Publications
289 results found
Segal J, Mullish B, Clark S, et 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
Martin I, Hawkins J, Hyer W, et al., 2020, Upper GI in patients with FAP-the need for formal research, GASTROINTESTINAL ENDOSCOPY, Vol: 91, Pages: 206-207, ISSN: 0016-5107
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- Citations: 1
Reza L, Van Praag E, Iqbal N, et al., 2020, Management of pouch vaginal fistulae in ulcerative colitis: A 35-year experience, Publisher: OXFORD UNIV PRESS, Pages: S367-S368, ISSN: 1873-9946
de Jong GM, Clark SK, 2019, The St Mark's retractor., Br J Surg, Vol: 106
Labib PL, Goodchild G, Turbett JP, et al., 2019, Endoscopic ultrasound in the assessment of advanced duodenal adenomatosis in familial adenomatous polyposis, BMJ Open Gastroenterology, Vol: 6, ISSN: 2054-4774
Objective: Current surveillance strategies for duodenal adenomatosis in familial adenomatous polyposis (FAP) miss malignancies and underestimate cancer risk in ampullary disease. This study aimed to evaluate the utility of endoscopic ultrasound (EUS) in the assessment of FAP patients with duodenal and/or ampullary polyposis referred for surgical intervention. Design: A retrospective analysis of FAP patients undergoing index EUS between December 2006 and May 2015 was performed. Follow-up was completed in January 2018, including review of all EUS procedures and surgical interventions (median follow-up 6 years). Results: Fifty-five patients underwent 188 EUS procedures. Six patients (11%) developed malignancy (three duodenal, three ampullary). Ampullary cancer risk was underestimated by Spigelman stage and overestimated by Kashiwagi classification. Ultrasound findings were poor predictors of malignancy, with common bile duct dilatation being the only finding present in one EUS prior to a diagnosis of ampullary cancer. The best predictors of ampullary malignancy were an ampullary polyp size >3 cm and an increase >1 cm in ampullary polyp size. Ampullary polyp size >3 cm provided the best predictive value, correctly identifying two of the three cases of ampullary cancer and both patients with high-grade dysplasia. EUS biopsy failed to detect malignancy later confirmed by surgical histology in two patients. Conclusion: EUS surveillance confers little additional benefit to standard endoscopic surveillance in FAP patients. The best predictor of ampullary malignancy is an ampullary polyp >3 cm; this could be regarded as a relative indication for surgery.
Segal J, Sarafian M, Contreras IJS, et al., 2019, URINARY FORMATE AND GLYCINE ARE ASSOCIATED WITH TREATMENT RESPONSE IN PATIENTS TREATED WITH ANTIBIOTICS FOR POUCHITIS, International Digestive Disease Forum (IDDF), Publisher: BMJ PUBLISHING GROUP, Pages: A9-A10, ISSN: 0017-5749
Segal J, Sarafian M, Pechlivanis A, et al., 2019, MUCOSAL TISSUE SHORT CHAIN FATTY ACIDS CONTRIBUTE TO PREDICTION OF POUCHITIS IN RESTORATIVE PROCTOCOLECTOMY, Annual Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, Pages: A93-A93, ISSN: 0017-5749
Clark SK, 2019, Management of genetically determined colorectal cancer, SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 17, Pages: 165-171, ISSN: 1479-666X
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- Citations: 10
Vallance AE, Harji D, Fearnhead NS, et al., 2019, Making an IMPACT: A priority setting consultation exercise to improve outcomes in patients with locally advanced, recurrent and metastatic colorectal cancer, European Journal of Surgical Oncology, ISSN: 0748-7983
Clark S, 2019, The future-what will it look like and how do we get there?, Colorectal Dis, Vol: 21
Worley GHT, Patsouras D, Sahnan K, et al., 2019, Ileal Pouch Excision: A Contemporary Observational Cohort, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 454-462, ISSN: 0012-3706
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- Citations: 15
Segal J, Sarafian M, Contreras JIS, et al., 2019, Plasma acetic acid, propanoic acid, and isobutyric acid are associated with treatment response in pouchitis patients treated with antibiotics, Publisher: OXFORD UNIV PRESS, Pages: S97-S98, ISSN: 1873-9946
Segal J, Sarafian M, Contreras JIS, et al., 2019, Urinary formate and glycine are associated with treatment response in patients treated with antibiotics for pouchitis, Publisher: OXFORD UNIV PRESS, Pages: S129-S129, ISSN: 1873-9946
Segal J, Sarafian M, Contreras JIS, et al., 2019, Mucosal tissue short chain fatty acids contribute to prediction of pouchitis in restorative proctocolectomy, Publisher: OXFORD UNIV PRESS, Pages: S124-S124, ISSN: 1873-9946
Worley GHT, Preston S, Clark SK, 2019, Ileoanal pouch excision - a video vignette., Colorectal Dis, Vol: 21
Segal JP, Leo CA, Hodgkinson JD, et al., 2019, Acceptability, effectiveness and safety of a Renew® anal insert in patients who have undergone restorative proctocolectomy with ileal pouch anal anastomosis, Colorectal Disease, Vol: 21, Pages: 73-78, ISSN: 1462-8910
IntroductionRestorative proctocolectomy has gained acceptance in the surgical management of medically refractive ulcerative colitis and cancer prevention in familial adenomatous polyposis. Incontinence following restorative proctocolectomy occurs in up to 25% of patients overnight. The Renew® insert is an inert single‐use device which acts as an anal plug. The aim of this study was to assess the acceptability, effectiveness and safety of the Renew® insert in patients who have undergone restorative proctocolectomy. The device has yet to be assessed in patients who have undergone restorative proctocolectomy.MethodThis was a prospective study exploring the acceptability, effectiveness and safety of the Renew® insert in improving incontinence in patients who had undergone restorative proctocolectomy. A total of 15 patients with incontinence were asked to use the Renew® insert for 14 days following their standard care. The Incontinence Questionnaire–Bowels was used pre‐ and posttreatment to assess response and patients were asked to report the perceived acceptability, effectiveness and safety of the device at the end of the trial.ResultsThe device was acceptable to 8/15 (53%) of patients and was effective in 6/15 (40%). Only 2/15 (13%) of patients raised any safety concerns, and these were minor. The device was associated with a significant reduction in night seepage (P = 0.034).ConclusionIn a small study, the Renew® insert can be both acceptable and effective and is also associated with few safety concerns. It is also associated with significant reductions in night‐time seepage.
Oke SM, Segal J, Clark SK, et al., 2019, Indications and outcomes of home parenteral nutrition in patients with an ileoanal pouch, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 101, Pages: 17-20, ISSN: 0035-8843
Segal J, Rottoli M, Felwick R, et al., 2018, Biological therapy for the treatment of pre-pouch ileitis: a retrospective observational study from three centres, Clinical and Experimental Gastroenterology, Vol: 11, Pages: 461-465, ISSN: 1178-7023
Aim: Prepouch ileitis (PPI) is inflammation of the ileum proximal to an ileoanal pouch, usually associated with pouchitis. The treatment of PPI as a specific entity has been poorly studied, but it is generally treated concurrently with pouchitis. This to our knowledge is the largest study to explore the efficacy of biologics for the specific treatment of PPI.Methods: This was a retrospective observational study reporting outcomes following biological treatment in patients with PPI across three centers. Data were collected between January 2004 and February 2018 from two centers in the UK and one center in Italy. Outcomes included the continued presence of PPI following biologic therapy, pouch failure defined by the need for an ileostomy, and remission of PPI defined by the absence of any prepouch inflammation on endoscopic assessment within a year of biologic therapy.Results: There were 29 patients in our cohort. On last endoscopic follow-up, 20/29 still had endoscopic evidence of PPI, seven had achieved endoscopic remission and avoided an ileostomy, and two had no endoscopic follow-up. In our cohort 11 patients had an ileostomy after a median time from starting a biologic of 25 months (range 14–91).Conclusion: Biologics fail to induce endoscopic remission of PPI in the majority of patients. Just under one-third patients with PPI coexistent with pouchitis can achieve endoscopic remission with biologics. In a large proportion of patients with PPI, surgery may be required despite biologic use.
Sinha A, Burns EM, Latchford A, et al., 2018, Risk of desmoid formation after laparoscopic versus open colectomy and ileorectal anastomosis for familial adenomatous polyposis, BJS Open, Vol: 2, Pages: 452-455, ISSN: 2474-9842
Background: Laparoscopy is used increasingly in prophylactic surgery for patients with familial adenomatous polyposis (FAP) undergoing colectomy with ileorectal anastomosis (IRA). Little is known about the impact of laparoscopy on subsequent desmoid risk. This study documented the risk of desmoid in patients undergoing laparoscopic and open IRA. Methods: This was an observational study of patients with FAP and known germline APC mutation, undergoing IRA at a tertiary referral centre between 1996 and 2016. Patients were retrieved from a prospectively maintained polyposis registry. Data included genotype, family history of desmoid, sex, surgical approach at IRA and postoperative complications. The main outcome was development of either a clinically or radiologically significant desmoid. Results: Some 112 patients (61 female) underwent colectomy and IRA. A laparoscopic approach was used in 69 patients (61·6 per cent). Baseline characteristics did not differ between patients having an open or laparoscopic approach. Median follow-up was 5·8 (i.q.r. 2·4-11·2) years. Patients who underwent laparoscopic IRA had a reduced risk of desmoid formation (3 of 69 (4 per cent) versus 7 of 43 (16 per cent) in the open group; P = 0·043). Discussion: Laparoscopic IRA may reduce risk of subsequent desmoid formation in patients with FAP.
Brown SR, Fearnhead NS, Faiz OD, et al., 2018, The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease, COLORECTAL DISEASE, Vol: 20, Pages: 3-117, ISSN: 1462-8910
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- Citations: 42
Anele CC, Latchford A, Faiz O, et al., 2018, Letter to the editor, FAMILIAL CANCER, Vol: 17, Pages: 565-566, ISSN: 1389-9600
Walton SJ, Malietzis G, Clark SK, et al., 2018, Urological sequelae of desmoids associated with familial adenomatous polyposis, FAMILIAL CANCER, Vol: 17, Pages: 525-530, ISSN: 1389-9600
Hurley JJ, Thomas LE, Walton S-J, et al., 2018, The impact of chromoendoscopy for surveillance of the duodenum in patients with MUTYH-associated polyposis and familial adenomatous polyposis, Gastrointestinal Endoscopy, Vol: 88, Pages: 665-673, ISSN: 0016-5107
BACKGROUND AND AIMS: Duodenal polyposis and cancer have become a key issue for patients with familial adenomatous polyposis (FAP) and MUTYH-associated polyposis (MAP). Almost all patients with FAP will develop duodenal adenomas, with 5% developing cancer. The incidence of duodenal adenomas in MAP appears to be lower than in FAP but the limited available data suggest a comparable increase in the relative risk and lifetime risk of duodenal cancer. Current surveillance recommendations, however, are the same for FAP and MAP, using the Spigelman score--incorporating polyp number, size, dysplasia, and histology--for risk stratification and determination of surveillance intervals. Previous studies have demonstrated a benefit of enhanced detection rates of adenomas by use of chromoendoscopy both in sporadic colorectal disease and in groups at high risk of colorectal cancer. We aimed to assess the effect of chromoendoscopy on duodenal adenoma detection, to determine the impact on Spigelman stage and to compare this in individuals with known pathogenic mutations in order to determine the difference in duodenal involvement between MAP and FAP. METHODS: A prospective study examined the impact of chromoendoscopy on the assessment of the duodenum in 51 consecutive patients with MAP and FAP in 2 academic centers in the United Kingdom (University Hospital Llandough, Cardiff and St Mark's Hospital, London) from 2011 to 2014. RESULTS: Enhanced adenoma detection of 3 times the number of adenomas after chromoendoscopy was demonstrated in both MAP (p=0.013) and FAP (p=0.002), but did not affect adenoma size. In both conditions, there was a significant increase in Spigelman stage after chromoendoscopy compared with endoscopy without dye spray. Spigelman scores and overall adenoma detection was significantly lower in MAP compared with FAP. CONCLUSIONS: Chromoendoscopy improved the diagnostic yield of adenomas in MAP and FAP 3-fold, and in both MAP and FAP this resulted in a clinically sig
Segal J, Penez L, Mohsen S, et al., 2018, Long term outcomes of initial Infliximab therapy for inflammatory pouch pathology: a multi-centre retrospective study, Scandinavian Journal of Gastroenterology, Vol: 53, Pages: 1051--1058, ISSN: 0036-5521
Background: Restorative proctocolectomy with ileal pouch-anal anastomosis is considered the procedure of choice in patients with ulcerative colitis refractory to medical therapy. Subsequent inflammation of the pouch is a common complication and in some cases pouchitis fails to respond to antibiotics, the mainstay of treatment. In such cases, corticosteroids, immunomodulatory or biologic treatments are options. However, our understanding of the efficacy of anti-tumour necrosis factor medications in both chronic pouchitis and Crohn’s-like inflammation are based on studies that include relatively small numbers of patients. Methods: This was an observational, retrospective, multi-centre study to assess the long-term effectiveness and safety of infliximab for inflammatory disorders related to the ileoanal pouch. The primary outcome was the development of infliximab failure defined by early failure to infliximab or secondary loss of response to infliximab. Results: Thirty-four patients met the inclusion criteria; 18/34 (53%) who were initiated on infliximab for inflammatory disorders of the pouch had infliximab failure, 3/34 (8%) had early failure, and 15/34 (44%) had secondary loss of response with a median follow-up of 280 days (range 3-47 months). In total, 24/34 (71%) avoided an ileostomy by switching to other medical therapies at a median follow-up of follow-up of 366 days (1-130 months). Conclusions:Initial infliximab therapy for pouch inflammatory conditions is associated with Infliximab failure in just over half of all patients. Despite a high failure rate, an ileostomy can be avoided in almost three quarters of patients at four years by using other medical therapies.
Van Der Ploeg VA, Maeda Y, Faiz OD, et al., 2018, Standardising assessment and documentation of pouchoscopy, Frontline Gastroenterology, Vol: 9, Pages: 309-314, ISSN: 2041-4137
Background/aims: Variation in quality of reporting on endoscopic procedures is a common clinical problem. Findings are not documented in a standardised manner and there is a tendency towards reporting abnormal findings only. This study aimed to review quality of flexible pouchoscopy reports and to develop a standardised reporting template. Methods: Ileo-anal-pouch experts (n=5) compiled a list of items that should be documented at flexible pouchoscopy. Reports were reviewed retrospectively for their completeness compared with the template. The template was then introduced and quality of reports was analysed prospectively. Results: One hundred and twenty-one reports produced between March 2015 and June 2015 were reviewed. Between August 2015 and November 2015, the template was introduced and reports were analysed. There was significant improvement in documentation of anus and perianal area (before template (B) 12% to after template (A) 51%, p<0.0001), rectal cuff (B: 55% to A: 75%, p=0.01), pouch-anal anastomosis (B: 37% to A: 67%, p=0.0002) and pouch inlet (B: 13% to A: 41%, p<0.0001). Pouch body was described in high percentage regardless of introduction of the template (B: 98% to A: 97%, p=0.61). Conclusions: Documentation of pouchoscopy findings was suboptimal and introduction of a template improved documentation of flexible pouchoscopy significantly.
Worley GHT, Segal JP, Warusavitarne J, et al., 2018, Management of early pouch-related septic complications in ulcerative colitis: a systematic review, Colorectal Disease, Vol: 20, Pages: O181-O189, ISSN: 1462-8910
AIM: It is well established that ileo-anal pouch-related septic complications (PRSC) increase the risk of pouch failure. There are a number of publications that describe the management of early PRSC in ulcerative colitis (UC) in small series. This article aims to systematically review and summarize the relevant current data on this subject and provide an algorithm for the management of early PRSC. METHOD: A systematic review was undertaken in accordance with PRISMA guidelines. Studies published between 2000 and 2017 describing the clinical management of PRSC in patients with UC within 30 days of primary ileo-anal pouch surgery were included. A qualitative analysis was undertaken due to the heterogeneity and quality of studies included. RESULTS: A total of 1157 abstracts and 266 full text articles were screened. Twelve studies were included for analysis involving a total of 207 patients. The studies described a range of techniques including image-guided, endoscopic, surgical and endocavitational vacuum methods. Based on the evidence from these studies, an algorithm was created to guide the management of early PRSC. CONCLUSION: The results of this review suggest that although successful salvage of early PRSC is improving there is little information available relating to methods of salvage and outcomes. Novel techniques may offer an increased chance of salvage but comparative studies with longer follow-up are required.
Santorelli C, Hollingshead J, Clark SK, 2018, Clinical value of pouchogram prior to ileostomy closure after ileal pouch anal anastomosis, Techniques in Coloproctology, Vol: 22, Pages: 541-544, ISSN: 1123-6337
BACKGROUND: In patients who undergo restorative proctocoletomy (RPC) a pouchogram is often used to assess the integrity of the ileal pouch-anal anastomosis (IPAA) before closing the covering ileostomy. There are no good data to support this practice. The aim of the study was to investigate whether contrast pouchography was clinically useful after RPC. METHODS: We conducted a retrospective study of patients who had undergone RPC with a covering ileostomy between September 2013 and September 2015. RESULTS: 61 patients were included. 7 (11%) presented with anastomotic leak and 2 (3%) with pelvic collection, detected on cross-sectional imaging for early postoperative symptoms. In the remaining 52 patients, without immediate postoperative complications, pouchography was performed at a median of 14 weeks (range 7-71 weeks) after RPC. Each patient also underwent examination under anaesthesia (EUA) to assess the integrity of the IPAA on the day of the ileostomy closure. One asymptomatic patient (2%) had an anastomotic leak demonstrated on pouchogram which was subsequently confirmed at EUA. Two patients (3%) with a normal pouchogram, 1 symptomatic and 1 asymptomatic, subsequently had an anastomotic leak demonstrated at EUA. CONCLUSIONS: Pouchogram has a low sensitivity in identifying anastomotic leak before ileostomy reversal in patients after RPC and only rarely changes management. In our series it identified the diagnosis of anastomotic leak in only 1 patient and gave false reassurance in two others. Complications are more frequently detected by clinical history and formal EUA before ileostomy closure.
Segal J, Penez L, Elkady SM, et al., 2018, PWE-052 Long term outcomes of initial IFX therapy for inflammatory pouch pathology: a multi-centre retrospective study, British Society of Gastroenterology, Annual General Meeting, Publisher: BMJ Publishing Group, Pages: A93-A93, ISSN: 0017-5749
Segal J, Penez L, Elkady S, et al., 2018, IDDF2018-ABS-0056 Long term outcomes of initial infliximab therapy for inflammatory pouch pathology: a multi-centre retrospective study, International Digestive Disease Forum 2018, Publisher: BMJ Publishing Group, Pages: A41-A41, ISSN: 0017-5749
Segal J, Penez L, Tozer P, et al., 2018, MANAGEMENT OF POUCH STRICTURES IN RESTORATIVE PROCTOCOLECTOMY. A TERTIARY CENTRE EXPERIENCE WITH A TREATMENT ALGORITHM, Annual General Meeting of the British-Society-of-Gastroenterology, Publisher: BMJ PUBLISHING GROUP, Pages: A201-A202, ISSN: 0017-5749
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