{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T01:44:09Z","timestamp":1772847849017,"version":"3.50.1"},"reference-count":15,"publisher":"S. Karger AG","issue":"4","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dig Surg"],"abstract":"<jats:p>&lt;p&gt;Introduction: Early detection and timely treatment of anastomotic leakage (AL) following rectal surgery are crucial for improving outcomes. However, no standardized early detection pathway exists. This study evaluates a multicenter clinical care pathway integrating bedside endoscopy to reduce time to diagnose AL. Methods: This international, multicenter, prospective observational study evaluates early endoscopic inspection for AL detection. Endoscopic assessments are performed at the bedside using a point-of-care digital rectoscope. Eligible patients include those undergoing colorectal resection for cancer with a colorectal or coloanal anastomosis within 15 cm of the anorectal junction. The clinical pathway includes bedside endoscopic inspection 3\u20136 days post-surgery, C-reactive protein-guided CT scans with rectal contrast, and follow-up endoscopy at 2\u20133 weeks. The primary outcome is time to AL diagnosis. Secondary outcomes include diagnostic accuracy, patient-reported comfort (Modified Gloucester Scale), stoma rate, anastomosis healing at 1 year, and cost-effectiveness. A propensity score-matched historical cohort will be used for comparison. Based on previous reports, we hypothesize this pathway will reduce the median diagnosis time from 15 to 5 days. With 95% confidence and 80% power, 130 patients are needed, with 153 total to account for a 15% maximum dropout rate. Conclusion: The REAL study is designed to evaluate whether a clinical pathway incorporating routine endoscopic assessment of colorectal anastomoses reduces time to diagnosis of AL and initiation of treatment. &lt;\/p&gt;<\/jats:p>","DOI":"10.1159\/000546041","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T12:01:59Z","timestamp":1747742519000},"page":"185-191","source":"Crossref","is-referenced-by-count":1,"title":["Routine Endoscopic Evaluation of Colorectal Anastomoses for Early Detection of Anastomotic Leakage (REAL Study): Protocol for a Multicenter Prospective Study"],"prefix":"10.1159","volume":"42","author":[{"given":"David J.","family":"Nijssen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wytze","family":"Lam\u00e9ris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quentin","family":"Denost","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonino","family":"Spinelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eloy","family":"Esp\u00edn-Basany","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Kinross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jurriaan","family":"Tuynman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roel","family":"Hompes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002429"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znab003"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-022-09274-y"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-016-2744-x"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1002\/bjs5.50106"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000002025"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1111\/codi.17189"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-022-09323-6"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.3393\/ac.2024.00584.0083"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7586"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1111\/codi.13534"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2008.04.009"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001560"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16591"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-024-02932-4"}],"container-title":["Digestive Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000546041","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000546041","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T16:03:07Z","timestamp":1755014587000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000546041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,20]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,8,12]]},"published-print":{"date-parts":[[2025,8,12]]}},"URL":"https:\/\/doi.org\/10.1159\/000546041","archive":["Portico"],"relation":{},"ISSN":["0253-4886","1421-9883"],"issn-type":[{"value":"0253-4886","type":"print"},{"value":"1421-9883","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,20]]}}}