Archive November 20, 2014

By-Band Trial Open in Leeds Nov 2014

We are pleased to announce that Leeds Teaching Hospitals has opened recruitment to the By-Band Randomised Controlled Trial. We have managed to recruit our first 3 patients into this important study. Thank you to all members of the teams in Leeds and Bristol for helping to get this off the ground in a relatively short time period.

Trek Kilimanjaro Challenge

I have recently decided to attempt a challenge of a lifetime and trek to the summit of Mount Kilimanjaro, the highest mountain in Africa. It will be a demanding walk spread out over 6-7 days to allow for altitude acclimatisation to try and reach the peak Kibo located 5895 metres (19341 ft) above sea level. I am raising funds for the Yorkshire Cancer Centre Appeal which supports patients with cancer in improving their quality of life. It also supports research projects and the purchase of vital medical equipment. A donation page has been set up (please copy into your browser). I am planning to do this Trek in February 2016.

Please visit this page for more information. All donations are gratefully received.

Enhanced Recovery for Oesophago-Gastric Cancer

The first meeting tool place in St James’s Institute of Oncology, Leeds on 25th June 2014 to move forward plans to set up enhanced recovery for oesophageal and gastric cancer patients. The meeting was well attended by members of the multidisciplinary team and a overall a positive discussion was achieved. The process aims to improve the experience and outcome for patients who receive an operation to remove this type of cancer. Other units have demonstrated that some of the problems after surgery and the duration of stay in hospital may be reduced with adoption of this pathway. We look forward to visiting colleagues in Nottingham who have this already in place and hope that Leeds Teaching Hospitals will support plans to implement this proposal.

By-Band Trial Meeting Bristol April 2014

I was fortunate to have the opportunity to attend a meeting organised by Jane Blazeby in Bristol yesterday. She has obtained a National Institute for Health Research grant to investigate outcomes of weight loss surgery at 3 years. There is no conclusive good quality evidence to support the benefit of one weight loss surgery operation over another for patients with morbid obesity. This study is known as a ‘randomized-controlled trial’ where those patients who qualify for bariatric surgery, and are willing to participate, are allocated to gastric band or gastric bypass on a random basis. There is a possibility that sleeve gastrectomy could be included as a treatment option in the trial. The aim of ‘randomization’ is to reduce bias which can affect outcome reports in other types of studies. I hope to register Leeds as a study centre along with other bariatric units around the UK whose representatives also attended the meeting.

Oesophageal Cancer: an update for primary care

I was invited to Huddersfield by the Yorkshire and Humber Strategic Clinical Network to give an update on oesophageal cancer and Barrett’s oesophagus to primary care cancer leads. A number of key points emerged. Even though the incidence of oesophageal cancer is increasing in the UK especially in male patients, overall survival is increasing. Five-year survival from cases that have been operated on in Leeds is around 40-50%.

It is very important for patients with Barrett’s oesophagus to have 2 yearly endoscopy and for those with dysplasia (where the oesophageal lining has started to become unstable), endoscopic surveillance is done by a specialist and more definitive treatment such as radio frequency ablation is considered. Patients with oesophageal cancer too advanced for surgery can be offered palliative anti-cancer treatment such as chemotherapy (medical treatment) and/or radiotherapy (radiation treatment) in addition to an oesophageal stent (a tube that is inserted that opens up the gullet to allow improved swallowing).

British Obesity and Metabolic Surgery Meeting 2014

I was privileged to be able to attend the excellent BOMSS Meeting in Leamington Spa last week. Internationally recognised speakers attended including George Fielding (New York), Bruno Dillemans (Bruges), Michel Gagner (Montreal) and John Dixon (Melbourne). A lively debate took place on Thursday with the three bariatric surgeons debating the ideal weight loss surgery option for a hypothetical patient aged 28 years with a BMI of 42. Audience participation was encouraged and they voted for their recommendation before and after the debate. There was a swing of opinion favouring the adjustable gastric band rather than the roux en y gastric by pass for this case after the arguments were heard. The debate continues…

The fact that this controversy exists was emphasized by Professor Jane Blazeby from Bristol. She requested support from surgeons around the UK for a multi-centre randomised trial of sleeve vs gastric bypass vs adjustable gastric band to try and work out which weight loss operation produces the best outcome and quality of life for patients. This is a large project which will require a lot of patients to take part and I hope that Leeds can support recruitment of patients for this study. We may finally be able to produce an answer regarding the most effective weight loss surgery procedure of these 3 options.

Weight loss surgery and fertility Jan 2014

I had the pleasure of presenting some evidence for weight loss surgery to the British Fertility Society Meeting in Sheffield on 8th January 2014. There is evidence that weight loss surgery may improve female fertility in patients with ‘morbid’ obesity (BMI >= 35) and lead to an increase in the chance of pregnancy afterwards. Pregnancy itself should be avoided in patients 12-18  months after undergoing weight loss surgery and contraception should be carefully considered by patients undergoing a bariatric procedure. A number of pregnancy outcomes are improved after weight loss surgery.