An analysis of the accuracy of computed tomography colonography when defining anatomy for novel full‐thickness colonic excision techniques in early colonic neoplasia

Currie, Andrew; Burling, David; Mainta, Evgenia; Ilangovan, R.; Moorghen, Morgan; Lung, Phillip F. C.; Faiz, O; Kennedy, Robin H.

doi:10.1111/codi.13316

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…If the lesion is located at mesenteric side or involves more than half of the circumference of colonic wall, it is considered not suitable for FLEX due to risks of bleeding, ischemia and post-operative stricture. Currie et al (29,46) suggested computed tomography colonography (CTC) should be done to select patients for FLEX. In their study, CTC correctly identified the location of the lesions in relation to the mesenteric border in all patients.…”

Section: Flexmentioning

confidence: 99%

Combined endo-laparoscopic surgery for difficult benign colorectal polyps

Liu¹,

Jiang²,

Chan³

et al. 2020

J Gastrointest Oncol

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Prevention of colorectal cancer (CRC) depends largely on the detection and removal of colorectal polyps. Despite the advances in endoscopic techniques, there are still a subgroup of polyps that cannot be treated purely by endoscopic approach, which comprise of about 10-15% of all the polyps. These so-called "difficult colorectal polyps" are polyps with large size, morphology, at difficult location, scarring or due to recurrence, which have historically been managed by surgical segmental resection. In treating benign difficult colorectal polyps, we have to balance the operative risks and morbidities associated with surgical segmental resection. Therefore, combined endoscopic and laparoscopic surgery (CELS) has been developed to remove this subgroup of difficult benign polyps. We review the currently use of CELS for difficult benign colorectal polyps which includes laparoscopy-assisted endoscopic polypectomy (LACP), full-thickness laparo-endoscopic excision (FLEX) and colonoscopy-assisted laparoscopic wedge resection (CAL-WR).

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Section: Flexmentioning

confidence: 99%

Combined endo-laparoscopic surgery for difficult benign colorectal polyps

Liu¹,

Jiang²,

Chan³

et al. 2020

J Gastrointest Oncol

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“…8 Furthermore, it has been found to be accurate with regard to finely targeted interventions of the solid abdominal viscera 9 and more recently, the colon itself. 10 Is this anatomical difference important?…”

Section: Is Ct a Suitable Technique To Analyse This Anatomy?mentioning

confidence: 99%

Sex differences in the splenic flexure

Brookes

Macano

Stone

et al. 2017

annals

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INTRODUCTION Anecdotally, surgeons claim splenic flexure mobilisation is more difficult in male patients. There have been no scientific studies to confirm or disprove this hypothesis. The implications in colorectal surgery could be profound. The aim of this study was to assess quantitatively whether there is an anatomical difference in the position of the splenic flexure between men and women using computed tomography (CT). METHODS Portal venous phase CT performed for preoperative assessment of colorectal malignancy was analysed using the hospital picture archiving and communication system. The splenic flexure was compared between men and women using two variables: anatomical height corresponding to the adjacent vertebral level (converted to ordinal values between 1 and 17) and distance from the midline. RESULTS In total, 100 CT images were analysed. Sex distribution was even. The mean ages of the male and female patients were 68.1 years and 66.7 years respectively (p=0.630). The mean vertebral level for men was 8.88, equating to the inferior half of the T11 vertebral body (range: 1-17 [superior half of T9 to inferior half of L2]), and 11.36 for women, equating to the inferior half of the T12 vertebral body (range: 4-16 [superior half of T10 to superior half of L2]). This difference was statistically significant (p=0.0001) and is equivalent to one whole vertebra. The mean distance from the midline was 160.8mm (range: 124-203mm) for men and 138.2mm (range: 107-185mm) for women (p<0.0001). CONCLUSIONS The splenic flexure is both higher and further from the midline in men than in women. This provides one theory as to why mobilising the splenic flexure may be more difficult in male patients.

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“…Patients were reviewed using endoscopy, and the Paris Classification of the polyp was recorded. All patients considered for FLEX underwent a CT colonography (CTC) to define the location of the polyp, mesenteric relationship and proportion of bowel circumference involvement, as previously described . The CTC images were then reviewed using the overview and endoluminal and cross‐sectional views in order to plan and rehearse the surgery (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…The median (IQR) polyp diameter in the benign polyps was 35 (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) mm. The median specimen diameter for completed FLEX procedures was 53 (48.5-60) mm (Table 2) (Fig.…”

Section: Treatment Outcomesmentioning

confidence: 99%

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Evaluation of an early‐stage innovation for full‐thickness excision of benign colonic polyps using the IDEAL framework

et al. 2019

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Aims Colectomy is the current approach for patients with endoscopically unresectable benign polyps but risks considerable morbidity. Full-thickness laparoendoscopic excision (FLEX) is a novel procedure, specifically developed to treat endoscopically unresectable benign colonic polyps, which could reduce the treatment burden of the current approach and improve outcomes. However, traditional evaluations of surgical innovations lack methodological rigour. This study reports the development and feasibility of the FLEX procedure in selected patients. ConclusionsThe FLEX procedure is still under development. Early data demonstrate that it is safe for excision of selected benign polyps. Modifications to transcolonic suture delivery are now required and there is a need for wider adoption before more definitive evaluation can be performed. What does this paper add to the literature?This study has shown, through an examination of the feasibility of the full-thickness laparoendoscopic excision (FLEX) procedure for resection of complex, benign colonic polyps in clinical practice, that incorporating the Idea, Development, Evaluation, Assessment, Long-term study (IDEAL) framework guidance can enhance transparency and reduce information bias.

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An analysis of the accuracy of computed tomography colonography when defining anatomy for novel full‐thickness colonic excision techniques in early colonic neoplasia

Abstract: CTC can accurately assess the key morphological features for the selection of patients with early colonic neoplasia for full-thickness laparo-endoscopic excision.

Cited by 5 publications

References 14 publications

Combined endo-laparoscopic surgery for difficult benign colorectal polyps

Combined endo-laparoscopic surgery for difficult benign colorectal polyps

Sex differences in the splenic flexure

Evaluation of an early‐stage innovation for full‐thickness excision of benign colonic polyps using the IDEAL framework

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