scholarly journals P-O03 The Management of Gallbladder Polyps at a Single Trust: Are we compliant with European Guidelines?

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Elias Jamieson ◽  
Chloe Short ◽  
Rachael Clifford ◽  
Kunal Rajput
Keyword(s):  
Risk Groups ◽  
Outpatient Setting ◽  
Definitive Treatment ◽  
Diagnostic Challenge ◽  
Polyp Size ◽  
Adherence To Guidelines ◽  
Gallbladder Polyps ◽  
Abdominal Radiology ◽  
European Guidelines

Abstract Background Gallbladder polyps affect approximately 5% of the global population, with rates highest in those of Indian descent. 10% of polyps will have malignant potential based on their size or rapid growth rate, which are associated with a poor 5-year survival once advanced of less than 25%. As gallbladder polyps are common but gallbladder cancer is rare, it is a diagnostic challenge to determine which polyps are likely to be malignant. Adherence to guidelines regarding radiological follow up and definitive treatment, in the form of a cholecystectomy, is therefore vital. Methods Retrospective data collection and analysis was completed for all patients who had a biliary ultrasound between December 2013 and December 2016 to enable 5-year follow up, and a snapshot of 47 patients selected at random. Patients having a gallbladder “polyp” documented on their scan report were eligible for inclusion and adherence to European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guidelines was assessed. Results Within the cohort there was a mean age of 56 years, with a male:female ratio of 17:30. All patients included were Caucasian, with 41 reporting “biliary symptoms” as the indication for the primary ultrasound. 26 patients were not followed up in adherence to guidelines, with 50% due to the sonographer reporting follow-up was not indicated on initial scan, 5 having unchanged polyp size and 2 discharged by the responsible consultant. Of the 21 who were followed up according to guidelines, 20 had a cholecystectomy within 5years, with none of these patients having cancer detected on histology. Conclusions Over 50% of patients within our cohort were not followed up according to the ESGAR guidelines. Although no patients in the study were found to have malignant polyps, the sample size is relatively small and limited to low-risk groups. We aim to expand this audit both locally and regionally, raise awareness of the importance of surveillance across the multi-disciplinary team, and produce local guidance for the outpatient setting.

scholarly journals P-BN22 The use of virtual clinics in gallbladder polyp surveillance

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
John Young ◽  
Anas Belhasan ◽  
Nisheeth Kansal ◽  
Sanjay Taribagil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Risk Groups ◽  
Gallbladder Polyp ◽  
Gallbladder Polyps ◽  
Lost To Follow Up ◽  
Current Guidelines ◽  
Gallbladder Malignancy ◽  
Virtual Clinic

Abstract Background Gallbladder polyps are common findings on ultrasound with a prevalence between 0.3-9.5%. Their significance is not clear but are theorised to have potential risk of transformation into gallbladder malignancy which have poor prognosis if not caught early. Current guidelines recommend surveillance of polyps and that laparoscopic cholecystectomy should be offered if certain criteria are met. Most patients are asymptomatic and regular reviews in clinic is time consuming for patients and adds to strain on services. This study looks at the use of virtual clinics in gallbladder polyp surveillance. Methods Since January 2019 patients identified with gallbladder polyps have been added to virtual clinic. Each patient is added to a database which is maintained by one upper GI surgeon. Current guidelines are followed: laparoscopic cholecystectomy is offered if polyps are greater than 1cm, there is an increase greater than 2mm between scans, and in high-risk groups or in symptomatic patients. All other patients are offered interval scans as per guidelines and a template letter is generated informing patients of their scan results and date of their follow up scan. Results Since January 2019, 70 patients have been identified to have gallbladder polyps. Of these 48 patients so far have benefitted from involvement from follow up in virtual clinic to date, this has resulted in 88 clinic appointments being saved. 12 patients have undergone laparoscopic cholecystectomy due to increase in size of their gallbladder polyps or secondary to symptoms. 7 patients have been lost to follow up, 2 discharged due to the gallbladder polyps disappearing and the other 49 remain under surveillance in the virtual clinic. Conclusions Long term polyp surveillance can be time consuming for both the patient and clinician. This model of a virtual clinic maintains clear communication with patients about their scan findings, the risks associated and plans for future scans. This is an efficient method of monitoring these patients that has good compliance and identifies patients appropriate for surgery.

scholarly journals SURGICAL TACTICS FOR GALLBLADDER POLYPS

2021 ◽  
Vol 5 (1) ◽  
pp. 61-64
Author(s):  
P. V. Harelik ◽  
◽  
M. I. Mileshko ◽  
A. N. Dziashuk ◽  
O. A. Fisenko ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Treatment Outcomes ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Diagnostic Technique ◽  
Diagnosis And Treatment ◽  
Polyp Size ◽  
Gallbladder Polyps ◽  
Surgical Tactics

Background. Due to the use of modern diagnostic technique the detection rate of gallbladder polyps constitutes 3-6%, and the number of cholecystectomies for polyps reaches up to 10% of all operations on this organ. Objective. To evaluate diagnosis and treatment outcomes in patients with gallbladder polyps and to define specific indications for surgical treatment (on the basis of a large number of observations). Material and methods. The article evaluates diagnosis and treatment outcomes in 237 patients with gallbladder polyps. Results. 235 (99,2%) patients underwent laparoscopic cholecystectomy. 2 (0,8%) patients with concomitant postoperative ventral hernia underwent herniolaparotomy, open cholecystectomy, anterior abdominal wall repair using a polypropylene mesh. Conclusions. Patients with small polyps (up to 5 mm) undergo follow-up ultrasound examination every 6 months; in case of doubtful findings CT or MRI of the gallbladder should be performed. The patients with medium polyps (5-10 mm) undergo laparoscopic cholecystectomy provided the polyps are multiple or with a broad base, otherwise such patients are followed-up. Laparoscopic cholecystectomy should be performed in case of large polyps or in patients with gallstone disease regardless of polyp size.

scholarly journals P-BN31 Surveillance for Gallbladder polyps at a NHS District General Hospital – a retrospective analysis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Sharib Ziya Khan ◽  
Sita Kotecha ◽  
Sakshi Rajain ◽  
Krish Ravi
Keyword(s):  
Primary Care ◽  
District General Hospital ◽  
Polyp Size ◽  
Gallbladder Polyps ◽  
Patient Demographics ◽  
European Guidelines ◽  
Size Number ◽  
Low Incidence ◽  
Surveillance Practice ◽  
The Uk

Abstract Background Gallbladder polyps are encountered in 5% of ultrasound scans and continue to remain a dilemma in terms of management. Very few polyps progress to cancer. However, most cancerous polyps are usually found at an advanced stage. It is therefore important to identify the premalignant polyps. There is a lack of national consensus in UK for surveillance of gallbladder polyps. Many trusts in the UK either adopt the European guidelines or formulate local protocols.  We aim to present our findings based on our local surveillance policy existent during the study period with a view to recommending new local guidelines. Methods A search from our radiology database being coded to gallbladder polyp identified patients. We identified 431 patients from 2017 – 2019 who had a total of 1014 scans. The data was collected from local hospital IT databases in terms of variables such as number of scans, polyp size, number of polyps, progression to surgery or discharge from surveillance and histology. The data was analysed on excel platform. Results Patient demographics revealed an incidence of 54% in females (males 46%) with an average age of 59.7 years. Pain was the dominant symptom prompting the first scan (48%). An average of 2.3 scans were performed per patient. 45% of the polyps were less than 5mm. Overall, 22% polyps demonstrated interval growth. Only 15% of polyps less than 5mm demonstrated interval growth and none required cholecystectomy.  6% patients proceeded to surgery mainly for symptoms (46%) compared to polyp progression (1.5%). No malignancy was identified in this study. 43% of patients with polyp diagnosis in primary care had no identified surveillance plan. Conclusions Our study demonstrates a low incidence of polyp progression. We would recommend stopping annual surveillance after 2 years from the index scan for multiple small (<5mm) polyps with little or no progression but continue with annual surveillance for polyps greater than 5mm. We would recommend reserving cholecystectomy for symptomatic polyps and polyps greater than 10mm. There is wide variation in surveillance practice particularly in primary care.  We would recommend sharing the guideline widely with primary care for optimal surveillance.  

Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

2014 ◽  
Vol 23 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Suvadip Chatterjee ◽  
Kofi W. Oppong ◽  
John S. Scott ◽  
Dave E. Jones ◽  
Richard M. Charnley ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
Rare Condition ◽  
Team Approach ◽  
Diagnostic Challenge ◽  
Multisystem Disorder ◽  
North East ◽  
The North ◽  
Work Up ◽  
Igg4 Level

Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature.Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more efiectively thereby reducing unnecessary interventions.

scholarly journals High risk groups for severe COVID-19 in a whole of population cohort in Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bette Liu ◽  
Paula Spokes ◽  
Wenqiang He ◽  
John Kaldor
Keyword(s):  
Socioeconomic Status ◽  
New South ◽  
Severe Disease ◽  
Risk Groups ◽  
Prevention Strategies ◽  
Complete Case ◽  
Relative Risks ◽  
South Wales ◽  
Hazard Ratios

Abstract Background Increasing age is the strongest known risk factor for severe COVID-19 disease but information on other factors is more limited. Methods All cases of COVID-19 diagnosed from January–October 2020 in New South Wales Australia were followed for COVID-19-related hospitalisations, intensive care unit (ICU) admissions and deaths through record linkage. Adjusted hazard ratios (aHR) for severe COVID-19 disease, measured by hospitalisation or death, or very severe COVID-19, measured by ICU admission or death according to age, sex, socioeconomic status and co-morbidities were estimated. Results Of 4054 confirmed cases, 468 (11.5%) were classified as having severe COVID-19 and 190 (4.7%) as having very severe disease. After adjusting for sex, socioeconomic status and comorbidities, increasing age led to the greatest risk of very severe disease. Compared to those 30–39 years, the aHR for ICU or death from COVID-19 was 4.45 in those 70–79 years; 8.43 in those 80–89 years; 16.19 in those 90+ years. After age, relative risks for very severe disease associated with other factors were more moderate: males vs females aHR 1.40 (95%CI 1.04–1.88); immunosuppressive conditions vs none aHR 2.20 (1.35–3.57); diabetes vs none aHR 1.88 (1.33–2.67); chronic lung disease vs none aHR 1.68 (1.18–2.38); obesity vs not obese aHR 1.52 (1.05–2.21). More comorbidities was associated with significantly greater risk; comparing those with 3+ comorbidities to those with none, aHR 5.34 (3.15–9.04). Conclusions In a setting with high COVID-19 case ascertainment and almost complete case follow-up, we found the risk of very severe disease varies by age, sex and presence of comorbidities. This variation should be considered in targeting prevention strategies.

scholarly journals Understanding and responding to COVID-19 in Wales: protocol for a privacy-protecting data platform for enhanced epidemiology and evaluation of interventions

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e043010
Author(s):  
Jane Lyons ◽  
Ashley Akbari ◽  
Fatemeh Torabi ◽  
Gareth I Davies ◽  
Laura North ◽  
...  
Keyword(s):  
Policy Development ◽  
Healthcare Utilisation ◽  
Population Data ◽  
Population Level ◽  
Risk Groups ◽  
Service Utilisation ◽  
Natural Experiments ◽  
Spread Of Infection ◽  
The Impact

IntroductionThe emergence of the novel respiratory SARS-CoV-2 and subsequent COVID-19 pandemic have required rapid assimilation of population-level data to understand and control the spread of infection in the general and vulnerable populations. Rapid analyses are needed to inform policy development and target interventions to at-risk groups to prevent serious health outcomes. We aim to provide an accessible research platform to determine demographic, socioeconomic and clinical risk factors for infection, morbidity and mortality of COVID-19, to measure the impact of COVID-19 on healthcare utilisation and long-term health, and to enable the evaluation of natural experiments of policy interventions.Methods and analysisTwo privacy-protecting population-level cohorts have been created and derived from multisourced demographic and healthcare data. The C20 cohort consists of 3.2 million people in Wales on the 1 January 2020 with follow-up until 31 May 2020. The complete cohort dataset will be updated monthly with some individual datasets available daily. The C16 cohort consists of 3 million people in Wales on the 1 January 2016 with follow-up to 31 December 2019. C16 is designed as a counterfactual cohort to provide contextual comparative population data on disease, health service utilisation and mortality. Study outcomes will: (a) characterise the epidemiology of COVID-19, (b) assess socioeconomic and demographic influences on infection and outcomes, (c) measure the impact of COVID-19 on short -term and longer-term population outcomes and (d) undertake studies on the transmission and spatial spread of infection.Ethics and disseminationThe Secure Anonymised Information Linkage-independent Information Governance Review Panel has approved this study. The study findings will be presented to policy groups, public meetings, national and international conferences, and published in peer-reviewed journals.

scholarly journals Accuracy of upper endoscopies with random biopsies to identify patients with gastric premalignant lesions who can safely be exempt from surveillance

2021 ◽  
Vol 24 (3) ◽  
pp. 680-690
Author(s):  
Michiel C. Mommersteeg ◽  
Stella A. V. Nieuwenburg ◽  
Wouter J. den Hollander ◽  
Lisanne Holster ◽  
Caroline M. den Hoed ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
High Risk ◽  
Low Risk ◽  
Premalignant Lesions ◽  
High Risk Patients ◽  
European Guidelines ◽  
Progression Of Disease ◽  
Risk Patients ◽  
Progression Risk

Abstract Introduction Guidelines recommend endoscopy with biopsies to stratify patients with gastric premalignant lesions (GPL) to high and low progression risk. High-risk patients are recommended to undergo surveillance. We aimed to assess the accuracy of guideline recommendations to identify low-risk patients, who can safely be discharged from surveillance. Methods This study includes patients with GPL. Patients underwent at least two endoscopies with an interval of 1–6 years. Patients were defined ‘low risk’ if they fulfilled requirements for discharge, and ‘high risk’ if they fulfilled requirements for surveillance, according to European guidelines (MAPS-2012, updated MAPS-2019, BSG). Patients defined ‘low risk’ with progression of disease during follow-up (FU) were considered ‘misclassified’ as low risk. Results 334 patients (median age 60 years IQR11; 48.7% male) were included and followed for a median of 48 months. At baseline, 181/334 (54%) patients were defined low risk. Of these, 32.6% were ‘misclassified’, showing progression of disease during FU. If MAPS-2019 were followed, 169/334 (51%) patients were defined low risk, of which 32.5% were ‘misclassified’. If BSG were followed, 174/334 (51%) patients were defined low risk, of which 32.2% were ‘misclassified’. Seven patients developed gastric cancer (GC) or dysplasia, four patients were ‘misclassified’ based on MAPS-2012 and three on MAPS-2019 and BSG. By performing one additional endoscopy 72.9% (95% CI 62.4–83.3) of high-risk patients and all patients who developed GC or dysplasia were identified. Conclusion One-third of patients that would have been discharged from GC surveillance, appeared to be ‘misclassified’ as low risk. One additional endoscopy will reduce this risk by 70%.

scholarly journals Ovarian Dysgerminoma in Pregnant Women with Viable Fetus: A Rare Case Report

2021 ◽  
pp. 141-146
Author(s):  
Reda Youssef ◽  
Gamal Sayed Ahmed ◽  
Samir Alhyassat ◽  
Sanaa Badr ◽  
Ahmed Sabry ◽  
...  
Keyword(s):  
Gestational Age ◽  
Ovarian Neoplasms ◽  
Imaging Modality ◽  
Reproductive Age ◽  
Diagnostic Challenge ◽  
Short Period ◽  
Ovarian Dysgerminoma ◽  
The Impact ◽  
In Pregnancy

Dysgerminoma is an uncommon malignant tumor arising from the germ cells of the ovary. Its association with pregnancy is extremely rare, with a reported incidence of about 0.2–1 per 100,000 pregnancies. Women in the reproductive age group are more commonly affected. It can be extremely rare to conceive naturally, without assisted reproductive interventions, in cases with ovarian dysgerminoma. If a pregnancy does occur with a concurrent dysgerminoma, it is even more unusual to carry the pregnancy to viability or childbirth without fetal or maternal compromise. We report a case of right ovarian dysgerminoma in a young female with a viable intrauterine pregnancy at 10 weeks, which is rarely diagnosed and managed at this gestational age. Numerous factors played a role in her favorable outcome, including early suspicion by ultrasound and presenting history, surgery, histopathological assessment, imaging, and involvement of the multidisciplinary oncology team. Ovarian neoplasms may rapidly increase in size within a short period with little or no symptoms. This poses a diagnostic challenge for obstetricians and oncologists. Hence, we aimed to evaluate the role of imaging in pregnancy using ultrasound as an imaging modality for both early detection of ovarian neoplasms and for follow-up. In conclusion, patients with ovarian dysgerminoma in pregnancy can have favorable outcomes. Treatment should be individualized on a case-to-case basis, depending on many factors; cancer stage, previous reproductive history, the impact of imaging in staging or follow-up of tumor on the fetus, fetal gestational age, and whether termination of the pregnancy can improve survival or morbidity for the mother.

scholarly journals Association of the Lung Immune Prognostic Index with Immunotherapy Outcomes in Mismatch Repair Deficient Tumors

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3776
Author(s):  
Edouard Auclin ◽  
Perrine Vuagnat ◽  
Cristina Smolenschi ◽  
Julien Taieb ◽  
Jorge Adeva ◽  
...  
Keyword(s):  
Checkpoint Inhibitors ◽  
Performance Status ◽  
Prognostic Index ◽  
Predictive Marker ◽  
Risk Groups ◽  
Two Factors ◽  
One Year ◽  
Metastatic Sites ◽  
Tumor Types

Background: MSI-H/dMMR is considered the first predictive marker of efficacy for immune checkpoint inhibitors (ICIs). However, around 39% of cases are refractory and additional biomarkers are needed. We explored the prognostic value of pretreatment LIPI in MSI-H/dMMR patients treated with ICIs, including identification of fast-progressors. Methods: A multicenter retrospective study of patients with metastatic MSI-H/dMMR tumors treated with ICIs between April 2014 and May 2019 was performed. LIPI was calculated based on dNLR > 3 and LDH > upper limit of normal. LIPI groups were good (zero factors), intermediate (one factor) and poor (two factors). The primary endpoint was overall survival (OS), including the fast-progressor rate (OS < 3 months). Results: A total of 151 patients were analyzed, mainly female (59%), with median age 64 years, performance status (PS) 0 (42%), and sporadic dMMR status (68%). ICIs were administered as first or second-line for 59%. The most frequent tumor types were gastrointestinal (66%) and gynecologic (22%). LIPI groups were good (47%), intermediate (43%), and poor (10%). The median follow-up was 32 months. One-year OS rates were 81.0%, 67.1%, and 21.4% for good, intermediate, and poor-risk groups (p <0.0001). After adjustment for tumor site, metastatic sites and PS, LIPI remained independently associated with OS (HR, poor-LIPI: 3.50, 95%CI: 1.46–8.40, p = 0.02. Overall, the fast-progressor rate was 16.0%, and 35.7% with poor-LIPI vs. 7.5% in the good-LIPI group (p = 0.02). Conclusions: LIPI identifies dMMR patients who do not benefit from ICI treatment, particularly fast-progressors. LIPI should be included as a stratification factor for future trials.

scholarly journals Trials and Tribulations: mHealth Clinical Trials in the COVID-19 Pandemic

2021 ◽  
Author(s):  
Praveen Indraratna ◽  
Uzzal Biswas ◽  
Jennifer Yu ◽  
Guenter Schreier ◽  
Sze-Yuan Ooi ◽  
...  
Keyword(s):  
Decompensated Heart Failure ◽  
Hospital Staff ◽  
Outpatient Setting ◽  
World Health ◽  
Randomised Control Trial ◽  
Contact Method ◽  
Model Of Care ◽  
Coronary Syndrome ◽  
Health Organization

Introduction: Mobile phone-based interventions in cardiovascular disease are growing in popularity. A randomised control trial (RCT) for a novel smartphone app-based model of care, named TeleClinical Care - Cardiac (TCC-Cardiac), commenced in February 2019, targeted at patients being discharged after care for an acute coronary syndrome or episode of decompensated heart failure. The app was paired to a digital sphygmomanometer, weighing scale and a wearable fitness band, all loaned to the patient, and allowed clinicians to respond to abnormal readings. The onset of the COVID-19 pandemic necessitated several modifications to the trial in order to protect participants from potential exposure to infection. The use of TCC-Cardiac during the pandemic inspired the development of a similar model of care (TCC-COVID), targeted at patients being managed at home with a diagnosis of COVID-19. Methods: Recruitment for the TCC-Cardiac trial was terminated shortly after the World Health Organization announced COVID-19 as a global pandemic. Telephone follow-up was commenced, in order to protect patients from unnecessary exposure to hospital staff and patients. Equipment was returned or collected by a ‘no-contact’ method. The TCC-COVID app and model of care had similar functionality to the original TCC-Cardiac app. Participants were enrolled exclusively by remote methods. Oxygen saturation and pulse rate were measured by a pulse oximeter, and symptomatology measured by questionnaire. Measurement results were manually entered into the app and transmitted to an online server for medical staff to review. Results: A total of 164 patients were involved in the TCC-Cardiac trial, with 102 patients involved after the onset of the pandemic. There were no hospitalisations due to COVID-19 in this cohort. The study was successfully completed, with only three participants lost to follow-up. During the pandemic, 5 of 49 (10%) of patients in the intervention arm were readmitted compared to 12 of 53 (23%) in the control arm. Also, in this period, 28 of 29 (97%) of all clinically significant alerts received by the monitoring team were managed successfully in the outpatient setting, avoiding hospitalisation. Patients found the user experience largely positive, with the average rating for the app being 4.56 out of 5. 26 patients have currently been enrolled for TCC-COVID. Recruitment is ongoing. All patients have been safely and effectively monitored, with no major adverse clinical events or technical malfunctions. Patient satisfaction has been high. Conclusion: The TCC-Cardiac RCT was successfully completed despite the challenges posed by COVID-19. Use of the app had an added benefit during the pandemic as participants could be monitored safely from home. The model of care inspired the development of an app with similar functionality designed for use with patients diagnosed with COVID-19.

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