Solitary rectal ulcer syndrome—The role of autofluorescence colonoscopy

Solitary Rectal Ulcer Syndrome Is Not Always Ulcerated: A Case Report

Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults that is characterized by a series of symptoms such as rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, a feeling of incomplete defecation, constipation and, rarely, rectal prolapse. The etiology of this syndrome remains obscure, and the diagnosis is easily confused with that of other diseases, contributing to difficulties in treatment. We present a case of a 37-year-old male with a nonulcerated rectal lesion grossly resembling a superficial depressed rectal cancer misdiagnosed in another hospital and describe its appearance on endoscopy and in the analysis of its pathological manifestations. The aim of this case report is to report an easily misdiagnosed case of SRUS, which needs to be distinguished from superficial rectal cancer, which should be educational for endoscopists.

Clinical Trials and Basic Research in Photodynamic Diagnostics and Therapies from the Center for Laser Diagnostics and Therapy in Poland

The purpose of this review is to present an overview of the development of photodiagnostic and photodynamic therapy (PDD and PDT) techniques in Poland. The paper discusses the principles of PDD, including fluorescent techniques in determining precancerous conditions and cancers of the skin, digestive tract, bladder and respiratory tract. Methods of PDT of cancer will be discussed and the current state of knowledge as well as future trends in the development of photodynamic techniques will be presented, including the possibility of using photodynamic antimicrobial therapy. Research pioneers in photodynamic medicine such as Thomas Dougherty are an inspiration for the development of methods of PDD and PDT in our Clinic. The Center for Laser Diagnostics and Therapy in Bytom, Poland, promotes the propagation of PDD and PDT through the training of clinicians and raising awareness among students in training and the general public. Physicians at the Center are engaged in photomedical research aimed at clinical implementation and exploration of new avenues in photomedicine while optimizing existing modalities. The Center promotes dissemination of clinical results from a wide range of topics in PDD and PDT and serving as representative authorities of photodynamic medicine in Poland and Europe.

Solitary Rectal Ulcer Syndrome: A Narrative Review

Solitary rectal ulcer syndrome is a multifactorial pathology, which entails a variety of clinical, histologic and endoscopic aspects that needs step-wise logical approach for management especially in relapsing refractory cases. Apart from the diagnostic dilemma that may be faced due to similarities of presentation with inflammatory bowel diseases or colorectal neoplastic lesions, the syndrome also overlaps with dyssynergic defecation syndrome, health anxiety disorder, obsessive compulsive disorder, and latent mucosal rectal prolapse, a systematic composite treatment modality including psychological, pharmacological, physiological and possibly surgical interventions are sometimes essential. Selecting appropriate treatment in this condition not only affects clinical outcome but also patients’ experience and further stigma of SRUS life-long. In this review, we will discuss the detailed pathophysiology, diagnostic and therapeutic approaches in dealing with solitary rectal ulcer syndrome.

Does the Numerical Colour Value (NCV) correlate with preneoplastic and neoplastic colorectal lesions?

BACKGROUND

White light endoscopy (WLE) is the gold standard for detection of colorectal cancer. Autofluorescence endoscopy (AFE) is among the novel methods expected to increase the sensitivity and specificity of endoscopic diagnosis. The main objective of the study was to determine the diagnostic efficacy of AFE for the detection of preneoplastic and neoplastic colorectal lesions and to identify high-grade neoplasia using Numerical Colour Value (NCV).

METHODS

This retrospective study included 188 patients with colorectal mucosal lesions diagnosed on WLE and assessed using AFE; they were included in the study if a complete patient record was available (description of visualized colorectal lesions, NCV and histopathology report). The NCV was compared with the histological result.

RESULTS

Histology revealed 38 hyperplastic colon polyps, 77 low-grade dysplastic lesions, 17 high-grade dysplastic lesions, 24 adenocarcinomas and 32 inflammatory lesions. The mean NCVs of high-grade dysplasia (HGD) and adenocarcinoma were 2.24 ± 0.22 and 2.73 ± 0.16, respectively, significantly higher than the NCV of hyperplastic colon polyps (0.95 ± 0.06), low-grade dysplasia (LGD) (1.27 ± 0.05) and inflammatory lesions (1.26 ± 0.17). The NCV cut-off value for HGD and adenocarcinoma was set at 1.7. The sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) were 95.2%, 87.9%, 97.5%, 84.8%, respectively.

CONCLUSION

Our study showed that AFE could provide useful diagnostic information regarding preneoplastic and neoplastic colorectal lesions. Additionally, the NCV significantly correlated with the histopathology results.

The benefits of targeted endoscopic biopsy performed using the autofluorescence based diagnostic technique in 67 cases of diagnostically difficult gastrointestinal tumors

INTRODUCTION

The search for new diagnostic and therapeutic procedures is an essential task in contemporary oncology. The purpose of our study was the evaluation of the practical usefulness of autofluorescence endoscopy (AFE) using the Onco-LIFE system, compared with the use of white light endoscopy (WLE), and the estimation of the correlation between the histopathological evaluation with the degree of lesions' Numerical Color Value (NCV index) and the method's sensitivity and specificity valuation.

MATERIAL

67 patients were analyzed at the Center for Laser Diagnostics and Therapy. All patients previously had a gastrointestinal tract tumor, which appeared malignant, but without histopathological confirmation. We measured NCV, estimated the correlation of the clinical diagnosis based on histopathological evaluation with the degree of NCV index from gastrointestinal lesions, and calculated the sensitivity and specificity of this method.

RESULTS

In the group of 67 patients, we found 44 cases of primary or secondary cancers and 7 cases of non-epithelial malignancies. In this group (51 patients) we identified 13 colorectal cancers and 38 upper gastrointestinal cancers. Based on the NCV index at NCV > 1.0, we revealed, that the sensitivity for malignant neoplastic lesions was 100% and the specificity was 73%, while for NCV > 1.5, the sensitivity for malignant neoplastic lesions was 86% and the specificity 100%.

CONCLUSION

AFE using the Onco-LIFE system is a helpful tool to perform targeted biopsies at the outset. A significant correlation was found between lesions' NCV index and the grade of dysplasia or tumor malignancy. AFE sensitivity and specificity is higher than WLE. Further studies are needed, especially performed by expert endoscopists.

Solitary rectal ulcer syndrome: A systematic review

BACKGROUND

Solitary rectal ulcer (SRUS) may mislead the inflammatory bowel disease (IBD) or rectal polyps, which may reduce the actual prevalence of it. Various treatments for SRUS have been described that can be referred to therapeutic strategies such as biofeedback, enema of corticosteroid, topical therapy, and rectal mucosectomy. Nevertheless, biofeedback should be considered as the first stage of treatment, while surgical procedures have been offered for those who do not respond to conservative management and biofeedback or those who have total rectal prolapse and rectal full-thickness.

METHODS

A systematic and comprehensive search will be performed using MEDLINE, PubMed, Scopus, EMBASE, AMED, the Cochrane Library, and Google Scholar.

RESULTS

The results of this systematic review will be published in a peer-reviewed journal.

CONCLUSION

To our knowledge, our study discusses the factors involved in the pathogenesis, clinical symptoms, diagnosis, treatment, and management of patients. This review can provide recommended strategies in a comprehensive and targeted vision for patients suffering from this syndrome.