Evidence map›Paper›PMID 33048240›Full record

ArticleInternational journal of colorectal disease2021

Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal.

S Lindner, K von Rudno, J Gawlitza, J Hardt, F Sandra-Petrescu, S Seyfried, P Kienle, C Reissfelder, A Bogner, F Herrle

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of colorectal disease, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 2 pooled it
0.4field-weighted citation impact, top 35% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 2 syntheses or guidelines pooled it, 7 citations in OpenAlex.

  1. Preoperative anastomotic evaluation prior to ileostomy closure: A 5-year UK survey, systematic review, and meta-analysis.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2025
    Pooled it
  2. Pooled it
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

S LindnerDepartment of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
K von RudnoDepartment of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany.
J GawlitzaDepartment of Radiology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
J HardtDepartment of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
F Sandra-PetrescuDepartment of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
S SeyfriedDepartment of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
P KienleDepartment of Surgery, Theresienkrankenhaus Mannheim, Mannheim, Germany.
C ReissfelderDepartment of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
A Bogner *Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany.
F Herrle *Department of Surgery, University Hospital Mannheim, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. florian.herrle@umm.de.ORCID http://orcid.org/0000-0003-2424-2066
Heidelberg University · DEUniversity Hospital Carl Gustav Carus · DEDiabetesinstitut Heidelberg · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis study investigates whether contrast enema (CE) and flexible endoscopy (FE) should be performed routinely after low anterior resection (LAR) before ileostomy reversal. Additionally, the impact of previous anastomotic leakage (AL) on diagnostic test accuracy (DTA) was assessed.

methodsThis is a retrospective analysis of prospectively collected tertiary care data of two centers. Consecutive rectal cancer patients undergoing LAR with loop ileostomy formation were included. Before ileostomy reversal, all patients were assessed by CE and FE. DTA of FE and CE for asymptomatic AL in patients who had previously suffered from clinically relevant AL (group 1) compared with those without apparent AL after LAR (group 0) were assessed separately.

resultsTwo hundred ninety-three patients were included in the analysis, 86 in group 1 and 207 in group 0. Overall sensitivity for detection of asymptomatic AL was 76% (FE) and 60% (CE). Specificity was 100% for both tests. DTA of FE was equal or superior to CE in all subgroups. Prevalence of asymptomatic AL at the time of testing was 1.4% in group 0 and 25.6% in group 1.

conclusionFlexible endoscopy is the more accurate diagnostic test for the detection of asymptomatic anastomotic leaks prior to ileostomy reversal. Contrast enema showed no gain of information. In the group without complications after the initial rectal resection, 104 must be tested to find one leak prior to reversal. In those patients, routine diagnostic testing additional to digital rectal examination may be questioned.

Indexed as

IleostomyRectal NeoplasmsAnastomosis, SurgicalAnastomotic LeakContrast MediaEndoscopyEnemaHumansRetrospective StudiesContrast MediaAsymptomatic anastomotic leakContrast enemaDiagnostic test accuracyFlexible endoscopyIleostomy reversal

Identifiers

PMID33048240
PMCPMC7801265
OpenAlexW3091873526

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.