AIM: To determine whether the transhepatic or transperitoneal approach is the optimal percutaneous cholecystostomy approach. MATERIALS AND METHODS: A systematic review and meta-analysis was undertaken in which the Medline, EMBASE, and PubMed databases were searched for studies that compared both approaches in patients undergoing percutaneous cholecystostomy. Statistical analysis of dichotomous variables was carried out using odds ratio as the summary statistic. RESULTS: Four studies totalling 684 patients (396 [58%] males, mean age 74 years) who had undergone percutaneous cholecystostomy via the transhepatic (n=367) and transperitoneal (n=317) approach were analysed. Although the overall risk of bleeding was low (4.1%), it was significantly higher in the transhepatic approach compared with the transperitoneal approach (6.3% versus 1.6% respectively, odds ratio = 4.02 [1.56, 10.38]; p=0.004). There were no significant differences in pain, bile leak, tube-related complications, wound infection, or abscess formation between the approaches. CONCLUSION: Percutaneous cholecystostomy can be performed safely and successfully via the transhepatic and transperitoneal approaches. Although the overall rate of bleeding was significantly higher with the transhepatic approach, there were confounding factors due to technical differences between the studies. The small number of the included studies, in addition to variability of the definitions of outcomes, imposed other limitations. Further largevolume cases series and ideally a randomised trial with well-defined outcomes are required to confirm these findings. (c) 2023 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Objective: This study aimed to compare the postoperative and pathological outcomes between carboplatin, paclitaxel, radiotherapy (CROSS) and 5-FU, leucovorine, oxaliplatin and docetaxel (FLOT) in esophageal adenocarcinoma (EAC) patients from an international, multicenter cohort. Summary of Background Data: Ongoing debate exists around optimum approach to locally advanced EAC, with proponents for perioperative chemotherapy, such as FLOT, or multimodal therapy, in particular the CROSS regimen. Methods: Patients undergoing CROSS (n = 350) and FLOT (n = 368), followed by curative esophagectomy for EAC were identified from the Oesophagogastric Anastomosis Audit. Results: The 90-day mortality was higher after CROSS than FLOT (5% vs 1%, P = 0.005), even on adjusted analyses [odds ratio (OR): 3.97, confidence interval (CI)(95%): 1.34-13.67]. Postoperative mortality in CROSS were related to higher pulmonary (74% vs 60%) and cardiac complications (42% vs 20%) compared to FLOT. CROSS was associated with higher pathologic complete response (pCR) rates (18% vs 10%, P = 0.004) and margin-negative resections (93% vs 76%, P < 0.001) compared with FLOT. On adjusted analyses, CROSS was associated with higher pCR rates (OR: 2.05, CI95%: 1.26-3.34) and margin-negative resections (OR: 4.55, CI95%: 2.70-7.69) compared to FLOT. Conclusions: This study provides real-world data CROSS was associated with higher 90-day mortality than FLOT, related to cardio-pulmonary complications with CROSS. These warrant a further review into causes and mechanisms in selected patients, and at minimum suggest the need for strict radiation therapy quality assurance. Research into impact of higher pCR rates and R0 resections with CROSS compared to FLOT on long-term survival is needed.

The study aims were to assess the technical success and clinical outcomes related to percutaneous cholecystostomy (PC) insertion in patients with acute calculous cholecystitis (ACC) based on procedural technique [transhepatic (TH) or transperitoneal (TP)] and determine the safest approach. The data set used was from the United Kingdom nationwide MACAFI (Multicentre Audit of Cholecystostomy and Further Interventions) study which included patients who underwent PC for ACC between 1st January 2019 and 1st January 2021. Data included patient demographics, imaging diagnosis, insertion technique, tube size, and 6 month follow-up/ outcomes (complications, readmission and mortality rate). Statistical analysis was performed using IBM SPSS v27 (IBM Corp. Armonk, NY). 1186 patients from 36 sites were identified through the MACAFI study with 913 patients having access route recorded. A TH route was used in 572 [62.6%] compared with 308 TP [33.7%]. There was an increased rate of bleeding when using the TH route (TH 2.5% vs TP 0.3%, P = 0.04) although other post procedural complications (such as bile leak) were similar between the two groups. No significant difference was demonstrated in 30 or 90 day mortality (TH v TP, 8.7% vs 9.3%, P = 0.86 and 13.8% vs 15.4%, P = 0.58 respectively). The readmission rate with recurrent cholecystitis was significantly greater in those with TH compared with TP approach (22.0% vs 14.9%, P = 0.01, respectively). The TP PC approach may be safer than TH, with lower bleeding complication rate and fewer readmissions.

AIM:To identify these barriers to research within interventional radiology (IR) and suggest potential solutions to support IR academia within the UK and beyond. MATERIALS AND METHODS:An electronic survey was compiled using Google Forms and distributed to the British Society of Interventional Radiology (BSIR) members by email and through social media (Twitter). The survey was open between 15 October 2021 and 15 December 2021. Questions included prior research experience and qualifications, research interests and barriers to research development. The data were analysed in Microsoft Excel 365. RESULTS:One hundred and six responses were received with the majority from junior (42.5%) and senior radiology trainees (25.5%). Eight-three percent had not undertaken formal research qualifications with 56.4% stating they would like to undertake a PhD or MD; 81.1% stated they planned to be involved in research. The most common perceived barriers were lack of time (64.2%), lack of research experience (61.3%), and lack of senior supervision (58.5%). CONCLUSION:Developing and supporting the academic IR infrastructure is vital to ensure the future of IR. Radiology trainees have shown interest in being involved with IR research and undertaking formal research training. Additional support from local hospitals, national societies, and the Royal College of Radiologists are required.

AIM:To evaluate the use of apps in radiology and consider advised changes to practice.MATERIALS AND METHODS:A survey was conducted of all radiology consultants and specialty trainees within Devon and Cornwall. The responses were collated, including the list of all medical applications used. These were assessed using the Medicine & Healthcare Products Regulatory Agency (MHRA) "Medical device stand-alone software including apps" guidance.RESULTS:The response rate was 88/150 (59%) radiologists who responded with the majority 48/88 (54.4%) using apps. Forty-four of 66 (67%) states that they did not assess the reliability or accuracy of these devices prior to use with 71/81 (88%) indicating that they were unaware of any regulations. Thirty-three items were identified of which 27 functioning apps were identified and three of these were considered medical devices and did not have complete and recognisable CE marking as required by the MHRA.CONCLUSION:This study highlights that application use is widespread. The vast majority of these applications are not considered medical devices; however, there are some devices that, according to the MHRA flow chart, are used in a way that classifies them as medical devices and should therefore be CE marked. This highlights the need for guidance and regulation of the medical application market with recommendations provided.

Background: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III-V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC. Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

The majority of out-of-hours cases relate to neurological, chest, and gastrointestinal pathologies with acute vascular cases being encountered less commonly. Trainees and exposure of non-vascular/interventional radiology (IR) consultants to angiographic imaging is often limited in working hours and this may lead to reporting on-call cases outside of normal daytime practice. In a recent local review, a number on-call vascular studies were found to contain a number of vascular-related discrepancies. Vascular reporting is a complex subspecialty, which comprises many clear diagnoses (large vessel occlusions, large vessel aneurysms, or dissections); however, also several subtle and complex abnormalities. These more subtle abnormalities, at times, require dedicated vascular specialist review to ensure subtle findings are communicated appropriately to the clinical team. The recent increased complexity of endovascular treatments and their complications has also provided further challenge for the non-specialist reporter. Similarly, improved imaging techniques have allowed for non-obvious but significant findings that may require urgent management, such as small aneurysms and dissection flaps. We will review a range of key vascular findings that demonstrate learning opportunities, particularly within the acute and on-call settings. These will include gastrointestinal haemorrhage, subtle aortic pathologies, head and neck vascular emergencies, small to mid-sized vessel injuries and imaging of post-procedural complications. Educational hints and tips will be provided to enable learning from mistakes encountered by trainees and non-vascular specialist radiologists in the on-call or urgent reporting settings, and these will be reviewed with reference to the literature.

AbstractBackgroundThe complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.MethodsData from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups.ResultsOf 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005).ConclusionTrainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.

Introduction Elective surgery in the UK came to a halt during the early part of the COVID-19 pandemic. As COVID-19-related infection and mortality rates in Devon and Cornwall were relatively low, however, urgent elective surgery continued in Plymouth, with the necessary precautions in place. This study aimed to assess outcomes following Ivor Lewis oesophagectomy (ILO) during the pandemic. Methods We prospectively analysed details of 20 consecutive patients who underwent ILO for cancer over a 3-month period between 17 March and 12 June 2020. All patients underwent COVID-19 swab testing 24-18 hours before surgery and during admission when clinically indicated. The primary outcome measure was COVID-19-related morbidity. Secondary outcome measures were non-COVID-19-related morbidity, mortality and length of hospital stay. Result Twenty patients underwent ILO during the study period. All patients identified as white British. No patients tested positive for COVID-19 pre- or postoperatively. There was no COVID-19-related morbidity. There was no in-hospital mortality. Seven patients developed pneumonia, which settled with antibiotics. One patient developed an anastomotic leak, which was treated conservatively. One patient returned to theatre for a para-conduit hernia repair. The median length of hospital stay was nine days. One patient required admission to the high dependency unit for inotropic support for two days. Conclusion ILO can be performed safely during the COVID-19 pandemic with the necessary precautions in place.

AimTo assess the impact of bariatric surgery on the progression of diabetic retinopathy in patients with Type2 diabetes.MethodWe conducted a retrospective, observational study of patients with Type2 diabetes who underwent bariatric surgery between 1 January 2001 and 31 December 2012 and had hospital-based retinal screening records. Data were collected from four surgical centres. Those who had pre-operative retinal screening and at least one post-operative retinal screen were eligible for analysis. A generalized linear mixed model was used to explore significant clinical predictors on the post-operative grade severity over time, controlling for important baseline characteristics.ResultsThree hundred and eighteen patients were eligible for analysis. Of these, 68.6% had no diabetic retinopathy pre-operatively compared with 18.9%, 8.5% and 4% with a diabetic retinopathy grade of minimal, mild or moderate and higher, respectively. First post-operative retinal screening results showed that after surgery 73% had no change in their diabetic retinopathy grade, 11% regressed and 16% progressed. The probability of having a diabetic retinopathy grade of moderate or higher over time post surgery was significantly associated with the magnitude of HbA(1c) reduction from pre-surgery HbA(1c) levels, a shorter post-operative retinal screening duration, more severe pre-operative retinal screening grade, male gender and non-Maori/Pacific ethnicity.ConclusionsA higher pre-operative diabetic retinopathy grade, and a large decrease in HbA(1c) post surgery warrant closer monitoring of diabetic retinopathy after bariatric surgery. Further prospective, randomized studies are required to investigate the gender and ethnic differences found.

Journal Article Case of arrested development of the small bowel in a man, age 28 Get access Alexander MacCormick Alexander MacCormick Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 2, Issue 8, January 1914, Pages 710–719, https://doi.org/10.1002/bjs.1800020821 Published: 02 March 2006