Gastroenterology

IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles (2026)

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Type of publication:

Journal article

Author(s):

*Rachaneni, Suneetha; Dietz, Hans Peter; Latthe, Pallavi; Sirany, Annie; Spivak, Anna; Dua, Anupreet.

Citation:

International Urogynecology Journal. 37(1):75-85, 2026 Jan.

Abstract:

INTRODUCTION AND HYPOTHESIS: Obstructed defecation syndrome (ODS) is a defecatory abnormality with a sensation of incomplete evacuation, the need to strain at stool, the need for digitation in the vagina, the anus, or the perineum. Anterior rectocele and rectal intussusception are the frequent pathologies behind ODS. The review focuses on the assessment and treatment of obstructed defecation in women with rectocele, recto-enterocele and rectal intussusception in the remit of a urogynecologist.

METHODS: A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed with colorectal surgeons from the American Society of Colon & Rectal Surgeons (ASCRS). An initial document was drafted based on a literature review. The review focused on the treatment options of women with presenting with obstructed defecation and posterior compartment prolapse either on clinical examination or on imaging. After evaluation by the entire IUGA R&D Committee revisions were made. The quality of the evidence was graded and used to form consensus recommendations.

RESULTS: Ultrasound and dynamic MRI are helpful imaging modalities in triaging patients. A defecating proctogram to evaluate the size of rectal intussusception and enterocele is the standard investigation. Conservative therapies are effective first-line management options. The transvaginal native tissue rectocele repair is a safe and effective first-line surgical treatment in women with obstructed defecation.

CONCLUSIONS: When evaluating patients with obstructive defecation, it is important to address anatomy as well as function. In the absence of a clinically significant rectocele or enterocele during vaginal examination, in women with obstructed defecation, referral to a gastroenterologist or colorectal surgeon for further evaluation and management is recommended.

DOI: 10.1007/s00192-025-06288-7

Outcomes of TEMS (Trans-anal Endoscopic Micro-Surgery) for early rectal cancer in a DGH - 10 years' experience (2024)

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Type of publication:

Conference abstract

Author(s):

Kumar S.; *Rehman S.; *McCloud J.; *Clarke R.G.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Wales United Kingdom. 26(Supplement 1) (pp 71-72), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Introduction: Trans-anal Endoscopic excision for Early Rectal Cancer (ERC) is low risk with excellent outcomes. Strict patient selection with discussion in an ERC MDT identifies appropriate patients for local excision. Trans-anal Endoscopic microsurgery (TEMS) with full-thickness excision is suitable for T1 rectal cancers as well as more advanced cancers in patients with significant comorbidity not fit for major surgery. We present results over a 10-year period. Method(s): We reviewed outcomes of patients undergoing TEMS for ERC, staged on MRI scans between March 2012 and Jan 2022 with follow up to Dec 2023. We included all patients withpotentially curable tumours and excluded patients deemed palliative at presentation. Result(s): 241 TEMS cases were performed with 73 for ERC with T1, T2 and T3 cancers being 70% (51/73), 24% (17/73) and 6% (5/73) respectively. Recurrence rates for T1 Cancer (Sm1, Haggit 1) was 0%. T1/2 with adverse histology was 18.7% to 41.7% and T3 was 80%. Resection margin R0 for T1 lesions was 86%-100% and for T2-T3 lesions was 20-60%. Correlation of T stage, resection margin and adverse histology to recurrence rates was significant. There were no major complications or deaths with 90 days. Conclusion(s): TEMS is a curative option for patients with ERC offering organ preservation and significantly less comorbidity than major resection. This is particularly important in the comorbid patient. Combination treatments with oncology can optimise outcomes in cancers with poor prognostic features and close surveillance will identify any local recurrence requiring salvage surgery.

DOI: 10.1111/codi.17066

Improvement to Stoma Care (2025)

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Type of publication:

Service improvement case study

Author(s):

*Paula Hilditch, *Rebekah Tudor

Citation:

SaTH Improvement Hub, December 2025

SMART Aim:

To improve the quality of stoma care given to patients on surgical wards as measured by pre and post teaching questionnaire and audit of stoma care practice by December 2025.

Link to PDF poster

Artificial Intelligence in Colonoscopy: A Systematic Review of Adenoma Versus Polyp Detection Rates (2025)

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Type of publication:

Systematic Review

Author(s):

Rabba, Waseem; *Asif, Fatima; Younis, Muhammad Y; Nasrullah, Haris; Fatima, Laraib; Arif, Muhammad A.

Citation:

Cureus. 17(12):e98528, 2025 Dec.

Abstract:

Colonoscopy is the gold standard in the prevention of colorectal cancer, but the miss rates of adenoma are high, which restricts its efficacy. To improve lesion recognition, artificial intelligence (AI), especially computer-aided detection (CADe) systems, has been introduced. The aim of this systematic review was to compare AI-assisted colonoscopy in terms of its ability to improve adenoma detection rate (ADR) and polyp detection rate (PDR). An extensive search was performed on PubMed, Embase, and Cochrane Library from 2015 to 2025. There were 17 randomized controlled trials (RCTs) comparing the use of AI-assisted colonoscopy with normal colonoscopy. The methodological quality measure of the included RCTs was Cochrane Risk of Bias 2.0 (RoB 2.0), which subdivided the studies based on low risk, some concerns, or high risk of bias based on whether they were biased in this or that domain. The robVis tool was used to produce the visual summaries. AI-aided colonoscopy effectively enhanced both adenoma detection rate (ADR) and polyp detection rate (PDR) in all of the included studies over conventional colonoscopy. In adenoma detection, accuracy was more than 85%, and in polyp detection, more than 90%. The advantage was also found especially in the detection of small and flat adenomas, which are very often missed in routine practice. The use of AI in colonoscopy is strongly associated with an increase in the detection rate of adenoma and polyps, minimizing the risk of underdiagnosis. The results highlight the clinical promise of AI in the form of a decision-support tool across gastroenterologists and suggest that AI can be applied to enhance the outcomes of preventive and screening colorectal cancer. Future research should be cost-efficient and practical, and combined with some clinical activities.

DOI: 10.7759/cureus.98528

Link to full-text [open access - no password required]

Safety and efficacy of IL-23 inhibitors in patients with moderate to severe ulcerative colitis: a systematic review and meta-analysis of randomized controlled trials. (2025)

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Type of publication:

Systematic Review

Author(s):

Amin, Hamza Muhammad; Hasan, Sundas; Abukhater, Reem; Lilley, Rachel; Atique, Arif; Shoaib, Maheen Sattar; Albustanji, Qutaiba; Sadique, Humza; *Khalid, Saad Muhammad; Hasan, Ali; Majeed, Salman; Shahzad, Muhammad Aamir; Shahzad, Maryam; Ahmed, Mushood; Ahmed, Raheel; Gardezi, Syed Anjum.

Citation:

International Journal of Colorectal Disease. 2025 Dec 30.

Abstract:

BACKGROUND AND OBJECTIVE: Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC.

METHODS: A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model.

RESULTS: Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade.

CONCLUSION: IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.

DOI: 10.1007/s00384-025-05014-5

Link to full-text [open access - no password required]

Factors associated with conversion from day-case to in-patient elective laparoscopic cholecystectomy surgery across England: an observational study using administrative data (2025)

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Type of publication:

Journal article

Author(s):

*Olagunju, Naomi; *Cheetham, Mark; Savage, Katrein; Briggs, Tim W R; Gray, William K.

Citation:

Surgical Endoscopy.  2025 Dec 18. [epub ahead of print]

Abstract:

PURPOSE: Elective laparoscopic cholecystectomy is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery stay in hospital for at least one night. The aim of this study was to identify factors associated with conversion from planned day-case to in-patient management for elective laparoscopic cholecystectomy.

METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged >= 17 years undergoing a planned elective day-case laparoscopic cholecystectomy between 1st April 2017 and 31st March 2024 were identified. The exposure of interest was discharge on the day of admission (day-case) or requiring overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level.

RESULTS: A total of 286,754 elective LCs planned as day-case were identified over the seven-year study period. Of these, 74,957 (26.1%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. In multilevel, multivariable modelling, conversion to in-patient stay was associated with great age (odds ratio (OR) 2.54 for 17-29 vs >= 70 years, p < 0.001), male sex (OR = 1.11, p < 0.001), deprivation (OR 1.14, first vs fifth quintile, p < 0.001), open surgery (46.93, p < 0.001), and low annual surgeon volume (OR 1.73, < 10 vs >= 80 LCs per year, p < 0.001). Comorbidities and post-procedural complications were also strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 14.5% to 39.0%, 18 (42.9%) ICBs had conversion rates above the 99.8% control limit.

CONCLUSIONS: Conversion from day-case to in-patient stay was associated with increasing age, male sex, deprivation, open surgery, low surgeon volume, comorbidity and post-procedural complication. Our findings will help surgical team identify patients suitable for day-case laparoscopic cholecystectomy.

DOI: 10.1007/s00464-025-12480-z

Hologenomic analysis of rectal mucus sampling for detection of adenomatous polyps and colorectal cancer (2025)

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Type of publication:

Journal article

Author(s):

Tock, Andrew J; Patel, Kamrun S; Morales-Walker, Emma; Zhang, Linglan; Orthodoxou, Chris; MacRitchie, Alasdair D; Njoroge, Stephen; Olaniru, Oladapo E; Mozolowski, Guy; Mendes, Ines; Baker, Dave J; Siew, Malvin; Humphrey, Hannah N; Walker-Davies, Eleanor T; McDermott, Frank; Spencer, Sue; Bird, Susan; Savva, Katerina-Vanessa; Cunningham, Christopher; Rottenburg, Hannah; Sisodia, Heena; Battersby, Nick J; *Jones, Gareth A R; *Lacy-Colson, Jon; Baggaley, Alice E; Peters, Christopher J; Dodd, Andrew; Kang, Kiran; Hamon, Chris; Crespillo-Casado, Ana; Law, Erica; Sands, Megan; Lywood, Hugo; Page, Andrew J; Daniels, Ian; Wise, Daniel.

Citation:

Nature communications . 16(1):10876, 2025 Dec 04.

Abstract:

Colorectal cancer (CRC) is the fourth most common cancer and the third leading cause of cancer-related mortality worldwide, with incidence rising among younger populations. The significant clinical and economic burden highlights the need for minimally invasive technologies capable of detecting pre-malignant and early-stage disease. Although liquid biopsy approaches have advanced, they have not achieved sufficient performance for clinical adoption when compared with colonoscopy, the current diagnostic gold standard. CRC is a mucosal pathology, yet current diagnostic methods have not leveraged mucosal biology. Here we demonstrate the clinical utility of rectal mucus specimens, collected using a minimally invasive device in an outpatient setting, without bowel preparation. Through a hologenomic approach integrating host and microbial genomics, we identify genetic and epigenetic aberrations and perturbations in microbial communities that drive the detection of adenomatous polyps and CRC in rectal mucus. Hologenomic integration enables superior stratification of CRC by disease site and stage compared with single-omics methods. In summary, we demonstrate the clinical utility of rectal mucus sampling combined with hologenomic analysis as a translatable prospective tool for diagnostic application.

DOI: 10.1038/s41467-025-66006-1

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Risk of major adverse cardiovascular events in Crohn's disease patients treated with biologic therapy: A meta-analysis and trial sequential analysis of randomised controlled trials (2025)

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Type of publication:

Conference abstract

Author(s):

Bharadwaj H.; Perros I.; Biggs D.; *Butterworth J.; Gohar F.; Sokhal B.S.; Mallen C.

Citation:

United European Gastroenterology Journal. Conference: The 33rd United European Gastroenterology Week, UEGW 2025. Berlin Germany. 13(Supplement_8) (pp 628), 2025. Date of Publication: 01 Oct 2025.

Abstract:

Introduction: Biologic therapies are the preferred treatment for induction and maintenance of remission in Crohn's Disease, although their cardiovascular safety remains uncertain. This systematic review and meta-analysis aimed to estimate the risk of major adverse cerebrovascular and cardiovascular events (MACCEs) in adult CD patients receiving biologic or small molecule therapies in randomised controlled trials (RCTs). Aims & Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, EMBASE, and Cochrane were searched to identify RCTs that assessed the risk of MACCEs in CD induction and maintenance trials. Data were pooled and analysed using random effects modelling with 95% confidence intervals (CIs). Result(s): 40 RCTs were included, describing 20 induction and 20 maintenance trials. A total of 17,718 patients were included, with 11,148 (62.9%) receiving biologic agents or small molecules. The risk of MACCEs was lower in induction (OR=0.56, 95%CI: 0.24,1.34, P=0.19) and maintenance trials (OR=0.75, 95%CI: 0.35,1.57, P=0.44) compared to placebo or active comparators. MACCE risk remained unaffected by drug agent, drug class, and trial duration. Overall, there was no difference in MACCE risk based on receipt of biological therapy (OR=0.65, 95%CI: 0.37,1.15, P=0.14). Conclusion(s): Biologic agents and small molecules did not increase MACCE risk in CD induction and maintenance trials. A slight cardioprotective effect was observed. Longer follow-up studies with real-world data are required to confirm these findings outside the RCT setting.

DOI: 10.1002/ueg2.70032

Link to full-text [no password required]

Impact of biological therapy on the risk of major adverse cerebrovascular and cardiovascular events in patients with ulcerative colitis: A systematic review, meta-analysis and trial sequential analysis of level 1 evidence (2025)

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Type of publication:

Systematic Review

Author(s):

Bharadwaj H.; Perros I.; Biggs D.; *Butterworth J.; Gohar F.; Mallen C.; Sokhal B.S.;

Citation:

United European Gastroenterology Journal. Conference: The 33rd United European Gastroenterology Week, UEGW 2025. Berlin Germany. 13(Supplement_8) (pp 466), 2025. Date of Publication: 01 Oct 2025.

Abstract:

Introduction: Biological therapies have improved remission rates in Ulcerative colitis (UC) and are superior to standard treatment. This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to estimate the risk of major adverse cerebrovascular and cardiovascular events (MACCE) in adult UC patients receiving biologics. Aims & Methods: MEDLINE, EMBASE and Cochrane were searched to identify RCTs that investigated the risk of MACCE in UC induction and maintenance trials. Data were pooled and analysed using random effects modelling with 95% confidence intervals (CIs). This study followed the Preferred Reporting items for Systematic Reviews and Meta-Analyses. Result(s): 31 studies were retrieved from inception to November 2024. 54 RCTs were included, describing 29 induction and 25 maintenance phases. A total of 26,114 patients were included, with 17,271 (66.1%) receiving biologic agents or small molecules. The risk of MACCEs was not higher in induction (OR=0.62, 95%CI:0.32,1.18, P=0.14) or maintenance trials (OR=0.57, 95%CI:0.28,1.18, P=0.13) compared to placebo or active comparators. No drug agent, drug class or trial duration incurred a higher risk of MACCEs. Overall, those treated with biologic agents and small molecules had a lower MACCE risk (OR=0.60, 95%CI:0.37,0.97, P<0.05). Heterogeneity for all outcomes and subgroups was low (I2=0.00%, P=1.00). Conclusion(s): Biologics were not associated with risk of MACCE. Longer follow- up studies with real-world data are required to confirm these findings outside the RCT setting.

DOI: 10.1002/ueg2.70032

Link to full-text [no password required]

IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles (2025)

Posted on by

Type of publication:

Journal article

Author(s):

*Rachaneni, Suneetha; Dietz, Hans Peter; Latthe, Pallavi; Sirany, Annie; Spivak, Anna; Dua, Anupreet.

Citation:

International Urogynecology Journal.  2025 Nov 11.

Abstract:

INTRODUCTION AND HYPOTHESIS: Obstructed defecation syndrome (ODS) is a defecatory abnormality with a sensation of incomplete evacuation, the need to strain at stool, the need for digitation in the vagina, the anus, or the perineum. Anterior rectocele and rectal intussusception are the frequent pathologies behind ODS. The review focuses on the assessment and treatment of obstructed defecation in women with rectocele, recto-enterocele and rectal intussusception in the remit of a urogynecologist.

METHODS: A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed with colorectal surgeons from the American Society of Colon & Rectal Surgeons (ASCRS). An initial document was drafted based on a literature review. The review focused on the treatment options of women with presenting with obstructed defecation and posterior compartment prolapse either on clinical examination or on imaging. After evaluation by the
entire IUGA R&D Committee revisions were made. The quality of the evidence was graded and used to form consensus recommendations.

RESULTS: Ultrasound and dynamic MRI are helpful imaging modalities in triaging patients. A defecating proctogram to evaluate the size of rectal intussusception and enterocele is the standard investigation. Conservative therapies are effective first-line management options. The transvaginal native tissue rectocele repair is a safe and effective first-line surgical treatment in women with obstructed defecation.

CONCLUSIONS: When evaluating patients with obstructive defecation, it is important to address anatomy as well as function. In the absence of a clinically significant rectocele or enterocele during vaginal examination, in women with obstructed defecation, referral to a gastroenterologist or colorectal surgeon for further evaluation and management is recommended.

DOI: 10.1007/s00192-025-06288-7