Katie Adams

Prospective evaluation of a colorectal cancer nurse follow‐up clinic

Aim  Colorectal Nurse Specialist (CNS) clinics for postoperative follow up of colorectal cancer aim to maintain clinical efficacy while reducing costs. We prospectively studied the efficacy and financial implications of such a clinic.

High-Frequency Mini Probe Ultrasound Before Endoscopic Resection of Colorectal Polyps - Is It Useful?

BACKGROUND: Endoscopic resection of benign colorectal polyps and early cancer is well established. Local staging is of paramount importance to ensure that local resection is feasible. Endoscopic ultrasound has been used to evaluate the depth of lesions in the rectum, but its use in the colon is limited. OBJECTIVE: This prospective study aims to evaluate the accuracy of 20-MHz mini probe ultrasound before the endoscopic resection of colorectal tumors. DESIGN: All patients underwent 20-MHz high-frequency mini probe ultrasound of the colorectal lesion during colonoscopic examination. The mini probes were inserted through the working channel of the colonoscope, and acoustic coupling was achieved by instilling water to completely submerge the lesion. The depth of infiltration of the colorectal tumor was identified before resection. The lesions were sent for histological examination, and the level of infiltration was compared with the preoperative ultrasound depth. SETTING: This study was conducted at a tertiary referral university teaching hospital. PATIENTS: Consecutive patients referred for consideration of endoscopic resection were included in the study. INTERVENTIONS: All patients were subject to colonoscopic high-frequency mini probe ultrasound to evaluate the depth of lesion before local resection. MAIN OUTCOME MEASURES: There were 2 outcome measures: the ultrasound depth of colorectal lesion and the histological depth. RESULTS: One hundred four patients were included with a mean age of 70 years. The surgical procedures included 59 endoscopic mucosal resections, 36 transanal endoscopic microsurgeries, and 9 endoscopic submucosal dissections. The 20-MHz ultrasound correctly staged 100 of 104 lesions, an overall accuracy of 96.1%. Eighty-eight of 89 mucosal lesions and 11 of 12 submucosal lesions were correctly staged. LIMITATIONS: The ultrasound examination was performed by the main author only and is therefore dependent on his experience alone. CONCLUSION: Colonoscopic high-frequency mini probe ultrasound has high accuracy in determining the depth of colorectal lesion and is useful before endoscopic resection.

Elderly patients have more infectious complications following laparoscopic colorectal cancer surgery.

Elderly patients may be at higher risk of postoperative complications, particularly infective, than younger patients.

Stapled transanal rectal resection (STARR) for obstructive defaecation syndrome: patients with previous pelvic floor surgery have poorer long-term outcome.

Stapled transanal rectal resection (STARR) is used for patients with obstructive defaecation syndrome (ODS) not responding to conservative management. Reports indicate mixed results and there are no studies publishing the long‐term outcome.

Diverticular disease as a chronic gastrointestinal condition: experience from a specialist clinic.

Background Although diverticular disease is a prevalent condition and a significant burden on the healthcare system, care is devolved across gastrointestinal, GP, and colorectal surgery clinics. We created a specialist Diverticular Disease Clinic to streamline care, enhance evidence-based practice and provide a base for research. The aim of this study was to assess patient referral sources, predictors of persistent disease and surgical outcomes. Methods We retrospectively reviewed all patients attending our clinic. Patients younger than 50 years of age on initial presentation were considered ‘younger’ patients. Persistent symptoms lasted for at least 3 months. Results Overall, 177 patients had confirmed diverticular disease. Patients were referred following hospital admission (82 patients, 46.3%) or from the community (95 patients, 53.7%). Ninety-five patients (53.7%) had persistent symptoms. Patients with more than two episodes of diverticulitis were more likely to have persistent symptoms (P<0.0001). Following hospitalization, younger patients were 3.98 times more likely to develop persistent symptoms (P=0.04). This was independent of the severity of the original infection, as a low peak C-reactive protein level of less than 50 mg/L was associated with persistent symptoms (odds ratio=3.62, P=0.03). Over the study period, 12 patients (6.9%) had elective surgery. Conclusion There is demand for dedicated care for patients with persistent symptoms from diverticular disease. Specialized clinics are a model for this care, provided by either gastroenterologists or surgeons, in centres with adequate demand. Our findings reinforce the hypotheses that chronic abdominal pain in diverticular disease may be related to sensation abnormalities similar to postinfective irritable bowel syndrome.