National Guidelines for Colorectal Cancer Screening in Saudi Arabia with strength of recommendations and quality of evidence

BACKGROUND: Colorectal cancer is the most common cancer among Saudi men and the third commonest among Saudi women. Given the predominance of colorectal cancer compared with other cancers in Saudi Arabia, context-specific guidelines are needed for screening. METHODS: Experts from the Saudi Society of Colon and Rectal Surgery, Saudi Gastroenterology Association, Saudi Oncology Society, Saudi Chapter of Enterostomal Therapy, Family Medicine and Department of Public Health at the Saudi Arabian Ministry of Health and a patient advocate was assembled by the Saudi Centre for Evidence-Based Healthcare, a subsidiary of the Saudi Arabian Ministry of Health. The panel collaborated with a methodological team from McMaster University, Canada to develop national guidelines for colorectal cancer screening. After identifying key questions, the panel conducted a systematic review of all reports on the utility of screening, the cost of screening for colorectal cancer in Saudi Arabia and on the values and preferences of Saudi patients. Meta- analyses, when appropriate, were performed to generate pooled estimates of effect. Using the GRADE approach, the panel used the evidence-to-decision (EtD) framework to assess all domains important in determining the strength and direction of the recommendations (benefits and harms, values and preferences, resource implications, equity, acceptability, and feasibility). Judgments related to the EtD domains were resolved through consensus or voting, if consensus was not reached. The final recommendations were developed during a two-day meeting held in Riyadh, Saudi Arabia in March 2015. Conflicts of interests among the panel members were handled according to the World Health Organization rules. LIMITATIONS: There is lack of national data on the incidence of adenomatous polyps or the age groups in which the incidence surges. There were no national clinical trials assessing the effectiveness of the different modalities of screening for colorectal cancer and their impact on mortality. CONCLUSION: The panel recommends screening for colorectal cancer in Saudi Arabia in asymptomatic Saudi patients at average risk of colorectal cancer. An infrastructure should be built to achieve that goal.(AU)

Use of the endostapler for the treatment of non-healing sinus secondary to a dehisced colorectal anastomosis.

BACKGROUND: A dehisced colorectal anastomosis complicated by a sinus, especially after preoperative radiation for colorectal cancer, may not heal. We describe our experience in the management of such a condition using the endoscopic surgical stapler. METHODS: Patients who underwent low anterior resection for rectal cancer after preoperative chemoradiation and who developed a dehisced anastomosis complicated by a chronic posterior sinus underwent the procedure. After exclusion of cancer recurrence, the common wall between the sinus and the rectal lumen was stapled using the endoscopic surgical stapler. RESULTS: Four patients received the day-surgery treatment. Healing of the sinus was confirmed in all patients using a contrast enema. Median time to healing was 10 weeks. All patients had a diverting ileostomy which was eventually closed. No complications were noted. CONCLUSION: Stapling the common wall between the sinus and the rectal lumen after a dehisced anastomosis is a viable option in the treatment of chronic posterior sinuses when coupled with fecal diversion.