EP.TU.465Role of CT scan as initial investigation in colorectal rapid access patients

Abstract Background We looked into CT colonoscopies and CT abdomen and pelvis which were booked as initial investigation in patients referred via the colorectal rapid access pathway. These tests were directly booked following the referral after a nurse led triage. As per our colorectal straight to test protocol (STT) any patients over the age of 75 or unfit individuals will have a CT colonoscopy (virtual colonoscopy) instead of colonoscopy. CT trunk was used during COVID pandemic as the initial investigation when the aerosol generating procedures were stopped. CT trunks are also the initial investigation as per the STT protocol when patients are referred with suspected abdominal mass, weight loss or abdominal pain. Methods Retrospective analysis of prospective electronic data base of colorectal STT referrals from Feb 2020 to end of October 2020. Results Conclusion CT colonoscopies and CT trunks form part of initial diagnostic tool in the colorectal rapid access patients. They are particularly useful in high risk patients who cannot tolerate colonoscopy. These investigations complement the lower GI endoscopy. These scans also identify non-colorectal malignancies and retroperitoneal pathology such as AAA.CT trunks were useful tools during COVID 19 Pandemic.

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SP10.1.6 Benefit of Two week colorectal cancer referrals of patients who had colonic imaging within the last 5 years: do they improve the colorectal cancer outcome?

British Journal of Surgery ◽

10.1093/bjs/znab361.179 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

A Bavikatte prasannakumar ◽

C Nathan ◽

K Kundrapu ◽

H Dennis ◽

T.W Athisayaraj ◽

...

Keyword(s):

Colorectal Cancer ◽

Virtual Colonoscopy ◽

Colorectal Polyps ◽

Significant Rise ◽

Surveillance Program ◽

Tubular Adenoma ◽

Rapid Access ◽

Additional Demand ◽

Cancer Outcome ◽

Access Pathway

Abstract Purpose There has been a significant rise in the number of colorectal rapid access referrals. These referral results in additional demand for hospital services as well as delays assessment and management of other patients. We analyzed the outcome of colorectal fast tract clinic re- referrals on bowel cancer outcome in patients with recent colonic imaging. Methods We retrospectively analyzed 1000 consecutive colorectal rapid access pathway referrals in 2019.Patients with complete colonic imaging within the preceding 5 years were included. We assessed their clinical outcome and colonic imaging when performed. Results In total, 82 (8.2%) patients out of 1000 met the selection criteria. Among these 12 patients (14%) did not need any further colonic investigations. A further 12 patients (14%) were already on the colorectal surveillance program, including a patient with recently diagnosed rectal cancer. Hence 24 patients (29.2%) referral was not indicated. 58 patients had further colonic imaging in the form of colonoscopy or virtual colonoscopy following clinic consultation. 32 (55.17%) of them had normal colonic imaging. 14 patients (24.1%) were identified with colorectal polyps with only one identified as tubular adenoma. The remaining 12 patients had non neoplastic pathology. Conclusion No new significant colorectal pathology was identified in this group of patients. We suggest that symptomatic patients who had complete colonic imaging within 5 years be referred to routine colorectal clinic in order to make the colorectal rapid access referral pathway more effective especially during these unprecedented times.

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Diagnostic utility of alarm features in predicting malignancy in patients with dyspeptic symptoms

Indian Journal of Gastroenterology ◽

10.1007/s12664-021-01155-x ◽

2021 ◽

Author(s):

Anurag Shetty ◽

Girisha Balaraju ◽

Shiran Shetty ◽

Cannanore Ganesh Pai

Keyword(s):

Weight Loss ◽

Epigastric Pain ◽

Characteristic Curve ◽

Abdominal Mass ◽

Screening Tools ◽

Disease Epidemiology ◽

Dyspeptic Symptoms ◽

Malignant Lesions ◽

Alarm Features ◽

Gastric Malignancy

Abstract Background Clinical features are of modest benefit in determining the etiology of dyspepsia. Dyspeptic patients with alarm features are suspected to have malignancy; but the proportions of patients and true cutoff values of various quantitative parameters in predicting malignancy are explored to a lesser extent. Methods This is a prospective observational study of consecutive patients undergoing esophagogastroduodenoscopy (EGD) for dyspeptic symptoms. Patients’ alarm features and clinical details were recorded in a predesigned questionnaire. The diagnostic accuracy of alarm features in predicting malignancy was studied. Results Nine hundred patients, 678 (75.3%) males, with a mean (standard deviation [SD]) age of 44.6 (13.54) years were enrolled. Commonest indication for EGD was epigastric pain in 614 (68.2%) patients. Dyspepsia was functional in 311 (34.6%) patients. EGD revealed benign lesions in 340 (37.8%) and malignancy in 50 (5.5%) patients. Among the malignant lesions, gastric malignancy was present in 28 (56%) and esophageal malignancy in 20 (40%) patients. Alarm features were present in 206 (22.9%), out of which malignant lesions were seen in 46 (22.3%) patients. Altogether, the alarm features had a sensitivity of 92% and specificity of 81.2% for predicting malignancy. The sensitivity and specificity for weight loss were 76% and 90.8%, while that of abdominal mass were 10% and 99.9% respectively. Based on receiver operating characteristic curve, the optimal age for screening of malignancy was 46.5 years in this population. Conclusions Patients of age group 40 to 49 years with dyspeptic alarm symptoms (predominant weight loss) need prompt endoscopy to screen for malignancy. The alarm features are inexpensive screening tools, found to be useful in India, and should be utilized in countries with similar healthcare conditions and disease epidemiology.

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Weight loss and an abdominal mass after resection of a lung carcinoma

Gut ◽

10.1136/gut.2005.090035 ◽

2006 ◽

Vol 55 (10) ◽

pp. 1422-1422

Author(s):

T Kiyokawa

Keyword(s):

Weight Loss ◽

Lung Carcinoma ◽

Abdominal Mass

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Huge trichobezoar presenting as abdominal mass and weight loss: Case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2019.02.033 ◽

2019 ◽

Vol 57 ◽

pp. 33-35

Author(s):

Ayad Ahmad Mohammed ◽

Sardar Hassan Arif

Keyword(s):

Weight Loss ◽

Case Report ◽

Abdominal Mass

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Nutritional intervention in high-risk patients receiving radiation for a broad spectrum of tumor types.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.203 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 203-203 ◽

Cited By ~ 1

Author(s):

Chelsea Hertel ◽

Amir Harandi ◽

Cliff P. Connery ◽

Dimitrios Papadopoulos ◽

Keyword(s):

Quality Of Life ◽

Weight Loss ◽

Radiation Therapy ◽

High Risk ◽

Nursing Staff ◽

Nutritional Intervention ◽

High Risk Patients ◽

Risk Patients ◽

Tumor Types

203 Background: Malnutrition is very common in patients receiving radiation therapy. This can result in significant weight loss, decreased functioning, depression, increased mortality, and dramatic declines in quality of life during and after treatment. Targeting patients at risk with nutritional counseling and progressive intervention can have important clinical implications. Methods: A total of 106 patients at a hospital-based cancer center getting radiation for a wide spectrum of cancers (breast, lung, gastrointestinal, genitourinary, and other types) were evaluated for individualized nutritional counseling and education. Patients with identified risk factors were deemed to be at high risk by nursing staff if meeting pre-specified criteria for weight loss ( > 2.5%), body mass index < 18.5%, and/or gastrointestinal symptoms (poor appetite, diarrhea, or constipation affecting quality of life). After high risk patients were identified by a nursing staff triage questionnaire, an automatic computer generated referral was made to the nutritionist. Results: Prior to the institution of this protocol, 13.7% of patients getting radiation therapy were noted to be at high risk and not receiving any nutritional intervention during their course of radiotherapy. However, after the initiation of adequate screening by nursing staff triggering a nutrition referral, the percentage of high risk patients without an associated nutrition consult declined to 1.1%. Conclusions: This study conveys important information for having a systemic screening process in place to identify those at risk for progressive malnutrition while getting radiotherapy for a broad spectrum of tumor types.

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Initial investigation of a novel noninvasive weight loss therapy using MRI-Guided high intensity focused ultrasound (MR-HIFU) of visceral fat

Magnetic Resonance in Medicine ◽

10.1002/mrm.25883 ◽

2015 ◽

Vol 76 (1) ◽

pp. 282-289 ◽

Cited By ~ 5

Author(s):

Patrick M. Winter ◽

Matthew Lanier ◽

Ari Partanen ◽

Charles Dumoulin

Keyword(s):

Weight Loss ◽

Visceral Fat ◽

High Intensity ◽

Focused Ultrasound ◽

High Intensity Focused Ultrasound ◽

Initial Investigation ◽

Mri Guided ◽

Weight Loss Therapy

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P-P51 Assessing the severity of pre and post-operative malnutrition in cancer patients undergoing pancreaticoduodenectomy: A review of a virtual dietetic prehabilitation service

British Journal of Surgery ◽

10.1093/bjs/znab430.273 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Leah Cox

Keyword(s):

Pancreatic Cancer ◽

Weight Loss ◽

Nutritional Status ◽

Cancer Patients ◽

Nutritional Assessment ◽

Nutritional Risk ◽

Perioperative Outcomes ◽

Risk Patients ◽

Median Weight Loss ◽

Dietetic Intervention

Abstract Background The prevalence of malnutrition amongst pancreatic cancer patients is widely reported. This is due to reduced nutritional intake, increased energy expenditure and increased nutrient losses secondary to malabsorption. A Whipple's procedure or pancreaticoduodenectomy is the only potentially curable intervention for pancreatic cancer patients. Malnutrition is associated with increased peri and post-operative complications including delayed wound healing, longer hospital admission and higher mortality rate. Dietetic prehabilitation is a proactive intervention to assess patients’ nutritional status in preparation for elective surgery and, through early dietetic intervention, has the potential to improve perioperative outcomes. This pilot study reviewed the severity of nutritional risk in both the pre and post-operative stages to understand the need for dietetic prehabilitation in this patient group. Methods All patients referred were nutritionally assessed as part of a dietetic cancer prehabilitation pathway, which includes pre-surgical nutritional assessment within one week of referral and early post discharge nutritional assessment. Nutritional assessment was carried out using the PG-SGA short form and patients were triaged as requiring either a universal, targeted or specialist dietetic intervention dependent on severity of nutritional risk. Patients who scored <4 were triaged as universal, and were low nutritional risk. Patients who scored 5-9 were triaged as targeted and were medium nutritional risk, and patients who scored >9 were triaged as specialist, and were high nutritional risk. Results 35 patients were referred for dietetic prehabilitation assessment. 71% of patients were triaged as requiring either a targeted or specialist prehabilitiation intervention. BMI ranged from 15.7kg/m² to 35.9kg/m² and median weight loss was 10.0%. 23 patients received early post surgical nutritional assessment, within 12 days of discharge from hospital. All 23 patients required targeted or specialist dietetic intervention. 22 patients reported post-operative weight loss, with a median weight loss of 7.5%. There was no correlation between pre-surgical and post-surgical nutritional risk. Conclusions Patients undergoing pancreaticoduodenectomy are at high nutritional risk in both the pre and post-operative periods. Patients without evidence of malnutrition in the pre-operative stage remain at high risk of malnutrition and the associated complications in the post operative stage. A prehabilitation programme can identify patients at nutritional risk and institute interventions to optimise perioperative nutritional status. Findings from this review will form the basis of a study examining the effects of a prehabilitation programme on outcomes following pancreaticoduodenectomy.

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Intestinal Complications of Roux-en-Y Gastric Bypass

10.1093/med/9780190608347.003.0029 ◽

2018 ◽

Author(s):

Kevin D. Helling ◽

Scott A. Shikora

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Small Bowel ◽

Signs And Symptoms ◽

Bariatric Operation ◽

Intestinal Volvulus ◽

Vein Thrombosis ◽

Internal Hernias ◽

Anastomotic Strictures ◽

Risk Patients

Roux-en-Y gastric bypass is a commonly performed bariatric operation, but it is a formidable procedure performed in technically challenging, medically high-risk patients. Although it is highly successful for achieving meaningful and durable weight loss, a variety of intestinal complications may occur. These include small bowel obstructions from a number of sources (internal hernias, adhesions, intussusception, incisional hernias, intestinal volvulus), anastomotic strictures, dumping syndrome, portal vein thrombosis, Roux-en-O construction, and small bowel diverticulitis. This chapter reviews several of the more commonly occurring postoperative intestinal complications. Clinicians need to understand the signs and symptoms of these complications and must be able to quickly diagnose the condition and initiate treatment.

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