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1.
Minerva Surg ; 79(3): 303-308, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38847767

ABSTRACT

BACKGROUND: Our aim was to describe the clinical outcomes of surgical interventions performed for the management of colonoscopy-related perforations and to compare these outcomes with those of matched colorectal surgeries performed in elective and emergency settings. METHODS: We included patients with endoscopic colonic perforation who underwent surgical intervention from the 2014-2017 National Surgery Quality Improvement Program participant use data colorectal targeted procedure file. The primary outcome in this study was short term surgical morbidity and mortality. Patients (group 1) were matched with 1:2 ratio to control patients undergoing same surgical interventions for other indications on an elective (group 2) or emergency basis (group 3). Bivariate analysis was conducted to compare categorical variables between the three groups, and multivariate logistic regression was used to evaluate the association between the surgical indication and 30-day postoperative outcomes. RESULTS: A total of 590 patients were included. The average age of the patients was 66.5±13.6 with female gender predominance (381, 64.6%) The majority of patients underwent open colectomy (365, 61.9%) while the rest had suturing (140, 23.7%) and laparoscopic colectomy (85, 14.4%). Overall mortality occurred in 4.1% and no statistically significant difference in mortality was found between the three techniques (P=0.468). Composite morbidity occurred in 163 patients (27.6%). It was significantly lower in laparoscopic colectomy (14.1%) compared to 30.2% and 29.4% in open colectomy and suturing approaches (P=0.014). Patients undergoing colectomy for iatrogenic colonic perforation had less mortality, infection rates and sepsis, as well as bleeding episodes compared to those who had colectomy on an emergent basis. Outcomes were comparable between the former group and patients undergoing elective colectomy for other indications. CONCLUSIONS: Surgical management of colonoscopy related perforations is safe and effective with outcomes that are similar to that of patients undergoing elective colectomy.


Subject(s)
Colectomy , Colonoscopy , Intestinal Perforation , Humans , Intestinal Perforation/surgery , Intestinal Perforation/mortality , Intestinal Perforation/epidemiology , Female , Male , Aged , Colonoscopy/adverse effects , Middle Aged , Case-Control Studies , Laparoscopy , Postoperative Complications/epidemiology , Postoperative Complications/mortality , Retrospective Studies , Elective Surgical Procedures , Colonic Diseases/surgery , Colonic Diseases/mortality , Colon/surgery , Colon/injuries , Suture Techniques , Treatment Outcome , Aged, 80 and over
4.
Ulus Travma Acil Cerrahi Derg ; 30(5): 361-369, 2024 May.
Article in English | MEDLINE | ID: mdl-38738679

ABSTRACT

Magnet ingestion in children can lead to serious complications, both acutely and chronically. This case report discusses the treatment approach for a case involving multiple magnet ingestions, which resulted in a jejuno-colonic fistula, segmental intestinal volvulus, hepa-tosteatosis, and renal calculus detected at a late stage. Additionally, we conducted a literature review to explore the characteristics of intestinal fistulas caused by magnet ingestion. A six-year-old girl was admitted to the Pediatric Gastroenterology Department pre-senting with intermittent abdominal pain, vomiting, and diarrhea persisting for two years. Initial differential diagnoses included celiac disease, cystic fibrosis, inflammatory bowel disease, and tuberculosis, yet the etiology remained elusive. The Pediatric Surgery team was consulted after a jejuno-colonic fistula was suspected based on magnetic resonance imaging findings. The physical examination revealed no signs of acute abdomen but showed mild abdominal distension. Subsequent upper gastrointestinal series and contrast enema graphy confirmed a jejuno-colonic fistula and segmental volvulus. The family later reported that the child had swallowed a magnet two years prior, and medical follow-up had stopped after the spontaneous expulsion of the magnets within one to two weeks. Surgical intervention was necessary to correct the volvulus and repair the large jejuno-colonic fistula. To identify relevant studies, we conducted a detailed literature search on magnet ingestion and gastrointestinal fistulas according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We identified 44 articles encompassing 55 cases where symptoms did not manifest in the acute phase and acute abdomen was not observed. In 29 cases, the time of magnet ingestion was unknown. Among the 26 cases with a known ingestion time, the average duration until fistula detection was 22.8 days (range: 1-90 days). Fistula repairs were performed via laparotomy in 47 cases.


Subject(s)
Intestinal Fistula , Humans , Female , Intestinal Fistula/etiology , Intestinal Fistula/surgery , Child , Foreign Bodies/complications , Foreign Bodies/surgery , Foreign Bodies/diagnostic imaging , Magnets/adverse effects , Malabsorption Syndromes/etiology , Malabsorption Syndromes/diagnosis , Jejunal Diseases/etiology , Jejunal Diseases/surgery , Jejunal Diseases/diagnosis , Intestinal Volvulus/surgery , Intestinal Volvulus/etiology , Intestinal Volvulus/diagnosis , Colonic Diseases/etiology , Colonic Diseases/surgery
5.
Nat Rev Gastroenterol Hepatol ; 21(6): 377-405, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38763974

ABSTRACT

The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.


Subject(s)
Rectal Diseases , Humans , Rectal Diseases/physiopathology , Rectal Diseases/therapy , Rectal Diseases/etiology , Rectal Diseases/diagnosis , Colonic Diseases/therapy , Colonic Diseases/physiopathology , Colonic Diseases/etiology , Sexual Behavior/physiology , Anus Diseases/therapy , Anus Diseases/physiopathology , Anus Diseases/etiology , Anus Diseases/diagnosis , Pleasure/physiology , Sexual Dysfunction, Physiological/etiology , Sexual Dysfunction, Physiological/therapy , Sexual Dysfunction, Physiological/physiopathology
6.
BMC Vet Res ; 20(1): 160, 2024 Apr 26.
Article in English | MEDLINE | ID: mdl-38671452

ABSTRACT

BACKGROUND: Ventricular bigeminy due to myocardial ischemia has been reported in humans as well as in canine patients with obstructive gastrointestinal diseases. This is the first case report of ventricular bigeminy in a dog with a colonic torsion that resolved after fluid resuscitation and restoration of myocardial perfusion. CASE PRESENTATION: An 11-year-old, male neutered mixed breed dog presented with a one day history of vomiting, tenesmus, and lethargy. Physical examination identified an irregular heart rhythm and intermittent pulse deficits. A ventricular arrhythmia represented by ventricular premature complexes (VPCs) organized in bigeminy, was appreciated on a 3-lead electrocardiogram (ECG) with a single lead (II) view. Abdominal radiographs confirmed a colonic torsion. Prior to anesthetic induction, ventricular bigeminy was non responsive to fentanyl or lidocaine. The patient was anesthetized and intravascular volume deficit was identified by dampened plethysmographic wave amplitude (plethysomographic variability), audible softening of the Doppler sound, and more pronounced pulse deficits. Fluid resuscitation was achieved with a combination of intravenous crystalloid and colloid fluid therapy comprising 7.2% hypertonic saline and 6% hetastarch. The patient's cardiac rhythm converted to normal sinus after fluid resuscitation. The colonic torsion was surgically corrected. The patient recovered well from anesthesia and was ultimately discharged from the hospital 5 days later. CONCLUSIONS: The present case report highlights that myocardial ischemia can lead to ventricular arrythmias, such as ventricular bigeminy. This is the first documented case of ventricular bigeminy in the canine patient with a colonic torsion. Assessment of patient volume status and appropriate fluid resuscitation along with continuous electrocardiogram (ECG) monitoring are vital to patient stability under general anesthesia.


Subject(s)
Dog Diseases , Fluid Therapy , Myocardial Ischemia , Dogs , Animals , Male , Dog Diseases/therapy , Fluid Therapy/veterinary , Myocardial Ischemia/veterinary , Colonic Diseases/veterinary , Colonic Diseases/therapy , Colonic Diseases/etiology , Electrocardiography/veterinary , Ventricular Premature Complexes/veterinary , Ventricular Premature Complexes/etiology , Ventricular Premature Complexes/therapy , Torsion Abnormality/veterinary
8.
Int J Surg ; 110(4): 2381-2388, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38668664

ABSTRACT

BACKGROUND: A colosplenic fistula (CsF) is an extremely rare complication. Its diagnosis and management remain poorly understood, owing to its infrequent incidence. Our objective was to systematically review the etiology, clinical features, diagnosis, management, and prognosis to help clinicians gain a better understanding of this unusual complication and provide aid if it is to be encountered. METHODS: A systematic review of studies reporting CsF diagnosis in Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and Wiley Cochrane Library from 1946 to June 2022. Additionally, a retrospective review of four cases at our institution were included. Cases were evaluated for patient characteristics (age, sex, and comorbidities), CsF characteristics including causes, symptoms at presentation, diagnosis approach, management approach, pathology findings, intraoperative complications, postoperative complications, 30-day mortality, and prognosis were collected. RESULTS: Thirty patients with CsFs were analyzed, including four cases at our institution and 26 single-case reports. Most of the patients were male (70%), with a median age of 56 years. The most common etiologies were colonic lymphoma (30%) and colorectal carcinoma (17%). Computed tomography (CT) was commonly used for diagnosis (90%). Approximately 87% of patients underwent a surgical intervention, most commonly segmental resection (81%) of the affected colon and splenectomy (77%). Nineteen patients were initially managed surgically, and 12 patients were initially managed nonoperatively. However, 11 of the nonoperative patients ultimately required surgery due to unresolved symptoms. The rate of postoperative complications was (17%). Symptoms resolved with surgical intervention in 25 (83%) patients. Only one patient (3%) had had postoperative mortality. CONCLUSIONS: Our review of 30 cases worldwide is the largest in literature. CsFs are predominantly complications of neoplastic processes. CsF may be successfully and safely treated with splenectomy and resection of the affected colon, with a low rate of postoperative complications.


Subject(s)
Splenic Diseases , Humans , Splenic Diseases/surgery , Splenic Diseases/diagnosis , Splenic Diseases/therapy , Male , Female , Middle Aged , Intestinal Fistula/surgery , Intestinal Fistula/diagnosis , Splenectomy , Adult , Aged , Postoperative Complications , Colonic Diseases/surgery , Colonic Diseases/diagnosis , Colonic Diseases/therapy , Tomography, X-Ray Computed
9.
BMJ Open ; 14(4): e080989, 2024 Apr 28.
Article in English | MEDLINE | ID: mdl-38684268

ABSTRACT

INTRODUCTION: Endometriosis is a prevalent gynaecological condition for women of reproductive age worldwide. While endometriosis primarily involves the reproductive system, it can also infiltrate additional viscera such as the gastrointestinal tract. Patients with colorectal endometriosis can have severe symptoms that require surgical intervention. There are limited data available to guide the choice of resection technique based on the functional outcomes of bowel resection versus shaving or disc excision in treating colorectal endometriosis. This protocol aims to outline the methods that will be used in a systematic review of the literature comparing the functional outcomes of bowel resection to shaving and disc excision when surgically treating colorectal endometriosis. METHODS AND ANALYSIS: Papers will be identified through database searches, scanning reference lists of relevant studies and citation searching of key papers. Two independent reviewers will screen studies against eligibility criteria and extract data using standardised forms. Databases including MEDLINE, EMBASE and Cochrane will be searched from the beginning of each database until February 2024. The primary outcome is comparing the functional bowel outcomes between the different methods of surgical treatment. Secondary outcome will be quality of life, based on the Low Anterior Resection Syndrome score and the incidence of postoperative pain. A meta-analysis will be performed if the data are homogenous. ETHICS AND DISSEMINATION: This study does not require ethics approval. The results of the systematic review described within this protocol will be disseminated through presentations at relevant conferences and publication in a peer-reviewed journal. The methods will be used to inform future reviews. PROSPERO REGISTRATION NUMBER: CRD42023461711.


Subject(s)
Endometriosis , Rectal Diseases , Systematic Reviews as Topic , Humans , Endometriosis/surgery , Female , Rectal Diseases/surgery , Quality of Life , Research Design , Colonic Diseases/surgery , Treatment Outcome
10.
Int J Mol Sci ; 25(7)2024 Apr 03.
Article in English | MEDLINE | ID: mdl-38612808

ABSTRACT

We examined the localization of the 5-hydroxytryptamine (5-HT) receptor and its effects on mouse colonic interstitial cells of Cajal (ICCs) using electrophysiological techniques. Treatment with 5-HT increased the pacemaker activity in colonic ICCs with depolarization of membrane potentials in a dose-dependent manner. Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blockers blocked pacemaker activity and 5-HT-induced effects. Moreover, an adenylate cyclase inhibitor inhibited 5-HT-induced effects, and cell-permeable 8-bromo-cAMP increased the pacemaker activity. Various agonists of the 5-HT receptor subtype were working in colonic ICCs, including the 5-HT4 receptor. In small intestinal ICCs, 5-HT depolarized the membrane potentials transiently. Adenylate cyclase inhibitors or HCN blockers did not show any influence on 5-HT-induced effects. Anoctamin-1 (ANO1) or T-type Ca2+ channel blockers inhibited the pacemaker activity of colonic ICCs and blocked 5-HT-induced effects. A tyrosine protein kinase inhibitor inhibited pacemaker activity in colonic ICCs under controlled conditions but did not show any influence on 5-HT-induced effects. Among mitogen-activated protein kinase (MAPK) inhibitors, a p38 MAPK inhibitor inhibited 5-HT-induced effects on colonic ICCs. Thus, 5-HT's effect on pacemaker activity in small intestinal and colonic ICCs has excitatory but variable patterns. ANO1, T-type Ca2+, and HCN channels are involved in 5-HT-induced effects, and MAPKs are involved in 5-HT effects in colonic ICCs.


Subject(s)
Colonic Diseases , Interstitial Cells of Cajal , Animals , Mice , Male , Serotonin/pharmacology , Leydig Cells , Adenylyl Cyclase Inhibitors , Calcium Channel Blockers , Protein Kinase Inhibitors
11.
Nutr Hosp ; 41(2): 510-513, 2024 Apr 26.
Article in Spanish | MEDLINE | ID: mdl-38450523

ABSTRACT

Introduction: Introduction: gastrocolic fistula is an infrequent but severe complication of percutaneous gastrostomy. Clinical suspicion in the presence of chronic diarrhea of unknown etiology manifesting after percutaneous radiological gastrostomy (PRG) tube replacement is key to early detection and treatment. Case report: we report the case of a patient with PRG that began with chronic diarrhea after tube replacement and developed severe malnutrition. Initial treatment was not effective, studies were extended with the finding of this complication in a CT image. The use of this tube was discontinued with resolution of diarrhea and a favorable nutritional outcome. Discussion: this case report shows the importance of considering gastrocolic fistula in the differential diagnosis of persistent diarrhea in a patient with a gastrostomy tube.


Introducción: Introducción: la fístula gastrocólica supone una complicación infrecuente pero potencialmente grave de las sondas de gastrostomía. La sospecha clínica ante una diarrea de origen incierto que comienza tras el recambio de la sonda es clave para la detección y el tratamiento precoces. Caso clínico: se presenta el caso de un paciente portador de gastrostomía radiológica percutánea (PRG) que comienza con diarrea persistente tras el primer recambio de la sonda y desnutrición grave secundaria. Tras el fracaso de las medidas terapéuticas iniciales se amplían los estudios, con hallazgo de esta complicación en la imagen de TC. Se suspende el uso de esta sonda con resolución de la diarrea y evolución nutricional favorable. Discusión: este caso pone de manifiesto la importancia de incluir la fístula gastrocólica en el diagnóstico diferencial de la diarrea persistente en un paciente portador de sonda de gastrostomía.


Subject(s)
Diarrhea , Gastric Fistula , Gastrostomy , Intestinal Fistula , Humans , Male , Chronic Disease , Colonic Diseases/etiology , Colonic Diseases/therapy , Diarrhea/etiology , Gastric Fistula/etiology , Gastrostomy/adverse effects , Intestinal Fistula/etiology , Intestinal Fistula/therapy , Postoperative Complications/etiology , Postoperative Complications/therapy , Tomography, X-Ray Computed , Aged
13.
Clin J Gastroenterol ; 17(3): 466-471, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38504057

ABSTRACT

Adult-onset intussusception, particularly associated with colonoscopy, is extremely rare. A 78-year-old man, referred to our hospital for colonic endoscopic mucosal resection (EMR), experienced subsequent dull abdominal pain, as well as elevated peripheral blood leukocytosis and C-reactive protein levels. Abdominal computed tomography (CT) revealed a colocolonic intussusception at the hepatic flexure. Emergency colonoscopy revealed ball-like swollen mucosa distal to the EMR site of the ascending colon. The mucosa was intact without necrosis. The endoscopic approach was able to temporarily release the intussusception. A transanal drainage tube was inserted through the endoscope to prevent relapse. Both CT and colonoscopy showed release of the intussusception. Our case underscores the importance of considering colocolonic intussusception in post-colonoscopy abdominal pain, advocating for endoscopic management after excluding mucosal necrosis.


Subject(s)
Colonic Diseases , Endoscopic Mucosal Resection , Intussusception , Humans , Aged , Male , Intussusception/surgery , Intussusception/etiology , Intussusception/diagnostic imaging , Endoscopic Mucosal Resection/adverse effects , Endoscopic Mucosal Resection/methods , Colonic Diseases/surgery , Colonic Diseases/etiology , Colonoscopy/methods , Tomography, X-Ray Computed , Intestinal Mucosa/surgery , Postoperative Complications/surgery , Postoperative Complications/etiology
14.
Am Surg ; 90(7): 1913-1915, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38516737

ABSTRACT

Successful surgical management of a chronic complex abdominal fistula requires thoughtful pre-operative evaluation and planning and often benefits from a multi-disciplinary approach. Initially, attention is focused on controlling sepsis and ensuring adequate hydration and electrolyte replacement. Next, efforts to optimize nutrition and engage the patient in prehabilitation are prioritized. Simultaneously, imaging is used to gain detailed assessment of anatomy. We present a challenging case involving a Jackson-Pratt (JP) drain from prior surgery causing a complex intra-abdominal fistula. The JP drain traversed multiple small bowel loops and the sigmoid colon before terminating in the bladder. Management required multi-disciplinary coordination involving colorectal surgery and urology. The patient's definitive surgery included anterior resection, colostomy takedown, right colectomy, three small bowel resections, and bladder repair. The use of JP drains after abdominal surgery is not without risk. Clinicians should have standardized indications for placement of JP drains and consistent protocols regarding timing of removal.


Subject(s)
Intestinal Fistula , Humans , Intestinal Fistula/surgery , Intestinal Fistula/etiology , Abdominal Wall/surgery , Male , Intestine, Small/surgery , Urinary Bladder Fistula/surgery , Urinary Bladder Fistula/etiology , Middle Aged , Colonic Diseases/surgery , Colonic Diseases/etiology , Drainage/methods , Colectomy/methods
15.
Int J Biol Macromol ; 263(Pt 2): 130274, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38373569

ABSTRACT

Inulin (INU) is a versatile natural polysaccharide primarily derived from chicory roots. INU possesses the unique quality of evading digestion or fermentation in the early stages of the human digestive tract, instead reaching the lower colon directly. Exploiting on this distinctive attribute, INU finds application in the creation of targeted carrier systems for delivering drugs tailored to colon-related diseases. This study presents a novel method for synthesizing highly stable and non-aggregatory inulin nanoparticles (INU NPs) by ionotropic gelation method, using calcium chloride as crosslinker and natural honey as a stabilizing agent. Different formulation and process parameters were optimized for the synthesis of monodispersed INU NPs. These INU NPs efficiently encapsulated a hydrophilic drug irinotecan hydrochloride trihydrate (IHT) and drug loaded formulation (IINPs) demonstrated excellent colloidal and storage stabilities. Notably, these IINPs exhibited pH-dependent drug release, suggesting potential for colon-specific drug delivery. Anticancer activity of the NPs was found significantly higher in comparison to IHT through cytotoxicity and apoptosis studies against human colorectal carcinoma cells. Overall, this study revealed that the INU NPs synthesized by ionotropic gelation will be an efficient nanocarrier system for colon-targeted drug delivery due to their exceptional biocompatibility and stability in stomach and upper intestinal conditions.


Subject(s)
Colonic Diseases , Honey , Nanoparticles , Humans , Inulin , Drug Carriers , Drug Delivery Systems
16.
Ann Saudi Med ; 44(1): 26-30, 2024.
Article in English | MEDLINE | ID: mdl-38311871

ABSTRACT

BACKGROUND: Solitary rectal ulcer syndrome (SRUS) is a very rare benign defecation disorder characterized by distinct clinical features and histological findings. Conventional measures are often shown to be ineffective for the treatment of ulcers. Argon plasma coagulation (APC) has recently been shown to be an effective treatment method for SRUS that is refractory to conventional therapy. OBJECTIVES: Determine the efficacy of APC treatment for patients suffering from SRUS. DESIGN: Prospective, single center. SETTINGS: Gastroenterology department at a military hospital in Pakistan. PATIENTS AND METHODS: This prospective study included patients with symptoms of rectal bleeding diagnosed with SRUS. Patients were recruited on the basis of clinical, sigmoidoscopic, and histological findings from September 2022 to March 2023. All patients had received conventional treatment initially and were assessed for persistence of symptoms. APC was performed only for those patients who were refractory to standard treatment. MAIN OUTCOME MEASURES: Effectiveness of APC for resistant SRUS. SAMPLE SIZE: 99 patients. RESULTS: The 99 patients diagnosed with SRUS had a median (minimum-maximum) age of patients was 20 (9-41) years. All the patients had undergone conventional treatment, which included the use of laxatives, drinking plenty of water and practicing biofeedback. After this standard treatment, 19 patients (19.19%) recovered fully. However, the remaining 80 patients did not show improvement and underwent APC sessions, out of which 61 patients (76.3%) achieved complete healing of ulcers, while the remaining 19 (23.8%) had no improvement at all. None of the patients reported post session complications. CONCLUSION: APC is an effective therapy with very promising results for rectal ulcer hemorrhage. It also helps with ulcer healing and alleviates clinical symptoms. However, further controlled investigations are required to consolidate the use of APC in SRUS patients. LIMITATIONS: Single centered.


Subject(s)
Colonic Diseases , Rectal Diseases , Humans , Young Adult , Adult , Prospective Studies , Ulcer/therapy , Ulcer/diagnosis , Ulcer/pathology , Argon Plasma Coagulation/adverse effects , Rectal Diseases/surgery , Rectal Diseases/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery
17.
BMC Gastroenterol ; 24(1): 80, 2024 Feb 22.
Article in English | MEDLINE | ID: mdl-38388860

ABSTRACT

OBJECTIVES: Poorly visualized images that appear during small bowel capsule endoscopy (SBCE) can confuse the interpretation of small bowel lesions and increase the physician's workload. Using a validated artificial intelligence (AI) algorithm that can evaluate the mucosal visualization, we aimed to assess whether SBCE reading after the removal of poorly visualized images could affect the diagnosis of SBCE. METHODS: A study was conducted to analyze 90 SBCE cases in which a small bowel examination was completed. Two experienced endoscopists alternately performed two types of readings. They used the AI algorithm to remove poorly visualized images for the frame reduction reading (AI user group) and conducted whole frame reading without AI (AI non-user group) for the same patient. A poorly visualized image was defined as an image with < 50% mucosal visualization. The study outcomes were diagnostic concordance and reading time between the two groups. The SBCE diagnosis was classified as Crohn's disease, bleeding, polyp, angiodysplasia, and nonspecific finding. RESULTS: The final SBCE diagnoses between the two groups showed statistically significant diagnostic concordance (k = 0.954, p < 0.001). The mean number of lesion images was 3008.5 ± 9964.9 in the AI non-user group and 1401.7 ± 4811.3 in the AI user group. There were no cases in which lesions were completely removed. Compared with the AI non-user group (120.9 min), the reading time was reduced by 35.6% in the AI user group (77.9 min). CONCLUSIONS: SBCE reading after reducing poorly visualized frames using the AI algorithm did not have a negative effect on the final diagnosis. SBCE reading method integrated with frame reduction and mucosal visualization evaluation will help improve AI-assisted SBCE interpretation.


Subject(s)
Capsule Endoscopy , Colonic Diseases , Crohn Disease , Humans , Artificial Intelligence , Intestine, Small/diagnostic imaging , Intestine, Small/pathology , Crohn Disease/diagnostic imaging , Crohn Disease/surgery , Retrospective Studies
18.
Am J Surg ; 232: 131-137, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38365550

ABSTRACT

BACKGROUND: Studies comparing opioid needs between benign and malignant colorectal diseases are inconclusive. METHODS: Single institution analysis of prospectively maintained colorectal surgery database. Multiple regression analyses done on perioperative numeric pain scores (NPS) and opioids prescribed at discharge. RESULTS: 641 patients in Benign and 276 patients in the Malignant group. Unadjusted comparison revealed significantly higher NPS for the Benign than the Malignant group preoperative and postoperative day 0 (after surgery), 1, 2, and 3 (all p â€‹≤ â€‹0.001). Opioids prescribed at discharge were significantly higher in the Benign group (60.0% vs 51.1%, p â€‹= â€‹0.018). After regression analysis, there was no longer a significant difference in NPS (B â€‹= â€‹0.703, p â€‹= â€‹0.095) and opioids prescribed between groups [OR â€‹= â€‹0.803 (95%CI 0.586, 1.1), p â€‹= â€‹0.173]. CONCLUSIONS: Pain and opioids prescribed at discharge are not significantly different between benign and malignant diseases in an enhanced recovery pain management pathway that maximizes non-opioid multimodal analgesic strategies.


Subject(s)
Analgesics, Opioid , Colorectal Neoplasms , Pain, Postoperative , Humans , Analgesics, Opioid/therapeutic use , Analgesics, Opioid/administration & dosage , Female , Male , Pain, Postoperative/drug therapy , Middle Aged , Aged , Colorectal Neoplasms/surgery , Pain Measurement , Pain Management/methods , Retrospective Studies , Rectal Diseases/surgery , Colectomy/adverse effects , Colonic Diseases/surgery , Adult
19.
Front Immunol ; 15: 1287632, 2024.
Article in English | MEDLINE | ID: mdl-38343544

ABSTRACT

Objective: Colorectal cancer (CRC) is the third most prevalent cancer worldwide and is associated with high morbidity and mortality rates. Colorectal carcinogenesis occurs via the conventional adenoma-to-carcinoma and serrated pathways. Conventional T helper (Th) and innate lymphoid cells (ILCs) play vital roles in maintaining intestinal homeostasis. However, the contribution of these two major lymphoid cell populations and their associated cytokines to CRC development is unclear. Therefore, we aimed to analyze peripheral lymphocyte profiles during colorectal carcinogenesis. Methods: We collected 86 blood samples concurrently, and pathologists confirmed the presence of various pathological conditions (i.e., HPs, adenoma, and carcinoma) using hematoxylin and eosin staining. Ten healthy donors were recruited as healthy controls (HCs) from the physical examination center. We performed flow cytometry on peripheral blood mononuclear cells collected from patients with various pathological conditions and the HCs, and cytokines (interleukin-2, interleukin-4, interleukin-5, interleukin-13, interleukin-17A, interleukin-17F, interleukin-22, interferon-γ, and tumor necrosis factor-α) were quantified. We also analyzed the published single-cell RNA sequence data derived from tissue samples from different stages of colorectal carcinogenesis. Results: The cytokine response in peripheral CD4+ T cells was upregulated during the carcinoma process. The frequency of peripheral regulatory T cells (Tregs) increased in the adenoma and carcinoma stages. While the T follicular helper (Tfh) cell proportion was downregulated in the adenoma and carcinoma processes. Thus, Th cell subsets, especially Tregs and Tfh cells, were involved in colonic diseases. Moreover, the immunological profile characteristics in the HPs were clarified. Conclusion: We comprehensively analyzed circulating ILCs and adaptive T-cell lymphocyte subtypes in colorectal carcinoma progression. Our results show the immunological profile characteristics and support the involvement of Th subsets, especially Treg and Tfh cell populations, in colonic diseases. These findings significantly enhance our understanding of the immune mechanisms underlying CRC and its precancerous lesions. Further investigation of the Treg and Tfh cells' function in colorectal disease development will provide potential therapeutic targets for monitoring and preventing CRC development.


Subject(s)
Adenoma , Carcinoma , Colonic Diseases , Colorectal Neoplasms , Humans , T-Lymphocytes, Regulatory/pathology , Leukocytes, Mononuclear/pathology , Immunity, Innate , Lymphocytes/pathology , T-Lymphocytes, Helper-Inducer , Cytokines/metabolism , Colorectal Neoplasms/pathology , Colonic Diseases/metabolism , Carcinoma/metabolism , Carcinogenesis/metabolism , Adenoma/metabolism
20.
World J Gastroenterol ; 30(3): 199-203, 2024 Jan 21.
Article in English | MEDLINE | ID: mdl-38314131

ABSTRACT

Medical care has undergone remarkable improvements over the past few decades. One of the most important innovative breakthroughs in modern medicine is the advent of minimally and less invasive treatments. The trend towards employing less invasive treatment has been vividly shown in the field of gastroenterology, particularly coloproctology. Parallel to foregut interventions, colorectal surgery has shifted towards a minimally invasive approach. Coloproctology, including both medical and surgical management of colorectal diseases, has undergone a remarkable paradigm shift. The treatment of both benign and malignant colorectal conditions has gradually transitioned towards more conservative and less invasive approaches. An interesting paradigm shift was the trend to avoid the need for radical resection of rectal cancer altogether in patients who showed complete response to neoadjuvant treatment. The trend of adopting less invasive approaches to treat various colorectal conditions does not seem to be stopping soon as further research on novel, more effective and safer methods is ongoing.


Subject(s)
Colonic Diseases , Digestive System Surgical Procedures , Laparoscopy , Rectal Neoplasms , Humans , Rectal Neoplasms/surgery , Colonic Diseases/surgery , Digestive System Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures
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