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Chong J, Wee NK, Tan CH, Low HM, Chew WD, Vu CKF, Lee CH. Pancreatic cysts: can surveillance interval for small low-risk lesions be lengthened? Acta Radiol 2024:2841851231222799. [PMID: 38196245 DOI: 10.1177/02841851231222799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Surveillance of pancreatic cysts are necessary due to risk of malignant transformation. However, reported progression rates to advanced neoplasia are variable and the high frequency of surveillance scans may pose a considerable burden on healthcare resources. PURPOSE To validate the effectiveness of the Fukuoka Guidelines surveillance regime and determine if a longer surveillance interval can be established. MATERIAL AND METHODS All magnetic resonance imaging (MRI) studies of the pancreas performed at our institution between January 2014 and December 2016 with at least one pancreatic cystic lesion and follow-up MRI or computed tomography (CT) over at least two years were reviewed for size, worrisome feature (WF), and high-risk stigmata (HRS) at diagnosis and follow-up imaging (up to year 6). Reference standards for advanced neoplasia were based on endoscopic ultrasound, fine needle aspiration cytology, or the presence of ≥2 WF or ≥1 HRS on imaging. Comparison of MRI features of progression and outcomes of diagnostic endpoints between lesions <20 mm and ≥20 mm was performed. RESULTS A total of 270 patients were included (201 cysts <20 mm, 69 cysts ≥20 mm). Compared with cysts <20 mm, cysts ≥20 mm were more likely to be associated with WF or HRS (40.6% vs. 12.4%; P ≤0.00001), demonstrate increase in size of ≥5 mm in two years (20.3% vs. 10.9%; P = 0.049), and develop advanced neoplasia (24.6% vs. 0.5%; P <0.00001). CONCLUSION Pancreatic cysts <20 mm have a low risk of developing WF and HRS and surveillance interval may be lengthened.
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Affiliation(s)
- Jingli Chong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nicole Kessa Wee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Hsien Min Low
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Da Chew
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Charles Kien Fong Vu
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chau Hung Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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Liang R, Kaliyaperumal K, Ng WK, Tsao SKK, Vu CKF. Motorised spiral enteroscopy: pilot experience from a tertiary care centre in Singapore. Singapore Med J 2023; 64:758-762. [PMID: 35849882 PMCID: PMC10775294 DOI: 10.11622/smedj.2022096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Raymond Liang
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
| | | | - Wee Khoon Ng
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
| | | | - Charles Kien Fong Vu
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
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Ng WK, Tan QR, Punamiya SJ, Ong PJL, Vu CKF. Novel method to remove deeply migrated pancreatic duct stent. Endoscopy 2022; 54:E748-E749. [PMID: 35359016 DOI: 10.1055/a-1792-2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Wee Khoon Ng
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
| | | | | | | | - Charles Kien Fong Vu
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
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Ang TL, Lim JF, Chua TS, Tan KY, Li JW, Chong CH, Gwee KA, Namasivayam V, Vu CKF, Khor CJL, Wang LM, Yeoh KG. Clinical guidance on endoscopic management of colonic polyps in Singapore. Singapore Med J 2020; 63:173-186. [PMID: 32668839 DOI: 10.11622/smedj.2020108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Colonoscopy with endoscopic resection of detected colonic adenomas interrupts the adenoma-carcinoma sequence and reduces the incidence of colorectal cancer and cancer-related mortality. In the past decade, there have been significant developments in instruments and techniques for endoscopic polypectomy. Guidelines have been formulated by various professional bodies in Europe, Japan and the United States of America, but some of the recommendations differ between the various bodies. An expert professional workgroup under the auspices of the Academy of Medicine, Singapore, was set up to provide guidance on the endoscopic management of colonic polyps in Singapore. A total of 23 recommendations addressed the following issues: accurate description and diagnostic evaluation of detected polyps; techniques to reduce the risk of post-polypectomy bleeding and delayed perforation; the role of specific endoscopic resection techniques; the histopathological criteria for defining endoscopic cure; and the role of surveillance colonoscopy following curative resection.
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Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | | | - Tju Siang Chua
- AliveoMedical, Mount Alvernia Hospital and Mount Elizabeth Hospitals, Singapore
| | - Kok Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | | | | | | | - Charles Kien Fong Vu
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
| | | | - Lai Mun Wang
- Pathology Section, Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Khay Guan Yeoh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
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Chang JPE, Wong YJ, Yang WL, Lim KBL, Tan PS, Ho GH, Yip BCH, Li JW, Chong CH, Ong DEH, Chua TS, Vu CKF, Gwee KA, Ang TL, Tan CK. Chapter of Gastroenterologists professional guidance for management of patients with liver disease in Singapore during the COVID-19 pandemic. Singapore Med J 2020; 61:619-623. [PMID: 32349198 DOI: 10.11622/smedj.2020069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this paper, we aim to provide professional guidance to clinicians who are managing patients with chronic liver disease during the current coronavirus disease 2019 (COVID-19) pandemic in Singapore. We reviewed and summarised the available relevant published data on liver disease in COVID-19 and the advisory statements that were issued by major professional bodies, such as the American Association for the Study of Liver Diseases and European Association for the Study of the Liver, contextualising the recommendations to our local situation.
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Affiliation(s)
- Jason Pik Eu Chang
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Yu Jun Wong
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Wei Lyn Yang
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
| | - Kieron Boon Leng Lim
- Mount Elizabeth Medical Centre, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Poh Seng Tan
- PS Tan Digestive and Liver Centre, Mount Elizabeth Hospital, Singapore
| | - Gim Hin Ho
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Division of Gastroenterology, Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - Benjamin Cherng Hann Yip
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Division of Gastroenterology, Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - James Weiquan Li
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Chern Hao Chong
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Gutcare Digestive Liver Endoscopy Associates, Singapore
| | - David Eng Hui Ong
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Tju Siang Chua
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,AliveoMedical, Mount Alvernia and Mount Elizabeth Hospitals, Singapore
| | - Charles Kien Fong Vu
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
| | - Kok Ann Gwee
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Gleneagles Hospital, Singapore
| | - Tiing Leong Ang
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Chee Kiat Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
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Ang TL, Li JW, Vu CKF, Ho GH, Chang JPE, Chong CH, Chua TS, Ong DEH, Yip BCH, Gwee KA. Chapter of Gastroenterologists professional guidance on risk mitigation for gastrointestinal endoscopy during COVID-19 pandemic in Singapore. Singapore Med J 2020; 61:345-349. [PMID: 32241065 DOI: 10.11622/smedj.2020050] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In this paper, we aimed to provide professional guidance to practising gastrointestinal (GI) endoscopists for the safe conduct of GI endoscopy procedures during the current coronavirus disease 2019 (COVID-19) pandemic and future outbreaks of similar severe respiratory tract infections in Singapore. It draws on the lessons learnt during the severe acute respiratory syndrome (SARS) epidemic and available published data concerning the COVID-19 pandemic. It addresses measures before, during and after endoscopy that must be considered for both non-infected and infected patients, and provides recommendations for practical implementation.
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Affiliation(s)
- Tiing Leong Ang
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - James Weiquan Li
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Charles Kien Fong Vu
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore
| | - Gim Hin Ho
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Division of Gastroenterology, Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - Jason Pik Eu Chang
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Chern Hao Chong
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Gutcare Digestive Liver Endoscopy Associates, Singapore
| | - Tju Siang Chua
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,AliveoMedical, Mount Alvernia Hospital and Mount Elizabeth Hospitals, Singapore
| | - David Eng Hui Ong
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Benjamin Cherng Hann Yip
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Division of Gastroenterology, Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - Kok Ann Gwee
- Chapter of Gastroenterologists, Academy of Medicine, Singapore.,Gleneagles Hospital, Singapore
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Abstract
INTRODUCTION There are growing concerns that the use of proton pump inhibitors (PPIs) may be inappropriate in instances that do not conform to evidence-based indications. This point-prevalence study aimed to investigate the frequency, indications and appropriateness of use of PPIs in hospitalised patients on a randomly chosen day. METHODS On a randomly chosen day, all inpatients were documented, and those on any form of PPIs on that day were determined. Indications for maintaining these patients on PPIs were obtained from the electronic medical records, which were then recorded and cross-referenced against a list of accepted indications adapted from the US Food and Drug Administration (FDA)-approved list. RESULTS In all, 1,025 inpatients were documented. Of the 477 (46.5%) inpatients using PPIs, only 219 (45.9%) fulfilled the FDA-approved indications, while the majority (n = 258, 54.1%) did not. Overall, PPIs were not strictly indicated for use in 206 (43.2%) inpatients, according to FDA criteria. Of the 477 inpatients on PPIs, 52 (10.9%) had borderline indications based on expert consensus/guidelines other than FDA criteria. CONCLUSION Although the use of PPIs is prevalent in hospitals, less than half of the hospitalised patients using PPIs in our study had evidence-based indications that supported such use. The overuse of PPIs has a negative impact on healthcare costs and may lead to adverse effects. Steps to curb the inappropriate use of PPIs should address factors such as indications for the initiation of PPIs, and reassessment of the need for ongoing PPI use in inpatients upon discharge and during outpatient reviews.
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Affiliation(s)
- Christopher Tze Wei Chia
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
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Abstract
BACKGROUND Several studies have cited the incidence of malnutrition in hospitals, which is correlated to negative clinical outcomes, to be up to 60%. Data in Singapore, however, are scarce. Its impact on casemix funding is not known. AIMS The aims of the present study were to determine the prevalence of malnutrition, the predisposing risk factors and the impact of documentation and coding of malnutrition on casemix funding in a local population in Singapore. METHODS Patients admitted to selected wards over a 1-month period were screened for malnutrition. Those at risk were further assessed using subjective global assessment. Logistic regression was used to ascertain the impact of identified factors on malnutrition. Financial impact analysis of coding of malnutrition as a comorbidity was carried out and tested with Wilcoxon signed rank tests. RESULTS Six hundred and fifty-eight patients were eligible for screening. The overall prevalence of malnutrition in the selected wards was 14.7% (95% confidence interval (CI): 12.0-17.4%). Old age, the occurrence of cancer and the admitting unit were statistically significant in explaining the occurrence of malnutrition. Coding of malnutrition was found to significantly increase the complexity of 24 of 105 episodes (22.9%) of patient care as measured by expected cost weights (P < 0.001) and expected lengths of stay (P < 0.001). As a result, the expected financing for these 24 patients increased by 59.7%. CONCLUSIONS Malnutrition is prevalent in hospitalised medical and surgical patients. Certain clinical factors should heighten awareness and prompt detection for malnutrition. Coding for malnutrition impacts favourably on casemix funding for a subset of malnourished patients.
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Affiliation(s)
- R Raja
- Department of Nutrition and Dietetics, Tan Tock Seng Hospital, Singapore.
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