|Year : 2022 | Volume
| Issue : 4 | Page : 188-189
Department of Medical Gastroenterology, SIMS Institute of Gastroenterology Hepatobiliary Sciences and Liver Transplantation, SRM Institute for Medical Science Hospital, Chennai, Tamil Nadu, India
|Date of Submission||01-Aug-2022|
|Date of Decision||14-Aug-2022|
|Date of Acceptance||15-Aug-2022|
|Date of Web Publication||13-Oct-2022|
No. 1, Jawaharlal Nehru Salai, 100 Feet Road, Vadapalani, Chennai - 600 026, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jayaraman K. Gastroenterology elsewhere. Gastroenterol Hepatol Endosc Pract 2022;2:188-9
| Does Colorectal Screening Detect Early Cancer? Real-world Data|| |
Cardoso R, Guo F, Heisser T. Proportion and stage distribution of screen-detected and nonscreen-detected colorectal cancer in nine European countries: An international, population-based study. Lancet Gastroenterol Hepatol 2022;7:711-23.
The establishment of colorectal cancer (CRC) developing from premalignant polyps: Polyp->cancer sequence was a landmark in preventing CRC. This European study comprised nine countries that had the screening rolled out at different times and protocols and aimed to take a panoramic snapshot of the effectiveness of screening in terms of proportion, stage, and treatment of CRC. Data from population-based registries were analyzed to find the proportion of CRC diagnosed during a screening and nonscreening visit. The number of screen-detected CRCs was higher than clinically detected cancers, especially in regions like Basque country, Slovenia, the Netherlands, and Denmark, where the screening had been fully rolled out and had >50% participation. The distal colon was commonly involved in the screening group, whereas proximal involvement dominated nonscreen. Furthermore, stage I cancers (35%–50% in screen vs. 13%–25% in nonscreen) were predominantly diagnosed in the screen group, whereas Stages IV was higher in the nonscreen group (5%–12% in screen vs. 22-32% in nonscreen) P < 0.0001. Those diagnosed through the screening program were less likely to undergo chemotherapy. Lead time and length time biases may be potential reasons for the favorable outcomes seen with early stage cancers. Nonetheless, CRC screening works and is here to stay. Screening became a thing in the 1990s, with few developed countries quickly incorporating them into an active program. Supportive data keeps coming and a vast majority, especially the developing nations, are yet to recommend screening.
| Endoscopic Transcecal Appendectomy, a Novel Procedure for Appendiceal Lesions|| |
Guo L, Ye L, Feng Y. Endoscopic transcecal appendectomy: A new endotherapy for appendiceal orifice lesions. Endoscopy 2022;54:585-90.
Appendiceal lesions are generally removed surgically by either right hemicolectomy or cecectomy. Endoscopic full-thickness resection has its limitation because the distal margin in lesions extending into the appendiceal lumen cannot be visualized. Endoscopic transcecal appendectomy (ETA) seems to offer a way out by combining full-thickness resection and dissection of the appendix. Researchers in this study have analyzed retrospectively 13 patients with appendiceal lesions who underwent ETA. Technical success was achieved in all patients (100%), and zero recurred after a median follow-up of 17 months. The median length of stay in the hospital was 8 days, and none had postoperative appendicitis. The median procedure time for the expert endoscopist in this study was 167 min, akin to a standard laparoscopic right hemicolectomy. The results are striking and need comparative studies with conventional surgical techniques. That said, the technique also requires extensive training and surgical backup. Future research may reveal more about this innovative and promising technique.
| Can the Degree of Hematochezia Hint at the Outcome of Ischemic Colitis?|| |
An Q, Yuan B, Guo Z. Clinical characteristics and long-term outcomes of hospitalized patients with ischemic colitis with different degrees of hematochezia: A retrospective study. Eur J Gastroenterol Hepatol 2022;34:823-30.
Qin An et al., in this retrospective analysis, define patients with severe hematochezia as having more than 2 g drop in hemoglobin, requiring more than three units of blood transfusion, low mean arterial blood pressure, or tachycardia. One hundred and thirty-nine hospitalized patients with ischemic colitis were divided into mild hematochezia, severe hematochezia, and nonhematochezia groups. Those presenting with mild hematochezia were less likely to undergo surgery (13% vs. 36%, P = 0.001) and had a shorter length of stay (12 vs. 17 days, P < 0.001) when compared with the nonhematochezia group. When the severity of bleed increased, the severity of illness (73% vs. 18%, P < 0.001) and surgical interventions also increased significantly (55% vs. 6%, P < 0.001) when compared to milder cases. Also, when severe hematochezia was compared with the nonhematochezia group, in-hospital mortality was higher in the former group (45% vs. 6%, P = 0.003). No differences were observed in long-term outcomes and recurrence. Previous studies have strikingly reported that the absence of hematochezia is associated with severe ischemic colitis. The absence of hematochezia may not be all good, and this study draws attention to the missing hue of “severe hematochezia” in the spectrum of ischemic colitis. The amount of blood loss could be a prudent clue to the severity and may help physicians triage patients with ischemic colitis.
| Mysterious Hepatitis and Adenovirus Viremia in Children: A Tale of Two Case Series|| |
Kelgeri C, Couper M, Gupte GL. Clinical spectrum of children with acute hepatitis of unknown cause. N Engl J Med 2022.Jul 13. doi: 10.1056/NEJMoa2206704. Epub ahead of print.
Gutierrez Sanchez LH, Shiau H. A case series of children with acute hepatitis and human adenovirus infection. N Engl J Med 2022.Jul 13. doi: 10.1056/NEJMoa2206704. Epub ahead of print.
Two case series (one from the UK and another from the US) appeared in the 2nd week of July 2022 NEJM, focusing on unknown hepatitis in pediatric patients (<18 years of age) with probable cases as high as 900 around the world as notified by the World Health Organization. 44 (6 had acute liver failure [ALF]) and 9 (3 had ALF) children in the UK and US cohort, respectively, were hospitalized for vomiting, diarrhea, fatigue, and jaundice. Workup for A-E hepatitis, metabolic, congenital, and mechanical causes was negative. Antinuclear and anti-smooth muscle antibodies were detected in 50% and 18% of those tested in the US and UK cohorts. 100% of children in the US cohort and 90% of the UK cohort tested positive for adenovirus. Liver histology showed varied features, including acute and chronic inflammation, interface hepatitis, and focal to massive pan-acinar necrosis. Half of the six explant livers in the UK cohort were positive for adenovirus by Hexon targeting polymerase chain reaction (PCR). In the US cohort, 3 out of 6 liver specimens tested by PCR and Sanger sequencing showed adenovirus. Treatment included supportive measures, cidofovir, steroids in some, and transplants for ALF (except for one child in the US cohort who improved with supportive care). All children survived. These studies cannot associate adenovirus with this hepatitis but is a much-wanted reassurance in the era of COVID-19 and vaccination taboos, especially in the vulnerable population. No child had a history of prior vaccination against SARS-CoV-2 in both cohorts. Few children in the UK cohort tested positive for SARS-CoV-2 molecular and antibody testing. Only one kid had documented Covid-19 a few weeks before the onset of hepatitis. Antonia Ho et al., in their preprint article, describe a similar case series (9 patients) with the detection of Adeno-associated virus 2 in the plasma of all patients and postulate the interplay of viruses in the unmasking of genetic susceptibility to autoimmune hepatitis. Whether this unknown hepatitis is autoimmune hepatitis or viral hepatitis is hard to conclude with existing data. We will have to wait for more information as the disease unfolds.
| PostAcute COVID-19 Syndrome and Persistent Viral Antigen in Patients with IBD|| |
Zollner A, Koch R, Jukic A. Postacute COVID-19 is characterized by gut viral antigen persistence in inflammatory bowel diseases. Gastroenterology 2022;163:495-506.e8.
Postacute COVID-19 syndrome, previously dismissed by many and now recognized, encompasses Long Covid, multi-organ effects, and the impact of COVID-19 hospitalization and treatment. This paper's investigators sought to determine if viral persistence in the gut mucosa was associated with this postviral syndrome. Forty-six patients with inflammatory bowel disease with past COVID-19 undergoing endoscopy for disease assessment were diagnosed with symptoms of long COVID using a questionnaire. Almost 2/3rds of patients with symptoms of the post-COVID-19 syndrome had demonstrable viral RNA in small and large bowel biopsy specimens by the quantitative polymerase chain reaction compared to asymptomatic individuals (P < 0.001). The authors also mention that immunofluorescence signals were more robust in cell lines enriched with receptors for Sars-CoV-2 when compared with prepandemic preserved intestinal mucosal tissue.
Interestingly, stool testing and cultivation were negative, implying no active replication. Postviral fatigue and postinfectious irritable syndrome are well-known acquiesences. The pandemic rekindled interest in how a pathogen affects the host in the aftermath of an illness. Whether the antigen is an innocent bystander or a pathogen remains to be explored, given the overlapping symptoms of IBD and post-COVID-19 syndrome.
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Conflicts of interest
There are no conflicts of interest.