International Journal of Colorectal Disease最新文献

Purpose: Defunctioning stoma (DS) has been suggested to mitigate the consequences of anastomotic leak (AL) after low anterior resection. Stoma reversal (SR) is commonly delayed for nonmedical reasons in many healthcare systems. This study investigated the impact of the elapsed time from AR to SR on postoperative 90-day complications. The secondary aim was to explore the independent factors associated with a delayed SR. M&M: This multicenter retrospective cohort study included rectal cancer patients who underwent anterior resection (AR) and DS between 2014 and 2018. Multivariable logistic regression was used to evaluate the influence of the elapsed time from AR to SR on postoperative complications within 90 days.

Results: Out of 905 patients subjected to AR with DS, 116 (18%) patients experienced at least one postoperative 90-day complication after SR. Multivariable analysis revealed an association between the elapsed time to SR and complications within 90 days from SR (OR 1.02; 95% CI, 1.00-1.04). The association with SR complications was further highlighted in patients who experienced delayed SR > 6 months after AR (OR 1.73; 95% CI, 1.04-2.86). AL after AR and nodal disease were both related to delayed SR.

Conclusion: This study demonstrated that postoperative 90-day complications are associated with the time elapsed to SR. These findings emphasize the importance of early SR, preferably within 6 months, to prevent complications.

Background: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is widely regarded as a definitive surgical option for managing ulcerative colitis (UC). Enhanced recovery programs (ERP) have shown potential in better outcomes following surgery; however, their perioperative benefits in UC patients undergoing IPAA remain insufficiently investigated.

Methods: This study included UC patients who underwent IPAA between January 2008 and September 2023 across multiple affiliated centers within the China UC Pouch Center Union. Key outcomes analyzed included postoperative complications and long-term quality of life (QOL), assessed via the comprehensive complication index (CCI) and Cleveland Global Quality of Life (CGQL) instrument.

Results: A total of 216 patients were included, with a median follow-up of 8.0 years (interquartile range, 4.0-11.0 years); 62 patients underwent comprehensive ERP. Results indicated that ERP implementation significantly lowered CCI scores (p = 0.036), reduced the incidence of severe complications (CCI > 26.2, p = 0.019), shortened hospital stays (p = 0.046), and improved long-term QOL (p < 0.001). Non-adherence to ERP emerged as an independent risk factor for severe postoperative complications (odds ratio, 3.195; 95% confidence interval, 1.332-7.664; p = 0.009) and impaired QOL (odds ratio, 3.222; 95% confidence interval, 1.462-7.101; p = 0.004).

Conclusion: Our study provided supporting evidence for the application of perioperative ERP in a specific homogeneous cohort of UC patients undergoing IPAA to further improve clinical outcomes for them.

Background: Limited research has focused on the characterization of Crohn's disease (CD) patients with surgical recurrence. This study aimed to evaluate risk factors and postoperative pharmacological prophylaxis patterns for surgical recurrence in CD.

Methods: Data were obtained from 349 CD patients over a 5-year follow-up after initial bowel surgery. Risk factors and postoperative pharmacological prophylaxis patterns affecting re-resection were analyzed. Multivariate Cox regression analysis was also used to identify risk factors for surgical recurrence. A nomogram was created to guide postoperative disease surveillance.

Results: A total of 349 CD patients were enrolled, with a median follow-up time of 68.0 months after surgery. The overall cumulative risk of surgical recurrence was 9.7% at 5 years. In a multivariate Cox regression analysis, stricturing and penetrating behavior, extensive small bowel resection, residual lesions, postoperative complications, and postoperative step-up to biologic therapy were the factors independently associated with an increased risk of surgical recurrence (P < 0.05). A nomogram with these variables had good predictive accuracy for surgical recurrence (C-index = 0.767). Kaplan-Meier curves showed that patients with residual lesions had a higher probability of surgical recurrence (P = 0.004). Furthermore, there were significantly more patients who received early step-up to biologics after primary bowel surgery within 8 weeks in the no-recurrence group (P = 0.014).

Conclusion: Several risk factors were found in CD patients with surgical recurrence, and a nomogram predicting surgical recurrence could guide individual postoperative management to avoid reoperations. Postoperative pharmacological prophylaxis patterns with early step-up to biologics might reduce the re-rection incidence.

Background: Sarcopenia is an age-related condition marked by muscle loss and weakened muscular strength. It is a new predictor of poor clinical outcomes in several illnesses. The association between sarcopenia and poor outcomes in Crohn's disease is still debated. Our main objective is to evaluate the impact of sarcopenia vs non-sarcopenia on the development of adverse outcomes in patients with Crohn's disease.

Methods: We conducted a systematic review and meta-analysis synthesizing observational studies, which were retrieved by systematically searching PubMed, Web of Science, SCOPUS, EMBASE, and Cochrane until October 1, 2024. The odd ratio (OR) for dichotomous outcomes with the corresponding 95% confidence interval (CI) was used.

Results: There were fourteen studies with a total of 2334 patients. The sarcopenia group was associated with a higher risk of hospitalization (OR, 1.87 with 95% CI [1.19-2.93], P = 0.006) and developing abscess (OR, 5.03 with 95% CI [2.05-12.38], P = 0.0004). However, there was no statistically significant difference between sarcopenia and non-sarcopenia groups, regarding the need for surgery (OR, 1.12 with 95% CI [0.5-2.5], P = 0.79), loss of biological response (OR, 1.11 with 95% CI [0.34-3.66], P = 0.86), need for biological therapy (OR, 0.77 with 95% CI [0.43-1.36], P = 0.36), and surgical site leak (OR, 2.01 with 95% CI [0.66-6.18], P = 0.22).

Conclusion: Our study showed that sarcopenia is associated with an increased risk of hospitalization and abscess formation in patients with Crohn's. However, sarcopenia does not significantly affect the need for surgery, loss of biological response, need for biological therapy, or the occurrence of surgical site leaks. Further studies are required to explore the mechanisms underlying these associations.

Purpose: Acute severe ulcerative colitis (ASUC) is a medical emergent condition, and approximately one-third of patients with ASUC do not respond to corticosteroid. Whether small molecule drugs are efficient and safe for salvage therapy of ASUC is not well-understood.

Methods: Consecutive patients with ASUC who failed responding to first-line corticosteroid were retrospectively enrolled. Clinical, laboratory, endoscopic, and pathological data were analyzed.

Results: Five Asian male patients (median age of 38.9 years old) with ASUC who received salvage therapy with upadacitinib were enrolled. The mean (± standard deviation) disease duration was 3.44 (± 3.30, 0.53 ~ 7.88) years. Baseline Montreal disease extent, C-reactive protein, and erythrocyte sedimentation rate were four (80%) E3 and one (20%) E2 disease, 40.54 (± 74.26) mg/dl, and 24.50 (± 19.09) mm/h, respectively. Daily upadacitinib 45 mg was prescribed for 56 days in all patients. Clinical response, clinical remission, corticosteroid-free remission, and endoscopic improvement at weeks 8 and 12 were achieved in five (100%) and five (100%), four (80%) and five (100%), four (80%) and five (100%), and four (80%) and five (100%) patients, respectively. One (20%) patient achieved histo-endoscopic remission at week 24. None of them had re-hospitalization or colectomy during the follow-up period but one patient developed penile simplex-1 infection which resolved after topical antiviral ointment without upadacitinib discontinuation.

Conclusions: Upadacitinib is an efficient salvage therapy for patients with ASUC. Further investigations are essential to assess long-term durability, safety profile, and viability as a bridging regimen in the treatment of ASUC.

Purpose: This study aimed to investigate the association between lymph node yield (LNY) and cancer-specific survival (CSS) in patients with T1 colorectal cancer (CRC) via data from two large cohorts.

Methods: We analyzed data from 4186 patients in the SEER cohort (2010-2015) and 533 patients from CHCAMS (2014-2019). Patients were categorized into two groups based on whether their LNY was above or below the guideline-recommended threshold of 12 nodes. Propensity score matching was used to adjust for confounding factors, and survival analysis was conducted using Kaplan-Meier and Cox proportional hazards models.

Results: No significant difference in CSS was found between patients with LNY ≥ 12 and those with LNY < 12 in either the SEER or CHCAMS cohorts (log-rank P > 0.05 for both). After multivariate adjustment, LNY was not independently associated with CSS. Factors such as age, tumor location, elevated preoperative CEA levels, and adjuvant chemotherapy were significant prognostic factors in the SEER cohort. In the CHCAMS cohort, lymph node metastasis (LNM) emerged as the sole independent predictor of CSS.

Conclusion: Our findings suggest that LNY is not significantly associated with CSS in patients with T1 CRC, challenging the necessity of adhering to the 12-node benchmark for early-stage disease. Instead, factors such as tumor biology, LNM, and patient demographics may be more relevant in determining survival outcomes. Further prospective studies are needed to validate these findings and refine guidelines for lymph node assessment in early-stage CRC.

Purpose: This study compared the diagnostic performance of standard endoscopic ultrasound (EUS) and submucosal injection of normal saline and epinephrine-enhanced EUS (SINE-EUS) in detecting early colorectal cancer (CRC), emphasizing accuracy, sensitivity, and specificity.

Methods: The self-controlled study was conducted with 115 patients diagnosed with early CRC through optical enhancement (OE) magnified endoscopy. Among them, 104 patients underwent sequential diagnostic procedures, starting with standard EUS and followed by SINE-EUS. Pathological findings were used as the reference standard. Statistical analyses assessed the diagnostic metrics and identified factors influencing accuracy.

Results: Among 104 patients, 82 were pathologically diagnosed with early CRC (63 cases of Tis/T1a and 19 cases of T1b). Standard EUS showed a sensitivity of 68.3%, specificity of 52.6%, and overall accuracy of 64.6%. In contrast, SINE-EUS significantly improved sensitivity (85.7%), specificity (68.4%), and overall accuracy (81.7%) (P < 0.0167). Risk factors such as ulceration were identified as independent predictors of reduced diagnostic accuracy.

Conclusions: SINE-EUS outperforms standard EUS in diagnosing early CRC, particularly in terms of sensitivity and overall accuracy. This technique is reliable for clinical application, although limitations remain in improving specificity for deeper lesions.

Purpose: Functional faecal incontinence (FFI) is a stigmatising condition for a child and parents and can be a challenge to treat even in tertiary centres. Transanal irrigation (TAI) is an emerging treatment with great success in refractory cases. We performed TAI with a substantially decreased amount of water used (low-volume TAI), yet no previous evidence exists on this treatment in children. We conducted this study to evaluate the efficacy of low-volume TAI in reducing faecal incontinence (FI) episodes and to provide associated factors for response.

Methods: Children with FFI trained in low-volume TAI in our outpatient incontinence clinic were identified. Baseline characteristics along with rectal ultrasound examination, information on weekly FI episodes and concomitant use of laxatives were noted. The continence status of patients was registered at the first outpatient clinic appointment after the commencement of TAI and after 6 months of treatment. During this period, information about side effects and changes in medication were captured.

Results: We identified 47 children (mean age 8.06 ± 2.08 years, 27 males) treated with low-volume TAI. Thirty-five (74%) were diagnosed with functional constipation and FI, while 12 (26%) suffered from non-retentive faecal incontinence. Twenty (42%) children gained full faecal continence after 6.75 ± 0.3 months. We found no differences between responders and non-responders in baseline characteristics.

Conclusions: Low-volume TAI appears safe and effective in the treatment of FFI refractory to first-line treatment in children. Low-volume TAI could be a valuable tool for the management of these children as the treatment is less invasive, low in cost and well accepted.

Purpose: Acute appendicitis (AA) is the leading cause of acute abdomen worldwide, with an incidence of 90-100 cases per 100,000 individuals annually and a lifetime risk of 7-12%. Despite its prevalence, historical accounts of AA are limited, particularly when compared to conditions like haemorrhoids, likely due to the appendix's internal location. This article traces the historical evolution of AA treatment from ancient times to the present, highlighting key contributions.

Methods: A review of common research databases and relevant literature on AA was conducted.

Results: Evidence from ancient Egypt suggests early recognition of the appendix, referring to it as the "worm of the bowel." However, detailed anatomical descriptions and treatment approaches for AA did not emerge until the Renaissance, particularly with contributions from Leonardo da Vinci and Berengario da Carpi. The article traces the progression of AA management, including the first autopsies and surgeries, the development of surgical techniques predating anaesthesia and antisepsis, and advancements achieved from the nineteenth to the twenty-first century. The shift from conservative to surgical approaches is discussed, alongside innovations such as laparoscopic appendicectomy, single-incision laparoscopic surgery (SILS), natural orifice transluminal endoscopic surgery (NOTES), and endoscopic retrograde appendicitis therapy (ERAT). The impact of the COVID-19 pandemic on AA treatment, including adaptations in medical practices, is also explored.

Conclusions: This review highlights the significant historical developments in AA treatment and its pivotal role in advancing abdominal surgery.