Early detection of anastomotic leak with C-reactive protein increases the chances of anastomotic salvage.

AIM: Anastomotic leak results in increased morbidity and affects functional and oncological outcomes after colectomy. Measurement of C-reactive protein (CRP) allows early detection of anastomotic leaks. The aim of this study was to evaluate the benefit to the patient of earlier diagnosis and management of anastomotic leaks, namely avoiding takedown of the anastomosis. METHOD: Patients with an anastomotic fistula after elective colorectal surgery from 2010 to 2020 were included. Three periods were defined according to progressive adherence to the CRP protocol in our department. A comparison was made between the periods 'before' (2010-2013) and 'after' (2016-2020) in terms of morbidity, mortality, anastomotic salvage, days spent in hospital within the first postoperative month, timely adjuvant chemotherapy and anastomotic stenosis. RESULTS: Out of 2655 elective colorectal operations, 171 patients presented with an anastomotic leak and 123 patients were included in the study. In univariate analysis, patients in the 'after' group had fewer severe complications (Clavien-Dindo Grade III to IV, 66.7% vs. 56.9; p = 0.017); the difference did not reach significance regarding timely postoperative chemotherapy (p = 0.058) and anastomotic stenosis (p = 0.682). In both, univariate and multivariate analysis, the 'after' period increased the chances of preserving the anastomosis (OR = 2.37 [1.08-5.17]) and increased the number of days out of hospital (p = 0.0002). CONCLUSION: A CRP-based protocol for the screening of anastomotic leaks after colorectal surgery was related to increased anastomotic conservation, a decreased impact and severity of the leak and a shorter length of hospital stay.

C-reactive protein identifies patients at low risk of anastomotic leak after esophagectomy.

PURPOSE: Fast-track protocols are increasingly used after digestive surgery. After esophagectomy, the gravity and the fear of anastomotic leak may be an obstacle to generalization of such protocols. C-reactive protein (CRP) might be a reliable tool to identify patients at low risk of anastomotic leak after esophagectomy, so that they can be safely included in a fast-track program. The aim of our retrospective bicentric study is to evaluate the interest of C-reactive protein measurement for the early diagnosis of anastomotic leak after esophagectomy. METHODS: Patients having undergone Ivor-Lewis procedure between January 2009 and September 2017 were included in this bicentric retrospective study. CRP values were recorded between postoperative day 3 (POD 3) and postoperative day 5 (POD 5). All postoperative complications were recorded, and the primary endpoint was anastomotic leak. RESULTS: We included 585 patients. Among them, 241 (41.2%) developed infectious complications and 69 patients (11.8%) developed anastomotic leak. CRP had the best predictive value on POD 5 (AUC = 0.74; 95% CI: 0.67-0.81). On POD 5, a cut-off value of 130 mg/L yielded a sensitivity of 87%, a specificity of 51%, and a negative predictive value of 96% for the detection of anastomotic leak. CONCLUSIONS: CRP may help in identifying patients at very low risk of anastomotic leak after esophagectomy. Patients with CRP values < 130 mg/L on POD 5 can safely undertake an enhanced recovery protocol.

Compliance with follow-up guidelines after high-risk colorectal polyp removal: a population-based study.

BACKGROUND AND AIMS: After high-risk colorectal adenoma removal, colorectal cancer risk remains higher than that in the general population. Depending on polyp characteristics, a 3-month or 3-year follow-up colonoscopy is recommended, and clear follow-up instructions must be given to the patient. Our primary aim was to evaluate compliance with French follow-up recommendations. Second, we evaluated the impact of how the information was given and if patients actually underwent their control colonoscopy according to the instructions given. METHODS: We collected data from the Burgundy polyp population-based registry and medical records from the endoscopy centers of the area. Between June 30, 2014 and July 1, 2015, 405 patients were included in this study. RESULTS: Written follow-up instructions were provided to 345 patients (85.2%), and 184 of them (53.3%) complied with guidelines. For 29.9% the interval to follow-up colonoscopy was longer than recommended, and for 6.4% the interval was shorter. Among the 303 patients who had clear follow-up instructions, 42.2% had their control colonoscopy and 83.6% respected the stipulated interval. Follow-up instructions were found in the colonoscopy report in at least 49% of cases. CONCLUSIONS: Compliance with follow-up guidelines was poor: Inappropriate intervals were often longer than recommended. Patients with written follow-up instructions and those who underwent follow-up colonoscopy mostly followed these instructions. Ensuring compliance with guidelines and giving written instructions to patients should be primary goals to achieve effective follow-up. Gastroenterologist training should be improved in this way.