22 results on '"Reena Sidhu"'
Search Results
2. P180 Magnetically-controlled capsule endoscopy to examine the upper gastrointestinal tract
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William Holland, Gary Neill, Stanley McKenzie, Priya Oka, FW David Tai, Reena Sidhu, and Mark McAlindon
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- 2022
3. P185 The evaluation of capsule endoscopy used in varices screening and surveillance
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Gary Neill, Stanley McKenzie, Laura Harrison, Reena Sidhu, and Mark McAlindon
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- 2022
4. P52 The utility of capsule endoscopy in the phenotype of crohn’s disease
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Sophie Vibhishanan, Priya Oka, Stefania C Zammit, Mark McAlindon, and Reena Sidhu
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- 2022
5. P181 Comparison of patient experience: conventional vs capsule endoscopy of the upper and lower gastrointestinal tract
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Stanley McKenzie, Gary Neill, Foong Way David Tai, Reena Sidhu, and Mark McAlindon
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- 2022
6. P402 Small bowel endoscopy: do we offer enough training?
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Stefania Chetcuti Zammit, Reena Sidhu, David S Sanders, and Suneil A Raju
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Moderate to severe ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Sedation ,General surgery ,Endoscopy ,Video capsule endoscopy ,medicine ,Intubation ,Double balloon endoscopy ,medicine.symptom ,business - Abstract
Background There are currently 12 centres offering device assisted endoscopy (DAE) in the UK and between 30–35 offering video capsule endoscopy (VCE). There is a paucity of data on those offering training. We therefore quantify the training provided in small bowel endoscopy (SBE) across the UK to assess future training requirements. Methods Online surveys and targeted calls to SBE centres were conducted of all British Society of Gastroenterology members in the UK to establish whether they were in SBE training and what level of training was offered to them. Results From 17 centres there were 22 responses from gastroenterology fellows, trainees and consultants (36.4%, 18.2%, 45.5% respectively). Of all responders, 95.4% were independent in gastroscopies and 90.9% colonoscopies. Training centres: In total, 86.4% of centres offered VCE with 3 (IQR: 2–4) endoscopists per site interpreting videos. DAE was available in 72.7% of centres performed by 2 endoscopists (IQR: 2–3) per centre. Single and double balloon endoscopy was performed in 64.7% and 35.3% respectively under conscious sedation, deep sedation and both (35.3%, 29.4%, 35.3% respectively). Training in video capsule endoscopy: VCE was interpreted by 63.6% of responders of which 78.6% were independent. 31.8% of responders were undergoing training in both VCE and DAE, 36.3% in VCE and 9.1% in DAE. Of those who did not regularly review VCE, 75% were interested in becoming proficient. Physicians required 50 (IQR: 20–50 videos) VCEs to gain competency. All physicians were confident in identifying pathology. To become independent, 50 videos (IQR 25–70) were reviewed. Responders who had attended VCE courses felt more confident in identifying pathology (100% vs 33.3% p= 0.002). Training in device assisted endoscopy: Only 36.4% of individuals undertook DAE of which 75% were independent. However 42.9% were interested in becoming proficient. On average, participants completed 55 (IQR: 19–85) procedures prior to being independent taking 12 months (IQR: 6–27 months). The target lesion was reached in 50–100% of cases. All DAE trainees performed therapeutic procedures. Moderate to severe pain was reported in 10% of patients under conscious sedation and no sedation related complications reported. The learning curve for antegrade DAE was easier than retrograde DAE. The terminal ileal intubation rate during retrograde DAE varied from less than 50% to greater than 90%. Conclusion Training offered in SBE is heterogenous with individuals having different levels of prior experience. There is a need to offer and formalise VCE and DAE training to ensure uniform competence. However, centres must have set requirements to achieve prior to being able to offer training to ensure the training offered is up to standard.
- Published
- 2021
7. P400 The first reverse mentoring in a clinical setting: can you teach old dogs new tricks?
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Mark E. McAlindon, Gloria S. Z. Tun, Andrew D Hopper, Foong Way David Tai, David S Sanders, Hey-Long Ching, Michelle S Lau, Suneil A Raju, Mustafa Jalal, Anupam Rej, Mo Thoufeeq, and Reena Sidhu
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Semi-structured interview ,Medical education ,Mentorship ,business.industry ,Health care ,Workforce ,Time management ,Thematic analysis ,Psychology ,business ,Session (web analytics) ,Likert scale - Abstract
Background The BSG offers a mentorship programme aimed at those in transitional phases of their career and less at experienced consultants. Reverse mentoring, the act of junior persons mentoring seniors, has gained traction in non-healthcare settings as a means of closing the gap between Boomers and Millennials. There is no data on applying this to a medical workforce. We present the first data of real clinical experience. Methods A mixed-methods feasibility study on the practicalities of reverse mentoring complete in two phases. Phase 1: all clinical fellows in a teaching hospital were invited to provide feedback in a group semi structured interview on their supervisors in 7 domains: use of technology, clinical practice, approach to juniors, time management, approachability, strengths and areas for improvement. Phase 2: information was fed back to consultants on a 1-2-1 basis with the opportunity to discuss the points raised. Pre and post mentoring questionnaires were collected. Likert scales were used to assess several aspects on a scale from 0 to 35 and thematic analysis to record participants thoughts. Results A total of 6 clinical fellows participated in the phase 1 feedback session (66.6% male, age range 31–40 years) and agreed to be mentors. All supervising consultants invited agreed to being mentees (80% male, age range 35–65 years) and have been consultants for 5–20 years. Mentoring sessions lasted 45 minutes (range 28–180 minutes) and all felt the time devoted was about right. Both mentors and mentees reported a good or excellent experience. Juniors became more confident in feeding back to seniors after the session (21vs 31, p=0.008) and had a greater understanding of their role as reverse mentors (2.5/5 vs 4/5, p=0.024). Seniors became more aware of how they were viewed after mentoring (25vs 32, p=0.04). All seniors felt this was a useful experience that will change their clinical practice and 80% reported less concern about reverse mentoring afterwards. All participants believed that feedback was important both prior to and after the study (31 vs 33, p=0.196) Common themes highlighted included the benefit of a different perspective to the norm and new ideas which can be implemented. There were concerns raised of the power gradient preventing effective mentoring and risks to relationships, however these were expressed as potential concerns and not experienced. Conclusion The experience of all participants in this feasibility study were positive supporting the benefits of reverse mentoring in a healthcare setting. Junior doctors became better equipped to be future mentors. Consultants were given a new perspective which inspired them to improve their clinical practice and work environment.
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- 2021
8. PWE-036 Polyethylene glycol purgatives prior to small bowel capsule endoscopy improve distal small bowel visualisation
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David Tai, Ailish Healy, Vicky Thurston, Nicholas Wray, Ryan Jennings, Mark E. McAlindon, Reena Sidhu, and Lawrence Hookey
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Intention-to-treat analysis ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Colon cleansing ,Colonoscopy ,Polyethylene glycol ,law.invention ,Endoscopy ,chemistry.chemical_compound ,Quartile ,chemistry ,Capsule endoscopy ,law ,PEG ratio ,medicine ,Nuclear medicine ,business - Abstract
Introduction Bowel purgatives are common practice prior to small bowel capsule endoscopy (SBCE). The use of Polyethylene glycol (PEG) laxatives is suggested to improve SB visualisation quality and diagnostic yield [Kotwal, Eur J Gastro Hep 2014]. However, this finding is not completely consistent, with other studies suggesting no clear benefit of PEG preparation over clear fluids only [Hookey, GIE 2017]. Therefore, unlike colonoscopy where the routine use of split dose bowel preparation to improve right colon cleansing has become a standard of care [Flemming, GIE 2012], the benefit and timing of purgatives prior to SBCE is unknown. We report the interim results from a clinical trial comparing the use of split dose PEG and single dose PEG against clear fluids only. Methods Adult patients referred for SBCE were invited to participate and subject to exclusion criteria, were randomised to control (clear fluids only), single dose PEG (2L PEG at 6am on the day of the exam) and split dose PEG (1L PEG at 7pm the day before and 6am on the day of the exam). Briefly, the mean red to green colour intensity from SBCE procedure colour bars were used to calculate a computed assessment of cleansing (CAC) scores described elsewhere [Van Weyenberg, Endoscopy 2011]. The CAC is a validated 10 point scoring system (0–10; least - most clean) used to assess small bowel visualisation quality. CAC scores are reported as mean ± SEM and student t-tests performed to compare the means. Results A total of 78 patients (35% male, mean age 48±2.0) were included (split n=28, single n=24 and control n=26). Intention to treat analysis show that split dose PEG preparation results in significantly greater mean CAC score in the distal quartile (5.58±0.16) of the small bowel compared to control (4.78±0.30; p=0.02). No differences in the overall, first, second and third quartile CAC score of the small bowel was found between control and PEG groups. Complete ingestion of PEG preparation occurred in 88% and 77% of single vs split dose (p=0.33). Subgroup analysis showed that amongst patients that completed preparation successfully, those randomised to both split dose (5.52±0.20; p=0.01) and single dose (5.64±0.18, p=0.003) PEG had a significantly greater mean CAC score in the distal quartile of the small bowel compared to control (4.58±0.28). Conclusions The use of split dose laxatives improves the visualisation quality of the distal small bowel. Initial results may suggest that the PEG dose in the morning of the procedure improves distal quartile visualisation.
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- 2019
9. PTU-084 The use of panoramic capsule endoscopy in obscure gastrointestinal bleeding
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Reena Sidhu, Mark E. McAlindon, and Stefania Chetcuti Zammit
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medicine.medical_specialty ,Endoscope ,medicine.diagnostic_test ,business.industry ,Stomach ,Incidence (epidemiology) ,Colonoscopy ,Gastroenterology ,Occult ,law.invention ,medicine.anatomical_structure ,Capsule endoscopy ,law ,Internal medicine ,medicine ,Upper gastrointestinal ,business ,Obscure gastrointestinal bleeding - Abstract
Introduction Up to 64% of patients with obscure gastrointestinal bleeding (OGIB) have lesions that can be reached with a standard gastroscope [1]. Positive findings outside the small bowel (SB) have been detected on axial small bowel capsule endoscopy (SBCE) (PillCam system, (Given Imaging) in patients with OGIB in up to 22% of patients in the stomach and 6% in the colon [2]. Our aim was to assess the diagnostic yield (DY) of panoramic SBCE (Capsocam) for the upper gastrointestinal tract, SB and colon in patients with OGIB. Methods Patients at a tertiary centre who underwent Capsocam as part of the examination of OGIB following negative gastroduodenoscopy and colonoscopy or CT colonography were included. This study was carried out over a 6 year period. Findings on SBCE were recorded. Results Forty-eight patients (37, 77.1% overt, 11, 22.9% occult OGIB) were included in this study. Thirty (62.5%) were males. Mean age was 67.5±16.5 years. OGIB was present for a mean of 19.9 SD±92 months. Only one SBCE (9.1%) was incomplete within the occult OGIB group (p=0.229). The panoramic SBCE had a diagnostic yield of 37.5% (18 patients) in the SB. It also picked up additional findings in the stomach (n=5, 10.4%) and in the colon (n=3, 6.3%). Some patients had more than one pathology (table 1). Conclusions Panoramic SBCE can be useful in the detection of lesions in the stomach and colon missed during upper and lower gastrointestinal examinations. It can also be better in the detection of pathologies in overt OGIB than in occult OGIB. References Zaman A, Katon RM: Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope. Gastrointest Endosc 1998, 47:37–76. Riccioni ME, Urgesi R, Cianci R, Marmo C, Galasso D, Costamagna G: Obscure recurrent gastrointestinal bleeding: a revealed mystery? Scand J Gastroenterol 2014, 49:102–026.
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- 2019
10. PWE-023 Coeliac disease – older patients have the most extensive small bowel involvement on capsule endoscopy
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Stefania Chetcuti Zammit, David S Sanders, and Reena Sidhu
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medicine.medical_specialty ,business.industry ,Disease ,Iron deficiency ,medicine.disease ,Gastroenterology ,Coeliac disease ,Serology ,law.invention ,medicine.anatomical_structure ,Capsule endoscopy ,law ,Internal medicine ,Duodenal bulb ,medicine ,Duodenum ,Gluten free ,business - Abstract
Introduction The relationship between symptomatology, serology and findings on small bowel capsule endoscopy (SBCE) in patients with coeliac disease (CD) remains unclear. Clarifying such associations will help determine if symptoms and serology can predict severity and extent of disease on SBCE. Methods Patients with newly diagnosed CD (villous atrophy on duodenal histology and positive CD serology) were recruited. Patients underwent a SBCE at the time of diagnosis. Information on SBCE was recorded. Signs and symptoms at presentation, serological markers, histological classification of disease in the duodenum were noted. Results Sixty patients with newly diagnosed CD (mean age 44.9 years SD±17.4, 17 - 76) were included in this study. Older patients (p=0.025) and patients presenting with iron deficiency anaemia had more extensive small bowel (SB) involvement (p=0.026). Patients presenting with weight loss were more likely to have SB involvement beyond the duodenum (p=0.027). Patients presenting with iron deficiency anaemia (p=0.038) and weight loss (p=0.009) were significantly older at diagnosis. Serum albumin was lower in those patients diagnosed later on in life (p=0.007). There was no significant association between anti-tissue transglutaminase antibody (p=0.396) and extent of affected SB mucosa. Patients with more severe Marsh classification of disease on histology from the duodenal bulb had more extensive SB involvement (p=0.017). Conclusions This is the largest study on newly diagnosed CD and SBCE. Older patients are likely to have more extensive disease on SBCE at diagnosis. Symptoms and serology had no impact on the findings on SBCE apart from weight loss and iron deficiency anaemia. Reference Lau M, Mooney P, White W, et al. PWE-058 The Role of A Point of Care Test, Simtomax, in Predicting Histological Remission in Coeliac Disease on A Gluten Free Diet. Gut 2016;65:A166–A167.
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- 2019
11. PTH-009 Capsule endoscopy in coeliac disease: the role of flexible spectral imaging colour enhancement
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Reena Sidhu, Cristina Carretero, Mark E. McAlindon, Pierre Ellul, Emanuele Rondonotti, Stefania Chetcuti Zammit, and David S Sanders
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medicine.medical_specialty ,business.industry ,Capsule ,medicine.disease ,Coeliac disease ,Chromoendoscopy ,law.invention ,Spectral imaging ,Capsule endoscopy ,law ,White light ,Medicine ,Radiology ,business ,Blue light - Abstract
Introduction Flexible spectral imaging colour enhancement (FICE) is a form of virtual chromoendoscopy that is incorporated in the capsule reading software and that can be used by reviewers to enhance the delineation of lesions in the small bowel. This has been shown to be useful in the detection of pigmented (ulcers, angioectasias) lesions. However, its application to coeliac disease (CD) images from small bowel capsule endoscopies (SBCEs) has rarely been studied. Methods This was a European, multicentre study that included 5 expert capsule reviewers who were asked to evaluate a number of normal and abnormal deidentified images from SBCEs of patients with CD to determine whether the use of FICE and blue light can improve the detection of CD related changes. Results Sensitivity and specificity of conventional white light in the delineation of CD related changes were 100%. The next best image modification was FICE 1 with a sensitivity of 88% and a specificity of 96%. There was no difference between conventional white light, FICE and blue light for the identification of CD related changes. There was a low agreement (Fleiss Kappa 0.107; p=0.147) between expert reviewers in selecting the best image modification that detected CD related changes. Conclusions FICE and blue light were not found to be superior to conventional white light in the delineation of macroscopic changes related to CD on SBCEs.
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- 2019
12. PTU-128 Double-headed capsule endoscopy: real-world experience from a multicentre British study
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John N. Plevris, Anastasios Koulaouzidis, Leena Sinha, Joanna Brzeszczynska, Diana Yung, Imdadur Rahman, Mark E. McAlindon, Sue Mason, Reena Sidhu, and Praful Patel
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0301 basic medicine ,medicine.medical_specialty ,Referral ,business.industry ,General surgery ,law.invention ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Capsule endoscopy ,law ,Recall bias ,Clinical diagnosis ,Cohort ,Medicine ,030211 gastroenterology & hepatology ,business ,Radiological imaging - Abstract
Introduction Capsule endoscopy (CE) is a well-established mode of investigation for small bowel (SB) pathology. This study examines the potential benefits of using double-headed capsules compared to conventional single-headed ones in a real-world cohort of patients referred for CE. We present initial results from the first multicentre British study. Methods Over a 9-month period, patients referred for routine SBCE at 4 tertiary referral centres in the UK underwent double-headed CE in lieu of conventional single-headed CE using MiroCam MC2000 capsules. CE was carried out as per routine protocols at each centre. Clinical data were anonymised. One head (L/R) was chosen at random and reported by an expert reviewer. The double-headed recordings, also anonymised and randomised, were reported by another expert reviewer. In centres with only one expert reviewer, double-headed CEs were read after a 4-week interval to minimise recall bias. For each CE, numbers and types of findings and overall conclusion/diagnosis were compared between single and double-headed examinations. Results 211 CE examinations were performed. 7 failed to reach the SB; 204 cases were analysed. Indications were (a) SB bleeding; (b) ?SB inflammation or reassessment of known inflammatory bowel disease (IBD); (c) ?SB neoplasia including suspicious radiological imaging and (d) others e.g. ?coeliac disease. Results are presented in table 1. Conclusions The use of double-headed CE provides more information which has the potential to change clinical diagnosis and therefore management. Therefore, the routine adoption of double-headed CE in SB assessment should be considered.
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- 2019
13. PWE-095 What is the role of capsule endoscopy in evaluating patients with refractory coeliac disease?
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Stefania Chetcuti Zammit, Reena Sidhu, and David S Sanders
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medicine.medical_specialty ,business.industry ,Histology ,Azathioprine ,medicine.disease ,Gastroenterology ,Coeliac disease ,law.invention ,Serology ,Lymphoma ,Refractory ,Capsule endoscopy ,law ,Internal medicine ,Medicine ,Abnormality ,business ,medicine.drug - Abstract
Introduction Small bowel capsule endoscopy (SBCE) is used in refractory coeliac disease (RCD) to assess the extent of disease and ensure there are no complications (lymphoma or ulcerative jejunitis). However there are no published reports on SBCE in RCD following immunosuppressive therapy. Methods Patients with histologically confirmed refractory coeliac disease (RCD) who underwent a SBCE at baseline and after treatment were enrolled in this study. These were compared to a group of control CD patients with no underlying RCD. Results 19 patients (median 53 years) with RCD (12 patients; 63.2% – type 1) were compared to 28 patients with control CD (median 48 years). There was no statistically significant difference in duration of disease, gender, age at SBCE and serology between the 2 groups. Patients with RCD were more likely to have worse histology (Marsh 3a-c) than SBCE. control CD who had a higher percentage of normal histology at the time of SBCE. (p=0.002) Those with RCD had a longer abnormal small bowel (SB) mucosa (185 SD ±167.6 vs 29.5 SD ±73 min p=0.0001) and longer percentage of abnormal SB (53.9 SD ±38.0 vs 6.9 SD ±15.2 min p=0.0001) when compared to those with control CD. A repeat SBCE was carried out after a mean of 9.63 SD ±6.6 months in patients with RCD following treatment. There was no statistical significant difference in histology and serology at the time of the first and second SBCE. Patients received the following treatment: 36.8% steroids, 26.3% immunosuppressants, 36.1% combination of mycophenolate azathioprine and steroids. However, there was an improvement in the length of abnormal SB mucosa (185 vs 116 min; p=0.035) and the percentage of abnormal SB (50.8 vs 32.9%; p=0.027). 7 patients (36.8%) had diffuse mucosal involvement on the first SBCE but only 4 (21.1%) had diffuse disease on repeat SBCE. (p=0.007) There was no statistical correlation between coeliac serology and small bowel passage time, length of mucosal abnormality and percentage of affected SB at first and second SBCE. The same findings were also true for histology. Conclusions More severe SB involvement on SBCE can be found in patients with RCD. This is the first study that shows an improvement in SB abnormality on SBCE following treatment of RCD patients. Histology is useful in distinguishing RCD from non-RCD but not for assessing improvement in patients with RCD following treatment. SBCE might potentially be regarded as a less invasive, more accurate way of following up these patients.
- Published
- 2018
14. ADWE-02 Diagnostic yield and early discharge in gastrointestinal bleeding: comparative trial between capsule endoscopy and gastroscopy
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Sabina Beg, Melissa F Hale, Hey-Long Ching, Reena Sidhu, Krish Ragunath, and Mark E. McAlindon
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medicine.medical_specialty ,Gastrointestinal bleeding ,Endoscope ,business.industry ,Capsule ,Gastric varices ,medicine.disease ,Surgery ,law.invention ,Capsule endoscopy ,law ,medicine ,cardiovascular diseases ,business ,Varices ,Early discharge ,Mace - Abstract
Introduction Capsule endoscopy may have a role in triaging patients with suspected acute upper gastrointestinal (GI) bleeding who need further invasive investigation. Method The Mirocam Navi (Intromedic Ltd., Korea) is a single camera capsule endoscope steerable by a handheld magnet. Magnetically assisted capsule endoscopy (MACE) was performed in stable patients with suspected acute upper GI bleeding and a decision made as to whether same day discharge was appropriate, prior to gastroscopy (OGD) performed by a different, blinded endoscopist followed by standard care by the admitting team during which small bowel capsule endoscopy was completed. Diagnostic yield and comfort were compared. Potential impact on hospital stay was examined and MACE mucosal visualisation quality was assessed. Results A total of 90 upper GI lesions were detected in 30 patients (80% male, median age 57 years (IQR=26)): 21 (23%) concomitantly identified by MACE and OGD, 49 (54%) by MACE alone and 20 (22%) by OGD alone (CI 0.05–0.58; p=0.0007). MACE and OGD concomitantly detected 50% of major pathologies (gastric and duodenal ulcers and oesophageal and gastric varices (n=2 each)). MACE alone identified 31% (D1 ulcers (n=4) and varices (n=1)) whereas OGD alone identified three D1 ulcers (19%; p=0.7). Ulcers (all classified as Forest class III at OGD) missed by MACE were due to rapid D1 transit and insufficient imaging. Review of small bowel images identified additional causes for GI bleeding distal to D2 in five cases: small bowel lymphoma (n=1), angioectasia (n=2), fresh bleeding in the proximal and distal small bowel with no culprit lesion seen (n=1 for each). MACE correctly suggested safe discharge for 21/21 patients. The median hospital stay of uncomplicated admissions where MACE suggested discharge was 53 (range 14–103) hours. Pain, discomfort and distress scores were lower with MACE than OGD (p 2 =133 (p Conclusions MACE has better diagnostic yield than OGD in suspected upper GI bleeding (with both modalities missing lesions), is better tolerated and used ‘at the front door’ might allow immediate discharge for two thirds of patients saving a median hospital stay for each of over two days. In addition, it suggests that about 10% of suspected upper GI bleeding may have a small bowel source.
- Published
- 2018
15. PWE-099 Premature dissolution of the agile patency device
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Reena Sidhu, Tony Blakeborough, David Tai, Mark E. McAlindon, Melissa F Hale, Victoria Thurston, Hey-Long Ching, Nicholas Wray, Ailish Healy, and Stefania Chetcuti Zammit
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medicine.medical_specialty ,Retrospective review ,Patency capsule ,medicine.diagnostic_test ,business.industry ,High density ,Computed tomography ,law.invention ,Swallowing ,Capsule endoscopy ,law ,Medicine ,Radiology ,business ,Bowel imaging ,Surgical Clips - Abstract
Introduction Confirmed (visual) passage of an intact Agile (Medtronic Ltd) patency device (which contains a radiofrequency (RF) tag), absence of an RF signal or failure to identify the patency device on radiological imaging 30 hours post-ingestion predicts safe capsule endoscopy. [Hererrias et al., Gastrointest Endosc 2008] Premature dissolution of the device would give false reassurance that capsule endoscopy could be performed safely. Methods Retrospective review of 2017 patency capsule database. Results RF scan was performed on 490 patients 30 hours after swallowing an Agile patency device and, if an RF signal was present, patients went for a scout film and, where indicated, limited CT scan. Premature dissolution occurred in four cases (0.8%). All had normal colonoscopies and symptoms of Crohn’s disease (two of whom had abnormal, one normal and one no prior small bowel imaging). In two, the scout films were reported normal, but a persistent RF signal prompted re-examination of the films and the identification of the RF tags. In the two later cases, the RF tag alone or with adjacent high density material (consistent with barium) was recognised as demonstrating premature dissolution. Conclusions This is the first report of premature dissolution of the Agile patency device which occurred in about 1:100 cases. If the RF signal remains 30 hours post ingestion, care should be taken to look for the RF device on radiological imaging when the intact patency device (see figure 1) is not evident. The tags may be confused with surgical clips, IUCDs, metallic items of clothing and jewellery.
- Published
- 2018
16. PWE-062 First clinical experience of panenteric capsule endoscopy using the pillcam crohn’s capsule
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Ailish Healy, Clare Parker, David Tai, Melissa F Hale, Sara Koo, Victoria Thurston, Reena Sidhu, Simon Panter, and Mark E. McAlindon
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Perianal Abscess ,Capsule ,Colonoscopy ,Disease ,medicine.disease ,Surgery ,law.invention ,Capsule endoscopy ,law ,Adalimumab ,Medicine ,Colitis ,business ,Inactive disease ,medicine.drug - Abstract
Introduction Guidelines support endoscopic assessment of mucosal healing in Crohn’s disease before a change in therapy. [Gomollon, J Crohn’s Colitis 2016] A recent study has shown that the PillCam Crohn’s (PCC, Medtronic, Dublin, Ireland) has a better diagnostic yield than ileocolonoscopy [Leighton, Gastrointest Endosc 2017] and that colon capsule (for which the same bowel preparation is used) is better tolerated [Ojidu, European J Gastroenterol Hepatol, in press]. We report the first experience of PCC in routine clinical practice. Methods Data was collected prospectively in Sheffield and South Tyneside hospitals. Montreal classification was used (ileal:L1; colonic: L2; ileocolonic: L3; upper GI: L4; B1: non-stricturing/penetrating; B2: stricturing; B3: penetrating). All patients passed an Agile patency capsule (Medtronic). Results Eighteen patients (median age 35 years, 38.9% male, known Crohn’s in 83%) had PCC. Indications were: symptom assessment (77.8%), assess response to treatment (11.1%), consideration of stepping down therapy (16.7%). Patients with established Crohn’s had L1 (53.3%), L2 (13.3%), and L3 disease (33.3%) which was uncomplicated (40%), stricturing (46.7%) and penetrating (13.3%). Patients were on medical treatment in 73.3%. PCC changed staging of disease in 33% of cases (L1 to L3 n=1, B2 to B1 n=3 and B1 to B2 n=1). One of three patients with suspected Crohn’s disease subsequently had endoscopic confirmation (L3 B1). PCC was normal (5/18), revealed L1 disease alone (8/18), L2 disease alone (1/18) and L3 disease (5/18). There were three incomplete procedures, all with an otherwise normal visualised colon. No capsule retentions occurred. Follow up data was available in 11 patients. Of eight patients with symptoms, five had active disease and three no or minimal activity. Of the five, three had a step-up in treatment, one had adalimumab temporarily suspended due to a perianal abscess and management continues to be discussed in one patient on maximal medical therapy. Other causes of symptoms were sought in the patients with inactive disease. Three patients had no symptoms, one had active disease and a step up in treatment, two had no or minimal activity of whom one continued therapy due to poor prognostic factors and one was already on no treatment (PCC being performed to provide supportive evidence of a diagnosis made in childhood). No patient known to have Crohn’s has been referred for further small bowel imaging or colonoscopy. Conclusion PCC provides a single visit assessment of both small and large bowel which was useful in guiding patient management without complications.
- Published
- 2018
17. ADTH-08 Robot magnet-controlled upper gastrointestinal capsule endoscopy: non-invasive investigation with excellent patient tolerance
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Melissa F Hale, Hey-Long Ching, Mark E. McAlindon, Reena Sidhu, and David Tai
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medicine.medical_specialty ,business.industry ,Stomach ,Gastric distension ,Distension ,Pylorus ,Curvatures of the stomach ,law.invention ,medicine.anatomical_structure ,Capsule endoscopy ,law ,medicine ,Radiology ,medicine.symptom ,business ,Antrum ,Mace - Abstract
Introduction Gastroscopy (OGD) is invasive and not always well tolerated. The NaviCam® (Ankon Technologies Co. Ltd., Shanghai, China) combines capsule endoscopy technology with external robot magnetic control. Operator joysticks command the robot to steer the capsule within the stomach. Real-time visualisation is displayed on two workstation monitors. When compared to OGD, the NaviCam® has already demonstrated high sensitivity and specificity for identifying focal gastric lesions.1 The focus of this study was to grade imaging quality and patient tolerance of the NaviCam®. Method Patients with dyspepsia were recruited. Patients swallowed 100 mls of water (containing 10 mls simethicone) 15 min prior to 1L of water followed by the NaviCam®. Clarity of views and adequacy of gastric distension were assessed (1, poor; 2, reasonable; 3, good), as was completeness of views of the oesophagogastric mucosa (1,>75% obscured; 2,>50% obscured; 3, Results Eighteen participants were included (mean age 53±16.1 years, 27.8% male). The NaviCam could be held stationary within the stomach (resisting peristaltic waves) and could cartwheel over rugal folds to a chosen proximal location using a preset programme activated by a ‘shoot’ button on the joystick. Mean examination duration was 25±3.4 mins. Mean clarity (2.3±0.7) and distension scores (2.9±0.3) were good. Complete views (5±0) for all areas of the gastric body (greater and lesser curvature, anterior and posterior wall) and distal stomach (antrum and pylorus) were achieved. Views of the oesophagus (4.3±1.3) and proximal stomach (cardia, 4.9±0.2; fundus 4.8±0.3) were also good. Duodenal images were not assessed real-time (but are provided after the capsule traverses the pylorus). Tolerance scores for anxiety, discomfort and pain were all lower with MACE compared to OGD (2.2±1.4 vs 5.8±3, 1.3±1 vs 4.9±3, 2.4±2.4 vs 3.4±2.5, respectively; p Conclusion The NaviCam® demonstrates excellent oesophagogastric views. The NaviCam® is extremely well tolerated compared to OGD and patients experience significantly fewer undesirable symptoms associated with upper GI endoscopy. Reference . Liao Z, et al. Clin Gastroenterol Hepatol2016;14(9):1266–73.e1.
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- 2018
18. PTH-022 Hyperamylasaemia post antegrade double balloon enteroscopy – does indomethacin make a difference?
- Author
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Reena Sidhu, Suneil A Raju, Hey-Long Ching, David S Sanders, and Stefania Chetcuti Zammit
- Subjects
Gastrointestinal bleeding ,medicine.medical_specialty ,medicine.diagnostic_test ,biology ,business.industry ,medicine.medical_treatment ,medicine.disease ,Gastroenterology ,Polypectomy ,Coeliac disease ,Double-balloon enteroscopy ,Internal medicine ,medicine ,biology.protein ,Pancreatitis ,Acute pancreatitis ,Amylase ,business ,Complication - Abstract
Introduction High amylase does not always signify acute pancreatitis and it can occur due to focal areas of ischaemia in the pancreas due to mechanical stress during double balloon enteroscopy (DBE). The use of rectal NSAIDs to prevent post DBE pancreatitis has never been explored unlike in ERCP where patients receiving rectal NSAIDs have a lower incidence of pancreatitis. Methods Patients who received rectal indomethacin (100 mg) 30 min prior to antegrade DBE were compared to a control group who did not receive indomethacin before the above protocol was implemented. Serum amylase and CRP 3 hours before and after DBE were compared. Results 240 patients (56 indomethacin, 184 controls; 50% males; mean age 58.5±SD14.0) were included. Indications included IDA (37.5%), obscure overt gastrointestinal bleeding (17.1%), suspected crohn’s disease and strictures (17.9%), complication of coeliac disease (1.3%), small bowel (SB) tumours/polyps (17.9%), others (8.3%). Patients had a median of 13.0±SD13.0 passes, 65.0±SD25.0 min, 170±SD52.0 cm of SB examined. 36.3% underwent a therapeutic procedure during DBE: APC/adrenaline/clips (27.5%), foreign body removal (0.4%), polypectomy (8.3%). Only 4 (1.67%; 2 females) patients developed pancreatitis, all prior to implementation of indomethacin into the local protocol. They had a median age of 47.0±SD3.20 years, 11±SD29.4 passes, 90±SD52.0 min, 150 cm ±SD64.2 cm of SB examined and median hospital stay of 14±SD3.70 days. 3 had polypectomies. 2 episodes occurred in the same patient. All had evidence of pancreatitis on CT scan. None of the patients received indomethacin before DBE. Mean amylase (51.6±SD22.7 vs 143.0±SD143.9 IU/L p=0.0001) and CRP (13.0±SD46.1 vs 17.3±SD81.7 mg/L p=0.0001) after the procedure were significantly higher than before the procedure. Females had a significantly higher amylase than males post procedure (155.2 vs 130.7 IU/L p=0.017). Mean amylase 3 hours after DBE was significantly lower in patients who received indomethacin (114 vs 152) (p=0.044). 83.9% had a rise in amylase in the indomethacin group compared to 92.2% controls.(p=0.064). Whilst there was no correlation between post-procedure amylase (p=0.552), CRP (p=0.058) and duration of the procedure, there was a significant association between amylase post procedure and length of SB examined.(Spearman’s rho 0.186; p=0.005) Conclusions This study identifies a role for rectal indomethacin in patients undergoing antegrade DBE. We have demonstrated that rectal indomethacin reduces amylase post DBE and no patients given indomethacin experienced pancreatitis. Larger studies are required to assess if this also transforms into lowering risk or severity of pancreatitis.
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- 2018
19. ADWE-07 How many capsule endoscopy cases can be read before accuracy is affected?
- Author
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Timothy R. Card, Reena Sidhu, Krish Ragunath, Ewa Wronska, and Sabina Beg
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Psychomotor learning ,medicine.medical_specialty ,media_common.quotation_subject ,Computer based ,Audiology ,Dreyfus model of skill acquisition ,law.invention ,Random order ,03 medical and health sciences ,0302 clinical medicine ,Single view ,Capsule endoscopy ,law ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,Abnormality ,Psychology ,Vigilance (psychology) ,media_common - Abstract
Introduction The interpretation of Small Bowel Capsule Endoscopy (SBCE) requires a high level of concentration. An abnormality may be present on just a few of the many thousands of images presented for interpretation. It is unknown whether fatigue affects the accuracy of SBCE reporting or how many SBCE can be read in one session. Methods 32 participants (16 Experienced readers and 16 Novices) were invited to participate in this study. Each was asked to read 6 consecutive pre-selected SBCE cases, these were presented in a random order. All readings took place using the single view mode, with readers able to choose the frames per second viewed from a pre-defined range. Fatigue was measured subjectively using a Likert scale and objectively using a computer based Psychomotor Vigilance Test (PVT). These measures were performed at prior to commencing the study and after every second capsule read. Accuracy in lesion detection was determined by comparison with a gold standard reading, derived from the non-consecutive readings of two experienced readers. Accuracy was plotted against reading order. Results In keeping with published data, high intra-observer variability amongst the participants was observed. Experienced readers demonstrated a mean correct detection rate of 48.3% (SD:16.1), compared to 21.3% (SD:15.1) amongst Novices. The accuracy of Experienced readers declined after interpreting just a single SBCE case (p=0.01) and plateaued thereafter. Novice readers demonstrated no significant change across time points, with a trend towards improvement, perhaps indicating skill acquisition during the study. The mean reading time to read a single SBCE case was 32 mins. When analysed with respect to reading order a statistically significant reduction in reading time was observed (p=0.05). Reading times were on average 25% faster when reading Case 6 compared to Case 1, representing a mean reduction of 9 mins and 36 secs (range 9–11 mins). Reading at higher frame rates was associated with a reduction in accuracy, which was most pronounced amongst Novice readers. No significant relationship between subjective fatigue or PVT and correct lesion detection was demonstrated. Conclusions This is the first study to demonstrate that accuracy in SBCE declines after reading a single capsule study. This phenomenon should be considered when reading high risk cases or when a SBCE case has been reported as normal, despite high clinical suspicion.
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- 2018
20. ADTH-09 Capsule endoscopy has better diagnostic yield than gastroscopy in recurrent iron deficiency anaemia
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Victoria Thurston, Matthew Kurien, Ailish Healy, Stefania Chetcuti Zammit, Jennifer A Campbell, John M Hebden, Reena Sidhu, Melissa F Hale, and Hey-Long Ching
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medicine.medical_specialty ,business.industry ,Stomach ,Capsule ,Iron deficiency ,medicine.disease ,Gastroenterology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,McNemar's test ,medicine.anatomical_structure ,Refractory ,Capsule endoscopy ,law ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,Upper gastrointestinal ,030211 gastroenterology & hepatology ,business ,Mace - Abstract
Introduction Repeat upper gastrointestinal (GI) examination and small bowel capsule endoscopy should be considered in iron deficiency anaemia (IDA) when recurrent/refractory. Magnetically assisted capsule endoscopy (MACE) using a handheld magnet to steer the MiroCam Navi (Intromedic Ltd., Korea) capsule around the stomach followed by passive small bowel transit might satisfy both requirements as a single procedure. Methods MACE was performed in patients with recurrent/refractory IDA who were due gastroscopy (OGD). Total (upper GI and small bowel) and upper GI diagnostic yields and patient tolerance of the two modalities were compared. Assuming a diagnostic yield of 25% and 55% for OGD and small bowel capsule endoscopy (SBCE) respectively in recurrent/refractory IDA, 41 patients were needed to achieve 80% power and 5% two-sided significance. McNemar’s test was used to measure differences in paired proportions. To allow for withdrawal, 50 patients were recruited. MACE mucosal visualisation was also assessed. Results OGD was performed within 2 days (IQR=13) of MACE in 49 patients (one failed to attend for OGD; median age 64 years (IQR=13), 39% male). Combined upper and mid-gut examination using MACE and passive SBCE yielded pathology in more patients than OGD alone (32 vs 6 (CI, 0.37 to 0.69); p Conclusions Combined upper GI and small bowel examination with the MiroCam Navi yields more pathology than OGD alone in patients with recurrent/refractory IDA. MACE also has better diagnostic yield than OGD in the upper GI tract and was better tolerated.
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- 2018
21. PTU-132 The changing platform of small bowel endoscopy: a 15-year experience of demand and outcomes
- Author
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S Chetcuti Zammit, H-L Ching, David S Sanders, Victoria Thurston, Reena Sidhu, Mark E. McAlindon, and Ailish Healy
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Enteroscopy ,medicine.medical_specialty ,Gastrointestinal bleeding ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Argon plasma coagulation ,medicine.disease ,Gastroenterology ,Polypectomy ,law.invention ,Endoscopy ,Surgery ,Capsule endoscopy ,law ,Double-balloon enteroscopy ,Internal medicine ,medicine ,Complication ,business - Abstract
Introduction The development of capsule endoscopy (CE) and enteroscopy have increased the ability to investigate and treat pathology in the small bowel. We have been providing a comprehensive small bowel endoscopy service and we present our data from the last 15 years evaluating demand, diagnostic yield and impact on patient management. Method A retrospective analysis was conducted on patients who underwent CE, push enteroscopy (PE), double balloon enteroscopy (DBE) and intraoperative enteroscopy (IOE) between January 2002 and December 2016. Results A total of 5065 CEs, 569 DBEs, 327 PEs and 22 IOEs were performed over 168 months. Obscure gastrointestinal bleeding (OGB) and anaemia were the most common indications for CE (37.8%), DBE (30%) and IOE (55%). Exclusion of coeliac disease complications (26.6%) was the most common indication for PE. The majority of patients had a CE prior to DBE (83.4%) and IOE (81.8%) (p=0.0001). Fifty percent of patients had a DBE prior to IOE. The demand for CE has plateaued over the past few years compared to the demand for DBE which is rising. The demand for PE has fallen dramatically (p=0.0001). This is also true for IOE and its use is reserved only for lesions beyond the limits of DBE (p=0.0001). In 2016, for every 11 CEs performed, 1 patient underwent a DBE locally. The diagnostic yield for CE, PE, DBE and IOE were 29%, 43.9%, 53.8% and 89.5% respectively (p=0.0001). The diagnostic yield for CE has fallen over the years (p=0.0001). This is perhaps due to the lower threshold for performing CE by the referring clinicians. The diagnostic yield for CE was highest for the indication of OGB (36%) compared to Crohn’s disease (30.0%, p=0.001). This contrasts with the diagnostic yield of DBE which has risen gradually (p=0.0001). Fifteen percent of patients underwent a DBE despite a negative CE. The yield for DBE in this group of patients was only 4.3% (p=0.0001). The rate of therapeutics for DBE, PE and IOE were 29%, 20% and 77% respectively. The majority of therapeutic procedures performed were argon plasma coagulation to angioectasias and polypectomies. The complication rates were 2% for DBE, 0.9% for PE and 13.6% for IOE (p=0.004). Complications following DBE included cardiovascular events (0.2%), respiratory compromise (0.9%), pancreatitis (0.2%) and gastrointestinal bleeding following polypectomy in (0.2%). Conclusion This is one of the largest series to date comparing the clinical utility and yield of all 4 small bowel endoscopic modalities. Enteroscopy has an important role in providing further management directed by CE. In patients with a negative CE, the yield of DBE is low, hence careful patient selection is required to maximise the use of resources. Disclosure of Interest None Declared
- Published
- 2017
22. OC-027 The use of lanreotide for the management of small bowel angioectasia
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SChetcuti Zammit, David S Sanders, and Reena Sidhu
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Enteroscopy ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Argon plasma coagulation ,medicine.disease ,Lanreotide ,Clopidogrel ,Gastroenterology ,chemistry.chemical_compound ,chemistry ,Refractory ,Internal medicine ,Double-balloon enteroscopy ,Medicine ,business ,Tranexamic acid ,Kidney disease ,medicine.drug - Abstract
Introduction Small bowel angiectasias (SBA) have been reported on capsule endoscopies in up to 60% of patients who present with obscure gastrointestinal (GI) bleeding. They are commonly found in elderly patients with multiple co-morbidities who might be deemed high risk for double balloon enteroscopy (DBE) and argon plasma coagulation (APC). A proportion of patients continue to have recurrent bleeding despite endoscopic therapy. Pharmacological therapy can thus be a useful adjuvant treatment. The aim of this study was to assess the role of Lanreotide (long-acting somatostatin analogue) in patients with refractory GI bleeding. Method Patients with confirmed SBAs who were started on Lanreotide between January 2010 and December 2016 were included in this study. Baseline demographics were recorded. Efficacy was evaluated in terms of improvement in mean haemoglobin, transfusion requirements and bleeding episodes (>2 g/dl drop in HB or overt bleeding). Results Twelve patients (67% males, mean age 74 SD ±15.5 years), started on lanreotide were included. All patients had multiple comorbidities including ischaemic heart disease (92%), respiratory problems (59%), diabetes (58%) and chronic kidney disease (50%). Three patients (25%) had hereditary haemorrhagic telangiectasia. Fifty percent was on warfarin whilst 8% were on clopidogrel. Seventy-five percent of patients were on oral iron supplements, 17% were on intravenous iron and 33% were on tranexamic acid. The angioectasias were distributed in the small bowel in 66.7%, small bowel and colon in 8.3% and small bowel and stomach in 25%. Lanreotide was given at a dosage of 60 mg (42%), 90 mg (33%) or 120 mg (25%). It was given at a 4 weekly interval in 75% of patients and at a 6 weekly interval in 17% of patients. One patient (8%) received a single dose. The mean duration of treatment was 19 months SD ±14.5 (range 1–41 months). Only 17% of patients had their lanreotide stopped due to cholelithiasis. There was a significant improvement in mean baseline and follow up haemoglobin levels with lanreotide therapy: 86.8 vs 98.0 (131–166 g/L).(p=0.012) Mean number of bleeding episodes improved with lanreotide use (4.18 vs 1.09 p=0.010). There was a significant improvement in the number of packed red cells (PRCs) received before and after lanreotide (total PRCs: 323 vs 152 p=0.006; PRCs over 12 months: 275 vs 126 p=0.055). Patients required a reduced number of DBEs±APCs after starting lanreotide (n=11) when compared to before (n=19) (p=0.048). Conclusion Lanreotide is a useful adjuvant treatment with therapeutic enteroscopy in patients with refractory obscure GI bleeding due SBA. It effectively improves haemoglobin, reduces transfusion requirements, bleeding episodes and reduces the number of DBEs needed in difficult to treat patients. Overall, it has a good safety profile. Disclosure of Interest None Declared
- Published
- 2017
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