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Research in brief – The Lancet Gastroenterology & Hepatology

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Management of patients with liver derangement during the COVID-19 pandemic: an Asia-Pacific position statement

Eflornithine plus sulindac for familial adenomatous polyposis

The combination of eflornithine plus sulindac is not superior to either drug alone in patients with familial adenomatous polyposis (FAP), new research has shown. Carol Burke and colleagues randomly assigned patients with FAP to receive 150 mg of sulindac (n=58), 750 mg of eflornithine (n=57), or both (n=56) once daily for up to 48 months. Disease progression was noted in 22 (38%) patients in the sulindac group, 23 (40%) in the eflornithine group, and 18 (32%) in the combination group (hazard ratio [HR] for combination vs sulindac 0·71, 95% CI 0·39–1·32; p=0·29; HR for combination vs eflornithine 0·66, 0·36–1·24). Mean time to first disease progression was 25·2 months (95% CI 24·2–26·1) in the sulindac group, 19·7 months (18·2–21·1) in the eflornithine group, and 39·3 months (37·1–41·6) in the combination group. Treatment-related serious adverse events occurred in four (7%) patients in the sulindac group, one (2%) in the eflornithine group, and three (5%) in the combination group.

Preop intravenous iron before major abdominal surgery

Preoperative intravenous iron does not reduce need for blood transfusion when administered to patients with anaemia before major abdominal surgery, new research shows. In the PREVENTT trial, Toby Richards and colleagues randomly assigned patients with anaemia (haemoglobin less than 130 g/L for men and 120 g/L for women) due to undergo major open elective abdominal surgery to receive intravenous iron (n=244) or placebo (n=243) 10–42 days before surgery. Coprimary endpoints of death or blood transfusion occurred in 67 (28%) of 237 patients in the placebo group and 69 (29%) of 237 patients in the intravenous iron group (risk ratio 1·03, 95% CI 0·78–1·37; p=0·84). There were 111 blood transfusions in the placebo group and 105 in the intravenous iron group (rate ratio 0·98, 95% CI 0·68–1·43; p=0·93). Safety profiles were similar between the two groups.

Early detection of colorectal peritoneal metastases

Second-look surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) does not improve survival in patients at high risk of developing colorectal peritoneal metastases. Standard surveillance of these patients remains the most appropriate strategy. In the PROPHYLOCHIP–PRODIGE 15 trial, Diane Goéré and colleagues randomly assigned patients with a primary colorectal cancer and high risk of developing colorectal peritoneal metastases to receive surveillance (n=75) or systematic second-look surgery plus HIPEC (n=75). At median follow-up of 50·8 months, 3-year disease-free survival was 53% (95% CI 41–64) in the surveillance group compared with 44% (33–56) in the surgery group (HR 0·97, 95% CI 0·61–1·56). Major grade 3–4 postoperative complications occurred in 29 (41%) of 71 patients in the surgery group, and no patients died postoperatively.

Restarting endoscopies during recovery phase of COVID-19

Gastrointestinal endoscopies can be delivered safely despite the ongoing pandemic, according to new research from so-called COVID-minimised centres that serve patients confirmed to be free of active infection in the UK. Bu’Hussain Hayee and colleagues collected data from 6208 patients undergoing endoscopy between April 30 and June 30, 2020, across 18 centres. Before undergoing endoscopy, three (0·11%, 95% CI 0·00–0·33) of 2611 asymptomatic patients tested positive for SARS-CoV-2 on nasopharyngeal swab. At days 7 and 14, follow-up telephone symptom screening found no cases of COVID-19 in either patients or staff. These findings support the use of such an approach to restart gastrointestinal endoscopies and other outpatient diagnostics in the COVID-19 recovery phase.

Autologous FMT to prevent weight regain

Autologous faecal microbiota transplantation (FMT) prevents weight regain in abdominally obese or dyslipidaemic participants who lost weight on a healthy diet in the DIRECT-PLUS weight loss trial. Ehud Rinott and colleagues randomly assigned participants to follow healthy dietary guidelines (n=16), Mediterranean diet (including 28 g walnuts a day; n=35), or green-Mediterranean diet (including 28 g walnuts, three to four cups of green tea, and a Wolffia globosa green shake a day; n=39) for 6 months. Following this weight-loss phase, participants provided a faecal sample that was processed into autologous FMT capsules. Participants were randomly assigned to receive 100 capsules containing their own faecal microbiota (n=44) or placebo (n=46) until month 14. Autologous FMT significantly reduced weight regain in the green-Mediterranean diet group compared with placebo (17% vs 50%; p=0·02) but not in the dietary guidelines group (p=0·57) nor the Mediterranean diet group (p=0·64). Similarly, autologous FMT reduced waist circumference gain and insulin rebound in the green-Mediterranean diet group but not in the dietary guidelines or Mediterranean diet groups. No treatment-related adverse events were reported.