International Journal Of Colorectal Disease[JOURNAL]
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200 papers
Management of symptomatic uncomplicated diverticular disease (SUDD) of the colon with Clostridium butyricum CBM588 versus rifaximin: a retrospective cross-sectional study.
Urgesi R, Pagnini C, De Angelis F … +11 more , Khan A, Pallotta L, Fanello G, Antypas P, Di Paolo MC, Villotti G, Bertuccioli A, Sisti D, Di Pierro F, Zerbinati N, Graziani MG
Int J Colorectal Dis · 2025 Oct · PMID 41108431 · Full text
BACKGROUND: Symptomatic uncomplicated diverticular disease (SUDD) is a chronic condition frequently characterized by abdominal pain, bloating, and altered bowel habits. While cyclic rifaximin is commonly used for symptom...
BACKGROUND: Symptomatic uncomplicated diverticular disease (SUDD) is a chronic condition frequently characterized by abdominal pain, bloating, and altered bowel habits. While cyclic rifaximin is commonly used for symptom control, interest is growing in the potential role of probiotics. This study aimed to compare the clinical outcomes of patients with SUDD treated with either Clostridium butyricum CBM588® or cyclic rifaximin over a 12-month period. METHODS: This retrospective cross-sectional study included 70 patients with a confirmed diagnosis of SUDD, treated between 2023 and 2024. Patients were divided into two groups based on treatment received: Group A (CBM588® daily for 12 months) and Group B (cyclic rifaximin 400 mg bid for 7 days per month). Clinical data, symptom profiles, and occurrence of diverticulitis were collected and compared. The primary outcome was the reduction of SUDD-related symptoms, and the secondary outcome was the incidence of acute diverticulitis episodes during follow-up. RESULTS: A total of 56 patients completed the 12-month follow-up (31 in Group A, 25 in Group B). No significant difference was observed in the rate of symptomatic flares between groups (19.4% vs. 20%, p = 0.7). However, a significantly higher proportion of patients in the CBM588 group reported adequate symptom relief (77.4% vs. 44%, p = 0.02). Improvements in bloating and tenesmus were more frequent in the CBM588 group, although not statistically significant. No treatment-related adverse events were recorded. CONCLUSION: In this retrospective comparison, Clostridium butyricum CBM588 demonstrated similar efficacy to rifaximin in preventing diverticulitis, with a potential advantage in subjective symptom improvement. These findings support further prospective studies to explore the role of CBM588 in SUDD management. Trial registration Clinicaltrial.gov reference: NCT06852274.
2025 Delphi consensus on robotic ventral mesh rectopexy.
Schena CA, Ascanelli S, Grossi U … +34 more , Gallo G, Marchegiani F, Martínez-Pérez A, Pavone G, Azzolina D, Adamina M, Bianchi PP, Bislenghi G, Braini A, Carra MC, Celentano V, Coratti A, Da Pozzo F, De Nardi P, De Simone V, D'Hoore A, Espin-Basany E, Genovese A, Khan J, Lenisa L, Martellucci J, Martinello R, Masetti M, Milone M, Naldini G, Pellino G, Sileri P, Stuto A, Talento P, Testini M, Tonsi A, Ratto C, de'Angelis N, Italian Club of Robotic Surgery (ICORS), the Società Italiana di Chirurgia Colo-Rettale (SICCR), and the Società Italiana Unitaria di ColoProctologia (SIUCP)
Int J Colorectal Dis · 2025 Oct · PMID 41099852 · Full text
PURPOSE: Robotic ventral mesh rectopexy (RVMR) has emerged as an effective technique for addressing rectal prolapse (RP) and associated pelvic floor disorders. However, variability persists regarding preoperative evaluat...
PURPOSE: Robotic ventral mesh rectopexy (RVMR) has emerged as an effective technique for addressing rectal prolapse (RP) and associated pelvic floor disorders. However, variability persists regarding preoperative evaluation, patient selection, and procedural techniques. This Delphi consensus aims to provide evidence-based recommendations to standardize practice, enhance patient outcomes, and address key gaps in the literature. METHODS: Thirty-three experts in RVMR participated in a structured Delphi process. The panel addressed 10 key clinical questions, covering preoperative workup, surgical indications, procedural steps, learning curves, training, and RVMR outcomes. The consensus process was reached through iterative surveys, literature reviews, and a rigorous voting methodology, applying the GRADE approach. RESULTS: A total of 27 consensus statements were formulated, providing standardized recommendations on patient selection, imaging modalities, surgical technique, and expected clinical outcomes. Concerning surgical technique, the panel addressed variations in trocar placement, robotic instrument selection, and docking strategies. Additionally, consensus statements addressed the role of mesh reinforcement, fixation techniques, and the potential for combined procedures in the treatment of multicompartment pelvic organ prolapse. Of the 27 consensus statements, 3 (11.1%) were supported by moderate-quality evidence, whereas 18 (66.7%) were based on low or very-low-quality evidence and 6 (22.2%) on expert opinion. CONCLUSION: This consensus provides a structured, consensus-based framework for clinicians and surgeons trying to address the complexities of RVMR and promote standardization and quality improvement in RP management, while acknowledging that the underlying evidence remains largely low-quality.
Martius flap in recurrent rectovaginal fistula: a video vignette.
Yildirim Y, Arslan C, Bayraktar O … +1 more , Bayraktar IE
Int J Colorectal Dis · 2025 Oct · PMID 41099837 · Full text
PURPOSE: We aimed to demonstrate the Martius flap treatment in a patient who had a recurrent iatrogenic rectovaginal fistula following cystocele repair. METHOD: We performed a Martius flap procedure for the reconstructio...
PURPOSE: We aimed to demonstrate the Martius flap treatment in a patient who had a recurrent iatrogenic rectovaginal fistula following cystocele repair. METHOD: We performed a Martius flap procedure for the reconstruction. A vascularized flap was harvested from the labial fat pad, ensuring preservation of its blood supply via the internal pudendal vessels. The flap was then transposed to the defect site to provide adequate vascular support and promote healing. RESULTS: The patient initially underwent a primary repair of the rectovaginal fistula, which did not achieve fistula healing. A diverting colostomy was then created. Following referral to our unit, a Martius flap using tissue from the left labium majus was performed. The patient was discharged on postoperative day 2 without complications. CONCLUSION: RVF is a debilitating condition that can significantly impair quality of life and often necessitates repeated surgical interventions. We believe that implementing techniques to facilitate the healing process may play a crucial role in optimizing patient outcomes.
Phase-specific learning curves in robot-assisted rectal surgery: implications for surgical training.
Ito R, Matsuda T, Hasegawa H … +7 more , Otowa Y, Ando M, Koterazawa Y, Urakawa N, Goto H, Kanaji S, Kakeji Y
Int J Colorectal Dis · 2025 Oct · PMID 41073577 · Full text
PURPOSE: Techniques for abdominal and pelvic manipulation vary in robot-assisted rectal surgery (RRS); thus, differences in the learning period between these two phases remain unclear. METHODS: This retrospective single-...
PURPOSE: Techniques for abdominal and pelvic manipulation vary in robot-assisted rectal surgery (RRS); thus, differences in the learning period between these two phases remain unclear. METHODS: This retrospective single-center study included 75 patients diagnosed with rectal malignancy who underwent RRS from September 2019 to May 2024. The cumulative sum method was used to analyze the learning curve and compare between abdominal and pelvic phases. RESULTS: The learning curve for the total console time consisted of three phases: I (learning phase, cases 1-25), II (consolidation phase, cases 26-55), and III (maturing phase, cases 56-71). The learning curve for the abdominal phase involved two phases: I (learning phase, cases 1-23) and II (maturing phase, cases 24-71), with no consolidation phase observed. Conversely, in the pelvic phase, the learning phase was achieved in 27 cases, followed by the consolidation phase in 32 cases (cases 28-59) and the maturing phase in the last 16 cases (cases 60-75). CONCLUSIONS: The learning period during RRS was shorter for the abdominal manipulation than for the pelvic manipulation, considering the absence of the consolidation phase. Education and training that consider these points may be useful for the more efficient learning of RRS.
Early- vs. late-onset colon cancer: clinicopathological insights and survival outcomes in an East Asian cohort.
Lin CC, Chang CY, Lin YZ … +11 more , Cheng HH, Huang SC, Lin HH, Lan YT, Wang HS, Chang SC, Yang SH, Jiang JK, Chen WS, Teng HW, Yang YW
Int J Colorectal Dis · 2025 Oct · PMID 41065866 · Full text
PURPOSE: Colorectal cancer (CRC) is the third most prevalent cancer worldwide, showing an increasing early-onset CRC in patients, which is defined as diagnoses made before the age of 50. Studies conflict on early-onset C...
PURPOSE: Colorectal cancer (CRC) is the third most prevalent cancer worldwide, showing an increasing early-onset CRC in patients, which is defined as diagnoses made before the age of 50. Studies conflict on early-onset CRC prognosis versus late-onset CRC with varying survival outcomes. This study explores the age-related survival differences in colon cancer by comparing early- and late-onset groups. METHODS: We performed a retrospective cohort study at a tertiary referral hospital (2010-2018), including 3459 patients with colon cancer (3076 late-onset, 383 early-onset). The clinicopathological features of early- and late-onset colon cancer were compared, and cancer-specific survival was evaluated using the Kaplan-Meier analysis with log-rank tests. The multivariate Cox regression identified independent prognostic factors. RESULTS: Early-onset colon cancer showed female predominance, better Eastern Cooperative Oncology Group performance, more left-sided tumors, and advanced stages. On the contrary, late-onset patients had worse cancer-specific survival (hazard ratio 1.506, 95% confidence interval 1.147-1.977, p = 0.003), particularly in stages II/III, with tumor perforation, signet ring cells, or no perineural invasion. CONCLUSION: In conclusion, despite early-onset colon cancer exhibiting more aggressive features, it is associated with better survival compared with late-onset cases. Further studies are required to validate these findings.
The efficacy and safety of extended thromboprophylaxis after colorectal surgery: a systematic review and meta-analysis.
Choi JDW, Huynh N, Shepherd T … +8 more , Shanmugalingam A, Gavegan FL, Shedden K, Cao A, Pathmanathan N, El-Khoury T, Hitos K, Toh JWT
Int J Colorectal Dis · 2025 Oct · PMID 41065855 · Full text
PURPOSE: To report (1) efficacy and (2) safety outcomes comparing extended thromboprophylaxis (ETP) with low molecular weight heparin (LMWH) and direct oral anticoagulants (DOAC) versus no ETP after colorectal surgery. M...
PURPOSE: To report (1) efficacy and (2) safety outcomes comparing extended thromboprophylaxis (ETP) with low molecular weight heparin (LMWH) and direct oral anticoagulants (DOAC) versus no ETP after colorectal surgery. METHODS: A systematic review using MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to March 2024. Randomised controlled trials and observational studies investigating ETP with LMWH or DOAC for at least 28 days were included. (1) Efficacy outcome was venous thromboembolism (VTE) rate at 30-days postoperatively. (2) Safety outcomes included major bleeding events at 30-90-days. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using a Mantel-Haenszel fixed effects model. RESULTS: Five studies (2936 patients) investigating colorectal surgery for colorectal cancer (CRC) or inflammatory bowel disease (IBD) were included. Total VTE rates were significantly reduced in the LMWH ETP group compared with no ETP [0.56% (OR 0.18, 95% CI 0.07-0.50]. The DOAC ETP group was also compared with no ETP with lower total VTE rates [OR 0.22, 95% CI 0.08-0.67]. There was no difference in VTE rates between LMWH and DOAC ETP. There were no differences in major bleeding events in the LMWH ETP group at 90-days [OR 0.25, 95% CI 0.03-2.24], or the DOAC ETP at 30-days [OR 2.68, 95% CI 0.32-22.35]. There were no VTE-related mortalities at 90-days in either group. CONCLUSION: ETP after colorectal surgery for CRC and IBD reduced the incidence of VTEs with no impact on major bleeding within 90-days. ETP for at least 28 days should be considered particularly for those who have a high risk for postoperative VTE.
Saireito (TJ-114) for Preventing High-Output Syndrome After Temporary Ileostomy in Rectal Cancer Surgery.
Uemura M, Kusunoki C, Sekido Y … +9 more , Takeda M, Hata T, Hamabe A, Ogino T, Miyoshi N, Tei M, Kagawa Y, Eguchi H, Doki Y
Int J Colorectal Dis · 2025 Oct · PMID 41051616 · Full text
PURPOSE: In rectal cancer surgery, a temporary ileostomy is often created to prevent clinical anastomotic leakage. However, high-output syndrome (HOS) frequently arises as a postoperative complication. We aimed to invest...
PURPOSE: In rectal cancer surgery, a temporary ileostomy is often created to prevent clinical anastomotic leakage. However, high-output syndrome (HOS) frequently arises as a postoperative complication. We aimed to investigate the preventive effect of Saireito, a traditional Japanese herbal medicine, on HOS in patients with a temporary ileostomy. METHODS: At the University of Osaka Hospital, Saireito has been routinely administered to patients undergoing rectal cancer surgery with a temporary ileostomy since October 2022. Patients received 9 g/day of Saireito in three divided doses starting from the afternoon of postoperative day 1 (POD1). Among 68 consecutive patients, five were excluded due to incomplete administration of Saireito according to the planned postoperative schedule. The remaining 63 patients were included in the analysis and divided into two groups: the Saireito group (n = 37) and the control group (n = 26). HOS was defined as stoma output ≥ 1,500 mL/day by POD10. RESULTS: There were no significant differences in patient background characteristics between the two groups (p > 0.05). HOS occurred in 13 patients (20.6%). The incidence of HOS was significantly lower in the Saireito group (4 / 37, 10.8%) compared with the control group (9 / 26, 34.6%) (p = 0.0291). CONCLUSION: Postoperative administration of Saireito in rectal cancer patients with temporary ileostomy was associated with a reduced incidence of high-output syndrome. Saireito may be a promising option for preventing HOS in such cases.
Advanced innovations in reducing anastomotic leak: a review of emerging biomaterial applications in colorectal surgery.
Chen E, Chen L, Zhang W … +1 more , Zhou W
Int J Colorectal Dis · 2025 Oct · PMID 41051406 · Full text
The rising global incidence of colorectal cancer surgeries has been paralleled by advancements in minimally invasive techniques such as laparoscopic and robot-assisted surgeries. Despite these improvements, anastomotic l...
The rising global incidence of colorectal cancer surgeries has been paralleled by advancements in minimally invasive techniques such as laparoscopic and robot-assisted surgeries. Despite these improvements, anastomotic leaks remain a significant postoperative complication, leading to increased mortality. Traditionally, diverting ileostomy has been the preferred method to reduce this risk, yet it carries its own set of complications and impacts on patient quality of life. Recent advancements in biomaterial science have introduced alternative methods to protect anastomosis without the need for external stomas. This review explores current technological approaches, including devices like Colovac, LeakGuard, CG-100, the C-seal, and the Self-degrading Intestinal Diversion stent, which aim to replicate the protective effects of ileostomy while minimizing associated complications. The Colovac device, an intraluminal bypass sheath, and the LeakGuard biodegradable stent are both designated as "breakthrough devices" by the FDA. The CG-100, C-seal devices, and Self-degrading Intestinal Diversion stent also demonstrate potential in reducing anastomotic leakage rates through innovative mechanisms. However, widespread clinical adoption of these devices requires further validation through large-scale randomized controlled trials to assess their long-term outcomes and cost-effectiveness. This review highlights the potential of these innovations to enhance the safety and efficacy of colorectal cancer surgeries, ultimately improving patient outcomes and quality of life.
Modified sclerobanding versus rubber band ligation for grade II/III hemorrhoidal disease: a retrospective study.
Wang W, Zheng Y, Lu J … +2 more , Yang M, Yu J
Int J Colorectal Dis · 2025 Oct · PMID 41047429 · Full text
PURPOSE: This study aimed to evaluate the efficacy and safety of a modified sclerobanding (mSB) procedure, which combines rubber band ligation (RBL) with 3% polidocanol foam sclerotherapy (PFS), for treating grade II/III...
PURPOSE: This study aimed to evaluate the efficacy and safety of a modified sclerobanding (mSB) procedure, which combines rubber band ligation (RBL) with 3% polidocanol foam sclerotherapy (PFS), for treating grade II/III hemorrhoidal disease (HD). METHODS: We retrospectively included patients with grade II/III HD who underwent RBL from January to December 2021 and mSB from January 2022 to February 2023 at Ningbo Medical Center Lihuili Hospital. The primary outcomes assessed were treatment failure rates and the incidence of delayed massive bleeding (DMB), while the secondary outcomes included postoperative complications such as pain, swelling, anal edema, and variations in bleeding grade. Long-term follow-up evaluated the HD Symptom Score (HDSS), Short Health Scale for HD (SHS-HD), and Patient Satisfaction (PS). RESULTS: Among the 307 patients, 162 received mSB and 125 underwent traditional RBL. The baseline characteristics were similar, except for the anticoagulant history and hospital stay length (P < 0.05). The mSB group had no cases of delayed major bleeding, compared to five cases in the RBL group. The recurrence (6.8% vs. 17.0%) and treatment failure (6.8% vs. 18.6%) rates were significantly lower in the mSB group (P < 0.05). Postoperative complications were comparable between the groups, but the mSB group showed greater improvement in bleeding by the seventh day (P < 0.05). One-year follow-up revealed no significant differences in the HDSS, SHS-HD, or PS. CONCLUSIONS: The modified sclerobanding procedure reduces the number of ligation sessions, lowers the risk of delayed bleeding, and decreases treatment failure rates without increasing the risk of postoperative complications.
Optimizing pediatric loop colostomy closure: a comparative study of linear stapler and hand-sewn anastomosis.
Hamid R, Nabi U, Sudhanshu A … +7 more , Sharma V, Nisar S, Bhat NA, Baba AA, Mufti GN, Shah WJ, Hassan MFU
Int J Colorectal Dis · 2025 Oct · PMID 41039168 · Full text
BACKGROUND: Conventional hand suture techniques for intestinal anastomosis have been standard practice for decades, but the development of staplers has significantly impacted surgical procedures. Staplers, designed to si...
BACKGROUND: Conventional hand suture techniques for intestinal anastomosis have been standard practice for decades, but the development of staplers has significantly impacted surgical procedures. Staplers, designed to simplify surgery, have been increasingly used in various gastrointestinal surgeries, including pediatric procedures. Colostomy takedown in infants is a commonly performed surgical procedure in pediatric surgery, yet the optimal technique remains debated. This study aims to compare the outcomes of linear stapler anastomosis and hand-sewn anastomosis for elective closure of loop colostomies in children. The hypothesis is that linear stapler anastomosis offers advantages over hand-sewn anastomosis in terms of operative time, recovery, and hospital stay. AIM: To compare the outcomes of linear stapler and hand-sewn anastomosis in the elective closure of pediatric loop colostomies. METHODS: This prospective, randomized controlled study was conducted at Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, J&K, India, between 2021 and 2023. A total of 70 infants were enrolled, randomly assigned to two groups: Group A (35 infants) underwent SA (Stapled Anastomosis), and Group B (35 infants) underwent HS (Hand-Sewn Anastomosis). Both groups were matched for clinical characteristics. The primary outcomes included operative time and time to return of bowel movements. Secondary outcomes included anastomotic leaks, wound infections, and length of hospital stay. Data analysis was performed using appropriate statistical methods including t-tests and chi-square tests. RESULTS: The mean age of patients was 5.79 ± 3.23 months in Group A and 4.21 ± 3.13 months in Group B. The mean time to return of bowel movements was significantly shorter in Group A (24.82 ± 6.34 h) compared to Group B (47.56 ± 5.65 h, p = 0.05). Oral feeding was commenced earlier in Group A (2.18 ± 0.39 days) than in Group B (3.16 ± 0.37 days, p < 0.001). Both groups had a follow-up of 1.81 ± 0.98 years, with no cases of anastomotic leakage or small bowel obstruction in either group. Hospital stay was shorter in Group A (53.82 ± 6.34 h) compared to Group B (79.56 ± 15.65 h, p < 0.0003).
Missed colorectal cancer diagnosis by screening colonoscopy based on the PLCO cancer screening trial.
Li Y, Xiong H, Liang T … +8 more , Liu Y, He L, Tan W, Wang Y, Qiu X, Zhong B, Xie C, Li J
Int J Colorectal Dis · 2025 Oct · PMID 41039049 · Full text
PURPOSE: This study aimed to evaluate the proportion of colorectal cancer (CRC) missed by colonoscopy and the characteristics of the patients with missed diagnosis using data from the prostate, lung, colorectal, and ovar...
PURPOSE: This study aimed to evaluate the proportion of colorectal cancer (CRC) missed by colonoscopy and the characteristics of the patients with missed diagnosis using data from the prostate, lung, colorectal, and ovarian (PLCO) cancer screening trial, and to analyze and compare patient survival between detection and missed diagnosis groups for an evidence-based basis for improving the effectiveness of colorectal cancer screening. PATIENTS AND METHODS: Patients with CRC identified by baseline or follow-up colonoscopy and those identified by annual study update questionnaires or National Death Index search, without any positive findings by colonoscopy in the screening arm of the PLCO study, were included in this study. We calculated the rate of missed CRC diagnosis by colonoscopy using the definition of missed cases as the numerator and the sum of patients with CRC as the denominator. RESULTS: Three hundred sixty patients with CRC were included in the final analysis (detection group, n = 298; missed diagnosis group, n = 62). The overall rate of missed CRC diagnosis by colonoscopy was 17.22%. Patients with a history of colorectal polyps had a higher rate of missed diagnoses (33.3%). The missed diagnosis rate was higher in patients with proximal CRC (31.3%). CRC occurring in the transverse colon (29.6%), hepatic flexure of the colon (40.0%), ascending colon (27.0%), and cecum (36.6%) were more likely to be missed by colonoscopy. The later the stage, the higher the missed CRC diagnosis rate (10.5, 20.0, 30.8, and 30.8% for stages I-IV, respectively). CONCLUSION: Colonoscopy missed a relatively high proportion of CRC, mainly in the proximal colon (especially in the hepatic flexure and cecum of the colon). Recent developments in non-invasive screening technologies, such as stool DNA testing and liquid biopsy, may help address the limitations of colonoscopy. Combining these approaches with traditional endoscopy could enhance overall detection accuracy and reduce the rate of missed colorectal cancer.
Correction to: Long-term outcomes of transanal irrigation in patients with low anterior resection syndrome: what happens after more than five years?
Martellucci J, Scheiterle M, Maltinti G … +3 more , Bergamini C, Cianchi F, Prosperi P
Int J Colorectal Dis · 2025 Oct · PMID 41039026 · Full text
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Development and validation of machine-learning model based on dynamic tumor markers in predicting pathological complete response after neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer: a multicenter cohort study.
Chen B, Peng T, Pan Z … +8 more , Li S, Wang Y, Zheng S, Zhuang J, Liu X, Lu X, Zeng C, Guan G
Int J Colorectal Dis · 2025 Sep · PMID 41003803 · Full text
OBJECTIVE: In this study, we constructed a new pCR predictor based on dynamic tumor marker changes before and after NCRT, the dynamic tumor marker score (DTMS), and combined it with other clinicopathological features to...
OBJECTIVE: In this study, we constructed a new pCR predictor based on dynamic tumor marker changes before and after NCRT, the dynamic tumor marker score (DTMS), and combined it with other clinicopathological features to build a machine-learning model. METHODS: In this retrospective study of patients with LARC between September 2010 and October 2017 at The First Affiliated Hospital of Fujian Medical University (FJMUFAH), Fujian Medical University Union Hospital (FJMUUH), and Fujian Provincial Hospital (FJPH), the DTMS predictor was constructed using logistic regression. Factors associated with pCR were screened using single-factor and multifactorial logistic regression, and 10 machine-learning algorithms were used to construct a pCR prediction model. Additionally, various metrics, including the area under the receiver operating characteristic curve (AUC), area under the precision-recall curve (AUPRC), decision curve analysis, and calibration curves, were obtained to validate the model performance and verified using an external validation set. Finally, SHapley Additive exPlanations (SHAP) values were used to interpret the predictive model. Moreover, we developed a website to facilitate the use of prediction modeling. RESULTS: After analyzing the data of 892 patients with LARC from FJMUFAH, DTMS, tumor size, N stage, and tumor distance from the anal verge were identified as independent predictive factors for pCR using univariate and multivariate regression analyses. The "extreme gradient boosting" (XGB) model displayed the best performance in the training set, with a mean AUC value of 0.86, an AUPRC value of 0.732, and SHAP values utilized in the analysis. In the two external validation sets, the model yielded AUC values of 0.80 and 0.82, along with corresponding AUPRC values of 0.519 and 0.593, respectively, which were the highest among all ten evaluated models, incorporating the use of SHAP values in the analysis. The model maintained superior predictive efficacy in the external validation cohorts (FJMUUH and FJPH). CONCLUSIONS: As a novel marker based on dynamic changes in CEA and CA19-9 levels, DTMS effectively predicted pCR within the XGB model, providing clinicians with a practical tool for treatment decision-making regarding LARC.
Intra-operative ultrasound in the surgical treatment of complex and recurrent pilonidal disease: a retrospective, observational, single-center study.
Gallo G, Goglia M, De Simone V … +4 more , Gravante G, Sileri P, Crucitti A, La Torre M
Int J Colorectal Dis · 2025 Sep · PMID 40974390 · Full text
BACKGROUND: Pilonidal disease (PD) is frequently associated with high recurrence rates and delayed healing, particularly in complex or recurrent cases. While Endoscopic Pilonidal Sinus Treatment (EPSiT) has improved post...
BACKGROUND: Pilonidal disease (PD) is frequently associated with high recurrence rates and delayed healing, particularly in complex or recurrent cases. While Endoscopic Pilonidal Sinus Treatment (EPSiT) has improved postoperative recovery and patient satisfaction, its effectiveness can be limited by incomplete identification of fistulous tracts. Intraoperative ultrasound (IUS) offers real-time visualization of subcutaneous structures and may aid in detecting hidden tracts during surgery. This study evaluates the clinical outcomes of combining IUS with EPSiT in the treatment of complex and recurrent PD. MATERIALS AND METHODS: A retrospective cohort, single-center study was conducted on patients with recurrent and complex PD treated between 2018 and 2021 using IUS in conjunction with EPSiT. All patients had a minimum follow-up of 36 months. The study recorded the number of cases in which IUS identified additional fistulous tracts and led to a modification of the surgical strategy, as well as clinical outcomes including recurrence rate, time to wound healing, and incidence of incomplete wound healing. RESULTS: Nineteen patients were included (14 males, 73.7%; mean age of 35.4 ± 6.4 years). The mean operative time was 42 min, with IUS requiring an additional 6 min. IUS identified previously undetected fistulous tracts in 6 patients (31.5%), leading to modifications in the surgical strategy. At 36-month follow-up, disease persistence (recurrence or incomplete healing) was observed in 5 patients (26.3%). Recurrent cases were successfully managed with additional procedures, achieving 100% healing after reintervention. CONCLUSIONS: Intraoperative IUS identified previously undetected secondary tracts in 31.5% of patients, leading to a modification of the surgical approach. Further comparative studies are needed to validate its effectiveness and assess its potential role as a standard adjunct in the surgical management of pilonidal disease.
Arterial flow in healthy individuals and patients with hemorrhoidal disease: a Doppler ultrasound-based pathophysiological analysis.
Gravante G, De Simone V, Sorge R … +3 more , Picciariello A, Sileri P, Gallo G
Int J Colorectal Dis · 2025 Sep · PMID 40971044 · Full text
BACKGROUND: To evaluate arterial flow patterns in healthy individuals and patients with hemorrhoidal disease (HD) using Doppler transperineal ultrasound (TPUS), aiming to clarify the vascular contribution to HD pathophys...
BACKGROUND: To evaluate arterial flow patterns in healthy individuals and patients with hemorrhoidal disease (HD) using Doppler transperineal ultrasound (TPUS), aiming to clarify the vascular contribution to HD pathophysiology. METHODS: A prospective observational study was conducted on 50 healthy controls (HC) and 94 HD patients classified by Goligher grade. All underwent TPUS with Doppler assessment to record vascular patterns and quantify peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI). RESULTS: A vascular Doppler pattern was observed in 92.6% of HD patients vs. 50% of HCs (p < 0.001). HD patients showed significantly higher PSV (11.1 ± 3.6 cm/s vs. 8.3 ± 2.9 cm/s, p < 0.001) and RI (0.8 ± 0.1 vs. 0.7 ± 0.1, p = 0.015), with no significant difference in EDV. Among Goligher groups, grades III and IV showed significantly elevated PSV compared to HCs. No differences were observed in EDV or RI among subgroups. CONCLUSION: Doppler TPUS can identify distinct hemodynamic profiles in HD patients, supporting a vascular component in HD pathogenesis. Its ability to detect subclinical alterations and distinguish severity grades may enhance diagnostic accuracy and guide tailored treatment strategies.
Interobserver agreement of the Taulí-pT1 classification in rectal pT1 adenocarcinoma.
Gener-Jorge C, Ferreres Piñas JC, Moreno Garcia AB … +6 more , Melgar Rivera DS, Casalots A, Nonell A, Espina B, Caro-Tarragó A, Serra-Aracil X
Int J Colorectal Dis · 2025 Sep · PMID 40957973 · Full text
PURPOSE: In pT1 rectal adenocarcinoma, adverse pathological features guide the indication for radical surgery; however, they are present in only 10-15% of cases. Therefore, in most patients, accurate en bloc local excisi...
PURPOSE: In pT1 rectal adenocarcinoma, adverse pathological features guide the indication for radical surgery; however, they are present in only 10-15% of cases. Therefore, in most patients, accurate en bloc local excision with clear margins and precise submucosal invasion assessment is essential for appropriate risk stratification. Beyond absolute depth, a major challenge is the wide interindividual variability in submucosal thickness. The Taulí-pT1 classification, based on the measurement of healthy residual submucosa (hrSB) from the muscularis propria, has been proposed as an objective and reproducible system. This study aimed to validate this classification. METHOD: An interobserver study was conducted on 30 patients with pT1 rectal adenocarcinoma treated by transanal endoscopic surgery. Four pathologists with varying experience levels independently evaluated digitized histological slides, measuring hrSB, total submucosal thickness, and invasion depth. They also classified specimens as sm1, sm2, or sm3. Interobserver agreement was assessed using intraclass correlation coefficients (ICC), and Fleiss' and Cohen's kappa indices. RESULTS: Excellent interobserver agreement was observed for hrSB (ICC = 0.99; 95% CI: 0.98-0.99), total submucosal thickness (ICC = 0.96; 95% CI: 0.93-0.98), and depth of invasion (ICC = 0.94; 95% CI: 0.9-0.97). The Taulí-pT1 classification demonstrated good agreement (Fleiss' kappa = 0.71). Identification of the muscularis mucosae showed moderate agreement (kappa = 0.612). CONCLUSION: The Taulí-pT1 classification demonstrates high interobserver reproducibility, even among pathologists with varying levels of experience, supporting its utility as an objective and standardized tool for the assessment of pT1 rectal adenocarcinoma. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06218108.
Adherence to multi-target stool DNA colorectal cancer screening and clinical follow-up in the Hartford HealthCare system.
Gohil S, D'Attilio D, Paladiya R … +4 more , Ganguly A, Vergara CM, Karlitz JJ, Greene M
Int J Colorectal Dis · 2025 Sep · PMID 40954367 · Full text
BACKGROUND: The multi-target stool DNA (mt-sDNA) test is a growing and convenient option for colorectal cancer (CRC) screening. Adherence to screening is critical to optimize patient outcomes. This study aimed to evaluat...
BACKGROUND: The multi-target stool DNA (mt-sDNA) test is a growing and convenient option for colorectal cancer (CRC) screening. Adherence to screening is critical to optimize patient outcomes. This study aimed to evaluate real-world adherence to mt-sDNA testing and the rate of follow-up colonoscopy after positive results among average-risk patients within a large regional health system. METHODS: This retrospective cohort study included patients aged 45-75 years in the Hartford HealthCare system whose provider ordered an mt-sDNA test between August 2014 and May 2023. Those at high risk of CRC were excluded. Adherence was defined as the return of a successfully completed test with valid results within 365 days of shipment. Rates of and time to follow-up colonoscopy were assessed in mt-sDNA-positive patients. Logistic regression assessed characteristics associated with adherence. RESULTS: Of 24,945 included patients, 96.8% had never previously taken an mt-sDNA test and 60.5% were female. Overall, 17,240 patients (69.1%) adhered to the mt-sDNA test. Younger adults aged 45-49 years had high adherence (74.0%). Logistic regression found age 45-49 years, income > $75K, history of mt-sDNA adherence, and seeing a gastrointestinal specialist were predictors of greater adherence. Of 2,468 patients (14.3%) with positive test results, 1,686 (68.3%) had follow-up colonoscopies within a year, and 1,322 (53.6%) within 4 months, of the test result. CONCLUSIONS: In this regional health system, nearly 70% of patients adhered to mt-sDNA testing. Among those with positive results, 68.3% completed follow-up colonoscopies. These findings highlight the potential utility of mt-sDNA testing in supporting CRC screening and follow-up in certain clinical settings. IMPACT: mt-sDNA testing may support improved CRC screening adherence and timely follow-up in certain health care settings.
Colonic Volvulus Associated with Hirschsprung's Disease in the Pediatric Age.
Amra HS, Elghandour MM, Abdel-Latif M
Int J Colorectal Dis · 2025 Sep · PMID 40947465 · Full text
PURPOSE: Colonic volvulus (CV) is a twist of part of the colon over its mesentery. Although CV is rare in children, its incidence is unknown. Hirschsprung's disease (HD) represents a significant risk factor of CV in chil...
PURPOSE: Colonic volvulus (CV) is a twist of part of the colon over its mesentery. Although CV is rare in children, its incidence is unknown. Hirschsprung's disease (HD) represents a significant risk factor of CV in children, especially when diagnosed late. AIM: To review the clinical, radiological and management data of children with CV associated with HD. METHODS: Medical records were reviewed from January 2000 to December 2022 looking for children had CV associated with HD. RESULTS: 21 cases (17 males and 4 females) were admitted with CV. Their ages ranged from 8 days to 14 years. Sigmoid volvulus was recorded in 17 (81%) cases, while 4 (19%) cases had cecal volvulus. CV was associated with HD in 9 (42.9%) cases. Their median age was 7 years. Eight cases had sigmoid volvulus associated with short segment HD, while one case had cecal volvulus with long segment HD. CV was the first presentation, before the diagnosis of HD, in 8 cases. The diagnosis of HD was overlooked in 3 cases; 2 cases had an anastomotic leakage after sigmoidectomy, while the third case had recurrence of volvulus after successful nonoperative management. CONCLUSION: The diagnosis of CV in children mandates a high index of suspicion. Moreover, HD should be suspected and excluded in every case of CV in children.
Standard of practice imaging vs. PET/MR: a comparative prospective study in rectal cancer staging.
Maksim R, Buczyńska A, Sidorkiewicz I … +6 more , Mojsak M, Śliwowska-Burzyńska J, Zuzda K, Gugnacki P, Krętowski A, Sierko E
Int J Colorectal Dis · 2025 Sep · PMID 40938454 · Full text
BACKGROUND: Rectal cancer (RC) remains a significant global health concern, with increasing incidence rates and associated mortality. Early detection of metastases plays a crucial role in the effective management of rect...
BACKGROUND: Rectal cancer (RC) remains a significant global health concern, with increasing incidence rates and associated mortality. Early detection of metastases plays a crucial role in the effective management of rectal cancer and predicting patient outcomes. Imaging modalities are vital in diagnosing and evaluating the extent of metastases. The integration of novel hybrid positron emission tomography utilizing fluorodeoxyglucose (18F-FDG) fused with magnetic resonance (PET/MR) has emerged as an innovative diagnostic tool. By combining both technologies' strengths, PET/MR imaging provides precise metabolic information from PET alongside detailed anatomical data from MR. This prospective study aimed to assess the clinical utility of PET/MR imaging with the 18F-FDG tracer compared to standard imaging modalities for detecting the extent of RC. METHODS: We enrolled 42 patients who underwent both standard imaging (CT and/or MRI) and whole-body PET/MR with 18F-FDG before preoperative therapy. RESULTS: Our results indicated that PET/MR with 18F-FDG provides superior detection of lymph nodes and tumor deposits in the mesorectum, with the highest diagnostic accuracy for tumor length measurement (area under the ROC curve (AUC) = 0.730; p < 0.05) and a combined model of SUVmax and CEA (AUC = 0.921; p < 0.001). Furthermore, PET/MR changed the clinical stage in 64% of patients and altered clinical management in 26% of cases. CONCLUSIONS: The presented findings demonstrate the effectiveness of this advanced imaging technique and its potential to enhance treatment planning. By providing more accurate staging information, this method could significantly improve diagnosis, treatment customization, and overall outcomes for patients with rectal cancer, particularly in cases where lymph node involvement and tumor deposits impact therapeutic decisions.
Visceral obesity as a predictor of ileal pouch reachability in ulcerative colitis: A prospective single-center study.
Horio Y, Uchino M, Kiriki M … +9 more , Tomoo Y, Nomura K, Nagano K, Kusunoki K, Kuwahara R, Kimura K, Kataoka K, Ikeda M, Ikeuchi H
Int J Colorectal Dis · 2025 Sep · PMID 40938440 · Full text
AIM: Obesity has been reported to increase the risk of technical inability in performing ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). This study aimed to prospectively investigate the ass...
AIM: Obesity has been reported to increase the risk of technical inability in performing ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC). This study aimed to prospectively investigate the association between visceral fat and the feasibility of pouch reach in hand-sewn IPAA. METHODS: We prospectively enrolled patients with UC scheduled for two-stage restorative proctocolectomy with a preoperative plan for hand-sewn IPAA. Patients were categorized into a conversion group that required conversion to stapled IPAA intraoperatively and a non-conversion group. Preoperative visceral fat area and anatomical indicators were measured using computed tomography (CT). Logistic regression analysis was performed to identify predictors of conversion surgery. RESULTS: A total of 106 patients were included, with 12 (11.3%) in the conversion group. Compared with those in the non-conversion group, patients in the conversion group had significantly higher body mass index (BMI), greater visceral fat, and a longer distance between the ileal end and the anal verge (p < 0.01). Logistic regression identified visceral fat (per 10 cm increase: odds ratio [OR] 1.19, 95% confidence interval [CI] 1.02-1.39, p = 0.01) as a significant predictor of conversion surgery, whereas BMI was not (OR 1.03, 95% CI 0.77-1.21, p = 0.72). CONCLUSIONS: Visceral fat is an independent risk factor for conversion surgery in patients undergoing hand-sewn IPAA. Preoperative CT-based measurement of visceral fat may provide a more accurate prediction of pouch reachability than BMI alone. These findings may help surgeons decide preoperatively whether a hand-sewn IPAA is feasible.
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