R0 Resection Margin, A New Quality Measure in the Era of National Bowel Screening?

Aims To determine the completeness of polyp resection (i.e. achieving an R0 margin) and its relation with Endoscopists, histopathologist, size, location and technique of polypectomy in an NSS cohort. The definition of R0 margin is complete macroscopic resection with a negative microscopic margin at polypectomy. Method NCCS (National Colon Cancer Screening) colonoscopies are offered to bowel cancer screening patients after a positive faecal immunochemical test (FIT) test in a Joint Advisory Group (JAG) accredited Gastrointestinal Endoscopy centre. We histologically evaluated the polyp margins for complete resection, which was defined as the absence of adenomatous or hyperplastic tissue in the resected polyp margins in a cohort of faecal immunochemical test positive patients. Results A total of 186 consecutive NCCS colonoscopies out of a total of 542 performed between 2013 and 2017 were included in this study. Of the polyps excised 152(27%) had a R0 margin histologically, and 30(5%) had involvement of the margin. Surprisingly in 373(67%) of polyps pathologists were unable to assess the margin. Conclusion Achieving an R0 margin should be a key performance indicator for endoscopists performing polypectomy. At the same time more studies on polyp margins are recommended.

Helicobacter pylori: prevalence of antimicrobial resistance in clinical isolates.

This study aims to determine the in vitro susceptibility of Helicobacter pylori to clarithromycin, metronidazole, amoxycillin and tetracycline, the four antibiotics commonly used in eradication therapies. These data are used to evaluate the efficacy of current empiric treatment of H. pylori infection in the Southern Region of Ireland. Culture is performed on gastric biopsy samples obtained from 147 consecutive patients undergoing gastroscopy for investigation of dyspepsia. Susceptibility testing to metronidazole, clarithromycin, amoxycillin and tetracycline is performed on the isolates by Etest. Isolates demonstrating clarithromycin resistance are subjected to polymerase chain reaction (PCR) amplification and nucleotide sequence analysis to identify the presence of point mutations in the peptidyltransferase region of the 23S rRNA gene previously associated with resistance to clarithromycin. Prevalence of H. pylori in the population studied was 31% (45 isolates). Antimicrobial resistance to metronidazole and clarithromycin was detected in nine (20%) and four (8.9%) of the isolates, respectively. A single isolate demonstrated co-resistance to metronidazole and clarithromycin (2.2%). No resistance was detected to either amoxycillin or tetracycline. The low level of resistance demonstrated among this group of isolates indicates that the empiric treatment currently in place in the Southern Region of Ireland is likely to be successful.

Functional dyspepsia and non-erosive reflux disease. A review.

Functional, or non-ulcer, dyspepsia (FD) and non-erosive reflux disease (NERD), or endoscopy negative reflux disease are common reasons for referral to both the primary care physician and the gastroenterologist. Their aetiology remains largely obscure but both clinical and basic research have revealed much to suggest that these two disease entities are inextricably linked and may represent part of the same disease process. Several theories have been proposed to explain the pathophysiology of functional dyspepsia, including visceral hypersensitivity, delayed gastric emptying, impaired gastric fundus accommodation, Helicobacter pylori infection and psychosocial factors. Recent work suggests that NERD is also a heterogeneous disorder, with some demonstrating abnormal acid exposure and/or sensitivity and others entirely normal 24-h pH studies (functional heartburn). It would appear that the overlap of these two conditions is most apparent between FD and those NERD patients with normal pH studies.

A simplified approach to otoplasty.

Outstanding or protruding ears are relatively common in the pediatric otolaryngology population. We propose a method of otoplasty that is simple to use and provides safe and predictable results. The technique of otoplasty is outlined in detail with emphasis on creation of a desired antehelical fold with the use of modified Mustarde sutures as well as modifications of the lobule and the need for conchal set-back.

Pressure, flow and resistance characteristics of the pediatric Storz-Hopkins bronchoscopes.

Poiseuille's law describes the relationship between pressure and the flow of a gas or liquid of known viscosity through a conduit of known length and radius. In clinical bronchoscopy, resistance varies directly with changes in viscosity of the inspired gas and the length of the bronchoscope. According to Poiseuille's law, resistance varies inversely to the fourth power of the radius of the bronchoscope. Flow-pressure curves were generated for commonly used pediatric Storz-Hopkins bronchoscopes with and without telescopes and the resistance of each system was calculated. Extremely high resistance is encountered with the 2.5 x 20 cm bronchoscope with telescope in place, a fact that most pediatric endoscopists are well aware of. However, comparable resistance is encountered when the 3.5 x 30 cm bronchoscope is used with the telescope in place, a fact not well appreciated by most clinicians.

Use of the modified barium swallow in the rehabilitation of the swallowing mechanism.

Swallowing is a rapid, dynamic and complex process. Surgical treatment of head and neck malignancies produces significant alterations in the swallowing mechanism. The modified barium swallow allows assessment of these physiologic and anatomic derangements in the postoperative patient. Small amounts of liquid barium, barium paste and a cookie coated with barium are ingested by the patient and the swallowing mechanism is recorded by videofluoroscopy. Unlike the routine barium swallow in which only the esophageal stage of swallowing is studied, using the modified barium swallow all four stages of swallowing are studied with particular emphasis on the oral and pharyngeal stages. Our experience with the modified barium swallow has shown it to be a valuable adjunct in the rehabilitation of the post-surgical patient allowing the otolaryngologist and speech pathologist to identify and modify swallowing abnormalities. Presentation of specific swallowing mechanism deficits as demonstrated using the modified barium swallow will be shown and appropriate therapeutic interventions discussed.

Medial meatal fibrosis: the University of Western Ontario experience.

Medial meatal fibrosis is an uncommon but surgically treatable cause of conductive hearing loss. A review of 10 years experience with this entity at The University of Western Ontario revealed a total of 15 cases involving nine patients. Each of them was treated by one of four otologists. This disease may arise from either recurring or chronic infection or from chronic dermatitis, and it frequently presents with bilateral involvement. It may occur at virtually any age, and to our knowledge, this series includes the first cases of this disease to be described in children. The medical and surgical management of this condition is described in detail and the results are summarized.