“PPIs are the most effective agents in preventing CIB, but they may increase the risk of pneumonia”.
Commentaries: We’re barely using the best tool we have to fight obesity – VOX (free) AND Gastric bypass patients sustain long-term weight loss, comorbidity reduction – Cardiovascular Business (free) AND Weight Loss After Bariatric Procedures Mostly Sustained Over Time – Medical Research (free)
Commentaries: Comparison of Fecal Transplant Using Capsule vs Colonoscopy to Prevent Clostridium Difficile Infection – The JAMA Network (free) AND New evidence suggests there’s a much easier way to get a fecal transplant – Quartz (free) AND Fecal transplant by capsule may match colonoscopy for C diff – CIDRAP (free)
Adherence to a Healthy Lifestyle is Associated With a Lower Risk of Diverticulitis among Men – American Journal of Gastroenterology (link to abstract – $ for full-text)
Commentary: Unhealthy lifestyle may cause half of diverticulitis cases – Reuters (free)
Commentary: Bariatric Surgery Can Lead to HTN ‘Remission’ in Obese: GATEWAY – Medscape (free) AND Gastric Bypass to Treat Obese Patients With Steady Hypertension – GATEWAY – American College of Cardiology, Latest in Cardiology (free)
Commentaries: Perioperative aspirin may improve short-term outcomes after noncardiac surgery in patients with prior PCI – ACP Internist (free) AND Aspirin can prevent heart attacks after noncardiac surgery in patients with prior PCI – University of Alberta Faculty of Medicine & Dentistry, via ScienceDaily (free) AND Aspirin Protective Against Early Death/MI in Prior PCI Patients Undergoing Noncardiac Surgery – TCTMD (free)
European guidelines on perioperative venous thromboembolism prophylaxis (free PDF articles):
Commentaries: Is Eating Fiber After Colorectal Cancer Diagnosis Associated with Lower Death Risk? – The JAMA Network (free) AND Higher Fiber Intake After Colorectal Cancer Diagnosis Tied to Improved Survival – Physician’s First Watch (free)
Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study – Gut (link to abstract – $ for full-text)
Commentaries: Acid reflux drug linked to more than doubled risk of stomach cancer – study – The Guardian (free) AND Gastric Cancer Risk Doubled With Long-term PPI Use – Medscape (free registration required) AND PPI Use After H. pylori Eradication Therapy Tied to Increased Risk for Gastric Cancer – Physician’s First Watch (free)
“Among 797 067 individuals on maintenance PPI therapy, the SIR of gastric cancer was over threefold increased (SIR=3.38, 95% CI 3.23 to 3.53)”.
25th UEG (United European Gastroenterology) Week: Long-term aspirin use reduces the incidence of digestive cancers by up to 47% (free)
Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries: Comparison of Outcomes for Robotic-Assisted vs Laparoscopic Surgical Procedures – The JAMA Network (free) AND Robotic docs can boost surgery time and cost – Science News (free) AND Robot-assisted surgery for kidney removal associated with longer operating times, higher cost – Stanford Medicine (free) AND Robotic-assisted surgery: more expensive, but not always more effective – Reuters (free)
Incidence, Demographics, and Clinical Characteristics of Diabetes of the Exocrine Pancreas (Type 3c): A Retrospective Cohort Study – Diabetes Care (link to abstract – $ for full-text)
“Diabetes of the exocrine pancreas is frequently labeled type 2 diabetes but has worse glycemic control and a markedly greater requirement for insulin”.
Antibiotic-associated diarrhea ocurred in 8.0% of the probiotic group compared to 17.7% in the control group. The number needed to treat (NNT) to prevent one case of diarrhea was 11 (95% CI 6 to 13).
Percutaneous cholecystostomy in the management of high-risk patients presenting with acute cholecystitis: Timing and outcome at a single institution – American Journal of Surgery (link to abstract – $ for full-text)
Commentary: Percutaneous Cholecystostomy: An Alternative to Urgent Surgery for Cholecystitis? – Medscape (free registration required)
“Concurrent bariatric operations occurred infrequently, but when they did, there was no observable increased risk for adverse perioperative outcomes compared with non-concurrent operations”.
Prevalence of Anemia 10 Years After Roux-en-Y Gastric Bypass in a Single Veterans Affairs Medical Center – JAMA Surgery (link to abstract – $ for full-text)
Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) – Gut (free)
Commentary: Standards for Upper GI Endoscopy Released – Medscape (free registration required)
Original article: Strategies for detecting colon cancer in patients with inflammatory bowel disease – Cochrane Library (link to abstract – $ for full-text)
Editorial: Increased risk of cancer in children with inflammatory bowel disease (free)
Commentaries: Inflammatory Bowel Disease in Childhood Tied to Higher Cancer Risk Later – Physician’s First Watch (free) AND IBD in Childhood Raises Cancer Risk – Medscape (free registration required)
Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis – British Journal of Surgery (link to abstract – $ for full-text)
See also a related meta-analysis suggesting the safety of nonoperative treatment for uncomplicated cases (free) and a recent guideline that incorporates the possibility of non-operative treatment for uncomplicated disease (free)
Weight and Metabolic Outcomes 12 Years after Gastric Bypass – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries: Benefits of gastric bypass persist for 12 years – Reuters (free) AND Gastric bypass surgery benefits continue for 12 years – Diabetes.co.uk (free) AND Bariatric Surgery’s Benefits Last Over a Decade – Physician’s First Watch (free)
Incidence, Demographics, and Clinical Characteristics of Diabetes of the Exocrine Pancreas (Type 3c): A Retrospective Cohort Study – Diabetes Care (link to abstract – $ for full-text)
Commentary: Glycemic control poor, insulin use high in diabetes after pancreatic disease – Haelio (free registration required)
Low-dose CT for the diagnosis of appendicitis in adolescents and young adults (LOCAT): a pragmatic, multicentre, randomised controlled non-inferiority trial – Lancet Gastroenterology &Hepatology (link to abstract – $ for full-text)
Original article: Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction for the prevention of postoperative pancreatic fistula following pancreaticoduodenectomy – Cochrane Library (link to abstract – $ for full-text)
“There is no reliable evidence to support the use of pancreatojejunostomy over pancreatogastrostomy”
Infographic: Preventing Colorectal Cancer (free)
Almost half cases of colorectal cancer can be prevented by staying lean, eating healthy, and moving more.
Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux – JAMA (link to abstract – $ for full-text)
Commentaries: Laparoscopic Antireflux Surgery Associated With High Rate of Recurrence of GERD – The JAMA Network (free) AND GERD Recurrence Fairly Common Following Laparoscopic Antireflux Surgery – Physician’s First Watch (free) AND High recurrence of gastroesophageal reflux disease in patients treated with laparoscopic antireflux surgery – 2 Minute Medicine (free)
Related: Enhanced recovery pathway for colorectal surgical patients improves outcomes, reduces cost – ACS, via EurekAlert (free) AND Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (free) AND Enhanced Recovery After Surgery (ERAS) Guidelines and Reviews in our collection (free) AND ERAS Society Website (free).
Related meta-analysis: A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients – World Journal of Emergency Surgery (free)
Commentaries: AGA releases recommendations on therapeutic drug monitoring in IBD – ACP Gastroenterology (free) AND New Guideline for Therapeutic Drug Monitoring in Inflammatory Bowel Disease – Journal Watch (free)
Full Review: Chemotherapy for advanced gastric cancer – Cochrane Library (link to abstract – $ for full-text)
Related: Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (free) AND Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Summary (free) AND Locally Advanced Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Summary (free)
Source: Hospital Medicine Virtual Journal Club (free resource to find articles of interest)
Gastrointestinal safety of celecoxib versus naproxen in patients with cardiothrombotic diseases and arthritis after upper gastrointestinal bleeding (CONCERN): an industry-independent, double-blind, double-dummy, randomised trial – The Lancet (link to abstract – $ for full-text)
Source: ACP Journal Club
In this study, patients at high risk of both cardiovascular and gastrointestinal events who required concomitant aspirin and NSAID, celecoxib associated with a proton pump inhibitor led to less recurrent gastrointestinal bleeding when compared to naproxen associated with a proton pump inhibitor (5.6% vs 12.3%).
Related: UK clinical practice guidelines for the management of gastrointestinal stromal tumours (GIST) – Clinical Sarcoma Research (free) AND SEOM Clinical Guideline for gastrointestinal sarcomas (GIST) – Clinical and Translational Oncology (free)
Commentaries: Flexible Sigmoidoscopy Tied to Lower Mortality Risk – Physician’s First Watch (free) AND Flexible Sigmoidoscopy Reduces All-Cause Mortality – Medscape (free registration required)
Starts Today! Free Online Course: Anatomy of the Abdomen and Pelvis; a journey from basis to clinic – Leiden University Medical Center and Coursera
Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial – Gastrointestinal Endoscopy (link to abstract – $ for full-text)
“A single EGD with endoscopic hemostasis is not inferior to scheduled second-look endoscopy in terms of reduction in rebleeding rate of peptic ulcer bleeding. Repeat endoscopy would be helpful in the patients with unsatisfactory initial endoscopic hemostasis, use of NSAIDs, and larger amounts of transfused blood”
Source: Journal Watch ($)
“we found that the risk associated with nonobstetric surgery was relatively low, confirming that surgical procedures during pregnancy are generally safe”
FDA Safety Alert: Liquid-filled Intragastric Balloon Systems: Letter to Healthcare Providers – Potential Risks (free)
Commentaries: Five People Die After Using Weight Loss Balloons for Obesity – Time (free) AND FDA Warns of Gastric Balloon Deaths – MedPage Today (free registration required) AND Five Deaths Tied to Intragastric Balloons, FDA Says – Medscape (free registration required)
Related book: Essential Surgery – Disease Control Priorities 3 (DCP3) (free)
Related report: Global Surgery 2030 (free PDF)
Related commentary on the subject: In countries with a shortage of surgeons, other health care workers can fill in the gaps – STAT (free)
Related guidelines: United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (free) AND Guidelines for the understanding and management of pain in chronic pancreatitis – Pancreatology (free)
Diet and Risk of Cholecystectomy: A Prospective Study Based on the French E3N Cohort – American Journal of Gastroenterology (link to abstract – $ for full-text)
Commentary: Fewer gallbladder surgeries with Mediterranean diets – Reuters (free)
Factors Associated With Achieving a Body Mass Index of Less Than 30 After Bariatric Surgery – JAMA Surgery (link to abstract – $ for full-text)
Commentaries: Opting for Weight-Loss Surgery at Lower BMIs May Be Best for Patients’ Health, Study Suggests – University of Michigan, via NewsWise (free) AND Delayed Weight Loss Surgery Tied to Worse Outcomes – MedPage Today (free registration required) AND Weight-loss surgery may work better when patients aren’t too obese – Reuters (free) AND With bariatric surgery, a patient’s starting weight makes a difference, study finds – STAT (free)
Related guideline: NCCN Guidelines Insights: Antiemesis, Version 2.2017 (free)
Commentaries: Antipsychotic Added to ASCO Antiemetic Guide – MedPage Today (free registration required) AND New Antiemetic Guidelines Issued by ASCO – Medscape (free registration required)
American College of Surgeons (ACS) 2017 Quality and Patient Safety Conference: Enhanced recovery pathway for colorectal surgical patients improves outcomes, reduces cost – ACS, via EurekAlert (free)
Related guideline: Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (free)
“Successful protocol shortens hospital stays, reduces patients’ risk of complications, and cuts costs up to $11,000 per procedure”
2017 ACS Quality and Safety Conference: “Strong for Surgery” Shows Promise in Reducing Smoking Rates for Patients Facing Surgery – American College of Surgeons, via NewsWise (free)
“Study suggests big drop in smoking rates when surgeons help patients quit before their operations”.
Source: Guidelines: 2017 Midyear Review – Medscape (free registration required)
What carcinoembryonic antigen level should trigger further investigation during colorectal cancer follow-up? A systematic review and secondary analysis of a randomised controlled trial – Health Technology Assessment (free)
Source: ACP Journal Wise ($)
“The results suggest that (1) CEA testing should not be used alone as a triage test; (2) in year 1, testing frequency should be increased (to monthly for 3 months and then every 2 months); (3) the threshold for investigating a single test result should be raised to 10 µg/l; (4) after the second CEA test, decisions to investigate further should be made on the basis of the trend in CEA levels; (5) the optimal threshold for investigating the CEA trend falls over time; and (6) continuing smokers should not be monitored with CEA testing”.
Commentary: 3 steps to restore patient trust in overlapping surgeries – FierceHealthcare (free)
This interesting viewpoint discusses the practice of scheduling overlapping surgeries, in which a qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery.
Molecular Biomarkers for the Evaluation of Colorectal Cancer: Guideline From the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and the American Society of Clinical Oncology (free)
Commentaries: ASCP/CAP/AMP/ASCO Guideline on Molecular Biomarkers in Colorectal Cancer – ASCO Post (free) AND ASCP/CAP/AMP/ASCO Clinical Practice Guideline Focuses on Molecular Biomarker Testing for Patients With Colorectal Cancer – ASCO Post (free) AND Clinical Practice Guideline Focuses on Molecular Biomarker Testing for Patients with Colorectal Cancer – College of American Pathologists (CAP), via NewsWise (free)
Source: Oncology Research Review Newsletter (free registration required)
New available guidelines are:
Clinical Review: Optimal diagnosis and disease activity monitoring of intestinal Behçet’s disease (free)
Clinical Review: Treatment and outcomes: medical and surgical treatment for intestinal Behçet’s disease (free)
Clinical Review: Prevalence, Pathogenesis, Diagnosis, and Management of Microscopic Colitis – Gut and Liver (free PDF)
Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (free)
Practical review of this common problem in the emergency department.
An analysis of a large database of de-identified electronic medical records (EMRs) with over 40.000.000 patients found no association.
Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study – Canadian Medical Association Journal (free)
Source: STAT News Newsletter
“Delayed operating room access for emergency surgery was associated with increased risk of inhospital mortality, longer length of stay and higher costs”.
Commentaries: Cases of recurrent Clostridium difficile infection are soaring – University of Pennsylvania School of Medicine, via EurekAlert (free) AND Multiply Recurrent C difficile Infection Rates Sharply Rise – Medscape (free registration required) AND Demand for FMT likely to increase with rise in multiply recurrent C. difficile cases – 2 Minute Medicine (free) AND Marked increase seen in multiply recurrent C diff – CIDRAP (free)
Commentaries: Proton pump inhibitors associated with raised mortality – OnMedica (free) AND Longtime use of heartburn drugs linked to increased risk of death – NewsMedical (free) AND People taking heartburn drugs could have higher risk of death, study claims – The Guardian (free) AND Some heartburn drugs linked with higher risk of death – CBS News (free) AND PPIs Linked to Higher Risk for Death – Medscape (free registration required)
In a large observational study, PPI use was associated with increased mortality (HR 1.25; CI 1.23 to 1.28). PPIs were also associated with increased risk compared to H2 blockers (HR 1.24; CI 1.21 to 1.27). See more on the trade-offs of PPI therapy in our July 3rd issue (see #10)
Commentary: Complications of Proton Pump Inhibitor Therapy – PracticeUpdate (free registration required)
Related: Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline – Canadian Family Physician (free) AND Proton Pump Inhibitors and Risk of Incident CKD and Progression to ESRD – Journal of the American Society of Nephrology (link to abstract – registration required for full text) AND Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis – Jama Neurology (link to abstract – subscription required for full text)
The authors of this review argue that the observational studies that brought up the safety issues associated with PPIs (above studies, for example) are insufficient to establish causation and suggest a more balanced approach to PPI prescribing.
Viewpoint: Monitoring Medical Devices: Missed Warning Signs Within Existing Data – JAMA (free)
Related: The lap band for weight loss is a tale of medicine gone wrong – VOX (free) Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery – JAMA Surgery (link to abstract – $ for full-text) AND Safety, Effectiveness of Gastric Banding Called Into Question – Medscape (free registration required) AND 1 In 5 Gastric Band Surgeries Require Corrective Operations – American Council on Science and Health (free)
The authors use the example of gastric band surgery to discuss how available data may be used more appropriately for earlier detection of problems in the safety of medical devices.
Source: EvidenceAlerts (free resource to find articles of interest)
“Antiplatelet therapy at the time of noncardiac surgery confers minimal bleeding risk with no difference in thrombotic complications. In many cases, it is safe to continue antiplatelet therapy in patients with important indications for their use”
Diagnostic Accuracy of Fecal Immunochemical Test in Patients at Increased Risk for Colorectal Cancer: A Meta-analysis – JAMA Internal Medicine (link to abstract – $ for full-text)
Commentaries: Fecal immunochemical testing demonstrates good diagnostic accuracy for high-risk individuals – 2 minute medicine (free) AND Mixed Results with FIT Screen for High-Risk Colon Cancer – MedPage Today (free registration required)
Interview with the author: Fecal Testing Better At Detecting Colon Cancer Than Advanced Atypical Changes – MedicalResearch.com (free)
1 – Introduction (free)
3 – Surgical Management (free)
8 – Anal Cancer (free)
Timing of Aspirin and Other Nonsteroidal Anti-Inflammatory Drug Use Among Patients With Colorectal Cancer in Relation to Tumor Markers and Survival – Journal of Clinical Oncology (link to abstract – $ for full-text)
Commentary: Study Informs NSAID Benefit in Colon Cancer – MedPage Today (free registration required)
Observational data suggests a benefit for individuals with KRAS wild-type tumors
Commentaries: Task Force presents new ranking of colorectal cancer screening tests – American Society of Gastrointestinal Endoscopy, via EurekAlert (free) AND Latest Colorectal Cancer Screening Guidelines – Latest Colorectal Cancer Screening Guidelines – GI and Hepatology News (free)
Surgeon-level variation in complications among surgeons was nearly twice as great for Minimally Invasive Colectomy than for Open Colectomy, implying a need for improved training in adoption of minimally invasive techniques.
Inspired by War Zones, Balloon Device May Save Civilians From Fatal Blood Loss – The New York Times (10 articles per month are free)
See also: QCancer-2017(colorectal, survival) risk calculator (free risk calculator based on the data)
Invited commentary: Preventing major gastrointestinal bleeding in elderly patients (free)
Commentaries: Aspirin Bleeding Risk in Over 75s Higher Than Thought – Medscape (free registration required) AND Aspirin linked to higher risk of serious bleeding in the elderly – Reuters Health News (free)
In this cohort, the risk of major bleeding increased sharply in patients above 75 years.
#ASCO2017 (Unpublished results) – Risk-Based Approach to Chemotherapy Duration Recommended for Stage III Colon Cancer – ASCO Daily News(free) AND ASCO2017:The IDEA Collaboration: Global Study Sets New Risk-Based Standard to Personalize Chemotherapy for Colon Cancer After Surgery – ASCO Post (free)
Commentaries: Chemo Cut in Half Following Surgery Without Increased Recurrence Risk in Patients With Low-Risk Colon Cancer – Targeted Oncology (free) Less Is More: Patients With Colon Cancer Get a Chemo Break – Medscape (free registration required) Cutting Chemo Time in Low-Risk Colon Ca an Option – MedPage Today (free registration required)
Antibiotics Versus Surgical Therapy for Uncomplicated Appendicitis: Systematic Review and Meta-analysis of Controlled Trials – Annals of Surgery (link to abstract – $ for full-text)
Commentary: Antibiotics Versus Surgery: Equally Effective in Treating Appendicitis? – Medscape (free registration required)
This meta-analysis and the author’s conclusions do not favor antibiotics alone for the treatment of uncomplicated appendicitis, contradiction the results of other recent meta-analysis, as well as a recent guideline on the subject, suggesting antibiotics might be an option in selected cases.
See also a recent study showing high complication rates of laparoscopic gastric band surgeries in our May 23rd issue (see #7)
Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery: A Cluster Randomized Clinical Trial – JAMA Surgery (free) (RT @PreetiNMalani see Tweet)
Multicomponent nonpharmacologic interventions, including orienting communications, oral and nutritional assistance, and early mobilization reduced postoperative delirium by 56% and length of stay by 2 days.
Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery – JAMA Surgery (link to abstract – $ for full-text)
Commentaries: Following gastric band surgery, device-related reoperation common, costly – Science Daily (free) AND Safety, Effectiveness of Gastric Banding Called Into Question – Medscape (free registration required) AND 1 In 5 Gastric Band Surgeries Require Corrective Operations – American Council on Science and Health (free)
Invited commentary: Surgical Site Infection Prevention – What We Know and What We Do Not Know – JAMA Surgery (free)
Commentary: ‘Long-Awaited’ CDC Guidelines on SSI Prevention Released – Medscape (free registration required)
Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative – Annals of Surgery (link to abstract – free PDF available)
Sources: Global Health NOW Newsletter (free) AND South Carolina Hospitals Saw Surgery Deaths Drop After Implementing WHO Checklist – AJMC News (free) AND A simple checklist prevents deaths after surgery, a large new study suggests – The Washington Post (a few articles per month are free)
See also: WHO Surgical Safety Checklist – World Health Organization (free) AND A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population – New England Journal of Medicine (free)
A single dose of 8 mg intravenous dexamethasone at induction of anesthesia reduced postoperative nausea and vomiting with no increase in adverse events.
ASCO has just published 3 guidelines on the management of pancreatic cancer:
1 – Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (free) AND 2 – Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Summary (free) AND 3 – Locally Advanced Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Summary (free)
Due to a recent study showing a 2,5 month increase in median overall survival, the doublet regimen of gemcitabine and capecitabine seems to be preferred in the absence of concerns for toxicity or tolerance.