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Clinics in Liver Disease Nov 2019Gastrointestinal varices are associated with cirrhosis and portal hypertension. Variceal hemorrhage is a substantial cause of morbidity and mortality, with esophageal... (Review)
Review
Gastrointestinal varices are associated with cirrhosis and portal hypertension. Variceal hemorrhage is a substantial cause of morbidity and mortality, with esophageal and gastric varices the most common source and rectal varices a much less common cause of severe gastrointestinal bleeding. The goals of managing variceal hemorrhage are control of active bleeding and prevention of rebleeding. This article focuses on reviewing the current management strategies, including optimal medical, endoscopic, and angiographic interventions and their clinical outcomes to achieve these goals. Evidence based discussion is used with current references as much as possible.
Topics: Adrenergic beta-Antagonists; Cyanoacrylates; Endoscopy, Digestive System; Esophageal and Gastric Varices; Fluid Therapy; Gastrointestinal Agents; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Hypertension, Portal; Ligation; Octreotide; Proctoscopy; Rectum; Sclerotherapy; Varicose Veins
PubMed: 31563215
DOI: 10.1016/j.cld.2019.07.005 -
Digestive Endoscopy : Official Journal... Jan 2020Suitable lesions for endoscopic treatment include not only early colorectal carcinomas but also several types of precarcinomatous adenomas. It is important to establish... (Review)
Review
Suitable lesions for endoscopic treatment include not only early colorectal carcinomas but also several types of precarcinomatous adenomas. It is important to establish practical guidelines wherein preoperative diagnosis of colorectal neoplasia and selection of endoscopic treatment procedures are appropriately outlined and to ensure that actual endoscopic treatment is useful and safe in general hospitals when carried out in accordance with guidelines. In cooperation with the Japanese Society for Cancer of the Colon and Rectum, the Japanese Society of Coloproctology, and the Japanese Society of Gastroenterology, the Japan Gastroenterological Endoscopy Society compiled colorectal endoscopic submucosal dissection/endoscopic mucosal resection guidelines by using evidence-based methods in 2014. The first edition of these guidelines was published 5 years ago. Accordingly, we have published the second edition of these guidelines based on recent new knowledge and evidence.
Topics: Adenocarcinoma; Colonoscopy; Colorectal Neoplasms; Endoscopic Mucosal Resection; Female; Gastroenterology; Humans; Japan; Male; Minimally Invasive Surgical Procedures; Neoplasm Invasiveness; Neoplasm Staging; Outcome Assessment, Health Care; Proctoscopy; Societies, Medical
PubMed: 31566804
DOI: 10.1111/den.13545 -
Annals of Surgery Jan 2023To determine the morbidity, mortality, and pathologic outcomes of transanal total mesorectal resection (taTME) versus laparoscopic total mesorectal excision (laTME)... (Randomized Controlled Trial)
Randomized Controlled Trial
Morbidity, Mortality, and Pathologic Outcomes of Transanal Versus Laparoscopic Total Mesorectal Excision for Rectal Cancer Short-term Outcomes From a Multicenter Randomized Controlled Trial.
OBJECTIVE
To determine the morbidity, mortality, and pathologic outcomes of transanal total mesorectal resection (taTME) versus laparoscopic total mesorectal excision (laTME) among patients with rectal cancer with clinical stage I to III rectal cancer below the peritoneal reflection.
BACKGROUND
Studies with sufficient numbers of patients allowing clinical acceptance of taTME for rectal cancer are lacking. Thus, we launched a randomized clinical trial to compare the safety and efficacy of taTME versus laTME.
METHODS
A randomized, open-label, phase 3, noninferiority trial was performed at 16 different hospitals in 10 Chinese provinces. The primary endpoints were 3-year disease-free survival and 5-year overall survival. The morbidity and mortality within 30 days after surgery, and pathologic outcomes were compared based on a modified intention-to-treat principle; this analysis was preplanned.
RESULTS
Between April 13, 2016, and June 1, 2021, 1115 patients were randomized 1:1 to receive taTME or laTME. After exclusion of 26 cases, modified intention-to-treat set of taTME versus laTME groups included 544 versus 545 patients. There were no significant differences between taTME and laTME groups in intraoperative complications [26 (4.8%) vs 33 (6.1%); difference, -1.3%; 95% confidence interval (CI), -4.2% to 1.7%; P =0.42], postoperative morbidity [73 (13.4%) vs 66 (12.1%); difference, 1.2%; 95% CI, -2.8% to 5.2%; P =0.53), or mortality [1 (0.2%) vs 1 (0.2%)]. Successful resection occurred in 538 (98.9%) versus 538 (98.7%) patients in taTME versus laTME groups (difference, 0.2%; 95% CI, -1.9% to 2.2%; P >0.99).
CONCLUSIONS
Experienced surgeons can safely perform taTME in selected patients with rectal cancer.
Topics: Humans; Postoperative Complications; Transanal Endoscopic Surgery; Operative Time; Rectal Neoplasms; Laparoscopy; Morbidity; Rectum; Treatment Outcome
PubMed: 35815886
DOI: 10.1097/SLA.0000000000005523 -
The Surgical Clinics of North America Jun 2020Anal cancer is a rare cancer, comprising less than 5% of gastrointestinal tract malignancies. Diagnosis of anal canal cancer can be difficult given that presenting... (Review)
Review
Anal cancer is a rare cancer, comprising less than 5% of gastrointestinal tract malignancies. Diagnosis of anal canal cancer can be difficult given that presenting symptoms are similar to those of benign anorectal diseases. General surgeons who encounter suspected anal canal cancer need to have a good understanding of the anatomy of the anal canal, high index of suspicion for malignancy, and low threshold to biopsy lesions when indicated. This article discusses the most commonly encountered anal canal tumors, the evaluation of these tumors, and their management. The foundation for successful therapy includes timely diagnosis, accurate staging, and routine surveillance.
Topics: Adenocarcinoma; Anal Canal; Anus Neoplasms; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Chemoradiotherapy; Diagnosis, Differential; Follow-Up Studies; Lymphatic Metastasis; Melanoma; Neoplasm Staging; Proctoscopy; Prognosis
PubMed: 32402305
DOI: 10.1016/j.suc.2020.02.007 -
Colorectal Disease : the Official... Apr 2021
Topics: Humans; Proctectomy; Transanal Endoscopic Surgery
PubMed: 33871160
DOI: 10.1111/codi.15655 -
Sexual Health Jan 2022Anal examination and proctoscopy are important skills needed to facilitate the diagnoses of STIs and cancer. Clinician (25 doctors/15 nurses) confidence was higher for...
Anal examination and proctoscopy are important skills needed to facilitate the diagnoses of STIs and cancer. Clinician (25 doctors/15 nurses) confidence was higher for anal examination versus proctoscopy (median Likert scores 4/5 vs 5/5, P≤0.05) and higher in doctors compared with nurses (median Likert scores 5/5 vs 4/5, P<0.008, 4/5 vs 2/5, P<0.005), and related to years of experience (5/5 vs 4/5, P<0.001, 3/5 vs 5/5, P=0.007). Barriers included lack of opportunities for training, concerns about patient reluctance, and lack of available equipment. We need to be innovative when up-skilling the specialist sexual health workforce using online training and optimising opportunities for clinical assessment of MSM.
Topics: HIV Infections; Homosexuality, Male; Humans; Male; Pilot Projects; Proctoscopy; Sexual Behavior; Sexual Health; Sexual and Gender Minorities
PubMed: 34838154
DOI: 10.1071/SH21196 -
Sexually Transmitted Infections Nov 2020We explored the association between nucleic acid amplification testing (NAAT) and rectal microscopy/proctoscopy findings and correlates of rectal STIs among 150 gay and...
OBJECTIVES
We explored the association between nucleic acid amplification testing (NAAT) and rectal microscopy/proctoscopy findings and correlates of rectal STIs among 150 gay and bisexual men (GBM) diagnosed with proctitis at the Sydney Sexual Health Centre from March 2016 to October 2017.
METHODS
From case files, we analysed risk behaviours, microscopy, proctoscopy and NAAT results for rectal STIs (, , , herpes simplex virus type 1/2, lymphogranuloma venereum and syphilis). χ test assessed the association between microscopy/proctoscopy findings and NAAT results. Linear regression assessed the association between NAAT positivity and correlates of rectal STIs.
RESULTS
The mean age was 32.5 (9.8) years, 43% (65/150) were taking pre-exposure prophylaxis, 17% (26/150) were HIV positive and 24% (36/147) had multiple rectal STIs.Among GBM with documented proctoscopy findings (n=113), 58% (65/113) had discharge, 36% (41/113) had anorectal erythema and 25% (28/113) had bleeding. A quarter of GBM (28/113) had negative proctoscopy findings.Discharge found on proctoscopy (p=0.001), positive HIV status (p=0.030) and time since last receptive anal intercourse (p=0.028) were independently associated with NAAT positivity for any rectal STI. Discharge had a positive likelihood ratio of 1.6 (95% CI 1.0 to 2.4).Among those with documented microscopy findings (n=69), 59% (41/69) and 41% (28/69) were NAAT positive and negative, respectively. Among NAAT-positive GBM, 27 (66%) had polymorphonuclear cells (PMNs) (mean number of PMNs, 10 (SD 9) cells per oil immersion field), 1 (2%) had Gram-negative intracellular diplococci and 11 (27%) had negative findings. There was no significant association between microscopy findings and NAAT results (p=0.651) or the number of rectal STI (p=0.279).
CONCLUSION
Microscopy does not reliably provide information necessary to tailor the management of GBM diagnosed with proctitis. Discharge found during proctoscopy may identify GBM with rectal STI. Services should consider recommendations to perform these investigations.
Topics: Adult; Australia; Health Risk Behaviors; Humans; Male; Microscopy; Nucleic Acid Amplification Techniques; Proctitis; Proctoscopy; Rectum; Sexual and Gender Minorities; Sexuality; Sexually Transmitted Diseases; Young Adult
PubMed: 32001659
DOI: 10.1136/sextrans-2019-054197 -
Clinical Colorectal Cancer Mar 2022Surgical resection is the cornerstone of curative intent therapy for rectal cancer. The introduction of the concept of total mesorectal excision (TME) led to significant... (Review)
Review
Surgical resection is the cornerstone of curative intent therapy for rectal cancer. The introduction of the concept of total mesorectal excision (TME) led to significant decreases in local recurrence. However, TME carries substantial morbidity. The advent of transanal endoscopic techniques, such as transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS), has allowed patients with early-stage disease to be managed with local excision and avoid the morbidity of TME. Advances in surgery such as laparoscopy, robotic surgery, and transanal approaches have also broadened the options for achieving TME. However, there is significant debate within the literature regarding the optimal approach and oncologic outcomes of these modalities.
Topics: Digestive System Surgical Procedures; Humans; Rectal Neoplasms; Rectum; Transanal Endoscopic Microsurgery; Transanal Endoscopic Surgery
PubMed: 35151585
DOI: 10.1016/j.clcc.2022.01.008 -
Colorectal Disease : the Official... Oct 2020
Topics: Humans; Minimally Invasive Surgical Procedures; Rectal Neoplasms; Rectum; Robotic Surgical Procedures; Transanal Endoscopic Surgery
PubMed: 33099876
DOI: 10.1111/codi.15172 -
JAMA Surgery Jan 2021
Review
Topics: Humans; Transanal Endoscopic Surgery
PubMed: 33206148
DOI: 10.1001/jamasurg.2020.4994