Selective ileostomy guided by CRP and CT in a rectal cancer trial, botulinum toxin fails to prevent fistula, and hemoclips cut delayed polypectomy bleeding

The edition in brief

In a randomised trial of 200 patients with stage II or III mid or low rectal cancer undergoing laparoscopic low anterior resection, a selective strategy (daily CRP from day 1, contrast CT if CRP reached 114 mg/L on day 3 or rose more than 15 mg/L per day, ileostomy only if CT was suspicious) cut ileostomy formation to 22.0% against 100% with routine diversion, with leaks of 0% versus 1.0% and similar overall complications (31.0% vs 32.0%). The trial was single-setting, small for leak, and retrospectively registered. A phase 2 open-label trial of 50 patients found that preoperative botulinum toxin into the sphincter of Oddi did not reduce grade B/C pancreatic fistula after distal pancreatectomy (28.6% vs 15%, P = 0.294) and was stopped early. A Nordic registry cohort of 784,105 people with obesity found bariatric surgery associated with fewer obesity-related cancers (adjusted IRR 0.81, 95% CI 0.77-0.85) but more pancreatic cancer, particularly in younger adults (aIRR 2.21). A meta-analysis of 10 randomised trials (4,588 patients) found prophylactic hemoclips halved delayed post-polypectomy bleeding after thermal resection of polyps of 5 mm or more (3.4% vs 6.5%, RR 0.51).