1
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Affiliation(s)
- K Sahnan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - J Warusavitarne
- Department of Surgery and Cancer, Imperial College London, London, UK. .,Department of Surgery, St Mark's Hospital, London, UK.
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2
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Bolckmans R, Singh S, Ratnatunga K, Wickramasinghe D, Sahnan K, Adegbola S, Kalman D, Jones H, Travis S, Warusavitarne J, Myrelid P, George B. Temporary faecal diversion in ileocolic resection for Crohn's disease: is there an impact on long-term surgical recurrence? Colorectal Dis 2020; 22:430-438. [PMID: 31715062 DOI: 10.1111/codi.14895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022]
Abstract
AIM Temporary faecal diversion after ileocolic resection (ICR) for Crohn's disease reduces postoperative anastomotic complications in high-risk patients. The aim of this study was to assess if this approach also reduces long-term surgical recurrence. METHOD This was a multicentre retrospective review of prospectively maintained databases. Patient demographics, medical and surgical details were collected by three specialist centres. All patients had undergone an ICR between 2000 and 2012. The primary end-point was surgical recurrence. RESULTS Three hundred and twelve patients (80%) underwent an ICR without covering ileostomy (one stage). Seventy-seven (20%) had undergone an ICR with end ileostomy/double-barrel ileostomy/enterocolostomy followed by closure (two stage). The median follow-up was 105 months [interquartile range (IQR) 76-136 months]. The median time to ileostomy closure was 9 months (IQR 5-12 months). There was no significant difference in surgical recurrence between the one- and two-stage groups (18% vs 16%, P = 0.94). We noted that smokers (20% vs 34%, P = 0.01) and patients with penetrating disease (28% vs 52%, P < 0.01) were more likely to be defunctioned. A reduced recurrence rate was observed in the small high-risk group of patients who were smokers with penetrating disease behaviour treated with a two-stage strategy (0/10 vs 4/7, P = 0.12). CONCLUSION Despite having higher baseline risk factors, the results in terms of rate of surgical recurrence over 9 years are similar for patients having a two-stage compared with a one-stage procedure.
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Affiliation(s)
- R Bolckmans
- Department of Colorectal Surgery, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Singh
- Department of Colorectal Surgery, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K Ratnatunga
- Department of Colorectal Surgery, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Wickramasinghe
- Department of Colorectal Surgery, St Mark's Hospital, London, UK
| | - K Sahnan
- Department of Colorectal Surgery, St Mark's Hospital, London, UK
| | - S Adegbola
- Department of Colorectal Surgery, St Mark's Hospital, London, UK
| | - D Kalman
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Surgery, County Council of Östergötland, Linköping, Sweden
| | - H Jones
- Department of Colorectal Surgery, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Travis
- Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - J Warusavitarne
- Department of Colorectal Surgery, St Mark's Hospital, London, UK
| | - P Myrelid
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Surgery, County Council of Östergötland, Linköping, Sweden
| | - B George
- Department of Colorectal Surgery, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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3
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Machielsen AJHM, Iqbal N, Kimman ML, Sahnan K, Adegbola SO, Kleijnen J, Vaizey CJ, Grossi U, Tozer PJ, Breukink SO. The development of a cryptoglandular Anal Fistula Core Outcome Set (AFCOS): an international Delphi study protocol. United European Gastroenterol J 2020; 8:220-226. [PMID: 32213065 DOI: 10.1177/2050640620907570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Cryptoglandular anal fistula is a disorder with an incidence of around 1 per 5,000 people per year in European countries. Many studies have been conducted to evaluate the effectiveness of interventions for anal fistula. However, there is considerable heterogeneity in the outcomes assessed and reported in these studies. This limits research quality and complicates evidence synthesis. A solution for heterogeneity in outcome reporting is the development of a Core Outcome Set (COS). This paper describes the protocol for the development of a European COS for Anal Fistula (AFCOS). METHODS The first step will be a systematic review of the literature to identify potential outcomes that may be included in the COS. Patient interviews will be conducted in The United Kingdom and The Netherlands to ensure that both clinician-important and patient-important outcomes are captured. The outcomes will be categorized using the COMET taxonomy and taken forward to a Delphi consensus exercise. In up to three web-based Delphi surveys the outcomes will be prioritized by patients, clinicians (surgeons, gastroenterologists, and radiologists), and (clinical) researchers. The responses will be summarized and reported anonymously in subsequent round(s) facilitating convergence to a consensus opinion. The final COS will be decided during a face-to-face consensus meeting with patients, clinicians, and (clinical) researchers. DISCUSSION This study protocol describes the development of a European COS for anal fistula to improve research quality, evidence synthesis, and patient care.
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Affiliation(s)
- A J H M Machielsen
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Centreþ, Maastricht, The Netherlands.,Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - N Iqbal
- Robin Phillips Fistula Research Unit, St Mark's Hospital, London, The United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, The United Kingdom
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centreþ, Maastricht, The Netherlands
| | - K Sahnan
- Robin Phillips Fistula Research Unit, St Mark's Hospital, London, The United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, The United Kingdom
| | - S O Adegbola
- Robin Phillips Fistula Research Unit, St Mark's Hospital, London, The United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, The United Kingdom
| | - J Kleijnen
- Department of Family Practice; Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - C J Vaizey
- Robin Phillips Fistula Research Unit, St Mark's Hospital, London, The United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, The United Kingdom
| | - U Grossi
- 4th Surgery Unit, Treviso Hospital, Treviso, Italy; University of Padua, Padua, Italy
| | - P J Tozer
- Robin Phillips Fistula Research Unit, St Mark's Hospital, London, The United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, The United Kingdom
| | - S O Breukink
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Centreþ, Maastricht, The Netherlands
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4
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Tozer P, Sahnan K, Adegbola S, Shaikh S, Lung P. Video-assisted anal fistula treatment (VAAFT) assisted seton placement - a video vignette. Colorectal Dis 2019; 21:1462. [PMID: 31400250 DOI: 10.1111/codi.14823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 07/29/2019] [Indexed: 02/08/2023]
Affiliation(s)
- P Tozer
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Imperial College London, Harrow, UK
| | - K Sahnan
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Imperial College London, Harrow, UK
| | - S Adegbola
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Imperial College London, Harrow, UK
| | - S Shaikh
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Imperial College London, Harrow, UK
| | - P Lung
- Robin Phillips Fistula Research Unit, St Mark's Hospital and Imperial College London, Harrow, UK
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5
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Kotze PG, Spinelli A, Warusavitarne J, Di Candido F, Sahnan K, Adegbola SO, Danese S. Darvadstrocel for the treatment of patients with perianal fistulas in Crohn's disease. Drugs Today (Barc) 2019; 55:95-105. [PMID: 30816884 DOI: 10.1358/dot.2019.55.2.2914336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite significant advances in medical and surgical therapy for perianal fistulas in Crohn's disease (CD), treatment results are still modest, and a specific need for more effective therapies is a reality. Darvadstrocel is composed of expanded human allogeneic mesenchymal adult stem cells extracted from adipose tissue and constitutes the first stem cell therapy for perianal fistulizing CD to receive approval from the European Medicines Agency (EMA). This therapy is injected in both internal and external openings, as well as inside the fistula tracks, to induce fistula healing. In this monograph, the authors review the preclinical pharmacology of darvadstrocel, as well as pharmacokinetics and metabolism, and cover the main indications and detailed information on the efficacy and safety profile of the agent. Possible interactions with other agents used to treat CD are also explored. Darvadstrocel is a safe and effective therapy for perianal complex fistulas in CD, and represents the beginning of a new era of mesenchymal stem cell therapy in this difficult phenotype of the disease.
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Affiliation(s)
- P G Kotze
- IBD Unit, Health Sciences Postgraduate Program (PPGCS), Catholic University of Paraná (PUCPR), Curitiba, Brazil.
| | - A Spinelli
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy; Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - J Warusavitarne
- Robin Phillips' Fistula Research Unit, St. Mark's Hospital, Harrow, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - F Di Candido
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - K Sahnan
- Robin Phillips' Fistula Research Unit, St. Mark's Hospital, Harrow, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - S O Adegbola
- Robin Phillips' Fistula Research Unit, St. Mark's Hospital, Harrow, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - S Danese
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy; IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
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6
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Sahnan K, Lung P, Adegbola S, Shaikh S, Iqbal N, Hart A, Warusavitarne J, Faiz O, Phillips R, Tozer P. The use of 3D imaging to facilitate training during complex fistula surgery - a video vignette. Colorectal Dis 2019; 21:376. [PMID: 30624849 DOI: 10.1111/codi.14551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/21/2018] [Indexed: 02/08/2023]
Affiliation(s)
- K Sahnan
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - P Lung
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - S Adegbola
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - S Shaikh
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK
| | - N Iqbal
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - A Hart
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - J Warusavitarne
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - O Faiz
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - R Phillips
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - P Tozer
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK.,Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
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7
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Sahnan K, Pellino G, Adegbola SO, Tozer PJ, Chandrasinghe P, Miskovic D, Hompes R, Warusavitarne J, Lung PFC. Development of a model of three-dimensional imaging for the preoperative planning of TaTME. Tech Coloproctol 2017; 22:59-63. [PMID: 29188460 PMCID: PMC5829114 DOI: 10.1007/s10151-017-1724-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/30/2017] [Indexed: 12/12/2022]
Affiliation(s)
- K Sahnan
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Imperial College University of London, Watford Road, Harrow, Middlesex, HA13UJ, UK.
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK.
| | - G Pellino
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Imperial College University of London, Watford Road, Harrow, Middlesex, HA13UJ, UK
- Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - S O Adegbola
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Imperial College University of London, Watford Road, Harrow, Middlesex, HA13UJ, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - P J Tozer
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Imperial College University of London, Watford Road, Harrow, Middlesex, HA13UJ, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - P Chandrasinghe
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Imperial College University of London, Watford Road, Harrow, Middlesex, HA13UJ, UK
- Department of Surgery, University of Kelaniya, Kelaniya, Sri Lanka
| | - D Miskovic
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Imperial College University of London, Watford Road, Harrow, Middlesex, HA13UJ, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - R Hompes
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J Warusavitarne
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Imperial College University of London, Watford Road, Harrow, Middlesex, HA13UJ, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - P F C Lung
- Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, Imperial College University of London, Watford Road, Harrow, Middlesex, HA13UJ, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
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8
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Lee MJ, Heywood N, Adegbola S, Tozer P, Sahnan K, Fearnhead NS, Brown SR. Systematic review of surgical interventions for Crohn's anal fistula. BJS Open 2017; 1:55-66. [PMID: 29951607 PMCID: PMC5989984 DOI: 10.1002/bjs5.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 07/06/2017] [Indexed: 12/14/2022] Open
Abstract
Background Anal fistula occurs in approximately one in three patients with Crohn's disease and is typically managed through a multimodal approach. The optimal surgical therapy is not yet clear. The aim of this systematic review was to identify and assess the literature on surgical treatments of Crohn's anal fistula. Methods A systematic review was conducted that analysed studies relating to surgical treatment of Crohn's anal fistula published on MEDLINE, Embase and Cochrane databases between January 1995 and March 2016. Studies reporting specific outcomes of patients treated for Crohn's anal fistula were included. The primary outcome was fistula healing rate. Bias was assessed using the Cochrane ROBINS‐I and ROB tool as appropriate. Results A total of 1628 citations were reviewed. Sixty‐three studies comprising 1584 patients were ultimately selected in the analyses. There was extensive reporting on the use of setons, advancement flaps and fistula plugs. Randomized trials were available only for stem cells and fistula plugs. There was inconsistency in outcome measures across studies, and a high degree of bias was noted. Conclusion Data describing surgical intervention for Crohn's anal fistula are heterogeneous with a high degree of bias. There is a clear need for standardization of outcomes and description of study cohorts for better understanding of treatment options.
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Affiliation(s)
- M J Lee
- Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - N Heywood
- University Hospital South Manchester Manchester UK
| | | | - P Tozer
- St Mark's Hospital Harrow UK
| | | | | | - S R Brown
- Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
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9
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Sahnan K, Askari A, Adegbola SO, Tozer PJ, Phillips RKS, Hart A, Faiz OD. Natural history of anorectal sepsis. Br J Surg 2017; 104:1857-1865. [DOI: 10.1002/bjs.10614] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/28/2017] [Accepted: 05/11/2017] [Indexed: 12/26/2022]
Abstract
Abstract
Background
Progression from anorectal abscess to fistula is poorly described and it remains unclear which patients develop a fistula following an abscess. The aim was to assess the burden of anorectal abscess and to identify risk factors for subsequent fistula formation.
Methods
The Hospital Episode Statistics database was used to identify all patients presenting with new anorectal abscesses. Cox regression analysis was undertaken to identify factors predictive of fistula formation.
Results
A total of 165 536 patients were identified in the database as having attended a hospital in England with an abscess for the first time between 1997 and 2012. Of these, 158 713 (95·9 per cent) had complete data for all variables and were included in this study, the remaining 6823 (4·1 per cent) with incomplete data were excluded from the study. The overall incidence rate of abscess was 20·2 per 100 000. The rate of subsequent fistula formation following an abscess was 15·5 per cent (23 012 of 148 286) in idiopathic cases and 41·6 per cent (4337 of 10 427 in patients with inflammatory bowel disease (IBD) (26·7 per cent coded concurrently as ulcerative colitis; 47·2 per cent coded as Crohn's disease). Of all patients who developed a fistula, 67·5 per cent did so within the first year. Independent predictors of fistula formation were: IBD, in particular Crohn's disease (hazard ratio (HR) 3·51; P < 0·001), ulcerative colitis (HR 1·82; P < 0·001), female sex (HR 1·18; P < 0·001), age at time of first abscess 41–60 years (HR 1·85 versus less than 20 years; P < 0·001), and intersphincteric (HR 1·53; P < 0·001) or ischiorectal (HR 1·48; P < 0·001) abscess location compared with perianal. Some 2·9 per cent of all patients presenting with a new abscess were subsequently diagnosed with Crohn's disease; the median time to diagnosis was 14 months.
Conclusion
The burden of anorectal sepsis is high, with subsequent fistula formation nearly three times more common in Crohn's disease than idiopathic disease, and female sex is an independent predictor of fistula formation following abscess drainage. Most fistulas form within the first year of presentation with an abscess.
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Affiliation(s)
- K Sahnan
- Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital and Academic Institute, Harrow, UK
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - A Askari
- Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital and Academic Institute, Harrow, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - S O Adegbola
- Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital and Academic Institute, Harrow, UK
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - P J Tozer
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - R K S Phillips
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - A Hart
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
| | - O D Faiz
- Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital and Academic Institute, Harrow, UK
- Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK
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10
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Vaughan-Shaw PG, Aung M, Sahnan K, Rai P, Goodman A. Findings on interval colonoscopies: an auditable performance indicator for colonoscopy quality? Frontline Gastroenterol 2014; 5:249-253. [PMID: 28839781 PMCID: PMC5369743 DOI: 10.1136/flgastro-2014-100439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 03/27/2014] [Accepted: 04/02/2014] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE An important marker of colonoscopy quality is detection of pathology and incidence of missed pathology. Back-to-back colonoscopies cannot ethically be performed for quality assurance alone yet may be required for clinical reasons. This study aims to investigate the incidence of new findings in colonoscopies repeated within a 12 month period and considers the role of such an analysis in the assessment of colonoscopy quality. DESIGN All colonoscopies performed over a 3-year period at an endoscopy training unit were studied. Colonoscopies repeated within a 12-month period were analysed. RESULTS 5747 colonoscopies were performed over the study period. 137 repeat colonoscopies were included with median interval from initial colonoscopy of 174 days. 19 (14%) repeat colonoscopies yielded new findings including one cancer, 234 days following a normal colonoscopy. Additional polyps were identified in 13 colonoscopies indicating a missed polyp rate of 9%. In these, a median number of two polyps per colonoscopy with median size 5.5 mm were found. There was no morbidity associated with repeat colonoscopy in this series. New findings on repeat colonoscopy appeared more likely following initial colonoscopy by non-consultant non-training grade endoscopists (23% vs 11%, p=0.09) yet small numbers involved preclude meaningful comparison. CONCLUSIONS Analysis of clinically indicated repeat colonoscopies and rate of detection of new pathology may offer utility in colonoscopy quality assurance and would offer a direct assessment of the most important aspect of colonoscopy quality.
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Affiliation(s)
- P G Vaughan-Shaw
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, GLOS, UK
| | - M Aung
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, GLOS, UK
| | - K Sahnan
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, GLOS, UK
| | - P Rai
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, GLOS, UK
| | - A Goodman
- Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, GLOS, UK
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11
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Sahnan K, Davis BJH, Bagenal J, Cullen S, Appleton S. Acute gastric necrosis after routine oesophagogastroduodenoscopy with therapeutic argon plasma coagulation. Ann R Coll Surg Engl 2013; 95:e99-101. [PMID: 24025279 DOI: 10.1308/003588413x13629960047515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A 56-year-old woman presented to the accident and emergency department with peritonitis 2 days after a routine oesophagogastroduodenoscopy. She was taken to theatre with the finding of gastric necrosis. Blood and peritoneal cultures grew group A haemolytic Streptococcus. Histology revealed normal vasculature, no volvulus but marked neutrophilia in the submucosa with an intact mucosa. The stomach was resected and the patient recovered in the intensive care unit but overwhelming acidosis progressed to multiorgan failure and treatment was eventually withdrawn. Acute phlegmonous gastritis has been well described in the literature but mainly before the advent of antibiotics. The most common organism is group A haemolytic Streptococcus (commonly found in throat infections) and predisposing factors include instrumentation. Should antibiotics be given at the start of an oesophagogastroduodenoscopy and should routine procedures be delayed if active upper respiratory tract infections are present?
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Affiliation(s)
- K Sahnan
- Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
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12
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Wang T, Naughton P, Aggarwal R, Van Herzeele I, Keeling A, Choong A, O'Donoghue K, Sahnan K, Darzi A, Gaines P, Cheshire N. Cognitive Distraction Worsens Endovascular Performance: Effects Related to Experience. Int J Surg 2010. [DOI: 10.1016/j.ijsu.2010.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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