Colorectal Disease最新文献

Background

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), necessitates frequent disease monitoring to guide management. While colonoscopy remains the gold standard for assessing disease activity, its invasive nature limits its feasibility. Bowel ultrasonography (BUS) has emerged as a noninvasive alternative.

Objective

This systematic review and meta-analysis evaluate the diagnostic accuracy of BUS in detecting IBD activity compared to colonoscopy.

Methods

A comprehensive literature search of PubMed, CINAHL and Embase was conducted, including 37 studies evaluating BUS modalities such as colour Doppler, small intestine contrast ultrasonography (SICUS) and contrast-enhanced ultrasound (CEUS). Pooled sensitivity, specificity, diagnostic odds ratios (DOR) and likelihood ratios were calculated. Subgroup analyses were performed based on diagnostic modality and IBD subtype.

Results

The overall pooled sensitivity and specificity of BUS in IBD were 90.0% and 83.5%, respectively. SICUS had the highest sensitivity (95.0%), while BUS with colour Doppler had the highest specificity (85.1%). CEUS demonstrated the highest DOR (75.52). BUS performed best in detecting postoperative CD recurrence (sensitivity 91.9%, DOR 61.9). Meta-regression identified surgical anastomosis type as a significant predictor of diagnostic performance.

Conclusion

BUS is a highly effective noninvasive imaging modality for diagnosing and monitoring IBD. Its accuracy varies by modality, with SICUS optimal for screening and colour Doppler BUS for confirmation. Future studies should standardize BUS protocols and evaluate its role alongside MRI and CT enterography.

Purpose

This study aimed to delineate the existing knowledge regarding the impact of colorectal cancer surgery on the sexuality of LGB patients, highlighting the need for culturally competent care tailored to their unique needs.

Methods

A comprehensive search was conducted from October 2024 onwards across PubMed, Embase, CINAHL, Google Scholar, Web of Science, Scopus, PsychINFO, Cochrane Library, and Joanna Briggs Institute using the MeSH terms ‘sexual and gender minorities’, ‘colorectal surgery’, ‘colorectal neoplasms’ and ‘sexuality’. Inclusion criteria required LGB patients over 18 years, at least 50% of the sample diagnosed with colorectal cancer and treated operatively. All studies were critically appraised.

Results

Six studies from the UK and the US were included. Sample size ranged from 1 to 480. Participants identifying as LGB ranged from 26.4 to 100%. Key findings revealed LGB patients experience similar physical consequences to heterosexual patients (erectile and ejaculatory dysfunction, dyspareunia, vaginal dryness), but implications might differ, e.g., regarding anal intercourse. A lower mental quality of life was reported, including body image issues related to stomas. Relationship challenges and intimacy issues were highlighted. The cultural competence of healthcare providers has a significant influence on patient experiences, highlighting a gap in inclusive care. Critical appraisal revealed both methodological strengths and weaknesses.

Conclusion

This review highlighted the sexual health challenges of LGB patients after colorectal cancer surgery, with issues like sexual function and mental wellbeing often being underreported. Cultural competence training for healthcare providers and integrating patients' partners into cancer care are crucial for a holistic approach.

Aim

This study aimed to evaluate the significance of a stepped nurse-led low anterior resection syndrome (LARS) clinic for patients.

Methods

A Nurse-Led Clinic (NLC) with a stepped intervention approach for patients with LARS was developed and implemented. An exploratory study was conducted in three hospitals to evaluate the nurse-led clinic. Adult rectal cancer patients experiencing LARS who attended the NLC were recruited via maximum variation sampling for semi-structured interviews. Thematic analysis was performed, employing researcher triangulation to enhance reliability.

Results

Seventeen participants were interviewed to evaluate the clinic. Participants described five characteristics: (1) presence of the nurse, (2) accessibility, (3) providing recognition, affirmation and understanding, (4) coordinating and (5) timing of the consultation. In addition, participants outlined four principal tasks: (1) providing information, (2) management of symptoms, (3) support and (4) follow-up and continuity of care.

Conclusion

The NLC offered meaningful support by addressing patients' concerns comprehensively. It normalised the condition, empowered patients with tailored information and provided effective symptom management strategies.

Reporting Method

SRQR checklist.

Aim

This retrospective observational cohort study aimed to investigate the prevalence of suspected lateral lymph node metastases (LLNM), as diagnosed by magnetic resonance imaging (MRI), and its impact on local recurrence (LR) and overall survival (OS). Patients who underwent dissection of suspected lymph nodes were evaluated in subgroup analysis.

Method

Patients diagnosed with rectal cancer in Sweden between 2017 and 2021 were identified through the Swedish colorectal cancer registry and grouped by MRI findings. Main outcome measures were LR at 3 years and OS at 3 and 5 years.

Results

In all, 2779 patients were analysed. Frequency of lateral lymph node (LLN) enlargement on MRI was 9.4%. In univariable analysis, the risk of LR at 3 years was increased in LLN-positive patients, HR 2.79 (CI 1.55–5.03). In multivariable analysis, adjusted for patient, tumour and neoadjuvant treatment factors, this difference remained (HR 1.97 (CI 1.04–3.73)). No difference in 3-year OS was observed. At 5 years, univariable analysis indicated increased mortality in LLN-positive patients (HR 1.64 (CI 1.24–2.17)), but not in multivariable analysis.

Among LLN-positive patients, those who had undergone LLN dissection (LLND) had an LR rate of 12.5% and increased risk at 3 years in univariable analysis (HR 3.73 (CI 1.93–10.76)). However, in multivariable analysis, there was no difference in LR risk or OS.

Conclusion

MRI-detected LLN positivity is associated with a higher risk of LR and correlates with other adverse prognostic factors. The effect of LLND on LR remains unclear. Further research is needed to optimize treatment strategies for patients with suspected LLNM.

Background

Colostomy irrigation is a well-established technique used for bowel management in patients with a permanent, left-sided colostomy. When performed routinely every 24–48 hours, it enables stool-free intervals, often allowing the use of only a stoma cap or simple dressing. Scientific evidence has shown significant improvements in health-related quality of life (HRQoL) for patients using this method.

Aim

This study aimed to evaluate the current application of colostomy irrigation in Germany and Austria and to identify reasons for its limited use, despite known benefits. A specific focus was placed on the perspectives and practices of stoma care nurses.

Methods

A cross-sectional, retrospective survey was conducted among certified stoma care nurses in both countries. Data were collected anonymously and analysed descriptively, including the use of interval-weighted means.

Results

A mean of 39 patients per stoma therapist per year with a permanent colostomy in the descending or sigmoid colon—regions anatomically suitable for irrigation—were reported. However, irrigation had been recommended to only 43.6% of these patients, and just 53% of those adopted it in daily practice. This results in an average of only nine patients per stoma expert using the technique annually. Reported barriers included time constraints, perceived patient reluctance, short inpatient stays and doubts regarding clinical indication.

Conclusion

Stoma irrigation therapy has shown potential to improve autonomy, self-image and everyday function. This study contributes valuable insights into under-explored care practices in the German-speaking context and underlines the need for enhanced training and awareness among healthcare professionals to better integrate irrigation therapy into routine care.

Aim

Perforated diverticulitis of the left colon with peritonitis remains life-threatening. However, the optimal surgical strategy is still under debate. The presented study compares the impact of a routinely applied two-stage damage control strategy (DCS) in perforated purulent or faeculent diverticulitis with currently used non-DCS strategies.

Methods

This international multicentre retrospective cohort study was conducted in nine European hospitals. In five hospitals, the therapeutic algorithm covered the routine application of a two-stage DCS as a surgical standard for treating perforated diverticulitis. Four hospitals performed conventional one-stage surgeries and served as controls. The primary outcome was stoma rate at the end of the initial hospital stay. The key secondary outcomes were morbidity and mortality rates.

Results

Overall, data from 558 patients were included, 365 of whom were from DCS centres with equally distributed sex. Patients treated in DCS centres were significantly younger (67 ± 14 vs. 70 ± 14, p = 0.007) but showed a higher Mannheim peritonitis index (22.3 ± 7.9 vs. 20.4 ± 8.0, p = 0.008). At discharge, patients treated in DCS hospitals had a significantly lower stoma rate (stoma-free: DCS, 45.6% vs. non-DCS, 20.8%; p = 0.001).

Secondary outcome parameters showed no differences between the investigated cohorts, in addition to significantly longer ICU stays (7.28 ± 11.13 vs. 5.15 ± 9.60 days; p < 0.001) and an increased number of surgical interventions during the hospital stay in DCS centres (2.64 ± 1.89 vs. 1.51 ± 1.10; p < 0.001).

Conclusion

Patients treated in DCS hospitals for perforated diverticulitis are significantly more likely to be discharged without a stoma than patients treated in hospitals using the current standard treatment.