Gastrointestinal Surgery Research Articles

Comparision of attributes between young and old patients who died in hospital after bowel obstruction: A multicenter retrospective cohort study

BackgroundIntestinal obstruction is one of the most frequent emergencies in gastrointestinal surgery and can concern patients of all ages and be life threatening. Postoperative mortality is reported to be higher in elderly patients, but there is currently no published study encompassing all patients regardless of their treatment. The aim of the present study was to compare outcomes between older and younger patients deceased after all kind bowel obstruction treated surgically or not. MethodsWe retrospectively included all consecutive patients declared dead following bowel obstruction, from 2007 to 2020, in 3 University hospital in Lyon, France. Patients were classified according to age, <75 and ≥75 years based on the definition of elderly patients of the French Haute Autorité de Santé. Patient's selection was made with the hospital discharge database and medical records were collected from the local electronic database. ResultsA total of 222 patients were included; 130 patients were aged ≥75 years and 92 < 75 years. Most patients did not show signs of severity at admission. Patients ≥75 years had a higher rate of death by acute respiratory distress (p = 0.02), while there is a trend to a higher frequency of death by general deterioration in a context of advanced cancer in the younger group (p = 0.06). ConclusionIntra-hospital death after bowel obstruction concerns patients of all ages, treated surgically or not. Elderly patients die from respiratory complications, and younger ones die from general deterioration in context of cancer. Most deceased patients did not show signs of severity at admission.

Changes in Skeletal Muscle Mass in the First 3 Months Following Gastrointestinal Cancer Surgery: A Prospective Study.

Surgical resection is the primary treatment for gastrointestinal (GI) cancers, but postoperative skeletal muscle loss (SML) is common and linked to poor prognosis. This study aims to identify patterns of muscle change, examine its association with quality of life (QoL), and explore predictors of SML in the first 3 months. A prospective cohort study was conducted on patients newly diagnosed with GI cancer and undergoing surgery in China between September 2021 and May 2022. Skeletal muscle mass (SMM) and QoL were assessed at admission, 7 days, 1 month, and 3 months post-surgery. Demographic, clinical data, and biomarkers were collected. Missing data were imputed using multiple imputation. Data were analyzed using growth mixture modelling, bivariate analyses, and logistic regression. A total of 483 patients completed baseline assessment. Of the 242 patients with complete muscle assessments, 92% experienced SML. Three distinct patterns of muscle change were identified: 57% had normal preoperative SMM with mild postoperative SML, 16% had low preoperative SMM with moderate SML, and 27% had normal preoperative mass but severe postoperative SML. Moderate/severe SML was associated with more postoperative complications, poorer health, and higher symptom burden. Independent predictors included advanced age, preoperative sarcopenia, advanced cancer stage, and low prognostic nutrition index (PNI ≤ 45). The results did not change when using imputed values. Although SML is prevalent, patterns of muscle change are heterogeneous among patients. Advanced age, preoperative sarcopenia, advanced cancer stage, and cancer-related inflammation are predictors for moderate/severe SML, highlighting the need for early detection and management.

Gastrointestinal cancer surgery in the elderly: The effects of preoperative oral nutritional supplements - A retrospective study.

The current study aimed to explore the effect of nutritional prehabilitation on the clinical prognosis of elderly patients undergoing abdominal cancer surgery. A retrospective study was conducted, where participants were divided into two groups based on whether they received oral nutritional supplementation at the first outpatient visit. The nutritional prehabilitation group (n=41) adopted a nutritional prehabilitation mode (a standard energy intake of 25-30 kcal/kg· d was recommended). While the control group (n=55) received routine care. All patients underwent laparoscopic surgery according to the National Comprehensive Cancer Network (NCCN) guidelines. Changes in nutritional status, complications, psychological status, symptoms, hospitalization days, and expenditures were compared between the two groups. Both groups of patients experienced weight loss. However, the decline in body weight in the prehabilitation group was less than that in the control group (-1.88 vs. -2.56 kg, p < 0.001). In the comparison of nutritional prehabilitation group and control group, significant improvements were observed in the Hospital Anxiety Scale scores (5 vs. 5, p = 0.01) and MD Anderson Symptom Inventory scores (3 vs. 0, p < 0.001) respectively. The infection rate in the nutritional prehabilitation group was lower than that in the control group (17.1% vs. 36.4%, p = 0.04). Additionally, patients in the nutritional prehabilitation group had significantly fewer hospitalization days at discharge (14.3 vs. 17.1 days, p = 0.03). In elderly patients undergoing abdominal cancer surgery, a nutritional prehabilitation model may help maintain better physical and mental status, reduce infection rates, and shorten hospitalization days.

Reconsideration of the clinical management of hepatic hemangioma

In this letter, we comment on the article by Zhou et al that was published in the recent issue of the World Journal of Gastrointestinal Surgery . This article proposes a new clinical grading system based on a multidisciplinary team, which prompts us to rethink the clinical management of hepatic hemangioma. Hepatic hemangioma is the most common benign solid liver tumor. In general, follow-up and observation for the vast majority of hepatic hemangioma is reasonable. For those patients with symptoms and severe complications, surgical intervention is necessary. Specific surgical indications, however, are still not clear. An effective grading system is helpful in further guiding the clinical management of hepatic hemangioma. In this article, we review the recent literature, summarize the surgical indications and treatment of hepatic hemangioma, and evaluate the potential of this new clinical grading system.

Endoscopic ultrasound-guided biliary drainage vs percutaneous transhepatic biliary drainage for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography failure

In a recent issue of the World Journal of Gastrointestinal Surgery , a meta-analysis investigated the safety and efficacy of electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) implantation for managing malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography. This manuscript endeavors to offer a comprehensive look at the progression of endoscopic ultrasound-guided biliary drainage (EUS-BD) technologies, weighing their merits and drawbacks against traditional percutaneous methods. Several meta-analyses and randomized controlled trials have compared the performance of EUS-BD and percutaneous transhepatic cholangiodrainage (PTCD). These studies revealed that the technical success rate, clinical success rate, and adverse events were similar between EUS-BD and PTCD. Nevertheless, given that most of these studies predate 2015, the safety and effectiveness of novel EUS-BD techniques, including ECE-LAMS, compared with those of percutaneous biliary drainage remain elusive. Further investigation is imperative to ascertain whether these novel EUS-BD techniques can safely and efficaciously replace conventional percutaneous therapeutic approaches.

Preoperative gastric retention in endoscopic retrograde cholangiopancreatography

We comment on the article by Jia et al , in the World Journal of Gastrointestinal Surgery . We focus mainly on the factors that impair gastric motility and cause gastric retention in the pre-operative setting of endoscopic retrograde cholangiopancreatography (ERCP). ERCP is a complex endoscopic therapeutic procedure, which demands great skill from the endoscopist but also has recognized complications. Gastric retention impairs the endoscopist’s visibility but also increases the risk of complications, such as aspiration pneumonia. Therefore, identifying the factors that predispose to gastric retention alerts the endoscopists of the possible risks and enables them to take evasive action. The authors in the current study by Jia et al developed and validated a predictive model, which incorporates five different factors, i.e. , gender, primary disease, jaundice, opioid use, and gastrointestinal obstruction, which were found to influence gastric retention. This model was shown to have a high predictive value to accurately identify patients at risk for gastric retention before a therapeutic ERCP.

Unlocking the diagnostic potential of vascular endothelial growth factor and interleukin-17: Advancing early detection strategies for hepatocellular carcinoma

Tian et al investigated the diagnostic value of serum vascular endothelial growth factor (VEGF) and interleukin-17 (IL-17) in primary hepatocellular carcinoma (PHC). Their retrospective study, published in the World Journal of Gastrointestinal Surgery , revealed that the serum levels of VEGF and IL-17 are significantly elevated in PHC patients compared with healthy controls. These biomarkers are closely associated with pathological features such as tumor metastasis and clinical tumor node metastasis stage. A receiver operating characteristic analysis further confirmed the diagnostic efficacy thereof, suggesting that VEGF and IL-17 could serve as valuable tools for early detection and treatment guidance. This study underscores the potential of integrating these biomarkers into clinical practice to increase diagnostic accuracy and improve patient management in PHC.

Immunotherapy for metastatic gastric cancer

This editorial discusses the article written by Chen et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery . The current study found that programmed cell death 1 ligand 1 (PD-L1) expression is considered as one of the pan-cancer biomarkers of immune checkpoint inhibitors (ICIs) treatment response. Four molecular subtypes are widely used to guide and evaluate the prognosis and diagnosis and treatment of gastric cancer (GC) patients. Clinical trials of ICI treatment including Nivolumab, Pembrolizumab, Avelumab have been conducted for metastatic GC (mGC). The effects of various single agent ICIs on mGC therapy varied. ICIs combined with chemotherapy can indeed bring survival benefits to patients with mGC. Combining ICIs with chemotherapy can give more patients the chance of surgery in the treatment of GC transformation. However, not all PD-L1 positive patients can benefit from it. It is urgent to find better biomarkers to predict the response of ICIs for more precise clinical treatment.

Application of dielectric properties for identification of normal and malignant gastrointestinal tumors and lymph nodes ex vivo.

A need exists for a quick, simple method to accurately assess resection margins and lymph node metastases in gastrointestinal cancer surgeries. We aimed to develop a real-time, non-destructive technique to differentiate between normal and cancerous tissues using dielectric properties. Dielectric properties of tissues from 50 gastric and 120 colorectal cancer patients were measured during surgery using an open-ended coaxial probe, spanning frequencies from 10MHz to 4GHz. Lymph nodes were classified based on pathology into metastatic and non-metastatic, and tissues were divided into cancerous and normal, the latter being 3cm from the cancer edge. Statistically significant differences in dielectric properties were found between metastatic and non-metastatic lymph nodes (P < 0.05), and between normal and malignant tissues. Metastatic lymph nodes showed higher dielectric permittivity and conductivity across the frequency range, with no significant difference between gastric and colorectal cancers. The coaxial probe method distinguishes between metastatic and non-metastatic lymph nodes by their dielectric properties within 10-4000MHz, offering a potential tool for real-time identification of malignant tissues during surgery, despite not identifying the cancer type.

Risk factors and prognostic analysis of microscopic positive esophageal margins after radical surgery for proximal gastric cancer.

Proximal gastric cancer has been on the rise worldwide in recent years. A positive surgical margin may result in incomplete tumor and affect the prognosis of patients. This study aims to analyse the risk factors for and prognosis associated with microscopic positive esophageal margins (R1 resection) after radical surgery for proximal gastric cancer patients. This was a retrospective analysis of 316 patients with proximal gastric cancer who underwent surgical resection at the Department of Gastrointestinal Surgery of Hengshui People's Hospital from January 2013 to June 2018. Patients were divided into the R1 group (n = 24) and R0 group (n = 292) according to the esophageal margin status. Differences in clinicopathological characteristics and prognosis between the two groups were compared. Tumor location at the esophagogastric junction, Borrmann type 3/4, Lauren diffuse/mixed type, margin distance < 3cm, pT4 stage, and vascular invasion were identified as independent risk factors for positive esophageal margins in proximal gastric cancer patients (all P < 0.05). The 5-year overall survival rate was significantly lower in the R1 group than in the R0 group (45.8% vs. 64.2%, P < 0.05). Subgroup analysis revealed that the 5-year overall survival rate was significantly lower in the R1 group in the pT2-3 and pN0 stages (P < 0.05), while there was no significant difference in the pT4 and pN(+) stages (P > 0.05). Multivariate Cox regression analysis revealed that Borrmann type, Lauren type, pT stage, pN stage, and lymphovascular invasion were independent risk factors affecting the prognosis of patients with proximal gastric cancer (all P < 0.05), while esophageal margin status was not an independent risk factor affecting prognosis (P > 0.05). Positive esophageal margins in proximal gastric cancer are associated with various clinicopathological factors and lead to a worse prognosis in patients with pT2-3 and pN0 stages but do not affect the prognosis of patients with pT4 and pN(+) stages.

Standardized surgical procedure of laparoscopic transphrenic approach for Siewert TypeⅡ adenocarcinoma of esophagogastric junction (2024 edition)

In recent years, with the popularization of minimally invasive surgery, laparoscopic transphrenic approach (LTP) surgery for Siewert Type II adenocarcinoma of esophagogastric junction (AEG) has gradually been applied in clinical practice. This technique combines the advantages of transthoracic and transabdominal approaches, achieving a combined operation of the thoracic and abdominal cavities. It can achieve thorough lymph node dissection, safe esophageal resection margin, and reliable digestive tract reconstruction, and has promising application prospects. However, there is no unified standard for LTP surgery at present, which hinders the standardization and further promotion of this technology. Therefore, the Oncology Gastroenterology Committee of China Anti-cancer Association has convened experts from domestic gastrointestinal and thoracic surgery fields, reviewed relevant literature, and combined with clinical practice. After extensive discussions, they formulated the LTP surgical operation standard. This standard encompasses various aspects, including the surgical approach, indications, contraindications, preoperative preparation, operational procedures (encompassing anesthesia, patient positioning, surgeon's stance, abdominal operation port layout, thoracic operation port layout, the Five-Step Maneuver lower mediastinal lymphadenectomy, and digestive tract reconstruction), as well as the prevention and management of specific complications. The aim is to provide a reference for clinical doctors conducting the Siewert Type II AEG radical surgery with LTP.

Application of Hand-Sewn Anastomosis in Totally Laparoscopic Radical Resection of Colorectal Cancer with Transanal Specimen Extraction

Objective: To explore the value of hand-sewn anastomosis in totally laparoscopic radical resection of colorectal cancer with transanal specimen extraction. Methods: A retrospective descriptive study was conducted. Clinical data of 54 patients with colorectal cancer who underwent total laparoscopic transrectal specimen extraction surgery between January 2019 and December 2023 at the Department of Gastrointestinal Surgery, Bayannur City Hospital, were collected. All patients underwent digestive tract reconstruction using hand-sewn end-to-end colonic or rectal anastomosis. Intraoperative and postoperative general conditions, pathological results, complications, and follow-up data were analyzed. Results: Among the 54 cases, 37 were male, and 17 were female. The cases included 26 sigmoid colon cancers, 27 high rectal cancers, and 1 descending colon cancer. All patients underwent total laparoscopic radical resection of colorectal cancer with transrectal specimen extraction. The average surgical duration was 187.87 ± 61.36 minutes, with 16 (14–19) minutes required for hand-sewn anastomosis. Intraoperative blood loss was 16 (10–200) mL, with no conversions to open surgery or blood transfusions. Postoperative outcomes included first flatus time of 1 (1–3) day, liquid diet resumption on 2 (2–3) days, postoperative Visual Analog Scale (VAS) pain score of 2 (2–3), and hospital stay duration of 8 (7–9) days. The total hospitalization cost was 41,011 (25,655–148,589) Chinese yuan, with an average cost of 42,558.81 ± 8,599.30 Chinese yuan after excluding three cases with complications. Pathological examination revealed all cases to be adenocarcinomas: 20 well-differentiated, 32 moderately differentiated, and 2 poorly differentiated. All resection margins were negative. An average of 16.85 ± 7.97 lymph nodes were dissected. Pathological staging included 18 stage I, 17 stage II, and 19 stage III cases. Postoperative complications included 2 cases of anastomotic leakage (3.7%), 1 case of anastomotic stricture (1.8%), and 1 case of pulmonary infection (1.8%). No unplanned readmissions or postoperative deaths occurred during the 30-day follow-up period. Conclusion: Hand-sewn anastomosis in totally laparoscopic radical resection of colorectal cancer with transanal specimen extraction is safe and feasible.

The Experiences of Patients Who Participated in a Family Involvement Program After Abdominal Cancer Surgery: An Interpretative Phenomenological Analysis.

To prepare patients' families for active care roles after discharge, a family involvement program was developed. We aimed to gain in-depth insight into patients' well-being and experience during the program regarding the active involvement of family caregivers after oncological gastrointestinal cancer surgery during their hospital stay. Semi-structured interviews were conducted with 13 patients who participated in the program. Patients emphasized that participation in the program gave them a sense of feeling at home. They reported that having a family caregiver on their side during hospitalization strengthened their existing relationship and contributed to their recovery by motivating them. Patients felt safer and more confident. Although patients described predominantly positive results, they also mentioned that unclear guidance from nurses made them feel less safe, especially when they saw their family caregivers struggling. Patients experience being accompanied and cared for by their family caregivers as meaningful and contributory to their recovery. Patients felt safer, more confident, and more relaxed.

An initial exploratory clinical study and outcome assessment of gastrointestinal surgeries using advanced robotic-assisted techniques.

In addition to the Da Vinci surgical robot, domestic surgical robots are being developed rapidly. Chinese Toumai® laparoscopic surgical robot was approved for urological surgery in 2022.This study aims to systematically evaluate the safety and efficacy of the Toumai® robotic surgical system in performing complex gastrointestinal surgeries. This prospective, single-center, single-arm exploratory study was conducted at Gansu Provincial Hospital between June 2022 and October 2023, enrolling 12 patients undergoing gastrectomyand 9 patients undergoing colorectal resection. The primary endpoints are oncological outcomes and surgical success rates, while secondary endpoints encompassed intraoperative blood loss, operative duration, complication rates, system performance metrics, length of hospital stay, and postoperative pain levels. All patients successfully underwent robotic-assisted surgery with adequate oncological resection and favorable postoperative outcomes. There were no conversions to open or laparoscopic surgery, resulting in a 100% procedural success rate. The median docking time for radical gastrectomy was 17.50 (14.25, 21.50) minutes, with a median master-slave control time of 121.50 (105.50, 172.00) minutes, median intraoperative blood loss of 100.00 (50.00, 275.00) mL, and a median postoperative hospital stay of 9.00 (7.25, 10.75) days. For radical colorectal surgery, the median docking time was 22 (17.50, 30.50) minutes, the median master-slave control time was 68 (56.50, 119.00) minutes, with a median blood loss of 50 (50.00, 150.00) mL, and a median postoperative hospital stay of 7 (7.00, 10.00) days. No intraoperative organ injury, mortality, system failure, or severe postoperative complications were reported. These preliminary findings provide compelling evidence supporting the safety and efficacy of the Toumai® laparoscopic surgical robotic system in performing gastric and colorectal surgeries.

Variation in Cost Centers Following Gastrointestinal Cancer Surgery.

Despite cost-standardization efforts, significant variations in hospital costs persist in insurance claims. We sought to identify and quantify factors driving cost variability at hospital and cost center levelsfollowing acomplex gastrointestinal surgical procedure. Individuals who underwent pancreatectomy (PA), colectomy (CO), and proctectomy (PR) were identified from the Surveillance, Epidemiology, and End Results database. Index surgery costs across 1,262 hospitals were compared, adjusting for clinical, demographic, and geographic factors. Multilevel regression modeling identified factors associated with variability in charges. Among 35,908 individuals (PA: 8.2%; CO: 79.4%; PR: 12.4%), the median age was 78 years (interquartile range [IQR] 72-84), with 56.1% male. Median Medicare payments varied significantly by cancer type (CO: $21,704, PA: $26,709, PR: $21,228; p < 0.001). Operating room ($6,891, 23.82%), hospital stay ($5,931, 20.9%), and professional fees ($4,352, 15.35%) were the top cost centers, comprising 60% of total costs. Surgeons had the highest charges (PA: $2,037; CO: $2,131; PR: $2,243), followed by anesthesiologists (PA: $622; CO: $431; PR: $480). Charges for critical care specialists and pathologists were relatively low. Multilevel modeling demonstrated total charge variability was primarily influenced by patient factors (83%), followed by surgeon factors (9%) and hospital factors (8%). There was marked variation in spending at the cost center level in the surgical treatment of gastrointestinal cancers. Patient factors demonstrated the greatest variability, followed by hospital and surgeon-level factors. Implementing value-based healthcare and standardized surgical protocols may improve both care quality and cost-effectiveness.

AHP SO03 - The role of the specialist upper gastrointestinal (UGI) benign dietitian in the management of benign UGI disorders – a review of the outpatient referral base

Abstract Background Benign UGI disorders can negatively affect patients’ nutritional status by impacting on oral intake and/or through malabsorption. GSTT performs a high volume of benign UGI surgeries and is a tertiary referral centre for oesophageal reconstructions and complex hernias. The role of the dedicated specialist UGI benign dietitian was established in 2019 to provide dietetic expertise to the UGI multidisciplinary team (MDT). It supports patients before and after surgery with the aim of reducing post-operative complications, length of hospital stay, re-admissions and improving patient experience and quality of life. Method Outpatient referrals to the UGI benign dietetic service between 02/02/2024 and 06/06/2024 were reviewed for source of referral, reason for dietetic referral and UGI diagnosis. Results Twenty-five new referrals were received from a variety of clinical specialities (table 1). The primary UGI disorders of referrals are outlined in table 2, with complex hernia repair being the most common. Table 3 outlines the broad range referral reasons. Nutrition support referrals were received for the following disorders: achalasia, oesophageal stricture and following oesophageal perforation, hiatus hernia repair, cholecystectomy and oesophagectomy. All weight management referrals were for complex hernia repair patients. Referrals for the side-effects of UGI surgery included dietetic support with pancreatic exocrine insufficiency (pancreatectomy; distal gastrectomy), dumping syndrome (hiatus hernia repair) and delayed gastric emptying (oesophagectomy). Conclusion The role of the benign UGI dietitian requires skills and expertise in a broad range of dietetic interventions. The service is well utilised by surgical and non-surgical colleagues. Next steps for service development would be to review the impact of interventions on surgical and patient reported outcomes, and explore feasibility of patient groups to deliver dietetic advice (for example weight reduction prior to surgery) to improve capacity within the service.

Meta-Analysis of the Efficacy of Rapid Rehabilitation Surgical Nursing in Lumbar Disc Herniation.

Background: Lumbar disc herniation (LDH) is a common cause of lower back pain and radiculopathy. In recent years, the enhanced recovery after surgery (ERAS) concept has been increasingly applied in orthopedics and gastrointestinal surgery. Purpose: To investigate the effect of using rapid rehabilitation surgical care for lumbar disc herniation by meta-analysis. Data source: Google Scholar, PubMed Medical, Cochrane and Embase databases were used for the analysis. Research selection: An initial search yielded a total of 322 relevant articles. Duplicate pieces of literature were screened using Endnote. In addition, non-randomized controlled trials and studies with a sample size of less than 30 were excluded. A total of seven papers were included in this study. Main outcomes: The Rapid Rehabilitation Surgical Nursing (RRSN) group showed significantly higher patient satisfaction (RR = 1.24; 95% CI: 1.06, 1.26; p < 0.01) and self-assessed health (Total MD = 5.67; 95% CI: 4.27, 7.06; p < 0.01) compared to the Normal Nursing (NN) group. Pain levels (MD = -0.66; 95% CI: -0.97, -0.36; p < 0.01), disability levels (MD = -18.64; 95% CI: -32.53, -4.76; p < 0.01), anxiety risk (SAS-MD = -4.33; 95% CI: -6.23, -2.44; p < 0.01), and depression risk (SDS-MD = -4.29; 95% CI: -7.50, -1.07; p < 0.01) were significantly lower in the RRSN group compared to the NN group. According to the GRADE classification, the certainty for patient satisfaction is high, while the certainty for post-care pain, functional capacity, risk of psychological disorders, and self-assessed health status is moderate. Conclusions: Rapid recovery surgical nursing can significantly improve postoperative recovery of lumbar disc herniation, increase patient satisfaction, reduce the risk of psychological disorders, improve lumbar function, and alleviate patient pain.

Postoperative pain management using high-dose oral acetaminophen for enhanced recovery after colorectal cancer surgery.

Postoperative pain management is important for enhanced recovery. High-dose oral acetaminophen is effective; however, the safety of its long-term use has not been established in gastrointestinal surgeries. This study aimed to investigate drug-induced liver injury (DILI) in patients with colorectal cancer using high-dose acetaminophen. One hundred sixty-eight consecutive colorectal cancer using high-dose oral acetaminophen (3600mg/day between postoperative day 1 and 7) were enrolled. One hundred forty-nine patients (88.7%) completed the administration of high-dose oral acetaminophen. DILI occurred in 58 patients (34.5%), and the cumulative incidence rates were 20.4% and 37.9% on postoperative 6 and 7, respectively. The severity of liver injury was grade 1 in all cases and returned to normal without treatment. Patients with DILI had a higher frequency of dyslipidemia (44.8% vs. 23.6%, P = 0.0047) and M1 staging (10.3% vs. 1.0%, P = 0.0036). A multivariate analysis showed that the presence of dyslipidemia (OR 2.61, P = 0.0067) and M1 stage (OR 12.4, P = 0.0053) were independent risk factors for DILI. The long-term use of high-dose oral acetaminophen in colorectal cancer patients enrolled in enhanced recovery protocols is feasible. Moreover, the presence of dyslipidemia and M status are risk factors for DILI.

OGC SO32 - Propensity score analysis of the impact of deprivation and the COVID-19 pandemic on Upper Gastro Intestinal (UGI) cancer surgery outcomes

Abstract Background Deprivation is a complex, multifaceted concept, not synonymous with poverty, but with the potential to widen health inequalities. This study aimed to explore demographic disparities in patients undergoing UGI cancer surgery in a UK regional cancer network during the COVID-19 pandemic. Method Consecutive 881 patients were studied prospectively (median age 67 (24 - 89) yr., 703 m, 178 f; 518 oesophageal, 363 gastric; 837 Adeno-, 44 SCC) over 13 years. The COVID-19 pandemic was defined as the 24-month period from February 1, 2020 to January 31, 2022, during which 118 patients were treated. The demographic profile of the pandemic cohort was compared with that of the 763 patients treated outside this period incorporating a propensity score analysis. Primary outcomes were operative morbidity, mortality, and one-year survival. Wales’ Index of Multiple Deprivation was used to assess deprivation disparity. Results A 24% reduction in the number of cancer operations was observed during the first pandemic year. No difference was observed in age, gender, histology, tumour site, ASA grade, or oncological treatment. During COVID-19 the proportion of patients from the two most deprived quartiles receiving potentially curative surgery fell from 53.2% to 40.7% (p=0.012). No difference was observed in severe morbidity (Clavien-Dindo &amp;gt;3, 22.2% vs. 19.8%, p=0.897), 30-day mortality (2.5% vs. 2.4%, p=0.886), or one-year survival (82.4% vs. 78.8%, p=0.374). Conclusion UGI cancer surgery safely continued during COVID-19, but patients from areas of high deprivation were over 20% less likely to access curative surgical treatment compared with before and after COVID-19. This emphasises the need for bespoke strategies to mitigate the disproportionate impact of any future pandemic on patients living in deprived geographical areas.

EGS SO17 - Foreign body management - Time for improvement

Abstract Background The management of foreign bodies (FBs) in clinical practice presents significant challenges across various medical specialties. FBs can be ingested, inhaled, inserted, or result from trauma, necessitating a comprehensive understanding of their management to prevent complications. The prevalence of FB incidents varies by age, with children being particularly susceptible to ingestion and inhalation, while adults often encounter FBs through trauma or occupational hazards. Effective management strategies are crucial to minimize morbidity and mortality associated with FB incidents. Method This study retrospectively reviewed cases of FB management over eight years (2015-2023), encompassing various specialties including gastroenterology, upper gastrointestinal and colorectal surgery. Data were collected on patient demographics, type and location of FB, method of removal, complications, and outcomes. Imaging techniques, such as X-rays, CT scans, and endoscopic evaluations, were analysed for their efficacy in FB detection. Different removal techniques, including endoscopic, surgical, and non-invasive methods, were evaluated for success rates and associated complications. Results Of the 153 FB incidents,47% involved male patients and 53% involved female patients.The paediatric group accounted for 36% of incidents.Non-invasive management was successful in 62% of cases,while 37% required invasive procedures.Among invasive interventions,70% required operative intervention,10% endoscopic intervention and 20% other minimally invasive options.The time to intervention for invasive procedures varied with more than 50% taking place after 24 hours.For operative interventions,64% occurred over 24 hours after presentation,21% within less than 24 hours, and 14% within 12 hours.All endoscopic interventions were performed within 12 hours.Outcomes showed that 96% of cases were managed without further complications.There were no reported mortalities. Conclusion Effective management of FBs requires a timely and appropriate intervention strategy tailored to the patient’s age and the type of FB. Non-invasive methods successfully managed most cases, while invasive procedures were necessary for a significant proportion. Prompt intervention, particularly endoscopic and other minimally invasive techniques, was associated with favorable outcomes and minimal complications. No mortalities were reported, underscoring the efficacy of current management protocols. Further research is needed to optimize these protocols and improve outcomes across diverse patient populations.