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Article ; Online: How to effectively use and interpret the barium swallow: Current role in esophageal dysphagia.

Sanagapalli, Santosh / Plumb, Andrew / Lord, Reginald V / Sweis, Rami

2023 Volume 35, Issue 10, Page(s) e14605

Abstract: Background: The barium swallow is a commonly performed investigation, though recent decades have seen major advances in other esophageal diagnostic modalities.: Purpose: The purpose of this review is to clarify the rationale for components of the ... ...

Abstract	Background: The barium swallow is a commonly performed investigation, though recent decades have seen major advances in other esophageal diagnostic modalities. Purpose: The purpose of this review is to clarify the rationale for components of the barium swallow protocol, provide guidance on interpretation of findings, and describe the current role of the barium swallow in the diagnostic paradigm for esophageal dysphagia in relation to other esophageal investigations. The barium swallow protocol, interpretation, and reporting terminology are subjective and non-standardized. Common reporting terminology and an approach to their interpretation are provided. A timed barium swallow (TBS) protocol provides more standardized assessment of esophageal emptying but does not evaluate peristalsis. Barium swallow may have higher sensitivity than endoscopy for detecting subtle strictures. Barium swallow has lower overall accuracy than high-resolution manometry for diagnosing achalasia but can help secure the diagnosis in cases of equivocal manometry. TBS has an established role in objective assessment of therapeutic response in achalasia and helps identify the cause of symptom relapse. Barium swallow has a role in the evaluating manometric esophagogastric junction outflow obstruction, in some cases helping to identify where it represents an achalasia-like syndrome. Barium swallow should be performed in dysphagia following bariatric or anti-reflux surgery, to assess for both structural and functional postsurgical abnormality. Barium swallow remains a useful investigation in esophageal dysphagia, though its role has evolved due to advancements in other diagnostics. Current evidence-based guidance regarding its strengths, weaknesses, and current role are described in this review.
MeSH term(s)	Humans ; Deglutition Disorders/diagnostic imaging ; Esophageal Achalasia/diagnosis ; Barium ; Esophageal Motility Disorders/diagnosis ; Manometry/methods
Chemical Substances	Barium (24GP945V5T)
Language	English
Publishing date	2023-04-27
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1186328-6
ISSN	1365-2982 ; 1350-1925
ISSN (online)	1365-2982
ISSN	1350-1925
DOI	10.1111/nmo.14605
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Article ; Online: Timed barium swallow: Esophageal stasis varies markedly across subtypes of esophagogastric junction obstruction.

Sanagapalli, Santosh / Plumb, Andrew / Sweis, Rami

Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

2022 Volume 34, Issue 3, Page(s) e14322

Abstract: Background: Timed barium swallow (TBS) is a recommended ancillary investigation in evaluation of esophagogastric junction (EGJ) obstruction, yet there are little data comparing esophageal stasis across subtypes.: Methods: A retrospective cohort study ...

Abstract	Background: Timed barium swallow (TBS) is a recommended ancillary investigation in evaluation of esophagogastric junction (EGJ) obstruction, yet there are little data comparing esophageal stasis across subtypes. Methods: A retrospective cohort study was performed. All type III achalasia diagnosed between November 2016 and November 2020 were included, along with matched numbers of consecutive types I and II and conclusive EGJOO cases with concurrent TBS evaluation. Co-primary outcomes were TBS retention at 1 and 5 min. Secondary outcomes were symptoms and manometric metrics of EGJ function and peristaltic integrity. Key results: One hundred patients were included (25 each of types I-III and conclusive EGJOO). TBS retention measured by height and width at 1 and 5 min differed significantly across the four subtypes (p < 0.0001 all comparisons), with esophageal stasis tending to be significantly greater for types I and II achalasia (88% and 84% with >5 cm column at 5 min) compared to type III and EGJOO (24% and 8% with >5 cm column; p < 0.0001). Eckardt symptom severity was similar across subtypes (p = 0.30). Magnitude of esophageal stasis and integrated relaxation pressure (IRP) were uncorrelated (R = 0.21). In EGJOO, the number of swallows with intact peristalsis inversely correlated with barium column height (R = -0.49) and those with disordered peristalsis were more likely to have any residual barium at 5 min compared to those without disordered peristalsis (43% vs. 0%; p = 0.02). Conclusions & inferences: Timed barium swallow findings differed markedly with significantly less esophageal stasis in type III achalasia and EGJOO, despite similar symptom severity and no correlation between degree of emptying and IRP. Preservation of peristalsis may underlie this finding in EGJOO.
MeSH term(s)	Barium ; Esophageal Achalasia/diagnostic imaging ; Esophagogastric Junction/diagnostic imaging ; Humans ; Manometry ; Retrospective Studies
Chemical Substances	Barium (24GP945V5T)
Language	English
Publishing date	2022-01-24
Publishing country	England
Document type	Journal Article
ZDB-ID	1186328-6
ISSN	1365-2982 ; 1350-1925
ISSN (online)	1365-2982
ISSN	1350-1925
DOI	10.1111/nmo.14322
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Article ; Online: Effectiveness of Training in CT Colonography Interpretation: Review of Current Literature.

Obaro, Anu E / McCoubrie, Paul / Burling, David / Plumb, Andrew A

Seminars in ultrasound, CT, and MR

2022 Volume 43, Issue 6, Page(s) 430–440

Abstract: International guidance recommends that readers be specifically trained before embarking on independent interpretation of CT colonography (CTC) examinations. Systematic comparison of both international training requirements and the effectiveness of CTC ... ...

Abstract	International guidance recommends that readers be specifically trained before embarking on independent interpretation of CT colonography (CTC) examinations. Systematic comparison of both international training requirements and the effectiveness of CTC training is lacking in the published literature. Therefore, we identified available international training standards for CTC and performed a review of studies published in the last 20 years to assess the impact of CTC interpretation training on reader diagnostic accuracy. A wide variation in training requirements was observed. Studies of the effectiveness of CTC reader training were heterogenous in methodology, with large variation in sample size and the type of training administered. Although training in CTC interpretation improves reader sensitivity overall, it has varying impact on specificity. Consensus agreement on the best way to train and assess readers in CTC interpretation may lead to lasting improvements in reader performance.
MeSH term(s)	Humans ; Colonography, Computed Tomographic
Language	English
Publishing date	2022-06-10
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1353113-x
ISSN	1558-5034 ; 0887-2171
ISSN (online)	1558-5034
ISSN	0887-2171
DOI	10.1053/j.sult.2022.06.002
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Article ; Online: Training in Computed Tomographic Colonography Interpretation: Recommendations for Best Practice.

Obaro, Anu E / McCoubrie, Paul / Burling, David / Plumb, Andrew A

Seminars in ultrasound, CT, and MR

2022 Volume 43, Issue 6, Page(s) 422–429

Abstract: The value of computed tomographic colonography (CTC) as a sensitive diagnostic investigation for colorectal cancer is well established. However, there is lack of consensus in the best way to achieve expertise in interpreting these studies. In this review ...

Abstract	The value of computed tomographic colonography (CTC) as a sensitive diagnostic investigation for colorectal cancer is well established. However, there is lack of consensus in the best way to achieve expertise in interpreting these studies. In this review we discuss the value of CTC training, accreditation and performance monitoring; the qualities of good CTC interpretation training, and specific training cases with associated learning points.
MeSH term(s)	Humans ; Colonography, Computed Tomographic
Language	English
Publishing date	2022-06-10
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1353113-x
ISSN	1558-5034 ; 0887-2171
ISSN (online)	1558-5034
ISSN	0887-2171
DOI	10.1053/j.sult.2022.06.001
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Article ; Online: The choice and definition of summary measure for meta-analysis of clinical studies with binary outcomes: effect on clinical interpretation.

Plumb, Andrew A / Halligan, Steve / Mallett, Susan

The British journal of radiology

2020 Volume 93, Issue 1108, Page(s) 20190976

Abstract: Many systematic reviews and meta-analyses concern the effect of a healthcare intervention on a binary ... ...

Abstract	Many systematic reviews and meta-analyses concern the effect of a healthcare intervention on a binary outcome
MeSH term(s)	Colonography, Computed Tomographic/statistics & numerical data ; Colonoscopy/statistics & numerical data ; Data Interpretation, Statistical ; Humans ; Meta-Analysis as Topic ; Odds Ratio ; Patient Compliance/statistics & numerical data ; Risk
Language	English
Publishing date	2020-02-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20190976
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Article ; Online: Are preoperative CT variables associated with the success or failure of subsequent ventral hernia repair: nested case-control study.

Kumar, Shankar / Rao, Nikhil / Parker, Sam / Plumb, Andrew / Windsor, Alastair / Mallett, Sue / Halligan, Steve

European radiology

2022 Volume 32, Issue 9, Page(s) 6348–6354

Abstract: Objectives: Systematic review of CT measurements to predict the success or failure of subsequent ventral hernia repair has found limited data available in the indexed literature. To rectify this, we investigated multiple preoperative CT metrics to ... ...

Abstract	Objectives: Systematic review of CT measurements to predict the success or failure of subsequent ventral hernia repair has found limited data available in the indexed literature. To rectify this, we investigated multiple preoperative CT metrics to identify if any were associated with postoperative reherniation. Methods: Following ethical permission, we identified patients who had undergone ventral hernia repair and had preoperative CT scanning available. Two radiologists made multiple measurements of the hernia and abdominal musculature from these scans, including loss of domain. Patients were divided subsequently into two groups, defined by hernia recurrence at 1-year subsequent to surgery. Hypothesis testing investigated any differences between CT measurements from each group. Results: One hundred eighty-eight patients (95 male) were identified, 34 (18%) whose hernia had recurred by 1-year. Only three of 34 CT measurements were significantly different when patients whose hernia had recurred were compared to those who had not; these significant findings were assumed contingent on multiple testing. In particular, preoperative hernia volume (recurrence 155.3 cc [IQR 355.65] vs. no recurrence 78.2 [IQR 303.52], p = 0.26) nor loss of domain, whether calculated using the Tanaka (recurrence 0.02 [0.04] vs. no recurrence 0.009 [0.04], p = 0.33) or Sabbagh (recurrence 0.019 [0.05] vs. no recurrence 0.009 [0.04], p = 0.25) methods, differed between significantly between groups. Conclusions: Preoperative CT measurements of ventral hernia morphology, including loss of domain, appear unrelated to postoperative recurrence. It is likely that the importance of such measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique. Key points: • Preoperative CT scanning is often performed for ventral hernia but systematic review revealed little data regarding whether CT variables predict postoperative reherniation. • We found that the large majority of CT measurements, including loss of domain, did not differ significantly between patients whose hernia did and did not recur. • It is likely that the importance of CT measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique.
MeSH term(s)	Abdominal Wall/surgery ; Case-Control Studies ; Female ; Hernia, Ventral/diagnostic imaging ; Hernia, Ventral/surgery ; Herniorrhaphy/methods ; Humans ; Male ; Retrospective Studies ; Surgical Mesh ; Tomography, X-Ray Computed
Language	English
Publishing date	2022-03-29
Publishing country	Germany
Document type	Journal Article ; Systematic Review
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-022-08701-x
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Article ; Online: Contemporary imaging of inguinal hernia and pain.

Plumb, Andrew A / Rajeswaran, Gajan / Abbasi, Maaz Ali / Masci, Lorenzo / Warren, Oliver / Wilson, Jonathan

The British journal of radiology

2022 Volume 95, Issue 1134, Page(s) 20220163

Abstract: Inguinal hernias are the commonest type of hernia, and are frequently encountered by general, abdominal and musculoskeletal radiologists. Such hernias may cause discomfort or pain; but many other conditions may cause pain in a similar location, meaning ... ...

Abstract	Inguinal hernias are the commonest type of hernia, and are frequently encountered by general, abdominal and musculoskeletal radiologists. Such hernias may cause discomfort or pain; but many other conditions may cause pain in a similar location, meaning it is not always straightforward to determine the underlying cause of a particular patient's symptoms. Although surgical fixation of hernia has high success rates with low recurrence, ongoing symptoms are common after apparently uncomplicated surgery. In particular, post-surgical chronic groin pain can be highly problematic in some patients. In this review, we highlight the relevant surgical and imaging anatomy, common modes of clinical presentation, contemporary surgical approaches to the repair of inguinal hernia, imaging techniques to diagnose such hernias in both unoperated and operated groins and mimics of hernia-related pain.
MeSH term(s)	Chronic Pain/diagnostic imaging ; Chronic Pain/etiology ; Groin/diagnostic imaging ; Hernia, Inguinal/diagnostic imaging ; Herniorrhaphy/adverse effects ; Herniorrhaphy/methods ; Humans ; Pain, Postoperative ; Recurrence ; Surgical Mesh/adverse effects
Language	English
Publishing date	2022-03-29
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20220163
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Article ; Online: Paris classification of colonic polyps using CT colonography: prospective cohort study of interobserver variation.

Gangi-Burton, Anmol / Plumb, Andrew A / De Paepe, Katja N / Godfrey, Edmund M / Halligan, Steve / Higginson, Antony / Khwaja, Samir / Patel, Anisha / Taylor, Stuart

European radiology

2024

Abstract: Background: The Paris classification categorises colorectal polyp morphology. Interobserver agreement for Paris classification has been assessed at optical colonoscopy (OC) but not CT colonography (CTC). We aimed to determine the following: (1) ... ...

Abstract	Background: The Paris classification categorises colorectal polyp morphology. Interobserver agreement for Paris classification has been assessed at optical colonoscopy (OC) but not CT colonography (CTC). We aimed to determine the following: (1) interobserver agreement for the Paris classification using CTC between radiologists; (2) if radiologist experience influenced classification, gross polyp morphology, or polyp size; and (3) the extent to which radiologist classifications agreed with (a) colonoscopy and (b) a combined reference standard. Methods: Following ethical approval for this non-randomised prospective cohort study, seven radiologists from three hospitals classified 52 colonic polyps using the Paris system. We calculated interobserver agreement using Fleiss kappa and mean pairwise agreement (MPA). Absolute agreement was calculated between radiologists; between CTC and OC; and between CTC and a combined reference standard using all available imaging, colonoscopic, and histopathological data. Results: Overall interobserver agreement between the seven readers was fair (Fleiss kappa 0.33; 95% CI 0.30-0.37; MPA 49.7%). Readers with < 1500 CTC experience had higher interobserver agreement (0.42 (95% CI 0.35-0.48) vs. 0.33 (95% CI 0.25-0.42)) and MPA (69.2% vs 50.6%) than readers with ≥ 1500 experience. There was substantial overall agreement for flat vs protuberant polyps (0.62 (95% CI 0.56-0.68)) with a MPA of 87.9%. Agreement between CTC and OC classifications was only 44%, and CTC agreement with the combined reference standard was 56%. Conclusion: Radiologist agreement when using the Paris classification at CT colonography is low, and radiologist classification agrees poorly with colonoscopy. Using the full Paris classification in routine CTC reporting is of questionable value. Clinical relevance statement: Interobserver agreement for radiologists using the Paris classification to categorise colorectal polyp morphology is only fair; routine use of the full Paris classification at CT colonography is questionable. Key points: • Overall interobserver agreement for the Paris classification at CT colonography (CTC) was only fair, and lower than for colonoscopy. • Agreement was higher for radiologists with < 1500 CTC experience and for larger polyps. There was substantial agreement when classifying polyps as protuberant vs flat. • Agreement between CTC and colonoscopic polyp classification was low (44%).
Language	English
Publishing date	2024-03-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-024-10631-9
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Article ; Online: CT Colonography Reporting and Data System (C-RADS): Version 2023 Update.

Yee, Judy / Dachman, Abraham / Kim, David H. / Kobi, Mariya / Laghi, Andrea / McFarland, Elizabeth / Moreno, Courtney / Park, Seong Ho / Pickhardt, Perry J. / Plumb, Andrew / Pooler, B Dustin / Zalis, Michael / Chang, Kevin J

Radiology

2024 Volume 310, Issue 1, Page(s) e232007

Abstract: The CT Colonography Reporting and Data System (C-RADS) has withstood the test of time and proven to be a robust classification scheme for CT colonography (CTC) findings. C-RADS version 2023 represents an update on the scheme used for colorectal and ... ...

Abstract	The CT Colonography Reporting and Data System (C-RADS) has withstood the test of time and proven to be a robust classification scheme for CT colonography (CTC) findings. C-RADS version 2023 represents an update on the scheme used for colorectal and extracolonic findings at CTC. The update provides useful insights gained since the implementation of the original system in 2005. Increased experience has demonstrated confusion on how to classify the mass-like appearance of the colon consisting of soft tissue attenuation that occurs in segments with acute or chronic diverticulitis. Therefore, the update introduces a new subcategory, C2b, specifically for mass-like diverticular strictures, which are likely benign. Additionally, the update simplifies extracolonic classification by combining E1 and E2 categories into an updated extracolonic category of E1/E2 since, irrespective of whether a finding is considered a normal variant (category E1) or an otherwise clinically unimportant finding (category E2), no additional follow-up is required. This simplifies and streamlines the classification into one category, which results in the same management recommendation.
MeSH term(s)	Humans ; Colonography, Computed Tomographic ; Confusion ; Constriction, Pathologic ; Diverticulum
Language	English
Publishing date	2024-01-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80324-8
ISSN	1527-1315 ; 0033-8419
ISSN (online)	1527-1315
ISSN	0033-8419
DOI	10.1148/radiol.232007
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Article ; Online: A case of dysphagia secondary to a double-lumen esophagus: endoscopic management with septotomy.

Rao, Rohit / Sweis, Rami / Everson, Martin / Plumb, Andrew / Haidry, Rehan

VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy

2020 Volume 5, Issue 3, Page(s) 98–101

Language	English
Publishing date	2020-03-03
Publishing country	United States
Document type	Journal Article
ISSN	2468-4481
ISSN (online)	2468-4481
DOI	10.1016/j.vgie.2019.11.015
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