Resection of the Right Colon and Anastomosis of the Ileum to the Transverse Colon after the Mikulicz Plan

Background: Mucosal healing (MH) is the key aim of the treat-to-target strategy for patients with Crohn’s disease (CD). The efficacy of infliximab (IFX) on MH in different ileocolonic segments is unclear. The aim of this study was to investigate endoscopic MH in different ileocolonic segments in patients with CD who received IFX treatment. Methods: A retrospective, single-center study was performed in patients with active ileocolonic CD between January 2012 and December 2018. All patients underwent IFX treatment for at least 30 weeks. The MH of five ileocolonic segments was assessed by the Simple Endoscopic Score for CD (SES-CD) at baseline, 14/22 weeks and 30/38 weeks. The SES-CD values were analyzed by a mixed-effects model after the correction for confounding factors. Results: A total of 101 eligible patients were included. The baseline endoscopic severity was similar across segments. At 30/38 weeks, the greatest changes in the SES-CD ulcer size and ulcerated surface subscores were −94.29% and −94.32% both in the transverse colon ( p < 0.0001), and the smallest changes were −67.88% and −69.67% both in the terminal ileum ( p < 0.0001) compared with baseline. Stenosis mainly presented in the right colon (12/29, 41.38%). The change in the SES-CD stenosis subscore was −6.25% in the right colon at 30/38 weeks compared with −71.88% at 14/22 weeks ( p = 0.0030). At 30/38 weeks, the transverse colon achieved the highest rate of complete MH (CMH) at 81.2%, and the lowest CMH rate occurred in the terminal ileum at 45.6%. Moreover, the degree of improvement in the rectum was negatively correlated with disease progression ( p = 0.011). Conclusions: Ileocolonic segments in CD presented different degrees of endoscopic MH during IFX treatment. The transverse colon showed the highest CMH rate, whereas the right colon with stenosis showed the poorest improvement. The differing propensities of ileocolonic segments may provide an individualized IFX treatment strategy.

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Correlation of Cleanliness among Different Bowel Segments during Colonoscopy: A Retrospective Study

Gastroenterology Research and Practice ◽

10.1155/2020/5363827 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Zhou Haibin ◽

Zhang Xiaofeng ◽

Yang Jianfeng

Keyword(s):

Retrospective Study ◽

Transverse Colon ◽

Intestinal Tract ◽

Left Colon ◽

Right Colon ◽

School Of Medicine ◽

The Difference ◽

The Right ◽

Bowel Segments ◽

Intestinal Preparation

Objective. To analyze the correlation of intestinal cleanliness in each segment of the Boston Intestinal Preparation Scale. Methods. From February 2017 to October 2019, the data of patients who underwent colonoscopy in the Department of Gastroenterology, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, were collected. Statistical analysis was performed according to the Boston Intestinal Preparation Scale score, and the correlation of intestinal cleanliness in each region was obtained. Results. A total of 1739 patients were included. The overall score of BBPS was 6.77±1.88. The scores of each region were 2.04±0.84 (right lateral colon), 2.25±0.68 (transverse colon), and 2.48±0.64 (left colon). The difference between the regions was statistically significant (P<0.05). The bowel cleanliness showed a gradual deterioration trend, and there was a positive correlation between colon cleanliness in each region. The accuracy of the transverse colon in predicting the right colon (AUC=0.809) is higher than that of the left colon (AUC=0.735), and the accuracy of predicting the cleanliness of the right colon intestinal tract by the cleanliness of the left colon intestinal tract is relatively low. Conclusion. Intestinal cleanliness gradually deteriorates from the direction of the insert. It is not reliable to predict the right side of poor cleanliness by using the left colon intestinal cleanliness (BBPS 0-1 score). It should continue to further endoscopy. When the cleanliness of the transverse colon is poor, then stopping further endoscopy is considered.

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Correlation of Metabolic Risk Factors with Sessile Serrated Lesions

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-507 ◽

2020 ◽

Vol 29 (2) ◽

pp. 175-179

Author(s):

Melania Macarie ◽

Simona Bataga ◽

Simona Mocan ◽

Monica Pantea ◽

Razvan Opaschi ◽

...

Keyword(s):

Risk Factors ◽

Statistical Significance ◽

Interval Cancer ◽

Metabolic Risk Factors ◽

Control Group ◽

Anatomical Site ◽

Metabolic Risk ◽

Right Colon ◽

Serrated Lesions ◽

The Right

Background and Aims: The importance of sessile serrated lesions (SSLs) in the pathogenesis of colorectal carcinoma has been recently established. These are supposed to cause the so-called “interval cancer”, having a rapidly progressive growth and being difficult to detect and to obtain an endoscopic complete resection. We aimed to establish the most important metabolic risk factors for sessile serrated lesions. Methods: We performed a retrospective case-control study, on a series of 2918 consecutive patients who underwent colonoscopy in Gastroenterology and Endoscopy Unit, County Clinical Emergency Hospital, Târgu-Mureș, Romania between 1 st of January 2015-31 th of December 2017. In order to evaluate the metabolic risk factors for polyps’ development, enrolled participants were stratified in two groups, a study group, 33 patients with SSLs lesions, and a control group, 138 patients with adenomatous polyps, selected by systematic sampling for age and anatomical site. Independent variables investigated were: gender, smoking, alcohol consumption, obesity, arterial hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, nonalcoholic liver disease. Results: For SSLs the most common encountered localization was the right colon in 30.55% of cases. By comparative bivariate analysis between SSLs group and control group, it was observed that hypertension (p=0.03, OR 2.33, 95 %CI 1.03-5.24), obesity (p=0.03, OR 2.61, 95 %CI 1.08-6.30), hyperuricemia (p=0.04, OR 2.72, 95 %CI 1.28-7.55), high cholesterol (p=0.002, OR 3.42; 95 %CI 1.48-7.87), and high triglycerides level (p=0.0006, OR 5.75; 95 %CI 1.92-17.2) were statistically associated with SSLs development. By multivariate analysis hypertension and hypertriglyceridemia retained statistical significance. Conclusions: Our study showed that the highest prevalence of SSLs was in the right colon and hypertension and increased triglycerides levels were associated with the risk of SSLs development. These risk factors are easy to detect in clinical practice and may help identifying groups with high risk for colorectal cancer, where screening is recommended.

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Impact of second forward-view examination on adenoma detection rate during unsedated colonoscopy: a randomized controlled trial

BMC Gastroenterology ◽

10.1186/s12876-021-01783-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Keshu Shan ◽

Hongpeng Lu ◽

Zhixin Zhang ◽

Jiarong Xie ◽

Lu Xu ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Detection Rate ◽

Controlled Trial ◽

Lesion Detection ◽

Adenoma Detection Rate ◽

Right Colon ◽

Randomized Controlled ◽

Adenoma Detection ◽

Advanced Lesion ◽

The Right

Abstract Objectives Colorectal cancer on the right side of the colon has been suggested to be harder to detect by colonoscopy. The aim of this study was to evaluate whether a second forward-view examination of the right side of the colon could increase the adenoma detection rate (ADR) and/or polyp detection rate (PDR). Methods This was a single-centre randomized controlled trial. Patients undergoing colonoscopy were recruited and randomly assigned to the second forward-view examination (SFE) group, in which the right side of the colon was examined twice or the traditional colonoscopy (TC) group in which the colonoscopy was performed in a standard manner. The primary outcome was the ADR of right colon. The overall PDR and ADR, PDR of the right colon, per-adenoma miss rate of the right colon, and advanced lesion detection rate were also recorded and compared. Results A total of 392 patients were included in the study (SFE group 197 vs. TC group 195). The ADR and PDR of the right colon in the SFE group were significantly higher than those in the TC group (ADR 10.7% vs. 5.1%; P = 0.042); PDR 17.8% vs. 9.7%, P = 0.021). No significant difference was found in overall PDR/ADR, or advanced lesion detection rate between the two groups. Conclusions This prospective controlled study revealed that a second forward-view examination could modestly increase the ADR and PDR of the right colon during unsedated colonoscopies. This simple, safe and time-effective technique might be recommended for routine unsedated colonoscopy. Trial registration: Clinical Trials.gov, NCT03619122. Registered on 7/8/2018.

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Sessile serrated adenoma invading a diverticulum in the right colon: tips and tricks for a safe complete endoscopic resection

Endoscopy ◽

10.1055/a-1463-2045 ◽

2021 ◽

Author(s):

Sophie Geyl ◽

Jérémie Albouys ◽

Romain Legros ◽

Hugo Lepetit ◽

Martin Dahan ◽

...

Keyword(s):

Endoscopic Resection ◽

Tips And Tricks ◽

Right Colon ◽

Sessile Serrated Adenoma ◽

Serrated Adenoma ◽

The Right

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Racial Disparities in Epigenetic Aging of the Right vs Left Colon

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa206 ◽

2020 ◽

Author(s):

Matthew Devall ◽

Xiangqing Sun ◽

Fangcheng Yuan ◽

Gregory S Cooper ◽

Joseph Willis ◽

...

Keyword(s):

Dna Methylation ◽

African Americans ◽

Racial Differences ◽

Age Of Onset ◽

Left Colon ◽

Right Colon ◽

Normal Colon ◽

Epigenetic Aging ◽

Epigenetic Age Acceleration ◽

The Right

Abstract There are well-documented racial differences in age-of-onset and laterality of colorectal cancer. Epigenetic age acceleration is postulated to be an underlying factor. However, comparative studies of side-specific colonic tissue epigenetic aging are lacking. Here, we performed DNA methylation analysis of matched right and left biopsies of normal colon from 128 individuals. Among African Americans (n = 88), the right colon showed accelerated epigenetic aging as compared to individual-matched left colon (1.51 years; 95% CI = 0.62 to 2.40 years; two-sided P = .001). In contrast, among European Americans (n = 40), the right colon shows remarkable age deceleration (1.93 years; 95% CI = 0.65 to 3.21 years; two-sided P = .004). Further, epigenome-wide analysis of DNA methylation identifies a unique pattern of hypermethylation in African American right colon. Our study is the first to report such race and side-specific differences in epigenetic aging of normal colon, providing novel insight into the observed younger age-of-onset and relative preponderance of right-side colon neoplasia in African Americans.

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Comparison of postoperative recovery of patients who underwent laparoscopic-assisted radical resection of right colon cancer with modified triangular anastomosis or tubular anastomosis: a retrospective cohort study

BMC Surgery ◽

10.1186/s12893-021-01086-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tianfang Xia ◽

Zhenguo Pan ◽

Jie Zhang ◽

Guo Xu

Keyword(s):

Colon Cancer ◽

Digestive Tract ◽

Transverse Colon ◽

Retrospective Cohort ◽

Radical Resection ◽

Anastomosis Group ◽

Group Differences ◽

Right Colon ◽

Right Colon Cancer ◽

Laparoscopic Assisted

Abstract Background We compared the advantages and disadvantages of modified triangular anastomosis and tubular anastomosis for digestive tract reconstruction in patients undergoing laparoscopic-assisted radical resection of right colon cancer. Methods This was a retrospective cohort analysis of 92 cases of laparoscopic-assisted resection of right colon cancer, treated from June 2017 to June 2018, at the Huai’an No. 1 People’s Hospital in China. Patients were divided into a modified triangular anastomosis group (n = 33) and a tubular anastomosis group (n = 59). In the modified triangular anastomosis group, digestive tract reconstruction was conducted using side-to-side anastomosis of the ileo-transverse colon with a 60-mm linear stapler. The common entry hole was closed with a running suture. The tubular anastomosis group underwent end-to-side anastomosis of the ileo-transverse colon with a tubular stapler anchor placed at the end of the ileum. Results At baseline and perioperatively, there were no significant between-group differences in age, sex, body mass index, tumor location, pathological stage, or tumour size (P > 0.05). There were also no significant between-group differences in operation time, estimated blood loss, the number of harvested lymph nodes, the first postoperative flatulence time, hospitalisation time, or postoperative complications (P > 0.05); however, the total cost of hospitalization for the triangular anastomosis group was significantly lower than the tubular anastomosis group (P < 0.05). Conclusion Modified triangular anastomosis is a safe and feasible procedure for laparoscopic-assisted radical resection of right colon cancer. These results affirm the safety and effectiveness of total laparoscopic radical resection of right colon cancer. Given the equivalent outcomes between the two procedures, the modified triangular procedure may be more a more cost-effective option for clinical application.

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