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Response to: Letter to the Editor: comment on “Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19” (by Café Balcı, MD, Hacettepe University Faculty of Medicine Department of Internal Medicine Division of Geriatric Medicine)

Wed, 22 Dec 2021 00:00:00 GMT

Reply to - Letter to the editor by Zhang et al entitled ‘ESPEN guideline on hospital diet nutrition’

Ronan Thibault, Stephan C. Bischoff — Tue, 21 Dec 2021 00:00:00 GMT

ESPEN guideline on hospital diet nutrition

Zhige Zhang, Shanjun Tan, Guohao Wu — Tue, 21 Dec 2021 00:00:00 GMT

Preoperative carbohydrate loading before elective abdominal surgery: a systematic review and network meta-analysis of phase II/III randomized controlled trials

Tue, 21 Dec 2021 00:00:00 GMT

The preoperative use of carbohydrate loading (CHO) is recommended in patients undergoing abdominal surgery, even if the advantages remain debatable. The aim was to evaluate the CHO benefits in patients undergoing abdominal surgery.

Combining the quantitative faecal immunochemical test and full blood count reliably rules out colorectal cancer in a symptomatic patient referral pathway

Tue, 21 Dec 2021 00:00:00 GMT

Abstract

Purpose

Faecal Immunochemical Test (FIT) has proven utility for Colorectal Cancer (CRC) detection in symptomatic patients. Most studies have examined FIT in symptomatic patients subsequently referred from primary care. We investigated associations between CRC and FIT in both referred and non-referred symptomatic patients.

Methods

A retrospective, observational study of all patients with a FIT submitted Aug 2018 to Jan 2019 in NHS GG&C was performed. Referral to colorectal/gastroenterology and decision to perform colonoscopy were recorded. FIT results were grouped as f-Hb < 10/10–149/150–399/ ≥ 400 μg/g. The MCN cancer registry identified new cases of CRC. Covariables were compared using the χ² test. Multivariate binary logistic regression identified independent predictors of CRC.

Results

A total of 4968 patients were included. Raised FIT correlated with decision to refer (p < 0.001) and scope (p < 0.001). With 23-month median follow-up, 61 patients were diagnosed with CRC. These patients were older (median 69 vs 59 years, cancer and no cancer respectively, p = 0.001), more likely to be male (55.7% vs 42.1%, p = 0.033), and to report rectal bleeding (51.7% vs 36.1%, p = 0.013). FIT (< 10 µg/g 8.2% vs 76.7% and ≥ 400 µg/g 55.7% vs 3.8%, p < 0.001) and anaemia (45.9% vs 19.7%, p < 0.001) were associated with CRC. On multivariate analysis, age (p = 0.023), male sex (p = 0.04), FIT (≥ 400 OR 54.256 (95% CI:20.683–142.325; p < 0.001)), and anaemia (OR 1.956 (1.071–3.574; p = 0.029)) independently predicted CRC. One patient (0.04%) with a negative FIT and normal haemoglobin had CRC.

Conclusion

GP referral and secondary care investigation patterns were influenced by FIT. The combination of normal Hb and f-Hb excluded CRC in 99.96% of cases, providing excellent reassurance to those prioritising access to endoscopy services.

Preoperative intravenous iron treatment reduces postoperative complications and postoperative anemia in preoperatively anemic patients with colon carcinoma

Mon, 20 Dec 2021 00:00:00 GMT

Abstract

Purpose

Anemia is common among patients with colorectal cancer and is associated with an increased risk of complications and poorer survival rate. The main objective of our study was to determine the effect of preoperative intravenous iron supplementation therapy on the need for red blood cell transfusions, other postoperative complications, and length of hospital stay in colon cancer patients undergoing colon resection.

Methods

In this retrospective cohort study, data were collected from medical records of all 549 colon carcinoma patients who underwent a colon resection in Helsinki University Hospital during the years 2017 and 2018. The patients were divided into two cohorts: one with anemic patients treated with preoperative intravenous iron supplementation therapy (180 patients) and one with anemic patients without preoperative intravenous iron supplementation therapy (138 patients). Non-anemic patients and patients requiring emergency surgery were excluded (231 patients).

Results

Patients treated with intravenous iron had less postoperative complications (33.9% vs. 45.9%, p = 0.045) and a lower prevalence of anemia at 1 month after surgery (38.7% vs. 65.3%, p < 0.01) when compared with patients without preoperative iv iron treatment. No difference was found in the amount of red blood cell transfusions, length of stay, or mortality between the groups.

Conclusion

This is the first study demonstrating a significant decrease in postoperative complications in anemic colon cancer patients receiving preoperative intravenous iron supplementation therapy. This treatment also diminishes the rate of postoperative anemia, which is often associated with a facilitated recovery.

Laparoscopic left hemicolectomy in morbid obesity for sigmoid adenocarcinoma – a video vignette

Sat, 18 Dec 2021 14:56:00 GMT

Abstract

Reply to Response letter to the editor: Associations of vitamin D deficiency with MRI markers of brain health in a community sample

Dongren Sun, Xin Mo, Yefan Lv, Fafa Tian — Sat, 18 Dec 2021 00:00:00 GMT

Laparoscopic‐assistedright hemicolectomy with transvaginal natural orifice specimen extraction.A Video Vignette

Xiaoming Zhu, Jinke Sui, Haifeng Gong, Wei Zhang — Fri, 17 Dec 2021 15:45:46 GMT

Abstract

Laparoscopic complete mesocolic excision with extended D3 lymphadenectomy for advanced hepatic flexure cancer: Addressing infrapyloric node dissection – A video vignette

Fri, 17 Dec 2021 14:37:06 GMT

Colorectal Disease, EarlyView.

Agreement between GLIM and PG-SGA for diagnosis of malnutrition depends on the screening tool used in GLIM

Fri, 17 Dec 2021 00:00:00 GMT

The Global Leadership Initiative on Malnutrition (GLIM) has suggested a process for the diagnosis of malnutrition. The process consists of applying an existing screening tool for malnutrition screening, followed by malnutrition diagnostics, and finally categorization of malnutrition severity (moderate or severe) according to specific GLIM criteria. However, it is not known how well the GLIM process agrees with other diagnostic tools used in the current clinical practice. The aim of this study was to validate the GLIM process against the Patient Generated-Subjective Global Assessment (PG-SGA) when different screening tools were applied in the screening step of the GLIM process.

Adhesion‐related readmissions after open and laparoscopic colorectal surgery in 16 524 patients

Thu, 16 Dec 2021 16:50:32 GMT

Abstract

Aim

Colorectal surgery is associated with a high risk of adhesion formation and subsequent complications. Laparoscopic colorectal surgery reduces adhesion formation by 50%, however the effect on adhesion-related complications is still unknown. This study aims to compare differences in incidence rates of adhesion-related readmissions after laparoscopic and open colorectal surgery.

Method

Population data from the Scottish National Health Service were used to identify patients who underwent colorectal surgery between June 2009 and June 2011. Readmissions were registered until December 2017 andcategorized as being either directly or possibly related to adhesions, or as reoperations potentially complicated by adhesions. The primary outcome measure was the difference in incidence ofdirectly adhesion-related readmissions between the open and laparoscopic cohort.

Results

Colorectal surgery was performed in 16 524 patients;4 455 (27%) underwent laparoscopic surgery. Patients undergoing laparoscopic surgery were readmitted less frequently for directly adhesion-related complications, 2.4% (95% CI 2.0 - 2.8%) vs. 7.5% (95% CI 7.1 - 7.9%) in the open cohort. Readmissions for possibly adhesion-related complications were less frequent in the laparoscopic cohort, 16.8% (95% CI 15.6 - 18.0%) vs. 21.7% (95% CI 20.9 - 22.5%), as well as reoperations potentially complicated by adhesions, 9.7% (95% CI 8.9 - 10.5%) vs. 16.9% (95% CI 16.3 - 17.5%).

Conclusion

Overall, any adhesion-related readmissions occurred in over one in three patients after open colorectal surgery and one in four afterlaparoscopic colorectal surgery. Compared with open surgery incidence rates of adhesion-related complications decrease but remain substantial after laparoscopic surgery.

Redo‐surgery after failed colorectal or coloanal anastomosis: morbidity, mortality and factors predictive of success. A retrospective study of 200 patients

Thu, 16 Dec 2021 15:46:13 GMT

Abstract

Aim

In case of anastomotic failure after colorectal (CRA) or coloanal anastomosis (CAA), revision of the anastomosis is an ambitious surgical option that can be proposed in order to maintain bowel continuity. Our aim was to assess post-operative morbidity, risk of failure and risk factor for failure in patients after CRA or CAA.

Method

All consecutive patients who underwent redo-CRA/CAA in our institution between 2007-2018 were retrospectively included. The success of redo-CRA/CAA was defined by the restoration of bowel continuity 12 months after the surgery.

Results

Two hundred patients (114 male: 57%) were analyzed. The indication for redo-CRA/CAA was chronic pelvic infection in 74 patients (37%), recto-vaginal or urinary fistula in 59 patients (30%), anastomotic stenosis in 36 patients (18%) and redo anastomosis after previous anastomosis takedown in 31 patients (15%). Twenty-three percent of the patients developed a severe post-operative complication. Anastomotic leakage was diagnosed in 39 patients (20%). One-year-success of the redo-CRA/CAA was obtained in 80% of patients. In multivariate analysis, only obesity was associated with redo-CRA/CAA failure (p=0.042). We elaborated a pre-operative predictive score of success using the 4 variables: male sex, age>60 years, obesity and history of pelvic radiotherapy. The success of redo-CRA/CAA was 92%, 86%, 80% and 62% for a pre-operative predictive score value of 0, 1, 2 and ≥3, respectively (p=0.010).

Conclusions

In case of failure of primary CRA/CAA, bowel continuity can be saved in 4 out of 5 patients by redo-CRA/CAA despite 23% suffering severe post-operative morbidity.

Nerve‐preserving laparoscopic total mesorectal excision (TME) – a video vignette

Thu, 16 Dec 2021 12:58:38 GMT

Colorectal Disease, EarlyView.

Step by step demonstration of laparoscopic pelvic lymph node dissection in rectal cancer – A video vignette

Vivek Sukumar, Mufaddal Kazi, Ashwin Desouza, Avanish Saklani — Thu, 16 Dec 2021 12:57:21 GMT

Colorectal Disease, EarlyView.

Correspondence: The right kind of rectal cancer operation for the right patient requires information on all relevant outcomes

Thu, 16 Dec 2021 09:37:23 GMT

Abstract

Completion surgery vs. primary TME for early rectal cancer: a national study

Thu, 16 Dec 2021 00:00:00 GMT

Abstract

Purpose

While local excision by transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS) is an option for low-risk early rectal cancers, inaccuracies in preoperative staging may be revealed only upon histopathological evaluation of the resected specimen, demanding completion surgery (CS) by formal resection. The aim of this study was to evaluate the results of CS in a national cohort.

Method

This was a retrospective analysis of national registry data, identifying and comparing all Norwegian patients who, without prior radiochemotherapy, underwent local excision by TEM or TAMIS and subsequent CS, or a primary total mesorectal excision (pTME), for early rectal cancer during 2000–2017. Primary endpoints were 5-year overall and disease-free survival, 5-year local and distant recurrence, and the rate of R0 resection at completion surgery. The secondary endpoint was the rate of permanent stoma.

Results

Forty-nine patients received CS, and 1098 underwent pTME. There was no difference in overall survival (OR 0.73, 95% CI 0.27–2.01), disease-free survival (OR 0.72, 95% CI 0.32–1.63), local recurrence (OR 1.08, 95% CI 0.14–8.27) or distant recurrence (OR 0.67, 95% CI 0.21–2.18). In the CS group, 53% had a permanent stoma vs. 32% in the pTME group (P = 0.002); however, the difference was not significant when adjusted for age, sex, and tumor level (OR 2.17, 0.95–5.02).

Conclusions

Oncological results were similar in the two groups. However, there may be an increased risk for a permanent stoma in the CS group.

A comment on ‘development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients e a prospective multicenter observational study (iSOFA study)’ (Reintam et al. 2021. Clinical nutrition, V 40 (8):p 4932–4940)

Varsha M. Asrani, Colin McArthur, Ian Bissett, John A. Windsor — Wed, 15 Dec 2021 00:00:00 GMT

Although the gastrointestinal (GI) tract can fail and exacerbate critical illness, gut dysfunction (GDF) has not been included in organ-based severity scoring systems [1,2]. Recently, a GDF scoring system was published in this journal [3] by the group that previously introduced the Acute Gastrointestinal Injury (AGI) grading system [4]. Reintam and colleagues have now developed the GIDS (or GastroIntestinal Dysfunction Score), based on a prospective multicentre study incorporating it into the SOFA score as the intestinal sequential organ function assessment, or i-SOFA) [3].

Comment on “effects of adequate dietary protein with whey protein, leucine, and vitamin D supplementation on sarcopenia in older adults: An open-label, parallel-group study”

Deniz Sevindik Günay, Umut Safer, Vildan Binay Safer — Wed, 15 Dec 2021 00:00:00 GMT

A recent article by Lin et al. published in the Clinical Nutrition points to affects of whey protein, leucine, and vitamin D supplementation on sarcopenia in older adults [1]. In older adults, sarcopenia was reported as important, because adults with sarcopenia have significantly lower health-related quality of life compared to non-sarcopenic older adults [2] In this content, we found results of study by Lin et al. particularly valuable meanwhile, some methodological points need to be highlighted before focusing on current results.

Comment on “vegan diet reduces neutrophils, monocytes and platelets related to branched-chain amino acids - A randomized, controlled trial”

Rajesh Kumar, Dibakar Borthakur, Rima Dada — Wed, 15 Dec 2021 00:00:00 GMT

We read the article “Vegan diet reduces neutrophils, monocytes and platelets related to branched-chain amino acids - A randomized, controlled trial” by Ann-Kathrin Lederer et al. with great interest [1]. The recent trend of nutrition research focuses on dietary pattern analysis rather than the traditional single nutrient analysis [2]. The authors meticulously designed this first ever randomized control trial taking exclusively vegan diet in one arm. We have the following concerns about the article.

Difficulty of treatment in patients with anorexia nervosa

Tomoyuki Kawada — Wed, 15 Dec 2021 00:00:00 GMT

Guinhut et al. summarized types and prevalence of medical complications in 354 patients with anorexia nervosa (AN) during their hospitalization for refeeding [1]. A total of 339 patients were female and mean (1 SD) of age was 28.7 (10.7) years old. Duration of AN was 9.5 years, and mean body mass index (BMI) (1 SD) at admission was 12.2 (1.6) kg/m2. During mean hospitalization of 36.9 days, the mean weight gain was 4.1 kg. Enteral nutrition was provided in 304 patients, and more than half of the patients presented medical complications such as anemia, neutropenia, and increased transaminase.

Effects of probiotic supplementation on anthropometric and metabolic characteristics in adults with metabolic syndrome: Letter to the editor

Leila Sadat Bahrami, Seyyed Mostafa Arabi — Wed, 15 Dec 2021 00:00:00 GMT

We read with interest the article by Hadi et al. [1], ' Effects of probiotic supplementation on anthropometric and metabolic characteristics in adults with metabolic syndrome’ in which the probiotic dose for the study by Xavier-Santos et al. [2] was recorded as 1 × 109 CFU. Further scrutiny into this study reveals that the dose of Lactobacillus acidophilus La-5 ranged between 9.2 and 9.5 log CFU per daily serving portion (40 g), which was mentioned to be equivalent to 1.65 × 109 CFU/ser = 9.2 log CFU/ser, and 2.86 × 109 CFU/ser = 9.5 log CFU/ser.

Letter to the editor: Comment on “Body mass index and mini nutritional assessment-short form as predictors of in-geriatric hospital mortality in older adults with COVID-19”

Cafer Balcı — Wed, 15 Dec 2021 00:00:00 GMT

I read with great interest the article by Kananen and colleagues that contributed greatly to our understanding of the relationship between body mass index (BMI), nutrition status, and in-hospital mortality among older adults hospitalized for coronavirus disease 2019 (COVID-19) [1]. The authors found that being underweight (BMI <18.5) and malnutrition increased the risk of in-hospital mortality after adjusting for some potential confounding factors, but being overweight and obese were not found to be associated with an increased risk of mortality in COVID-19 patients.

Doubly labelled water for determining total energy expenditure in adult critically ill and acute care hospitalized inpatients: A scoping review

Wed, 15 Dec 2021 00:00:00 GMT

Doubly labelled water (DLW) is considered the reference standard method of measuring total energy expenditure (TEE), but there is limited information on its use in the Intensive Care Unit (ICU) and acute care setting. This scoping review aims to systematically summarize the available literature on TEE measured using DLW in these contexts.

Association between dairy protein and body composition in middle-aged and older women: A community-based, 12-year, prospective cohort study

Jun-Hyuk Lee, A-Ra Cho, Yu-Jin Kwon — Wed, 15 Dec 2021 00:00:00 GMT

Changes in body composition during aging include decreased muscle mass and increased fat mass. Women with low muscle mass with abdominal obesity (LMAO), in particular, could be at higher risk of morbidities and mortality than those with either sarcopenia or obesity alone. Dairy products, which contain whey protein and all essential amino acids, could have a beneficial role in preserving muscle mass and reducing obesity. We aimed to analyze the association between dairy protein and the development of LMAO in women using a large-scale, community-based prospective cohort.

Red meat consumption, obesity, and the risk of nonalcoholic fatty liver disease among women: Evidence from mediation analysis

Wed, 15 Dec 2021 00:00:00 GMT

Previous studies have suggested consumption of red meat may be associated with an increased risk of developing nonalcoholic fatty liver disease (NAFLD). However, large-scale, prospective data regarding red meat consumption in relation to the incidence of NAFLD are lacking, nor is it known whether any association is mediated by obesity.

Correction to: The treatment of acute appendicitis in two age‑based groups during COVID‑19 pandemic: a retrospective experience in a COVID‑19 referral hospital

Wed, 15 Dec 2021 00:00:00 GMT

TNF inhibitors in Crohn’s disease and the effect on surgery rates

Tue, 14 Dec 2021 14:35:03 GMT

Abstract

Aim

Surgery is an important therapeutic option for Crohn’s disease. The need for first bowel surgery seems to have decreased with the introduction of TNF-inhibitors (TNFi; adalimumab or infliximab). However, the impact of TNFi on the need for intestinal surgery in Crohn’s disease patients irrespective of prior bowel resection is not known. Our aim is to compare the incidence of bowel surgery in Crohn’s disease patients who remain on versus those who discontinue TNFi treatment.

Method

We performed a nationwide register-based observational cohort study in Sweden 2006-2017 of all incident and prevalent cases of Crohn’s disease who started first line TNFi treatment. Patients were categorized according to TNFi treatment retention less than or beyond one year. The study cohort was evaluated with regards to incidence of bowel surgery from 12 months after first ever TNFi dispensation.

Results

We identified 5003 TNFi exposed Crohn’s disease patients, 3748 surgery-naïve and 1255 with bowel surgery prior to TNFi initiation. Of all these patients, 7% (n=353) were subjected to abdominal surgery during the first 12 months after start of TNFi and subsequently excluded from the main analysis. A majority (62%) continued TNFi ≥12 months. TNFi drug survival <12 months was associated with a significantly higher surgery rate compared to patients who continued TNFi ≥12 months (HR 1.26, 95% CI, 1.09-1.46; p=.002).

Conclusion

Treatment with TNFi <12 months was associated with a higher risk of bowel surgery in Crohn’s disease patients compared to continuing TNFi ≥12 months.

Long‐term Oncological Outcomes in Patients Undergoing Laparoscopic vs. Open Surgery for Colon Cancer: A Nationwide Cohort Study

Tue, 14 Dec 2021 14:33:15 GMT

Abstract

Aim

To estimate the effect of laparoscopy vs. laparotomy on recurrence status in patients undergoing intended curative resection for stage I-III colon cancer using nationwide data.

Method

A retrospective cohort study using prospectively collected nationwide quality assurance data on all patients undergoing elective, intended curative surgery for UICC stage I-III colon cancer in Denmark from January 1, 2010, through December 31, 2013. The association between laparoscopic vs. open surgery and recurrence status was investigated using cause-specific hazard and subdistribution hazard models with death from any cause as a competing event.

Results

In total,4369 patients undergoing elective intended curative surgery for colon cancer were included in the analysis. Overall, 3243 (74.2%) patients underwent laparoscopic surgery. During a median follow-up time of 84 months, 1191 (27.2%) patients experienced recurrence, and 1304 (29.8%) patients died. The cause-specific hazard of recurrence following laparoscopic vs. open surgery was HR_CS=1.08, 95% CI: 0.90 to 1.28, p=0.422. The subdistribution hazard of recurrence following laparoscopic vs. open surgery was HR_SD=0.99, 95% CI: 0.84 to 1.16, p=0.880.

Conclusion

Elective laparoscopic resection for UICC stage I-III colon cancer was oncologically safe and comparable with open resection. These results confirm the external validity of previous RCTs in everyday clinical settings.

Robotic natural orifice specimen extraction surgery for complicated diverticulitis requiring sigmoid colon resection and colovesical fistulectomy followed by colorectal anastomosis and repair of the urinary bladder – A video vignette

Hsiang‐Chih Chen, Tzu‐Chun Chen, Jin‐Tung Liang — Mon, 13 Dec 2021 11:15:36 GMT

Colorectal Disease, EarlyView.

Standardized documentation and synoptic reporting of complex intestinal anatomy in enteric fistulation and intestinal failure

Mon, 13 Dec 2021 11:01:41 GMT

Abstract

Aim

In intestinal failure, delineation of both structure and function are key to controlling symptoms and planning further intervention. We have developed a template for developing an ‘anatomy at a glance’ patient-specific map to aid decision making and counselling.

Method

A core dataset was developed and used to create an editable template to demonstrate the gastrointestinal tract, its relationship to the genitourinary tract, and specific anterior abdominal wall features. This was then used to create an anatomical template, specific to each patient, and stored in the electronic patient record and imaging archive.

Results

We have developed a technique for integration of multi-modal information into one diagram, easily referenced by the multidisciplinary team. Radiology, endoscopy and previous operation notes can be used to fill out a core dataset, which is then transposed into a standardized template. A worked example is shown.

Conclusion

The mapping template has been successfully integrated into practice and aided decision making at all stages of the patient's therapeutic journey. It has been found helpful in planning routes of nutrition, preoperative optimization, surgical planning, interpreting postoperative imaging and managing patient expectations.

Iron status in early childhood is modified by diet, sex and growth: Secondary analysis of a randomized controlled vitamin D trial

Mon, 13 Dec 2021 00:00:00 GMT

During early childhood the risk of iron deficiency (ID) is high. Serum ferritin serves as a marker of iron status. We explored prevalence of ID and iron deficiency anemia (IDA), and identified determinants of iron status in infants and toddlers.

Alcohol – The myth of cardiovascular protection

Rudolph Schutte, Lee Smith, Goya Wannamethee — Mon, 13 Dec 2021 00:00:00 GMT

To investigate potential biases that exist in available epidemiological evidence resulting in negative associations or underestimation of cardiovascular (CV) risk associated with alcohol consumption.

Mortality following elective and emergency colectomy in patients with cirrhosis: a population-based cohort study from England

Sat, 11 Dec 2021 00:00:00 GMT

Abstract

Background

Patients with cirrhosis undergoing colectomy have a higher risk of postoperative mortality, but contemporary estimates are lacking and data on associated risk and longer term outcomes are limited. This study aimed to quantify the risk of mortality following colectomy by urgency of surgery and stage of cirrhosis.

Data sources.

Linked primary and secondary-care electronic healthcare data from England were used to identify all patients undergoing colectomy from January 2001 to December 2017. These patients were classified by the absence or presence of cirrhosis and severity. Case fatality rates at 90 days and 1 year were calculated, and cox regression was used to estimate the hazard ratio of postoperative mortality controlling for age, gender and co-morbidity.

Results

Of the total, 36,380 patients undergoing colectomy, 248 (0.7%) had liver cirrhosis, and 70% of those had compensated cirrhosis. Following elective colectomy, 90-day case fatality was 4% in those without cirrhosis, 7% in compensated cirrhosis and 10% in decompensated cirrhosis. Following emergency colectomy, 90-day case fatality was higher; it was 16% in those without cirrhosis, 35% in compensated cirrhosis and 41% in decompensated cirrhosis. This corresponded to an adjusted 2.57 fold (95% CI 1.75–3.76) and 3.43 fold (95% CI 2.02–5.83) increased mortality risk in those with compensated and decompensated cirrhosis, respectively. This higher case fatality in patients with cirrhosis persisted at 1 year.

Conclusion

Patients with cirrhosis undergoing emergency colectomy have a higher mortality risk than those undergoing elective colectomy both at 90 days and 1 year. The greatest mortality risk at 90 days was in those with decompensation undergoing emergency surgery.

Managing folate deficiency implies filling the gap between laboratory and clinical assessment

Fri, 10 Dec 2021 00:00:00 GMT

The characterization of folate status in subjects at risk of deficiency and with altered vitamin homeostasis is crucial to endorse preventive intervention health policies, especially in developed countries. Several physiological changes (i.e. pregnancy), clinical situations and diseases have been associated to increased requirement, impaired intake and absorption of folate. However clinical practice guidelines (CPG) endorse folic acid supplementation generally discarding the use of its determination in serum to assess the risk of deficiency and/or its concentration at baseline.

Early vs late initiation of sodium glycerophosphate: Impact on hypophosphatemia in preterm infants <32 weeks

Buse Ozer Bekmez, Serife Suna Oguz — Fri, 10 Dec 2021 00:00:00 GMT

Early electrolyte and mineral imbalances have emerged as a conspicuous problem in very preterm babies since the revision of nutrition guidelines and the eventual implementation of early aggressive parenteral nutrition (PN). We opted to carry out a study with the introduction of phosphorus as sodium glycerophosphate in PN from the first day onward to reveal the impact on serum phosphorus and calcium levels following the surge in the incidence of hypercalcemia and hypophosphatemia.

Laparoscopic sphincter‐preserving total pelvic exenteration with transanal total mesorectal excision for locally advanced rectal cancer—A video vignette

Isaac Seow‐En, Yu Guang Tan, Kae Jack Tay — Thu, 09 Dec 2021 18:33:19 GMT

Colorectal Disease, EarlyView.

Laparoscopic Repair of Traumatic Rectal Injury with Transanal Endoscopic Microsurgery (TEM) Beads

Methods

We reviewed all constipated children who underwent a rectal biopsy to diagnose a possible Hirschsprung’s disease at a tertiary referral hospital over a 6-year period (2013–2018). We registered clinical and demographic factors in these children and conducted correlation and multivariate regression analysis to evaluate the relation between these factors and a diagnosis of Hirschsprung’s disease.

Results

We identified 225 children, aged 0–17 years. In total, Hirschsprung’s disease was diagnosed in only 49/225 (22%). Among the 49 children with Hirschsprung’s disease, 29 (59%) were diagnosed in the neonatal period. Among girls, HD was confirmed in only 10/101 (10%) children, and only 1 of these 10 girls was older than 6 months at the time of the biopsy. The following factors correlated significantly with Hirschsprung’s disease diagnosis in children older than 1 month: “male sex”, “failure to thrive”, “gross abdominal distention plus vomiting” and “fulfils the Rome 4 criteria for functional constipation”.

Conclusion

In children referred for rectal biopsy, the factors most indicative of Hirschsprung’s disease were “male sex”, “failure to thrive”, “gross abdominal distention plus vomiting” and “fulfils the Rome 4 criteria for functional constipation”. Notably, the prevalence of Hirschsprung’s disease decreased with the increasing age of the children. Girls referred for a biopsy rarely had Hirschsprung’s disease, especially those older than 1 month.

Video Vignette: Laparoscopic Sigmoid Colon Vaginoplasty

Deena Harji, Alexander Chauvet, Julian Pouplin, Quentin Denost — Wed, 08 Dec 2021 19:49:06 GMT

Abstract

Chylous ascites after complete mesocolic excision for right‐sided colon cancer with D3 lymphadenectomy: a retrospective cohort‐study

Wed, 08 Dec 2021 13:41:21 GMT

Abstract

Aim

This retrospective study was designed to evaluate risk factors of occurrence and severity of chylous ascites after complete mesocolic excision (CME) and D3 lymphadenectomy in patients with right-sided colon cancer.

Method

Consecutive colorectal cancer patients receiving CME and D3 lymphadenectomy for right-sided colon cancer were included. Risk factors of occurrence and severity of chylous ascites by using logistic analysis were assessed. A nomogram predicting chylous ascites was constructed.

Results

Among 661 patients included, postoperative chylous ascites occurred in 48 (7.3%) patients. Logistic regression analysis demonstrated that prognostic nutritional index (PNI ≤ 47, OR = 2.172, P = 0.016), laparoscopic surgery (OR = 2.798, P = 0.034), operating time (> 225min, OR = 2.645, P = 0.002), and apical lymph node (APN) metastasis (OR = 3.698, P = 0.034) were correlated with the occurrence of postoperative chylous ascites. A nomogram predicting postoperative chylous ascites was constructed (C-index 0.701). 31.2% (15/48) of patients with chylous ascites were resolved in more than 7 days. The number of retrieved lymph nodes (OR = 1.074, 95% CI: 1.002-1.152, P = 0.044) and PNI ≤ 47 (OR = 7.890, 95% CI: 1.224-50.869, P = 0.030) were independently predictive of prolonged chylous ascites resolution (≥ 7 days).

Conclusion

In our series, 7.3% of patients developed chylous ascites after right hemicolectomy with CME. Laparoscopic surgery, PNI, operation time, and APN metastasis were independently predictive of postoperative chylous ascites. Lower PNI and more retrieved lymph nodes were correlated with prolonged resolution of chylous ascites.

Hybrid robotic and laparoscopic hand‐assisted proctocolectomy with complete mesocolic excision, ileal pouch–anal anastomosis and loop ileostomy – A video vignette

Wed, 08 Dec 2021 09:40:50 GMT

Colorectal Disease, EarlyView.

Correction: PTU-67 Differential expression of the potassium of voltage-gated channel subfamily members, kchn

Wed, 08 Dec 2021 09:28:04 GMT

Dong X. PTU-67 Differential expression of the potassium of voltage-gated channel subfamily members, kchn. Gut 2021;70:A145. doi: 10.1136/gutjnl-2021-BSG.269

Due to submitting loading errors, the fully list of authors and the institutions of this abstract were incomplete. The following are the correct information for the authors and institutions:

¹Xuefei Dong, ¹Yuxin Cui, ¹Tracey A Martin, ²Jiafu Ji, ²Chunyi Hao, ¹Wen G Jiang

¹Cardiff China Medical Collaborative, School of Medicine, Cardiff University, Cadiff, UK

²Peking University Cancer Hospital and Key Laboratory for Carcinogenesis, Haidian District, Beijing, China

Correction: PTH-94 DRIM expression in colorectal cancer and its possible tumour suppressive role, clinical and prognostic significance

Wed, 08 Dec 2021 09:28:04 GMT

Dong X, Cui Y, Dong X. PTH-94 DRIM expression in colorectal cancer and its possible tumour suppressive role, clinical and prognostic significance. Gut 2021;70:A160. doi: 10.1136/gutjnl-2021-bsg.297

Due to submitting loading errors, the fully list of authors and the institutions of this abstract were incomplete. The following are the correct information for the authors and institutions:

Xuefei Dong, Yuxin Cui, Fiona Ruge, Tracey A Martin, Rachel Hargest, Wen G Jiang

Cardiff University School of Medicine, Heath Park, Cardiff, UK

Correction: PTH-27 Risk-stratified FIT for urgent colonoscopy in Lynch Syndrome: A clinical service throughout the COVID-19 pandemic

Wed, 08 Dec 2021 09:28:04 GMT

Lincoln A, Lincoln A, Benton S, et al. PTH-27 Risk-stratified FIT for urgent colonoscopy in Lynch Syndrome: A clinical service throughout the COVID-19 pandemic. Gut 2021;70:A184. doi: 10.1136/gutjnl-2021-BSG.342

The authors listed are in correct and should read:

Anne Lincoln¹, Sally C Benton², Prof Peter Sasieni¹, Kevin J Monahan³,⁴

Author Affiliations:

1 Comprehensive Cancer Centre, King’s College London, London, UK,

2 Bowel Cancer Screening South of England Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK

3 The Lynch Syndrome Family Cancer Clinic, St Mark’s Hospital and Academic Institute, Harrow, UK

4 Imperial College London, London, UK

Liver injury, hypoalbuminaemia and severe SARS-CoV-2 infection

In Gut, Mezzano and colleagues have undertaken huge efforts to homogenise and compare the existing evidence.2 They present an extensive systematic review and meta-analysis on the burden of ACLF worldwide (

Automated sizing of colorectal polyps using computer vision

Abdelrahim, M., Saiga, H., Maeda, N., Hossain, E., Ikeda, H., Bhandari, P. — Wed, 08 Dec 2021 09:28:03 GMT

Message

Colorectal polyp size is an important biomarker that influences management decisions, but currently used subjective methods are flawed. We explored two computer vision (CV) techniques for binary classification of polyp size as either ≤5 mm or >5 mm. First, we used premeasured phantom polyps (22 such polyps’ videos) fixed on a pig colon model to explore the concept of automated sizing using structure from motion (SfM) approach and compared it with the sizing by 10 independent endoscopists: overall, average diagnostic accuracy of the SfM system (85.2%) was superior to endoscopists judgement (59.5%). Second, we developed a deep learning model based on convolutional neural networks (CNN) and found 80% accuracy in 10 videos of human polyps. Real-time automated polyp sizing when combined with artificial intelligence (AI) assissted polyp characterisation could improve polyp management strategies.

In more detailsCV techniques

CV can be defined as the ability of machines...

Endoscopic findings in a patient with epigastric pain

Eda, H., Oshima, T., Hirota, S., Miwa, H. — Wed, 08 Dec 2021 09:28:03 GMT

Clinical presentation

A 16-year-old girl had repeated epigastric pain and nausea without any lower abdominal symptoms for 2 years prior to being referred to our hospital. Two years previously, she had undergone oesophagogastroduodenoscopy (EGD) and was diagnosed with chronic gastritis. She denied any other medical history. Physical examination was normal. Laboratory data revealed an iron deficiency anaemia and she had hypoalbuminaemia (serum albumin, 3.1 g/dL). Serum gastrin was 200 pg/mL and vitamin B₁₂ was 270 pg/mL. Antigastric parietal cell and anti-intrinsic factor antibodies and Helicobacter pylori infection were negative. Colonoscopy did not show any abnormalities, and EGD in our hospital revealed diffuse atrophic mucosa with nodular changes observed only in the gastric body circumferentially (figure 1A). In addition, there were multiple polypoid lesions that consisted of round isolated mucosa, which was enhanced by indigo carmine dye spraying (figure 1B). The fornix and the antrum were spared (

Pneumatic dilation for persistent dysphagia after antireflux surgery, a multicentre single-blind randomised sham-controlled clinical trial

Wed, 08 Dec 2021 09:28:03 GMT

Objective

There is no evidence-based treatment for persistent dysphagia after laparoscopic fundoplication. The aim of this study was to evaluate the effect of pneumatic dilation on persistent dysphagia after laparoscopic fundoplication.

Design

We performed a multicentre, single-blind, randomised sham-controlled trial of patients with persistent dysphagia (>3 months) after laparoscopic fundoplication. Patients with an Eckardt symptom score ≥4 were randomly assigned to pneumatic dilation (PD) using a 35 mm balloon or sham dilation. Primary outcome was treatment success, defined as an Eckardt score <4 and a minimal reduction of 2 points in the Eckardt score after 30 days. Secondary outcomes included change in stasis on timed barium oesophagogram, change in high-resolution manometry parameters and questionnaires on quality of life, reflux and dysphagia symptoms.

Results

Forty-two patients were randomised. In the intention-to-treat analysis, the success rates of PD (7/21 patients (33%)) and sham dilation (8/21 patients (38%)) were similar after 30 days (risk difference –4.7% (95% CI (–33.7% to 24.2%) p=0.747). There was no significant difference in change of stasis on the timed barium oesophagogram after 2 min (PD vs sham: median 0.0 cm, p25–p75 range 0.0–4.3 cm vs median 0.0 cm, p25–p75 range 0.0–0.0; p=0.122) or change in lower oesophageal sphincter relaxation pressure (PD vs sham: 10.54±6.25 vs 14.60±6.17 mm Hg; p=0.052). Quality of life, reflux and dysphagia symptoms were not significantly different between the two groups.

Conclusion

Wed, 08 Dec 2021 09:28:03 GMT

Objective

Nucleotides are danger signals that activate inflammatory responses via binding P2 receptors. The nucleoside triphosphate diphosphohydrolase-8 (NTPDase8) is an ectonucleotidase that hydrolyses P2 receptor ligands. We investigated the role of NTPDase8 in intestinal inflammation.

Design

We generated NTPDase8-deficient (Entpd8 ^–/–) mice to define the role of NTPDase8 in the dextran sodium sulfate (DSS) colitis model. To assess inflammation, colons were collected and analysed by histopathology, reverse transcriptase-quantitative real-time PCR (RT-qPCR) and immunohistochemistry. P2 receptor expression was analysed by RT-qPCR on primary intestinal epithelium and NTPDase8 activity by histochemistry. The role of intestinal P2Y₆ receptors was assessed by bone marrow transplantation experiments and with a P2Y₆ receptor antagonist.

Results

NTPDase8 is the dominant enzyme responsible for the hydrolysis of nucleotides in the lumen of the colon. Compared with wild-type (WT) control mice, the colon of Entpd8 ^–/– mice treated with DSS displayed significantly more histological damage, immune cell infiltration, apoptosis and increased expression of several proinflammatory cytokines. P2Y₆ was the dominant P2Y receptor expressed at the mRNA level by the colonic epithelia. Irradiated P2ry6 ^–/– mice transplanted with WT bone marrow were fully protected from DSS-induced intestinal inflammation. In agreement, the daily intrarectal injection of a P2Y₆ antagonist protected mice from DSS-induced intestinal inflammation in a dose-dependent manner. Finally, human intestinal epithelial cells express NTPDase8 and P2Y₆ similarly as in mice.

Conclusion

NTPDase8 protects the intestine from inflammation most probably by limiting the activation of P2Y₆ receptors in colonic epithelial cells. This may provide a novel therapeutic strategy for the treatment of inflammatory bowel disease.

Activated intestinal muscle cells promote preadipocyte migration: a novel mechanism for creeping fat formation in Crohns disease

Wed, 08 Dec 2021 09:28:03 GMT

Objective

Creeping fat, the wrapping of mesenteric fat around the bowel wall, is a typical feature of Crohn’s disease, and is associated with stricture formation and bowel obstruction. How creeping fat forms is unknown, and we interrogated potential mechanisms using novel intestinal tissue and cell interaction systems.

Design

Tissues from normal, UC, non-strictured and strictured Crohn’s disease intestinal specimens were obtained. The muscularis propria matrisome was determined via proteomics. Mesenteric fat explants, primary human preadipocytes and adipocytes were used in multiple ex vivo and in vitro cell migration systems on muscularis propria muscle cell derived or native extracellular matrix. Functional experiments included integrin characterisation via flow cytometry and their inhibition with specific blocking antibodies and chemicals.

Results

Crohn’s disease muscularis propria cells produced an extracellular matrix scaffold which is in direct spatial and functional contact with the immediately overlaid creeping fat. The scaffold contained multiple proteins, but only fibronectin production was singularly upregulated by transforming growth factor-β1. The muscle cell-derived matrix triggered migration of preadipocytes out of mesenteric fat, fibronectin being the dominant factor responsible for their migration. Blockade of α5β1 on the preadipocyte surface inhibited their migration out of mesenteric fat and on 3D decellularised intestinal tissue extracellular matrix.

Conclusion

Crohn’s disease creeping fat appears to result from the migration of preadipocytes out of mesenteric fat and differentiation into adipocytes in response to an increased production of fibronectin by activated muscularis propria cells. These new mechanistic insights may lead to novel approaches for prevention of creeping fat-associated stricture formation.

Gluten-induced RNA methylation changes regulate intestinal inflammation via allele-specific XPO1 translation in epithelial cells

Wed, 08 Dec 2021 09:28:03 GMT

Objectives

Coeliac disease (CD) is a complex autoimmune disorder that develops in genetically susceptible individuals. Dietary gluten triggers an immune response for which the only available treatment so far is a strict, lifelong gluten free diet. Human leucocyte antigen (HLA) genes and several non-HLA regions have been associated with the genetic susceptibility to CD, but their role in the pathogenesis of the disease is still essentially unknown, making it complicated to develop much needed non-dietary treatments. Here, we describe the functional involvement of a CD-associated single-nucleotide polymorphism (SNP) located in the 5’UTR of XPO1 in the inflammatory environment characteristic of the coeliac intestinal epithelium.

Design

The function of the CD-associated SNP was investigated using an intestinal cell line heterozygous for the SNP, N6-methyladenosine (m⁶A)-related knock-out and HLA-DQ2 mice, and human samples from patients with CD.

Results

Individuals harbouring the risk allele had higher m⁶A methylation in the 5’UTR of XPO1 RNA, rendering greater XPO1 protein amounts that led to downstream nuclear factor kappa B (NFkB) activity and subsequent inflammation. Furthermore, gluten exposure increased overall m⁶A methylation in humans as well as in in vitro and in vivo models.

Conclusion

We identify a novel m⁶A-XPO1-NFkB pathway that is activated in CD patients. The findings will prompt the development of new therapeutic approaches directed at m⁶A proteins and XPO1, a target under evaluation for the treatment of intestinal disorders.

Disrupted spermatogenesis in a metabolic syndrome model: the role of vitamin A metabolism in the gut-testis axis

Wed, 08 Dec 2021 09:28:03 GMT

Objective

Effects of the diet-induced gut microbiota dysbiosis reach far beyond the gut. We aim to uncover the direct evidence involving the gut–testis axis in the aetiology of impaired spermatogenesis.

Design

An excessive-energy diet-induced metabolic syndrome (MetS) sheep model was established. The testicular samples, host metabolomes and gut microbiome were analysed. Faecal microbiota transplantation (FMT) confirmed the linkage between gut microbiota and spermatogenesis.

Results

We demonstrated that the number of arrested spermatogonia was markedly elevated by using 10x single-cell RNA-seq in the MetS model. Furthermore, through using metabolomics profiling and 16S rDNA-seq, we discovered that the absorption of vitamin A in the gut was abolished due to a notable reduction of bile acid levels, which was significantly associated with reduced abundance of Ruminococcaceae_NK4A214_group. Notably, the abnormal metabolic effects of vitamin A were transferable to the testicular cells through the circulating blood, which contributed to abnormal spermatogenesis, as confirmed by FMT.

Conclusion

These findings define a starting point for linking the testicular function and regulation of gut microbiota via host metabolomes and will be of potential value for the treatment of male infertility in MetS.

Autoimmune susceptibility gene PTPN2 is required for clearance of adherent-invasive Escherichia coli by integrating bacterial uptake and lysosomal defence

Wed, 08 Dec 2021 09:28:03 GMT

Objectives

Alterations in the intestinal microbiota are linked with a wide range of autoimmune and inflammatory conditions, including inflammatory bowel diseases (IBD), where pathobionts penetrate the intestinal barrier and promote inflammatory reactions. In patients with IBD, the ability of intestinal macrophages to efficiently clear invading pathogens is compromised resulting in increased bacterial translocation and excessive immune reactions. Here, we investigated how an IBD-associated loss-of-function variant in the protein tyrosine phosphatase non-receptor type 2 (PTPN2) gene, or loss of PTPN2 expression affected the ability of macrophages to respond to invading bacteria.

Design

IBD patient-derived macrophages with wild-type (WT) PTPN2 or carrying the IBD-associated PTPN2 SNP, peritoneal macrophages from WT and constitutive PTPN2-knockout mice, as well as mice specifically lacking PTPN2 in macrophages were infected with non-invasive K12 Escherichia coli, the human adherent-invasive E. coli (AIEC) LF82, or a novel mouse AIEC (mAIEC) strain.

Results

Loss of PTPN2 severely compromises the ability of macrophages to clear invading bacteria. Specifically, loss of functional PTPN2 promoted pathobiont invasion/uptake into macrophages and intracellular survival/proliferation by three distinct mechanisms: Increased bacterial uptake was mediated by enhanced expression of carcinoembryonic antigen cellular adhesion molecule (CEACAM)1 and CEACAM6 in PTPN2-deficient cells, while reduced bacterial clearance resulted from defects in autophagy coupled with compromised lysosomal acidification. In vivo, mice lacking PTPN2 in macrophages were more susceptible to mAIEC infection and mAIEC-induced disease.

Conclusions

Our findings reveal a tripartite regulatory mechanism by which PTPN2 preserves macrophage antibacterial function, thus crucially contributing to host defence against invading bacteria.

Risks of post-colonoscopic polypectomy bleeding and thromboembolism with warfarin and direct oral anticoagulants: a population-based analysis

Wed, 08 Dec 2021 09:28:03 GMT

Background

There were limited data on the risk of post-polypectomy bleeding (PPB) in patients on direct oral anticoagulants (DOAC). We aimed to evaluate the PPB and thromboembolic risks among DOAC and warfarin users in a population-based cohort.

Methods

We performed a territory-wide retrospective cohort study involving patients in Hong Kong from 2012 to 2020. Patients who received an oral anticoagulant and had undergone colonoscopy with polypectomy were identified. Propensity-score models with inverse probability of treatment weighting were developed for the warfarin-DOAC and between-DOAC comparisons. The primary outcome was clinically significant delayed PPB, defined as repeat colonoscopy requiring haemostasis within 30 days. The secondary outcomes were 30-day blood transfusion requirement and new thromboembolic event.

Results

Apixaban was associated with lower PPB risk than warfarin (adjusted HR (aHR) 0.39, 95% CI 0.24 to 0.63, p<0.001). Dabigatran (aHR 2.23, 95% CI 1.04 to 4.77, adjusted p (ap)=0.035) and rivaroxaban (aHR 2.72, 95% CI 1.35 to 5.48, ap=0.002) were associated with higher PPB risk than apixaban. In subgroup analysis, apixaban was associated with lower PPB risk in patients aged ≥70 years and patients with right-sided colonic polyps.

For thromboembolic events, apixaban was associated with lower risk than warfarin (aHR 0.22, 95% CI 0.11 to 0.45, p<0.001). Dabigatran (aHR 2.60, 95% CI 1.06 to 6.41, ap=0.033) and rivaroxaban (aHR 2.96, 95% CI 1.19 to 7.37, ap =0.013) were associated with higher thromboembolic risk than apixaban.

Conclusions

Apixaban was associated with a significantly lower risk of PPB and thromboembolism than warfarin, dabigatran and rivaroxaban, particularly in older patients with right-sided polyps.

Proton pump inhibitors and risk of colorectal cancer

Wed, 08 Dec 2021 09:28:03 GMT

Objective

To determine whether proton pump inhibitors (PPIs) are associated with an increased risk of colorectal cancer, compared with histamine-2 receptor antagonists (H2RAs).

Design

The United Kingdom Clinical Practice Research Datalink was used to identify initiators of PPIs and H2RA from 1990 to 2018, with follow-up until 2019. Cox proportional hazards models were fit to estimate marginal HRs and 95% CIs of colorectal cancer. The models were weighted using standardised mortality ratio weights using calendar time-specific propensity scores. Prespecified secondary analyses assessed associations with cumulative duration, cumulative dose and time since treatment initiation. The number needed to harm was calculated at five and 10 years of follow-up.

Results

The cohort included 1 293 749 and 292 387 initiators of PPIs and H2RAs, respectively, followed for a median duration of 4.9 years. While the use of PPIs was not associated with an overall increased risk of colorectal cancer (HR: 1.02, 95% CI 0.92 to 1.14), HRs increased with cumulative duration of PPI use (<2 years, HR: 0.93, 95% CI 0.83 to 1.04; 2–4 years, HR: 1.45, 95% CI 1.28 to 1.60; ≥4 years, HR: 1.60, 95% CI 1.42 to 1.80). Similar patterns were observed with cumulative dose and time since treatment initiation. The number needed to harm was 5343 and 792 for five and 10 years of follow-up, respectively.

Conclusion

While any use of PPIs was not associated with an increased risk of colorectal cancer compared with H2RAs, prolonged use may be associated with a modest increased risk of this malignancy.

PI3K-driven HER2 expression is a potential therapeutic target in colorectal cancer stem cells

Wed, 08 Dec 2021 09:28:03 GMT

Objective

Cancer stem cells are responsible for tumour spreading and relapse. Human epidermal growth factor receptor 2 (HER2) expression is a negative prognostic factor in colorectal cancer (CRC) and a potential target in tumours carrying the gene amplification. Our aim was to define the expression of HER2 in colorectal cancer stem cells (CR-CSCs) and its possible role as therapeutic target in CRC resistant to anti- epidermal growth factor receptor (EGFR) therapy.

Design

A collection of primary sphere cell cultures obtained from 60 CRC specimens was used to generate CR-CSC mouse avatars to preclinically validate therapeutic options. We also made use of the ChIP-seq analysis for transcriptional evaluation of HER2 activation and global RNA-seq to identify the mechanisms underlying therapy resistance.

Results

Here we show that in CD44v6-positive CR-CSCs, high HER2 expression levels are associated with an activation of the phosphatidylinositol 3-kinase (PI3K)/AKT pathway, which promotes the acetylation at the regulatory elements of the Erbb2 gene. HER2 targeting in combination with phosphatidylinositol 3-kinase (PI3K) and mitogen-activated protein kinase kinase (MEK) inhibitors induces CR-CSC death and regression of tumour xenografts, including those carrying Kras and Pik3ca mutation. Requirement for the triple targeting is due to the presence of cancer-associated fibroblasts, which release cytokines able to confer CR-CSC resistance to PI3K/AKT inhibitors. In contrast, targeting of PI3K/AKT as monotherapy is sufficient to kill liver-disseminating CR-CSCs in a model of adjuvant therapy.

Conclusions

While PI3K targeting kills liver-colonising CR-CSCs, the concomitant inhibition of PI3K, HER2 and MEK is required to induce regression of tumours resistant to anti-EGFR therapies. These data may provide a rationale for designing clinical trials in the adjuvant and metastatic setting.

Inflammatory cell-derived CXCL3 promotes pancreatic cancer metastasis through a novel myofibroblast-hijacked cancer escape mechanism

Wed, 08 Dec 2021 09:28:03 GMT

Objective

Pancreatic ductal adenocarcinoma (PDAC) is the most lethal malignancy and lacks effective treatment. We aimed to understand molecular mechanisms of the intertwined interactions between tumour stromal components in metastasis and to provide a new paradigm for PDAC therapy.

Design

Two unselected cohorts of 154 and 20 patients with PDAC were subjected to correlation between interleukin (IL)-33 and CXCL3 levels and survivals. Unbiased expression profiling, and genetic and pharmacological gain-of-function and loss-of-function approaches were employed to identify molecular signalling in tumour-associated macrophages (TAMs) and myofibroblastic cancer-associated fibroblasts (myoCAFs). The role of the IL-33–ST2–CXCL3–CXCR2 axis in PDAC metastasis was evaluated in three clinically relevant mouse PDAC models.

Results

IL-33 was specifically elevated in human PDACs and positively correlated with tumour inflammation in human patients with PDAC. CXCL3 was highly upregulated in IL-33-stimulated macrophages that were the primary source of CXCL3. CXCL3 was correlated with poor survival in human patients with PDAC. Mechanistically, activation of the IL-33–ST2–MYC pathway attributed to high CXCL3 production. The highest level of CXCL3 was found in PDAC relative to other cancer types and its receptor CXCR2 was almost exclusively expressed in CAFs. Activation of CXCR2 by CXCL3 induced a CAF-to-myoCAF transition and α-smooth muscle actin (α-SMA) was uniquely upregulated by the CXCL3–CXCR2 signalling. Type III collagen was identified as the CXCL3–CXCR2-targeted adhesive molecule responsible for myoCAF-driven PDAC metastasis.

Conclusions

Our work provides novel mechanistic insights into understanding PDAC metastasis by the TAM-CAF interaction and targeting each of these signalling components would provide an attractive and new paradigm for treating pancreatic cancer.

Global burden of disease: acute-on-chronic liver failure, a systematic review and meta-analysis

Wed, 08 Dec 2021 09:28:03 GMT

Background and aims

Acute-on-chronic liver failure (ACLF) is characterised by acute decompensation of cirrhosis associated with organ failures. We systematically evaluated the geographical variations of ACLF across the world in terms of prevalence, mortality, aetiology of chronic liver disease (CLD), triggers and organ failures.

Methods

We searched EMBASE and PubMed from 3/1/2013 to 7/3/2020 using the ACLF-EASL-CLIF (European Association for the Study of the Liver-Chronic Liver Failure) criteria. Two investigators independently conducted the abstract selection/abstraction of the aetiology of CLD, triggers, organ failures and prevalence/mortality by presence/grade of ACLF. We grouped countries into Europe, East/South Asia and North/South America. We calculated the pooled proportions, evaluated the methodological quality using the Newcastle-Ottawa Scale and statistical heterogeneity, and performed sensitivity analyses.

Results

We identified 2369 studies; 30 cohort studies met our inclusion criteria (43 206 patients with ACLF and 140 835 without ACLF). The global prevalence of ACLF among patients admitted with decompensated cirrhosis was 35% (95% CI 33% to 38%), highest in South Asia at 65%. The global 90-day mortality was 58% (95% CI 51% to 64%), highest in South America at 73%. Alcohol was the most frequently reported aetiology of underlying CLD (45%, 95% CI 41 to 50). Infection was the most frequent trigger (35%) and kidney dysfunction the most common organ failure (49%). Sensitivity analyses showed regional estimates grossly unchanged for high-quality studies. Type of design, country health index, underlying CLD and triggers explained the variation in estimates.

Conclusions

The global prevalence and mortality of ACLF are high. Region-specific variations could be explained by the type of triggers/aetiology of CLD or grade. Health systems will need to tailor early recognition and treatment of ACLF based on region-specific data.

Non-alcoholic fatty liver disease and risk of incident chronic kidney disease: an updated meta-analysis

Wed, 08 Dec 2021 09:28:03 GMT

Objective

Studies reported a significant association between non-alcoholic fatty liver disease (NAFLD) and increased risk of chronic kidney disease (CKD). However, whether this risk changes with increasing severity of NAFLD remains uncertain. We performed a meta-analysis of observational studies to quantify the magnitude of the association between NAFLD and risk of incident CKD.

Design

We systematically searched PubMed, Web of Science and Scopus from January 2000 to August 2020 using predefined keywords to identify observational studies with a follow-up duration of ≥1 year, in which NAFLD was diagnosed by blood biomarkers/scores, International Classification of Diseases codes, imaging techniques or biopsy. Data from selected studies were extracted, and meta-analysis was performed using random-effects modelling.

Results

13 studies with 1 222 032 individuals (28.1% with NAFLD) and 33 840 cases of incident CKD stage ≥3 (defined as estimated glomerular filtration rate <60 mL/min/1.73 m², with or without accompanying overt proteinuria) over a median follow-up of 9.7 years were included. NAFLD was associated with a moderately increased risk of incident CKD (n=10 studies; random-effects HR 1.43, 95% CI 1.33 to 1.54; I ²=60.7%). All risks were independent of age, sex, obesity, hypertension, diabetes and other conventional CKD risk factors. Sensitivity analyses did not alter these findings. Funnel plot did not reveal any significant publication bias.

Conclusion

This large and updated meta-analysis indicates that NAFLD is significantly associated with a~1.45-fold increased long-term risk of incident CKD stage ≥3. Further studies are needed to examine the association between the severity of NAFLD and risk of incident CKD.

PBMC transcriptomics identifies immune-metabolism disorder during the development of HBV-ACLF

Wed, 08 Dec 2021 09:28:03 GMT

Objective

Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) pathophysiology remains unclear. This study aims to characterise the molecular basis of HBV-ACLF using transcriptomics.

Methods

Four hundred subjects with HBV-ACLF, acute-on-chronic hepatic dysfunction (ACHD), liver cirrhosis (LC) or chronic hepatitis B (CHB) and normal controls (NC) from a prospective multicentre cohort were studied, and 65 subjects (ACLF, 20; ACHD, 10; LC, 10; CHB, 10; NC, 15) among them underwent mRNA sequencing using peripheral blood mononuclear cells (PBMCs).

Results

The functional synergy analysis focusing on seven bioprocesses related to the PBMC response and the top 500 differentially expressed genes (DEGs) showed that viral processes were associated with all disease stages. Immune dysregulation, as the most prominent change and disorder triggered by HBV exacerbation, drove CHB or LC to ACHD and ACLF. Metabolic disruption was significant in ACHD and severe in ACLF. The analysis of 62 overlapping DEGs further linked the HBV-based immune-metabolism disorder to ACLF progression. The signatures of interferon-related, neutrophil-related and monocyte-related pathways related to the innate immune response were significantly upregulated. Signatures linked to the adaptive immune response were downregulated. Disruptions of lipid and fatty acid metabolism were observed during ACLF development. External validation of four DEGs underlying the aforementioned molecular mechanism in patients and experimental rats confirmed their specificity and potential as biomarkers for HBV-ACLF pathogenesis.

Conclusions

This study highlights immune-metabolism disorder triggered by HBV exacerbation as a potential mechanism of HBV-ACLF and may indicate a novel diagnostic and treatment target to reduce HBV-ACLF-related mortality.

Sofosbuvir/velpatasvir with or without low-dose ribavirin for patients with chronic hepatitis C virus infection and severe renal impairment

Wed, 08 Dec 2021 09:28:03 GMT

Objective

Data regarding the real-world effectiveness and safety of sofosbuvir/velpatasvir (SOF/VEL) with or without low-dose ribavirin (RBV) in patients with chronic hepatitis C virus (HCV) infection and severe renal impairment (RI) are limited. We evaluated the performance of SOF/VEL with or without low-dose RBV in HCV-infected patients with chronic kidney disease stage 4 or 5.

Design

191 patients with compensated (n=181) and decompensated (n=10) liver diseases receiving SOF/VEL (400/100 mg/day) alone and SOF/VEL with low-dose RBV (200 mg/day) for 12 weeks were retrospectively recruited at 15 academic centres in Taiwan. The effectiveness was determined by sustained virological response at off-treatment week 12 (SVR₁₂) in evaluable (EP) and per-protocol populations (PP). The safety profiles were assessed.

Results

The SVR₁₂ rates by EP and PP analyses were 94.8% (95% CI 90.6% to 97.1%) and 100% (95% CI 97.9% to 100%). In patients with compensated liver disease, the SVR₁₂ rates were 95.0% and 100% by EP and PP analyses. In patients with decompensated liver disease, the SVR₁₂ rates were 90.0% and 100% by EP and PP analyses. Ten patients who failed to achieve SVR₁₂ were attributed to non-virological failures. Among the 20 serious adverse events (AEs), none were judged related to SOF/VEL or RBV. The AEs occurring in ≥10% included fatigue (14.7%), headache (14.1%), nausea (12.6%), insomnia (12.0%) and pruritus (10.5%). None had ≥grade 3 total bilirubin or alanine aminotransferase elevations.

Conclusion

SOF/VEL with or without low-dose RBV is effective and well-tolerated in HCV-infected patients with severe RI.

Placental growth factor promotes tumour desmoplasia and treatment resistance in intrahepatic cholangiocarcinoma

Wed, 08 Dec 2021 09:28:03 GMT

Objective

Intrahepatic cholangiocarcinoma (ICC)—a rare liver malignancy with limited therapeutic options—is characterised by aggressive progression, desmoplasia and vascular abnormalities. The aim of this study was to determine the role of placental growth factor (PlGF) in ICC progression.

Design

We evaluated the expression of PlGF in specimens from ICC patients and assessed the therapeutic effect of genetic or pharmacologic inhibition of PlGF in orthotopically grafted ICC mouse models. We evaluated the impact of PlGF stimulation or blockade in ICC cells and cancer-associated fibroblasts (CAFs) using in vitro 3-D coculture systems.

Results

PlGF levels were elevated in human ICC stromal cells and circulating blood plasma and were associated with disease progression. Single-cell RNA sequencing showed that the major impact of PlGF blockade in mice was enrichment of quiescent CAFs, characterised by high gene transcription levels related to the Akt pathway, glycolysis and hypoxia signalling. PlGF blockade suppressed Akt phosphorylation and myofibroblast activation in ICC-derived CAFs. PlGF blockade also reduced desmoplasia and tissue stiffness, which resulted in reopening of collapsed tumour vessels and improved blood perfusion, while reducing ICC cell invasion. Moreover, PlGF blockade enhanced the efficacy of standard chemotherapy in mice-bearing ICC.

Conclusion

PlGF blockade leads to a reduction in intratumorous hypoxia and metastatic dissemination, enhanced chemotherapy sensitivity and increased survival in mice-bearing aggressive ICC.

Novel therapeutic targets for cholestatic and fatty liver disease

Trauner, M., Fuchs, C. D. — Wed, 08 Dec 2021 09:28:03 GMT

Cholestatic and non-alcoholic fatty liver disease (NAFLD) share several key pathophysiological mechanisms which can be targeted by novel therapeutic concepts that are currently developed for both areas. Nuclear receptors (NRs) are ligand-activated transcriptional regulators of key metabolic processes including hepatic lipid and glucose metabolism, energy expenditure and bile acid (BA) homoeostasis, as well as inflammation, fibrosis and cellular proliferation. Dysregulation of these processes contributes to the pathogenesis and progression of cholestatic as well as fatty liver disease, placing NRs at the forefront of novel therapeutic approaches. This includes BA and fatty acid activated NRs such as farnesoid-X receptor (FXR) and peroxisome proliferator-activated receptors, respectively, for which high affinity therapeutic ligands targeting specific or multiple isoforms have been developed. Moreover, novel liver-specific ligands for thyroid hormone receptor beta 1 complete the spectrum of currently available NR-targeted drugs. Apart from FXR ligands, BA signalling can be targeted by mimetics of FXR-activated fibroblast growth factor 19, modulation of their enterohepatic circulation through uptake inhibitors in hepatocytes and enterocytes, as well as novel BA derivatives undergoing cholehepatic shunting (instead of enterohepatic circulation). Other therapeutic approaches more directly target inflammation and/or fibrosis as critical events of disease progression. Combination strategies synergistically targeting metabolic disturbances, inflammation and fibrosis may be ultimately necessary for successful treatment of these complex and multifactorial disorders.

GI highlights from the literature

Smith, P. J. — Wed, 08 Dec 2021 09:28:03 GMT

Basic scienceDistinct pathways driving inflammatory bowel disease pathotypes with different response to therapy

Friedrich M, Pohin M, Jackson M et al. IL-1-driven stromal–neutrophil interactions define a subset of patients with inflammatory bowel disease that does not respond to therapies. Nat Med 2021; doi: 10.1038/s41591-021-01520-5

Despite progress in the development of novel therapeutics targeting intestinal inflammation in inflammatory bowel disease (IBD), it appears that a ceiling of treatment has been reached, with a large proportion of patients not achieving mucosal healing. In addition, there is an unmet need for precision medicine approaches such as not giving the right drug to the right person at the right time. Our current methods of phenotyping patients, based on clinical parameters and endoscopic or histological findings do not appear to be fit for this purpose.

Friedrich et al use bulk RNA sequencing (RNAseq) to quantify transcriptional changes in the inflamed mucosa of...

Surveillance failure in ultrasound for hepatocellular carcinoma: a systematic review and meta-analysis

Wed, 08 Dec 2021 09:28:03 GMT

Recently, various advances have been achieved in the diagnosis and treatment of hepatocellular carcinoma (HCC).1 We read with great interest the paper by De Toni et al2 demonstrating the importance of early diagnosis of HCC by surveillance with respect to survival benefits, and that by Zeng et al3 emphasising risk stratifications in HCC surveillance. As these papers suggest, effective surveillance to detect early stage HCC is crucial in the management of patients at-risk.

Although ultrasound (US) is recommended as a standard surveillance modality,4 5 the sensitivity of US for detecting early stage HCC is suboptimal, being only 47%.6 Updated guidelines suggest alternative surveillance tools including MRI in patients likely to have inadequate US examinations.4 5 Recently, MRI surveillance, including abbreviated MRI-protocols, has been drawing attention because of its high diagnostic performance compared with...

Letter to the editor regarding: Multicentre, prospective, randomised study comparing the diagnostic yield of colon capsule endoscopy versus CT colonography in a screening population (the TOPAZ study)

Ahmed, F., Brewington, C., Chang, K. J., Moreno, C. C., Gollub, M., Yee, J. — Wed, 08 Dec 2021 09:28:03 GMT

In a prospective, multicentre, randomised controlled trial in an average colon cancer risk population, the TOPAZ trial, Dr Cash and colleagues1 report that colon capsule endoscopy (CCE) revealed higher diagnostic yield (defined by finding a colonic polyp ≥6 mm that warrants an optical colonoscopy) and higher sensitivity compared with CT colonography (CTC). Based on these findings, Cash et al1 advocate the use of CCE as a more accurate/superior diagnostic test among patients who cannot/prefer not to undergo optical colonoscopy.

As abdominal radiologists experienced in CTC and as members of the American College of Radiology’s Colon Cancer Committee, we appreciate the effort by the authors in this clinical trial, but we have comments and concerns about the results, discussion and drawn conclusions:

The very low CTC sensitivities reported by Cash et al (26.8% for polyps ≥6 mm and 50% for polyps ≥10 mm) are significantly lower compared with...

Role of the gut microbiome in mediating lactose intolerance symptoms

Wed, 08 Dec 2021 09:28:03 GMT

Misselwitz et al recently reviewed the multifactorial aspects of lactose intolerance (LI).1 Their work highlights the known effects of genetic makeup and dietary patterns in the occurrence of gastrointestinal symptoms in LI individuals. The authors define LI as the occurrence of gastrointestinal complaints on lactose exposure and discuss the wide variety of symptoms among LI patients.1 Regarding lactose metabolism, Misselwitz et al mention the influence of the gut microbiome, in particular that Bifidobacterium or other lactose-fermenting bacteria are reported to affect the levels of lactose in the gut. However, the impact of the gut microbiome on the occurrence of gut-related LI symptoms remains unclear.

We previously observed that the Bifidobacterium abundance in the adult human gut depends on the interaction between LI genetic variants and dairy intake.2 This observation complements other findings indicating a mutual relationship between the gut microbiome and host lactose...

CT colonography remains an important test for colorectal cancer

Burr, N. E., Plumb, A., Sood, R., Rembacken, B., Tolan, D. J. M. — Wed, 08 Dec 2021 09:28:03 GMT

We read with interest the recent article by Cash et al comparing colon capsule (CCE) and CT colonography (CTC) with optical colonoscopy (OC) for detecting colonic polyps and colorectal cancer (CRC) in a screening population.1 The study reports low CTC detection rates for ≥6 mm and ≥10 mm polyps of only 8.6% and 6.3%, respectively. These were much lower than the detection rates seen for CCE and OC. These results contradict larger trials, where the performance of CTC and OC tests are similar. The Dutch COCOS randomised controlled trial (RCT) in a screening population ultimately reported identical advanced neoplasia detection rates for CTC and OC.2 3 The UK SIGGAR RCT reported identical detection rates of 11% for large polyps or CRC.4 Earlier studies from the USA also support the use of CTC.5 6 The 8.6% detection rate for ≥6 mm...

Chronic small intestinal dysmotility presenting as jejunal diverticulosis with refractory malabsorption: role for partial enterectomy?

Wed, 08 Dec 2021 09:28:03 GMT

We read with interest the guidelines on the management of adult patients with severe chronic small intestinal dysmotility by Nightingale et al.1 Enteric myopathies can indeed manifest as jejunal diverticulosis, either acquired or congenital.2 Besides asymptomatic or acute complicated cases, chronic malabsorption due to bacterial overgrowth is a possible presentation of jejunal diverticulosis.3 As stated in the guidelines, this mechanism may lead to malnutrition or even intestinal failure.1 Although surgical options (resection, bypass or stoma formation) were discussed for pseudo-obstruction, resection of diverticula is usually not considered, as surgical outcomes of treatment-refractory cases have been rarely reported.

We report here on our experience with a small series of patients with documented and refractory malabsorption due to small bowel diverticulosis who underwent partial enterectomy at the Leuven Intestinal Failure and Transplantation Centre (Leuven, Belgium) after consent. Bacterial overgrowth, steatorrhoea and medical treatment,...

Utility of mismatch repair protein expression screening via an endoscopic ultrasound assessment of treatment-naive pancreas ductal adenocarcinoma

Wed, 08 Dec 2021 09:28:03 GMT

We read with great interest the recent articles by Luchini et al1 2 and Grant et al3 highlighting the low prevalence (1%–2%) of mismatch repair deficient pancreatic ductal adenocarcinoma (dMMR PDAC) and offering further knowledge pertaining to the molecular spectrum of this disease subtype. A plea was raised to augment translational and clinical research efforts to improve our understanding of dMMR PDAC.

However, from a practical perspective, only 20% of patients with PDAC reach surgical oncologic resection.4 These resection specimens have served as the source of prior dMMR PDAC analysis. Following the United States Food and Drug Administration approval of pembrolizumab as the first cancer therapy targeting a specific molecular signature, we identified a dMMR prevalence of 3% in a small retrospective cohort of archived pancreas endoscopic ultrasound fine-needle biopsy (EUS FNB) specimens.5 We recently completed an 18-month prospective...

If pneumatic dilation is not enough efficient for post fundoplication dysphagia, is Per Oral Endoscopic Myotomy a good answer to manage it?

Debourdeau, A., Vitton, V., Barthet, M. A., Gonzalez, J.-M. — Wed, 08 Dec 2021 09:28:03 GMT

We read with interest the article by Schuitenmaker et al1 that evaluated oesophageal pneumatic dilation (PD) for persistent dysphagia after antireflux surgery (ARS).

The authors concluded that PD is not more effective than sham procedure in patients with persistent dysphagia after laparoscopic fundoplication.

The therapeutic target of PD is the esogastric junction (EGJ) and its effect is theoretically explained by mechanical forces applied on an EGJ obstacle, being either cardial muscular in achalasia or extrinsic valve after antireflux fundoplication. But most of the patients included in the study (76%) did not have an EGJ outflow obstruction (EGJOO).

The realisation of an antireflux valve can lead to the development of inefficient oesophageal motility in nearly 20% of cases2 and the study of Schuitenmake et al reinforces the idea that post-ARS dysphagia is not necessarily related to EGJ outflow obstruction (EGJOO), despite a seemingly logical anatomical explanation...

Six-month follow-up of gut microbiota richness in patients with COVID-19

Wed, 08 Dec 2021 09:28:03 GMT

We read with great interest the recent article published in Gut in which Yeoh et al demonstrated that gut microbiota composition of recovered patients with COVID-19 remained significantly distinct from uninfected controls.1 Persisting symptoms, also known as ‘long COVID-19’, have been reported in a significant proportion of patients following hospital discharge.2 3 Gut dysbiosis might link to long COVID-19 risks.1 Few studies have focused on the recovery process of gut microbiota following SARS-CoV-2 infection.

Here, we conducted a prospective study to longitudinally monitor alterations of gut microbiota in patients with COVID-19 using 16S rDNA sequencing (detailed methods in ). Faecal microbiota was monitored at three timepoints, acute phase (from illness onset to viral clearance), convalescence (from viral clearance to 2 weeks after hospital discharge), postconvalescence (6 months after hospital discharge).

The gut microbiota richness, measured by Chao 1 index, was obviously...

ROAD: A standardized method for endoscopic assessment of rectal tumours – A video vignette

Wed, 08 Dec 2021 09:13:28 GMT

Colorectal Disease, EarlyView.

Clinical and functional outcome of surgery for posttraumatic cloacal deformity

Wed, 08 Dec 2021 09:06:28 GMT

Abstract

Aim

Cloacal deformity is a disabling condition that severely affects a patient’s quality of life. Surgery to repair cloacal deformity remains the mainstay of treatment. The aim of this study is to assess the clinical and functional outcome of patients treated for traumatic cloacal deformity by three different techniques.

Method

A retrospective multicentre study was carried out using data from women operated on for cloacal deformity between 2015 and 2019. Demographic characteristics, the presence of urinary and/or faecal incontinence and manometric findings were collected. The main outcome measures were represented by St Mark’s and Rockwood faecal incontinence quality of life scores.

Results

Thirty eight women with a median age of 34 years [interquartile range (IQR) 31–39 years] were enrolled. Perineoplasty was performed in 23 patients by direct suture of the rectovaginal septum, in five using the X-flap and in 10 by the Singapore flap. Median resting and squeezing pressures increased significantly from 28.15 (IQR 23–32.7) cmH₂O to 45 (IQR 31–60.7) cmH₂O (p = 0.0001) and from 47 (IQR 41.2–54.7) cmH₂O to 97.2 (IQR 80–118) cmH₂O (p = 0.0001), respectively. Maximum tolerable volume improved from 120 (IQR 90–137.5) ml to 137.5 (IQR 120–150) ml (p = 0.002). The St Mark’s score decreased from 18 (IQR 14–20) to 4.5 (IQR 2–8) after 20 months (p = 0001). Sexual activity was confirmed by 16 patients preoperatively and by 27 postoperatively. A diverting stoma was performed in three patients after X-flap perineoplasty and in 14 treated by direct closure. No significant differences were found pre- and postoperatively between the three groups.

Conclusion

Regardless of the technique used, surgical repair significantly improves both clinical and functional outcomes irrespective of the presence of a covering stoma.

Pull‐through as an anastomotic salvage technique after taTME for low rectal cancer complicated by colon ischaemia – A video vignette

Tue, 07 Dec 2021 18:46:20 GMT

Colorectal Disease, EarlyView.

Evaluation of the implementation of the sigmoid take‐off landmark in the Netherlands

Tue, 07 Dec 2021 18:34:12 GMT

Abstract

Aim

The sigmoid take-off (STO), the point on imaging where the sigmoid sweeps ventral from the sacrum, was chosen as the definition of the rectum during an international Delphi consensus meeting and has been incorporated into the Dutch guidelines since October 2019. The aim of this study was to evaluate the implementation of this landmark 1 year after the guideline implementation and to perform a quality assessment of the STO training.

Method

Dutch radiologists, surgeons, surgical residents, interns, PhD students and physician assistants were asked to complete a survey and classify 20 tumours on MRI as ‘below’, ‘on’ or ‘above’ the STO. Outcomes were agreement with the expert reference, inter-rater variability and accuracy before and after the training.

Results

Eighty-six collaborators participated. Six radiologists (32%) and 11 surgeons (73%) used the STO as the standard landmark to distinguish between rectal and sigmoidal tumours during multidisciplinary meetings. Overall agreement with the expert reference improved from 53% to 70% (p < 0.001) after the training. The positive predictive value for diagnosing rectal tumours was high before and after the training (92% vs. 90%); the negative predictive value for diagnosing sigmoidal tumours improved from 39% to 63%.

Conclusion

Approximately half of the represented hospitals have implemented the new definition of rectal cancer 1 year after the implementation of the Dutch national guidelines. Overall baseline agreement with the expert reference and accuracy for the tumours around the STO was low, but improved significantly after training. These results highlight the added value of training in implementation of radiological landmarks to ensure unambiguous assessment.

Usefulness of the waist-to-height ratio for predicting cardiometabolic risk in children and its suggested boundary values

Tue, 07 Dec 2021 00:00:00 GMT

Only limited information is available on the usefulness of the waist-to-height ratio (WHtR) as an abdominal obesity marker in children. Our aim was to compare the ability of a WHtR >90th percentile, a WHtR ≥0.50, a WHtR ≥0.55 and a BMI z-score ≥2 SD to predict cardiometabolic risk in children followed-up at different ages.

Protein intake pattern in non-breastfed infants and toddlers: A survey in a nationally representative sample of French children

Jean-Pierre Chouraqui, Dominique Darmaun, Aurée Salmon-Legagneur, Raanan Shamir — Tue, 07 Dec 2021 00:00:00 GMT

Protein intake plays a key role in infants and children's growth, but high protein intake may have adverse long-term effects. Data on actual intakes in various populations are scarce.The aims of this study were (i) to assess daily protein intake (DPI) in non-breastfed infants and children aged 0.5–35 months in comparison with the population reference intake (PRI) set by the European Food Safety Authority, and to examine (ii) the various sources of this intake and their consumption patterns, and (iii) time-related changes in DPI over the last 4 decades.

Body composition assessment and sarcopenia in patients with biliary tract cancer: A systematic review and meta-analysis

Tue, 07 Dec 2021 00:00:00 GMT

Sarcopenia, as assessed by body composition, can affect morbidity and survival in several gastrointestinal cancer. However, the impact of sarcopenia, referring to both quantity and quality of skeletal muscle, in biliary tract cancer (BTC) is debatable. We aimed to investigate the impact of sarcopenia on morbidity and mortality in patients with BTC.

Step‐by‐step approach to laparoscopic D3 lymph node dissection while preserving the inferior mesenteric artery for advanced descending colon cancer – a video vignette

Mon, 06 Dec 2021 20:48:55 GMT

Colorectal Disease, EarlyView.

Risk factors for anastomotic leakage after anterior resection for rectal cancer (RALAR study): A nationwide retrospective study of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group

Mon, 06 Dec 2021 20:20:55 GMT

Abstract

Aim

Anastomotic leakage after restorative surgery for rectal cancer shows high morbidity and related mortality. Identification of risk factors could change operative planning, with indications for stoma construction. This retrospective multicentre study aims to assess the anastomotic leak rate, identify the independent risk factors and develop a clinical prediction model to calculate the probability of leakage.

Methods

The study used data from 24 Italian referral centres of the Colorectal Cancer Network of the Italian Society of Surgical Oncology. Patients were classified into two groups, AL (anastomotic leak) or NoAL (no anastomotic leak). The effect of patient-, disease-, treatment- and postoperative outcome-related factors on anastomotic leak after univariable and multivariable analysis was measured.

Results

A total of 5398 patients were included, 552 in group AL and 4846 in group NoAL. The overall incidence of leaks was 10.2%, with a mean time interval of 6.8 days. The 30-day leak-related mortality was 2.6%. Sex, body mass index, tumour location, type of approach, number of cartridges employed, weight loss, clinical T stage and combined multiorgan resection were identified as independent risk factors. The stoma did not reduce the leak rate but significantly decreased leak severity and reoperation rate. A nomogram with a risk score (RALAR score) was developed to predict anastomotic leak risk at the end of resection.

Gaetano Gallo, Mario Trompetto, Elia Diaco — Sun, 05 Dec 2021 19:49:23 GMT

Colorectal Disease, EarlyView.

Extraction of Migrated Colonic Stent

Pinak Dasgupta, Ajay Pai — Sun, 05 Dec 2021 11:34:47 GMT

Abstract

We present a case of a 70 year old male diagnosed with metastatic rectosigmoid colon cancer with bilobar liver metastases. He was stented for acute large bowel obstruction secondary to the colonic tumour.

After completion of three cycles of FOLFOX (5 Fluorouracil, Leucovorin, Oxaliplatin) plus Bevacizumab chemotherapy, he developed severe acute onset pain in the anal region with no other associated complaints. He consulted the primary physician and was advised a PET CT scan which showed a significant resolution of the primary obstructing tumour, as well as the liver metastases along with distal stent migration. He presented to us with severe and constant pain related to the migrated stent.

Methodological issues on açaí (Euterpe oleracea Mart.) and juçara (Euterpe edulis Mart.) juices improved HDL-c levels and antioxidant defense of healthy adults in a 4-week randomized cross-over study

Mojtaba Soltani-Kermanshahi — Sat, 04 Dec 2021 00:00:00 GMT

I was interested to read the paper authored by de Liz et al. [1] which is published in the Journal of Clinical Nutrition in Dec 2020. The authors aimed that the a positive impact of regular consumption of açaí and juçara juices on the HDL-c levels, as well as on the antioxidant enzyme activities, which may contribute to cardiovascular health with a cross-over study. Although the results of the study are very interesting, however, it seems that several statistical and methodological issues should be considered when interpreting the results.

The outcome of patients with inflammatory bowel disease–associated colorectal cancer is not worse than that of patients with sporadic colorectal cancer–a matched-pair analysis of survival

Sat, 04 Dec 2021 00:00:00 GMT

Abstract

Purpose

Patients with inflammatory bowel disease (IBD) have an increased risk for colorectal cancer (CRC). In IBD patients, cancer is often diagnosed in advanced stages and conflicting data on survival compared to sporadic CRC have been reported. The aim of this study was to directly compare clinical characteristics and prognosis of patients with IBD-CRC and sporadic CRC.

Methods

The clinical and pathological data of 63 patients with IBD-CRC and 3710 patients with sporadic CRC treated at the University Hospital of Erlangen between 1995 and 2015 were compared. Forty-seven M0 patients with IBD were matched with sporadic CRC patients after curative resection (R0) according to tumor localization, stage, sex, and year of treatment. Overall and disease-free survival were compared.

Results

Sixty-three patients presented IBD-CRC. Fifty were affected with ulcerative colitis (UC) and 13 with Crohn’s disease (CD). CRC was diagnosed within 1.45 years since last endoscopic surveillance. Twelve patients (19%) had a diagnosis of primary sclerosing cholangitis. In matched analysis, IBD patients were diagnosed with CRC at younger age compared to sporadic CRC and were more likely to have right-sided CRC (40% versus 23.3%) and rare histological subtypes (19% versus 9.2%). No differences in 5-year overall (78.7 versus 80.9 months) and 5-year disease-free survival (74.5 versus 70.2 months) were noted.

Conclusion

IBD-CRC patients were younger and more frequently had right-sided carcinomas compared to sporadic CRC. CRC in IBD patients did not show survival difference compared to matched-pair sporadic CRC patients without distant metastases after curative resection. Surveillance might be important for early detection of CRC in IBD patients.

Are colorectal surgery patients willing to accept an increased risk of surgical site infection to avoid mechanical bowel preparation? Implications for future trial design

Steven Gu, Mantaj Brar, Selina Schmocker, Erin Kennedy — Fri, 03 Dec 2021 09:37:05 GMT

Abstract

Aim

Recent evidence has shown no difference in the risk of surgical site infection (SSI) with oral antibiotics alone (OA) and oral antibiotics in combination with mechanical bowel preparation (OA + MBP), suggesting that the use of MBP may be safely avoided. The aim of this work was to determine the absolute risk of SSI that patients would accept with OA relative to OA + MBP.

Method

Standardized, in-person interviews were conducted using the threshold task with patients attending colorectal surgery clinics who had previously had MBP. Participants were asked which option they preferred when the absolute risk of SSI was 7% for both options. Next, their switch point was determined by increasing the risk of SSI with OA by 1% intervals until their preference changed from OA to OA + MBP. Median switch point scores were reported and represented the absolute increased risk of SSI that patients would accept with OA relative to OA + MBP.

Results

Fifty patients completed the interview. All participants chose OA over OA + MBP when the risk of SSI was 7% for both options. Switch points ranged from 8% to 25%, with a median of 10%, indicating that participants were willing to accept up to a 3% increase in absolute risk of developing a SSI with OA to avoid MBP.

Conclusions

The results showed that patients are willing to accept an increased risk of up to 3% for SSI with OA relative to OA + MBP. Incorporating patient preferences into the planning of future trials has the potential to improve the uptake of trial results into clinical practice.

TAMIS management of large peritoneal entry for recurrent rectal polyp – A video vignette

Fri, 03 Dec 2021 09:37:02 GMT

Colorectal Disease, EarlyView.

Prevalence of pouchitis in both ulcerative colitis and familial adenomatous polyposis: A systematic review and meta‐analysis

Fri, 03 Dec 2021 09:32:49 GMT

Abstract

Aim

Pouchitis is a clinically significant complication of ileal pouch–anal anastomosis with its prevalence varying in the literature. Pouchitis is thought to occur more commonly in patients with ulcerative colitis (UC) than in patients with familial adenomatous polyposis (FAP). We conducted a systematic review with meta-analysis of all published literature to report the prevalence of pouchitis in all pouch patients as well as specifically in UC and FAP. We also investigated the prevalence of acute and chronic pouchitis in UC and FAP.

Methods

A meta-analysis was conducted by searching the Embase, Embase Classic and PubMed databases between 1978 and 2021 exploring the prevalence of pouchitis in UC and FAP. We then performed a random effects model in order to find the pooled prevalence of pouchitis and used odds ratios to report differences in the prevalence of pouchitis in UC and FAP.

Results

Fifty-nine full papers and conference abstracts were included in the meta-analysis comprising 18 117 patients with UC and 860 with FAP. The prevalence of pouchitis in UC was 0.32 (95% CI 0.27–0.37) and in FAP was found to be 0.06 (95% CI 0.03–0.15). The odds ratio of pouchitis in UC patients compared with FAP patients was 4.95 (95% CI 3.17–7.72, P < 0.0001).

Conclusions

Our findings support the consensus that the prevalence of pouchitis is higher in UC than in FAP. More significantly our findings suggest that the true prevalence of pouchitis is higher than commonly reported in the literature. This literature may help counsel patients prior to undergoing restorative proctocolectomy.

Robotic extra‐sphincteric pelvic floor excision: A Video Vignette

Michelle Smigielski, Kheng‐Seong Ng, Peter Lee — Fri, 03 Dec 2021 09:29:26 GMT

Colorectal Disease, EarlyView.

Effectiveness of carbohydrate counting and Dietary Approach to Stop Hypertension dietary intervention on managing Gestational Diabetes Mellitus among pregnant women who used metformin: A randomized controlled clinical trial

Fri, 03 Dec 2021 00:00:00 GMT

Gestational diabetes mellitus (GDM) is one of the most common complication of pregnancy that has significant impacts on both mother and her offspring health. The present study aimed to examine the effect of carbohydrate counting, carbohydrate counting combined with DASH, and control dietary interventions on glycemic control, and maternal and neonatal outcomes.

Reply - Letter to the editor: Methodological issues on açaí (Euterpe oleracea Mart.) and juçara (Euterpe edulis Mart.) juices improved HDL-c levels and antioxidant defense of healthy adults in a 4-week randomized cross-over study

Fri, 03 Dec 2021 00:00:00 GMT

Thank you for forwarding the letter by Soltani-Kermanshahi [1]. We would also like to thank Soltani-Kermanshahi for his interest in reading our work and for pointing out that “Although the results of the study are very interesting, it seems that several statistical and methodological issues should be considered when interpreting the results”, such as washout period (definition of four weeks) and statistical analysis (normality test and test of equality for carryover effects) in our published original article [2].

The use of ileal pouch–anal anastomosis in patients with ulcerative colitis from 2009 to 2018

Thu, 02 Dec 2021 19:09:12 GMT

Abstract

Aim

The existing literature was updated, assessing the use of surgery in patients with ulcerative colitis in more recent years.

Methods

This was a retrospective observational study identifying all patients with ulcerative colitis within the National Inpatient Sample, years 2009–2018. All patients with International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification diagnostic codes for ulcerative colitis were included. The primary outcome was the trend in total number of total abdominal colectomy, proctocolectomy and simultaneous versus delayed pouch construction.

Results

A total of 1 184 711 ulcerative-colitis-related admissions were identified. An increase of 18.6% in the number of patients was observed, while the number of surgeries decreased. A total of 40 499 patients underwent total colectomy, annually decreasing from 5241 to 3185. The number of proctocolectomies without pouch decreased from 1191 to 530, while the number of patients undergoing pouch construction decreased from 2225 to 1284. The proportion of patients undergoing initial pouch at time of proctocolectomy decreased from 995 (45%) to 265 (21%), while the proportion of patients undergoing delayed pouch construction in 2018 was 79% (n = 1120).

Conclusion

Surgery use in ulcerative colitis has decreased in the last decade despite increasing numbers of hospital admissions in patients with this condition. While the overall proportion of patients undergoing pouch construction remained stable, the majority of patients were initially treated with total colectomy and their ileal pouches werre constructed in a delayed fashion.

Redo colorectal anastomosis for rectovaginal fistula following posterior pelvic exenteration – A video vignette

Thu, 02 Dec 2021 18:30:18 GMT

Colorectal Disease, EarlyView.

Oncologic colorectal surgical site infection: oral or not oral antibiotic preparation, that is the question

Thu, 02 Dec 2021 00:00:00 GMT

Abstract

Purpose

Surgical wound infection is the most frequent postoperative complication in abdominal surgery, especially at the colorectal level. The aim of this study is analysing the results of mechanical colon preparation combined with oral antibiotic versus mechanical colon preparation without antibiotic therapy in patients with colorectal cancer undergoing elective surgery.

Methods

This retrospective cohort study had been developed from November 2017 to February 2020. We have included a total of 281 consecutive patients undergoing elective colon and rectal oncological surgeries by the same surgical group using laparoscopic and open approaches. Transanal minimally invasive surgery (TAMIS) and transanal total mesorectal excision (TaTME) approaches were excluded. Exposed patients undergoing colon and rectal cancer surgery received mechanical bowel preparation and oral antibiotics with three doses of neomycin 1 g and erythromycin 500 mg the day before surgery.

Results

The primary outcome was reduction in surgical wound infection rates before and after starting the oral antibiotic therapy from 17 to 6% (p < 0.05). As a secondary analysis, we evaluated the anastomotic dehiscence rate, corresponding with a decrease from 12 to 3% (p < 0.05).

Conclusion

Mechanical bowel preparation combined with oral antibiotic therapy is still not unanimously carried out in all the medical hospitals. In this report, we show that mechanical bowel preparation in combination with oral antibiotic reduces the risk of surgical wound infection and anastomotic leakage in patients undergoing colon and rectal cancer surgery.

Pregnancy after bariatric surgery: Effects of personalized nutrition counseling on pregnancy outcomes

Shir Araki, Carmi Shani Levi, Shani Abutbul Vered, Ido Solt, Geila S. Rozen — Wed, 01 Dec 2021 00:00:00 GMT

Nutritional challenges following bariatric surgery can be intensified during pregnancy and may have crucial effects on the fetus, including lower birth weight. To the best of our knowledge, the effect of nutritional counseling during post-bariatric pregnancy to improve maternal diet quality and eating habits on neonatal outcome has not been evaluated. The aim of this research was to examine the effects of personal nutritional counseling during post-bariatric pregnancy on nutritional intake and neonatal outcomes.

Serum lysophospholipidome of dietary origin as a suitable susceptibility/risk biomarker of human hypercholesterolemia: A cross-sectional study

Wed, 01 Dec 2021 00:00:00 GMT

Whether bioactive lysophospholipids (lyso-PLs) and trimethylamine-N-oxide (TMAO) serve as non-invasive biomarkers in early human hypercholesterolemia (HC) is unknown. The present work aimed at assessing whether serum lyso-PLs and plasma TMAO may be suitable susceptibility/risk biomarkers of HC in humans. Secondarily, we aimed to evaluate the relationships between targeted metabolites with diet composition and circulating liver transaminases, and verified the results in hamsters.

Announcement

Wed, 01 Dec 2021 00:00:00 GMT

The Editorial Office, staff, fellow Associate Editors and ESPEN Committees would like to take this opportunity to extend our gratitude to Dr Claude Pichard. Dr Pichard has been a large part of the continued growth of these journals, Clinical Nutrition and Clinical Nutrition ESPEN. He has devoted many years and numerous hours to the improvement and quality and impact factors of these journals. His background in Critical Care, Cancer and many other spectrums has been of great value to Clinical Nutrition.

Editorial board

Wed, 01 Dec 2021 00:00:00 GMT

Letter to Editor Regarding the Article Entitled “Treatment Effects for Dysphagia in Adults with Multiple Sclerosis: A Systematic Review”

Wed, 01 Dec 2021 00:00:00 GMT

Abstract

This letter is written to inform an important error in the methodology section of a systematic review article entitled “Treatment Effects for Dysphagia in Adults with Multiple Sclerosis: A Systematic Review” by Dalal Alali et al., which consequently resulted in a precise paradox probably and inadvertently affecting the search strategy, results, discussion, and/or conclusion of this systematic review.

Correction to: Annular Flow in the Upper Esophageal Sphincter Demonstrated with Dynamic 320-row Area Detector Computed Tomography

Ultrasonographic Measurement of Masseter Muscle Thickness Associates with Oral Phase Dysphagia in Institutionalized Elderly Individuals

Wed, 01 Dec 2021 00:00:00 GMT

Prophylactic oral CAM together with relatively simple skin care was found to be effective in suppressing the development of grade ≥ 2 skin toxicities induced by panitumumab.

Clinical trial registration

UMIN000011485

Date of registration

Sep 1st, 2013

Can MRI pelvimetry predict the technical difficulty of laparoscopic rectal cancer surgery?

Wed, 01 Dec 2021 00:00:00 GMT

Abstract

Purpose

Selection of an open or minimally invasive approach to total mesorectal excision (TME) is generally based on surgeon preference and an intuitive assessment of patient characteristics but there consensus on criteria to predict surgical difficulty. Pelvimetry has been used to predict the difficult surgical pelvis, typically using only bony landmarks. This study aimed to assess the relationship between pelvic soft tissue measurements on preoperative MRI and surgical difficulty.

Methods

Preoperative MRIs for patients undergoing laparoscopic rectal resection in the Australasian Laparoscopic Cancer of the Rectum Trial (ALaCaRT) were retrospectively reviewed by two blinded surgeons and pelvimetric variables measured. Pelvimetric variables were analyzed for predictors of successful resection of the rectal cancer, defined by clear circumferential and distal resection margins and completeness of TME.

Results

There was no association between successful surgery and any measurement of distance, area, or ratio. However, the was a strong association between the primary outcome and the estimated total pelvic volume on adjusted logistic regression analysis (OR = 0.99, P = 0.01). For each cubic centimeter increase in the pelvic volume, there was a 1% decrease in the odds of successful laparoscopic rectal cancer surgery. Intuitive prediction of unsuccessful surgery was correct in 43% of cases, and correlation between surgeons was poor (ICC = 0.18).

Conclusions

A surgeon’s intuitive assessment of the difficult pelvis, based on visible MRI assessment, is not a reliable predictor of successful laparoscopic surgery. Further assessment of pelvic volume may provide an objective method of defining the difficult surgical pelvis.

Multicenter phase II clinical study of the efficiency and safety of capecitabine plus intermittent oxaliplatin with bevacizumab as first-line therapy in patients with metastatic colorectal cancer (VOICE trial)

Wed, 01 Dec 2021 00:00:00 GMT

Abstract

Purpose

Abstract

Background and purpose

In female colorectal cancer patients, a mean proportion of synchronous and/or metachronous ovarian metastases of 3.4% was described. Previous literature showed that young or premenopausal women (≤ 55 years of age) may be more frequently affected. Once ovarian metastases are diagnosed, the prognosis of the patient is generally dismal, with 5-year survival varying from 12 to 27%.

The present study is aimed at determining the proportion of young or premenopausal women diagnosed with colorectal cancer who presented with or developed ovarian metastases by reviewing the current literature on this topic.

Methods

This review was performed by querying MEDLINE and EMBASE databases using a combination of terms: “colorectal neoplasms, colorectal cancer, ovarian neoplasms, Krukenberg tumor, young adult, young age, premenopause.” Studies that indicated ovarian metastases, either synchronous or metachronous (or a combination of the two), in young women were retrieved and analyzed.

Results

The review identified 14 studies encompassing 3379 young or premenopausal female colorectal cancer patients. In this selected group of patients, a mean proportion of ovarian metastases of 4.6% [95% CI: 4.0;5.4] was found.

Conclusions

This review showed that approximately one in twenty young female colorectal cancer patients will present with or develop ovarian metastases. Since outcome of this specific oncological pathology is often dismal, this finding is clinically relevant. It demonstrates the need to develop strategies to lower the incidence of ovarian metastases with adequate treatment and counseling of these patients.

Type of recurrence is associated with disease-free survival after salvage surgery for locally recurrent rectal cancer

Wed, 01 Dec 2021 00:00:00 GMT

Abstract

Purpose

To compare the characteristics and outcomes of rectal cancer patients with local recurrence at a perianastomotic site (PA), a surgical field (SF) site, or in lateral lymph nodes (LLN).

Methods

A total of 114 consecutive patients who underwent surgery for recurrent, non-metastatic rectal cancer at a single comprehensive cancer center between 1997 and 2012 were grouped on the basis of radiographic assessment of type of recurrence: PA, 76 (67%) patients; SF, 25 (22%) patients; LLN, 13 (11%) patients. Demographic, clinical, and pathological features were compared between the three groups, as were disease-free survival (DFS) and overall survival (OS).

Results

Recurrence type was associated with positive circumferential margin in the primary resection (PA, 4 [6%]; SF, 4 [19%]; LLN, 3 [25%]; P = 0.027), prior neoadjuvant therapy for the primary tumor (PA, 57 [75%]; SF, 18 [72%]; LLN, 4 [31%]; P = 0.007), and location of the primary tumor in the upper rectum (PA, 33 [45%]; SF, 5 [23%]; LLN, 1 [8%]; P < 0.001). Patients with PA had longer median DFS (PA, 5.1 years; SF, 1.5 years; LLN, 1.2 years; P = 0.036). There was a non-significant trend toward longer OS and higher rates of R0 resection for PA.

Conclusion

Type of recurrence after salvage surgery for locally recurrent rectal cancer is associated with longer DFS in patients with PA recurrence.

Low anterior resection syndrome: can it be prevented?

Wed, 01 Dec 2021 00:00:00 GMT

Abstract

Surgery remains the cardinal treatment in colorectal cancers but changes in bowel habits after rectal cancer surgery are common and disabling conditions that affect patients’ quality of life. Low anterior resection syndrome is a disorder of bowel function after rectal resection resulting in a lowering of the QoL and recently has been defined by an international working group not only by specified symptoms but also by their consequences. This review aims to explore an extensive bibliographic research on preventive strategies for LARS. All “modifiable variables,” quantified by the LARS Score, such as type of anastomosis, neoadjuvant therapy, surgical strategy, and diverting stoma, were evaluated, while “non-modifiable variables” such as age, sex, BMI, ASA, preoperative TMN, tumor height, and type of mesorectal excision were excluded from the comparative analysis. The role of defunctioning stoma, local excision, neoadjuvant radiotherapy, and non operative management seems to significantly affect risk of LARS, while type of anastomosis and surgical TME approach do not impact on LARS incidence or gravity in the long term period. Although it is established that some variables are associated with a greater onset of LARS, in clinical practice, technical difficulties and oncological limits often make difficult the application of some prevention plans. Transtomal irrigations, intraoperative neuromonitoring, pelvic floor rehabilitation before stoma closure, and early transanal irrigation represent new arguments of study in preventive strategies which could, if not eliminate the symptoms, at least mitigate them.

Laparoscopic management of small bowel obstruction after abdominoperineal resection and a unique method to prevent it—A Video Vignette

Tue, 30 Nov 2021 20:44:15 GMT

Colorectal Disease, EarlyView.

The diagnostic accuracy of the faecal immunohistochemical test in identifying significant bowel disease in a symptomatic population

Tue, 30 Nov 2021 20:21:07 GMT

Abstract

Aim

Provisional research on the faecal immunohistochemical test (FIT) for symptomatic colorectal patients has shown a high negative predictive value but has lacked long-term patient follow-up, raising the possibility of missed diagnoses of colorectal cancer (CRC). The aim of this work is to describe the long-term diagnostic accuracy of the FIT for CRC and significant bowel disease (SBD) in a symptomatic population in NHS Lanarkshire.

Method

From October 2016 to February 2019, all primary care referrals of symptomatic colorectal patients in NHS Lanarkshire were asked to provide a FIT. The baseline demographics, investigations and diagnoses for each patient were prospectively completed until February 2021. A FIT result of ≥10 μg haemoglobin (Hb)/g faeces was considered to be positive.

Results

A total of 5250 patients were identified (median age 62 years; 46% male; median follow-up 31 months) with 65.1% (3418) being FIT negative. The SBD rate was 6.2% and the CRC rate was 2.9% (151). The SBD rate was significantly higher in the FIT-positive group (13.8% vs. 2.2%; p < 0.001) and 32.9% of patients with FIT ≥ 400 μg Hb/g had SBD. The sensitivity of FIT ≥ 10 μg Hb/g for CRC was 87.4% and for SBD it was 76.9%. Specificity was 66.6% and 66.7%, and the negative-predictive value was 99.4% and 97.7%, respectively. Sensitivity for CRC could theoretically be increased to 94.8% if FIT-negative patients were to undergo flexible sigmoidoscopy.

Conclusion

A FIT-only referral pathway for symptomatic colorectal patients will miss over 12% of cancers and over 23% of SBD. Theoretically, combining FIT-negative patients with flexible sigmoidoscopy increases the sensitivity for CRC. The FIT offers a mechanism for prioritizing patient access to investigations, particularly in resource-limited areas; however, further work to identify FIT-negative patients diagnosed with CRC is required.

Comment on "Association between dietary fat intake and mortality from all-causes, cardiovascular disease, and cancer: A systematic review and meta-analysis of prospective cohort studies"

Liuliu Feng, Yanyan Bai, Yu Wang — Tue, 30 Nov 2021 00:00:00 GMT

In a recent issue of the journal, Kim et al. described the results of an interesting systematic review and meta-analysis on the association between dietary fat and mortality. They concluded that saturated fat and trans-fat were associated with higher mortality, whereas polyunsaturated fat and monounsaturated fat were associated with lower mortality [1]. The authors should be congratulated for performing a well-designed study. Nevertheless, we would like to underline some issues when interpreting these findings.

Transanal total mesorectal excision with two stage Turnbull–Cutait pull‐through for delayed low anastomotic leakage – A video vignette

Isaac Seow‐En, Aik Yong Chok, Emile Kwong‐Wei Tan — Mon, 29 Nov 2021 11:24:51 GMT

Colorectal Disease, EarlyView.

Prevalence and determinants of depression up to 5 years after colorectal cancer surgery: results from the ColoREctal Wellbeing (CREW) study

Thu, 25 Nov 2021 19:19:27 GMT

Abstract

Aim

Depression experienced by people with colorectal cancer (CRC) is an important clinical problem affecting quality of life. Recognition of depression at key points in the pathway enables timely referral to support. This study aimed to examine depression before and 5 years after surgery to examine its prevalence and identify determinants.

Method

The ColoREctal Wellbeing (CREW) study is a prospective UK cohort study involving 872 adults with nonmetastatic CRC recruited before surgery with curative intent. Questionnaires completed before surgery and 3, 9, 15, 24, 36, 48 and 60 months after surgery captured socio-demographics and assessed depression (Centre for Epidemiologic Studies Depression Scale, CES-D) and other psychosocial factors. Clinical details were also gathered. We present the prevalence of clinically significant depression (CES-D ≥ 20) over time and its predictors assessed before and 2 years after surgery.

Results

Before surgery, 21.0% of the cohort reported CES-D ≥ 20 reducing to 14.7% 5 years after surgery. Presurgery risk factors predicting subsequent depression were clinically significant depression and anxiety, previous mental health service use, low self-efficacy, poor health, having neoadjuvant treatment and low social support. Postsurgery risk factors at 2 years predicting subsequent depression were clinically significant depression, negative affect, cognitive dysfunction, accommodation type and poor health.

Conclusion

Depression is highly pervasive in people with CRC, exceeding prevalence in the general population across follow-up. Our findings emphasize the need to screen and treat depression across the pathway. Our novel data highlight key risk factors of later depression at important and opportune time points: before surgery and at the end of routine surveillance. Early recognition and timely referral to appropriate support is vital to improve long-term psychological outcomes.

Regular endoscopic surveillance and polypectomy is effective in managing rectal adenoma progression following colectomy and ileorectal anastomosis in patients with familial adenomatous polyposis

Thu, 25 Nov 2021 19:19:11 GMT

Abstract

Aim

Total colectomy with ileorectal anastomosis (TC-IRA) is a surgical option for patients with familial adenomatous polyposis (FAP). Regular endoscopic surveillance of the rectum is recommended to prevent rectal cancer. We aimed to document polyp progression in the rectum following TC-IRA and evaluate the role of polypectomy during surveillance.

Method

Patients with FAP who underwent TC-IRA between 1990 and 2017 were identified. Demographic, endoscopic and genetic data were retrieved. Cumulative rectal adenoma (polyp) counts were obtained, whilst accounting for any polypectomies during the study period. The rate of polyp progression and factors influencing secondary proctectomy were evaluated.

Results

One hundred and ninety-nine patients fulfilled our inclusion criteria, of which 44% were male. The median age at colectomy was 19 (range 11–70) years and median preoperative rectal polyp count was 7 (range 0–50). All patients had an APC pathogenic variant, of which 151 (79%) were 5' of the mutation cluster region (MCR), 19 (10%) in the MCR, six (3%) were 3' of the MCR and 15 (8%) had a gross deletion. After a median follow-up of 8.6 (range1–27) years and a median of 11 (range 2–37) flexible sigmoidoscopies per patient, the median rate of polyp progression was 5.5 polyps/year (range 0–70.2). There was no evidence of polyp regression. Eight (4%) patients underwent secondary proctectomy for neoplasia, of which one (0.5%) had rectal adenocarcinoma. A total of 13,527 polyps were removed, a median of 35 polyps/patient (range 0–829). The rate of polyp progression was not significantly associated with genotypic or phenotypic factors.

Conclusion

Progression of rectal adenoma burden following TC-IRA appears to be slow and dependent on the length of follow-up. In the modern era of stringent endoscopic surveillance and therapeutic procedures such as cold snare polypectomy, the rate of secondary proctectomy and the risk of rectal cancer after TC-IRA are very low. These findings are important when counselling patients with regard to the choice of surgery for FAP and implementing endoscopic surveillance.

Response to Igor Eckert: Sometimes, the absence of evidence is evidence of its absence

Alfred Adiamah, Simon P. Allison, Dileep N. Lobo — Thu, 25 Nov 2021 00:00:00 GMT

“The absence of evidence is not evidence of absence”, is an aphorism attributed to Carl Sagan [1], which is invoked when claims of the existence of God are encountered. Nonetheless, it is a succinct and elegant statement, which in this instance is simultaneously beautiful and wrong. At first glance, the lack of evidence is not evidence of absence, would suggest that for every treatment: medical, nutritional, or alternative therapy unless science has exhausted every mechanistic process available we cannot state it does not work even after randomised, double-blind studies, or as is the case here, multiple systematic reviews, none of which have found survival benefit.

Inaccurate conclusions due to absence of evidence fallacy on Adiamah et al

Igor Eckert — Thu, 25 Nov 2021 00:00:00 GMT

In a long-term survival analysis [1], Adiamah and colleagues conclude that early postoperative enteral feeding with arginine-enriched immunomodulating nutrition (IMN) confers no additional benefit compared with a control formula. This conclusion of absence of effect assumes the study provides evidence that the treatment confers no benefit. In this letter, I argue that the correct interpretation of these results would lead to different conclusions and potential real-life implications.

Letter to the Editor: A comment to “Is sarcopenia a predictor of prognosis for patients undergoing radiotherapy for head and neck cancer? A meta-analysis”

Xin Jin, Xin-Tian Xu, Meng-Xing Tian — Thu, 25 Nov 2021 00:00:00 GMT

With great interest, we read the article by Merran Findlay et al., in which they investigated the prognostic value of sarcopenia in patients with head and neck cancer undergoing radiotherapy [1]. The results are consistent with the previous meta-analysis on the prognostic role of sarcopenia in patients with head and neck under multiple treatments [2]. The paper was excellent. However, the method used in this meta-analysis was not rigorous.

The end of the era of routine diversion after rectal cancer resection?

Conclusions

Method

A single-centre, triple-blind, feasibility, randomized controlled trial (RCT) of adults scheduled for planned laparoscopic colorectal surgery. The primary outcome was recruitment. Secondary outcomes included feasibility of blinding, acceptability to patients and suitability of objective measures: patient-reported quality of recovery using a validated questionnaire (QoR-40), patient pain scores and semi-continuous core temperature measurements.

Results

Thirty-nine participants were randomized to either the WHCO2 group (n = 19) or standard care alone (n = 20). Recruitment to the study was successful and acceptable to patients. Blinding of the surgeons, patients and assessors was effective. Response rates to QoR-40 were high but ceiling effects were observed, indicating that the tool was unsuitable in this population. Fewer patients in the WHCO2 group reported postoperative nausea and vomiting (PONV) at days 1 (53% vs. 65%) and 3 (37% vs. 60%). The median hospital length of stay was 5.5 days in the standard care group and 4 days in the WHCO2 group.

Conclusion

A study of WHCO2 for insufflation in laparoscopic colorectal surgery would be highly acceptable to both patients and researchers. Potential reductions in PONV and hospital length of stay in patients treated with WHCO2 merit further investigation. The design of the full-scale RCT will benefit from this feasibility study.

Nodal metastases in small rectal neuroendocrine tumours

Tue, 23 Nov 2021 14:17:21 GMT

Abstract

Aim

Rectal neuroendocrine tumours (NETs) are the most common type of gastrointestinal NET. European Neuroendocrine Tumour Society guidelines suggest that rectal NETs measuring ≤10 mm are indolent with low risk of spread. In practice, many patients with lesions ≤1 cm do not undergo complete tumour staging. However, the size of the lesion may not be the only risk factor for nodal involvement/metastases. The aim of this study was to determine if MRI ± nuclear medicine imaging alters tumour stage in patients with rectal NETs ≤10 mm.

Methods

Patients referred to a tertiary NET centre between 2005 and 2020 who met the inclusion criteria of a rectal NET ≤10 mm, full cross-sectional imaging, primarily an MRI scan and, if abnormal findings were identified, a subsequent ⁶⁸Ga-DOTATATE positron emission tomography scan were included. All patients were followed up at our institution.

Results

In all, 32 patients with rectal NETs 10 mm or less were included in the study: 16 women; median age 58 years (range 33–71); 47% (n = 15) were referred from bowel cancer screening procedures. The median size of the lesions was 5 mm (range 2–10 mm). 81% (n = 26) were World Health Organization Grade 1 tumours with Ki67 <3%. Radiological staging confirmed nodal involvement in 25% (8/32); two cases had distant metastatic disease. Lymphovascular invasion was present in 3% (1/32) of patients but none demonstrated peri-neural invasion.

Mon, 22 Nov 2021 00:00:00 GMT

Dysphagia can be a consequence of prolonged hospitalization in intensive care units (ICUs) due to severe SARS-CoV-2 pneumonia. This study aims at Identifying the risk factors for dysphagia in ICU patients with COVID-19 pneumonia requiring invasive mechanical ventilation, and at determining the frequency of postextubation dysphagia in this population.

Endoscopic management of colovesical and colovaginal fistulas with over‐the‐scope clips: A single‐institution case series

Wed, 17 Nov 2021 18:18:02 GMT

Abstract

Aim

Conventional surgical management of colovesical and colovaginal fistulas can be morbid and is contraindicated in many patients. Our aim in this work is to evaluate our experience in the management of colovesical and colovaginal fistulas with endoscopic over-the-scope (OTS) clips.

Method

A retrospective review of all patients who underwent attempted endoscopic OTS clip management of colovesical and colovaginal fistulas between 2013 and 2020 was performed. Preoperative risk factors, operative details and postoperative outcomes are reported.

Results

Ten patients were identified. Fistula types were: colovesical (five), rectovesical (two), colovaginal (two) and rectovaginal (one). The aetiology of the fistula was diverticular disease in seven (70%) cases and surgical complication of pelvic surgery in three (30%). The mean defect age was 157 ± 98 days, the mean defect diameter was 4.5 mm (range 2–10 mm) and the mean fistula length was 15 mm (range 2–25 mm). In nine (90%) cases, fistula identification and cannulation were performed through the nonenteric lumen of the fistula. Initial management with an OTS clip was technically successful in eight (80%) patients. Of the eight patients who underwent OTS clip placement, long-term success (mean follow-up 218 days, range 25–673 days) was achieved after initial intervention in four (50%) patients. One patient underwent serial OTS clip procedures and achieved long-term success after four interventions; three patients have not undergone a repeat procedure after initial failure.

Tue, 16 Nov 2021 19:59:51 GMT

Abstract

Aim

Prolonged postoperative ileus (PPOI) is a common complication following colonic surgery, and is associated with longer hospital stay, greater risk of complications and substantial cost for patients and hospitals. Some reports have recently suggested that gastrointestinal (GI) recovery varies based on the side of resection (i.e., right-sided vs. left-sided colectomy). This systematic review and meta-analysis aimed to compare GI recovery by resection side.

Methods

The MEDLINE, Embase, Cochrane Library and CENTRAL databases were systematically searched for articles reporting GI recovery outcomes in adults undergoing elective right- versus left-sided colectomy (excluding with ileostomy) of any surgical approach. The primary outcome was PPOI, and secondary outcomes included time to first passage of flatus, stool and tolerance of solid diet, and postoperative complications. Subgroup analyses of laparoscopic procedures and cohorts without inflammatory bowel disease and sensitivity analysis of adjusted multivariate results were also performed.

Results

Nine studies were identified, of which seven were included in the meta-analysis, comprising 29 068 colectomies (14 581 right-sided; 14 487 left-sided). PPOI was heterogeneously defined and was significantly more likely following right-sided compared to left-sided colectomy regardless of the surgical approach (OR 1.78, 95% CI 1.32–2.39; P < 0.01; I ² = 51%), as well as on subgroup analyses and adjusted multivariate meta-analysis. Secondary outcomes were reported in only a few small studies; hence meta-analysis did not produce reliable results.

Conclusion

Based on heterogeneous definitions, consistently higher rates of PPOI were observed following right- versus left-sided colectomy. These differences are currently unexplained and highlight the need for further research into the pathophysiology of ileus.

Is there a bias against open surgery for colorectal cancer?

Methods

We present two patients with gender dysphoria and a history of stricture of the penoscrotal skin flap vaginoplasty. We performed sigmoid vaginoplasty by the laparoscopic approach. We began the procedure with the mobilization and section of 30 cm of sigmoid colon, selective ligation of the vessels assisted by ICG, 180° sigmoid rotation, externalized on antiperistaltic position, construction of colovestibular anastomosis and promontory fixation. We finished the procedure with virtual ileostomy construction and drain placement.

Results

Patients recovered satisfactorily and were discharged on the seventh day after surgery without complications.

Conclusion

Sigmoid vaginoplasty is a safe and feasible procedure. ICG has great value, contributing to the selective ligation of the vessels, allowing 180° sigmoid rotation and guaranteeing the irrigation of the neovagina.

The role of faecal calprotectin in the identification of colorectal neoplasia in patients attending for screening colonoscopy

Tue, 02 Nov 2021 14:15:01 GMT

Abstract

Aim

Although the relationship between colorectal neoplasia and inflammation is well described, the role of faecal calprotectin (FC) in clinical practice to diagnose or screen patients for colorectal neoplasia is less defined. This prospective study characterizes the relationship between FC and colorectal neoplasia in patients within the faecal occult blood testing (FOBT) positive patients in the Scottish Bowel Screening Programme.

Methods

All FOBT positive patients attending for colonoscopy between February 2016 and July 2017 were invited to participate. Patients provided a stool sample for FC before commencing bowel preparation. All demographics and endoscopic findings were collected prospectively.

Results

In all, 352 patients were included. 210 patients had FC > 50 µg. Colorectal cancer (CRC) patients had a higher median FC (138.5 μg/g, P < 0.05), in comparison to those without CRC, and 13/14 had an FC > 50 µg/g (93%). FC had a high sensitivity (92.8%) and negative predictive value (99.3%) for CRC, but with a low specificity (41.7%) and positive predictive value (6.2%). FC sensitivity increased sequentially as neoplasms progressed from non-advanced to malignant neoplasia (48.6% non-advanced adenoma vs. 92.9% CRC). However, no significant relationship was observed between FC and non-cancer neoplasia.

Conclusion

In an FOBT positive screening population, FC was strongly associated with CRC (sensitivity 92.8%, specificity 41.7% for CRC, at 50 µg/g). However, although sensitive for the detection of CRC, FC failed to show sufficient sensitivity or specificity for the detection of non-cancer neoplasia. Based on these results we cannot recommend routine use of FC in a bowel screening population to detect cancer per se, but it is apparent that, with further optimization, faecal assessments including quantification of haemoglobin and inflammation could form part of a risk assessment tool aimed at refining the selection of patients for colonoscopy in both symptomatic and screening populations.

Nutritional management and clinical outcome of critically ill patients with COVID-19: A retrospective study in a tertiary hospital

Mon, 01 Nov 2021 00:00:00 GMT

Severe COVID-19 infection is characterized by an inflammatory response and lung injury that can evolve into an acute respiratory distress syndrome that needs support treatment in intensive care unit. Nutritional treatment is an important component of the management of critically ill patients and should be started in the first 48 h of ICU admission to avoid malnutrition. This study describes the characteristics of the patients treated in a tertiary hospital in Madrid during the months of March–May 2020 (first wave), the medical nutrition treatment employed and its influence in the clinical outcome of these patients.

Preoperative abdominal fat distribution and systemic immune inflammation were associated with response to intravesical Bacillus Calmette-Guerin immunotherapy in patients with non-muscle invasive bladder cancer

Mon, 01 Nov 2021 00:00:00 GMT

To investigate the predictors of response to intravesical Bacillus Calmette-Guerin (BCG) immunotherapy for intermediate and high-risk non-muscle invasive bladder cancer (NMIBC) patients.

Immediate vs. gradual advancement to goal of enteral nutrition after elective abdominal surgery: A multicenter non-inferiority randomized trial

Sat, 30 Oct 2021 00:00:00 GMT

The strategy of increasing the postoperative enteral nutrition dose to the target goal has not yet been clarified. This study aimed to determine whether an immediate goal-dose enteral nutrition (IGEN) strategy is non-inferior to a gradual goal-dose enteral nutrition (GGEN) strategy in reducing infections in patients undergoing abdominal surgery involving the organs of the digestive system.

Comment on: Maternal vitamin D status and risk of gestational diabetes mellitus: A systematic review and meta-analysis of prospective cohort studies

Tingting Zhang — Thu, 28 Oct 2021 00:00:00 GMT

A recently study by Milajerdi et al. searched available databases and conducted a systematic review and meta-analysis to assess the association between maternal serum vitamin D deficiency or insufficiency and risk of gestational diabetes mellitus (GDM), which was published in the recent issue of Clinical Nutrition [1]. They came to the conclusion that a significant association between vitamin D deficiency and an increased risk of GDM was found. Although the results are of great importance, we would like to underline some issues as to identification of the studies, screening process, and data analysis that we feel ought to be considered when interpreting these findings.

Nutritional state assessed by ultrasonography, but not by bioelectric impedance, predicts 28-day mortality in critically ill patients. Prospective cohort study

Wed, 27 Oct 2021 00:00:00 GMT

Malnutrition is a disease associated with unfavorable outcomes and high prevalence among critically ill patients. The primary aim of the study was to correlate the nutritional status of patients recently admitted to the intensive care unit (ICU) with the 28-day mortality rate. The secondary aim was to establish cut-off values for the bioelectrical impedance analysis (BIA) and ultrasonography (USG) methods for the classification of the nutritional status of critically ill patients.

Plant-based diet quality and the risk of total and disease-specific mortality: A population-based prospective study

Jihye Kim, Hyunju Kim, Edward L. Giovannucci — Sun, 24 Oct 2021 00:00:00 GMT

Plant-based diets have been suggested to have health benefits, and risk differs by quality of plant foods. However, evidence on the association between the quality of plant-based diets and mortality are limited. This study examined the associations between 3 different types of plant-based diet indices and risk of total and disease-specific mortality.

Adherence to Mediterranean diet and its associations with circulating cytokines, musculoskeletal health and incident falls in community-dwelling older men: The Concord Health and Ageing in Men Project

Sat, 23 Oct 2021 00:00:00 GMT

Mediterranean dietary patterns may exert favourable effects on various health conditions. This study aimed to determine associations of adherence to Mediterranean diet as well as its components, with circulating cytokine levels, musculoskeletal health and incident falls in community-dwelling older men.

Phenotype assessment in neurologically impaired paediatric patients: Impact of a nutrition intervention protocol

Fri, 22 Oct 2021 00:00:00 GMT

Deficits in nutritional status and functional feeding disorders are common in Neurologically Impaired Paediatric Patients (NIPP). Interventions addressing these problems could offer better overall health status and quality of life in this group of patients, but the extent of their effectiveness is yet to be determined. Recent guidelines concerning the nutritional care of NIPP have been published from ESPGHAN but compliance to them has not been assessed.

Body mass trajectories and multimorbidity in old age: 12-year results from a population-based study

Thu, 21 Oct 2021 00:00:00 GMT

Body weight changes reflect and impact several health conditions in older age, but little is known about its relationship with multimorbidity. We aimed to study the association of long-terms trajectories of body mass index (BMI) with contemporaneous changes in multimorbidity −and multimorbidity type− development in a population-based cohort of older adults.

Effect of the consumption of hesperidin in orange juice on the transcriptomic profile of subjects with elevated blood pressure and stage 1 hypertension: A randomized controlled trial (CITRUS study)

Thu, 21 Oct 2021 00:00:00 GMT

Hesperidin exerts cardiovascular beneficial effects, but its mechanisms of action remain undefined. In a previous study we demonstrated that a single dose and a 12-week treatment of hesperidin decreased systolic blood pressure. The aim of this study was to ascertain the action mechanisms of hesperidin consumption in subjects with elevated blood pressure or with stage 1 hypertension, by determining their transcriptomic profile after a single dose or a 12-week treatment.

One year of omega 3 polyunsaturated fatty acid supplementation does not reduce circulating prothrombotic microvesicles in elderly subjects after suffering a myocardial infarction

Wed, 20 Oct 2021 00:00:00 GMT

Circulating microvesicles (cMV) are both effectors and biomarkers of cardiovascular disease (CVD), and the effects of omega 3 polyunsaturated fatty acids (n3 PUFA) in MV shedding are not yet well known. Therefore, we aimed to investigate the effects of long-term n3 PUFA supplementation on cMV release from cells of the vascular compartment in elderly subjects at very high risk of CVD.

ESPEN guideline on hospital nutrition

Wed, 20 Oct 2021 00:00:00 GMT

In hospitals through Europe and worldwide, the practices regarding hospital diets are very heterogeneous. Hospital diets are rarely prescribed by physicians, and sometimes the choices of diets are based on arbitrary reasons. Often prescriptions are made independently from the evaluation of nutritional status, and without taking into account the nutritional status. Therapeutic diets (low salt, gluten-free, texture and consistency modified, …) are associated with decreased energy delivery (i.e. underfeeding) and increased risk of malnutrition.

Early supplemental parenteral nutrition is associated with reduced mortality in critically ill surgical patients with high nutritional risk

Joohyun Sim, Jeong Hong, Eun Mi Na, Seorin Doo, Yun Tae Jung — Tue, 19 Oct 2021 00:00:00 GMT

Adequate nutritional provision is important for critically ill patients to improve clinical outcomes. Starting enteral nutrition (EN) as early as possible is recommended and preferred to parenteral nutrition (PN). However, patients who undergo emergency abdominal operations may have alterations in their intra-abdominal environment and gastrointestinal motility leading to limitation in starting an enteral diet. Therefore, our study was designed to evaluate the benefit of early supplemental PN to achieve adequate calorie and protein supply in critically ill patients undergoing surgery who are not eligible for early EN.

A protein-supplemented very-low-calorie diet does not mitigate reductions in lean mass and resting metabolic rate in subjects with overweight or obesity: A randomized controlled trial

Mon, 18 Oct 2021 00:00:00 GMT

The European Food Safety Authority recently recommended an increase in the protein content of total diet replacement (TDR) products from 50 to 75 g/day. The rationale was to minimize reductions in lean mass (LM) and resting metabolic rate (RMR) that occur with weight loss, and thereby facilitate maintenance of lost weight. We sought to directly compare the efficacy of TDR regimens with the new vs the current protein requirement.

Impact of synbiotics treatment on bacteremia induced during neoadjuvant chemotherapy for esophageal cancer: A randomised controlled trial

Tue, 12 Oct 2021 00:00:00 GMT

To elucidate the impact of synbiotics on bacterial translocation and subsequent bacteremia during neoadjuvant chemotherapy for esophageal cancer.

Dietary omega-3 polyunsaturated fatty acids and fish intake and risk of age-related macular degeneration

Mon, 11 Oct 2021 00:00:00 GMT

Epidemiologic studies are inconsistent regarding the association of dietary omega-3 polyunsaturated fatty acids (PUFA) and/or fish intake with risk of age-related macular degeneration (AMD) incidence and progression. The objective was to determine these associations by conducting a meta-analysis of available studies.

Quantity and variety of food groups consumption and the risk of diabetes in adults: A prospective cohort study

Sun, 10 Oct 2021 00:00:00 GMT

Evidence remains inconsistent regarding the association between quantity of food groups and diabetes, and remains scarce regarding the relation of dietary diversity with diabetes.

Impact of the level of adherence to the Mediterranean Diet on blood pressure: A systematic review and meta-analysis of observational studies

Sat, 09 Oct 2021 00:00:00 GMT

High blood pressure (BP) constitutes a common and serious medical condition which is rising globally, and is among preventable factors for cardiovascular, renal, brain and other diseases. Modifiable risk factors of high BP include unhealthy dietary patterns, presence of obesity, excess alcohol consumption and lack of physical activity. Data in regard to the different types of diets show that Mediterranean diet (MD) is associated with healthy levels of BP. In this study we aimed to investigate the impact of the level of adherence to MD in BP.

Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study

Mon, 27 Sep 2021 00:00:00 GMT

Nutrition therapy for Intensive Care Unit (ICU) patients involves complex decision-making, especially during the COVID-19 pandemic. We investigated the use of nutrition therapy in ICU patients with and without COVID-19 infections.

Critical comments on the “impact of curcumin supplementation on expression of inflammatory transcription factors in hemodialysis patients: A pilot randomized, double-blind, controlled study” by Alvarenga

Meysam Zarezadeh, Mohammad Nosrati-Oskouie, Ali Tarighat-Esfanjani — Fri, 17 Sep 2021 00:00:00 GMT

We recently read the published article in “Clinical Nutrition” entitled: “Impact of curcumin supplementation on expression of inflammatory transcription factors in hemodialysis patients: A pilot randomized, double-blind, controlled study” by Alvarenga and et al. [1].

Comment on “Effectiveness of dietetic intervention for people with type 2 diabetes: A meta-analysis”

Xiaomin Luo, Cen Yan, Yuejie Zhang, Wang Lu, Yingmei Feng — Mon, 13 Sep 2021 00:00:00 GMT

It was with great interest that we read the article entitled “Effectiveness of dietetic intervention for people with type 2 diabetes: A meta-analysis”, published in 2021 in the Clin Nutr. The authors performed a systematic review and meta-analysis and aimed to compare the effectiveness of nutrition therapy delivered by dietitians to nutrition advice delivered by other healthcare professionals in adults with type 2 diabetes on metabolic parameters [1]. The authors should be congratulated for performing a well-designed study.

The impact of COVID-19 on diet quality, food security and nutrition in low and middle income countries: A systematic review of the evidence

Fiorella Picchioni, Luis F. Goulao, Dominique Roberfroid — Thu, 26 Aug 2021 00:00:00 GMT

The current global pandemic of Coronavirus (COVID-19), and measures adopted to reduce its spread, threaten the nutritional status of populations in Low- and middle-income countries (LMICs). Documenting how the COVID-19 affects diets, nutrition and food security can help generating evidence-informed recommendations for mitigating interventions and policies.

Influence of reduced muscle mass and quality on ventilator weaning and complications during intensive care unit stay in COVID-19 patients

Sun, 15 Aug 2021 00:00:00 GMT

Sarcopenia, a loss of muscle mass, quality and function, which is particularly evident in respiratory muscles, has been associated with many clinical adverse outcomes. In this study, we aimed at evaluating the role of reduced muscle mass and quality in predicting ventilation weaning, complications, length of intensive care unit (ICU) and of hospital stay and mortality in patients admitted to ICU for SARS-CoV-2-related pneumonia.

Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19

Wed, 28 Jul 2021 00:00:00 GMT

Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19.

Nutritional parameters associated with prognosis in non-critically ill hospitalized COVID-19 patients: The NUTRI-COVID19 study

Fri, 25 Jun 2021 00:00:00 GMT

To investigate the association between the parameters used in nutritional screening assessment (body mass index [BMI], unintentional weight loss [WL] and reduced food intake) and clinical outcomes in non-critically ill, hospitalized coronavirus disease 2019 (COVID-19) patients.

Anti-COVID-19 measures threaten our healthy body weight: Changes in sleep and external synchronizers of circadian clocks during confinement

Fri, 25 Jun 2021 00:00:00 GMT

Emergency measures in the face of the recent COVID-19 pandemic have been different among countries, although most have opted for confinement and restrictions on social contact. These measures have generated lifestyle changes with potential effects on individuals' health. The disturbances in daily routines due to confinement and remote work have impacted circadian rhythms and energy balance; however, the consequences of these disruptions have not been studied in depth. The objective was to evaluate the impact of 12-week confinement on body weight, considering changes in several external synchronizers of the biological clock.

COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic

Mon, 14 Jun 2021 00:00:00 GMT

Prevalence and complications of oropharyngeal dysphagia (OD) and malnutrition (MN) in COVID-19 patients is unknown. Our aim was to assess the prevalence, risk factors and clinical outcomes of OD and MN in a general hospital during the first wave of the COVID-19 pandemic.

Dietary interventions and blood pressure in overweight or obese individuals: A systematic review and meta-analysis

Karla Arnotti, Mandy Bamber, Veronica Brewer — Thu, 10 Jun 2021 00:00:00 GMT

Increased fruit and vegetable consumption (FVC) beneficially impacts hypertension, yet researchers have not synthesized the effects of FVC interventions on blood pressure (BP) among overweight or obese individuals. Therefore, we aimed to examine if diets with increased FVC decrease BP in overweight and obese persons and explore effects of moderators, study methods, participants, intervention, and source characteristics.

Myosteatosis predicting risk of transition to severe COVID-19 infection

Sun, 06 Jun 2021 00:00:00 GMT

About 10–20% of patients with Coronavirus disease 2019 (COVID-19) infection progressed to severe illness within a week or so after initially diagnosed as mild infection. Identification of this subgroup of patients was crucial for early aggressive intervention to improve survival. The purpose of this study was to evaluate whether computer tomography (CT) - derived measurements of body composition such as myosteatosis indicating fat deposition inside the muscles could be used to predict the risk of transition to severe illness in patients with initial diagnosis of mild COVID-19 infection.

Impact of nutritional therapy during the first wave of the COVID-19 pandemic in intensive care patients: A retrospective observational study

Fri, 04 Jun 2021 00:00:00 GMT

The COVID-19 pandemic has caused major organizational challenges to healthcare systems concerning staff, material and bed availability. Nutrition was not a priority in the intensive care unit (ICU) at the beginning of the pandemic with the need for simplified protocols. We aimed to assess the impact of a simplified nutritional protocol for critically ill COVID-19 patients during the pandemic first wave.

Neuromuscular blockade administration is associated with altered energy expenditure in critically ill intubated patients with COVID-19

Tue, 25 May 2021 00:00:00 GMT

ESPEN guidelines advocate that energy needs of critically ill patients with COVID 19 should be assessed using indirect calorimetry, if safely available. This study described energy needs of intubated patients with COVID-19 and explores whether neuromuscular blockade administration (NMBAs) is associated with altered energy expenditure.

Evolution of the nutritional status of COVID-19 critically-ill patients: A prospective observational study from ICU admission to three months after ICU discharge

Mon, 24 May 2021 00:00:00 GMT

Malnutrition following intensive care unit (ICU) stay is frequent and could be especially prominent in critically ill Coronavirus Disease 2019 (COVID-19) patients as they present prolonged inflammatory state and long length stay. We aimed to determine the prevalence of malnutrition in critically ill COVID-19 patients both at the acute and recovery phases of infection.

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

Mon, 10 May 2021 00:00:00 GMT

The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications.

Impact of COVID-19 on nutritional status during the first wave of the pandemic

Sat, 08 May 2021 00:00:00 GMT

Patients affected by COVID-19 may develop disease related malnutrition (DRM) due to the catabolic situation, symptoms that interfere with intake and prolonged hospital stay. This study aims to know the percentage of patients admitted for COVID-19 who required artificial nutrition (AN), their clinical characteristics, as well as the prevalence of DRM and the risk of sarcopenia at hospital discharge and after 6 months.

Hypozincemia in the early stage of COVID-19 is associated with an increased risk of severe COVID-19

Mon, 03 May 2021 00:00:00 GMT

Nutritional predisposition to severe coronavirus disease 2019 (COVID-19) remains unclear. Zinc deficiency could be critical since it is associated with a higher susceptibility to infections. We evaluated the prevalence of hypozincemia in the early stage of COVID-19, its association with risk factors for severe COVID-19 and its prognostic value for hospitalization for respiratory complications within 10 days.

The impact of COVID-19 lockdown on snacking habits, fast-food and alcohol consumption: A systematic review of the evidence

Fri, 16 Apr 2021 00:00:00 GMT

The pandemic of coronavirus disease 2019 (COVID-19) and lockdown measures, that were implemented in many countries in order to control the virus transmission, had negatively influenced the lifestyle of millions of people worldwide. In this study we aimed to investigate the impact of the first COVID-19 lockdown period (March–May 2020) on snacking behavior, fast-food and alcohol consumption. A systematic search in PubMed®, Scopus® and Web of Science® databases was conducted and 32 studies were included.

Impact of the first COVID-19 lockdown on body weight: A combined systematic review and a meta-analysis

Tue, 13 Apr 2021 00:00:00 GMT

The coronavirus disease 2019 (COVID-19) and the imposed lockdowns in order to control the pandemic, had undoubtedly influenced the lifestyle of millions of people worldwide. The period of confinement, which was characterized by seizing most business activities and allowing only for e-classes at schools and universities, leading also to a lower physical activity, could have affected eating behaviors of people of all ages. In this study we aimed to investigate the impact of the first lockdown period (March–May 2020) on body weight (BW) and on body mass index (BMI) in both adults and adolescents (>16 years old).

Nutritional status in post SARS-Cov2 rehabilitation patients

Mon, 12 Apr 2021 00:00:00 GMT

After prolonged hospitalization, the assessment of nutritional status and the identification of adequate nutritional support is of paramount importance. In this observational study, we aimed at assessing the presence of a malnutrition condition in SARS-Cov2 patients after the acute phase and the effects of a multidisciplinary rehabilitation program on nutritional and functional status.

Mediterranean diet and the risk of COVID-19 in the ‘Seguimiento Universidad de Navarra’ cohort

Fri, 09 Apr 2021 00:00:00 GMT

A potential protection against COVID-19 by a high-quality dietary pattern is to be expected given the biological plausibility supporting the beneficial effects of an adequate dietary intake on the immune system. However, knowledge on the relationship between long-term maintained healthy dietary patterns, such as the Mediterranean diet, and the risk of SARS-CoV-2 infection is still sparse. We longitudinally assessed this association in a well-known Mediterranean cohort.

Feeding intolerance in critically ill patients with COVID-19

Mon, 29 Mar 2021 00:00:00 GMT

Early reports suggest significant difficulty with enteral feeding in critically ill COVID-19 patients. This study aimed to characterize the prevalence, clinical manifestations, and outcomes of feeding intolerance in critically ill patients with COVID-19.

Polydatin and COVID-19

Viroj Wiwanitkit — Mon, 29 Mar 2021 00:00:00 GMT

I would like to share ideas on the publication “Polydatin and its potential protective effect on COVID-19”. Bonucci et al. concluded that “it is reasonable to suggest the phytochemical polydatin as preventative (co-) treatment for individual at risk of COVID-19, as (asymptomatic or pauci-symptomatic) relatives and contacts of swap positive confirmed case [1].” The advantage of plant derived natural products for managing COVID-19 is interesting. Polygonum Cuspidatum is a general plant in many Asian countries (such as China, Korea and Japan) [2].

Nutritional risk at hospital admission is associated with prolonged length of hospital stay in old patients with COVID-19

Mon, 22 Mar 2021 00:00:00 GMT

To investigate the association of nutritional risk at admission with the length of hospital stay (LOS) and mortality in older patients with COVID-19.

Influence of foods and nutrients on COVID-19 recovery: A multivariate analysis of data from 170 countries using a generalized linear model

Fri, 19 Mar 2021 00:00:00 GMT

COVID-19 is an emergency public health problem of global importance. This study aimed to investigate the effect of foods and nutrients as complementary approaches on the recovery from COVID-19 in 170 countries, especially considering the complexity of the disease and the current scarcity of active treatments.

Vitamin D deficiency in critically ill COVID-19 ARDS patients

Sun, 07 Mar 2021 00:00:00 GMT

Vitamin D's pleiotropic effects include immune modulation, and its supplementation has been shown to prevent respiratory tract infections. The effectivity of vitamin D as a therapeutic intervention in critical illness remains less defined. The current study analyzed clinical and immunologic effects of vitamin D levels in patients suffering from coronavirus disease 2019 (COVID-19) induced acute respiratory distress syndrome (ARDS).

Early caloric deficit is associated with a higher risk of death in invasive ventilated COVID-19 patients

Mon, 01 Mar 2021 00:00:00 GMT

The aim of this study was to evaluate the nutritional support management in mechanically ventilated coronavirus disease 2019 (COVID-19) patients and explore the association between early caloric deficit and mortality, taking possible confounders (i.e. obesity) into consideration.

Region-specific COVID-19 risk scores and nutritional status of a high-risk population based on individual vulnerability assessment in the national survey data

Inkyung Baik — Tue, 23 Feb 2021 00:00:00 GMT

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic outbreak leading to more than 1 million deaths worldwide as reported in 2020. Several risk assessment tools, including individual vulnerability to COVID-19, have been developed. The present study aimed to characterize a high-risk population using such a tool and examine risk factors and nutritional status in the national survey data and estimate the region-specific population size.

Phase angle and standardized phase angle from bioelectrical impedance measurements as a prognostic factor for mortality at 90 days in patients with COVID-19: A longitudinal cohort study

Tue, 16 Feb 2021 00:00:00 GMT

Severe acute COVID-19 has taken on pandemic proportions with growing interest in identification of prognostic factors for mortality. Standardized bioelectrical impedance (BI) phase angle (SPhA), which is PhA adjusted by age and sex, has been related to mortality in patients with several diseases but never investigated in COVID-19. Inflammation, a consequence of COVID-19 infection, affects fluid status (hydration) and can be identified with PhA. The aim of this study was to determine the predictive role of PhA on 90 days survival of adults with COVID-19.

WITHDRAWN: Reply - Letter to the Editor - Malnutrition according to the ESPEN definition and falls in general older population: findings in the EPIDOS study-Toulouse cohort

T. Cederholm, P. Singer — Wed, 22 Apr 2020 00:00:00 GMT

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.clnu.2020.02.026. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Outcomes for Patients with apparent Chronic Idiopathic Pelvic Pain and associated Pelvic Floor Disorders undergoing Laparoscopic Ventral Mesh Rectopexy

A Newman, G L Greenslade, K McCarthy, A R Dixon — Thu, 06 Jul 2017 19:00:00 GMT

Abstract

This article has been temporarily withdrawn, with the agreement of all authors and the journal editor, whilst an investigated is being carried out by the North Bristol NHS Trust and the General Medical Council following some concerns raised.

ANCHOR Trial Results Are In: So Where Do We Go From Here?.

Author: Goldstone, Stephen E. M.D.

Page: 1-3

Are Women Colorectal Surgeons Overrepresented in the Treatment of Pelvic Floor Disorders?.

Author: Baratta, Vanessa M. M.D., M.H.S.; Kurbatov, Vadim M.D., M.H.S.; Einarsdottir, Hulda M. M.D.; Reddy, Vikram M.D., Ph.D. M.B.A.; Longo, Walter E. M.D.; Pantel, Haddon J. M.D.

Page: 4-5

Planetary Health Care for Colorectal Surgeons.

Author: Moloo, Husein M.D., M.Sc., M.P.H. 1; MacNeill, Andrea M.D., M.Sc. 2

Page: 6-7

Report from American Society of Clinical Oncology Symposium 2020 and American Society of Clinical Oncology Gastrointestinal Cancer Symposium 2021.

Author: You, Y. Nancy M.D., M.H.Sc. 1; Dasari, Arvind M.D., M.S. 2; Chang, George J. M.D., M.S. 1

Page: 8-10

Postoperative Evaluation and Management of Portomesenteric Venous Thrombosis in Patients With IBD.

Author: Patel, Maitri M.P.H. 1; Hedrick, Traci M.D. 2

Page: 11-13

Expert Commentary on Postoperative Evaluation and Management of Portomesenteric Venous Thrombosis in Patients With Inflammatory Bowel Disease.

Author: Lightner, Amy L. M.D.

Page: 14-15

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Systematic Review.

Author: Parikh, Manasi S. M.B.B.S, M.S. 1; Johnson, Paul M.D. 1; Romanes, Jonathan Paul B.S. 2; Freitag, Harvey E. B.S. 3; Spring, Mary E. D.O. 4; Garcia-Henriquez, Norbert M.D. 1; Monson, John R.T. M.D. 1

Page: 16-26

Research Perspective on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Systematic Review.

Author: Davis, Kurt G. M.D.

Page: 27

Incidence Rate and Risk Factors for Anal Squamous Cell Carcinoma in a Cohort of People Living With HIV from 2004 to 2017: Implementation of a Screening Program.

Author: Milanes Guisado, Yusnelkis Ph.D. 1; Sotomayor, Cesar M.D. 1; Fontillon, Maria Ph.D. 2; Dominguez Castano, Ana Ph.D. 3; Espinosa, Nuria M.D., Ph.D. 1; Roca, Cristina M.D. 1; Lopez-Cortes, Luis F. M.D., Ph.D. 1,4; Viciana, Pompeyo M.D., Ph.D. 1; Neukam, Karin Pharm.D., Ph.D. 1,4; On behalf of the SeVIHanal Study Group

Page: 28-39

Evaluation of Urinalysis-Based Screening for Urothelial Carcinoma in Patients With Lynch Syndrome.

Author: Chouhan, Hanumant M.B.B.S., F.R.A.C.S. 1,2,3; Abbass, Mohammad Ali M.D. 4; Hrabe, Jennifer E. M.D. 1; Ferrandon, Sylvain Ph.D. 5; DeVecchio, Jennifer B.A. 3; Mankaney, Gautam M.D. 2; Burke, Carol A. M.D. 2; Heald, Brandie M.Sc. 2; Ann LaGuardia, Lisa R.N., B.S.N. 2; O'Malley, Margaret B.Sc. 2; Milicia, Susan R.N., B.S.N. 2; Liska, David M.D. 1,2,3; Church, James M.B.Ch.B., F.R.A.C.S. 7; Campbell, Steven C. M.D. 2,6; Kalady, Matthew F. M.D. 5

Page: 40-45

Functional Outcomes and Quality of Life After Transanal Total Mesorectal Excision for Rectal Cancer: A Prospective Observational Study.

Author: de Lacy, F. Borja M.D. 1; Turrado-Rodriguez, Victor M.D. 1; Torroella, Alba M.D. 1; van Laarhoven, Jacqueline M.D., Ph.D. 2; Otero-Pineiro, Ana M.D., Ph.D. 1; Almenara, Raul M.D., Ph.D. 1; Lacima, Gloria M.D., Ph.D. 1; Castells, Antoni M.D. 3; Lacy, Antonio M. M.D., Ph.D. 1

Page: 46-54

What Is the Optimal Elective Colectomy for Splenic Flexure Cancer: End of the Debate? A Multicenter Study From the GRECCAR Group With a Propensity Score Analysis.

Author: Manceau, Gilles M.D., Ph.D. 1; Alves, Arnaud M.D., Ph.D. 2; Meillat, Helene M.D. 3; Benhaim, Leonor M.D., Ph.D. 4; Ouaissi, Mehdi M.D., Ph.D. 5; Panis, Yves H. M.D., Ph.D. 6; Tuech, Jean-Jacques M.D., Ph.D. 7; Dousset, Bertrand M.D., Ph.D. 8; Brigand, Cecile M.D., Ph.D. 9; Cotte, Eddy M.D., Ph.D. 10; Lakkis, Zaher M.D., Ph.D. 11; Badic, Bogdan M.D., Ph.D. 12; Marchal, Frederic M.D. 13; Sabbagh, Charles M.D., Ph.D. 14; Diouf, Momar Ph.D. 15; Karoui, Mehdi M.D., Ph.D. 1

Page: 55-65

Cumulative Incidence and Risk Factors of Permanent Stoma After Intersphincteric Resection for Ultralow Rectal Cancer.

Author: Zhang, Bin M.D.; Zhuo, Guang-Zuan M.D.; Zhao, Ke M.M.; Zhao, Yong M.D.; Gao, Dong-Wei M.D.; Zhu, Jun M.D.; Ding, Jian-Hua M.D.

Page: 66-75

Perianal Fistula After Ileoanal Pouch in Patients With Ulcerative Colitis: A Review of 475 Patients Operated on at a Major IBD Center.

Author: Heimann, Tomas M. M.D.; Swaminathan, Santosh M.D.; Slater, Gary I. M.D.; Kurtz, Robert J. M.D.

Page: 76-82

Translumbosacral Anorectal Magnetic Stimulation Test for Fecal Incontinence.

Author: Yan, Yun M.D., Ph.D.; Sharma, Amol M.D., M.S.; Herekar, Anam A. M.B.B.S.; Jimenez, Enoe M.D.; Hudgi, Amit R. M.B.B.S.; Gu, Qiaochu G. M.D.; Rao, Satish S.C. M.D., Ph.D.

Page: 83-92

The Role of Traditional Acupuncture in Low Anterior Resection Syndrome Treatment: A Pilot Study.

Author: Dulskas, Audrius M.D., Ph.D. 1,2; Aukstikalnis, Tomas M.D. 3; Kavaliauskas, Povilas M.D. 2; Samalavicius, Narimantas Evaldas M.D., Ph.D. 2,4,5

Page: 93-99

Effect of Changing Surgical Instruments Before Wound Closure to Prevent Wound Infection in Lower GI Surgery: A Randomized Controlled Trial.

Author: Kuwahara, Ryuichi M.D. 1; Uchino, Motoi M.D., Ph.D. 1; Ikeuchi, Hiroki M.D., Ph.D. 1; Bando, Toshihiro M.D. 1; Sasaki, Hirofumi M.D., Ph.D. 1; Yasuhara, Michiko M.D. 2; Kimura, Kei M.D. 2; Goto, Yoshiko M.D., Ph.D. 1; Horio, Yuki M.D., Ph.D. 1; Minagawa, Tomohiro M.D., Ph.D. 1; Ikeda, Masataka M.D., Ph.D. 2; Ueda, Takashi Ph.D. 3; Takesue, Yoshio M.D., Ph.D. 3

Page: 100-107

Incidence and Characterization of Rectal Complications From Fecal Management Systems.

Author: Kane, William J. M.D. 1; Hassinger, Taryn E. M.D., M.S. 1; Xu, Thomas O. B.S. 2; Kirkner, Allison E. M.S.N., R.N. 1; Maddox, Michele J. R.N., B.S.N. 1; Hoang, Sook C. M.D. 1; Friel, Charles M. M.D. 1; Hedrick, Traci L. M.D., M.S. 1

Page: 108-116

Combination of Enhanced Instructions Improve Quality of Bowel Preparation: A Prospective, Colonoscopist-Blinded, Randomized, Controlled Study.

Author: Jung, Da Hyun M.D. 1; Gweon, Tae-Geun M.D., Ph.D. 2; Lee, SeJoon M.D., Ph.D. 3; Son, Nak-Hoon Ph.D. 4; Kim, Byung-Wook M.D., Ph.D. 2; Huh, Cheal Wung M.D., Ph.D. 2,3

Page: 117-124

Abridged Abstracts From the Medical Literature.

Author: Merchea, Amit M.D.; Schwartzberg, David M. M.D.

Page: 125-129

Transanal Minimally Invasive Surgery for Local Excision of a Rectal Schwannoma.

Author: Guevara-Martinez, Jenny M.D.; Toribio-Vazquez, Carlos M.D.; Noire, Fernando Prieto-La M.D.; Cantero, Ramon M.D., Ph.D.

Page: e1-e3

Robotic Ventral Mesh Rectopexy.

Author: Araujo, Sergio Eduardo Alonso M.D., Ph.D.; Seid, Victor Edmond M.D., Ph.D.; Portilho, Ana Sarah M.D.; Marcante, Marcelli T. M.D.; Pandini, Rafael Vaz M.D.; Gerbasi, Lucas S. M.D.; Figueiredo, Marleny N. M.D., Ph.D.

Page: e4

Mesenteric Excision and Exclusion for Ileocolic Crohn's Disease: Feasibility and Safety of an Innovative, Combined Surgical Approach With Extended Mesenteric Excision and Kono-S Anastomosis.

Author: Holubar, Stefan D. M.D., M.S. 1; Gunter, Rebecca L. M.D., M.S. 1; Click, Benjamin H. M.D., M.S. 2; Achkar, Jean-Paul M.D. 2; Lightner, Amy L. M.D. 1; Lipman, Jeremy M. M.D. 1; Hull, Tracy L. M.D. 1; Regueiro, Miguel M.D. 2; Rieder, Florian M.D., Ph.D. 2; Steele, Scott R. M.D., M.B.A. 1

Page: e5-e13

Open Left Hemicolectomy for Proximal Sigmoid Cancer.

Author: Samalavicius, Narimantas E. M.D., Ph.D. 1,2,3; Klimasauskiene, Vita M.D. 4; Dulskas, Audrius M.D., Ph.D. 2,5

Page: e14-e15

Robotic Ventral Mesh Rectopexy and Sacrocolpopexy.

Author: Brady, Justin T. M.D. 1; Kow, Nathan M.D. 2; deBeche-Adams, Teresa M.D. 1

Page: e16-e17

Robotic NICE Procedure With Natural Orifice-Assisted Small-Bowel Resection and Anastomosis for Complicated Diverticulitis with Enterocolic Fistula.

Author: Haas, Eric M. M.D. 1,2; Ortiz De Elguea-Lizarraga, Jose I. M.D. 3; Luna-Saracho, Roberto M.D. 1; Secchi del Rio, Roberto M.D. 3; LeFave, Jean-Paul M.D. 2,3

Page: e18-e20

A Missed Chance for Organ Preservation after Watch and Wait.

Author: Vila, Frenki M.D.; Yuksel, Bulent Cavit Prof., M.D.

Page: e21

cT2N0 Distal Rectal Cancer: Do Not Believe in Fairy Tales.

Author: Fernandez, Laura M. M.D. 1; Figueiredo, Nuno M.D., Ph.D. 3; Habr-Gama, Angelita M.D., Ph.D. 2,3; Sao Juliao, Guilherme P. M.D. 2; Vieira, Pedro M.D. 1; Vailati, Bruna B. M.D. 2; Nasir, Irfan M.D. 1; Pares, Oriol M.D. 1; Santiago, Ines M.D. 1; Castillo-Martin, Mireia M.D., Ph.D. 1; Carvalho, Carlos M.D. 1; Parvaiz, Amjad M.D. 1; Perez, Rodrigo O. M.D., Ph.D. 2,3,4

Page: e22

Definitive Surgery on Initial Presentation for Anal Fistula Associated With Acute Anorectal Abscess: A Definite Way Forward.

Author: Garg, Pankaj M.B.B.S., M.S. 1; Kaur, Baljit M.B.B.S., M.D. 2

Page: e23

The Authors Reply.

Author: Sahakitrungruang, Chucheep M.D., M.Sc. 1,2; Malakorn, Songphol M.D. 1,2; Rojanasakul, Arun M.D., Ph.D.(hon). 1,2

Page: e24

Does Sex-Difference Matter for the Decrease in Serum Albumin?.

Author: Hu, Kang B.M.; Tong, Weidong M.D.

Page: e25

Outcomes of the PILLAR III Trial Reassessed.

Author: Samadov, Elgun M.D.; Ibrahimli, Arturan M.D.

Page: e26

More Than Lymph Node Dissection Has an Effect on Overall Survival For Right Colon Cancer.

Author: Ignjatovic, Dejan M.D., Ph.D.; Stimec, Bojan V. M.D., Ph.D.

Page: e27

January 2022 translations.

Author:

Page: e28-e66

Announcements.

Author:

Page: e67

Colon and Rectal Surgery Regional Society Meetings.

Author:

Page: e68-e69