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

    Dilke, Stella Maye / Gould, Laura / Yao, Mark / Souvatzi, Maria / Stearns, Adam / Ignjatovic-Wilson, Ana / Tozer, Phil / Vaizey, Carolynne J

    Frontline gastroenterology

    2020  Volume 12, Issue 7, Page(s) 677–682

    Abstract: 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 ... ...

    Abstract 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.
    Language English
    Publishing date 2020-08-18
    Publishing country England
    Document type Systematic Review
    ZDB-ID 2521857-8
    ISSN 2041-4137
    ISSN 2041-4137
    DOI 10.1136/flgastro-2019-101359
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Cumulative burden of inflammation predicts colorectal neoplasia risk in ulcerative colitis: a large single-centre study.

    Choi, Chang-Ho Ryan / Al Bakir, Ibrahim / Ding, Nik-Sheng John / Lee, Gui-Han / Askari, Alan / Warusavitarne, Janindra / Moorghen, Morgan / Humphries, Adam / Ignjatovic-Wilson, Ana / Thomas-Gibson, Siwan / Saunders, Brian P / Rutter, Matthew D / Graham, Trevor A / Hart, Ailsa L

    Gut

    2017  Volume 68, Issue 3, Page(s) 414–422

    Abstract: Objective: Ulcerative colitis (UC) is a dynamic disease with its severity continuously changing over time. We hypothesised that the risk of colorectal neoplasia (CRN) in UC closely follows an actuarial accumulative inflammatory burden, which is ... ...

    Abstract Objective: Ulcerative colitis (UC) is a dynamic disease with its severity continuously changing over time. We hypothesised that the risk of colorectal neoplasia (CRN) in UC closely follows an actuarial accumulative inflammatory burden, which is inadequately represented by current risk stratification strategies.
    Design: This was a retrospective single-centre study. Patients with extensive UC who were under colonoscopic surveillance between 2003 and 2012 were studied. Each surveillance episode was scored for a severity of microscopic inflammation (0=no activity; 1=mild; 2=moderate; 3=severe activity). The cumulative inflammatory burden (CIB) was defined as sum of: average score between each pair of surveillance episodes multiplied by the surveillance interval in years. Potential predictors were correlated with CRN outcome using time-dependent Cox regression.
    Results: A total of 987 patients were followed for a median of 13 years (IQR, 9-18), 97 (9.8%) of whom developed CRN. Multivariate analysis showed that the CIB was significantly associated with CRN development (HR, 2.1 per 10-unit increase in CIB (equivalent of 10, 5 or 3.3 years of continuous mild, moderate or severe active microscopic inflammation); 95% CI 1.4 to 3.0; P<0.001). Reflecting this, while inflammation severity based on the most recent colonoscopy alone was not significant (HR, 0.9 per-1-unit increase in severity; 95% CI 0.7 to 1.2; P=0.5), a mean severity score calculated from all colonoscopies performed in preceding 5 years was significantly associated with CRN risk (HR, 2.2 per-1-unit increase; 95% CI 1.6 to 3.1; P<0.001).
    Conclusion: The risk of CRN in UC is significantly associated with accumulative inflammatory burden. An accurate CRN risk stratification should involve assessment of multiple surveillance episodes to take this into account.
    MeSH term(s) Adult ; Colitis, Ulcerative/complications ; Colitis, Ulcerative/pathology ; Colonoscopy ; Colorectal Neoplasms/etiology ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Population Surveillance ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors ; Severity of Illness Index ; Young Adult
    Language English
    Publishing date 2017-11-17
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80128-8
    ISSN 1468-3288 ; 0017-5749
    ISSN (online) 1468-3288
    ISSN 0017-5749
    DOI 10.1136/gutjnl-2017-314190
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Low-grade dysplasia in ulcerative colitis: risk factors for developing high-grade dysplasia or colorectal cancer.

    Choi, Chang-ho Ryan / Ignjatovic-Wilson, Ana / Askari, Alan / Lee, Gui Han / Warusavitarne, Janindra / Moorghen, Morgan / Thomas-Gibson, Siwan / Saunders, Brian P / Rutter, Matthew D / Graham, Trevor A / Hart, Ailsa L

    The American journal of gastroenterology

    2015  Volume 110, Issue 10, Page(s) 1461–71; quiz 1472

    Abstract: Objectives: The aim of this study was to identify risk factors associated with development of high-grade dysplasia (HGD) or colorectal cancer (CRC) in ulcerative colitis (UC) patients diagnosed with low-grade dysplasia (LGD).: Methods: Patients with ... ...

    Abstract Objectives: The aim of this study was to identify risk factors associated with development of high-grade dysplasia (HGD) or colorectal cancer (CRC) in ulcerative colitis (UC) patients diagnosed with low-grade dysplasia (LGD).
    Methods: Patients with histologically confirmed extensive UC, who were diagnosed with LGD between 1993 and 2012 at St Mark's Hospital, were identified and followed up to 1 July 2013. Demographic, endoscopic, and histological data were collected and correlated with the development of HGD or CRC.
    Results: A total of 172 patients were followed for a median of 48 months from the date of initial LGD diagnosis (interquartile range (IQR), 15-87 months). Overall, 33 patients developed HGD or CRC (19.1% of study population; 20 CRCs) during study period. Multivariate Cox proportional hazard analysis revealed that macroscopically non-polypoid (hazard ratio (HR), 8.6; 95% confidence interval (CI), 3.0-24.8; P<0.001) or invisible (HR, 4.1; 95% CI, 1.3-13.4; P=0.02) dysplasia, dysplastic lesions ≥1 cm in size (HR, 3.8; 95% CI, 1.5-13.4; P=0.01), and a previous history of "indefinite for dysplasia" (HR, 2.8; 95% CI, 1.2-6.5; P=0.01) were significant contributory factors for HGD or CRC development. Multifocal dysplasia (HR, 3.9; 95% CI, 1.9-7.8; P<0.001), metachronous dysplasia (HR, 3.5; 95% CI, 1.6-7.5; P=0.001), or a colonic stricture (HR, 7.4; 95% CI, 2.5-22.1; P<0.001) showed only univariate correlation to development of HGD or CRC.
    Conclusions: Lesions that are non-polypoid or endoscopically invisible, large (≥1 cm), or preceded by indefinite dysplasia are independent risk factors for developing HGD or CRC in UC patients diagnosed with LGD.
    MeSH term(s) Aged ; Colitis, Ulcerative/pathology ; Colon/pathology ; Colonic Diseases/pathology ; Colonic Polyps/pathology ; Colonoscopy ; Colorectal Neoplasms/pathology ; Constriction, Pathologic/pathology ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors
    Language English
    Publishing date 2015-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 390122-1
    ISSN 1572-0241 ; 0002-9270
    ISSN (online) 1572-0241
    ISSN 0002-9270
    DOI 10.1038/ajg.2015.248
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

    Kamiński, Michał F / Hassan, Cesare / Bisschops, Raf / Pohl, Jürgen / Pellisé, Maria / Dekker, Evelien / Ignjatovic-Wilson, Ana / Hoffman, Arthur / Longcroft-Wheaton, Gaius / Heresbach, Denis / Dumonceau, Jean-Marc / East, James E

    Endoscopy

    2014  Volume 46, Issue 5, Page(s) 435–449

    Abstract: Main recommendations: 1 ESGE suggests the routine use of high definition white-light endoscopy systems for detecting colorectal neoplasia in average risk populations (weak recommendation, moderate quality evidence). 2 ESGE recommends the routine use of ... ...

    Abstract Main recommendations: 1 ESGE suggests the routine use of high definition white-light endoscopy systems for detecting colorectal neoplasia in average risk populations (weak recommendation, moderate quality evidence). 2 ESGE recommends the routine use of high definition systems and pancolonic conventional or virtual (narrow band imaging [NBI], i-SCAN) chromoendoscopy in patients with known or suspected Lynch syndrome (strong recommendation, low quality evidence). 2b ESGE recommends the routine use of high definition systems and pancolonic conventional or virtual (NBI) chromoendoscopy in patients with known or suspected serrated polyposis syndrome (strong recommendation, low quality evidence). 3 ESGE recommends the routine use of 0.1 % methylene blue or 0.1 % - 0.5 % indigo carmine pancolonic chromoendoscopy with targeted biopsies for neoplasia surveillance in patients with long-standing colitis. In appropriately trained hands, in the situation of quiescent disease activity and adequate bowel preparation, nontargeted, four-quadrant biopsies can be abandoned (strong recommendation, high quality evidence). 4 ESGE suggests that virtual chromoendoscopy (NBI, FICE, i-SCAN) and conventional chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained and audited (weak recommendation, high quality evidence). 5 ESGE suggests the use of conventional or virtual (NBI) magnified chromoendoscopy to predict the risk of invasive cancer and deep submucosal invasion in lesions such as those with a depressed component (0-IIc according to the Paris classification) or nongranular or mixed-type laterally spreading tumors (weak recommendation, moderate quality evidence).
    Conclusion: Advanced imaging techniques will need to be applied in specific patient groups in routine clinical practice and to be taught in endoscopic training programs.
    MeSH term(s) Colonoscopy/methods ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/therapy ; Diagnosis, Computer-Assisted ; Diagnosis, Differential ; Europe ; Humans ; Neoplasm Invasiveness
    Language English
    Publishing date 2014-05
    Publishing country Germany
    Document type Journal Article ; Practice Guideline
    ZDB-ID 80120-3
    ISSN 1438-8812 ; 0013-726X
    ISSN (online) 1438-8812
    ISSN 0013-726X
    DOI 10.1055/s-0034-1365348
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

    Kamiński, Michał F. / Hassan, Cesare / Bisschops, Raf / Pohl, Jürgen / Pellisé, Maria / Dekker, Evelien / Ignjatovic-Wilson, Ana / Hoffman, Arthur / Longcroft-Wheaton, Gaius / Heresbach, Denis / Dumonceau, Jean-Marc / East, James E.

    Endoscopy

    2014  Volume 46, Issue 05, Page(s) 435–457

    Abstract: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the role of advanced endoscopic imaging for the detection and differentiation of colorectal neoplasia. : Main recommendations: 1: ESGE ... ...

    Abstract This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the role of advanced endoscopic imaging for the detection and differentiation of colorectal neoplasia.
    Main recommendations: 1: ESGE suggests the routine use of high definition white-light endoscopy systems for detecting colorectal neoplasia in average risk populations (weak recommendation, moderate quality evidence).
    2: ESGE recommends the routine use of high definition systems and pancolonic conventional or virtual (narrow band imaging [NBI], i-SCAN) chromoendoscopy in patients with known or suspected Lynch syndrome (strong recommendation, low quality evidence).
    2b: ESGE recommends the routine use of high definition systems and pancolonic conventional or virtual (NBI) chromoendoscopy in patients with known or suspected serrated polyposis syndrome (strong recommendation, low quality evidence).
    3: ESGE recommends the routine use of 0.1 % methylene blue or 0.1 % – 0.5 % indigo carmine pancolonic chromoendoscopy with targeted biopsies for neoplasia surveillance in patients with long-standing colitis. In appropriately trained hands, in the situation of quiescent disease activity and adequate bowel preparation, nontargeted, four-quadrant biopsies can be abandoned (strong recommendation, high quality evidence).
    4: ESGE suggests that virtual chromoendoscopy (NBI, FICE, i-SCAN) and conventional chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained and audited (weak recommendation, high quality evidence).
    5: ESGE suggests the use of conventional or virtual (NBI) magnified chromoendoscopy to predict the risk of invasive cancer and deep submucosal invasion in lesions such as those with a depressed component (0-IIc according to the Paris classification) or nongranular or mixed-type laterally spreading tumors (weak recommendation, moderate quality evidence).
    Conclusion: Advanced imaging techniques will need to be applied in specific patient groups in routine clinical practice and to be taught in endoscopic training programs.
    Language English
    Publishing date 2014-03-17
    Publisher © Georg Thieme Verlag KG
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 80120-3
    ISSN 1438-8812 ; 0013-726X
    ISSN (online) 1438-8812
    ISSN 0013-726X
    DOI 10.1055/s-0034-1365348
    Database Thieme publisher's database

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