Iranian Journal of Colorectal Research
Volume:9 Issue: 2, Jun 2021

Context- The oral cavity and the colon, though part of the alimentary tract are distantly located anatomically and hence are colonized by totally divergent microbes. The mouth is affected by several pathologies and so is the colon. So it is quite natural to investigate the probable connection between poor oral health and colorectal pathologies. Evidence acquisition- This article is a small attempt to identify the oral microbiota, how they translocate to the colon-rectum area and then how do they create pathology there. Pubmed indexed journals relating to this topic were screened and shortlisted to construct this article. Results- The organisms generally responsible for the oral diseases, namely Fusobacterium nucleatum and Porphyromonas gingivalis among others have been found in colon disorders resulting in intestinal dysbiosis and ultimately leading to colorectal cancer. Conclusions- If the disease pathogenesis is well understood, then it will open new ways on how to prevent or treat colorectal pathologies. However further studies are needed in this arena.

The concept of ghost/Khatith ileostomy is a bridge between covering ileostomy and no-ileostomy (‘Khatith’ meaning ‘hidden’ in Kashmiri language). We performed the pre-stage ghost ileostomy (GI) without parietal wall split. The technique of GI is that after the completion of resection-anastomosis of rectal cancer, a terminal ileal loop at about 20cm from ileocecal junction is identified. Small (10-12F) Ryle’s tube (RT) is passed through a small opening in the mesentery of the identified ileal loop. A small 4-5mm incision is given on abdominal wall at pre-operatively marked proposed stoma site in right iliac fossa region. Haemostatic Kelly’s forceps is introduced through this small incision to get out the two limbs of the RT that has been already looped around the identified ileal loop. These two limbs of the RT are cut short and fixed to each other and to the skin around it with 2-0 silk sutures, taking care to keep the tubing loop loose enough to avoid any tension to the vascular supply of the ileal loop and without causing any luminal compression of the loop to avoid bowel obstruction. In case of AL, the pre-stage GI can be converted into a formal covering stoma under local or spinal anesthesia by gentle pull of the two limbs of the looped RT to extract the isolated ileal loop through an adequate circular incision around the site of GI. In case of uncomplicated postoperative course, the fixing RT is pulled out gently from the abdominal cavity to release down the GI.

Colonoscopy is the standard for primary colorectal cancer (CRC) detection, but is invasive and imperfect. The aim of this study was to assess the accuracy of 18F-fluorodeoxyglucose (FDG) Positron emission tomography/Computed tomography (PET/CT) and colonoscopy in the diagnosis of primary CRC.

A retrospective analysis of all patients identified as undergoing a FDG PET/CT scan and a colonoscopy within six months of each other, with no intervening malignancy treatment, over a 12 month period in a single University teaching hospital.

Two hundred and sixty-two patients had FDG PET/CT and colonoscopy within 6 months. 206 were excluded for prior treatment. 56 patients were included, 26 (46%) with confirmed primary CRC tumors and 30 (54%) without. Multivariate logistic regression analysis indicated that CRC diagnosis was more likely when colonoscopy was performed before the FDG PET/CT (Odds Ratio (OR) 21.9 (CI 2.6-183) and when CRC was diagnosed on FDG PET/CT (OR 12.3 (CI 3.0-51.0). The ROC-AUC for FDG PET/CT and colonoscopy was 0.81 (CI 0.70-0.93, p <0.001) and 0.96 (CI 0.90-1.0, p <0.001) respectively.

Colonoscopy is very good and FDG PET/CT is good as diagnostic tests for CRC primary diagnosis. Together they facilitated diagnosis in all CRC primaries. PET/CT should be considered in patients’ with incomplete colonoscopy where there is suspicion for CRC primary.

Autophagy and unfolded protein response (UPR) are mechanisms with dual roles in both maintaining the cellular homeostasis and progression of various diseases such as cancer. Therefore, identification of different molecules and proteins involved in the regulation of these pathways may contribute to find new therapeutic targets. A member of the M28 family of the metallopeptidases, Endoplasmic Reticulum Metallo Protease 1 (ERMP1), is overexpressed in cancers such as colorectal cancer. The role of this protein in the UPR activation was previously reported in breast cancer. We aimed to evaluate the role of ERMP1 in the activation of autophagy and apoptosis in colorectal cancer.

ERMP1 Gene silencing was performed using specific small hairpin RNA (shRNA) in HCT-116 colorectal cancer cell line. Then, autophagy associated protein markers including Beclin 1, p62 and LC3II were evaluated using western blot. The effect of ERMP1 knockdown on cellular apoptosis was also assessed by propidium iodide staining flow cytometry analysis. Statistical analysis was performed using SPSS software version 20.

All three autophagy markers were increased significantly in the ERMP1-silenced HCT116 cell lines compared with negative control cells (P < 0.05). It seems that ERMP1 silencing inhibits autophagy at the flux stage. However, ERMP1 knockdown had no significant effect on HCT-116 apoptotic cell death (P > 0.05).

The oncogenic protein, ERMP1, activates autophagy in colorectal cancer cell line. Targeting of ERMP1 may be considered as a proper approach in colorectal cancer therapy. Further investigations are required to confirm these results.

The aim of this study is to assess the outcomes of Laser Pile Ablation (LPA) in patients affected by II-III degree symptomatic hemorrhoidal disease.

Consecutive patients suffering of II-III degree symptomatic HD were enrolled to undergo LPA. The primary study endpoint was to assess the post-operative pain using NRS scale (0-10) and the use of painkiller. Secondary endpoints were: intraoperative, postoperative complications and recurrence rate (including bleeding and prolapse). Patients satisfaction was assessed at 6- and 12-months using VAS scale (0-10) and also through the questions “Would you undergo this surgery again?” and “Would you recommend this procedure to a relative or friend?”.

Twenty-five patients (7F–18M) were enrolled in the study. All the procedures were performed under spinal anesthesia and the mean amount of energy delivered was 472.6±50.7 J. The mean follow-up was 9 months (range 6-12). Mean postoperative pain, assessed through NRS scale, was 4.7±1.5 at 12 h, 4.4±1.3 at 24 h and 2.2±1.0 at day 10. The pain was managed with paracetamol 1 gr only 30.7 % required NSAIDs in addition for 3 days. Recurrence rate was 7.7% at 3 and 6 months after the procedure referring persistent bleeding. The mean time interval to return to work is 2.7±2.1 days. All the patients were extremely satisfied of the procedure VAS 9.

LPA resulted to be a safe, effective and minimally invasive procedure to treat II-III degree HD with optimal management of post-operative pain and excellent patient satisfaction.

Rectal cancer is a malignant tumor of the digestive tract and as it is a widespread condition it demands comprehensive research. At the time of the writing of the present study, COVID-19 infection rates are rising rapidly in Iran and the study attempts to make an evaluation of the country’s rectal cancer management during the pandemic.

83 patients were divided into two groups and closely studied. The first group underwent rectal cancer surgery during a 9 month period in 2019, while the second group underwent the same process during the same amount of time in 2020. Demographic data, surgery and outcomes after surgery were assessed and compared between the two groups. The data were analyzed by SPSS (statistical analyzer software, ver. 22).

The age, weight, height, BMI, size of tumor, and numbers of involved lymph nodes were not different between the two groups. The radiotherapy techniques were significantly different between two groups (p=0.012). Neoadjuvant long course chemoradiation therapy was changed to short-course radiation therapy during the pandemic and hospital stay for the patients was significantly longer during the pandemic (p=0.010). There is no difference in the recurrence or overall survival between the two groups. Metastasis was seen in six patients in the 2019 group,, whereas this phenomenon was not observed in the 2020 group. . The size of tumors were larger in the 2020 group, but it was not statistically different (p=0.064).

Cancer is a highly complicated and problematic decease which stresses the importance of immediate diagnosis and treatment; however during the COVID-19 pandemic, medical centers may need to take additional measures to protect their cancer patients.

Collagenous Enteritis (CE) is a less common cause of enteropathy presenting with malabsorption as its cardinal symptom. While historically considered a resistant form of celiac disease, newer evidence supports the interaction between genetic predispositions and environmental triggers as the pathophysiologic basis of CE.

Herein we present the case of a 40-year-old woman with two-year history of diarrhea and 32 kg weight loss who was incorrectly diagnosed with celiac disease with refractory symptoms despite adherence to a gluten-free diet. Extensive infectious, inflammatory, secretory, autoimmune workup did not reveal an underlying etiology. Endoscopic evidence of severe villous blunting and biopsy with characteristic patchy enlarged subepithelial collagen layer solidified a diagnosis of CE. Treatment with steroids resulted in resolution of malabsorptive symptoms and gradual weight gain.

This case highlights the importance of considering CE in patients presenting with malabsorption especially given significant clinical overlap with other malasbsorptive conditions as well as its therapeutic implications.

Transanal Minimally invasive surgery (TAMIS) is indicated for benign lesions of the rectum distant up to 5 cm and not exceeding more than 1/3 of the rectal circumference; for early stage malignancies confined to the submucosa (T1 sm1 according to the Kikuchi classification); for cancers after complete response to neoadiuvant treatments or with T1 residue (due to a risk of mesorectal positive lymph node between 3-6%); for T2-T3 N0 in patients who cannot undergo major surgical resections due to a compromised general (rescue surgery). TAMIS is especially recommended for neoplasms located at a distance between 5 and 18 cm from the anal verge.

We performed TAMIS on a 72-year-old patient diagnosed with diffuse polyposis syndrome (FAP), with multimorbidity and a history of recurrences, all treated with surgical resection, AND with a new recurrence on the ileo-rectal anastomosis at about 25 cm from the anal verge. A rectoscopy and a total body CT were performed (anastomotic level; size 2 cm; staging: cT1-2, N0, M0; histology: adenocarcinoma). The final decision after multidisciplinary meeting was for TAMIS, due to high intra- and post-operative risk contraindicating major surgery. Data regarding total operating time, blood losses, length of stay, surgical and general intra and post-operative complications, resumption of nutrition and therapies (antibiotics and pain relievers) were collected. The operation was successful, with a total operating time of 55 minutes, and an estimated blood loss of 20 ml. The patient was rapidly mobilized and nutrition promptly resumed. The length of stay was 3 days. We did not observe any complications.

We showed for this patient the feasibility and safety of TAMIS resections at greater distances than those normally recommended.