Aggressive Colorectal Cancer in the Young
This article reviews the most recent evidence from population-based studies and institutional series, as well as the newest screening guidelines, and provides an up-to-date summary of our current understanding of EOCRC, from clinical presentation to tumor biology and prognosis, and future directions in treatment and prevention. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - August 3, 2020 Category: Surgery Authors: Read, Blake Sylla, Patricia Tags: Review Article Source Type: research

Introduction: Why Do We Need to Know the Differences Between the East and West?
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1714234 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - August 3, 2020 Category: Surgery Authors: Konishi, Tsuyoshi Tags: Preface Source Type: research

Improving Rectal Cancer Outcomes with the National Accreditation Program for Rectal Cancer
Conclusions Based on the results of studies within the United States and on the successes demonstrated in Europe, it remains our hope and expectation that the management of rectal cancer in the United States will rapidly improve. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - July 25, 2020 Category: Surgery Authors: Wexner, Steven D. White, Christopher M. Tags: Review Article Source Type: research

Neoadjuvant Chemotherapy without Radiation in Colorectal Cancer
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1713746In colon cancer, primary surgery followed by postoperative chemotherapy represents the standard of care. In rectal cancer, the standard of care is preoperative radiotherapy or chemoradiation, which significantly reduces local recurrence but has no impact on subsequent metastatic disease or overall survival. The administration of neoadjuvant chemotherapy (NACT) before surgery can increase the chance of a curative resection and improves long-term outcomes in patients with liver metastases. Hence, NACT is being explored in both primary rectal and colon cancers as an alternativ...
Source: Clinics in Colon and Rectal Surgery - July 25, 2020 Category: Surgery Authors: Bhudia, Jyotsna Glynne-Jones, Rob Smith, Thomas Hall, Marcia Tags: Review Article Source Type: research

Perforated Colorectal Cancer
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1713741The majority of patients with colorectal tumors will present via the elective route. However, one-fifth of patients will present as an emergency. The most common cause of emergency presentation of colorectal cancer is obstruction followed by perforation, and in many cases, patients will present with both. We discuss the management of the patient presenting with a perforated colorectal tumor covering the acute presentation and also how to deal with consequences of a perforated tumor, namely, the management of colorectal peritoneal metastasis (CPM). CPM used to be considered ...
Source: Clinics in Colon and Rectal Surgery - July 20, 2020 Category: Surgery Authors: Tzivanakis, Alexios Moran, Brendan J. Tags: Review Article Source Type: research

Women in Leadership
Clin Colon Rectal Surg 2020; 33: 238-242 DOI: 10.1055/s-0040-1712977The role of a surgeon is inherently that of a leader and as women become a larger minority in surgical specialties, the next step becomes greater representation of women in positions of surgical leadership. Leadership is a relationship of granting and claiming wherein society must accept that women are deserving of leadership and women must realize their rightfulness to lead. Implicit gender bias undermines this relationship by perpetuating traditional gender norms of women as followers and not as leaders. Though female representation in academia and leade...
Source: Clinics in Colon and Rectal Surgery - July 1, 2020 Category: Surgery Authors: Wells, Katerina Fleshman, James W. Tags: Review Article Source Type: research

Leadership in Surgical Residency
Clin Colon Rectal Surg 2020; 33: 221-224 DOI: 10.1055/s-0040-1709438Surgical training can be compared with a functioning military unit with chain of command, responsibility/accountability relationship, and graduated leadership assignments. Proficiency, commitment, communication, consistency, ownership, relationships, confidence, humility, feedback and evaluation, exemplary behavior, empathy, and humanity are all aspects of leadership. Leadership skills developed in the protected environment of residency are the basis for a successful career. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Articl...
Source: Clinics in Colon and Rectal Surgery - July 1, 2020 Category: Surgery Authors: Kostka, Ryan Fleshman, James W. Tags: Review Article Source Type: research

Colorectal Cancer in Inflammatory Bowel Disease
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1713748Patients with inflammatory bowel disease (IBD) are at an increased risk for developing colorectal cancer (CRC). However, the incidence has declined over the past 30 years, which is probably attributed to raise awareness, successful CRC surveillance programs and improved control of mucosal inflammation through chemoprevention. The risk factors for IBD-related CRC include more severe disease (as reflected by the extent of disease and the duration of poorly controlled disease), family history of CRC, pseudo polyps, primary sclerosing cholangitis, and male sex. The molecular pa...
Source: Clinics in Colon and Rectal Surgery - June 30, 2020 Category: Surgery Authors: Nebbia, Martina Yassin, Nuha A. Spinelli, Antonino Tags: Review Article Source Type: research

Staging of Locally Advanced Rectal Cancer Beyond TME
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1713743The management of rectal cancer is complex and continually evolving. With advancements in technology and the use of multidisciplinary teams to guide the treatment decision making, staging, oncologic, and functional outcomes are improving, and the management is moving toward personalized treatment strategies to optimize each individual patient's outcomes. Key in this evolution is imaging. Magnetic resonance imaging (MRI) has emerged as the dominant method of pelvic imaging in rectal cancer, and use of MRI for staging is best practice in multiple international guidelines. MRI...
Source: Clinics in Colon and Rectal Surgery - June 30, 2020 Category: Surgery Authors: Keller, Deborah S. Tags: Review Article Source Type: research

Stenting as a Bridge to Surgery or a Palliative Treatment
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1713745Endoscopic stenting of the colorectum has emerged as a viable alternative to surgical interventions in a selected group of patients. The main indication for stenting is bowel obstruction. As such stenting can be used to palliate patients with metastatic disease or bridge patients to surgical intervention. The main advantages of stenting in the emergency setting include lower morbidity and mortality, lower incidence of stoma formation, shorter hospitalization, and better quality of life. For patients with unresectable disease and short life expectancy, stenting can be consid...
Source: Clinics in Colon and Rectal Surgery - June 30, 2020 Category: Surgery Authors: Darr, Humaa Abbas, Maher A. Tags: Review Article Source Type: research

Surgical Leadership
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1712976There are few topics of more importance in health care today than surgical leadership. The surgical leader will need to organize and maintain a collective effort if the organization is going to be effective. Health care teams work in a volatile, uncertain, complex, and ambiguous ecosystem. Therefore, surgeons must develop skills beyond the operating room. The facilitative leader will lead from the middle, not the top. They will empower coworkers to participate in creating a vision by building consensus, developing teams, clarifying roles, and earning the loyalty and trust o...
Source: Clinics in Colon and Rectal Surgery - June 3, 2020 Category: Surgery Authors: Peters, Walter Picchioni, Anthony Fleshman, James Tags: Review Article Source Type: research

Types of Leadership and How to Use Them in Surgical Areas
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1709457Surgery is a very complex, changing, and, sometimes, threatening environment. Emotional intelligence is a key skill for surgical leaders. Authoritarian, hierarchical, transactional, transformational, adaptive, situational, and servant–shepherd leadership can all be used in surgical leadership. Patient care must be the priority for surgical leaders. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - June 3, 2020 Category: Surgery Authors: Onaca, Nicholas Fleshman, James Tags: Review Article Source Type: research

Informal Leadership in Health Care
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1709439Informal leaders in nursing, medical specialties, and administration positively impact the success of an institution. Developing all members of the team as leader then becomes important, especially in the area of nursing. The result is less need for management and control and more individual self-motivated participation in quality improvement. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - June 3, 2020 Category: Surgery Authors: Lawson, Douglas Fleshman, James Tags: Review Article Source Type: research

Leadership and Ethics: Virtue Ethics as a Model for Leadership Development
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1709437Leaders are held to the highest of standards in both performance and ethics. The same is true for leaders in medicine. Thus, medical leaders must give attention to ethical development as well as performance development. Virtue ethics provide a way for the leader to develop ethically. Virtue ethics is the oldest form of ethics. Although other ethical approaches focus on external considerations, virtue ethics focuses on the inward development of character. Following the examples of virtuous people and developing habits of virtue are critical with this approach. The cardinal v...
Source: Clinics in Colon and Rectal Surgery - June 3, 2020 Category: Surgery Authors: Gentry, Lonnie Fleshman, James Tags: Review Article Source Type: research

Why is the Surgical Leader also a Manager?
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1709436The surgeon acts as a manager in the operating room, ward, classroom, and in daily life to control time. Skills cross all boundaries of medicine with specific needs in each area. Without leadership skills the nonmedical aspect of practice becomes more difficult and can make the physician less successful. Learning to manage, therefore, becomes critical. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - June 3, 2020 Category: Surgery Authors: Funk, Geoffrey Fleshman, James Tags: Review Article Source Type: research

How to Develop a Leadership Training Program
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1712975Leadership training is an essential component of faculty development and resident training. Characteristics of leaders include growth mindset, curiosity, humility, selflessness, intrinsic motivation, hunger to achieve, insight, collaboration, harmony, introversion and analytical approach (inherited) and emotional intelligence, empathy, flexibility, adaptability, conflict management, resilience, interpersonal skills, and judgment (learned). Training for each of these characteristics will enhance the leadership abilities of the surgical department. [...] Thieme Medical Publis...
Source: Clinics in Colon and Rectal Surgery - June 3, 2020 Category: Surgery Authors: Fleshman, James Tags: Review Article Source Type: research

Linking Emotional Intelligence to Successful Health Care Leadership: The Big Five Model of Personality
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1709435Research has identified emotional intelligence as the ability to understand and manage emotions. This is especially important for surgical leaders who must interact constructively with teams, administrators, patients, colleagues, and the community. Conventional intelligence emphasizes the rational and analytical brain. When one becomes aware of emotional intelligence, it adds to the repertoire of the surgical leader. It gives them insight into the dynamics of interpersonal relationships. This will allow the surgeon to control the emotional side of communication. Specificall...
Source: Clinics in Colon and Rectal Surgery - June 3, 2020 Category: Surgery Authors: Cavaness, Keith Picchioni, Anthony Fleshman, James Tags: Review Article Source Type: research

Leadership in the Setting of the Operating Room Surgical Team
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1709442Leadership in the operating room requires the ability to adopt different styles under specific circumstances. Transformational leadership grows the team. The style used to guide the team can vary; coercive, visionary, affiliative, democratic, pacesetting, and coaching are all important styles in team leadership. The ability to adapt to different needs in the operating room by using the appropriate style is leadership. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract&nb...
Source: Clinics in Colon and Rectal Surgery - June 3, 2020 Category: Surgery Authors: Arnold, David Fleshman, James Tags: Review Article Source Type: research

Clinics Leadership Issue
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1709441 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - June 3, 2020 Category: Surgery Authors: Fleshman, James Tags: Preface Source Type: research

James W. Fleshman, MD
Clin Colon Rectal Surg DOI: 10.1055/s-0040-1709440 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - June 3, 2020 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to the Guest Editor Source Type: research

Future Directions
Clinics in Colon and Rectal Surgery 2020; 33: 180-186 DOI: 10.1055/s-0039-3402781Transanal total mesorectal excision (taTME) is a novel technique that has evolved over the years to address the challenges of low rectal cancer surgery by applying the principles and benefits of laparoscopic surgery to more historic transanal techniques. It has been popularized through its use in rectal cancer, but the transanal approach is slowly being expanded to tackle different clinical scenarios including benign conditions such as inflammatory bowel disease and endometriosis. For all of these new indications, it is the desire to access an...
Source: Clinics in Colon and Rectal Surgery - April 28, 2020 Category: Surgery Authors: Soares, Ant ónio S. Chand, Manish Tags: Review Article Source Type: research

Tips and Tricks
Clinics in Colon and Rectal Surgery 2020; 33: 173-179 DOI: 10.1055/s-0039-3402780The role of transanal total mesorectal excision (taTME) in minimally invasive proctectomy, especially rectal cancer surgery, is increasing. There has been exponential growth in uptake from the initial in vivo case in 2010 to the present day. Early adopters of taTME are well within the mature portions of their learning curve, but there are a significant number of novice taTME surgeons. We have overviewed the critical aspects of patient selection, operating room set-up, and necessary equipment. In particular, we recommend that a one-team approac...
Source: Clinics in Colon and Rectal Surgery - April 28, 2020 Category: Surgery Authors: Albert, Matthew Lee, Lawrence Tags: Review Article Source Type: research

Learning Transanal Total Mesorectal Excision
This article documents the training pathway followed by pioneers in the taTME technique as well as consensus reports outlining the process of learning the taTME technique. A literature search was performed for taTME training, learning, and technique. Key elements in learning the taTME technique include appropriate indications, cadaver training, and outcomes reporting such as participating in a taTME registry. Consensus reports also agree on the following facets associated with improved outcomes: (1) appropriate case selection of mid and low rectal cancers, (2) prerequisite completion of an accredited training program in la...
Source: Clinics in Colon and Rectal Surgery - April 28, 2020 Category: Surgery Authors: McLemore, Elisabeth C. Lavi, Peyman Attaluri, Vikram Tags: Review Article Source Type: research

Anatomical Considerations and Procedure-Specific Aspects Important in Preventing Operative Morbidity during Transanal Total Mesorectal Excision
Clinics in Colon and Rectal Surgery 2020; 33: 157-167 DOI: 10.1055/s-0040-1701604As transanal total mesorectal excision (taTME) becomes increasingly utilized, its technical challenges and potential pitfalls have become more clearly appreciated. This chapter explores the differences in how anatomy presents itself from the taTME vantage point as compared with traditional approaches to taTME, and how special problems unique to taTME pose a new set of operative challenges. Morbidity related, specifically, to the technique of taTME is also delineated with particular focus on male urethral injury. [...] Thieme Medical Publishers...
Source: Clinics in Colon and Rectal Surgery - April 28, 2020 Category: Surgery Authors: Atallah, Sam Tags: Review Article Source Type: research

Summary of Oncologic and Functional Outcomes
Clinics in Colon and Rectal Surgery 2020; 33: 150-156 DOI: 10.1055/s-0039-3402778Large cohort and collaborative studies to date have shown that the short-term oncological outcomes appear to be at least as good as traditional laparoscopic surgery. These results need confirmation in randomized controlled trials, which are currently underway (GRECCAR 11 and COLOR III). The functional data on transanal total mesorectal excision is still very scarce and more mature data on quality of life and function outcomes are eagerly awaited. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJou...
Source: Clinics in Colon and Rectal Surgery - April 28, 2020 Category: Surgery Authors: Hompes, Roel Penna, Marta Tags: Review Article Source Type: research

Transanal Total Mesorectal Excision: Description of the Technique
Clinics in Colon and Rectal Surgery 2020; 33: 144-149 DOI: 10.1055/s-0039-3402777Surgery remains the gold standard for the treatment of locally advanced rectal cancer. The most effective approach to reduce locoregional recurrence is total mesorectal excision (TME). However, obtaining an optimal TME is demanding, especially in low rectal tumors and anatomically unfavorable pelvis. Transanal TME (taTME) was developed to facilitate low pelvis dissection and potentially provide optimal outcomes for oncologic resection.Current studies have reported satisfactory short-term outcomes. However, taTME is a technically challenging pr...
Source: Clinics in Colon and Rectal Surgery - April 28, 2020 Category: Surgery Authors: Tr épanier, Jean-Sébastien Lacy, F. Borja de Lacy, Antonio M. Tags: Review Article Source Type: research

Total Mesorectal Excision Technique —Past, Present, and Future
Clinics in Colon and Rectal Surgery 2020; 33: 134-143 DOI: 10.1055/s-0039-3402776While the treatment of rectal cancer is multimodal, above all, a proper oncological resection is critical. The surgical management of rectal cancer has substantially evolved over the past 100 years, and continues to progress as we seek the best treatment. Rectal cancer was historically an unsurvivable disease, with poor understanding of the embryological planes, lymphatic drainage, and lack of standardized technique. Major improvements in recurrence, survival, and quality of life have resulted from advances in preoperative staging, pathologic ...
Source: Clinics in Colon and Rectal Surgery - April 28, 2020 Category: Surgery Authors: Knol, Joep Keller, Deborah S. Tags: Review Article Source Type: research

Evolution of Transanal Total Mesorectal Excision
Clinics in Colon and Rectal Surgery 2020; 33: 113-127 DOI: 10.1055/s-0039-3402773Minimally invasive techniques continue to transform the field of colorectal surgery. Because traditional surgical approaches for rectal cancer are associated with significant mortality and morbidity, developing less invasive approaches to this disease is paramount. Natural orifice transluminal endoscopic surgery (NOTES), commonly known as “no incision surgery,” represents the ultimate minimally invasive approach to disease. Although transgastric and transvaginal approaches for NOTES surgery were the initially explored, a transrecta...
Source: Clinics in Colon and Rectal Surgery - April 28, 2020 Category: Surgery Authors: Carmichael, Heather Sylla, Patricia Tags: Review Article Source Type: research

Transanal Total Mesorectal Excision
Clinics in Colon and Rectal Surgery 2020; 33: 111-112 DOI: 10.1055/s-0039-3402775 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - April 28, 2020 Category: Surgery Authors: Sands, Dana Wexner, Steven D. Tags: Preface Source Type: research

Dana Sands, MD, FACS, FASCRS, Steven D. Wexner, MD, PhD (Hon), FACS, FRCS (Eng), FRCS (Ed), FRCSI (Hon), Hon FRCS (Glasg)
Clinics in Colon and Rectal Surgery 2020; 33: 109-110 DOI: 10.1055/s-0039-3402774 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - April 28, 2020 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to the Guest Editors Source Type: research

Hospital Infection Control: Clostridioides difficile
Clinics in Colon and Rectal Surgery 2020; 33: 098-108 DOI: 10.1055/s-0040-1701234 Clostridioides difficile remains a leading cause of healthcare-associated infection. Efforts at C. difficile prevention have been hampered by an increasingly complex understanding of transmission patterns and a high degree of heterogeneity among existing studies. Effective prevention of C. difficile infection requires multimodal interventions, including contact precautions, hand hygiene with soap and water, effective environmental cleaning, use of sporicidal cleaning agents, and antimicrobial stewardship. Roles for probiotics, avoidance of...
Source: Clinics in Colon and Rectal Surgery - February 25, 2020 Category: Surgery Authors: Turner, Nicholas A. Anderson, Deverick J. Tags: Review Article Source Type: research

Fecal Microbiota Transplantation: Redefining Surgical Management of Refractory Clostridium difficile Infection
Clinics in Colon and Rectal Surgery 2020; 33: 092-097 DOI: 10.1055/s-0040-1701233Fecal microbiota transplantation (FMT) is the process of transplanting stool from a healthy donor into the gut of a diseased individual for therapeutic purposes. It has a clearly defined role in the treatment of recurrent Clostridium difficile (reclassified as “Clostridioides difficile”) infection (CDI), with cure rates over 90% and decreased rates of subsequent recurrence compared with anti-CDI antibiotics. There is emerging evidence that FMT is also effective in the treatment of severe and fulminant CDI, with associated decreases...
Source: Clinics in Colon and Rectal Surgery - February 25, 2020 Category: Surgery Authors: Cheng, Yao-Wen Fischer, Monika Tags: Review Article Source Type: research

Role of Surgery in Clostridium difficile Infection
Clinics in Colon and Rectal Surgery 2020; 33: 087-091 DOI: 10.1055/s-0040-1701232 Clostridium (reclassified as “Clostridioides”) difficile infection (CDI) occurs as a chronic or an acute illness with intensity varying from mild to severe. Although most cases of CDI can be managed with antibiotics and supportive care, when the patient presents with fulminant disease, the early decision to perform surgery is imperative for survival. The current standard of care is the subtotal colectomy. However, loop ileostomy with vancomycin enemas delivered into the colonic mucosa has been described as a viable option on se...
Source: Clinics in Colon and Rectal Surgery - February 25, 2020 Category: Surgery Authors: Vely, Aela Ferrada, Paula Tags: Review Article Source Type: research

Physical, Laboratory, Radiographic, and Endoscopic Workup for Clostridium difficile Colitis
Clinics in Colon and Rectal Surgery 2020; 33: 082-086 DOI: 10.1055/s-0039-3400474 Clostridium (reclassified as “Clostridioides”) difficile colitis is a common nosocomial infection associated with increased morbidity and mortality. Like many clinical encounters, a focused history and physical examination will help to guide initial management. Further laboratory testing will assist with diagnosis through stool studies, and blood tests, such as white blood cell counts and serum creatinine, can help to stratify patients into illness severity groups for treatment decisions. Radiographic evaluation can be helpful ...
Source: Clinics in Colon and Rectal Surgery - February 25, 2020 Category: Surgery Authors: Baker, Samantha J. Chu, Daniel I. Tags: Review Article Source Type: research

Laboratory Tests for the Diagnosis of Clostridium difficile
Clinics in Colon and Rectal Surgery 2020; 33: 073-081 DOI: 10.1055/s-0039-3400476 Clostridium (reclassified as “Clostridioides”) difficile is an anaerobic, gram-positive bacterium that causes significant disease through elaboration of two potent toxins in patients whose normal gut microbiota has been altered through antimicrobial or chemotherapeutic agents (dysbiosis). The optimum method of laboratory diagnosis is still somewhat controversial. Recent practice guidelines published by professional societies recommend a two-step approach beginning with a test for glutamate dehydrogenase (GDH), followed by a tox...
Source: Clinics in Colon and Rectal Surgery - February 25, 2020 Category: Surgery Authors: Carroll, Karen C. Mizusawa, Masako Tags: Review Article Source Type: research

The Inflammasome and Type-2 Immunity in Clostridium difficile Infection
Clinics in Colon and Rectal Surgery 2020; 33: 067-072 DOI: 10.1055/s-0040-1701231 Clostridium difficile (reclassified as “Clostridioides”) is the leading cause of hospital-acquired infections in the United States, and is associated with high-patient mortality and high rates of recurrence. Inflammasome priming and activation by the bacterial toxins, TcdA, TcdB, and C. difficile transferase (CDT), initiates a potent immune response that is characterized by interleukin- (IL) 8, IL-1β, and neutrophil recruitment, and is required for pathogen killing. However, it is becoming clearer that a strong inflammator...
Source: Clinics in Colon and Rectal Surgery - February 25, 2020 Category: Surgery Authors: Donlan, Alexandra Petri, William A. Tags: Review Article Source Type: research

Clostridioides difficile Spores: Bile Acid Sensors and Trojan Horses of Transmission
Clinics in Colon and Rectal Surgery 2020; 33: 058-066 DOI: 10.1055/s-0040-1701230The Gram-positive, spore-forming bacterium, Clostridioides difficile is the leading cause of healthcare-associated infections in the United States, although it also causes a significant number of community-acquired infections. C. difficile infections, which range in severity from mild diarrhea to toxic megacolon, cost more to treat than matched infections, with an annual treatment cost of approximately $6 billion for almost half-a-million infections. These high–treatment costs are due to the high rates of C. difficile disease recurrence ...
Source: Clinics in Colon and Rectal Surgery - February 25, 2020 Category: Surgery Authors: Shen, Aimee Tags: Review Article Source Type: research

Clostridium difficile Infection: An Epidemiology Update
Clinics in Colon and Rectal Surgery 2020; 33: 049-057 DOI: 10.1055/s-0040-1701229 Clostridium (reclassified as “Clostridioides”) difficile infection (CDI) is a healthcare-associated infection and significant source of potentially preventable morbidity, recurrence, and death, particularly among hospitalized older adults. Additional risk factors include antibiotic use and severe underlying illness. The increasing prevalence of community-associated CDI is gaining recognition as a novel source of morbidity in previously healthy patients. Even after recovery from initial infection, patients remain at risk for rec...
Source: Clinics in Colon and Rectal Surgery - February 25, 2020 Category: Surgery Authors: De Roo, Ana C. Regenbogen, Scott E. Tags: Review Article Source Type: research

Clostridioides difficile Infection
Clinics in Colon and Rectal Surgery 2020; 33: 047-048 DOI: 10.1055/s-0040-1701228 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - February 25, 2020 Category: Surgery Authors: Stewart, David B. Tags: Preface Source Type: research

David B. Stewart, MD, FACS, FASCRS
Clinics in Colon and Rectal Surgery 2020; 33: 045-046 DOI: 10.1055/s-0040-1701227 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - February 25, 2020 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to the Guest Editor Source Type: research

Bleeding from Small Intestine: No Man's Land
Clinics in Colon and Rectal Surgery 2020; 33: 016-021 DOI: 10.1055/s-0039-1695032Bleedings from small intestine account for 5% of all gastrointestinal bleeding. With advanced endoscopic tools, such as video capsule endoscopy and deep enteroscopy, accurate diagnosis and treatment is possible in majority of cases with low mortality and morbidity. Nonoperative management includes endoscopic hemostasis and angiographic embolization. Recurrence after initial treatment is relatively common. Surgery is reserved for the cases that are refractory to endoscopic or angiographic treatment, bleeding from tumor or mass lesions, or hemod...
Source: Clinics in Colon and Rectal Surgery - January 7, 2020 Category: Surgery Authors: Sahakian, Ara Lee, Sang W. Shin, Joongho Tags: Review Article Source Type: research

Surgical Options and Approaches for Lower Gastrointestinal Bleeding: When do we operate and what do we do?
Clinics in Colon and Rectal Surgery 2020; 33: 010-015 DOI: 10.1055/s-0039-1693439Lower gastrointestinal bleeding (LGIB) is a common entity encountered by the surgeon. Though most LGIB stops on its own, familiarity with the diagnoses and their treatments is critical to optimal patient care. Even in 2016, surgery may be required. Advances in imaging have led to an enhanced ability to localize bleeding. Newer anticoagulants have developed which provide ease of use to the patient, but challenges to caregivers when bleeding arises. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJo...
Source: Clinics in Colon and Rectal Surgery - January 7, 2020 Category: Surgery Authors: Greco, Laura Zhang, Jeanette Ross, Howard Tags: Review Article Source Type: research

Diagnostic Modalities in Gastrointestinal Bleeding
This article reviews some older technologies like colonoscopy, nuclear scintigraphy, and conventional angiography and will also review the newest additions to the lower GI bleeding diagnostic toolbox, which are video capsule endoscopy and computed tomography (CT) angiography. The management algorithm used at a given institution depends on the available expertise and resources. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - January 7, 2020 Category: Surgery Authors: Feingold, Daniel L. Pappou, Emmanouil P. Lee-Kong, Steven A. Tags: Review Article Source Type: research

Upper Gastrointestinal Bleeding
We present the most common sources of upper gastrointestinal bleeding and treatments. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - November 20, 2019 Category: Surgery Authors: Patel, Vihas Nicastro, Jeffrey Tags: Review Article Source Type: research

Lower Gastrointestinal Bleeding
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-3400279 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - November 20, 2019 Category: Surgery Authors: Rivadeneira, David E. Tags: Preface Source Type: research

Current Nonoperative Therapeutic Interventions for Lower Gastrointestinal Hemorrhage
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1695033Lower gastrointestinal hemorrhage remains a common cause of hospitalization, with significant health care costs. Initial management should include aggressive resuscitation followed by localization of bleeding with nuclear scintigraphy, colonoscopy, or computed tomography (CT) angiography. If bleeding does not resolve spontaneously, expeditious intervention with minimally invasive endoscopic or angiographic methods is necessary with surgical intervention as a last resort. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thie...
Source: Clinics in Colon and Rectal Surgery - November 11, 2019 Category: Surgery Authors: Serur, Anna Rhee, Rebecca Ramjist, Joshua Tags: Review Article Source Type: research

Lower GI Bleeds: An Update on Incidences and Causes
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1695035Bleeding from the lower gastrointestinal tract represents a significant source of morbidity and mortality. The colon represents the vast majority of the location of bleeding with only a much smaller incidence occurring in the small intestine. The major causes of lower gastrointestinal bleeding (LGIB) are from diverticulosis, vascular malformations, and cancer. We discuss the incidence and causes of LGIB. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract&nbs...
Source: Clinics in Colon and Rectal Surgery - November 11, 2019 Category: Surgery Authors: Adegboyega, Titilayo Rivadeneira, David Tags: Review Article Source Type: research

David E. Rivadeneira, MD, MBA, FACS, FASCRS.
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1695034 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Clinics in Colon and Rectal Surgery)
Source: Clinics in Colon and Rectal Surgery - November 11, 2019 Category: Surgery Authors: Steele, Scott R. Tags: Introduction to the Guest Editor Source Type: research

Transanal Surgery: A History of taTME Ancestry
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1698395Transanal total mesorectal excision (taTME) is the culmination of major developments in rectal cancer management and minimally invasive surgery. This surgical breakthrough holds great promise and excitement for the care of the rectal cancer patient. We would be remiss in discussing taTME to not acknowledge the role of transanal abdominal transanal proctosigmoidectomy, transanal endoluminal microsurgery, laparoscopy, and natural orifice transluminal endoscopic surgery that got us to this modern day explosion of the taTME approach. In this article, we detail and ...
Source: Clinics in Colon and Rectal Surgery - November 7, 2019 Category: Surgery Authors: Izquierdo, Kevin M. Salem, Jean F. Cha, Esther Unal, Ece Marks, John H. Tags: Review Article Source Type: research

Special Considerations in the GI Bleeding Patient
Clinics in Colon and Rectal Surgery DOI: 10.1055/s-0039-1695036Lower gastrointestinal bleeding (LGIB) is an increasingly common problem in patients with comorbid medical conditions that place them at higher bleeding risk. This discussion of some special considerations in the GI bleeding patient encompasses an overview of the elderly patient, and selects comorbid conditions that place patients at higher risk of developing intestinal bleeding. The discussion lends itself to exploring the challenges of and new advancements in anticoagulation therapy. Radiation induced proctitis and rectal varices as sources of LGIB will also ...
Source: Clinics in Colon and Rectal Surgery - November 7, 2019 Category: Surgery Authors: Chung, Haniee Mutch, Matthew G. Tags: Review Article Source Type: research