Use of percutaneous endoscopic colostomy (PEC) to treat sigmoid volvulus: a systematic review.

BACKGROUND AND AIM: Percutaneous endoscopic colostomy provides an alternative management option for patients with recurrent sigmoid volvulus who are considered too high risk to undergo surgery. We reviewed the literature to assess whether the National Institute for Health and Clinical Excellence guidelines published in 2006 supporting the use of percutaneous endoscopic colostomy are still valid. METHODS: A systematic literature search was conducted using PubMed, Web of Science, and Embase. The exploded search terms "Percutaneous Endoscopic Colostomy" and "Sigmoid Volvulus" were used. Librarian support was used to ensure the maximum number of relevant articles were returned. Identified abstracts were then analyzed and included if they met the inclusion criteria. RESULTS: Five observational studies and 5 case reports were identified that met the inclusion criteria. They provided data on 56 patients with recurrent sigmoid volvulus treated with percutaneous endoscopic colostomy placement. Sixteen of the 56 patients were treated with a single percutaneous endoscopic colostomy (PEC) tube while 38 patients were treated with 2 PEC tubes. For 2 patients the details of the procedure were unknown. Five patients developed major complications following the procedure: 1 patient developed peritonitis after 4 days, due to fecal contamination secondary to tube migration and 2 patients with cognitive impairment pulled their PEC tubes out. Two other patients died following PEC insertion. Nine patients developed minor complications following the procedure. The most commonly reported minor complication was infection at the PEC site. Four of 56 patients developed a recurrent sigmoid volvulus with a PEC tube in situ. CONCLUSION: Although in these case series there is a 21 % risk of morbidity and 5 % risk of mortality from the use of a PEC, this is favorable compared to the mortality risk of 6.6 % to 44 % reported with operative intervention. This review of contemporary literature therefore supports the use of PEC in frail and elderly patients.

Relative quality of internet-derived gastrointestinal cancer information.

Internet-derived health care information is increasingly accessed by patients, yet its quality and accuracy is variable and unregulated. The aim of this study was to assess the information available regarding common gastrointestinal cancers via three internet search engines (Google, Yahoo and Bing). The top 30 websites for each of the terms: oesophageal, gastric, pancreatic, colon and rectal cancer were evaluated (University of Michigan Consumer Health Website Checklist) and scored [-80 (poor) to 90 (excellent)]. The median score was 53 (-7 to 81) and was significantly higher for oesophageal (61) and pancreatic (65) cancer websites, compared with gastric (49), colon (48) and rectal cancer (50) (p = 0.014). Median scores related to charitable organisations were significantly better than academic, commercial, news agency, care provider, layperson and medical information websites collectively (79 vs. 42, p < 0.0001). Overall quality of internet-derived gastrointestinal cancer information remains poor and patients and clinicians should be aware.

The management of primary small bowel and colon lymphoma--a review.

AIMS: The management of primary small bowel and colon lymphoma is controversial. A review of the literature was therefore undertaken to evaluate the evidence for the classification, staging, diagnosis, and treatment of primary small bowel and colon lymphoma and guide management. METHODS: A literature search was performed utilising Embase, Medline, and Pubmed and papers were evaluated on an individual basis. RESULTS: Consensus opinion favours the WHO classification scheme and the TNM staging systems for primary small bowel and colon lymphoma. CT enteroclysis and barium enterolysis are recommended for the diagnosis of primary small bowel lymphoma and capsule endoscopy and double-balloon enteroscopy maybe useful diagnostic tools. In terms of the diagnosis and staging of primary colonic lymphoma, the evidence is scarce and CT is to be recommended. The mainstay of treatment for primary GI lymphoma is surgery and/or chemotherapy. For primary small bowel and colonic lymphoma, there was no definitive evidence regarding the benefits of either strategy; however, chemotherapy seemed to give a survival benefit over surgery alone for primary small bowel lymphoma and colonic lymphoma was skewed towards surgery plus chemotherapy due to the large number of patients presenting as an emergency. CONCLUSION: Published data regarding the management of primary small bowel and colon lymphoma is very limited. Classification and staging should be standardised to enable accurate evaluation of investigations and treatments and a large RCT undertaken to compare chemotherapy and surgery. Currently, we would recommend that management should involve chemotherapy with surgery reserved for those with clinical indication.

Early cholecystectomy after acute admission with cholecystitis: how much work?

BACKGROUND: This study was designed to determine the number of cases and amount of operating room time required, for a population of 600,000, to provide definitive treatment in the form of cholecystectomy for all patients admitted as an emergency with cholecystitis. METHODS: The total number of patients admitted to a single NHS trust in South East Wales with the diagnosis of cholecystitis during a 1-year period was assessed. The number of laparoscopic cholecystectomies performed and the time taken was investigated with the conversion rates. RESULTS: There were a total of 787 individual emergency admissions attributed to cholecystitis, and 224 patients (36%) underwent cholecystectomy on the same admission. The median operative time was 77 (range, 23-238) min, and the median operating room time was 108 (range, 37-278) min. To treat all patients definitively would necessitate 12 cholecystectomies per week, requiring 1,296 min or 5.4 sessions of operating room time. CONCLUSIONS: A population of 600,000 could be expected to generate enough emergency cholecystectomies to require more than one operating session per day. A significant increase in emergency operating room availability would be necessary to allow the provision of definitive treatment for all emergency admissions with cholelithiasis.

Evaluation of the quality and accuracy of information regarding aromatase inhibitors available on the internet.

The internet is commonly used by patients to access medical information, particularly where new treatments become available and are highlighted in the press. There is however, no regulation of the quality or accuracy of the information presented on web sites. The aim of this study was to evaluate the quality and accuracy of the information concerning the aromatase inhibitors (AIs). The three most popular search engines: Google, Yahoo, and MSN were utilized. The top ten "hits" for the generic and proprietary names of each AIs: anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara) were evaluated using a 12-point score by a single assessor. The accuracy of the information provided was compared with the National Institute for Health and Clinical Excellence guidelines. The mean score for the 180 web sites was only 6.13 out of 12 (0-11). If we consider a score of 9 or more out of 12 (> or =75%) for a web site to represent good quality information, then 51 (28%) of pages scored well. Google was slightly better than Yahoo and MSN; with the highest percentage of web sites scoring well. In evaluating hits according to type of web sites, 50 (28%) were charity web sites and 30 (17%) were drug company web sites and both groups scored significantly higher than the overall mean (charity p = 0.014, drug company p = 0.001). Only 2 of 180 hits gave accurate statistical evidence regarding the benefits of AIs over tamoxifen. We have found that the quality and accuracy of information concerning AIs provided on the Internet is poor and patients using it are unlikely to find accurate information. It is therefore our duty as healthcare providers to guide patients, so as to avoid them from being overwhelmed by irrelevant and conflicting information.