Publications by authors named "Lucy Mills"

2 Publications

  • Page 1 of 1

Shear wave elastography to predict oesophageal varices, morbidity and mortality in chronic liver disease.

N Z Med J 2021 10 8;134(1543):103-112. Epub 2021 Oct 8.

MBChB, PhD, FRACP, Gastroenterologist, Department of Gastroenterology, Counties Manukau District Health Board, Auckland, New Zealand; Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand.

Introduction: In chronic liver disease (CLD), Fibroscan® (transient elastography) can be a useful "rule-out" test for oesophageal varices, but it is limited by body habitus. Shear wave elastography (SWE) is another non-invasive fibrosis test that is better suited for overweight subjects. We determined SWE's ability to predict oesophageal varices, morbidity and mortality in a predominantly overweight population.

Methods: Subjects (n=1,120) with CLD who underwent SWE at Middlemore Hospital between 1 July 2015 and 30 June 2018 were identified. The diagnostic accuracy of SWE to rule out oesophageal varices in advanced hepatic fibrosis was assessed, as well as associations with morbidity and mortality.

Results: Of 304 subjects with advanced fibrosis, 89 had endoscopic data and 18 had varices. Median body mass index was 28.2kg/m2. Area under the receiver operating characteristic curve value for liver stiffness to predict varices was 0.74 and 0.80 when combined with serum albumin. Liver stiffness ≤12.4kPa and albumin ≥37g/L had a negative predictive value of 95%. There were 135 hospital admissions and 19 deaths. Liver stiffness correlated with hospital admissions (p=0.007) and independently predicted mortality.

Conclusions: Shear wave elastography could be a useful rule-out test for screening endoscopy in overweight populations with CLD.
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October 2021

Chromoendoscopy versus standard colonoscopy for detection of nonpolypoid dysplasia in patients with inflammatory bowel disease.

N Z Med J 2018 07 13;131(1478):32-38. Epub 2018 Jul 13.

FRACP Consultant Gastroenterologist, Middlemore Hospital, Counties Manukau District Health Board, Auckland.

Aim: Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer. Studies show that chromoendoscopy (CE) can increase the detection of dysplasia at surveillance colonoscopy, compared to standard white light endoscopy (WLE). We performed a retrospective cohort study to compare standard WLE to CE with targeted biopsies in detecting nonpolypoid dysplasia in IBD patients undergoing surveillance colonoscopy at a single tertiary centre.

Method: Data was collected on 110 consecutive patients with IBD who underwent surveillance colonoscopy from 1 August 2015 to 31 July 2017 at Counties Manukau District Health Board, Auckland. Patients had either WLE or CE. Patient characteristics, endoscopic and histologic descriptions were reviewed. Rates of dysplasia detection by the different endoscopic techniques were compared using an exact Poisson test.

Results: 76/110 (69%) had WLE (mean age 56y; median disease duration 18y) and 34/110 (31%) had CE (median age 59y; median disease duration 19y). Nonpolypoid dysplasia was detected in 0/76 (0%) patients who had WLE. Seven nonpolypoid dysplastic lesions were detected in 4/34 (11.8%) patients who had CE. Dysplasia pick up rate was significantly higher in the CE group with a risk difference of 11.8%, 95% confidence interval (0.93, 22.59), p=0.008. Dysplasia detection rate per patient was also significantly higher in the CE group with a rate difference of 20.6 lesions per 100 patients, 95% confidence interval (5.3, 35.8), p=0.0003. As expected, there was no difference between the number of polypoid dysplastic lesions found between the two groups (p=0.12).

Conclusion: In our cohort of IBD patients undergoing surveillance colonoscopy, CE with targeted biopsy is associated with a significantly increased nonpolypoid dysplasia detection rate when compared to WLE. These results are comparable to studies performed in the rest of the world.
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July 2018