Colonic Bleeding Research Articles

Stereotactic Magnetic Resonance Guided Adaptive Radiation Therapy for Abdominopelvic Metastases

Stereotactic body radiation therapy (SBRT) can be an effective method for treating metastases. However, the proximity of organs at risk (OARs) to the target can limit the safe delivery of ablative doses, particularly in the abdomen and pelvis where there can be significant interfraction and intrafraction motion. Stereotactic magnetic resonance guided adaptive radiation therapy (SMART) may allow for safer delivery of ablative radiation to abdominopelvic metastases. We report the feasibility and early outcomes of patients with abdominopelvic metastases treated with SMART using a 0.35T MR Linac in a (1) retrospective cohort and (2) a prospective phase 1 trial.We identified 44 patients in the retrospective cohort and enrolled 13 patients onto the phase 1 protocol, all with abdominopelvic metastases. Patients with metastases of the liver, kidneys, or adrenal glands were excluded and were enrolled on companion phase 1 trials. Patients were treated between 10/29/19-2/18/21. For the retrospective cohort, dose prescription and coverage were at the discretion of the treating physician, with 67% of sites receiving 40 Gy/5 fractions. For the phase 1 cohort, patients were treated to 40 Gy/5 fractions daily with goal PTV coverage of V40 ≥95% (ideal) and V30 ≥95% (acceptable).Overall, the 44 patients in the retrospective cohort were treated to 49 sites of abdominopelvic disease, and the 13 patients in the phase 1 cohort received treatment to one site of abdominopelvic disease each on protocol. The most common histology was prostate adenocarcinoma (57%). In total, 308 fractions were delivered, with 138 (45%) using a breath hold and 170 (55%) using free breathing. Online adaptation was necessary for 269/308 fractions (87%) to either satisfy critical OAR metrics (62%) or improve target coverage (38%). Additionally, there were two instances when on-board MRI allowed for the detection of bowel which had displaced the target to such a degree as to interfere with safe treatment delivery, even when utilizing adaptive planning. These two treatments were postponed to either later the same day or a subsequent day. Patients spent an average of 61 minutes in the treatment room. With median follow-up of 150 days (interquartile range 90-224 days), there were no deaths and one local failure (a patient with urothelial carcinoma who received 35 Gy/5 fractions at 102 days after start of SBRT). There was one grade ≥3 treatment-related toxicity (colonic hemorrhage in a patient with serous ovarian cancer who received 40 Gy/5 fractions at 86 days after start of SBRT in the setting of thrombocytopenia).SMART is a feasible method for delivering ablative doses of radiation. Adaptive planning was necessary in a large portion of cases. Early data suggest a high rate of local control and low risk of significant toxicity. Longer-term results of the phase 1 protocol will be reported in the future.

S3533 Tenckoff Catheter Rectal Perforation Presenting as GI Bleeding

Introduction: Peritoneal dialysis catheter erosion into the bowel is a very rare, late complication of peritoneal dialysis. Clinical presentation can range from asymptomatic to features of peritonitis. With only a few case reports in existence there is no consensus on management. The following is a case of patient on long-term peritoneal dialysis, presenting with rectal bleeding, found to have a dialysis catheter eroding into the rectum. Case Description/Methods: 81-year-old man with a history of ESRD on peritoneal dialysis, initially presented with abdominal pain and bloody stools. Colonoscopy revealed old blood with several polyps, but no active bleeding. CT angiography with embolization to control right colonic bleeding was unsuccessful. The patient underwent right hemicolectomy. Intraoperatively, the Tenckhoff catheter was positioned in the cul-de-sac and the patient was started on hemodialysis. Two months later the patient was readmitted for hematochezia with hemodynamic instability. Repeat colonoscopy showed old blood throughout the colon, including the terminal ileum and the presence of a Tenckhoff catheter inside the rectum. EGD was unremarkable. He taken to the OR for an exploratory laparotomy with intraoperative colonoscopy. The Tenckhoff catheter was removed by the surgeon, and an over-the-scope (OVESCO) clip was applied to close the defect. Discussion: Delayed peritoneal catheter perforation is a late complication that occurs more commonly in patients with dormant catheters. These patients lack the constant lubricating effect of the dialysate on the bowel. When peritoneal dialysis is stopped, the catheter exerts constant pressure on the intestinal wall, causing ischemia, and perforation. Since this is a slow process, it rarely causes bleeding. The most common presentations are aqueous diarrhea with dialysate instillation, and peritonitis. Less commonly patients may present with catheter protrusion through the anus and bleeding. Because the incidence of delayed peritoneal catheter perforations is very low, there is no established guidelines on management. Most approaches are surgical interventions with catheter removal and defect repair.Figure 1.: Peritoneal dialysis catheter eroded into the rectum.

Low prevalence of colonic mucosal injury and bleeding in patients taking direct oral anticoagulants for non-valvular atrial fibrillation.

Direct oral anticoagulants are frequently used to prevent systemic embolism associated with atrial fibrillation. Gastrointestinal bleeding is a common adverse event of this pharmacotherapy, especially in the lower gastrointestinal tract. However, the prevalence of mucosal injury of the colon in patients taking direct oral anticoagulants has remained unknown. This was a retrospective study using endoscopic records of the colon from patients taking oral anticoagulants. Records from colonoscopies for 120 patients with non-valvular atrial fibrillation who had been prescribed direct oral anticoagulants between April 2011 and June 2017 were reviewed to determine the prevalence of mucosal injury and other findings, compared with those of 140 patients on warfarin. The prevalence of mucosal injury was 1.6% in patients taking direct oral anticoagulants and 1.4% in those taking warfarin, lower than other findings such as diverticula, hemorrhoids, and polyps. Bleeding was more frequent with direct oral anticoagulants (18 patients; 15%) than with warfarin (9 patients; 6.4%). Colonic diverticulum was the most common cause of bleeding in patients on direct oral anticoagulants. The prevalence of mucosal injury and causes of bleeding did not differ among direct oral anticoagulants. Colonic mucosal injury was infrequent in patients on direct oral anticoagulants. Bleeding was more frequent with direct oral anticoagulants than with warfarin. Colonic diverticulum and vascular ectasia were common causes of bleeding in patients on direct oral anticoagulants. Little difference in cause of bleeding was evident among oral anticoagulants.

Unique challenges of endotherapeutics in malignant lower gastrointestinal bleeding in a patient with COVID-19 pneumonia—case report and literature review

: Acute lower gastrointestinal bleeding (LGIB) attributed to malignant colorectal lesion presents an endoscopically demanding task to manage due to multiple contributing factors. This ranges from an array of compounding issues such as tumour friability, neovascularization and coagulopathy arising from either medical comorbidities or pharmacological medications. We present a challenging case of malignant rectosigmoid colonic tumour bleeding in the setting of COVID-19 infection at its highest level in our country where all resources were severely stretched and strained. A 58-year-old man admitted for stage 3 COVID-19 pneumonia had been complaining of intermittent hematochezia for 1 month. Relevant blood investigations revealed a hemoglobin count of 5.1 g/dL with normal coagulation profile. Index colonoscopy demonstrated a bulky, circumferential rectosigmoid colon tumour with significantly narrowed (3–4 mm) luminal opening. As there was no bleeding, no endoscopic intervention was forthcoming. Staging computed tomography (CT) scan done the following day, confirmed a large but localized rectosigmoid colon tumour measuring 5 cm in length with no signs of bowel obstruction. Owing to hospital restrictions in place during the pandemic, he was unable to undergo definitive surgical intervention when he rebled 10 days later. This was complicated with hemodynamic instability which warranted an urgent endoscopic treatment with argon plasma coagulation (APC). This timely intervention was successful in buying sufficient time for him to recover from COVID-19 pneumonia and subsequently undergo surgery. The final overall diagnosis was pT3N0M0 moderately differentiated colonic adenocarcinoma. Though APC has limited role in the management of bleeding colorectal cancers due to high rebleeding rates, its’ temporizing hemostatic benefits may still be of use when other modalities are unavailable. The COVID-19 pandemic has brought about various disruptions in our routine endoscopic practices. Aside from delays in timely diagnosis and definitive intervention, endoscopic practices alongside performance are equally affected by resource limitation which is highlighted in our case.

Crohn’s disease manifested with massive colonic bleeding (review and a clinical case)

Massive gastrointestinal bleeding (GIB) is a rare complication of Crohn’s disease (CD). For the recent decades a number of medical and surgical methods to control the GIB have been introduced. However, the unified algorithm and approach to this subset of patients is still lacking, mostly due to the absence of adequately powered and wellconducted RCTs. Determining the optimal treatment approach to inflammatory bowel disease (IBD) in patients who develop a GIB is still a valid research target.

Crohn’s disease manifested with massive colonic bleeding (review and a clinical case)

Massive gastrointestinal bleeding (GIB) is a rare complication of Crohn’s disease (CD). For the recent decades a number of medical and surgical methods to control the GIB have been introduced. However, the unified algorithm and approach to this subset of patients is still lacking, mostly due to the absence of adequately powered and wellconducted RCTs. Determining the optimal treatment approach to inflammatory bowel disease (IBD) in patients who develop a GIB is still a valid research target.

Efficient Colonoscopic Identification of Colonic Bleeding Diverticulum Using Intradiverticular Water Injection with a Nontraumatic Tube.

Objectives: The colonoscopic identification of stigmata of recent hemorrhage (SRH) in patients with colonic diverticular bleeding (CDB) is difficult. Factors that influence the identification of SRH in the diagnosis of CDB were investigated. Methods: This was a retrospective study of 487 early colonoscopy patients with acute lower gastrointestinal bleeding who were diagnosed with CDB. Comorbidities, medications, bowel preparation, use of a transparent cap, use of a water-jet scope, colonoscopy by an expert colonoscopist, and use of a nontraumatic (NT) tube were assessed. A multivariate analysis was used to estimate the odds ratio and 95% confidence interval. Results: Of the 487 colonoscopy patients diagnosed with CDB, 191 (39%) were definitively identified with SRH. The use of a transparent cap, a water-jet scope, an expert colonoscopist, and an NT tube were independent predictive factors for SRH on univariate analysis. A multivariable logistic regression model showed that colonoscopy by an expert colonoscopist and the use of an NT tube were predictive factors for SRH. Conclusions: Intradiverticular water injection with an NT tube by an expert colonoscopist is useful in identifying CDB, and may help achieve effective endoscopic hemostasis.

New Trends and Advances in Non-Variceal Gastrointestinal Bleeding-Series II.

The gastrointestinal tract is a long tubular structure wherein any point in the mucosa along its entire length could be the source of a hemorrhage. Upper (esophagel and gastroduodenal) and lower (jejunum, ileum, and colon) gastrointestinal bleeding are common. Gastroduodenal and colonic bleeding are more frequent than bleeding from the small bowel, but nowadays the entire gastrointestinal tract can be explored endoscopically and bleeding lesions can be locally treated successfully to stop or prevent further bleeding. The extensive use of antiplatelet and anticoagulants drugs in cardiovascular patients is, at least in part, the cause of the increasing number of patients suffering from gastrointestinal bleeding. Patients with these conditions are usually older and more fragile because of their comorbidities. The correct management of antithrombotic drugs in cases of gastrointestinal bleeding is essential for a successful outcome for patients. The influence of the microbiome in the pathogenesis of small bowel bleeding is an example of the new data that are emerging as potential therapeutic target for bleeding prevention. This text summarizes the latest research and advances in all forms of acute gastrointestinal bleeding (i.e., upper, small bowel and lower). Diagnosis is approached, and medical, endoscopic or antithrombotic management are discussed in the text in an accessible and comprehensible way.

Successful hemostasis for refractory colonic diverticulum bleeding by clipping with polyglycolic acid sheets.

Video 1Endoscopic clipping with polyglycolic acid sheets for colonic diverticulum bleeding.

Lower Gastrointestinal Bleeding

Bleeding from the lower part of the digestive system that appears as hematochezia (fresh blood, clot or cherry-coloured stool) or melena (dark-coloured tarry stool) is called lower gastrointestinal tract bleeding (lower GI bleeding) (or colonic bleeding). In the traditional definition, lower GI bleeding was generally classified as bleeding distal to the Treitz ligament (duodenojejunal junction) as the border. In the last decade, GI bleeding has adopted three categories in some recent publications: Upper, middle, and lower. According to this category, bleeding from a source between the Treitz ligament and the ileocecal valve is classified as middle GI bleeding, bleeding from the distal of the ileocecal valve is classified lower GI bleeding. Lower GI bleeding and hospitalization rates increase with ageing. Currently, physicians managing lower GI bleeding have many different diagnostics and therapeutic options ranging from colonoscopy and flexible sigmoidoscopy to radiographic interventions such as scintigraphy or angiography. Lower GI bleeding often stops spontaneously and less common than upper GI bleeding. Even though no modality has emerged as the gold standard in the treatment of lower GI bleeding, colonoscopy has several advantages and is generally considered as the preferred initial test in most of the cases.

Adipose-derived mesenchymal stem cell-secreted exosome alleviates dextran sulfate sodium-induced acute colitis by Treg cell induction and inflammatory cytokine reduction.

Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is an inflammatory condition that results in gastrointestinal tract damage. Various factors, including environmental and genetic agents, disrupt the function of the intestinal immune system that can lead to IBD. Mesenchymal stem cells (MSCs) display an immunoregulatory function and demonstrate regenerative potential by paracrine action. In this study, we evaluated the immunomodulatory effects of MSCs' derived exosomes in the acute form of dextran sulfate sodium (DSS)-induced colitis. Exosomes were isolated from adipose-derived MSCs. Acute colitis was induced by DSS. The exosome was used by intraperitoneal injection into mice with acute colitis. Stool consistency, body weight changes, bleeding severity, colon length, and weight were examined. At the experimental endpoint (Day 7), the changes in the colon tissue were evaluated. The level of cytokines of interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17), IL-4, IL-12, transforming growth factor-β (TGF-β) and, IL-10, and Treg cells percentage were assayed. Results showed that exosome administration diminished colon shortening, bodyweight loss, bleeding, and colon injury. The levels of IFN-γ, TNF-α, IL-12, and IL-17 were decreased, and the level of TGF-β, IL-4, and IL-10 were increased in lymph node and spleen of mice treated with exosome. Percentages of CD4+ CD25+ Foxp3+ Treg cells were grown in the lymph node and spleen of mice treated with exosomes. Overall, current data suggestthat MSC-derived exosome could regulate the Treg population and improves inflammation in DSS-induced acute colitis.

Prophylactic clipping to prevent delayed colonic post-polypectomy bleeding: meta-analysis of randomized and observational studies

Delayed post-polypectomy bleeding (DPPB) is a commonly described adverse event following polypectomy. Prophylactic clipping may prevent DPPB in some patient subgroups. We performed a meta-analysis to assess both the efficacy and real-world effectiveness of prophylactic clipping. We performed a database search through March 2020 for clinical trials or observational studies assessing prophylactic clipping and DPPB. Pooled risk ratios (RR) were calculated using random effects models. Subgroup, sensitivity, and meta-regression analyses were performed to elucidate clinical or methodological factors associated with effects on outcomes. A total of 2771 citations were screened, with 11 randomized controlled trials (RCTs) and 9 observational studies included, representing 24,670 colonoscopies. DPPB occurred in 2.0% of patients overall. The pooled RR of DPPB was 0.47 (95% CI 0.29-0.77) from RCTs enrolling only patients with polyps ≥ 20 mm. Remaining pooled RCT data did not demonstrate a benefit for clipping. The pooled RR of DPPB was 0.96 (95% CI 0.61-1.51) from observational studies including all polyp sizes. For patients with proximal polyps of any size, the RR was 0.73 (95% CI 0.33-1.62) from RCTs. Meta-regression confirmed that polyp size ≥ 20 mm significantly influenced the effect of clipping on DPPB. Pooled evidence demonstrates a benefit when clipping polyps measuring ≥ 20 mm, especially in the proximal colon. In lower-risk subgroups, prophylactic clipping likely results in little to no difference in DPPB.

Early massive gastrointestinal bleeding as a complication of left ventricular assist device implantation

Introduction. Implantation of left ventricular assist device (LVAD) improves survival and quality of life in patients with end-stage heart failure. We reported a case of a severe gastrointestinal bleeding as a life threatening complication in early recovering postoperative period of continuous blood flow LVAD implantation. Case report. The patient had a history of heart failure due to ischemic cardiomyopathy with low systolic function, as an indication for LVAD implantation. The operation and the postoperative course were uneventful. On the 17th postoperative day, the patient developed severe anemia, which was followed by melena with blood clots. Endoscopic examinations revealed diffuse colonic bleeding. Oral anticoagulation therapy was discontinued, and fresh frozen plasma, K vitamin substitution, and human prothrombin complex were administered. The LVAD speed was reduced and subcutaneous administration of somatostatin analog octreotide was initiated. These measures successfully stopped the bleeding and the patient was stabilized. Due to a multidisciplinary team approach, the bleeding was successfully managed and the patient re-covered. Conclusion. Acute gastrointestinal bleeding represents a serious, life-threatening condition that can develop after LVAD implantation, but with timely and appropriate measurements, it can be successfully treated.

Use of over-the-scope clips in the colon in clinical practice: results from a German administrative database.

Background The efficacy and safety of over-the-scope (OTS) clips in the colon is limited. This study aimed to evaluate OTS clip use in the colon in routine colonoscopy. Methods Using administrative data from a large health insurance company, patients with OTS clip placement during colonoscopy were identified and analyzed by specific administrative codes. Indication for OTS clipping was analyzed, and follow-up was evaluated for surgical and repeat endoscopic interventions. Results In 505 patients, indications for OTS clips were iatrogenic perforations (n = 80; Group A), polypectomy (n = 315; Group B), colonic bleeding (n = 51; Group C), and various underlying diseases (n = 59; Group D). In 11 Group A patients (13.8 %), surgical interventions occurred, mostly within 24 hours after clipping (n = 9), predominantly overstitching (n = 8). OTS clipping during polypectomy (Group B) was for complications (e. g. bleeding in 27 %) or was applied prophylactically. Only five patients required early surgery, three of whom had colorectal cancer. In four Group C patients (7.8 %), surgical resections were performed (persistent bleeding n = 1, colorectal cancer n = 2), while six patients underwent early repeat colonoscopy for recurrent bleeding. During further follow-up (days 11–30), 17 patients underwent resection for colonic neoplasms (n = 12) or persistent bleeding (n = 4), but only one case could be directly traced back to local OTS clip complication. Conclusion Colonic OTS clipping appears safe and effective in selected indications and complications in clinical routine but must be anatomically and technically feasible, avoiding overuse.

Obscure Gastrointestinal Bleeding Due to Colonic Source

Acute GI bleeding is a prevalent condition responsible for significant morbidity, mortality, and overall health care burden in the United States and globally. Obscure GIB is defined as recurrent or persistent evidence of blood loss after negative endoscopic assessment. The purpose of this review is to further examine colonic sources of obscure GI bleeding with regard to epidemiology, diagnosis, therapy, rebleeding rate, and areas in need of further study. Newer diagnostic modalities like video capsule endoscopy have shown the importance of continued investigation of colonic bleeding after negative colonoscopy, but the risk of rebleeding has not changed significantly over time. New practice recommendations for lower GI bleeding may increase the yield of evaluation. Obscure lower GI bleeding causes significant morbidity even though it is a common problem usually caused by common colonic lesions, including diverticulosis, gastrointestinal angiodysplastic lesions, colitis, or colon cancer.

Outcomes of Initial Subtotal Colectomy for Pediatric Inflammatory Bowel Disease

BackgroundSubtotal colectomy with end ileostomy (STC-I) has been well established in the adult literature as an initial surgical treatment for refractory inflammatory bowel disease (IBD)-related colitis. However, in the pediatric population, the efficacy of this approach has been less well characterized, likely because of concerns regarding the advisability of leaving a diseased rectum in situ. Our aim was to examine the outcomes after STC-I for refractory IBD at our pediatric tertiary care center. MethodsAn institutional review board–approved retrospective review of patients aged 5-21 y who underwent operative treatment with initial STC-I for medically refractory IBD from January 2010 to August 2018. Only complications related to the STC-I were considered; complications subsequent to reconstruction are excluded from analysis. Early complications were defined as occurring within 60 d of STC-I. We performed descriptive statistics using the Fisher exact test and the Student t-test, as appropriate. ResultsOver the study period, 37 patients (aged 12.3 ± 4.2 y) underwent STC-I, with 73.0% performed laparoscopically. Patients were predominately male (51.4%) and Caucasian (48.6%). Thirty-one (83.8%) colectomies were performed for ulcerative colitis, two (5.4%) for Crohn disease, and four (10.8%) for indeterminate colitis. Nutritional status improved postcolectomy. Albumin levels of 3.3 ± 0.8 preoperatively increased to 4.3 ± 0.47 postoperatively (P < 0.001). Colonic bleeding was stopped by STC-I with increases in the hematocrit from 30.5 ± 6.8 preoperative to 38.9 ± 4.1 postoperatively (P < 0.001). Average time to discontinuation of IBD-related medications was 4 wk (n = 27). Forty-eight percent required outpatient rectal treatment for proctitis. Patients did well long term, with 67.5% reestablishing intestinal continuity at our institution. Average postoperative length of stay was shorter in the laparoscopic group compared with those undergoing open operations (5.1 ± 2.2 versus 6.9 ± 1.6 d, P = 0.03). Readmission rate at 30 d was 21.1%. Patients experiencing unplanned readmission or unplanned operations were similar between groups (30% versus 33.3%, P = 0.85 and 30% versus 18.5%, P = 0.45, respectively). Overall, 14 (37.8%) patients experienced a complication with many patients experiencing multiple complications. Early complications occurred in nine (24.3%) patients. Late complications also occurred in 24.3% of patients. There were four (10.8%) patients with five admissions for bowel obstruction, two of whom required operative intervention (5.4%). ConclusionsUse of STC-I as an initial procedure in the treatment of refractory IBD-related colitis in children is a safe and reasonable surgical approach that allows weaning from immunosuppressing mediations and stops colonic bleeding. Implementing a laparoscopic approach to subtotal colectomy provides further benefit by reducing postoperative length of stay.

An integrated metabolism in vivo analysis and network pharmacology in UC rats reveal anti-ulcerative colitis effects from Sophora flavescens EtOAc extract

Ulcerative colitis (UC), an immune system disease, is characterized by long duration and easy relapse. Sophora flavescens (S. flavescens), also named “Kushen”, is a traditional Chinese medicine, widely used to treat UC in clinics. Alkaloids and flavonoids are the main constituents of S. flavescens. Previous studies indicated that the effects of S. flavescens against UC mainly attribute to its alkaloids. In view of the clinical applications of its flavonoids and our preliminary experiments on the effects of S. flavescens treatment, we speculated that flavonoids also could exert an anti-UC effect, but its efficacy and mechanism are still not yet to be revealed. Herein, we examined the pharmacodynamic effects of the ethyl acetate (EtOAc) extract of S. flavescens EtOAc (SFE) against dextran sodium sulfate-induced UC rats for the first time. Pharmacodynamic effects indicated that SFE could significantly alleviate the loss in the body weight and shortening of the colon length, reduce colon bleeding and improve colon tissue damage of UC rats. A total of 28 prototypes and 41 metabolites were unambiguously or tentatively detected in rat’s plasma and urine. Among them, 28 prototypes and 3 phase I metabolites shared 40 UC targets, the targets contributed to 51 metabolic pathways in 5 modules. Additionally, genistein, formononetin, isokurarinone, kurarinone, maackiain, kushenol N, trifolirnizin, kuraridin and norkurarinone were suggested to be potential active compounds in SFE for treating UC by comprehensively investigating the results of network pharmacology analysis, metabolic analysis in vivo, and previous researches. Finally, a combination of metabolic analysis in vivo with network pharmacology can elucidate the material basis and pharmacodynamic effect of traditional Chinese medicines, and lay the foundation for further clarify the anti-UC mechanism of SFE.

Successful surgical management of mesenteric inflammatory veno-occlusive disease

BackgroundThe term “mesenteric inflammatory veno-occlusive disease (MIVOD)” is used to describe an ischemic injury resulting from phlebitis or venulitis that affects the bowel or mesentery in the absence of arteritis. MIVOD is difficult to diagnose because of its rarity and frequent confusion with other diseases. The incidence and etiology of MIVOD remain unclear; only a few cases have been reported. We describe a case of the successful surgical management of a patient with MIVOD with characteristic images.Case presentationA 65-year-old Japanese man visited a hospital with the chief complaint of abdominal pain in January 2018. CT showed edema and thickening of the intestinal wall from the descending colon to the rectum. The patient was admitted to the hospital. Suspected diagnoses were enteritis, ulcerative colitis, amyloidosis, vasculitis, malignant lymphoma, and venous thrombus, but no definitive diagnosis was obtained. The patient was transferred to our hospital for the treatment of stenosis (located from the descending colon to the rectum) and bowel obstruction. An emergency transverse colostomy was performed. The sigmoid colon and mesentery were too rigid and edematous to resect. Colonic hemorrhage occurred 2 weeks after the surgery. With radiology intervention, coiling for the arteriovenous fistula in the descending colon was performed, and hemostasis was obtained. A colonoscopy at 6 months post-surgery showed neither ulceration nor stenosis in the rectum, indicating that the rectum could be preserved in the next surgery. However, severe stenosis in the descending and sigmoid colon remained unchanged. Ten months after the transverse colostomy, we performed a subtotal colectomy and ileorectal anastomosis, and an ileostomy was created. The sigmoid colon and mesentery were not so rigid compared to the first surgery’s findings, and we were able to resect intestine and mesentery. Histopathology revealed phlebitis and venulitis, fibrinoid necrosis, and normal arteries, meeting the diagnostic criteria for MIVOD. Postoperatively, the patient showed no recurrence for 8 months.ConclusionClinicians should consider MIVOD when examining a patient with intestinal ischemia. When MIVOD is suspected, the patient is indicated for surgery based on an accurate diagnosis and good prognosis.

P203 FIT and FC as a surrogate non-invasive marker for mucosal healing in inflammatory bowel disease

Abstract Background Mucosal healing (MH) is one of the goals of IBD therapy. Currently, the only way to assess MH is by colonoscopy. Faecal calprotectin (FC) and faecal immunochemical test (FIT) which detect colonic inflammation and bleeding might be useful adjuncts. Aim To assess FIT and FC as surrogate markers of MH. Methods Following ethical approval, patients undergoing routine colonoscopy were prospectively recruited. Demographics and colonoscopy findings were documented. A FIT and FC were collected prior to colonoscopy. FIT and FC were processed in our laboratory and reported as µg/g of stool. MH was defined no visible activity on colonoscopy. Results Of 105 colonoscopies, FC and FIT results were available in 99 and 88 patients. Mean age 48.8, 52% (55) males, 34% (36) UC, 60% (63) Crohn’s, 0.05% (6) IBDU. In all, MH occurred in 12%, (n = 12). In MH, the mean FIT and FC were 1142 and 353, while in active cases were 750 and 819. Only FC was significantly lower in MH cases (353 vs. 819, p = 0.05). Using standard cut-offs of &amp;gt;50; sensitivity, specificity, PPV and NPV for MH for FIT was poor; 59%, 33%, 89%, 9% and for FC was better at 74%, 73%, 91%, 44%. The overall correlation between the biomarkers was weak r = 0.2, p &amp;lt; 0.01. FC ROC analysis gave a specificity and sensitivity of 75% and 67% for a cut-off of &amp;lt;64µg/g, AUC = 0.65. Conclusion MH was uncommon (12%) reflecting our clinical practice. FIT was a poor predictor of MH. FC might be a useful marker albeit ongoing research is needed to set an appropriate cut-off.

Anti-Inflammatory, Antioxidant, and Microbiota-Modulating Effects of Camellia Oil from Camellia brevistyla on Acetic Acid-Induced Colitis in Rats.

Altering the microbiota by the daily diet is highly associated with improved human health. Studies confirms the gastrointestinal protective and anti-inflammatory effects of camellia oil; however, the benefits in gut microbiota remain unclear. Camellia oils of Camellia oleifera (PCO) and C. brevistyla (TCCO) were used to evaluate probiotic growth in vitro. In addition, the protective effects of camellia oils in the acetic acid (AA)-induced colitis rat model were investigated. In vitro fermentation study showed the proliferation of Lactobacillus spp. and Bifidobacterium spp. from human intestinal microbiota was increased after TCCO treatment. Moreover, the rats pretreated with TCCO exhibited significantly less AA-induced colonic injury and hemorrhage, higher serum immunoglobulin G 1 (IgG 1) levels, lower malondialdehyde levels, and lower inflammatory cytokine production in the colon tissue compared with those in the PCO group. Surprising, the protective effect against acetic acid-induced colitis by TCCO was similar to sulfasalazine (positive control) treatment. Moreover, TCCO increased the richness and diversity of probiotics in gut microbiota. TCCO alleviated AA-induced colitis by modulating gut microbiota, reducing oxidative stress and suppressing inflammatory responses.