Narrow Band Imaging Can Be Used for Anastomotic Assessment

Ahmed Z Kaleem,Syed M Ahmad,Nabish Naheed

doi:10.4236/ss.2016.72017

Abstract

Background: Anastomotic leak is the most dreaded complication and it accounts for one third of post-operative deaths in colorectal surgery. There is strong need of research in this field in order to reduce anastomotic leak rate. If there was a test available to signify probability of leak at the time of surgery, it would potentially avoid a leak at a later date. Aim: We propose that intra operative use of narrow band imaging colonoscopy in left sided colonic anastomosis can predict and detect anastomosis related problems, problems i.e. vascularity, anastomotic lumen patency and rigidness of anastomosis which in turn lead to correction at the time of surgery resulting in significant decrease in anastomotic leak rate associated with morbidity and mortality. Methodology: A pilot, single blind, prospective, randomised controlled trial. Aim is to divide patient in 2 groups, containing 15 patients in each group. One group will be assessed by intra-operative NBI colonoscopy and other with standard technique. Analysis: This will be performed using SPSS with the help of statistician. Significance: This area of research is particularly important because it improves survival by reducing morbidity and mortality associated with anastomotic leak. If a leak is avoided then it does not only mean early recovery but it also saves NHS in terms of ICU care, NHS bed, inpatient nursing care and home help, unfortunately all required if leak is to occur. As a result, this research will have better financial implication with significantly improve patient care.

Highlights

The author has discovered that it is necessary to facilitate future specialist developments to improve patient care
It is the requirement of General medical council (GMC) to undergo continuous professional development
The author became as described by Dr Steven Covey [5] and was able to perform a comprehensive literature search to find a solution for previously stated anastomotic leak problem

Summary

Introduction

The author has discovered that it is necessary to facilitate future specialist developments to improve patient care He was able to act as active leader and effective manager. Past studies have revealed that intra-operative ordinary colonoscopy can be safely performed to assess anastomosis This helps mainly detecting anastomotic defects and bleeding. Past studies has uncovered that intra-operative evaluation of anastomosis with the ordinary colonoscope prevents early anastomotic related problems and eventually reduces anastomotic leak rate [6]. Aim: We propose that intra operative use of narrow band imaging colonoscopy in left sided colonic anastomosis can predict and detect anastomosis related problems, problems i.e. vascularity, anastomotic lumen patency and rigidness of anastomosis which in turn lead to correction at the time of surgery resulting in significant decrease in anastomotic leak rate associated with morbidity and mortality. The author strongly feels that there is desperate need to have a definite tool to improve clinical outcome, reduce morbidity and mortality

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Conclusion