scholarly journals Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal

2020 ◽  
Author(s):  
S. Lindner ◽  
K. von Rudno ◽  
J. Gawlitza ◽  
J. Hardt ◽  
F. Sandra-Petrescu ◽  
...  
Keyword(s):  
Diagnostic Test ◽  
Loop Ileostomy ◽  
Tertiary Care ◽  
Digital Rectal Examination ◽  
Flexible Endoscopy ◽  
Contrast Enema ◽  
Test Accuracy ◽  
Ileostomy Reversal ◽  
The Impact ◽  
Group 1

Abstract Purpose This study investigates whether contrast enema (CE) and flexible endoscopy (FE) should be performed routinely after low anterior resection (LAR) before ileostomy reversal. Additionally, the impact of previous anastomotic leakage (AL) on diagnostic test accuracy (DTA) was assessed. Methods This is a retrospective analysis of prospectively collected tertiary care data of two centers. Consecutive rectal cancer patients undergoing LAR with loop ileostomy formation were included. Before ileostomy reversal, all patients were assessed by CE and FE. DTA of FE and CE for asymptomatic AL in patients who had previously suffered from clinically relevant AL (group 1) compared with those without apparent AL after LAR (group 0) were assessed separately. Results Two hundred ninety-three patients were included in the analysis, 86 in group 1 and 207 in group 0. Overall sensitivity for detection of asymptomatic AL was 76% (FE) and 60% (CE). Specificity was 100% for both tests. DTA of FE was equal or superior to CE in all subgroups. Prevalence of asymptomatic AL at the time of testing was 1.4% in group 0 and 25.6% in group 1. Conclusion Flexible endoscopy is the more accurate diagnostic test for the detection of asymptomatic anastomotic leaks prior to ileostomy reversal. Contrast enema showed no gain of information. In the group without complications after the initial rectal resection, 104 must be tested to find one leak prior to reversal. In those patients, routine diagnostic testing additional to digital rectal examination may be questioned.

scholarly journals Less is more—the best test for anastomotic leaks in rectal cancer patients prior to ileostomy reversal

2021 ◽  
Author(s):  
Simon Lindner ◽  
Steffen Eitelbuss ◽  
Svetlana Hetjens ◽  
Joshua Gawlitza ◽  
Julia Hardt ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Methodological Quality ◽  
Colorectal Anastomosis ◽  
Digital Rectal Examination ◽  
Contrast Enema ◽  
Paired Data ◽  
Endoscopic Procedures ◽  
Rectal Examination ◽  
Ileostomy Reversal

Abstract Purpose No clear consensus exists on how to routinely assess the integrity of the colorectal anastomosis prior to ileostomy reversal. The objective of this study was to evaluate the accuracy of contrast enema, endoscopic procedures, and digital rectal examination in rectal cancer patients in this setting. Methods A systematic literature search was performed. Studies assessing at least one index test for which a 2 × 2 table was calculable were included. Hierarchical summary receiver operating characteristic curves were calculated and used for test comparison. Paired data were used where parameters could not be calculated. Methodological quality was assessed with the QUADAS-2 tool. Results Two prospective and 11 retrospective studies comprising 1903 patients were eligible for inclusion. Paired data analysis showed equal or better results for sensitivity and specificity of both endoscopic procedures and digital rectal examination compared to contrast enema. Subgroup analysis of contrast enema according to methodological quality revealed that studies with higher methodological quality reported poorer sensitivity for equal specificity and vice versa. No case was described where a contrast enema revealed an anastomotic leak that was overseen in digital rectal examination or endoscopic procedures. Conclusions Endoscopy and digital rectal examination appear to be the best diagnostic tests to assess the integrity of the colorectal anastomosis prior to ileostomy reversal. Accuracy measures of contrast enema are overestimated by studies with lower methodological quality. Synopsis of existing evidence and risk–benefit considerations justifies omission of contrast enema in favor of endoscopic and clinical assessment. Trial registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019107771

scholarly journals Clinical Value of Contrast Enema Prior to Ileostomy Closure

2017 ◽  
Vol 189 (09) ◽  
pp. 855-863 ◽  
Author(s):  
Andrea Goetz ◽  
Natascha da Silva ◽  
Christian Moser ◽  
Ayman Agha ◽  
Lena-Marie Dendl ◽  
...  
Keyword(s):  
Decision Making ◽  
Loop Ileostomy ◽  
Contrast Enema ◽  
Ileostomy Closure ◽  
Diagnostic Methods ◽  
Contrast Imaging ◽  
Group I ◽  
Ileostomy Reversal ◽  
Radiological Report ◽  
Group Ii

Purpose To determine the value of routine contrast enema of loop ileostomy before elective ileostomy closure regarding the influence on the clinical decision-making. Materials and Methods Retrospective analysis of contrast enemas at a tertiary care center between 2005 und 2011. Patients were divided into two groups: Group I with ileostomy reversal, group II without ileostomy closure. Patient-related parameters (underlying disease, operation method) and parameters based on the findings (stenosis, leakage of anastomosis, incontinence) were evaluated. Results Analyzing a total of 252 patients in 89 % (group I, n = 225) ileostomy closure was performed. In 15 % the radiologic report was the only diagnostic modality needed for therapy decision; in 36 % the contrast enema and one or more other diagnostic methods were decisive. In 36 % the radiological report of the contrast imaging was not relevant for decision at all. In 11 % (group II, n = 27) no ileostomy closure was performed. In this group in 11 % the radiological report of the contrast enema was the only decision factor for not performing the ileostomy reversal. In 26 % one or more examination was necessary. In 26 % the result of the contrast examination was not relevant. Conclusion The radiologic contrast imaging of loop ileostomy solely plays a minor role in complex surgical decision-making before planned reversal, but is important as first imaging method in detecting complications and often leads to additional examinations. Key points  Citation Format

scholarly journals Understanding Sources of Bias in Diagnostic Accuracy Studies

2013 ◽  
Vol 137 (4) ◽  
pp. 558-565 ◽  
Author(s):  
Robert L. Schmidt ◽  
Rachel E. Factor
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Test ◽  
Study Design ◽  
Reporting Quality ◽  
Risk Of Bias ◽  
Data Sources ◽  
Test Accuracy ◽  
Design Features ◽  
The Impact ◽  
Specific Diagnostic Test

Context.—Accuracy is an important feature of any diagnostic test. There has been an increasing awareness of deficiencies in study design that can create bias in estimates of test accuracy. Many pathologists are unaware of these sources of bias. Objective.—To explain the causes and increase awareness of several common types of bias that result from deficiencies in the design of diagnostic accuracy studies. Data Sources.—We cite examples from the literature and provide calculations to illustrate the impact of study design features on estimates of diagnostic accuracy. In a companion article by Schmidt et al in this issue, we use these principles to evaluate diagnostic studies associated with a specific diagnostic test for risk of bias and reporting quality. Conclusions.—There are several sources of bias that are unique to diagnostic accuracy studies. Because pathologists are both consumers and producers of such studies, it is important that they be aware of the risk of bias.

scholarly journals The Impact of Using Emotionally Arousing Stimuli on Muscle Response Testing Accuracy

2019 ◽  
Vol 26 (5) ◽  
pp. 301-309
Author(s):  
Anne M. Jensen ◽  
Richard J. Stevens ◽  
Amanda J. Burls
Keyword(s):  
Diagnostic Test ◽  
Diagnostic Tool ◽  
Assessment Method ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Muscle Response ◽  
Testing Accuracy ◽  
Response Testing ◽  
The Impact ◽  
Better Than

Introduction: Muscle response testing (MRT) is an assessment method used by 1 million practitioners worldwide, yet its usefulness remains uncertain. The aim of this study, one in a series assessing the accuracy of MRT, was to determine whether emotionally arousing stimuli influence its accuracy compared to neutral stimuli. Methods: To assess diagnostic test accuracy 20 MRT practitioners were paired with 20 test patients (TPs). Forty MRTs were performed as TPs made true and false statements about emotionally arousing and neutral pictures. Blocks of MRT alternated with blocks of intuitive guessing (IG). Results: MRT accuracy using emotionally arousing stimuli was different than when using neutral stimuli. However, MRT accuracy was found to be significantly better than IG and chance. Similar to previous studies in this series, this study failed to detect any characteristic that consistently influenced MRT accuracy. Conclusion: Using emotionally arousing stimuli had no effect on MRT accuracy compared to using neutral stimuli. This study would have been strengthened by adding personally relevant lies instead of impersonal stimuli. A limitation of this study is its lack of generalizability to other applications of MRT. This study shows that a simple yet robust methodology for assessing MRT as a diagnostic tool can be implemented effectively.

The Impact of an Enhanced Recovery Program on Loop Ileostomy Closure

2020 ◽  
pp. 000313482098284
Author(s):  
Kathryn Ottaviano ◽  
Robert Brookover ◽  
Jonathan J. Canete ◽  
Ashar Ata ◽  
Jordan Sheehan ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Loop Ileostomy ◽  
Disease Process ◽  
Ileostomy Closure ◽  
Study Patient ◽  
Complication Rates ◽  
Retrospective Case ◽  
Ileostomy Reversal ◽  
Eras Protocol ◽  
The Impact

Background The implementation of enhanced recovery after surgery (ERAS) protocols has decreased the length of stay (LOS) and complications in colorectal procedures. However, little data has been published on the subset of patients undergoing loop ileostomy closure. We investigated the outcomes of loop ileostomy reversals prior to and after initiation of an ERAS protocol. Methods Patients undergoing ileostomy reversal over a 5-year period by 4 colorectal surgeons were studied and divided into pre-ERAS patients and ERAS patients in a retrospective, case-control study. Patient demographics, comorbidities, LOS, underlying disease process, index intra-abdominal procedure, readmission rate, and complications were evaluated. Results Overall, 208 patients were analyzed 149 pre-ERAS and 59 ERAS–with median LOS significantly lower in the ERAS group than the pre-ERAS group (50.8 hours vs. 96.1 hours, P < .0001). In subgroup analysis, the LOS was significantly lower if the index procedure performed was laparoscopic when comparing ERAS to pre-ERAS (49.9 hours vs. 96.6 hours, P < .001). ERAS did not confer a significant decrease in the LOS during ileostomy reversal with open index procedures (72.9 hours vs. 95.5 hours, P = .05). Conclusion Utilizing an ERAS protocol is safe and effective for loop ileostomy closure with a shorter LOS and no difference in complication rates or 30-day readmission rates.

scholarly journals Measuring the impact of screening automation on meta-analyses of diagnostic test accuracy

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Christopher R. Norman ◽  
Mariska M. G. Leeflang ◽  
Raphaël Porcher ◽  
Aurélie Névéol
Keyword(s):  
Systematic Review ◽  
Diagnostic Test ◽  
Systematic Reviews ◽  
Estimation Error ◽  
Meta Analysis ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Screening Process ◽  
Meta Analyses ◽  
The Impact

Abstract Background The large and increasing number of new studies published each year is making literature identification in systematic reviews ever more time-consuming and costly. Technological assistance has been suggested as an alternative to the conventional, manual study identification to mitigate the cost, but previous literature has mainly evaluated methods in terms of recall (search sensitivity) and workload reduction. There is a need to also evaluate whether screening prioritization methods leads to the same results and conclusions as exhaustive manual screening. In this study, we examined the impact of one screening prioritization method based on active learning on sensitivity and specificity estimates in systematic reviews of diagnostic test accuracy. Methods We simulated the screening process in 48 Cochrane reviews of diagnostic test accuracy and re-run 400 meta-analyses based on a least 3 studies. We compared screening prioritization (with technological assistance) and screening in randomized order (standard practice without technology assistance). We examined if the screening could have been stopped before identifying all relevant studies while still producing reliable summary estimates. For all meta-analyses, we also examined the relationship between the number of relevant studies and the reliability of the final estimates. Results The main meta-analysis in each systematic review could have been performed after screening an average of 30% of the candidate articles (range 0.07 to 100%). No systematic review would have required screening more than 2308 studies, whereas manual screening would have required screening up to 43,363 studies. Despite an average 70% recall, the estimation error would have been 1.3% on average, compared to an average 2% estimation error expected when replicating summary estimate calculations. Conclusion Screening prioritization coupled with stopping criteria in diagnostic test accuracy reviews can reliably detect when the screening process has identified a sufficient number of studies to perform the main meta-analysis with an accuracy within pre-specified tolerance limits. However, many of the systematic reviews did not identify a sufficient number of studies that the meta-analyses were accurate within a 2% limit even with exhaustive manual screening, i.e., using current practice.

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