Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or inc...Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or incomplete resections and is now recognized as one of the most reliable quality indicators for assessing colonoscopy performance.With an incidence rate of 3.6%to 9.3%,PCCRC remains a significant concern,highlighting the limitations of colonoscopy in CRC screening—not only in terms of diagnostic accuracy but also in its preventive role and effectiveness in treating lesions.A range of clinical,endoscopic,and biological factors has been associated with an increased risk of PCCRC.Identifying these factors can help stratify high-risk patients,enabling earlier detection and improving preventive strategies for interval CRC.Reducing PCCRC should be a top priority for every endoscopy unit.While technological advancements will enhance polyp detection,minimize missed lesions,prevent incomplete resections,and improve overall procedural quality,the most impactful strategy remains internal self-assessment within each unit.This review should evaluate key performance metrics,including cecal intubation rate,adenoma detection rate,withdrawal time,PCCRC incidence,and incomplete resections—both at the individual endoscopist level and across the entire unit.展开更多
Background:We present a case of two major complications following insertion of a nephrostomy managed in a minimally invasive way.Our case is the first in the literature to describe this minimally invasive treatment te...Background:We present a case of two major complications following insertion of a nephrostomy managed in a minimally invasive way.Our case is the first in the literature to describe this minimally invasive treatment technique for colon perforation in a completely asymptomatic patient.Case Description:A 75-year-old female patient with a history of bilateral obstructive uropathy secondary to bilateral radiation-induced ureteric strictures attended for bilateral nephrostomy placement.The patient had a history of endometrial cancer,treated previously by total hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemo-radiotherapy and brachytherapy.Her recovery had been further complicated by the development of radiation cystitis,small bowel resection,and short gut syndrome.The strictures had previously been managed with bilateral double J stents,which have now failed.A left-sided nephrostomy insertion was performed.ACT-scan prompted by a repeat deterioration in renal function revealed a right-sided hydronephrosis and suggested transcolic passage of the previously placed leftsided nephrostomy.She had remained clinically well and apyretic.A right-sided nephrostomy was inserted,and the left re-sited following a colonoscopy-guided nephrostomy removal and clip occlusion of the nephrostomy tract.The patient then developed a pseudoaneurysm,which was managed with embolization.The patient was able to return home with corrected kidney function.The three-monthly checks for changes in nephrostomy catheters did not reveal any complications.Conclusions:The patient therefore presented with two major complications of nephrostomy placement:colonic perforation and pseudoaneurysm,classified as Clavien IIIb and IIIa,respectively.Multidisciplinary management,including urologists,gastroenterologists,general surgeons,and radiologists,enabled a minimally invasive management.Minimally invasive management with endoscopic clip placement appears to be a safe alternative to directed fistula of colonic perforation.展开更多
Background Weaning-induced diarrhoea and growth retardation in piglets are associated with impaired intestinal barrier function and decreased levels of colonic short-chain fatty acids(SCFAs).Although SCFA supplementat...Background Weaning-induced diarrhoea and growth retardation in piglets are associated with impaired intestinal barrier function and decreased levels of colonic short-chain fatty acids(SCFAs).Although SCFA supplementation has been proposed to mitigate these issues,the efficacy and optimal dosage of sodium isobutyrate remain unclear.Results We investigated the effects of sodium isobutyrate supplementation(500,1,000,2,000,and 4,000 mg/kg diet)on weaned piglets(Duroc×Landrace×Yorkshire,28 d of age;n=8).After a 28-d feeding trial,supplementation at 500–2,000 mg/kg significantly improved average daily gain and feed efficiency and reduced diarrhoea frequency,with maximal benefits observed at 1,000 mg/kg(P<0.0001).Additionally,500–1,000 mg/kg sodium isobutyrate supplementation increased the apparent digestibility of crude protein,organic matter,and crude fibre(P<0.05).Serum biochemical parameters were unaffected,although secretory immunoglobulin A(SIgA)levels significantly increased upon supplementation with 500–1,000 mg/kg(P<0.05).16S rRNA gene sequencing indicated that sodium isobutyrate increased the abundance of beneficial colonic microbiota.The 1,000 mg/kg group presented the most pronounced effect,with a significant increase of the relative abundance of Prevotella and the greatest improvement in SCFA concentrations(P<0.05).Metabolomics revealed elevated levels of colonic indole-3-lactic acid and 3-hydroxybutyrate upon supplementation with 1,000 mg/kg(P<0.05).Transcriptomic analyses indicated activation of protein digestion and absorption pathways,and PI3K-Akt signalling,marked by TSG-6 upregulation and the suppression of ISG15 and DDIT4 expression(P<0.05).Supplementation with 1,000 mg/kg was associated with improved intestinal barrier-related markers,including reduced serum D-lactate,diamine oxidase,and lipopolysaccharide levels,increased tight junction protein expression;activation of G protein-coupled receptors;and inhibition of TLR4/MyD88/NF-κB signalling(P<0.05),suggesting enhanced barrier function.Conclusions In conclusion,dietary supplementation with 1,000 mg/kg sodium isobutyrate was associated with improved intestinal morphology,reduced serum permeability,increased expression of tight junction proteins,and enhanced immune function in weaned piglets,suggesting enhanced colonic barrier function and providing dosage guidance and mechanistic insights for future applications.展开更多
The metastatic pattern of colon cancer is typically well characterized,with initial dissemination occurring through regional lymphatics,followed by hematogenous spread.The most frequent sites of metastasis in colorect...The metastatic pattern of colon cancer is typically well characterized,with initial dissemination occurring through regional lymphatics,followed by hematogenous spread.The most frequent sites of metastasis in colorectal cancer(CRC)include regional lymph nodes(50%–70%),liver(35%–50%),lungs(21%),peritoneum(15%),and ovaries(13%).1 Isolated distant lymph node metastasis,particularly in the absence of concurrent systemic disease,is exceedingly rare in CRC.To date,only six cases of isolated axillary lymph node metastasis(ALNM)from colorectal primaries have been documented in the literature.1–6 Even more uncommon is the incidental discovery of malignant cells in anastomotic doughnuts following stoma reversal procedures.Herein,we report a rare case involving both the incidental histopathological detection of tumor cells within doughnuts during stoma closure and the subsequent development of isolated ALNM after curative resection of sigmoid colon carcinoma.展开更多
Computed tomography colonography(CTC) in colorectal cancer(CRC) screening has two roles:one present and the other potential.The present role is,without any further discussion,the integration into established screening...Computed tomography colonography(CTC) in colorectal cancer(CRC) screening has two roles:one present and the other potential.The present role is,without any further discussion,the integration into established screening programs as a replacement for barium enema in the case of incomplete colonoscopy.The potential role is the use of CTC as a first-line screening method together with Fecal Occult Blood Test,sigmoidoscopy and colonoscopy.However,despite the fact that CTC has been officially endorsed for CRC screening of average-risk individuals by different scientif ic societies including the American Cancer Society,the American College of Radiology,and the US Multisociety Task Force on Colorectal Cancer,other entities,such as the US Preventive Services Task Force,have considered the evidence insuff icient to justify its use as a mass screening method.Medicare has also recently denied reimbursement for CTC as a screening test.Nevertheless,multiple advantages exist for using CTC as a CRC screening test:high accuracy,full evaluation of the colon in virtually all patients,non-invasiveness,safety,patient comfort,detection of extracolonic findings and cost-effectiveness.The main potential drawback of a CTC screening is the exposure to ionizing radiation.However,this is not a major issue,since low-dose protocols are now routinely implemented,delivering a dose comparable or slightly superior to the annual radiation exposure of any individual.Indirect evidence exists that such a radiation exposure does not induce additional cancers.展开更多
BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of con...BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.AIM To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.METHODS A search was conducted in MEDLINE,EMBASE,and Scopus from inception to August 2024.Studies reporting the clinical success,perforation,recurrence,and need for surgery after colonoscopic decompression in ACPO were included.A random-effects inverse-variance model was used to calculate the pooled proportion.RESULTS Sixteen studies were included in the final analysis.The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8%(95%CI:72.0-85.6)and 91.5%(95%CI:87.0-96.0),respectively.The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85(95%CI:2.00-7.42).The pooled incidence of perforation was 0.9%(95%CI:0.0-2.0),while recurrence was observed in 17.1%(95%CI:12.9-21.3)of the patients after clinical success.The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5%(95%CI:5.0-15.9)and 3.7%(95%CI:0.3-7.1),respectively.Subgroup analysis,excluding the low-quality studies,did not significantly change the event rates.CONCLUSION Colonoscopic decompression for ACPO is associated with a clinical success rate of>90%with a perforation rate of<1%,demonstrating high efficacy and safety.展开更多
BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,...BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,ADR can vary significantly among endoscopists,leading to missed polyps or cancer.Artificial intelligence(AI)has shown promise in improving ADR by assisting in real-time polyp identification or diagnosis.While multiple randomized controlled trials(RCTs)and metanalyses highlight the benefits of AI in increasing detection rates and reducing missed polyps,concerns remain about its real-world applicability,impact on procedure time,and cost-effectiveness.AIM To explore the current status of AI assistance colonoscopy in adenoma detection and improving quality of colonoscopy.METHODS This systematic review followed PRISMA guidelines,both PubMed and Web of Science databases were used for articles search.Metanalyses and systematic reviews that assessed AI's role during colonoscopy.English article only published between January 2000 and January 2025 were included.Articles related to nonadenoma indications were excluded.Data extraction was independently performed by two researchers for accuracy and consistency.RESULTS 22 articles met the inclusion criteria,with significant heterogeneity(I2=28%-91%)observed in multiple studies.The number of studies per metanalysis ranged from 5 to 33,with higher heterogeneity in analyses involving more than 18 RCTs.AI demonstrated improvement in ADR,with an approximate 20%increase across multiple studies.However,its effectiveness in detecting flat or serrated adenomas remains unproven.Endoscopists with low ADR benefit more from AI-colonoscopies,while expert endoscopists outperformed AI in ADR,adenoma miss rate,and the identification of advanced lesions.No significant change in withdrawal time was observed when comparing AI-assisted colonoscopy to conventional endoscopy.CONCLUSION While AI-assisted colonoscopy has been shown to improve procedural quality,particularly for junior endoscopists and those with lower ADR,its performance decreases when compared to expert endoscopists in real-time clinical practice.This is especially evident in non-randomized studies,where AI demonstrates limited real-world benefits despite its benefit in controlled settings.Furthermore,no meta-analyses have specifically examined AI's impact on the learning experience of fellows and residents.Some experts caution that reliance on AI may prevent trainees from developing essential observational skills,potentially leading to less thorough examinations.Further research is needed to determine the actual benefits of AI-colonoscopy,particularly its role in cancer prevention.As technology advances,improved outcomes are expected,especially in detecting small,flat,and lesions at difficult anatomical locations.展开更多
Colon cancer is one of the malignant tumors with high morbidity and mortality worldwide[1],and its early diagnosis is crucial for improving patient survival.However,due to the lack of obvious early symptoms of colon c...Colon cancer is one of the malignant tumors with high morbidity and mortality worldwide[1],and its early diagnosis is crucial for improving patient survival.However,due to the lack of obvious early symptoms of colon cancer,many patients are in the middle to late stage when diagnosed and miss the best time for treatment.Therefore,developing an efficient and accurate diagnostic method for colon cancer is of great clinical significance and scientific value.Currently,the current colon cancer biomarkers carcinoembryonic antigen and carbohydrate antigen 19-9[2]have low sensitivity and specificity,the emerging markers circulating tumor DNA(ctDNA)and miRNA face high cost and standardization challenges,and the existing methods lack spatial resolution,prompting the incorporation of spatial metabolomics technologies to enhance diagnostic capabilities.展开更多
Colorectal cancer (CRC) remains a leading cancer killer worldwide. But the disease is both curable and preventable at an early stage. Regular CRC cancer screening has been shown to reduce the risk of dying from CRC. H...Colorectal cancer (CRC) remains a leading cancer killer worldwide. But the disease is both curable and preventable at an early stage. Regular CRC cancer screening has been shown to reduce the risk of dying from CRC. However, the importance of large-scale screening is only now starting to be appreciated. This article reviews a variety of imaging procedures available for detecting ulcerative colitis (UC) and Crohn's disease (CD), polyps and CRC in their early stage and also presents details on various screening options. Detecting, staging and re-staging of patients with CRC also require multimodality, multistep imaging approaches. Staging and re-staging with conventional colonoscopy (CC), computer tomography colonography (CTC), magnetic resonance colonography (MRC) and positron emission tomography/computer tomography colonography (PET/CTC) are of paramount importance in determining the most appropriate therapeutic method and in predicting the risk of tumor recurrence and overall prognosis. The advantages and limitations of these modalities are also discussed.展开更多
This article explored the application of dexmedetomidine(Dex),a highly selective alpha-2 agonist,in managing postoperative cognitive dysfunction(POCD)in elderly patients undergoing radical colon cancer surgery.Aging i...This article explored the application of dexmedetomidine(Dex),a highly selective alpha-2 agonist,in managing postoperative cognitive dysfunction(POCD)in elderly patients undergoing radical colon cancer surgery.Aging is associated with a progressive decline in physiological functions and an increased risk of adverse surgical outcomes,including POCD,which encompasses many neurocognitive disorders that manifest during the perioperative period.The aging population is at a higher risk for POCD,which can lead to prolonged hospital stays,delayed recovery,and increased healthcare costs.Dex has neuroprotective,opioid-sparing,and sympatholytic properties,which reduces the incidence and severity of POCD.Dex was introduced for sedation in patients receiving mechanical ventilation but has since been adopted in anesthesia due to its multifaceted benefits.Its appli-cation extends to sedation,analgesia,maintenance of anesthesia,and controlling delirium.Its neuroprotective and anti-inflammatory effects have been explored in managing POCD.This article discussed the broad range of patient and procedure-related risk factors for POCD.Early identification and intervention are crucial to prevent the progression of POCD,which can have severe physical,psychological,and economic consequences.The article underscored the importance of a mul-tidisciplinary approach in managing POCD,involving the optimization of comor-bidities,depth of anesthesia monitoring,hemodynamic stability,and cerebral oxygenation monitoring.展开更多
BACKGROUND Breast cancer(BC)metastasis to the gastrointestinal tract is uncommon,colonic metastasis from BC(CMBC)is even rarer.CASE SUMMARY This report describes a 44-year-old female patient with metastatic triple-neg...BACKGROUND Breast cancer(BC)metastasis to the gastrointestinal tract is uncommon,colonic metastasis from BC(CMBC)is even rarer.CASE SUMMARY This report describes a 44-year-old female patient with metastatic triple-negative BC in the ascending colon who underwent laparoscopic radical right hemicolectomy.The patient had undergone left modified radical mastectomy only 15 months ago and stopped chemotherapy just 3 months ago.The diagnosis of CMBC was made based on the previous history of BC and positive results of several specific immunohistochemical markers(gross cystic disease fluid protein 15,mammaglobin,GATA-binding protein 3,and cytokeratin 7)for breast carcinoma.CONCLUSION CMBC should be highly cautious in patients with a previous history of BC,especially triple-negative BC,and further examination to aid in diagnosis.展开更多
BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters ...BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.展开更多
Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions accou...Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.展开更多
Objectives:Radiation enteropathy is a common complication of cervical cancer radiotherapy,and there is currently no effective treatment.This study evaluates the radioprotective effect of Premna microphylla Turcz.(PMT)...Objectives:Radiation enteropathy is a common complication of cervical cancer radiotherapy,and there is currently no effective treatment.This study evaluates the radioprotective effect of Premna microphylla Turcz.(PMT)on radiation-induced colon injury in mice.Materials and Methods:An 8 Gy abdominal irradiation model was established in mice,which were then gavaged with low(0.325 g/kg),medium(0.65 g/kg),or high(1.3 g/kg)doses of PMT.Weight and other routine information were recorded.The mice were euthanized on the 7 th day after radiotherapy.Colonic tissue was collected for observing structural changes.Reverse transcription quantitative polymerase chain reaction(RTqPCR)was used to detect inflammation infiltration in colon tissue.16S rRNA gene sequencing was performed to analyze the alterations in gut microbiota composition.Hepatic and renal function assessments were conducted to evaluate the safety profile of PMT.Results:PMT at medium dose significantly reduced radiation-induced weight loss(P<0.05).PMT alleviated gastrointestinal discomfort and partially reduced radiotherapy-induced faecal occult blood,although these effects were not statistically significant.Both medium and high doses of PMT reversed the shortening of colon length caused by radiotherapy(both P<0.05).The medium-and high-dose PMT improved the colonic inflammatory microenvironment by reducing the expression of inflammatory factors and chemokines(IL-1β,IL-6,IFN-γ,TNF-α,and Cxcl1)(P<0.05).PMT restored the diversity of the gut microbiota and normalized the Bacteroidetes/Firmicutes ratio disrupted by radiation.Beyond intestinal protection,PMT administration at all doses significantly reduced the postirradiation levels of serum creatinine(Cr),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)(all P<0.05).Conclusions:PMT,particularly at medium doses,has potential for treating radiation-induced colonic injury in mice without causing hepatorenal toxicity,providing a novel therapeutic approach for radiation-induced colonic diseases.展开更多
BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains ...BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.AIM To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.METHODS The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively.They underwent colonic stenting as a bridge to elective surgery(BTS group:n=40)or emergency resection(ER group:n=56).Demographic characteristics,stoma rate,laparoscopy rate,postoperative complications,and oncological outcomes were compared between the two groups.RESULTS The two groups were comparable with regard to the demographics and tumor characteristics.The stoma rate was 7.5%in the BTS group vs 48.2%in the ER group(P<0.05).Primary anastomosis was performed in all patients in the BTS group,and only three patients underwent protective stoma in the BTS group.The BTS group had a significantly higher rate of laparoscopic surgery than the ER group(90%vs 57.1%,P<0.05),and the major postoperative complication rate was significantly higher in the ER group than in the BTS group(33.9%vs 15%,P=0.04).According to the Kaplan-Meier survival analysis and log rank test,no significant differences existed in the two groups with regard to the overall survival and disease-free survival.CONCLUSION The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO.SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.展开更多
BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat t...BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat the source of bleeding,which is crucial for effective management.CASE SUMMARY We present the case of a 70-year-old male with acute painless hematochezia.Colonoscopy showed active bleeding originating from a diverticulum,and the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding.No further evidence of bleeding was observed at the end of the procedure.The patient was discharged from hospital on the seventh day.CONCLUSION The EyeMax system proved advantageous in localizing the bleeding diverticulum,thereby facilitating successful hemostatic measures.展开更多
Surgical advancements have transformed colorectal cancer treatment, withcomplete mesocolic excision (CME) becoming a crucial method to guaranteeoncological safety and effectiveness. The article by Yadav emphasized the...Surgical advancements have transformed colorectal cancer treatment, withcomplete mesocolic excision (CME) becoming a crucial method to guaranteeoncological safety and effectiveness. The article by Yadav emphasized the significanceof CME in attaining optimal resection margins, thorough lymph nodedissection, and enhanced long-term survival rates. The adjunctive function of D3lymphadenectomy, emphasizing the clearance of lymphatic drainage along thesupplying vessels, was also addressed. CME with central vascular ligation, basedon the principles of total mesorectal excision for rectal cancer, entails en bloc tumorresection and precise dissection along the embryological planes, thus diminishingrecurrence and improving survival rates. The viability and safety of minimallyinvasive techniques, such as laparoscopic CME, have been confirmed;however,technical difficulties remain owing to the intricate vascular anatomy. Roboticassistedsurgery presents potential benefits, including accurate lymphatic dissectionand intracorporeal anastomosis. However, evidence demonstrating itssuperiority over laparoscopic techniques is scarce owing to high costs and prolongedduration. This study promotes the global standardization of CME as anessential element of modern colorectal cancer surgery. CME epitomizes contemporaryoncological practices, requiring widespread adoption to achieve superiorityin colon cancer management.展开更多
BACKGROUND The Asia-Pacific Colorectal Screening(APCS)score was designed with the purpose of distinguishing individuals at high risk(HR)for colorectal advanced neoplasia(AN).Traditional Chinese medicine(TCM)constituti...BACKGROUND The Asia-Pacific Colorectal Screening(APCS)score was designed with the purpose of distinguishing individuals at high risk(HR)for colorectal advanced neoplasia(AN).Traditional Chinese medicine(TCM)constitution was also linked with colorectal cancer(CRC).AIM To integrate the APCS score with TCM constitution identification as a new algorithm to screen for CRC.METHODS A cross-sectional multicenter study was carried out in three hospitals,enrolling 1430 patients who were asymptomatic and undergoing screening colonoscopy from 2022 to 2023.Patients were considered to have average risk,moderate risk,or HR with their APCS score.Odd ratios assessed the relationship between TCM constitution and disease progression.A TCM constitution risk score was created.The sensitivity and specificity of the new algorithm were calculated to evaluate diagnostic performance in detecting advanced adenoma(AA),CRC,and AN.RESULTS Of the 1430 patients,370(25.9%)were categorized as average risk,755(52.8%)as moderate risk,and 305(21.3%)as HR.Using the combined APCS score and the TCM constitution(damp-heat,qi-deficiency,yang-deficiency,phlegm-dampness,and inherited special constitution as positive)algorithm,72.2%of patients with AA and 73.7%of patients with AN were detected.Compared with the APCS score alone,the new algorithm significantly improved the sensitivity for screening AA[72.2%,95%confidence interval(CI):64.4%-80.0%vs 49.2%,95%CI:40.5%-57.9%]and AN(73.7%,95%CI:66.4%-81.1%vs 51.1%,95%CI:42.7%-59.5%).CONCLUSION The combination of APCS and TCM constitution identification questionnaires was valuable in identifying Chinese individuals who were asymptomatic for colorectal screening prioritization.展开更多
AIM: To see the possibility of avoiding routine colostomy in patients presenting with unprepared bowel. METHODS: The cohort is composed of 103 patients, of these, 86 patients presented as emergencies (self- inflected ...AIM: To see the possibility of avoiding routine colostomy in patients presenting with unprepared bowel. METHODS: The cohort is composed of 103 patients, of these, 86 patients presented as emergencies (self- inflected and iatrogenic colon injuries, stab wounds and blast injury of the colon, volvulus sigmoid, obstructing left colon cancer, and strangulated ventral hernia). Another 17 patients were managed electively for other colon pathologies. During laparotomy, the involved segment was resected and the two ends of the colon were brought out via a separate colostomy wound. One layer of interrupted 3/0 silk was used for colon anastomosis. The exteriorized segment was immediately covered with a colostomy bag. Between the 5th and 7th postoperative day, the colon was easily dropped into the peritoneal cavity. The defect in the abdominal wall was closed with interrupted nonabsorbable suture. The skin was left open for secondary closure. RESULTS: The mean hospital stay (± SD) was 11.5 ± 2.6 d (8-20 d). The exteriorized colon was successfully dropped back into the peritoneal cavity in all patients except two. One developed a leak from oesophago- jejunostomy and from the exteriorized colon. She subsequently died of sepsis and multiple organ failure (MOF). In a second patient the colon proximal to the exteriorized anastomosis prolapsed and developed severe serositis, an elective ileo-colic anastomosis (to the left colon) was successfully performed. CONCLUSION: Exteriorized colon anastomosis is simple, avoids the inconvenience of colostomy and can be an alternative to routine colostomy. It is suitable where colostomy is socially unacceptable or the facilities and care is not available.展开更多
BACKGROUND Type Ⅱ diabetes mellitus(T2DM)has been associated with increased risk of colon cancer(CC)and worse prognosis in patients with metastases.The effects of T2DM on postoperative chemoresistance rate(CRR)and lo...BACKGROUND Type Ⅱ diabetes mellitus(T2DM)has been associated with increased risk of colon cancer(CC)and worse prognosis in patients with metastases.The effects of T2DM on postoperative chemoresistance rate(CRR)and long-term disease-free survival(DFS)and overall survival(OS)in patients with stage Ⅲ CC who receive curative resection remain controversial.AIM To investigate whether T2DM or glycemic control is associated with worse postoperative survival outcomes in stage Ⅲ CC.METHODS This retrospective cohort study included 278 patients aged 40-75 years who underwent surgery for stage Ⅲ CC from 2018 to 2021.Based on preoperative T2DM history,the patients were categorized into non-DM(n=160)and DM groups(n=118).The latter was further divided into well-controlled(n=73)and poorly controlled(n=45)groups depending on the status of glycemic control.DFS,OS,and CRR were compared between the groups and Cox regression analysis was used to identify risk factors.RESULTS Patients in the DM and non-DM groups demonstrated similar DFS,OS,and CRR(DFS:72.03%vs 78.75%,P=0.178;OS:81.36%vs 83.12%,P=0.638;CRR:14.41%vs 7.5%,P=0.063).Poorly controlled DM was associated with a significantly worse prognosis and higher CRR than well-controlled DM(DFS:62.22%vs 78.07%,P=0.021;OS:71.11%vs 87.67%,P=0.011;CRR:24.40%vs 8.22%,P=0.015).High preoperative fasting plasma glucose[DFS:Hazard ratio(HR)=2.684,P<0.001;OS:HR=2.105,P=0.019;CRR:HR=2.214,P=0.005]and glycosylated hemoglobin levels(DFS:HR=2.344,P=0.006;OS:HR=2.119,P=0.021;CRR:HR=2.449,P=0.009)indicated significantly poor prognosis and high CRR,while T2DM history did not(DFS:HR=1.178,P=0.327;OS:HR=0.933,P=0.739;CRR:HR=0.997,P=0.581).CONCLUSION Increased preoperative fasting plasma glucose and glycosylated hemoglobin levels,but not T2DM history,were identified as risk factors associated with poor postoperative outcomes and high CRR in patients with stage Ⅲ CC.展开更多
文摘Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or incomplete resections and is now recognized as one of the most reliable quality indicators for assessing colonoscopy performance.With an incidence rate of 3.6%to 9.3%,PCCRC remains a significant concern,highlighting the limitations of colonoscopy in CRC screening—not only in terms of diagnostic accuracy but also in its preventive role and effectiveness in treating lesions.A range of clinical,endoscopic,and biological factors has been associated with an increased risk of PCCRC.Identifying these factors can help stratify high-risk patients,enabling earlier detection and improving preventive strategies for interval CRC.Reducing PCCRC should be a top priority for every endoscopy unit.While technological advancements will enhance polyp detection,minimize missed lesions,prevent incomplete resections,and improve overall procedural quality,the most impactful strategy remains internal self-assessment within each unit.This review should evaluate key performance metrics,including cecal intubation rate,adenoma detection rate,withdrawal time,PCCRC incidence,and incomplete resections—both at the individual endoscopist level and across the entire unit.
文摘Background:We present a case of two major complications following insertion of a nephrostomy managed in a minimally invasive way.Our case is the first in the literature to describe this minimally invasive treatment technique for colon perforation in a completely asymptomatic patient.Case Description:A 75-year-old female patient with a history of bilateral obstructive uropathy secondary to bilateral radiation-induced ureteric strictures attended for bilateral nephrostomy placement.The patient had a history of endometrial cancer,treated previously by total hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemo-radiotherapy and brachytherapy.Her recovery had been further complicated by the development of radiation cystitis,small bowel resection,and short gut syndrome.The strictures had previously been managed with bilateral double J stents,which have now failed.A left-sided nephrostomy insertion was performed.ACT-scan prompted by a repeat deterioration in renal function revealed a right-sided hydronephrosis and suggested transcolic passage of the previously placed leftsided nephrostomy.She had remained clinically well and apyretic.A right-sided nephrostomy was inserted,and the left re-sited following a colonoscopy-guided nephrostomy removal and clip occlusion of the nephrostomy tract.The patient then developed a pseudoaneurysm,which was managed with embolization.The patient was able to return home with corrected kidney function.The three-monthly checks for changes in nephrostomy catheters did not reveal any complications.Conclusions:The patient therefore presented with two major complications of nephrostomy placement:colonic perforation and pseudoaneurysm,classified as Clavien IIIb and IIIa,respectively.Multidisciplinary management,including urologists,gastroenterologists,general surgeons,and radiologists,enabled a minimally invasive management.Minimally invasive management with endoscopic clip placement appears to be a safe alternative to directed fistula of colonic perforation.
基金The National Natural Science Foundation of China(32302759,32372924)the CAST Youth Talent Support Project-Special Program for Doctoral Students(156-O-230-0000375-5)。
文摘Background Weaning-induced diarrhoea and growth retardation in piglets are associated with impaired intestinal barrier function and decreased levels of colonic short-chain fatty acids(SCFAs).Although SCFA supplementation has been proposed to mitigate these issues,the efficacy and optimal dosage of sodium isobutyrate remain unclear.Results We investigated the effects of sodium isobutyrate supplementation(500,1,000,2,000,and 4,000 mg/kg diet)on weaned piglets(Duroc×Landrace×Yorkshire,28 d of age;n=8).After a 28-d feeding trial,supplementation at 500–2,000 mg/kg significantly improved average daily gain and feed efficiency and reduced diarrhoea frequency,with maximal benefits observed at 1,000 mg/kg(P<0.0001).Additionally,500–1,000 mg/kg sodium isobutyrate supplementation increased the apparent digestibility of crude protein,organic matter,and crude fibre(P<0.05).Serum biochemical parameters were unaffected,although secretory immunoglobulin A(SIgA)levels significantly increased upon supplementation with 500–1,000 mg/kg(P<0.05).16S rRNA gene sequencing indicated that sodium isobutyrate increased the abundance of beneficial colonic microbiota.The 1,000 mg/kg group presented the most pronounced effect,with a significant increase of the relative abundance of Prevotella and the greatest improvement in SCFA concentrations(P<0.05).Metabolomics revealed elevated levels of colonic indole-3-lactic acid and 3-hydroxybutyrate upon supplementation with 1,000 mg/kg(P<0.05).Transcriptomic analyses indicated activation of protein digestion and absorption pathways,and PI3K-Akt signalling,marked by TSG-6 upregulation and the suppression of ISG15 and DDIT4 expression(P<0.05).Supplementation with 1,000 mg/kg was associated with improved intestinal barrier-related markers,including reduced serum D-lactate,diamine oxidase,and lipopolysaccharide levels,increased tight junction protein expression;activation of G protein-coupled receptors;and inhibition of TLR4/MyD88/NF-κB signalling(P<0.05),suggesting enhanced barrier function.Conclusions In conclusion,dietary supplementation with 1,000 mg/kg sodium isobutyrate was associated with improved intestinal morphology,reduced serum permeability,increased expression of tight junction proteins,and enhanced immune function in weaned piglets,suggesting enhanced colonic barrier function and providing dosage guidance and mechanistic insights for future applications.
文摘The metastatic pattern of colon cancer is typically well characterized,with initial dissemination occurring through regional lymphatics,followed by hematogenous spread.The most frequent sites of metastasis in colorectal cancer(CRC)include regional lymph nodes(50%–70%),liver(35%–50%),lungs(21%),peritoneum(15%),and ovaries(13%).1 Isolated distant lymph node metastasis,particularly in the absence of concurrent systemic disease,is exceedingly rare in CRC.To date,only six cases of isolated axillary lymph node metastasis(ALNM)from colorectal primaries have been documented in the literature.1–6 Even more uncommon is the incidental discovery of malignant cells in anastomotic doughnuts following stoma reversal procedures.Herein,we report a rare case involving both the incidental histopathological detection of tumor cells within doughnuts during stoma closure and the subsequent development of isolated ALNM after curative resection of sigmoid colon carcinoma.
文摘Computed tomography colonography(CTC) in colorectal cancer(CRC) screening has two roles:one present and the other potential.The present role is,without any further discussion,the integration into established screening programs as a replacement for barium enema in the case of incomplete colonoscopy.The potential role is the use of CTC as a first-line screening method together with Fecal Occult Blood Test,sigmoidoscopy and colonoscopy.However,despite the fact that CTC has been officially endorsed for CRC screening of average-risk individuals by different scientif ic societies including the American Cancer Society,the American College of Radiology,and the US Multisociety Task Force on Colorectal Cancer,other entities,such as the US Preventive Services Task Force,have considered the evidence insuff icient to justify its use as a mass screening method.Medicare has also recently denied reimbursement for CTC as a screening test.Nevertheless,multiple advantages exist for using CTC as a CRC screening test:high accuracy,full evaluation of the colon in virtually all patients,non-invasiveness,safety,patient comfort,detection of extracolonic findings and cost-effectiveness.The main potential drawback of a CTC screening is the exposure to ionizing radiation.However,this is not a major issue,since low-dose protocols are now routinely implemented,delivering a dose comparable or slightly superior to the annual radiation exposure of any individual.Indirect evidence exists that such a radiation exposure does not induce additional cancers.
文摘BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.AIM To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.METHODS A search was conducted in MEDLINE,EMBASE,and Scopus from inception to August 2024.Studies reporting the clinical success,perforation,recurrence,and need for surgery after colonoscopic decompression in ACPO were included.A random-effects inverse-variance model was used to calculate the pooled proportion.RESULTS Sixteen studies were included in the final analysis.The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8%(95%CI:72.0-85.6)and 91.5%(95%CI:87.0-96.0),respectively.The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85(95%CI:2.00-7.42).The pooled incidence of perforation was 0.9%(95%CI:0.0-2.0),while recurrence was observed in 17.1%(95%CI:12.9-21.3)of the patients after clinical success.The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5%(95%CI:5.0-15.9)and 3.7%(95%CI:0.3-7.1),respectively.Subgroup analysis,excluding the low-quality studies,did not significantly change the event rates.CONCLUSION Colonoscopic decompression for ACPO is associated with a clinical success rate of>90%with a perforation rate of<1%,demonstrating high efficacy and safety.
文摘BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,ADR can vary significantly among endoscopists,leading to missed polyps or cancer.Artificial intelligence(AI)has shown promise in improving ADR by assisting in real-time polyp identification or diagnosis.While multiple randomized controlled trials(RCTs)and metanalyses highlight the benefits of AI in increasing detection rates and reducing missed polyps,concerns remain about its real-world applicability,impact on procedure time,and cost-effectiveness.AIM To explore the current status of AI assistance colonoscopy in adenoma detection and improving quality of colonoscopy.METHODS This systematic review followed PRISMA guidelines,both PubMed and Web of Science databases were used for articles search.Metanalyses and systematic reviews that assessed AI's role during colonoscopy.English article only published between January 2000 and January 2025 were included.Articles related to nonadenoma indications were excluded.Data extraction was independently performed by two researchers for accuracy and consistency.RESULTS 22 articles met the inclusion criteria,with significant heterogeneity(I2=28%-91%)observed in multiple studies.The number of studies per metanalysis ranged from 5 to 33,with higher heterogeneity in analyses involving more than 18 RCTs.AI demonstrated improvement in ADR,with an approximate 20%increase across multiple studies.However,its effectiveness in detecting flat or serrated adenomas remains unproven.Endoscopists with low ADR benefit more from AI-colonoscopies,while expert endoscopists outperformed AI in ADR,adenoma miss rate,and the identification of advanced lesions.No significant change in withdrawal time was observed when comparing AI-assisted colonoscopy to conventional endoscopy.CONCLUSION While AI-assisted colonoscopy has been shown to improve procedural quality,particularly for junior endoscopists and those with lower ADR,its performance decreases when compared to expert endoscopists in real-time clinical practice.This is especially evident in non-randomized studies,where AI demonstrates limited real-world benefits despite its benefit in controlled settings.Furthermore,no meta-analyses have specifically examined AI's impact on the learning experience of fellows and residents.Some experts caution that reliance on AI may prevent trainees from developing essential observational skills,potentially leading to less thorough examinations.Further research is needed to determine the actual benefits of AI-colonoscopy,particularly its role in cancer prevention.As technology advances,improved outcomes are expected,especially in detecting small,flat,and lesions at difficult anatomical locations.
文摘Colon cancer is one of the malignant tumors with high morbidity and mortality worldwide[1],and its early diagnosis is crucial for improving patient survival.However,due to the lack of obvious early symptoms of colon cancer,many patients are in the middle to late stage when diagnosed and miss the best time for treatment.Therefore,developing an efficient and accurate diagnostic method for colon cancer is of great clinical significance and scientific value.Currently,the current colon cancer biomarkers carcinoembryonic antigen and carbohydrate antigen 19-9[2]have low sensitivity and specificity,the emerging markers circulating tumor DNA(ctDNA)and miRNA face high cost and standardization challenges,and the existing methods lack spatial resolution,prompting the incorporation of spatial metabolomics technologies to enhance diagnostic capabilities.
文摘Colorectal cancer (CRC) remains a leading cancer killer worldwide. But the disease is both curable and preventable at an early stage. Regular CRC cancer screening has been shown to reduce the risk of dying from CRC. However, the importance of large-scale screening is only now starting to be appreciated. This article reviews a variety of imaging procedures available for detecting ulcerative colitis (UC) and Crohn's disease (CD), polyps and CRC in their early stage and also presents details on various screening options. Detecting, staging and re-staging of patients with CRC also require multimodality, multistep imaging approaches. Staging and re-staging with conventional colonoscopy (CC), computer tomography colonography (CTC), magnetic resonance colonography (MRC) and positron emission tomography/computer tomography colonography (PET/CTC) are of paramount importance in determining the most appropriate therapeutic method and in predicting the risk of tumor recurrence and overall prognosis. The advantages and limitations of these modalities are also discussed.
文摘This article explored the application of dexmedetomidine(Dex),a highly selective alpha-2 agonist,in managing postoperative cognitive dysfunction(POCD)in elderly patients undergoing radical colon cancer surgery.Aging is associated with a progressive decline in physiological functions and an increased risk of adverse surgical outcomes,including POCD,which encompasses many neurocognitive disorders that manifest during the perioperative period.The aging population is at a higher risk for POCD,which can lead to prolonged hospital stays,delayed recovery,and increased healthcare costs.Dex has neuroprotective,opioid-sparing,and sympatholytic properties,which reduces the incidence and severity of POCD.Dex was introduced for sedation in patients receiving mechanical ventilation but has since been adopted in anesthesia due to its multifaceted benefits.Its appli-cation extends to sedation,analgesia,maintenance of anesthesia,and controlling delirium.Its neuroprotective and anti-inflammatory effects have been explored in managing POCD.This article discussed the broad range of patient and procedure-related risk factors for POCD.Early identification and intervention are crucial to prevent the progression of POCD,which can have severe physical,psychological,and economic consequences.The article underscored the importance of a mul-tidisciplinary approach in managing POCD,involving the optimization of comor-bidities,depth of anesthesia monitoring,hemodynamic stability,and cerebral oxygenation monitoring.
基金The Science and Technology Bureau of Wuhu,Anhui Province,China,Under The Key Research and Development and Achievement Transformation Project,No.2023yf099.
文摘BACKGROUND Breast cancer(BC)metastasis to the gastrointestinal tract is uncommon,colonic metastasis from BC(CMBC)is even rarer.CASE SUMMARY This report describes a 44-year-old female patient with metastatic triple-negative BC in the ascending colon who underwent laparoscopic radical right hemicolectomy.The patient had undergone left modified radical mastectomy only 15 months ago and stopped chemotherapy just 3 months ago.The diagnosis of CMBC was made based on the previous history of BC and positive results of several specific immunohistochemical markers(gross cystic disease fluid protein 15,mammaglobin,GATA-binding protein 3,and cytokeratin 7)for breast carcinoma.CONCLUSION CMBC should be highly cautious in patients with a previous history of BC,especially triple-negative BC,and further examination to aid in diagnosis.
文摘BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.
文摘Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.
基金supported by the Zhejiang Province Traditional Chinese Medicine Key Laboratory Project(No.GZY-ZJ-SY-2303)the Cultivation Foundation of National Natural Science Foundation of Zhejiang Cancer Hospital(No.PY2024047)+1 种基金the Joint TCM Science&Technology Projects of National Demonstration Zones for Comprehensive TCM Reform(No.GZY-KJS-ZJ-2025-036)the Key Project of Zhejiang Provincial Administration of Traditional Chinese Medicine(No.GZY-ZJ-KJ-23050),China。
文摘Objectives:Radiation enteropathy is a common complication of cervical cancer radiotherapy,and there is currently no effective treatment.This study evaluates the radioprotective effect of Premna microphylla Turcz.(PMT)on radiation-induced colon injury in mice.Materials and Methods:An 8 Gy abdominal irradiation model was established in mice,which were then gavaged with low(0.325 g/kg),medium(0.65 g/kg),or high(1.3 g/kg)doses of PMT.Weight and other routine information were recorded.The mice were euthanized on the 7 th day after radiotherapy.Colonic tissue was collected for observing structural changes.Reverse transcription quantitative polymerase chain reaction(RTqPCR)was used to detect inflammation infiltration in colon tissue.16S rRNA gene sequencing was performed to analyze the alterations in gut microbiota composition.Hepatic and renal function assessments were conducted to evaluate the safety profile of PMT.Results:PMT at medium dose significantly reduced radiation-induced weight loss(P<0.05).PMT alleviated gastrointestinal discomfort and partially reduced radiotherapy-induced faecal occult blood,although these effects were not statistically significant.Both medium and high doses of PMT reversed the shortening of colon length caused by radiotherapy(both P<0.05).The medium-and high-dose PMT improved the colonic inflammatory microenvironment by reducing the expression of inflammatory factors and chemokines(IL-1β,IL-6,IFN-γ,TNF-α,and Cxcl1)(P<0.05).PMT restored the diversity of the gut microbiota and normalized the Bacteroidetes/Firmicutes ratio disrupted by radiation.Beyond intestinal protection,PMT administration at all doses significantly reduced the postirradiation levels of serum creatinine(Cr),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)(all P<0.05).Conclusions:PMT,particularly at medium doses,has potential for treating radiation-induced colonic injury in mice without causing hepatorenal toxicity,providing a novel therapeutic approach for radiation-induced colonic diseases.
文摘BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.AIM To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.METHODS The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively.They underwent colonic stenting as a bridge to elective surgery(BTS group:n=40)or emergency resection(ER group:n=56).Demographic characteristics,stoma rate,laparoscopy rate,postoperative complications,and oncological outcomes were compared between the two groups.RESULTS The two groups were comparable with regard to the demographics and tumor characteristics.The stoma rate was 7.5%in the BTS group vs 48.2%in the ER group(P<0.05).Primary anastomosis was performed in all patients in the BTS group,and only three patients underwent protective stoma in the BTS group.The BTS group had a significantly higher rate of laparoscopic surgery than the ER group(90%vs 57.1%,P<0.05),and the major postoperative complication rate was significantly higher in the ER group than in the BTS group(33.9%vs 15%,P=0.04).According to the Kaplan-Meier survival analysis and log rank test,no significant differences existed in the two groups with regard to the overall survival and disease-free survival.CONCLUSION The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO.SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.
文摘BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat the source of bleeding,which is crucial for effective management.CASE SUMMARY We present the case of a 70-year-old male with acute painless hematochezia.Colonoscopy showed active bleeding originating from a diverticulum,and the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding.No further evidence of bleeding was observed at the end of the procedure.The patient was discharged from hospital on the seventh day.CONCLUSION The EyeMax system proved advantageous in localizing the bleeding diverticulum,thereby facilitating successful hemostatic measures.
文摘Surgical advancements have transformed colorectal cancer treatment, withcomplete mesocolic excision (CME) becoming a crucial method to guaranteeoncological safety and effectiveness. The article by Yadav emphasized the significanceof CME in attaining optimal resection margins, thorough lymph nodedissection, and enhanced long-term survival rates. The adjunctive function of D3lymphadenectomy, emphasizing the clearance of lymphatic drainage along thesupplying vessels, was also addressed. CME with central vascular ligation, basedon the principles of total mesorectal excision for rectal cancer, entails en bloc tumorresection and precise dissection along the embryological planes, thus diminishingrecurrence and improving survival rates. The viability and safety of minimallyinvasive techniques, such as laparoscopic CME, have been confirmed;however,technical difficulties remain owing to the intricate vascular anatomy. Roboticassistedsurgery presents potential benefits, including accurate lymphatic dissectionand intracorporeal anastomosis. However, evidence demonstrating itssuperiority over laparoscopic techniques is scarce owing to high costs and prolongedduration. This study promotes the global standardization of CME as anessential element of modern colorectal cancer surgery. CME epitomizes contemporaryoncological practices, requiring widespread adoption to achieve superiorityin colon cancer management.
文摘BACKGROUND The Asia-Pacific Colorectal Screening(APCS)score was designed with the purpose of distinguishing individuals at high risk(HR)for colorectal advanced neoplasia(AN).Traditional Chinese medicine(TCM)constitution was also linked with colorectal cancer(CRC).AIM To integrate the APCS score with TCM constitution identification as a new algorithm to screen for CRC.METHODS A cross-sectional multicenter study was carried out in three hospitals,enrolling 1430 patients who were asymptomatic and undergoing screening colonoscopy from 2022 to 2023.Patients were considered to have average risk,moderate risk,or HR with their APCS score.Odd ratios assessed the relationship between TCM constitution and disease progression.A TCM constitution risk score was created.The sensitivity and specificity of the new algorithm were calculated to evaluate diagnostic performance in detecting advanced adenoma(AA),CRC,and AN.RESULTS Of the 1430 patients,370(25.9%)were categorized as average risk,755(52.8%)as moderate risk,and 305(21.3%)as HR.Using the combined APCS score and the TCM constitution(damp-heat,qi-deficiency,yang-deficiency,phlegm-dampness,and inherited special constitution as positive)algorithm,72.2%of patients with AA and 73.7%of patients with AN were detected.Compared with the APCS score alone,the new algorithm significantly improved the sensitivity for screening AA[72.2%,95%confidence interval(CI):64.4%-80.0%vs 49.2%,95%CI:40.5%-57.9%]and AN(73.7%,95%CI:66.4%-81.1%vs 51.1%,95%CI:42.7%-59.5%).CONCLUSION The combination of APCS and TCM constitution identification questionnaires was valuable in identifying Chinese individuals who were asymptomatic for colorectal screening prioritization.
文摘AIM: To see the possibility of avoiding routine colostomy in patients presenting with unprepared bowel. METHODS: The cohort is composed of 103 patients, of these, 86 patients presented as emergencies (self- inflected and iatrogenic colon injuries, stab wounds and blast injury of the colon, volvulus sigmoid, obstructing left colon cancer, and strangulated ventral hernia). Another 17 patients were managed electively for other colon pathologies. During laparotomy, the involved segment was resected and the two ends of the colon were brought out via a separate colostomy wound. One layer of interrupted 3/0 silk was used for colon anastomosis. The exteriorized segment was immediately covered with a colostomy bag. Between the 5th and 7th postoperative day, the colon was easily dropped into the peritoneal cavity. The defect in the abdominal wall was closed with interrupted nonabsorbable suture. The skin was left open for secondary closure. RESULTS: The mean hospital stay (± SD) was 11.5 ± 2.6 d (8-20 d). The exteriorized colon was successfully dropped back into the peritoneal cavity in all patients except two. One developed a leak from oesophago- jejunostomy and from the exteriorized colon. She subsequently died of sepsis and multiple organ failure (MOF). In a second patient the colon proximal to the exteriorized anastomosis prolapsed and developed severe serositis, an elective ileo-colic anastomosis (to the left colon) was successfully performed. CONCLUSION: Exteriorized colon anastomosis is simple, avoids the inconvenience of colostomy and can be an alternative to routine colostomy. It is suitable where colostomy is socially unacceptable or the facilities and care is not available.
基金Supported by the Leading Innovation Specialist Support Program of Guangdong Provincethe Science and Technology Planning Project of Ganzhou,No.202101074816the National Natural Science Foundation of China,No.82260501.
文摘BACKGROUND Type Ⅱ diabetes mellitus(T2DM)has been associated with increased risk of colon cancer(CC)and worse prognosis in patients with metastases.The effects of T2DM on postoperative chemoresistance rate(CRR)and long-term disease-free survival(DFS)and overall survival(OS)in patients with stage Ⅲ CC who receive curative resection remain controversial.AIM To investigate whether T2DM or glycemic control is associated with worse postoperative survival outcomes in stage Ⅲ CC.METHODS This retrospective cohort study included 278 patients aged 40-75 years who underwent surgery for stage Ⅲ CC from 2018 to 2021.Based on preoperative T2DM history,the patients were categorized into non-DM(n=160)and DM groups(n=118).The latter was further divided into well-controlled(n=73)and poorly controlled(n=45)groups depending on the status of glycemic control.DFS,OS,and CRR were compared between the groups and Cox regression analysis was used to identify risk factors.RESULTS Patients in the DM and non-DM groups demonstrated similar DFS,OS,and CRR(DFS:72.03%vs 78.75%,P=0.178;OS:81.36%vs 83.12%,P=0.638;CRR:14.41%vs 7.5%,P=0.063).Poorly controlled DM was associated with a significantly worse prognosis and higher CRR than well-controlled DM(DFS:62.22%vs 78.07%,P=0.021;OS:71.11%vs 87.67%,P=0.011;CRR:24.40%vs 8.22%,P=0.015).High preoperative fasting plasma glucose[DFS:Hazard ratio(HR)=2.684,P<0.001;OS:HR=2.105,P=0.019;CRR:HR=2.214,P=0.005]and glycosylated hemoglobin levels(DFS:HR=2.344,P=0.006;OS:HR=2.119,P=0.021;CRR:HR=2.449,P=0.009)indicated significantly poor prognosis and high CRR,while T2DM history did not(DFS:HR=1.178,P=0.327;OS:HR=0.933,P=0.739;CRR:HR=0.997,P=0.581).CONCLUSION Increased preoperative fasting plasma glucose and glycosylated hemoglobin levels,but not T2DM history,were identified as risk factors associated with poor postoperative outcomes and high CRR in patients with stage Ⅲ CC.
