Effectiveness of Colonoscopy in Reducing Incidence of Late-stage Colorectal Cancer Within an Opportunistic Screening Program.

BACKGROUND: The effectiveness of colonoscopy in preventing colorectal cancer (CRC) within opportunistic screening programs has not been clearly established. The aim of this study was to analyze the effectiveness of colonoscopy within an opportunistic screening program using nested case-control study. METHODS: Subjects who received a diagnosis of CRC (CG) between the ages of 50 and 90 years were included and matched by age and gender in a 1:5 ratio with patients without CRC diagnosis (COG) during the period 2015 to 2023. Using conditional regression analyses, we tested the association between screening colonoscopy and CRC. Subgroup analyses were then performed for CRC location, endoscopist specialty, and colonoscopy quality. RESULTS: Of the 134 patients in CG, 19 (14.18%) had a colonoscopy in the preceding 5 years compared with 258 out of 670 (38.51%) in COG (AOR, 0.24; 95% CI: 0.14-0.41). Any colonoscopy was strongly associated with decreased odds for left-sided CRC (AOR, 0.09; 95% CI: 0.04-0.24) but not for right-sided CRC (AOR, 0.58; 95% CI: 0.29-1.17). Only complete colonoscopy (AOR, 0.41; 95% CI: 0.19-0.89) and colonoscopy with satisfactory bowel preparation (AOR, 0.38; 95% CI: 0.15-0.98) were associated with decreased odds for right-sided CRC. No significant differences in colonoscopy outcomes were found when stratifying by endoscopist specialty. CONCLUSIONS: In the setting of an opportunistic screening program, exposure to any colonoscopy significantly reduced left-sided CRC incidence; however, only high-quality colonoscopy was associated with a lower incidence of right-sided CRC. Therefore, every possible effort should be made to optimize the quality and cost-effectiveness of colonoscopy within an opportunistic screening program.

Outcomes after open posterior component separation via transversus abdominis release (TAR) for incisional hernia repair. A systematic review and meta-analysis.

PURPOSE: Given its potential advantages, open Transversus Abdominis Release (oTAR) has been proposed as a durable solution for complex AWR. However, its applicability in different scenarios remains uncertain. We aimed to analyze the current available evidence and determine surgical outcomes after oTAR. METHODS: We performed a systematic electronic search on oTAR in PubMed/Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Postoperative morbidity and recurrence rates were included as primary endpoints and Quality of life (QoL) was included as secondary endpoint. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) between all studies. RESULTS: A total of 22 studies with 4,910 patients undergoing oTAR were included for analysis. Mean hernia defect and mesh area were 394 (140-622) cm2 and 1065 (557-2206) cm2, respectively. Mean follow-up was 19.7 (1-32) months. The weighted pooled proportion of recurrence, overall morbidity, surgical site occurrences (SSO), surgical site infection (SSI), surgical site occurrences requiring procedural intervention (SSOPI), major morbidity and mortality were: 6% (95% CI, 3-10%), 34% (95% CI, 26-43%), 22% (95% CI, 16-29%), 11% (95% CI, 8-16%), 4% (95% CI, 3-7%), 6% (95% CI, 4-10%) and 1% (95% CI, 1-2%), respectively. A significant improvement in QoL after oTAR was reported among studies. CONCLUSION: Open TAR is an effective technique for complex ventral hernias as it is associated with low recurrence rate and a significant improvement in QoL. However, the relatively high morbidity rates observed emphasize the necessity of further patients' selection and optimization to improve outcomes.

Outcomes of Endoscopic Antireflux Mucosectomy for the Treatment of Gastroesophageal Reflux Disease: Systematic Review and Meta-analysis.

OBJECTIVE: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders in western countries. Endoscopic procedures have recently emerged as an alternative therapy to surgery for patients with GERD. The aim of this study was to determine outcomes after endoscopic antireflux mucosectomy (ARMS). METHODS: A systematic review and meta-analysis were performed to analyze outcomes after ARMS. The main outcomes included patients' satisfaction, GERD health-related quality of life, use of proton pump inhibitors, and DeMeester score. The secondary endpoint was postprocedural adverse events. A meta-analysis of proportions was used to assess the effect of each approach on different outcomes. RESULTS: A total of 22 studies comprising 654 patients were included for analysis. The mean age of patients was 51.83 (36 to 59.39) years, and the mean body mass index was 25.06 (23.5 to 27) kg/m 2 . The weighted pooled proportion of patient satisfaction after ARMS was 65% (95% CI: 52%-76%). The pooled proportion of patients taking proton pump inhibitors decreases from 100% to 40.84% ( P < 0.001). The mean GERD health-related quality of life scores (pre 19.48 vs post 7.90, P < 0.001) and DeMeester score (pre 44.99 vs post 15.02 P = 0.005) significantly improved after ARMS. Overall morbidity rate was 27% (95% CI: 13%-47%), with a weighted pooled proportion of perforation, stricture, and bleeding of 3% (95% CI: 2%-6%), 12% (95% CI: 9%-16%), and 6% (95% CI: 2%-17%), respectively. CONCLUSIONS: Endoscopic ARMS for GERD is associated with symptomatic improvement, reduction of medical therapy, and enhanced quality of life. Refinements of the technique, however, are needed to decrease morbidity.

Disparities in Bariatric Surgery Outcomes: A Regional Analysis.

PURPOSE: The success of metabolic and bariatric surgery (MBS) is impacted by significant pre-surgical attrition rates and poor postoperative follow-up. This study focused on geographic variations in attrition rates and surgical outcomes for MBS practice for which the patient population is drawn from nine Chicago neighborhoods, to examine whether suboptimal weight loss or reduced adherence to the program varied across neighborhoods. METHODS: Patients who presented for their initial MBS consultation at the University of Illinois (UI) Health's program between January 2019 and December 2020 were identified from electronic medical records. Demographic and medical information was extracted, along with postoperative weight at 3, 6, and 12 months after surgery. The Chicago area was divided into nine geographic regions. The outcomes of interest were preoperative attrition rate, postoperative compliance to follow-up appointments, and postoperative weight loss for each group and by residential neighborhood. RESULTS: A total of 1202 patients were included in this analysis, of whom 423 (35%) underwent surgery and 780 did not, representing a pre-surgical attrition rate of 64.9%. Age, sex, and race/ethnic distribution varied markedly across geographic regions. Postoperative weight loss varied significantly in neighborhoods with higher proportions of residents from racial/ethnic minority backgrounds. Preoperative attrition and postoperative compliance did not differ across geographic regions. CONCLUSION: Patients' residential neighborhoods may influence weight loss after MBS. Preoperative and postoperative compliance did not vary by residential neighborhood.

Endoscopic submucosal dissection for early gastric cancer: A major challenge for the west.

Gastric cancer (GC) is the 5th most common cancer and the 3rd most common cause of cancer mortality worldwide. Two main endoscopic resective techniques exist for early GC (EGC): Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). ESD has been widely embraced in the last decade because it allows radical en bloc resections and is associated with better outcomes, as compared to EMR. However, the lack of training opportunities and flat learning curve due to low volume of EGC cases represent major obstacles to obtain proficiency on ESD in the West. As this procedure is highly efficient for the treatment of EGC, dedicated training programs with a stepwise approach and updated guidelines for ESD embracement are needed in Western countries.

Predictors of response to a dietary intervention in patients with irritable bowel syndrome.

BACKGROUND: Different diets have emerged as potential therapeutic options for patients with irritable bowel syndrome (IBS). OBJECTIVE: To identify predictors of improvement after a low-FODMAP, low-starch and low-sucrose diet among patients with IBS. METHODS: We performed a descriptive cross-sectional study including patients with IBS according to Rome IV criteria undertaking a social-media based program with a two-week dietary intervention. Patients completed an online survey before and after the intervention including the presence of intestinal and extra-intestinal symptoms, the IBS-SSS (irritable bowel syndrome symptoms severity scale) and the PHQ-9 (patient health questionnaire-9). Clinical improvement was defined as a decrease of at least 50% in IBS-SSS post dietary intervention. Variables associated with symptomatic response were identified with logistic regression analysis. A clinical score to predict response was created and tested with a with a receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 3583 patients with IBS were included. Mean IBS-SSS before and after dietary intervention was 295.5±52.32 and 240±48.66, respectively (p=0.01); 1178 (32.8%) patients showed clinical improvement. A mean basal IBS-SSS >400 (OR 3.04), chronic headache (OR 1.96), and chronic fatigue (OR 1.81) were significantly associated with symptomatic response. Patients with arthralgia (OR 0.41) and/or fibromyalgia (OR 0.33) were less likely to improve. Each variable received the following individuals scores: IBS-SSS >400: +2, chronic headache: +1.5, chronic fatigue: +1, arthralgia: -1, and fibromyalgia: -1. The ROC curve analysis of the proposed score showed an area under the curve of 0.72 (95% CI 0.69-0.76). A score ≥3 had a sensitivity of 72.64% and specificity of 60.56% for predicting symptomatic improvement. CONCLUSIONS: There are clinical variables that could serve as reliable predictors of response to a low-FODMAP, low-sucrose, low-starch diet among patients with IBS. Further research is needed to understand the link between the presence of extra-intestinal symptoms and clinical improvement after dietary interventions for IBS.

Management of Gastroesophageal Reflux Disease after Sleeve Gastrectomy: Effectiveness of Medical, Endoscopic, and Surgical Therapies.

Introduction: Sleeve gastrectomy (SG) has become the most frequently performed bariatric operation in the United States. One of the main disadvantages of this procedure is the risk of developing gastroesophageal reflux disease (GERD) after the operation. We aimed to analyze different approaches for the treatment of GERD after SG. Methods: A literature review was performed to identify all possible treatment options for post-SG GERD. All the studies were assessed for full eligibility by manual assessment of their aims, methodology, results, and conclusions. Records were individually reviewed by the authors comparing outcomes and complications between procedures. Results: Although some studies have shown improvement or even resolution of GERD symptoms after SG, most patients develop or worsen symptoms. Lifestyle modifications along with medical therapy should be started on patients with GERD after SG. For those who are refractory to medication, endoscopic and surgical therapies can be offered. Conversion to Roux-en-Y gastric bypass (RYGB) is consistently effective in treatment of GERD and is the ideal therapy in patients with associated insufficient weight loss. Endoscopic and alternative surgical procedures are also available and have shown acceptable short-term outcomes. Conclusions: Several treatment options exist for the treatment of GERD after SG. Although conversion to RYGB remains the most effective therapy, other emerging endoscopic and surgical procedures could avoid the potential morbidity of this procedure and should be further evaluated. An evidence-based algorithm for the management of GERD after SG is proposed to guide decision making.

Prevalence of extra-intestinal symptoms according to irritable bowel syndrome subtype.

BACKGROUND: Irritable bowel syndrome (IBS) is a functional disorder commonly associated with extra-intestinal symptoms. However, the prevalence of these symptoms according to IBS subtype is not well established. AIM: To compare the prevalence of extra-intestinal symptoms among patients with different subtypes of IBS. METHODS: A descriptive cross-sectional study including patients with IBS according to Rome IV criteria was performed between July 2022 and April 2023. Patients were classified according their subtype of IBS: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), and IBS-M (mixed bowel habits). Patients completed the IBS severity scoring system questionnaire (IBS-SSS) to determine severity of IBS symptoms and patient health questionnaire- 9 (PHQ-9) to define presence and severity of depressive symptoms. The prevalence of reported extra-intestinal symptoms was also assessed and compared between groups. KEY RESULTS: A total of 4862 patients with IBS were included; 608 IBS-D (12.5%), 1978 IBS-C (40.7%), and 2276 IBS-M (46.8%). Patients with IBS-C had significantly lower IBS-symptoms severity (mean IBS-SSS 290 vs. 310 and 320 for IBS-D and IBS-M, respectively, p = 0.03). The prevalence of obesity was also significantly lower in these patients (17.1% vs. 30.9% IBS-D and 27.9% IBS-M, p = 0.0001). Patients with IBS-D showed a significantly higher prevalence of food intolerance perception (9.5%, p = 0.03), history of cholecystectomy (17.8%, p = 0.03), and fecal incontinence (36.2%, p = 0.0001) as compared to the other groups. Patients with IBS-M had significantly higher mean PHQ-9 score (12.7 vs. 11.1 IBS-D and 10.5 IBS-C, p = 0.001) and prevalence of depressive symptoms (80.0%, p = 0.01). Patients with IBS-M also had higher prevalence of extra-intestinal symptoms such as arthralgia (62.4%, p = 0.0001), extremity numbness (64.5%, p = 0.0001), atopic dermatitis (28.2%, p = 0.02), and chronic cervicalgia (81.0%, p = 0.01). CONCLUSIONS & INFERENCES: The prevalence of most extra-intestinal symptoms is higher among patients with IBS-M. Further research is needed to better characterize IBS subtypes, which could potentially help refining tailored therapeutic strategies.

MAGNETIC SPHINCTER AUGMENTATION DEVICE FOR GASTROESOPHAGEAL REFLUX DISEASE: EFFECTIVE, BUT POSTOPERATIVE DYSPHAGIA AND RISK OF EROSION SHOULD NOT BE UNDERESTIMATED. A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: Magnetic ring (MSA) implantation in the esophagus is an alternative surgical procedure to fundoplication for the treatment of gastroesophageal reflux disease. AIMS: The aim of this study was to analyse the effectiveness and safety of magnetic sphincter augmentation (MSA) in patients with gastroesophageal reflux disease (GERD). METHODS: A systematic literature review of articles on MSA was performed using the Medical Literature Analysis and Retrieval System Online (Medline) database between 2008 and 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) across all studies. RESULTS: A total of 22 studies comprising 4,663 patients with MSA were analysed. Mean follow-up was 27.3 (7-108) months. The weighted pooled proportion of symptom improvement and patient satisfaction were 93% (95%CI 83-98%) and 85% (95%CI 78-90%), respectively. The mean DeMeester score (pre-MSA: 34.6 vs. post-MSA: 8.9, p=0.03) and GERD-HRQL score (pre-MSA: 25.8 vs. post-MSA: 4.4, p<0.0001) improved significantly after MSA. The proportion of patients taking proton pump inhibitor (PPIs) decreased from 92.8 to 12.4% (p<0.0001). The weighted pooled proportions of dysphagia, endoscopic dilatation and gas-related symptoms were 18, 13, and 3%, respectively. Esophageal erosion occurred in 1% of patients, but its risk significantly increased for every year of MSA use (odds ratio - OR 1.40, 95%CI 1.11-1.77, p=0.004). Device removal was needed in 4% of patients. CONCLUSIONS: Although MSA is a very effective treatment modality for GERD, postoperative dysphagia is common and the risk of esophageal erosion increases over time. Further studies are needed to determine the long-term safety of MSA placement in patients with GERD.

Colorectal Cancer Prevention: Is Chat Generative Pretrained Transformer (Chat GPT) ready to Assist Physicians in Determining Appropriate Screening and Surveillance Recommendations?

OBJECTIVE: To determine whether a publicly available advanced language model could help determine appropriate colorectal cancer (CRC) screening and surveillance recommendations. BACKGROUND: Poor physician knowledge or inability to accurately recall recommendations might affect adherence to CRC screening guidelines. Adoption of newer technologies can help improve the delivery of such preventive care services. METHODS: An assessment with 10 multiple choice questions, including 5 CRC screening and 5 CRC surveillance clinical vignettes, was inputted into chat generative pretrained transformer (ChatGPT) 3.5 in 4 separate sessions. Responses were recorded and screened for accuracy to determine the reliability of this tool. The mean number of correct answers was then compared against a control group of gastroenterologists and colorectal surgeons answering the same questions with and without the help of a previously validated CRC screening mobile app. RESULTS: The average overall performance of ChatGPT was 45%. The mean number of correct answers was 2.75 (95% CI: 2.26-3.24), 1.75 (95% CI: 1.26-2.24), and 4.5 (95% CI: 3.93-5.07) for screening, surveillance, and total questions, respectively. ChatGPT showed inconsistency and gave a different answer in 4 questions among the different sessions. A total of 238 physicians also responded to the assessment; 123 (51.7%) without and 115 (48.3%) with the mobile app. The mean number of total correct answers of ChatGPT was significantly lower than those of physicians without [5.62 (95% CI: 5.32-5.92)] and with the mobile app [7.71 (95% CI: 7.39-8.03); P < 0.001]. CONCLUSIONS: Large language models developed with artificial intelligence require further refinements to serve as reliable assistants in clinical practice.

Gastroesophageal Reflux Disease After Roux-en-Y Gastric Bypass: Pathophysiology and Management.

Introduction: Patients with obesity are often affected by gastroesophageal reflux disease (GERD). Roux-en-Y gastric bypass (RYGB) is considered the ideal operation for patients with severe obesity and GERD. Although the majority of patients improve their reflux with the operation, some might persist symptomatic and others can even develop de novo GERD. The aim of this study was to determine pathophysiologic factors involved in the development of GERD after RYGB surgery and define potential treatments for this condition. Materials and Methods: Studies including patients with GERD before and after RYGB and/or analyzing possible GERD therapies were analyzed by the authors. Searches were conducted in PubMed, Cochrane Library, and Embase databases. Results: GERD can persist, worsen, or develop after RYGB. There are certain technical elements of the operation identified as potential risk factors for GERD. Medical therapy is effective in the majority of patients. Both endoscopic and surgical procedures can also help resolving GERD after RYGB. Conclusions: Although the majority of patients with GERD after RYGB can be effectively managed with medical therapy, some may require endoscopic or surgical treatment. Critical technical elements of RYGB should be considered to reduce the risk of postoperative GERD.

Strengths and weaknesses of telemedicine: Survey analysis in a single center bariatric surgery program.

BACKGROUND: Despite Telemedicine being considered by most patients as the preferred follow-up method, bariatric surgery programs that include virtual consults still exhibit high attrition rates. This study analyzed the strengths and weaknesses of telemedicine in a single-center bariatric surgery program. METHODS: We developed a 5-minute, 10-question online survey via Qualtrics and examined the results between 108 patients under telehealth visits by the bariatric team at the University of Illinois at Chicago from August to November 2022. RESULTS: Most patients reported telehealth utilization was easy (91%). Virtual visits were chosen as the preferred method for follow-up (88%), while avoidance of having to take time off work/school was mentioned as the leading reason. However, a small fraction (6%) considered that connecting with the bariatric team took some time/effort. CONCLUSION: Telemedicine is a fundamental tool to overcome several barriers that hinder access to obesity treatment among patients. Understanding its weaknesses will increase compliance with bariatric surgery programs.

Impact of an Educational Mobile App on Inflammatory Bowel Disease Colonoscopy Report Quality.

BACKGROUND: Inadequate endoscopic assessment of disease activity might lead to suboptimal treatment of patients with inflammatory bowel disease (IBD). AIMS: We aimed to determine if the implementation of an educational mobile app could help improving the quality of colonoscopy reports in patients with IBD. METHODS: We retrospectively analyzed a consecutive series of colonoscopy reports in patients with IBD during the period 2016-2023. The sample was divided into two groups: before and after the implementation of an educational mobile app (JEDII app ™). The main outcome was the inclusion of validated activity assessment scoring systems and previously stablished reporting required elements. RESULTS: A total of 883 IBD colonoscopy reports were included for analysis; 621 (70.3%) procedures were performed before the implementation of the app and 262 (29.7%) after. An IBD scoring system was included in 201 (32.4%) and 148 (56.5%) colonoscopy reports before and after the adoption of the mobile app, respectively (p < 0.001). The mean number of recommended elements for quality IBD colonoscopy reporting was significantly increased after the app implementation (4.3 vs. 1.9, p < 0.001). Diagnosis of ulcerative colitis, gastroenterologist as endoscopist, endoscopist with IBD clinical interest, and the implementation of the educational mobile app were independently associated with the inclusion of an IBD score in the colonoscopy report. CONCLUSION: The inclusion of scoring systems and recommended elements for quality IBD colonoscopy report significantly increased after the implementation of an educational mobile app. E-health technologies should be further explored to improve quality of care in patients with IBD.