IntroductionVideo Capsule Endoscopy (VCE) has the unique ability to visualise the small intestinal mucosa, which traditionally is difficult to reach with a standard endoscope. The indications for this test are primarily to investigate the small bowel (SB) in patients with Crohn’s Disease (CD) and to evaluate the SB for causes of Iron Deficiency Anaemia (IDA). Despite the high diagnostic yield with VCE, one of its main drawbacks is its low specificity in patients with inflammatory bowel disease (IBD). In a prospective blinded 4 way comparison study, capsule endoscopy had a sensitivity of 83% and a specificity of 53%.1 We intended to evaluate the additional benefit of VCE in our patient cohort with particular emphasis on those patients who had MRE prior to their VCE as part of their work up for IBD.MethodsPatients who had VCE in Nottingham University Hospitals NHS Trust between January 1st 2014 and January 1st 2016 were included. Patient data including demographics, previous investigations and the treating physician’s interpretation of results and resultant change in management, from these investigations, were abstracted on to an excel spreadsheet.Results171 patients were included, of whom 148 were adults and 87 were female. The commonest indication was IDA [n = 70 (41%)]. Diarrhoea and IBD were the second most common indication with 63 patients (37%). SB abnormalities were detected in 96 patients, of which 48 had not previously been visualised on alternative investigations. This changed management in 28 patients (16%) based on the abnormalities detected. There was one complication observed; the capsule remained in the stomach stuck within rugal folds and requiring endoscopic retrieval.44 patients with suspected CD had MRE prior to capsule endoscopy. Abnormalities were seen in 20 of these capsule endoscopies, of which 14 had not been seen in previous investigations. However, only in 5 patients (10%) did these positive capsule findings facilitate a change in their disease management.Of the 63 patients who were investigated for IBD or diarrhoea, 15 patients were diagnosed with CD in light of the VCE findings. However, of these, only 4 patients had had a change in management, of whom 3 had had findings consistent with CD already demonstrated on MRE.ConclusionVCE is a useful and safe diagnostic test to detect SB pathology. This modality assisted management in 16% of our patient cohort. However, in the setting of IBD it appears that VCE rarely has findings that lead to a change in management over and above MRE.Reference1 Solem CA, Loftus EV, Jr, Fletcher JG, Baron TH, Gostout CJ, Petersen BT, et al. Small-bowel imaging in Crohn’s disease: a prospective, blinded, 4-way comparison trial. Gastrointest Endosc 2008;68(2):255–66.Disclosure of InterestNone Declared
The success of conversion Total Hip Arthroplasty (THA) among primary THA and revision THA re- mains unclear. We hypothesized that most conversion THAss can be performed using primary implants and will have an uncomplicated post-operative course. Thirty-six patients (23 females, mean age 68,0y) who underwent conversion THA for failed interventions for proximal femur fractures in the period 2006-2018 were matched sequentially against patients of the same sex and age who underwent primary THA or revision THA. Data was collected on implants used, major complications, and mortality. PROMs used included the Western Ontario and McMaster Osteoarthritis Index, Harris Hip Score, Visual Analogue Scale and the EQ-5D Health Questionnaire. Seventy- two percent of patients who underwent conversion THA were treated with primary implants and never suffered from a major complication. PROMs were excellent for this group of patients. The distinction primary / conversion / revision THA could not explain differences in outcomes, however the necessity of using revision implants and the development of major complications could. The majority of conversion total hip arthroplasties can be considered a primary replacement. Predicting outcomes for THA should focus on patient frailty and technical difficulties dealing with infection, stability and loss of bone stock and should discard the conversion versus revision terminology.
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