常规内镜评估结直肠吻合器早期发现吻合口漏(REAL研究):一项多中心前瞻性研究方案。

IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
David J Nijssen, Wytze Laméris, Quentin Denost, Antonino Spinelli, Eloy Espin-Basany, James Kinross, Jurriaan Tuynman, Roel Hompes
{"title":"常规内镜评估结直肠吻合器早期发现吻合口漏(REAL研究):一项多中心前瞻性研究方案。","authors":"David J Nijssen, Wytze Laméris, Quentin Denost, Antonino Spinelli, Eloy Espin-Basany, James Kinross, Jurriaan Tuynman, Roel Hompes","doi":"10.1159/000546041","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Early detection and timely treatment of anastomotic leakage (AL) following rectal surgery are crucial for improving outcomes. However, no standardized early detection pathway exists. This study evaluates a multicenter clinical care pathway integrating bedside endoscopy to reduce time to diagnose AL.</p><p><strong>Methods: </strong>This international, multicenter, prospective observational study evaluates early endoscopic inspection for AL detection. Endoscopic assessments are performed at the bedside using a point-of-care digital rectoscope. Eligible patients include those undergoing colorectal resection for cancer with a colorectal or coloanal anastomosis within 15 cm of the anorectal junction. The clinical pathway includes bedside endoscopic inspection 3-6 days post-surgery, C-reactive protein-guided CT scans with rectal contrast, and follow-up endoscopy at 2-3 weeks. The primary outcome is time to AL diagnosis. Secondary outcomes include diagnostic accuracy, patient-reported comfort (Modified Gloucester Scale), stoma rate, anastomosis healing at one year, and cost-effectiveness. A propensity score-matched historical cohort will be used for comparison. Based on previous reports, we hypothesize this pathway will reduce the median diagnosis time from 15 to 5 days. With 95% confidence and 80% power, 130 patients are needed, with 153 total to account for a 15% maximum dropout rate.</p><p><strong>Conclusion: </strong>The REAL study is designed to evaluate whether a clinical pathway incorporating routine endoscopic assessment of colorectal anastomoses reduces time to diagnosis of AL and initiation of treatment.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.8000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Routine Endoscopic evaluation of colorectal anastomoses for early detection of Anastomotic Leakage (REAL study): protocol for a multicenter prospective study.\",\"authors\":\"David J Nijssen, Wytze Laméris, Quentin Denost, Antonino Spinelli, Eloy Espin-Basany, James Kinross, Jurriaan Tuynman, Roel Hompes\",\"doi\":\"10.1159/000546041\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Early detection and timely treatment of anastomotic leakage (AL) following rectal surgery are crucial for improving outcomes. However, no standardized early detection pathway exists. This study evaluates a multicenter clinical care pathway integrating bedside endoscopy to reduce time to diagnose AL.</p><p><strong>Methods: </strong>This international, multicenter, prospective observational study evaluates early endoscopic inspection for AL detection. Endoscopic assessments are performed at the bedside using a point-of-care digital rectoscope. Eligible patients include those undergoing colorectal resection for cancer with a colorectal or coloanal anastomosis within 15 cm of the anorectal junction. The clinical pathway includes bedside endoscopic inspection 3-6 days post-surgery, C-reactive protein-guided CT scans with rectal contrast, and follow-up endoscopy at 2-3 weeks. The primary outcome is time to AL diagnosis. Secondary outcomes include diagnostic accuracy, patient-reported comfort (Modified Gloucester Scale), stoma rate, anastomosis healing at one year, and cost-effectiveness. A propensity score-matched historical cohort will be used for comparison. Based on previous reports, we hypothesize this pathway will reduce the median diagnosis time from 15 to 5 days. With 95% confidence and 80% power, 130 patients are needed, with 153 total to account for a 15% maximum dropout rate.</p><p><strong>Conclusion: </strong>The REAL study is designed to evaluate whether a clinical pathway incorporating routine endoscopic assessment of colorectal anastomoses reduces time to diagnosis of AL and initiation of treatment.</p>\",\"PeriodicalId\":11241,\"journal\":{\"name\":\"Digestive Surgery\",\"volume\":\" \",\"pages\":\"1-10\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-05-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Digestive Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000546041\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000546041","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

前言:直肠手术后吻合口瘘的早期发现和及时治疗对改善预后至关重要。然而,目前尚无标准化的早期检测途径。本研究评估了一种整合床边内窥镜的多中心临床护理途径,以减少诊断AL的时间。方法:这项国际、多中心、前瞻性观察性研究评估了早期内窥镜检查对AL检测的影响。内窥镜评估在床边使用即时数字直肠镜进行。符合条件的患者包括直肠癌行结直肠切除术且结直肠或结直肠吻合术在肛肠结15厘米内的患者。临床路径包括术后3-6天床边内镜检查,c反应蛋白引导CT扫描直肠造影,2-3周随访内镜检查。主要结果是AL诊断的时间。次要结局包括诊断准确性、患者报告的舒适度(改良格洛斯特量表)、造口率、一年内吻合愈合和成本-效果。将使用倾向评分匹配的历史队列进行比较。根据之前的报道,我们假设这种途径将把中位诊断时间从15天减少到5天。在95%的置信度和80%的有效性下,需要130名患者,总共153名患者才能达到15%的最大辍学率。结论:REAL研究旨在评估纳入常规内镜下结肠吻合器评估的临床途径是否缩短了AL的诊断和开始治疗的时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Routine Endoscopic evaluation of colorectal anastomoses for early detection of Anastomotic Leakage (REAL study): protocol for a multicenter prospective study.

Introduction: Early detection and timely treatment of anastomotic leakage (AL) following rectal surgery are crucial for improving outcomes. However, no standardized early detection pathway exists. This study evaluates a multicenter clinical care pathway integrating bedside endoscopy to reduce time to diagnose AL.

Methods: This international, multicenter, prospective observational study evaluates early endoscopic inspection for AL detection. Endoscopic assessments are performed at the bedside using a point-of-care digital rectoscope. Eligible patients include those undergoing colorectal resection for cancer with a colorectal or coloanal anastomosis within 15 cm of the anorectal junction. The clinical pathway includes bedside endoscopic inspection 3-6 days post-surgery, C-reactive protein-guided CT scans with rectal contrast, and follow-up endoscopy at 2-3 weeks. The primary outcome is time to AL diagnosis. Secondary outcomes include diagnostic accuracy, patient-reported comfort (Modified Gloucester Scale), stoma rate, anastomosis healing at one year, and cost-effectiveness. A propensity score-matched historical cohort will be used for comparison. Based on previous reports, we hypothesize this pathway will reduce the median diagnosis time from 15 to 5 days. With 95% confidence and 80% power, 130 patients are needed, with 153 total to account for a 15% maximum dropout rate.

Conclusion: The REAL study is designed to evaluate whether a clinical pathway incorporating routine endoscopic assessment of colorectal anastomoses reduces time to diagnosis of AL and initiation of treatment.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信