Serum methylation of GALNT9, UPF3A, WARS, and LDB2 as noninvasive biomarkers for the early detection of colorectal cancer and advanced adenomas.

BACKGROUND: Early detection has proven to be the most effective strategy to reduce the incidence and mortality of colorectal cancer (CRC). Nevertheless, most current screening programs suffer from low participation rates. A blood test may improve both the adherence to screening and the selection to colonoscopy. In this study, we conducted a serum-based discovery and validation of cfDNA methylation biomarkers for CRC screening in a multicenter cohort of 433 serum samples including healthy controls, benign pathologies, advanced adenomas (AA), and CRC. RESULTS: First, we performed an epigenome-wide methylation analysis with the MethylationEPIC array using a sample pooling approach, followed by a robust prioritization of candidate biomarkers for the detection of advanced neoplasia (AN: AA and CRC). Then, candidate biomarkers were validated by pyrosequencing in independent individual cfDNA samples. We report GALNT9, UPF3A, WARS, and LDB2 as new noninvasive biomarkers for the early detection of AN. The combination of GALNT9/UPF3A by logistic regression discriminated AN with 78.8% sensitivity and 100% specificity, outperforming the commonly used fecal immunochemical test and the methylated SEPT9 blood test. CONCLUSIONS: Overall, this study highlights the utility of cfDNA methylation for CRC screening. Our results suggest that the combination methylated GALNT9/UPF3A has the potential to serve as a highly specific and sensitive blood-based test for screening and early detection of CRC.

Genetic Variants as Predictors of the Success of Colorectal Cancer Treatments.

BACKGROUND: Some genetic polymorphisms (SNPs) have been proposed as predictors for different colorectal cancer (CRC) outcomes. This work aims to assess their performance in our cohort and find new SNPs associated with them. METHODS: A total of 833 CRC cases were analyzed for seven outcomes, including the use of chemotherapy, and stratified by tumor location and stage. The performance of 63 SNPs was assessed using a generalized linear model and area under the receiver operating characteristic curve, and local SNPs were detected using logistic regressions. RESULTS: In total 26 of the SNPs showed an AUC > 0.6 and a significant association (p < 0.05) with one or more outcomes. However, clinical variables outperformed some of them, and the combination of genetic and clinical data showed better performance. In addition, 49 suggestive (p < 5 × 10-6) SNPs associated with one or more CRC outcomes were detected, and those SNPs were located at or near genes involved in biological mechanisms associated with CRC. CONCLUSIONS: Some SNPs with clinical data can be used in our population as predictors of some CRC outcomes, and the local SNPs detected in our study could be feasible markers that need further validation as predictors.

Care burden and outcome of the surgical management of ulcerative colitis: A retrospective analysis of the last 20 years in a tertiary hospital in Spain.

AIM: To analyze the surgical burden of UC care in the last two decades, analyzing the characteristics of the patients, surgical indications along with the short and long-term results. METHOD: Single-center retrospective cohort analysis of UC patients undergoing abdominal and anorectal surgery between January 2000 and December 2020. The care burden, clinical data and results were analyzed according to distribution by decades. RESULTS: 128 patients, 37% female, underwent 376 surgical interventions (296 intestinal procedures and 80 anorectal). Mean follow-up for the cohort was 106±64 months. Timing from diagnosis to first surgery was under 5 years in 53.3%. In the second decade of the study there were fewer operated patients (73 vs. 48) as well as the total number of interventions per patient (2.7 vs. 2.0). The proportion between elective and urgent surgery was reversed in the second decade, observing an increase in laparoscopic surgery (70% vs. 8%) together with a decrease in major postoperative morbidity (Clavien-Dindo≥IIIa) (20% vs 8.4%). 80 patients underwent a restorative proctocolectomy, with a failure of 5% at 1 year but 23.7% in the long term. 37 patients required anorectal surgery, of which 26 (71%) were serial interventions, most due to septic complications of the pouches. CONCLUSIONS: The number of colectomies and interventions per patient decreased in the last decade, while there were improvements in morbidity and surgical approach. The need for sequential surgeries and long-term active instrumental surveillance for possible functional deterioration constitutes a significant clinical burden.

Care burden and outcome of the surgical management of ulcerative colitis: A retrospective analysis of the last 20 years in a tertiary hospital in Spain / Carga asistencial y resultados del tratamiento quirúrgico de la colitis ulcerativa: un análisis retrospectivo de los últimos 20 años en un hospital terciario de España

Aim: To analyze the surgical burden of UC care in the last two decades, analyzing the characteristics of the patients, surgical indications along with the short and long-term results. Method: Single-center retrospective cohort analysis of UC patients undergoing abdominal and anorectal surgery between January 2000 and December 2020. The care burden, clinical data and results were analyzed according to distribution by decades. Results: 128 patients, 37% female, underwent 376 surgical interventions (296 intestinal procedures and 80 anorectal). Mean follow-up for the cohort was 106±64 months. Timing from diagnosis to first surgery was under 5 years in 53.3%. In the second decade of the study there were fewer operated patients (73 vs. 48) as well as the total number of interventions per patient (2.7 vs. 2.0). The proportion between elective and urgent surgery was reversed in the second decade, observing an increase in laparoscopic surgery (70% vs. 8%) together with a decrease in major postoperative morbidity (Clavien-Dindo≥IIIa) (20% vs 8.4%). 80 patients underwent a restorative proctocolectomy, with a failure of 5% at 1 year but 23.7% in the long term. 37 patients required anorectal surgery, of which 26 (71%) were serial interventions, most due to septic complications of the pouches. Conclusions: The number of colectomies and interventions per patient decreased in the last decade, while there were improvements in morbidity and surgical approach. The need for sequential surgeries and long-term active instrumental surveillance for possible functional deterioration constitutes a significant clinical burden. (AU)

Objetivo: Analizar la carga quirúrgica asistencial por CU en 20 años, analizando las características de los pacientes, indicaciones quirúrgicas y resultados a corto y largo plazo. Método: Análisis retrospectivo unicéntrico de pacientes intervenidos de enero del 2000 a diciembre del 2020. La carga asistencial, los datos clínicos y los resultados se analizaron según distribución por décadas. Resultados: Ciento veintiocho pacientes, 37% mujeres, con 376 intervenciones quirúrgicas (296 procedimientos intestinales y 80 anorrectales). El seguimiento medio de la cohorte fue de 106±64 meses. El lapso entre el diagnóstico y la primera cirugía fue <5 años en el 53,3%. En la segunda década del estudio hubo menos pacientes operados (73 frente a 48) y un menor número de intervenciones por paciente (2,7 frente a 2,0). La proporción entre cirugía electiva y urgente se revirtió en la segunda década, observándose un aumento de la cirugía laparoscópica (70% vs. 8%) junto con una disminución de la morbilidad postoperatoria mayor (Clavien-Dindo≥IIIa) (20% vs 8.4%). Se realizó una proctocolectomía restauradora a 80 pacientes, con un fracaso al año del 5% pero del 23,7% a largo plazo. Treinta y siete pacientes requirieron cirugía anorrectal, de los cuales 26 (71%) fueron intervenciones seriadas, la mayoría por complicaciones sépticas de los reservorios. Conclusiones: El número de colectomías y de intervenciones por paciente disminuyó en la última década, a la vez que hubo mejorías en la morbilidad y el abordaje quirúrgico. La necesidad de cirugías secuenciales y de una vigilancia instrumental activa a largo plazo por el posible deterioro funcional constituye una importante carga clínica. (AU)

Care burden and outcome of the surgical management of ulcerative colitis: A retrospective analysis of the last 20 years in a tertiary hospital in Spain / Carga asistencial y resultados del tratamiento quirúrgico de la colitis ulcerativa: un análisis retrospectivo de los últimos 20 años en un hospital terciario de España

Aim: To analyze the surgical burden of UC care in the last two decades, analyzing the characteristics of the patients, surgical indications along with the short and long-term results. Method: Single-center retrospective cohort analysis of UC patients undergoing abdominal and anorectal surgery between January 2000 and December 2020. The care burden, clinical data and results were analyzed according to distribution by decades. Results: 128 patients, 37% female, underwent 376 surgical interventions (296 intestinal procedures and 80 anorectal). Mean follow-up for the cohort was 106±64 months. Timing from diagnosis to first surgery was under 5 years in 53.3%. In the second decade of the study there were fewer operated patients (73 vs. 48) as well as the total number of interventions per patient (2.7 vs. 2.0). The proportion between elective and urgent surgery was reversed in the second decade, observing an increase in laparoscopic surgery (70% vs. 8%) together with a decrease in major postoperative morbidity (Clavien-Dindo≥IIIa) (20% vs 8.4%). 80 patients underwent a restorative proctocolectomy, with a failure of 5% at 1 year but 23.7% in the long term. 37 patients required anorectal surgery, of which 26 (71%) were serial interventions, most due to septic complications of the pouches. Conclusions: The number of colectomies and interventions per patient decreased in the last decade, while there were improvements in morbidity and surgical approach. The need for sequential surgeries and long-term active instrumental surveillance for possible functional deterioration constitutes a significant clinical burden. (AU)

Objetivo: Analizar la carga quirúrgica asistencial por CU en 20 años, analizando las características de los pacientes, indicaciones quirúrgicas y resultados a corto y largo plazo. Método: Análisis retrospectivo unicéntrico de pacientes intervenidos de enero del 2000 a diciembre del 2020. La carga asistencial, los datos clínicos y los resultados se analizaron según distribución por décadas. Resultados: Ciento veintiocho pacientes, 37% mujeres, con 376 intervenciones quirúrgicas (296 procedimientos intestinales y 80 anorrectales). El seguimiento medio de la cohorte fue de 106±64 meses. El lapso entre el diagnóstico y la primera cirugía fue <5 años en el 53,3%. En la segunda década del estudio hubo menos pacientes operados (73 frente a 48) y un menor número de intervenciones por paciente (2,7 frente a 2,0). La proporción entre cirugía electiva y urgente se revirtió en la segunda década, observándose un aumento de la cirugía laparoscópica (70% vs. 8%) junto con una disminución de la morbilidad postoperatoria mayor (Clavien-Dindo≥IIIa) (20% vs 8.4%). Se realizó una proctocolectomía restauradora a 80 pacientes, con un fracaso al año del 5% pero del 23,7% a largo plazo. Treinta y siete pacientes requirieron cirugía anorrectal, de los cuales 26 (71%) fueron intervenciones seriadas, la mayoría por complicaciones sépticas de los reservorios. Conclusiones: El número de colectomías y de intervenciones por paciente disminuyó en la última década, a la vez que hubo mejorías en la morbilidad y el abordaje quirúrgico. La necesidad de cirugías secuenciales y de una vigilancia instrumental activa a largo plazo por el posible deterioro funcional constituye una importante carga clínica. (AU)

Evaluation of Blood Soluble CD26 as a Complementary Biomarker for Colorectal Cancer Screening Programs.

Fecal hemoglobin immunodetection (FIT) in combination with endoscopy has been implemented to reduce mortality from colorectal cancer (CRC), although there are issues that can be improved in relation to participation rates. We studied whether the blood biomarker soluble-CD26 (sCD26), related at least in part to the immune system and inflammation, and/or its dipeptidyl peptidase enzyme activity (DPP4), could help reduce false positives. In a cohort of 1703 individuals who underwent colonoscopy and had a serum sample, sCD26 and DPP4 activity showed statistically significant differences regarding sex and age. According to the colonoscopy findings, sCD26 and DPP4 activity progressively decreased in advanced adenomas and CRC, with statistically significant differences, even between both groups; 918 of them had a FIT result (n = 596 positive cases) with approximately 70% of these (n = 412) false positives. With cut-offs of 440 ng/mL for sCD26, 42 mU/mL for DPP4, and 11 ng/mU for their ratio, the combined information of the three biomarkers (at least positive for one biomarker) identified almost all advanced adenomas and CRC cases in the FIT cohort with approximately half of the false positives compared to FIT. A sequential testing strategy with FIT and our blood biomarker test is proposed.

Performance of the Use of Genetic Information to Assess the Risk of Colorectal Cancer in the Basque Population.

Although the genetic contribution to colorectal cancer (CRC) has been studied in various populations, studies on the applicability of available genetic information in the Basque population are scarce. In total, 835 CRC cases and 940 controls from the Basque population were genotyped and genome-wide association studies were carried out. Mendelian Randomization analyses were used to discover the effect of modifiable risk factors and microbiota on CRC. In total, 25 polygenic risk score models were evaluated to assess their performance in CRC risk calculation. Moreover, 492 inflammatory bowel disease cases were used to assess whether that genetic information would not confuse both conditions. Five suggestive (p < 5 × 10−6) loci were associated with CRC risk, where genes previously associated with CRC were located (e.g., ABCA12, ATIC or ERBB4). Moreover, the analyses of CRC locations detected additional genes consistent with the biology of CRC. The possible contribution of cholesterol, BMI, Firmicutes and Cyanobacteria to CRC risk was detected by Mendelian Randomization. Finally, although polygenic risk score models showed variable performance, the best model performed correctly regardless of the location and did not misclassify inflammatory bowel disease cases. Our results are consistent with CRC biology and genetic risk models and could be applied to assess CRC risk in the Basque population.

Incidence and evolution of foreign body impaction in the upper gastrointestinal tract and its relationship with eosionophilic oesophagitis / Incidencia y evolución de las impactaciones por cuerpos extraños en el tracto digestivo superior y su relación con la esofagitis eosinofílica

Background: Foreign body impaction is a frequent indication of urgent endoscopy. One of the reasons for impaction is eosinophilic oesophagitis (EE). To analyze characteristics of oesophageal foreign body impactions and their relationship with eosinophilic oesophagitis.Methods: In this retrospective study, urgent endoscopies in a tertiary care centre were analyzed. We included all urgent endoscopies due to bolus and foreign body impactions performed between September 1st 2018 and September 1st 2020. We reviewed clinical data of all patients who were diagnosed with EE and compared it to impactions that were due to other motives. The mean follow-up time was 18.7 months.Results: 693 urgent endoscopy procedures were performed. 239 (34%) of these were due to foreign body ingestion. Mean age of the patients was 63 years old and 135 (63%) were men. EE was diagnosed in 36 (17%) patients. The factors associated with EE were age, to be younger than 50 years (OR, 7.3; 95% CI, 1.1–48.4; p=0.04), asthma/rhinitis/atopic dermatitis (OR, 8.9; 95% CI, 2.3–35.3; p=0.002), findings in the endoscopy as trachealization (OR, 9.7; 95% CI, 1.3–70.9; p=0.03) and psychotropic/calcium channel blocker drugs (OR, 0.09; 95% CI, 0.009–0.9; p=0.04). 15 (7%) patients died. In 6 of them death was impaction-related. None patients with EE died.Conclusions: Foreign body impaction in the upper gastrointestinal tract due to EE is a frequent cause of urgent endoscopy. Being under 50 years of age, having asthma/rhinitis/atopic dermatitis, trachealization on the oesophagus and not taking psychotropic/calcium channel blocker drugs are factors associated with the diagnosis of EE. Mortality in the follow-up of patients without EE is important.(AU)

Antecedentes: La impactación por cuerpos extraños es una indicación frecuente de endoscopia urgente. Una de las causas de impactación es la esofagitis eosinofílica. Nuestro objetivo es analizar las características de las impactaciones por cuerpos extraños en el esófago y su relación con la esofagitis eosinofílica.Métodos: En este estudio retrospectivo, se analizan todas las endoscopias urgentes realizadas por impactación de alimentos y cuerpos extraños en un hospital terciario entre el 1 de septiembre de 2018 y el 1 de septiembre de 2020. Se analizan las características clínicas de los pacientes diagnosticados de esofagitis eosinofílica y se comparan con las impactaciones debidas a otros motivos. El seguimiento medio fue de 18,7 meses.Resultados: Se realizaron 693 procedimientos de endoscopia urgentes; de ellos, 239 (34%) fueron por impactación por cuerpos extraños. La edad media fue de 63 años y 135 (63%) eran hombres; 36 (17%) de todos los pacientes con impactación fueron diagnosticados de esofagitis eosinofílica. Los factores asociados a ella fueron la edad, ser menor de 50 años (OR 7,3; IC 95%: 1,1-48,4; p=0,04), el antecedente de asma y/o rinitis y/o dermatitis atópica (OR 8,9; IC 95%: 2,3-35,3; p=0,002), los hallazgos endoscópicos como traquealización (OR 9,7; IC 95%: 1,3-70,9; p=0,03) y el consumo de fármacos psicotrópicos o antagonistas del calcio (OR 0,09; IC 95%: 0,009-0,9; p=0,04). Fallecieron 15 (7%) pacientes, todos sin esofagitis eosinofílica y en 6 el fallecimiento se relacionó con las impactaciones.Conclusiones:La impactación por cuerpos extraños en el tubo digestivo por esofagitis eosinofílica es una entidad frecuente en los servicios de endoscopia de urgencia.(AU)

Local genetic variation of inflammatory bowel disease in Basque population and its effect in risk prediction.

Inflammatory bowel disease (IBD) is characterised by chronic inflammation of the gastrointestinal tract. Although its aetiology remains unknown, environmental and genetic factors are involved in its development. Regarding genetics, more than 200 loci have been associated with IBD but the transferability of those signals to the Basque population living in Northern Spain, a population with distinctive genetic background, remains unknown. We have analysed 5,411,568 SNPs in 498 IBD cases and 935 controls from the Basque population. We found 33 suggestive loci (p < 5 × 10-6) in IBD and its subtypes, namely Crohn's Disease (CD) and Ulcerative Colitis (UC), detecting a genome-wide significant locus located in HLA region in patients with UC. Those loci contain previously associated genes with IBD (IL23R, JAK2 or HLA genes) and new genes that could be involved in its development (AGT, BZW2 or FSTL1). The overall genetic correlation between European populations and Basque population was high in IBD and CD, while in UC was lower. Finally, the use of genetic risk scores based on previous GWAS findings reached area under the curves > 0.68. In conclusion, we report on the genetic architecture of IBD in the Basque population, and explore the performance of European-descent genetic risk scores in this population.

Incidence and evolution of foreign body impaction in the upper gastrointestinal tract and its relationship with eosionophilic oesophagitis.

BACKGROUND: Foreign body impaction is a frequent indication of urgent endoscopy. One of the reasons for impaction is eosinophilic oesophagitis (EE). To analyze characteristics of oesophageal foreign body impactions and their relationship with eosinophilic oesophagitis. METHODS: In this retrospective study, urgent endoscopies in a tertiary care centre were analyzed. We included all urgent endoscopies due to bolus and foreign body impactions performed between September 1st 2018 and September 1st 2020. We reviewed clinical data of all patients who were diagnosed with EE and compared it to impactions that were due to other motives. The mean follow-up time was 18.7 months. RESULTS: 693 urgent endoscopy procedures were performed. 239 (34%) of these were due to foreign body ingestion. Mean age of the patients was 63 years old and 135 (63%) were men. EE was diagnosed in 36 (17%) patients. The factors associated with EE were age, to be younger than 50 years (OR, 7.3; 95% CI, 1.1-48.4; p=0.04), asthma/rhinitis/atopic dermatitis (OR, 8.9; 95% CI, 2.3-35.3; p=0.002), findings in the endoscopy as trachealization (OR, 9.7; 95% CI, 1.3-70.9; p=0.03) and psychotropic/calcium channel blocker drugs (OR, 0.09; 95% CI, 0.009-0.9; p=0.04). 15 (7%) patients died. In 6 of them death was impaction-related. None patients with EE died. CONCLUSIONS: Foreign body impaction in the upper gastrointestinal tract due to EE is a frequent cause of urgent endoscopy. Being under 50 years of age, having asthma/rhinitis/atopic dermatitis, trachealization on the oesophagus and not taking psychotropic/calcium channel blocker drugs are factors associated with the diagnosis of EE. Mortality in the follow-up of patients without EE is important.

Circulating miRNA Signature Predicts Response to Preoperative Chemoradiotherapy in Locally Advanced Rectal Cancer.

Patients with locally advanced rectal cancer (LARC) are recommended to receive preoperative chemoradiotherapy (PCRT) followed by surgery. Response to PCRT varies widely: 60%-70% of patients with LARC do not derive therapeutic benefit from PCRT, whereas 15%-20% of patients achieve pathologic complete response (pCR). We sought to develop a liquid biopsy assay for identifying response to PCRT in patients with LARC. MATERIALS AND METHODS: We analyzed two genome-wide microRNA (miRNA) expression profiling data sets from tumor tissue samples for in silico discovery (GSE68204) and validation (GSE29298). We prioritized biomarkers in pretreatment plasma specimens from clinical training (n = 41; 15 responders and 26 nonresponders) and validation (n = 65; 29 responders and 36 nonresponders) cohorts of patients with LARC. We developed an integrated miRNA panel and established a risk assessment model, which was combined with the miRNA panel and carcinoembryonic antigen levels. RESULTS: Our comprehensive discovery effort identified an 8-miRNA panel that robustly predicted response to PCRT, with an excellent accuracy in the discovery (area under the curve [AUC] = 0.95) and validation (AUC = 0.92) cohorts. We successfully established a circulating miRNA panel with remarkable diagnostic accuracy in the clinical training (AUC = 0.82) and validation (AUC = 0.81) cohorts. Moreover, the predictive accuracy of the panel was significantly superior to conventional clinical factors in both cohorts (P < .01) and the risk assessment model was superior (AUC = 0.83). Finally, we applied our model to detect patients with pathologic complete response and showed that it was dramatically superior to currently used pathologic features (AUC = 0.92). CONCLUSION: Our novel risk assessment signature for predicting response to PCRT has a potential for clinical translation as a liquid biopsy assay in patients with LARC.

Care burden and outcome of the surgical management of ulcerative colitis: A retrospective analysis of the last 20 years in a tertiary hospital in Spain.

AIM: To analyze the surgical burden of UC care in the last two decades, analyzing the characteristics of the patients, surgical indications along with the short and long-term results. METHOD: Single-center retrospective cohort analysis of UC patients undergoing abdominal and anorectal surgery between January 2000 and December 2020. The care burden, clinical data and results were analyzed according to distribution by decades. RESULTS: 128 patients, 37% female, underwent 376 surgical interventions (296 intestinal procedures and 80 anorectal). Mean follow-up for the cohort was 106±64 months. Timing from diagnosis to first surgery was under 5 years in 53.3%. In the second decade of the study there were fewer operated patients (73 vs. 48) as well as the total number of interventions per patient (2.7 vs. 2.0). The proportion between elective and urgent surgery was reversed in the second decade, observing an increase in laparoscopic surgery (70% vs. 8%) together with a decrease in major postoperative morbidity (Clavien-Dindo≥IIIa) (20% vs 8.4%). 80 patients underwent a restorative proctocolectomy, with a failure of 5% at 1 year but 23.7% in the long term. 37 patients required anorectal surgery, of which 26 (71%) were serial interventions, most due to septic complications of the pouches. CONCLUSIONS: The number of colectomies and interventions per patient decreased in the last decade, while there were improvements in morbidity and surgical approach. The need for sequential surgeries and long-term active instrumental surveillance for possible functional deterioration constitutes a significant clinical burden.

Procedimiento LIFT en fístulas anales de localización posterior. ¿Son buenos los resultados? Revisión sistemática y metaanálisis de estudios observacionales / LIFT procedure for posterior fistula-in-ano. Are outcomes good enough? A systematic review and meta-analysisis of observational studies

Introducción: El procedimiento LIFT para las FA de localización posterior ha sido cuestionado. Sin embargo esta controversia no ha sido analizada previamente y es el objetivo de esta revisión sistemática con metaanálisis. Material y método: Revisión sistemática PRISMA, de las bases MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library y Google Scholar hasta marzo de 2020. La evaluación de la calidad y sesgos de los estudios seleccionados se ha realizado mediante la escala Newcastle-Ottawa, según la AHRQ. Se empleó el método inverso de la varianza y el modelo de efectos aleatorios. Además, se realizó un análisis de sensibilidad y sobre el sesgo de publicación mediante funnel-plot y las pruebas de Beg y Egger. Resultados: No se apreciaron diferencias significativas en el porcentaje de recurrencias entre los pacientes con fístula posterior y el resto de localizaciones (OR 1,36 [IC 95% 0,60-3,07]; p=0,46). El valor I2 fue de 77%, lo cual muestra la heterogeneidad de resultados entre los estudios elegidos. Los 9 estudios incluidos presentaron una mediana ponderada (RI) de recidiva global del 37,8% (RI 18,3-47,7%), recidiva de fístula posterior del 47,1% (RI 30,7-63,7%) y de fístula no posterior del 36,3% (RI 15,8-51,3%) (p=0,436). Ni el número de pacientes ni la diferente calidad metodológica de los estudios explican el nivel de heterogeneidad de los mismos. No se demostró sesgo de publicación. (AU)

Introduction: Efficacy of the ligation of intersphincteric fistula tract (LIFT) procedure for posterior fistula-in-ano remains under debate. However, there is scarcity of quality evidence analysing this issue. Thus, the aim of this study is to evaluate outcomes of LIFT surgery in patients with posterior anal fistula. Material and methods: Systematic review and meta-analysis to evaluate efficacy of LIFT procedure for posterior anal fistula. MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar data sources were searched for key-words (MeSH terms): “LIFT” OR “Ligation of the intersphincteric fistula tract” AND “posterior anal fistula” OR “posterior fistula-in-ano”. Original, observational and experimental, non-language restriction studies published from January 2000 to March 2020 and reporting outcomes on LIFT procedure for posterior anal fistula were reviewed. Quality and potential biases were assessed using Newcastle-Ottawa scale, following AHRQ recommendations. Additional sensitivity analysis and publication bias evaluation (Beg and Egger's tets) were performed. Results: No significant differences were found in recurrence rate among patients undergoing LIFT procedure for posterior fistula-in-ano in contrast to other locations (OR 1.36 [IC 95% 0.60-3.07]; p=.46). I2 test value was 77%, expressing a fair heterogeneity among included studies. The weighed median for overall recurrence was 37.8% (RI 18.3-47.7%); with a weighed median of 47.1% (RI 30.7 - 63.7%) and 36.3% (RI 15.8-51.3%) (p=.436) respectively for recurrence after LIFT for posterior fistula and fistula in other locations. There was not clear evidence about the sample size (“n”) of included studies nor the disparities in quality assessment of those, could justify the observed heterogeneity. No significant publication bias was found. (AU)

LIFT procedure for posterior fistula-in-ano. Are outcomes good enough? A systematic review and meta-analysisis of observational studies. / Procedimiento LIFT en fístulas anales de localización posterior. ¿Son buenos los resultados? Revisión sistemática y metaanálisis de estudios observacionales.

INTRODUCTION: Efficacy of the ligation of intersphincteric fistula tract (LIFT) procedure for posterior fistula-in-ano remains under debate. However, there is scarcity of quality evidence analysing this issue. Thus, the aim of this study is to evaluate outcomes of LIFT surgery in patients with posterior anal fistula. MATERIAL AND METHODS: Systematic review and meta-analysis to evaluate efficacy of LIFT procedure for posterior anal fistula. MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar data sources were searched for key-words (MeSH terms): "LIFT" OR "Ligation of the intersphincteric fistula tract" AND "posterior anal fistula" OR "posterior fistula-in-ano". Original, observational and experimental, non-language restriction studies published from January 2000 to March 2020 and reporting outcomes on LIFT procedure for posterior anal fistula were reviewed. Quality and potential biases were assessed using Newcastle-Ottawa scale, following AHRQ recommendations. Additional sensitivity analysis and publication bias evaluation (Beg and Egger's tets) were performed. RESULTS: No significant differences were found in recurrence rate among patients undergoing LIFT procedure for posterior fistula-in-ano in contrast to other locations (OR 1.36 [IC 95% 0.60-3.07]; p=.46). I2 test value was 77%, expressing a fair heterogeneity among included studies. The weighed median for overall recurrence was 37.8% (RI 18.3-47.7%); with a weighed median of 47.1% (RI 30.7 - 63.7%) and 36.3% (RI 15.8-51.3%) (p=.436) respectively for recurrence after LIFT for posterior fistula and fistula in other locations. There was not clear evidence about the sample size ("n") of included studies nor the disparities in quality assessment of those, could justify the observed heterogeneity. No significant publication bias was found. CONCLUSION: This systematic review and meta-analysis suggests that there are no clear data in the literature for not performing the LIFT procedure in posteriorly located fistulas.