Effects of colorectal endoscopic submucosal dissection on postoperative abdominal symptoms: a prospective observational study

A triple-masked, two-center, randomized parallel clinical trial to assess the superiority of eight weeks of grape seed flour supplementation against placebo for weight loss attenuation during perioperative period in patients with cachexia associated with colorectal cancer: a study protocol

Background

Progressive, involuntary weight and lean mass loss in cancer are linked to cachexia, a prevalent syndrome in gastrointestinal malignancies that impacts quality of life, survival and postoperative complications. Its pathophysiology is complex and believed to involve proinflammatory cytokine-mediated systemic inflammation resulting from tumor-host interaction, oxidative stress, abnormal metabolism and neuroendocrine changes. Therapeutic options for cachexia remain extremely limited, highlighting the need for clinical research targeting new interventions. Thus, this study primarily assesses the effects of grape-seed flour (GSF), rich in polyphenols and fibers, for attenuating perioperative weight loss in colorectal cancer.

Methods

This is a dual-center, triple-masked, placebo-controlled, parallel-group, phase II, randomized clinical trial designed to investigate GSF supplementation in subjects with pre- or cachexia associated with colorectal cancer during the perioperative period. Eighty-two participants will receive 8g of GSF or cornstarch (control) for 8 weeks. Assessments are scheduled around surgery: pre-intervention (4 weeks prior), day before, first week after, and post-intervention (4 weeks later). The primary endpoint is the difference in body weight mean change from baseline to week 8. The secondary endpoints describe the harms from 8-week supplementation and assess its superiority to improve body composition, post-surgical complications, quality of life, anorexia, fatigue, gastrointestinal symptoms, and handgrip strength. The study will also explore its effects on gut bacteria activity and composition, systemic inflammation, and muscle metabolism.

Discussion

The current trial addresses a gap within the field of cancer cachexia, specifically focusing on the potential role of a nutritional intervention during the acute treatment phase. GSF is expected to modulate inflammation and oxidative stress, both involved in muscle and intestinal dysfunction. The research findings hold substantial implications for enhancing the understanding about cachexia pathophysiology and may offer a new clinical approach to managing cachexia at a critical point in treatment, directly impacting clinical outcomes.

Trial registration

The Brazilian Registry of Clinical Trials (ReBEC), RBR-5p6nv8b; UTN: U1111-1285-9594. Prospectively registered on February 07, 2023.

Endoscopic Management of Complex Colorectal Polyps: Current Insights and Future Trends

Most colorectal cancers arise from adenomatous polyps and sessile serrated lesions. Screening colonoscopy and therapeutic polypectomy can potentially reduce colorectal cancer burden by early detection and removal of these polyps, thus decreasing colorectal cancer incidence and mortality. Most endoscopists are skilled in detecting and removing the vast majority of polyps endoscopically during a routine colonoscopy. Polyps can be considered “complex” based on size, location, morphology, underlying scar tissue, which are not amenable to removal by conventional endoscopic polypectomy techniques. They are technically more challenging to resect and carry an increased risk of complications. Most of these polyps were used to be managed by surgical intervention in the past. Rapid advancement in endoscopic resection techniques has led to a decreasing role of surgery in managing these complex polyps. These endoscopic resection techniques do require an expert in the field and advanced equipment to perform the procedure. In this review, we discuss various advanced endoscopic techniques for the management of complex polyps.

Assessment of BNP and BDNF results in elective endovascular cerebral aneurysm treatment

BACKGROUND

B-type natriuretic peptide (BNP) levels increase with an increase in intracranial pressure. A decrease in BNP levels has been found to be associated with patient positive prognosis. Brain-derived neurotrophic factor (BDNF) levels decrease in patients with acute stroke.

AIMS

To compare the BNP and BDNF values in serum before and after elective endovascular cerebral aneurysm treatment (ECAT).

METHODS

A total of 50 patients who underwent elective ECAT were included in the study. Exclusion criteria were determined to be history of heart failure or heart attack (n = 8), renal failure (n = 5), subarachnoid hemorrhage (n = 4), or previous aneurysm clip procedure (n = 3). Intravenous blood samples were obtained from 30 patients who underwent elective ECAT before and after treatment. After centrifugation, the BNP and BDNF values in serum were obtained with the ELISA method and compared.

RESULTS

This study included 19 female and 11 male patients, aged between 24 and 75 years. The average age of the patients was 51.27 ± 13.31 years. The median BDNF values did not change significantly after ECAT (before the endovascular procedure: 3.1 ± 1.3 pg/dl; after the endovascular procedure: 2.8 ± 0.9 pg/dl, p = 0.16). Median BNP levels decreased significantly after ECAT (before the endovascular procedure: 617.50 ± 483.11 pg/ml; after the endovascular procedure: 395.00 ± 352.15 pg/ml, p < 0.001).

CONCLUSIONS

After elective endovascular cerebral aneurysm treatment, the BNP values in serum decreased significantly, and the BDNF values in serum did not change significantly.