January 2025
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2 Reads
Gastroenterology Report
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January 2025
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2 Reads
Gastroenterology Report
November 2024
Diseases of the Colon & Rectum
August 2024
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13 Reads
Techniques in Coloproctology
Surgery for Crohn’s disease (CD) is considered to have more complications due to the underlying inflammation, immunosuppression, and malnutrition. We sought to study the outcomes of right-sided colonic resection in patients with CD and patients with cancer at a high-volume tertiary center utilizing a standardized perioperative protocol. This is a retrospective study of outcomes for all patients with CD or patients undergoing ileocolic resection or right hemicolectomy with ileocolic anastomosis at a single institution from 2013 to 2022. Patients were excluded if they simultaneously underwent another procedure or ostomy creation. Data were analyzed using Wilcoxon rank-sum and chi-squared tests for univariate analyses, and logistic and linear regressions for multivariate analyses. In total 141 patients with CD and 589 patients with cancer were included. Patients with CD were significantly younger with lower body mass index and less likely to have comorbidities, including diabetes and hypertension. Patients with CD were less likely to have a smoking history or prior abdominal surgery, but more likely to be on steroids. Both groups had similar rates of laparoscopy, intraoperative complications, and blood loss. Despite the preoperative and intraoperative differences, both patients with CD and patients with cancer had similar lengths of stay (LOS), readmission, reoperation, and mortality rates. None of the surgical outcomes differed significantly between the two groups. On multivariate analysis, CD diagnosis was not associated with reoperation, readmission, mortality, or LOS while controlling for other characteristics. With the use of standardized perioperative protocols, surgery for CD at a high-volume center with expertise in CD can be performed with comparable results to other indications like cancer.
July 2024
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5 Reads
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1 Citation
Gastroenterology Report
July 2024
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1 Read
Journal of Gastrointestinal Surgery
June 2024
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10 Reads
Gastrointestinal Endoscopy
May 2024
May 2024
October 2023
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15 Reads
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2 Citations
World Journal of Surgery
Anal fistulae are common, predominantly cryptoglandular, and almost invariably require surgical treatment. Recurrences are common for procedures other than fistulotomy regardless of technique and adequacy of repair. Growing evidence supports the pivotal role of specific intestinal bacteria in anastomotic failures after bowel resection. Anal crypts harbor colonic microbiota suggesting that similar mechanisms to anastomotic healing might prevail after anal fistula repair and hence influence healing. This study aims at assessing the potential role of the intestinal microbiome in the clinical outcomes after surgical repair of cryptoglandular anal fistula. This is a pilot prospective cohort study enrolling patients with anal fistula undergoing endoanal advancement flap. For microbiome analysis, stool samples are taken via rectal swab before the procedure; additionally, a portion of the fistula is collected intraoperatively after fistulectomy. Samples from groups with treatment failure are compared to samples from patients who healed after surgical repair. Alpha and beta diversities and differential abundance of microbial taxa are determined and compared between groups with DADA2 analytical pipeline. Five patients have been enrolled to date (one female, four male). At median follow-up of 6 months (2–11), one patient experienced disease recurrence at 3 months. DNA from the 5 rectal swab and tissue samples was extracted, showing increased relative abundance of Enterococcus faecalis in samples from the patient who developed a recurrent fistula but not in those without recurrence. These very preliminary data suggest that intestinal microbiome may represent a crucial determinant of the surgical outcomes after anal fistula surgery.
September 2023
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16 Reads
Surgical Endoscopy
Introduction For patients with cancer or injury of the esophagus, esophagectomy with reconstruction using the stomach (gastric pull-up, GPU) or colon (colonic interposition, CI) can restore function but is associated with high morbidity. We sought to describe the differences in outcomes between the two replacement organs using a national database. Methods From ACS-NSQIP, patients who underwent GPU or CI between 2006 and 2020 were identified. Univariate analyses were performed on length of stay, complications, reoperation, readmission, and mortality. Variables with P ≤ 0.2 were included in the multivariate regression. Primary outcomes were 30-day reoperation, readmission, and mortality. Data were assessed using Chi-squared tests and logistic regression. Results There were 12,545 GPU and 502 CI patients. GPU patients were older with higher BMI, and more likely to be male (80.3% versus 70.3%, P < 0.0001) and white (77.8% versus 69.1%, P < 0.0001). More GPU patients had independent functional status and underlying bleeding disorders, but fewer other preoperative comorbidities than CI patients. On univariate analysis, CI patients had longer hospital stays (13 versus 10 days, P < 0.0001); more reoperations (23.9% versus 14.5%, P < 0.0001); a lower rate of discharge to home (70.9% versus 82.1%, P < 0.0001); and a higher mortality rate (6.2% versus 2.9%, P < 0.0001). On multivariate analysis, CI was associated with increased risk of reoperation but not with readmission or mortality. Reoperation was associated with CI, smoking, chronic wound, hypertension, higher ASA class, contaminated or dirty wound class, and longer operative time. Readmission was associated with female gender, hypertension, and longer operative time. Mortality was associated with age, metastatic cancer, preoperative sepsis, preoperative renal failure, malignant esophageal disease, higher ASA class, incomplete closure, and longer operative time. Conclusion Colonic interposition, although a more difficult option with traditionally worse outcomes, should still be considered for patients requiring esophagectomy if the stomach cannot be used to restore continuity, as differences in outcomes appear to be due to underlying frailty of patients rather than the procedure.
... Colonoscopy aims to diagnose and, if necessary, treat the bleeding source in hemodynamically stable patients [9,10]. According to numerous studies, colonoscopy can reveal definitive bleeding sites in more than 70% of patients [5,7]. ...
September 2023
Diseases of the Colon & Rectum
... At least in a select group of the Society of Abdominal Radiology surveyed, dynamic rectal emptying studies on MR have replaced fluoroscopic studies in evaluating patients with rectal emptying symptoms [3]. However, as has been emphasized by Church in this symposium and elsewhere [4][5][6], pouch emptying physiology is distinctly different from rectal emptying physiology. Unless an open magnet is used in which the patient is seated upright, MR defecography can only be performed with the patient in the supine position. ...
Reference:
Future directions in imaging pouches
February 2023
Abdominal Radiology
... Ideally, the radiology report should utilize consistent terminology as well as address clinically important findings. Both Chenchan [9] and Ream [11] have proposed templates that can be used for examinations of the pouch. These can be applied to MRE/CTE, contrast enemas, and pouch emptying studies. ...
Reference:
Future directions in imaging pouches
February 2023
Abdominal Radiology
... Cuffitis is a common diagnosis for patients following IPAA, leading to decreased health-related quality of life due to gastrointestinal symptoms and a higher risk for subsequent pouch failure [12,13,17]. Patients with chronic cuffitis may also be at risk additional complications such as development of neoplasia with guidelines from the International Ileal Pouch Consortium suggesting that endoscopic surveillance be more frequent (every 1-3 years) in patients with chronic cuffitis as compared to those without risk factors [20,54]. Although no studies have explored whether successful treatment of cuffitis reduces the risk of long-term complications, optimizing treatments may decrease the risk of adverse sequelae. ...
July 2022
The Lancet Gastroenterology & Hepatology
... Median length of stay in this pilot study was 1 day. This length of stay is similar to previous studies on early discharge protocols [19,26,32]. Complication rates of the early discharge pathway in this study are in line with current literature, showing low severe complication rates in patients following an early discharge pathway [20,32]. ...
June 2022
Annals of Surgery
... The coexistence of HCSS and IBDs is rare, with only a limited number of cases documented in the literature [37][38][39][40][41][42][43][44]. ...
January 2022
World Journal of Clinical Oncology
... According to these data, recent minimally invasive techniques, such as TAMIS [35] and multistage polypectomy with flexible sigmoidoscopy [23], could be considered the main and resolute approach in most cases of cancer of the rectal stump. Our approach is in line with that of the Center for Hereditary Colorectal Neoplasia of Cleveland Clinic Foundation (Cleveland, Ohio) [36], with, in our opinion, narrower initial selective criteria, such as, for instance, the genetic background of the single patient, together with the phenotype and the clinical features. ...
April 2021
Diseases of the Colon & Rectum
... Combination therapeutic achievements: Combination therapies that amalgamate conventional chemotherapeutics with CSC-targeted agents have exhibited significant promise in overcoming drug resistance. For example, the integration of standard chemotherapeutics with PI3K/ AKT/mTOR inhibitors has proven successful in diminishing the viability of CSCs in ovarian and colorectal cancers, thereby improving treatment outcomes [89,384]. This approach aims to concurrently target both bulk tumor cells and CSC populations, thereby mitigating the likelihood of relapse. ...
Reference:
s12935-024-03558-0
March 2021
JNCI Cancer Spectrum
... Deux autres tests, la détection de la Septine 9, un marqueur plasmatique des CCR, et la coloscopie par capsule, visualisation du tube digestif par ingestion d'une caméra, ont été approuvés mais ne sont pas nécessairement recommandés en première intention (F. Bray & Soerjomataram, 2015;Ladabaum et al., 2020;Rex et al., 2017 (Kalady et al., 2019;Umar et al., 2004). Enfin, les individus à haut risque présentant une MICI sont également étroitement suivis avec une coloscopie et la réalisation de biopsies plusieurs années après le début de la maladie et après rémission (E. ...
January 2019
... Recent advances in artificial intelligence have led to increased implementation of automated, patient-directed conversational agents (i.e., chatbots) to increase genetic service utilization [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. There is a growing literature on the potential utility of chatbots compared with conventional methods (i.e., in-person genetic counseling appointments) in the cancer/clinical genetics setting [13,14]. ...
November 2020
Journal of Medical Genetics