Publications
190 results found
Alexander JL, Wilson ID, Teare J, et al., 2017, Gut microbiota modulation of chemotherapy efficacy and toxicity., Nature Reviews Gastroenterology and Hepatology, Vol: 14, Pages: 356-365, ISSN: 1759-5045
Evidence is growing that the gut microbiota modulates the host response to chemotherapeutic drugs, with three main clinical outcomes: facilitation of drug efficacy; abrogation and compromise of anticancer effects; and mediation of toxicity. The implication is that gut microbiota are critical to the development of personalized cancer treatment strategies and, therefore, a greater insight into prokaryotic co-metabolism of chemotherapeutic drugs is now required. This thinking is based on evidence from human, animal and in vitro studies that gut bacteria are intimately linked to the pharmacological effects of chemotherapies (5-fluorouracil, cyclophosphamide, irinotecan, oxaliplatin, gemcitabine, methotrexate) and novel targeted immunotherapies such as anti-PD-L1 and anti-CLTA-4 therapies. The gut microbiota modulate these agents through key mechanisms, structured as the 'TIMER' mechanistic framework: Translocation, Immunomodulation, Metabolism, Enzymatic degradation, and Reduced diversity and ecological variation. The gut microbiota can now, therefore, be targeted to improve efficacy and reduce the toxicity of current chemotherapy agents. In this Review, we outline the implications of pharmacomicrobiomics in cancer therapeutics and define how the microbiota might be modified in clinical practice to improve efficacy and reduce the toxic burden of these compounds.
Clancy NT, Elson DS, Teare J, 2017, Hyperspectral imaging of colonic polyps in vivo (Conference Presentation), Conference on Advanced Biomedical and Clinical Diagnostic and Surgical Guidance Systems XV, Publisher: SPIE-INT SOC OPTICAL ENGINEERING, ISSN: 0277-786X
Cundy TP, Burns EM, Cohen P, et al., 2016, Duplication cyst of the appendix: a proposal for modification of the Cave-Wallbridge classification., ANZ Journal of Surgery, Vol: 86, Pages: 731-732, ISSN: 1445-1433
Alexander J, Gildea L, Balog J, et al., 2016, A novel methodology for in vivo endoscopic phenotyping of colorectal cancer based on real-time analysis of the mucosal lipidome: a prospective observational study of the iKnife, Surgical Endoscopy and Other Interventional Techniques, Vol: 31, Pages: 1361-1370, ISSN: 1432-2218
Background:This pilot study assessed the diagnostic accuracy of rapid evaporative ionization mass spectrometry (REIMS) in colorectal cancer (CRC) and colonic adenomas.Methods:Patients undergoing elective surgical resection for CRC were recruited at St. Mary’s Hospital London and The Royal Marsden Hospital, UK. Ex vivo analysis was performed using a standard electrosurgery handpiece with aspiration of the electrosurgical aerosol to a Xevo G2-S iKnife QTof mass spectrometer (Waters Corporation). Histological examination was performed for validation purposes. Multivariate analysis was performed using principal component analysis and linear discriminant analysis in Matlab 2015a (Mathworks, Natick, MA). A modified REIMS endoscopic snare was developed (Medwork) and used prospectively in five patients to assess its feasibility during hot snare polypectomy.Results:Twenty-eight patients were recruited (12 males, median age 71, range 35–89). REIMS was able to reliably distinguish between cancer and normal adjacent mucosa (NAM) (AUC 0.96) and between NAM and adenoma (AUC 0.99). It had an overall accuracy of 94.4 % for the detection of cancer versus adenoma and an adenoma sensitivity of 78.6 % and specificity of 97.3 % (AUC 0.99) versus cancer. Long-chain phosphatidylserines (e.g., PS 22:0) and bacterial phosphatidylglycerols were over-expressed on cancer samples, while NAM was defined by raised plasmalogens and triacylglycerols expression and adenomas demonstrated an over-expression of ceramides. REIMS was able to classify samples according to tumor differentiation, tumor budding, lymphovascular invasion, extramural vascular invasion and lymph node micrometastases (AUC’s 0.88, 0.87, 0.83, 0.81 and 0.81, respectively). During endoscopic deployment, colonoscopic REIMS was able to detect target lipid species such as ceramides during hot snare polypectomy.Conclusion:REIMS demonstrates high diagnostic accuracy for tumor type and for established histological featur
Patel N, Alexander J, Ashrafian H, et al., 2016, Meta-analysis comparing differing methods of endoscopic therapy for colorectal lesions, WORLD JOURNAL OF META-ANALYSIS, Vol: 4, Pages: 44-54, ISSN: 2308-3840
Clancy NT, Teare J, Hanna GB, et al., 2016, Flexible multimode endoscope for tissue reflectance and autofluorescence hyperspectral imaging, Optical Tomography and Spectroscopy 2016, Publisher: Optica Publishing Group
A dual reflectance and autofluorescence spectral imaging probe compatible with the biopsy channels of standard flexible endoscopes is demonstrated. Spatially-resolved haemoglobin and autofluorescent signals from porcine bowel were obtained in vivo.
Patel N, Patel K, Ashrafian H, et al., 2016, Colorectal endoscopic submucosal dissection: Systematic review of mid-term clinical outcomes., Digestive Endoscopy, Vol: 28, Pages: 405-416, ISSN: 0915-5635
With a drive towards minimally invasive surgery, endoscopic submucosal dissection (ESD) is now gaining popularity. In a number of East Asian countries, ESD is now the treatment of choice for early non-metastatic gastric cancer, but the outcomes of ESD for colorectal lesions are unclear. The present review summarizes the mid-term outcomes of colorectal ESD including complication and recurrence rates. A systematic literature search was done in May 2014, identifying 20 publications reporting the outcomes of colorectal ESD which were included in this review. En-bloc resection rates, complete (R0) resection rates, endoscopic clearance rates, complication and recurrences rates were analyzed. Statistical pooling was done to calculate weighted means using random effects modeling. Twenty studies reporting the outcomes of 3060 colorectal ESD procedures were reported. Overall weighted en-bloc resection rate was 89% (95% CI: 83-94%), R0 resection rate 76% (95% CI: 69-83%), endoscopic clearance rate 94% (95% CI: 90-97%) and recurrence rate 1% (95% CI: 0.5-2%). Studies that followed up patients for over 1 year were found to have an en-bloc resection rate of 91% (95% CI: 86-96%), R0 resection rate of 81% (95% CI: 75-88%), endoscopic clearance rate 93% (95% CI: 90-97%) and recurrence rate of 0.8% (95% CI: 0.4-1%). Colorectal ESD can be carried out effectively and safely with a 1% recurrence rate. Further studies with longer follow-up periods are required to determine whether colorectal ESD is a viable alternative to conventional surgical therapy.
Alexander JL, Scott A, Mroz A, et al., 2016, Mass Spectrometry Imaging (MSI) of Microbiome-Metabolome Interactions in Colorectal Cancer, Digestive Disease Week (DDW), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S23-S23, ISSN: 0016-5085
Edmondson MJ, Pucher PH, Sriskandarajah K, et al., 2016, Looking towards objective quality evaluation in colonoscopy: Analysis of visual gaze patterns, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Vol: 31, Pages: 604-609, ISSN: 0815-9319
Background and AimThere are currently limited training and assessment tools available to novice endoscopists. A potential tool for the objective assessment of endoscopist visual search strategy is eye‐tracking technology. The aim of this study is to assess whether eye‐tracking technology can be used to differentiate the visual gaze patterns (VGP) of experienced and novice endoscopists, and to characterize any differences arising between the two groups.MethodWith the use of portable eye‐tracking glasses, VGP of novice (n = 20) and experienced (n = 14) endoscopists were compared while viewing a colonoscopy withdrawal through the hepatic flexure. Analysis was performed by comparing the central versus peripheral distribution and the horizontal distribution of novice and experienced endoscopist fixations, along with comparison of basic eye‐tracking metrics.ResultsThis study found that experienced endoscopists had a significantly higher percentage of fixations within the periphery of the screen (13.4% vs 23.0%, P = 0.013). Experienced endoscopists also had a significantly greater percentage of fixations on the left side of the screen (18.6% vs 33.5%, P = 0.005) that displayed the poorly visualized “inside bend” of the hepatic flexure.ConclusionThis study has detailed specific VGP acquired through expertise, which can potentially explain why adenomas are regularly missed at the hepatic flexure during colonoscopy. These may be useful for the training of novice colonoscopists, and further validation may utilize VGP in the development of an objective proficiency based curriculum to improve the detection of pathology and overall quality in endoscopy.
Penny HA, Mooney PD, Burden M, et al., 2016, High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy, Digestive and Liver Disease, Vol: 48, Pages: 644-649, ISSN: 1878-3562
BACKGROUND AND AIMS: Celiac disease remains underdiagnosed at endoscopy. We aimed to assess the utility of I-Scan (virtual chromo-endoscopy) to improve sensitivity of endoscopy to detect markers of villous atrophy in this condition. METHODS: Patients from 2 UK hospitals were studied in 3 groups. Group 1: standard high definition, white light endoscopy (WLE); Group 2: WLE plus I-Scan; Group 3: non-high definition control group. The presence of endoscopic markers was recorded. At least 4 duodenal biopsies were taken from all patients. Serology was performed concurrently and observations were compared with histology. RESULTS: 758 patients (62% female, mean age 52) were recruited (Group 1: 230; Group 2: 228; Group 3: 300). 135 (17.8%) new diagnoses of coeliac disease were made (21 Group 1; 24 Group 2; 89 Group 3). The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 (85.7%, p=0.0004) and Group 2 (75%, p=0.005) compared to non-high definition controls (41.6%). There was no significant difference between high definition only and I-Scan groups (p=0.47). In non-high definition endoscopy a missed diagnosis was associated with lesser degrees of villous atrophy (p=0.019) and low tTG titre (p=0.007). CONCLUSIONS: High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.
Patel N, Seneci CA, Shang J, et al., 2015, Evaluation of a novel flexible snake robot for endoluminal surgery, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 29, Pages: 3349-3355, ISSN: 0930-2794
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- Citations: 25
Teare J, Le Roux CW, Chiquette E, et al., 2015, Metabolic improvements observed in subjects receiving EndoBarrier: a pooled analysis of clinical trials, 51st Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Publisher: SPRINGER, Pages: S304-S305, ISSN: 0012-186X
Cantillon-Murphy P, Cundy TP, Patel NK, et al., 2015, Magnets for therapy in the GI tract: a systematic review, GASTROINTESTINAL ENDOSCOPY, Vol: 82, Pages: 237-245, ISSN: 0016-5107
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- Citations: 7
Halligan S, Wooldrage K, Dadswell E, et al., 2015, Identification of extracolonic pathologies by computed tomographic colonography in colorectal cancer symptomatic patients, Gastroenterology, Vol: 149, Pages: 89-101.e5, ISSN: 0016-5085
Background & AimsSymptoms suggestive of colorectal cancer may originate outside the colorectum. Computed tomographic colonography (CTC) is used to examine the colorectum and abdominopelvic organs simultaneously. We performed a prospective randomized controlled trial to quantify the frequency, nature, and consequences of extracolonic findings.MethodsWe studied 5384 patients from 21 UK National Health Service hospitals referred by their family doctor for the investigation of colorectal cancer symptoms from March 2004 through December 2007. The patients were assigned randomly to groups that received the requested test (barium enema or colonoscopy, n = 3574) or CTC (n = 1810). We determined the frequency and nature of extracolonic findings, subsequent investigations, ultimate diagnosis, and extracolonic cancer diagnoses 1 and 3 years after testing patients without colorectal cancer.ResultsExtracolonic pathologies were detected in 959 patients by CTC (58.7%), in 42 patients by barium enema analysis (1.9%), and in no patients by colonoscopy. Extracolonic findings were investigated in 142 patients (14.2%) and a diagnosis was made for 126 patients (88.1%). Symptoms were explained by extracolonic findings in 4 patients analyzed by barium enema (0.2%) and in 33 patients analyzed by CTC (2.8%). CTC identified 72 extracolonic neoplasms, however, barium enema analysis found only 3 (colonoscopy found none). Overall, CTC diagnosed extracolonic neoplasms in 72 of 1634 patients (4.4%); 26 of these were malignant (1.6%). There were significantly more extracolonic malignancies detected than expected 1 year after examination, but these did not differ between patients evaluated by CTC (22.2/1000 person-years), barium enema (26.5/1000 person-years; P = .43), or colonoscopy (32.0/1000 person-years; P = .88).ConclusionsMore than half of the patients with symptoms of colorectal cancer are found to have extracolonic pathologies by CTC analysis. However, the proportion of patients found t
Burden M, Mooney PD, Patel N, et al., 2015, HIGH DEFINITION (HD) ENDOSCOPY BUT NOT I-SCAN SIGNIFICANTLY INCREASES THE DETECTION OF MARKERS OF COELIAC DISEASE: A MULTICENTRE UK STUDY, 2nd Digestive-Disorders-Federation Conference, Publisher: BMJ PUBLISHING GROUP, Pages: A224-A224, ISSN: 0017-5749
Teare J, Le Roux CW, Chiquette E, et al., 2015, Metabolic Improvements Observed in Subjects Receiving Endobarrier: A Pooled Analysis of Clinical Trials, 75th Scientific Sessions of the American-Diabetes-Association, Publisher: AMER DIABETES ASSOC, Pages: A565-A565, ISSN: 0012-1797
Mooney PD, Patel N, Burden M, et al., 2015, High Definition (HD) Endoscopy but Not I-SCAN Significantly Increases the Detection of Markers of Celiac Disease: a Multicentre UK Study, Publisher: MOSBY-ELSEVIER, Pages: AB583-AB583, ISSN: 0016-5107
Pucher PH, Sodergren MH, Lord AC, et al., 2015, Consumer demand for surgical innovation: a systematic review of public perception of NOTES, Surgical Endoscopy, Vol: 29, Pages: 774-780, ISSN: 0930-2794
BackgroundThe full scope of benefits offered by NOTES over traditional laparoscopy, if any, is not yet fully clear. Perceived patient demand for truly “scarless surgery” is often referenced one of the driving factors in the continued development of this relatively new technique. The true scale of patient preference and demand for NOTES as a surgical technique is unknown. This review aims to summarise currently available literature on the topic of patient perceptions of NOTES to guide future development of the technique.MethodsA comprehensive search of PubMed and Web of Science electronic databases was performed on 1st Jan 2014. To be considered for inclusion, articles were required to assess and report the perception of NOTES in a sample of laypersons (patients or general public). The primary endpoint assessed was acceptance or preference rates expressed by patients for NOTES procedures. Reasons given for preference or rejection of NOTES were recorded, as well as preferred access routes and any predicting factors of NOTES acceptance.ResultsInitial search returned 1,334 results, resulting in 15 articles included in final data synthesis. These polled a total of 4,420 subjects. Acceptance of NOTES ranged between 41 and 84 %. Compared to a laparoscopic approach, preference rates for NOTES ranged from 0 to 78 %. Reasons for preferring NOTES were largely centred on potentially reduced recovery time, complications (particularly with reference to hernias) and postoperative pain. Improved cosmesis also played a role, but was secondary to the above issues. Overall, study quality was poor.ConclusionsThis review suggests significant public interest in NOTES and scarless surgery in general. Further research and consideration of differences in public perceptions across regions, countries and cultures are required.
Patel N, Darzi A, Teare J, 2015, The endoscopy evolution: 'the superscope era', Frontline Gastroenterology, Vol: 6, Pages: 101-107, ISSN: 2041-4145
Developments to the design of the flexible endoscope are transforming the field of gastroenterology. There is a drive to improve colonic adenoma detection rates leading to advancements in the design of the colonoscope. Novel endoscopes now allow increased visualisation of colonic mucosa, including behind colonic folds, and aim to reduce pain associated with the procedure. In addition, a shift in surgical paradigm towards minimally invasive endoluminal surgery has meant innovations in flexible platforms are being sought. There are a number of limitations of the basic endoscope. These include a lack of stability and triangulation of instruments. Modifications to the flexible endoscope design form the basis of a number of newly developed and research platforms, some of which are discussed in this review.
Zaheri S, Carton J, Teare J, et al., 2015, Severe vulval swelling in a young woman, CLINICAL AND EXPERIMENTAL DERMATOLOGY, Vol: 40, Pages: 342-343, ISSN: 0307-6938
Seneci CA, Shang J, Leibrandt K, et al., 2014, Design and evaluation of a novel flexible robot for transluminal and endoluminal surgery, IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Pages: 1314-1321
Precise and repetitive positional control of surgical robots is important to reduce time and risks of surgical procedures. These factors become particularly important when deploying the surgical system through a flexible path to areas with a tight workspace such as the stomach or oesophagus where high dexterity, flexibility, accuracy and stability are required. This paper presents a flexible access robot combining articulated joints and continuum flexible section for both transluminal and endoluminal surgeries. Kinematic model and control strategy for the flexible robot are described in the paper. The experiment simulating a transoral gastric procedure demonstrates great flexibility and dexterity of the device. The results show that good accuracy and repetitive control of the device are achieved, which demonstrate the potential application of the device for transluminal or endoluminal surgery.
Patel N, Seneci C, Yang G-Z, et al., 2014, Flexible platforms for natural orifice transluminal and endoluminal surgery, Endoscopy International Open, Vol: 2, Pages: E117-E123, ISSN: 2364-3722
The flexible endoscope is playing an increasingly pivotal role in minimally invasive transluminal and endoluminal surgery. Whilst the flexible nature of the platform is desirable in order to navigate through the abdominal cavity or through a lumen, there are a number of issues with using the platform for this purpose.The challenges associated with using flexible endoscopes such as a lack of triangulation of instruments and force transmission, which is often inadequate for endoscopic surgery are discussed in this review.As a result of these difficulties, a number of mechanically and robotically driven devices based upon the flexible endoscope are emerging. The design of these devices and potential problems are also reviewed. Finally, future robotic systems which are still in the development and validation stage are briefly discussed.The field of gastroenterology is diverging. The narrowing divide between minimally invasive and endoluminal surgery has led to a surge of innovative and novel devices which may in the future enable precise, seamless and scar less surgery.
Sodergren MH, Warren A, Nehme J, et al., 2014, Endoscopic Horizon Stabilization in Natural Orifice Translumenal Endoscopic Surgery A Randomized Controlled Trial, SURGICAL INNOVATION, Vol: 21, Pages: 74-79, ISSN: 1553-3506
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patel NP, seneci CS, yang GZY, et al., 2014, Flexible platforms for natural orifice transluminal and endoluminal surgery. Endoscopy International Open, 2(02), E117-E123., Endoscopy International Open
Ye M, Giannarou S, Patel N, et al., 2013, Pathological Site Retargeting under Tissue Deformation Using Geometrical Association and Tracking, 16th International Conference on MICCAI 2013, Publisher: Springer Berlin Heidelberg, Pages: 67-74, ISSN: 0302-9743
Recent advances in microscopic detection techniques includefluorescence spectroscopy, fibred confocal microscopy and optical coher-ence tomography. These methods can be integrated with miniaturisedprobes to assist endoscopy, thus enabling diseases to be detected at anearly and pre-invasive stage, forgoing the need for histopathological sam-ples and off-line analysis. Since optical-based biopsy does not leave vis-ible marks after sampling, it is important to track the biopsy sites toenable accurate retargeting and subsequent serial examination. In thispaper, a novel approach is proposed for pathological site retargeting ingastroscopic examinations. The proposed method is based on affine defor-mation modelling with geometrical association combined with cascadedonline learning and tracking. It provides online in vivo retargeting, and is able to track pathological sites in the presence of tissue deformation. It is also robust to partial occlusions and can be applied to a range of imaging probes including confocal laser endomicroscopy.
Teare J, Byrne J, Mason J, et al., 2013, Interim 12 month results from a post market clinical trial of DJBL treatment outcomes in subjects with type 2 diabetes and/or obesity, 49th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Publisher: SPRINGER, Pages: S40-S41, ISSN: 0012-186X
Moghul M, Sodergren M, Clark J, et al., 2013, A randomised controlled trial investigating didactic transfer of NOTES skills from experts to novices using a multimedia video, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 159-159, ISSN: 0007-1323
Moghul MR, Sodergren MH, Clark J, et al., 2013, Education and Training in NOTES: A Systematic Review, SURGICAL INNOVATION, Vol: 20, Pages: 282-291, ISSN: 1553-3506
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- Citations: 2
Pucher P, Sodergren MH, Alkhusheh M, et al., 2013, The Effects of Natural Orifice Translumenal Endoscopic Surgery (NOTES) on Cardiorespiratory Physiology: A Systematic Review, SURGICAL INNOVATION, Vol: 20, Pages: 183-189, ISSN: 1553-3506
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- Citations: 3
Halligan S, Wooldrage K, Dadswell E, et al., 2013, Computed tomographic colonography versus barium enema for diagnosis of colorectal cancer or large polyps in symptomatic patients (SIGGAR): a multicentre randomised trial., Lancet, Vol: 381, Pages: 1185-1193
BACKGROUND: Barium enema (BE) is widely available for diagnosis of colorectal cancer despite concerns about its accuracy and acceptability. Computed tomographic colonography (CTC) might be a more sensitive and acceptable alternative. We aimed to compare CTC and BE for diagnosis of colorectal cancer or large polyps in symptomatic patients in clinical practice.METHODS: This pragmatic multicentre randomised trial recruited patients with symptoms suggestive of colorectal cancer from 21 UK hospitals. Eligible patients were aged 55 years or older and regarded by their referring clinician as suitable for radiological investigation of the colon. Patients were randomly assigned (2:1) to BE or CTC by computer-generated random numbers, in blocks of six, stratified by trial centre and sex. We analysed the primary outcome-diagnosis of colorectal cancer or large (≥10 mm) polyps-by intention to treat. The trial is an International Standard Randomised Controlled Trial, number 95152621.FINDINGS: 3838 patients were randomly assigned to receive either BE (n=2553) or CTC (n=1285). 34 patients withdrew consent, leaving for analysis 2527 assigned to BE and 1277 assigned to CTC. The detection rate of colorectal cancer or large polyps was significantly higher in patients assigned to CTC than in those assigned to BE (93 [7·3%] of 1277 vs 141 [5·6%] of 2527, relative risk 1·31, 95% CI 1·01-1·68; p=0·0390). CTC missed three of 45 colorectal cancers and BE missed 12 of 85. The rate of additional colonic investigation was higher after CTC than after BE (283 [23·5%] of 1206 CTC patients had additional investigation vs 422 [18·3%] of 2300 BE patients; p=0·0003), due mainly to a higher polyp detection rate. Serious adverse events were rare.INTERPRETATION: CTC is a more sensitive test than BE. Our results suggest that CTC should be the preferred radiological test for patients with symptoms suggestive of colorectal cancer.FUNDING: NIH
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