Effect of Duration of Biliary Patenting on Quality of Life in patients with Obstructive Jaundice

Aim: Effects of duration of biliary patenting on quality of life in patients suffering from obstructive jaundice. Methodology: A case control study in OPD of general surgery, Unit-1, Civil Hospital, Karachi, by using non-probability consecutive sampling technique. The sample size is 195 subjects with the age of 20-80 years for both the genders. Ethical approval was taken from the concerned department. 105 patients had a duration upto 12 months since biliary patenting whereas 90 patients had duration >12 months since biliary patenting. Results: Mean duration since biliary patenting was 11.9±3.7 months whereas 105 (53.8%) of them had biliary patenting within last one year while 90(46.2%) of them had biliary patenting over a year ago. Moreover, their mean total SF-36 quality of life score was 55.2±12.5. There was a statistically significant effect of duration since biliary patenting on quality of life of obstructive jaundice patients (p<0.01) where patients who had biliary patenting within the last year had significantly higher SF-36 QOL scores than patients who had biliary patenting >one year ago. Conclusion: In obstructive jaundice, quality of life was observed more better in those patients who had a duration upto 12 months than those who had duration >12 months since biliary patenting Keywords: Obstructive jaundice, Bile duct obstruction, malignant, polyp.

TP9.2.9Luminal Investigation Following CT Diagnosed Acute Diverticulitis

The commissioning guide for colonic diverticular disease by the Royal Collage of Surgeons (2014) states that all patients should undergo luminal investigations once an acute attack of diverticulitis has passed. The rational behind this is to ensure a malignant polyp is not missed, however there is mounting evidence and opinion that this may not be necessary. We aim to evaluate how our unit follows the commissioning guide and investigate the number of subsequent polyps and cases of malignancy found. Surgical inpatients with a CT proven diagnosis of acute diverticulitis within a one year period (2018) were included. Their CT scans were reviewed to confirm the diagnosis and electronic records examined to see if luminal investigations were requested, occurred and what the findings were. There were 78 cases of CT confirmed diverticulitis. Of these 11 patients underwent emergency Hartmanns procedure. This left 67 patients in whom investigations were requested in 47. Within the 20 cases were follow up was not requested, 50% had a mitigating factor. 40/47 patients who had investigations booked underwent the requested test. In 6 cases a polyp was found and there were no cases of colorectal cancer. Based on current guidance there is scope to improve the follow up investigations in this population of patients with CT proven diverticulitis. As no colorectal cancers were found this is in keeping with the growing notion that colonoscopy may be reserved for those with complicated diverticulitis on CT or with CT findings on a background of ‘red flag’ symptoms.

Endoscopic Submucosal Hydrodissection with Paradoxical Movement of the Colonoscope Using Hybrid Knife “Traction Mode” for Malignant Polyp in the Cecum

The water-jet hydro dissection technique has been shown to be effective for colorectal tumors. This case report illustrates type T hybrid knife for the elevation of the submucosal layer, cutting the mucosa and dissecting submucosal fibers. ESD was performed using ERBEJET 2 hydrodissection system and hybrid Knife. The resection was completed en bloc within 135 minutes without adverse events. Pathology examination revealed a well-differentiated adenocarcinoma confined to the shallow submucosal layer with free resection margins.

Incidental Gallbladder Carcinoma in Gallbladder Polyps: Challenges of Gallbladder Malignancy for an Endemic Population

Background: Gallbladder polyps are considered pre-malignant lesions of gallbladder carcinoma. This study aims to highlight the role of early cholecystectomy in the management of gallbladder polyps in an endemic population. Methods: A retrospective analysis of 2,076 lap cholecystectomy procedures performed at the Department of Surgical Gastroenterology at a tertiary referral centre in Northern India was conducted and incidental malignancy in gallbladder polyps analysed. The 8th edition of the American Joint Committee on Cancer for tumour-node-metastasis (TNM) staging of gallbladder carcinoma was used. Results: Of 54 patients with gallbladder polyps, 53 had benign histology and one had malignant cells in the lamina propria suggestive of T1a adenocarcinoma. The patient with the malignant polyp was older (57 years old) than the patients in the non-cancer group, which had a mean age of 45 (P = 0.039). The size of the malignant polyp was approximately 4 mm, significantly smaller than the average 7.9 mm size of the benign polys (P = 0.031). Conclusion: Cholecystectomy needs to be considered early in the management of small- sized gallbladder polyps, particularly in areas endemic for gallbladder carcinoma.

Morbidity and mortality after major large bowel resection of non-malignant polyp among participants in a population-based screening program

Background and aims Colonoscopy following positive fecal occult blood screening may detect non-malignant polyps deemed to require major large bowel resection. We aimed to estimate the major inpatient morbidity and mortality associated with major resection of non-malignant polyps detected at colonoscopy following positive guaiac fecal occult blood screening in Ontario's population-based colorectal screening program. Methods We identified those without a diagnosis of colorectal cancer in the Ontario Cancer Registry ≤24 months following the date of colonoscopy prompted by positive fecal occult blood screening between 2008 and 2017, who underwent a major large bowel resection ≤24 months after the colonoscopy, with a diagnosis code for non-malignant polyp, in the absence of a code for any other large bowel diagnosis. We extracted records of major inpatient complications and readmissions ≤30 days following resection. We computed mortality within 90 days following resection. Results For those undergoing colonoscopy ≤6 months following positive guaiac fecal occult blood screening, 420/127,872 (0.03%) underwent major large bowel resection for a non-malignant polyp. In 50/420 (11.9%), the resection included one or more rectosigmoid or rectal polyps, with or without a colonic polyp. There were one or more major inpatient complications or readmissions within 30 days in 117/420 (27.9%). Death occurred within 90 days in 6/420 (1.4%). Conclusions Serious inpatient complications and readmissions following major large bowel resection for non-malignant colorectal polyps are common, but mortality ≤90 days following resection is low. These outcomes should be considered as unintended adverse consequences of population-based colorectal screening programs.

Colorectal endoscopic full-thickness resection using a novel, flat-base over-the-scope clip: a prospective study

Background and study aims We aimed to evaluate the feasibility and safety of a new, flat-based over-the-scope clip (Padlock Clip) for colorectal endoscopic full-thickness resection (eFTR). Patients and methods We prospectively included 26 patients with lesions < 20 mm. Indications for eFTR were re-resection of the scar of a low risk malignant polyp (n = 11), recurrent adenoma in a non-lifting scar (n = 10), non-lifting polyp (n = 4), and an adenoma located in a diverticulum (n = 1). Results Technical success rate and full-thickness resection rate were 100 % (26/26) and 92 % (24/26), respectively. Median procedure time was 43 minutes (IQR 27 – 56). No complications occurred during the procedure; 3 complications (12 %) occurred within 48 hours, of which one was a perforation requiring laparoscopic suturing. Specimen volumes from eFTR of scar tissue where the original polyp had been ≥ 20 mm (n = 13) were smaller compared with those from non-scar resections or scars where the original polyps had been < 20 mm (n = 13) (median 0.8 vs. 1.5 cm3, P = 0.03). Conclusions In this first series of colorectal eFTR using the Padlock Clip, feasibility was demonstrated. It was relatively safe in view of surgery as the alternative treatment, but could still benefit from technical refinement. Future studies should explore for which indication this technique is most suitable.Trial registration: NTR5562 (Dutch Trial Register).