P-BN18 Cholecystectomy following ERCP: A retrospective audit from a single centre

Abstract Background 15% of the adult population are estimated to have gallstones (GS) and managing GS related disease can represent a significant challenge to surgical and endoscopic services alike. One particular challenge is the management of bile duct calculi (BDC), and treatment can vary according to the unit/institution. NICE has published guidelines (CG188) on the management of GS disease with the recommendation that bile duct clearance and cholecystectomy be offered for symptomatic and asymptomatic BDC. This retrospective audit was performed to determine compliance of a single centre with respect to offering cholecystectomy following ERCP for BDC. Methods A retrospective audit was performed for the year 2018 at a single centre utilising the trust ERCP database. The audit was analysed against NICE guideline CG188 and specifically whether patients treated with ERCP for BDC were then treated with cholecystectomy or had a documented justification as to why cholecystectomy was declined. 2018 was chosen so that at least a 2-year period of follow-up could be analysed. As well as the trust ERCP database, the trust electronic documentation record and paper notes were consulted to determine compliance with the guideline. Results 149 ERCPs were performed on 121 patients at this centre in 2018. Of these, 82 patients were included as 39 had an ERCP for malignant disease or had already had a cholecystectomy. Of those 82, 51 (62%) had an ERCP as an emergency while 31 (38%) had an elective procedure. The median age was 65, 54% being male and 46% female. 45 (55%) had a cholecystectomy following ERCP, 29 as an emergency, and 16 electively. Of those 37 who did not have a cholecystectomy, 20 (54%) had no recorded documentation to justify a decision not to proceed to cholecystectomy. Conclusions GS disease has the potential to cause significant morbidity. If an ERCP has been performed for BDC, NICE recommends that cholecystectomy should be offered to mitigate further GS related complications. Patients may of course decline an operation, or a joint decision made not to pursue operative management due to identified surgical risks. This audit demonstrated that 54% of patients at this institution who did not have a cholecystectomy following ERCP had no documented reason why cholecystectomy was declined. Robust follow-up and documentation measures have since been put in place and a follow-up audit is being performed to monitor improvement.

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P5252Can functional MR imaging supersede angiography? An audit of stress cardiac MRI outcomes compared those seen in the CE-MARC trials

European Heart Journal ◽

10.1093/eurheartj/ehz746.0223 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Brown ◽

H Thomas ◽

I Matthews ◽

C Runnett ◽

A Lee ◽

...

Keyword(s):

Cardiac Mri ◽

Stable Angina ◽

Major Adverse Cardiovascular Event ◽

Adverse Cardiovascular Event ◽

Nice Guideline ◽

Retrospective Audit ◽

Guideline Care ◽

Number Of Patients ◽

Stress Cmr

Abstract Background Recent studies have compared the performance of cardiac MRI (CMR) with coronary angiography. The CE-MARC trial established CMR's high diagnostic accuracy for coronary artery disease (CAD). Following these results, and those of CE-MARC 2, which showed reduced unnecessary angiography rates with CMR-guided care, we increased our adoption of CMR as an investigation of choice for CAD at our centre. Purpose In patients who have a CMR for stable angina, what is the outcome after detection of CAD, how do findings compare with angiography, and do those without CAD identified go on to have a major adverse cardiovascular event (MACE)? Method We performed a retrospective audit of all stress CMR performed from August 2016 to March 2017 at our hospital in North England. All patients were followed up for a minimum of 12 months. NICE guideline care was used during the study period. The CE-MARC trial was used for quality standards and to compare results. Results 91 stress CMRs were performed. 13 were excluded as they were performed on out-of-area patients. Median follow up was 14.5 months. Of the remaining 78 patients, 34 (43%) had a positive CMR. 20/34 (59%) proceeded to angiogram. In 16/20 of patients, CMR findings correlated with angiogram findings. A PPV of 80%. The PPV in CE-MARC was 77.2% (72.1–81.6). Of those who did not proceed to angiography, 8/14 had non-viable myocardium, 3 continued with medical management, in two it was unclear. 3/34 (8.8%) with positive CMR had a MACE. 44 patients had a negative CMR. Three had an angiogram during follow up. All were negative. There was a MACE in 1/44 (2.3%). Conclusion The audit population has a similar PPV to that of CE-MARC. MACE rates at 12 months were similar to CE-MARC which suggests that the trial results are reproducible in our setting. The wider use of CMR can therefore improve investigation and management for patients with stable angina. The audit is limited by the small number of patients proceeding to angiogram and the ability to confirm negative CMR results.

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Long-term follow-up of a prospective randomized study of endoscopic versus surgical treatment of bile duct calculi in patients with gallbladder in situ

British Journal of Surgery ◽

10.1002/bjs.1800830532 ◽

1996 ◽

Vol 83 (5) ◽

pp. 708-709

Author(s):

S. P. Misra ◽

M. Dwivedi ◽

L.-E. Hammarstrom

Keyword(s):

Surgical Treatment ◽

Bile Duct ◽

Randomized Study ◽

Prospective Randomized Study ◽

Long Term Follow Up ◽

Bile Duct Calculi ◽

Gallbladder In Situ

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Long-Term Follow-up after Endoscopic Treatment of Bile Duct Calculi in Cholecystectomized Patients

World Journal of Surgery ◽

10.1007/s002689900043 ◽

1996 ◽

Vol 20 (3) ◽

pp. 272-276 ◽

Cited By ~ 15

Author(s):

Lars-Erik Hammarström ◽

Hans Stridbeck ◽

Ingemar Ihse

Keyword(s):

Bile Duct ◽

Endoscopic Treatment ◽

Long Term Follow Up ◽

Bile Duct Calculi

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Economic impact of recurrent respiratory papillomas in a UK adult population

The Journal of Laryngology & Otology ◽

10.1017/s0022215116001201 ◽

2016 ◽

Vol 130 (7) ◽

pp. 645-649 ◽

Cited By ~ 2

Author(s):

A Harrison ◽

J Montgomery ◽

F B Macgregor

Keyword(s):

Financial Burden ◽

Adult Population ◽

Information Services ◽

Single Centre ◽

Cost Information ◽

Benign Condition ◽

Papilloma Virus ◽

History Of ◽

Recurrent Nature

AbstractObjective:To calculate the financial burden of recurrent respiratory papilloma. This study is UK-based, where up until now no financial estimates have been calculated for this group of patients.Background:Recurrent respiratory papilloma is caused by the human papilloma virus (subtypes 6 and 11). The burden for the patient and the healthcare system is significant given the recurrent nature of the disease.Methods:Data were collected, using a questionnaire completed during routine clinical follow up, from a single centre managing recurrent respiratory papilloma in Glasgow, Scotland. Cost information was sourced from the Scottish Government's Information Services Division.Results:Fourteen patients with active recurrent respiratory papilloma between 2013 and 2014 were identified. The direct measurable cost to NHS Greater Glasgow and Clyde amounted to £107 478.Conclusion:Recurrent respiratory papilloma is a benign condition, but the financial implications of diagnosis are significant. Recurrent respiratory papilloma has a natural history of relapse and remission, and patients may require healthcare input over a period of several years.

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Long-term follow-up of a prospective randomized study of endoscopicversus surgical treatment of bile duct calculi in patients with gallbladderin situ

British Journal of Surgery ◽

10.1002/bjs.1800821121 ◽

1995 ◽

Vol 82 (11) ◽

pp. 1516-1521 ◽

Cited By ~ 75

Author(s):

L.-E. Hammarström ◽

T. Holmin ◽

H. Stridbeck ◽

I. Ihse

Keyword(s):

Surgical Treatment ◽

Bile Duct ◽

Randomized Study ◽

Prospective Randomized Study ◽

Long Term Follow Up ◽

Bile Duct Calculi

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P-OGC42 Hiatus Hernia following Minimally Invasive Oesophagectomy - a Single Centre Experience

British Journal of Surgery ◽

10.1093/bjs/znab430.170 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Mridul Rana ◽

Akshata Sanga ◽

Sotiris Mastoridis ◽

Bruno Sgromo

Keyword(s):

Minimally Invasive ◽

Surgical Management ◽

Hiatus Hernia ◽

Operative Management ◽

Single Centre ◽

Invasive Approach ◽

Significant Difference ◽

Minimally Invasive Oesophagectomy ◽

Crural Repair

Abstract Background Hiatus hernia is an established complication following oesophagectomy, with a higher incidence when a minimally invasive approach (MIO) is undertaken. Literature reports the incidence post-MIO to be vary between 4.5% -26%. There is no clear consensus on the optimum operative management of this complication. The aim of this study was to establish the incidence of hiatus hernia post MIO (HiHO) at a single hospital site, identify predisposing factors, and evaluate subsequent surgical management of this complication. Methods Single-center data were retrospectively analysed of MIOs conducted consecutively between May 2018 and October 2020. A minimum follow-up period of 6 months was required for inclusion. HiHO was defined by radiological confirmation. Data collected included patient demographics, comorbidities, risk factors for hiatus hernia and patient’s post-operative course. Statistical analyses were performed using Fischer’s exact or independent t-test as appropriate. Results 50 patients who underwent MIO were included; mean follow up of 1.92 years. 7 (14%) presented with HiHO. There was no significant difference in age or gender between patients with and without HiHO. HiHO patients had a significantly lower BMI (95% CI 1.083-8.271; P = 0.012) and were more likely to have underlying lung conditions (P = 0.029). A higher incidence of pre-existing hiatus hernia was present among the HiHO group (43% vs 21%). Of those developing HiHO, 6 (86%) were symptomatic requiring surgical reduction with crural repair of hiatus or colopexy; 2 had a recurrence of HiHO requiring subsequent colopexy. Conclusions This study represents the largest single centre analysis of hiatus hernia post minimally invasive oesophagectomy. Our results correlate with the literature, that there is a significant risk of hiatus hernia following minimally invasive oesophagectomy. This risk is increased among patients with pre-operative hiatus hernia, low BMI, and pre-existing lung conditions. Crural repair or colopexy are options for surgical management of HiHO. Colopexy may potentially prevent recurrence of HiHO. A larger study size and a consensus from experts in the field would be beneficial in guiding operative management of HiHO to improve patient outcomes.

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P-BN26 The effect of cholecystectomy on unplanned admissions following endoscopic sphincterotomy and bile duct stone removal

British Journal of Surgery ◽

10.1093/bjs/znab430.026 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Kate Toogood ◽

Thomas Pike ◽

Peter Coe ◽

Simon Everett ◽

Matthew Huggett ◽

...

Keyword(s):

Bile Duct ◽

Operative Management ◽

University Hospital ◽

Biliary Surgery ◽

Operative Morbidity ◽

Cbd Stones ◽

Unplanned Admissions ◽

Non Operative Management ◽

Complex Surgery

Abstract Background Choledocholithiasis is common, with patients usually treated with ERCP and subsequent cholecystectomy to remove the presumed source of common bile duct (CBD) stones. However, previous investigations into the management of patients following ERCP have focussed on recurrent CBD stones, negating the risks of cholecystectomy. Methods Patients undergoing ERCP and CBD clearance for choledocholithiasis at St James’s University Hospital January 2015 - December 2018 were included. Patients were divided into those who received cholecystectomy and those managed non-operatively. Readmissions, operative morbidity, mortality and treatment costs were investigated. Results 844 patients received ERCP and CBD clearance with 3.9 years follow up. 209 patients underwent cholecystectomy with 15% requiring complex surgery. 373 patients were non-operatively managed. Unplanned readmissions occurred in 15% following ERCP, mostly within two years. There was no difference in readmissions between the two groups. Accounting for the entire patient pathway, non-operative management was less expensive. Conclusions The majority of patients do not require readmission following ERCP for CBD stones and cholecystectomy did not reduce the risk of readmission. Few patients have recurrent CBD stones, but difficult biliary surgery is frequently required. Routine cholecystectomy following ERCP needs to be re-evaluated and a more stratified approach to future risk developed.

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Periprocedural risk and long-term outcome of intracranial angioplasty based on a single-centre experience

VASA ◽

10.1024/0301-1526/a000287 ◽

2013 ◽

Vol 42 (4) ◽

pp. 264-274

Author(s):

Dagmar Krajíčková ◽

Antonín Krajina ◽

Miroslav Lojík ◽

Martina Mulačová ◽

Martin Vališ

Keyword(s):

Death Rate ◽

Long Term Outcomes ◽

Single Centre ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis ◽

Angioplasty And Stenting ◽

Aggressive Medical Management ◽

Stroke Death

Background: Intracranial atherosclerotic stenosis is a major cause of stroke and yet there are currently no proven effective treatments for it. The SAMMPRIS trial, comparing aggressive medical management alone with aggressive medical management combined with intracranial angioplasty and stenting, was prematurely halted when an unexpectedly high rate of periprocedural events was found in the endovascular arm. The goal of our study is to report the immediate and long-term outcomes of patients with ≥ 70 % symptomatic intracranial atherosclerotic stenosis treated with balloon angioplasty and stent placement in a single centre. Patients and methods: This is a retrospective review of 37 consecutive patients with 42 procedures of ballon angioplasty and stenting for intracranial atherosclerotic stenosis (≥ 70 % stenosis) treated between 1999 and 2012. Technical success (residual stenosis ≤ 50 %), periprocedural success (no vascular complications within 72 hours), and long-term outcomes are reported. Results: Technical and periprocedural success was achieved in 90.5 % of patients. The within 72 hours periprocedural stroke/death rate was 7.1 % (4.8 % intracranial haemorrhage), and the 30-day stroke/death rate was 9.5 %. Thirty patients (81 %) had clinical follow-up at ≥ 6 months. During follow-up, 5 patients developed 6 ischemic events; 5 of them (17 %) were ipsilateral. The restenosis rate was 27 %, and the retreatment rate was 12 %. Conclusions: Our outcomes of the balloon angioplasty/stent placement for intracranial atherosclerotic stenosis are better than those in the SAMMPRIS study and compare favourably with those in large registries and observational studies.

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