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Article: Therapeutic anticoagulation in patients with acute pancreatitis and splanchnic vein thrombosis: a best evidence topic.

Redman, Ishtar / Panahi, Pedram / Bananis, Kyriakos / Drymousis, Panagiotis

Annals of medicine and surgery (2012)

2023 Volume 86, Issue 1, Page(s) 271–278

Abstract: A best evidence topic in general surgery was written according to a structured protocol. The clinical question addressed was: in adult patients with splanchnic vein thrombosis in acute pancreatitis, would administration of therapeutic anticoagulation be ... ...

Abstract	A best evidence topic in general surgery was written according to a structured protocol. The clinical question addressed was: in adult patients with splanchnic vein thrombosis in acute pancreatitis, would administration of therapeutic anticoagulation be advisable considering the rates of vessel recanalization and bleeding complications? Four hundred twenty-four papers were found on Ovid Embase and Medline whilst 222 were found on PubMed using the reported literature search. From these, five articles represented the best evidence to the clinical question. The authors, publication dates, countries, patient groups, study outcomes, and results of these papers were tabulated. There were three systematic reviews with meta-analyses, one systematic review without meta-analysis and one randomized, retrospective study. The authors conclude that among patients with splanchnic vein thrombosis in the context of acute pancreatitis, therapeutic anticoagulation improved the rates of recanalization without increasing the risk of bleeding complications. However, there remains a need for randomized studies to address this clinical dilemma to further increase the quality of available evidence.
Language	English
Publishing date	2023-11-16
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1097/MS9.0000000000001440
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Article: Postoperative packing of perianal abscesses following incision and drainage.

Redman, Ishtar A / Panahi, Pedram / Gill, Moneet / Drymousis, Panagiotis

British journal of hospital medicine (London, England : 2005)

2023 Volume 84, Issue 11, Page(s) 1–6

Abstract: A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should postoperative wound packing be undertaken considering the rates of pain experienced, wound ...

Abstract	A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should postoperative wound packing be undertaken considering the rates of pain experienced, wound healing and abscess recurrence? The literature search identified 159 papers on Ovid, Embase and Medline and 48 on PubMed. These were independently screened, and three articles were included in this review as these offered the best information to answer the question. One was a systematic review without meta-analysis, one was a randomised controlled trial and one was a multicentre observational study. Review of these articles led the authors to conclude that routine postoperative packing of perianal abscesses following incision and drainage is costly, associated with increased pain and confers no protection against recurrence of abscesses or formation of fistulae.
MeSH term(s)	Adult ; Humans ; Abscess/surgery ; Drainage ; Multicenter Studies as Topic ; Observational Studies as Topic ; Pain ; Postoperative Period ; Randomized Controlled Trials as Topic ; Skin Diseases
Language	English
Publishing date	2023-11-27
Publishing country	England
Document type	Journal Article ; Review
ISSN	1750-8460
ISSN	1750-8460
DOI	10.12968/hmed.2023.0308
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Article: Management of Small Bowel Neuroendocrine Tumours: 10 Years' Experience at a Tertiary Referral Centre.

Clift, Ashley K / Drymousis, Panagiotis / von Roon, Alexander / Humphries, Adam / Goldin, Robert / Bomanji, Jamshed / Leaman, Sydney / Wasan, Harpreet / Habib, Nagy / Frilling, Andrea

Cancers

2023 Volume 15, Issue 18

Abstract: Background: Neuroendocrine tumours (NET) arising from the small bowel are clinically challenging and are often diagnosed at advanced stages. Disease control with surgery alone can be demanding. Multimodal treatment concepts integrating surgery and non- ... ...

Abstract	Background: Neuroendocrine tumours (NET) arising from the small bowel are clinically challenging and are often diagnosed at advanced stages. Disease control with surgery alone can be demanding. Multimodal treatment concepts integrating surgery and non-surgical modalities could be of benefit. Method: Retrospective review of consecutive adult patients with SB NET treated at Imperial College Healthcare NHS Trust between 1 January 2010 and 31 December 2019. Data regarding clinicopathological characteristics, treatments, and disease trajectory were extracted and summarised. Overall and progression/recurrence-free survival were estimated at 5 and 10 years. Results: 154 patients were identified, with a median age of 64 years (range 33-87); 135/154 (87.7%) had stage III/IV disease at diagnosis. Surgery was used in 125 individuals (81.2%), typically with either segmental small bowel resection (60.8%) or right hemicolectomy (33.6%) and mesenteric lymphadenectomy for the primary tumour. Systemic and/or liver-directed therapies were used in 126 (81.8%); 60 (47.6%) had more than one line of non-surgical treatment. Median follow-up was 67.2 months (range 3.1-310.4); overall survival at 5 and 10 years was 91.0% (95% CI: 84.9-94.7%) and 82.5% (95% CI: 72.9-88.9%), respectively. Imaging-based median progression-free survival was 42.7 months (95% CI: 24.7 to 72.4); 5-year progression-free survival was 63.4% (95% CI: 55.0-70.6%); 10-year progression-free survival was 18.7% (95% CI: 12.4-26.1). Nineteen patients (12.3%) reached 10 years follow-up without disease recurrence and therefore were considered cured. Conclusions: Most patients with SB NET present in a metastasised stage. Multimodal treatment concepts may be associated with excellent clinical outcomes. Future work should explore optimal approaches to treatment sequencing and patient selection.
Language	English
Publishing date	2023-09-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15184438
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Article: Neuroendocrine Neoplasms: Identification of Novel Metabolic Circuits of Potential Diagnostic Utility.

Jiménez, Beatriz / Abellona U, Mei Ran / Drymousis, Panagiotis / Kyriakides, Michael / Clift, Ashley K / Liu, Daniel S K / Rees, Eleanor / Holmes, Elaine / Nicholson, Jeremy K / Kinross, James M / Frilling, Andrea

Cancers

2021 Volume 13, Issue 3

Abstract: The incidence of neuroendocrine neoplasms (NEN) is increasing, but established biomarkers have poor diagnostic and prognostic accuracy. Here, we aim to define the systemic metabolic consequences of NEN and to establish the diagnostic utility of proton ... ...

Abstract	The incidence of neuroendocrine neoplasms (NEN) is increasing, but established biomarkers have poor diagnostic and prognostic accuracy. Here, we aim to define the systemic metabolic consequences of NEN and to establish the diagnostic utility of proton nuclear magnetic resonance spectroscopy (
Language	English
Publishing date	2021-01-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers13030374
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Article: Goblet cell carcinomas of the appendix: rare but aggressive neoplasms with challenging management.

Clift, Ashley K / Kornasiewicz, Oskar / Drymousis, Panagiotis / Faiz, Omar / Wasan, Harpreet S / Kinross, James M / Cecil, Thomas / Frilling, Andrea

Endocrine connections

2018 Volume 7, Issue 2, Page(s) 268–277

Abstract: Goblet cell carcinomas (GCC) are a rare, aggressive sub-type of appendiceal tumours with neuroendocrine features, and controversy exists with regards to therapeutic strategy. We undertook a retrospective review of GCC patients surgically treated at two ... ...

Abstract	Goblet cell carcinomas (GCC) are a rare, aggressive sub-type of appendiceal tumours with neuroendocrine features, and controversy exists with regards to therapeutic strategy. We undertook a retrospective review of GCC patients surgically treated at two tertiary referral centres. Clinical and histopathological data were extracted from a prospectively maintained database. Survival analyses utilised Kaplan-Meier methodology. Twenty-one patients were identified (9 females). Median age at diagnosis was 55 years (range 32-77). There were 3, 6 and 9 grade 1, 2 and 3 tumours, respectively. One, 10, 5 and 5 patients had stage I, II, III and IV disease at diagnosis, respectively. There were 8, 10 and 3 Tang class A, B and C tumours, respectively. Index operation was appendectomy (
Language	English
Publishing date	2018-01-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2668428-7
ISSN	2049-3614
ISSN	2049-3614
DOI	10.1530/EC-17-0311
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Article ; Online: Metabonomic profiling: a novel approach in neuroendocrine neoplasias.

Kinross, James M / Drymousis, Panagiotis / Jiménez, Beatriz / Frilling, Andrea

Surgery

2013 Volume 154, Issue 6, Page(s) 1185–92; discussion 1192–3

Abstract: Background: A metabonomic phenotyping strategy was developed as part of a pilot study to define a diagnostic metabolic phenotype for neuroendocrine neoplasms (NEN).: Methods: Twenty-eight patients with NEN were prospectively recruited: small bowel ... ...

Abstract	Background: A metabonomic phenotyping strategy was developed as part of a pilot study to define a diagnostic metabolic phenotype for neuroendocrine neoplasms (NEN). Methods: Twenty-eight patients with NEN were prospectively recruited: small bowel NEN, n = 8; pancreatic NEN, n = 10; and others, n = 10 (mean age 49.4 years [26–81] male/female ratio 17:11). There were 17 healthy control patients. Urine samples were subjected to 1H nuclear magnetic resonance spectroscopic profiling via the use of a Bruker Avance 600-MHz spectrometer (Bruker, Rheinstetten, Germany). Acquired spectral data were imported into SIMCA and MATLAB for supervised and unsupervised multivariate analysis. Results: Partial least squares-discriminant analysis differentiated between NEN and healthy samples with accuracy (R(2)Y = 0.79, Q2Y = 0.53, area under the curve [AUC] 0.90). Orthogonal partial least squares-discriminant analysis was able to distinguish between small bowel NEN and pancreatic NEN (R2Y = 0.91, Q2Y = 0.35). Subclass analysis also demonstrated class separation between functional and nonfunctional NEN (R2Y = 0.98, Q2Y = 0.77, AUC 0.6) and those with metastases (R2Y = 0.72 , Q2 Y = 0.41, AUC 0.86) due to variations in hippurate metabolism (P < .0001). Conclusion: Metabonomic analysis suggests that subgroups of NEN may possess a stratified metabolic phenotype. Metabolic profiling could provide novel biomarkers for NEN.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cohort Studies ; Female ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Metabolome ; Metabolomics/methods ; Metabolomics/statistics & numerical data ; Middle Aged ; Neuroendocrine Tumors/diagnosis ; Neuroendocrine Tumors/metabolism ; Neuroendocrine Tumors/urine ; Pilot Projects ; Prospective Studies
Language	English
Publishing date	2013-09-05
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2013.06.018
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Article ; Online: Radioembolisation with 90Y microspheres for neuroendocrine liver metastases: an institutional case series, systematic review and meta-analysis.

Frilling, Andrea / Clift, Ashley K / Braat, Arthur J A T / Alsafi, Ali / Wasan, Harpreet S / Al-Nahhas, Adil / Thomas, Robert / Drymousis, Panagiotis / Habib, Nagy / Tait, Paul N

HPB : the official journal of the International Hepato Pancreato Biliary Association

2019 Volume 21, Issue 7, Page(s) 773–783

Abstract: Background: Neuroendocrine liver metastases are clinically challenging due to their frequent disseminated distribution. This study aims to present a British experience with an emerging modality, radioembolisation with yttrium-90 labelled microspheres, ... ...

Abstract	Background: Neuroendocrine liver metastases are clinically challenging due to their frequent disseminated distribution. This study aims to present a British experience with an emerging modality, radioembolisation with yttrium-90 labelled microspheres, and embed this within a meta-analysis of response and survival outcomes. Methods: A retrospective case series of patients treated with SIR-Spheres (radiolabelled resin microspheres) was performed. Results were included in a systematic review and meta-analysis of published results with glass or resin microspheres. Objective response rate (ORR) was defined as complete or partial response. Disease control rate (DCR) was defined as complete/partial response or stable disease. Results: Twenty-four patients were identified. ORR and DCR in the institutional series was 14/24 and 21/24 at 3 months. Overall survival and progression-free survival at 3-years was 77.6% and 50.4%, respectively. There were no grade 3/4 toxicities post-procedure. A fixed-effects pooled estimate of ORR of 51% (95% CI: 47%-54%) was identified from meta-analysis of 27 studies. The fixed-effects weighted average DCR was 88% (95% CI: 85%-90%, 27 studies). Conclusion: Current data demonstrate evidence of the clinical effectiveness and safety of radioembolisation for neuroendocrine liver metastases. Prospective randomised studies to compare radioembolisation with other liver directed treatment modalities are needed.
MeSH term(s)	Aged ; Disease Progression ; Embolization, Therapeutic/adverse effects ; Embolization, Therapeutic/mortality ; Female ; Humans ; Liver Neoplasms/diagnostic imaging ; Liver Neoplasms/mortality ; Liver Neoplasms/radiotherapy ; Liver Neoplasms/secondary ; Male ; Microspheres ; Middle Aged ; Neuroendocrine Tumors/diagnostic imaging ; Neuroendocrine Tumors/mortality ; Neuroendocrine Tumors/radiotherapy ; Neuroendocrine Tumors/secondary ; Progression-Free Survival ; Radiopharmaceuticals/administration & dosage ; Radiopharmaceuticals/adverse effects ; Retrospective Studies ; Time Factors ; Yttrium Radioisotopes/administration & dosage ; Yttrium Radioisotopes/adverse effects
Chemical Substances	Radiopharmaceuticals ; Yttrium Radioisotopes
Language	English
Publishing date	2019-02-05
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2018.12.014
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Article ; Online: Is octreotide beneficial in patients undergoing pancreaticoduodenectomy? Best evidence topic (BET).

Drymousis, Panagiotis / Pai, Madhava / Spalding, Duncan / Jiao, Long R / Habib, Nagy / Zacharakis, Emmanouil

International journal of surgery (London, England)

2013 Volume 11, Issue 9, Page(s) 779–782

Abstract: A best evidence topic was written according to a structured protocol. The question addressed was whether the prophylactic administration of somatostatin or somatostatin analogues in patients undergoing pancreaticoduodenectomy (Whipple's procedure) is ... ...

Abstract	A best evidence topic was written according to a structured protocol. The question addressed was whether the prophylactic administration of somatostatin or somatostatin analogues in patients undergoing pancreaticoduodenectomy (Whipple's procedure) is beneficial in terms of improved surgical outcomes, reduced morbidity or reduced mortality. A total of 118 papers were found using the reported searches of which 5 represented the best evidence (1 meta-analysis, 1 systematic review and 3 randomized control trials). The authors, date, journal, study type, population, main outcome measures and results were tabulated. There is evidence that the perioperative administration of somatostatin or somatostatin analogues reduces biochemical incidence of pancreatic fistula but, it is still unclear if there is a beneficial effect in the incidence of clinically significant pancreatic fistula. Further adequately powered trials with low risk of bias are necessary. From the available data, somatostatin or somatostatin analogues have no effect on mortality post Whipple's. Interestingly, there are only limited data available on the cost-benefit and financial constraints imposed by this treatment, an issue that has only been addressed in a few studies.
MeSH term(s)	Gastrointestinal Agents/adverse effects ; Gastrointestinal Agents/therapeutic use ; Humans ; Octreotide/adverse effects ; Octreotide/therapeutic use ; Pancreas/surgery ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/adverse effects ; Pancreaticoduodenectomy/methods ; Postoperative Complications ; Randomized Controlled Trials as Topic ; Treatment Outcome
Chemical Substances	Gastrointestinal Agents ; Octreotide (RWM8CCW8GP)
Language	English
Publishing date	2013
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2013.06.013
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Article: Glucagon receptor gene mutations with hyperglucagonemia but without the glucagonoma syndrome.

Miller, Helen C / Kidd, Mark / Modlin, Irvin M / Cohen, Patrizia / Dina, Roberto / Drymousis, Panagiotis / Vlavianos, Panagiotis / Klöppel, Günter / Frilling, Andrea

World journal of gastrointestinal surgery

2015 Volume 7, Issue 4, Page(s) 60–66

Abstract: Pancreatic neoplasms producing exclusively glucagon associated with glucagon cell hyperplasia of the islets and not related to hereditary endocrine syndromes have been recently described. They represent a novel entity within the panel of non-syndromic ... ...

Abstract	Pancreatic neoplasms producing exclusively glucagon associated with glucagon cell hyperplasia of the islets and not related to hereditary endocrine syndromes have been recently described. They represent a novel entity within the panel of non-syndromic disorders associated with hyperglucagonemia. This case report describes a 36-year-old female with a 10 years history of non-specific abdominal pain. No underlying cause was evident despite extensive diagnostic work-up. More recently she was diagnosed with gall bladder stones. Abdominal ultrasound, computerised tomography and magnetic resonance imaging revealed no pathologic findings apart from cholelithiasis. Endoscopic ultrasound revealed a 5.5 mm pancreatic lesion. Fine needle aspiration showed cells focally expressing chromogranin, suggestive but not diagnostic of a low grade neuroendocrine tumor. OctreoScan(®) was negative. Serum glucagon was elevated to 66 pmol/L (normal: 0-50 pmol/L). Other gut hormones, chromogranin A and chromogranin B were normal. Cholecystectomy and enucleation of the pancreatic lesion were undertaken. Postoperatively, abdominal symptoms resolved and serum glucagon dropped to 7 pmol/L. Although H and E staining confirmed normal pancreatic tissue, immunohistochemistry was initially thought to be suggestive of alpha cell hyperplasia. A count of glucagon positive cells from 5 islets, compared to 5 islets from 5 normal pancreata indicated that islet size and glucagon cell ratios were increased, however still within the wide range of normal physiological findings. Glucagon receptor gene (GCGR) sequencing revealed a heterozygous deletion, K349_G359del and 4 missense mutations. This case may potentially represent a progenitor stage of glucagon cell adenomatosis with hyperglucagonemia in the absence of glucagonoma syndrome. The identification of novel GCGR mutations suggests that these may represent the underlying cause of this condition.
Language	English
Publishing date	2015-04-20
Publishing country	United States
Document type	Case Reports
ZDB-ID	2573700-4
ISSN	1948-9366
ISSN	1948-9366
DOI	10.4240/wjgs.v7.i4.60
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Article ; Online: Incidence of Second Primary Malignancies in Patients with Neuroendocrine Tumours.

Clift, Ashley K / Drymousis, Panagiotis / Al-Nahhas, Adil / Wasan, Harpreet / Martin, John / Holm, Sture / Frilling, Andrea

Neuroendocrinology

2015 Volume 102, Issue 1-2, Page(s) 26–32

Abstract: Background: An association between neuroendocrine tumours (NET) and increased risk of developing second primary malignancies (SPM) has been recognised.: Methods: This was a retrospective review of our institutional prospectively maintained database ... ...

Abstract	Background: An association between neuroendocrine tumours (NET) and increased risk of developing second primary malignancies (SPM) has been recognised. Methods: This was a retrospective review of our institutional prospectively maintained database of NET patients. We identified patients who had been diagnosed with both neuroendocrine and any additional malignancies via examination of patient notes. Results: Clinical data for 169 patients were analysed. After exclusion of patients known to have hereditary tumour predisposition syndromes, 29 SPM were identified in 26 patients (15.38%), the commonest being colorectal (n = 6), breast and renal carcinomas (both n = 5). SPM were classified as previous, synchronous or subsequent relative to NET diagnosis. Rates of SPM in pancreatic and small-bowel NET patients were comparable (15.7 vs. 19.6%, p = 0.78). A person-year methodology was used to compare observed numbers of SPM against expected values generated from age- and sex-specific incidence tables, with standardised incidence ratios (SIR) and 95% confidence intervals (CI) calculated. SPM incidence was significantly elevated in the synchronous subset (SIR 2.732, CI 1.177-5.382) whilst significantly fewer NET patients had a cancer history compared to the general population (SIR 0.4, CI 0.241-0.624). No overall differences were evident between observed and expected incidences of subsequent SPM (SIR 0.36, CI 0.044-1.051). The incidence of synchronous colorectal cancers was markedly elevated (SIR 13.079, CI 4.238-30.474). Conclusions: Our data support the use of colonoscopy in the diagnostic work-up of NET patients in anticipation of a colorectal SPM. The mechanistic underpinnings of this clinical phenomenon require further genetic investigation, and consideration of this knowledge in patient management pathways is warranted.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/epidemiology ; Colorectal Neoplasms/epidemiology ; Female ; Humans ; Incidence ; Kidney Neoplasms/epidemiology ; Male ; Middle Aged ; Neoplasms, Second Primary/epidemiology ; Neuroendocrine Tumors/epidemiology ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2015
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	123303-8
ISSN	1423-0194 ; 0028-3835
ISSN (online)	1423-0194
ISSN	0028-3835
DOI	10.1159/000381716
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