Gastroenterology

Survival outcomes in basaloid squamous cell carcinoma of the anorectal region: A Surveillance, Epidemiology, and End Results (SEER) database analysis (2025)

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Type of publication:

Conference abstract

Author(s):

*Arunachalam J.

Citation:

Annals of Oncology. Conference: The ESMO Gastrointestinal Cancers Congress. Barcelona Spain. 36(Supplement 1) (pp S87), 2025. Date of Publication: 01 Jul 2025.

Abstract:

Background: Basaloid squamous cell carcinoma (BSCC) of the anorectal region is a rare and aggressive variant of squamous cell carcinoma, arising primarily in the transitional zone of the anal canal and lower rectum. Historically referred to as cloacogenic carcinoma, BSCC is characterized by distinctive histological features. Chemoradiation remains the standard of care. Given its rarity, data on survival outcomes and demographic disparities are limited. We aimed to assess clinical characteristics and survival outcomes using a large U.S. population-based dataset. Method(s): We conducted a retrospective analysis using the SEER database (2000-2021) to identify patients with BSCC, defined by ICD codes 8083/3 and 8124/3, located in C21.0, C20.9, C21.1, C21.2, and C21.8. Variables extracted included age, sex, race, tumor stage, and treatments. Kaplan-Meier survival analyses were used to assess overall survival (OS) and cancer-specific survival (CSS). Group comparisons were evaluated using the log-rank test. Result(s): A total of 3,446 patients were identified. At diagnosis, 54% were under 65 years, 75% were female, and 80% were White. Metastatic disease was present in 11%. Median OS (mOS) was 120 months. The 1-, 3-, and 5-year CSS rates were 91.1%, 78.9%, and 73.3%, respectively; 10- and 20-year CSS rates were 67.4% and 61.5%. Male patients had poorer survival (mOS 66 months) compared to females (mOS 143 months; p < 0.0001; HR 1.595, 95% CI 1.420-1.791). Patients aged >=65 had a mOS of 72 months versus 219 months for those <65 (p < 0.0001; HR 2.124, 95% CI 1.926-2.342). Median OS by stage was 25 months (metastatic), 124 months (regional), and 175 months (localized) (p < 0.0001). Patients undergoing surgery had a mOS of 154 months, and those receiving radiation therapy had a mOS of 134 months. Lack of chemotherapy was associated with worse survival (mOS 50 months; HR 1.780, 95% CI 1.570-2.020; p < 0.0001). Race was not significantly associated with survival differences. Conclusion(s): Favorable outcomes were associated with younger age, female sex, early stage, and chemotherapy. Future studies should refine treatment strategies and explore targeted therapies in BSCC to guide precision medicine. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

DOI: 10.1016/j.annonc.2025.05.230

Prognostic impact of microsatellite instability and survival disparities in rectal cancer: A SEER-based retrospective analysis (2025)

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Type of publication:

Conference abstract

Author(s):

*Arunachalam J.; Nabeta G.; Naagendran M.S.; Hegde U.;

Citation:

Annals of Oncology. Conference: The ESMO Gastrointestinal Cancers Congress. Barcelona Spain. 36(Supplement 1) (pp S97), 2025. Date of Publication: 01 Jul 2025.

Abstract:

Background: Microsatellite instability (MSI), a molecular marker of defective DNA mismatch repair (MMR), is observed in ~7% of rectal cancers. MSI-high (MSI-H) tumors, arising from sporadic or germline MMR deficiency, are highly responsive to immune checkpoint inhibitors. We aimed to evaluate the prognostic significance of MSI in rectal cancer in the era of immunotherapy and to explore demographic disparities in survival using real-world data from the U.S. Method(s): We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) cancer database for patients diagnosed with rectal cancer between 2018 and 2021. We assessed cancer-specific survival (CSS) across MSI subtypes-MSI-H, MSI-low (MSI-L), and microsatellite stable (MSS)-and evaluated survival differences by age, gender, race, and stage. Analyses were performed using R. Kaplan-Meier curves visualized survival outcomes, and group comparisons were done using the log-rank test. <br/>Result(s): Among 17,487 patients, 3.6% were MSI-H (n=637), 1.9% MSI-L (n=332), and 94.5% MSS (n=16,518). Overall 1-year and 3-year CSS were 90% and 75%, respectively. In metastatic patients, median CSS (mCSS) was 25 months, increasing to 36 months in those with MSI-H tumors. By MSI status, 1- and 3-year CSS were 90.6% and 77.7% for MSI-H, 89.9% and 74.9% for MSS, and 84.8% and 68.6% for MSI-L (p=0.0087). Racial disparities were evident: 1- and 3-year CSS were 92% and 80% in White patients, 88% and 70% in Black patients, and 90% and 75% in Hispanic patients (p<0.0001). Age impacted survival significantly: 1- and 3-year CSS were 91% and 74% in patients <65 years vs. 86% and 61% in those >=65 (p<0.0001). Females had better long-term survival than males, with 3-year CSS under 80% for both, but significantly higher in females (p<0.0001). Conclusion(s): MSI-H status is associated with improved survival, reinforcing its role as a favorable prognostic biomarker in rectal cancer and highlighting the importance of routine MSI testing to guide treatment decisions. Worse outcomes among older adults, males, and Black patients reflect persistent disparities in rectal cancer care. These findings underscore the urgent need to identify and address the drivers of these differences to ensure equitable outcomes. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

DOI: 10.1016/j.annonc.2025.05.261

Factors predicting conversion from colon capsule endoscopy to conventional optical endoscopy-findings from the CESCAIL study (2025)

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Type of publication:

Journal article

Author(s):

Lei, Ian Io; Parisi, Ioanna; Bhandare, Anirudh; Perez, Francisco Porras; Lee, Thomas; Shehkar, Chander; McStay, Mary; Anderson, Simon; Watson, Angus; Conlin, Abby; Badreldin, Rawya; Malik, Kamran; Jacob, John; Dixon, Andrew; *Butterworth, Jeffrey; Parsons, Nicholas; Koulaouzidis, Anastasios; Arasaradnam, Ramesh P.

Citation:

BMC Gastroenterology. 25(1):363, 2025 May 13.

Abstract:

BACKGROUND: Colon capsule endoscopy (CCE) has become an alternative to traditional colonoscopy for low-risk patients. However, CCE's low completion rate and inability to take biopsies or remove polyps often result in a CCE-to-conventional colonoscopy conversion (CCC).

OBJECTIVE(S): The aim is to identify the factors that predict issues with bowel cleansing, capsule excretion rates, pathology detection, and the need for CCC.

METHODS: This prospective study analysed data from patients who underwent CCE as part of the CESCAIL study from Nov 2021 till June 2024. Predictive factors were examined for their association with CCC, including patient demographics, comorbidities, medications, and laboratory results from symptomatic and surveillance groups. Statistical methods such as LASSO, linear, and logistic regression were applied.

RESULTS: Six hundred and three participants were analysed. Elevated f-Hb levels (OR = 1.48, 95% CI:1.18-1.86, p = 0.0002) and smoking (OR = 1.44, 95% CI: 1.01-2.11, p = 0.047) were significantly associated with CCC. The area under the curve (AUC) of elevated f-Hb for predicting CCC was 0.62 after adjusting for confounders. Diabetes was linked to poor bowel preparation (OR = 0.40, 95%CI:0.18-0.87, p = 0.022). Alcohol (p = 0.004), smoking (p = 0.003), psychological conditions (p = 0.001), and haemoglobin levels (p = 0.046) were significantly associated with the number of polyps, whilst antidepressants (p = 0.003) and beta-blockers (p = 0.001) were linked to the size of polyps.

CONCLUSION: Non-smokers with lower f-Hb levels are less likely to need conventional colonoscopy (CCC). Patient selection criteria are key to minimising the colonoscopy conversion rate. Our findings would benefit from validation in different populations to develop a robust CCE Conversion Scoring System (CECS) and ultimately improve the cost-effectiveness.

DOI: 10.1186/s12876-025-03828-9

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Robotic Versus Laparoscopic Approaches to Distal Pancreatectomy: Quality Assessment of the Current Evidence (2025)

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Type of publication:

Journal article

Author(s):

*Khan, Attam Ullah; Khan, Adan; Danial, Arbab.

Citation:

JCPSP, Journal of the College of Physicians & Surgeons – Pakistan. 35(5):628-635, 2025 May.

Abstract:

Pancreatic surgery, associated with technical difficulties and high complication rates, remains a challenge for surgeons. The laparoscopic approach has been shown to have benefits over the open approach; however laparoscopic distal pancreatectomy (LDP) still has its challenges. Robotic distal pancreatectomy (RDP) offers a technical edge over the laparoscopic approach in terms of superior imaging and ergonomics. Whether the technical advantages translate into improved outcomes is to be established. The aim of this study was to produce an overview of systematic reviews, summarising the evidence to date comparing RDP and LDP in terms of intraoperative, postoperative, and oncological outcomes and assessing the quality of the included reviews. Three electronic databases, PubMed, Embase, and Scopus, were searched to identify systematic reviews with meta-analyses comparing RDP with LDP. The AMSTAR-2 format was used to assess the quality of the studies. Fourteen systematic reviews were identified for inclusion. RDP had a significantly higher rate of spleen preservation, significantly shorter hospital stay, and a significantly lower rate of conversion to open surgery, whilst having higher total costs compared to LDP. The overall quality of the reviews was variable. The evidence suggests that RDP has potential advantages over LDP in terms of higher spleen preservation rate, shorter hospital stays, and lower conversion rate to open surgery, whilst maintaining comparability with most other outcomes. Based on the variable quality evidence, RDP is a safe alternative to LDP.

DOI: 10.29271/jcpsp.2025.05.628

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Hospital length of stay, 30-day emergency readmissions and the role of the DrEaMing enhanced recovery pathways in colonic and rectal surgery in England (2025)

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Type of publication:

Journal article

Author(s):

Dawes, Mindy; Packman, Zoe; McDonald, Ruth A; *Cheetham, Mark J; Gallagher-Ball, Nannette M T; Warwick, Eleanor; Oyston, Maria; McCone, Emma; Snowden, Chris; Swart, Michael; Briggs, Tim W R; Gray, William K.

Citation:

British Journal of Anaesthesia. 2025 Apr 22.

Abstract:

BACKGROUND: Enhanced recovery pathways (ERPs) are designed to improve patient outcomes after elective surgery. Our primary aim was to examine whether shorter hospital stay, as a surrogate ERP outcome, was associated with higher 30-day emergency readmission rates for colonic and rectal surgery in England. A secondary aim was to assess how hospital trust compliance with a specific postoperative care bundle, drinking, eating, and mobilising (DrEaMing) within 24 h, relates to outcomes.

METHODS: This was a retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged >=17 yr undergoing elective colonic or rectal surgery for cancer between April 1, 2014, and March 31, 2024, were included.

RESULTS: Shorter hospital stays were significantly associated with a lower rate of 30-day emergency readmission among 124 580 colonic and 87 036 rectal surgery patients. Comparing the first (reference) and fourth quartile of length of stay, the odds of 30-day emergency readmission increased by 2.16 (95% confidence interval [CI] 2.04-2.30) and 2.41 (95% CI 2.26-2.57) for colonic and rectal surgery, respectively. Increased hospital trust DrEaMing compliance was associated with a reduction in the number of patients with extended length of stay (colonic surgery: X2=24.885, P<0.001; rectal surgery: X2=61.670, P<0.001) and was not associated with 30-day emergency readmission.

CONCLUSIONS: We found no evidence that shorter length of stay, or greater DrEaMing compliance, were associated with higher emergency admission rates. These findings should not be interpreted as causal.

DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk-multicentre retrospective study (2025)

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Type of publication:

Journal article

Author(s):

Issa, Mohamed Talaat; *Sultana, Emiko; Hamid, Mohammed; Mohamedahmed, Ali Yasen; Albendary, Mohamed; Zaman, Shafquat; Bhandari, Santosh; *Ball, William; Narayanasamy, Sangara; Thomas, Pradeep; Husain, Najam; Peravali, Rajeev; Sarma, Diwakar.

Citation:

International Journal of Colorectal Disease. 40(1):68, 2025 Mar 15.

Abstract:

INTRODUCTION: Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all malignancies. Emerging trends of association with risk factors such as diverticulitis highlight the need for updated screening and follow-up protocols. We aimed to examine risk factors associated with the development of CRC within 12 months following an episode of acute diverticulitis, and identify areas to streamline follow-up.

METHODS: We performed a retrospective multicentre study of adult patients admitted in 2022 with computed tomography (CT) confirmed acute diverticulitis across four large NHS Trusts in the UK. Patient
demographics, comorbidities, clinical presentation, vital signs, laboratory results, details of in-patient stay, and follow-up investigations were collected and analysed. Our primary outcome was the incidence of CRC within 12 months of index presentation with acute diverticulitis. Analysed secondary outcomes were potential patient risk factors associated with a diagnosis of CRC and follow-up protocols. All statistical analysis was performed using R (version 4.4) and P-values of < 0.05 were considered statistically significant.

RESULTS: A total of 542 patients with acute diverticulitis over the study period were included. The median age of our cohort was 62 (51-73) years, and 204 (37.6%) were male. Ten (1.8%) patients were diagnosed with CRC within the 12-month period. Hinchey grade Ib was significantly associated
with CRC (OR 4.51, P = 0.028). Colonoscopic follow-up requests were associated with age between 40 and 60 years, mild white cell count (WCC) elevation, and a hospital stay of 3-7 days. Male gender, age between 18 and 40 years, and elevated C-reactive protein (CRP) were all strongly associated with CRC but not statistically significant. Follow-up was inconsistent with 53.7% of the cohort having luminal investigations.

CONCLUSION: The incidence of CRC was in-keeping with published literature. Hinchey grade 1b was significantly associated with a subsequent CRC diagnosis. These findings emphasise the need for specialised radiological review of CT scans to detect underlying malignancy. Moreover, standardised follow-up protocols following an episode of acute diverticulitis are needed to avoid missing malignant
lesions.

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Embracing qualitative approaches in gastroenterology research: a call to action (2025)

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Type of publication:

Journal article

Author(s):

Little S.; Tawn J.; Khalil G.; Hardasani R.; Radford S.; Das D.; Peerally M.F.;

Citation:

Frontline Gastroenterology. (no pagination), 2025. Article Number: flgastro-2024-102952. Date of Publication: 2025 [epub ahead of print]

Abstract:

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A multi-centred retrospective cohort study comparing JAK inhibitor therapies in moderate to severe ulcerative colitis (2025)

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Type of publication:

Conference abstract

Author(s):

Kumar A.; Baxter J.; Rimmer P.; Noble B.; Makki M.; Chikhlia A.; Cheesbrough J.; Disney B.; *Muir J.; Karova M.; *Butterworth J.; Bower J.; Sagar N.; Al-Talib I.; Nahal J.; Hatta A.; Ali N.; Sagar V.; Varyani F.; Smith S.; Bourne S.; Hsu Y.K.; Eltahir A.; De silva S.; Harvey P.;

Citation:

Journal of Crohn's and Colitis. Conference: 20th Congress of ECCO. Berlin Germany. 19(Supplement 1) (pp i2143), 2025. Date of Publication: 01 Jan 2025.

Abstract:

Background: Tofacitinib, filgotinib and upadacitinib are JAK inhibitors (JAKi) that are licensed for treatment in moderate to severe ulcerative colitis (UC). Whilst these drugs have demonstrated efficacy against placebo, there is no head-to-head data. This study aims to compare the clinical efficacy between these drugs.

Method(s): This is a multi-centred, retrospective cohort study with data collected from January 2018 to June 2024. Patients with UC were recruited on their first JAKi, irrespective of previous advanced therapies. Clinical remission (faecal calprotectin (FCP) <250, Mayo 1, UCEIS 1, pMayo 2, SCCAI 2) and response (50% reduction in FCP from baseline, reduction in partial Mayo or UCEIS by 3 or more, or sustained <3) was measured at 3- and 6-months. If a patient stopped taking JAKi, they were considered to have failed both response and remission. Data was non-parametric and outcome measures were compared using Chi-squared tests.

Result(s): There was a total of 266 patients included in the final analysis. 70 (26%) were on upadacitinib, 47 (18%) on filgotinib and 149 (56%) on tofacitinib (Table 1). At least 87% (129/149) on tofacitinib had exposure to a previous biologic compared to 80% (56/70) for upadacitinib and 66% (31/47) for filgotinib. At 3-months, clinical response in upadacitinib, filgotinib and tofacitinib was demonstrated in 83%, 74% and 75% patients, respectively and clinical remission was seen in 69%, 64% and 52%, respectively. At 6-months, clinical response was demonstrated in 79%, 65% and 63%, respectively and remission was seen in 75%, 61% and 51%, respectively. Upadacitinib demonstrated significantly higher 3-months remission rate (p=0.019) and 6-months response (p=0.010) and remission rates (p= 0.001) compared to tofacitinib. In the bio-exposed cohorts, upadacitinib demonstrated greater 6-months remission rates (71%) compared to 64% on filgotinib (p=NS) and 52% tofacitinib (p= 0.022). In bio-naive cohorts (n=50), upadacitinib demonstrated greater 6-months remission rates (93%) compared to 56% on filgotinib (p=0.024) and 50% tofacitinib (p= 0.009). Combining the JAKi, 90% of patients were not on steroids at 3-months and 94% were not on steroids at 6-months. A total of 26 patients had a colectomy at the time of their JAKi, 17 on tofacitinib, 5 on filgotinib and 4 on upadacitinib.

Conclusion(s): This study demonstrates that upadacitinib is more likely to achieve 3- and 6-month remission compared to tofacitinib. In a small subgroup of bio-naive patients Upadacitinib was more likely to achieve 6-month remission compared to filgotinib and tofacitinib. JAKi were associated with minimal adverse events and importantly, the efficacy of JAKi does not appear diminished by prior biologic use.

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VEST: The UK vedolizumab real life experience study in Inflammatory Bowel Disease (2024)

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Type of publication:

Conference abstract

Author(s):

Bodger K.; Booker C.; Kok K.; Lobo A.; Ahmad T.; Bloom S.; *Butterworth J.; Irving P.; Cummings F.

Citation:

Journal of Crohn's and Colitis. Conference: 19th Congress of the European Crohn's and Colitis Organisation, ECCO 2024. Stockholm Sweden. 18(Supplement 1) (pp i1775-i1777), 2024. Date of Publication: January 2024.

Abstract:

Background: The characteristics and outcomes of patients treated with vedolizumab in routine healthcare settings have not been widely evaluated in the UK. Method(s): Prospective, multicentre observational study of 364 patients started on vedolizumab in UK practice from January 2017 until February 2019 using the UK IBD Registry clinical web-based tool. For the present analysis, the primary outcome was drug survival (persistence) at 1-year, defined as attendance for infusion >=48 weeks after the first dose. Secondary outcomes were: Clinical remission (CR, based on partial Mayo score [<=1] or Harvey Bradshaw index [<=4]), physician global assessment (PGA), IBD-Control Questionnaire (IBD-Control-8, IBD-Control-VAS and individual item scores), laboratory parameters and adverse events. Result(s): Age (mean): 44 yrs; Males: 48%; IBD duration (mean): 6 yrs; Prev. resection: 18%; Steroids at baseline: 39%; Outcomes are summarized in Table 1. 37% of CD patients were assessed as being in clinical remission at baseline. Overall, 210 (58%) continued treatment beyond 48 weeks. At 1 year, 67.1% and 52.3% of CD and UC patients were in clinical remission with a clear improvement in QoL as assessed by IBD-Control -8. There were significant improvements across each IBD-Control-8 domain, including fatigue, with few patients considering switching treatment at that point (Figure 1). Conclusion(s): Vedolizumab was effective in clinical practice with 58% of patients remaining on treatment at one-year. Baseline status differed significantly from those recruited into RCTs. Patient reported outcomes demonstrated significant and meaningful improvements across physical, psychological, social and treatment domains.

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Ambulatory management of acute uncomplicated diverticulitis (AmbUDiv study): a multicentre, propensity score matching study (2024)

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Type of publication:

Journal article

Author(s):

Mohamedahmed, Ali Yasen; Hamid, Mohammed; Issa, Mohamed; Albendary, Mohamed; *Sultana, Emiko; Zaman, Shafquat; Bhandari, Santosh; Sarma, Diwakar; *Ball, William; Thomas, Pradeep; Husain, Najam.

Citation:

International Journal of Colorectal Disease. 39(1):184, 2024 Nov 18.

Abstract:

INTRODUCTION: Recent studies have suggested that ambulatory management is feasible for acute uncomplicated diverticulitis (AUD); however, there is still no consensus regarding the most appropriate management settings. This study presents a multi-centre experience of managing patients presenting with AUD, specifically focusing on clinical outcomes and comparing ambulatory treatment with in-patient management.

METHODS: A retrospective multi-centre study was conducted across four hospitals in the UK and included all adult patients with computed tomography (CT) confirmed (Hinchey grade 1a) acute diverticulitis over a
12-month period (January – December 2022). Patient medical records were followed up for 1-year post-index episode, and outcomes were compared between those treated through the ambulatory pathway versus inpatient treatment using 1:1 propensity score matching (PSM). All statistical analysis was performed using the R Foundation for Statistical Computing, version 4.4.

RESULTS: A total of 348 patients with Hinchey 1a acute diverticulitis were included (260 in-patients; 88 ambulatory pathway), of which nearly a third (31.3%) had a recurrent disease. Inpatient management was dominant (74.7%), with a median of 3 days of hospital stay. PSM resulted in 172 patients equally divided between the two care settings. Ambulatory management was associated with a lower readmission rate (P = 0.02 before PSM, P = 0.08 after PSM), comparable surgical (P = 0.57 before PSM, 0% in both groups after PSM) and radiological interventions (P = 0.99 before and after PSM) within one year. In both matched and non-matched groups, a strong association between readmissions and inpatient management was noted in univariate analysis (P = 0.03 before PSM, P = 0.04 after PSM) and multivariate analysis (P = 0.02 before PSM, P = 0.03 after PSM).

CONCLUSION: Our study supports the safety and efficacy of managing patients with AUD through a well-designed ambulatory care pathway. In particular, hospital re-admission rates are lower and other outcomes are non-inferior to in-patient treatment. This has implications for substantial cost-savings and better utilisation of limited healthcare resources.

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