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1.
Obes Surg ; 30(1): 233-237, 2020 01.
Article in English | MEDLINE | ID: mdl-31440956

ABSTRACT

BACKGROUND: Retraction of the left lobe of the liver is an important step in most bariatric surgical procedures. Bariatric patients may have enlarged, fatty livers and retraction can be complicated with injuries, haematoma, or necrosis. The aim of this study was to compare the effects of two standard liver retractors, Nathanson and PretzelFlex on patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: All consecutive patients undergoing LRYGB in our center from April 2017 to January 2019 were analysed. The type of retractor used was dependent on the surgeon's preference and the availability of instruments. Patients were divided into two groups, based on the type of liver retraction device used. Each group was assessed and compared for postoperative pain score, presence of nausea or vomiting, blood test results (liver function tests and C-reactive protein), and length of hospital stay. RESULTS: LRYGB was performed on 167 patients in which Nathanson was used in 93 patients and PretzelFlex in 74 patients. The duration of surgery was similar in both groups. Alanine transaminase (ALT) levels and C-reactive protein (CRP) were significantly higher in the group where Nathanson's retractor was used. The postoperative pain score and length of stay were also higher when Nathanson's retractor was used but it did not reach statistical significance. CONCLUSION: The PretzelFlex liver retractor causes significantly less measurable liver damage and is associated with less postoperative pain and nausea when compared with Nathanson's retractor.


Subject(s)
Gastric Bypass/instrumentation , Laparoscopy/instrumentation , Liver/pathology , Obesity, Morbid/surgery , Surgical Instruments , Adult , Equipment Design , Female , Gastric Bypass/adverse effects , Gastric Bypass/methods , Humans , Laparoscopy/adverse effects , Laparoscopy/methods , Length of Stay , Liver Function Tests , Male , Middle Aged , Pain, Postoperative/etiology , Prospective Studies , Retrospective Studies , Surgical Instruments/adverse effects
2.
Obes Surg ; 28(8): 2550-2559, 2018 08.
Article in English | MEDLINE | ID: mdl-29948874

ABSTRACT

Obesity among human immunodeficiency virus (HIV)-infected individuals is on the rise. Bariatric procedures such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) alter the GI tract. Whether this alteration has any impact on the absorption of highly active antiretroviral therapy (HAART), thus affecting HIV disease markers such as CD4 cell count or viral load (VL), is not yet known. We conducted this review to look into the outcomes of bariatric surgery procedures, RYGB, SG and adjustable gastric band (AGB) and its effects on the CD4 cell counts and VL and HAART therapy. A literature search was conducted between January and April 2017, by two independent reviewers, using Pubmed and Google Scholar. The terms 'bariatric surgery and HIV', 'obesity surgery and HIV', 'gastric bypass surgery and HIV', 'sleeve gastrectomy and HIV' and 'gastric band and HIV' were used to retrieve available research. Of the 49 papers reviewed, only 12 reported the outcomes of patients with HIV undergoing bariatric surgery and were therefore included in this review. Six papers assessed patients undergoing RYGB only (N = 18), 3 papers reported on SG only (N = 18) and 3 papers reported on case mix, including 7 cases of RYGB, 4 cases of SG and 11 cases of AGB. Data is limited; however, based on the available data, bariatric surgery is safe in HIV-infected individuals and does not have any adverse impact on HIV disease progress. Additionally, there was no difference in HIV-related outcomes between SG and RYGB.


Subject(s)
Gastrectomy , Gastric Bypass , HIV Infections/complications , Obesity, Morbid/surgery , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Bariatric Surgery/methods , CD4 Lymphocyte Count , HIV Infections/drug therapy , Humans , Obesity, Morbid/complications , Retrospective Studies , Viral Load
3.
Obes Surg ; 25(7): 1302-6, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25875353

ABSTRACT

BACKGROUND: Gastric band slippage is a significant challenge in gastric band surgery and can result in poor weight loss, pain and dysphagia, often requiring re-operation. The Royal Berkshire Hospital is one of 49 UK centres performing bariatric surgery. We audited our band slippage rates. METHODS: All patients undergoing gastric banding from February 2007 to December 2013 were included (follow-up until December 2014). Slip rate was calculated and compared to an audit standard (3.9 %). The impact of two interventions altering the method of band filling and post-operative dietary advice was studied. RESULTS: Initial slippage rates were high (17 %). Rates decreased following the interventions: 8.5 % by July 2012 (p = 0.05); 2.7 % by December 2014 (p = 0.2). CONCLUSIONS: Two simple, low-risk interventions have reduced complication rates in a high-risk population.


Subject(s)
Gastroplasty/adverse effects , Laparoscopy/adverse effects , Obesity, Morbid/surgery , Postoperative Complications/prevention & control , Adult , Female , Gastroplasty/methods , Humans , Laparoscopy/methods , Male , Middle Aged , Reoperation , Retrospective Studies
4.
World J Gastroenterol ; 20(28): 9611-7, 2014 Jul 28.
Article in English | MEDLINE | ID: mdl-25071359

ABSTRACT

AIM: To investigate the lifetime risk of development of esophageal adenocarcinoma and/or high-grade dysplasia in patients diagnosed with Barrett's esophagus. METHODS: Data were extracted from the United Kingdom National Barrett's Oesophagus Registry on date of diagnosis, patient age and gender of 7877 patients from who had been registered from 35 United Kingdom centers. Life expectancy was evaluated from United Kingdom National Statistics data based upon gender and age at year at diagnosis. These data were then used with published estimates of annual adenocarcinoma and high-grade dysplasia incidences from meta-analyses and large population-based studies to estimate overall lifetime risk of development of these study endpoints. RESULTS: The mean age at diagnosis of Barrett's esophagus was 61.6 years in males and 67.3 years in females. The mean life expectancy at diagnosis was 23.1 years in males, 20.7 years in females and 22.2 years overall. Using data from published meta-analyses, the lifetime risk of development of adenocarcinoma was between 1 in 8 and 1 in 14 and the lifetime risk of high-grade dysplasia or adenocarcinoma was 1 in 5 to 1 in 6. Using data from 3 large recent population-based cohort studies the lifetime risk of adenocarcinoma was between 1 in 10 and 1 in 37 and of the combined end-point of high-grade dysplasia and adenocarcinoma was between 1 in 8 and 1 in 20. Age at Barrett's esophagus diagnosis is reducing and life expectancy is increasing, which will partially counter-balance lower annual cancer incidence. CONCLUSION: There is a significant lifetime risk of development of high-grade dysplasia and adenocarcinoma in Barrett's esophagus.


Subject(s)
Adenocarcinoma/epidemiology , Barrett Esophagus/epidemiology , Esophageal Neoplasms/epidemiology , Precancerous Conditions/epidemiology , Adenocarcinoma/diagnosis , Age Factors , Aged , Aged, 80 and over , Barrett Esophagus/diagnosis , Esophageal Neoplasms/diagnosis , Female , Humans , Incidence , Life Expectancy , Linear Models , Male , Middle Aged , Neoplasm Grading , Precancerous Conditions/diagnosis , Registries , Risk Assessment , Risk Factors , Sex Factors , Time Factors , United Kingdom/epidemiology
5.
Int J Surg Case Rep ; 4(9): 761-4, 2013.
Article in English | MEDLINE | ID: mdl-23856254

ABSTRACT

INTRODUCTION: Haemobilia is a rare complication of acute cholecystitis and may present as upper gastrointestinal bleeding. PRESENTATION OF CASE: We describe two patients with acute cholecystitis presenting with upper gastrointestinal bleeding due to haemobilia. Bleeding from the duodenal papilla was seen at endoscopy in one case but none in the other. CT demonstrated acute cholecystitis with a pseudoaneurysm of the cystic artery in both cases. Definitive control of intracholecystic bleeding was achieved in both cases by embolisation of the cystic artery. Both patients remain symptom free. One had subsequent laparoscopic cholecystostomy and the other no surgery. DISCUSSION: Pseudoaneurysms of the cystic artery are uncommon in the setting of acute cholecystitis. OGD and CT angiography play a key role in diagnosis. Transarterial embolisation (TAE) is effective in controlling bleeding. TAE followed by interval cholecystectomy remains the treatment of choice in surgically fit patients. CONCLUSION: We highlight an unusual cause of upper GI haemorrhage. Surgeons need to be aware of this rare complication of acute cholecystitis. Immediate non-surgical management in these cases proved to be safe and effective.

6.
BMJ Case Rep ; 20122012 Sep 25.
Article in English | MEDLINE | ID: mdl-23010467

ABSTRACT

Torsion of the vermiform appendix is a rare disorder that causes symptoms similar to those of acute appendicitis. Primary and secondary causes of appendiceal torsion have been reported in the literature. Laparoscopy appears to be the most appropriate modality for diagnosis and treatment where the condition is suspected. To our knowledge this is the first case of appendiceal torsion in an adult causing right upper quadrant pain related to caecal malposition.


Subject(s)
Appendix , Cecum/abnormalities , Torsion Abnormality/diagnosis , Abdominal Pain/etiology , Appendix/pathology , Appendix/surgery , Cecum/pathology , Cecum/surgery , Diagnosis, Differential , Female , Humans , Middle Aged , Torsion Abnormality/complications , Torsion Abnormality/surgery
7.
J Minim Access Surg ; 8(3): 102-3, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22837600

ABSTRACT

A 41-year-old man presented with chylous ascites 6 weeks after a laparoscopic Nissen fundoplication. The chyle leak was successfully treated with laparoscopic ligation of the leaking duct at the right crus. We would now recommend early consideration of this as a treatment option for this rare complication.

8.
Eur J Cancer Prev ; 21(6): 507-10, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22433630

ABSTRACT

The aim of this study was to examine the relationship between smoking and oesophageal high-grade dysplasia (HGD) or adenocarcinoma (AC) in a large cohort of patients with Barrett's columnar-lined oesophagus (CLO). A total of 1280 patients diagnosed with CLO and registered with the UK National Barrett's Oesophagus Registry were included. Data, including smoking habits, were collected from the patient's notes and development of HGD or AC noted. Analysis was performed with SPSS using logistic regression for calculation of odds ratios (ORs) for development of HGD/AC. Data on smoking habits were available in 956 (74.6%) patients. There was no significant difference between smokers and nonsmokers in mean age (P=0.877) or length of follow-up (P=0.359). There was a significant risk of HGD/AC in patients with any history of smoking compared with those who had never smoked (P<0.001, OR 2.81). Ex-smokers of 10 years or more remained at a significantly higher risk of HGD/AC compared with those who had never smoked (P=0.001, OR 3.37). Current smokers were not at a significantly higher risk of HGD/AC compared with ex-smokers (P=0.857) nor were those who smoked at least 20 a day compared with those who smoked fewer than 20 a day (P=0.632). In patients with CLO, smoking appears to be a significant risk factor for the development of severe dysplastic disease; however, we did not observe a dose-dependent effect of smoking on progression of disease.


Subject(s)
Adenocarcinoma/etiology , Barrett Esophagus/complications , Esophageal Neoplasms/etiology , Esophagus/pathology , Precancerous Conditions/etiology , Smoking/adverse effects , Adenocarcinoma/pathology , Barrett Esophagus/pathology , Cohort Studies , Disease Progression , Esophageal Neoplasms/pathology , Female , Humans , Male , Middle Aged , Neoplasm Grading , Precancerous Conditions/pathology , Prognosis , Risk Factors
9.
Eur J Gastroenterol Hepatol ; 23(9): 801-6, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21701391

ABSTRACT

INTRODUCTION: Incidence of oesophageal adenocarcinoma (OAC) is increasing rapidly. OAC arises in columnar-lined oesophagus (CLO), a metaplastic change affecting some patients with gastro-oesophageal reflux disease (GORD). As yet there is no reliable method of identifying those at highest risk. Our earlier observation of an association between OAC and blood group O Rhesus negative, if confirmed, may help identify those at greatest risk. AIM AND METHODS: To assess the distribution of blood group and Rhesus D (RhD) factor in patients with GORD compared with the blood donating general population. GORD was categorized as nonerosive reflux (NER), erosive oesophagitis, CLO and OAC. The Rotherham Hospital database holds details of all GORD, CLO and OAC patients seen in the Gastroenterology Unit. Blood group information for patients with GORD was obtained from patients' records and the hospital's blood transfusion service. The blood group distribution in the general population was obtained from the National Blood Transfusion Service. The number of expected to observed patients in each blood group for each subtype was compared. RESULTS: Two thousand six hundred and ten NER, 2813 erosive oesophagitis, 568 CLO and 73 OAC patients had a recorded blood group. For RhD positive patients observed proportions in each blood group were similar to expected. The most striking difference was the marked excess of OAC in blood group O, Rhesus negative (P=0.002). CONCLUSION: CLO patients with blood group O, RhD negative carry a disproportionately higher risk of developing OAC. The mechanism is unknown but the finding has practical application in guiding risk stratification and intensity of surveillance.


Subject(s)
Adenocarcinoma/blood , Barrett Esophagus/blood , Blood Group Antigens , Esophageal Neoplasms/blood , Nitric Oxide/physiology , Precancerous Conditions/blood , ABO Blood-Group System , Adenocarcinoma/etiology , Barrett Esophagus/etiology , Disease Progression , Esophageal Neoplasms/etiology , Female , Gastroesophageal Reflux/blood , Gastroesophageal Reflux/complications , Humans , Male , Precancerous Conditions/etiology , Retrospective Studies , Rh-Hr Blood-Group System
10.
Histopathology ; 54(7): 814-9, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19635100

ABSTRACT

AIMS: To examine the natural history of columnar-lined oesophagus with routinely diagnosed low-grade dysplasia and ascertain the risk of oesophageal adenocarcinoma development. METHODS AND RESULTS: A multicentre retrospective cohort study of 283 patients with low-grade dysplasia. Follow-up data were obtained from examination of hospital records. One hundred and forty-four patients had biopsies prior to low-grade dysplasia diagnosis and 217 had follow-up biopsies after index low-grade dysplasia diagnosis. In these patients the incidence of high-grade dysplasia and adenocarcinoma combined was 4.6% per annum and of adenocarcinoma alone was 2.7% per annum. At most recent follow-up, 43 (19.8%) had persistent low-grade dysplasia, 37 (17.1%) had changes indefinite for dysplasia and 108 (49.8%) had non-dysplastic columnar-lined oesophagus. When prevalent cases were excluded (those occurring within 1 year of index low-grade dysplasia diagnosis), the annual incidence of high-grade dysplasia and adenocarcinoma combined was 2.2% and of adenocarcinoma alone was 1.4%. The relative risk for adenocarcinoma development in low-grade dysplasia compared with non-dysplastic columnar-lined oesophagus was 2.871 (P = 0.002). CONCLUSIONS: Low-grade dysplasia has a threefold increased risk of progression to cancer compared with non-dysplastic epithelium, but in the majority of patients dysplasia is not subsequently detected.


Subject(s)
Barrett Esophagus/pathology , Adenocarcinoma/etiology , Barrett Esophagus/complications , Barrett Esophagus/diagnosis , Barrett Esophagus/therapy , Cohort Studies , Epithelium/pathology , Esophageal Neoplasms/etiology , Esophagoscopy , Follow-Up Studies , Humans , Metaplasia , Retrospective Studies , Risk Factors , Time Factors , United Kingdom
11.
Eur J Cancer Prev ; 18(5): 381-4, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19620873

ABSTRACT

Barrett's columnar-lined oesophagus is the precursor lesion for oesophageal adenocarcinoma. The overall rate of progression to adenocarcinoma is 0.59% per annum. A large prospective multicentre trial is recruiting to assess the role of aspirin as a chemoprotective agent in prevention of development of cancer as well as cardiovascular protection in patients with Barrett's oesophagus. This retrospective analysis of the large UK National Barrett's Oesophagus Registry database seeks to analyse this question from within its large natural history study cohort. Multicentre UK retrospective cohort compared patients known to have been taking aspirin with those who did not take aspirin during the course of surveillance for columnar-lined oesophagus. End point was development of dysplasia or oesophageal adenocarcinoma. Analysis was undertaken using Cox's proportional hazard ratio. Total follow-up was 3683 patient-years. Eighty-six patients were taking aspirin, 650 were not taking aspirin (reference group). Numbers of patients developing all grades of dysplasia and adenocarcinoma were: 13 aspirin (15.1%) and 97 no aspirin (14.9%) (hazard ratio 0.723, 95% confidence interval 0.410-1.310, P = 0.294), high-grade dysplasia and adenocarcinoma: five aspirin (5.8%) and 25 no aspirin (3.8%) (hazard ratio 0.898, 95% confidence interval 0.340-2.368, P = 0.827) and adenocarcinoma: four aspirin (4.7%) and 16 no aspirin (2.5%) (hazard ratio 1.092, 95% confidence interval 0.358-3.335, P = 0.877). No significant difference was observed in hazard of developing dysplasia or adenocarcinoma between patients taking aspirin and those not taking aspirin during the course of follow-up of surveillance for columnar-lined oesophagus. In conclusion, no difference in risk of development of dysplasia or adenocarcinoma was observed between patients taking aspirin and those not taking aspirin in this large cohort.


Subject(s)
Adenocarcinoma/prevention & control , Anticarcinogenic Agents/therapeutic use , Aspirin/therapeutic use , Barrett Esophagus/drug therapy , Esophageal Neoplasms/prevention & control , Precancerous Conditions/drug therapy , Adenocarcinoma/epidemiology , Adenocarcinoma/pathology , Barrett Esophagus/pathology , Cohort Studies , Demography , Esophageal Neoplasms/epidemiology , Esophageal Neoplasms/pathology , Female , Humans , Male , Middle Aged , Precancerous Conditions/epidemiology , Precancerous Conditions/pathology
12.
Eur J Gastroenterol Hepatol ; 21(10): 1127-31, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19295439

ABSTRACT

OBJECTIVES: The prevalence of columnar-lined oesophagus seems to have increased steadily in the past three decades in Europe and North America. Although the vast majority of columnar-lined oesophagus will not progress to malignancy, it is nevertheless important to identify the risk factors associated with this condition. This study investigates whether there has been a change, at diagnosis, in age of columnar-lined oesophagus patients between 1990 and 2005, or an increase in the number of patients aged less than 50 years. METHODS: Data on age of diagnosis were abstracted from medical records of 7220 patients from 19 centres registered with UK National Barrett's Oesophagus Registry, between the years 1990 and 2005. Linear regression analysis was carried out to assess any trends in the mean age of diagnosis. RESULTS: Overall there was a mean decrease in age at diagnosis for each 1-year increase in time. This equated to a mean decrease of 3 years over the study period, 1990-2005 with the greatest difference being seen in female patients. About 18% of patients in the study were aged less than 50 years at the time of diagnosis. With this group also, the trend was similar, with an increase in the number of patients aged less than 50 years, at the time of diagnosis, with increasing years. CONCLUSION: The mean age of diagnosis of columnar-lined oesophagus has decreased between the years 1990 and 2005 in both men and women, more so in women. This is also reflected in an increase in newly diagnosed columnar-lined oesophagus patients below the age of 50 years.


Subject(s)
Barrett Esophagus/epidemiology , Esophageal Neoplasms/epidemiology , Precancerous Conditions/epidemiology , Adult , Age Distribution , Age Factors , Aged , Barrett Esophagus/diagnosis , Esophageal Neoplasms/diagnosis , Female , Humans , Male , Middle Aged , Precancerous Conditions/diagnosis , Registries , Risk Factors , Sex Distribution , United Kingdom/epidemiology
13.
Eur J Gastroenterol Hepatol ; 21(6): 636-41, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19177028

ABSTRACT

OBJECTIVES: Endoscopic surveillance of patients with columnar-lined oesophagus (CLO) may identify those with early adenocarcinoma (AC). The benefits of surveillance are unproven and there is little evidence to support recommendations for precise endoscopic intervals. We sought to examine surveillance practice for CLO in the UK and the impact of endoscopic intervals on detection of dysplastic disease. METHODS: Eight hundred and seventeen patients with CLO, registered with the UK National Barrett's Oesophagus registry and undergoing surveillance were studied. Endoscopic intervals were calculated and frequency of detection of dysplastic disease analysed using chi2 test of association. Factors affecting surveillance intervals were analysed using multiple linear regression. RESULTS: 94.7% of patients with low-grade dysplasia (LGD), 95.0% with high-grade dysplasia (HGD) and 71.4% with AC were diagnosed on surveillance endoscopies. Mean endoscopic surveillance intervals varied between the centres from 1.07 to 1.63 years for nondysplastic CLO; 0.69-1.19 years for LGD, and 0.35-1.17 years for HGD; with overall mean surveillance intervals of 1.29, 1.01 and 0.44 years, respectively. When LGD was surveyed, significantly higher proportions of HGD/AC were detected at intervals of 3 months or less (P=0.013). Shorter endoscopic intervals were significantly associated with the presence of oesophageal strictures (P=0.002), ulcers (P=0.046), increasing patient age (P<0.001) and higher grade of dysplasia surveyed (P<0.001). CONCLUSION: A variation in surveillance practice for CLO was observed throughout the UK. A large proportion of dysplastic disease is detected on specific surveillance endoscopies. Shorter endoscopic intervals for surveillance of LGD are associated with an increased detection of HGD/AC.


Subject(s)
Adenocarcinoma/diagnosis , Barrett Esophagus/diagnosis , Esophageal Neoplasms/diagnosis , Population Surveillance/methods , Precancerous Conditions/diagnosis , Aged , Disease Progression , Early Diagnosis , Esophagoscopy/methods , Female , Humans , Male , Middle Aged , Professional Practice , Registries , Time Factors , United Kingdom
14.
Dis Esophagus ; 22(2): 133-42, 2009.
Article in English | MEDLINE | ID: mdl-19018855

ABSTRACT

Columnar metaplasia is the precursor lesion for esophageal adenocarcinoma, resulting from prolonged gastroesophageal reflux. The influence of the efficacy of reflux control on the development of neoplastic change in columnar-lined esophagus is not established. This study compares the rate of development of dysplasia and adenocarcinoma in patients with columnar metaplasia of the esophagus between patients treated pharmacologically and those treated with antireflux surgery. This study is a retrospective review of a cohort of patients enrolled in a multicenter national registry involving 738 patients from seven UK centers. Forty-one were treated with antireflux surgery, 42 with H2 receptor antagonist, 532 with proton pump inhibitor, and 114 with a combination of these medications. Nine had none of these medications or surgery. Total follow-up was 3697 years. Mean age and follow-up for patients treated medically were 61.6 and 4.96 years and surgically were 50.5 and 6.19 years, respectively. No patient in the surgical group developed high-grade dysplasia (HGD) or adenocarcinoma. Twenty patients treated medically developed adenocarcinoma and 10 developed HGD. Hazards ratio comparing pharmacological to surgical therapy for development of all grades of dysplasia and adenocarcinoma 1.77 (P = 0.272). Log rank test comparing antireflux surgery to pharmacological therapy for development of HGD or adenocarcinoma P = 0.1287 and for adenocarcinoma P = 0.2125. Although there was a trend towards greater efficacy of antireflux surgery over pharmacological therapy in reducing the development of dysplasia and adenocarcinoma, this did not reach statistical significance.


Subject(s)
Adenocarcinoma/pathology , Barrett Esophagus/pathology , Esophageal Neoplasms/pathology , Esophagus/pathology , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/therapy , Precancerous Conditions/pathology , Disease Progression , Female , Fundoplication , Gastroesophageal Reflux/pathology , Histamine H2 Antagonists/therapeutic use , Humans , Male , Metaplasia , Middle Aged , Proton Pump Inhibitors/therapeutic use , Retrospective Studies
15.
Eur J Cancer Prev ; 17(5): 422-5, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18714183

ABSTRACT

The management of the columnar-lined oesophagus (CLO) has remained controversial for the last 10 years, with practices varying between individual physicians and centres throughout the United Kingdom. Various guidelines exist, although international consensus over issues such as the recognition of short-segment disease and surveillance policies for uncomplicated and dysplastic disease is lacking. Questionnaires examining the practice of diagnosis and surveillance of CLO were sent to 41 centres spread throughout the United Kingdom. Thirty (73%) centres replied. Twelve (40%) had a specific written policy for the management of CLO. Twenty-five (83%) centres made a diagnosis of CLO in the presence of any length of columnarization. Twenty-seven (90%) centres surveyed CLO with 81% of them undertaking a selective surveillance policy. Endoscopic surveillance intervals were fairly consistent for uncomplicated CLO and high-grade dysplasia, but were less consistent for low-grade dysplasia. Results confirmed that even amongst centres with a specialist interest in the management of CLO, marked variations exist in diagnosis and surveillance practice.


Subject(s)
Esophageal Diseases/diagnosis , Esophageal Diseases/therapy , Practice Patterns, Physicians' , Precancerous Conditions/diagnosis , Precancerous Conditions/therapy , Adenocarcinoma/diagnosis , Adenocarcinoma/pathology , Adenocarcinoma/therapy , Biopsy , Esophageal Diseases/pathology , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/pathology , Esophageal Neoplasms/therapy , Esophagoscopy/methods , Esophagoscopy/statistics & numerical data , Humans , Neoplasm Staging , Population Surveillance , Precancerous Conditions/pathology , Registries , Surveys and Questionnaires , United Kingdom
16.
Scand J Gastroenterol ; 43(5): 524-30, 2008.
Article in English | MEDLINE | ID: mdl-18415743

ABSTRACT

OBJECTIVE: In the USA, detection of intestinal metaplasia is a requirement for enrollment in surveillance programmes for dysplasia or adenocarcinoma in columnar-lined oesophagus. In the UK, it is believed that failure to detect intestinal metaplasia at index endoscopy does not imply its absence within the columnarized segment or that the tissue is not at risk of neoplastic transformation. The aim of this study was to investigate the factors predicting the probability of detection of intestinal metaplasia in the columnarized segment. MATERIAL AND METHODS: Demonstration of intestinal metaplasia was analysed in 3568 biopsies of non-dysplastic columnar-lined oesophagus from 1751 patients from 7 centres in the UK. Development of dysplasia and adenocarcinoma was analysed in 322 patients without intestinal metaplasia and compared with that in 612 patients with intestinal metaplasia. RESULTS: Intestinal metaplasia was more commonly detected in males than in females (odds ratio 1.244), longer segment length (10.3% increase per centimetre) and increasing number of biopsies taken (24% increase per unit increase). After 5 years of follow-up, 54.8% of patients without intestinal metaplasia at index endoscopy demonstrated intestinal metaplasia, and 90.8% after 10 years. There was no significant difference in the rate of development of dysplasia or adenocarcinoma between patients with or without intestinal metaplasia detection at index endoscopy. CONCLUSIONS: Detection of intestinal metaplasia is subject to significant sampling error. It increases with segment length and number of biopsies taken. In the majority of patients, if sufficient biopsies are taken over time, intestinal metaplasia will be demonstrated. The decision to offer surveillance should not be based upon the presence or absence of intestinal metaplasia at index endoscopy as the risk of dysplasia and adenocarcinoma is similar in both groups.


Subject(s)
Barrett Esophagus/pathology , Esophagus/pathology , Adenocarcinoma/etiology , Adenocarcinoma/pathology , Barrett Esophagus/complications , Biopsy, Needle , Esophageal Neoplasms/etiology , Esophageal Neoplasms/pathology , Female , Follow-Up Studies , Humans , Male , Metaplasia
17.
Eur J Gastroenterol Hepatol ; 19(11): 969-75, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18049166

ABSTRACT

OBJECTIVE: Longer columnar-lined oesophagus (CLO) segments have been associated with higher cancer risk, but few studies have demonstrated a significant difference in neoplastic risk stratified by CLO segment length. This study establishes adenocarcinoma risk in CLO by segment length. METHODS: This is a multicentre retrospective observational study. Medical records of 1000 patients registered from six centres were examined and data extracted on demographic factors, endoscopic features and histopathology of oesophageal biopsies. Adenocarcinoma incidence was evaluated for patients stratified by their diagnostic segment length. RESULTS: Seven hundred and eighty-one patients had biopsy-proven CLO and a segment length recorded. Four hundred and ninety patients had at least 1 year of follow-up, providing 2620 patient-years of follow-up for incidence analysis. The overall annual adenocarcinoma incidence was 0.62%/year (95% confidence interval: 0.36-1.01). The annual incidence in the segment length groups was 0.59% (0.19-1.37) in short segment (3 6 9 cm; P=0.004. CONCLUSION: This study demonstrates that the neoplastic risk of CLO varies according to segment length, and that overall, the risk of adenocarcinoma development is similar in short-segment and long-segment (>3 cm) CLO. The highest adenocarcinoma risk was found in the longest CLO segments and lowest risk in segments >3

Subject(s)
Adenocarcinoma/pathology , Barrett Esophagus/pathology , Esophageal Neoplasms/pathology , Esophagus/pathology , Precancerous Conditions/pathology , Age Factors , Aged , Biopsy , Chi-Square Distribution , Disease Progression , Esophagoscopy , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Regression Analysis , Retrospective Studies , Risk , United Kingdom
18.
19.
Dig Dis Sci ; 52(10): 2821-5, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17410451

ABSTRACT

The relationship between Helicobacter pylori infection and reflux-induced esophageal diseased is controversial. We examined esophageal disease severity in patients with columnar-lined esophagus and compared results between patients with and without Helicobacter pylori infection. Medical records of 1000 patients diagnosed with columnar-lined esophagus were examined. Endoscopic and histological findings of reflux-induced esophageal disease were compared between H. pylori-positive and H. pylori-negative patients. Four hundred twenty-nine patients (42.9%) showed evidence of H. pylori status, of whom 239 (55.7%) were positive and 190 (44.3%) negative. There were no significant differences in length of columnar-lined segment (P = 0.305), frequency of associated esophagitis (P = 0.583), or presence of gastroduodenal inflammation (P = 0.335, P = 0.131) between the two groups. Histological grade of esophageal disease severity was similar between them, with no statistically significant differences (P = 0.231). We conclude that in patients with established columnar-lined esophagus, there appears to be no difference in severity of reflux-induced esophageal disease between those with and those without H. pylori infection.


Subject(s)
Esophagus/pathology , Gastroesophageal Reflux/diagnosis , Helicobacter Infections/diagnosis , Helicobacter pylori/isolation & purification , Endoscopy, Gastrointestinal , Esophagus/microbiology , Follow-Up Studies , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/epidemiology , Helicobacter Infections/complications , Helicobacter Infections/epidemiology , Humans , Incidence , Prognosis , Risk Factors , Severity of Illness Index , United Kingdom/epidemiology
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