Anoscrotal fistula is a rare variant of anal fistula, often mimicking primary scrotal disease and causing diagnostic delay. Unlike typical cryptoglandular fistulas, anoscrotal extensions are frequently linked to Crohn's disease, tuberculosis, hidradenitis suppurativa, or actinomycosis. Published data remain scarce, especially in Europe. This study aimed to describe the clinical features, etiologies, imaging findings, management, and outcomes of anoscrotal fistulas treated in a French tertiary center. We retrospectively reviewed all men managed for anoscrotal fistula at the Institute of Proctology, Paris Saint-Joseph Hospital, between 2014 and 2024. Demographic, clinical, radiological, surgical, and outcome data were analyzed. Healing was defined as closure of all fistula openings without recurrence at last follow-up. Twenty-nine patients were included (mean age 48.2 years). Initial presentation was abscess in 55% and purulent discharge in 45%. External scrotal openings were present in 90%. Magnetic resonance imaging (MRI) identified complex tracts in 59% of cases. Etiologies were cryptoglandular (63%), Crohn's disease (15%), hidradenitis (11%), tuberculosis (7%), and actinomycosis (4%). Nineteen patients (66%) had prior anorectal surgery. Most (72%) underwent initial seton drainage, followed by fistulotomy (31%), advancement flap (12%), or other sphincter-preserving techniques. A urologist was involved in 31% of cases. After a median follow-up of 22 months, 59% healed, 28% had persistent disease, and none recurred once healed. Continence was preserved, and 73% of patients were highly satisfied. No predictors of healing were identified. This series represents one of the largest European experiences with anoscrotal fistula. Findings emphasize frequent non-cryptoglandular causes, the key role of MRI, and the need for multidisciplinary, individualized management.

Small bowel adenocarcinoma (SBA) is rare. Palliative chemotherapy was evaluated mainly in retrospective studies. No randomized trial has been previously performed to evaluate front line chemotherapy in advanced SBA. Randomized, non-comparative, open-label, multi-center phase II study to evaluate mFOLFOX (D1=D15: oxaliplatin 85 mg/m2, folinic acid: 400 mg/m2, 5FU bolus: 400 mg/m2 followed by 5FU: 2400 mg/m2 IV infusion over 46 h) and mFOLFIRINOX (mFOLFOX plus irinotecan 180 mg/m2, without 5FU bolus) in the first line treatment of unresectable locally advanced or metastatic SBA. Ampullary carcinoma and MSI-H/dMMR SBA are excluded. The primary endpoint is to assess the percentage of patients alive without progression at 8 months. In each arm, assuming a null hypothesis of 40 % of patients free of progression at 8 months, and a target percentage of 55 %, 65 patients per arm are needed with 85 % power and 10 % one-sided type I error. Randomizations started in February 2024.

Obesity is increasing among patients with inflammatory bowel disease, but bariatric surgery has been rare in this group owing to concerns about worsening the inflammatory bowel disease. The aim of the study was to evaluate inflammatory bowel disease-related outcomes following bariatric surgery. Nationwide cohort of all adult patients in Sweden between 2007 and 2020 with obesity and inflammatory bowel disease. Patients were matched 1 : 1 with a two-stage matching process between those undergoing bariatric surgery with those who did not (classified by inflammatory bowel disease subtype followed by a propensity score match including sex, age, number of previous targeted therapies, presence of immunotherapy, cumulative oral corticosteroid dose, and previous intestinal surgery). The primary composite outcome comprised inflammatory bowel disease-related hospitalization, initiation of corticosteroid therapy, immunomodulation, commencement of a new targeted therapy or major inflammatory bowel disease-related surgery. The study included 798 patients with inflammatory bowel disease and obesity: 399 who underwent bariatric surgery (145 Crohn's disease, 238 ulcerative colitis, 16 unclassified inflammatory bowel disease) versus 399 who did not. Over a median observation period of 3.3 years in the surgery group and 3.0 years in the non-surgery group, the composite primary endpoint occurred in 201 patients who had surgery (incidence rate 11.9 (95% confidence interval (c.i.) 10.2 to 13.5) per 100 person-years) and 226 without surgery (incidence rate 15.1 (13.1 to 17.0) per 100 person-years), corresponding to an adjusted hazard ratio of 0.66 (95% c.i. 0.51 to 0.85) in those undergoing bariatric surgery compared with those who did not. Bariatric surgery was associated with improved inflammatory bowel disease-related outcomes among patients with inflammatory bowel disease and obesity, suggesting a potential benefit from bariatric surgery among patients with concomitant obesity and inflammatory bowel disease.

This real-life study is designed to investigate the short and long-term efficacy and safety of teduglutide (TED) and its effects on the quality of life (QoL) in a cohort of adult, stable patients with short bowel syndrome and chronic intestinal failure receiving long-term parenteral support (PS). A prospective, single-center study was conducted for individuals who began to take TED between March 2017 and August 2023. Ten patients were included in the analysis, among whom the median duration of TED administration was 48 (range, 12-71) months. Data relative to short-term clinical outcomes demonstrate that 4 of 10 (40%) patients were early responders to TED therapy, defined as a >20% reduction in PS requirement at 3 months. Six of the 10 (60%) were non-responders. Data relative to 48 months long-term clinical outcomes demonstrated the absence of late responder patients and underline that all 4 early TED responder patients continued to maintain a sustained reduction in PS. Indeed, two of the 4 patients (50%) responding to TED discontinued PS while the other 2 patients (50%) reduced the number of weekly PS infusions by approximately 50%. The physical and mental components of the QoL improved significantly (P < 0.05) in responsive patients but did not change in non-responsive ones. Predictability of response to TED therapy in this study seemed to be linked to 1) SBS type 3, which was completely absent in the non-responder patients (P < 0.0001), 2) the residual small bowel length was significantly (P < 0.02) higher in responder (102 ± 18 cm) compared to non-responder patients (67 ± 27 cm), and 3) SBS type 1 and 2, enterostomy, surgical complications are significantly predictive of no response. Crohn's disease is equally present in both responder and non-responder patients. The number of side effects observed in our experience was extremely small both at the 3rd (0.01 n°/d/patients) and at the 48th month (0.001 n°/d/patients). No endoscopic neoplastic lesions were observed up to the 48th month of TED therapy. This real-world experience allows us to state that, after 48 months of treatment, TED: 1) is a safe therapy with minimal, rare side effects; 2) produces a rapid reduction in PS volumes in 40% of treated patients; 3) consents 20% of enrolled patients to be weaned off PS; 4) maintains a stable nutritional state and, finally, 5) significantly improves the QoL.

We aimed to assess gastrointestinal cancers risks in a large cohort of individuals with primary antibody deficiency (PAD) and their association with risk of autoimmune and inflammatory gastrointestinal diseases. Investigating a French national database of inpatient admissions between 2010 and 2018, we identified 12,748 patients with PAD and 38,244 control non-exposed individuals. We performed multiple exposed-non-exposed studies using conditional logistic regression. In comparison with non-exposed patients, PAD patients had increased risk of in situ gastric carcinoma (Odds Ratio (OR) =10.5 [95 % CI 2.2; 50.5]), malignant gastric tumor (OR=3.2 [95 % CI 2.2; 4.4]) and colorectal cancer (OR=1.2 [95 % CI 1; 1.5]). PAD patients had also increased risk of pernicious anaemia (OR=8 |95 % CI 5.6; 11.5]), Crohn's disease (OR= 4.4 [95 % CI 3.5; 5.6]), ulcerative colitis (OR=2.9 [95 % CI 2.4; 3.6]) and coeliac disease (OR=13.3 [95 % CI 9.1; 19.5]). Within patients with gastric cancer, those with PAD had increased risk of pernicious anaemia (OR=8.4 [95 % CI 1.5; 215]; p = 0.01) but not of H. pylori infection. Risk of gastric cancer is particularly high in PAD patients and notably risk of in situ gastric carcinoma in association with pernicious anaemia. It supports indication of early endoscopic screening in these patients.