An Observational Analysis of a Novel Digital Rectoscope.

BACKGROUND: This is an analysis of the first 50 in-human uses of a novel digital rigid sigmoidoscope. The technology provides digital image capture, telemedicine capabilities, improved ergonomics, and the ability to biopsy under pneumorectum while maintaining the low cost of conventional rigid sigmoidoscopy. The primary outcome was adverse events, and the secondary outcome was diagnostic view. PRELIMINARY RESULTS: Fifty patients underwent outpatient (n = 25) and surgical rectal assessment (n = 25), with a mean age of 60 years. This included 31 men and 19 women with 12 different clinical use indications. No adverse events were reported, and no defects were reported with the instrumentation. Satisfactory diagnoses were obtained in 48 (96%) of 50 uses, images were captured in 48 (96%) of 50 uses, and biopsies were successfully taken in 13 uses (26%). No adverse events were recorded. Independent reviewers of recorded videos agreed on the quality and diagnostic value of the images with a κ of 0.225 (95% CI, 0.144-0.305) when assessing whether the target pathology was adequately visualized. IMPACT OF INNOVATION: The improved views afforded by digital rectoscopy facilitated a satisfactory clinical diagnosis in 96% of uses. The device was successfully deployed in the operating room and outpatients irrespective of bowel preparation method, where it has the potential to replace flexible sigmoidoscopy for specific use cases. The technology provides a high-quality image and video that can be securely recorded for documentation and medicolegal purposes with agreement between blinded users despite a lack of standardized training and heterogenous pathology. We perceive significant impact of this technology for the assessment of colorectal anastomoses, the office management of colitis, "watch and wait," and for diagnostic support in rectal cancer diagnosis. The technology has significant potential to facilitate proctoring and training, and it now requires prospective trials to validate its diagnostic accuracy against more costly flexible sigmoidoscopy systems.

Distal feeding-bowel stimulation to treat short-term or long-term pathology: a systematic review.

BACKGROUND: Distal feeding (DF) describes the insertion of a feeding tube into a fistula or stoma to administer a liquid feed into the distal bowel. It is currently used clinically in patients who are unable to absorb enough nutrition orally. This systematic review investigates DF as a therapeutic measure across a spectrum of patients with stomas and fistulae. METHODS: A total of 2825 abstracts and 44 full-text articles were screened via OVID. Fifteen papers were included for analysis. Randomised controlled trials, cohort and observational studies investigating DF as a therapeutic measure were included. RESULTS: Three feeds were used across the studies-reinfusion of effluent, infusion of prebiotic or a mixture. The studies varied the length of feeding between 24 hours and 61 days, and the mode of feeding, bolus or continuous varied.DF was demonstrated to effectively wean patients from parenteral nutrition in two papers. Two papers demonstrated a significant reduction in stoma output. Three papers demonstrated improved postoperative complication rates with distal feeding regimens, including ileus (2.85% vs 20% in unfed population, p=0.024). One paper demonstrated a reduction in postoperative stool frequency. CONCLUSIONS: This review was limited by study heterogeneity and the lack of trial data, and in the patient groups involved, the variability in diet and length of regimen. These studies suggest that DF can significantly reduce stoma output and improve renal and liver function; however, the mechanism is not clear. Further mechanistic work on the immunological and microbiological action of DF would be important.

Prognostic value of COL6A3 in pancreatic adenocarcinoma.

BACKGROUNDS/AIMS: Pancreatic cancer is one of the most fatal human malignancies with poor prognosis, despite advances in therapy. Here, we evaluated the potential role of collagen type VI α3 chain (COL6A3) as a non-invasive biomarker for pancreatic adenocarcinoma. METHODS: In this study, we investigated immunohistochemically the expression of COL6A3 in 30 patients with resectable pancreatic adenocarcinoma by immunohistochemistry in a tissue sample of the cancer and a tissue sample of normal pancreas for each patient. Also, we looked for associations between COL6A3 and other prognostic factors of pancreatic cancer. RESULTS: All of the pancreatic cancer tissue samples revealed in different ranges of intensity from weak (+) in 16.67%, moderate (+2) in 50%, to strongly positive (+3) in 33.33% staining for COL6A3. We found no moderate or strongly positive staining in normal pancreatic tissue. There was only weak positive staining in 23 samples (76.67%) and 7 (23.30%) were negative. Also, there was significant correlation between COL6A3 moderate and strongly expression and negative prognostic factors for pancreatic cancer. CONCLUSIONS: The greatest density of COL6A3 was observed in pancreatic cancer tissues and was correlated with negative prognostic factors for pancreatic cancer. Therefore, we suggest that COL6A3 could be used as prognostic factor in pancreatic cancer, but more studies need to prove its value.