SP6.1.10 Can gallbladder polyp surveillance be justified? Experience of a large DGH

Aims Gallbladder polyps are typically an incidental finding on sonographic or pathological examination with an estimated prevalence of 0.3 – 9.5%. Their role as a precursor to gallbladder malignancy is disputed. The 2017 European Joint Society Guidelines (ESGAR/EAES/EFISDS/ESGE) aim to standardise management of gallbladder polyps detected prior to cholecystectomy. We aim to describe our experience in the management of gallbladder polyps in a district general hospital. Methods This single centre retrospective case series included consecutive cholecystectomies over an 8-year period, identified through pathology records. Medical records were interrogated to identify the presence of gallbladder polyps identified pre-operatively and at subsequent histopathological analysis. Results 3835 cases were included. Four cases (0.1%) had an adenocarcinoma identified; none of these had pre-operatively identified polyps. Two cases (0.05%) were found to have lesions with high-grade dysplasia, 1 of which had a 17mm polyp preoperatively. One case (0.03%) had cellular atypia, without a pre-operative polyp. Forty six cases (1.2%) were found to have low-grade dysplasia; 1 (2.2%) of these had adenomyomatosis pre-operatively but none had pre-operative polyps. Overall, 53 patients (1.4%) had abnormal pathology with only 1 (1.9%) of these having a pre-operative polyp identified. Conclusions Our results suggest that in the real-world setting, intensive surveillance of gallbladder polyps has limited utility in identifying cases of gallbladder malignancy. The burden on services produced by adherence to strict surveillance guidelines is difficult to justify and a less arduous approach is unlikely to significantly influence the management or outcome in patients with gallbladder malignancy.

1108 Comparing the Accuracy of Ultrasonography and Nuclear Imaging Scan in Preoperative Localisation of Parathyroid Lesions in Patients with Primary Hyperparathyroidism

Aim Parathyroidectomy remains the only method to cure Primary Hyperparathyroidism. Preoperative localisation of the lesion is vital for successful surgical management. The preferred initial preoperative imaging is an ultrasound scan (USS) of the neck. NICE recommends a second preoperative imaging modality to guide the surgical management. This study was conducted to compare the effectiveness of USS of the neck and SPECT scan in the preoperative localisation of parathyroid lesions in a single Teaching Hospital. Method A retrospective study performed included a cohort of patients between 2018 and 2020. 31 patients that underwent elective focussed parathyroidectomy were followed up. Data on preoperative investigations including USS of the neck and SPECT and final histological diagnosis of the specimen was captured using the hospital’s electronic medical records Quadramed. Results Both USS and SPECT scan correctly identified the nature and location of the lesion in only 35.4% patients. USS alone correctly identified the nature and location of the lesion in 50.0% patients whereas SPECT was 46.7%. USS incorrectly identified the nature or the location of the lesion in 33.3% patients whereas SPECT was 40.0%. Interestingly, the USS did not identify any abnormal pathology in 5 patients and SPECT in 4 patients, although all 9 showed pathological histology findings. Conclusions Data collected shows that either scan alone would not be sufficient to confirm the absence of parathyroid pathology. A second scan decreases the likelihood of missing any abnormal pathology. However, in patients with a high clinical suspicion abnormality cannot be ruled out despite having two negative scan results.

Does Transvaginal Ultrasonography Have Good Diagnostic Value in Endometrial Pathology?

Introduction: Endometrial biopsy is usually considered unnecessary in post-menopausal uterine bleeding when the endometrial thickness (ET) is less than 5 mm because the risk of endometrial hyperplasia or cancer is low. However, there is still much controversy from this as some believe that the diagnostic value of ET in diagnosis of endometrial pathology (EP) in postmenopausal bleeding is necessary. In this study, the diagnostic value of ET for diagnosis of EP in post-menopausal bleeding was evaluated. Materials and methods: Sixty post-menopausal women with uterine bleeding were evaluated. Transvaginal ultrasonography (TVS) was used for measurement of ET followed by dilatation and curettage in a one-day interval. According to the EP, patients were divided in two groups, normal and abnormal. Endometrial atrophy was considered as normal and hyperplasia, polyps and carcinoma was considered as abnormal. Results: Twenty nine cases had ET more than 6 mm, among them, 25 cases had abnormal pathology (hyperplasia, polyp, cancer) and 4 cases were normal (atrophy). Thirty-one patients had ET equal or less than 6mm, among them, 26 cases were normal (atrophy) and 5 cases had abnormal pathology. The sensitivity, specifi ty, positive and negative predictive values of TVS in the diagnosis of uterine pathology were 83.3%, 86.7%, 86.2%, 83.9% respectively. Conclusion: We suggest that an ET of less than 6 mm in TVS is unlikely to indicate EP in post-menopausal women with uterine bleeding.

Esophageal, Gastric, and Duodenal Histologic Findings in Patients with Feeding Difficulties

Currently, there are inconsistencies in the recommendations of when to obtain an esophagogastroduodenoscopy (EGD) in children with feeding difficulties. The aim of our study was to identify EGD findings in patients presenting to a large, outpatient feeding program. Additionally, we investigated the presence of any relationship between abnormal pathology seen on biopsies (inflammation) and symptoms of feeding intolerance such as vomiting, gagging, retching, or abdominal pain. Retrospective analysis of electronic medical records (EMRs) was conducted for all new patients aged 0–17 years presenting to the Multidisciplinary Feeding Clinic. Three hundred and thirty patients (50.2%) had an EGD with complete biopsies. Of these 330 patients, biopsies revealed esophagitis in 40%, gastritis in 33.6%, and duodenitis in 15.2%. Overall, 61.21% had an abnormal pathology in at least one site. We found that children with feeding disorders commonly have esophagitis, gastritis, and/or duodenitis and that symptoms are poor predictors of pathology. This study underscores the importance of gastrointestinal evaluation as part of a multidisciplinary evaluation in patients with feeding difficulties.

Abnormal pathology seen on appendectomy in patients with predominant right-sided pelvic pain

Introduction: Previous studies have linked chronic pelvic pain (CPP) to appendix pathologies. However, few studies have investigated appendix pathology specifically in the context of CPP that is right-side predominant (R-CPP). We hypothesized that women with R-CPP have higher rates of appendix pathology compared with women with CPP that is not right-side predominant (N-CPP). Methods: We conducted a retrospective case–control study of 220 women who underwent diagnostic laparoscopy and planned or incidental appendectomy for CPP and suspected endometriosis between January 2015 and December 2018 at a tertiary care center in Saint Louis, MO. Results: No significant difference in abnormal appendix pathology was found between women with R-CPP and women with N-CPP (30.9% vs 34.5%, p = 0.74, odds ratio = 0.85, 95% CI: (0.44, 1.62)). Gross abnormalities of the appendix were documented in 40 of 220 patients (18.2%), with the most common abnormal gross findings being adhesions (8.2%), followed by abnormal lesions (7.3%). Conclusion: In this study, the presence of abnormal pathology within the appendix did not correlate with R-CPP, indicating triage based on predominant pain location cannot help identify patients with underlying appendix pathology. However, consistent with previous studies, we identified a high rate of abnormal appendix pathology overall, supporting the practice of many surgeons to perform routine appendectomy in women with CPP.

Diagnostic Yield of Colonoscopy in Young Adults with Lower Gastrointestinal Symptoms in a Multicenter Midwest Cohort

<b><i>Background/Aims:</i></b> Serious gastrointestinal (GI) pathologies are common in older adults compared to young adults (≤40 years). Data on the diagnostic yield (DY) of colonoscopy in young adults with lower GI symptoms are lacking. We aimed to evaluate the overall DY of colonoscopy; and the DY stratified by the presence or absence of bright red blood per rectum (BRBPR) in young adults ≤40 years. <b><i>Methods:</i></b> We reviewed diagnostic colonoscopies performed in young adults by 18 gastroenterologists at 2 different institutions from ­October 2016 to April 2019. Patients with familial colorectal cancer (CRC) syndromes were excluded. DY was calculated based on the proportion of abnormal colonoscopy defined as having inflammatory bowel disease (IBD), microscopic colitis (MC), advanced adenoma, or CRC. <b><i>Results:</i></b> We included 454 patients, mean (SD) age was 31 (3) years, 162 (36%) were males and mean (SD) BMI was 30 (8.5). BRBPR was the indication for colonoscopy in 194 (43%) patients, 260 (57%) patients had colonoscopy for other lower GI symptoms (abdominal pain, chronic diarrhea, constipation) but without BRBPR. Overall DY of colonoscopy in young adults with lower GI symptoms was 15%; IBD was seen in 43 (10%) patients, MC 10 (2%), and advanced neoplasia/CRC 20 (4%). Overall DY in patients with BRBPR was significantly higher than in patients without BRBPR (22 vs. 11%, <i>p</i> = 0.001). The DY for IBD was also higher in young adults with BRBPR versus without BRBPR (15 vs. 6%, <i>p</i> = 0.003). The DY of patients with both BRBPR and abdominal pain was 34%, for BRBPR and diarrhea was 40%, and for all 3 symptoms of BRBPR, diarrhea, and abdominal pain was 52%. <b><i>Conclusions:</i></b> Significant proportion of young adults with BRBPR have abnormal pathology (22%) justifying evaluation by colonoscopy. For other lower GI symptoms without BRBPR, the necessity of endoscopic evaluation should be determined clinically on a case-to-case basis due to the low overall DY.

Hysteroscopy: a boon in abnormal uterine bleeding

Background: Aim of the study was to analyze retrospectively the efficacy of hysteroscopy in the diagnosis of abnormal uterine bleeding (AUB).Methods: Eighty-six women in the reproductive and perimenopausal age group (20-50 years) visiting the gynaecology OPD from March 2018 to February 2019 with the complaints of abnormal uterine bleeding were enrolled in the study. All the patients who underwent hysteroscopic examination were subjected to endometrial curettage; which was sent for histopathological examination (HPE). The hysteroscopic findings were then corelated and compared with HPE.Results: Mean age of the patients was 37.2 years. Around 60.46% patients presented within six months of complaints. Clinically, 54.65% were diagnosed as menorrhagia, 37.2% as polymenorrhoea and 8.13% as intermenstrual bleeding. On hysteroscopy, 44.1% showed abnormal pathology. The positive findings including polyps (8.13%), calcification (3.48%), submucous myoma (12.79%), necrotic mass and forgotten IUCD (2.32%) and adhesions in one case. On the other hand, the findings of histopathology; 56 patients (65.11%) had normal / proliferative / atrophic endometrium, 17 (19.76%) had hyperplasia, 10 (11.62%) had polyps and 3 (3.48%) had calcified endometrium. There was no significant difference between two modalities for normal / proliferative / atrophic endometrium. The HPE diagnosed slightly higher patients of hyperplasia as compared to hysteroscopy. Hysteroscopy diagnosed a higher number of patients with submucous myoma and necrotic mass.Conclusions: Hysteroscopy provided additional visual information for some pathologies which otherwise would remain undiagnosed by HPE.

The Prevalence of ADHD in American Society: The Influence of Parent-Child and Child-Technology Interactions

Attention Deficit Hyperactivity Disorder (ADHD) is a behavioral disorder that begins in childhood and persists throughout adulthood and is characterized by symptoms of inattention, hyperactivity, and impulsivity. Societal attitudes classify the diagnosis of ADHD differently in establishing what behaviors are deemed acceptable or tolerable in children depending on the particular region or area. American culture provides an important framework for societal perspectives of how ADHD is expressed through behaviors that are considered an abnormal pathology. The purpose of this study is to conduct a literature review of ADHD in various cultures to ascertain why the prevalence of this disorder continues to rise in American society. The hypothesis we assume for the increased rates of ADHD in our society is based on a linkage of events created by effects from a lack of parent-child interactions that lead to an increase in technology use which develops behaviors that mimic ADHD-like traits.