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Article ; Online: Significant polyp and early colorectal cancer - decision-making and treatment planning in regional networks and multidisciplinary teams.

Dolwani, S

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2019 Volume 21 Suppl 1, Page(s) 16–18

MeSH term(s)	Clinical Decision-Making/methods ; Colorectal Neoplasms/etiology ; Colorectal Neoplasms/therapy ; Humans ; Intestinal Polyps/complications ; Intestinal Polyps/therapy ; Patient Care Planning ; Patient Care Team ; Regional Health Planning/methods
Language	English
Publishing date	2019-02-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.14492
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Article ; Online: Comparison of recommendations for surveillance of advanced colorectal polyps: A systematic review of guidelines.

Parker, Jody / Gupta, Sunnia / Torkington, Jared / Dolwani, Sunil

Journal of gastroenterology and hepatology

2023 Volume 38, Issue 6, Page(s) 854–864

Abstract: Background and aim: Patients diagnosed with advanced colorectal lesions have a higher risk of developing colorectal cancer. International polyp surveillance guidelines have recently been updated. The aim of this systematic review was to assess ... ...

Abstract	Background and aim: Patients diagnosed with advanced colorectal lesions have a higher risk of developing colorectal cancer. International polyp surveillance guidelines have recently been updated. The aim of this systematic review was to assess surveillance recommendations for advanced colorectal polyps and compare the patient, polyp, and colonoscopy quality factors considered in their recommendations. Methods: Guidelines with surveillance recommendations for colorectal polyps were identified. Databases searched included PubMed, Web of Science, Scopus, TripPro, and guidelines identified by two blinded reviewers. The review protocol was registered on PROSPERO and performed in line with PRISMA guidelines. Results: Six guidelines from the US Multi-Society Task Force, British Society of Gastroenterology, Cancer Council Australia, European Society of Gastrointestinal Endoscopy, Japan Gastroenterological Endoscopy Society, and Asia-Pacific Working Group on Colorectal Cancer Screening were included. The recommended surveillance interval of 3 years was consistent, but the criteria used for advanced polyps were variable. Polyp factors were the key determinant for when surveillance should be performed. Although all guidelines recognized their importance, the application of and evidence underlying patient characteristics and the quality of baseline colonoscopy were limited. All included guidelines were rated of average to high quality by the AGREE II instrument. Conclusion: Surveillance guidelines for advanced colorectal polyps are of good quality but limited by their underlying evidence. Standardization of definitions would be valuable for both research and clinical application. Better knowledge of colonoscopist quality indicators and patient factors is recommended to further economize surveillance recommendations, minimize patient risk, and achieve optimal outcomes without increasing pressure on services.
MeSH term(s)	Humans ; Colonic Polyps/pathology ; Colonoscopy/methods ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/prevention & control ; Colorectal Neoplasms/epidemiology ; Early Detection of Cancer ; Databases, Factual
Language	English
Publishing date	2023-03-12
Publishing country	Australia
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	632882-9
ISSN	1440-1746 ; 0815-9319
ISSN (online)	1440-1746
ISSN	0815-9319
DOI	10.1111/jgh.16157
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Article ; Online: Laparoscopically assisted endoscopic mucosal resection reduces the need for bowel resection for complex colonic polyps.

Parker, J / Torkington, J / Davies, M M / Dolwani, S

The British journal of surgery

2021 Volume 108, Issue 5, Page(s) e196–e198

MeSH term(s)	Aged ; Colonic Polyps/surgery ; Colonoscopy ; Endoscopic Mucosal Resection/methods ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies
Language	English
Publishing date	2021-03-28
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znab053
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Article: Planning management for complex colorectal polyps: a qualitative assessment of factors influencing decision-making among colonoscopists.

Parker, Jody / Semedo, Lenira / Shenbagaraj, Lavanya / Torkington, Jared / Dolwani, Sunil

BMJ open gastroenterology

2023 Volume 10, Issue 1

Abstract: Objective: Endoscopic therapy is the recommended primary treatment for most complex colorectal polyps, but high colonic resection rates are reported. The aim of this qualitative study was to understand and compare between specialities, the clinical and ... ...

Abstract	Objective: Endoscopic therapy is the recommended primary treatment for most complex colorectal polyps, but high colonic resection rates are reported. The aim of this qualitative study was to understand and compare between specialities, the clinical and non-clinical factors influencing decision making when planning management. Design: Semi-structured interviews were performed among colonoscopists across the UK. Interviews were conducted virtually and transcribed verbatim. Complex polyps were defined as lesions requiring further management planning rather than those treatable at the time of endoscopy. A thematic analysis was performed. Findings were coded to identify themes and reported narratively. Results: Twenty colonoscopists were interviewed. Four major themes were identified including gathering information regarding the patient and their polyp, aids to decision making, barriers in achieving optimal management and improving services. Participants advocated endoscopic management where possible. Factors such as younger age, suspicion of malignancy, right colon or difficult polyp location lead towards surgical intervention and were similar between surgical and medical specialties. Availability of expertise, timely endoscopy and challenges in referral pathways were reported barriers to optimal management. Experiences of team decision-making strategies were positive and advocated in improving complex polyp management. Recommendations based on these findings to improve complex polyp management are provided. Conclusion: The increasing recognition of complex colorectal polyps requires consistency in decision making and access to a full range of treatment options. Colonoscopists advocated the availability of clinical expertise, timely treatment and education in avoiding surgical intervention and providing good patient outcomes. Team decision-making strategies for complex polyps may provide an opportunity to coordinate and improve these issues.
MeSH term(s)	Humans ; Colonic Polyps/diagnosis ; Colonic Polyps/surgery ; Colonic Polyps/pathology ; Colonoscopy ; Colorectal Neoplasms/surgery ; Colorectal Neoplasms/pathology ; Endoscopy, Gastrointestinal
Language	English
Publishing date	2023-05-22
Publishing country	England
Document type	Journal Article
ISSN	2054-4774
ISSN	2054-4774
DOI	10.1136/bmjgast-2022-001097
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Article ; Online: Persistent viral shedding of SARS-CoV-2 in faeces - a rapid review.

Gupta, S / Parker, J / Smits, S / Underwood, J / Dolwani, S

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2020 Volume 22, Issue 6, Page(s) 611–620

Abstract: Aim: In addition to respiratory symptoms, COVID-19 can present with gastrointestinal complaints suggesting possible faeco-oral transmission. The primary aim of this review was to establish the incidence and timing of positive faecal samples for SARS-CoV- ...

Abstract	Aim: In addition to respiratory symptoms, COVID-19 can present with gastrointestinal complaints suggesting possible faeco-oral transmission. The primary aim of this review was to establish the incidence and timing of positive faecal samples for SARS-CoV-2 in patients with COVID-19. Methods: A systematic literature review identified studies describing COVID-19 patients tested for faecal virus. Search terms for MEDLINE included 'clinical', 'faeces', 'gastrointestinal secretions', 'stool', 'COVID-19', 'SARS-CoV-2' and '2019-nCoV'. Additional searches were done in the American Journal of Gastroenterology, Gastroenterology, Gut, Lancet Gastroenterology and Hepatology, the World Health Organization Database, the Centre for Evidence-Based Medicine, New England Journal of Medicine, social media and the National Institute for Health and Care Excellence, bioRxiv and medRxiv preprints. Data were extracted concerning the type of test, number and timing of positive samples, incidence of positive faecal tests after negative nasopharyngeal swabs and evidence of viable faecal virus or faeco-oral transmission of the virus. Results: Twenty-six relevant articles were identified. Combining study results demonstrated that 53.9% of those tested for faecal RNA were positive. The duration of faecal viral shedding ranged from 1 to 33 days after a negative nasopharyngeal swab with one result remaining positive 47 days after onset of symptoms. There is insufficient evidence to suggest that COVID-19 is transmitted via faecally shed virus. Conclusion: There is a high rate of positive polymerase chain reaction tests with persistence of SARS-CoV-2 in faecal samples of patients with COVID-19. Further research is needed to confirm if this virus is viable and the degree of transmission through the faeco-oral route. This may have important implications on isolation, recommended precautions and protective equipment for interventional procedures involving the gastrointestinal tract.
MeSH term(s)	Betacoronavirus ; COVID-19 ; COVID-19 Testing ; Clinical Laboratory Techniques ; Coronavirus Infections/diagnosis ; Coronavirus Infections/transmission ; Feces/virology ; Humans ; Nasopharynx/virology ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/transmission ; Reverse Transcriptase Polymerase Chain Reaction ; SARS-CoV-2 ; Virus Shedding
Keywords	covid19
Language	English
Publishing date	2020-06-04
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.15138
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Article ; Online: Participants' experiences of the management of screen-detected complex polyps within a structured bowel cancer screening programme.

Semedo, Lenira / Gjini, Ardiana / Dolwani, Sunil / Lifford, Kate J

Health expectations : an international journal of public participation in health care and health policy

2022 Volume 25, Issue 5, Page(s) 2355–2364

Abstract: Background: The Bowel Screening Wales complex polyp removal service was introduced to address variations in surgery rates for screen-detected complex benign colorectal polyps, to improve the quality of the screening service and to make management of ... ...

Abstract	Background: The Bowel Screening Wales complex polyp removal service was introduced to address variations in surgery rates for screen-detected complex benign colorectal polyps, to improve the quality of the screening service and to make management of these polyps more equitable across Wales. Little is known about patient experiences and the potential impact on quality of life when undergoing complex polyp removal. This study is part of a wider research programme evaluating the decision-making, pathways and outcomes from complex polyp removal. Objective: This study aimed to understand experiences of having a complex polyp removed and how this may influence quality of life. Design: Semi-structured telephone interviews were conducted, and a thematic approach was used for data analysis. Setting and participants: All participants had a complex polyp removed after a positive stool test and review by Bowel Screening Wales' Network Multi-Disciplinary Team. Results: Twenty-one participants were interviewed. Most participants had their complex polyps removed endoscopically and reported no or minor problems or negative outcomes following their procedure. For a small minority, worse problems (e.g., pain, bowel dysfunction) and negative outcomes (e.g., cancer) followed their procedures. Most participants felt supported and reassured throughout their procedures. Any physical and emotional changes to quality of life were mainly linked to procedure outcomes. Discussion: Experiences of complex polyp removal were generally positive, with minimal changes in quality of life. Conclusions: While most people had a positive experience of having a complex polyp removed, support initiatives, such as counselling or signposting to coping strategies, may be helpful to reduce any potential negative effects of procedures on quality of life. Patient or public contribution: Four patient and public involvement partners provided feedback on participant materials.
MeSH term(s)	Humans ; Colonic Polyps/diagnosis ; Colonic Polyps/surgery ; Colonoscopy/methods ; Early Detection of Cancer/methods ; Quality of Life ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/surgery
Language	English
Publishing date	2022-07-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2119434-8
ISSN	1369-7625 ; 1369-6513
ISSN (online)	1369-7625
ISSN	1369-6513
DOI	10.1111/hex.13525
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Article ; Online: Multidisciplinary decision-making strategies may reduce the need for secondary surgery in complex colonic polyps - A systematic review and pooled analysis.

Parker, Jody / Gupta, Sunnia / Torkington, Jared / Dolwani, Sunil

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2021 Volume 23, Issue 12, Page(s) 3101–3112

Abstract: Aim: The recognition of complex colonic polyps is increasing. Management varies considerably and the impact of this on clinical outcomes is unclear. The aim of this systematic review was to assess the impact of group decision-making strategies and ... ...

Abstract	Aim: The recognition of complex colonic polyps is increasing. Management varies considerably and the impact of this on clinical outcomes is unclear. The aim of this systematic review was to assess the impact of group decision-making strategies and defined selection criteria on the treatment outcomes of complex colonic polyps. Method: A systematic literature review identified studies reporting complex polyp treatment outcomes and describing their decision-making strategies. Databases searched included PubMed, Web of Science, CINAHL and Scopus. Articles were identified by two blinded reviewers using defined inclusion criteria. The review protocol was registered on PROSPERO and performed in line with PRISMA guidelines. Results: There were 303 identified articles describing treatment outcomes of complex colonic polyps. Only nine of these fully described the decision-making strategy and met the inclusion criteria. Adverse events ranged from 1.3% to 10% across the studies. Unsuspected malignancy and secondary surgery rates ranged from 2.4% to 15.4% and 3.3% to 43.9%, respectively. Grouping of articles into a hierarchy of decision-making strategies demonstrated a sequential reduction in secondary surgery rates with improving strategies. There were no differences in comparisons of adverse event or unsuspected malignancy rates. Conclusions: There is limited description of decision-making strategies and variability in reporting of studies describing complex polyp treatment outcomes. The use of multidisciplinary decision-making and defined selection criteria may reduce the need for secondary surgical intervention in complex colonic polyps, but further evidence is required to draw definite conclusions.
MeSH term(s)	Colonic Polyps/surgery ; Decision Making ; Humans
Language	English
Publishing date	2021-09-17
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.15901
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Article ; Online: Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies-a multi-centre observational study.

Parker, J / Gupta, S / Shenbagaraj, L / Harborne, P / Ramaraj, R / Karandikar, S / Mottershead, M / Barbour, J / Mohammed, N / Lockett, M / Lyons, A / Vega, R / Torkington, J / Dolwani, S

International journal of colorectal disease

2023 Volume 38, Issue 1, Page(s) 28

Abstract: Purpose: Team management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational ... ...

Abstract	Purpose: Team management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational study was to assess procedures and outcomes of patients managed using these approaches. Method: This was a retrospective, observational study of patients managed by six UK sites. Information was collected regarding procedures and outcomes including length of stay, adverse events, readmissions and cancers. Results: Two thousand one hundred ninety-two complex polyps in 2109 patients were analysed with increasing referrals annually. Most presented symptomatically and the mean polyp size was 32.1 mm. Primary interventions included endoscopic therapy (75.6%), conservative management (8.3%), colonic resection (8.1%), trans-anal surgery (6.8%) or combined procedures (1.1%). The number of primary colonic resections decreased over the study period without a reciprocal increase in secondary procedures or recurrence. Secondary procedures were required in 7.8%. The median length of stay for endoscopic procedures was 0 days with 77.5% completed as day cases. Median length of stay was 5 days for colonic resections. Overall adverse event and 30-day readmission rates were 9.0% and 3.3% respectively. Malignancy was identified in 8.8%. Benign polyp recurrence occurred in 13.1% with a median follow up of 30.4 months. Screening detected lesions were more likely to undergo bowel resection. Colonic resection was associated with longer stays, higher adverse events and more cancers on final histology. Conclusion: Multi-disciplinary team management of complex polyps is safe and effective. Standardisation of organisation and quality monitoring is needed to continue positive effects on outcomes and services.
MeSH term(s)	Humans ; Colonic Polyps/pathology ; Colonoscopy/adverse effects ; Colonoscopy/methods ; Colon/pathology ; Retrospective Studies ; Referral and Consultation
Language	English
Publishing date	2023-02-03
Publishing country	Germany
Document type	Multicenter Study ; Observational Study ; Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-022-04299-0
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Article ; Online: Antibiotic exposure and the risk of colorectal adenoma and carcinoma: a systematic review and meta-analysis of observational studies.

Sanyaolu, L N / Oakley, N J / Nurmatov, U / Dolwani, S / Ahmed, H

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2020 Volume 22, Issue 8, Page(s) 858–870

Abstract: Aim: The Incidence of colorectal cancer (CRC) is increasing, and evidence suggests that maladaptation of the bowel microbiome may be associated with colorectal carcinogenesis. Consumption of antibiotics may cause imbalance of the bowel microbiome but ... ...

Abstract	Aim: The Incidence of colorectal cancer (CRC) is increasing, and evidence suggests that maladaptation of the bowel microbiome may be associated with colorectal carcinogenesis. Consumption of antibiotics may cause imbalance of the bowel microbiome but research assessing an association between antibiotic exposure and CRC is inconsistent. The aim of this systematic review and meta-analysis was to appraise and synthesize the available evidence. Method: The MEDLINE, EMBASE and CINAHL databases were searched for published observational studies. We included eight studies of 3 408 312 patients. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the odds of CRC following antibiotic exposure were estimated. Sensitivity analyses were performed according to exposure definition, study design and risk of bias. Results: A weak association between antibiotic exposure and CRC was demonstrated when exposure was assessed cumulatively by the number of prescriptions (OR 1.204, 95% CI 1.097-1.322, P < 0.001) or duration of antibiotic exposure (OR 1.168, 95% CI 1.087-1.256, P < 0.001). Antibiotic exposure assessed as a binary variable demonstrated no association with CRC. Conclusion: The findings suggest a weak association between cumulative antibiotic consumption and risk of CRC but no causal conclusions can be made. Limitations include the heterogeneity and quality of the available research, particularly with regard to measurement of antibiotic exposure.
MeSH term(s)	Adenoma/chemically induced ; Adenoma/epidemiology ; Anti-Bacterial Agents/adverse effects ; Carcinoma ; Colorectal Neoplasms/chemically induced ; Colorectal Neoplasms/epidemiology ; Humans ; Incidence
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2020-01-06
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.14921
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Article: Surveying and understanding colonoscopy technique.

Dolwani, Sunil

Frontline gastroenterology

2012 Volume 3, Issue 4, Page(s) 218–219

Language	English
Publishing date	2012-07-21
Publishing country	England
Document type	Editorial
ZDB-ID	2521857-8
ISSN	2041-4137
ISSN	2041-4137
DOI	10.1136/flgastro-2012-100206
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