership and 54.5% were married. 72% of patients received chemotherapy, and 10% received external beam radiation therapy. Median overall survival (mOS) for primary cardiac DLBCL was 42 months. Cancer-specific survival (CSS) was 130 months. mOS was 144 months in patients under 65 years, and mOS was 26 months in patients aged 65 and older with p value=0.0010 (HR 2.402, 95% CI 1.470 to 3.926). In stage I disease, mOS was 144 months in < 65 and 33.5 months in 65+ (p = 0.0157). In stage IV, mOS was only 9 months in the 65+ age group, compared to those younger with p = 0.0254. mOS were 109 months in those who were married at the time of diagnosis, compared to a mOS of 25 months in those who were not (p value = 0.0030, HR 0.4825 95% CI 0.2867 to 0.8118). No statistically significant difference was found in overall survival when stratified based on sex, race, residency or median household income. Summary/Conclusion While the median cancer-specific survival of cardiac DLBCL was excellent (~ 10 years), the median overall survival was noted to be significantly lower (3.5 years), highlighting non-cancer causes of mortality. However, our analysis shows that advanced age (>65 yrs) has a significant negative impact on survival. While marital status seemed to be associated with better survival, reflecting the role of social support during cancer care, a firm conclusion requires understanding of additional factors. Future studies should explore the factors contributing to the non-cancer causes of mortality in cardiac DLBCL and poorer survival outcomes in the elderly to assist develop strategies to improve outcomes for this subset.

DOI: 10.1002/hem3.70152

Link to full-text [no password required]

Epidemiological and Survival Trends of Alk-Positive Large B-Cell Lymphoma: a Seer (Surveillance, Epidemiology, and End Results) Study (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Arunachalam J.; Meleveedu K.

Citation:

HemaSphere. Conference: 30th Congress of the European Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 1319-1321), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Anaplastic lymphoma kinase-positive (ALK+) large B-cell lymphoma (LBCL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL), representing < 1% of all DLBCLs. Tumor growth is driven by ALK gene rearrangements which lead to proto-oncogene activation. Unlike ALK-positive anaplastic large-cell lymphoma (ALCL), ALK+ LBCL shows plasmablastic immunophenotype and often lacks typical T cell (CD2, CD3) and B-cell (CD20, CD79a) markers. It is known to be more aggressive than typical DLBCL due to limited response to conventional systemic chemotherapies like R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), with a dismal 5-year OS of 8% in advanced stage disease. Off-label use of ALK inhibitors has demonstrated encouraging results in multiple case studies. Aims This study aims to analyze the incidence trends, and survival outcomes of ALK+ LBCL using the Surveillance, Epidemiology, and End Results database. SEER provides population-based data on cancer incidence, survival, and treatment outcomes by compiling various cancer registries across the U.S. Methods We conducted a retrospective population-based study between 2010-2021 utilizing the SEER database. Using ICD code 9737/3, we identified patients diagnosed with ALK+ LBCL. Demographic data, including age, sex, race, and stage, were collected. Incidence rates (IR) were calculated per 100,000 and age adjusted to the US standard population. Kaplan-Meier survival analysis was performed using GraphPad Prism to estimate overall survival (OS) and cancer specific survival (CSS). Log rank test was used to detect factors associated with survival outcomes. Results A total of 58 cases of ALK+ LBCL were included. IR was 0.0049 (SE 0.0010, 95% CI 0.0031-0.0073) during the years 2010-2015 and 0.0067 (SE 0.0011, 95% CI 0.0047-0.0094) from 2016-2021. IR was 0.0025 (SE 0.0007, 95% CI 0.0013-0.0044), 0.0035 (SE 0.0007, 95% CI 0.0022-0.0053), 0.0028 (SE 0.0008, 95% CI 0.0015-0.0049), and 0.0052 (SE 0.0015, 95%CI 0.0027-0.0091) in the age groups <20 years, 20-44 years, 45-64 years, and 65+ years respectively. Incidence rate ratio (IRR) was 4.08 (95% CI 2.08 – 7.98) when comparing males and females, indicating that incidence rate in males was 4 times higher than in females. 65% of patients presented with advanced stage disease at the time of diagnosis. Median time from diagnosis to treatment was 13 days. mOS median overall survival was 101 months. The 1-year and 10- year CSS rates were 86%, and 68% respectively. mOS was 53 months for those with advanced stage disease at initial presentation. mOS was 17 months for ages >65 years (p=0.0002), compared to those aged less than 65 years. In Ann Arbor stage I disease, mOS was 144 months in patients < 65 years and 33.5 months in 65+ age group (p = 0.0157). In Ann Arbor stage IV disease, mOS was only 9 months in 65+ age group with p value of 0.0254 when comparing with the younger age group. There was no statistically significant difference in survival outcomes based on sex, and race. Summary/Conclusion This is one of the largest retrospective studies on ALK+ LBCL. We found that incidence of anaplastic lymphoma kinase-positive large B-cell lymphoma is more common in males and adults older than 65. Survival outcomes continue to be poor, especially in older adults. Further multicenter research is warranted to explore the genomic framework and discover novel combination therapies, to improve patient outcomes.

DOI: 10.1002/hem3.70152

Link to full-text [no password required]

Standardisation of colorectal robotic-assisted surgery (RAS) training: A roundtable discussion (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Kawar L.; Shakir T.; *El-sayed C.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Harrogate United Kingdom. 27(Supplement 2) (no pagination), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Purpose: The current landscape of colorectal robotic-assisted surgery (RAS) training is marked by significant variability. In order to gather opinions, a webinar was hosted by The Dukes' Club, the UK network for colorectal surgical trainees. This seeked to understand from a panel of expert RAS surgeons with various stakeholder roles in RAS training, the optimal method of delivering standardised RAS training in the UK. Method(s): This consensus study is based on a one-hour webinar held on 4th March 2024. Panellists included robotic surgery preceptors and proctors from both CMR Surgical (UK) and Intuitive (USA) respectively; members of robotic subcommittees within speciality associations, and providers of European fellowships. A thematic analysis was conducted to systematically analyse the qualitative data. Result(s): The roundtable featured two consultant urologists and three consultant colorectal surgeons. Four main themes with relevant sub-themes emerged: (1) the current state of robotic training, (2) training components of RAS, (3) challenges in delivering training, and (4) strategies for improvement. The discussion highlighted the variability in training based on geographical location and surgical speciality. Trainer readiness was discussed, with emphasis placed on the temporary nature of this. The importance of adopting RAS skills early in training with stepwise progression, was highlighted. Essential components of a standardised curriculum were identified including e-learning, simulation, and mentorship. Conclusion(s): Standardising colorectal RAS training is vital for equitable and effective skill development. Future directions include enhancing access and resource allocation, implementing stepwise certification, and integrating artificial intelligence and machine learning.

DOI: 10.1111/codi.70177

Link to full-text [no password required]

Acute management of severe inflammatory bowel disease: a clinical audit for quality improvement (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Baumert A.; *Cheetham M.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Harrogate United Kingdom. 27(Supplement 2) (no pagination), 2025. Date of Publication: 01 Sep 2025.

Abstract:

National guidelines for the acute management of inflammatory bowel disease (IBD) have been developed to advise clinicians on first-line investigations and optimal treatment pathways. Clinical audits are vital at a trust level for identifying gaps in these pathways and creating opportunities to implement positive change. For this project, a retrospective review was carried out on patients who underwent an emergency subtotal colectomy following admission with acute severe ulcerative colitis. Surgical patients were identified via a histopathology database and elective surgeries excluded. Key points throughout each admission were audited against national standards outlined in IBD UK and the BMJ (Lamb et al, 2019). This project specifically collected data on initial investigations (stool cultures and sigmoidoscopy), medical management (steroids and biologics) and surgical intervention (first contact with surgeons and timeframe until surgery). This audit primarily identified inconsistencies in organising investigations: 37.5% of patients did not have stool cultures recorded, and sigmoidoscopy was often delayed, occurring on average 5 days post-admission. Following the results of this audit, implementations have been suggested to create a more standardised approach for initial investigations of acute flares of ulcerative colitis. Guidelines have been made more accessible, alongside informative resources explaining why these investigations are necessary. Finally, while all patients ultimately underwent surgery within an acceptable timeframe, further education has been proposed to develop a clear pathway for appropriate surgical review. We hope that easy visualisation of the IBD treatment pathway can remind clinicians when to re-assess and escalate treatment accordingly.

DOI: 10.1111/codi.70177

Link to full-text [no password required]

A Case of Ventricular Standstill in Hypertrophic Cardiomyopathy: The Role of AV Block and Beta-Blockers (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Owolabi O.H.; *Yera H.O.; *Choy C.H.; *Htet K.; *Kundu S.

Citation:

Heart. Conference: British Cardiovascular Society Annual Conference, BCS 2025. Manchester United Kingdom. 111(Supplement 3) (pp A30-A33), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Introduction Atrioventricular (AV) nodal disease is a rare but serious complication of hypertrophic cardiomyopathy (HCM), often leading to conduction abnormalities. While atrial fibrillation is common, high-degree AV block (AVB) is rare. We present a case of hypertrophic obstructive cardiomyopathy (HOCM) complicated by ventricular standstill, emphasizing the need for early recognition and management. Case Presentation A 46-year-old man with a family history of HCM (mother with ICD) presented with exertional dyspnea, palpitations, and presyncope for six months. No family history of sudden cardiac death. Examination revealed HR 76 bpm, BP 115/75 mmHg, and an ejection systolic murmur. ECG showed ventricular hypertrophy, dagger-shaped Q waves, Twave inversions, first-degree AVB (280 ms), and ventricular ectopics (figures 1 and 2). Troponin and NT-proBNP were elevated. Echocardiography confirmed HOCM with severe septal hypertrophy, a maximal LVOT gradient of 43 mmHg, and systolic anterior motion of the mitral valve. Indexed left atrial volume was 48 mL/m2 (figures 3 and 4). CT coronary angiogram was normal. He was started on bisoprolol 2.5 mg OD and within 48 hours developed intermittent high-degree AVB (2:1, 3:1). Bisoprolol was discontinued due to worsening conduction abnormalities, but he later developed symptomatic complete heart block, necessitating emergency ICD placement (figure 5). He was started on bisoprolol 2.5 mg OD and within 48 hours developed intermittent high-degree AVB (2:1, 3:1). Bisoprolol was discontinued due to worsening conduction abnormalities, but he later developed symptomatic complete heart block, necessitating emergency ICD placement. Discussion HCM is the most common genetic heart disease, inherited in an autosomal dominant manner in 50% of cases. MYBPC3 mutations are frequently linked to high-degree AV block.1 While atrial fibrillation is common in HCM, highdegree AV block remains rare. First-degree AVB in HCM is increasingly recognized as a marker of disease progression and arrhythmic risk.1 Mechanisms include left atrial enlargement (predisposing to atrial fibrillation and thromboembolism) and myocardial fibrosis, promoting electrical instability.1 Our patient had a 3.1% five-year sudden cardiac death risk and developed high-degree AV block and ventricular standstill. This progression was likely exacerbated by bisoprolol, which slowed AV conduction in the setting of pre-existing firstdegree AV block. Beta-blockers, though essential in HCM management, should be used cautiously in patients with conduction abnormalities. This case underscores the need for personalized HCM management. First-degree AVB may identify high-risk individu- als requiring closer monitoring, medication adjustments, and early device therapy. Conclusion High-degree AV block and ventricular standstill are rare but significant complications of HCM. First-degree AVB may serve as an early risk marker linked to left atrial enlargement, fibrosis, and arrhythmias. Clinicians should monitor conduction abnormalities closely, especially when prescribing AV-slowing medications. Genetic evaluation, surveillance, and individualized treatment strategies are crucial for optimizing outcomes in HCM patients.

DOI: 10.1136/heartjnl-2025-BCS.33

Link to full-text [no password required]

Lipid Management Post Myocardial Infarction: A Call for Improved Monitoring and Therapy Intensification (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Bhambra G.; Kukoyi B.; Joshi M.; Tran P.; Lo T.; Ajiboye J.; Oyedeji O.

Citation:

Heart. Conference: British Cardiovascular Society Annual Conference, BCS 2025. Manchester United Kingdom. 111(Supplement 3) (pp A210-A211), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Background Lipid management is a cornerstone of secondary prevention in acute coronary syndrome (ACS). Despite established national guidelines, real-world practice often reveal gaps in lipid monitoring and intensification of lipid-lowering therapy. This study investigated these challenges in a large tertiary centre, proposing a streamlined pathway to address these gaps. Methods A retrospective analysis was conducted in 225 ACS patients (92 STEMI and 133 NSTEMI) from July-August 2023. We assessed lipid monitoring on admission and 2-3 months post-discharge, prescription rates of high-intensity statins and use of alternative lipid-lowering therapies. Multivariate logistic regression evaluated the relationship between highintensity statin initiation and lipid monitoring rates on admission and follow-up, adjusted for comorbidities. Results Initial guideline adherence was strong, with 83.1% having lipids checked on admission and 83.6% prescribed high-intensity statins (table 1). After adjusting for ACS type and comorbidities, patients started on high-intensity statin were nearly twice as likely to have lipids checked on admission (90.4% vs. 45.9%, p<0.001). Notably, patients not receiving high-intensity statins were more likely to have a prior history of ACS (43.2% vs 26.1%, p=0.035). Despite the perceived higher severity of STEMI, there was no significant difference in post-discharge lipid-checking rates between STEMI and NSTEMI patients (51.1% vs 53.4%, p=0.735). In terms of follow-up, only 52.4% of patients had lipids rechecked post-discharge, leaving almost half without adequate monitoring. Neither high-intensity statins nor ezetimibe initiation increased the likelihood of follow-up lipids. Among 118 patients with follow-up lipid assessment, 69.5% achieved target levels. However, of the 36 patients (30.5%) not meeting targets, only 3 (8.3%) had therapy intensified limited to the use of ezetimibe, highlighting a critical gap in care. Conclusion This study highlights the dichotomy between strong initial guideline adherence and significant lapses in follow-up care and therapy intensification. Whilst this single- centre study limits generalisability, several interesting observations emerged. The association between high-intensity statin prescription and admission lipid check highlights the importance of fostering a culture of guideline adherence, where attention to one aspect of care positively influences others. Patients with prior ACS were less likely to receive high-intensity statins, potentially due to perceived stability on existing regimen, leading to missed opportunities for therapy intensification. More strikingly, nearly half of the cohort lacked adequate lipid monitoring on follow-up with restricted use of lipid-lowering therapies. This highlights the need for a structured approach involving cardiac rehabilitation and primary care team via the proposed pathway (Figure 1) to ensure better lipid management in this high-risk cohort.

DOI: 10.1136/heartjnl-2025-BCS.206

Link to full-text [no password required]

Surgical Treatment of Wrist and Hand Deformity in Children with Cerebral Palsy (2025)

Posted on by

Type of publication:

Journal article

Author(s):

*Patel, Ravi; *Khan, Muhammad Murtaza; *Gurukiran, Gurukiran; Carsi, Maria Belen; Singh, Rohit Amol.

Citation:

Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 92(4):210-217, 2025 Aug.

Abstract:

Cerebral palsy (CP) is a complex disorder resulting from injury to developing brain. It involves multimodal and multidisciplinary approach that involves various disciplines of medical science. The entire focus of this approach is to provide patients with this disorder the best quality of life. Although CP can affect both upper and lower limbs, the functional expectation of upper limb is much higher and complex. This implies particularly to hand and wrist based on complex functional movements expected of them. This puts orthopaedic surgeons in a unique position in managing these patients. It is worth mentioning here that it is not about offering them a surgical intervention the emphasis should lie on the entire process of selection, evaluation, and intervention. All these steps need to be considered very thoroughly so that the best outcome is achieved based on patients' expectation at present and keeping the future consideration in mind as well. This paper focuses only on children with hand and wrist deformity. Although children have a great healing potential, but they have high functional demand and longer-life expectancy in general so getting things right for the first time should be of paramount importance. This paper tries to address this issue by reviewing the literature to help orthopaedic surgeons in developing an algorithm in their mind when offering intervention. The consideration of inclusion and exclusion criteria along with review of literature has been considered with this background in mind. This paper primarily addresses the surgical aspect of disease and steps that are critical in this regard. Follow up planning, long-term outcome, rehabilitation planning, use of conservative treatment has not been considered in this review.

DOI: 10.55095/achot2025/011

Link to full-text [no password required]

Enhancing Sustainability in Endoscopically Assisted Naso-Jejunal Tube Insertion - A Novel Approach (2025)

Posted on by

Type of publication:

Poster presentation

Author(s):

Bhargava K.; Bhargava C.; Dimitriadis S.; Sawyer M.; *Desai K.; Shekhar C.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A287), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction Due to the high caseload and heavy reliance on plastic predominant equipment in endoscopy, single use consumables remain a significant contributor to endoscopy related CO2 emissions (CO2e). Naso-jejunal tube (NJT) is a flexible tube that enables post-pyloric feeding. Conventionally, NJT insertion is performed endoscopically utilising consumables (e. g. single use laryngoscopes). We aimed to calculate and compare the CO2e of the standard NJT insertion process (SNIP) and a proposed innovative NJT insertion process (INIP). Method We dismantled each consumable used in the SNIP and INIP and calculated their associated CO2e by multiplying their weights by pre-established greenhouse gas emission factors published by the government of the United Kingdom. We further contacted relevant manufacturers to include emissions related to packaging, travel and transport, where possible. Results The SNIP emitted 1.327kg CO2e, while the INIP emitted 0.113kg CO2e – yielding an 11-times lower carbon footprint. The most significant contributor to SNIP emissions was the utilisation of the single use laryngoscope (0.838kg CO2e). In contrast, the INIP enabled NJT insertion, independent of conventional single-use instrumentation. Conclusion Implementing the INIP approach for NJT insertions for hospital and community-based patients would provide a sustainable alternative to existing procedural standards. Based on current data, utilising the INIP as standard practice would reduce 5827.2kg of NJT associated CO2e per year, in the UK. Further epidemiological research on populations receiving enteral feeding is required to more accurately evaluate the INIP's environmental impact.

DOI: 10.1136/gutjnl-2025-BSG.454

Link to full-text [NHS OpenAthens account required]