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A study was conducted to evaluate and compare the benefits of gastric binding as against an optimal lifestyle program in the case of severely obese adolescents. Results indicated that gastric binding led to nearly 50% of weight loss and more benefits to health and quality of life.

A comparative study of the adjustable gastric banding and the conventional therapy used for the treatment of type 2 diabetes is presented. The surgical therapy is found to be more effective for the treatment, as it leads to greater weight loss.

Surgery at this point has been proposed as a means of reducing tumour burden, promoting a durable response to immunotherapy in patients with demonstrated tumour regression or stable disease after this time. Resection of residual disease in patients with metastatic gastrointestinal stromal tumors responding to treatment with imatinib. Int. J. Cancer 2005; 117: 316 - 25. 9 Okamura T, Kanda T, Hirota S, Nishimura A, Kawahara M, Nikkuni K. Imatinib therapy for a patient with metastasis of colonic gastrointestinal stromal tumor: report of a case. [Extracted from the article]

Background: Small bowel obstruction (SBO) is a common general surgical presentation and there has been a shift towards non-operative management (NOM) for patients with previous abdominal surgery. Historically, exploratory surgery has been mandated for SBO in patients with a virgin abdomen. However, there is increasing evidence for NOM in this group of patients. Methods: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was undertaken between 1995 and 2020 on Ovid MEDLINE, EMBASE and PubMed. Primary outcome measures were success and failure rates, whereas secondary outcome measures were morbidity, mortality rates and identifying underlying aetiologies. Results: Six observational studies were included, with 205 patients in the NOM and 211 patients in the operative group. There was a high success rate of 95.6% and low morbidity rate of 3.1% in the NOM group compared to 88.6% and 26% in the operative group, respectively. Both groups reported no mortalities. The most common aetiologies for SBO in a virgin abdomen were adhesions (63%), malignancy (11%), foreign body/bezoar (5%), internal hernia (4%) and volvulus (4%). Conclusion: NOM for SBO is a safe and feasible option for a select group of clinically stable patients with a virgin abdomen without features of closed-loop obstruction. Adhesions are the most common cause of SBO in this group of patients. Further large-scale prospective clinical studies with standardized NOM modality, homogenous clinical resolution indicators and long-term follow-up data are warranted to allow for quantitative analysis to reinforce this evidence. [ABSTRACT FROM AUTHOR]

Abdominal and pelvic computed tomography (CT) demonstrated numerous rounded radiodense material within the small bowel and caecum, with associated dilatation and air fluid levels (Fig. A 67-year-old man presented to hospital with 3 days of abdominal pain, nausea and obstipation after consuming whole cherries with pips 1 week prior to presentation (standard practice for patient). The patient was discharged home with a plan for outpatient CT colonography prior to elective bowel resection. [Extracted from the article]

Background: Anal intraepithelial neoplasia (AIN) is dysplasia in the epithelium of the anus and is a pre‐malignant condition associated with a low rate of progression to invasive squamous cell carcinoma (SCC). The natural history of progression for AIN to anal SCC is poorly defined. This study aims to review our experience with AIN and investigate the natural history of progression. Methods: Data on all patients with AIN from January 2005 to December 2015 were retrospectively reviewed. Three separate databases were searched – Colorectal, Radiation Oncology and Infectious Diseases. All databases were cross‐referred to obtain a complete but non‐duplicated data set. Electronic charts were reviewed to obtain clinical information. Results: Twenty‐eight patients were identified with AIN of various grades. There were 25 males, three females. Twenty of the male patients were human immunodeficiency virus (HIV) positive. Mean length of follow up was 56 months. Complete regression of AIN to normal was noted in 13 patients (46%). Four patients had persisting AIN III with no evidence of regression or malignant transformation. Nine patients with pre‐existing AIN developed SCC (32%). Seven were positive for HIV infection (all males). Median time to progression was 36 months. None of the patients demonstrated clear linear pattern of progression of AIN to SCC. Conclusion: High grade AIN may progress to anal SCC and surveillance is indicated. The exact natural history of progression for AIN is difficult to predict. There is no linear progression over time evident. HIV patients with AIN are at higher risk of developing SCC. [ABSTRACT FROM AUTHOR]

Introduction: Durability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of laparoscopic adjustable gastric banding (LAGB) with 20 years of follow-up.Methods: Systematic review with meta-analysis was performed on all eligble reports containing 10 or more years of follow-up data on weight loss after bariatric surgery. In addition, a prospective cohort study of LAGB patients measuring weight loss and reoperation at up to 20 years is presented.Results: Systematic review identified 57 datasets of which 33 were eligible for meta-analysis. Weighted means of the percentage of excess weight loss (%EWL) were calculated for all papers included in the systematic review. Eighteen reports of gastric bypass showed a weighted mean of 56.7%EWL, 17 reports of LAGB showed 45.9%EWL, 9 reports of biliopancreatic bypass +/− duodenal switch showed 74.1%EWL and 2 reports of sleeve gastrectomy showed 58.3%EWL. Meta-analyses of eligible studies demonstrated comparable results. Reoperations were common in all groups. At a single centre, 8378 LAGB patients were followed for up to 20 years with an overall follow-up rate of 54%. No surgical deaths occurred. Weight loss at 20 years (N = 35) was 30.1 kg, 48.9%EWL and 22.2% total weight loss (%TWL). Reoperation rate was initially high but reduced markedly with improved band and surgical and aftercare techniques.Conclusion: All current procedures are associated with substantial and durable weight loss. More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy. Reoperation is likely to remain common across all procedures. [ABSTRACT FROM AUTHOR]

De Jong, Tanya A., Stewart A. Skinner, Cathy Malcontenti-Wilson, Daphne Vogiagis, Michael Bailey, Ian R. van Driel, and Paul E. O'Brien. Inhibition of rat colon tumors by sulindac and sulindac sulfone is independent of K-ras (codon 12) mutation. Am. J. Physiol. Gastrointest. Liver Physiol. 278: G266-G272, 2000.--Nonsteroidal anti-inflammatory drug (NSAID) use reduces the risk of colorectal cancer by 40-50%. Previous studies suggest that effective inhibition of colorectal cancer by NSAIDs may be dependent on the presence or absence of a K-ras mutation. This study was aimed at determining the relationship between inhibition of colorectal cancer by sulindac and sulindac sulfone and the presence of activating K-ras mutations in the 1,2-dimethylhydrazine dihydrochloride rat model. Sulindac (20 mg [multiplied by] [kg.sup.-1] [multiplied by] [day.sup.-1]), sulindac sulfone (40 mg [multiplied by] [kg.sup.-1] [multiplied by] [day.sup.-1]), or vehicle was administered orally to male Sprague-Dawley rats for a 4-wk period beginning 20 wk after tumor induction. Tumor number and volume were measured before treatment by laparotomy and colonoscopy and again after treatment. Sulindac and sulindac sulfone treatment significantly reduced the number and volume of colorectal tumors compared with control rets. For K-ras (codon 12) mutation detection, frozen tumor tissue was collected at the endpoint. We found K-ras codon 12 mutations in 11 of 21 (52%) control tumors. The proportion of tumors with K-ras mutations in the sulindac-treated group [5 of 8 (62%); odds ratio = 1.51 (95% confidence interval = 0.29, 8.33)] and the proportion of sulindac sulfone-treated tumors [9 of 14 (64%); odds ratio = 1.63 (95% confidence interval = 0.41, 6.66)] were not significantly different from controls. Tumor inhibition did not correlate with K-ras (codon 12) mutation status, which suggests that the mechanism of inhibition of rat colorectal cancer by sulindac and sulindac sulfone is independent of K-ras mutation. colorectal cancer; 1,2-dimethylhydrazine dihydrochloride, nonsteroidal anti-inflammatory drugs

Background Botulinum toxin ( Botox) injection for chronic anal fissure ( CAF) is commonly performed, yet there remains no consensus on optimal dosage or frequency of injections required to achieve complete resolution of anal fissure. The aim of this study was to determine the effectiveness of Botox and side-effect profile in the management of CAF. Methods A retrospective clinical study of patients between 2010 and 2014 who underwent a Botox injection for CAF at a tertiary centre was performed. The effectiveness of Botox was measured using standardized outcomes including overall healing rate, presence of anal pain, recurrence and need for repeat botulinum injection. Binary outcomes were assessed using logistic regression model. The analysis was performed using Stata version 13 ( Stata Corp, College Station, TX, USA). Results One hundred and one patients underwent 126 Botox injections within the study period. The mean first post-operative visit was at 1 month. The overall recurrence rate was 32%. The majority of patients were given 33 U. No statistically significant relationship between dose and recurrence was identified. The presence of pain at the first post-operative visit was a predictor of future recurrence (odds ratio 3.92, confidence interval 1.58-9.74, P = 0.003). Conclusion Botox is an effective strategy for CAF. Low doses can be given with good efficacy as highlighted by our audit and has the potential for great cost saving. The best predictor of recurrence is the presence of pain at the first post-procedure visit. [ABSTRACT FROM AUTHOR]