Felty's syndrome (FS) (rheumatoid arthritis with neutropenia and splenomegaly) has a poor prognosis, largely because of the high risk of severe infection. Granulocyte colony-stimulating factor (G-CSF) is an emerging treatment for chronic neutropenia. We prospectively monitored its use in eight patients with recurrent infections or who required joint surgery. Significant side-effects were documented in five, including nausea, malaise, generalized joint pains, and in one patient, a vasculitic skin rash. In two patients treatment had to be stopped, and in these cases G-CSF had been started at full vial dosage (300 micrograms/ml filgrastim or 263 micrograms/ml lenograstim) alternate days or daily. G-CSF treatment was continued in three patients by restarting at reduced dose, and changing the proprietary formulation. G-CSF raised the neutrophil count, reduced severe infection, and allowed surgery to be performed. A combined clinical and laboratory index suggested that long-term treatment (up to 3.5 years) did not exacerbate the arthritis. Once on established treatment, it may be possible to use smaller weekly doses of G-CSF to maintain the same clinical benefit. One of the three patients whose FS was associated with a large granular T-cell lymphocytosis showed a reduction in this subset of lymphocytes during G-CSF treatment.
with 2 or more risk factors for poor bowel preparation. Data was analysed using SPSS. Results 1840 colonoscopies were carried out during the time period.. Total number analysed was 1704. Mean age was 61.7 years with a range of 16-94. 404 patients were pre assessed. Pre-assessment has significantly increased the quality of bowel preparation across all groups (OR = 1.605, p = 0.002). In groups 1 and 2 the odds of good quality bowel preparation was 80% and 72% higher respectively in patients who had been preassessed however these improvements were not statistically significant. Patients stratified into group 3 were 52% more likely to have good bowel preparation (p = 0.039) compared to those who were not pre-assessed. 88 patients had eGFR <60 ml/min. They had eGFR checked before and after administration of OBCA. There was a significant difference in the percentage change in eGFR between those patients that had Pre-assessment (Median = 7.7%) compared with those who did not (Median= -6.6%) (p = .006, Mann-Whitney). Conclusion Face-to-face pre-assessment improved the quality of bowel preparation for patients undergoing colonoscopy. It helps to minimise the risk of renal injury in patients with CKD. Those stratified to group 3 saw a significant improvement in the quality of their bowel preparation. We conclude pre-assessment is a prerequisite for patients who are at risk of poor bowel preparation and with significant co-morbidities.
PWE-032 ENDOSCOPIC RESECTION OF LARGE COLORECTAL POLYPS IN A TERTIARY REFERRAL UNIT IS SAFE WITH A LOW RISK OF COMPLICATIONSA Haji*, K Adams. Colorectal Surgery, King's College Hospital, London, UK 10. 1136/gutjnl-2014-307263.292 Introduction Patients with large sessile colorectal polyps can be technically challenging to resect endoscopically and have been subject to colorectal resection in the United Kingdom. Our aims were to determine the safety and efficacy of endoscopic resection of large colorectal lesions at a tertiary referral unit. Methods A prospective observational study of all patients referred for endoscopic resection to a single endoscopist. Consecutive patients were included in the study from June 2010 to March 2013. All patients underwent magnification chromoendoscopy and NBI for polyp assessment under conscious sedation. ESD was undertaken for lesions that were LST -non granular, flat and pseudodepressed type and those with type Vi pit pattern. Piecemeal EMR was undertaken for the remainder of the lesions.All patients underwent colonoscopic surveillance at 3 and 12 months by the same endoscopist to check for recurrence at the scar. Results One hundred and fourteen patients underwent 134 endoscopic resections. There were 54 (47.4%) women and 60 (52.6%) men with a mean age of 71.2 (SD = 10.3 years). 120 lesions underwent EMR (89.6%) and 14 had enbloc resection with ESD (10.5%) with complete resection. The mean size of the lesions was 56 mm (SD 37.1mm). The median lesion size was 50mm (range 25-150 mm).Histological analyses revealed 8 hyperplastic lesions, 28 tubular adenoma...
Understanding of test risks was greater for colonoscopy than CTC: 95.7% understood risks of colonoscopy vs 86.9% for CTC (odds ratio=1.88 95% CI: 1.71-2.07, p < 0.0001). Test benefits were also better understood for colonoscopy than for CTC: 98.2% understood colonoscopy benefits vs. 93.6% for CTC (OR=1.67 95% CI: 1.52-1.84 p < 0.0001). Just over one-quarter found CTC more uncomfortable than expected (25.7%), more than for colonoscopy (20.8%; OR = 1.34 95% CI: 1.24-1.46, p < 0.0001, Figure 1). Post-procedural pain showed no significant difference between tests (CTC = 14.6%, colonoscopy=14.3%; OR = 1.07 95% CI: 0.93-1.22, p = 0.35). More patients understood their colonoscopy result (97.0%) than CTC (90.5%, OR=2.19 95% CI: 1.99-2.41, p < 0.0001).Direct CTC-related complications were rare (n = 16; 0.5%) although a further 20 (0.6%) suffered complications from subsequent procedures provoked by CTC. Colonoscopy complication rates were similar (n = 779; 1.0%). Conclusion Although CTC is generally well-tolerated, it is more frequently judged unexpectedly uncomfortable than colonoscopy. Similarly, while overall understanding of test risks, benefits and results is high, rates are lower than for colonoscopy. Post-procedural discomfort and complication rates are similar between both tests. Clear communication of the risks, benefits, procedural experience and results of CTC is required in the BCSP.
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