In 2004, the first report appeared about the watch-and-wait (WW) approach for patients with rectal cancer and a clinical complete response after neoadjuvant chemoradiotherapy.¹ Patients treated by this nonoperative approach were observed by strict surveillance, potentially avoiding total mesorectal excision (TME) and associated surgical risks. Excellent survival was seen for patients with a clinical complete response observed by the WW approach as local regrowth, occurring in 15% to 35% of patients, is generally amenable for curative treatment with TME.^2,3 Since this first report, there has been increasing interest in WW and organ-preserving strategies, reflected by an increasing number of reports by centers and research groups.^4-10

Introduction: The goal of this project was to create an up‐to‐date joint European clinical practice guideline for the diagnosis and treatment of faecal incontinence (FI), using the best available evidence. These guidelines are intended to help guide all medical professionals treating adult patients with FI (e.g., general practitioners, surgeons, gastroenterologists, other healthcare workers) and any patients who are interested in information regarding the diagnosis and management of FI.Methods: These guidelines have been created in cooperation with members from the United European Gastroenterology (UEG), European Society of Coloproctology (ESCP), European Society of Neurogastroenterology and Motility (ESNM) and the European Society for Primary Care Gastroenterology (ESPCG). These members made up the guideline development group (GDG). Additionally, a patient advisory board (PAB) was created to reflect and comment on the draft guidelines from a patient perspective. Relevant review questions were established by the GDG along with a set of outcomes most important for decision making. A systematic literature search was performed using these review questions and outcomes as a framework. For each predefined review question, the study or studies with the highest level of study design were included. If evidence of a higher‐level study design was available, no lower level of evidence was sought or included. Data from the studies were extracted by two reviewers for each predefined important outcome within each review question. Where possible, forest plots were created. After summarising the results for each review question, a systematic quality assessment using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach was performed. For each review question, we assessed the quality of evidence for every predetermined important outcome. After evidence review and quality assessment were completed, recommendations could be formulated. The wording used for each recommendation was dependent on the level of quality of evidence. Lower levels of evidence resulted in weaker recommendations and higher levels of evidence resulted in stronger recommendations. Recommendations were discussed within the GDG to reach consensus.Results: These guidelines contain 45 recommendations on the classification, diagnosis and management of FI in adult patients.Conclusion: These multidisciplinary European guidelines provide an up‐to‐date comprehensive evidence‐based framework with recommendations on the diagnosis and management of adult patients who suffer from FI.

Background: Restorative proctocolectomy with IPAA is an optimal surgical treatment for patients with familial adenomatous polyposis and therapy resistant ulcerative colitis, few data are available on long-term results in patients who have undergone this operation at a young age. Objective: The aim of this study was to investigate long-term functional outcome, quality of life, body image, and sexual function after restorative proctocolectomy with IPAA in young patients with familial adenomatous polyposis or ulcerative colitis. Design, Settings, and Patients: The study consisted of a retrospective review of medical records and questionnaire follow-up of 26 consecutive patients with familial adenomatous polyposis or ulcerative colitis who had undergone surgery between January 1992 and October 2008 at the Maastricht University Medical Center, were aged 10 to 24 years at the time of surgery, and had at least 1 year of follow-up after surgery. Main Outcome Measures: We reviewed medical records from an institutional database regarding surgical procedures and short- and long-term complications. At the end of 2009, validated questionnaires covering bowel function (Colorectal Functional Outcome Questionnaire), quality of life (Short Form-36 and Gastrointestinal Quality of Life Index), body image and cosmesis (Body Image Questionnaire), and sexual function (International Index of Erectile Function for men and Female Sexual Function Index for women) were mailed to patients. Results: Median age at surgery was 18 years, and median follow-up was 12.5 (range, 2–18) years. Long-term colorectal complications occurred in 23 patients (88%), and were directly related to the surgery in 20 patients (77%). Five patients needed pouch excision. The questionnaire response rate was 88%. Bowel function, quality-of-life, and body image and cosmesis scores were all lower in patients than in historical normal control populations. Men did not report impotence or retrograde ejaculation, but 50% of women reported sexual dysfunction. Limitations: This was a retrospective study in a small number of patients from a single institution with no comparison groups. Conclusions: Restorative proctocolectomy with IPAA can be performed in young patients with an acceptable functional outcome, but at the cost of relatively high complication rates, poor body image and cosmesis, and a high rate of sexual dysfunction in women. Because young patients undergoing this surgical procedure may experience negative long-term effects, surgeons should be aware of all potential consequences, inform patients as to what to expect, and ensure long-term follow-up to deal with long-term complications.

To evaluate what features on restaging MRI and endoscopy led to a false clinical diagnosis of residual tumour in patients with a pathological complete response after rectal cancer surgery. Patients with an unrecognized complete response after (chemo)radiotherapy were selected in a tertiary referral centre for rectal cancer treatment. An unrecognized complete response was defined as a clinical incomplete response at MRI and/or endoscopy with a pathological complete response of the primary tumour after surgery. The morphology of the tumour bed and the lymph nodes were evaluated on post-CRT T2-weighted MRI (T2-MRI) and diffusion weighted imaging (DWI). Post-CRT endoscopy images were evaluated for residual mucosal abnormalities. MRI and endoscopy features were correlated with histopathology. Thirty-six patients with an unrecognized complete response were included. Mucosal abnormalities were present at restaging endoscopy in 84%, mixed signal intensity on T2-MRI in 53%, an irregular aspect of the former tumour location on T2-MRI in 69%, diffusion restriction on DWI in 51% and suspicious lymph nodes in 25%. Overstaging of residual tumour after (chemo)radiotherapy in rectal cancer is mainly due to residual mucosal abnormalities at endoscopy, mixed signal intensity or irregular fibrosis at T2-MRI, diffusion restriction at DWI and residual suspicious lymph nodes. Presence of these features is not definitely associated with residual tumour and in selected cases an extended waiting interval can be considered.