Association Of Coloproctology Of Great Britain And Ireland Research Articles

Estimation of risk posed by malignant polyps amongst colorectal surgeons in Australia and New Zealand.

The estimation of the risk posed by malignant polyps for residual or lymphatic disease plays a central role. This study investigated colorectal surgeons' assessment of these risks associated with malignant polyps. A cross-sectional questionnaire was electronically administered to colorectal surgeons in Australia and New Zealand in October 2022. The questionnaire contained 17 questions on demographics, when surgeons consider colorectal resection appropriate, and the risk assessment for 5 hypothetical malignant polyps. The mean risk of residual or lymphatic disease that would prompt surgeons to recommend colonic resection was 5%. However, this increased to a mean risk of 10% if the malignant polyp was located in the rectum, and the only resection option was abdominoperineal resection with end-colostomy. There was high concordance between the estimated risk of residual or lymphatic disease by colorectal surgeons and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines for the 5 hypothetical malignant polyps, with the ACPGBI estimated risk lying within the 95% confidence interval for 4 of the 5 malignant polyps. Nonetheless, 96.6% of surgeons felt that an online risk calculator would improve clinical practice. Colorectal surgeons in Australia and New Zealand accurately estimated the risk posed by malignant polyps. An online risk calculator may assist in better conveying risk to patients.

Adherence to Post-polypectomy Surveillance Guidelines at a Large District General Hospital.

Introduction In 2020, the British Society of Gastroenterologists(BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI), and Public Health England (PHE) published joint guidelines regardingpost-polypectomy surveillance. This study aimed to establish clinician adherence at the Royal Devon University Healthcare NHS Foundation Trust to the 2020 guidelines compared to the now-retired 2010 guidelines. Materials and Methods Data on 152 patients treated under the 2010 guidelines and 133 patients treated under the 2020 guidelines were collected retrospectively from the hospital's colonoscopy database. Data were analysed to determine whether patients who had a colonoscopy fulfilled BSG/ACPGBI/PHE guidelines for follow-up. Costs were estimated using the price of colonoscopy in the NHS National Schedule. Results Approximately 41.4% (63/152) of patients were adherent to the 2010 guidelines while 66.2% (88/133) of patients were adherent to the 2020 guidelines. The difference in adherence rate was 24.7% (95% confidence interval 13.5% - 35.9%, p<0.0001). Nearly 37% (35/95) of patients who would have been followed up under the 2010 guidelines did not receive any follow-up as a result of the 2020 guidelines. This represents a cost saving of £36,892.28 per year in our hospital. Approximately 47% (28/60) of patients treated under the 2020 guidelines had surveillance colonoscopy planned when the guidelines recommended no follow-up. If every clinician were fully adherent to the 2020 guidelines, then a further £29,513.82 per year would have been saved. Discussion and Conclusion Following the introduction of the 2020 guidelines, adherence to polyp surveillance guidelines increased in our hospital. However, nearly half of the colonoscopies were performed unnecessarily due to non-adherence. Furthermore, our results demonstrate that the 2020 guidelines have decreased the need for follow-up.

Management of high and low risk malignant polyps: a population-wide analysis.

The management of malignant polyps is a treatment dilemma in selecting between polypectomy and colorectal resection. To assist clinicians, guidelines have been developed by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to provide treatment recommendations. This study compared management strategy based on the ACPGBI risk categorization for malignant polyps. Univariable and multivariable statistical analysis was undertaken to assess the factors predicting management strategy. A population-wide analysis was performed of 1646 malignant polyps and the factors that predicted their management strategy, from Queensland, Australia, from 2011 to 2019. Overall, 31.55% of patients with very low or low risk disease proceeded to resection. Of those with high or very high risk disease, 36.69% did not proceed to resection. In very low and low risk polyps, age (P=0.003) and polyp location (P < 0.001) were significantly different between the colorectal resection group and the polypectomy alone group. In those with very high or high risk polyps age (P < 0.001), type of facility (public or private) for the colonoscopy (P=0.037), right colonic polyps compared to left colonic polyps (P=0.015) and rectal polyps (P < 0.001) and mismatch repair mutations present (P=0.027) were predictive of resection in high risk disease using a multivariable model. Over 30% of patients with very low and low risk malignant polyps proceeded to resection, against the advice of guidelines. Furthermore, over 35% of patients with very high or high risk malignant polyps did not proceed to resection. Education strategies may improve management decision choices. Furthermore, improvements in data collation will improve the understanding of management choices in the future.

The European Society of Coloproctology Collecting Opinions on Sustainable Surgery Study.

ESCP ECOS-Surgery Study Committee: The European Society of Coloproctology (ESCP), Porstsmouth, United Kingdom Funding/Source: None reported. Financial Disclosures: None reported. This study has been presented as Podium Presentation at the Association of Surgeons of Great Britain and Ireland (ASGBI) meeting 5/3-5/2022, Liverpool, UK and as Poster Presentation at the Association of Coloproctology of Great Britain and Ireland (ACPGBI) 4-6 July 2022, Edinburgh, UK. Members of the ESCP ECOS-Surgery Study Committee: The study committee members are listed in the Acknowledgements. Correspondence: Gianluca Pellino, M.D., Ph.D., Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania Luigi Vanvitelli, Naples, Italy. Email: [email protected][email protected]

TU2.5 Compliance of colonic polyp surveillance with British Society of Gastroenterology (BSG) and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines

Abstract Introduction The guidelines for post-polypectomy and post-colorectal cancer resection have recently been changed after consensus by the British Society of Gastroenterology, the Association of Coloproctology of Great Britain and Ireland and Public Health England. The aim of our study is to evaluate the rate of compliance with the recommended guidelines following polyp removal. Methods The data was collected retrospectively by reviewing the colonoscopy database in a single centre district general hospital for all patients who underwent polypectomy during April-September 2021. We excluded patients who had prior history of colorectal malignancy. The frequency of subsequent colonoscopic surveillance were evaluated against the BSG/ACPGBI guidelines based on the clinico-histological characteristics of the removed polyps. Results There were 104 colonoscopies with polypectomies performed during April-September 2021. The patient cohort had a mean age of 65 years (range, 35–85 years), with the most common diagnosis being tubular adenoma with low grade dysplasia (n=86, 82.7%). Adherence to BSG/ACPGBI colonoscopic post-polypectomy surveillance guidelines, based on the characteristics of the colonic polyps at colonoscopy and histology, was 86.5% (n=90). There were 5 (4.8%) patients who had their surveillance endoscopy requested earlier than recommended and 8 (7.7%) patients had a surveillance colonoscopy requested but did not require any surveillance. 1 patient had colonoscopy requested later than recommended. There was no significant difference in compliance between physicians (87.5%) and surgeons (86.1%). Conclusion There is a high compliance with post-polypectomy surveillance guidelines. However more efforts and staff training are required to improve compliance even further.

TU2.11 Adherence to post-polypectomy surveillance guidelines in a district general hospital

Abstract Aims National guidelines instruct clinical decision making around post-polypectomy surveillance. The current polyp surveillance guidelines were jointly published by the British Society of Gastroenterologists (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE) in 2019, updating the 2010 surveillance guidelines. Adherence to polyp surveillance guidelines is historically poor, both in the UK and globally. This audit set out to establish the adherence rate of clinicians to the 2019 polyp surveillance guidelines in a district general hospital and to compare this to the adherence rate to the 2010 surveillance guidelines. Methods We aimed to collect 300 patients who had been treated under the 2010 or 2019 polyp surveillance guidelines. After exclusion criteria were applied we collected 152 and 133 patients who had respectively been treated under the 2010 and 2019 guidelines. Each patient record was analysed and it was determined by our team whether the chosen polyp surveillance was adherent to the respective guidelines or not. Results Of 152 patients treated under the 2010 guidelines, 41.4% (63) of patients were adherent. Of 133 patients treated under the 2019 guidelines, 66.2% (88) of patients were adherent. This represents a score difference of 24.7% (95% confidence interval of 13.5% to 35.9%, p&amp;lt;0.0001). Conclusions Our results show that following the introduction of the 2019 guidelines, adherence to polyp surveillance guidelines increased. Increased adherence to guidelines has significant implications for improving patient safety, financial savings and protecting endoscopy capacity.

31 Quality or Quantity? An Analysis of the Colorectal Cancer Resection Volume-Outcome Relationship From the 2019 National Bowel Cancer Audit Data

Abstract Aim Despite increasing evidence supporting cancer services centralisation, no consensus exists in the association between high-hospital or high-surgeon volume and mortality following colorectal cancer surgery. This study aimed to identify and characterise a volume-outcome relationship in colorectal cancer. Method National Bowel Cancer Audit (NBOCA) dataset was combined with the Association of Coloproctology of Great Britain and Ireland (ACPGBI) Clinical Outcomes Publication (COP) 2019 report. Adjusted 90-day and 2-year mortality were derived from patients included in the 2018 and 2016 datasets, respectively. The impact of centre volume, surgeon volume and ACPGBI membership rates on outcomes was assessed. Cumulative sum (CUSUM) analysis was performed to identify the centre and surgeon volume threshold. Results 144 hospitals were included, with 17,235 and 17,703 patients from the 2018 and 2016 datasets, respectively. 781 surgeons were identified, with 478 holding ACPGBI memberships. No significant difference was found between centre or surgeon volumes for adjusted 90-day and 2-year mortality. High ACPGBI membership rates were significantly associated with a reduced 90-day (p=0.006), but not 2-year mortality (p=0.198). CUSUM analysis found 36 per year as threshold centre volume (p=0.003) and 15 surgeries per year as the threshold surgeon volume (p=0.241). Conclusions The high degree of existing centralisation for cancer services in the UK limits the number of true low-volume centres compared to other countries. Surgeon volume may be a better predictor of colorectal cancer surgery outcomes than centre volume. More granular data is needed to improve the current understanding of the association between surgeon volume, ACPGBI membership and outcomes in colorectal surgery.

Are we overtreating patients with malignant colorectal polyps? A 5-year review of the ACPGBI position statement.

In 2013, The Association of Coloproctology of Great Britain and Ireland (ACPGBI) issued a position statement regarding management of malignant polyps. We reviewed the management of endoscopically resected malignant colorectal polyps in a district general hospital to evaluate whether patients were being overtreated as per these guidelines. All patients who underwent a complete, non-piecemeal endoscopic removal of a malignant polyp between October 2013 and September 2018 were studied. Polyps were risk stratified for residual disease and followed up as per the ACPGBI. Patients were divided into two groups based on management after polypectomy. Primary outcome measured was the presence of residual tumour or involved lymph nodes in the resection specimen. Secondary outcomes included complications and recurrence. Thirty-three patients were included: 21 in the non-operative group (NOG) and 12 in the operative group (OG). The ACPGBI risk score in the NOG varied between 1 and over 4 compared with the OG who all scored over 4. Two patients in the OG (16%) demonstrated residual disease. Five patients suffered a postoperative complication. No recurrences were noted in the OG and one in the NOG. Our findings against a backdrop of the available literature suggest that the risk of residual disease after malignant polypectomy may not be as high as stated by the ACPGBI. As a result, there is a risk of overtreating patients and exposing them to the significant complications of surgery if careful consideration is not exercised.

EP.FRI.535 A clinical audit of post-operative antibiotics prescription in uncomplicated perianal abscesses

Abstract Aims Management of perianal abscesses continues to revolve around prompt surgical drainage. The Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines state that all patients should have incision and drainage within 24 hours and antibiotics are not indicated in routine uncomplicated perianal abscesses. We aimed to study the antibiotics prescription after surgical drainage in a London university teaching hospital against the national standard. Methods A single-centred retrospective analysis of all emergency surgical admissions for incision and drainage of perianal abscess was carried out for a 6 month period. Patients’ demographics, Co-morbidities, local and systemic complications and readmissions were studied. Results A total of 36 patients, (mean age 43, 64% males) were included in this study, 21 received incision and drainage without antibiotics prescription, while 15 received empirical post-operative antibiotics. Indications for antibiotic therapy in this group included diabetes, immunocompromise, local complications (necrosis, cellulitis) and recurrence. There was no clear indication for antibiotics in 60% of patients who received them. 86% of patients had surgical drainage within 24 hours of presentation. One patient was readmitted for a second drainage 3 months later. Most common empirical agent used was co-amoxiclav (53%), followed by (33%) combination of co-amoxiclav and metronidazole. Conclusion Although surgical drainage was generally carried out in timely manner according to guidance, there was excessive post-operative antibiotic prescriptions. Increase awareness of guidelines is required to improve antibiotic stewardship in these surgical patients in order to avoid unnecessary drugs’ prescription.

Bowel cancer screening workforce survey: developing the endoscopy workforce for 2025 and beyond

AimThe demand for bowel cancer screening (BCS) is expected to increase significantly within the next decade. Little is known about the intentions of the workforce required to meet this demand....

The surgical management of cutaneous abscesses: A UK cross-sectional survey

AimCutaneous abscesses are one of the most common acute general surgery presentations. This study aimed to understand the current practice in the management of cutaneous abscesses in the United Kingdom (UK), once the decision has been made that acute surgical incision and drainage (I&D) is required. MethodGeneral surgeons from across the UK were surveyed on their opinions on the optimum management of cutaneous abscesses. Outcomes measured included anaesthesia, incision technique, antibiotic administration, departmental abscess pathways, and post-drainage management. A combination of Likert scales, multiple-choice questions, and short answer questions were used. Comparisons were made of Likert scales between regions using a two-sample independent t-test. The survey was peer reviewed and distributed through the Association of Coloproctology of Great Britain and Ireland (ACPGBI) network between April and June 2018. ResultsSixty-one responses were collected from surgeons throughout the UK. Of these respondents, 69% indicated that cutaneous abscesses would always or usually require a General Anaesthetic (GA) for treatment, and 82% indicated that abscesses were at least sometimes not treated until the next day due to a lack of resources. While 79% of surgeons stated that pus swabs are always or are usually taken, 44% of respondents never or rarely chased the results. The main indications for giving antibiotics were sepsis/systemically unwell patients, and cellulitis. 31% of responding centres had an abscess management protocol, and 82% of respondents confirmed that they would always pack the abscess wound post-operatively. Conclusion‘Incision and drainage’ is currently the most widely used technique for the surgical management of cutaneous abscess. However, this study demonstrates the significant variability in the use of anaesthesia, antibiotics, packing and the use of protocols to guide and streamline patient management.

Legacy of COVID‐19 – the opportunity to enhance surgical services for patients with colorectal disease

The COVID-19 crisis has undoubtedly taken a toll on the care of patients with colorectal disease. Elective services, be that face to face contact, endoscopy or operating all but ceased during the pandemic.

The ACPGBI recommends pause for reflection on transanal total mesorectal excision.

The ACPGBI recommends pause for reflection on transanal total mesorectal excision.

Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG)

Heritable factors account for approximately 35% of colorectal cancer (CRC) risk, and almost 30% of the population in the UK have a family history of CRC. The quantification of an...

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide...

Nicholas David Carr

It is with great sadness that we mark the passing of Nicholas David Carr (“Nick”), a former president of the Association of Coloproctology of Great Britain and Ireland (ACPGBI). Nick...

Publication Fate of Abstracts Presented at Four British Surgical Meetings: An 11-Year Follow-Up

BackgroundThe gold standard for research is publication within a peer-reviewed journal. There is a discrepancy between the number of abstracts presented at scientific meetings and the number published as full articles. We identified publication rates for the 2012 meetings of four British surgical societies. These were the Association of Surgeons of Great Britain & Ireland (ASGBI), the Vascular Society of Great Britain and Ireland, the British Transplantation Society (BTS), and the Association of Coloproctology of Great Britain and Ireland (ACPGBI). We also compared publication rates with these societies' 2001 meetings and identified univariate factors associated with publication. Materials and methodsPubMed was searched to identify publications stemming from meeting abstracts. We extracted abstract characteristics to identify factors associated with publication and also characteristics of subsequent publications to enable comparison. ResultsPublication rates were 24.1% (ASGBI), 24.6% (BTS), 21.7% (ACPGBI), and 39.4% (Vascular Society of Great Britain and Ireland). Rates for ASGBI, BTS, and ACPGBI meetings were significantly lower compared to 2001 meetings (P = 0.001-0.026). Mean time to publication was 12.1-22.0 mo. Mean 5-y impact factor differed significantly between meetings (P = 0.001), with the BTS meeting having the highest mean 5-y impact factor (4.658). Factors associated with publication included being an oral presentation (ASGBI P = 0.001), multi-institution study (ASGBI P = 0.003), or randomized-controlled trial (BTS P = 0.049). ConclusionsReduced publication rates may represent increased acceptance of low-quality abstracts at meetings or a more competitive journal submission process. Further data are required to strengthen conclusions. Nonetheless, authors and meeting organizers should push for higher quality abstracts to promote future peer-reviewed journal publication.

Review of current practice and outcomes following ileoanal pouch surgery: lessons learned from the Ileoanal Pouch Registry and the 2017 Ileoanal Pouch Report.

The second Association of Coloproctology of Great Britain and Ireland (ACPGBI) Ileoanal Pouch Registry (IPR) report was released in July 2017 following a first report in 2012. This article provides a summary of data derived from the most recent IPR report (2017 Ileoanal Pouch Report. https://www.acpgbi.org.uk/content/uploads/2016/07/Ileoanal-Pouch-Report-2017-FINAL.compressed.pdf). The IPR is an electronic database of voluntarily submitted data including patient demographics, disease, intra-operative and postoperative factors submitted by consultant surgeons or delegates. Data up to 31 March 2017 have been analysed for this report. A total of 5352 pouch operations were carried out at 76 UK and four European centres by 154 surgeons over four decades. Recorded procedures have increased over time but data submission is voluntary and underestimates actual volume. Significant variation exists in institutional volume; 73 centres entered data on patients undergoing pouch surgery during the past 5 years. Of these, 44 centres have submitted ≤ 10 cases, with 10 centres submitting one patient and nine centres two cases. Since 2013, minimal access surgery has been employed in 54% of cases. Rectal dissection was undertaken in the total mesorectal excision plane in 69%. J-pouch configuration was used in 99% of cases and 90% of pouch-anal anastomoses were performed using a stapled technique. Including all years, the IPR rate of pelvic sepsis was 9.4% and the rate of pouch failure was 4.7%. The IPR holds the largest voluntary repository of data on ileoanal pouch surgery. The second report from the IPR records marked refinements in surgical technique over time but also highlights wide variation in institutional caseload and outcome across the UK.

Time to rethink surgeon-specific outcome data for colorectal surgeons in England: Cross-sectional data of 73,842 resections for colorectal cancer

Since 2013, individual surgeon and NHS Trusts outcomes following elective colorectal cancer surgery have been in the public domain in England. The 90-day operative mortality rates following colorectal resections are available for the public to view online. AimThe aim of this study is to evaluate the quality of the published data. It also aims to find whether this data will show the expected pattern of inverse correlation between case volume and the postoperative 90-day mortality rate. MethodologyThe postoperative 90-day mortality data was taken from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) website. Surgeons and Trusts were categorized according to case volume. Completeness of data at Trust and surgeon levels was analysed. All statistical analyses were performed in Statistical Package for Social Science (SPSS, version 23, IBM, Armonk, NY). Results788 colorectal surgeons performed 73,842 resections for colorectal cancer in 143 hospitals over a 5-year period (1st April 2010 and 31st March 2015). The mean national 90-day mortality after colorectal resections was 2.6%. No significant effect was identified when mortality rates were correlated with the surgeon or Trust volume. There was a missing data of 3874 patients in the individual surgeon level analysis when compared to the number of procedures included in Trust analysis (73,842 vs 69,968 cases). About one-third of hospitals (n = 43) had a case ascertainment of less than 90%. Out of the 788 surgeons, there were only two outliers whose mortality rates were outside the “funnel limit”. ConculsionThe expected relationship between case volume and mortality rates could not be established. The completeness of data and low numbers of procedures per surgeon are major concerns. Additional outcome metrics should be utilized to assess performance quality. Failure to Rescue approach should be explored and utilized. It is crucial to have more rigorous and streamlined methods for data collection and case ascertainment to present to the public reliable, complete and relevant data.

Prevention and treatment of parastomal hernia: a position statement on behalf of the Association of Coloproctology of Great Britain and Ireland.

The Association of Coloproctology of Great Britain and Ireland (ACPGBI) Delphi process identified prevention and treatment of parastomal hernia (PSH) as the second highest priority non-cancer related colorectal pathology. This position statement aims to summarize the current evidence base. Four broad themes were identified (prevention, diagnosis/classification, management and operative repair). Guidelines are based on evidence from an extensive literature review using organized searches on the PubMed, MEDLINE, Embase and Cochrane databases. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adhered to for classifying the quality of evidence and reporting the strength of recommendations. The suture repair of PSH other than for patients in extremis is not recommended. Synthetic non-absorbable mesh can be used safely in the short term in the construction of colostomies post rectal surgery, but longer-term follow-up is needed. Other broad recommendations are made around access to stoma care nurses, prevention classification and management. There is a lack of high quality evidence for many domains in the prevention and treatment of PSH but the results of several studies are awaited. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: Parastomal hernias are a common and debilitating condition following stoma formation. This position statement from ACPGBI details the current evidence base and ongoing research for the prevention, diagnosis and management of parastomal hernias.