Annals of Coloproctology最新文献

Purpose: This study was conducted to evaluate the validity of a new imaging-guided, anatomy-based classification of anorectal fistulas in defining disease severity and predicting surgical outcomes.

Methods: This multicenter, retrospective cohort study analyzed data from patients with perianal fistulas who underwent surgery between 2017 and 2023. All patients underwent preoperative 3-dimensional endoanal ultrasound, with adjunctive magnetic resonance imaging performed if ultrasound indicated a complex fistula. Imaging examinations were retrospectively evaluated to categorize fistulas according to the Garg classification and the newly proposed classification system. The new classification included 6 severity grades based on the characteristics of the primary tract: submucosal, intersphincteric, low transsphincteric, high transsphincteric, multiple, and suprasphincteric/extrasphincteric. Each grade was further subdivided into 3 subtypes (A, B, C) based on the extension of secondary tracts.

Results: When compared with the new classification, the Garg classification demonstrated a slightly lower ability to predict the feasibility of fistulotomy in simple fistulas (94.2% vs 99.1%; Fisher exact test, P=0.006). A strong positive correlation was found between the surgery failure rate and the severity grade of the new classification (Spearman rho, 0.90; P<0.001), whereas the Garg classification showed a nonsignificant positive correlation with surgical failure rate (Spearman rho, 0.90; P=0.08).

Conclusion: The new imaging-guided, anatomy-based classification of anorectal fistulas demonstrates high accuracy in defining disease severity. It represents a valuable tool for preoperative grading of anal fistulas, standardizing the reporting of diagnostic imaging, and improving the communication of findings among healthcare professionals.

Purpose: This study aims to assess the performance of 4 generative artificial intelligence (AI) platforms-Gemini (formerly Bard), Bing, GPT-4, and Wrtn-in answering questions about colon cancer in the Korean language. Two main research questions guided this study. First, which AI platform provides the most accurate answers? Second, can these AI-generated answers be reliably used to educate patients and their families about colon cancer?

Methods: Ten questions selected by the author were posed to the 4 generative AI platforms on February 22, 2024. Two colorectal surgeons in Korea, each with over 20 years of clinical experience, independently evaluated the answers provided by these generative AI platforms.

Results: The generative AI platforms scored an average of 5.5 out of 10 points. Wrtn achieved the highest score at 6 points, followed by GPT-4 and Gemini, each with 5.5, and Bing, scoring 5 points. The weighted κ for inter-rater reliability was 0.597 (P<0.001). The generative AI platforms performed well in explaining the occult blood test for cancer screening, keyhole surgery, and dietary recommendations for cancer prevention. However, they demonstrated significant limitations in answering more complex topics, such as estimating survival rates following surgery, choosing targeted therapy after surgery, and accurately reporting the mortality rate due to colon cancer in Korea.

Conclusion: The findings suggest that using these generative AI platforms as educational resources for patients and their families regarding colon cancer is premature. Further training on colorectal diseases is required before these AI platforms can be considered reliable information sources for the general public in Korea.

Purpose: The incidence of rectal neuroendocrine tumors (NETs) is increasing owing to a rise in colonoscopy screening. For the endoscopic removal of NETs, complete resection including the submucosal layer is essential. Therefore, appropriate endoscopic resection techniques are of critical importance. This study aimed to analyze data on rectal NETs and help provide guidance for their endoscopic treatment.

Methods: A retrospective analysis was conducted on data from patients who underwent resection for rectal NETs at 6 institutions between 2010 and 2021.

Results: A total of 1,406 tumors were resected from 1,401 patients. During a mean follow-up period of 55.4 months, there were 8 cases (0.5%) of recurrence. Overall, a complete resection was achieved in 77.6% of the patients, with modified endoscopic mucosal resection (mEMR) and endoscopic submucosal dissection (ESD) showing the highest rate at 86.0% and 84.9%, respectively, followed by conventional EMR (cEMR; 68.7%) and snare polypectomy (59.0%). In the subgroup analysis, statistically significant differences were observed in complete resection rates based on tumor size. ESD and mEMR demonstrated significantly higher complete resection rates compared with cEMR. Univariate and multivariate analyses showed that tumor location of the lower rectum and advanced techniques (mEMR and ESD) were significant prognostic factors for complete resection rates.

Conclusion: When encountering rectal subepithelial lesions on endoscopic examination, endoscopists should consider the possibility of NETs and carefully decide on the endoscopic treatment method. Therefore, it is advisable to perform mEMR or ESD to achieve complete resection, especially for rectal NETs measuring ≤10 mm.

Sclerosing encapsulating peritonitis (SEP) is a rare but serious condition characterized by the progressive formation of a dense fibrous sheath encasing the small bowel within the peritoneal cavity. This review provides a comprehensive overview of the current understanding of SEP, focusing on its etiology, clinical presentation, diagnostic modalities, and management strategies. SEP can be classified into primary and secondary forms, each with distinct etiologies and treatment approaches. Primary SEP typically presents with acute or subacute bowel obstruction symptoms, necessitating surgical intervention to excise the fibrous sheath and relieve the obstruction. Secondary SEP often occurs in patients undergoing peritoneal dialysis, with cessation of dialysis being a key component of management. Medical treatments, including corticosteroids, immunosuppressive agents, and nutritional support, may complement surgical intervention, particularly in cases of secondary SEP. Advanced imaging techniques and personalized medicine approaches show promise in improving diagnostic accuracy and tailoring treatment strategies to individual patients. Future research directions include investigating targeted pharmacological therapies, exploring minimally invasive surgical techniques, and conducting long-term follow-up studies to evaluate treatment efficacy and disease recurrence. Multidisciplinary care teams play a crucial role in the comprehensive management of SEP, emphasizing collaboration among various specialties to optimize patient outcomes.

Purpose: The technique for transanal resection of rectal tumors has evolved from conventional methods to minimally invasive approaches. However, the research comparing long-term results between these approaches is limited.

Methods: Between 2016 and 2022, a total of 133 patients who underwent transanal excision were analyzed. Patients were classified into 2 groups according to surgical approach: conventional transanal approach (CTA) and minimally invasive transanal approach (MTA). Medical records were analyzed to compare surgical and oncological outcomes between the 2 groups.

Results: There were no significant differences observed in patient's demographics and tumor characteristics, except the MTA group exhibited a statistically longer distance from the anal verge. Although statistical significance was not reached, the MTA group demonstrated a 100% margin-negative rate in contrast to the CTA group, which had worse outcomes for both margin status and fragmentation. Recurrence was observed only in the CTA group containing pT1 rectal cancer and grade 1 neuroendocrine tumor, with negative margins and no fragmentation.

Conclusion: The minimally invasive approach did not demonstrate statistical superiority but showed technical feasibility through the absence of margin-positive cases and the use of the clip handle method. Further studies are needed to validate these findings and assess broader applicability.

Purpose: Early diagnosis of anastomotic leakage (AL) after colorectal surgery can reduce severe postoperative morbidity and ensure successful treatment. This study evaluated the feasibility of bedside endoscopic inspection of the anastomosis early postoperatively using a point-of-care digital rectoscope.

Methods: This prospective study was conducted at 2 tertiary centers. Patients who underwent minimally invasive or open sphincter-preserving surgery with creation of a colorectal or coloanal anastomosis were included. Data were collected from December 2022 to October 2023. Bedside anastomotic inspections were performed postoperative day (POD) 3 to 5 using a point-of-care digital rectoscope. The primary outcome was feasibility, defined as adequate clinical assessment of the anastomosis during bedside inspection. Secondary outcomes included patient tolerability, efficacy compared to other diagnostic methods, and clinical outcomes during 90 days of follow-up.

Results: In total, 35 patients were included. All bedside anastomotic inspections were carried out successfully. The examination showed complete visibility of the entire anastomosis in 30 patients (85.7%), with minimal discomfort reported by 3 (8.6%). No adverse events were recorded. AL occurred in 6 patients (17.1%), with 3 cases detected during bedside inspections between POD 3 and 5. Two leaks were detected without clinical or biochemical suspicion. Three patients with negative rectoscopy between POD 3 and 5 were later diagnosed with AL: 2 by a computed tomography scan and 1 by a bedside rectoscopy.

Conclusion: Bedside inspection of rectal anastomoses early postoperatively is feasible and tolerable for patients. Routine anastomotic inspections can detect early AL even without clear clinical or biochemical signs.

Purpose: Colorectal cancer (CRC) is the most common malignancy of the gastrointestinal system globally. Identifying specific gene expression patterns indicative of early-stage CRC could enable early diagnosis and rapid treatment initiation. Matrix metalloproteinases (MMPs) play crucial roles in extracellular matrix degradation and tissue remodeling. Among them, MMP-2 and MMP-9 have been found to be upregulated in various cancers, including CRC, and are associated with tumor invasion, metastasis, and angiogenesis. In contrast, a disintegrin and metalloproteinase like decysin 1 (ADAMDEC1) is a relatively newly discovered gene with demonstrated involvement in immune response and inflammation. This study investigated serum levels of MMP-2 and MMP-9, along with tissue expression of MMP-2, MMP-9, and ADAMDEC1, and explored potential associations with pathological and clinical factors in patients with CRC.

Methods: This study included 100 patients with CRC and 100 control participants. Tissue and blood samples were collected. Serum MMP-2 and MMP-9 levels were analyzed using the enzyme-linked immunosorbent assay. Quantitative real-time polymerase chain reaction was employed to assess the expression levels of MMP-2, MMP-9, and ADAMDEC1 in CRC tissue samples compared to adjacent control tissue.

Results: The expression levels of MMP-2, MMP-9, and ADAMDEC1 were significantly upregulated in CRC relative to adjacent control tissues. Analysis of clinicopathological features revealed statistically significant differences in the expression levels of MMP-2, MMP-9, and ADAMDEC1 between patients with CRC with and without lymphovascular invasion (P<0.001). Based on receiver operating characteristic curve analysis, these genes represent promising candidate diagnostic biomarkers for CRC.

Conclusion: MMP-2, MMP-9, and ADAMDEC1 levels may serve as potential diagnostic biomarkers for CRC.