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Multidisciplinary tumor board (MDT) discussion is standard practice in the management of Upper Gastrointestinal (UGI) cancers. However, poor adherence to MDT recommendations may account for the lack of improved oncological outcomes with MDTs. We aim to quantify adherence rates and compare outcomes between adherent and non-adherent patients.We included all patients with potentially curable primary UGI carcinomas who were discussed at UGI MDT from 2017 to 2018. MDT recommendations were compared to actual treatment received. Oncological and survival outcomes were compared between both groups.Amongst 153 patients, 64 (41.8%) were non-adherent to MDT recommendations. Reasons for non-adherence were patient refusal (50.0%), treatment-related complications (31.3%), disease factors (17.2%) and clinician decision (1.56%). Univariate analysis showed that non-adherent patients were older (71.6 vs 65.2 years, p 0.001), with higher clinical stage at point of diagnosis (p = 0.028), pathological stage after resection (p 0.001) and were more likely to be recommended for multimodal therapy. No significant factors were associated with non-adherence at multivariate analysis. Non-adherent patients had worse median overall survival (19.5 months) compared to adherent patients (not reached at follow-up) with both unmatched and propensity-score matched analysis. Patients who received only part of the intended adjuvant chemotherapy course had worse median overall survival and disease-free survival compared to patients who completed or did not initiate adjuvant chemotherapy.Non-adherence to MDT recommendations was associated with advanced age and tumor stage, and potentially contributes to the worse oncological outcomes in a group of patients already predisposed to poor outcomes.

Background: Laparoscopic sleeve gastrectomy (LSG) is one of the commonest bariatric procedures. However, it is associated with postoperative gastroesophageal reflux disease (GERD) and erosive esophagitis (EE). This study aims to assess the impact of various preoperative clinical and endoscopic characteristics on the development of postoperative GERD and EE. Methods: A single institution retrospective cohort study involving all patients who underwent LSG. A univariate and multivariate analysis was performed to identify preoperative parameters that were significantly associated with the development of postoperative GERD and EE, at up to 1-year follow-up. Results:At up to 1-year follow-up, out of 127 patients, only preoperative endoscopic presence of a hiatal hernia noted on axial length (p=0.024), and the Hill’s classification of the gastroesophageal junction (p

Aim: Weight-based stigmatization is prevalent. They have been reported in schools, work and healthcare settings. However, almost all the literature on such weight-based stereotypes were from Western countries. The study aims to evaluate the prevalence of weight-based stigmatization in an Asian population. Methods: An anonymized questionnaire-based cross-sectional study was conducted. Respondents were asked about their socioeconomic status, followed by questions on perceived weight-based stigmatization across 4 domains (self, social, healthcare, work and education). A subsequent subgroup analysis was performed to evaluate the impact of different obesity classes on perceived stigmatization across these domains. Results: A total of 101 respondents replied. Respondents with higher BMI were middle-aged (p = 0.040), Malays (p = 0.018), low-income (p = 0.041) and had lower educational qualifications (p = 0.038). Total prevalence of perceived weight-based stigmatization was 65.6%. Class III obesity respondents were more stigmatized at work (Prevalence Rate Ratio (PRR) 5.73, 95% Confidence Interval (CI): 1.16–28.47), and resort to increased consumption of unhealthy food or partake in lesser exercise due to stigma (PRR 24.94, 95% CI: 3.61-172.41). Conclusion: Obesity stigmatization is equally prevalent in Asian societies. Individuals with higher BMI were more likely to report perceived stigmatization in the workplace, as well as maladaptive dietary and exercise behaviours in response to stigmatization, regardless of socioeconomic status.

Following bariatric surgery, accurate charting of weight loss and regain is crucial. Various preoperative factors affect postoperative weight loss, including age, sex, ethnicity, and surgical type. These are not considered by current weight loss metrics, limiting comparison of weight loss outcomes between patients or centers and across time.Patients (n=1022) who underwent sleeve gastrectomy (n=809) and gastric bypass (n=213) from 2008 to 2020 in a single center were reviewed. Weight loss outcomes (% total weight loss) were measured for 60 months postoperatively. Longitudinal centile lines were plotted using the post-estimation predictions of quantile regression models, adjusted for type of procedure, sex, ethnicity, and baseline BMI.Median regression showed that %TWL was 1.0% greater among males than females (β = +1.1, 95% CI: +0.6 to +1.7, P =0.0001). Participants who underwent SG had less %TWL compared to GB (β = -1.3, 95% CI: -1.9 to -0.8, P0.0001). There was a trend towards less %TWL among the Indian and Malay participants compared to Chinese. Age and diabetes were not significant predictors. Reference centile charts were produced for the overall cohort, as well as specific charts adjusted for type of bariatric procedure, sex, ethnicity, and baseline BMI.Centile charts provide a clinically relevant method for monitoring of weight trajectories postoperatively and aid in realistic and personalised goal setting, and the early identification of "poor responders". This is the first study to present post-bariatric surgery centile charts for an Asian cohort.

Achalasia refractory to Heller cardiomyotomy is a rare problem. Complications arising from long-standing achalasia include perforation because of stasis ulcers and malignancy. Here, we report a case of refractory achalasia presenting with recurrent hematemesis because of a perforated stasis ulcer leading to a bleeding esophagopulmonary fistula.

ConversionofaGastricBandintoanIntraperitonealPortinaPatientwithOptimallyDebulkedStage3CSerousOvarianCarcinomaPaige.E.Tucker,Paul.A.Cohen,JeremyTan,JasonTanPII: S2352-5789(15)00025-9DOI: doi:10.1016/j.gore.2015.03.008Reference: GORE48Toappearin:Receiveddate: 12January2015Accepteddate: 22March2015Please cite this article as: Tucker, Paige.E., Cohen, Paul.A., Tan, Jeremy, Tan, Jason,Conversion of a Gastric Band into an Intraperitoneal Port in a Patient with OptimallyDebulked Stage 3C Serous Ovarian Carcinoma, (2015), doi: 10.1016/j.gore.2015.03.008This is a PDF le of an unedited manuscript that has been accepted for publication.As a service to our customers we are providing this early version of the manuscript.The manuscript will undergo copyediting, typesetting, and review of the resulting proofbefore it is published in its nal form. Please note that during the production processerrors may be discovered which could affect the content, and all legal disclaimers thatapply to the journal pertain.

Laparoscopic cholecystectomy is now the gold standard procedure for the treatment of symptomatic gall bladder stones. Spillage of gall bladder stones into the peritoneal cavity may occur due to inadvertent iatrogenic gall bladder perforation during dissection of the gall bladder. We report a case of a 66 year old woman who had to return to theatre three times over two years to deal with complications from retained intra-peritoneal gallstones that were spilt at her initial laparoscopic cholecystecomy.