Maria de Lourdes Setsuko Ayrizono

Background/objective: Crohn’s Disease (CD) is a chronic inflammatory bowel disease that affects micronutrient levels, impacting metabolic pathways. Homocysteine (Hcy) levels, regulated by folate and vitamin B12, are associated with cardiovascular and extraintestinal manifestations (EIMs). This study aims to analyze the dietary intake and serum concentrations of folate and vitamin B12 and their relationship with systemic complications in patients with CD in remission and active phases. Methods: This cross-sectional study included 60 patients, and nutrient intake was stratified into tertiles by disease phase. The metabolic safety of folate and B12 was evaluated by characterizing metabolic risk patterns associated with elevated Hcy. Statistical analyses evaluated associations between dietary intake, metabolic safety, and disease phenotype. Results: Vitamin B12 intake was negatively associated with erythrocyte sedimentation rate and positively associated with the absence of EIMs. Serum folate and non-HDL cholesterol levels were lower in the active group. Clinical vitamin B12 deficiency was more frequent in active disease, contributing to an elevated Hcy risk. Stricturing/penetrating phenotypes showed lower vitamin B12 levels compared to non-stricturing, non-penetrating phenotypes. Additionally, 96% of patients with structuring/penetrating disease were at high Hcy risk, while 30% of patients with non-stricturing, non-penetrating disease were in the lowest risk category. Conclusions: The data suggest that folate and B12 levels could be markers for clinical characteristics and associated metabolic risk in patients with CD. Our study highlighted associations that may justify the importance of nutritional follow-up and biochemical assessments in the clinical routine of patients with CD.

Background: Iatrogenic ureteral injuries (IUI) are rare surgical complications in abdominopelvic surgeries, with an incidence varying between 0.15 and 1.0%. Aims: To evaluate the incidence of IUI in elective colorectal surgeries performed in a tertiary university hospital. Methods: This is a retrospective analysis of patients operated from 2004 to 2022, who presented IUI. Demographic data, underlying disease, predisposing factors, surgery access, location of the lesions and their characteristics, diagnosis time, treatment carried out, and follow-up were analyzed. Results: In the period, 2,312 abdominopelvic surgeries were performed, of which 1,998 were open and 314 were laparoscopic, with 19 IUI (0.82%). The mean age was 55.6 years, 57.9% were male, and 89.5% were white. The majority of patients were overweight (52.6%), and 73.7% had a history of abdominal surgery. Primary rectal adenocarcinoma was the most common disease (47.4%), followed by tumor recurrences (21.0%). IUI occurred in 1.91% of laparoscopic surgeries and 0.65% of open surgeries (p=0.053); patients with tumor recurrence presented more IUI than those with primary tumors or benign diseases (p=0.006). They were commonly observed in the left ureter (52.6%) and in the distal portion (89.5%), the main mechanism being the section (57.9%). Intraoperative diagnosis occurred in 12 patients (63.2%). IUI correction was predominant in ureteral reimplantation and end-to-end ureteral anastomosis. Postoperative complications were common (47.4%), and one patient died from causes unrelated to surgery. Conclusions: IUI presented low incidence in colorectal elective surgeries and were more frequent in surgeries for tumor recurrences, in the left ureter and the distal third. Early diagnosis with repair of the injury provided better results.

Juvenile polyposis syndrome (JPS) is an inherited autosomal dominant disease that is distinguished by the emergence of numerous juvenile polyps within the gastrointestinal (GI) tract and has an increased risk of cancer. JPS is associated with germline mutations of the BMPR1A or SMAD4 genes. We aim to describe a case of familial occurrence of the SMAD4 germline pathogenic variant c.403C>T in a Brazilian family. We present a case of an 18‐year‐old female with rectal bleeding and chronic anemia who had a family history of colorectal issues—her mother had a total colectomy due to multiple polyps, and her maternal grandfather died from colorectal cancer (CRC). Despite a negative physical examination for attenuated familial adenomatous polyposis (AFAP) signs, a colonoscopy revealed around 30 proximal colon polyps of juvenile nature. These were systematically removed through multiple sessions, and an upper digestive endoscopy uncovered a few sessile inflammatory polyps. Notably, no polyps were found in the small intestine via double‐balloon enteroscopy. After polyp removal, her bleeding episodes ceased, and her anemia resolved. She now maintains her health through biennial colonoscopies, upper digestive endoscopies, and endoscopic capsule procedures. Genetic testing identified a pathogenic mutation in exon 3 of the SMAD4 gene (c.403C>T), resulting in a truncated SMAD4 protein (p.Arg135   ^∗ ). While previously documented in international databases, this represents the first report of a Brazilian family carrying this variant. Additionally, no mutations were found in the BMPR1A gene during genetic testing. In conclusion, molecular analysis confirmed the familial occurrence of the SMAD4 germline pathogenic variant c.403C>T within this Brazilian family.

Rectal anastomotic stricture (RAS) is a significant complication following rectal resection. Several techniques have been proposed for its management. However, treating complete strictures remains challenging. To describe a simple, safe, and effective technique for the treatment of complete RAS using a circular stapler under ileocolonoscopic guidance. A 43-year-old man underwent laparoscopic anterior resection of the rectum for a 7 cm serrated adenoma located 10 cm from the anal verge. The anastomosis was created 8 cm from the anal verge, and a protective loop ileostomy was fashioned. Histopathological analysis revealed a sessile serrated adenoma confined to the mucosa with foci of intramucosal carcinoma (TisN0). At 2 years postoperatively, delayed follow-up due to the COVID-19 pandemic revealed a complete RAS. Computed tomography (CT) with contrast administered through both the ileostomy efferent loop and the rectum demonstrated a short (< 1 cm) stricture at the anastomosis. The patient underwent transanal correction using a single-port system, assisted by colonoscopy through the ileostomy efferent loop. After circumferential stricturoplasty, a 31 mm circular stapler was used to perform reanastomosis under colonoscopic guidance. The patient had an uneventful recovery and was discharged on postoperative day 1. The ileostomy was closed after 45 days, and the patient presented only minimal symptoms of low anterior resection syndrome. Transanal stricturoplasty followed by circular stapler reanastomosis under endoscopic guidance appears to be a safe, simple, and effective approach for managing complete benign RAS. This technique may be considered in cases refractory to endoscopic dilation, in the place of redo surgery.

Crohn’s disease (CD) is a chronic, idiopathic inflammatory bowel condition with increasing incidence globally. For a long time, the treatment for ileal disease relied on surgery for complications or refractoriness to conventional clinical management. With the advent of immunobiological agents, the natural history of the disease has been altered, establishing a new treatment paradigm. This study aimed to perform a systematic review (SR) depicting the role of surgical resection in the post-biological era, especially as initial therapy for limited disease. A comprehensive search of PubMed, PubMed PMC, BVS/BIREME, CINAHL, Web of Science, Embase, Cochrane Library, and ProQuest databases was performed, including studies published up to July 2025. Six retrospective and two prospective studies were included, all developed in Europe, except for one in Canada. Only one included a pediatric population. Of the eight studies, two directly compared ileocolic resection with biological therapy. The remaining studies assessed only surgical outcomes. Five studies evaluated complications after surgical treatment and one after medical treatment, with median rates of 10% and 3%, respectively. Five studies analyzed clinical remission rates, and five assessed endoscopic remission at varying follow-up times. At approximately 1 year of follow-up, endoscopic remission rates ranged from 29% to 79% in the surgical group and from 48% to 84% in the biologics group. Clinical remission was assessed only in the surgical group, with rates of 60%, 83.7%, and 92% at 1 year, and 74% and 88% at 10 years. In the direct comparison of surgery versus biological therapy, only one study evaluated the subsequent need for additional biological treatment during follow-up, and this need was similar among the groups. Ileocolectomy is an effective and viable therapeutic alternative to primary biological therapy for localized and refractory ileal CD. Early surgery can offer more sustained control for specific phenotypes, reducing the need for long-term treatment. The decision should be individualized, taking into account risks, disease phenotype, and patient preferences. Further randomized trials are needed to refine recommendations.

Background: Crohn’s disease (CD) is a chronic inflammatory condition requiring regular follow-up through consultations and monitoring via laboratory, radiographic, and endoscopic examinations. Fecal calprotectin (FC) and magnetic resonance (MR) enterography are prominent non-invasive methods for assessing disease activity. However, while MR enterography is a valuable diagnostic tool, its high cost and limited accessibility present challenges for widespread use. In contrast, FC is a more affordable and accessible biomarker. To perform a systematic review (SR) examining the correlation between FC levels and MR enterography findings in patients with ileal CD. Methods: A systematic literature search was conducted across the following databases: PubMed, PubMed PMC, BVS-BIREME, SCOPUS, Web of Science, EMBASE, and Cochrane Library, and it was completed in October 2024. Results: Eight studies were included in this SR. Seven demonstrated a positive correlation between FC levels and MR enterography findings. Additionally, two studies reported significantly lower FC levels in ileal CD than in exclusive colonic or ileocolonic CD cases. The FC cutoff values ranged from >100 to >430 µg/g of feces to determine the activity of the disease. Conclusions: FC proved to be a reliable biomarker for diagnosing and monitoring CD, demonstrating a positive correlation with findings from MR enterography.

Background: Aggressive fibromatosis, also known as desmoid tumor (DT), is a locally aggressive myofibroblastic neoplasm originating from deep soft tissues, characterized by an infiltrative growth pattern with a tendency for local recurrence. DTs account for 0.03% of all neoplasms, and cases associated with familial adenomatous polyposis (FAP) account for 5–15% of DTs. Aims: The aim of this study was to report the prevalence of DTs in patients operated on for FAP, describe the epidemiological profile, and evaluate the risk factors for tumor development, treatments performed, associated complications, and follow-up. Methods: This retrospective study assessed the medical records of patients with FAP who underwent surgery between 1990 and 2021 and developed DTs during follow-up. Results: In the study period, 147 patients with FAP were operated on; of these, 97 underwent total proctocolectomy with ileal-pouch anal anastomosis, 33 underwent total colectomy with ileorectal anastomosis (IRA), 14 underwent total proctocolectomy with terminal ileostomy, and three underwent total colectomy with partial proctectomy and low IRA using an ileal-pouch. A total of 26 patients (17.7%) developed DT; most were female (61.5%), were White (73.1%), and had a family history (84.6%). The most frequent complications were intestinal and ureteral obstructions. Long-term follow-up showed that six patients were free of disease, 14 were stable and undergoing drug therapy, four died due to complications of the disease, and two were lost to follow-up. Conclusions: The prevalence of DT tumor was relatively high and more commonly observed in patients with a family history of the tumor. The disease presented high rates of morbidity and mortality.

BACKGROUND: The carcinogenesis of colorectal cancer is well understood. Adenomas are the precursor lesions in about 70% of cases, highlighting the importance of screening programs.

Background: To evaluate the relationship between the ratio of affected lymph nodes (LNR) and clinical and anatomopathological variables in patients with rectal adenocarcinoma submitted or not to neoadjuvant chemoradiotherapy. Methods: The LNR was determined by dividing the number of compromised LNR by the total number of LNR dissected in the surgical specimen. Patients were divided into two groups: with QRT and without QRT. In each group, the relationship between LNR and the following variables was evaluated: degree of cell differentiation, depth of invasion in the rectal wall, angiolymphatic /perineural invasion, degree of tumor regression and occurrence of metastases. The LNR was evaluated in patients with more than 1, LNR (LNR >12) or less (LNR<12) in the surgical specimen with overall survival (OS) and disease-free survival (DFS). The results were expressed as the mean with the respective standard deviation. Qualitative variables were analyzed using Fisher’s exact test, while quantitative variables were analyzed using the Kruskal -Wallis and Mann-Whitney tests. The significance level was 5%. Results: We evaluated 282 patients with QRT and 114 without QRT, between 1995-2011. In the QRT Group, LNR showed a significant association with mucinous tumors (P=0.007) and degree of tumor regression (P=0.003). In both groups, LNR was associated with poorly differentiated tumors (P=0.001, P=0.02), presence of angiolymphatic invasion (PT2; P<0.0001, P=0.02); Compromised LNR (P<0.0001, P<0.01), metastases (P<0.0001, P<0.01). In patients with QRT, LNR12 with DFS and OS (17.984; 95%CI5.931-54.351; P<0.001 and 10.286; 95%CI 2.654-39.854; P=0.007, respectively). Conclusion: LNR was associated with histological aspects of poor prognosis, regardless of the use of QRT. In the occurrence of less than 12 evaluated LNR, the LNR was associated only with the DFS.