Radiation enteritis leading to intestinal failure: 1994 patient-years of experience in a national referral centre

Kalaiselvan, R; Theis, V; Dibb, Martyn; Teubner, Antje; Anderson, I. D.; Shaffer, Jon; Carlson, Gordon L; Lal, Simon

doi:10.1038/ejcn.2013.251

Cited by 30 publications

(16 citation statements)

References 23 publications

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“…In the present study, based on the abovementioned data, the MSCT characteristics of CRC&R may be summarized as follows: i) The highest incidence (96.7%) was in patients with rectal lesions, followed by 30.5% in those with sigmoid colon lesions and 26.1% in those with both rectal and sigmoid colon lesions. It has been demonstrated that the intestinal sensitivity to radiation varies among different sites, and the order from highest to lowest is as follows: Rectum, sigmoid colon, transverse colon, ileum, jejunum and duodenum, consistently with data reported by relevant studies (23,24). ii) Intestinal changes included thickening of the involved intestinal walls and most cases exhibited a thickening of no more than 10 mm, and even thickening of the smooth muscle layer and entire intestinal wall.…”

Section: Discussionsupporting

confidence: 78%

Multi‑slice spiral CT evaluation of chronic radiation colitis and rectitis

Xiao

2020

Exp Ther Med

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The aim of the present study was to retrospectively analyse the multi-slice spiral CT (MSCT) findings of radiation colitis and rectitis (RC&R). A total of 23 cases of RC&R detected by helical CT were included. The CT findings and clinical and endoscopy data of the patients were reviewed. The primary tumours included cancers of the cervix (n=17), rectum (n=4), ovaries (n=1) and bladder (n=1). The total dose of radiation per patient was 46-60 Gy (mean, 49.7 Gy) delivered over 5 weeks. The CT manifestations included different degrees of increased thickness of the intestinal wall (n=20, 87.0%), with a maximum thickness of 16.6 mm. On enhanced CT, the target sign was observed (n=16, 69.9%), with an obviously enhanced mucosa and/or serosa and the following changes observed: Oedema and increased density of the mesentery (n=15, 65.2%); increased density of the subcutaneous fat, and blurred and oedematous pelvic wall muscles (n=4, 17.4%), with the obturator internus and levator ani muscles being most commonly affected; narrowed intestinal lumen (n=3, 13.0%); and a small amount of ascitic fluid (n=2, 8.7%) located in the paracolic sulci and bladder or Douglas pouch. The 23 patients underwent colonoscopy and were diagnosed with RC&R. The major manifestations included telangiectasia and mucosal hyperaemia (n=21, 91.3%). MSCT of chronic RC&R (CRC&R) was associated with certain characteristic findings, which, combined with a medical history of radiotherapy and the clinical manifestations, may prove to be of value in the diagnosis of CRC&R.

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Section: Discussionsupporting

confidence: 78%

Multi‑slice spiral CT evaluation of chronic radiation colitis and rectitis

Xiao

2020

Exp Ther Med

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“…Intestinal failure (IF) is a debilitating condition characterized by inability to maintain a state of adequate nutrition and/or fluid and electrolyte balance because of an anatomical and/or physiological disorder of the intestine. There are various causes of IF such as ischaemic bowel, Crohn's disease, radiation enteritis, enterocutaneous fistula caused by iatrogenic injury or enteroatmospheric fistula caused by open abdomen, malignancy and severe gastrointestinal dysmotility . IF can be an acute or a chronic condition.…”

Section: Introductionmentioning

confidence: 99%

European Society of Coloproctology consensus on the surgical management of intestinal failure in adults

et al. 2016

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Intestinal failure (IF) is a debilitating condition of inadequate nutrition due to an anatomical and/or physiological deficit of the intestine. Surgical management of patients with acute and chronic IF requires expertise to deal with technical challenges and make correct decisions. Dedicated IF units have expertise in patient selection, operative risk assessment and multidisciplinary support such as nutritional input and interventional radiology, which dramatically improve the morbidity and mortality of this complex condition and can beneficially affect the continuing dependence on parenteral nutritional support. Currently there is little guidance to bridge the gap between general surgeons and specialist IF surgeons. Fifteen European experts took part in a consensus process to develop guidance to support surgeons in the management of patients with IF. Based on a systematic literature review, statements were prepared for a modified Delphi process. The evidence for each statement was graded using Oxford Centre for Evidence-Based Medicine Levels of Evidence. The current paper contains the statements reflecting the position and practice of leading European experts in IF encompassing the general definition of IF surgery and organization of an IF unit, strategies to prevent IF, management of acute IF, management of wound, fistula and stoma, rehabilitation, intestinal and abdominal reconstruction, criteria for referral to a specialist unit and intestinal transplantation.

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“…PN is ineffective and probably harmful in oncological patients in whom there is no gastrointestinal reason for intestinal failure [ 23 ]. In chronic radiation enteritis that evolves into intestinal failure, home PN appears to be a reasonable treatment option and is possibly superior to surgery [ 24 , 25 ].…”

Section: General Conceptsmentioning

confidence: 99%

SEOM clinical guidelines on nutrition in cancer patients (2018)

et al. 2019

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Nutritional deficiency is a common medical problem that affects 15–40% of cancer patients. It negatively impacts their quality of life and can compromise treatment completion. Oncological therapies, such as surgery, radiation therapy, and drug therapies are improving survival rates. However, all these treatments can play a role in the development of malnutrition and/or metabolic alterations in cancer patients, induced by the tumor or by its treatment. Nutritional assessment of cancer patients is necessary at the time of diagnosis and throughout treatment, so as to detect nutritional deficiencies. The Patient-Generated Subjective Global Assessment method is the most widely used tool that also evaluates nutritional requirements. In this guideline, we will review the indications of nutritional interventions as well as artificial nutrition in general and according to the type of treatment (radiotherapy, surgery, or systemic therapy), or palliative care. Likewise, pharmacological agents and pharmaconutrients will be reviewed in addition to the role of regular physical activity.

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Radiation enteritis leading to intestinal failure: 1994 patient-years of experience in a national referral centre

Cited by 30 publications

References 23 publications

Multi‑slice spiral CT evaluation of chronic radiation colitis and rectitis

Multi‑slice spiral CT evaluation of chronic radiation colitis and rectitis

European Society of Coloproctology consensus on the surgical management of intestinal failure in adults

SEOM clinical guidelines on nutrition in cancer patients (2018)

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