Publications
315 results found
Maeda Y, Phillips RKS, 2009, Open Hemorrhoidectomy, Surgical Treatment of Hemorrhoids, Editors: Khubuchandani, Paonessa, Azimuddin, Publisher: Springer, Pages: 71-76, ISBN: 9781848003132
The second edition of Surgical Treatment of Hemorrhoids covers this important and common disorder, offering a comprehensive critical analysis of advantages and disadvantages of recognized treatment options, covering both recent advances and ...
Segditsas S, Sieber OM, Rowan A, et al., 2008, Promoter hypermethylation leads to decreased <i>APC</i> mRNA expression in familial polyposis and sporadic colorectal tumours, but does not substitute for truncating mutations, EXPERIMENTAL AND MOLECULAR PATHOLOGY, Vol: 85, Pages: 201-206, ISSN: 0014-4800
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- Citations: 39
Postgate A, Despott E, Burling D, et al., 2008, Significant small-bowel lesions detected by alternative diagnostic modalities after negative capsule endoscopy, GASTROINTESTINAL ENDOSCOPY, Vol: 68, Pages: 1209-1214, ISSN: 0016-5107
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- Citations: 119
Will OCC, Robinson J, Günther T, et al., 2008, APC mutation spectrum in ileoanal pouch polyps resembles that of colorectal polyps, The British journal of surgery, Vol: 95, Pages: 765-769
Parés D, Duncan J, Dudding T, et al., 2008, Investigation to predict faecal continence in patients undergoing reversal of a defunctioning stoma (Porridge enema test)., Colorectal Dis, Vol: 10, Pages: 379-385
OBJECTIVE: A defunctioning stoma is often performed in cases of major anorectal surgery or sphincter injury. This study aimed to assess the Porridge enema (PE) test as a tool to evaluate function prior to stoma closure. METHOD: Thirty-eight patients underwent PE test at a median of 12.5 months after stoma formation prior to consideration of stoma closure. Outcome was assessed by immediate leakage after PE test on lying, standing, walking and the ability to hold the enema for 30 min. Patients available for follow-up were divided into two groups: group 1 (n = 20) patients with stoma closure performed and group 2 (n = 10) patients where the stoma remains. Eight patients were excluded from analysis as the stoma had not been reversed for reasons unrelated to continence. The results of other investigations performed in these patients were analysed. Finally, we studied the agreement in the interpretation of the test by two investigators blinded to the patient's group and each other's interpretation and to functional results after the stoma was reversed. RESULTS: Anorectal physiology testing and imaging assessment of the anal sphincters was not statistically different between the two groups. There was a significant difference in the percentage of patients in each group that had enema leakage in: lying position (P = 0.002), standing position (P = 0.013), walking (P = 0.002) and ability to defer for 30 min (P = 0.005). There was a good correlation in the interpretation of PE test results by two investigators. Among patients whose stoma was closed and who were evaluated functionally, 55% were fully continent. CONCLUSION: This report suggests that the PE test is a promising tool as part of evaluation of anorectal function prior to stoma reversal.
Vasen HFA, Moeslein G, Alonso A, et al., 2008, Guidelines for the clinical management of familial adenomatous polyposis (FAP), GUT, Vol: 57, ISSN: 0017-5749
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- Citations: 469
von Roon AC, Tekkis PP, Lovegrove RE, et al., 2008, Comparison of outcomes of ileal pouch-anal anastomosis for familial adenomatous polyposis with and without previous ileorectal anastomosis, BRITISH JOURNAL OF SURGERY, Vol: 95, Pages: 494-498, ISSN: 0007-1323
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- Citations: 15
Will OCC, Man RF, Phillips RKS, et al., 2008, Familial adenomatous polyposis and the small bowel: A loco-regional review and current management strategies, PATHOLOGY RESEARCH AND PRACTICE, Vol: 204, Pages: 449-458, ISSN: 0344-0338
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- Citations: 14
Jones AM, Thirlwell C, Howarth KM, et al., 2007, Analysis of copy number changes suggests chromosomal instability in a minority of large colorectal adenomas, JOURNAL OF PATHOLOGY, Vol: 213, Pages: 249-256, ISSN: 0022-3417
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- Citations: 24
Carvajal-Carmona LG, Howarth KM, Lockett M, et al., 2007, Molecular classification and genetic pathways in hyperplastic polyposis syndrome, JOURNAL OF PATHOLOGY, Vol: 212, Pages: 378-385, ISSN: 0022-3417
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- Citations: 68
von Roon AC, Tekkis PP, Clark SK, et al., 2007, The impact of technical factors on outcome of restorative proctocolectomy for familial adenomatous polyposis, DISEASES OF THE COLON & RECTUM, Vol: 50, Pages: 952-961, ISSN: 0012-3706
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- Citations: 24
Monahan KJ, Thomas HJ, Silver AR, et al., 2007, Polyposis families without mutations have a less severe phenotype, Annual Meeting of the British-Society-of-Gastroenterology, Publisher: B M J PUBLISHING GROUP, Pages: A24-A24, ISSN: 0017-5749
Thirlwell C, Howarth KM, Segditsas S, et al., 2007, Investigation of pathogenic mechanisms in multiple colorectal adenoma patients without germline APC or MYH/MUTYH mutations., Br J Cancer, Vol: 96, Pages: 1729-1734
Latchford A, Greenhalf W, Vitone LJ, et al., 2006, Peutz-Jeghers syndrome and screening for pancreatic cancer., Br J Surg, Vol: 93, Pages: 1446-1455, ISSN: 0007-1323
BACKGROUND: Cancer risk, including pancreatic, is high in those with Peutz-Jeghers syndrome (PJS). It has been suggested that such patients should undergo screening for pancreatic cancer. METHODS: The risk of pancreatic cancer in PJS, pancreatic screening and potential screening strategies were reviewed. Cost-effectiveness was assessed according to American Gastroenterology Association guidelines and a risk stratification model proposed by the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer. RESULTS: The risk of pancreatic cancer is increased in PJS but screening would cost over US 35,000 dollars per life saved. Risk stratification reduces cost by 100,000 dollars and costs fall to 50,000 dollars per life saved if deaths from other forms of cancer are avoided. CONCLUSION: Screening should be performed only on a research basis to evaluate the benefit and cost-effectiveness in high-risk groups.
Latchford AR, Sturt NJH, Neale K, et al., 2006, A 10-year review of surgery for desmoid disease associated with familial adenomatous polyposis., Br J Surg, Vol: 93, Pages: 1258-1264, ISSN: 0007-1323
BACKGROUND: Desmoid tumours affect 10-25 per cent of patients with familial adenomatous polyposis and represent a major cause of morbidity and mortality. Surgery for intra-abdominal desmoids has traditionally been used as a last resort or to manage obstructive complications. The aim was to review 10 years of desmoid surgery in patients with familial adenomatous polyposis from a single centre. METHODS: Patients who had surgery for desmoid disease between 1994 and 2004 were identified from the Polyposis Registry database and their hospital notes reviewed. RESULTS: Twenty patients had surgery to remove 32 desmoid tumours (16 intra-abdominal, 12 abdominal wall, four extra-abdominal). Complete clearance was achieved in 19 tumours and, of these, clinically significant recurrence occurred in eight. There was no difference in recurrence rates for site or sex. There was no operative mortality. Intra-abdominal desmoid resection was associated with a mean resection of 45.55 (range 10-200) cm of small bowel. One patient required long-term parenteral feeding. Median follow-up was 5 (range 0.6-10) years. During this period, one patient died (metastatic duodenal cancer); there was no mortality from desmoid disease. CONCLUSION: Surgery for intra-abdominal desmoids in selected patients is less hazardous than previously reported. Surgery for abdominal wall and extra-abdominal tumours is safe. However, disease recurrence remains a major problem.
Monahan KJ, Volikos E, Phillips RK, et al., 2006, The genotype-phenotype relationship of polyposis families reveals clinically distinct subgroups, Digestive Disease Week Meeting/107th Annual Meeting of the American-Gastroenterlogical-Association, Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: 152-152, ISSN: 0016-5085
Aziz O, Athanasiou T, Fazio VW, et al., 2006, Meta-analysis of observational studies of ileorectal <i>versus</i> ileal pouch-anal anastomosis for familial adenomatous polyposis, BRITISH JOURNAL OF SURGERY, Vol: 93, Pages: 407-417, ISSN: 0007-1323
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- Citations: 129
Gallagher MC, Phillips RKS, Bulow S, 2006, Surveillance and management of upper gastrointestinal disease in Familial Adenomatous Polyposis., Fam Cancer, Vol: 5, Pages: 263-273, ISSN: 1389-9600
Almost all patients affected by Familial Adenomatous polyposis (FAP) will develop foregut as well as hindgut polyps, and following prophylactic colectomy duodenal cancer constitutes one of the leading causes of death in screened populations. Without prophylactic colectomy, FAP patients predictably develop colorectal cancer, but the lifetime risk of upper gastrointestinal cancer is lower, estimated at approximately 5%. Management of the upper gastrointestinal cancer risk is one of the greatest challenges facing clinicians involved in the care of Polyposis families, and with improved survival following prophylactic colectomy, the burden of foregut disease (particularly duodenal adenomatosis) will increase. Until recently, the value of upper gastrointestinal surveillance in FAP populations has been contentious, but with improved understanding of the natural history coupled with developments in surgery, interventional endoscopy and medical therapy, treatment algorithms for duodenal adenomatosis in FAP are becoming clearer.
Tekkis PP, Heriot AG, Von-Roon A, et al., 2005, Impact of technical factors on outcome of restorative proctocolectomy for familial adenomatous polyposis, Annual Meeting of the Association-of-Surgeons-of-Great-Britian-and-Ireland, Publisher: JOHN WILEY & SONS LTD, Pages: 120-120, ISSN: 0007-1323
Groves CJ, Beveridge LG, Swain DJ, et al., 2005, Prevalence and morphology of pouch and ileal adenomas in familial adenomatous polyposis., Dis Colon Rectum, Vol: 48, Pages: 816-823, ISSN: 0012-3706
PURPOSE: In familial adenomatous polyposis, the long-term risk of pouch polyposis and potential for pouch cancer are unknown. Our aim was to evaluate prospectively the prevalence, nature, and etiology of pouch ileal adenomas with that of nonpouch ileal adenomas in familial adenomatous polyposis. METHODS: Sixty patients with familial adenomatous polyposis pouch, 47 familial adenomatous polyposis patients with ileorectal anastomosis, and 20 younger patients with familial adenomatous polyposis who had prophylactic colectomy were examined with videoendoscopy. RESULTS: Adenomatous polyps were found in the pouches of 34 patients (57 percent). A total of 362 polyps were identified (range, 0-50 per patient). A logistic regression model confirmed that there was a significant association between the increasing age of the patient and the presence of pouch adenomas (P < 0.02) and the length of follow-up since pouch surgery (P < 0.05). There was no apparent relationship between the development of pouch adenomas and the severity of either colonic or duodenal polyposis and there were no clear genotype or phenotype correlations. Most polyps were tubular adenomas with mild dysplasia, but 11 patients had more advanced histology, including two patients with large villous adenomas. Nonpouch ileal mucosa was spared from visually observed adenomas, with only 1 of 48 (2 percent) patients with ileorectal anastomosis adenomas and 0 of 20 (0 percent) younger, precolectomy patients having terminal ileal adenomas. However, microadenomas were present on random biopsy in 4 percent to 5 percent of nonpouch ileum. CONCLUSION: The risk of pouch cancer in familial adenomatous polyposis is unclear, but follow-up periods since surgery remain relatively short. Long-term endoscopic surveillance of familial adenomatous polyposis pouches is thus recommended along with evaluation of potential therapeutic options for pouch adenomas.
Hearle NCM, Tomlinson I, Lim W, et al., 2005, Sequence changes in predicted promoter elements of <i>STK11/LKB1</i> are unlikely to contribute to Peutz-Jeghers syndrome -: art. no. 38, BMC GENOMICS, Vol: 6, ISSN: 1471-2164
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- Citations: 12
Tekkis PP, Heriot AG, Gallagher M, et al., 2005, Phenotypic factors can predict the risk of proctectomy after total colectomy and ileorectal anastomosis for patients with familial adenomatous polyposis (FAP) - A multifactorial model, Annual Meeting of the American-Society-of-Colon-and-Rectal-Surgeons, Publisher: SPRINGER, Pages: 613-613, ISSN: 0012-3706
Tekkis PP, Heriot AG, Von-Roon A, et al., 2005, Impact of technical factors on outcome of restorative proctocolectomy for familial adenomatous poylposis, Annual Meeting of the American-Society-of-Colon-and-Rectal-Surgeons, Publisher: SPRINGER, Pages: 656-656, ISSN: 0012-3706
Sturt NJH, Gallagher MC, Bassett P, et al., 2004, Evidence for genetic predisposition to desmoid tumours in familial adenomatous polyposis independent of the germline APC mutation., Gut, Vol: 53, Pages: 1832-1836, ISSN: 0017-5749
BACKGROUND: Many patients with familial adenomatous polyposis (FAP) die from desmoid tumours which can arise spontaneously but often appear to be surgically induced by prophylactic colectomy. FAP results from germline adenomatous polyposis coli (APC) gene mutations and desmoids arise following biallelic APC mutation, with one change usually occurring distal to the second beta-catenin binding/degradation repeat of the gene (3' to codon 1399). We have suggested that because families with germline mutations in this region already have the requisite change, they are more likely to develop desmoids. However, there are families with 5' germline mutations where desmoids are common. PATIENTS AND METHODS: We examined desmoid risk dependent on germline APC mutation, sex, history of abdominal surgery, and family history in FAP patients from the St Mark's Hospital Polyposis Registry. RESULTS: Overall desmoid prevalence was 15%. Desmoids tended to cluster in susceptible individuals, irrespective of the germline APC mutation. Independent predictors of increased desmoid risk were: germline mutation distal to codon 1399; any family history of disease; and a strong family history of desmoids. A family history of multiple desmoids (>1) increased an individual's own risk of multiplicity. Females had twice the odds of developing desmoids compared with males. There was no significant interaction between any of the three explanatory variables. CONCLUSIONS: Our results indicate the influence of unknown genetic factors independent of APC in susceptibility to desmoid tumours in FAP. The data have implications in terms of clinical management of FAP patients and assessing the balance between chemoprevention and prophylactic colectomy.
Lee J, Hargest R, Wasan H, et al., 2004, Liposome-mediated adenomatous polyposis coli gene therapy: A novel anti-adenoma strategy in multiple intestinal neoplasia mouse model, DISEASES OF THE COLON & RECTUM, Vol: 47, Pages: 2105-2113, ISSN: 0012-3706
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- Citations: 6
Taylor SA, Halligan S, Moore L, et al., 2004, Multidetector-row CT duodenography in familial adenomatous polyposis: a pilot study., Clin Radiol, Vol: 59, Pages: 939-945, ISSN: 0009-9260
AIM: To investigate the feasibility of using multidetector-row computed tomography (CT) duodenography to stage duodenal polyposis in patients with familial adenomatous polyposis. MATERIALS AND METHODS: Six patients underwent multidetector-row CT duodenography before upper gastrointestinal endoscopy. A single-blinded radiologist used a surface shaded three-dimensional endoluminal fly though and two-dimensional axial and multiplanar reformats to assign a score for maximum polyp size and number based on the Spigelman classification. Comparison was made with the corresponding Spigelman scores obtained from subsequent endoscopy. RESULTS: CT duodenography was technically successful in five of six patients. The CT derived Spigelman score based on maximum polyp size was accurate in all five patients. The CT derived Spigelman score based on polyp number was accurate in only two cases: Polyp number was overestimated in one patient and underestimated in a further two. In retrospect, fine carpeting of tiny duodenal polyps was poorly visualized with CT. CONCLUSIONS: CT duodenography is technically feasible and accurately predicts maximum polyp size but CT estimates of polyp number are relatively inaccurate. CT duodenography potentially has a useful role for duodenal surveillance in those patients intolerant of conventional endoscopy.
Ali IU, Chelius D, Umar A, et al., 2004, Search for celecoxib-modulated proteomic markers: Use of two-dimensional liquid chromatography and tandem mass spectrometry, MOLECULAR & CELLULAR PROTEOMICS, Vol: 3, Pages: S17-S17, ISSN: 1535-9476
O'Bichere A, Green C, Phillips RKS, 2004, Randomized cross-over trial of polyethylene glycol electrolyte solution and water for colostomy irrigation., Dis Colon Rectum, Vol: 47, Pages: 1506-1509, ISSN: 0012-3706
PURPOSE: Water for colostomy irrigation is largely absorbed by the colon, which may result in less efficient expulsion of stool. This study compared the outcome of colonic cleansing with water and polyethylene glycol solution. METHODS: In a cross-over study, 41 colostomy irrigators were randomly assigned to water or polyethylene glycol solution irrigation first and then the other regimen, each for one week. Patients recorded fluid inflow time, total washout time, cramps, leakage episodes, number of stoma pouches used, and satisfaction scores (Visual Analog Scale, 1-10: 1 = poor, and 10 = excellent). The median and interquartile range for each variable was calculated, and the two treatments were compared (Wilcoxon's test). RESULTS: Eight patients failed to complete the study. Thirty-three patients (20 females; mean age, 55 (range, 39-73) years) provided 352 irrigation sessions: water (n = 176), and polyethylene glycol solution (n = 176). Irrigation was performed every 24, 48, and 72 hours by 17, 9, and 7 patients respectively, using 500 ml (n = 1), 750 ml (n = 2), 1,000 ml (n = 16), 1,500 ml (n = 11), 2,000 ml (n = 2), and 3,500 ml (n = 1) of fluid. The median and interquartile range for water vs. polyethylene glycol solution were: fluid inflow time (6 (range, 4.4-10.8) vs. 6.3 (range, 4.1-11) minutes; P = 0.48), total washout time (53 (range, 33-69) vs. 38 (range, 28-55) minutes; P = 0.01), leakage episodes (2.3 (range, 1.7-3.8) vs. 0.7 (range, 0.2-1); P < 0.001), satisfaction score (5.8 (range, 4-7.5) vs. 8.8 (range, 8.3-10); P < 0.001), and stoma pouch usage per week (75 (range, 45-80) vs. 43 (range, 0-80); P = 0.008). No difference was demonstrated for frequency of cramps ( P = 0.24). CONCLUSIONS: Polyethylene glycol solution performed significantly better than water and may be a superior alternative fluid regimen for colostomy irrigation.
Gallagher MC, Shankar A, Groves CJ, et al., 2004, Pylorus-preserving pancreaticoduodenectomy for advanced duodenal disease in familial adenomatous polyposis., Br J Surg, Vol: 91, Pages: 1157-1164, ISSN: 0007-1323
BACKGROUND: Although only 5 per cent of patients with familial adenomatous polyposis (FAP) die from duodenal cancer, a recent study indicated that the mortality rate is much higher in patients with Spigelman stage IV disease. This has prompted an increased rate of referral for excisional surgery and an analysis of the results. METHODS: Between January 1994 and June 2002, 16 patients with FAP (mean age 55 years; eight men) were referred to a single surgeon for pylorus-preserving pancreaticoduodenal resection for Spigelman stage IV duodenal adenomatosis. RESULTS: One patient died from multiple organ failure after relaparotomy for haemorrhage and a jejunal perforation; other major complications included anastomotic leak (one), primary haemorrhage (one), lymphatic leak (one), chylous ascites (one), pulmonary embolus (two) and prolonged delayed gastric emptying that required total parenteral nutrition (three). Overall there were 11 major complications in eight patients. Two patients developed insulin-dependent diabetes and one postprandial dumping. Postoperative histological examination revealed five unsuspected cancers, which led to four deaths within 3 years of surgery. One patient died 2 months after surgery from pulmonary thromboembolism and another at 5 months from an inoperable brain tumour. Nine of the 16 patients were alive and well at a mean of 38 months after surgery. CONCLUSION: The choice between continued endoscopic surveillance and excisional surgery for Spigelman stage IV duodenal disease remains finely balanced.
Sturt NJH, Phillips RKS, Clark SK, 2004, High-dose tamoxifen and sulindac as first-line treatment for desmoid tumors, Cancer, Vol: 101, Pages: 652; author reply 653-652; author reply 653
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