AIM:To determine the utility of computed tomography(CT) scanning in localizing colon tumors.METHODS:At a single tertiary care teaching hospital,a retrospective chart review was conducted on patients who underwent surg...AIM:To determine the utility of computed tomography(CT) scanning in localizing colon tumors.METHODS:At a single tertiary care teaching hospital,a retrospective chart review was conducted on patients who underwent surgery for colon malignancies between January 2004 and May 2006.One hundred and four charts containing all of the following data were reviewed:preop erative colonoscopy report,preoperative CT report,surgical operative report,tumor pathology report.The colon was divided into five segments from the cecum to the sigmoid and the location of the lesions was categorized into one of these areas.The tumor location was considered "erroneous" if its location determined during surgery differed from the location determined by colonoscopy or CT.RESULTS:Over all,tumor location was accurately determined via colonoscopy in 83/104 cases(79.8%) and erroneously in 21/104(20.2%) of cases.CT scan accurately localized colon tumors in 52/104(50.0%) of cases,incorrectly localized tumors in 18/104(17.3%) of cases,and did not detect known tumors in 34/104(32.7%) of cases.Of the 21 tumors erroneously located by colonoscopy,11(52.4%) were accurately localized by CT scan.The average tumor size for all patients in this study was 5.72(+/-3.11) cm.The average size of tumors properly located by colonoscopy and CT was 5.39(+/-3.34) cm and 6.79(+/-3.48) cm,respectively.The average size of the tumors not detected by CT was 3.98(+/-1.75) cm.CONCLUSION:CT scanning may be used in concert with colonoscopy to help localize colon tumors.展开更多
AIM:To compare the results from computed tomography (CT) colonography with conventional colonoscopy in symptomatic patients referred for colonoscopy. METHODS: The study included 227 adult outpatients, mean age 60 year...AIM:To compare the results from computed tomography (CT) colonography with conventional colonoscopy in symptomatic patients referred for colonoscopy. METHODS: The study included 227 adult outpatients, mean age 60 years, with appropriate indications for colonoscopy. CT colonography and colonoscopy were performed on the same day in a metropolitan teaching hospital. Colonoscopists were initially blinded to the results of CT colonography but there was segmental unblinding during the procedure. The primary outcome measures were the sensitivity and specificity of CT colonography for the identification of polyps seen at colonoscopy (i.e. analysis by polyp). Secondary outcome measures included an analysis by patient, extracolonic findings at CT colonography, adverse events with both procedures and patient acceptance and preference. RESULTS: Twenty-five patients (11%) were excluded from the analysis because of incomplete colonoscopy or poor bowel preparation that affected either CT colonography, colonoscopy or both procedures. Polyps and masses (usually cancers) were detected at colonoscopy and CT colonography in 35% and 42% of patients, respectively. Of nine patients with a finaldiagnosis of cancer, eight (89%) were identified by CT colonography as masses (5) or polyps (3). For polyps analyzed according to polyp, the overall sensitivity of CT colonography was 50% (95% CI, 39%-61%) but this increased to 71% (95% CI, 52%-85%) for polyps ≥ 6 mm in size. Similarly, specificity for all polyps was 48% (95% CI, 39%-58%) increasing to 67% (95% CI, 56%-76%) for polyps ≥ 6 mm. Adverse events were uncommon but included one colonic perforation at colonoscopy. Patient acceptance was high for both procedures but preference favoured CT colonography. CONCLUSION: Although CT colonography was more sensitive in this study than in some previous studies, the procedure is not yet sensitive enough for widespread application in symptomatic patients.展开更多
AIM： TO examine the diagnostic yield of colorectal neoplasia at computed tomographic colonoscopy （CTC） as well as the feasibility of contrast enhanced CTC in patients with gastric cancer. METHODS： To examine the i...AIM： TO examine the diagnostic yield of colorectal neoplasia at computed tomographic colonoscopy （CTC） as well as the feasibility of contrast enhanced CTC in patients with gastric cancer. METHODS： To examine the incidence of colon polyp we selected postoperative 188 gastric cancer patients, which we refer to as the ‘colon polyp survey group’. To examine the feasibility of CTC for early detection of colon cancer or advanced colon adenoma, we selected 47 gastric cancer patients （M：F 29：18, mean age 53.8 years）, which we call the ‘CT colonoscopy group’. All the 47 patients underwent successive CTC and colonoscopy on the same day. RESULTS： Totally 109 colon polyps were observed from 59 out of 188 gastric cancer patients, the inddence rate of colon polyps in gastric cancer patients being 31.4%. The sensitivity of CTC in detecting individuals with at least 1 lesion of any size was 57.1%, the specificity was 72.7%, the positive predictive value was 47.1%, and the negative predictive value was 71.9%. When the cutoff size was decreased to 6 mm, the sensitivity and specificity were 80.0% and 92.9%, respectively, with positive and negative predictive values of 57.1% and 97.5%, respectively. Only one patient was classified as false negative by virtual colonoscopy. CONCLUSION： The diagnostic yield of colorectal polyp was 31.4% in patients with gastric cancer, and contrast enhanced CTC is an acceptable tool for the detection of synchronous colorectal advanced adenoma and postoperative surveillance of gastric cancer patients.展开更多
BACKGROUND Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding(CDB)is recommended.However,little is known about rates of rebleeding within 30 d.We posited that a group of patients who under...BACKGROUND Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding(CDB)is recommended.However,little is known about rates of rebleeding within 30 d.We posited that a group of patients who underwent contrast-enhanced computed tomography(CT)within 4 h of the last hematochezia and colonoscopy within 24 h would experience fewer incidences of rebleeding.AIM To evaluate the outcomes of early colonoscopy for CDB among different groups of patients.METHODS Data from 182 patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018 at the study site were retrospectively reviewed.Patients were divided into groups based on the timing of the CT imaging,within or at 4 h were defined as urgent CTs(n=100)and those performed after 4 h were defined as elective CTs(n=82).Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage(SRH)(i.e.,active bleeding,non-bleeding visible vessels,or adherent clots).RESULTS In total,182 patients(126 men and 56 women)with median ages of 68.6(range,37-92)and 73.7(range,48-93)years,respectively,underwent CT imaging and colonoscopy within 24 h of the last hematochezia.Patients for whom CT was performed within 4 h of the last hematochezia were included in the urgent CT group(n=100)and patients for whom CT was performed after 4 h were included in the elective CT group(n=82).SRH were identified in 35.0%(35/100)of the urgent CT cases and 7.3%(6/82)of the elective CT cases(P<0.01).Among all patients with extravasation-positive images on CT,SRH was identified in 31 out of 47 patients(66.0%)in the urgent CT group and 4 out of 20 patients(20.0%)in the elective CT group(P<0.01).Furthermore,rates of rebleeding within 30 d were significantly improved in the urgent CT and extravasation-positive cases(P<0.05).Results from the evaluation of early colonoscopy did not show a difference in the ability to detect SRH identification or rebleeding rates.Only cases by urgent CT reduced risk of rebleeding due to the evidence of active bleeding on the image.CONCLUSION To improve rates of rebleeding,colonoscopy is recommended within 24 h in patients with extravasation-positive CT images within 4 h of the last hematochezia.Otherwise,elective colonoscopy can be performed.展开更多
AIM:To assess the value of computed tomography(CT)for diagnosis of synchronous colorectal cancers(SCRCs)involving incomplete colonoscopy.METHODS:A total of 2123 cases of colorectal cancer(CRC)were reviewed and divided...AIM:To assess the value of computed tomography(CT)for diagnosis of synchronous colorectal cancers(SCRCs)involving incomplete colonoscopy.METHODS:A total of 2123 cases of colorectal cancer(CRC)were reviewed and divided into two groups according to whether a complete or incomplete colonoscopy was performed.CT results and final histological findings were compared to calculate the sensitivity and specificity associated with CT for detection of SCRCs following complete vs incomplete colonoscopy.Factors affecting the CT detection were also analyzed.RESULTS:Three hundred and seventy-four CRC patients underwent incomplete colonoscopy and 1749received complete colonoscopy.Fifty-six cases of SCRCs were identified by CT,and 36 were missed.In the incomplete colonoscopy group,the sensitivity and specificity of CT were 44.8%and 93.6%,respectively.The positive and negative predictive values were 23.6%and 95.0%,respectively.In contrast,the sensitivity and specificity of CT for the complete colonoscopy group were 68.3%and 97.0%,while the positive and negative predictive values were 22.2%and 98.7%,respectively.In both groups,the mean maximum dimension of the concurrent cancers identified in the CT-negative cases was shorter than in the CT-positive cases(incomplete group:P=0.02;complete group:P<0.01)Topographical proximity to synchronous cancers was identified as a risk factor for missed diagnosis(P=0.03).CONCLUSION:CT has limited sensitivity in detecting SCRCs in patients receiving incomplete colonoscopy.Patients with risk factors and negative CT results should be closely examined and monitored.展开更多
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
Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible ligh...Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals.This direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced artifacts.In pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young age.Enhanced spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart defects.Additionally,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media doses.Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular cases.As PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.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
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
Caustic ingestion is a relatively rare but potentially catastrophic gastroentero-logical emergency.Upper gastrointestinal(GI)endoscopy is currently regarded as the gold standard modality not only to assess the depth a...Caustic ingestion is a relatively rare but potentially catastrophic gastroentero-logical emergency.Upper gastrointestinal(GI)endoscopy is currently regarded as the gold standard modality not only to assess the depth and the extension of GI caustic injury,but also to guide the appropriate treatment.Intriguingly,contrast-enhanced computed tomography(CECT)has recently emerged as a promising non-invasive and more accurate alternative to endoscopy in this setting.However,to date,evidence concerning the role of CECT as an alternative or complementary diagnostic tool to endoscopy in caustic ingestion is still limited.The aim of our review was to summarize and discuss the current evidence concerning the role of CECT in the emergency diagnosis of caustic ingestion and its value in assessing injury severity among non-pediatric patients.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
The paper presents experimental investigation results of crack pattern change in cement pastes caused by external sulfate attack(ESA).To visualize the formation and development of cracks in cement pastes under ESA,an ...The paper presents experimental investigation results of crack pattern change in cement pastes caused by external sulfate attack(ESA).To visualize the formation and development of cracks in cement pastes under ESA,an X-ray computed tomography(X-ray CT)was used,i e,the tomography system of Zeiss Xradia 510 versa.The results indicate that X-CT can monitor the development process and distribution characteristics of the internal cracks of cement pastes under ESA with attack time.In addition,the C3A content in the cement significantly affects the damage mode of cement paste specimens during sulfate erosion.The damage of ordinary Portland cement(OPC)pastes subjected to sulfate attack with high C3A content are severe,while the damage of sulfate resistant Portland cement(SRPC)pastes is much smaller than that of OPC pastes.Furthermore,a quadratic function describes the correlation between the crack volume fraction and development depth for two cement pastes immermed in sulfate solution.展开更多
BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significan...BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significant challenge due to its limited accessibility through conventional endoscopic methods.AIM To establish a noninvasive radiomic model based on computed tomography enterography(CTE)for MH assessment in SBCD patients.METHODS Seventy-three patients diagnosed with SBCD were included and divided into a training cohort(n=55)and a test cohort(n=18).Radiomic features were obtained from CTE images to establish a radiomic model.Patient demographics were analysed to establish a clinical model.A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic features.The diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.RESULTS Of the 73 patients enrolled,25 patients achieved MH.The radiomic-clinical nomogram had an area under the ROC curve of 0.961(95%confidence interval:0.886-1.000)in the training cohort and 0.958(0.877-1.000)in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone,as demonstrated by DCA.CONCLUSION These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.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 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
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 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
文摘AIM:To determine the utility of computed tomography(CT) scanning in localizing colon tumors.METHODS:At a single tertiary care teaching hospital,a retrospective chart review was conducted on patients who underwent surgery for colon malignancies between January 2004 and May 2006.One hundred and four charts containing all of the following data were reviewed:preop erative colonoscopy report,preoperative CT report,surgical operative report,tumor pathology report.The colon was divided into five segments from the cecum to the sigmoid and the location of the lesions was categorized into one of these areas.The tumor location was considered "erroneous" if its location determined during surgery differed from the location determined by colonoscopy or CT.RESULTS:Over all,tumor location was accurately determined via colonoscopy in 83/104 cases(79.8%) and erroneously in 21/104(20.2%) of cases.CT scan accurately localized colon tumors in 52/104(50.0%) of cases,incorrectly localized tumors in 18/104(17.3%) of cases,and did not detect known tumors in 34/104(32.7%) of cases.Of the 21 tumors erroneously located by colonoscopy,11(52.4%) were accurately localized by CT scan.The average tumor size for all patients in this study was 5.72(+/-3.11) cm.The average size of tumors properly located by colonoscopy and CT was 5.39(+/-3.34) cm and 6.79(+/-3.48) cm,respectively.The average size of the tumors not detected by CT was 3.98(+/-1.75) cm.CONCLUSION:CT scanning may be used in concert with colonoscopy to help localize colon tumors.
文摘AIM:To compare the results from computed tomography (CT) colonography with conventional colonoscopy in symptomatic patients referred for colonoscopy. METHODS: The study included 227 adult outpatients, mean age 60 years, with appropriate indications for colonoscopy. CT colonography and colonoscopy were performed on the same day in a metropolitan teaching hospital. Colonoscopists were initially blinded to the results of CT colonography but there was segmental unblinding during the procedure. The primary outcome measures were the sensitivity and specificity of CT colonography for the identification of polyps seen at colonoscopy (i.e. analysis by polyp). Secondary outcome measures included an analysis by patient, extracolonic findings at CT colonography, adverse events with both procedures and patient acceptance and preference. RESULTS: Twenty-five patients (11%) were excluded from the analysis because of incomplete colonoscopy or poor bowel preparation that affected either CT colonography, colonoscopy or both procedures. Polyps and masses (usually cancers) were detected at colonoscopy and CT colonography in 35% and 42% of patients, respectively. Of nine patients with a finaldiagnosis of cancer, eight (89%) were identified by CT colonography as masses (5) or polyps (3). For polyps analyzed according to polyp, the overall sensitivity of CT colonography was 50% (95% CI, 39%-61%) but this increased to 71% (95% CI, 52%-85%) for polyps ≥ 6 mm in size. Similarly, specificity for all polyps was 48% (95% CI, 39%-58%) increasing to 67% (95% CI, 56%-76%) for polyps ≥ 6 mm. Adverse events were uncommon but included one colonic perforation at colonoscopy. Patient acceptance was high for both procedures but preference favoured CT colonography. CONCLUSION: Although CT colonography was more sensitive in this study than in some previous studies, the procedure is not yet sensitive enough for widespread application in symptomatic patients.
文摘AIM： TO examine the diagnostic yield of colorectal neoplasia at computed tomographic colonoscopy （CTC） as well as the feasibility of contrast enhanced CTC in patients with gastric cancer. METHODS： To examine the incidence of colon polyp we selected postoperative 188 gastric cancer patients, which we refer to as the ‘colon polyp survey group’. To examine the feasibility of CTC for early detection of colon cancer or advanced colon adenoma, we selected 47 gastric cancer patients （M：F 29：18, mean age 53.8 years）, which we call the ‘CT colonoscopy group’. All the 47 patients underwent successive CTC and colonoscopy on the same day. RESULTS： Totally 109 colon polyps were observed from 59 out of 188 gastric cancer patients, the inddence rate of colon polyps in gastric cancer patients being 31.4%. The sensitivity of CTC in detecting individuals with at least 1 lesion of any size was 57.1%, the specificity was 72.7%, the positive predictive value was 47.1%, and the negative predictive value was 71.9%. When the cutoff size was decreased to 6 mm, the sensitivity and specificity were 80.0% and 92.9%, respectively, with positive and negative predictive values of 57.1% and 97.5%, respectively. Only one patient was classified as false negative by virtual colonoscopy. CONCLUSION： The diagnostic yield of colorectal polyp was 31.4% in patients with gastric cancer, and contrast enhanced CTC is an acceptable tool for the detection of synchronous colorectal advanced adenoma and postoperative surveillance of gastric cancer patients.
文摘BACKGROUND Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding(CDB)is recommended.However,little is known about rates of rebleeding within 30 d.We posited that a group of patients who underwent contrast-enhanced computed tomography(CT)within 4 h of the last hematochezia and colonoscopy within 24 h would experience fewer incidences of rebleeding.AIM To evaluate the outcomes of early colonoscopy for CDB among different groups of patients.METHODS Data from 182 patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018 at the study site were retrospectively reviewed.Patients were divided into groups based on the timing of the CT imaging,within or at 4 h were defined as urgent CTs(n=100)and those performed after 4 h were defined as elective CTs(n=82).Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage(SRH)(i.e.,active bleeding,non-bleeding visible vessels,or adherent clots).RESULTS In total,182 patients(126 men and 56 women)with median ages of 68.6(range,37-92)and 73.7(range,48-93)years,respectively,underwent CT imaging and colonoscopy within 24 h of the last hematochezia.Patients for whom CT was performed within 4 h of the last hematochezia were included in the urgent CT group(n=100)and patients for whom CT was performed after 4 h were included in the elective CT group(n=82).SRH were identified in 35.0%(35/100)of the urgent CT cases and 7.3%(6/82)of the elective CT cases(P<0.01).Among all patients with extravasation-positive images on CT,SRH was identified in 31 out of 47 patients(66.0%)in the urgent CT group and 4 out of 20 patients(20.0%)in the elective CT group(P<0.01).Furthermore,rates of rebleeding within 30 d were significantly improved in the urgent CT and extravasation-positive cases(P<0.05).Results from the evaluation of early colonoscopy did not show a difference in the ability to detect SRH identification or rebleeding rates.Only cases by urgent CT reduced risk of rebleeding due to the evidence of active bleeding on the image.CONCLUSION To improve rates of rebleeding,colonoscopy is recommended within 24 h in patients with extravasation-positive CT images within 4 h of the last hematochezia.Otherwise,elective colonoscopy can be performed.
文摘AIM:To assess the value of computed tomography(CT)for diagnosis of synchronous colorectal cancers(SCRCs)involving incomplete colonoscopy.METHODS:A total of 2123 cases of colorectal cancer(CRC)were reviewed and divided into two groups according to whether a complete or incomplete colonoscopy was performed.CT results and final histological findings were compared to calculate the sensitivity and specificity associated with CT for detection of SCRCs following complete vs incomplete colonoscopy.Factors affecting the CT detection were also analyzed.RESULTS:Three hundred and seventy-four CRC patients underwent incomplete colonoscopy and 1749received complete colonoscopy.Fifty-six cases of SCRCs were identified by CT,and 36 were missed.In the incomplete colonoscopy group,the sensitivity and specificity of CT were 44.8%and 93.6%,respectively.The positive and negative predictive values were 23.6%and 95.0%,respectively.In contrast,the sensitivity and specificity of CT for the complete colonoscopy group were 68.3%and 97.0%,while the positive and negative predictive values were 22.2%and 98.7%,respectively.In both groups,the mean maximum dimension of the concurrent cancers identified in the CT-negative cases was shorter than in the CT-positive cases(incomplete group:P=0.02;complete group:P<0.01)Topographical proximity to synchronous cancers was identified as a risk factor for missed diagnosis(P=0.03).CONCLUSION:CT has limited sensitivity in detecting SCRCs in patients receiving incomplete colonoscopy.Patients with risk factors and negative CT results should be closely examined and monitored.
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.
文摘Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals.This direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced artifacts.In pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young age.Enhanced spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart defects.Additionally,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media doses.Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular cases.As PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.
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.
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Caustic ingestion is a relatively rare but potentially catastrophic gastroentero-logical emergency.Upper gastrointestinal(GI)endoscopy is currently regarded as the gold standard modality not only to assess the depth and the extension of GI caustic injury,but also to guide the appropriate treatment.Intriguingly,contrast-enhanced computed tomography(CECT)has recently emerged as a promising non-invasive and more accurate alternative to endoscopy in this setting.However,to date,evidence concerning the role of CECT as an alternative or complementary diagnostic tool to endoscopy in caustic ingestion is still limited.The aim of our review was to summarize and discuss the current evidence concerning the role of CECT in the emergency diagnosis of caustic ingestion and its value in assessing injury severity among non-pediatric patients.
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.
基金Funded by Chinese National Natural Science Foundation of China(No.U2006224)。
文摘The paper presents experimental investigation results of crack pattern change in cement pastes caused by external sulfate attack(ESA).To visualize the formation and development of cracks in cement pastes under ESA,an X-ray computed tomography(X-ray CT)was used,i e,the tomography system of Zeiss Xradia 510 versa.The results indicate that X-CT can monitor the development process and distribution characteristics of the internal cracks of cement pastes under ESA with attack time.In addition,the C3A content in the cement significantly affects the damage mode of cement paste specimens during sulfate erosion.The damage of ordinary Portland cement(OPC)pastes subjected to sulfate attack with high C3A content are severe,while the damage of sulfate resistant Portland cement(SRPC)pastes is much smaller than that of OPC pastes.Furthermore,a quadratic function describes the correlation between the crack volume fraction and development depth for two cement pastes immermed in sulfate solution.
基金Supported by Natural Science Foundation of Anhui Medical University,No.2023xkj130.
文摘BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significant challenge due to its limited accessibility through conventional endoscopic methods.AIM To establish a noninvasive radiomic model based on computed tomography enterography(CTE)for MH assessment in SBCD patients.METHODS Seventy-three patients diagnosed with SBCD were included and divided into a training cohort(n=55)and a test cohort(n=18).Radiomic features were obtained from CTE images to establish a radiomic model.Patient demographics were analysed to establish a clinical model.A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic features.The diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.RESULTS Of the 73 patients enrolled,25 patients achieved MH.The radiomic-clinical nomogram had an area under the ROC curve of 0.961(95%confidence interval:0.886-1.000)in the training cohort and 0.958(0.877-1.000)in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone,as demonstrated by DCA.CONCLUSION These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.
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.
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 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.
