Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or inc...Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or incomplete resections and is now recognized as one of the most reliable quality indicators for assessing colonoscopy performance.With an incidence rate of 3.6%to 9.3%,PCCRC remains a significant concern,highlighting the limitations of colonoscopy in CRC screening—not only in terms of diagnostic accuracy but also in its preventive role and effectiveness in treating lesions.A range of clinical,endoscopic,and biological factors has been associated with an increased risk of PCCRC.Identifying these factors can help stratify high-risk patients,enabling earlier detection and improving preventive strategies for interval CRC.Reducing PCCRC should be a top priority for every endoscopy unit.While technological advancements will enhance polyp detection,minimize missed lesions,prevent incomplete resections,and improve overall procedural quality,the most impactful strategy remains internal self-assessment within each unit.This review should evaluate key performance metrics,including cecal intubation rate,adenoma detection rate,withdrawal time,PCCRC incidence,and incomplete resections—both at the individual endoscopist level and across the entire unit.展开更多
BACKGROUND Difficulty of colonoscopy insertion(DCI)significantly affects colonoscopy effectiveness and serves as a key quality indicator.Predicting and evaluating DCI risk preoperatively is crucial for optimizing intr...BACKGROUND Difficulty of colonoscopy insertion(DCI)significantly affects colonoscopy effectiveness and serves as a key quality indicator.Predicting and evaluating DCI risk preoperatively is crucial for optimizing intraoperative strategies.AIM To evaluate the predictive performance of machine learning(ML)algorithms for DCI by comparing three modeling approaches,identify factors influencing DCI,and develop a preoperative prediction model using ML algorithms to enhance colonoscopy quality and efficiency.METHODS This cross-sectional study enrolled 712 patients who underwent colonoscopy at a tertiary hospital between June 2020 and May 2021.Demographic data,past medical history,medication use,and psychological status were collected.The endoscopist assessed DCI using the visual analogue scale.After univariate screening,predictive models were developed using multivariable logistic regression,least absolute shrinkage and selection operator(LASSO)regression,and random forest(RF)algorithms.Model performance was evaluated based on discrimination,calibration,and decision curve analysis(DCA),and results were visualized using nomograms.RESULTS A total of 712 patients(53.8%male;mean age 54.5 years±12.9 years)were included.Logistic regression analysis identified constipation[odds ratio(OR)=2.254,95%confidence interval(CI):1.289-3.931],abdominal circumference(AC)(77.5–91.9 cm,OR=1.895,95%CI:1.065-3.350;AC≥92 cm,OR=1.271,95%CI:0.730-2.188),and anxiety(OR=1.071,95%CI:1.044-1.100)as predictive factors for DCI,validated by LASSO and RF methods.Model performance revealed training/validation sensitivities of 0.826/0.925,0.924/0.868,and 1.000/0.981;specificities of 0.602/0.511,0.510/0.562,and 0.977/0.526;and corresponding area under the receiver operating characteristic curves(AUCs)of 0.780(0.737-0.823)/0.726(0.654-0.799),0.754(0.710-0.798)/0.723(0.656-0.791),and 1.000(1.000-1.000)/0.754(0.688-0.820),respectively.DCA indicated optimal net benefit within probability thresholds of 0-0.9 and 0.05-0.37.The RF model demonstrated superior diagnostic accuracy,reflected by perfect training sensitivity(1.000)and highest validation AUC(0.754),outperforming other methods in clinical applicability.CONCLUSION The RF-based model exhibited superior predictive accuracy for DCI compared to multivariable logistic and LASSO regression models.This approach supports individualized preoperative optimization,enhancing colonoscopy quality through targeted risk stratification.展开更多
BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,...BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,ADR can vary significantly among endoscopists,leading to missed polyps or cancer.Artificial intelligence(AI)has shown promise in improving ADR by assisting in real-time polyp identification or diagnosis.While multiple randomized controlled trials(RCTs)and metanalyses highlight the benefits of AI in increasing detection rates and reducing missed polyps,concerns remain about its real-world applicability,impact on procedure time,and cost-effectiveness.AIM To explore the current status of AI assistance colonoscopy in adenoma detection and improving quality of colonoscopy.METHODS This systematic review followed PRISMA guidelines,both PubMed and Web of Science databases were used for articles search.Metanalyses and systematic reviews that assessed AI's role during colonoscopy.English article only published between January 2000 and January 2025 were included.Articles related to nonadenoma indications were excluded.Data extraction was independently performed by two researchers for accuracy and consistency.RESULTS 22 articles met the inclusion criteria,with significant heterogeneity(I2=28%-91%)observed in multiple studies.The number of studies per metanalysis ranged from 5 to 33,with higher heterogeneity in analyses involving more than 18 RCTs.AI demonstrated improvement in ADR,with an approximate 20%increase across multiple studies.However,its effectiveness in detecting flat or serrated adenomas remains unproven.Endoscopists with low ADR benefit more from AI-colonoscopies,while expert endoscopists outperformed AI in ADR,adenoma miss rate,and the identification of advanced lesions.No significant change in withdrawal time was observed when comparing AI-assisted colonoscopy to conventional endoscopy.CONCLUSION While AI-assisted colonoscopy has been shown to improve procedural quality,particularly for junior endoscopists and those with lower ADR,its performance decreases when compared to expert endoscopists in real-time clinical practice.This is especially evident in non-randomized studies,where AI demonstrates limited real-world benefits despite its benefit in controlled settings.Furthermore,no meta-analyses have specifically examined AI's impact on the learning experience of fellows and residents.Some experts caution that reliance on AI may prevent trainees from developing essential observational skills,potentially leading to less thorough examinations.Further research is needed to determine the actual benefits of AI-colonoscopy,particularly its role in cancer prevention.As technology advances,improved outcomes are expected,especially in detecting small,flat,and lesions at difficult anatomical locations.展开更多
The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can i...The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can improve the results of colonoscopy,it may interfere with the gut microbiota.Bowel preparation for colonoscopy can lead to transient changes in the gut microbiota,potentially affecting an individual’s health,especially in vulnerable populations,such as patients with inflammatory bowel disease.However,measures such as oral pro-biotics may ameliorate these adverse effects.We focused on the bowel prepa-ration-induced changes in the gut microbiota and host health status,hypothesized the factors influencing these changes,and attempted to identify measures that may reduce dysbiosis,thereby providing more information for individualized bowel preparation for colonoscopy in the future.展开更多
This study discusses the impact of the increasing use of colonoscopy on the trends of colorectal cancer(CRC)in Korea.Different views are raised on the research methods and conclusions of Kim et al.It emphasizes the ne...This study discusses the impact of the increasing use of colonoscopy on the trends of colorectal cancer(CRC)in Korea.Different views are raised on the research methods and conclusions of Kim et al.It emphasizes the need to carefully consider the balance between the benefits of early detection and the risks of over-screening.This letter also suggests directions for future research and policy considerations in the field of CRC screening and prevention in Korea.展开更多
Background Unsedated colonoscopy is an important method used for diagnosing colorectal cancer,but it can cause discomfort such as pain and bloating,as well as anxiety.At present,the relief is mainly achieved through m...Background Unsedated colonoscopy is an important method used for diagnosing colorectal cancer,but it can cause discomfort such as pain and bloating,as well as anxiety.At present,the relief is mainly achieved through methods such as changing positions and manual pressing,but the efficacy is limited.Hence alternative therapies for sedation and analgesia in unsedated colonoscopy warrant further study.Electroacupuncture(EA)can simplify the procedure of anesthesia and analgesia,while the efficacy of EA on unsedated colonoscopy remains unclear.Therefore,a well-designed randomized controlled trial is needed to demonstrate the potential efficacy of acupuncture in unsedated colonoscopy,particularly for pain relief.Methods In this prospective randomized sham-controlled trial,105 eligible participants will be recruited and randomly assigned to either EA group(n=35),sham EA group(n=35),or control group(n=35)in a 1:1:1 ratio.The EA group will receive acupuncture intervention on bilateral Hegu(LI4),Neiguan(PC6),Zusanli(ST36),and Shenmen(HT7),with LI4 and PC6 on both sides connected to the EA device.The sham EA group will received non transdermal needling on points of no meridian,and deliberately connect the needle to the incorrect output socket of EA device to block the stimulation.The needling will conducted from 30 min before the unsedated colonoscopy to the end of the colonoscopy,the whole retention time would be approximately 40 min.The participants in the control group will not receive any acupuncture intervention.All participants of the three groups will not receive any other treatment.Primary outcomes:Numerical Rating Scale(NRS)reported by participants and Face Pain Scale Revised(FPS-R)evaluated by observers of four areas of the participants during the unsedated colonoscopy.Secondary outcomes:tolerance reported by endoscopists,tolerance reported by participants,satisfaction reported by endoscopists,satisfaction reported by participants,adverse events during the unsedated colonoscopy,postoperative discomfort,unsedated colonoscopy smoothness(cecal insertion time,unwinding time,success rate of one-time intubation).Both intention-to-treat(ITT)and per-protocol(PP)analyses will be performed to assess the efficacy of EA.Discussion The trial will explore the efficacy of relieving pain,improving tolerability,and reducing undesirable adverse events of EA for unsedated colonoscopy.The results of this trial will provide sound evidence for promoting the clinical application of EA for unsedated colonoscopy.Trial registration ClinicalTrials.gov Identifier:ChiCTR2300069903,retrospectively registered on March 16,2023.展开更多
The bowel preparation is a crucial step to achieve an optimal quality in colonoscopy.The major clinical impact of an adequate colonic cleansing is to allow a more detailed and thorough inspection reducing the rates of...The bowel preparation is a crucial step to achieve an optimal quality in colonoscopy.The major clinical impact of an adequate colonic cleansing is to allow a more detailed and thorough inspection reducing the rates of missing lesions during the procedure and consequently reducing the incidence of interval colorectal carcinomas.Currently there are different colonoscopic preparation schemes,being the polyethylene glycol(PEG)based regimen one of the most used and recommended by the main international clinical guidelines.Nevertheless,PEG preparation requires the ingestion of considerably large volumes to achieve an optimal colonic cleansing,leading to poor tolerability in may patients,particularly in an elderly population.Other aspects that make accessibility to most colonoscopy preparation regimens difficult is their high cost and low availability.New options of colonoscopic preparation schemes based on oral lactulose are emerging with promising results,showing excellent efficacy-safety profiles and high tolerability indexes.Lactulose regimens present other benefits such as low cost and wide availability.The aim of this review is to analyze the scientific evidence to date and the current status of colonoscopy bowel preparation utilizing lactulose-based regimens,in order to consolidate this agent as a feasible“new player”in the field of colonoscopic preparation.展开更多
Colorectal cancer(CRC)is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide.In this regard,CRC screening is one of the most important issues in modern preventive medicine...Colorectal cancer(CRC)is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide.In this regard,CRC screening is one of the most important issues in modern preventive medicine.Colorectal polyps are potential predictors of CRC,and therefore represent one of the leading targets for screening colonoscopy.The difficulty of analyzing the information obtained during colonoscopy,including the size,location,shape,type of polyps,the need to standardize morphological data,determines that recently a number of works have promoted the opinion on the advisability of using various artificial intelligence(AI)methods to improve the effectiveness of endoscopic screening for CRC.At the same time,they point to a number of errors and methodological problems in the use of AI systems for the diagnosis of colorectal polyps.In this regard,the interpretation of the work of Shi et al,devoted to the use of a machine learning-based predictive model for monitoring the results of colorectal polypectomy,is undoubtedly interesting.In our opinion,the prospects for using AI to assess endoscopic screening for CRC look certainly positive,but the road to its widespread use will not be easy.展开更多
BACKGROUND Currently,colonoscopy still needs continuous optimization and exploration of novel alternative approaches to enhance the experience of patients during co-lonoscopy.AIM To analyze the efficacy of water infus...BACKGROUND Currently,colonoscopy still needs continuous optimization and exploration of novel alternative approaches to enhance the experience of patients during co-lonoscopy.AIM To analyze the efficacy of water infusion combined with defoamers in colono-scopy.METHODS This study included 97 patients undergoing colonoscopy from January 2024 to June 2024.The participants were categorized into two groups,namely,the control group(n=47),who underwent conventional colonoscopy,and the experimental group(n=50),who received colonoscopy using water injection combined with defoamers.A comparative analysis was then conducted on the disease detection rate(colonic polyps,colonorrhagia,colonic ulcers,colonic mucosal lesions,and others),colonoscopy duration,abdominal pain[visual analog scale(VAS)],Boston bowel preparation scale(BBPS),self-rating anxiety scale(SAS),bowel preparation comfort,complications(intestinal perforation,bleeding,nausea and vomiting,abdominal pain,and abdominal distension),and patient satisfaction.RESULTS The experimental group demonstrated a significantly higher total disease detection rate,BBPS scores,and patient satisfaction compared with the control group.Further,the research group exhibited shorter colonoscopy duration,lower VAS and SAS scores and total complication rate,and better patient comfort and satisfaction.CONCLUSION These results indicate that the combination of water injection and defoamers exhibited an overall better therapeutic effect than conventional colonoscopy,mainly reflected in higher disease detection rate,faster examination ef-ficiency,lower abdominal pain,anxiety,and complication incidences,and significantly better bowel preparation,comfort,and patient satisfaction.展开更多
BACKGROUND Colorectal cancer has a high incidence and mortality rate,and the effectiveness of routine colonoscopy largely depends on the endoscopist’s expertise.In recent years,computer-aided detection(CADe)systems h...BACKGROUND Colorectal cancer has a high incidence and mortality rate,and the effectiveness of routine colonoscopy largely depends on the endoscopist’s expertise.In recent years,computer-aided detection(CADe)systems have been increasingly integrated into colonoscopy to improve detection accuracy.However,while most studies have focused on adenoma detection rate(ADR)as the primary outcome,the more sensitive adenoma miss rate(AMR)has been less frequently analyzed.AIM To evaluate the effectiveness of CADe in colonoscopy and assess the advantages of AMR over ADR.METHODS A comprehensive literature search was conducted in PubMed,Embase,and the Cochrane Central Register of Controlled Trials using predefined search strategies to identify relevant studies published up to August 2,2024.Statistical analyses were performed to compare outcomes between groups,and potential publication bias was assessed using funnel plots.The quality of the included studies was evaluated using the Cochrane Risk of Bias tool and the Grading of Recommendations,Assessment,Development,and Evaluation approach.RESULTS Five studies comprising 1624 patients met the inclusion criteria.AMR was significantly lower in the CADe-assisted group than in the routine colonoscopy group(147/927,15.9%vs 345/960,35.9%;P<0.01).However,CADe did not provide a significant advantage in detecting advanced adenomas or lesions measuring 6-9 mm or≥10 mm.The polyp miss rate(PMR)was also lower in the CADe-assisted group[odds ratio(OR),0.35;95% confidence interval(CI):0.23-0.52;P<0.01].While the overall ADR did not differ significantly between groups,the ADR during the first-pass examination was higher in the CADe-assisted group(OR,1.37;95%CI:1.10-1.69;P=0.004).The level of evidence for the included randomized controlled trials was graded as moderate.CONCLUSION CADe can significantly reduce AMR and PMR while improving ADR during initial detection,demonstrating its potential to enhance colonoscopy performance.These findings highlight the value of CADe in improving the detection of colorectal neoplasms,particularly small and histologically distinct adenomas.展开更多
Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed duri...Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed during inspection by experienced endoscopists.Missed lesions are one of the primary reasons for post colonoscopy CRC and are associated with a significant variability in adenoma detection rate(ADR),which is the most important quality indicator for colonoscopy.Increasing ADR unquestionably decreases carcinoma miss rate.Simple measures to improve ADR include among others slower withdrawal time and position change.The introduction of optical imaging innovations has improved mucosal visualization.Moreover,auxiliary devices attached to the colonoscope tip have been introduced,aiming to improve lumen visualization by flattening the folds and revealing lesions hidden in blind spots,thereby increasing ADR.Digital image analysis using artificial intelligence is the latest approach to polyp detection.All of the above approaches have been separately evaluated concerning their effect in ADR;however,it has not been thoroughly investigated whether any benefit exists from their combined use.We aim to review the available data on the efficacy of each technique/technology and whether their combination offers any additional benefit while remaining cost-effective.展开更多
BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial ...BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial variation raises concerns about missed lesions and post-colonoscopy colorectal cancer.This study investigates determinants associated with SSL-DR variation in regional Australia.AIM To study how patient,clinical,and colonoscopy factors are associated with SSL detection in a regional Australian practice.We aimed to contribute high-detection data to the literature by analyzing the association of SSL detection with various determinants.METHODS This retrospective,cross-sectional analysis examined 1450 colonoscopies performed at Port Macquarie Gastroenterology during 2023.Sigmoidoscopies and repeat procedures were excluded.Multivariate logistic regression analyzed associations between SSL detection and patient demographics,clinical indications,procedural factors,and comorbidities.RESULTS The overall SSL-DR was 30.7%.Multivariate analysis identified several independent predictors:Clinical indication,bowel preparation quality,inflammatory bowel disease status,and serrated polyposis syndrome.The faecal occult blood test positive(FOBT)(+)cohort showed the highest predicted SSL detection probability(39.8%),while clinical symptoms showed the lowest(22.3%).After adjustment,SSL detection odds were 2.3 times greater among FOBT(+)patients than those with clinical symptoms(adjusted odds ratio=2.30,95%confidence interval:1.20-4.40,P=0.004).CONCLUSION SSL-DR as a quality indicator requires contextualization regarding clinical indications,bowel preparation quality,and comorbidities.There was a significantly higher prevalence of SSLs in FOBT(+)patients.Despite comprehensive adjustment,this study cannot fully explain the wide SSL-DR variation in Australia,highlighting the need for standardized detection protocols and further research to ensure optimal cancer prevention outcomes.展开更多
BACKGROUND Elevated plasma homocysteine(Hcy)levels are associated with increased risk of colorectal cancer(CRC),particularly in patients with systemic inflammation or AIM To evaluate serum Hcy levels as a predictive m...BACKGROUND Elevated plasma homocysteine(Hcy)levels are associated with increased risk of colorectal cancer(CRC),particularly in patients with systemic inflammation or AIM To evaluate serum Hcy levels as a predictive marker of lesion risk and CRC to prioritize patients undergoing diagnostic colonoscopy.METHODS We conducted a prospective cohort study of 301 fecal occult blood test-positive patients at San Agustín University Hospital in Asturias,Spain.Plasma Hcy levels were measured prior to the colonoscopy and classified into three thresholds:≤12,12-15,and>15μmol/L.Colonoscopy and histopathology determined the presence of low-risk,high-risk polyps or adenocarcinoma.Predictive performance of serum Hcy to detect lesions was assessed using logistic regression and diagnostic accuracy measures,including models adjusted for age and sex.RESULTS Median Hcy levels rose progressively with lesion severity,reaching 15.3μmol/L in adenocarcinoma(P<0.001).Higher levels were also observed in men and individuals aged 65 or older.A threshold above 15μmol/L showed good sensitivity(76.6%)and positive predictive value(87.2%)for detecting adenocarcinoma.When combined with age and sex,predictive accuracy improved(area under the receiver operating characteristic curve=0.706).Based on these findings,we propose a three-tier triage system:Green(≤12μmol/L in both sexes,colonoscopy within three months),Yellow(>12-15μmol/L in men,intervention within one month and red(≥15 in either sex or>12μmol/L in women,immediate colonoscopy).CONCLUSION Serum Hcy is a clinically useful biomarker for identifying high-risk colorectal lesions and cancer,particularly when interpreted in combination with age and sex.This composite model improves predictive accuracy and enables a structured three-tiered triage system that supports faster colonoscopy scheduling for at-risk groups.The traffic light approach offers a low cost,scalable strategy to reduce delays and optimize resource use in CRC screening,especially in public health systems with limited endoscopic capacity.展开更多
Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, parti...Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, particularly with the advent ofminimally invasive surgical techniques. Preoperative tattoo marking is commonlyused for tumor localization;however, it poses challenges such as intraperitonealink scattering and difficulty in defining dissection planes in the lower rectum. Toaddress these limitations, a new technology utilizing a near-infrared fluorescenceclip placed preoperatively enables accurate intraoperative tumor localization.Intraoperative colonoscopy offers additional advantages, including real-timetumor localization, colonic irrigation, visualization of the proximal colon inobstructive cases, and assessment of anastomosis following colorectal resection.Notably, intraoperative colonoscopy allows for the immediate detection andmanagement of complications, such as anastomotic bleeding and leakage, potentiallyimproving postoperative outcomes. Furthermore, advances in endoscopicresections, including endoscopic mucosal resection, endoscopic submucosal dissection,hybrid endoscopic submucosal dissection, and combined endoscopiclaparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches areincreasingly applicable beyond conventional colorectal neoplasms and showpromise in managing appendiceal tumors as well.展开更多
Colorectal cancer ranks third in the global cancer data in 2020.Colorectal scope is the most effective method to diagnose colorectal diseases such as benign and malignant colorectal tumors.The poor quality of intestin...Colorectal cancer ranks third in the global cancer data in 2020.Colorectal scope is the most effective method to diagnose colorectal diseases such as benign and malignant colorectal tumors.The poor quality of intestinal preparation causes an increased rate of missed diagnosis of colorectal tumors,reduces the rate of cecal intubation for colorectal examination,increases the discomfort,and reduces the compliance of re-examination.Therefore,we should try our best to improve the quality of intestinal preparation.This study reviewed the latest advances related to the preoperative preparation for colonoscopy.Recent research shows that smartphone apps can provide more detailed education and guidance on bowel preparation;Pre-packaged foods are more suitable as a way to eat before colonoscopy.The use of smaller doses,better taste of cathartic agents,and some auxiliary measures,combined with the patient’s situation to provide personalized intestinal preparation measures to improve the quality of intestinal preparation.Starting from the quality of colonoscopy bowel preparation,continuous improvement of patients’tolerance to bowel preparation,continuous improvement of bowel preparation plan based on individual factors’needs,and better communication with examined subjects by using existing scientific information technology,may be the hot spot of colonoscopy bowel preparation research in the next few years.展开更多
OBJECTIVE:To evaluate the effects of acupuncture anesthesia on the consumption of sedatives and anesthetics,pain,and time consumption in patients undergoing colonoscopy,thus providing evidence that acupuncture anesthe...OBJECTIVE:To evaluate the effects of acupuncture anesthesia on the consumption of sedatives and anesthetics,pain,and time consumption in patients undergoing colonoscopy,thus providing evidence that acupuncture anesthesia should be extended to endoscopists and anesthetists.METHODS:Four English and four Chinese databases were searched for randomised controlled trials of acupuncture anaesthesia in patients undergoing colonoscopy,published from database inception to 1 March 2023.Outcomes were consumption of sedatives and anaesthetics,pain tolerance,visual analog scale(VAS)score,the meantime consumption of examination,satisfaction,and adverse reactions.RESULTS:Thirty-one randomized controlled trials with a total of 4790 participants were included.Results showed that acupuncture anaesthesia significantly reduced consumption of sedatives and anaesthetics[9 studies,n=944,standardized mean difference(SMD)=-0.82,95%CI(-1.31,-0.33),P=0.001],VAS score[9 studies,n=1790,mean difference(MD)=-1.13,95%CI(-1.70,-0.57),P<0.001],meantime consumption[21 studies,n=3799,MD=-2.09,95%CI(-3.15,-1.03),P<0.001]and adverse reactions of colonoscopy[7 studies,n=738,odds ratio(OR)=0.17,95%CI(0.10,0.28),P<0.001].Acupuncture also significantly improved pain tolerance[14 studies,n=1661,OR=7.05,95%CI(3.79,13.12),P<0.001],while no beneficial effects were found for satisfaction[7 studies,n=843,SMD=0.02,95%CI(-0.38,0.43),P=0.91].CONCLUSION:Acupuncture has beneficial effects on patients undergoing colonoscopy,particularly in reducing consumption of sedatives and anaesthetics,alleviating pain,shortening the time consumption of examination and preventing adverse events.As an alternative,effective,inexpensive,and accessible approach,acupuncture anaesthesia should be extended to endoscopists and anaesthesiologists.展开更多
BACKGROUND The incidence of colorectal cancer(CRC)and preinvasive CRC(e.g.,early colon cancer and advanced adenoma)is gradually increasing in several countries.AIM To evaluate the trend in incidence of CRC and preinva...BACKGROUND The incidence of colorectal cancer(CRC)and preinvasive CRC(e.g.,early colon cancer and advanced adenoma)is gradually increasing in several countries.AIM To evaluate the trend in incidence of CRC and preinvasive CRC according to the increase in the number of colonoscopies performed in Korea.METHODS This retrospective cohort study enrolled Korean patients from 2002 to 2020 to evaluate the incidence of CRC and preinvasive CRC,and assess the numbers of diagnostic colonoscopies and colonoscopic polypectomies.Colonoscopy-related complications by age group were also determined.RESULTS The incidence of CRC showed a rapid increase,then decreased after 2012 in the 50-75 year-age group.During the study period,the rate of incidence of preinvasive CRC increased at a similar level in patients under 50 and 50-75 years of age.Since 2009,the increase has been rapid,showing a pattern similar to the increase in colonoscopies.The rate of colonoscopic polypectomy in patients aged under 50 was similar to the rate in patients over 75 years of age after 2007.The rate of complications after colonoscopy and related deaths within 3 mo was high for those over 75 years of age.CONCLUSION The diagnosis of preinvasive CRC increased with the increase in the number of colonoscopies performed.As the risk of colonoscopy-related hospitalization and death is high in the elderly,if early lesions at risk of developing CRC are diagnosed and treated under or at the age of 75,colonoscopy-related complications can be reduced for those aged 76 years or over.展开更多
BACKGROUND The bowel preparation process prior to colonoscopy determines the quality of the bowel preparation,which in turn affects the quality of the colonoscopy.Colono-scopy is an essential procedure for postoperati...BACKGROUND The bowel preparation process prior to colonoscopy determines the quality of the bowel preparation,which in turn affects the quality of the colonoscopy.Colono-scopy is an essential procedure for postoperative follow-up monitoring of colorec-tal cancer(CRC)patients.Previous studies have shown that advanced age and a history of colorectal resection are both risk factors for inadequate bowel prepara-tion.However,little attention has been paid to the bowel preparation experiences and needs of predominantly older adult postoperative CRC patients.AIM To explore the experiences and needs of older adult postoperative CRC patients during bowel preparation for follow-up colonoscopy.METHODS Fifteen older adult postoperative CRC patients who underwent follow-up colonoscopy at a tertiary hospital in Shanghai were selected using purposive sampling from August 2023 to November 2023.The phenomenological method in qualitative research was employed to construct an interview outline and conduct semi-structured interviews with the patients.Colaizzi's seven-step analysis was utilized to organize,code,categorize,summarize,and verify the interview data.RESULTS The results of this study were summarized into four themes and eight sub-themes:(1)Inadequate knowledge about bowel preparation;(2)Decreased physiological comfort during bowel preparation(gastrointestinal discomfort and sleep deprivation caused by bowel cleansing agents,and hunger caused by dietary restrictions);(3)Psychological changes during different stages of bowel preparation(pre-preparation:Fear and resistance due to previous experiences;during preparation:Irritation and helplessness caused by taking bowel cleansing agents,and post-preparation:Anxiety and worry while waiting for the colonoscopy);and(4)Needs related to bowel preparation(detailed instructions from healthcare professionals;more ideal bowel cleansing agents;and shortened waiting times for colonoscopy).CONCLUSION Older adult postoperative CRC patients'knowledge of bowel preparation is not adequate,and they may encounter numerous difficulties and challenges during the process.Healthcare professionals should place great emphasis on providing instruction for their bowel preparation.展开更多
Constipation is a significant sociomedical problem,which can be caused by various reasons.In the diagnostic approach to patients with constipation,the following data are usually sufficient:History,complete physical ex...Constipation is a significant sociomedical problem,which can be caused by various reasons.In the diagnostic approach to patients with constipation,the following data are usually sufficient:History,complete physical examination(including rectal examination),and additional diagnostic tests.A colonoscopy is not a necessary diagnostic method for all patients with constipation.However,if patients have alarm symptoms/signs,that suggest an organic reason for constipation,a colonoscopy is necessary.The most important alarm symptoms/signs are age>50 years,gastrointestinal bleeding,new-onset constipation,a palpable mass in the abdomen and rectum,weight loss,anemia,inflammatory bowel disease,and family history positive for colorectal cancer.Most endoscopists do not like to deal with patients with constipation.There are two reasons for this,namely the difficulty of endoscopy and the adequacy of preparation.Both are adversely affected by constipation.To improve the quality of colonoscopy in these patients,good examination techniques and often more extensive preparation are necessary.Good colonoscopy technique implies adequate psychological preparation of the patient,careful insertion of the endoscope with minimal insufflation,and early detection and resolution of loops.Bowel preparation for colonoscopy often requires prolonged preparation and sometimes the addition of other laxatives.展开更多
Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure.Colonoscopy is associated with di...Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure.Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used,the sedatives used,but to the procedure related as well including bleeding and perforation.Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon,however,serious complications related to the procedure have been reported infrequently in the literature.Life threatening injuries to the spleen,liver,pancreas,mesentery,and urinary bladder have been reported as early as in mid-1970s.These injuries should not be overlooked by clinicians and endoscopists.Steadily increasing abdominal pain,abdominal distension,and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury.Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening.Although conservative management may help,yet they usually need interventional radiology or surgical intervention.Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively.The mechanism of abdominal organ injuries during colonoscopy is not fully understood,however many risk factors have been identified,which can be classified as-organ related,procedure related,and local abdominal factors.Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries.Left lateral position,avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.展开更多
文摘Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or incomplete resections and is now recognized as one of the most reliable quality indicators for assessing colonoscopy performance.With an incidence rate of 3.6%to 9.3%,PCCRC remains a significant concern,highlighting the limitations of colonoscopy in CRC screening—not only in terms of diagnostic accuracy but also in its preventive role and effectiveness in treating lesions.A range of clinical,endoscopic,and biological factors has been associated with an increased risk of PCCRC.Identifying these factors can help stratify high-risk patients,enabling earlier detection and improving preventive strategies for interval CRC.Reducing PCCRC should be a top priority for every endoscopy unit.While technological advancements will enhance polyp detection,minimize missed lesions,prevent incomplete resections,and improve overall procedural quality,the most impactful strategy remains internal self-assessment within each unit.This review should evaluate key performance metrics,including cecal intubation rate,adenoma detection rate,withdrawal time,PCCRC incidence,and incomplete resections—both at the individual endoscopist level and across the entire unit.
基金the Chinese Clinical Trial Registry(No.ChiCTR2000040109)approved by the Hospital Ethics Committee(No.20210130017).
文摘BACKGROUND Difficulty of colonoscopy insertion(DCI)significantly affects colonoscopy effectiveness and serves as a key quality indicator.Predicting and evaluating DCI risk preoperatively is crucial for optimizing intraoperative strategies.AIM To evaluate the predictive performance of machine learning(ML)algorithms for DCI by comparing three modeling approaches,identify factors influencing DCI,and develop a preoperative prediction model using ML algorithms to enhance colonoscopy quality and efficiency.METHODS This cross-sectional study enrolled 712 patients who underwent colonoscopy at a tertiary hospital between June 2020 and May 2021.Demographic data,past medical history,medication use,and psychological status were collected.The endoscopist assessed DCI using the visual analogue scale.After univariate screening,predictive models were developed using multivariable logistic regression,least absolute shrinkage and selection operator(LASSO)regression,and random forest(RF)algorithms.Model performance was evaluated based on discrimination,calibration,and decision curve analysis(DCA),and results were visualized using nomograms.RESULTS A total of 712 patients(53.8%male;mean age 54.5 years±12.9 years)were included.Logistic regression analysis identified constipation[odds ratio(OR)=2.254,95%confidence interval(CI):1.289-3.931],abdominal circumference(AC)(77.5–91.9 cm,OR=1.895,95%CI:1.065-3.350;AC≥92 cm,OR=1.271,95%CI:0.730-2.188),and anxiety(OR=1.071,95%CI:1.044-1.100)as predictive factors for DCI,validated by LASSO and RF methods.Model performance revealed training/validation sensitivities of 0.826/0.925,0.924/0.868,and 1.000/0.981;specificities of 0.602/0.511,0.510/0.562,and 0.977/0.526;and corresponding area under the receiver operating characteristic curves(AUCs)of 0.780(0.737-0.823)/0.726(0.654-0.799),0.754(0.710-0.798)/0.723(0.656-0.791),and 1.000(1.000-1.000)/0.754(0.688-0.820),respectively.DCA indicated optimal net benefit within probability thresholds of 0-0.9 and 0.05-0.37.The RF model demonstrated superior diagnostic accuracy,reflected by perfect training sensitivity(1.000)and highest validation AUC(0.754),outperforming other methods in clinical applicability.CONCLUSION The RF-based model exhibited superior predictive accuracy for DCI compared to multivariable logistic and LASSO regression models.This approach supports individualized preoperative optimization,enhancing colonoscopy quality through targeted risk stratification.
文摘BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,ADR can vary significantly among endoscopists,leading to missed polyps or cancer.Artificial intelligence(AI)has shown promise in improving ADR by assisting in real-time polyp identification or diagnosis.While multiple randomized controlled trials(RCTs)and metanalyses highlight the benefits of AI in increasing detection rates and reducing missed polyps,concerns remain about its real-world applicability,impact on procedure time,and cost-effectiveness.AIM To explore the current status of AI assistance colonoscopy in adenoma detection and improving quality of colonoscopy.METHODS This systematic review followed PRISMA guidelines,both PubMed and Web of Science databases were used for articles search.Metanalyses and systematic reviews that assessed AI's role during colonoscopy.English article only published between January 2000 and January 2025 were included.Articles related to nonadenoma indications were excluded.Data extraction was independently performed by two researchers for accuracy and consistency.RESULTS 22 articles met the inclusion criteria,with significant heterogeneity(I2=28%-91%)observed in multiple studies.The number of studies per metanalysis ranged from 5 to 33,with higher heterogeneity in analyses involving more than 18 RCTs.AI demonstrated improvement in ADR,with an approximate 20%increase across multiple studies.However,its effectiveness in detecting flat or serrated adenomas remains unproven.Endoscopists with low ADR benefit more from AI-colonoscopies,while expert endoscopists outperformed AI in ADR,adenoma miss rate,and the identification of advanced lesions.No significant change in withdrawal time was observed when comparing AI-assisted colonoscopy to conventional endoscopy.CONCLUSION While AI-assisted colonoscopy has been shown to improve procedural quality,particularly for junior endoscopists and those with lower ADR,its performance decreases when compared to expert endoscopists in real-time clinical practice.This is especially evident in non-randomized studies,where AI demonstrates limited real-world benefits despite its benefit in controlled settings.Furthermore,no meta-analyses have specifically examined AI's impact on the learning experience of fellows and residents.Some experts caution that reliance on AI may prevent trainees from developing essential observational skills,potentially leading to less thorough examinations.Further research is needed to determine the actual benefits of AI-colonoscopy,particularly its role in cancer prevention.As technology advances,improved outcomes are expected,especially in detecting small,flat,and lesions at difficult anatomical locations.
文摘The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can improve the results of colonoscopy,it may interfere with the gut microbiota.Bowel preparation for colonoscopy can lead to transient changes in the gut microbiota,potentially affecting an individual’s health,especially in vulnerable populations,such as patients with inflammatory bowel disease.However,measures such as oral pro-biotics may ameliorate these adverse effects.We focused on the bowel prepa-ration-induced changes in the gut microbiota and host health status,hypothesized the factors influencing these changes,and attempted to identify measures that may reduce dysbiosis,thereby providing more information for individualized bowel preparation for colonoscopy in the future.
文摘This study discusses the impact of the increasing use of colonoscopy on the trends of colorectal cancer(CRC)in Korea.Different views are raised on the research methods and conclusions of Kim et al.It emphasizes the need to carefully consider the balance between the benefits of early detection and the risks of over-screening.This letter also suggests directions for future research and policy considerations in the field of CRC screening and prevention in Korea.
基金Supported by National Basic Evidence-based Capacity Building Project of Traditional Chinese Medicine([2019]130)Natural Science Foundation of Liaoning Province:2024-MS-042+1 种基金Xingliao Talent Program Medical Master Project:YXMJ-QNMZY-10Liaoning University of Traditional Chinese Medicine Key Laboratory of Traditional Chinese Medicine Theory and Application of Ministry of Education open fund project:zyzx2302.
文摘Background Unsedated colonoscopy is an important method used for diagnosing colorectal cancer,but it can cause discomfort such as pain and bloating,as well as anxiety.At present,the relief is mainly achieved through methods such as changing positions and manual pressing,but the efficacy is limited.Hence alternative therapies for sedation and analgesia in unsedated colonoscopy warrant further study.Electroacupuncture(EA)can simplify the procedure of anesthesia and analgesia,while the efficacy of EA on unsedated colonoscopy remains unclear.Therefore,a well-designed randomized controlled trial is needed to demonstrate the potential efficacy of acupuncture in unsedated colonoscopy,particularly for pain relief.Methods In this prospective randomized sham-controlled trial,105 eligible participants will be recruited and randomly assigned to either EA group(n=35),sham EA group(n=35),or control group(n=35)in a 1:1:1 ratio.The EA group will receive acupuncture intervention on bilateral Hegu(LI4),Neiguan(PC6),Zusanli(ST36),and Shenmen(HT7),with LI4 and PC6 on both sides connected to the EA device.The sham EA group will received non transdermal needling on points of no meridian,and deliberately connect the needle to the incorrect output socket of EA device to block the stimulation.The needling will conducted from 30 min before the unsedated colonoscopy to the end of the colonoscopy,the whole retention time would be approximately 40 min.The participants in the control group will not receive any acupuncture intervention.All participants of the three groups will not receive any other treatment.Primary outcomes:Numerical Rating Scale(NRS)reported by participants and Face Pain Scale Revised(FPS-R)evaluated by observers of four areas of the participants during the unsedated colonoscopy.Secondary outcomes:tolerance reported by endoscopists,tolerance reported by participants,satisfaction reported by endoscopists,satisfaction reported by participants,adverse events during the unsedated colonoscopy,postoperative discomfort,unsedated colonoscopy smoothness(cecal insertion time,unwinding time,success rate of one-time intubation).Both intention-to-treat(ITT)and per-protocol(PP)analyses will be performed to assess the efficacy of EA.Discussion The trial will explore the efficacy of relieving pain,improving tolerability,and reducing undesirable adverse events of EA for unsedated colonoscopy.The results of this trial will provide sound evidence for promoting the clinical application of EA for unsedated colonoscopy.Trial registration ClinicalTrials.gov Identifier:ChiCTR2300069903,retrospectively registered on March 16,2023.
文摘The bowel preparation is a crucial step to achieve an optimal quality in colonoscopy.The major clinical impact of an adequate colonic cleansing is to allow a more detailed and thorough inspection reducing the rates of missing lesions during the procedure and consequently reducing the incidence of interval colorectal carcinomas.Currently there are different colonoscopic preparation schemes,being the polyethylene glycol(PEG)based regimen one of the most used and recommended by the main international clinical guidelines.Nevertheless,PEG preparation requires the ingestion of considerably large volumes to achieve an optimal colonic cleansing,leading to poor tolerability in may patients,particularly in an elderly population.Other aspects that make accessibility to most colonoscopy preparation regimens difficult is their high cost and low availability.New options of colonoscopic preparation schemes based on oral lactulose are emerging with promising results,showing excellent efficacy-safety profiles and high tolerability indexes.Lactulose regimens present other benefits such as low cost and wide availability.The aim of this review is to analyze the scientific evidence to date and the current status of colonoscopy bowel preparation utilizing lactulose-based regimens,in order to consolidate this agent as a feasible“new player”in the field of colonoscopic preparation.
文摘Colorectal cancer(CRC)is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide.In this regard,CRC screening is one of the most important issues in modern preventive medicine.Colorectal polyps are potential predictors of CRC,and therefore represent one of the leading targets for screening colonoscopy.The difficulty of analyzing the information obtained during colonoscopy,including the size,location,shape,type of polyps,the need to standardize morphological data,determines that recently a number of works have promoted the opinion on the advisability of using various artificial intelligence(AI)methods to improve the effectiveness of endoscopic screening for CRC.At the same time,they point to a number of errors and methodological problems in the use of AI systems for the diagnosis of colorectal polyps.In this regard,the interpretation of the work of Shi et al,devoted to the use of a machine learning-based predictive model for monitoring the results of colorectal polypectomy,is undoubtedly interesting.In our opinion,the prospects for using AI to assess endoscopic screening for CRC look certainly positive,but the road to its widespread use will not be easy.
基金Supported by Foshan City Self-Raised Funds Science and Technology Innovation Project,No.2320001007369.
文摘BACKGROUND Currently,colonoscopy still needs continuous optimization and exploration of novel alternative approaches to enhance the experience of patients during co-lonoscopy.AIM To analyze the efficacy of water infusion combined with defoamers in colono-scopy.METHODS This study included 97 patients undergoing colonoscopy from January 2024 to June 2024.The participants were categorized into two groups,namely,the control group(n=47),who underwent conventional colonoscopy,and the experimental group(n=50),who received colonoscopy using water injection combined with defoamers.A comparative analysis was then conducted on the disease detection rate(colonic polyps,colonorrhagia,colonic ulcers,colonic mucosal lesions,and others),colonoscopy duration,abdominal pain[visual analog scale(VAS)],Boston bowel preparation scale(BBPS),self-rating anxiety scale(SAS),bowel preparation comfort,complications(intestinal perforation,bleeding,nausea and vomiting,abdominal pain,and abdominal distension),and patient satisfaction.RESULTS The experimental group demonstrated a significantly higher total disease detection rate,BBPS scores,and patient satisfaction compared with the control group.Further,the research group exhibited shorter colonoscopy duration,lower VAS and SAS scores and total complication rate,and better patient comfort and satisfaction.CONCLUSION These results indicate that the combination of water injection and defoamers exhibited an overall better therapeutic effect than conventional colonoscopy,mainly reflected in higher disease detection rate,faster examination ef-ficiency,lower abdominal pain,anxiety,and complication incidences,and significantly better bowel preparation,comfort,and patient satisfaction.
文摘BACKGROUND Colorectal cancer has a high incidence and mortality rate,and the effectiveness of routine colonoscopy largely depends on the endoscopist’s expertise.In recent years,computer-aided detection(CADe)systems have been increasingly integrated into colonoscopy to improve detection accuracy.However,while most studies have focused on adenoma detection rate(ADR)as the primary outcome,the more sensitive adenoma miss rate(AMR)has been less frequently analyzed.AIM To evaluate the effectiveness of CADe in colonoscopy and assess the advantages of AMR over ADR.METHODS A comprehensive literature search was conducted in PubMed,Embase,and the Cochrane Central Register of Controlled Trials using predefined search strategies to identify relevant studies published up to August 2,2024.Statistical analyses were performed to compare outcomes between groups,and potential publication bias was assessed using funnel plots.The quality of the included studies was evaluated using the Cochrane Risk of Bias tool and the Grading of Recommendations,Assessment,Development,and Evaluation approach.RESULTS Five studies comprising 1624 patients met the inclusion criteria.AMR was significantly lower in the CADe-assisted group than in the routine colonoscopy group(147/927,15.9%vs 345/960,35.9%;P<0.01).However,CADe did not provide a significant advantage in detecting advanced adenomas or lesions measuring 6-9 mm or≥10 mm.The polyp miss rate(PMR)was also lower in the CADe-assisted group[odds ratio(OR),0.35;95% confidence interval(CI):0.23-0.52;P<0.01].While the overall ADR did not differ significantly between groups,the ADR during the first-pass examination was higher in the CADe-assisted group(OR,1.37;95%CI:1.10-1.69;P=0.004).The level of evidence for the included randomized controlled trials was graded as moderate.CONCLUSION CADe can significantly reduce AMR and PMR while improving ADR during initial detection,demonstrating its potential to enhance colonoscopy performance.These findings highlight the value of CADe in improving the detection of colorectal neoplasms,particularly small and histologically distinct adenomas.
文摘Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed during inspection by experienced endoscopists.Missed lesions are one of the primary reasons for post colonoscopy CRC and are associated with a significant variability in adenoma detection rate(ADR),which is the most important quality indicator for colonoscopy.Increasing ADR unquestionably decreases carcinoma miss rate.Simple measures to improve ADR include among others slower withdrawal time and position change.The introduction of optical imaging innovations has improved mucosal visualization.Moreover,auxiliary devices attached to the colonoscope tip have been introduced,aiming to improve lumen visualization by flattening the folds and revealing lesions hidden in blind spots,thereby increasing ADR.Digital image analysis using artificial intelligence is the latest approach to polyp detection.All of the above approaches have been separately evaluated concerning their effect in ADR;however,it has not been thoroughly investigated whether any benefit exists from their combined use.We aim to review the available data on the efficacy of each technique/technology and whether their combination offers any additional benefit while remaining cost-effective.
文摘BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial variation raises concerns about missed lesions and post-colonoscopy colorectal cancer.This study investigates determinants associated with SSL-DR variation in regional Australia.AIM To study how patient,clinical,and colonoscopy factors are associated with SSL detection in a regional Australian practice.We aimed to contribute high-detection data to the literature by analyzing the association of SSL detection with various determinants.METHODS This retrospective,cross-sectional analysis examined 1450 colonoscopies performed at Port Macquarie Gastroenterology during 2023.Sigmoidoscopies and repeat procedures were excluded.Multivariate logistic regression analyzed associations between SSL detection and patient demographics,clinical indications,procedural factors,and comorbidities.RESULTS The overall SSL-DR was 30.7%.Multivariate analysis identified several independent predictors:Clinical indication,bowel preparation quality,inflammatory bowel disease status,and serrated polyposis syndrome.The faecal occult blood test positive(FOBT)(+)cohort showed the highest predicted SSL detection probability(39.8%),while clinical symptoms showed the lowest(22.3%).After adjustment,SSL detection odds were 2.3 times greater among FOBT(+)patients than those with clinical symptoms(adjusted odds ratio=2.30,95%confidence interval:1.20-4.40,P=0.004).CONCLUSION SSL-DR as a quality indicator requires contextualization regarding clinical indications,bowel preparation quality,and comorbidities.There was a significantly higher prevalence of SSLs in FOBT(+)patients.Despite comprehensive adjustment,this study cannot fully explain the wide SSL-DR variation in Australia,highlighting the need for standardized detection protocols and further research to ensure optimal cancer prevention outcomes.
文摘BACKGROUND Elevated plasma homocysteine(Hcy)levels are associated with increased risk of colorectal cancer(CRC),particularly in patients with systemic inflammation or AIM To evaluate serum Hcy levels as a predictive marker of lesion risk and CRC to prioritize patients undergoing diagnostic colonoscopy.METHODS We conducted a prospective cohort study of 301 fecal occult blood test-positive patients at San Agustín University Hospital in Asturias,Spain.Plasma Hcy levels were measured prior to the colonoscopy and classified into three thresholds:≤12,12-15,and>15μmol/L.Colonoscopy and histopathology determined the presence of low-risk,high-risk polyps or adenocarcinoma.Predictive performance of serum Hcy to detect lesions was assessed using logistic regression and diagnostic accuracy measures,including models adjusted for age and sex.RESULTS Median Hcy levels rose progressively with lesion severity,reaching 15.3μmol/L in adenocarcinoma(P<0.001).Higher levels were also observed in men and individuals aged 65 or older.A threshold above 15μmol/L showed good sensitivity(76.6%)and positive predictive value(87.2%)for detecting adenocarcinoma.When combined with age and sex,predictive accuracy improved(area under the receiver operating characteristic curve=0.706).Based on these findings,we propose a three-tier triage system:Green(≤12μmol/L in both sexes,colonoscopy within three months),Yellow(>12-15μmol/L in men,intervention within one month and red(≥15 in either sex or>12μmol/L in women,immediate colonoscopy).CONCLUSION Serum Hcy is a clinically useful biomarker for identifying high-risk colorectal lesions and cancer,particularly when interpreted in combination with age and sex.This composite model improves predictive accuracy and enables a structured three-tiered triage system that supports faster colonoscopy scheduling for at-risk groups.The traffic light approach offers a low cost,scalable strategy to reduce delays and optimize resource use in CRC screening,especially in public health systems with limited endoscopic capacity.
文摘Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, particularly with the advent ofminimally invasive surgical techniques. Preoperative tattoo marking is commonlyused for tumor localization;however, it poses challenges such as intraperitonealink scattering and difficulty in defining dissection planes in the lower rectum. Toaddress these limitations, a new technology utilizing a near-infrared fluorescenceclip placed preoperatively enables accurate intraoperative tumor localization.Intraoperative colonoscopy offers additional advantages, including real-timetumor localization, colonic irrigation, visualization of the proximal colon inobstructive cases, and assessment of anastomosis following colorectal resection.Notably, intraoperative colonoscopy allows for the immediate detection andmanagement of complications, such as anastomotic bleeding and leakage, potentiallyimproving postoperative outcomes. Furthermore, advances in endoscopicresections, including endoscopic mucosal resection, endoscopic submucosal dissection,hybrid endoscopic submucosal dissection, and combined endoscopiclaparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches areincreasingly applicable beyond conventional colorectal neoplasms and showpromise in managing appendiceal tumors as well.
文摘Colorectal cancer ranks third in the global cancer data in 2020.Colorectal scope is the most effective method to diagnose colorectal diseases such as benign and malignant colorectal tumors.The poor quality of intestinal preparation causes an increased rate of missed diagnosis of colorectal tumors,reduces the rate of cecal intubation for colorectal examination,increases the discomfort,and reduces the compliance of re-examination.Therefore,we should try our best to improve the quality of intestinal preparation.This study reviewed the latest advances related to the preoperative preparation for colonoscopy.Recent research shows that smartphone apps can provide more detailed education and guidance on bowel preparation;Pre-packaged foods are more suitable as a way to eat before colonoscopy.The use of smaller doses,better taste of cathartic agents,and some auxiliary measures,combined with the patient’s situation to provide personalized intestinal preparation measures to improve the quality of intestinal preparation.Starting from the quality of colonoscopy bowel preparation,continuous improvement of patients’tolerance to bowel preparation,continuous improvement of bowel preparation plan based on individual factors’needs,and better communication with examined subjects by using existing scientific information technology,may be the hot spot of colonoscopy bowel preparation research in the next few years.
基金the Excellent Youth Project of Heilongjiang Natural Science Foundation:Mechanism of Inhibition of Liver Fibrosis by Qishen Decoction by Dendritic Cell Maturation and Differentiation(YQ2022H015)Projects of Heilongjiang Administration of Traditional Chinese Medicine:Exploration of the Therapeutic Mechanism of Qishen Decoction on Non-alcoholic Fatty Liver Fibrosis through Gut Microbiota(ZHY19-062)。
文摘OBJECTIVE:To evaluate the effects of acupuncture anesthesia on the consumption of sedatives and anesthetics,pain,and time consumption in patients undergoing colonoscopy,thus providing evidence that acupuncture anesthesia should be extended to endoscopists and anesthetists.METHODS:Four English and four Chinese databases were searched for randomised controlled trials of acupuncture anaesthesia in patients undergoing colonoscopy,published from database inception to 1 March 2023.Outcomes were consumption of sedatives and anaesthetics,pain tolerance,visual analog scale(VAS)score,the meantime consumption of examination,satisfaction,and adverse reactions.RESULTS:Thirty-one randomized controlled trials with a total of 4790 participants were included.Results showed that acupuncture anaesthesia significantly reduced consumption of sedatives and anaesthetics[9 studies,n=944,standardized mean difference(SMD)=-0.82,95%CI(-1.31,-0.33),P=0.001],VAS score[9 studies,n=1790,mean difference(MD)=-1.13,95%CI(-1.70,-0.57),P<0.001],meantime consumption[21 studies,n=3799,MD=-2.09,95%CI(-3.15,-1.03),P<0.001]and adverse reactions of colonoscopy[7 studies,n=738,odds ratio(OR)=0.17,95%CI(0.10,0.28),P<0.001].Acupuncture also significantly improved pain tolerance[14 studies,n=1661,OR=7.05,95%CI(3.79,13.12),P<0.001],while no beneficial effects were found for satisfaction[7 studies,n=843,SMD=0.02,95%CI(-0.38,0.43),P=0.91].CONCLUSION:Acupuncture has beneficial effects on patients undergoing colonoscopy,particularly in reducing consumption of sedatives and anaesthetics,alleviating pain,shortening the time consumption of examination and preventing adverse events.As an alternative,effective,inexpensive,and accessible approach,acupuncture anaesthesia should be extended to endoscopists and anaesthesiologists.
文摘BACKGROUND The incidence of colorectal cancer(CRC)and preinvasive CRC(e.g.,early colon cancer and advanced adenoma)is gradually increasing in several countries.AIM To evaluate the trend in incidence of CRC and preinvasive CRC according to the increase in the number of colonoscopies performed in Korea.METHODS This retrospective cohort study enrolled Korean patients from 2002 to 2020 to evaluate the incidence of CRC and preinvasive CRC,and assess the numbers of diagnostic colonoscopies and colonoscopic polypectomies.Colonoscopy-related complications by age group were also determined.RESULTS The incidence of CRC showed a rapid increase,then decreased after 2012 in the 50-75 year-age group.During the study period,the rate of incidence of preinvasive CRC increased at a similar level in patients under 50 and 50-75 years of age.Since 2009,the increase has been rapid,showing a pattern similar to the increase in colonoscopies.The rate of colonoscopic polypectomy in patients aged under 50 was similar to the rate in patients over 75 years of age after 2007.The rate of complications after colonoscopy and related deaths within 3 mo was high for those over 75 years of age.CONCLUSION The diagnosis of preinvasive CRC increased with the increase in the number of colonoscopies performed.As the risk of colonoscopy-related hospitalization and death is high in the elderly,if early lesions at risk of developing CRC are diagnosed and treated under or at the age of 75,colonoscopy-related complications can be reduced for those aged 76 years or over.
文摘BACKGROUND The bowel preparation process prior to colonoscopy determines the quality of the bowel preparation,which in turn affects the quality of the colonoscopy.Colono-scopy is an essential procedure for postoperative follow-up monitoring of colorec-tal cancer(CRC)patients.Previous studies have shown that advanced age and a history of colorectal resection are both risk factors for inadequate bowel prepara-tion.However,little attention has been paid to the bowel preparation experiences and needs of predominantly older adult postoperative CRC patients.AIM To explore the experiences and needs of older adult postoperative CRC patients during bowel preparation for follow-up colonoscopy.METHODS Fifteen older adult postoperative CRC patients who underwent follow-up colonoscopy at a tertiary hospital in Shanghai were selected using purposive sampling from August 2023 to November 2023.The phenomenological method in qualitative research was employed to construct an interview outline and conduct semi-structured interviews with the patients.Colaizzi's seven-step analysis was utilized to organize,code,categorize,summarize,and verify the interview data.RESULTS The results of this study were summarized into four themes and eight sub-themes:(1)Inadequate knowledge about bowel preparation;(2)Decreased physiological comfort during bowel preparation(gastrointestinal discomfort and sleep deprivation caused by bowel cleansing agents,and hunger caused by dietary restrictions);(3)Psychological changes during different stages of bowel preparation(pre-preparation:Fear and resistance due to previous experiences;during preparation:Irritation and helplessness caused by taking bowel cleansing agents,and post-preparation:Anxiety and worry while waiting for the colonoscopy);and(4)Needs related to bowel preparation(detailed instructions from healthcare professionals;more ideal bowel cleansing agents;and shortened waiting times for colonoscopy).CONCLUSION Older adult postoperative CRC patients'knowledge of bowel preparation is not adequate,and they may encounter numerous difficulties and challenges during the process.Healthcare professionals should place great emphasis on providing instruction for their bowel preparation.
基金Supported by the Ministry of Science,Technological Development and Innovations,Republic of Serbia,No.451-03-66/2024-03/200110.
文摘Constipation is a significant sociomedical problem,which can be caused by various reasons.In the diagnostic approach to patients with constipation,the following data are usually sufficient:History,complete physical examination(including rectal examination),and additional diagnostic tests.A colonoscopy is not a necessary diagnostic method for all patients with constipation.However,if patients have alarm symptoms/signs,that suggest an organic reason for constipation,a colonoscopy is necessary.The most important alarm symptoms/signs are age>50 years,gastrointestinal bleeding,new-onset constipation,a palpable mass in the abdomen and rectum,weight loss,anemia,inflammatory bowel disease,and family history positive for colorectal cancer.Most endoscopists do not like to deal with patients with constipation.There are two reasons for this,namely the difficulty of endoscopy and the adequacy of preparation.Both are adversely affected by constipation.To improve the quality of colonoscopy in these patients,good examination techniques and often more extensive preparation are necessary.Good colonoscopy technique implies adequate psychological preparation of the patient,careful insertion of the endoscope with minimal insufflation,and early detection and resolution of loops.Bowel preparation for colonoscopy often requires prolonged preparation and sometimes the addition of other laxatives.
文摘Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure.Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used,the sedatives used,but to the procedure related as well including bleeding and perforation.Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon,however,serious complications related to the procedure have been reported infrequently in the literature.Life threatening injuries to the spleen,liver,pancreas,mesentery,and urinary bladder have been reported as early as in mid-1970s.These injuries should not be overlooked by clinicians and endoscopists.Steadily increasing abdominal pain,abdominal distension,and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury.Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening.Although conservative management may help,yet they usually need interventional radiology or surgical intervention.Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively.The mechanism of abdominal organ injuries during colonoscopy is not fully understood,however many risk factors have been identified,which can be classified as-organ related,procedure related,and local abdominal factors.Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries.Left lateral position,avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.
