Overview
The evolving synthesis of this wiki — the closest thing to a running thesis across everything ingested so far. This page should be rewritten (not just appended to) as the wiki grows, so it always reflects the current state of understanding rather than a history of edits.
Where things stand (2026-08-20)
The wiki has grown well past its original ingest list. Two large Sabiston textbook chapters —
“Colon and Rectum” (82 pages, 6 chunks) and “Small Intestine” (61 pages, 3 chunks) — still supply
the anatomic/disease scaffolding, but primary literature and society guidelines now run well over
20 sources deep in several areas, and three full lint passes (2026-08-19 ×2, 2026-08-20) have kept
cross-references, frontmatter, and stale claims from drifting. wiki/Research Priorities.md tracks
remaining evidence gaps as a living punch list rather than letting them scatter across individual
pages’ Open items sections — check it before proposing a new ingest.
Shape of the wiki so far
The textbook chapters give the wiki broad anatomic/disease coverage across the colon, rectum, and small bowel: obstruction (large and small bowel, plus Ogilvie pseudo-obstruction), inflammatory bowel disease (UC and Crohn’s, each covered from both a colonic-surgery and a small-bowel angle), infectious/ischemic colitis and small bowel enteritis, the full spectrum of colorectal and small bowel neoplasia (hereditary syndromes, polyps, colon and rectal cancer surgery, NETs, adenocarcinoma, GIST, lymphoma), pelvic floor disorders, and small bowel diverticular disease/miscellaneous problems.
Layered on top, primary literature has built real depth in four clusters:
- Rectal cancer neoadjuvant therapy — eight trials (Bahadoer 2021 - RAPIDO Trial plus its 5-year follow-up, Conroy 2024 - PRODIGE 23 Long-Term Results, Jin 2022 - STELLAR Trial, Schrag 2023 - PROSPECT Trial, Ciseł 2019 - POLISH II Long-Term Results, plus the protocol-only Alvarez 2024 - JANUS Trial Protocol and Brouquet 2020 - GRECCAR16 Trial Protocol) now ground Total Neoadjuvant Therapy (TNT) and Rectal Cancer in primary data across both the higher-risk (TNT) and lower-risk (radiation-omission) treatment questions.
- Perforated diverticulitis — SCANDIV Trial and both arms of the Ladies trial (LOLA, DIVA) cover lavage-vs-resection and Hartmann’s-vs-primary-anastomosis.
- Appendiceal neoplasms and NETs — the Hoehn 2021 - Appendiceal Neoplasms review plus four primary NET trials (Rinke 2009 - PROMID Trial, Caplin 2014 - CLARINET Trial, Strosberg 2017 - NETTER-1 Trial, Yao 2016 - RADIANT-4 Trial) cover subtyping, staging, and systemic therapy; Quénet 2021 - PRODIGE 7 Trial covers CRS/HIPEC for peritoneal disease.
- IBD medical management — three society guidelines (ACG 2025 - Ulcerative Colitis Guideline, AGA 2024 - Moderate-to-Severe UC Pharmacotherapy Guideline, BSG 2025 - IBD Guidelines (Adults)) took Ulcerative Colitis and Crohn Disease from textbook-only surgical coverage to full advanced-therapy, ASUC, and cross-cutting management content — including an explicitly preserved methodological disagreement between ACG and AGA on ranking therapies via network meta-analysis.
Known asymmetries and gaps
Most of the wiki’s remaining condition pages are still single-sourced from a textbook chapter with
no primary-literature cross-check — GIST, short bowel syndrome, radiation enteritis, enterocutaneous
fistula, Meckel diverticulum, the pelvic-floor trio (rectal prolapse/rectocele/SRUS), and the
hereditary CRC syndromes are the clearest candidates. A handful of trials are referenced by name in
multiple pages but not yet independently ingested despite being load-bearing to the surrounding
discussion — OPRA (organ-preservation/NOM) and VARSITY (the one head-to-head UC biologic trial) are
the two flagged in the most recent lint pass. The full, actively-maintained list of these gaps lives
in wiki/Research Priorities.md, organized by how directly each one resolves an identified hole
rather than repeated here.
Next steps are open — deeper primary-literature ingest in a specific area (Research Priorities.md has the ranked list), or leaving the wiki as-is for querying — and should be driven by what Stephen wants to do next.