Authors: Taib, Adnan; Killick, Rebecca; Hussain, Kamran et al.
Source: In HPB November 2021 23(11):1732-1743
Background Gallstone related pathology (GRP) accounts for a significant proportion of general surgery admissions. The aim of this study is to investigate if seasonal variation for GRP admissions exist in England allowing improved resource allocation and planning.
Results A total of 396 879 GRP related admissions were recorded during the specified period, accounting for 1.44% of all emergency admissions. Our study suggests a significant seasonal peak in Summer (n = 102 620) based cumulative admissions per season and a linear regression model (p < 0.001), followed by Autumn (n = 102 267), then Spring (n = 97 807) and finally Winter (n = 94 185). Spectral analysis confirmed there is seasonality in the emergency GRP admissions every 12 months. A forecasting model was shown to be reliable; all observed admissions for 2019 were within the 95% prediction intervals for each month for the proportion of emergency GRP admissions.
Conclusion Resource allocation towards the Summer months to target seasonal peaks in GRP should be considered.
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Authors: Lamb R; Kahlon A; Sukumar S; Layton B;
Source: Clinical radiology [Clin Radiol] 2022 Apr; Vol. 77 (4), pp. 264-273. Date of Electronic Publication: 2022 Jan 07.
Abstract: Diverticula of the small bowel can be categorised as true, with Meckel's being the only example, or false. False small bowel diverticula (SBD) are acquired through herniation of the internal layers of the bowel wall through the muscularis propria. Peri-ampullary duodenal diverticula are a well-recognised example; however, the importance of more distal SBD in the jejunum and ileum is underappreciated, and they are under-reported on cross-sectional imaging. SBD are a known cause of anaemia, malabsorption, and diarrhoea, and there are myriad complications of SBD and Meckel's diverticula, which range in severity from inflammation and perforation to haemorrhage, tumour formation, and obstruction. Before the advent of computed tomography (CT), SBD were readily diagnosed on fluoroscopic oral contrast studies; however, radiologists are less comfortable with their cross-sectional imaging appearances. This imaging review combines our experience of multiple proven cases, with illustrative diagrams and radiological images of SBD to provide distinct imaging characteristics, allowing for confident diagnosis of SBD and their numerous complications. We discuss the importance of SBD as a cause of benign, non-surgical pneumoperitoneum. We additionally provide important pitfalls to be aware of such as SBD masquerading as other abnormalities.
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A prospective multicentre feasibility study of a novel digital rectoscope for the triage of lower gastrointestinal symptoms in primary care
Author(s): James Lewis, Alan Askari, Arihant Mehta, et al
Source: BJGP Open 21 June; BJGPO.2022.0036
Adults meeting two week wait (2WW) criteria for suspected lower GI cancer or suspected new diagnosis or flare-up of inflammatory bowel disease (IBD) were enrolled. Examinations were performed by primary care practitioners using the LumenEye® rectoscope. The CHiP platform allowed immediate remote review by secondary care. A prospective analysis was performed of patient and clinician experiences, diagnostic accuracy, and cost.
Results 114 patients were recruited (46 (40%) females: 68 (60%) males). No serious adverse events were reported. 82 (75%) patients reported that examination was more comfortable than expected, 104 (94%) felt intervention was most convenient if delivered in the community. Clinicians were confident of their assessment in 100 (87%) examinations. Forty-eight (42.1%) patients subsequently underwent colonoscopy, flexible sigmoidoscopy, or CT virtual colonoscopy. The overall sensitivity and specificity of LumenEye® in identifying rectal pathology was 90.0% and 88.9%. It was 100%/100% for cancer, and 83.3%/97.8% for polyps. Following LumenEye® examination, 19 (17%) patients were discharged, with projected savings of £11,305.
Conclusion Digital rectoscopy in primary care is safe, acceptable, and can reduce referrals. A Phase III randomised controlled trial is indicated to define its utility in reducing the burden on hospital diagnostic services.
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