Amyn Haji

National Health Service | NHS ·  Department of Surgery

Background and aims: OverStitch devices (OverStitchTM/OverStitch-SxTM)are used for a wide range of applications. A European registry was created to prospectively collect technical/clinical data regarding both systems, to provide procedural outcomes and to find correlation between procedural characteristics and outcomes.This study shows the initial...

Objective Endoscopic submucosal dissection (ESD) in a curative intent for submucosa-invasive early (T1) colorectal cancers (T1-CRCs) often leads to subsequent surgical resection in case of histologic parameters indicating higher risk of nodal involvement. In some cases, however, the expected benefit may be offset by the surgical risks, suggesting a...

Aim Rectal neuroendocrine tumours (NETs) are the most common type of gastrointestinal NET. European NET Society guidelines suggest that rectal NET tumours measuring ≤10mm are indolent with low risk of spread. In practice, many patients with lesions ≤1cm do not undergo complete tumour staging. However, the size of the lesion may not be the only risk...

Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This internati...

Diverticular disease (DD), and the complications that derive from it, constitute an increasing burden on Western healthcare systems. DD is not only typical of industrialized countries, and is regarded as a consequence of socioeconomic development and the associated dietary changes, but it is also typical of advanced age.

Background and aims: There are no agreed-upon endoscopic signs for the diagnosis of villous atrophy (VA) in celiac disease (CD), necessitating biopsies for diagnosis. Here we evaluated the role of near-focus narrow-band imaging (NF-NBI) for the assessment of villous architecture in suspected CD with the development and further validation of a nove...

Background Histopathological features associated with coexistent invasive adenocarcinoma in large colorectal adenomas have not been described. This study aimed to determine the association of histopathological features in areas of low-grade dysplasia with coexistent invasive adenocarcinoma. Methods High-grade lesions (containing high-grade dysplas...

Objective Hydrothermal duodenal mucosal resurfacing (DMR) is a safe, outpatient endoscopic procedure. REVITA-2, a double-blind, superiority randomised controlled trial, investigates safety and efficacy of DMR using the single catheter Revita system (Revita DMR (catheter and system)), on glycaemic control and liver fat content in type 2 diabetes (T2...

Background and Aims Endoscopic mucosal resection (EMR) of large (≥2 cm) nonpedunculated colorectal polyps (LNPCP) is associated with high rates of recurrent/residual adenoma, possibly due to microadenoma left at the margin of resection. Data supporting this mechanism are required. We aimed to determine the incidence of residual microadenoma at the...

Introduction Artificial intelligence (AI)-driven polyp detection (PD) modules to assist colonoscopy in real time are now commercially available. Early controlled studies suggests that polyp detection rates (and by inference adenoma detection rates (ADR)) and mean adenomas per patient (MAP) is improved by using such a module. We wished to examine th...

Introduction The practice of endoscopic submucosal dissection (ESD) for treatment of early gastrointestinal neoplasia has been increasing in the West, however, the uptake has been slow due to a long learning curve and higher complication rate. We aim to analyse UK ESD practice through the development of the first UK national ESD registry. Methods...

Introduction The gastroduodenal full thickness resection device (FTRD®) is a new device that allows resection of tethered epithelial or subepithelial lesions (SELs) in the stomach and duodenum, but data on outcomes are limited¹. Here we present first UK experience of this technique, including technical feasibility, safety and early outcomes. Metho...

Introduction Per-oral endoscopic myotomy (POEM) is a proven, effective treatment for patients with achalasia, but there are concerns regarding the risk of developing post procedure acid reflux with published studies reporting conflicting results. This study aims to determine the risk of acid reflux and related complications following POEM and influ...

Introduction In 2020, the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland, and Public Health England revised post-polypectomy surveillance guidelines. Here, we compare colonoscopy findings and planned surveillance dates at our institution, a tertiary referral centre, with novel recommendatio...

Background and aims: Although Peroral Endoscopic Myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aims to compare the outcomes of different management strategies in patients who had failed POEM. Patients and methods: Thi...

Background: There is growing interest in developing impedance planimetry as a tool to enhance the clinical outcomes for endoscopic and surgical management of achalasia. The primary aim of this study was to determine whether impedance planimetry measurements can predict clinical response and reflux following peroral endoscopic myotomy (POEM). Meth...

Background: The technical evolution of hernia repair has brought to the introduction of laparoscopy in this field. The most common laparoscopic techniques are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. Indirect comparisons between TAPP and TEP have raised questions as to which is the superior approach in i...

Artificial intelligence is a strong focus of interest for global health development. Diagnostic endoscopy is an attractive substrate for artificial intelligence with a real potential to improve patient care through standardisation of endoscopic diagnosis and to serve as an adjunct to enhanced imaging diagnosis. The possibility to amass large data t...

Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM fo...

Introduction: Haemorrhage remains a major cause of morbidity and death in all surgical specialties. The aim of this study was to analyse the feasibility of PuraStat®, a new synthetic haemostatic device, made of self-assembling peptides in laparoscopic colorectal surgery. Material and methods: This was a prospective observational non-randomised stud...

Background: There is a trend toward organ conservation in the management of rectal tumors. However, there is no consensus on standardized investigations to guide treatment. Objective: We report the value of multimodal endoscopic assessment (white light, magnification chromoendoscopy and narrow band imaging, selected colonoscopic ultrasound) for...

Objectives: Recently, several studies have demonstrated the usefulness of endoscopic submucosal dissection (ESD) for residual or locally recurrent colorectal lesions after endoscopic treatment. However, the feasibility of ESD for recurrent rectal lesions after transanal endoscopic microsurgery (TEM) has not been fully investigated. In this study,...

Background and aims: Inflammatory bowel disease is associated with an increased risk of colorectal cancer, with estimates ranging 2-18%, depending on the duration of colitis. The management of neoplasia in colitis remains controversial. Current guidelines recommend endoscopic resection if the lesion is clearly visible with distinct margins. Colect...

Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student-...

Main Recommendation There is a need for well-organized comprehensive strategies to achieve good training in ESD. In this context, the European Society of Gastrointestinal Endoscopy (ESGE) have developed a European core curriculum for ESD practice across Europe with the aim of high quality ESD training. Advanced endoscopy diagnostic practice is advi...

The latest state of the art technological innovations have led to a palpable progression in endoscopic imaging and may facilitate standardisation of practice. One of the most rapidly evolving modalities is artificial intelligence with recent studies providing real time diagnoses and encouraging results in the first randomised trials to conventional...

Purpose Injudicious attempts at resection and extensive sampling of large colorectal adenomas prior to referral for endoscopic resection (ER) are common. This has deleterious effects, but little is known about the outcomes following ER. We retrospectively analysed the outcomes of ER of large adenomas previously subjected to substantial manipulation...

Introduction Inflammatory stromal changes are frequent findings in large colorectal adenomas that can contribute to neoplastic progression, but their role is not fully established in high-grade adenomas of the colon as predictors of coexistent invasive malignancy. Methods ER of large colorectal adenomas (2011–2016) were analysed. A subset containi...

Introduction Delay in diagnosis of colorectal cancer (CRC) is associated with worse outcomes. Although studies have shown the incidence of CRC missed at endoscopy to be 2.5%-7.7% (Morris et al., 2014), there are additional non-endoscopic factors that may lead to delays. This study aimed to identify all factors leading to a delayed diagnosis, includ...

Introduction Little is known about the cost of treating recurrence after colorectal endoscopic resection (ER). Endoscopic mucosal resection (EMR) has proven efficacy and safety and is the procedure of choice for the majority of western endoscopists. However, recurrence is not infrequent but no studies examine the cost associate with ER taking into...

Introduction Successful endoscopic resection (ER) relies on endoscopic diagnosis to predict the risk of invasive cancer. However, a detailed evaluation of histopathological features and the molecular profile of the dysplastic mucosa to predict coexistent invasive cancer is not available. Methods ER of large colorectal adenomas (2011–2016) were ana...

Introduction There are no agreed endoscopic signs for the diagnosis of villous atrophy(VA) in coeliac disease(CD), necessitating biopsies and for both diagnosis and exclusion. Here we evaluated the role of near focus Narrow Band Imaging(NF-NBI) for the assessment of villous architecture in suspected CD with development and further validation of a n...

Introduction Safe sedation practice is a recognised cornerstone of high-quality endoscopy. There are concerns that local anaesthetic throat spray (TS) in combination with intravenous sedative and analgesic agents (ISAAs) can precipitate respiratory complications, specifically, aspiration pneumonia. Current BSG standards for upper gastrointestinal e...

Introduction Per-oral endoscopic myotomy (POEM) has gained acceptance as an effective treatment for achalasia and other oesophageal motility disorders but may not be seen as a ‘first-line’ intervention. Many patients referred for POEM to our institution had, therefore, undergone other therapies and little is known about the influence of this or oth...

Introduction Current literature estimates that complete endoscopic resection (ER) of duodenal adenomas can be achieved in 79–100% of cases, but complication rates are high and adenoma recurrence is encountered in up to 37% of cases (Basford & Bhandari, 2012). We present our retrospective experience. Methods Data from the electronic patient record...

Introduction Gastro-oesophageal reflux disease(GORD) is a common condition carrying an arduous process for diagnosis. Symptom questionnaires and proton-pump inhibitor challenge lack reliability and white light endoscopy (WLE) is often normal. Objective measurement of oesophageal acid exposure time (AET) require invasive testing. Changes in intrapap...

Introduction There are no published reports on registrar training in colorectal Endoscopic Submucosal Dissection (ESD) in western practice. It is unclear if any such training takes place in western centres where uptake of colorectal ESD has been slow and training, where it exists, is confined to experienced endoscopists who have already completed s...

Introduction Resection of large rectal adenomas by TEM or endoscopic resection (ER) varies by institution and region. There is a paucity of data directly comparing these strategies and the procedure of choice remains under intense debatable. We report outcomes of TEM and ER of large rectal adenomas from a large tertiary cohort. Methods Large (≥20...

Introduction ESD is rarely practiced in western centres. Given its technical difficulty, many western experts believe indications for ESD are limited. However, histopathologic diagnostic and treatment uncertainty resulting in over- or under-treatment can have grave consequences in the rectum. As a result, our unit recently opted for the exclusive u...

Introduction Gastroparesis (GP) is a disorder evidenced by delayed gastric emptying in the absence of mechanical obstruction, commonly idiopathic or secondary to diabetes mellitus. G-POEM has been used to treat refractory gastroparesis and we present our initial experience with this novel endoscopic technique. Methods All patients undergoing G-POE...

Purpose Almost any colorectal superficial neoplastic lesion can be treated by endoscopic resection (ER) but very little is known about outcomes of ER leaving circumferential or near-circumferential mucosal defects. We report the outcomes of ER leaving ≥ 75% circumferential mucosal defects performed in a western expert centre. Methods Five hundred...

Introduction The grading of both neoplastic and dysplastic lesions is based on morphological and genetic changes of the epithelial cells. The inflammatory stromal changes are frequent findings that can contribute to the neoplastic progression, and their correlation is not fully established in high-grade adenomas of the colon as predictors of coexi...

Introduction Safe and effective endoscopic resection (ER) relies on the endoscopic diagnosis of large lesions to predict the risk of invasive cancer. However, a detailed evaluation of histopathological features and the molecular profile of the polypoid dysplastic mucosa to predict coexistent invasive neoplasm is not available. Methods: Data from...

Background: Safe and effective endoscopic resection (ER) relies on the endoscopic diagnosis of large lesions to predict the risk of invasive cancer. However, a detailed evaluation of histopathological features and the molecular profile of the polypoid dysplastic mucosa to predict coexistent invasive neoplasm is not available. Design: Data from endo...

Background and aims: Few large Western series examine risk factors for recurrence after endoscopic resection (ER) of large (≥20 mm) colorectal laterally spreading tumors. Recurrence beyond initial surveillance is seldom reported, and differences between residual/recurrent adenoma and late recurrence are not scrutinized. We report the incidence of...

Background Chromoendoscopy (CE) is the recommended surveillance technique for colitis, but uptake has been limited and the literature provides scant information on patient experience (PE); imperative to adherence to surveillance programmes. Virtual CE (VCE) by Fujinon Intelligent Colour Enhancement digitally reconstructs mucosal images in real time...

This chapter presents an overview of the important academic surgical issues that surgical trainees may face throughout their core and specialist training. Competition for core and specialty training posts and indeed consultant surgical appointments is fierce and it is therefore no surprise that trainees need to maximise their clinical and academic...

Background and study aims The efficacy of per oral endoscopic myotomy (POEM) in non-achalasia esophageal motility disorders such as esophagogastric junction outflow obstruction (EGJOO), diffuse esophageal spasm (DES), and jackhammer esophagus (JE) has not been well demonstrated. The aim of this international multicenter study was to assess clinica...

Introduction Guidelines on endoscopic resection (ER) of colorectal superficial neoplastic lesions (CSNL) recommend against biopsy sampling but many are extensively sampled prior to referral, despite the deleterious effect on ER, to exclude adenocarcinoma or high grade dysplasia (HGD), reflecting a lack of understanding of the incidence and nature o...

Introduction Guidelines on endoscopic resection (ER) of colorectal superficial neoplastic lesions (CSNL) recommend against biopsy sampling, but many lesions are extensively sampled prior to referral. Although this has a deleterious effect on ER, endoscopists are often eager to exclude adenocarcinoma or high-grade dysplasia (HGD), which is seen as a...

Background: Colorectal endoscopic submucosal dissection results in high rates of en bloc resection, few recurrences, and accurate diagnosis, and it is useful in lesions with significant fibrosis. However, endoscopic submucosal dissection has not been widely adopted by Western endoscopists and the published experience from Western centers is very l...