Subject(s)
COVID-19/prevention & control , Colorectal Neoplasms/diagnosis , Infection Control/organization & administration , Occult Blood , Referral and Consultation/organization & administration , Telemedicine/organization & administration , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Colorectal Neoplasms/therapy , Critical Pathways , Female , Humans , Infection Control/methods , Male , Middle Aged , Pandemics , Patient Acceptance of Health Care , Referral and Consultation/trends , Telemedicine/methods , Triage/methods , Triage/organization & administrationSubject(s)
Capsule Endoscopes/adverse effects , Colonic Diseases/etiology , Foreign Bodies/complications , Intestinal Perforation/etiology , Aged , Carcinoid Tumor/complications , Carcinoid Tumor/surgery , Colonic Diseases/surgery , Humans , Ileal Neoplasms/complications , Ileal Neoplasms/surgery , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intestinal Perforation/surgery , MaleABSTRACT
BACKGROUND: The number of colonoscopic procedures continues to rise rapidly. With widespread adoption of colonoscopy based bowel screening programmes, this rising trend is set to continue. AIMS: This study aimed to identify whether elective colonoscopy could provoke cardiac rhythm disturbances and/or myocardial ischaemia, as evidenced by 12 lead Holter ECG recordings and troponin I (cTnI) changes. MATERIALS AND METHODS: Patients were stratified into three groups based on the presence of cardiac disease or cardiovascular risk factors. They underwent real time 12 lead Holter monitoring before, during and after colonoscopy. Bloods were taken for pre- and post-procedure cTnI estimation. RESULTS: Holter ECG recordings of the three groups showed a high incidence of new but silent ischaemic and arrhythmic ECG changes during the colonoscopy in patients with documented but stable heart disease and to a lesser extent in those patients with one or more risk factors for heart disease. Three patients had high cTnI concentrations both before and after colonoscopy. Two patients with known heart disease died within 30 days of colonoscopy. CONCLUSIONS: This study demonstrates for the first time the occurrence of potentially clinically significant ST-T wave changes and rhythm disturbances during elective colonoscopy in patients with known heart disease and to a lesser extent in those patients with a known cardiovascular risk profile.
ABSTRACT
INTRODUCTION: Endoscopic retrograde cholangiopancreaticography (ERCP) is available in many district general hospitals in the UK. Most of the published literature on ERCP in cases with Billroth II gastrectomy reflects teaching hospital experience. The aim of this study was to evaluate this procedure in the district general hospital setting, over a 10-year period. PATIENTS AND METHODS: Details of 41 consecutive patients, whom had previously undergone Billroth II gastrectomy and were referred for ERCP were analysed for presenting symptoms and outcome of their ERCP. All procedures were carried out by a single radiologist using a conventional Olympus side-viewing duodenoscope. RESULTS: 48 examinations and 44 therapeutic procedures were carried out in 41 cases. Afferent loop intubation and cannulation of ampulla was successful in 87.5% and 98%, respectively. Two episodes of minor bleeding occurred after sphincterotomy, not requiring blood transfusion. One case of afferent loop perforation (2%) was repaired surgically. There were no cases of pancreatitis or death in this series. DISCUSSION AND CONCLUSIONS: The results show that ERCP after a Bilroth II gastrectomy can be safe and successful in the majority of cases when carried out by clinicians with a special interest, including those in a district general hospital However, experience with this procedure will diminish due to fewer indications for Billroth II gastrectomy and emergence of magnetic resonance cholangiopancreatography. It may be advisable to concentrate this technique in a few designated centres with skill and expertise.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/methods , Gastrectomy/methods , Postoperative Care/methods , Aged , Aged, 80 and over , Female , Hospitals, General , Humans , Male , Middle Aged , Pancreatic Diseases/diagnosis , Postoperative ComplicationsABSTRACT
BACKGROUND: Faecal diversion is often indicated in perineal sepsis and in the palliation of advanced ano-rectal malignancy. This can be performed open or laparoscopically. The aim of this study was to assess the outcome of these two approaches to stoma creation. METHODS: Prospective evaluation of laparoscopic or 'trephine' stoma creation in 49 consecutive unselected patients. RESULTS: Eighteen (37%) patients (median age 68 years) underwent a laparoscopic approach in which there were no conversions. One patient required a laparotomy for stoma mal-orientation and there were two (11%) deaths. Thirty-one patients (median age 70 years) had a trephine stoma formed with two (6%) conversions but no deaths. Thirteen (42%) of these patients had surgery performed under regional anaesthesia. There was no difference in the hospital stay between the two groups and at a mean follow-up of 16 months, 20 (41%) patients had died mainly from disease progression. CONCLUSION: Both approaches to faecal diversion give adequate results in the short term. Laparoscopic techniques should be reserved for fitter patients as a trephine stoma can be performed under regional anaesthesia.
