P-OGC94 Outcomes of oesophagectomy post endoscopic mucosal resection

Background Within developed nations, oesophageal adenocarcinoma has the greatest incidence of any solid organ tumour with number escalating on a yearly basis. A recent expert review by the AGA suggests that high grade Barrett’s dysplasia and intramucosal adenocarcinoma are better treated endoscopically rather than oesophagectomy and that endoscopic management is a reasonable alternative to oesophagectomy for selected patients with low risk pT1b tumours.. Risk factors for nodal involvement and recurrence have been suggested by Lee et al (1). This study aims to review the pathological and clinical outcomes following oesophagectomy post EMR. Methods Results Conclusions Whilst some low risk patients had residual tumour at oesophagectomy, these findings were similar to Nelson et al 3; recurrent/recurrent local tumour could be potentially managed by repeat EMR. The absence of nodal metastasis in this small series is consistent with the AGA recommendation of EMR as a reasonable alternative to oesophagectomy for patients with selected low risk pT1b tumors.

The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

Crohn’s disease (CD) represents a heterogeneous and complex disease with no curative therapeutic option available to date. Current therapy is mainly antibody-based focusing on the immune system while other treatment alternatives such as surgery are considered to be “last options”. However, medical therapy for CD results in mild to severe side effects in a relevant amount of patients and some patients do not respond to the medication. Following that, quality of life is often significantly reduced in this patient cohort, thus, therapeutic alternatives are urgently needed. Updated evidence has revealed that surgery such as ileocecal resection (ICR) might be a potential therapeutic option in case of localized terminal ileitis since resection at early time points improves quality of life and significantly reduces the postoperative need for immunosuppressive medication with low rates of morbidity. In addition, new surgical approaches such as Kono-S anastomosis or inclusion of the mesentery result in significantly reduced rates of disease recurrence and reoperation. Based on the new evidence, the goal of this review is to provide an update on the role of surgery as a reasonable alternative to medical therapy in the interdisciplinary treatment of patients with CD.

Prologue: Peritoneal Dialysis in Pakistan: A Journey Just Started.

I was asked to write on recent initiatives taken to promote peritoneal dialysis (PD) in Pakistan. I will try to take you through this journey that led us here, that is in establishing PD as a viable and reasonable alternative to hemodialysis (HD) in a subset of end stage renal disease (ESRD) patients.

17. Duress

Duress occurs when B exerts illegitimate pressure upon A to enter into a contract, leaving A with no reasonable practical alternative but to enter into that contract. Duress is founded upon a threat made by B to A, but there is no tort of duress. However, duress will render a contract voidable. This chapter considers the two principal forms of duress. The first is physical act duress, where A’s physical integrity is threatened. The second is economic duress, where A’s economic interests are threatened. Particularly in the context of economic duress, it is important that the threats caused A to enter into the agreement, and that A had no reasonable alternative but to succumb to the threat. As a general rule, any threatened breach of contract can constitute illegitimate pressure. In some instances, even a threat to carry out a lawful act may, perhaps, ground a claim in duress.