ABSTRACT
Introduction: Colorectal cancer (CRC) is the third most prevalent cancer in the United States, with a 4% lifetime incidence. While more clinicians have begun ordering multitarget stool DNA (mt-sDNA) testing due to the COVID-19 pandemic, adherence to guidelines on mt-sDNA and rates of subsequent follow-up testing has not been well studied. We assessed the appropriateness of mt-sDNA orders and rate of high-quality colonoscopy completion following a positive result in a large academic medical center. Method(s): We identified patients ordered for mt-sDNA in primary care and gastroenterology clinics at our institution between April 2020 and July 2021. For each case, we reviewed the appropriateness of mtsDNA testing, documentation of shared decision making, result of testing, and subsequent follow-up. Appropriateness was defined in accordance to the most recent American College of Gastroenterology guidelines on mt-sDNA use for CRC screening. Result(s): Of the 797 patients in our study, 685 (86%) met all appropriateness criteria for mt-sDNA testing (Table). Shared decision making was documented in 488 (62%) cases, and the most common reason for ordering mt-SDNA was hesitancy for colonoscopy. 483 patients (61%) completed mt-sDNA testing, of which 74 cases (15%) were positive. Rates of positivity were higher in cases of inappropriate (28%) rather than appropriate (13.7%) orders (p = 0.01). Colonoscopy was ordered in 73 cases (99%) and completed by 59 patients (80%). Of the 56 patients who underwent colonoscopy at our institution, most had documentation of a high-quality colonoscopy, defined as adequate prep (84%), cecal intubation (93%), visualization of the appendiceal orifice and ileocecal valve (94%), and right colon retroflexion (83%). Sixteen patients (29%) were found with advanced adenomas and 19 (34%) had other adenomas or sessile polyps. Among the 409 patients with negative tests, a 3-year follow-up recommendation was documented for 369 patients (90%). Conclusion(s): Most clinicians at our institution identified appropriate patients for mt-sDNA testing and provided appropriate follow-up< and the majority of patients who underwent colonoscopy had documentation of a high-quality colonoscopy. In contrast, there were suboptimal rates of mt-sDNA completion and documentation of shared decision making. Further studies are needed to identify barriers to documentation of shared-decision making and to completion of high-quality colonoscopies in patients being screened with mt-sDNA.
ABSTRACT
Purpose/Background: Combined endoscopic robotic surgery (CERS) is a novel surgical technique that modifies traditional endoscopic laparoscopic surgery with robotic assistance to aid in removal of complex colonic polyps. Hypothesis/Aim: This study aimed to evaluate the safety and outcomes of combined endoscopic robotic surgery. Methods/Interventions: A retrospective review of a prospective database was conducted. Patients underwent CERS by a single colorectal surgeon from March 2018 to October 2021. Polyps were initially found by a referring gastroenterologist and deemed unresectable by traditional endoscopy. Complex polyps were identified in the colon endoscopically while the da Vinci Xi robot was utilized to aid in polyp resection. Once complete, the resection site was over-sewn with absorbable Lembert sutures under endoscopic supervision. Based on pathology, patients were instructed to undergo repeat colonoscopy 3 to 12 months from their operative date. Results/Outcome(s): Combined endoscopic and robotic surgery was successfully completed in 85 of 93 (91%) cases. Patients were converted to other procedures due to discovery of a smaller polyp than anticipated, concern for malignancy, involvement of the ileocecal valve, inability to lift the polyp, or involvement of the appendiceal stump. Among the 85 participants seeing CERS to completion, average age was 66 years (SD=10), body mass index was 29 (SD=6), and history of abdominal surgeries was 1 (SD=1). Median operative time and polyp size were 73 mins (range 31-184 mins) and 40 mm (range 5-180 mm), respectively. Most common polyp locations were cecum, ascending, and transverse colon (29%, 29%, 24%). Pathology mainly demonstrated tubular adenoma (76%). To date, 40 patients underwent follow-up colonoscopy, with an average follow-up time of 7 months (range 3-22 months). Of those, one patient (2.5%) had resection site polyp recurrence. Limitations: Limitations for our study include lack of randomization and follow-up rate to assess for recurrence. The low compliance rate may be due to patient reluctance to get a colonoscopy or procedure cancelations/ difficulty scheduling due to changing COVID-19 regulations. Conclusions/Discussion: Most recent literature reports median operative times for combined endoscopic laparoscopic surgery (CELS) as 85 mins (range 50-225 mins) and 135 mins (range 120-170 mins). Resection site polyp recurrence for traditional endoscopic mucosal resection and CELS ranges from 13.1% and 3.3-10%, respectively. Our findings suggest that CERS is associated with decreased operating time and resection site polyp recurrence. Overall, CERS is a practical technique that enhances current methods for the resection of complex colonic polyps.
ABSTRACT
Introduction: Multisystem Inflammatory Syndrome in Children (MISC) is a new and life-threatening disease temporally associated to Covid-19. Objectives: The aim of the study is to analyze the clinical, laboratoristic and instrumental features of patients with diagnosis of MIS-C at the onset in order to early recognize the disease. Methods: We retrospectively reviewed clinical records of children admitted to our Emergency Department between April 2020 and March 2021, who were ultimately diagnosed with MIS-C associated with SARS-CoV2. Data collected included all clinical and laboratory parameters at presentation to the Emergency Department. We also recorded data regarding the duration of fever and hospitalization and the presence of abnormalities at chest X-ray, abdominal and cardiac ultrasound. Results: Clinical and laboratory data of the twenty-seven children retrospectively enrolled, including symptoms at presentation to the Emergency Department, are summarized in Table 1. Median duration of fever was 4 days (range 1.5 - 7). With the exception of fever, abdominal pain and diarrhea were the most frequent complaints at presentation. No significant differences were found between laboratory parameters in children with or without abdominal pain, diarrhea, vomit, conjunctivitis or rash. Heart ultrasound showed no abnormalities in 11 out of 27 children (41%). Findings in other children were mainly represented by mild pericardial effusion (29.6%) and mild mitral valve insufficiency (25.9%). Minor abnormalities in the interventricular septal dynamics were detected in 3 subjects (11.1%). Abdominal ultrasound was unremarkable in 5 out of 27 patients (18.5%). Most children (51.8%) had mild-to-moderate peritoneal effusion, which was often associated with ileal loops wall thickening (29.6%). The thickened segments were mostly located in proximity of the ileo-cecal valve or of the appendix. Mesenteric lymphadenitis was found in eleven children (40.7%). No significant differences were found in clinical or laboratory parameters between children with abnormal heart or abdominal ultrasounds and those without pathologic findings at these exams. Chest X ray at presentation showed no significant abnormalities in most patients, and only the child who died one day after admission showed bilateral basal opacities. Conclusion: The collected data allow to identify clinical and laboratoristic tic elements of patients admitted to Emergency care unit to provide early recognition of the MIS-C .The study included a modest sample size and for this reason the generalizability of results is limited. A national multicentre study is ongoing.
ABSTRACT
Aim of the study: The aim of the study was to determine the influence of fascial and soft tissue treatment on respiratory efficiency and chest mobility of men and women between 22 and 54 years old. Materials and Methods: Subjects between 22 and 54 y.o., vaccinated or healed from CoViD-19 and without any other pathologies were recruited. Fascial and soft tissues manual treatment was made on mesentery's roots, right pillar of diaphragm and ileocecal valve. Spirometry was executed before and after the treatment. Patients had been adequately instructed on how to make a spirometry. Results: FEV1 showed an average increase of 2% meanwhile FEF2575 showed an average increase of 14.38% [from 0.26% to 31.76%]. Conclusions: Although FEV1's improvement is not indicative, there is an improvement in FEF2575 indicating better spontaneous return of the diaphragm to its resting state after the treatment. The treatment doesn't act on filling because we have seen that the increase in FEV1 is not significant but it affects emptying so it could be interesting to evaluate how patients are able, after the treatment, to better empty themselves and, since better emptying is a prerequisite for better filling, whether and how the residual functional capacity improves. It is as if with the treatment we had made patients learn to better empty themselves, getting therefore a more elastic return of the diaphragm in its relaxed position. There is a gain except for smokers who always remain hyperinflated emphasizing then how the share of emphysema is already measurable for the smoker.