237 Antibiotic Prophylaxis of Precision Point Prostate Biopsy Under LA: Changed Practice in a District General Hospital

Aim

More than 4 million prostate biopsies are performed worldwide each year (1). Out of three different techniques (Template, transperineal, TRUS), Transperineal precision point biopsy under local anaesthesia is the latest and reported to have fewer infectious complications (2). UTI, Urosepsis, septicaemia are some well-known infectious complications following prostate biopsies. Therefore, the Canadian Urological Association recommended the use of broad-based Gram-negative antibiotic prophylaxis 30 to 60 minutes before the procedure and continued for 2 to 3 days in their guideline (3). Our aim was to compare the outcome of two different antibiotic prophylaxis regimens.

Method

In our study to assess the outcome of single-dose prophylaxis compared to regular dose, we collected retrospective data of 119 patients who had undergone precision point biopsy in our hospital.

Results

Among 119 patients, 52 (43.69%) were given 3 days of oral antibiotic followed by preprocedural dose and 67 (56.31%) were given just a single dose before the procedure. None of these patients from both groups were readmitted with any infectious complication post-procedure. 1 patient from the second group (single dose) was admitted with urinary retention but no increased inflammatory markers were found.

Conclusions

TRUS biopsy breeches the rectal mucosa and carries higher chances of post-biopsy infection so requires antibiotic prophylaxis. Single-dose antibiotic prophylaxis is recommended option for transperineal biopsies as the infection rate is lower. Our study shows the same outcome for single-dose and 3-day regimens for transperineal precision point prostate biopsy. Moreover, the use of single dose will significantly reduce medicine costs and antibiotic resistance to improve patient compliance.

969 Intra-Abdominal Rectal Perforation Post Haemorrhoidal Artery Ligation Operation (HALO) And Converted Ligasure Open Haemorrhoidectomy

Case Report

Symptomatic prolapsing haemorrhoids are usually treated with either haemorrhoidal artery ligation operation (HALO), stapled haemorrhoidopexy or open haemorrhoidectomy. Complications are rare with serious complications like rectal perforation reported scarcely in literature. We report a case of intraperitoneal rectal perforation following transanal haemorrhoidal artery ligation and converted open Ligasure-assisted haemorrhoidectomy in a 74-year-old lady with background portal hypertension secondary to primary biliary cirrhosis. We present this case to highlight the importance of preoperative medical optimisation of portal hypertension prior to surgical intervention and consideration of primary open techniques in grade 4 haemorrhoid surgery.

1214 A Combined Approach to Prioritise Patients for Colonoscopy

Aim

Correlating colonoscopy finding with presenting features to assess the diagnostic yield of different symptoms.

Method

We looked at findings of 100 patients retrospectively who had colonoscopy in Dhaka Medical College Hospital, Bangladesh during first peak of COVID (August 2020 to December 2020). We reviewed NICE guideline for high-risk symptoms and NHS guideline for prioritisation of colonoscopy patients.

Results

100 cases were reviewed, 67% were male among the patients, average age was 42.11 (4 – 75 years). 47 were found to have significant pathology. Findings included colorectal malignancy (28%), Polyp (9%), IBD (6%), tuberculosis (2%) etc. PR bleed had highest diagnostic yield (21.27%), followed by abdominal lump (17.02%) and lower abdominal pain (14.89%). Weight loss showed lowest diagnostic yield (4.25%). 28% colonoscopy findings were normal. Patients were chosen based on clinical assessments and imaging results, as stool biochemical marker tests (FIT test, faecal calprotectin) are not available in DMCH.

Conclusions

Being an aerosol generating procedure which has a considerable amount of risk of transmitting COVID infection from patient to clinician or vice versa, it is important to triage patients with lower GI symptoms for colonoscopy. In a developing country like Bangladesh, it is essential to make the most reasonable use of limited resources. Symptoms-based triaging systems are poor predictors of clinically significant disease on colonoscopy. Therefore, a more holistic and novel approach needs to be studied and formulated using a combination of symptoms, blood, and stool biomarkers in order to reduce the need for a ‘negative’ colonoscopy and avoid unnecessary risks.