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Toffoli EC, van Vliet AA, Forbes C, Arns AJ, Verheul HWM, Tuynman J, van der Vliet HJ, Spanholtz J, de Gruijl TD. Allogeneic NK cells induce the in vitro activation of monocyte-derived and conventional type-2 dendritic cells and trigger an inflammatory response under cancer-associated conditions. Clin Exp Immunol 2024; 216:159-171. [PMID: 38330230 PMCID: PMC11036108 DOI: 10.1093/cei/uxae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/27/2023] [Accepted: 02/06/2024] [Indexed: 02/10/2024] Open
Abstract
Natural killer (NK) cells are innate lymphocytes capable to recognize and kill virus-infected and cancer cells. In the past years, the use of allogeneic NK cells as anti-cancer therapy gained interest due to their ability to induce graft-versus-cancer responses without causing graft-versus-host disease and multiple protocols have been developed to produce high numbers of activated NK cells. While the ability of these cells to mediate tumor kill has been extensively studied, less is known about their capacity to influence the activity of other immune cells that may contribute to a concerted anti-tumor response in the tumor microenvironment (TME). In this study, we analyzed how an allogeneic off-the-shelf cord blood stem cell-derived NK-cell product influenced the activation of dendritic cells (DC). Crosstalk between NK cells and healthy donor monocyte-derived DC (MoDC) resulted in the release of IFNγ and TNF, MoDC activation, and the release of the T-cell-recruiting chemokines CXCL9 and CXCL10. Moreover, in the presence of prostaglandin-E2, NK cell/MoDC crosstalk antagonized the detrimental effect of IL-10 on MoDC maturation leading to higher expression of multiple (co-)stimulatory markers. The NK cells also induced activation of conventional DC2 (cDC2) and CD8+ T cells, and the release of TNF, GM-CSF, and CXCL9/10 in peripheral blood mononuclear cells of patients with metastatic colorectal cancer. The activated phenotype of MoDC/cDC2 and the increased release of pro-inflammatory cytokines and T-cell-recruiting chemokines resulting from NK cell/DC crosstalk should contribute to a more inflamed TME and may thus enhance the efficacy of T-cell-based therapies.
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Affiliation(s)
- E C Toffoli
- Department of Medical Oncology, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
| | - A A van Vliet
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
- Glycostem Therapeutics, Oss, The Netherlands
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
| | - C Forbes
- Department of Medical Oncology, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
| | - A J Arns
- Department of Medical Oncology, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
| | - H W M Verheul
- Department of Medical Oncology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Tuynman
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
| | - H J van der Vliet
- Department of Medical Oncology, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
- Lava Therapeutics, Utrecht, The Netherlands
| | - J Spanholtz
- Glycostem Therapeutics, Oss, The Netherlands
| | - T D de Gruijl
- Department of Medical Oncology, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
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van Haaps AP, Wijbers JV, Schreurs AMF, Vlek S, Tuynman J, De Bie B, de Vogel AL, van Wely M, Mijatovic V. Reply. Beyond the plate: exploring the complexities of using dietary approaches to manage endometriosis. Hum Reprod 2024; 39:865-866. [PMID: 38366917 DOI: 10.1093/humrep/deae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Affiliation(s)
- A P van Haaps
- Department of Reproductive Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - J V Wijbers
- Department of Obstetrics and Gynaecology, Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
- Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, Den Haag, the Netherlands
| | - A M F Schreurs
- Department of Reproductive Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - S Vlek
- Department of Obstetrics and Gynaecology, Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - J Tuynman
- Department of Obstetrics and Gynaecology, Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - B De Bie
- Endometriose Stichting, Dutch Patient Organization for Endometriosis, Sittard, the Netherlands
| | - A L de Vogel
- Dietician Practice Aileen de Vogel, Dordrecht, the Netherlands
| | - M van Wely
- Department of Reproductive Medicine, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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van Haaps AP, Wijbers JV, Schreurs AMF, Vlek S, Tuynman J, De Bie B, de Vogel AL, van Wely M, Mijatovic V. The effect of dietary interventions on pain and quality of life in women diagnosed with endometriosis: a prospective study with control group. Hum Reprod 2023; 38:2433-2446. [PMID: 37877417 PMCID: PMC10754387 DOI: 10.1093/humrep/dead214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
STUDY QUESTION What is the influence of dietary interventions, namely the low fermentable oligo-, di-, mono-saccharides, and polyols (Low FODMAP) diet and endometriosis diet, on endometriosis-related pain and quality of life (QoL) compared to a control group? SUMMARY ANSWER After adhering to a dietary intervention for 6 months, women with endometriosis reported less pain and an improved QoL compared to baseline whereas, compared to the control group, they reported less bloating and a better QoL in 3 of 11 domains. WHAT IS KNOWN ALREADY Standard endometriosis treatment can be insufficient or may be accompanied by unacceptable side effects. This has resulted in an increasing interest in self-management strategies, including the appliance of the Low FODMAP diet and the endometriosis diet (an experience-based avoidance diet, developed by women with endometriosis). The Low FODMAP diet has previously been found effective in reducing endometriosis-related pain symptoms, whereas only limited studies are available on the efficacy of the endometriosis diet. A survey study recently found the endometriosis diet effective in improving QoL but currently no guidelines on use of the diet exist. STUDY DESIGN, SIZE, DURATION A prospective one-center pilot study was performed between April 2021 and December 2022. Participants could choose between adherence to a diet-the Low FODMAP diet or endometriosis diet-or no diet (control group). Women adhering to a diet received extensive guidance from a dietician in training. The follow-up period was 6 months for all three groups. For all outcomes, women adhering to the diets were compared to their baseline situation and to the control group. PARTICIPANTS/MATERIALS, SETTING, METHODS We included women diagnosed with endometriosis (surgically and/or by radiologic imaging) who reported pain scores ≥3 cm on the visual analogue score (0-10 cm) for dysmenorrhea, deep dyspareunia, and/or chronic pelvic pain. The primary endpoint focused on pain reduction for all pain symptoms, including dysuria, bloating, and tiredness. Secondary endpoints, assessed via questionnaires, focused on QoL, gastro-intestinal health, and diet adherence. MAIN RESULTS AND THE ROLE OF CHANCE A total of 62 participants were included in the low FODMAP diet (n = 22), endometriosis diet (n = 21), and control group (n = 19). Compared to their baseline pain scores, participants adhering to a diet reported less pain in four of six symptoms (range P < 0.001 to P = 0.012) and better scores in 6 of 11 QoL domains (range P < 0.001 to P = 0.023) after 6 months. Compared to the control group, analyzed longitudinally over the 6-month follow-up period, participants applying a diet reported significant less bloating (P = 0.049), and better scores in 3 of 11 QoL domains (range P = 0.002 to P = 0.035). LIMITATIONS, REASONS FOR CAUTION No sample size was calculated since efficacy data were lacking in the literature. In order to optimize dietary adherence, randomization was not applied, possibly resulting in selection bias. WIDER IMPLICATIONS OF THE FINDINGS Our study suggests that women could benefit from adherence to a dietary intervention, since we found lower pain scores and better QoL after 6 months. However, caution is implied since this is a pilot study, no sample size was calculated, and data on long-term effects (>6 months) are lacking. The results of this pilot study underline the importance of further research and the drawing up of guidelines. STUDY FUNDING/COMPETING INTEREST(S) A.v.H. reports receiving a travel grant from Merck outside the scope of this study. J.W., S.V., J.T., and B.D.B. have no conflicts of interest to report. A.d.V. reports having received KP-register points for internship guidance of J.W., performing paid consultations with endometriosis patients outside the study and receiving reimbursements for educational lectures at the local hospital (Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands). A.S. reports having received expenses for travel and hotel costs as an invited speaker from ESHRE. This was outside the scope of this study. M.v.W. reports that she is a Co-Ed of Cochrane Gynecology and Fertility. V.M. reports receiving travel and speaker's fees from Guerbet and research grants from Guerbet, Merck and Ferring. The department of reproductive medicine (V.M.) of the Amsterdam UMC, location VUmc, has received several research and educational grants from Guerbet, Merck and Ferring not related to the submitted work. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A P van Haaps
- Department of Reproductive Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
- Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J V Wijbers
- Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
- Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, Den Haag, The Netherlands
| | - A M F Schreurs
- Department of Reproductive Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
- Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - S Vlek
- Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - J Tuynman
- Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - B De Bie
- Endometriose Stichting, Dutch Patient Organization for Endometriosis, Sittard, The Netherlands
| | - A L de Vogel
- Dietician Practice Aileen de Vogel, Dordrecht, The Netherlands
| | - M van Wely
- Department of Reproductive Medicine, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
- Endometriosis Center, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Moynihan A, Hardy N, Dalli J, Aigner F, Arezzo A, Hompes R, Knol J, Tuynman J, Cucek J, Rojc J, Rodríguez-Luna MR, Cahill R. CLASSICA: Validating artificial intelligence in classifying cancer in real time during surgery. Colorectal Dis 2023; 25:2392-2402. [PMID: 37932915 DOI: 10.1111/codi.16769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 11/08/2023]
Abstract
AIM Treatment pathways for significant rectal polyps differ depending on the underlying pathology, but pre-excision profiling is imperfect. It has been demonstrated that differences in fluorescence perfusion signals following injection of indocyanine green (ICG) can be analysed mathematically and, with the assistance of artificial intelligence (AI), used to classify tumours endoscopically as benign or malignant. This study aims to validate this method of characterization across multiple clinical sites regarding its generalizability, usability and accuracy while developing clinical-grade software to enable it to become a useful method. METHODS The CLASSICA study is a prospective, unblinded multicentre European observational study aimed to validate the use of AI analysis of ICG fluorescence for intra-operative tissue characterization. Six hundred patients undergoing transanal endoscopic evaluation of significant rectal polyps and tumours will be enrolled in at least five clinical sites across the European Union over a 4-year period. Video recordings will be analysed regarding dynamic fluorescence patterns centrally as software is developed to enable analysis with automatic classification to happen locally. AI-based classification and subsequently guided intervention will be compared with the current standard of care including biopsies, final specimen pathology and patient outcomes. DISCUSSION CLASSICA will validate the use of AI in the analysis of ICG fluorescence for the purposes of classifying significant rectal polyps and tumours endoscopically. Follow-on studies will compare AI-guided targeted biopsy or, indeed, AI characterization alone with traditional biopsy and AI-guided local excision versus traditional excision with regard to marginal clearance and recurrence.
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Affiliation(s)
- A Moynihan
- University College Dublin, Dublin, Ireland
| | - N Hardy
- University College Dublin, Dublin, Ireland
| | - J Dalli
- University College Dublin, Dublin, Ireland
| | - F Aigner
- Krankenhaus der Barmherzigen Brüder Graz, Graz, Austria
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
- European Association for Endoscopic Surgery, Eindhoven, The Netherlands
| | - R Hompes
- Ziekenhuis Oost-Limburg Autonome Verzorgingsinstelling, Genk, Belgium
| | - J Knol
- Ziekenhuis Oost-Limburg Autonome Verzorgingsinstelling, Genk, Belgium
| | - J Tuynman
- Stitching VUMC, Amsterdam, The Netherlands
| | - J Cucek
- Arctur, Nova Gorica, Slovenia
| | - J Rojc
- Arctur, Nova Gorica, Slovenia
| | | | - R Cahill
- University College Dublin, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
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Bakkers C, Rovers K, Rijken A, Mols F, Simkens G, Brandt-Kerkhof A, Tuynman J, Aalbers A, Kok N, Wiezer M, Reuver PD, Grevenstein WV, Hemmer P, Dijkgraaf M, Punt C, Tanis P, Hingh ID. P-275 Quality of life and symptoms in patients undergoing CRS-HIPEC with or without perioperative systemic treatment for colorectal peritoneal metastases: Results from the randomised CAIRO6 trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rovers K, Bakkers C, Nienhuijs S, Burger J, Creemers G, Brandt-Kerkhof A, Tuynman J, Aalbers A, Wiezer M, Reuver PD, Hemmer P, Grevenstein WV, Erve IV', Snaebjornsson P, Nederend J, Lahaye M, Dijkgraaf M, Punt C, Tanis P, Hingh ID. LBA-6 Safety, feasibility, tolerability, and preliminary efficacy of perioperative systemic therapy for resectable colorectal peritoneal metastases: Pilot phase of a randomised trial (CAIRO6). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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van Oostendorp SE, Sietses C, Hompes R, Kusters M, Tuynman J. Author response to: Evidence supporting the sunk cost fallacy of advocating for transanal total mesorectal excision. Br J Surg 2020; 107:e348. [PMID: 32506454 DOI: 10.1002/bjs.11719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 11/10/2022]
Affiliation(s)
- S E van Oostendorp
- Department of Surgery, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - C Sietses
- Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | - R Hompes
- Amsterdam UMC, Location AMC, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - M Kusters
- Department of Surgery, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - J Tuynman
- Department of Surgery, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
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Spinelli A, Carvello M, Sacchi M, Bonifacio C, Bertuzzi A, Tuynman J, Montorsi M, Foppa C. Transanal minimally invasive surgery (TAMIS) for anterior rectal GIST. Tech Coloproctol 2019; 23:501-502. [PMID: 31037577 DOI: 10.1007/s10151-019-01979-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 03/29/2019] [Indexed: 11/26/2022]
Affiliation(s)
- A Spinelli
- Division of Colon and Rectal Surgery, Department of Surgery, Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
| | - M Carvello
- Division of Colon and Rectal Surgery, Department of Surgery, Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - M Sacchi
- Division of Colon and Rectal Surgery, Department of Surgery, Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - C Bonifacio
- Division of Diagnostic Radiology, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - A Bertuzzi
- Division of Medical Oncology and Hematology, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - J Tuynman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - M Montorsi
- Division of General and Digestive Surgery, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - C Foppa
- Division of Colon and Rectal Surgery, Department of Surgery, Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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Bronzwaer MES, Koens L, Bemelman WA, Dekker E, Fockens P, Tuynman J, de Bruin G, Van Geloven A, Bruins Slot W, van der Hulst R, Vuylsteke R, Cahen D, Baan A, Dekkers P, den Boer F, Depla A, Bruin S, Jansen J, Gerhards M, Stokkers P, van Tets W, Mundt M, van de Ven A, Peters J, Cense H, van der Spek B, Dunker M, van Leerdam M, Aalbers A, Vlug M, Sonneveld D. Volume of surgery for benign colorectal polyps in the last 11 years. Gastrointest Endosc 2018; 87:552-561.e1. [PMID: 29108978 DOI: 10.1016/j.gie.2017.10.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/14/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Traditionally large, complex colorectal polyps were managed by surgical resection (SR), and in recent years endoscopic resection (ER) has progressed significantly. However, to what extent ER has replaced SR remains largely unknown. We performed a multicenter retrospective cohort study to assess the volume and volume changes of SR for benign colorectal polyps over the past decade. METHODS Patients who underwent SR for a benign colorectal polyp in the Netherlands between 2005 and 2015 were selected from the prospective nationwide Dutch Pathology Registry (PALGA database). Clinical characteristics were obtained from the charts of patients who underwent SR in the province of Noord-Holland. RESULTS A total of 5937 patients were treated with SR for a colorectal polyp and the absolute (454-739 per year) and relative volumes (0.20%-0.37% per colonoscopy per year) of SR remained stable. In the province of Noord-Holland, 928 patients (15.6%) underwent SR. In these patients, submucosal lifting and ER were attempted in 19.9% (n = 175) and 15.0% (n = 134). After 2010, patients were more likely to undergo lifting (27.7% vs 11.4%, P < .001) and ER attempts (18.8% vs 10.9%, P = .001) before definitive SR. Twenty-two patients (2.4%) had been referred to another endoscopy clinic. CONCLUSIONS SR for large, complex colorectal polyps is still frequently performed and has remained stable. A small percentage of patients underwent ER attempts before SR, and referral for an additional ER attempt only occurred in a minority of cases. To increase ER attempts, implementation of a regional multidisciplinary referral network should be considered.
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Affiliation(s)
- Maxime E S Bronzwaer
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Lianne Koens
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Willem A Bemelman
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Henneman D, Lagarde S, Geubbels N, Tuynman J, Jensch S, Van Wagensveld B. Complications after Laparoscopic Roux-en-Y gastric bypass: a diagnostic challenge. Report of three cases and review of the literature. G Chir 2012; 33:209-217. [PMID: 22958801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The number of Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) procedures for morbid obesity and type 2 diabetes mellitus will increase worldwide, and therefore, an increase in perioperative morbidity can be anticipated. The authors present three cases based on different complications after LRYGB to demonstrate the diagnostic challenge that clinicians face in this particular group of patients. Also, a review of the literature covering the value of different imaging in these particular cases is provided by the authors. The role of imaging in the diagnostic process is discussed.
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Affiliation(s)
- D Henneman
- St. Lucas Andreas Hospital, Amsterdam, The Netherlands
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