Category Archives: Gastroenterology

Survival, Healthcare Utilization, and End-of-life Care among Older Adults with Malignancy-associated Bowel Obstruction

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“Among patients with cancer, the estimated prevalence of malignancy-associated bowel
obstruction (MBO) is 3-15%, including up to 51% in ovarian cancer and up to 28% in
cancers of the gastrointestinal tract. MBO is among the most common palliative
indications for surgical consultation5 and typically signifies a poor prognosis, with mean
survival of 3-8 months in surgical cases and 4-5 weeks in those with inoperable MBO.
Managing the considerable symptom burden associated with MBO frequently
requires hospitalization and contributes to high-intensity healthcare utilization.1, In light
of national efforts to address the poor quality and high cost of care near the end of life, it is
critical to understand the relationship between treatment for complications of terminal
cancer, such as MBO, and end-of-life (EOL) care.”

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Definitive surgical treatment of enterocutaneous fistula

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“Enterocutaneous Fistula (ECF) is defined as an abnormal connection between the gastrointestinal tract and the skin, and it requires labor-intensive medical management and surgical expertise. Complex wound management, severe malnutrition, frequent infectious complications, chronic pain, and depression require significant investment of health care resources and make the short-term and longterm care of these patients difficult. The
subsequent operative management often requires lengthy procedures in hostile abdomens with abundant adhesions and surrounding inflammation. In addition to the significant risk of mortality, morbidity can be equally as devastating.”

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Differential diagnosis in inflammatory bowel disease colitis

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“Distinction between Crohn’s disease of the colon-rectum and ulcerative colitis or inflammatory bowel disease (IBD) type unclassified can be of pivotal importance for a tailored clinical management, as each entity often involves specific therapeutic strategies and prognosis. Nonetheless, no gold standard is available and the uncertainty of diagnosis may frequently lead to misclassification or repeated examinations. Hence, we have performed a literature search to address the problem of differential diagnosis in IBD colitis, revised current and emerging diagnostic tools and refined disease classification strategies. Nowadays, the differential diagnosis is an untangled issue, and the proper diagnosis
cannot be reached in up to 10% of patients presenting with IBD colitis.”

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Japanese Gastric Cancer Treatment Guidelines 2021

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“The sixth edition of the Japanese Gastric Cancer Treatment Guidelines was completed in July 2021, incorporating new evidence that emerged after publication of the previous edition. It consists of a text-based “Treatments” part and a “Clinical Questions” part including recommendations and explanations for clinical questions. The treatments parts include a comprehensive description regarding surgery, endoscopic resection and chemotherapy for gastric cancer. The clinical question part is based on the literature search and evaluation by an independent systematic review team.”

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Does preoperative enteral or parenteral nutrition reduce postoperative complications in Crohn’s disease patients?

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“Surgery is frequently needed in Crohn’s Disease (CD) patients who have malnutrition. Patients with CD are at a risk of malnutrition secondary to decreased oral intake, malabsorption, and inflammation. The prevalence of malnutrition in IBD patients is profound: 60–80% of IBD patients are anemic, 39–81% are iron deficient, 20–60% are vitamin B12
deficient, 36–54% are folate deficient, and 25–80% have hypoalbuminemia. This high prevalence of malnutrition presents a challenge in the surgical management of CD patients because poor preoperative nutritional status has been linked to increase postoperative complications.
Therefore, nutritional optimization using enteral nutrition (EN) and total parenteral nutrition (TPN) have been used for many years to improve the nutritional status of CD patients in hopes of decreasing postoperative complications.”

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Gastrointestinal Stromal Tumors of the Stomach: Is There Any Advantage of Robotic Resections?

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“Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the digestive system. They account for less than 3% of all gastrointestinal malignancies, with an annual incidence rate estimated at 10–20 cases per million population in the United States. The most frequent anatomical location is the stomach (approximately 60% of cases). Although the introduction of tyrosine kinase inhibitors has changed the therapeutic algorithm of GISTs, surgical resection with negative margins remains the main treatment option for localized resectable tumors.”

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The Importance of Abdominal Wall Closure After DefinitiveSurgery for Enterocutaneous Fistula

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“In the case of enterocutaneous fistula (ECF) initial medical therapy aims to stabilize the patient, optimize the nutritional status and control of infections and fistula output. When surgery is required, extensive adhesiolysis, bowel resection and anastomosis along with abdominal wall reconstruction are necessary. The primary endpoint in patients undergoing surgical treatment with ECF as well as in the case of intestinal stomas, is to solve the intestinal defect, thus leaving in secondary terms other problems such as ventral hernias.
The simultaneous treatment of fistula/stoma closure with abdominal wall defect closure has been widely debated since some argue that the risk of complications such as anastomotic leakage is increased due to prolonged surgery and anesthetic time. However, various studies are reporting good results in patients undergoing simultaneous stoma with giant wall defect correction surgery, without increased risks and rates of complications.”

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