September 2018

11th Annual Laparoscopic Training Day – Friday, 26 October 2018, Musgrove Park Academy, Taunton and Somerset NHS Foundation Trust.

This Training Day is aimed at Consultant Surgeons and Trainees. The Laparoscopic Training Day will include procedures being projected to the Academy Lecture Theatre live from the operating theatres at Musgrove Park Hospital, Taunton, as well as presentations.

Course Organisers: Prof Giles Toogood (Pres-Elect AUGIS) Mr Richard Welbourn, Mr Paul Mackey, Mr Simon Dexter (President ALSGBI) Mr David Mahon, Mr Hamish Noble

To register for this FREE training day please email postgrad.centre@tst.nhs.uk /   01823 342430.

September 2018

We are hosting a collaborative meeting between ACPGBI, AUGIS and NHS Innovation Agency at the Wanderers Suite, Macron Stadium (Burnden Way, Horwich, Bolton BL6 6JW) on November 13.

The morning session will have important updates on common but difficult areas of Emergency Surgery, concentrating on recommendations for pathway change.

Continuing the theme in the afternoon, we will introduce the Emergency Laparotomy Collaborative which includes a care bundle and pathway to improve mortality from emergency abdominal surgery. Attendees will hear how the care bundle has been successfully implemented in other regions and have the opportunity to consider how it can improve care for your patients locally

It would be useful to have representation from as many North West Trusts as possible.

Registration is via Eventbrite – https://www.eventbrite.co.uk/e/update-in-emergency-surgery-tickets-49738370806

Please discuss within your departments and register your places as soon as possible. Places will be limited and on a first-come first-served basis. Lunch and refreshments will be provided.

The meeting is free to attend.

Arnab Bhowmick, Consultant Colorectal/General Surgeon,
Divisional Medical Director, Division of Surgery,
Lancashire Teaching Hospitals
North West Chapter Representative ACPGBI

August 2018

It has been a really busy first half of the year both locally and nationally for AUGIS. In April I attended the council meeting in London with Dawn Drury, who has been appointed as the Allied Health Professional (AHP) lead for the Trent region. We gave a joint presentation regarding our plans for the AHP group and our first task will be to appoint a deputy to work with Dawn, with a complimentary specialist interest. We have 11 AUGIS members in the Trent AHP group, the majority of whom are cancer Clinical Nurse Specialists (CNS) and our aim is to expand both the number and breadth of the membership.

At a local level in Trent we have had a busy year with a successful local Trent AUGIS meeting at the Nottingham Doubletree Hilton in May. We had 87 registered delegates, over half of whom were trainees, and received universally positive feedback. Sessions included complications of bariatric surgery, tips and tricks with difficult cholecystectomy, an ERCP vs. Laparoscopic CBD exploration debate, an interactive benign biliary MDT and a session on career options in Upper GI and HPB surgery. I would like to extend my personal thanks to all colleagues who gave talks, chaired sessions or just travelled to attend the meeting. Unfortunately Professor Ashley Dennison from Leicester was unable to attend due to a mix up with unleaded petrol and a diesel car!

The Midlands HPB meeting took place in Oxford on in July at Balliol College organised by Mr Keaton Jones and Mr Michael Silva.
Iain Cameron, Regional Representative Trent

August 2018

The South West region comprises Devon, Cornwall, Somerset, Wiltshire, Avon and Gloucestershire.

Our UGI cancer surgical centres are Plymouth, Bristol and Gloucester. An additional 10 DGHs form our cancer networks, divided between the two cancer alliances of Peninsula and SWAG.

Although cancer is rightly an important part of our regions work, our network of hospitals includes enthusiasts and leaders in bariatric and benign UGI surgery.

Research and education are strong interests.

ROMIO and ByBand Sleeve continue to recruit and lead the way in pragmatic research.

Education and collaboration have been seen in benign UGI surgery, with a regional meeting on severe acute pancreatitis. A multidisciplinary gathering involving intensivists, gastroenterologists and surgeons – leading to guidelines for care and tentative steps to a regional network for managing this difficult condition.

In July, AUGIS hosted a benign UGI education day in Bristol, for senior trainees and consultants. Barrett’s, bariatrics, bile duct stones and pancreatitis – something for everyone.

We are planning a meeting on reflux and its surgical management for 2019.

Education and collaboration have been hugely enjoyable and largely lead by the interest and enthusiasm of our regions clinicians and AHP’s. As your regional representative, I welcome your ideas, suggestions and comments.
Mr Richard Krysztopik – South West Regional Representative

August 2018

The Liver Transplant and HPB Unit at Royal Free and the Barts and London HPB Unit is part of the London Cancer which provides the HPB service in the region. The HPB units have continued to grow especially at the Royal Free since the unification a few years ago of the Royal Free and UCH. The Royal Free Liver Transplant Programme is the fastest growing adult liver transplant programme in the country and performed 116 liver transplants in the last year.

The combined sites from Royal Free and Royal London held a combined London Cancer Liver Education Afternoon at the Royal Free London on 18 April. This was a multidisciplinary meeting which was well attended from various sites and received very good feedback and extolled the plans to revamp the patient pathways especially at the Royal Free, as part of improving patient pathways through the improving delivery of service vanguard.

In addition to excellence in clinical work, the region has been very active in HPB research. To mention some of the achievements:

  • First trial on goal-directed therapy post-OLT now completed on target. (NIHR RfPB funded)
  • Data being analysed and results will be presented soon.
  • LAVA trial on resection vs ablation for CRC mets has unfortunately closed due to recruitment failure.
  • Current recruitment to trial of ward-based goal directed fluid therapy in acute pancreatitis is ongoing.
  • Successful NIHR i4i funding to further develop the UCL image guided lap liver surgery system.

London Cancer incorporates the geographical areas of North Central and East London and West Essex with a population of 3.7 million. Since 2016, London Cancer has become one of the six principal programme of the UCLH Cancer Collaborative.

The Upper GI (OG) Cancer Tumour Pathway Board is a cancer care specific board which was led by Prof Muntzer Mughal until March 2018. In April 2018 Mr Dip Mukherjee took over as Tumour Pathway Director.

2017/18, as part of the UCLH Cancer Collaborative, the Upper GI (OG) Tumour Pathway Board has worked collaboratively with our Vanguard partners in Manchester and London on developing a new best practice timed pathway for OG patients.

This year has been our second full year after the reconfiguration of OG cancer surgery at UCLH. The focus has been to ensure and maintain the success of this reconfiguration. Some achievements in Upper GI cancer services are:

  • 70 oesophago-gastric cancer resections and 9 benign-complex operations were performed during 2017. This is a reduction in activity compared to 2016 (93 cancer resections and 14 benign-complex operations) as expected due to the improvements in staging. Surgical outcomes have remained excellent, and the 90-day mortality reported in the 2017 National Oesophago Gastric Cancer Audit was 1.1%. The centre was one of 6 out of the 37 centres nationally to have a mortality of less than 1.5%.
  • The service has successfully passed Gateway 5 and 6 assurance documents for the reconfiguration of specialist surgical treatment to UCLH.
  • The service this year has been involved in a number of research projects including LASER (lasting symptoms after esophageal resection) study and is taking part in the genomics of gastric cancer study as part of the 100,000 genomics project.
  • An exciting new project is the development of a micro-CT to enable imaging of endoscopic and surgical cancer resections to a resolution of one micron, which has received a grant of £950,000 from the Engineering and Physical Sciences Research Council. This will provide histology-level information rapidly. The project is led by Professor Alessandro Sandro from the Dept of Medical Engineering at UCL and the team includes Professors Laurence Lovat, Muntzer Mughal and Marco Novelli. The micro-CT scanner is currently being built and trials will start in 2019. We were successful in the award of a Macmillian grant of £100,000 to develop digital health innovation to improve the care of oesophageal cancer patients. This is a joint project between the OG Pathway Board (represented by Professors Mughal and Pritchard-Jones) and the Department of Primary Care and Population Health, led by Dr Henry Goodfellow working with Professor Elizabeth Murray.
    Mr Dinesh Sharma – North Thames Regional Representative

June 2018

Walsall Manor Hospital’s Bariatric Unit have managed to secure a visit by Doctor Rutledge who will be sharing his experience on Mini Gastric Bypass and he will be performing live surgery on Monday, 25 June.

Please click here for the programme for the day. If you would like to attend, contact Paula Lightwood, Bariatric Medical Secretary at Walsall Manor Hospital, on 01922 721172 ext 7763 to secure your place.

April 2018

The Bariatric unit at Doncaster Bassetlaw Teaching Hospitals is pleased to announce the second MGB/OAGB course on 24 May.

The course is for one day including live surgery and keynote lectures.The deadline for application is 24 April.

  • The course fee is £95 and the UGI trainees will enjoy 50% discount.
  • The course is for UGI trainees with bariatric interest and also for junior bariatric Consultants who are interested in the procedure.
  • Email Mr A Hussain, consultant bariatric surgeon, at abdulzahra.hussain@nhs.net or Sandra Patterson at sandrapatterson1@nhs.net  for a registration form and programme details.

March 2018

Andy Strickland and Richard Krysztopik would like to invite people to an Educational Day to highlight key topics in UGI surgery, on Wednesday, 4 July 2018 at the Holiday Inn in Bristol.

Topics include:

  • Endoluminal treatment of oesophageal disease
  • Complications of bariatric surgery for the non-bariatric surgeon
  • Management of common bile ducts stones
  • Severe acute pancreatitis and its complications

There will be an expert faculty with a wide range of expertise:

  • Professor Jane Blazeby, UGI Surgeon, Bristol
  • Professor Mark Callaway, Radiologist, , Bristol
  • Ben Colleypriest, Gastroenterologist, Bath
  • Jim Hewes, UGI and Bariatric Surgeon, Bristol
  • James Hopkins, UGI and Bariatric Surgeon, Bristol
  • Lee Humphreys, UGI and Bariatric Surgeon, Plymouth
  • Richard Krysztopik, UGI Surgeon, Bath
  • Hamish Noble, UGI Surgeon, Taunton
  • Sally Norton, UGI Surgeon, Bristol
  • Alan Osborne, UGI and Bariatric Surgeon, Bristol
  • Jim Portal, Gastroenterologist, Bristol
  • Jonathan Rees, HpB Surgeon, Bristol
  • James Skipworth, UGI and Bariatric Surgeon, Bristol
  • Andy Strickland, HpB Surgeon, Bristol
  • Dan Titcomb, UGI Surgeon, Bristol
  • Profesor Giles Toogood, UGI Surgeon, Leeds
  • Richard Welbourn, UGI and Bariatric Surgeon, Taunton
  • Paul Wilkerson, UGI Surgeon, Bristol

The event is free. The programme is here – SW UGI training day – 4th July 2018

The Holiday Inn in Bristol is close to the train station, and with onsite parking available. To register please email richard.krysztopik@nhs.net

Richard Krysztopik (South West rep)

March 2018

The AUGIS – Trent Region Education Day will take place on Friday 18th May (10am start) at the Nottingham Doubletree Hilton

Topics to be covered include :Difficult Day on Call – Case Discussions, Safety in Cholecystectomy, Benign Biliary Strictures, Management of Acute Pancreatitis, Complications of Bariatric Surgery, Career Options in Upper GI Surgery, ERCP vs Laparoscopic CBD exploration – Debate, Surgery for Giant Hiatus Hernia and Getting it Right First Time – Implications for UGI Surgery

Registration is free – 100 places available (first come first served).

Please click on the link below for further information and registration details:

AUGIS Trent Meeting – 18th May 2018 Flyer

December 2017

South Thames: The South-East Thames region continues to be busy with mergers of Trusts and efforts to improve on hospital performance against government measures and targets. Currently, the tertiary HPB service is provided by King’s College Hospital and the Oesophagogastric Cancer Service by Guys and St Thomas’ Hospitals. Both trusts cover Kent as well as South-East London, making them some of the busiest units nationally. Kings College Hospital also provides the regional bariatric service together with Lewisham Hospital.

The dissolution of the London Cancer Alliance has led to the development of regional Accountable Clinical Networks (ACNs). The OG ACN has been in existance for over 6 months and is working on methods to improve the 62 day treatment pathways. This is a constant challenge and is putting pressure on the endoscopy services to provide 2 week wait assessments. The HPB ACN is due to start in the New Year.

On the OG side, the region held the autumn annual ‘Houses of Parliament’ meeting with both regional and international speakers. It was a great success with an update on the CROSS results. In November, King’s College Hospital held the 7th Endosurgery Masterclass which welcomed a record attendance. The OG symposium at the Royal College of Surgeons is due in March 2018.

Mr James Gossage (South Thames rep)

East Anglia: Within the East of England significant progress has been made in organising the first regional AUGIS meeting between Addenbrooke’s hospital in Cambridge and the Norfolk and Norwich University Hospital. This joint meeting will be held in mid-January at Newmarket and is kindly sponsored by Medtronic. Both units are ever busy with OG cancer referrals and currently offer Fellowship training with a new collaboration in 2018 between Norwich and the Australian New Zealand Gastro-oesophageal Association (ANZGOSA). Both sites have worked closely together as pilot centres in the forthcoming RCS ‘Improving Surgical Training’ (IST) programme in 2018. Other meetings in the horizon include the 7th Cambridge Upper GI symposium at Addenbrookes as well as the Annual meeting of the British Oesophageal Group in Norwich.

Bhaskar Kumar (East Anglia rep)

Oxford & Wessex Report: The Oxford & Wessex region is made up of five cancer centres (Oxford, Basingstoke, Portsmouth, Southampton and Bournemouth), and around 10 DGHs, stretching from Banbury to the Isle of Wight, and from Poole to Chichester. The Improving Outcomes Guidance was implemented reasonably swiftly in this region, and the position has been stable for over 10 years – referral patterns are ingrained, and all units are performing at nationally acceptable levels. Local Sustainability & Transformation Projects have instigated discussions about whether further centralisation might be beneficial – particularly on the South Coast; it is hoped that the clinicians in each unit will be engaged and empowered in planning for the future treatment of their patients.

Professor Underwood continues to bloom as the poster-boy for the upper GI cancer world – this year he was awarded an Advanced Clinician Scientist Fellowship by CRUK and RCSE, and during the autumn gave plenary lectures at AUGIS in Cork and ESDE in Utrecht. An administrative whirlwind with Professor Mo Abu-Hilal at its centre put together a hugely successful gathering of Laparoscopic Liver surgeons in February, leading to the publication of the Southampton Laparoscopic Liver Surgery Guidelines, and their public unveiling at AUGIS in Cork.

Following on from Krishna Moorthy’s Oesophagogastric Anastomisis symposium in London last June, Bruno Sgromo arranged a successful video symposium on Laparoscopic Gastric Mobilisation in Oxford in March; several of the Oxford & Wessex upper GI teams have embraced minimal access oesophagectomy, and are organising a MAO anastomosis video symposium in Spring 2018.

Mr Stuart Mercer (Oxford & Wessex)

Trent: We have had a busy year with several successful local meetings. In February we hosted a regional Neuroendocrine Tumour Meeting in Nottingham and, in July, Professor Ashley Dennison and Mr Ali Arshad hosted the Midlands HPB meeting in Leicester. More recently, there has been a regional training day focusing on pancreatitis and pancreatic cancer pathways, with Mr Andrew Smith from Leeds proving a fantastic outside speaker.

As we look ahead to 2018, plans are already at an advanced stage for a local Trent AUGIS meeting in June which hopefully will involve speakers form every hospital in our region. The local database has been updated and all consultants involved with Upper Gastrointestinal surgery who are not members will receive another invitation to join us early in the New Year, as will all ANPs involved in Upper GI cancer care who are not yet members.

Mr Iain Cameron (Trent)

February 2017

North Thames: Over the last two years there has been a major re-configuration of cancer services in North, North East London and West Essex, which make up London Cancer, covering a population of 3.2 million. This included oesophagogastric cancer surgery with the merger of the surgical units at UCLH and The Royal London Hospital at UCLH in December 2015. One year on, the new centre, based on a hub and spoke model, is working well and providing excellent training. The centre is tracking outcomes but the centralisation of OG and urological cancer services in London Cancer and Manchester Cancer is also part of the RESPECT-21 (reorganising specialist cancer surgery for the 21st century: a mixed methods evaluation) study which will report in a few years.

An oesophageal anastomosis workshop was held at UCLH in June 2016, under the auspices of the UGI Collaborative. It was attended by 12 consultants and 9 trainees. In September, a symposium on recent advances in benign oesophageal disease was held at Imperial College, London. It was attended by 42 delegates. Feedback was excellent for both meetings.

Mr Dinesh Sharma (North Thames)