Publications
40 results found
Marks IH, Janmohamed IK, Malas S, et al., 2023, Derivation and validation of a novel risk score to predict need for haemostatic intervention in acute upper gastrointestinal bleeding (London Haemostat Score), BMJ Open Gastroenterology, Vol: 10, Pages: 1-9, ISSN: 2054-4774
Background: Acute Upper Gastrointestinal Bleeding (AUGIB) is a common medical emergency which takes up considerable healthcare resources. However, only approximately 20-30% of bleeds require urgent haemostatic intervention. Current standard of care is for all patients admitted to hospital to undergo endoscopy within 24 hours for risk stratification, but this is difficult to achieve in practice, invasive and costly. Aim To develop a novel non-endoscopic risk stratification tool for AUGIB to predict the need for haemostatic intervention by endoscopic, radiological or surgical treatments. We compared this with the Glasgow-Blatchford Score (GBS). Design: Model development was carried out using a derivation (n=466) and prospectively collected validation cohort (n=404) of patients who were admitted with AUGIB to three large hospitals in London, UK (2015-2020). Univariable and multivariable logistic regression analysis was used to identify variables that were associated with increased or decreased chances of requiring haemostatic intervention. This model was converted into a risk scoring system, the London Haemostat Score (LHS). Results: The LHS was more accurate at predicting need for haemostatic intervention than the GBS, in the derivation cohort (Area Under the Receiver Operating Curve [AUROC] 0.82; 95% Confidence Interval (CI), 0.78-0.86 vs 0.72; 95% CI, 0.67-0.77; p<0.001) and validation cohort (AUROC 0.80; 95% CI, 0.75-0.85 vs 0.72; 95% CI, 0.67-0.78; p<0.001). At cut-off scores at which LHS and GBS identified patients who required haemostatic intervention with 98% sensitivity, the specificity of the LHS was 41% vs 18% with the GBS (p<0.001). This could translate to 32% of inpatient endoscopies for AUGIB being avoided at a cost of only a 0.5% false negative rate.Conclusions: The London Haemostat score is accurate at predicting the need for haemostatic intervention in AUGIB and could be used identify a proportion of low-risk patients who can undergo delayed
Sivananthan A, Nazarian S, Ayaru L, et al., 2022, Does computer-aided diagnostic endoscopy improve the detection of commonly missed polyps? A meta-analysis, Clinical Endoscopy, Vol: 55, Pages: 355-364, ISSN: 2234-2400
Background/AimsColonoscopy is the gold standard diagnostic method for colorectal neoplasia, allowing detection and resection of adenomatous polyps; however, significant proportions of adenomas are missed. Computer-aided detection (CADe) systems in endoscopy are currently available to help identify lesions. Diminutive (≤5 mm) and nonpedunculated polyps are most commonly missed. This meta-analysis aimed to assess whether CADe systems can improve the real-time detection of these commonly missed lesions.MethodsA comprehensive literature search was performed. Randomized controlled trials evaluating CADe systems categorized by morphology and lesion size were included. The mean number of polyps and adenomas per patient was derived. Independent proportions and their differences were calculated using DerSimonian and Laird random-effects modeling.ResultsSeven studies, including 2,595 CADe-assisted colonoscopies and 2,622 conventional colonoscopies, were analyzed. CADe-assisted colonoscopy demonstrated an 80% increase in the mean number of diminutive adenomas detected per patient compared with conventional colonoscopy (0.31 vs. 0.17; effect size, 0.13; 95% confidence interval [CI], 0.09–0.18); it also demonstrated a 91.7% increase in the mean number of nonpedunculated adenomas detected per patient (0.32 vs. 0.19; effect size, 0.05; 95% CI, 0.02–0.07).ConclusionsCADe-assisted endoscopy significantly improved the detection of most commonly missed adenomas. Although this method is a potentially exciting technology, limitations still apply to current data, prompting the need for further real-time studies.
Boger P, Rahman I, Hu M, et al., 2021, Endoscopic full thickness resection in the colo-rectum: outcomes from the UK Registry, EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, Vol: 33, Pages: 852-858, ISSN: 0954-691X
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- Citations: 6
Sivananthan A, Nazarian S, Ayaru L, et al., 2021, PERFORMANCE OF COMPUTER AIDED DETECTION SYSTEMS IN FLAT, SESSILE AND DIMINUITIVE ADENOMAS: A META-ANALYSIS, Publisher: MOSBY-ELSEVIER, Pages: AB197-AB197, ISSN: 0016-5107
Sivananthan A, Glover B, Patel K, et al., 2020, The evolution of lower gastrointestinal endoscopy; where are we now, Therapeutic Advances in Gastrointestinal Endoscopy, Vol: 13, Pages: 1-16
Lower gastrointestinal (LGI) endoscopy has evolved over time fulfilling a widening diagnostic and therapeutic remit. As our understanding of colorectal cancer and its prevention has improved, endoscopy has progressed with improved diagnostic technologies and advancing endoscopic therapies. Despite this the fundamental design of the endoscope has remained similar since its inception. This review presents the important role LGI endoscopy serves in the prevention of colorectal cancer and the desirable characteristics of the endoscope that would enhance this. A brief history of the endoscope is presented. Current and future robotic endoscopic platforms, that may fulfil these desirable characteristics, are discussed. The incorporation of new technologies from allied scientific disciplines will help the endoscope fulfil its maximum potential in preventing the increasing global burden of colorectal cancer. There are a number of endoscopic platforms under development that show significant promise.
Harlow C, Sivananthan A, Ayaru L, et al., 2020, Endoscopic submucosal dissection: an update on tools and accessories, Therapeutic Advances in Gastrointestinal Endoscopy, Vol: 13, Pages: 1-13, ISSN: 2631-7745
Endoscopic submucosal dissection (ESD) is a minimally invasive therapeutic procedure to remove larger polyps or early non-metastatic lesions. It has long been used in Asia, but is now fast growing in popularity in the West.There are multiple challenges faced by ESD practitioners. While the practice of ESD in gastric lesions is relatively well established, the oesophagus with its narrow lumen and challenging workspace, and the colon with its tortuous course and folds are more challenging frontiers. The nature of performing a procedure endoscopically means that conventional methods offer no mechanism for providing counter-traction while performing dissection, impeding visibility and increasing the rate of complications.There are a multitude of tools available to those performing ESD for the different stages of the procedure. This article reviews the accessories currently used in regular ESD practice including the knives used to cut and dissect lesions, the cap and hood devices used to improve visibility and safety, injection fluids to lift the submucosal plane, haemostatic devices, generators, and finally, emerging traction apparatus. There is some evidence behind the use of these tools, however, ESD remains the domain of a small number of practitioners and the practice relies heavily on expert experience. Evolution of the ESD toolbox will make the procedure more accessible to more endoscopists, which in turn will drive the development of a more substantial evidence base to evaluate efficacy and safety of the multitude of tools.
Banister T, Spiking J, Ayaru L, 2018, Discharge of patients with an acute upper gastrointestinal bleed from the emergency department using an extended Glasgow Blatchford Score, BMJ Open Gastroenterology, Vol: 5, ISSN: 2054-4774
Objective To use an extended Glasgow-Blatchford Score (GBS) cut-off of ≤1 to aid discharge of patients presenting with acute upper gastrointestinal bleeding (AUGIB) from emergency departments.Background The GBS accurately predicts the need for intervention and death in AUGIB, and a cut-off of 0 is recommended to identify patients for discharge without endoscopy. However, this cut-off is limited by identifying a low percentage of low-risk patients. Extension of the cut-off to ≤1 or ≤2 has been proposed to increase this proportion, but there is controversy as to the optimal cut-off and little data on performance in routine clinical practice.Methods Dual-centre study in which patients with AUGIB and GBS ≤1 were discharged from the emergency department without endoscopy unless there was another reason for admission. Retrospective analysis of associated adverse outcome defined as a 30-day combined endpoint of blood transfusion, intervention or death.Results 569 patients presented with AUGIB from 2015 to 2018. 146 (25.7%) had a GBS ≤1 (70, GBS=0; 76, GBS=1). Of these, 103 (70.5%) were managed as outpatients, and none had an adverse outcome. GBS ≤1 had a negative predictive value=100% and the GBS had an area under receiver operator characteristic​​ (AUROC)=0.89 (95% CI 0.86 to 0.91) in predicting adverse outcomes. In 2008–2009, prior to risk scoring (n=432), 6.5% of patients presenting with AUGIB were discharged safely from the emergency department in comparison with 18.1% (p<0.001) in this cohort. A GBS cut-off ≤2 was associated with an adverse outcome in 8% of cases.Conclusion GBS of ≤1 is the optimal cut-off for the discharge of patients with an AUGIB from the emergency department.
Oakland K, Jairath V, Uberoi R, et al., 2017, Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study, LANCET GASTROENTEROLOGY & HEPATOLOGY, Vol: 2, Pages: 635-643, ISSN: 2468-1253
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- Citations: 68
Ayaru L, Ypsilantis P-P, Nanapragasam A, et al., 2015, Prediction of Outcome in Acute Lower Gastrointestinal Bleeding Using Gradient Boosting, PLOS ONE, Vol: 10, ISSN: 1932-6203
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- Citations: 37
Chen Y, Ayaru L, Mathew S, et al., 2014, Expansion of Anti-Mesothelin Specific CD4<SUP>+</SUP> and CD8<SUP>+</SUP> T Cell Responses in Patients with Pancreatic Carcinoma, PLOS ONE, Vol: 9, ISSN: 1932-6203
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- Citations: 21
Coda S, Thompson AJ, Kennedy GT, et al., 2014, Fluorescence lifetime spectroscopy of tissue autofluorescence in normal and diseased colon measured ex vivo using a fiber-optic probe, Biomedical Optics Express, Vol: 5, Pages: 515-538, ISSN: 2156-7085
We present an ex vivo study of temporally and spectrally resolved autofluorescence in a total of 47 endoscopic excision biopsy/resection specimens from colon, using pulsed excitation laser sources operating at wavelengths of 375 nm and 435 nm. A paired analysis of normal and neoplastic (adenomatous polyp) tissue specimens obtained from the same patient yielded a significant difference in the mean spectrally averaged autofluorescence lifetime −570 ± 740 ps (p = 0.021, n = 12). We also investigated the fluorescence signature of non-neoplastic polyps (n = 6) and inflammatory bowel disease (n = 4) compared to normal tissue in a small number of specimens.
Choi CH, Swingland J, Ali A, et al., 2012, ASSESSING RISK OF ADVERSE OUTCOME IN ACUTE LOWER GASTROINTESTINAL BLEEDING: ARTIFICIAL NEURAL NETWORK VS SIGN GUIDELINES AND BLEED SCORE, GUT, Vol: 61, Pages: A156-A157, ISSN: 0017-5749
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- Citations: 2
Ali A, Swingland J, Choi CH, et al., 2012, ARTIFICIAL NEURAL NETWORK FOR THE RISK STRATIFICATION OF ACUTE UPPER GASTROINTESTINAL BLEEDING: MULTICENTRE COMPARATIVE ANALYSIS VS THE GLASGOW BLATCHFORD AND ROCKALL SCORES, GUT, Vol: 61, Pages: A62-A62, ISSN: 0017-5749
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- Citations: 2
Thomas T, Ayaru L, Lee EY, et al., 2011, Length of Barrett's segment predicts success of extensive endomucosal resection for eradication of Barrett's esophagus with early neoplasia, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 25, Pages: 3627-3635, ISSN: 0930-2794
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- Citations: 9
Matull W-R, Dhar DK, Ayaru L, et al., 2011, R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer, LIVER INTERNATIONAL, Vol: 31, Pages: 99-107, ISSN: 1478-3223
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- Citations: 37
Chan JCH, Ayaru L, 2011, Analysis of risk scoring for the outpatient management of acute upper gastrointestinal bleeding, Frontline Gastroenterology, Vol: 2, Pages: 19-25
Pereira SP, Ayaru L, Ackroyd R, et al., 2010, The pharmacokinetics and safety of porfimer after repeated administration 30-45 days apart to patients undergoing photodynamic therapy, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 32, Pages: 821-827, ISSN: 0269-2813
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- Citations: 8
Chan J, Ayaru L, 2010, Risk scoring for the outpatient management of acute upper gastrointestinal bleeding, UEGW, Pages: A43-A44
Thomas T, Ayaru L, Lee EY, et al., 2009, Extensive Endomucosal Resection (EMR) for Complete Eradication of Barrett's Esophagus (BE) with High-Grade Intraepithelial Neoplasia (HGIN) or Intramucosal Carcinoma (IMC): Efficacy, Safety and Factors Predicting Complete Eradication, Annual Meeting of the American-Society-for-Gastrointestinal-Endoscopy/Digestive Disease Week, Publisher: MOSBY-ELSEVIER, Pages: AB340-AB340, ISSN: 0016-5107
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- Citations: 1
Ayaru L, Stoeber K, Webster GJ, et al., 2009, DIAGNOSIS OF PANCREATICOBILIARY MALIGNANCY BY DETECTION OF MINICHROMOSOME MAINTENANCE PROTEIN 5 IN BILIARY BRUSH CYTOLOGY SPECIMENS, Annual Meeting of the British-Society-of-Gastroenterology, Publisher: B M J PUBLISHING GROUP, Pages: A25-A25, ISSN: 0017-5749
Pereira SP, Matull WR, Dhar DK, et al., 2009, Palliative photodynamic therapy for biliary tract carcinoma may improve survival and has a similar outcome to attempted curative surgery with positive resection margins, 12th World Congress of the International-Photodynamic-Association (IPA) on Photodynamic Therapy - Back to the Future, Publisher: SPIE-INT SOC OPTICAL ENGINEERING, ISSN: 0277-786X
Ayaru L, Stoeber K, Webster GJ, et al., 2008, Diagnosis of pancreaticobiliary malignancy by detection of minichromosome maintenance protein 5 in bile aspirates, BRITISH JOURNAL OF CANCER, Vol: 98, Pages: 1548-1554, ISSN: 0007-0920
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- Citations: 30
Alisa A, Boswell S, Pathan AA, et al., 2008, Human CD4<SUP>+</SUP> T cells recognize an epitope within α-fetoprotein sequence and develop into TGF-β-producing CD4<SUP>+</SUP> T cells, JOURNAL OF IMMUNOLOGY, Vol: 180, Pages: 5109-5117, ISSN: 0022-1767
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- Citations: 25
Ayaru L, Kurzawinski TR, Shankar A, et al., 2008, Complications and diagnostic difficulties arising from biliary self-expanding metal stent insertion before definitive histological diagnosis, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Vol: 23, Pages: 315-320, ISSN: 0815-9319
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- Citations: 14
Sandanayake NS, Johnson GJ, Smyth CM, et al., 2008, Azathioprine in the management of relapsing autoimmune pancreatitis/IgG4 sclerosing cholangitis, Annual General Meeting of the British-Society-of-Gastroenterology, Publisher: B M J PUBLISHING GROUP, Pages: A24-A24, ISSN: 0017-5749
Pereira SP, Ayaru L, Rogowska A, et al., 2007, Photodynamic therapy of malignant biliary strictures using meso-tetrahydroxyphenylchlorin, EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, Vol: 19, Pages: 479-485, ISSN: 0954-691X
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- Citations: 37
Matull WR, Ayaru L, Dias A, et al., 2007, Prognostic factors in biliary tract carcinoma: Multivariate analysis of 259 patients, Annual Meeting of the British-Society-of-Gastroenterology, Publisher: B M J PUBLISHING GROUP, Pages: A3-A3, ISSN: 0017-5749
Ayaru L, Stoeber K, George W, et al., 2007, Diagnosis of pancreaticobiliary malignancy by detection of minichromosome maintenance 5 protein in bile aspirates, Digestive Disease Weeking Meeting/ASGE Postgraduate Course Meeting, Publisher: MOSBY-ELSEVIER, Pages: AB210-AB210, ISSN: 0016-5107
Ayaru L, Stoeber K, Webster GJ, et al., 2007, Diagnosis of pancreaticobiliary malignancy by detection of minichromosome maintenance 5 protein in bile aspirates, Annual Meeting of the British-Society-of-Gastroenterology, Publisher: B M J PUBLISHING GROUP, Pages: A14-A14, ISSN: 0017-5749
Ayaru L, Pereira SP, Alisa A, et al., 2007, Unmasking of α-fetoprotein-specific CD4<SUP>+</SUP> T cell responses in hepatocellular carcinoma patients undergoing embolization, JOURNAL OF IMMUNOLOGY, Vol: 178, Pages: 1914-1922, ISSN: 0022-1767
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- Citations: 114
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