Intestinal Research

Original Articles

The prevalence of pouch fistulas in ulcerative colitis following restorative proctocolectomy: a systematic review and meta-analysis: Sheng Wei Lo, Ishaan Dharia, Danujan Sriranganathan, Maia Kayal, Edward L. Barnes, Jonathan P. Segal; Received January 17, 2024 Accepted May 9, 2024 Published online August 9, 2024; DOI: https://doi.org/10.5217/ir.2024.00009 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
One complication of restorative proctocolectomy with ileo-anal pouch anastomosis is fistula formation in the pouch. Fistulas can be associated with significant morbidity and pouch failure. We conducted a systematic review with meta- analysis to try and understand the prevalence of pouch fistulas in patients with ulcerative colitis following restorative proctocolectomy.
Methods
The Embase, Embase Classic, and PubMed databases were searched between January 1979 and April 2022. Studies were included if there were cross-sectional, case-controlled, population-based or cohort studies reporting on prevalence of pouch fistulas in ulcerative colitis. Studies had to report the number of patients with pouch fistulas using either clinical, endoscopic, or radiological diagnosis in an adult population.
Results
Thirty-three studies screened met the inclusion criteria. The pooled prevalence of developing at least 1 fistula was 0.05 (95% confidence interval [CI], 0.04–0.07). The pooled prevalence of pouch failure in patients with pouch fistula was found to be 0.24 (95% CI, 0.19–0.30). The pooled prevalence of developing a pouch fistula at 3 years, 5 years and more than 5 years was 0.04 (95% CI, 0.02–0.07), 0.05 (95% CI, 0.02–0.07), and 0.05 (95% CI, 0.02–0.10), respectively.
Conclusions
This is the first systematic review and meta-analysis to report the prevalence of pouch fistula. It also provides a pooled prevalence of pouch failure in these patients. These results can help to shape future guidelines, power future studies, and help counsel patients.

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Defining management strategies for acute severe ulcerative colitis using predictive models: a simulation-modeling study: Danny Con, Peter De Cruz; Received November 17, 2023 Accepted February 15, 2024 Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2023.00175 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
Robust management algorithms are required to reduce the residual risk of colectomy in acute severe ulcerative colitis (ASUC) refractory to standard infliximab salvage therapy. The aim of this study was to evaluate the performance and benefits of alternative ASUC management strategies using simulated prediction models of varying accuracy.
Methods
This was a simulation-based modeling study using a hypothetical cohort of 5,000 steroid-refractory ASUC patients receiving standard infliximab induction. Simulated predictive models were used to risk-stratify patients and escalate treatment in patients at high risk of failing standard infliximab induction. The main outcome of interest was colectomy by 3 months.
Results
The 3-month colectomy rate in the base scenario where all 5,000 patients received standard infliximab induction was 23%. The best-performing management strategy assigned high-risk patients to sequential Janus kinase inhibitor inhibition and mediumrisk patients to accelerated infliximab induction. Using a 90% area under the curve (AUC) prediction model and optimistic treatment efficacy assumptions, this strategy reduced the 3-month colectomy rate to 8% (65% residual risk reduction). Using an 80% AUC prediction model with only modest treatment efficacy assumptions, the 3-month colectomy rate was reduced to 15% (35% residual risk reduction). Overall management strategy efficacy was highly dependent on predictive model accuracy and underlying treatment efficacy assumptions.
Conclusions
This is the first study to simulate predictive model-based management strategies in steroid-refractory ASUC and evaluate their effect on short-term colectomy rates. Future studies on predictive model development should incorporate simulation studies to better understand their expected benefit.

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Infection

How the COVID-19 pandemic affected the severity and clinical presentation of diverticulitis: Sara S. Soliman, Rolando H. Rolandelli, Grace C. Chang, Amanda K. Nemecz, Zoltan H. Nemeth; Intest Res 2023;21(4):493-499. Published online October 26, 2023; DOI: https://doi.org/10.5217/ir.2022.00042

Abstract PDF PubReader ePub

Background/Aims
Single-institution studies showed that patients presented with more severe diverticulitis and underwent more emergency operations during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, we studied this trend using nationwide data from the American College of Surgeons National Surgical Quality Improvement Program database.
Methods
Patients (n = 23,383) who underwent a colectomy for diverticulitis in 2018 (control year) and 2020 (pandemic year) were selected. We compared these groups for differences in disease severity, comorbidities, perioperative factors, and complications.
Results
During the pandemic, colonic operations for diverticulitis decreased by 13.14%, but the rates of emergency operations (17.31% vs. 20.04%, P< 0.001) and cases with a known abscess/perforation (50.11% vs. 54.55%, P< 0.001) increased. Likewise, the prevalence of comorbidities, such as congestive heart failure, acute renal failure, systemic inflammatory response syndrome, and septic shock, were higher during the pandemic (P< 0.05). During this same period, significantly more patients were classified under American Society of Anesthesiologists classes 3, 4, and 5, suggesting their preoperative health states were more severe and life-threatening. Correspondingly, the average operation time was longer (P< 0.001) and complications, such as organ space surgical site infection, wound disruption, pneumonia, acute renal failure, septic shock, and myocardial infarction, increased (P< 0.05) during the pandemic.
Conclusions
During the pandemic, surgical volume decreased, but the clinical presentation of diverticulitis became more severe. Due to resource reallocation and possibly patient fear of seeking medical attention, diverticulitis was likely underdiagnosed, and cases that would have been elective became emergent. This underscores the importance of monitoring patients at risk for diverticulitis and intervening when criteria for surgery are met.

Citations

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Surgical and non-operative treatment of acute complicated diverticulitis in a COVID hospital
A. E. Tyagunov, N. A. Shcherbakov, R. R. Akhmedov, N. S. Donchenko, B. K. Laipanov, Z. M. Alieva, E. A. Stradymov, A. V. Tavadov, A. T. Mirzoyan, D. D. Fyodorov, A. A. Tyagunov, A. V. Sazhin
Koloproktologia.2024; 23(2): 108. CrossRef

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IBD

Risk factors for non-reaching of ileal pouch to the anus in laparoscopic restorative proctocolectomy with handsewn anastomosis for ulcerative colitis: Shigenobu Emoto, Keisuke Hata, Hiroaki Nozawa, Kazushige Kawai, Toshiaki Tanaka, Takeshi Nishikawa, Yasutaka Shuno, Kazuhito Sasaki, Manabu Kaneko, Koji Murono, Yuuki Iida, Hiroaki Ishii, Yuichiro Yokoyama, Hiroyuki Anzai, Hirofumi Sonoda, Soichiro Ishihara; Intest Res 2022;20(3):313-320. Published online March 12, 2021; DOI: https://doi.org/10.5217/ir.2020.00158

Abstract PDF PubReader ePub

Background/Aims
Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis and handsewn anastomosis for ulcerative colitis requires pulling down of the ileal pouch into the pelvis, which can be technically challenging. We examined risk factors for the pouch not reaching the anus.
Methods
Clinical records of 62 consecutive patients who were scheduled to undergo RPC with handsewn anastomosis at the University of Tokyo Hospital during 1989–2019 were reviewed. Risk factors for non-reaching were analyzed in patients in whom hand sewing was abandoned for stapled anastomosis because of nonreaching. Risk factors for non-reaching in laparoscopic RPC were separately analyzed. Anatomical indicators obtained from presurgical computed tomography (CT) were also evaluated.
Results
Thirty-seven of 62 cases underwent laparoscopic procedures. In 6 cases (9.7%), handsewn anastomosis was changed to stapled anastomosis because of non-reaching. Male sex and a laparoscopic approach were independent risk factors of non-reaching. Distance between the terminal of the superior mesenteric artery (SMA) ileal branch and the anus > 11 cm was a risk factor for non-reaching.
Conclusions
Laparoscopic RPC with handsewn anastomosis may limit extension and induction of the ileal pouch into the anus. Preoperative CT measurement from the terminal SMA to the anus may be useful for predicting non-reaching.

Citations

Citations to this article as recorded by

Preoperative Simulation of Ileal Pouch–Anal Anastomosis in Patients With Ulcerative Colitis Using a 3-Dimensional Printed Model
Shota Yokose, Koji Murono, Hiroaki Nozawa, Kazuhito Sasaki, Shigenobu Emoto, Hiroyuki Matsuzaki, Yuichiro Yokoyama, Shinya Abe, Yuzo Nagai, Yuichiro Yoshioka, Takahide Shinagawa, Hirofumi Sonoda, Shin Murai, Koichi Komatsu, Soichiro Ishihara
Inflammatory Bowel Diseases.2023; 29(12): 1865. CrossRef
Preoperative Computed Tomography Indices Predict Non-reach Prior to Ileal Pouch-Anal Anastomosis
Evan D. Adams, Charlotte A Lansky, Cindy E. Kallman, Karen N. Zaghiyan, Phillip R. Fleshner
Diseases of the Colon & Rectum.2023;[Epub] CrossRef
Laparoscopic vs open restorative proctectomy after total abdominal colectomy for ulcerative colitis or familial adenomatous polyposis
Hiroaki Nozawa, Keisuke Hata, Kazuhito Sasaki, Koji Murono, Kazushige Kawai, Shigenobu Emoto, Soichiro Ishihara
Langenbeck's Archives of Surgery.2022; 407(4): 1605. CrossRef
Recent Advance in the Management of Dysplasia in the Ulcerative Colitis
Dong-Hoon Yang
Journal of Digestive Cancer Reports.2021; 9(2): 50. CrossRef

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Inflammatory Bowel Diseases

Long-term outcomes of infliximab in a real-world multicenter cohort of patients with acute severe ulcerative colitis: Shin Ju Oh, Ga Young Shin, Hosim Soh, Jae Gon Lee, Jong Pil Im, Chang Soo Eun, Kang-Moon Lee, Dong Il Park, Dong Soo Han, Hyo Jong Kim, Chang Kyun Lee; Intest Res 2021;19(3):323-331. Published online August 18, 2020; DOI: https://doi.org/10.5217/ir.2020.00039

Abstract PDF PubReader ePub

Background/Aims
Infliximab (IFX) has proven effective as rescue therapy in steroid-refractory acute severe ulcerative colitis (ASUC), however, the long-term real-world data are scarce. Our study aimed to assess the long-term treatment outcomes of IFX in a real-life cohort.
Methods
We established a multicenter retrospective cohort of hospitalized patients with ASUC, who met Truelove and Witt’s criteria and received intravenous corticosteroid (IVCS) or IFX during index hospitalization between 2006 and 2016 in 5 university hospitals in Korea. The cohort was systematically followed up until colectomy, death or last follow-up visit.
Results
A total of 296 patients were followed up for a mean of 68.9 ± 44.0 months. During index hospitalization, 49 patients were treated with IFX; as rescue therapy for IVCS failure in 37 and as first-line medical therapy for ASUC in 12. All patients treated with IFX avoided colectomy during index hospitalization. The cumulative rates of rehospitalization and colectomy were 20.4% and 6.1% at 3 months and 39.6% and 18.8% at the end of follow-up, respectively. Patients treated with IFX presented with significantly shorter colectomy-free survival than IVCS responders (P= 0.04, log-rank test). Both cytomegalovirus colitis and Clostridioides difficile infection (CDI) were the significant predictors of colectomy in the overall study cohort (hazard ratios of 6.57 and 4.61, respectively). There were no fatalities.
Conclusions
Our real-world cohort study demonstrated that IFX is an effective therapeutic option in Korean patients with ASUC, irrespective of IFX indication. Aggressive vigilance for cytomegalovirus colitis and CDI is warranted for hospitalized patients with ASUC.

Citations

Citations to this article as recorded by

Factors Associated With Response to Rescue Therapy in Acute Severe Ulcerative Colitis
Christopher F D Li Wai Suen, Dean Seah, Matthew C Choy, Peter De Cruz
Inflammatory Bowel Diseases.2024; 30(8): 1389. CrossRef
Tofacitinib in Acute Severe Ulcerative Colitis (TACOS): A Randomized Controlled Trial
Arshdeep Singh, Manjeet Kumar Goyal, Vandana Midha, Ramit Mahajan, Kirandeep Kaur, Yogesh Kumar Gupta, Dharmatma Singh, Namita Bansal, Ramandeep Kaur, Shivam Kalra, Omesh Goyal, Varun Mehta, Ajit Sood
American Journal of Gastroenterology.2024; 119(7): 1365. CrossRef
Emergency subtotal colectomy rates in relation to anti-TNF therapy in inflammatory bowel disease patients: comparison of retrospective cohorts
Saman Sajjadi, Rebecca Svensson Neufert, Emilia Ruhr, Sebastian Tryggmo, Jan Marsal, Pamela Buchwald
Scandinavian Journal of Gastroenterology.2023; 58(1): 15. CrossRef
The role and prospect of tofacitinib in patients with ulcerative colitis
Jun Lee
Intestinal Research.2023; 21(1): 168. CrossRef
Risks of colorectal cancer and biliary cancer according to accompanied primary sclerosing cholangitis in Korean patients with ulcerative colitis: a nationwide population-based study
Eun Hye Oh, Ye-Jee Kim, Minju Kim, Seung Ha Park, Tae Oh Kim, Sang Hyoung Park
Intestinal Research.2023; 21(2): 252. CrossRef
Rescue Therapies for Steroid-refractory Acute Severe Ulcerative Colitis: A Review
Javier P Gisbert, María José García, María Chaparro
Journal of Crohn's and Colitis.2023; 17(6): 972. CrossRef
The Efficacy of Currently Licensed Biologics for Treatment of Ulcerative Colitis: A Literature Review
Humza Awan, Urooj Fatima, Ryan Eaw, Naomi Knox, Laith Alrubaiy
Cureus.2023;[Epub] CrossRef
Reviewing not Homer’s Iliad, but “Kai Bao Ben Cao”: indigo dye—the past, present, and future
Yusuke Yoshimatsu, Tomohisa Sujino, Takanori Kanai
Intestinal Research.2023; 21(2): 174. CrossRef
Concomitant ankylosing spondylitis can increase the risk of biologics or small molecule therapies to control inflammatory bowel disease
Yu Kyung Jun, Hyuk Yoon, Seong-Joon Koh, A Hyeon Kim, Kwang Woo Kim, Jun Won Park, Hyun Jung Lee, Hyoun Woo Kang, Jong Pil Im, Young Soo Park, Joo Sung Kim
Intestinal Research.2023; 21(2): 244. CrossRef
Characteristics and Treatment Outcomes of Transition among Patients with Inflammatory Bowel Disease
Eun Jin Yoo, Sang-Hoon Cho, Soo Jung Park, Tae Il Kim, Won Ho Kim, Jae Hee Cheon
Yonsei Medical Journal.2023; 64(9): 541. CrossRef
CURRENT STATUS, PROBLEMS AND PROSPECTS OF ULCERATIVE COLITIS MEDICAL CORRECTION (LITERATURE REVIEW)
T. O. Briukhanova, O. A. Nakonechna, O. V Babenko
Bulletin of Problems Biology and Medicine.2023; 1(3): 28. CrossRef
Comparison of 1-Year Colectomy Risk Between the US and Korean Patients with Acute Severe Ulcerative Colitis: A Propensity Score Matching Analysis
Eun Soo Kim, Kyeong Ok Kim, Byung Ik Jang, Eun Young Kim, Yoo Jin Lee, Hyun Seok Lee, Joon Seop Lee, Sung Kook Kim, Yun Jin Jung, Sang-Bum Kang, Manasi Agrawal, Ryan Ungaro, Jean-Frederic Colombel
Digestive Diseases and Sciences.2022; 67(7): 2866. CrossRef
Biomarker dynamics during infliximab salvage for acute severe ulcerative colitis: C-reactive protein (CRP)-lymphocyte ratio and CRP-albumin ratio are useful in predicting colectomy
Danny Con, Bridgette Andrew, Steven Nicolaides, Daniel R van Langenberg, Abhinav Vasudevan
Intestinal Research.2022; 20(1): 101. CrossRef
Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
Chan Hyuk Park, Jung Ho Park, Yoon Suk Jung
Journal of Personalized Medicine.2022; 12(3): 507. CrossRef
Updates on conventional therapies for inflammatory bowel diseases: 5-aminosalicylates, corticosteroids, immunomodulators, and anti-TNF-α
Jihye Park, Jae Hee Cheon
The Korean Journal of Internal Medicine.2022; 37(5): 895. CrossRef
Oral beclomethasone dipropionate as an add-on therapy and response prediction in Korean patients with ulcerative colitis
Kyuwon Kim, Hee Seung Hong, Kyunghwan Oh, Jae Yong Lee, Seung Wook Hong, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Byong Duk Ye, Sang Hyoung Park
The Korean Journal of Internal Medicine.2022; 37(6): 1140. CrossRef
Progress in Diagnosis and Treatment of Ulcerative Colitis with Cytomegalovirus Infection
海丽吴
Advances in Clinical Medicine.2022; 12(08): 7627. CrossRef
Viral Hepatitis in Patients with Inflammatory Bowel Disease
Seung Hwan Shin, Sang Hyoung Park
The Korean Journal of Gastroenterology.2022; 80(2): 51. CrossRef
Improvement in Medication Adherence after Pharmacist Intervention Is Associated with Favorable Clinical Outcomes in Patients with Ulcerative Colitis
Jae Song Kim, Min Jung Geum, Eun Sun Son, Yun Mi Yu, Jae Hee Cheon, Kyeng Hee Kwon
Gut and Liver.2022; 16(5): 736. CrossRef
Effectiveness and Safety of Golimumab in Patients with Ulcerative Colitis: A Multicenter, Prospective, Postmarketing Surveillance Study
Jongwook Yu, Soo Jung Park, Hyung Wook Kim, Yun Jeong Lim, Jihye Park, Jae Myung Cha, Byong Duk Ye, Tae Oh Kim, Hyun-Soo Kim, Hyun Seok Lee, Su Young Jung, Youngdoe Kim, Chang Hwan Choi
Gut and Liver.2022; 16(5): 764. CrossRef
Physician education can minimize inappropriate steroid use in patients with inflammatory bowel disease: the ACTION study
Yehyun Park, Chang Hwan Choi, Hyun Soo Kim, Hee Seok Moon, Do Hyun Kim, Jin Ju Kim, Dennis Teng, Dong Il Park
Intestinal Research.2022; 20(4): 452. CrossRef
Optimal Management of Acute Severe Ulcerative Colitis (ASUC): Challenges and Solutions
Tom Holvoet, Triana Lobaton, Pieter Hindryckx
Clinical and Experimental Gastroenterology.2021; Volume 14: 71. CrossRef
Pharmacogenetics-based personalized treatment in patients with inflammatory bowel disease: A review
Ji Young Chang, Jae Hee Cheon
Precision and Future Medicine.2021; 5(4): 151. CrossRef

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Inflammatory bowel diseases

Tacrolimus for ulcerative colitis in children: a multicenter survey in Japan: Tadahiro Yanagi, Kosuke Ushijima, Hidenobu Koga, Takeshi Tomomasa, Hitoshi Tajiri, Reiko Kunisaki, Takashi Isihige, Hiroyuki Yamada, Katsuhiro Arai, Atsushi Yoden, Tomoki Aomatsu, Satoru Nagata, Keiichi Uchida, Yoshikazu Ohtsuka, Toshiaki Shimizu; Intest Res 2019;17(4):476-485. Published online August 31, 2019; DOI: https://doi.org/10.5217/ir.2019.00027

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Tacrolimus is effective for refractory ulcerative colitis in adults, while data for children is sparse. We aimed to evaluate the effectiveness and safety of tacrolimus for induction and maintenance therapy in Japanese children with ulcerative colitis.
Methods
We retrospectively reviewed the multicenter survey data of 67 patients with ulcerative colitis aged < 17 years treated with tacrolimus between 2000 and 2012. Patients’ characteristics, disease activity, Pediatric Ulcerative Colitis Activity Index (PUCAI) score, initial oral tacrolimus dose, short-term (2-week) and long-term (1-year) outcomes, steroid-sparing effects, and adverse events were evaluated. Clinical remission was defined as a PUCAI score < 10; treatment response was defined as a PUCAI score reduction of ≥ 20 points compared with baseline.
Results
Patients included 35 boys and 32 girls (median [interquartile range] at admission: 13 [11–15] years). Thirty-nine patients were steroid-dependent and 26 were steroidrefractory; 20 had severe colitis and 43 had moderate colitis. The initial tacrolimus dose was 0.09 mg/kg/day (range, 0.05–0.12 mg/kg/day). The short-term clinical remission rate was 47.8%, and the clinical response rate was 37.3%. The mean prednisolone dose was reduced from 19.2 mg/day at tacrolimus initiation to 5.7 mg/day at week 8 (P< 0.001). The adverse event rate was 53.7%; 6 patients required discontinuation of tacrolimus therapy.
Conclusions
Tacrolimus was a safe and effective second-line induction therapy for steroid-dependent and steroid-refractory ulcerative colitis in Japanese children.

Citations

Citations to this article as recorded by

Real‐world effectiveness of ustekinumab and vedolizumab in TNF‐exposed pediatric patients with ulcerative colitis
Perseus V. Patel, Amy Zhang, Balu Bhasuran, Vignesh G. Ravindranath, Melvin B. Heyman, Sofia G. Verstraete, Atul J. Butte, Michael J. Rosen, Vivek A. Rudrapatna
Journal of Pediatric Gastroenterology and Nutrition.2024; 78(5): 1126. CrossRef
Medical management of pediatric inflammatory bowel disease in the Asia‐Pacific region: A position paper by the Asian Pan‐Pacific Society for Pediatric Gastroenterology, Hepatology, and Nutrition (APPSPGHAN) PIBD Working Group
Way Seah Lee, Katsuhiro Arai, George Alex, Suporn Treepongkaruna, Kyung Mo Kim, Chee Liang Choong, Karen S. C. Mercado, Andy Darma, Anshu Srivastava, Marion M. Aw
Journal of Gastroenterology and Hepatology.2023; 38(4): 523. CrossRef
Clinical outcome of ulcerative colitis with severe onset in children: a multicenter prospective cohort study
Ryusuke Nambu, Katsuhiro Arai, Takahiro Kudo, Takatsugu Murakoshi, Reiko Kunisaki, Tatsuki Mizuochi, Sawako Kato, Hideki Kumagai, Mikihiro Inoue, Takashi Ishige, Takeshi Saito, Atsuko Noguchi, Toshifumi Yodoshi, Shin-Ichiro Hagiwara, Naomi Iwata, Shigeo N
Journal of Gastroenterology.2023; 58(5): 472. CrossRef
Oral Tacrolimus in Steroid Refractory and Dependent Pediatric Ulcerative Colitis—A Systematic Review and Meta-Analysis
Rishi Bolia, Akhil Goel, Pooja Semwal, Anshu Srivastava
Journal of Pediatric Gastroenterology & Nutrition.2023; 77(2): 228. CrossRef
Tacrolimus as an alternative treatment for patients with juvenile idiopathic arthritis
Susumu Yamazaki, Masaki Shimizu, Yuko Akutsu, Asami Shimbo, Masaaki Mori
Modern Rheumatology.2022; 32(4): 783. CrossRef
3D printed tacrolimus suppositories for the treatment of ulcerative colitis
Iria Seoane-Viaño, Jun Jie Ong, Asteria Luzardo-Álvarez, Miguel González-Barcia, Abdul W. Basit, Francisco J. Otero-Espinar, Alvaro Goyanes
Asian Journal of Pharmaceutical Sciences.2021; 16(1): 110. CrossRef
Does cytomegalovirus load predict the outcome of acute severe ulcerative colitis?
You Sun Kim
Intestinal Research.2021; 19(4): 357. CrossRef
Tacrolimus in pediatric ulcerative colitis: does it have a role?
Seung Kim
Intestinal Research.2019; 17(4): 441. CrossRef

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Colorectal neoplasia

Rates of metachronous adenoma after curative resection for left-sided or right-sided colon cancer: Yuk Fai Lam, Wai Kay Seto, Teresa Tong, Ka Shing Cheung, Oswens Lo, Ivan FN Hung, Wai Lun Law, Wai K Leung; Intest Res 2018;16(4):619-627. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00013

Abstract PDF PubReader ePub

Background/Aims
We determined the rates of metachronous colorectal neoplasm in colorectal cancer (CRC) patients after resection for right (R)-sided or left (L)-sided cancer.
Methods
Consecutive CRC patients who had undergone surgical resection for curative intent in our hospital between 2001 and 2004 were identified. R-sided colonic cancers refer to cancer proximal to splenic flexure whereas L-sided cancers include rectal cancers. Patients were included only if they had a clearing colonoscopy performed either before or within 6 months after the operation. Findings of surveillance colonoscopy performed up to 5 years after colonic resection were included in the analysis.
Results
Eight hundred and sixty-three CRC patients underwent curative surgical resection during the study period. Three hundred and twenty-seven patients (107 R-sided and 220 L-sided) fulfilled the inclusion criteria and had at least 1 postoperative surveillance colonoscopy performed. The proportion of patients who had polyp and adenoma on surveillance colonoscopy was significantly higher among patients with L-sided than R-sided cancers (polyps: 30.9% vs. 19.6%, P=0.03; adenomas: 25.5% vs. 13.1%, P=0.01). The mean number of adenoma per patient on surveillance colonoscopy was also higher for patients with L-sided than R-sided tumors (0.52; 95% confidence interval [CI], 0.37–0.68 vs. 0.22; 95% CI, 0.08–0.35; P<0.01). Multivariate analysis showed that L-sided cancers, age, male gender and longer follow-up were independent predictors of adenoma detection on surveillance colonoscopy.
Conclusions
Patients with Lsided cancer had a higher rate of metachronous polyps and adenoma than those with R-sided cancer on surveillance colonoscopy.

Citations

Citations to this article as recorded by

The absolute number of small and diminutive adenomas with high-grade dysplasia is substantially higher compared with large adenomas: a retrospective pooled study
Jiancheng Zhang, Huajun Sun, Fei Xiong, Shan Lei, Guanyu Zhou, Xun Xiao, Lin Liu, Pu Wang
Frontiers in Oncology.2024;[Epub] CrossRef
A survey of current practices in post-polypectomy surveillance in Korea
Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Eun Ran Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoo
Intestinal Research.2024; 22(2): 186. CrossRef
Delineation of gastrointestinal tumors biopsies using a fluorescence lifetime imaging optical fiber probe
D. Suraci, E. Baria, L. Tirloni, J. L. Lagarto, S. Buccianti, C. Agostini, S. Pillozzi, L. Antonuzzo, A. Taddei, R. Cicchi
Journal of Biophotonics.2024;[Epub] CrossRef
Risk factors of advanced metachronous neoplasms in surveillance after colon cancer resection
Kwangwoo Nam, Jeong Eun Shin
The Korean Journal of Internal Medicine.2021; 36(2): 305. CrossRef

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