Open access

Gastrointestinal Surgery

Efficacy and safety of stress ulcer prophylaxis in critically ill patients: a network meta-analysis of randomized trials – Intensive Care Medicine (free)

“PPIs are the most effective agents in preventing CIB, but they may increase the risk of pneumonia”.


Maintenance therapy with proton pump inhibitors and risk of gastric cancer: a nationwide population-based cohort study in Sweden – BMJ Open (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)”.


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: Newly-identified third type of diabetes is being wrongly diagnosed as type 2 – The Conversation (free)

“Diabetes of the exocrine pancreas is frequently labeled type 2 diabetes but has worse glycemic control and a markedly greater requirement for insulin”.


Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis – Antibiotics (free)

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).


Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study – The BMJ (free)

“Concurrent bariatric operations occurred infrequently, but when they did, there was no observable increased risk for adverse perioperative outcomes compared with non-concurrent operations”.


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)

“Diabetes following pancreatic disease associated with poor glycemic control compared with T2 diabetes” (RT @kamleshkhunti see Tweet)


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%).


Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial – Gastrointestinal Endoscopy (link to abstract – $ for full-text)

Source: No Benefit of Second-Look Endoscopy After Endoscopic Hemostasis – Journal Watch ($)

“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”


The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy: Estimates From a Retrospective Cohort Study of 6.5 Million Pregnancies – Annals of Surgery (free)

Source: Journal Watch ($)

“we found that the risk associated with nonobstetric surgery was relatively low, confirming that surgical procedures during pregnancy are generally safe”


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)

See other Enhanced Recovery After Surgery (ERAS) Guidelines and Reviews in our collection and in the ERAS Society Website.

“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”.


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”.


Viewpoint: The Evolving Story of Overlapping Surgery – JAMA (free) (RT @pash22 see Tweet)

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.


Post-Surgical Complications – emDocs (free)

Practical review of this common problem in the emergency department.


The relationship between eosinophilic esophagitis and esophageal cancer – Diseases of The Esophagus (free)

An analysis of a large database of de-identified electronic medical records (EMRs) with over 40.000.000 patients found no association.


Complications of Proton Pump Inhibitor Therapy – Gastroenterology (free)

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.


A Meta-analysis of the Impact of Aspirin, Clopidogrel, and Dual Antiplatelet Therapy on Bleeding Complications in Noncardiac Surgery – Annals of Surgery (link to abstract – $ for full-text)

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”


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


Surgeon Variation in Complications With Minimally Invasive and Open Colectomy: Results From the Michigan Surgical Quality Collaborative – JAMA Surgery (free) (RT @MaryDixonWoods see Tweet)

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.


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.


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)

Commentary: Anti-delirium strategy reduces after-surgery confusion in elderly – Reuters Health (free)

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.


Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial) – The BMJ (free)

A single dose of 8 mg intravenous dexamethasone at induction of anesthesia reduced postoperative nausea and vomiting with no increase in adverse events.


Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (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.


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