Colonic Segments Research Articles

BA-Net: Brightness prior guided attention network for colonic polyp segmentation

Automatic polyp segmentation at colonoscopy plays an important role in the early diagnosis and surgery of colorectal cancer. However, the diversity of polyps in different images greatly increases the difficulty of accurately segmenting polyps. Manual segmentation of polyps in colonoscopic images is time-consuming and the rate of polyps missed remains high. In this paper, we propose a brightness prior guided attention network (BA-Net) for automatic polyp segmentation. Specifically, we first aggregate the high-level features of the last three layers of the encoder with an enhanced receptive field (ERF) module, which further fed to the decoder to obtain the initial prediction maps. Then, we introduce a brightness prior fusion (BF) module that fuses the brightness prior information into the multi-scale side-out high-level semantic features. The BF module aims to induce the network to localize salient regions, which may be potential polyps, to obtain better segmentation results. Finally, we propose a global reverse attention (GRA) module to combine the output of the BF module and the initial prediction map for obtaining long-range dependence and reverse refinement prediction results. With iterative refinement from higher-level semantics to lower-level semantics, our BA-Net can achieve more refined and accurate segmentation. Extensive experiments show that our BA-Net outperforms the state-of-the-art methods on six common polyp datasets.

Changes of Enterocyte Morphology and Enterocyte: Goblet Cell Ratios in Dogs with Protein-Losing and Non-Protein-Losing Chronic Enteropathies.

This study aimed to assess the morphometry of enterocytes as well as the goblet cell-to-enterocyte ratio in different intestinal segments of dogs with chronic enteropathies (CE). Histopathological intestinal samples from 97 dogs were included in the study (19 healthy juveniles, 21 healthy adults, 24 dogs with protein-losing enteropathy (PLE), and 33 CE dogs without PLE). Healthy adult small intestinal enterocytes showed progressively reduced epithelial cell height in the aboral direction, while juvenile dogs showed progressively increased epithelial cell height in the aboral direction. CE dogs had increased epithelial cell height in the duodenum, while PLE dogs had decreased epithelial cell heights compared to healthy adult dogs. Both the CE and PLE dogs showed decreased enterocyte width in the duodenal segment, and the ileal and colonic enterocytes of CE dogs were narrower than those of healthy adult dogs. CE dogs had a lower goblet cell-to-enterocyte ratio in the colon segment compared to healthy dogs. This study provides valuable morphometric information on enterocytes during canine chronic enteropathies, highlighting significant morphological enterocyte alterations, particularly in the small intestine, as well as a reduced goblet cell-to-enterocyte ratio in the colon of CE cases compared to healthy adult dogs.

Spontaneous Bilateral Lumbar Region Colocutaneous Fistulae. A Case Report

Bilateral spontaneous lumbar colocutaneous fistulae are rare. They are associated with high costs of care, morbidity, and mortality. We present the case of a 50- year-old male patient who presented with a 10-year history of two low-output spontaneous colocutaneous fistulae from both the left and right lower lumbar regions with no identifiable risk factors. He was managed operatively with segmental left colon resection and a temporary loop ileostomy with uneventful recovery after reversal of the ileostomy 2 months later. Whether the etiology of the fistulae is clinically apparent or not, the management should follow commonly known principles. This report highlights a case of bilateral lumbar region spontaneous colocutaneous fistulae of unknown cause that was managed operatively with satisfactory short-term outcomes.

Oligoelements in serum and intestinal tissue of pediatric IBD patients

IntroductionInflammatory bowel disease (IBD) develops through complex interplay of genetic, microbial, immune, and environmental factors. Trace elements alterations are commonly present in IBD and may have influence on IBD development. Heavy metal pollution is one of the major environmental issues nowadays and IBD incidence is rising in countries where industry starts to develop. Metals are implicated in processes that are connected to IBD pathogenesis. AimThe aim of this study was to investigate toxic and trace element levels in pediatric population of IBD patients both in serum and intestinal mucosa. Materials and methodsThis prospective study enrolled children newly diagnosed with IBD in University children’s hospital in Belgrade. Concentrations of thirteen elements: Al, As, Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Se and Zn in serum and intestinal mucosa of 17 newly diagnosed children with IBD (10 Crohn’s disease (CD) and 7ulcerative colitis (UC)) and 10 controls were assessed using inductively coupled plasma mass spectrometry (ICP-MS). Intestinal mucosa samples were taken from terminal ileum and six different colon segments (cecum, ascending colon, colon transversum, descending and sigmoid colon and rectum). ResultsThe results demonstrated significant alterations in serum and intestinal mucosa concentrations of investigated elements. Serum iron was significantly decreased in IBD and CD group, compared to controls while serum Cu significantly differed between three investigated groups with highest concentration observed in CD children. Serum manganese was the highest in the UC subgroup. Terminal ileums of IBD patients contained significantly lower amount of Cu, Mg, Mn and Zn with Mn being significantly decreased also in CD patients compared to control. IBD patients’ caecum contained significantly less Mg and Cu while colon transversum tissue samples from IBD and Crohn’s patients contained significantly more chromium than controls. Moreover, sigmoid colon of IBD patients were poorer in Mg than controls (p < 0.05). Colon Al, As and Cd were significantly reduced in IBD, and UC children compared to control. Correlations of investigated elements in CD and UC groups were different from controls. Biochemical and clinical parameters showed correlation with element concentrations in intestines. ConclusionSera of CD, UC and control children significantly differ in Fe, Cu and Mn levels. Serum manganese was the highest in the UC subgroup creating the most prominent and only significant difference between UC and CD subgroups. Terminal ileum of IBD patients contained significantly lower amount of majority of investigated essential trace elements and toxic elements were significantly reduced in colon of IBD and UC patients. Investigation of macro- and microelement alterations in children and adults has potential to further elucidate IBD pathogenesis.

Vasculature in the mouse colon and spatial relationships with the enteric nervous system, glia, and immune cells.

The distribution, morphology, and innervation of vasculature in different mouse colonic segments and layers, as well as spatial relationships of the vasculature with the enteric plexuses, glia, and macrophages are far from being complete. The vessels in the adult mouse colon were stained by the cardiovascular perfusion of wheat germ agglutinin (WGA)-Alexa Fluor 448 and by CD31 immunoreactivity. Nerve fibers, enteric glia, and macrophages were immunostained in the WGA-perfused colon. The blood vessels entered from the mesentery to the submucosa and branched into the capillary networks in the mucosa and muscularis externa. The capillary net formed anastomosed rings at the orifices of mucosa crypts, and the capillary rings surrounded the crypts individually in the proximal colon and more than two crypts in the distal colon. Microvessels in the muscularis externa with myenteric plexus were less dense than in the mucosa and formed loops. In the circular smooth muscle layer, microvessels were distributed in the proximal, but not the distal colon. Capillaries did not enter the enteric ganglia. There were no significant differences in microvascular volume per tissue volume between the proximal and distal colon either in the mucosa or muscularis externa containing the myenteric plexus. PGP9.5-, tyrosine hydroxylase-, and calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibers were distributed along the vessels in the submucosa. In the mucosa, PGP9.5-, CGRP-, and vasoactive intestinal peptide (VIP)-immunoreactive nerves terminated close to the capillary rings, while cells and processes labeled by S100B and glial fibrillary acidic protein were distributed mainly in the lamina propria and lower portion of the mucosa. Dense Iba1 immunoreactive macrophages were closely adjacent to the mucosal capillary rings. There were a few macrophages, but no glia in apposition to microvessels in the submucosa and muscularis externa. In conclusion, in the mouse colon, (1) the differences in vasculature between the proximal and distal colon were associated with the morphology, but not the microvascular amount per tissue volume in the mucosa and muscle layers; (2) the colonic mucosa contained significantly more microvessels than the muscularis externa; and (3) there were more CGRP and VIP nerve fibers found close to microvessels in the mucosa and submucosa than in the muscle layers.

Effect of walnut peptide‐ZnO nanocomposites on the colon adhesion behavior of Lactobacillus rhamnosus LRa05

AbstractWhen the nanoparticles (NPs) in food contact materials are exposed, they may be ingested with the food matrix, resulting in unknown impacts. Here, the biological response of the nanocomposites of nano zinc oxide (nZnO) and walnut protein‐derived peptides (i.e., PW5, WN5, AE6, and WE7) on the Lactobacillus rhamnosus LRa05 growth and adhesion was studied. In an in vitro mouse intestinal adhesion model, we first spotted that the probiotics LRa05 primarily adhered to and colonized the colonic segment. nZnO effectively inhibited the growth and adhesion properties of LRa05 at high concentrations (≥ 1000 μg/mL). Fortunately, when compared to the individual nZnO, the nZnO‐walnut‐derived peptides nanocomposites significantly increased the growth of LRa05. It was found that the alterations in the adhesion ability of LRa05 after treatment with various substances (nZnO and nanocomposites of nZnO‐walnut peptides) were related to the auto‐aggregating property on the LRa05 surface. These results shed light on the effect of food matrices on the safety of nanomaterials in food, and they may have far‐reaching implications for the use of nanomaterials in the food industry.

Biotransformation and metabolism of three methyl salicylate glycosides by gut microbiota in vitro

MSTG-A, MSTG-B and Gualtherin are three natural methyl salicylate glycosides isolated from Dianbaizhu (Gaultheria leucocarpa var. yunnanensis), which is a traditional Chinese folk medicine widely used for the treatment of rheumatoid arthritis. They share the same mother nucleus with aspirin, exhibit similar activity and have fewer side effects. In this study, the incubation of MSTG-A, MSTG-B and gaultherin monomers with human fecal microbiota (HFM), microbiota in 4 intestinal segments (jejunum, ileum, cecal, and colon) and feces of rats in vitro was carried out to comprehensively and meticulously understand their metabolism by gut microbiota (GM) in the body. MSTG-A, MSTG-B and Gualtherin were hydrolyzed by GM to lose glycosyl moieties. The quantity and position of xylosyl moiety significantly affected the rate and extent of the three components being metabolized. The -glc-xyl fragments of these three components could not be hydrolyzed and broken by GM. In addition, the existence of terminal xylosyl moiety prolonged the degradation time. Different results appeared in metabolism of the three monomers by microbiota of different intestinal segments and feces due to the alternation of the species and abundance of microorganisms along the longitudinal axis of the intestinal lumen. Cecal microbiota had strongest degradation ability on these three components. The metabolic details of GM on MSTG-A, MSTG-B and Gualtherin were clarified in this study, providing data support and basis for clinical development and bioavailability improvement.

Comparison of the magnetic resonance scoring systems for Crohn's disease activity: MaRIA, simplified MaRIA, and Nancy scores.

The most widely used score for assessing the activity of Crohn's disease (CD) is the Magnetic Resonance Index of Activity (MaRIA) score, but it is time-consuming. The aim of this study was to compare the diagnostic accuracy of MaRIA score to the other two easily calculated scores. Between January 2011 and May 2021, 67 patients with CD who underwent MRE and ileocolonoscopy within 2weeks were enrolled. The MRE-based scores including the MaRIA score, simplified MaRIA (sMaRIA) score, and Nancy score for each colonic segment and terminal ileum were calculated and correlated with the ileocolonoscopic findings. The simplified endoscopic score for Crohn's disease (SES-CD) was considered the gold standard. A total of 343 intestinal segments were included in the analysis, of which 109 (31.8%) showed active inflammation on ileocolonoscopy. The areas under the receiver operating characteristic curve (AUC) of the MaRIA, sMaRIA, and Nancy scores for detecting active disease were 0.752, 0.764, and 0.765, respectively. In the sub-analysis for different indications, the MaRIA and sMaRIA scores showed a higher AUC (0.721 and 0.741) than the Nancy score (0.652) for disease monitoring. The sMARIA and Nancy scores showed comparable diagnostic accuracy to the MaRIA score, and thus could be used as alternatives to the MaRIA score. Furthermore, considering the range of application, especially for disease monitoring, the sMaRIA score may be more suitable for use in clinical practice.

Neonatal colon exhibits enhanced post-ischemic repair relative to the neonatal jejunum

Intestinal ischemia is the most common cause of gastrointestinal-related morbidity and mortality within the neonatal intensive care unit. Ischemia-induced loss of the intestinal epithelial barrier predisposes patients to life-threatening sepsis unless that barrier is rapidly restored. Early barrier restoration relies on epithelial restitution to achieve wound closure, followed by rearrangement of tight junction proteins to re-establish barrier resistance. To inform putative therapeutics that promote rapid barrier repair in neonates, we have developed a highly-translational model of intestinal ischemia in the neonatal pig. Previous studies have demonstrated a significant defect in post-ischemic repair of the neonatal pig (2-weeks-old) jejunum relative to the juvenile (6-weeks-old) pig. Therefore, we hypothesized that the neonatal colon will demonstrate a similar defect in epithelial barrier repair. Segments of distal jejunum and spiral colon were subjected to surgically-induced ischemia followed by ex vivo recovery on Ussing chambers. Barrier repair was calculated by percent mucosal epithelialization, a measure of restitution, as well as transepithelial electrical resistance, a measure of barrier resistance. Unexpectedly, the ischemically-injured, ex vivo-recovered neonatal colon demonstrated significantly increased epithelial wound healing by restitution (p&lt;0.005) as well as barrier resistance (p&lt;0.05) relative to the neonatal jejunum. Furthermore, scanning electron microscopy revealed that colonocytes demonstrate a restitution phenotype defined by loss of their columnar morphology, marked flattening of their cellular profile and frequent formation of lamellipodia-like processes. Under identical experimental conditions, enterocytes do not demonstrate this phenotypic change. These findings suggest the presence of a colon-specific mechanism of intestinal epithelial barrier repair that is not present in the jejunum. Ongoing experiments aim to better elucidate the inter- and intracellular pathways that define this colon-specific mechanism of repair. Defining these pathways may inform the formulation of future pharmaceuticals that directly upregulate these pathways along the entire length of the intestine and therefore mitigate the effects of ischemic injury in neonates. NIH K01 OD 028207, NIH-NICHD R01 HD095876, U01 TR002953, T32OD011130 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Colorectal polyp segmentation method based on fusion of transformer and cross-level phase awareness

In order to address the issues of spatial induction bias and lack of effective representation of global contextual information in colon polyp image segmentation, which lead to the loss of edge details and mis-segmentation of lesion areas, a colon polyp segmentation method that combines Transformer and cross-level phase-awareness is proposed. The method started from the perspective of global feature transformation, and used a hierarchical Transformer encoder to extract semantic information and spatial details of lesion areas layer by layer. Secondly, a phase-aware fusion module (PAFM) was designed to capture cross-level interaction information and effectively aggregate multi-scale contextual information. Thirdly, a position oriented functional module (POF) was designed to effectively integrate global and local feature information, fill in semantic gaps, and suppress background noise. Fourthly, a residual axis reverse attention module (RA-IA) was used to improve the network's ability to recognize edge pixels. The proposed method was experimentally tested on public datasets CVC-ClinicDB, Kvasir, CVC-ColonDB, and EITS, with Dice similarity coefficients of 94.04%, 92.04%, 80.78%, and 76.80%, respectively, and mean intersection over union of 89.31%, 86.81%, 73.55%, and 69.10%, respectively. The simulation experimental results show that the proposed method can effectively segment colon polyp images, providing a new window for the diagnosis of colon polyps.

Simultaneous Volvulus of the Caecum and Sigmoid: Case Report

Volvulus of the colon is a frequent cause of colonic occlusion, it can sit along the colonic frame when it is abnormally mobile. Sigmoid volvulus is the most common, followed by cecum, transverse colon, and left colic angle. The mechanism of volvulus is torsion or rocking. The clinical picture is nonspecific, most often with an association of abdominal pain, cessation of matter and gas, and meteorism. The reference complementary examination is currently the abdominopelvic scanner, which makes it possible to make the diagnosis and to look for possible complications. Emergency surgical management is the rule in the event of clinical and radiological severity criteria. It is exceptional to encounter two volvulated colonic segments in the same patient. In our study, we describe the case of a patient who presents to the emergency room for acute abdominal pain with cessation of matter and gas, an abdominal pelvic CT scan done in emergency found a volvulus of the sigmoid. His emergency management after failed endoscopy revealed simultaneous volvulus of the sigmoid and cecum. The extremely rare nature of this epiphenomenon leads us to discuss the causes, the clinical modalities and the management of this pathology.

Magnetic resonance imaging in the diagnosis of necrosis of a pulled-through colon segment after abdomino-anal resection of the rectum for cancer

This study presents a case of necrosis of the pulled-through colon after abdomino-anal resection of the rectum, which was diagnosed by magnetic resonance imaging.&#x0D; A 47-year-old man underwent laparoscopically assisted abdomino-anal resection of the rectum with reconstruction of a coloplasty pouch and transverse colostomy in the course of combination treatment for locally advanced rectal cancer. The postoperative period was complicated by the development of an inflammatory response syndrome. On postoperative day 3, contrast-enhanced magnetic resonance imaging revealed swelling of the 15-cm segment of pulled-through colon up to the coloanal anastomosis with sharply attenuated contrast enhancement, whereas rectoscopy showed no changes. On postoperative day 6, a magnetic resonance imaging scan revealed a defect in the anterior wall of the coloplasty pouch with a parietal aerocele, and rectoscopy showed signs of necrosis of the bowel wall. On postoperative day 10, the magnetic resonance imaging scan presented no changes. Because of increasing signs of inflammation, relaparotomy with anastomosis disconnection and resection of the necrotized bowel segment were performed.&#x0D; Ischemia of the pulled-through colon after rectal surgery is a rare but serious complication. Our clinical case report demonstrates the potential of contrast-enhanced magnetic resonance imaging as a non-invasive method in case follow-up in patients with a complicated postoperative period for early diagnosis of ischemia and bowel wall defects, which helps to make the appropriate patient management plan.

Bacterial community mapping of the AIA mouse gastrointestinal tract under dietary intervention with skipjack tuna (Katsuwonus pelamis) elastin peptides

BackgroundOur previous study demonstrated that a dietary intervention with skipjack tuna (Katsuwonus pelamis) elastin peptides alleviated adjuvant-induced arthritis (AIA) and affected the gut microbiota of AIA mice. However, whether the faecal microbiota serves as a surrogate to reflect the dynamics of the gut microbiota has not been determined. MethodsUsing 16 S rRNA sequencing technology, the present study investigated the microbiota in three segments (stomach, colon and caecum) of mice to comprehensively define microbial dysregulation and regulation related to rheumatoid arthritis (RA). ResultsThe results showed that the composition and distribution of the microbiota in the stomach, colon and caecum were significantly different depending on their intrinsic environment and their functions, and the colon possessed the richest and most diverse microbiota structure. The gut microbiota of AIA mice showed ecological dysbiosis, and a dietary intervention with skipjack tuna elastin peptides improved this negative effect, particularly the changes in the gastric microbiota, which were most obvious at RA onset and remission. ImplicationThe results not only indicate the spatial heterogeneity of the gut microbiota in terms of composition and distribution, but also indicate the potential of the application of elastin peptides for the alleviation of RA.

Impact of cold snare versus cold forceps resection of diminutive adenomas on segmental incomplete resection rate.

Polypectomy technique, for diminutive lesion resection, is variable amongst colonoscopists using either cold snare (CSP) or cold forceps (CFP) polypectomy. While it is well described that CSP is a preferred technique to resect small lesions, there is little data evaluating the impact resection techniques have on metachronous adenoma burden. The study aim was to evaluate the rate of incomplete resection attributable to CSP and CFP of diminutive adenomas. This is a two-center retrospective cohort study evaluating the segmental incomplete resection rate (S-IRR) of diminutive tubular adenomas (TA). S-IRR was calculated by subtracting the segmental metachronous adenoma rate in a specific colonic segment without adenoma from segments with adenoma on index colonoscopy. The primary outcome was the S-IRR of diminutive TA resected by CSP or CFP on index colonoscopy. 1504 patients were included in the analysis: 1235 with TA <6 mm and 269 with TA 6-9 mm as the most advanced lesion. The S-IRR in a segment that had a <6 mm TA incompletely resected by CFP on index colonoscopy was 13%. The S-IRR in a segment which had a <6 mm TA incompletely resected by CSP was 0%. Among 12 included colonoscopists, the range of overall S-IRR was 1.1% - 24.4% with an average S-IRR of 10.3%. S-IRR was 13% higher with CFP resection of diminutive TA than with CSP. A proposed S-IRR metric of <5% is a target goal for all diminutive polyp resection, as 3/12 colonoscopists achieved this low rate. S-IRR can be utilized as a methodology to compare and quantify the difference in segmental metachronous adenoma burden across various polypectomy removal methods.

The Long Noncoding RNA Cardiac Mesoderm Enhancer-Associated Noncoding RNA (Carmn) Is a Critical Regulator of Gastrointestinal Smooth Muscle Contractile Function and Motility

Visceral smooth muscle cells (SMCs) are an integral component of the gastrointestinal (GI) tract that regulate GI motility. SMC contraction is regulated by posttranslational signaling and the state of differentiation. Impaired SMC contraction is associated with significant morbidity and mortality, but the mechanisms regulating SMC-specific contractile gene expression, including the role of long noncoding RNAs (lncRNAs), remain largely unexplored. Herein, we reveal a critical role of Carmn (cardiac mesoderm enhancer-associated noncoding RNA), an SMC-specific lncRNA, in regulating visceral SMC phenotype and contractility of the GI tract. Genotype-Tissue Expression and publicly available single-cell RNA sequencing (scRNA-seq) data sets from embryonic, adult human, and mouse GI tissues were interrogated to identify SMC-specific lncRNAs. The functional role of Carmn was investigated using novel green fluorescent protein (GFP) knock-in (KI) reporter/knock-out (KO) mice. Bulk RNA-seq and single nucleus RNA sequencing (snRNA-seq) of colonic muscularis were used to investigate underlying mechanisms. Unbiased in silico analyses and GFP expression patterns in Carmn GFP KI mice revealed that Carmn is highly expressed in GI SMCs in humans and mice. Premature lethality was observed in global Carmn KO and inducible SMC-specific KO mice due to GI pseudo-obstruction and severe distension of the GI tract, with dysmotility in cecum and colon segments. Histology, GI transit, and muscle myography analysis revealed severe dilation, significantly delayed GI transit, and impaired GI contractility in Carmn KO vs control mice. Bulk RNA-seq of GI muscularis revealed that loss of Carmn promotes SMC phenotypic switching, as evidenced by up-regulation of extracellular matrix genes and down-regulation of SMC contractile genes, including Mylk, a key regulator of SMC contraction. snRNA-seq further revealed SMC Carmn KO not only compromised myogenic motility by reducing contractile gene expression but also impaired neurogenic motility by disrupting cell-cell connectivity in the colonic muscularis. These findings may have translational significance, because silencing CARMN in human colonic SMCs significantly attenuated contractile gene expression, including MYLK, and decreased SMC contractility. Luciferase reporter assays showed that CARMN enhances the transactivation activity of the master regulator of SMC contractile phenotype, myocardin, thereby maintaining the GI SMC myogenic program. Our data suggest that Carmn is indispensable for maintaining GI SMC contractile function in mice and that loss of function of CARMN may contribute to human visceral myopathy. To our knowledge this is the first study showing an essential role of lncRNA in the regulation of visceral SMC phenotype.

V04-02 INTRACORPOREAL ROBOTIC SIGMOID &amp; VAGINOPLASTY

You have accessJournal of UrologyCME1 Apr 2023V04-02 INTRACORPOREAL ROBOTIC SIGMOID & VAGINOPLASTY Daniel Tennenbaum, Luciana Lerendegui, Rafael Gosalbez, and Miguel Castellan Daniel TennenbaumDaniel Tennenbaum More articles by this author , Luciana LerendeguiLuciana Lerendegui More articles by this author , Rafael GosalbezRafael Gosalbez More articles by this author , and Miguel CastellanMiguel Castellan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are different strategies in the construction of a neovagina, with no consensus on which is the best approach. We have previously published our experience with sigmoid Monti vaginoplasty via an open approach. In this video, we present a case of neovagina construction by way of sigmoid Monti vaginoplasty, via an intracorporeal robotic-assisted approach. METHODS: An 18-year-old transwoman with a long history of gender dysphoria, followed since puberty by a multidisciplinary team, sought definitive gender affirmation surgery. The procedure was performed by two teams working simultaneously, with the external component of the surgery happening whilst the bowel surgery was being performed. The intra-abdominal component of the surgery was performed using one umbilical camera port and 4 additional ports. The neovagina was created using a ∼12 cm segment of distal sigmoid colon and detubularized longitudinally before being retubularized to form a Monti cuff by closing the mesenteric edge, while leaving the mesentery in a cephalad position. Dissection into the pouch of Douglas was then performed to advance the neovagina into the perineum, before anastomosis to the surrounding tissues. RESULTS: Total operative time was approximately 8 hours, with the robotic component approximately 5 hours. The postoperative course was uneventful, with expected return of bowel function and adequate pain control, and with discharge on postoperative day 6. The patient reported great satisfaction at 3-month followup. CONCLUSIONS: Intracorporeal robotic Monti sigmoid vaginoplasty allows for the construction of a neovagina with a tension-free vascular pedicle, with improved morbidity and quicker time to recovery. This approach allows two surgical teams working simultaneously and preparing the perineum for anastomosis. Our video, the first of its kind to the knowledge of the authors, demonstrates that this approach can be performed in a safe and effective manner. Further pursuit of this approach may be warranted in the right clinical environment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e338 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Tennenbaum More articles by this author Luciana Lerendegui More articles by this author Rafael Gosalbez More articles by this author Miguel Castellan More articles by this author Expand All Advertisement PDF downloadLoading ...

A116 OPTIMIZING CROHN’S DISEASE ENDOSCOPIC SCORING OPERATING CHARACTERISTICS TO ASSIST WITH THE ADVENT OF ARTIFICIAL INTELLIGENCE

Abstract Background To date, no studies have used Artificial Intelligence (AI) to produce standard endoscopic scores for Crohn’s Disease (CD). These scores are essential to clinical practice and have a major cost in clinical trials. Purpose We aimed to re-examine the components of the Simple Endoscopic Score for Crohn’s Disease (SES-CD) and Modified Multiplier (MM-SES-CD) to see if scoring of individual colonic segments could be combined while maintaining predictive value accuracy, thus simplifying scoring for AI. Method Data from 279 participants in the UNITI and EXTEND trials as well as an infliximab biosimilar trial (NCT02096861) were used in this retrospective study. The primary outcome was endoscopic remission (ER-1) of the colon, defined as absence of ulcers. Secondary outcomes included alternative definitions of colonic endoscopic remission including SES-CD score of 0 (ER-2), SES-CD &amp;lt;3 (ER-3), and SES-CD reduction by 50% or greater from baseline (colonic endoscopic response). Result(s) The mean baseline SES-CD score was 13.7 (SD 7.7) and the mean MM-SES-CD score was 22.8 (SD 12.4). Among all possible colonic segment combinations, the combination of Right + Rectum + worst of Left or Transverse performed best for prediction of one-year ER-1, with fair accuracy (AUC 0.71, 95% CI 0.65-0.78, p &amp;lt; 0.0001). Accuracy of prediction of one-year ER-2 was poor (AUC 0.68, 95% CI 0.62-0.75, p &amp;lt; 0.0001), ER-3 was fair (AUC 0.71, 95% CI 0.65-0.77, p &amp;lt; 0.0001), and prediction of endoscopic response was poor (AUC 0.64, 95% CI 0.56-0.72, p &amp;gt; 0.01). These results were very similar to conventional scoring (without combining any “worst of” segments) with all of the colonic MM-SES-CD scores, with AUCs of 0.70, 0.69, 0.71, and 0.61 for the respective outcomes. Assessing only for the presence of ulcers was as accurate as the full assessment and exclusion of scoring stenosis had minimal impact on scores. Image Conclusion(s) By combining assessment of colonic segments accuracy was maintained compared with currently used endoscopic scoring. Assessing for features other than ulceration had no significant impact on overall scores. By combining colonic segments and limiting assessment to ulceration, it may be simpler to develop AI algorithms reliably scoring endoscopic severity of CD for clinical practice and trials. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

A47 THE GUT MICROBIOTA INFLUENCES COLONIC HEALING AFTER SURGERY IN PATIENTS UNDERGOING BOWEL RESECTION FOR COLORECTAL CANCER

Abstract Background The standard treatment of colorectal cancer (CRC) consists of a surgical resection of the colonic segment with the tumor, followed by a reconnection of the remaining bowel ends, or "anastomosis". The anastomosis may fail to heal in up to 20% of patients, which leads to anastomotic leak, a major complication that increases postoperative morbidity and mortality. This complication is unpredictable and its causes remain poorly understood. Purpose The objective of this study is to investigate the possible role of the gut microbiome in anastomotic healing after surgery in patients with CRC. Method We collected preoperative fecal samples and intraoperative mucosal samples from CRC patients undergoing surgery with anastomosis. The gut microbiota of patients with AL and of others that presented optimal healing after surgery was analyzed and compared using the Anchor 16S pipeline. To assess the role of the patients' microbiota in healing, fecal microbiota transplantation (FMT) was performed in mice using preoperative fecal samples from CRC patients with and without AL. Mice were then subjected to colonic surgery using a colonic anastomosis model. Six days after surgery, anastomotic healing was assessed macroscopically and microscopically. The gut barrier function was also assessed. The gut microbiota composition was compared between the groups colonized with samples from patients with and without AL to detect potential differences. Result(s) Mice colonized by FMT with the microbiota of donors with AL displayed poor anastomotic healing macroscopically, and a weaker wound microscopically. These same mice displayed a weaker gut barrier, as objectified by higher bacterial translocation to the spleen. The anastomoses of mice receiving the microbiota of AL donors displayed lower concentrations of collagen and fibronectin and higher inflammatory cytokines and collagenolytic enzymes, indicating poor extracellular matrix formation and collagen degradation locally.The beta-diversity of the gut microbiota was significantly different between mice receiving the microbiota of donors with and without AL, and several bacterial species were differentially abundant between the two groups. Conclusion(s) The preoperative gut microbiota in CRC patients who experience anastomotic leak after surgery induces poor anastomotic healing in mice and a weaker gut barrier after colonic surgery. Several bacterial species were found to be associated with the healing process. Please acknowledge all funding agencies by checking the applicable boxes below CIHR, Other Please indicate your source of funding; NSERC, FRQS, New Frontiers in Research, Montreal Cancer Institute. Disclosure of Interest None Declared

Segmental vs. extended colon resection for colorectal cancer associated with Crohn's disease

Segmental vs. extended colon resection for colorectal cancer associated with Crohn's disease

The role of intraoperative hyperspectral imaging (HSI) in colon interposition after esophagectomy

BackgroundColon conduit is an alternative approach to reconstructing the alimentary tract after esophagectomy. Hyperspectral imaging (HSI) has been demonstrated to be effective for evaluating the perfusion of gastric conduits, but not colon conduits. This is the first study to describe this new tool addressing image-guided surgery and supporting esophageal surgeons to select the optimal colon segment for the conduit and anastomotic site intraoperatively.Patients and methodsOf 10 patients, eight who underwent reconstruction with a long-segment colon conduit after esophagectomy between 01/05/2018 and 01/04/2022 were included in this study. HSI was recorded at the root and tip of the colon conduit after clamping the middle colic vessels, allowing us to evaluate the perfusion and appropriate part of the colon segment.ResultsAnastomotic leak (AL) was detected in only one (12.5%) of all the enrolled patients (n = 8). None of the patients developed conduit necrosis. Only one patient required re-anastomosis on postoperative day 4. No patient needed conduit removal, esophageal diversion, or stent placement. There was a change in the anastomosis site to proximal in two patients intraoperatively. There was no need to change the side of colon conduit intraoperatively in any patient.ConclusionHSI is a promising and novel intraoperative imaging tool to objectively assess the perfusion of the colon conduit. It helps the surgeon to define the best perfused anastomosis site and the side of colon conduit in this type of operation.