Defecation disorders following rectal resection have long been overlooked as an inevitable surgical complication due to the lack of established diagnostic criteria or definitions. However, these disorders have been recently termed low anterior resection syndrome (LARS), which is a defecation disorder that occurs following rectal resection and impairs the patient's quality of life (QOL). The LARS score developed by Emmertsen et al., which is a patient-reported outcome measure to evaluate the severity of bowel dysfunction following rectal surgery by scoring the major symptoms of LARS, facilitates the diagnosis and assessment of LARS and enables international comparison and validation through the use of validated scores generated according to the international standards. Based on comparisons with other evaluation instruments, the use of the LARS score is strongly recommended internationally for LARS screening in patients following rectal resection. Recent findings have indicated that multiple pathophysiological changes, including reservoir function and evacuation of the neorectum, anal sphincter function, negative impact of a diverting stoma, autonomic denervation, and radiotherapy, are involved in the etiology of LARS. Due to the lack of established treatments and prevention of LARS, a suggested treatment chart for patients with LARS was presented in the Management Guidelines for Low Anterior Resection Syndrome (MANUEL) project. Future surgical treatment should focus not only on the radical cure of cancer and safety of treatment but also on the maintenance and improvement of QOL, with particular attention to the preservation of function. Particularly for rectal cancer, surgeons must formulate treatment plans that consider the prevention and treatment of LARS.

Crohn's disease (CD) causes gastrointestinal symptoms (i.e., diarrhea and abdominal pain), systemic symptoms (i.e., fatigue, anemia, weight loss, and fever), and perianal fistulas that produce anal pain. Because of the frequent occurrence of diarrhea and ulcers in the rectum, CD is often exacerbated by perianal abscesses and/or fistulas. Perianal fistulizing CD (PFCD) has an unknown etiology and recurring symptoms such as pain and discharge, which seriously affects the patient's quality of life (QOL). In the past, radical surgery was performed for PFCD, but due to the risk of anal sphincter impairment, conservative therapy using antibiotics and immunosuppressive medications is currently the first treatment option. PFCD management has greatly improved with the use of biologics such as the antitumor necrosis factor alpha (TNF-α) antibodies infliximab and adalimumab. In this review, the results of the administration of anti-TNF-α (certolizumab pegol), anti-interleukin-12/23 (ustekinumab), and anti-α₄β₇ integrin antibodies (vedolizumab) were evaluated. Our investigation showed that these medications may be effective for maintenance therapy to prevent the recurrence of anal fistulas. In addition to biologics, molecular target drugs and even regenerative medicine using mesenchymal stem cells have been introduced to further expand the treatment options for consideration by medical personnel. We herein discuss the management of PFCD by focusing on studies conducted in the United States and Europe where researchers used recommended guidelines and consensus statements to evaluate the efficacy of each medication and published their findings in peer-reviewed journals.

The tumor microenvironment has recently been well-studied in various gastrointestinal cancers, including colorectal cancer (CRC). The gut microbiota, a collection of microorganisms in the human gastrointestinal tract, is one of the microenvironments associated with colon carcinogenesis. It has been challenging to elucidate the mechanisms by which gut microbiota contributes to carcinogenesis and cancer progression due to complex interactions with the host, including its metabolites and immune and inflammatory responses. Various studies described the influence of diet on reported changes in the composition and microbiota of gut bacteria and its association with CRC. In recent years, metagenomic techniques such as shotgun sequencing and genome-wide association studies focused on understanding the role of the microbiota and the metabolome on early CRCs and colon carcinogenesis to determine if there are modifiable or intervenable targets for CRC. In this review, we will attempt to provide an overview of gut microbiota related to CRC, with particular attention to the findings of recent studies.

Fever and diarrhea are the common symptoms of Clostridioides difficile infection (CDI); however, pseudomembranous enteritis, megacolonization, and paralytic ileus have been observed in severe cases. C. difficile spores are resistant to several types of disinfectants. Thus, they are often the causative pathogens of healthcare-associated infections. Rapid diagnostic tests based on glutamate dehydrogenase and toxins are the mainstay of CDI laboratory diagnosis owing to their simplicity. CDI can be diagnosed with high specificity using the nucleic acid amplification test, a genetic test for C. difficile toxins. The risk factors for CDI include age ≥65 years; history of antimicrobial use; previous hospitalization; history of gastrointestinal surgery, chronic kidney disease, or inflammatory bowel disease; nasal tube feeding; and use of proton pump inhibitors and histamine H2 receptor antagonists. The risk of CDI development persists even 1 year after discontinuation of proton pump inhibitor use. Furthermore, colorectal surgery and radical cystectomy with urinary diversion are associated with high incidences of postoperative CDI. The choice of therapeutic agent depends on the severity of the disease and recurrence. However, a combination of oral or nasogastric vancomycin, intracolonic vancomycin, and intravenous metronidazole can be considered in patients with toxic megacolonization and paralytic ileus. In January 2024, the European Committee on Antimicrobial Susceptibility Testing established a breakpoint for fidaxomicin (minimum inhibitory concentration breakpoint > 2 mg/L) against C. difficile. Rapid progress has been achieved in CDI treatment. Thus, multidisciplinary teams must collaborate to diagnose, treat, and control CDI.

Objectives: Squamous cell carcinoma of the anal canal (SCCA) is a rare condition. Standard treatment includes chemoradiotherapy, with surgical treatment reserved for limited cases. In the future, the decrease in surgical frequency makes it more difficult to pathologically assess the depth of tumor invasion and lymph node status; therefore, those studies based on relatively recent surgical cases may offer valuable insights into diagnosing and treating SCCA.

Methods: This multicenter, retrospective cohort study evaluated 435 patients with SCCA in Japan, of which 84 underwent surgical lymph node dissection. The correlation of regional/extraregional lymph node metastasis with T-primary tumor category/depth of tumor invasion, and the index of estimated benefit from lymph node dissection (IEBLD) was evaluated histopathologically.

Results: Primary tumor progression was associated with metastasis and recurrence of the inguinal node and further inferior mesenteric trunk/root node metastasis, an extraregional lymph node. The IEBLD for the inferior mesenteric trunk/root node was 6.9, which was higher than 4.0 IEBLD of the lateral lymph nodes classified as the regional lymph nodes.

Conclusions: The assessment of the primary tumor involvement can predict metastases of the inguinal node and inferior mesenteric trunk/root node and recurrence of the inguinal node. Although the UICC TNM Classification considered the inferior mesenteric trunk/root nodes as extraregional lymph nodes, actively targeting them with the treatment can improve the prognosis.

Objectives: This study aimed to evaluate the safety and long-term outcomes of a one-stage resection and anastomosis approach without preoperative decompression in patients with left-sided incomplete obstructive colorectal cancer.

Methods: We conducted a retrospective analysis of 571 patients diagnosed with pT3-4NanyM0 left-sided colorectal cancer who underwent radical resection and primary anastomosis without preoperative decompression or a diverting stoma from April 2012 to December 2019. Of these, 97 (17%) patients presented with incomplete obstruction, while 474 (83%) had no obstruction. Incomplete obstruction was characterized by the inability of a small-caliber endoscope to pass through the tumor without necessitating emergency surgery or decompression due to bowel obstruction. We compared perioperative short-term outcomes, as well as the 5-year overall survival rate and the 5-year relapse-free survival rate between the two groups.

Results: Patients in the incomplete obstruction group experienced significantly longer median intervals between admission and surgery (6 vs. 2 days, P<0.001), higher complication rates (25.8% vs. 15%, P=0.016), and longer median postoperative hospital stays (10 vs. 9 days, P=0.002). However, the rates of anastomotic leakage (2.1% vs. 2.3%, P=1), the 5-year overall survival (91.5% vs. 93.7%, P=0.436), and the 5-year relapse-free survival (80.2% vs. 85.6%, P=0.195) were comparable between the groups.

Conclusions: The outcomes regarding anastomotic leakage and long-term survival for one-stage resection and anastomosis without preoperative decompression in cases of incomplete obstructive colorectal cancer are promising. This management strategy appears feasible and safe with appropriate preoperative bowel preparation.

Objectives: Although curative resection for synchronous peritoneal carcinomatosis has been reported to improve prognosis, cases with positive intraoperative lavage cytology have not been reported. In this study, we investigated the prognostic value of potentially curative resection based on colorectal cancer and lavage cytology positivity in patients with synchronous peritoneal carcinomatosis.

Methods: We retrospectively evaluated 72 patients who underwent intraoperative lavage cytology and one-stage potentially curative resection of primary and metastatic lesions (lavage cytology-positive, n = 21; lavage cytology-negative, n = 51) between July 2004 and December 2019. We compared the 5-year overall survival and 3-year recurrence rates between the lavage cytology-positive and lavage cytology-negative groups.

Results: No significant differences were observed in the 5-year overall survival (48.2% vs. 45.5%, P = 0.924) or 3-year recurrence rates (74.5% vs. 62%, P = 0.143) between the two groups. Univariate analysis for 3-year recurrence revealed that lavage cytology-positive status was not an explanatory variable (hazard ratio: 1.552, 95% confidence interval: 0.83-2.902, P = 0.169). Multivariate analysis identified colon cancer as an independent risk factor of recurrence.

Conclusions: In resectable cases, the resection of synchronous peritoneal carcinomatosis from colorectal cancer can be considered even if intraoperative lavage cytology is positive.

Objectives: Differences in oncological outcomes between conservative and surgical treatments for anastomotic leakage (AL) in patients undergoing colorectal cancer surgery remain unclear.

Methods: From July 2011 to June 2020, 385 patients underwent curative resection with double-stapling anastomosis for left-sided colon and rectal cancers. Among them, 33 patients who experienced AL were retrospectively evaluated and categorized into two groups: conservative (n = 20) and surgical (n = 13). In the surgical group, abdominal lavage using a sufficient amount of normal saline was performed during reoperation. The primary endpoint was the 3-year cumulative incidence of local recurrence (LR).

Results: Seven (21.2%) patients in the conservative group experienced LR, while none in the surgical group. Survival analysis indicated no differences in overall and recurrent-free survival. However, the 3-year cumulative incidence of LR was significantly lower in the surgical group than in the conservative group (0% versus 31.3%, p=0.045).

Conclusions: Differences in AL management were associated with oncological outcomes, specifically a decreased LR. Therefore, surgeons should consider our findings when determining the most appropriate AL treatment to improve oncological outcomes.

Objectives: This study was conducted to investigate whether preoperative or postoperative carcinoembryonic antigen (CEA) with a new cut-off value is more optimal for predicting long-term outcomes in patients with Stage II/III rectal cancer, and to investigate the effectiveness of postoperative adjuvant chemotherapy (POAC) based on the CEA values.

Methods: Serum CEA levels were measured preoperatively (pre-CEA) and postoperatively (post-CEA). The area under the receiver operating curve (AUROC) was used to determine a cut-off for CEA. The cut-off for CEA relative to recurrence-free survival (RFS) was established as that giving the highest AUROC. In comparison of superiority between pre- and post- CEA levels, Akaike's information criterion (AIC) was used in the Cox proportional-hazard regression model.

Results: The subjects were 323 patients who underwent curative surgical treatment for Stage II/III rectal cancer. AIC values indicated that RFS was better stratified by a post-CEA level with a cut-off of 2.3 ng/ml compared with other classifications of pre- or post- CEA. In Stage III or high-risk Stage II cases, there was no effect of POAC on RFS in those with post-CEA <2.3 ng/ml (p=0.39), but in those with post-CEA ≥2.3 ng/ml there was a trend for better RFS in patients who received POAC compared to those without POAC (p=0.06).

Conclusions: Patients with post-CEA ≥2.3 ng/ml had worse long-term outcomes compared with those with post-CEA <2.3 ng/ml. Post-CEA with a cut-off of 2.3 ng/ml may be useful in determining the indication for POAC for in Stage III or high-risk Stage II cases.

Objectives: Colonoscopy is the gold standard for screening cancer and precancerous lesions in the large intestine. Recently, remarkable advances in artificial intelligence (AI) have led to the development of various computer-aided detection (CADe) systems for colonoscopy. This study aimed to evaluate the usefulness of AI for colonoscopy using CAD-EYE^® (Fujifilm, Tokyo, Japan) to calculate the adenoma miss rate (AMR).

Methods: This randomized, open-label, single-center, tandem study was conducted at Fukuoka University Chikushi Hospital from February 2022 to November 2022. Patients were randomly assigned to the CADe or non-CADe group. Immediately after the completion of the first endoscopy by an endoscopist, a new endoscopist was assigned to perform the second endoscopy. As a result, different endoscopists performed the examinations in a tandem fashion. A missed lesion was defined as a newly detected colorectal polyp by the second endoscopy. Finally, the AMR was compared between the two groups.

Results: The study population comprised 48 patients in the CADe group and 46 patients in the non-CADe group. The AMR was 17.4% in the CADe group and 30.3% in the non-CADe group. Therefore, the AMR in the CADe group was statistically significantly lower than that in the non-CADe group (P=0.009).

Conclusions: The application of CAD-EYE^® to colonoscopy reduced the AMR. Overall, CAD-EYE^® might be useful for reducing missed colorectal adenomas.

Objectives: In rectal cancer surgery, a diverting stoma (DS) is used to prevent severe anastomotic leakage (AL), peritonitis, reoperation, and longer hospitalization. DS creation has increased in the last few decades, without establishment of clear criteria for construction of a DS. Therefore, the goal of the study was to investigate the validity of DS construction based on risk factors for AL, as an approach to reduce the number of stoma creations.

Methods: The subjects were 143 patients with rectal cancer who underwent laparoscopic or robot-assisted low anterior resection with DS creation from January 2010 to May 2021. Patients and operative characteristics were examined using univariate and multivariate analyses to identify risk factors for AL.

Results: Of the 143 subjects, 30 (21%) had AL, including asymptomatic AL in 19 cases (13%) and AL requiring conservative therapy in 11 cases (8%). No case of AL required reoperation. In cases with asymptomatic AL, there was a defect in the anastomosis found by colonoscopy several days after the operation, before discharge. In univariate analysis, preoperative Glasgow prognostic score (GPS) ≥1 (p=0.046) and number of stapler firings ≥3 (p=0.002) were associated with AL. In multivariate analysis, only GPS ≥1 was significantly associated with increased AL (p=0.033; OR=4.225; 95% CI 1.122 to 15.905).

Conclusions: DS creation is effective for avoiding reoperation for AL. Preoperative GPS ≥1 is a risk factor for AL in low anterior resection with a DS for rectal cancer. Thus, DS construction should be considered in a case with an elevated preoperative GPS.

Objectives: To describe detailed surgical techniques for totally stapled intracorporeal anastomosis (TSIA) and determine their feasibility and safety by comparing short-term outcomes with those of conventional totally stapled extracorporeal anastomosis (TSEA).

Methods: In total, 59 consecutive patients who underwent laparoscopic colectomy between June 2018 and August 2021 were retrospectively assessed. Linear staplers were used for all anastomoses. The TSIA and TSEA groups included 23 and 36 patients, respectively. Following a comprehensive description of each surgical technique, propensity score matching analysis was conducted to compare matched groups on the basis of clinicopathological characteristics, surgical and perioperative outcomes, complications, and postoperative inflammatory reactions. After matching, 17 cases each were analyzed in the TSIA and TSEA groups.

Results: Both groups were well matched. The TSIA group had significantly lesser blood loss than did the TSEA group (10 versus 20 mL, p=0.002), although this result was not clinically significant. The skin excision length (4 versus 6 cm, p<0.001) and postoperative hospital stay length (6 versus 7 days, p<0.001) were significantly shorter in the TSIA group than in the TSEA group. Increasing C-reactive protein (CRP) values at 1, 3, and 6 postoperative days were significantly lower in the TSIA group than in the TSEA group (p=0.016, p=0.011, and p=0.012, respectively).

Conclusions: TSIA is a simple, feasible, and efficient surgical technique; compared with TSEA, it is less invasive and associated with lesser blood loss, shorter skin incision lengths, shorter postoperative hospital stays, and lower CRP level increases.

Objectives: Effective treatments for diarrhea-type irritable bowel syndrome (IBS-D) are limited. Hangeshashinto (HST), an anti-inflammatory Kampo medicine, may offer benefits but its efficacy for IBS-D requires further investigation. This study evaluated IBS-D symptom improvement and gut microbiota changes following HST administration.

Methods: This was a multicenter retrospective study with a prospective analysis of microbiota conducted at five affiliated institutions. Patients diagnosed with IBS-D based on the ROME IV criteria between April 2019 and December 2023, who received HST 7.5 g/day for 2-3 weeks were included. The outcome measures were improvement rates in overall symptoms, stool frequency, stool consistency, and abdominal pain. Intestinal microbiota was analyzed using 16S rRNA gene sequencing from fecal samples of 20 patients before and after HST treatment.

Results: One hundred patients (42 males/58 females, mean age: 69.5±11.8 years) were analyzed. The overall improvement rate of HST was 82.0%. Those of males and females were 81.0% and 82.8% (p=0.816). By age, those of patients aged ≥75 and aged <75 years were 82.9% and 81.5% (p=0.869). The improvement rates of stool frequency, stool consistency, and abdominal pain were 59.0%, 51.0%, and 62.0%, respectively. The stool frequency per week before and after HST was 21.7±18.2 vs. 14.0±12.6 (p<0.001). Significant differences in gut microbiota β diversity were observed, although α diversity was not significantly changed. Bacteroides (p=0.003) and Ruminococcus (p=0.010) decreased significantly, while Megasphaera (p=0.030) and Subdoligranulum (p=0.002) increased.

Conclusions: HST may improve IBS-D symptoms by altering microbiota composition.

Objectives: This study explored the clinical utility of CT radiomics-driven machine learning as a predictive marker for chemotherapy response in colorectal liver metastasis (CRLM) patients.

Methods: We included 150 CRLM patients who underwent first-line doublet chemotherapy, dividing them into a training cohort (n=112) and a test cohort (n=38). We manually delineated three-dimensional tumor volumes, selecting the largest liver metastasis for measurement, using pretreatment portal-phase CT images and extracted 107 radiomics features. Treatment response was classified as responder (complete or partial response) or non-responder (stable or progressive disease), based on the best overall response according to RECIST criteria, version 1.1. Employing Random Forest and Boruta algorithms, we identified significant features for responder-non-responder differentiation. Radiomics signatures were developed and validated in the training cohort using five-fold cross-validation, and performance was assessed using the area under the curve (AUC).

Results: Among the patients, 91 (61%) were responders and 59 (39%) were non-responders. Variable selection with Boruta revealed three key parameters ( "DependenceVariance," "ClusterShade," and "RunVariance" ). In the training cohort, individual CT texture parameter AUCs ranged from 0.4 to 0.65, while the machine learning analysis incorporating all valid parameters exhibited a significantly higher AUC of 0.94 (p<0.01). The validation cohort also demonstrated strong predictive accuracy, with an AUC of 0.87 for treatment response.

Conclusions: This study highlights the potential of CT radiomics-driven machine learning in predicting chemotherapy responses among CRLM patients.

Objectives: Studies have suggested that computer-aided polyp detection using artificial intelligence improves adenoma identification during colonoscopy. However, its real-world effectiveness remains unclear. Therefore, this study evaluated the usefulness of computer-aided detection during regular surveillance colonoscopy.

Methods: Consecutive patients who underwent surveillance colonoscopy with computer-aided detection between January and March 2023 and had undergone colonoscopy at least twice during the past 3 years were recruited. The clinicopathological findings of lesions identified using computer-aided detection were evaluated. The detection ability was sub-analyzed based on the expertise of the endoscopist and the presence of diminutive adenomas (size ≤5 mm).

Results: A total of 78 patients were included. Computer-aided detection identified 46 adenomas in 28 patients; however, no carcinomas were identified. The mean withdrawal time was 824 ± 353 s, and the mean tumor diameter was 3.3 mm (range, 2-8 mm). The most common gross type was 0-Is (70%), followed by 0-Isp (17%) and 0-IIa (13%). The most common tumor locations were the ascending colon and sigmoid colon (28%), followed by the transverse colon (26%), cecum (7%), descending colon (7%), and rectum (4%). Overall, 34.1% and 38.2% of patients with untreated diminutive adenomas and those with no adenomas, respectively, had newly detected adenomas. Endoscopist expertise did not affect the results.

Conclusions: Computer-aided detection may help identify adenomas during surveillance colonoscopy for patients with untreated diminutive adenomas and those with a history of endoscopic resection.

Objectives: To clarify the risk factors affecting prognosis after primary tumor resection (PTR) in patients with metastatic colorectal cancer with synchronous peritoneal metastasis (mCRC-SPM).

Methods: Patients were enrolled prospectively in the JSCCR project "Grading of Peritoneal Seeding in Colorectal Cancer." Factors that may influence overall survival-age, sex, location of the primary tumor, lymph node metastasis, presence of liver metastasis, degree of peritoneal metastasis, peritoneal cancer index (PCI), cancer cure, and postoperative chemotherapy-in the PTR group were examined using multivariate analysis.

Results: Of the 133 enrolled patients with mCRC-SPM, 112 patients underwent PTR. Among them, 26 (23.2%) had mCRC-SPM of grade P1, 47 (42.0%) of P2, and 39 (34.8%) of P3. The median PCI was 4 (range, 1-28); no surgery-related deaths occurred. Postoperative complications of Clavien-Dindo classification ≥grade 2 were observed in 20 (17.9%) patients. R0 surgery became more difficult as the degree of dissemination increased, and the PTR group had a significantly better prognosis than the non-PTR group. In the multivariate analysis, age ≥75 years, rectal cancer, presence of liver metastasis, higher PCI, non-curative resection, and non-treatment with systemic chemotherapy were associated with poor prognosis in patients after PTR.

Conclusions: In patients with mCRC-SPM, postoperative complications are infrequent for P1 with localized peritoneal dissemination, and PTR may be considered as aggressive treatment. Factors including age ≥75 years, rectal cancer, presence of liver metastasis, increased PCI, non-curative resection, and non-treatment with systemic chemotherapy are associated with a reduced survival benefit from PTR.

Objectives: Mismatch repair (MMR) -deficient (dMMR) colorectal cancer (CRC) have been largely categorized into three subtypes: MLH1-methylated, Lynch syndrome (LS) -associated, and Lynch-like syndrome (LLS) -associated. No studies have examined the prevalence and subtypes of synchronously diagnosed dMMR CRCs in detail. Therefore, this study aimed to examine the frequency and molecular characteristics of the dMMR status among multiple synchronous CRCs to clarify the clinical significance of identifying patients with such tumors.

Methods: Immunohistochemistry (IHC) of MMR proteins (MLH1, MSH2, MSH6, and PMS2) was performed for surgically and endoscopically resected (in conjunction with surgical resection) lesions from consecutive patients with initially diagnosed multiple synchronous CRCs between July 2014 and June 2020. When necessary, MLH1-methylation analysis and testing of germline and somatic MMR genes were performed.

Results: In total, 133 patients (33 females) had 309 lesions. The combinations of synchronous tumor sites were the left-sided colon/rectum only (n=67, 50.4%), both the right-sided colon and left-sided colon/rectum (n=42, 31.6%), and the right-sided colon only (n=24, 18.0%). IHC showed a loss of expression of at least one MMR protein in 10 (7.5%) of 133 patients and 17 (5.5%) of 309 lesions. Molecular analysis revealed that these 10 patients were categorized as having MLH1-methylated (n=5, 3.8% of all patients), LS-associated (n=4, 3.0%), or LLS-associated (n=1, 0.8%) CRC.

Conclusions: Our data will be useful for genetic counseling in patients with synchronous CRCs suspected of having LS. Screening for LS using IHC for MMR proteins in individuals with multiple synchronous CRCs is an effective approach.

Colorectal cancer with gut-associated lymphoid tissue (GALT) carcinoma histopathology is particularly rare in very elderly patients. GALT is characterized by submucosal localization and prominent lymphoid infiltration with germinal center formation within tumor-infiltrating lymphocytes. This study aims to report a case of colorectal cancer with GALT carcinoma histopathology in a very elderly patient and to provide a comprehensive literature review. In this case, a 90-year-old female presented with an irregularly elevated tumor in the sigmoid colon, diagnosed via colonoscopy. Computed tomography revealed no lymph node or distant metastases. The patient underwent laparoscopy-assisted sigmoid colon resection with D3 dissection. Histopathological examination revealed well-differentiated adenocarcinoma in the submucosal layer with partial invasion into the muscle layer. Lymphocytes, along with lymph follicles, proliferated compressively in the stroma surrounding the tumor glands. Immunohistochemical analysis showed lost expression of mismatch repair proteins, MLH1 and PMS2, consistent with the tumor immunohistochemistry profile. B cells (CD20- and CD79a-positive) were generally distributed in and around the lymph follicles, while T cells (CD3-positive) were primarily located between the lymph follicles. This case highlights the rare histopathology of GALT carcinoma in colorectal cancer and underscores the importance of considering such diagnoses in elderly patients with colorectal tumors.

Achieving hemostasis during post-hemorrhoidectomy bleeding (PHB) is often challenging owing to poor visibility within the anal canal. We investigated the feasibility of using endoscopy for observation and maintaining hemostasis during PHB. Endoscopic evaluation was performed in patients with normal vital signs and no severe pain or excessive bleeding was observed during proctoscopy. Hemostatic clipping was performed if the bleeding site was clearly identified. In cases with profuse bleeding and endoscopic hemostasis deemed difficult, surgical hemostasis was performed. Of the 14 patients who developed PHB during the 3-year study period, endoscopic observation was performed in 6 cases. Arterial bleeding was confirmed in five of these cases; while, spontaneous hemostasis had already occurred in the remaining case. Hemostasis was achieved with endoscopic clipping in all cases. The mean procedure time was 14.7 minutes with no adverse events or re-bleeding. Endoscopic evaluation for PHB provides a detailed view of the bleeding site and facilitates hemostasis using clips.