End-to-Side Anastomosis May Reduce Crohn’s Recurrence; Early-Onset Colorectal Cancer Burden Rises
A study finds end-to-side anastomosis for Crohn’s disease may reduce endoscopic recurrence, while global data show early-onset colorectal cancer has the highest GI cancer burden in young adults, with rising incidence. Both studies highlight evolving challenges and treatment options in gastroenterology.
Two new studies shed light on gastrointestinal diseases, with one evaluating a surgical technique for Crohn’s disease and another assessing the global burden of early-onset gastrointestinal cancers.
A retrospective chart review of 239 adult patients who underwent ileocecectomy for Crohn’s disease at a university center between 2018 and 2022 found that an end-to-side anastomosis configuration is safe and may reduce endoscopic recurrence. The analysis, published in Diseases of the Colon & Rectum, included 100 side-to-side, 70 end-to-end, 63 end-to-side, 3 side-to-end, and 3 Kono-S anastomoses. Mean patient age was 41 years, 43.1% were men, and 12% were active smokers.
End-to-side anastomoses were associated with shorter operation duration and less intraoperative blood loss compared with other configurations. The average length of stay was 4.71 days, with no significant difference among groups, and the overall anastomotic leak rate was 1.7%, again without significant difference. No differences were observed in rates of venous thromboembolism, pulmonary embolism, urinary, or respiratory complications.
At a mean follow-up of 32 months for 179 patients, endoscopic recurrence occurred in 5.7% of the end-to-side group versus 14.9% in the side-to-side group, though this did not reach statistical significance. After adjusting for age, sex, smoking, and medication exposure, elective operation and end-to-side configuration were significantly associated with reduced recurrence (odds ratio 0.20 and 0.30, respectively). The authors note that further investigation is needed to confirm end-to-side as a low-recurrence option.
Meanwhile, an analysis of Global Burden of Disease 2021 data, published in the Journal of Digestive Diseases, shows that early-onset colorectal cancer had the highest disease burden among gastrointestinal cancers in people aged 15–49 years globally in 2021. The age-standardized disability-adjusted life year rate was 101.37 per 100,000, followed by early-onset gastric cancer (97.73) and liver cancer (73.18).
While most early-onset GI cancers saw downward trends in age-standardized DALY rates from 1990 to 2021, early-onset pancreatic cancer showed a slight increase, and early-onset colorectal cancer incidence rose significantly (average annual percentage change 0.99). In 2021, the highest age-standardized incidence rate was for colorectal cancer (5.37 per 100,000). Men had a higher burden of early-onset GI cancers than women, except for gallbladder and biliary tract cancer. Smoking was the leading cause in men, while increased body mass index and dietary factors were major risk factors. Projections estimate that by 2040, early-onset colorectal cancer will have the highest disease burden, with an age-standardized DALY rate of 94.90 and incidence of 5.69 per 100,000.