Gastroenterology

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

A survey of the current state of training in inflammatory disease (IBD) surgery in the United Kingdom (UK) (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

Argyriou O.; *El-Sayed C.; Drami I.; Celentano V.; Reza L.

Citation:

Colorectal Disease. Conference: 20th Scientific and Annual Conference of the European Society of Coloproctology, ESCP 2025. Paris France. 27(Supplement 1) (no pagination), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Aim: Inflammatory Bowel Disease (IBD) surgery demands advanced technical skills due to the complexity and variability of procedures. High-quality training is essential, not only for the management of acute IBD-related emergencies but also for the development of a specialist IBD practice. This survey, developed by the Dukes' Club for UK colorectal surgery trainees and the IBD Subcommittee of the Association of Coloproctology of Great Britain and Ireland (ACPGBI), aims to evaluate the current state of IBD surgical training in the UK and to identify key areas and potential interventions for improvement. Method(s): An electronic survey was designed by members of the Dukes' Club executive committee and the ACPGBI IBD subcommittee, followed by dissemination via various professional networks, between September 2024 and April 2025.The survey investigated a number of key domains, including exposure to IBD procedures (routine/complex), participation in multidisciplinary team (MDT) meetings and joint surgical-gastroenterological clinics, career and fellowship intentions, as well as access to training resources. Result(s): The survey was completed by 103 participants (70% in training, 30% early years consultants).Senior trainees (ST6-ST8) represented 58.4% of the trainee participants.58.4% of trainees reported lack of exposure to IBD MDTs, with only 5.6% undertaking an active role in the MDT.Trainees reported minimal exposure to ileoanal pouch surgery and complex procedures such as strictureplasties and Kono-S anastomosis. In contrast, higher levels of exposure were noted for subtotal colectomies, ileo-caecal resections for Crohn's Disease, and IBD-related perianal fistula procedures. Conclusion(s): The survey demonstrated a lack of focus in IBD surgical training. Apart from high-quality educational activities that are delivered by the Dukes' Club and ACPGBI, a structured approach to ensure better exposure, through the training curriculum, is called for.

DOI: 10.1111/codi.70174

Link to full-text [no password required]

Colorectal cancer mortality rates in an English county, Shropshire (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Wilson R.; *Shah J.; *Shittu S.; *Goh Y.L.; *Ball W.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii69), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Aim: To evaluate outcomes of patients dying within 12 months of colorectal cancer diagnosis in Shropshire County. Method(s): A single-centre retrospective review was conducted on patients who died within 12 months of diagnosis between 2020 and 2024. Patient demographics, performance status, time from referral to imaging, diagnosis, MDT, death, and treatment intent were collected. Result(s): A total of 103 patients (44 male, 59 female), with a mean age of 74 (range 32-96) years. Most had a performance status of 1 and lived in their own home (92%). Geographically, 60% lived in Shrewsbury, 34% in Telford, and 9% in Wolverhampton. Referral sources were mainly from GPs (55%), with 74% seen within two weeks. Other referral sources include emergency admission to SAU (20%) and AMU (16%). All patients underwent CT imaging, and 57% had endoscopic procedures. The average age at death was 75 (range 34-97), with the most common cause being distant metastatic sigmoid cancer. The average time from diagnosis to death was 4.4 months. Treatment intent was palliative for 90% of patients (44% best supportive care, 56% oncology), and 59% of those referred to oncology received palliative treatment. Eight patients with curative intent died due to emergency presentation with sepsis and multiorgan failure (2), prior to commencing treatment (1), complications of treatment (3), or declined treatment (2). Conclusion(s): This audit highlights that colorectal cancer patients in Shropshire are predominantly elderly, over 70 years, with significant co-morbidities and a performance status of at least 1.

DOI: 10.1093/bjs/znaf166.263

Standardisation of colorectal robotic-assisted surgery (RAS) training: A roundtable discussion (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Kawar L.; Shakir T.; *El-sayed C.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Harrogate United Kingdom. 27(Supplement 2) (no pagination), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Purpose: The current landscape of colorectal robotic-assisted surgery (RAS) training is marked by significant variability. In order to gather opinions, a webinar was hosted by The Dukes' Club, the UK network for colorectal surgical trainees. This seeked to understand from a panel of expert RAS surgeons with various stakeholder roles in RAS training, the optimal method of delivering standardised RAS training in the UK. Method(s): This consensus study is based on a one-hour webinar held on 4th March 2024. Panellists included robotic surgery preceptors and proctors from both CMR Surgical (UK) and Intuitive (USA) respectively; members of robotic subcommittees within speciality associations, and providers of European fellowships. A thematic analysis was conducted to systematically analyse the qualitative data. Result(s): The roundtable featured two consultant urologists and three consultant colorectal surgeons. Four main themes with relevant sub-themes emerged: (1) the current state of robotic training, (2) training components of RAS, (3) challenges in delivering training, and (4) strategies for improvement. The discussion highlighted the variability in training based on geographical location and surgical speciality. Trainer readiness was discussed, with emphasis placed on the temporary nature of this. The importance of adopting RAS skills early in training with stepwise progression, was highlighted. Essential components of a standardised curriculum were identified including e-learning, simulation, and mentorship. Conclusion(s): Standardising colorectal RAS training is vital for equitable and effective skill development. Future directions include enhancing access and resource allocation, implementing stepwise certification, and integrating artificial intelligence and machine learning.

DOI: 10.1111/codi.70177

Link to full-text [no password required]

Acute management of severe inflammatory bowel disease: a clinical audit for quality improvement (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Baumert A.; *Cheetham M.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Harrogate United Kingdom. 27(Supplement 2) (no pagination), 2025. Date of Publication: 01 Sep 2025.

Abstract:

National guidelines for the acute management of inflammatory bowel disease (IBD) have been developed to advise clinicians on first-line investigations and optimal treatment pathways. Clinical audits are vital at a trust level for identifying gaps in these pathways and creating opportunities to implement positive change. For this project, a retrospective review was carried out on patients who underwent an emergency subtotal colectomy following admission with acute severe ulcerative colitis. Surgical patients were identified via a histopathology database and elective surgeries excluded. Key points throughout each admission were audited against national standards outlined in IBD UK and the BMJ (Lamb et al, 2019). This project specifically collected data on initial investigations (stool cultures and sigmoidoscopy), medical management (steroids and biologics) and surgical intervention (first contact with surgeons and timeframe until surgery). This audit primarily identified inconsistencies in organising investigations: 37.5% of patients did not have stool cultures recorded, and sigmoidoscopy was often delayed, occurring on average 5 days post-admission. Following the results of this audit, implementations have been suggested to create a more standardised approach for initial investigations of acute flares of ulcerative colitis. Guidelines have been made more accessible, alongside informative resources explaining why these investigations are necessary. Finally, while all patients ultimately underwent surgery within an acceptable timeframe, further education has been proposed to develop a clear pathway for appropriate surgical review. We hope that easy visualisation of the IBD treatment pathway can remind clinicians when to re-assess and escalate treatment accordingly.

DOI: 10.1111/codi.70177

Link to full-text [no password required]

A Systematic Review of Long-Term Use of Proton Pump Inhibitors (PPIs) in Older Adults on Polypharmacy: Do PPIs Deplete Nutrients? (2025)

Posted on by

Type of publication:

Systematic Review

Author(s):

Shahid, Muhammad Salman; Ahmed, Nouman; Kamal, Zeeshan; Nathaniel, Laibah; Singla, Bhavna; Singla, Shivam; Kumawat, Sunita; Batool, Munaza; *Ekomwereren, Osatohanmwen; Anika, Nabila N; Sahil, Muhammad.

Citation:

Cureus. 17(8):e90888, 2025 Aug.

Abstract:

Proton pump inhibitors (PPIs) are widely prescribed in older adults, often beyond recommended durations, raising concerns about nutrient depletion. This systematic review examined the impact of long-term PPI use (>=6 months) on micronutrient status in older adults receiving polypharmacy. A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) identified five eligible studies, including 693 participants. Results showed a 12-18% reduction in serum vitamin B12 over 12 months of PPI use. Calcium and parathyroid hormone levels declined significantly in a 12-month cohort, while bone turnover markers increased despite stable bone mineral density. Findings for magnesium were inconsistent, with results ranging from no change after 12 months to pharmacokinetic alterations without systemic depletion. Overall, the evidence consistently supports an association between prolonged PPI therapy and reductions in vitamin B12 and calcium, with conflicting results for magnesium. These deficiencies may contribute to cognitive decline, bone fragility, and increased fall risk in older adults. Routine nutritional monitoring, targeted supplementation, and deprescribing where appropriate should be considered to mitigate these risks, while further large-scale trials are needed in frail geriatric populations.

DOI: 10.7759/cureus.90888

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

Is AI the Game-Changer for Polyp Detection in Colon Capsule Endoscopy? Insights from the CESCAIL Study (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

Lei I.I.; Parisi I.; Bhandare A.; Perez F.P.; Lee T.; Shehkar C.; McStay M.; Anderson S.; Watson A.; Conlin A.; Badreldin R.; Malik K.; Jacob J.; Dixon A.; *Butterworth J.; Parson N.; Koulaouzidis A.; Robertson A.; Treceno P.; Arasaradnam R.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A9-A10), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Colon Capsule Endoscopy (CCE) provides a noninvasive alternative to colonoscopy for evaluating the lower gastrointestinal (LGI) tract. However, its widespread use has been limited by prolonged reading times and variability in diagnostic accuracy, often affected by factors such as bowel preparation quality and completion rates. In recent years, artificial intelligence (AI) has demonstrated potential in overcoming these limitations, particularly in small bowel CE, by enabling clinicians to achieve high diagnostic accuracy with significantly reduced reading times. The CESCAIL multi-centre study aims to evaluate a Computer-Aided Detection (CADe) system (AiSPEEDTM) to enhance polyp detection efficiency in CCE. Objective The primary aim is to assess AI-assisted CCE readings' diagnostic accuracy and non-inferiority in detecting polypoid lesions compared to standard readings using a per-patient analysis. The secondary objective focuses on mean reading time to evaluate the efficiency of each approach. Methods Patients aged 18 years or older, referred under urgent cancer or post-polypectomy surveillance pathway to one of the 14 CESCAIL participating centres across the UK, were prospectively enrolled in the study. Participants underwent CCE examinations, which were analysed using the AiSPEEDTM system, a convolutional neural network designed for automated polyp detection. Clinicians conducted initial manual readings, followed by AI-assisted readings, which involved an AI-automated first read, a review and annotation by a pre-reader, and a clinician assessment of selected images to create a report. Results Between February 2022 and September 2024, 673 patients were included in the final analysis. The overall completion rate was 77.1%, with adequate bowel preparation achieved in 78.1% of the standard pathway and 74.9% of the AI-assisted pathway (McNemar p=0.1). In the standard pathway, 403 patients (59.9%) required further investigation, including 243 (36.1%) colonoscopies and 138 (20.5%) flexible sigmoidoscopies. In the per-patient analysis, the diagnostic yield for polyp detection leading to a follow-up colonoscopy was 71.9% (484/673) for AI-assisted reading and 63.6% (428/ 673) for standard reading, confirming non-inferiority (p<0.0001). The diagnostic accuracy was 0.96 (95% CI: 0.95-0.98) for AI-assisted reading and 0.91 (95% CI: 0.89- 0.93) for standard reading (McNemar p<0.0001). The mean clinician reading time per video was 8.7 (SD=11.3) minutes for AI-assisted reading, compared to 47.3 (SD=24) minutes for standard reading, with a 5-fold reduction. Conclusion AI-assisted reading using AiSPEEDTM demonstrated significantly higher detection yield with improved diagnostic accuracy coupled with reduced reading time for polyp detection in CCE compared to standard clinician readings. These findings emphasise AI's potential to enhance efficiency and scalability in CCE, supporting its broader adoption for LGI investigations in clinical practice.

DOI: 10.1136/gutjnl-2025-BSG.14

Link to full-text [NHS OpenAthens account required]

Decoding the Strength of AI-Assisted Reading in Colon Capsule Endoscopy: Factors Influencing Accuracy in Polyp Detection; CESCAIL Study's Interim Result (2025)

Posted on by

Type of publication:

Oral presentation

Author(s):

Lei I.I.; Parisi I.; Bhandare A.; Perez F.P.; Lee T.; Shekhar C.; McStay M.; Anderson S.; Watson A.; Conlin A.; Badreldin R.; Malik K.; Jacob J.; Dixon A.; *Butterworth J.; Parsons N.; Robertson A.; Koulaouzidis A.; Arasaradnam R.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A48-A49), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Artificial Intelligence (AI) assisted reading in Small Bowel Capsule Endoscopy (SBCE) has recently been shown to achieve comparable and potentially superior accuracy compared to standard clinician reading. In Colon Capsule Endoscopy (CCE), AI algorithms have also demonstrated some promising results.1 However, the extent of AI-assisted reading's advantage remains unclear, particularly regarding its performance across different polyp sizes, morphologies, locations, and non-polyp-related factors. Understanding this is essential for optimising AI performance and clinical integration. Objective(s) This CESCAIL sub-analysis evaluates the per-polyp diagnostic accuracy of AI-assisted versus standard clinician reads (pathways) and identifies key factors influencing AIassisted accuracy using AiSPEEDTM. Methods A total of 1,803 polyps from 673 patients were analysed at the per-polyp level to assess diagnostic accuracy in terms of sensitivity and PPV, as well as the factors influencing the improved accuracy of AI-assisted readings compared to standard clinician readings. Factors examined included polyp size, morphology, location, patient demographics (age and sex), bowel preparation quality, capsule excretion rates, comorbidities, medications, reading time, and video duration. Statistical methods included, McNemar's test, superiority and noninferiority analyses, Generalised Estimating Equations, and generalized linear models with interaction terms, were employed to identify key predictors of enhanced diagnostic accuracy in both AI-assisted and standard readings. Results AI-assisted reading demonstrated significantly higher sensitivity with clear superiority for smaller polyps (<10 mm) compared to larger ones (>=10 mm) (OR 2.27 vs 0.88, p<0.0001). While there was no observed difference in diagnostic accuracy between pathways for polyps >=10 mm, noninferiority was established. AI accuracy remained consistent between polyps measuring 6-9 mm and <=5 mm (p=0.64). The most notable improvement was observed with hyperplastic polyps (OR 5.4, p<0.0001), particularly in the rectal region (OR 5.7, p<0.0001). No significant differences were identified for pedunculated, subpedunculated, LST, or SSL polyps. Furthermore, AI-assisted readings were significantly more accurate for left-sided polyps compared to right-sided ones (OR 2.36 vs 1.66, p<0.0001), although AI-assisted reads outperformed standard reads in both locations. Conclusion This study highlights the strengths of AI-assisted reading, particularly for detecting smaller adenomas and hyperplastic polyps, with notable accuracy in the left colon. Next-generation AI should focus on distinguishing significant from diminutive polyps and enhancing polyp characterisation, especially for right-sided lesions.

DOI: 10.1136/gutjnl-2025-BSG.72

Link to full-text [NHS OpenAthens account required]