Twenty years after its introduction, computed tomographic colonography (CTC) has reached its maturity, and it can reasonably be considered the best radiological diagnostic test for imaging colorectal cancer (CRC) and ...Twenty years after its introduction, computed tomographic colonography (CTC) has reached its maturity, and it can reasonably be considered the best radiological diagnostic test for imaging colorectal cancer (CRC) and polyps. This examination technique is less invasive than colonoscopy (CS), easy to perform, and standardized. Reduced bowel preparation and colonic distention using carbon dioxide favor patient compliance. Widespread implementation of a new image reconstruction algorithm has minimized radiation exposure, and the use of dedicated software with enhanced views has enabled easier image interpretation. Integration in the routine workflow of a computer-aided detection algorithm reduces perceptual errors, particularly for small polyps. Consolidated evidence from the literature shows that the diagnostic performances for the detection of CRC and large polyps in symptomatic and asymptomatic individuals are similar to CS and are largely superior to barium enema, the latter of which should be strongly discouraged. Favorable data regarding CTC performance open the possibility for many different indications, some of which are already supported by evidence-based data: incomplete, failed, or unfeasible CS; symptomatic, elderly, and frail patients; and investigation of diverticular disease. Other indications are still being debated and, thus, are recommended only if CS is unfeasible: the use of CTC in CRC screening and in surveillance after surgery for CRC or polypectomy. In order for CTC to be used appropriately, contraindications such as acute abdominal conditions (diverticulitis or the acute phase of inflammatory bowel diseases) and surveillance in patients with a long-standing history of ulcerative colitis or Crohn’s disease and in those with hereditary colonic syndromes should not be overlooked. This will maximize the benefits of the technique and minimize potential sources of frustration or disappointment for both referring clinicians and patients.展开更多
AIM： To determine the diagnostic yield of the “third eye retroscope”, on adenoma detection rate during screening colonoscopy.METHODS： The “third eye retroscope” when used with standard colonoscopy provides an ad...AIM： To determine the diagnostic yield of the “third eye retroscope”, on adenoma detection rate during screening colonoscopy.METHODS： The “third eye retroscope” when used with standard colonoscopy provides an additional retro-grade view to visualize lesions on the proximal aspects of folds and fexures. We searched MEDLINE （PubMed and Ovid）, SCOPUS （including MEDLINE and EMBASE databases）, Cochrane Database of Systemic Reviews, Google Scholar, and CINAHL Plus databases to identify studies that evaluated diagnostic yield of “third eye retroscope” during screening colonoscopy. DerSimonian Laird random effects model was used to generate the overall effect for each outcome. We evaluated statistical heterogeneity among the studies by using the Cochran Q statistic and quantifed by I2 statistics.RESULTS： Four distinct studies with a total of 920 pa-tients, mean age 59.83 （95%CI： 56.77-62.83） years, were included in the review. The additional adenoma detection rate （AADR） defined as the number of ad-ditional adenomas identified due to “third eye retro-scope” device in comparison to standard colonoscopy alone was 19.9% （95%CI： 7.3-43.9）. AADR for right and left colon were 13.9% （95%CI： 9.4-20） and 10.7 （95%CI： 1.9-42）, respectively. AADR for polyps ≥ 6 mm and ≥ 10 mm were 24.6% （95%CI： 16.6-34.9） and 24.2% （95%CI： 12.9-40.8）, respectively. The ad-ditional polyp detection rate defined as the number of additional polyps identifed due to “third eye retro-scope” device in comparison to standard colonoscopyalone was 19.8% （95%CI： 7.9-41.8）. There were no complications reported with use of “third eye retro-scope” device.CONCLUSION： The “third eye retroscope” device when used with standard colonoscopy is safe and de-tects 19.9% additional adenomas, compared to stan-dard colonoscopy alone.展开更多
Colonoscopic screening has been reported to reduce deaths from colorectal cancer.Adequate bowel preparation is essential for this and safety is an important issue in choosing the methods.Polyethylene glycol(PEG)is reg...Colonoscopic screening has been reported to reduce deaths from colorectal cancer.Adequate bowel preparation is essential for this and safety is an important issue in choosing the methods.Polyethylene glycol(PEG)is regarded as a safe method for cleansing,especially compared with oral sodium phosphate.Here,we present a case of hyponatremia caused by the syndrome of inappropriate antidiuretic hormone(ADH)syndrome after PEG precolonoscopic cleansing resulting in generalized tonic-clonic seizures.A 62-year-old women had ingested PEG for precolonoscopic bowel cleansing.While waiting for the colonoscopy,she developed a stuporous mentality and generalized tonic-clonic seizures,which did not correlate with brain magnetic resonance imaging.Her serum sodium level was 113 mEq per liter and laboratory analyses were consistent with inappropriate ADH syndrome.Her thyroid and adrenal functions were normal.There were no malignancies,infections,respiratory disorders or central nervous disorders and she had no history of taking either diuretics or other medications,which might have caused inappropriate ADH syndrome.She was treated with 3%hypertonic saline and showed a complete neurological recovery as her sodium levels recovered.Follow-up visits showed the patient to have a normal sodium level without neurologic deficits.This case shows that inappropriate ADH syndrome can be caused by PEG preparation,which implies that physicians have to be aware of the possible side effects of this colonic cleansing approach and mindful of the possible ensuing symptoms.展开更多
文摘Twenty years after its introduction, computed tomographic colonography (CTC) has reached its maturity, and it can reasonably be considered the best radiological diagnostic test for imaging colorectal cancer (CRC) and polyps. This examination technique is less invasive than colonoscopy (CS), easy to perform, and standardized. Reduced bowel preparation and colonic distention using carbon dioxide favor patient compliance. Widespread implementation of a new image reconstruction algorithm has minimized radiation exposure, and the use of dedicated software with enhanced views has enabled easier image interpretation. Integration in the routine workflow of a computer-aided detection algorithm reduces perceptual errors, particularly for small polyps. Consolidated evidence from the literature shows that the diagnostic performances for the detection of CRC and large polyps in symptomatic and asymptomatic individuals are similar to CS and are largely superior to barium enema, the latter of which should be strongly discouraged. Favorable data regarding CTC performance open the possibility for many different indications, some of which are already supported by evidence-based data: incomplete, failed, or unfeasible CS; symptomatic, elderly, and frail patients; and investigation of diverticular disease. Other indications are still being debated and, thus, are recommended only if CS is unfeasible: the use of CTC in CRC screening and in surveillance after surgery for CRC or polypectomy. In order for CTC to be used appropriately, contraindications such as acute abdominal conditions (diverticulitis or the acute phase of inflammatory bowel diseases) and surveillance in patients with a long-standing history of ulcerative colitis or Crohn’s disease and in those with hereditary colonic syndromes should not be overlooked. This will maximize the benefits of the technique and minimize potential sources of frustration or disappointment for both referring clinicians and patients.
文摘AIM： To determine the diagnostic yield of the “third eye retroscope”, on adenoma detection rate during screening colonoscopy.METHODS： The “third eye retroscope” when used with standard colonoscopy provides an additional retro-grade view to visualize lesions on the proximal aspects of folds and fexures. We searched MEDLINE （PubMed and Ovid）, SCOPUS （including MEDLINE and EMBASE databases）, Cochrane Database of Systemic Reviews, Google Scholar, and CINAHL Plus databases to identify studies that evaluated diagnostic yield of “third eye retroscope” during screening colonoscopy. DerSimonian Laird random effects model was used to generate the overall effect for each outcome. We evaluated statistical heterogeneity among the studies by using the Cochran Q statistic and quantifed by I2 statistics.RESULTS： Four distinct studies with a total of 920 pa-tients, mean age 59.83 （95%CI： 56.77-62.83） years, were included in the review. The additional adenoma detection rate （AADR） defined as the number of ad-ditional adenomas identified due to “third eye retro-scope” device in comparison to standard colonoscopy alone was 19.9% （95%CI： 7.3-43.9）. AADR for right and left colon were 13.9% （95%CI： 9.4-20） and 10.7 （95%CI： 1.9-42）, respectively. AADR for polyps ≥ 6 mm and ≥ 10 mm were 24.6% （95%CI： 16.6-34.9） and 24.2% （95%CI： 12.9-40.8）, respectively. The ad-ditional polyp detection rate defined as the number of additional polyps identifed due to “third eye retro-scope” device in comparison to standard colonoscopyalone was 19.8% （95%CI： 7.9-41.8）. There were no complications reported with use of “third eye retro-scope” device.CONCLUSION： The “third eye retroscope” device when used with standard colonoscopy is safe and de-tects 19.9% additional adenomas, compared to stan-dard colonoscopy alone.
文摘Colonoscopic screening has been reported to reduce deaths from colorectal cancer.Adequate bowel preparation is essential for this and safety is an important issue in choosing the methods.Polyethylene glycol(PEG)is regarded as a safe method for cleansing,especially compared with oral sodium phosphate.Here,we present a case of hyponatremia caused by the syndrome of inappropriate antidiuretic hormone(ADH)syndrome after PEG precolonoscopic cleansing resulting in generalized tonic-clonic seizures.A 62-year-old women had ingested PEG for precolonoscopic bowel cleansing.While waiting for the colonoscopy,she developed a stuporous mentality and generalized tonic-clonic seizures,which did not correlate with brain magnetic resonance imaging.Her serum sodium level was 113 mEq per liter and laboratory analyses were consistent with inappropriate ADH syndrome.Her thyroid and adrenal functions were normal.There were no malignancies,infections,respiratory disorders or central nervous disorders and she had no history of taking either diuretics or other medications,which might have caused inappropriate ADH syndrome.She was treated with 3%hypertonic saline and showed a complete neurological recovery as her sodium levels recovered.Follow-up visits showed the patient to have a normal sodium level without neurologic deficits.This case shows that inappropriate ADH syndrome can be caused by PEG preparation,which implies that physicians have to be aware of the possible side effects of this colonic cleansing approach and mindful of the possible ensuing symptoms.
