Gastroenterology

Development of a TEAM-ENTS simulation based training day (2024)

Posted on by

Type of publication:

Conference abstract

Author(s):

Shah A.; Kelly S.; Powell S.; Henderson N.; Jackson T.; Richardson S.; *Ball A.; Livett H.; Murugananthan A.

Citation:

Gut. Conference: British Society of Gastroenterology Congress, BSG 2024. Birmingham United Kingdom. 73(Supplement 1) (pp A237-A238), 2024. Date of Publication: June 2024.

Abstract:

Introduction Non-technical skills impact clinical outcomes and team performance.1 Endoscopy team behaviours have been mapped to 5 categories, 16 elements and 47 behavioural descriptors via a national DELPHI process (Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills-TEAM-ENTS).1 Training in non-technical skills can improve team performance.2 A pilot simulation based TEAMENTS course was devised and piloted. Methods Faculty with prior training and experience in delivering ENTS focused simulation courses agreed objectives and designed scenarios. Faculty agreement extended the training offer to administrative and clerical teams. Participating teams from 3 Trusts provided teams of 4 participants (endoscopist, 2 workforce and 1 administration). Senior staff also attended from participating sites as observers. Pre and post course evaluation was via electronic questionnaires, analysed with Wilcoxon signed rank test. Results Teams members were endoscopists (band 7 Clinical Endoscopists), nurse workforce members [band 7 (1), band 5 (4) and band 2 (1)] and 3 admin team members. 5 observers also attended (2 Consultants and 3 band 6 nurses). Delegate and pooled course attendee data is displayed in table 1. All participants felt the scenarios were realistic and strongly agreed (87%) or agreed (13%) the course would change their practice. All delegates expressed they would have been comfortable working in different teams and they would recommend the course to others. Conclusions Delegates and observers expressed high background knowledge levels of all parameters of TEAM-ENTS categories resulting in little improvement with post course scores. Confidence in the ability to display categories of TEAM ENTS showed improvement in delegates as well as all attendees including observers. Further pilot courses will continue to shape this novel training offer.

Link to full-text [no password required]

Barrett’s Oesophagus Service Improvement Project (2024)

Posted on by

Type of publication:

Service improvement case study

Author(s):

*Shriya Begum

Citation:

SaTH Improvement Hub, July 2024

Abstract:

To improve patient education post diagnosis of Barrett’s Oesophagus by June 2024 as evidenced by all new patients with an initial diagnosis of Barrett’s Oesophagus to be offered a follow-up clinic appointment within 6 weeks of their diagnosis, as per NICE guidelines (NG231)

Link to PDF poster

Barrett’s lost to surveillance project (2024)

Posted on by

Type of publication:

Service improvement case study

Author(s):

*Margaret Meredith

Citation:

SaTH Improvement Hub, August 2024

Abstract:

To identify patients that have had a previous diagnosis of Barrett’s Oesophagus and offer a service that is compliant with NICE guidelines (2023).

Link to PDF poster

The Effect of Colesevelam on the Microbiome in Postoperative Crohn's (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Kumar, Aditi; Quraishi, Mohammed Nabil; Al-Hassi, Hafid O; Elasrag, Mohammed; Segal, Jonathan P; Jain, Manushri; Steed, Helen; *Butterworth, Jeffrey; Farmer, Adam; Mclaughlin, John; Beggs, Andrew D; Brookes, Matthew J.

Citation:

Inflammatory Bowel Diseases. 31(2):539-551, 2025 Feb 10.

Abstract:

BACKGROUND: While surgery plays a pivotal role in the management of ileal Crohn's disease, the risk of endoscopic recurrence following an ileocaecal resection can be greater than 65% within 12 months of surgery. More than 90% of patients with Crohn's disease have a concomitant diagnosis of bile acid diarrhea following an ileal resection. This pilot study aimed to assess whether the use of bile acid sequestrants in patients with Crohn's disease who have undergone a primary terminal ileal resection with concomitant bile acid diarrhea can alter the microbiome and prevent disease recurrence. METHODS: Patients with Crohn's disease who underwent a primary terminal ileal resection and had symptoms of diarrhea within 1-3 months of surgery underwent 75SeHCAT testing for bile acid diarrhea. If positive (75SeHCAT <= 15%), patients were treated with colesevelam and stool samples were collected at 4 weeks, 8 weeks, and 6-12 months posttreatment. If negative (75SeHCAT > 15%), treatment was not given and were reviewed in the clinic as per local guidelines. All patients underwent a 6-12 month postoperative colonoscopy where further stool samples and mucosal biopsies were taken. Disease activity was established using the endoscopic Rutgeert's score, with disease remission defined as Rutgeert's score <i2 and disease recurrence >=i2. 16S ribosomal RNA gene analysis was undertaken for the collected fecal and mucosal samples to assess alpha/beta-diversity and microbial composition. RESULTS: A total of 14 patients who completed the study, 10 of whom had a   75SeHCAT positive diagnosis of bile acid diarrhea and were started on   treatment with colesevelam. Four patients did not require treatment as 3 were asymptomatic and 1 had a negative 75SeHCAT scan. Three of the fourteen patients had disease recurrence at their 6-12 month postoperative colonoscopy assessment, of which 1 patient was taking colesevelam and 2 patients were not taking colesevelam. A total of 44 fecal samples and 44 mucosal biopsies underwent 16S ribosomal RNA gene analysis to assess alpha/beta-diversity and microbial composition. In the colesevelam treated patients there was no significant difference in alpha/beta-diversity pre- and posttreatment. Pretreatment, the 3 most abundant bacterial classes in all patients were Bacteroidia, Clostridia, and Gammaproteobacteria. Following 6-12 months of treatment, out of the 9 patients on colesevelam, 5/9 (55.6%) had a reduction in Bacteroidia, 9/9 (100%) had an increase in Clostridia, and 7/9 (77.8%) had a reduction in Gammaproteobacteria. Of the 2 patients not given colesevelam, one showed a reduction in Bacteroidia, increase in Clostridia and a reduction in Gammaproteobacteria. CONCLUSIONS: This small pilot study demonstrated that patients who were given colesevelam, were more likely to be in disease remission at their 6-12 months colonoscopy review compared with those not treated. Furthermore, treatment with colesevelam may have a role in altering the microbiome to help maintain remission states in postoperative Crohn's disease. Larger mechanistic studies are now needed to confirm these findings and demonstrate statistical significance as well as investigate whether this benefit may be present even in those patients with 75SeHCAT negative disease. 

Altmetrics:

To study morbidity and mortality related to ileostomy/colostomy closure at tertiary care hospital (2024)

Posted on by

Type of publication:
Journal article

Author(s):
Gilani S.S.; *Shahzeb M.; Salman D.M.; Nadeem M.; Khan S.; Thomas J.J.; Almesri A.

Citation:
Journal of Population Therapeutics and Clinical Pharmacology. 31(8) (pp 853-858), 2024. Date of Publication: 01 Aug 2024.

Abstract:
Background and Aim: Gastrointestinal stomas main function is to divert the flow away from a difficult anastomoses or intestinal obstruction. There is now a trend toward avoiding permanent stomas, and temporary loop stomas often used to protect anastomotic or distal bowel segments in high-risk patients. The present study aimed to determine the morbidity-mortality after ileostomy or colostomy closure. Patients and Methods: This comparative observational study investigated 42 cases of ileostomy and colostomy closure in the Surgical Unit of Jinnah Hospital, Lahore from January 2020 to January 2024. Patients were divided into two groups; Group-I (Ileostomy closure) and Group-II (Colostomy closure). Demographic details such as age and gender, Clinical details such as indications, types of stoma technique used, and operative times, length of hospital stay, morbidity, and mortality recorded. SPSS version 26 was used for data analysis. Result(s): The overall mean age was 46.8+/-6.52 years (15-75 years). Out of 42 cases, 28 (66.7%) underwent ileostomy and 14 (33.3%) underwent colostomy closure. The most prevalent indication for closure was protection of anastomosis in both stoma groups. The interval between creation and closure of stoma was shorter (117.8 days) in Group-I than Group-II (162.4 days). The incidence of hand sewing sutures and stapled technique was 32 (76.2%) and 10 (23.8%), respectively. The Group-II patients took 107.9+/-5.24 minutes as operative time which was significantly higher than 82.96+/-8.84 minutes in Group-I. The prevalence of morbidity in Group-I and Group-II was 10.7% (n=3) and 14.3% (n=2), respectively. Prolong hospital stay was required in Group-II. No mortality case reported in both stoma groups. Conclusion(s): The present study observed that Stomatal closure well tolerated procedure, with low morbidity and mortality. The results suggest that ileostomy closure is a relatively simple procedure.

Link to full-text [open access - no password required]

Effect of Alvimopan on Postoperative Ileus and Length of Hospital Stay in Patients Undergoing Bowel Resection: A Systematic Review and Meta-Analysis (2024)

Posted on by

Type of publication:
Systematic Review

Author(s):
Murtaza, Rashid; Clarke, Olivia; Sivakanthan, Tharshan; Al-Sarireh, Hashim; Al-Sarireh, Ahmad; Raza, Muhammad Musa; *Navid, Ahmad Zia; Ali, Baqar; Hajibandeh, Shahin; Hajibandeh, Shahab

Citation:
American Surgeon. 31348241265149, 2024 Jul 20 [epub ahead of print]

Abstract:
AIMS: The aim is to investigate the effect of alvimopan on postoperative ileus and length of hospital stay in patients undergoing bowel resection. METHODS: The PRISMA statement standards were followed to conduct a systematic review and meta-analysis. The available literature was searched to identify all studies comparing alvimopan with no alvimopan in patients undergoing bowel resection. Postoperative ileus and length of hospital stay were the primary outcomes, and time to first bowel motion was the secondary outcome. Random-effects modeling was applied for analyses. RESULTS: Analysis of 94 833 patients from 26 studies showed that alvimopan was associated with lower risk of postoperative ileus (OR: .57, 95% CI .48 to .67, P <.00001; high GRADE certainty), shorter length of hospital stay (MD: -1.08 day, 95% CI -1.36 to -.81, P < .00001; moderate GRADE certainty), and shorter time to first bowel motion (MD: -.43 day, 95% CI -.58 to -.28, P < .00001; moderate GRADE certainty). Separate analyses of randomized controlled trials and observational studies showed similar findings. Subgroup analyses suggested consistent findings in patients undergoing elective bowel resection, emergency bowel resection, and open surgery; however, alvimopan did not improve the outcomes in patients undergoing minimally invasive surgery. CONCLUSION: Robust evidence supports the routine use of alvimopan in patients undergoing open bowel resection as indicated by lower risk of postoperative ileus and shorter length of hospital stay. We support incorporation of alvimopan into enhanced recovery after surgery programs for the procedures involving open bowel resection. The role of alvimopan in minimally invasive bowel resection needs more research.

Link to full-text [NHS OpenAthens account required]

Altmetrics:

Stratification to Neoadjuvant Radiotherapy in Rectal Cancer by Regimen and Transcriptional Signatures (2024)

Posted on by

Type of publication:
Journal article

Author(s):
Mahmood U; Blake A; Rathee S; Samuel L; Murray G; Sebag-Montefiore D; *Gollins S; West NP; Begum R; Bach SP; Richman SD; Quirke P; Redmond KL; Salto-Tellez M; Koelzer VH; Leedham SJ; Tomlinson I; Dunne PD; Buffa FM; Maughan TS; Domingo E

Citation:
Cancer Research Communications. 4(7):1765-1776, 2024 Jul 01.

Abstract:
Response to neoadjuvant radiotherapy (RT) in rectal cancer has been associated with immune and stromal features that are captured by transcriptional signatures. However, how such associations perform across different chemoradiotherapy regimens and within individual consensus molecular subtypes (CMS) and how they affect survival remain unclear. In this study, gene expression and clinical data of pretreatment biopsies from nine cohorts of primary rectal tumors were combined (N = 826). Exploratory analyses were done with transcriptomic signatures for the endpoint of pathologic complete response (pCR), considering treatment regimen or CMS subtype. Relevant findings were tested for overall survival and recurrence-free survival. Immune and stromal signatures were strongly associated with pCR and lack of pCR, respectively, in RT and capecitabine (Cap)/5-fluorouracil (5FU)-treated patients (N = 387), in which the radiosensitivity signature (RSS) showed the strongest association. Upon addition of oxaliplatin (Ox; N = 123), stromal signatures switched direction and showed higher chances to achieve pCR than without Ox (p for interaction 0.02). Among Cap/5FU patients, most signatures performed similarly across CMS subtypes, except cytotoxic lymphocytes that were associated with pCR in CMS1 and CMS4 cases compared with other CMS subtypes (p for interaction 0.04). The only variables associated with survival were pCR and RSS. Although the frequency of pCR across different chemoradiation regimens is relatively similar, our data suggest that response rates may differ depending on the biological landscape of rectal cancer. Response to neoadjuvant RT in stroma-rich tumors may potentially be improved by the addition of Ox. RSS in preoperative biopsies provides predictive information for response specifically to neoadjuvant RT with 5FU. SIGNIFICANCE: Rectal cancers with stromal features may respond better to RT and 5FU/Cap with the addition of Ox. Within patients not treated with Ox, high levels of cytotoxic lymphocytes associate with response only in immune and stromal tumors. Our analyses provide biological insights about the outcome by different radiotherapy regimens in rectal cancer.

Link to full-text [open access - no password required]

Altmetrics:

Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study (2024)

Posted on by

Type of publication:
Journal article

Author(s):
Abouelazayem, Mohamed; Jain, Rajesh; Wilson, Michael S J; Martinino, Alessandro; Balasubaramaniam, Vignesh; Biffl, Walter; Coccolini, Federico; *Riera, Manel; Wadhawan, Himanshu; Wazir, Ishaan; Abderaouf, Bettahar; Abramov, Daniil; Abu Jayyab, Mustafa A; Al-Shami, Khayry; Alfarwan, Ahmad; Alhajami, Faris M; Alkaseek, Akram; Alozairi, Ous; Ammar, Ahmed Siddique; Atar, Burak; Baatarjav, Gan-Erdene; Bains, Lovenish; Bakri, Ashraf; Bayramov, Nuru; Bhojwani, Rajesh; Brachini, Gioia; Calini, Giacomo; Campanelli, Michela; Cheng, Shi Yu; Choudhary, Charan Singh; Chowdhury, Sharfuddin; Colak, Elif; Das, Jayanta Kumar; Dawani, Surrendar; Donmez, Turgut; Elzayat, Ibrahim; Erdene, Sarnai; Faizi, Tashaba Qaiser; Frountzas, Maximos; Gafsi, Besma; Gentileschi, Paolo; Guler, Mert; Gupta, Gaurav; Harkati, Nour Elhouda; Harris, Matthew; Hasan, Doaa M; Irowa, Omorodion Omoruyi; Jafferi, Salman; Jain, Sumita Agarwal; Jun Han, Lai; Kandiboyina, Satyanarayana Murthy; Karabulut, Mehmetu; Khamees, Almu'atasim; Khan, Shahzeb; Khan, Madiha Masood; Khaw, Cheng Jing; Kisielewski, Michal; Klib, Mohamad; Kosir, Jurij A; Krawczyk, Wiktor Jan; Lisi, Giorgio; Makama, Jerry Godfrey; Maqbool, Baila; Marques, Claudia Neves; Meric, Serhat; Mietla, Mateusz Przemyslaw; Ads, Alaa Mohamed; Muhumuza, Joshua; Mulita, Francesk; Mustafayeva, Matanat; Omar, Mohammed A; Omarov, Taryel; Pathak, Akshant Anil; Paul, Ratnadeep; Pavone, Giovanna; Podda, Mauro; Raja Ram, Novinth Kumar; Rauf, Fatima; Rauf, Sidra; Safy, Ahmed Mohamed; Sandag, Erdene; Sanli, Ahmet Necati; Siddiqui, Adeela Z; Sotiropoulou, Maria; Talib, Vikash; Tatar, Cihad; Thota, Anuroop; Tokocin, Merve; Tolat, Aditya; Uchikov, Petar Angelov; Valenzuela, Jose I; Venkatappa, Sunil Kumar; Verras, Georgios-Ioannis; Vlahovic, Ivan; Zreeg, Dafer Abdulhakim S; Cardoso, Victor Roth; Gkoutos, Georgios V; Singhal, Rishi; Mahawar, Kamal.

Citation:
Surgical Endoscopy. 2024 Jun 17.

Abstract:
BACKGROUND: There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients
undergoing surgery for PPU and to identify variables associated with these. METHOD: We performed an international study of adults (>= 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (<= 50 and > 50 years) and time from onset of symptoms to hospital presentation (<= 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. RESULTS: 1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female
gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI
2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality. CONCLUSIONS: This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.

Altmetrics:

Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England (2025)

Posted on by

Type of publication:
Journal article

Author(s):
Ayyaz, F M; Joyner, J; *Cheetham, M; Briggs, Twr; Gray, W K.

Citation:
Annals of the Royal College of Surgeons of England. 107(1):54-60, 2025

Abstract:
INTRODUCTION: The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. METHODS: This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic
cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. RESULTS: Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December
2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of
prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. CONCLUSIONS: Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.

Link to full-text [open access - no password required]

Coeliac disease (2024)

Posted on by

Type of publication:
Journal article

Author(s):
*Butterworth J.; Los L.

Citation:
Medicine (United Kingdom). 52(3) (pp 174-180), 2024. Date of Publication: March 2024.

Abstract:
Coeliac disease (CD) is a common, chronic, immune-mediated small bowel enteropathy resulting from gluten exposure in genetically susceptible individuals. Considerable clinical and immunopathological heterogeneity is seen in newly diagnosed patients, and the diagnosis is not always straightforward even for experienced physicians. Population screening using tissue transglutaminase-2 has revealed a higher prevalence of seropositivity than previously appreciated. There is a wide differential diagnosis for mucosal villous atrophy, crypt hyperplasia and increased intraepithelial lymphocyte concentrations. Life-long adherence to a gluten-free diet is currently the only recommended treatment for CD, although many newer approaches are being explored. CD is rightly described as a multisystem disorder and is associated with other gastrointestinal- and non-gastrointestinal-related disorders, numerous complications and possibly reduced survival. The landscape has recently expanded with the identification that some patients with symptoms suggestive of CD but without the mucosal changes seem to respond to a gluten-free diet. This group are currently labelled as having non-coeliac gluten sensitivity. Controversy exists over whether this is a separate disease entity. This review briefly discusses the important clinical, immunological and therapeutic aspects of CD.