Imperial College London

MissSueClark

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Practice (Colorectal Surgery)
 
 
 
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Contact

 

+44 (0)20 8235 4018sue.clark

 
 
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Location

 

St Marks HospitalNorthwick Park and St Marks Site

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Summary

 

Publications

Publication Type
Year
to

285 results found

Clark SK, 2022, Genetic Testing in Colorectal Surgery: Routine Profiling of Tumor Genomes is Not Far Off., Dis Colon Rectum, Vol: 65, Pages: 783-784

Journal article

Anele CC, Martin I, McGinty Duggan PM, Chauhan J, Clark SK, Faiz OD, Latchford ARet al., 2022, Attenuated Familial Adenomatous Polyposis: A Phenotypic Diagnosis but Obsolete Term?, Dis Colon Rectum, Vol: 65, Pages: 529-535

BACKGROUND: Attenuated familial adenomatous polyposis is characterised by low number (≤100) and delayed development of colorectal adenomas. Various definitions have been used, and genotype-phenotype correlations have been suggested. OBJECTIVE: We aimed to evaluate phenotypic and genotypic correlation in patients with presumed attenuated familial adenomatous polyposis and assess familial variability. DESIGN: This is a retrospective study. SETTINGS: This study was conducted at a tertiary polyposis registry. PATIENTS: Individuals with attenuated familial adenomatous polyposis were identified. Phenotypic group was defined as 100 or fewer adenomas at age 25 years and genotypic group was defined as a variant in the adenomatous polyposis coli region associated with attenuated familial adenomatous polyposis. Pathology polyp count was used for patients who had undergone surgery and endoscopic polyp count for those with intact colon. MAIN OUTCOME MEASURES: We evaluated phenotypic and genotypic correlation in patients with presumed attenuated familial adenomatous polyposis and familial variability. RESULTS: A total of 69 patients were identified in the phenotypic group, of whom 54 (78%) had a pathogenic variant in the attenuated regions of the adenomatous polyposis coli gene. Forty-eight (70%) had intact colon (median age at last colonoscopy 43 [25-73] years; median endoscopic polyp count 20 [0-100]) and 21 (30%) had undergone colectomy (median age at surgery 45 [25-54] years; median pathology polyp count 43 [3-100]). Eighty-three patients were identified in the genotypic group of which 54 (65%) had attenuated phenotype. Inter- and intrafamilial variability were observed. LIMITATIONS: This study was limited by its retrospective nature and single-center experience. CONCLUSION: Phenotype in familial adenomatous polyposis lies on a spectrum and is determined in part by genotype and age at adenoma count. Diagnosis of attenuated familial adenomatous polyposis should be based on

Journal article

Noble A, Durant L, Dilke SM, Man R, Martin I, Patel R, Hoyles L, Pring ET, Latchford A, Clark SK, Carding SR, Knight SCet al., 2022, Altered mucosal immune-microbiota interactions in familial adenomatous polyposis., Clin Transl Gastroenterol

INTRODUCTION: Familial adenomatous polyposis (FAP) is a condition caused by a constitutional pathogenic variant of the adenomatous polyposis coli (APC) gene that results in intestinal adenoma formation and colorectal cancer (CRC), necessitating pre-emptive colectomy. We sought to examine interaction between the mucosal immune system and commensal bacteria in FAP to test for immune dysfunction that might accelerate tumorigenesis. METHODS: Colonic biopsies were obtained from macroscopically normal mucosal tissue from 14 healthy donors and 13 patients with FAP during endoscopy or from surgical specimens. Intraepithelial and lamina propria lymphocytes were phenotyped. Intraepithelial microbes were labelled with anti-IgA/IgG and analyzed by flow cytometry. RESULTS: Proportions of resident memory CD103-expressing CD8+ and γδ T cell receptor+ intraepithelial lymphocytes were dramatically reduced in both left and right colon of patients with FAP compared to healthy controls. In lamina propria, T-cells expressed less CD103 and CD4+ CD103+ cells expressed less CD73 ectonucleotidase. IgA coating of epithelia-associated bacteria, IgA+ peripheral B cells and CD4 T-cell memory responses to commensal bacteria were increased in FAP. DISCUSSION: Loss of resident memory T-cells and γδ T-cells in mucosal tissue of patients with FAP accompanies intestinal microbial dysbiosis previously reported in this pre-cancerous state and suggests impaired cellular immunity and tumor surveillance. This may lead to barrier dysfunction, possible loss of regulatory T-cell function and excess IgA antibody secretion. Our data are the first to implicate mucosal immune dysfunction as a contributing factor in this genetically driven disease and identify potentially critical pathways in the etiology of CRC.

Journal article

Anele CC, Xiang J, Martin I, Hawkins M, Man R, Clark SK, Faiz OD, Latchford Aet al., 2021, Regular endoscopic surveillance and polypectomy is effective in managing rectal adenoma progression following colectomy and ileorectal anastomosis in patients with familial adenomatous polyposis, COLORECTAL DISEASE, Vol: 24, Pages: 277-283, ISSN: 1462-8910

Journal article

Mak S, Latchford A, Hawkins M, Cuthill V, Thomas H, Clark S, Monahan Ket al., 2021, DIAGNOSTIC YIELD OF CONSTITUTIONAL GENETIC TESTING IN PATIENTS WITH MULTIPLE COLORECTAL ADENOMAS (MCRA), Publisher: BMJ PUBLISHING GROUP, Pages: A16-A17, ISSN: 0017-5749

Conference paper

Patel R, McGinty P, Cuthill V, Hawkins M, Clark SK, Latchford Aet al., 2021, Risk of colorectal adenomas and cancer in monoallelic carriers of MUTYH pathogenic variants: a single-centre experience, INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, Vol: 36, Pages: 2199-2204, ISSN: 0179-1958

Journal article

Patel R, Reza L, Worley GHT, Allison L, Evans S, Antoniou A, Jenkins JT, Faiz OD, Corr A, Clark SK, von Roon A, Latchford Aet al., 2021, Presentation, management and outcomes of ileoanal pouch cancer: a single-centre experience, COLORECTAL DISEASE, Vol: 23, Pages: 2041-2051, ISSN: 1462-8910

Journal article

Worley G, Burling D, Corr A, Clark S, Baldwin-Cleland R, Faiz O, Jenkins Jet al., 2021, MRI-enema for the assessment of pelvic intestinal anastomotic integrity, COLORECTAL DISEASE, Vol: 23, Pages: 1890-1899, ISSN: 1462-8910

Journal article

Palles C, Martin L, Domingo E, Chegwidden L, McGuire J, Cuthill V, Heitzer E, Kerr R, Kerr D, Kearsey S, Clark SK, Tomlinson I, Latchford Aet al., 2021, The clinical features of polymerase proof-reading associated polyposis (PPAP) and recommendations for patient management, FAMILIAL CANCER, Vol: 21, Pages: 197-209, ISSN: 1389-9600

Journal article

Martin I, Wu Y, Patel R, Kalra P, Clark SK, von Roon A, Latchford A, Moore JGet al., 2021, A NOVEL BOWEL DISEASE MODEL: PHENOTYPIC DIVERSITY OF CONTROL VS FAP ORGANOIDS, Publisher: OXFORD UNIV PRESS, Pages: 8-8, ISSN: 0007-1323

Conference paper

Deputy M, Segal J, Reza L, Worley G, Costello S, Burns E, Faiz O, Clark S, Hart Aet al., 2021, The pouch behaving badly: management of morbidity after ileal pouch-anal anastomosis, COLORECTAL DISEASE, Vol: 23, Pages: 1193-1204, ISSN: 1462-8910

Journal article

McDermott FD, Newton K, Beggs AD, Clark SKet al., 2021, Implications for the colorectal surgeon following the 100 000 Genomes Project, COLORECTAL DISEASE, Vol: 23, Pages: 1049-1058, ISSN: 1462-8910

Journal article

Thomas LE, Hurley JJ, Sanchez AA, Aznarez MR, Backman A-S, Bjork J, Capella G, Clark SK, Colas C, Dekker E, Dolwani S, Ghorbanoghli Z, Gonn M, Romero SG, Hes FJ, Jundi H, Kelland S, Latchford AR, Brito HL, Lynch PM, Meuser E, Mork ME, Mort M, Garcia MN, Nielsen M, Parc Y, Ricci MT, Saurin J-C, van der Tuin K, Vasen H, Vilar E, Vinet O, Vitellaro M, Walton S-J, West HD, Sampson JRet al., 2021, Duodenal Adenomas and Cancer in MUTYH-associated Polyposis: An International Cohort Study, GASTROENTEROLOGY, Vol: 160, Pages: 952-+, ISSN: 0016-5085

Journal article

Segal JP, Askari A, Clark SK, Hart AL, Faiz ODet al., 2021, The Incidence and Prevalence of Human Papilloma Virus-associated Cancers in IBD, INFLAMMATORY BOWEL DISEASES, Vol: 27, Pages: 34-39, ISSN: 1078-0998

Journal article

Anele CC, Xiang J, Martin I, Hawkins M, Clark SK, Faiz OD, Latchford A, Hyer Wet al., 2020, Polyp Progression in Paediatric Patients With Familial Adenomatous Polyposis: A Single-centre Experience., J Pediatr Gastroenterol Nutr, Vol: 71, Pages: 612-616

OBJECTIVES: Prophylactic colectomy at a premalignant stage is the cornerstone of management of familial adenomatous polyposis (FAP). Before surgery, colonoscopy surveillance is recommended in children with FAP. This study aimed to examine the natural history of FAP in children by evaluating adenoma progression and factors influencing timing of colectomy. METHOD: Patients with FAP younger than 18 years at first surveillance colonoscopy and who had undergone more than 1 colonoscopy were identified. Demographic, endoscopic, genetic, and surgical data were retrieved. Cumulative adenoma (polyp) counts were obtained while accounting for any polypectomies during the study period. The rate of polyp progression and factors influencing the timing of colectomy were evaluated. RESULTS: Eighty-four patients (50% boys; mean age at first colonoscopy 13 years [standard deviation 1.97]) were identified, of which 83 had a family history of FAP. At first colonoscopy, 67 (79%) had <100 adenomas and 29 (35%) had colonic polyps identified despite rectal sparing. The median rate of polyp progression per patient was 12.5 polyps/year (range 0-145). Of the 45 (54%) patients who had undergone surgery, 41 (91%) underwent colectomy with ileorectal or ileodistal sigmoid anastomosis. Polyp progression did not alter the choice of surgical intervention in any patient. CONCLUSION: Our results suggest that adenoma number remains relatively stable in the majority of children under surveillance. Tailored surveillance intervals according to phenotype are a more appropriate strategy as recommended by recently published guidelines.

Journal article

Sehmbhi M, Sellers P, Segal J, Clark Set al., 2020, Interesting case of dual pathology: Crohn's disease and Peutz-Jeghers syndrome, BMJ CASE REPORTS, Vol: 13

Journal article

ACPGBI Legacy Working Group, 2020, Legacy of COVID-19 - the opportunity to enhance surgical services for patients with colorectal disease., Colorectal Dis, Vol: 22, Pages: 1219-1228

Journal article

Martin I, Roos VH, Anele C, Walton S-J, Cuthill V, Suzuki N, Bastiaansen BA, Clark SK, von Roon A, Dekker E, Latchford Aet al., 2020, Gastric adenomas and their management in familial adenomatous polyposis, ENDOSCOPY, Vol: 53, Pages: 795-801, ISSN: 0013-726X

Journal article

Segal JP, Askari A, Clark SK, Hart AL, Faiz ODet al., 2020, HPV-related Cancers in Inflammatory Bowel Disease: Association Not Yet Causation, INFLAMMATORY BOWEL DISEASES, Vol: 26, Pages: E102-E102, ISSN: 1078-0998

Journal article

Anele CC, Xiang J, Martin I, Hawkins M, Clark SK, Faiz OD, Latchford A, Hyer Wet al., 2020, Polyp Progression in Paediatric Patients with Familial Adenomatous Polyposis - A Single Centre Experience., Journal of Pediatric Gastroenterology and Nutrition, ISSN: 0277-2116

OBJECTIVES: Prophylactic colectomy at a premalignant stage is the cornerstone of management of familial adenomatous polyposis (FAP). Prior to surgery, colonoscopy surveillance is recommended in children with FAP. This study aimed to examine the natural history of FAP in children by evaluating adenoma progression and factors influencing timing of colectomy. METHOD: Patients with FAP under the age of 18 years at first surveillance colonoscopy and who had undergone more than one colonoscopy were identified. Demographic, endoscopic, genetic and surgical data were retrieved. Cumulative adenoma (polyp) counts were obtained whilst accounting for any polypectomies during the study period. The rate of polyp progression and factors influencing the timing of colectomy.were evaluated. RESULTS: Eighty-four patients (50% male; mean age at first colonoscopy 13 years [SD 1.97]) were identified, of which 83 had a family history of FAP. At first colonoscopy, 67 (79%) had <100 adenomas and 29 (35%) had colonic polyps identified despite rectal sparing. The median rate of polyp progression per patient was 12.5 polyps/year (range 0-145). Of the 45 (54%) patients who had undergone surgery, 41 (91%) underwent colectomy with ileorectal or ileodistal sigmoid anastomosis. Polyp progression did not alter the choice of surgical intervention in any patient. CONCLUSION: Our results suggest that adenoma number remains relatively stable in the majority of children under surveillance. Tailored surveillance intervals according to phenotype are a more appropriate strategy as recommended by recently published guidelines.

Journal article

Patel R, McGinty P, Cuthill V, Hawkins M, Moorghen M, Clark SK, Latchford Aet al., 2020, MUTYH-associated polyposis - colorectal phenotype and management, COLORECTAL DISEASE, Vol: 22, Pages: 1271-1278, ISSN: 1462-8910

Journal article

Reza LM, Lung PFC, Lightner AL, Hart AL, Clark SK, Tozer PJet al., 2020, Perianal fistula and the ileoanal pouch - different aetiologies require distinct evaluation, COLORECTAL DISEASE, Vol: 22, Pages: 1436-1439, ISSN: 1462-8910

Journal article

Latchford AR, Maeda Y, Clark SK, 2020, Nonsteroidal anti-inflammatory drugs (NSAID) and aspirin for preventing colorectal adenomas and carcinomas in patients with previous adenomas and/or genetic disposition, Cochrane Database of Systematic Reviews, Vol: 2020

This protocol for a Cochrane Review has been withdrawn.
 
 Reason for withdrawal: Authors have made no progress with this protocol in 3 years. New authors are being sought to take over this protocol.
 
 The protocol is being withdrawn by Kristoffer Andresen, Managing Editor - Cochrane Colorectal Group. The authors have agreed to the withdrawal.

Journal article

Latchford AR, Maeda Y, Clark SK, 2020, Nonsteroidal anti-inflammatory drugs (NSAID) and aspirin for preventing colorectal adenomas and carcinomas in general population, Cochrane Database of Systematic Reviews, Vol: 2020

This protocol for a Cochrane Review has been withdrawn.
 
 Reason for withdrawal: Authors have made no progress with this protocol in 3 years. New authors are being sought to take over this protocol.
 
 The protocol is being withdrawn by Kristoffer Andresen, Managing Editor - Cochrane Colorectal Group. The authors have agreed to the withdrawal.

Journal article

Latchford AR, Maeda Y, Clark SK, 2020, Nonsteroidal anti-inflammatory drugs (NSAID) and aspirin for preventing recurrence and metachronous colorectal carcinomas in patients previously treated for colorectal cancer, Cochrane Database of Systematic Reviews, Vol: 2020

This protocol for a Cochrane Review has been withdrawn.
 
 Reason for withdrawal: Authors have made no progress with this protocol in 3 years. New authors are being sought to take over this protocol.
 
 The protocol is being withdrawn by Kristoffer Andresen, Managing Editor - Cochrane Colorectal Group. The authors have agreed to the withdrawal.

Journal article

Segal J, Mullish B, Clark S, Marchesi J, Hart Aet al., 2020, P844 Higher proportions of genera and species in the Firmicutes phylum are associated with a healthy pouch compared with patients with chronic pouchitis, Journal of Crohn's and Colitis, Vol: 14, Pages: S652-S652, ISSN: 1873-9946

BackgroundStudies highlighting changes in bacterial composition in the ileoanal pouch are limited by heterogeneity in analysis techniques and sampling strategies Therefore, caution must be used when interpreting microbiota data. Similar to findings in IBD, a decrease in bacterial diversity and ‘dysbiosis’ are associated with acute and chronic inflammation in the pouch. Changes in Clostridium spp. and E. coli are associated with inflamed pouches and treatment response. This study aimed to compare the bacterial microbiota composition in patients with chronic pouchitis who responded to antibiotics vs. those who did not.MethodsPatients with confirmed chronic pouchitis defined by a pouch disease activity score ≥ 7 were treated with antibiotics. If patients were already on antibiotics, they were offered the opportunity to stop. Follow up was at 4 weeks to check clinical status. Patients who came off antibiotics who flared were given the opportunity to restart the antibiotics to prevent deterioration. Patients were analysed as either on antibiotics if they received antibiotics 2 weeks prior to the clinic or off antibiotics if they had stopped all antibiotics 2 weeks prior to follow-up. Stool was collected from patients on follow-up and DNA was extracted from this stool. Sequencing was performed on an Illumina platform. Statistical analysis was performed using STAMP 2.1.3 software with Welch’s two-sided t-test for comparing two groups with false discovery rate correction.ResultsThere were 28 patients in the cohort; 23 patients with chronic pouchitis and 5 healthy controls who had never had pouchitis. Ten patients were female. The median age of the cohort was 47 years (range 26–74 years). A total of 12 samples on antibiotics and 11 off antibiotics. There were 10 responders and 13 non-responders. There were no differences between responders and non-responders and no differences in those taking antibiotics vs. those not taking antibiotics with chroni

Journal article

Martin I, Hawkins J, Hyer W, Attard T, Cohen S, Spigelman A, Clark SK, Latchford Aet al., 2020, Upper GI in patients with FAP-the need for formal research, GASTROINTESTINAL ENDOSCOPY, Vol: 91, Pages: 206-207, ISSN: 0016-5107

Journal article

Reza L, Van Praag E, Iqbal N, Twum-Barima C, Hart A, Clark S, Tozer Pet al., 2020, Management of pouch vaginal fistulae in ulcerative colitis: A 35-year experience, Publisher: OXFORD UNIV PRESS, Pages: S367-S368, ISSN: 1873-9946

Conference paper

de Jong GM, Clark SK, 2019, The St Mark's retractor., Br J Surg, Vol: 106

Journal article

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