Diseases of the Colon & Rectum最新文献

{"title":"Disparities In Uptake of the 2021 United States Preventive Services Task Force Colorectal Cancer Screening Recommendations Among Adults Aged 45-49.","authors":"Sara Myers, Elizabeth S Davis, Olivia A Sacks, Jeffrey A Franks, Jennifer S Davids, Kelly M Kenzik","doi":"10.1097/DCR.0000000000003789","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003789","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer screening lowers mortality, and in 2021, the United States Preventive Services Task Force lowered the recommended age to start colorectal cancer screening for average-risk adults from 50 to 45. However, social and structural factors impact access to screening, and sociodemographic disparities in uptake of the recommendation to begin colorectal cancer screening at age 45 has not been studied among the general population.</p><p><strong>Objective: </strong>Examine disparities in uptake of the 2021 United States Preventive Services Task Force recommendation to start colorectal cancer screening at age 45.</p><p><strong>Design: </strong>Utilizing 2022 and 2023 Behavioral Risk Factor Surveillance System data, we examined factors associated with colorectal cancer screening using multivariable logistic regression models.</p><p><strong>Setting: </strong>Data from the Behavioral Risk Factor Surveillance System national phone survey.</p><p><strong>Patients: </strong>Adults aged 45-49.</p><p><strong>Main outcome measure: </strong>Colorectal cancer screening.</p><p><strong>Results: </strong>Higher proportions of people with low-income, limited education, no health insurance, and rural residence were unscreened. Uninsured individuals had the lowest odds of undergoing screening (OR = 0.48, 95% CI= 0.37-0.63). Among insured people, low-income (OR = 0.83, 95% CI = 0.73-0.93) and low-education (OR = 0.69, 95% CI = 0.51-0.94) individuals had lower odds of screening; rural uninsured individuals had lower odds of screening than their urban uninsured counterparts (OR = 0.57, 95% CI = 0.37-0.89).</p><p><strong>Limitations: </strong>We could not identify individuals with polyps or family histories of hereditary cancer syndromes who would be recommended for early screening regardless of the 2021 guidelines.</p><p><strong>Conclusions: </strong>Sociodemographic disparities exist in uptake of the 2021 United States Preventive Services Task Force recommendation to start colorectal cancer screening at age 45. Uninsured people had the lowest odds of screening, and uninsured rural individuals had lower odds of screening than their uninsured urban counterparts. Insured low-income and low-education individuals had lower odds of accessing colorectal cancer screening than their higher-income and higher-educated counterparts. Expanding insurance coverage among adults aged 45-49 may increase access to colorectal cancer screening. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural History of Anal Strictures in Pediatric-Onset Crohn's Disease: Long-term Follow-up of a Population-Based Study.","authors":"Perrine Mortreux, Ariane Leroyer, Delphine Ley, Claire Dupont, Valérie Bertrand, Nathalie Guillon, Pauline Wils, Hugues Coevoet, Thierry Paupard, Corinne Gower-Rousseau, Laurent Siproudhis, Nicolas Richard, Dominique Turck, Guillaume Savoye, Hélène Sarter, Mathurin Fumery","doi":"10.1097/DCR.0000000000003788","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003788","url":null,"abstract":"<p><strong>Background: </strong>The risk and clinical course of anal stricture observed in Crohn's disease remains poorly known, particularly in pediatric-onset Crohn's disease.</p><p><strong>Objective: </strong>To investigate the long-term clinical course of anal stricture in pediatric-onset CD using data from a population-based cohort.</p><p><strong>Design: </strong>A retrospective observational study from a prospective population-based study.</p><p><strong>Settings: </strong>Population-based study in Northern France.</p><p><strong>Patients: </strong>All patients with a diagnosis of Crohn's disease before the age of 17 years between 1988 and 2011 within the population-based registry EPIMAD.</p><p><strong>Main outcome measures: </strong>Primary outcome was the cumulative risk of anal stricture. Secondary outcomes included include risk of anal cancer, surgery, stoma and risk factors associated with anal stricture.</p><p><strong>Results: </strong>A total of 1,007 patients were included (median age at diagnosis, 14.5 years; IQR, 12.0-16.1), median duration of follow-up 8.8 years (IQR, 4.6-14.2)). Among them one (0,1%) had an anal stricture at diagnosis and 26 (2.6%) during follow-up. From diagnosis, the 5- and 10-years cumulative incidence of anal stricture at was 0.6% (95% CI, 0.1-1.1) and 1.4% (95% CI, 0.5-2.3), respectively. Twenty-five (n = 25/27, 93%) patients had at least one episode of anal ulceration or fistulizing perineal Crohn's disease. In multivariable analysis, extraintestinal manifestations (HR 2.2, 95% CI, 1.0-4.8, p = 0.0270), colonic location (L2 vs L3 HR 1.2, 95% CI 0.6-2.7, p = 0.0064) and a history of fistulizing perineal Crohn's disease (HR 9.9, 95% CI, 4.3-22.8, p < 0.0001) were significantly associated with anal stricture. After a median follow-up of 6.2 years (2.4-10.6), 11 (41%) patients required at least one anal dilatation, and healing was observed in one patient. One patient (3.7%) had an anal cancer 7 years after stricture diagnosis, and 9 (33%) patients needed a stoma. Anal stricture was significantly associated with the need of stoma (HR 5.8, 95% CI, 2.3-14.3), p = 0.0002).</p><p><strong>Limitations: </strong>It has a retrospective design which makes it prone to selection bias and residual confounding.</p><p><strong>Conclusion: </strong>Within a population-based cohort of pediatric-onset Crohn's diease, the 10-year cumulative incidence of anal stricture was 1.4%, with associations identified with colonic disease location, and fistulizing perianal involvement. The presence of an anal stricture was linked to a fivefold increase in the likelihood of stoma formation. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Appendiceal Neoplasms.","authors":"Wolfgang B Gaertner, Shaun Brown, Michael Deutsch, Mehraneh D Jafari, Mukta K Krane, Vlad V Simianu, Michael A Valente, Amy L Lightner, Daniel L Feingold, Ian M Paquette","doi":"10.1097/DCR.0000000000003796","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003796","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the Gray Zones of Appendix Cancer Management.","authors":"Cherry E Koh","doi":"10.1097/DCR.0000000000003797","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003797","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply.","authors":"Eyal Aviran","doi":"10.1097/DCR.0000000000003786","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003786","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the Correlation Between Robotic System Deployment Numbers and in Minimally Invasive Surgery Trends.","authors":"Wenhan Wu","doi":"10.1097/DCR.0000000000003787","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003787","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the Ambiguities in Postoperative Bleeding Clinical Significance in ERAS Studies.","authors":"Wenhan Wu","doi":"10.1097/DCR.0000000000003785","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003785","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardizing the Definition of Each Colon Cancer Segment: Delphi Consensus on Clinical Decision-Making for Oncologic Outcomes.","authors":"Mehmet Ayhan Kuzu, Cigdem Benlice, Amjad Parvaiz, Emre Gorgun, Claus A Bertelsen, Steven Wexner, Eric J Dozois, Werner Hohenberger, Danilo Miskovic, Konichi Sugihara, Antonino Spinelli, Theo Wiggers, Woo Yong Lee, Gabriela Möslein, Petr Tsarkov, Eloy Espin Basany, Juan Carlos Patron Uriburu, Rodrigo Olivia Perez, Craig Lynch, Zheng Liu, Dieter Hahnloser, Per J Nilsson, Nisar Ahmad Chowdri, Gina Brown, Philippe Rouanet, Robert D Madoff, Nick P West, Turgut Sahin, Atilla Halil Elhan, Liliana G Bordeianou","doi":"10.1097/DCR.0000000000003739","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003739","url":null,"abstract":"<p><strong>Background: </strong>Data registries lack a definitive classification system that distinguishes different locations of colon cancer from one another.</p><p><strong>Objective: </strong>To establish an international consensus on the definition of primary colon cancer segment locations.</p><p><strong>Design: </strong>Between December 2022 and June 2023, Delphi survey study was conducted to seek opinions from relevant international experts and eventually develop a consensus definition of each colon cancer segment.</p><p><strong>Setting: </strong>Three-round online-based Delphi survey study.</p><p><strong>Interventions: </strong>Online survey included 17 questions. In the first two rounds, participating experts were asked to rank each statement on a scale of 1-9 (9 is the most relevant). Consensus statements and definitions were revised according to results, obtaining a consensus score of 7-9. During the third round and online meeting, definitions and statements reached a moderate or high consensus(above 4 in more than 70% of participants) were included.</p><p><strong>Main outcome and measure: </strong>Primary goal of our project was focused on precisely localizing the specific segment affected by primary colon cancer, rather than to identify surgical treatment or type of resection needed for particular segment.</p><p><strong>Results: </strong>The first round included 331 experts, 301 (91%) completed the second round, and 295 (98%) completed the final round. Experts strongly supported the use of a \"10 cm rule\" to describe colon cancer sites at the flexures and anatomical landmarks for other segments. Regarding the definition of rectosigmoid cancer, experts from America and Europe reached a high consensus that the term rectosigmoid as a colon cancer location must be abolished in contrast to experts from Asia. Description of cancers overlapping segments achieved a consensus of 64%.</p><p><strong>Limitations: </strong>Subjective decisions are based on individual expert clinical experience.</p><p><strong>Conclusions: </strong>This Delphi survey, the first internationally conducted consensus study, achieved a remarkable level of consensus among a panel of global experts. Ambiguity still exists regarding overlapping lesions. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Antibiotics and Mechanical Bowel Preparation Impact the Colonic Mucosa Associated Microbiota But Not Anastomotic Leak Rate After Colorectal Resection.","authors":"Emily C Hoedt, Georgia Carroll, Bree Stephensen, Mark Morrison, Veral Vishnoi, Annalisa Cuskelly, Brian Draganic, Brendan McManus, Louise Clarke, Kalpesh Shah, Stephen R Smith, Nicholas J Talley, Simon Keely, Peter Pockney","doi":"10.1097/DCR.0000000000003775","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003775","url":null,"abstract":"<p><strong>Background: </strong>Alterations in the gastrointestinal microbiome have been associated with increased anastomotic leak risk. Oral antibiotics and bowel preparations may both reduce anastomotic leaks rates.</p><p><strong>Objective: </strong>Within patients undergoing colorectal surgery, we aimed to examine the impact of oral antibiotic use, bowel preparation and other perioperative factors on the mucosa associated microbiota and investigated association with anastomotic leak rates.</p><p><strong>Design: </strong>We opportunistically sampled Australian patients undergoing colorectal resection for any indication with anastomosis, mucosal swabs were taken from the proximal and distal extent of the resected specimen immediately after extraction.</p><p><strong>Settings: </strong>A single site, public tertiary referral hospital of 694 beds with an accredited specialist colorectal unit in Newcastle, Australia.</p><p><strong>Patients: </strong>Of 192 patients; 31 patients were identified as receiving oral antibiotics pre-surgery. Thirty-one patients received mechanical preparation and 58 received enema pre-surgery.</p><p><strong>Main outcome measures: </strong>The influence of patient factors on mucosa-associated microbiota composition and associations to rate of anastomotic leaks.</p><p><strong>Results: </strong>The leak rate was 15% (N = 28/192). Preoperative oral antibiotic manipulation and bowel preparation minimally affected the mucosa-associated microbiota, but neither were associated with anastomotic leaks. Erythromycin (N = 14/192) had the greatest impact on the mucosa-associated microbiota. Of the different bowel preparation regimes, excluding patients given antibiotics, only fleet enemas (N = 58/161) had a significant impact on the mucosa-associated microbiota. Bowel preparation was not associated with occurrence of anastomotic leaks. There were only subtle differences observed in the mucosa-associated microbiota between anastomotic leaks and non-anastomotic leaks patients.</p><p><strong>Limitations: </strong>Antibiotic recipient numbers included were modest.</p><p><strong>Conclusions: </strong>This is the largest series of routine colorectal anastomoses for which the mucosa-associated microbiota adjacent the anastomoses was examined. We show that antibiotics and bowel preparation in the preoperative period exert only limited effects on the mucosa-associated microbiota and conclude that there are no obvious mucosa-associated microbiota characteristics that are predictive for an anastomotic leak.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Follow-up Colonoscopy on Survival in a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program: A Nationwide Study.","authors":"Matas Jakubauskas, Eugenijus Jasiunas, Kestutis Strupas, Tomas Poskus","doi":"10.1097/DCR.0000000000003771","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003771","url":null,"abstract":"<p><strong>Background: </strong>Various colorectal cancer screening programs are thought to be responsible for the decline in colorectal cancer incidence and mortality in developed countries. Few recently published studies indicate that a lot of patients do not fully complete the pre-planned colorectal cancer screening. Currently, there is a lack of high-volume data examining patient compliance and its impact on the screening program results.</p><p><strong>Objective: </strong>To assess the relationship between participation and compliance within the program and mortality of patients that participate in the screening program.</p><p><strong>Design: </strong>Large database cohort study.</p><p><strong>Settings: </strong>Nationwide colorectal cancer screening program of a European Union country (Lithuania).</p><p><strong>Patients: </strong>Data of patients aged 50-74, who participated in the colorectal cancer screening program from January 2013 to December 2019, were extracted from a national database.</p><p><strong>Main outcome measures: </strong>Mortality data was extracted on all persons, who died from 2013 to December 2020. Patients were divided into four groups according to their adherence to the colonoscopy screening program.</p><p><strong>Results: </strong>A total of 1,521,394 patients participated in the screening program. Positive fecal immunochemical test was detected for 127,503 (8.3%) patients, 55,202 (43.3%) of them proceeded with further colonoscopy. Patients with a negative fecal immunochemical test had the lowest mortality rates and the ones with a positive fecal immunochemical test but without undergoing a follow up colonoscopy had the worst ones with 4.9% and 8.6% respectively, p < 0.001. Logistic regression model indicated that patients with a positive fecal immunochemical test and without a subsequent colonoscopy had a significantly increased mortality risk (OR 2.18; 95% CI: 2.12-2.24; p < 0.001).</p><p><strong>Limitations: </strong>Lack of data on timing of colonoscopy, comorbidities, lifestyle factors, or previous medical history.</p><p><strong>Conclusions: </strong>Our study indicates that non-compliers with colonoscopy, especially women, after a positive fecal immunochemical test are at a significantly increased all-cause mortality risk. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}