patients (2 R1 and 1 R0 resection) and distant metastases in six. ... and endoscopic findings was reassuring. ... Endoscopic mucosal resection (EMR) is.
Abstracts between October 2008 and March 2013. The perineum was reconstructed using a biological mesh (Surgisis® Biodesign™, Cook Medical). Short and long-term outcomes were evaluated and the pelvis clinically assessed for herniation, and computed tomography scans reviewed by a specialist gastrointestinal radiologist for disease recurrence. Results Thirty-four patients (27 male, median age 62 years (range 40–72)) were included. Median operative time was 248 mins (range 120–340) with a median length of hospital stay of 9 days (range 4–20). Median length of follow-up was 32 months (range 21–64). Complications included three superficial perineal wound problems requiring surgery. No biological mesh weas removed and no further procedures were required. No perineal hernias have been detected. Local recurrence occurred in three patients (2 R1 and 1 R0 resection) and distant metastases in six. There was no 90-day mortality and 13% of patients died by the end of this study period. Conclusion Reduced incidence of long term complications, including low perineal hernia rates demonstrates that pelvic floor reconstruction with a biological mesh following ELAPER without the additional use of myocutaneous flaps is both safe and feasible. Disclosure of interest None Declared.
diverticular disease (24%) and polyps (14%). We found that 37.5% of patients had extra colonic abnormalities. There were no recorded complications. Conclusion It is essential to audit the quality of CTC service provision against standards set by the International CT Colonography Standards Collaboration and the NHS Bowel Cancer Screening Programme. In our institution, the correlation of CTC and endoscopic findings was reassuring. In addition, a large number of extra colonic abnormalities were detected using CTC, some of which were significant – this is especially important in the 2 week wait patients. Colonoscopy, however, still remains the gold standard investigation for the detection of colon related pathology. Disclosure of interest None Declared. REFERENCES 1 2 3
Johnson CD, Chen MH, Toledano AY et al. Accuracy of CT colonography for detection of large adenomas and cancer. NEJM. 2008;359:1207–17 Burling D. Effect of Directed training on reader performance for CT colonography: multicenter study. Radiology. 2007;242:152–61 NICE guidelines CT Colonography. http://guidance.nice.org.uk/IPG129;2009
PWE-289 A REGIONAL AUDIT ON OUTCOMES OF ENDOSCOPIC MUCOSAL RESECTION FOR COLONIC POLYP CANCER 1
PWE-288 IS COMPUTED TOMOGRAPHIC COLONOGRAPHY MORE USEFUL THAN COLONOSCOPY IN 2 WEEK WAIT PATIENTS? A Gumber*, C Ntala, G Kaur. Surgery, Scunthorpe General Hospital, Scunthorpe, UK 10.1136/gutjnl-2015-309861.734
Introduction CT colonography (CTC) is now widely available as the radiological imaging test for the colon, replacing barium enema. It is recommended that regular audit processes should be in place to audit the quality of CTC service provision against internationally agreed standards. This is especially important when considering the national bowel cancer screening programme with reference to FOB positive patients unfit for a colonoscopy and/or with incomplete colonoscopic examinations. The other advantage of CTC is the ability to detect extra colonic lesions at the same time as evaluating the colon. We aimed to audit our CTC practice with reference to endoscopic findings and to determine the value of any extra colonic lesions found on CTC, especially in our 2 week wait and bowel cancer screening patients. Method All patients who had a CTC performed over a period of 13 months were evaluated against the electronic record of endoscopic procedures. Of 264 patients who had a CTC, 78 also had a contemporaneous flexible sigmoidoscopy or colonoscopy performed. Results The main indications for an investigation of the colon were altered bowel habit (45%), anaemia (11%), abdominal pain (6.8%) and cancer/ polyp follow up (7.9%). The most common indication for CTC in the 264 patients reviewed was exclusion of synchronous colonic tumours in patients who had an incomplete colonoscopy (112 patients); 140 patients had been deemed unfit to have a colonoscopy and 12 patients declined one. 11 BCSP underwent CTC, 5 due to an incomplete scope and 6 were deemed unfit for colonoscopy. 68% of the CTC and endoscopic findings were in agreement. 19/78 endoscopic abnormalities were not picked up on CTC (24%). No cancers were missed on CTC. The most common positive findings were A338
2
B Yeung*, P Konanahalli. 1General Surgery; 2Pathology, Southern General Hospital, Glasgow, UK
10.1136/gutjnl-2015-309861.735
Introduction Since the introduction of national colonic screening, the incidence of detection of colonic polyp cancer has increased significantly. Endoscopic mucosal resection (EMR) is the standard technique for excision of polyps. We aim to assess the outcome of polyp cancer management from a prospectively collected database from our regional centralised pathology department. Method Our study period was from 01/06/2012—31/07/2013. The census date was 30/01/2015. A prospectively collected database of all polyp cancer patients from the West of Scotland centralised pathology unit was assessed. Management outcome including endoscopic malignant suspicion, resection completeness, recurrence, and subsequent intervention were assessed through electronic patient record. Results 35 polyp cancer were detected in 33 patients over 13 month period. Median age of diagnosis was 66.5 (Max 80.4 – Min 52.4). The median size was 15 mm ((Max 34 mm Min 3 mm). EMR was attempted in 32 (91%) polyp cancer. 1 (3%) polyp cancer was managed by transanal minimally invasive surgery. 2 (6%) were treated by primary resection surgery. Of the cancers treated by EMR, 30 (94%) were located in the descending, sigmoid colon and rectum. 7 (22%) had complete excision based on pathology. At census date, 1 patient had recurrence and required colectomy. In 25 (78%) patients, completeness of excision could not be assessed. 6 (24%) patients were managed by surveillance endoscopy and none were found to have recurrence. No complication was observed in surveillance group. 19 (76%) patients were managed by colectomy. 14 (74%) had no evidence of residual disease in the specimen. The morbidity rate was 20%; these included: 1 (5%) pneumonia, 2 (10%) wound infection and 1 (5%) dehiscence. 1 (5%) patient with liver cirrhosis died within thirty days of operation. Conclusion A low number of disease recurrence was observed after EMR. Despite the relatively small size and distal position Gut 2015;64(Suppl 1):A1–A584
Abstracts of most detected polyp cancers, completeness of excision could not be assessed in a high number of cases. This leads to a significant number of unnecessary surgery with associated morbitidy and mortality. An increase in adoption of surveillance endoscopy, endoscopic submucosal dissection and flexible endoscopic multitasking platform may improve the management of this group of patients. Disclosure of interest None Declared. REFERENCES 1 2
Logan RFA, Patnick J, Nickerson C et al. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut. 2012;61:1439–1446 Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, Fukuzawa M, Kobayashi N, Nasu J, Michida T, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video) Gastrointest Endosc. 2010;72:1217–1225
PWE-290 AN OPEN-LABEL, RANDOMISED CONTROLLED TRIAL COMPARING THE EFFICACY OF INTRAVENOUS AND ORAL IRON IN THE PREOPERATIVE MANAGEMENT OF COLORECTAL CANCER ANAEMIA: IVICA TRIAL 1
BD Keeler*, 1JA Simpson, 1O Ng, 2H Padmanabhan, 3MJ Brookes, 1AG Acheson, IVICA Trial Group. 1GI Surgery, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham; 2Gastroenterology, Royal Wolverhampton Hospital NHS Trust; 3 Gastroenterology, Royal Wolverhampton Hospital NHS Trust and University of Birmingham, Wolverhampton, UK 10.1136/gutjnl-2015-309861.736
Introduction Perioperative allogeneic red blood transfusions (ARBT) are associated with impaired short and long term outcomes.1 Consequently, perioperative ARBT should be avoided, yet preoperative anaemia increases this need. The study aimed to compare the efficacy of preoperative intravenous (IVI) and oral iron (OI) in reducing ARBT use in anaemic patients undergoing colorectal cancer (CRC) surgery. Method 116 anaemic patients with non-metastatic CRC adenocarcinoma were recruited preoperatively and randomised to receive either OI (ferrous sulphate) or IVI (ferric carboxymaltose). Perioperative changes in Haemoglobin (HB) and ARBT were recorded across groups. Parametric data was compared with 2 tailed T-test and non-parametric data with Wilcoxon Rank test, and Mann-Whitney U test. Nominal data was compared with 2 tailed Chi squared test. Results There was no difference in demographic data between groups. HB levels at recruitment were comparable (OI 10.4g/dL 95% CI 10.1–10.7; IVI 10.2g/dL 95% CI 9.8–10.5; P = 0.24), as was median treatment duration (OI 21days IQR15–33; IVI 21days IQR15–34; P = 0.75). However, HB was higher on day of Surgery with IVI (11.9g/dL 95% CI 11.5–12.3 vs OI 11g/dL 95% CI 10.6–11.4; P < 0.01). Median preoperative HB change in patients not transfused preoperatively was higher with IVI (1.5g/dL IQR0.9–2.6 vs. OI 0.5g/dL IQR-0.1–1.3; P < 0.01). There were fewer anaemic patients at surgery in the IVI group after treatment (75% vs. 90%; P < 0.05). OI patients received a mean 0.63u (95% CI 0.26–1) from recruitment to day 28 postoperatively vs. mean 0.47u (95% CI 0.1–0.84) for IVI. Neither number of patients transfused (P = 0.33) nor mean units transfused (P = 0.54) differed over this period. When patients with heavy intraoperative losses (>1.5L) were excluded, a significant difference in mean units of blood transfused was seen up to 7 days post operatively (n = 108; OI 0.6u 95% CI 0.23–0.96; IVI 0.16u 95% CI 0.01–0.3; P < 0.05) and significantly less IVI patients were transfused (10% vs. 25%; P < 0.05).
Gut 2015;64(Suppl 1):A1–A584
Conclusion In patients undergoing CRC surgery, IVI appears more efficacious than OI at treating preoperative anaemia. It does not appear to minimise overall ARBT requirement, but may reduce ARBT use in the immediate perioperative period when the implications of ARBT are probably at their greatest.2 Disclosure of interest B. Keeler: None Declared, J. Simpson: None Declared, O. Ng: None Declared, H. Padmanabhan: None Declared, M. Brookes Grant/ Research Support from: MB’s research department has received grant support from SynerMed, UK, and Vifor Pharma, Switzerland, Speaker Bureau of: He has received honoraria or travel support for consulting or lecturing from the following companies: Vifor Pharma Ltd, Glattbrugg, Switzerland; Merck Sharp and Dohme Limited, UK. MB is also an advisory board member to Vifor International and to Sanofi UK, A. Acheson Grant/ Research Support from: AA’s research department has received grant support from SynerMed, UK, Vifor Pharma, Switzerland, and Pharmacosmos A/S, Denmark, Consultant for: He is an advisory board member for Pharmacosmos A/S, Denmark., Conflict with: received honoraria or travel support for consulting or lecturing from the following companies: Ethicon Endosurgery, Johnson and Johnson Ltd, UK; Olympus, Essex, UK; and Vifor Pharma Ltd, Glattbrugg, Switzerland. REFERENCES 1 2
Acheson AG; Brookes MJ; Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery:a systematic review and meta-analysis. Ann Surg. 2012;256(2):235–44 Nielsen HJ. Detrimental effects of perioperative blood transfusion. BJS 1995; 82(5):582–7
PWE-291 FALLING EMERGENCY OPERATION RATES AND REDUCED MORTALITY AFTER COLON CANCER SURGERY IN ENGLAND: A COHORT STUDY 1
BE Byrne*, 2CA Vincent, 3J Stebbing, 4A Darzi, 5OD Faiz. 1Patient Safety Translational Research Centre, Imperial College London, London; 2Department of Experimental Psychology, University of Oxford, Oxford; 3Department of Surgery and Cancer; 4Surgery and Cancer, Imperial College London, London; 5Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital, Harrow, UK
10.1136/gutjnl-2015-309861.737
Introduction Recent years have seen many changes within colorectal surgery. Laparoscopic techniques, fast track management, and bowel cancer screening have become widespread. This study examined changes in surgical treatment and outcomes for colon cancer over time against background registration rates, with subgroup analysis by urgency and age. Method Annual data on colon cancer registrations and population size was obtained. Administrative data were used to identify adults undergoing colonic resection for cancer in England between April 1998 and March 2012. Cancer registrations, treatment and mortality rates were age-standardised. The proportion of registrations undergoing surgery was examined, and subgroups were analysed by urgency of admission and age group. Temporal trends were assessed using the Joinpoint Regression Program (National Cancer Institute, USA). Results The standardised rate of colon cancer registration rose from 27.1 to 29.1 per 100 000 population. The proportion of registrations undergoing surgery fell, from approximately 67% to 57% (Annual Percentage Change = 1.44, p < 0.05), due to a significant fall in non-elective operating; the elective treatment rate did not change. Postoperative 90-day mortality rates fell
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