Abstract Introduction Colorectal cancer is the third most common malignant neoplasm worldwide, with ~ 150 thousand new cases each year. Screening policies have brought significant progress due to the possibility of early diagnosis and polyp resection. Therefore, there is a need for continuous evaluation of the quality of colonoscopies based on well-established criteria in the literature. Materials and Methods The present retrospective study assesses the quality of colonoscopies performed at a tertiary hospital, comparing resident physicians with their preceptors. A total of 422 preceptor exams and 115 resident exams were evaluated, with a comparison of the adenoma detection rate, cecal intubation rate, examination time, and bowel preparation quality. Results The adenoma detection rate in the exams performed by preceptors was of 46.9%, while in those performed by residents, it was of 35.2% (p = 0.038). The cecal intubation rate was of 98.6% in the preceptor group and of 94.8% in the resident group (p = 0.025). The median total examination time was of 13 minutes and 42 seconds in the preceptor group and of 19 minutes and 22 seconds in the resident group (p < 0.005). Conclusion During their training, resident physicians perform an adequate number of colonoscopies, which enables them to achieve adenoma detection rates, cecal intubation and examination times within the limits proposed by the literature. worldwide 15 year resection Therefore wellestablished well established literature hospital 11 evaluated 469 46 9 46.9% residents 352 35 2 35.2 p 0.038. 0038 0.038 . 0 038 0.038) 986 98 6 98.6 948 94 8 94.8 0.025. 0025 0.025 025 0.025) 1 4 0.005. 0005 0.005 005 0.005) training rates 46.9 3 35. 003 0.03 03 98. 94. 002 0.02 02 000 0.00 00 46. 0.0 0.

Abstract Introduction Evaluation of patients' reports of characteristics of rectal effluents as a predictor of the quality of the colonoscopy preparation assessed by the endoscopist. Methods A total of 270 patients, aged 18 or older, were consecutively included to perform an outpatient colonoscopy, for a period of 8 months. Demographic and clinical data were collected and evaluated, as well as the rectal effluents' characteristics and data concerning the colonoscopy. The quality of bowel preparation was evaluated by employing the Boston Bowel Preparation Scale. The association between rectal effluents and the quality of preparation was verified by binary logistic regression. Results Of the 270 patients, 67.3% were female, with a mean age of 59.69 ± 12.48 years. Reports of dark and thick, dark orange, or brown and thick effluents produced a higher likelihood of inadequate preparation (OR 4.26, CI 95% 1.51; 11.14, p = 0.004). Conclusions Reports of dark and thick, dark orange, or brown and thick rectal effluents are predictors of inadequate preparation in the endoscopist assessment. patients 27 1 older months Scale regression 673 67 3 67.3 female 5969 59 69 59.6 1248 12 48 12.4 years orange OR 426 4 26 4.26 95 1.51 151 51 1114 11 14 11.14 0.004. 0004 0.004 . 0 004 0.004) assessment 2 6 67. 596 5 59. 124 12. 42 4.2 9 1.5 15 111 11.1 000 0.00 00 4. 1. 11. 0.0 0.

Abstract Introduction Colonic polyps and diverticulosis are common colon findings on colonoscopy. One of the risk factors of colorectal polyps and diverticulosis is the anthropometric index. Therefore, we aimed to investigate the association between the anthropometric index and colorectal findings. Methods In this cross-sectional study, we included 536 patients referred to Razi Hospital, Rasht, Iran, in 2023 for colonoscopy evaluation. Demographical data, clinical characteristics, and colonoscopy findings were recorded for further analysis. All data were analyzed using SPSS.16 by considering a significant level < 0.05 Results The results showed that 35.4% of the patients had polyps, with the majority having a single polyp. The patient's mean age was 55.94 ± 13.33 years; most were females (54.1%). The most common type of polyp was pedunculated, and most were located in the sigmoid colon. The prevalence of diverticular was 11.4%, most of which were also located in the sigmoid colon. Obesity was significantly associated with an increased risk of polyps, while overweight individuals had a higher risk of diverticula (P < 0.05). Age, rural residence, and low physical activity level were identified as factors associated with an increased risk of polyps and diverticula. Conclusion The findings suggest that obesity and overweight are risk factors for polyps and diverticula, respectively. Further research is warranted to explore additional factors and develop preventive strategies for colorectal diseases. These results support the need for preventive strategies and screening programs to reduce the risk of future colorectal lesions. Therefore crosssectional cross sectional study 53 Hospital Rasht Iran 202 evaluation characteristics analysis SPSS16 SPSS 16 SPSS.1 005 0 05 0.0 354 35 4 35.4 patient s 5594 55 94 55.9 1333 13 33 13.3 years 54.1%. 541 54.1% . 54 1 (54.1%) pedunculated 114 11 11.4% P 0.05. 0.05) Age residence respectively diseases lesions 5 20 SPSS1 SPSS. 00 0. 3 35. 559 9 55. 133 13. 54.1 (54.1% 11.4 2 54. (54.1 11. (54. (54 (5 (

Abstract Introduction Patients with colonic obstruction are at risk for emergency resection, which is a risk factor for increased mortality and morbidity. In left-sided obstructive colon cancer, the principle of bridge-to-surgery is already recommended to reduce complications. From this treatment strategy, the obstruction treatment is derived. In this treatment strategy, bowel wall distention is reduced by minimizing stool production through laxatives and dietary measures. Short-term outcomes have already shown promising results. This study aims to evaluate long-term outcomes in patients treated with this obstruction treatment. Methods This is a multicenter prospective study that included patients who presented with symptomatic colonic obstruction and radiologic confirmation of obstruction between May 2019 and August 2020 in the contributing hospitals. Patients with malignant and benign colonic obstruction were included. Follow-up in this study consisted of at least 36 months. Endpoints of the study included 1- and 3-year stoma and mortality rates. Results Ninety-eight patients were included in this study. For the overall cohort complication, reoperation, and readmission rates after one year were 37%, 14%, and 10% respectively. Overall, 3-year mortality was 21%. The presence of a stoma after 1 year was 18%, and after 3 years 17% in this cohort. Conclusion Long-term results of this study indicate that obstruction treatment has acceptable long-term outcomes in terms of mortality and stoma rates, compared to literature on emergency surgery and bridge-to-surgery alternatives. Permanent stoma rates are lower, compared to the literature on other treatment strategies in bowel obstruction. resection morbidity leftsided left sided cancer bridgetosurgery bridge complications strategy derived measures Shortterm Short term longterm long 201 202 hospitals Followup Follow up months 3year Ninetyeight Ninety eight complication reoperation 37 37% 14 14% 10 respectively Overall 21 21% 18 18% 17 Longterm Long alternatives lower 20 2

Abstract Treatment of fistula in ano by seton has become less in vogue due to the complications and disadvantages associated with its use. In its place, more technically demanding and expensive procedures, with less morbidity but more recurrence, such as endorectal advancement flaps and laser, are being employed more commonly. To overcome some of the limitations of conventional seton, we have designed a composite seton. In the present study, we evaluated our experience with a composite seton made from two silastic vessel loops sutured together with 5-0 polypropylene. The composite seton was found to not present many of the disadvantages of the conventional seton. The use of the composite seton resulted in low incontinence and recurrence rates, less pain, and high quality of life. This technically simple and cheaper material may have a wider applicability. place procedures laser commonly study 50 5 0 5- polypropylene rates pain life applicability

Abstract Introduction Almost 25% of colorectal cancer (CRC) patients have synchronous colorectal liver metastasis (SCLM) coinciding with the disease diagnosis. Liver-first approach for the treatment of SCLM involves neoadjuvant chemotherapy, subsequent liver resection, and then primary tumor resection. This strategy is adopted as the prognosis of the disease depends mainly on the metastases, not the primary tumor. This study aims to evaluate the feasibility of the liver-first approach and clinical prognosis in managing SCLM. Materials and Methods This retrospective study included 25 patients with SCLM from July 2015 to July 2020. All patients were subjected to a liver-first approach with an "intention-to-treat" approach. Follow-up was planned for at least 3 years. Data were collected from the hospital records and included survival rates and univariate analyses of the prognostic factors, such as gender, age, and number of chemotherapy cycles to evaluate their effect on the survival probability. Results Nineteen patients completed the treatment paradigm. Long-term outcomes reported a median overall survival (OS) of 32 months. One-year and 3-year survival probabilities were 89.5% and 42.1%, respectively. The median disease-free survival was 13 months. The number of metastatic lesions, unilobar versus bilobar disease, and the frequency of administered chemotherapy cycles significantly affected survival (p < 0.05). Seven patients (36.84%) remained disease free (no recurrence) while 2 patients (10.53%) survived with recurrence. The overall mortality included 10 deaths (52.63%) due to recurrence. Conclusion Synchronous colorectal liver metastasis treated with the liver-first approach achieved a notable overall advantage. However, the recurrence rate remained relatively high. CRC (CRC (SCLM diagnosis Liverfirst Liver first resection metastases liverfirst 201 2020 intentiontotreat intention treat "intention-to-treat Followup Follow up years factors gender age probability paradigm Longterm Long term OS (OS months Oneyear One year 3year 895 89 5 89.5 421 42 1 42.1% respectively diseasefree lesions p 0.05. 005 0.05 . 0 05 0.05) 36.84% 3684 36 84 (36.84% no 10.53% 1053 53 (10.53% 52.63% 5263 52 63 (52.63% advantage However high 20 202 8 89. 4 42.1 00 0.0 36.84 368 (36.84 10.53 105 (10.53 52.63 526 6 (52.63 42. 0. 36.8 (36.8 10.5 (10.5 52.6 (52.6 36. (36. 10. (10. 52. (52. (36 (10 (52 (3 (1 (5 (

Abstract Introduction This article describes an unusual case of perianal Paget's Disease in a 42-year-old man, highlighting distinct characteristics about more typical cases. Case report 42-year-old male patient with persistent perianal lesion, recurrent abscesses, and discomfort. Magnetic resonance imaging indicated a possible fistulous path. Biopsy revealed secondary anal Paget's disease and adenocarcinoma. Chemotherapy and radiotherapy treatment demonstrated a positive response. Discussion Perianal Paget's Disease is a rare condition of the anal canal that is part of the Extramammary Paget's Disease (EMPD) group. Symptoms include itching, pain, perianal bleeding, and skin lesions. Diagnosis can be challenging and usually involves performing a histopathological biopsy associated with an immunohistochemical study. Treatment varies and may involve surgery, radiotherapy, and chemotherapy. Due to the rarity of the disease, the best therapeutic approach is not yet well defined, and follow-up is essential due to the risk of recurrence. Conclusion Perianal Paget's Disease is rare and requires differentiation from other conditions. Early detection is essential to prevent malignancy. Pagets Paget s 42yearold yearold 42 year old man cases lesion abscesses discomfort path adenocarcinoma response EMPD (EMPD group itching pain bleeding lesions study surgery chemotherapy defined followup follow up recurrence conditions malignancy 4

Abstract Introduction Constipation is a common clinical condition, particularly among cancer patients. Objective To assess the prevalence and severity of CF in women with high-grade intraepithelial neoplasia (HSIL) and cervical cancer (CC), as well as the impact of this condition on their daily lives. Methods A cross-sectional study was conducted at a tertiary cancer center. To assess the presence and severity of constipation, the Rome IV criteria, and the Constipation Scoring System (CSS) were used. To assess the impact of constipation on daily life, the Visual Analogue Scale (VAS) was used. Results The study included 153 patients with HSIL or CC, with a median age of 44 (IQR 35–56) years. Constipation was reported in 54 (35.3%) patients, 33 (61.1%) of those with HSIL, and 21 (38.9%) of those with CC. In constipated patients, the median number of positive Rome IV criteria items was 3 (IQR 2–5). "Irregular or hard stools" was the most common complaint, affecting 41 (75.9%) of the patients. In patients with CC, the use of analgesic medications was associated with constipation (p = 0.016). There is no link between constipation and invasive cancer (p = 0.492). Constipation had a daily impact of 7.5 (IQR 4.75–9), with no relationship between VAS and clinical diagnosis (HSIL or CC) [7 (IQR 3-9) X 8 (5-9.5), p-value = 0.536] The more severe the constipation, the more disturbing it is to these women's daily lives. Conclusion Constipation is common in women with cervical lesions, affecting their daily lives regardless of their severity. highgrade high grade CC , (CC) crosssectional cross sectional center CSS (CSS used life (VAS 15 4 IQR 35–56 3556 35 56 years 5 35.3% 353 (35.3% 61.1% 611 61 1 (61.1% 2 38.9% 389 38 9 (38.9% 2–5. 25 2–5 . 2–5) Irregular stools complaint 75.9% 759 75 (75.9% p 0.016. 0016 0.016 0 016 0.016) 0.492. 0492 0.492 492 0.492) 7 7. 4.75–9, 4759 4.75–9 4.75–9) [ 39 3-9 59.5, 595 9.5 (5-9.5) pvalue value 0.536 0536 536 womens s lesions (CC 35–5 355 35.3 (35.3 61.1 6 (61.1 38.9 (38.9 2– 75.9 (75.9 001 0.01 01 049 0.49 49 475 4.75– 3- 59 59.5 95 9. (5-9.5 0.53 053 53 35– 35. (35. 61. (61. 38. (38. 75. (75. 00 0.0 04 0.4 47 4.75 59. (5-9. 0.5 05 (35 (61 (38 (75 0. 4.7 (5-9 (3 (6 (7 4. (5- ( (5

Abstract Obstetric anal sphincter injury affects about 5.7% of primiparous women who deliver vaginally. Perineal injury during childbirth is a common event with important morbidity associated with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries—OASIS). As there was a lack of consistency in the classification of a partial anal sphincter injury, with up to 33% of consultant obstetricians classifying a complete or partial tear of the EAS as a second-degree tear. We have proposed simple, digital diagrammatic drawings to visually represent all degrees (grades) of OASIS based on the WHO OASIS classification. 57 5 7 5.7 vaginally thirdandfourth third and fourth also injuriesOASIS. injuriesOASIS injuries . injuries—OASIS) 33 seconddegree second simple grades (grades 5. injuries—OASIS 3

Abstract Objective To evaluate the relapse rate after discontinuation of biological therapy in patients with Crohn's disease treated at the University Hospital. Methods This is a series of 9 cases of CD patients who used long-term immunobiologicals. Non-randomized sample, followed for 1 year, prospectively. Results Nine patients were studied, 8 females, with an average age of 43.8 years, and non-smokers. The average time of use of the immunobiological for suspension was 6.77 years, with 66.66% of them having been in use for more than 5 years. The mean initial CDAI was 25. After 6 months of follow-up, CRP was less than 10 mg/L in 88.8% of them. Only 3 patients measured the Calprotectin, low. (10, 15 and 30 mcg/g). The ESR averaged 15.77 mm/h. In 66.6% of those studied, the 6-month colonoscopy was normal - mayo 0. In the 1-year follow-up, 3 patients underwent CT, normal. At 1-year colonoscopy of 3 patients, there was endoscopic recurrence in 2. The mean CDAI after the first year was 38.11. The mean ESR was 17.11 mm/h. The worst outcomes occurred in 2 (20%) patients, both Montreal A3L3B2, with clinical and endoscopic recurrence. The same previous immunobiological was reintroduced, with excellent clinical response. Conclusion Individualized analysis of the course of the disease proves to be the best way for adequate clinical monitoring during its use, optimization of the therapeutic regimen, and the possibility of interruption. Crohns Crohn s Hospital longterm long term immunobiologicals Nonrandomized Non randomized sample prospectively studied females 438 43 43. years nonsmokers. nonsmokers non smokers. smokers non-smokers 677 77 6.7 6666 66 66.66 25 followup, followup follow up, up follow-up mgL mg L 888 88 88.8 Calprotectin low 10, (10 mcg/g. mcgg mcg/g . mcg g mcg/g) 1577 15.7 mmh mm h mm/h 666 66.6 6month month 0 1year CT 3811 38 11 38.11 1711 17 17.1 20% 20 (20% A3L3B2 ALB A B reintroduced response regimen interruption 4 67 7 6. 88. (1 157 15. 66. 381 38.1 171 17. (20 A3L3B ( 38. (2

Abstract As it is an infrequent etiology, the diagnosis of perianal tuberculosis is challenging, especially in the absence of a pulmonary focus. TB should be considered in the differential diagnosis of perianal ulcers, fistulas, abscesses, mainly in non-healing and recurrent anal lesions. Treatment with anti-TB agents can provide complete recovery. Furthermore, these lesions are often diagnosed later after complete histopathological and mycobacterial results, where the benefit of avoiding morbid multiple surgeries by effective anti-TB treatment is lost. We reported a rare case of an immuno-competent patient with perianal TB, which was the first manifestation of the disease. A fit-and-well man in his 20s presented a large perianal abscess. Unexpectedly, his chest X-ray showed a rounded hyper-transparency in the left lung. The abscess was drained. Posterior investigation with culture analysis from pus swabs and sputum revealed the presence of Mycobacterium tuberculosis complex infection. After completing the 6 months of oral administration of anti-TB drugs, the patient was asymptomatic. By highlighting this unusual manifestation, we aim to improve clinicians' awareness of perianal TB, facilitating early recognition and appropriate management. etiology challenging focus ulcers fistulas abscesses nonhealing non healing antiTB anti recovery Furthermore results lost immunocompetent immuno competent disease fitandwell fit well s Unexpectedly Xray X ray hypertransparency hyper transparency lung drained infection drugs asymptomatic clinicians management

Abstract Introduction Surgical site infections (SSIs) remain a significant concern in colorectal surgery, impacting patient outcomes and healthcare costs. Mechanical bowel preparation (MBP) and antibiotic prophylaxis are widely used strategies to reduce the incidence of SSIs. However, their effectiveness and the associated risks continue to be topics of debate within the medical community. This review aims to assess the current evidence on the use of MBP and antibiotics in preventing SSIs during colorectal procedures, highlighting the benefits, controversies, and ongoing discussions in the field. Objective This review evaluates the effectiveness and controversy surrounding the use of mechanical bowel preparation (MBP) and antibiotic prophylaxis in preventing surgical site infections (SSIs) during colorectal procedures. Methodology The review looks at a variety of research, such as meta-analyses and trials, and examines the timing, choice of antibiotics, and various facets of MBP. Findings Prophylactic antibiotic use considerably lowers SSIs; however, resistance issues are raised. MBP works well, but there are debates over the risks involved. With continuous discussions, combined antibiotic-MBP methods are prevalent. Conclusion the evaluation acknowledges the potential for prevention but emphasizes the need for careful use that takes patient variables into account. Optimal techniques are the subject of ongoing study, which emphasizes the dynamic nature of SSI prevention in colorectal surgery. (SSIs surgery costs (MBP However community procedures benefits controversies field research metaanalyses meta analyses trials timing however raised well involved antibioticMBP prevalent account study

Abstract Introduction and Objectives Certolizumab Pegol (CZP) is an anti-TNF agent approved in Brazil for Crohn's disease (CD). There is a lack of data in Brazil and Latin America detailing real-world experiences with CZP. The primary objective was clinical remission in weeks 26 and 54. The secondary endpoints were clinical response in weeks 26 and 54, endoscopic remission, biological switch rates, rates of CD-related surgery, persistence with treatment over time, and adverse events. Remission and clinical response were defined as HBI ≤4 and ≥3 points reduction of HBI, respectively. Endoscopic remission was defined as the complete healing of the intestinal mucosa. Methods This observational and retrospective study included patients with CD from 4 Brazilian centers who received CZP during their disease course. Results Forty-five patients were included. The median age was 42.16 years old, 53.3% had perianal involvement, 37.8% had undergone previous surgery, and 71.1% of patients were anti-TNF naïve. Clinical remission was observed in 73.2% and 62.5% of patients at weeks 26 and 54, respectively. Clinical response was observed in 14.63% and 18.75% in weeks 26 and 54, respectively. Endoscopic remission was observed in 36.4% of patients. A switch to biological therapy was performed in 57.8% of patients. Eleven patients underwent abdominal surgery; 62.25% discontinued treatment with CZP, with a median of 16 months, and 22.2% presented drug-related adverse events. Conclusions CZP in CD was associated with clinical remission and response rates compatible with international real-world case series. Most patients needed to switch to biological therapy due to inadequate disease control. (CZP antiTNF anti TNF Crohns Crohn s CD. . (CD) realworld real world 2 54 CDrelated related surgery time events ≤ 3 ≥ respectively mucosa course Fortyfive Forty five 4216 42 42.1 old 533 53 53.3 involvement 378 37 8 37.8 711 71 1 71.1 naïve 732 73 73.2 625 62 5 62.5 1463 14 63 14.63 1875 18 75 18.75 364 36 36.4 578 57 57.8 6225 25 62.25 months 222 22 22.2 drugrelated drug series control (CD 421 42. 53. 37. 7 71. 73. 6 62. 146 14.6 187 18.7 36. 57. 622 62.2 22. 14. 18.

Abstract Introduction The involvement of circular RNAs (circRNAs) in cancer research has been emphasized in recent years due to evidence of their involvement in malignancy pathogenesis. Yet, the involvement of circRNAs in the resistance to cancer treatment remains to be clarified. Circular RNA 0001313 (circ_0001313) has a distinct expression in different cancers, and it is overexpressed in rectal cancer; hence, it could be a promising non-invasive stable biomarker and a therapeutic target for rectal cancer. Yet, its predictive role has not been studied in Egyptian rectal cancer patients. Objective To study the predictive value of circulating circ_0001313 (circ_CCDCC6) in assessing the response to neoadjuvant chemoradiotherapy (nCRT) in patients with rectal cancer and its relation to radiological and pathological response. Materials and Methods The present study included 50 patients with locally advanced rectal cancer and 20 healthy subjects as controls. The analysis of the relative circ_CCDCC6 expression was performed using the real-time quantitative polymerase chain reaction (qPCR) method. Results The circ_CCDCC6 was found to be significantly more expressed in rectal cancer patients compared with controls (p < 0.001). Moreover, its expression level was significantly higher in nonresponders to nCRT compared with responders (p < 0.001). Furthermore, a receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of circulating circ_0001313; its sensitivity in predicting the response to treatment was of 93.33%, and its specificity was of 91.43%. Conclusion Significant up-regulation of circ_0001313 in rectal cancer suggests a potential oncogenic role, and higher expression of circ_0001313 among nonresponders suggests that it could be a predictor of the response to nCRT. (circRNAs pathogenesis Yet clarified 000131 circ0001313 circ (circ_0001313 cancers hence noninvasive non invasive circ_000131 circCCDCC6 circCCDCC CCDCC6 CCDCC (circ_CCDCC6 (nCRT 5 2 circ_CCDCC realtime real time qPCR (qPCR method p 0.001. 0001 0.001 . 0 001 0.001) Moreover Furthermore ROC (ROC 9333 93 33 93.33% 9143 91 43 91.43% upregulation up regulation 00013 circ000131 (circ_000131 circ_00013 (circ_CCDCC 000 0.00 00 933 9 3 93.33 914 4 91.43 circ00013 (circ_00013 circ_0001 0.0 93.3 91.4 circ0001 (circ_0001 circ_000 0. 93. 91. circ000 (circ_000 circ_00 circ00 (circ_00 circ_0 circ0 (circ_0 circ_ (circ_ (circ