Abstract Introduction The impact of the SARS-CoV-2 pandemic on patterns of aetiology of acute pancreatitis (AP) and management of AP in the UK is unknown. Methods A prospective multicentre cohort study of consecutive patients admitted with AP between 01/03/2020 and 23/07/2020 was undertaken. Patients were followed up for 12 months. Results 1628 patients presenting with AP were included in the analysis. Gallstones (GSP) were the predominant aetiology (43.6%), followed by alcohol associated (25.8) and idiopathic (21.5%) AP. After completing aetiological investigations, 14.4% of the idiopathic cohort remained to have an idiopathic aetiology. 113/187 patients were readmitted during the ‘second wave’ of SARS-CoV-2 pandemic (after September 2020) with predominantly alcohol-related AP aetiology (49, 43.3%). Patients readmitted during the ‘second wave’, more commonly had alcoholic AP compared to the index cohort (43.4% vs 23.5% respectively; p<0.001); however, there were no significant differences in AP severity (p=0.268). Of the 1358 patients with complete follow-up data, 620 (45.7%) presented with GSP of which only 66 (10.6%) underwent index cholecystectomy and 108 (17.4%) had an interval cholecystectomy with median waiting time of 32 days (IQR 16–56). Accounting for 44/456 patients with previous cholecystectomies, and 24 patients deemed unfit for cholecystectomy, the remaining 388 (77.3%) were still awaiting cholecystectomy at the end of 12 months. Conclusion The patterns of aetiology for AP changed during the SARS-CoV-2 pandemic with an increase in alcohol associated AP. Most significantly, access to cholecystectomy was restricted during the pandemic and readmission to hospital may have been driven by the need for cholecystectomy. Take-home message The patterns of aetiology for AP changed during the SARS-CoV-2 pandemic with an increase in alcohol associated AP. Most significantly, access to cholecystectomy was restricted during the pandemic and readmission to hospital may have been driven by the need for cholecystectomy.
{"title":"O001 SARS-CoV-2 pandemic has impacted on patterns of aetiology for acute pancreatitis and management of gallstone pancreatitis in the United Kingdom","authors":"Hvm Spiers, M. Nayar, S. Pandanaboyana","doi":"10.1093/bjs/znac242.001","DOIUrl":"https://doi.org/10.1093/bjs/znac242.001","url":null,"abstract":"Abstract Introduction The impact of the SARS-CoV-2 pandemic on patterns of aetiology of acute pancreatitis (AP) and management of AP in the UK is unknown. Methods A prospective multicentre cohort study of consecutive patients admitted with AP between 01/03/2020 and 23/07/2020 was undertaken. Patients were followed up for 12 months. Results 1628 patients presenting with AP were included in the analysis. Gallstones (GSP) were the predominant aetiology (43.6%), followed by alcohol associated (25.8) and idiopathic (21.5%) AP. After completing aetiological investigations, 14.4% of the idiopathic cohort remained to have an idiopathic aetiology. 113/187 patients were readmitted during the ‘second wave’ of SARS-CoV-2 pandemic (after September 2020) with predominantly alcohol-related AP aetiology (49, 43.3%). Patients readmitted during the ‘second wave’, more commonly had alcoholic AP compared to the index cohort (43.4% vs 23.5% respectively; p<0.001); however, there were no significant differences in AP severity (p=0.268). Of the 1358 patients with complete follow-up data, 620 (45.7%) presented with GSP of which only 66 (10.6%) underwent index cholecystectomy and 108 (17.4%) had an interval cholecystectomy with median waiting time of 32 days (IQR 16–56). Accounting for 44/456 patients with previous cholecystectomies, and 24 patients deemed unfit for cholecystectomy, the remaining 388 (77.3%) were still awaiting cholecystectomy at the end of 12 months. Conclusion The patterns of aetiology for AP changed during the SARS-CoV-2 pandemic with an increase in alcohol associated AP. Most significantly, access to cholecystectomy was restricted during the pandemic and readmission to hospital may have been driven by the need for cholecystectomy. Take-home message The patterns of aetiology for AP changed during the SARS-CoV-2 pandemic with an increase in alcohol associated AP. Most significantly, access to cholecystectomy was restricted during the pandemic and readmission to hospital may have been driven by the need for cholecystectomy.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"102 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78171844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Counter, R. Owen, S. Sinha, A. Muthusamy, M. Drage, C. Callaghan, D. Elker, S. Harper, A. Sutherland, D. Van Dellen, P. Johnson, D. Manas, J. Shaw, J. Forsythe, C. Wilson, S. Hughes, J. Casey, S. White
Abstract Introduction WHO declared a pandemic of COVID-19 in March 2020. This study analyses the impact of COVID-19 on beta-cell replacement therapy in the UK. Methods Pancreas and islet donation and transplant activity in the period March 2020/2021 was compared with the same period the previous year. Results 2,180 patients had a functioning graft during March 2020/2021. 5.8%(n=126) tested positive for COVID-19 and two died (1%). In this period there was a 43% reduction in solid organ donors n=1,615, compared with the previous year, n=2,840. Of the 625 solid organ donors with a pancreas offered, 32% had the pancreas retrieved compared with 51% the previous period. 97 whole pancreas and islet transplants were performed in the UK down 54% from the prior period. Of the 84 pancreas transplant recipients; four tested positive for COVID-19 but none died, and two grafts failed within the first week from vascular thrombosis (neither were COVID-19 positive). Of the 13 SIK and islet alone transplant recipients, two tested positive for COVID-19 but neither died. Of these SIK transplants, one is known to have failed within a month and this is equivalent to that seen in the previous time period. To our knowledge, no patient receiving beta cell replacement therapy died of COVID during the first year of the pandemic despite immunosuppression. Conclusion In the UK, pancreas, and islet transplantation have continued during the pandemic at a lower rate. Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior. Take-home message Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior.
{"title":"O007 Pancreas and islet transplantation in the United Kingdom during the COVID-19 era","authors":"C. Counter, R. Owen, S. Sinha, A. Muthusamy, M. Drage, C. Callaghan, D. Elker, S. Harper, A. Sutherland, D. Van Dellen, P. Johnson, D. Manas, J. Shaw, J. Forsythe, C. Wilson, S. Hughes, J. Casey, S. White","doi":"10.1093/bjs/znac242.007","DOIUrl":"https://doi.org/10.1093/bjs/znac242.007","url":null,"abstract":"Abstract Introduction WHO declared a pandemic of COVID-19 in March 2020. This study analyses the impact of COVID-19 on beta-cell replacement therapy in the UK. Methods Pancreas and islet donation and transplant activity in the period March 2020/2021 was compared with the same period the previous year. Results 2,180 patients had a functioning graft during March 2020/2021. 5.8%(n=126) tested positive for COVID-19 and two died (1%). In this period there was a 43% reduction in solid organ donors n=1,615, compared with the previous year, n=2,840. Of the 625 solid organ donors with a pancreas offered, 32% had the pancreas retrieved compared with 51% the previous period. 97 whole pancreas and islet transplants were performed in the UK down 54% from the prior period. Of the 84 pancreas transplant recipients; four tested positive for COVID-19 but none died, and two grafts failed within the first week from vascular thrombosis (neither were COVID-19 positive). Of the 13 SIK and islet alone transplant recipients, two tested positive for COVID-19 but neither died. Of these SIK transplants, one is known to have failed within a month and this is equivalent to that seen in the previous time period. To our knowledge, no patient receiving beta cell replacement therapy died of COVID during the first year of the pandemic despite immunosuppression. Conclusion In the UK, pancreas, and islet transplantation have continued during the pandemic at a lower rate. Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior. Take-home message Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82750556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Farkas, JW O’Brien, L. Palyvos, W. Maclean, S. Benton, T. Rockall, I. Jourdan
Abstract Introduction Increasing demand has placed colorectal cancer (CRC) two-week wait (TWW) pathways under pressure. The primary aims of this paper are to review TWW referral numbers and CRC diagnoses within our centre over the past 3 years (before, during and in recovery from the COVID-19 pandemic) and compare outcomes to our previously published data (2009–18). This incorporates the introduction of FIT into our clinical practice. Methods TWW CRC referral data from 1st July 2018–31st July 2021 was analysed. Parameters assessed; monthly TWW referrals, CRC detection, % of TWW referrals seen <14 days and investigations utilised. Data from January 2009 to 31 June 2018 was combined. Unpaired t-test was used to compare group means. Results TWW referrals have increased 360% from 2009 to 2020. The proportion of TWW referrals with CRC has decreased from 8.87% to 3.24% over this period, whilst the incidence of CRC remained static (mean 58.7 per annum). From 2009–18, TWW referrals=8921, CRC diagnoses=533, mean monthly CRC detection rate=4.7, ratio of referrals to CRC=16.7:1. From 2018–21, TWW referrals= 6523, CRC diagnoses=232, mean monthly CRC detection rate=6.3, ratio of referrals to CRC=28.4:1. There was a statistically significant difference in mean monthly referrals (p-value<0.00001) between the two periods. Conclusion Despite ever-increasing TWW referral numbers, no significant change in CRC diagnoses has occurred. We find our service under ever-increasing strain. Additional strategies and guidance are required to help address this. Further studies evaluating FIT and repeat FIT in the symptomatic TWW cohort may have a role in generating such a consensus. Take-home message Two week wait colorectal cancer referrals have increased 360% in 12 years. Colorectal cancer detection rate remains static over this timeframe.
{"title":"O013 The increasing burden of the two-week wait colorectal cancer pathway within a single centre","authors":"N. Farkas, JW O’Brien, L. Palyvos, W. Maclean, S. Benton, T. Rockall, I. Jourdan","doi":"10.1093/bjs/znac242.013","DOIUrl":"https://doi.org/10.1093/bjs/znac242.013","url":null,"abstract":"Abstract Introduction Increasing demand has placed colorectal cancer (CRC) two-week wait (TWW) pathways under pressure. The primary aims of this paper are to review TWW referral numbers and CRC diagnoses within our centre over the past 3 years (before, during and in recovery from the COVID-19 pandemic) and compare outcomes to our previously published data (2009–18). This incorporates the introduction of FIT into our clinical practice. Methods TWW CRC referral data from 1st July 2018–31st July 2021 was analysed. Parameters assessed; monthly TWW referrals, CRC detection, % of TWW referrals seen <14 days and investigations utilised. Data from January 2009 to 31 June 2018 was combined. Unpaired t-test was used to compare group means. Results TWW referrals have increased 360% from 2009 to 2020. The proportion of TWW referrals with CRC has decreased from 8.87% to 3.24% over this period, whilst the incidence of CRC remained static (mean 58.7 per annum). From 2009–18, TWW referrals=8921, CRC diagnoses=533, mean monthly CRC detection rate=4.7, ratio of referrals to CRC=16.7:1. From 2018–21, TWW referrals= 6523, CRC diagnoses=232, mean monthly CRC detection rate=6.3, ratio of referrals to CRC=28.4:1. There was a statistically significant difference in mean monthly referrals (p-value<0.00001) between the two periods. Conclusion Despite ever-increasing TWW referral numbers, no significant change in CRC diagnoses has occurred. We find our service under ever-increasing strain. Additional strategies and guidance are required to help address this. Further studies evaluating FIT and repeat FIT in the symptomatic TWW cohort may have a role in generating such a consensus. Take-home message Two week wait colorectal cancer referrals have increased 360% in 12 years. Colorectal cancer detection rate remains static over this timeframe.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89781357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on: Unfamiliar liver lesions.","authors":"Xiao-ou Diao, Li Wei, Hu Zhou","doi":"10.1093/bjs/znac218","DOIUrl":"https://doi.org/10.1093/bjs/znac218","url":null,"abstract":"","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76344700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Author response to: Comment on: Unfamiliar liver lesions.","authors":"Damian Wong, Z. Ng, D. Weber","doi":"10.1093/bjs/znac221","DOIUrl":"https://doi.org/10.1093/bjs/znac221","url":null,"abstract":"","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72800670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Balancing quality and equity of access in specialist neonatal surgery: implications of the GIRFT report.","authors":"N. Lansdale, R. Goldacre, D. Wilkinson, P. Bower","doi":"10.1093/bjs/znac205","DOIUrl":"https://doi.org/10.1093/bjs/znac205","url":null,"abstract":"","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82156603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Launer, R. Sayyid, Z. Klaassen, Emily Whelan, D. Magee, A. Luckenbaugh, C. Wallis
{"title":"On the shoulders of giants: correlation of rates of female first authorship with senior authorship gender.","authors":"B. Launer, R. Sayyid, Z. Klaassen, Emily Whelan, D. Magee, A. Luckenbaugh, C. Wallis","doi":"10.1093/bjs/znac163","DOIUrl":"https://doi.org/10.1093/bjs/znac163","url":null,"abstract":"","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"31 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72399227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sustainable surgery: roadmap for the next 5 years.","authors":"D. Nepogodiev, A. Bhangu","doi":"10.1093/bjs/znac199","DOIUrl":"https://doi.org/10.1093/bjs/znac199","url":null,"abstract":"","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85772876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Organ preservation as a successful management for rectal cancer is an evolving field. Refinement of neoadjuvant therapies and extended interval to response assessment has improved tumour downstaging and cCR rates. METHODS This was a narrative review of the current evidence for all aspects of organ preservation in rectal cancer management, together with a review of the future direction of this field. RESULTS Patients can be selected for organ preservation opportunistically, based on an unexpectedly good tumour response, or selectively, based on baseline tumour characteristics that predict organ preservation as a viable treatment strategy. Escalation in oncological therapy and increasing the time interval from completion of neaodjuvant therapy to tumour assessment may further increase tumour downstaging and complete response rates. The addition of local excision to oncological therapy can further improve organ preservation rates. Cancer outcomes in organ preservation are comparable to those of total mesorectal excision, with low regrowth rates reported in patients who achieve a complete response to neoadjuvant therapy.Successful organ preservation aims to achieve non-inferior oncological outcomes together with improved functionality and survivorship. Future research should establish consensus of follow-up protocols, and define criteria for oncological and functional success to facilitate patient-centred decision-making. CONCLUSION Modern neoadjuvant therapy for rectal cancer and increasing the interval to tumour response increases the number of patients who can be managed successfully with organ preservation in rectal cancer, both as an opportunistic event and as a planned treatment strategy.
{"title":"Organ preservation in rectal cancer: review of contemporary management.","authors":"C. Fleming, V. Vendrely, E. Rullier, Q. Denost","doi":"10.1093/bjs/znac140","DOIUrl":"https://doi.org/10.1093/bjs/znac140","url":null,"abstract":"BACKGROUND\u0000Organ preservation as a successful management for rectal cancer is an evolving field. Refinement of neoadjuvant therapies and extended interval to response assessment has improved tumour downstaging and cCR rates.\u0000\u0000\u0000METHODS\u0000This was a narrative review of the current evidence for all aspects of organ preservation in rectal cancer management, together with a review of the future direction of this field.\u0000\u0000\u0000RESULTS\u0000Patients can be selected for organ preservation opportunistically, based on an unexpectedly good tumour response, or selectively, based on baseline tumour characteristics that predict organ preservation as a viable treatment strategy. Escalation in oncological therapy and increasing the time interval from completion of neaodjuvant therapy to tumour assessment may further increase tumour downstaging and complete response rates. The addition of local excision to oncological therapy can further improve organ preservation rates. Cancer outcomes in organ preservation are comparable to those of total mesorectal excision, with low regrowth rates reported in patients who achieve a complete response to neoadjuvant therapy.Successful organ preservation aims to achieve non-inferior oncological outcomes together with improved functionality and survivorship. Future research should establish consensus of follow-up protocols, and define criteria for oncological and functional success to facilitate patient-centred decision-making.\u0000\u0000\u0000CONCLUSION\u0000Modern neoadjuvant therapy for rectal cancer and increasing the interval to tumour response increases the number of patients who can be managed successfully with organ preservation in rectal cancer, both as an opportunistic event and as a planned treatment strategy.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85165437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Sørensen, E. Westwood, Mahmoud Motawea, S. Hashim, N. Hall, C. Rees
{"title":"Impact of the COVID-19 pandemic on inguinal hernia management in infants under 6 months of age in the UK.","authors":"E. Sørensen, E. Westwood, Mahmoud Motawea, S. Hashim, N. Hall, C. Rees","doi":"10.1093/bjs/znac149","DOIUrl":"https://doi.org/10.1093/bjs/znac149","url":null,"abstract":"","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79126367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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