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
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 The Asia-Pacific Colorectal Screening(APCS)score was designed with the purpose of distinguishing individuals at high risk(HR)for colorectal advanced neoplasia(AN).Traditional Chinese medicine(TCM)constituti...BACKGROUND The Asia-Pacific Colorectal Screening(APCS)score was designed with the purpose of distinguishing individuals at high risk(HR)for colorectal advanced neoplasia(AN).Traditional Chinese medicine(TCM)constitution was also linked with colorectal cancer(CRC).AIM To integrate the APCS score with TCM constitution identification as a new algorithm to screen for CRC.METHODS A cross-sectional multicenter study was carried out in three hospitals,enrolling 1430 patients who were asymptomatic and undergoing screening colonoscopy from 2022 to 2023.Patients were considered to have average risk,moderate risk,or HR with their APCS score.Odd ratios assessed the relationship between TCM constitution and disease progression.A TCM constitution risk score was created.The sensitivity and specificity of the new algorithm were calculated to evaluate diagnostic performance in detecting advanced adenoma(AA),CRC,and AN.RESULTS Of the 1430 patients,370(25.9%)were categorized as average risk,755(52.8%)as moderate risk,and 305(21.3%)as HR.Using the combined APCS score and the TCM constitution(damp-heat,qi-deficiency,yang-deficiency,phlegm-dampness,and inherited special constitution as positive)algorithm,72.2%of patients with AA and 73.7%of patients with AN were detected.Compared with the APCS score alone,the new algorithm significantly improved the sensitivity for screening AA[72.2%,95%confidence interval(CI):64.4%-80.0%vs 49.2%,95%CI:40.5%-57.9%]and AN(73.7%,95%CI:66.4%-81.1%vs 51.1%,95%CI:42.7%-59.5%).CONCLUSION The combination of APCS and TCM constitution identification questionnaires was valuable in identifying Chinese individuals who were asymptomatic for colorectal screening prioritization.展开更多
Objective To examine the effect of excess body weight on adherence and lesion detection in colorectal cancer(CRC)screening.Methods A cross-sectional analysis was conducted within an opportunistic CRC screening program...Objective To examine the effect of excess body weight on adherence and lesion detection in colorectal cancer(CRC)screening.Methods A cross-sectional analysis was conducted within an opportunistic CRC screening program in Chongqing,which enrolled 43,797 adults aged 35–74 years between 2021 and 2022.A total of 42,279 participants were included in the final analysis,of whom 19,462(46.0%)had excess body weight(BMI>24.0 kg/m2).Colonoscopy adherence and detection were compared between normal and excess body weight group,and associated factors were examined.Results Of the 7,002 participants recommended for colonoscopy,3,808(54.4%)had excess body weight.Adherence was significantly lower in the excess weight group(6.6%)than in the normal weight group(10.7%,P<0.001),and this trend was consistent across sex and age groups.The detection rates of advanced neoplasms(3.6%vs.1.8%)and non-advanced adenomas(10.7%vs.6.7%)were higher in the excess weight cohort,with a significant difference for any neoplasm(14.2%vs.8.9%,P<0.05).Differences in adherence-and detection-related factors were also observed between the groups.Conclusion Excess body weight was associated with lower colonoscopy adherence but higher neoplasm detection.These findings support the integration of weight management with targeted screening promotion to improve CRC prevention in this high-risk population.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
Many advanced age patients who are diagnosed with colorectal cancer are often not offered surgical treatment due to presumed high risks of the procedure.While there is data to support surgical treatment of colorectal ...Many advanced age patients who are diagnosed with colorectal cancer are often not offered surgical treatment due to presumed high risks of the procedure.While there is data to support surgical treatment of colorectal cancer in advanced age patients,screening colonoscopy is not currently recommended for patients older than 85 years.Moreover,recent studies concluded that the incidence of colorectal cancer in patients 80 years and older is increasing.This raises the concern that the current guidelines are withholding screening colonoscopy for healthy elderly patients.Another concern contrary to this would be the new trend of growing incidence of advanced colorectal cancer in the younger patient population.Together they raise the ethical dilemma of how to best utilize colonoscopies as well as surgical intervention,as they are limited resources.展开更多
BACKGROUND Since its complete roll-out in 2009,the French colorectal cancer screening program(CRCSP)experienced 3 major constraints[use of a less efficient Guaiac-test(gFOBT),stopping the supply of Fecal-Immunochemica...BACKGROUND Since its complete roll-out in 2009,the French colorectal cancer screening program(CRCSP)experienced 3 major constraints[use of a less efficient Guaiac-test(gFOBT),stopping the supply of Fecal-Immunochemical-Test kits(FIT),and suspension of the program due to the coronavirus disease 2019(COVID-19)]affecting its effectiveness.AIM To describe the impact of the constraints in terms of changes in the quality of screeningcolonoscopy(Quali-Colo).METHODS This retrospective cohort study included screening-colonoscopies performed by gastroenterologists between Jan-2010 and Dec-2020 in people aged 50-74 living in Ile-de-France(France).The changes in Quali-colo(Proportion of colonoscopies performed beyond 7 mo(Colo_7 mo),Frequency of serious adverse events(SAE)and Colonoscopy detection rate)were described in a cohort of Gastroenterologists who performed at least one colonoscopy over each of the four periods defined according to the chronology of the constraints[gFOBT:Normal progress of the CRCSP using gFOBT(2010-2014);FIT:Normal progress of the CRCSP using FIT(2015-2018);STOP-FIT:Year(2019)during which the CRCSP experienced the cessation of the supply of test kits;COVID:Program suspension due to the COVID-19 health crisis(2020)].The link between each dependent variable(Colo_7 mo;SAE occurrence,neoplasm detection rate)and the predictive factors was analyzed in a two-level multivariate hierarchical model.RESULTS The 533 gastroenterologists(cohort)achieved 21509 screening colonoscopies over gFOBT period,38352 over FIT,7342 over STOP-FIT and 7995 over COVID period.The frequency of SAE did not change between periods(gFOBT:0.3%;FIT:0.3%;STOP-FIT:0.3%;and COVID:0.2%;P=0.10).The risk of Colo_7 mo doubled between FIT[adjusted odds ratio(aOR):1.2(1.1;1.2)]and STOPFIT[aOR:2.4(2.1;2.6)];then,decreased by 40%between STOP-FIT and COVID[aOR:2.0(1.8;2.2)].Regardless of the period,this Colo_7 mo’s risk was twice as high for screening colonoscopy performed in a public hospital[aOR:2.1(1.3;3.6)]compared to screening-colonoscopy performed in a private clinic.The neoplasm detection,which increased by 60%between gFOBT and FIT[aOR:1.6(1.5;1.7)],decreased by 40%between FIT and COVID[aOR:1.1(1.0;1.3)].CONCLUSION The constraints likely affected the time-to-colonoscopy as well as the colonoscopy detection rate without impacting the SAE’s occurrence,highlighting the need for a respectable reference time-tocolonoscopy in CRCSP.展开更多
Unsedated colonoscopy is available worldwide,but is not a routine option in the United States(US).We conducted a literature review supplemented by our experience and expert commentaries to provide data to support the ...Unsedated colonoscopy is available worldwide,but is not a routine option in the United States(US).We conducted a literature review supplemented by our experience and expert commentaries to provide data to support the use of unsedated colonoscopy for colorectal cancer screening.Medline data from 1966 to 2009 were searched to identify relevant articles on the subject.Data were summarized and co-authors provided critiques as well as accounts of unsedated colonoscopy for screening and surveillance.Diagnostic colonoscopy was initially dev eloped as an unsedated procedure.Procedure-re lated discomfort led to wide adoption of sedation in the US,although unsedated colonoscopy remains the usual practice elsewhere.The increased use of colonoscopy for colorectal cancer screening in healthy,asymptomatic individuals suggests a reass-essment of the burden of sedation in colonoscopy for screening is appropriate in the US for lowering costs and minimizing complications for patients.A water method developed to minimize discomfort has shown promise to enhance outcomes of unsedated colonoscopy.The use of scheduled,unsedated colono scopy in the US appears to be feasible for colorectal cancer screening.Studies to assess its applicability in diverse practice settings deserve to be conducted and supported.展开更多
AIMTo identify the prevalence, and clinical and pathologic characteristic of colonic polyps among Iranian patients undergoing a comprehensive colonoscopy, and determine the polyp detection rate (PDR) and adenoma detec...AIMTo identify the prevalence, and clinical and pathologic characteristic of colonic polyps among Iranian patients undergoing a comprehensive colonoscopy, and determine the polyp detection rate (PDR) and adenoma detection rate (ADR). METHODSIn this cross-sectional study, demographics and epidemiologic characteristics of 531 persons who underwent colonoscopies between 2014 and 2015 at Mehrad gastrointestinal clinic were determined. Demographics, indication for colonoscopy, colonoscopy findings, number of polyps, and histopathological characteristics of the polyps were examined for each person. RESULTSOur sample included 295 (55.6%) women and 236 (44.4%) men, with a mean age of 50.25 ± 14.89 years. Overall PDR was 23.5% (125/531). ADR and colorectal cancer detection rate in this study were 12.8% and 1.5%, respectively. Polyps were detected more significantly frequently in men than in women (52.8% vs 47.2%, P vs 56.4 years, P CONCLUSIONThe prevalence of polyps and adenomas in this study is less than that reported in the Western populations. In our patients, distal colon is more susceptible to developing polyps and cancer than proximal colon.展开更多
Colorectal cancer (CRC) remains a leading cancer killer worldwide. But the disease is both curable and preventable at an early stage. Regular CRC cancer screening has been shown to reduce the risk of dying from CRC. H...Colorectal cancer (CRC) remains a leading cancer killer worldwide. But the disease is both curable and preventable at an early stage. Regular CRC cancer screening has been shown to reduce the risk of dying from CRC. However, the importance of large-scale screening is only now starting to be appreciated. This article reviews a variety of imaging procedures available for detecting ulcerative colitis (UC) and Crohn's disease (CD), polyps and CRC in their early stage and also presents details on various screening options. Detecting, staging and re-staging of patients with CRC also require multimodality, multistep imaging approaches. Staging and re-staging with conventional colonoscopy (CC), computer tomography colonography (CTC), magnetic resonance colonography (MRC) and positron emission tomography/computer tomography colonography (PET/CTC) are of paramount importance in determining the most appropriate therapeutic method and in predicting the risk of tumor recurrence and overall prognosis. The advantages and limitations of these modalities are also discussed.展开更多
In the United States,colorectal cancer(CRC)is the second leading cause of mortality in men and women.We are now seeing an increasing number of patients with advanced-stage diagnosis and mortality from colorectal cance...In the United States,colorectal cancer(CRC)is the second leading cause of mortality in men and women.We are now seeing an increasing number of patients with advanced-stage diagnosis and mortality from colorectal cancer before 50 years of age,which requires earlier screening.With the increasing need for CRC screening through colonoscopy,and thus endoscopists,easier and simpler techniques are needed to train proficient endoscopists.The most widely used approach by endoscopists is air insufflation colonoscopy,where air distends the colon to allow visualization of the colonic mucosa.This technique is uncomfortable for patients and requires an anesthetist to administer sedation.In addition,patients commonly complain about discomfort post-op as air escapes into the small bowel and cannot be adequately removed.Current research into the use of water insufflation colonoscopies has proved promising in reducing the need for sedation,decreasing discomfort,and increasing the visibility of the colonic mucosa.Future direction into water insufflation colonoscopies which have shown to be simpler and easier to teach may increase the number of proficient endoscopists in training to serve our aging population.展开更多
AIM： To compare high resolution colonoscopy （Olympus Lucera） with a megapixel high resolution system （Pentax HiLine） as an in-service evaluation. METHODS： Polyp detection rates and measures of performance were c...AIM： To compare high resolution colonoscopy （Olympus Lucera） with a megapixel high resolution system （Pentax HiLine） as an in-service evaluation. METHODS： Polyp detection rates and measures of performance were collected for 269 colonoscopy procedures. Five colonoscopists conducted the study over a three month period, as part of the United Kingdom bowel cancer screening program. RESULTS：There were no differences in procedure duration （x^2 p = 0.98）, caecal intubation rates （x^2 P = 0.67）, or depth of sedation （x^2 P = 0.64）. Mild discomfort was more common in the Pentax group （x^2 p = 0.036）. Adenoma detection rate was significantly higher in the Pentax group （x^2 test for trend P = 0.01）. Most of the extra polyps detected were flat or sessile adenomas. CONCLUSION： Megapixel definition colonoscopes improve adenoma detection without compromising other measures of endoscope performance. Increased polyp detection rates may improve future outcomes in bowel cancer screening programs.展开更多
AIM： TO assess the gender preferences, specifically the gender of the nursing staff （endoscopy assistants） and the impact on acceptance for screening colonoscopy （SC）. METHODS： Patients or relatives attending th...AIM： TO assess the gender preferences, specifically the gender of the nursing staff （endoscopy assistants） and the impact on acceptance for screening colonoscopy （SC）. METHODS： Patients or relatives attending the clinics or health care workers working in a tertiary center were invited to participate in this questionnaire study. The questionnaire enquired on the general demographics （1） age, gender, ethnicity, education level, and employ- ment status, previous history of colonoscopy, family or personal history of colonic pathologies, personal and family history of any cancers; （2） subjects were asked if they would go for an SC if they had appropriate indi- cations （age over 50 years, family history of colorectal cancer （CRC）, fecal occult blood positive, anemia espe- cially iron deficiency anemia, bleeding per rectum with or without loss of appetite, weight loss and abdominal pain） with and without symptoms attributable to CRC; and （3） preferences for the gender of the endoscopists and assistants and whether they would still undergo SC even if their preferences were not met. RESULTS： Eighty-four point seven percent （470/550） completed questionnaire were analysed. More female subjects expressed gender preferences for the endos- copists [overall 70%; female （67.7%） and male （2.3%）] compared to male subjects [overall 62.8%; male （56%） and female （6.8%）, P = 0.102]. Similarly, more female subjects expressed gender preferences for the assis- tants [overall 74.5%; female （73.4%） and male （1.1%）] compared to male subjects [overall 58%, male （49.3%） and female （8.7%）, P 〈 0.001]. Overall, a third would decline an SC, despite having appropriate indications, if their preferences were not met. On univariate analysis, male gender, non-Malay ethnicity （Chinese and others） and previous colonoscopy experience were more likely to undergo an SC, even if their preferences were not met （all P 〈 0.05）. Gender and previous experience fodds ratio （OR） 1.68, 95% confidence interval （CI） 1.00-2.82, P 〈 0.05] with colonoscopy （OR 4.70, 95% CI 1.41-15.66, P 〈 0.05） remained significant on multi variate analysis. CONCLUSION： Genders preference for the endoscopy nurses/assistants is more common than for the endos- copist among women and has implications for the suc cess of a screening colonoscopy program.展开更多
Colorectal cancer is a term used to describe colon and rectal cancer,which is the third most common type of cancer.A MEDLINE and PubMed search resulted in the inclusion of manuscripts written in the last 10 years,usin...Colorectal cancer is a term used to describe colon and rectal cancer,which is the third most common type of cancer.A MEDLINE and PubMed search resulted in the inclusion of manuscripts written in the last 10 years,using keywords relevant to the topic of the manuscript.By analyzing the aim of the searched studies and manuscripts,adequate articles were included that described the stated problem.The frequency of colorectal cancer varies with climate,nutrition,and many other factors,primarily endogenous,hereditary,intestinal microbiome,as well as external factors,such as exposure of the individual to stress,and bad eating habits.Colon cancer and rectal cancer or colorectal cancer in general in the early stages of the disease,may not show symptoms or are barely noticeable.Colorectal cancer symptoms will most often not develop until the disease has progressed to stage 2 or beyond.Regular screening tests for colon or rectal cancer,especially colonoscopy,are recommended as part of a regular checkup for people aged 50 years or younger who are at high risk due to a family history of the disease or other cancers.Diet and colonoscopy as an early screening method play an important role in the prevention of colorectal cancer.展开更多
BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors,and early screening is crucial to improving the survival rate of patients.The combination of colonoscopy and immune fecal occult blood detect...BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors,and early screening is crucial to improving the survival rate of patients.The combination of colonoscopy and immune fecal occult blood detection has garnered significant attention as a novel method for CRC screening.Colonoscopy and fecal occult blood tests,when combined,can improve screening accuracy and early detection rates,thereby facilitating early intervention and treatment.However,certain risks and costs accompany it,making the establishment of a risk classification model crucial for accurate classification and management of screened subjects.AIM To evaluate the feasibility and effectiveness of colonoscopy,immune fecal occult blood test(FIT),and risk-graded screening strategies in CRC screening.METHODS Based on the randomized controlled trial of CRC screening in the population conducted by our hospital May 2020 to May 2023,participants who met the requirements were randomly assigned to a colonoscopy group,an FIT group,or a graded screening group at a ratio of 1:2:2(after risk assessment,the high-risk group received colonoscopy,the low-risk group received an FIT test,and the FITpositive group received colonoscopy).The three groups received CRC screening with different protocols,among which the colonoscopy group only received baseline screening,and the FIT group and the graded screening group received annual follow-up screening based on baseline screening.The primary outcome was the detection rate of advanced tumors,including CRC and advanced adenoma.The population participation rate,advanced tumor detection rate,and colonoscopy load of the three screening programs were compared.RESULTS A total of 19373 subjects who met the inclusion and exclusion criteria were enrolled,including 8082 males(41.7%)and 11291 females(58.3%).The mean age was 60.05±6.5 years.Among them,3883 patients were enrolled in the colonoscopy group,7793 in the FIT group,and 7697 in the graded screening group.Two rounds of follow-up screening were completed in the FIT group and the graded screening group.The graded screening group(89.2%)and the colonoscopy group(42.3%)had the lowest overall screening participation rates,while the FIT group had the highest(99.3%).The results of the intentional analysis showed that the detection rate of advanced tumors in the colonoscopy group was greater than that of the FIT group[2.76%vs 2.17%,odds ratio(OR)=1.30,95%confidence interval(CI):1.01-1.65,P=0.037].There was no significant difference in the detection rate of advanced tumors between the colonoscopy group and the graded screening group(2.76%vs 2.35%,OR=1.9,95%CI:0.93-1.51,P=0.156),as well as between the graded screening group and the FIT group(2.35%vs 2.17%,OR=1.09%,95%CI:0.88-1.34,P=0.440).The number of colonoscopy examinations required for each patient with advanced tumors was used as an index to evaluate the colonoscopy load during population screening.The graded screening group had the highest colonoscopy load(15.4 times),followed by the colonoscopy group(10.2 times),and the FIT group had the lowest(7.8 times).CONCLUSION A hierarchical screening strategy based on CRC risk assessment is feasible for screening for CRC in the population.It can be used as an effective supplement to traditional colonoscopy and FIT screening programs.展开更多
AIM:To compare the bowel cleansing efficacy,tolerability and acceptability of split 2-L polyethylene glycol(PEG)-citrate-simethicone(PEG-CS)plus bisacodyl(BIS)vs 4-L PEG for fecal occult blood test-positive screening ...AIM:To compare the bowel cleansing efficacy,tolerability and acceptability of split 2-L polyethylene glycol(PEG)-citrate-simethicone(PEG-CS)plus bisacodyl(BIS)vs 4-L PEG for fecal occult blood test-positive screening colonoscopy.METHODS:This was a randomised,observer-blind comparative study.Two hundred and sixty-four subjects underwent screening colonoscopy(mean age 62.5±7.4years,male 61.7%).The primary objective of the study was to compare the bowel cleansing efficacy of the two preparations.Interventions:BIS plus PEG-CS:3 tablets of 5-mg BIS at 16:00,PEG-CS 1-L at 19:00 and 1-L at7:00,4-L PEG:3-L at 17:00,and 1-L at 7:00.Colonoscopy was carried out after 11:00,at least 3 h after the completion of bowel preparation.Bowel cleansing was evaluated using the Harefield Cleansing Scale.RESULTS:Bowel preparation was successful for 92.8%of subjects in the PEG-CS group and for 92.1%of subjects in the 4-L PEG(RR=1.01;95%CI:0.94-1.08).BIS+PEG-CS was better tolerated than 4-L PEG.A greater rate of patients in the BIS+PEG-CS group had no difficulty and/or were willing to repeat the same preparation compared to split-dose 4-L PEG group.Subjects in the BIS+PEG-CS group rated the prep as good or satisfactory in 90.6%as compared to 77%in the 4-L PEG(P=0.003).Subjects receiving BIS+PEGCS stated they fully adhered to instructions drinking all the 2-L solution in 97.1%compared with 87.3%in the4-L PEG(P=0.003).CONCLUSION:BIS plus split 2-L PEG-CS was as effective as but better tolerated and accepted than split4-L PEG for screening colonoscopy.This new procedure may increase the positive attitude and participation to colorectal cancer screening colonoscopy.展开更多
AIM To identify risk factors for a suboptimal preparation among a population undergoing screening or surveillance colonoscopy.METHODS Retrospective review of the University of Michigan and Veteran's Administration...AIM To identify risk factors for a suboptimal preparation among a population undergoing screening or surveillance colonoscopy.METHODS Retrospective review of the University of Michigan and Veteran's Administration(VA) Hospital records from 2009 to identify patients age 50 and older who underwent screening or surveillance procedure and had resection of polyps less than 1 cm in size and no more than 2 polyps. Patients with inflammatory bowel disease or a family history of colorectal cancer were excluded. Suboptimal procedures were defined as procedure preparations categorized as fair, poor or inadequate by the endoscopist. Multivariable logistic regression was used to identify predictors of suboptimal preparation.RESULTS Of 4427 colonoscopies reviewed, 2401 met our inclusion criteria and were analyzed. Of our population, 16% had a suboptimal preparation. African Americans were 70% more likely to have a suboptimal preparation(95%CI: 1.2-2.4). Univariable analysis revealed that narcotic and tricyclic antidepressants(TCA) use, diabetes, prep type, site(VA vs non-VA), and presence of a gastroenterology(GI) fellow were associated with suboptimal prep quality. In a multivariable model controlling for gender, age, ethnicity, procedure site and presence of a GI fellow, diabetes [odds ratio(OR) = 2.3; 95%CI: 1.6-3.2], TCA use(OR = 2.5; 95%CI: 1.3-4.9), narcotic use(OR = 1.7; 95%CI: 1.2-2.5) and Miralax-Gatorade prep vs 4L polyethylene glycol 3350(OR = 0.6; 95%CI: 0.4-0.9) were associated with a suboptimal prep quality. CONCLUSION Diabetes, narcotics use and TCA use were identified as predictors of poor preparation in screening colonoscopies while Miralax-Gatorade preps were associated with better bowel preparation.展开更多
AIM:To investigate the changes in renal function at 12-24 mo in patients following sodium phosphate(NaP) preparation for screening colonoscopy.METHODS:We carried out a retrospective study on the results from patients ...AIM:To investigate the changes in renal function at 12-24 mo in patients following sodium phosphate(NaP) preparation for screening colonoscopy.METHODS:We carried out a retrospective study on the results from patients who received health check-up services as part of an employer-provided wellness program performed between August 2006 and May 2008 and who were followed up for 12-24 mo.Prior to screening colonoscopy,224 patients underwent bowel cleansing with NaP(NaP group) and 113 patients with polyethylene glycol(PEG group).The control group comprised 672 age-matched patients.We compared the changes in the creatinine levels and the glomerular filtration rates(GFRs) from baseline to 12-24 mo between the NaP,PEG,and control groups using two-way repeated measured analysis of variance.In addition,multivariate linear regression analysis was performed to assess the risk factors for a decreased GFR.RESULTS:The baseline mean serum creatinine level in the NaP,PEG,and control groups was 1.12 ± 0.15,1.12 ± 0.16,and 1.12 ± 0.15 mg/dL,which increased to 1.15 ± 0.15,1.15 ± 0.18,and 1.15 ± 0.15 mg/dL,respectively,after 12-24 mo.The baseline mean GFR in the NaP,PEG,and control groups was 69.0 ± 7.7,68.9 ± 8.0,and 69.6 ± 6.7 mL/min per 1.73 m2,which decreased to 66.5 ± 7.8,66.5 ± 8.3,and 67.4 ± 6.4 mL/min per 1.73 m2,respectively,after 12-24 mo.The changes in serum creatinine levels and GFRs were not significantly between the NaP,PEG,and control groups(P = 0.992 and P = 0.233,respectively).Using multivariate linear regression analysis,only the baseline GFR was associated with the change in GFR(P < 0.001).Indeed,the bowel preparations were not associated with the change in GFR(P = 0.297).CONCLUSION:NaP bowel preparation in subjects with normal renal function was not associated with renal injury,and NaP can thus be used safely for screening colonoscopy.展开更多
AIM:To compare the performance characteristics of Pentax HiLine(PHL)(with i-scan) and Olympus Lucera(OL) systems in a screening population.METHODS:Screening colonoscopies in asymptomatic guaiac faecal occult blood tes...AIM:To compare the performance characteristics of Pentax HiLine(PHL)(with i-scan) and Olympus Lucera(OL) systems in a screening population.METHODS:Screening colonoscopies in asymptomatic guaiac faecal occult blood test-positive patients with PHL(n = 58) and OL(n = 425) colonoscopes were analysed.All procedures were performed by a single colonoscopist.PHL used white-light endoscopy(WLE) on scope insertion and contrast/surface enhancement(i-scan 1) on withdrawal,and OL utilised WLE both on insertion and withdrawal.Patient age,sex,instrument insertion and withdrawal times,nurse assessed patient comfort scores,midazolam and fentanyl doses,procedure completion and rates of lesion detection were recorded separately for each group.Comparisons between the groups were made using either Fisher's exact test(for dichotomous variables) or Mann-Whitney U test(for ordinal and continuous variables).RESULTS:Colonoscopy completion rates were similar in both groups:413/425(97.2%) for OL and 55/58(94.9%) for PHL(P = 0.24).For complete colonoscopies,the two groups were well matched for age,sex,colonoscope insertion times(mean 11.1 min in OL vs 11.6 min in PHL,P = 0.93) and normal colonoscopy withdrawal times(mean 15.6 min in OL vs 14.7 min in PHL,P = 0.2).Patients in the PHL group experienced a small increase in discomfort(mean patient comfort scores were 0.49 in the OL and 0.95 in the PHL group,P < 0.0001).While Fentanyl doses required were similar between groups(mean 57.5 μg in OL vs 61.4 μg in PHL,P = 0.13),slightly more Midazolam was required in the PHL group(mean 2.1 mg in OL vs 2.4 mg in PHL,P = 0.035).There was no difference in polyp(58% in OL vs 67% in PHL) or adenoma(49% in OL vs 56% in PHL) detection rates between the groups.Neither the total number of polyps and adenomas,nor the characteristics of these(including size,location or presence of advanced features) were different between the two systems.CONCLUSION:This study suggests that there is no advantage of either colonoscope system in lesion detection.展开更多
Background and Aims: The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain the...Background and Aims: The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there in increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients. Methods: A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45 - 75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas. Results: Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance was associated with adenoma detection. Conclusion: In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.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.
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.
文摘BACKGROUND The Asia-Pacific Colorectal Screening(APCS)score was designed with the purpose of distinguishing individuals at high risk(HR)for colorectal advanced neoplasia(AN).Traditional Chinese medicine(TCM)constitution was also linked with colorectal cancer(CRC).AIM To integrate the APCS score with TCM constitution identification as a new algorithm to screen for CRC.METHODS A cross-sectional multicenter study was carried out in three hospitals,enrolling 1430 patients who were asymptomatic and undergoing screening colonoscopy from 2022 to 2023.Patients were considered to have average risk,moderate risk,or HR with their APCS score.Odd ratios assessed the relationship between TCM constitution and disease progression.A TCM constitution risk score was created.The sensitivity and specificity of the new algorithm were calculated to evaluate diagnostic performance in detecting advanced adenoma(AA),CRC,and AN.RESULTS Of the 1430 patients,370(25.9%)were categorized as average risk,755(52.8%)as moderate risk,and 305(21.3%)as HR.Using the combined APCS score and the TCM constitution(damp-heat,qi-deficiency,yang-deficiency,phlegm-dampness,and inherited special constitution as positive)algorithm,72.2%of patients with AA and 73.7%of patients with AN were detected.Compared with the APCS score alone,the new algorithm significantly improved the sensitivity for screening AA[72.2%,95%confidence interval(CI):64.4%-80.0%vs 49.2%,95%CI:40.5%-57.9%]and AN(73.7%,95%CI:66.4%-81.1%vs 51.1%,95%CI:42.7%-59.5%).CONCLUSION The combination of APCS and TCM constitution identification questionnaires was valuable in identifying Chinese individuals who were asymptomatic for colorectal screening prioritization.
基金supported by the National Natural Science Foundation of China(grant number 82404340)the Fundamental Research Funds for the Central Universities,Peking Union Medical College(grant number 3332024216).
文摘Objective To examine the effect of excess body weight on adherence and lesion detection in colorectal cancer(CRC)screening.Methods A cross-sectional analysis was conducted within an opportunistic CRC screening program in Chongqing,which enrolled 43,797 adults aged 35–74 years between 2021 and 2022.A total of 42,279 participants were included in the final analysis,of whom 19,462(46.0%)had excess body weight(BMI>24.0 kg/m2).Colonoscopy adherence and detection were compared between normal and excess body weight group,and associated factors were examined.Results Of the 7,002 participants recommended for colonoscopy,3,808(54.4%)had excess body weight.Adherence was significantly lower in the excess weight group(6.6%)than in the normal weight group(10.7%,P<0.001),and this trend was consistent across sex and age groups.The detection rates of advanced neoplasms(3.6%vs.1.8%)and non-advanced adenomas(10.7%vs.6.7%)were higher in the excess weight cohort,with a significant difference for any neoplasm(14.2%vs.8.9%,P<0.05).Differences in adherence-and detection-related factors were also observed between the groups.Conclusion Excess body weight was associated with lower colonoscopy adherence but higher neoplasm detection.These findings support the integration of weight management with targeted screening promotion to improve CRC prevention in this high-risk population.
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Many advanced age patients who are diagnosed with colorectal cancer are often not offered surgical treatment due to presumed high risks of the procedure.While there is data to support surgical treatment of colorectal cancer in advanced age patients,screening colonoscopy is not currently recommended for patients older than 85 years.Moreover,recent studies concluded that the incidence of colorectal cancer in patients 80 years and older is increasing.This raises the concern that the current guidelines are withholding screening colonoscopy for healthy elderly patients.Another concern contrary to this would be the new trend of growing incidence of advanced colorectal cancer in the younger patient population.Together they raise the ethical dilemma of how to best utilize colonoscopies as well as surgical intervention,as they are limited resources.
文摘BACKGROUND Since its complete roll-out in 2009,the French colorectal cancer screening program(CRCSP)experienced 3 major constraints[use of a less efficient Guaiac-test(gFOBT),stopping the supply of Fecal-Immunochemical-Test kits(FIT),and suspension of the program due to the coronavirus disease 2019(COVID-19)]affecting its effectiveness.AIM To describe the impact of the constraints in terms of changes in the quality of screeningcolonoscopy(Quali-Colo).METHODS This retrospective cohort study included screening-colonoscopies performed by gastroenterologists between Jan-2010 and Dec-2020 in people aged 50-74 living in Ile-de-France(France).The changes in Quali-colo(Proportion of colonoscopies performed beyond 7 mo(Colo_7 mo),Frequency of serious adverse events(SAE)and Colonoscopy detection rate)were described in a cohort of Gastroenterologists who performed at least one colonoscopy over each of the four periods defined according to the chronology of the constraints[gFOBT:Normal progress of the CRCSP using gFOBT(2010-2014);FIT:Normal progress of the CRCSP using FIT(2015-2018);STOP-FIT:Year(2019)during which the CRCSP experienced the cessation of the supply of test kits;COVID:Program suspension due to the COVID-19 health crisis(2020)].The link between each dependent variable(Colo_7 mo;SAE occurrence,neoplasm detection rate)and the predictive factors was analyzed in a two-level multivariate hierarchical model.RESULTS The 533 gastroenterologists(cohort)achieved 21509 screening colonoscopies over gFOBT period,38352 over FIT,7342 over STOP-FIT and 7995 over COVID period.The frequency of SAE did not change between periods(gFOBT:0.3%;FIT:0.3%;STOP-FIT:0.3%;and COVID:0.2%;P=0.10).The risk of Colo_7 mo doubled between FIT[adjusted odds ratio(aOR):1.2(1.1;1.2)]and STOPFIT[aOR:2.4(2.1;2.6)];then,decreased by 40%between STOP-FIT and COVID[aOR:2.0(1.8;2.2)].Regardless of the period,this Colo_7 mo’s risk was twice as high for screening colonoscopy performed in a public hospital[aOR:2.1(1.3;3.6)]compared to screening-colonoscopy performed in a private clinic.The neoplasm detection,which increased by 60%between gFOBT and FIT[aOR:1.6(1.5;1.7)],decreased by 40%between FIT and COVID[aOR:1.1(1.0;1.3)].CONCLUSION The constraints likely affected the time-to-colonoscopy as well as the colonoscopy detection rate without impacting the SAE’s occurrence,highlighting the need for a respectable reference time-tocolonoscopy in CRCSP.
基金Supported in part by Veterans Affairs Clinical Merit Medical Research Funds,the ASGE Career Development Award (FWL1985)American College of Gastroenterology Clinical Research Award(FWL 2009)
文摘Unsedated colonoscopy is available worldwide,but is not a routine option in the United States(US).We conducted a literature review supplemented by our experience and expert commentaries to provide data to support the use of unsedated colonoscopy for colorectal cancer screening.Medline data from 1966 to 2009 were searched to identify relevant articles on the subject.Data were summarized and co-authors provided critiques as well as accounts of unsedated colonoscopy for screening and surveillance.Diagnostic colonoscopy was initially dev eloped as an unsedated procedure.Procedure-re lated discomfort led to wide adoption of sedation in the US,although unsedated colonoscopy remains the usual practice elsewhere.The increased use of colonoscopy for colorectal cancer screening in healthy,asymptomatic individuals suggests a reass-essment of the burden of sedation in colonoscopy for screening is appropriate in the US for lowering costs and minimizing complications for patients.A water method developed to minimize discomfort has shown promise to enhance outcomes of unsedated colonoscopy.The use of scheduled,unsedated colono scopy in the US appears to be feasible for colorectal cancer screening.Studies to assess its applicability in diverse practice settings deserve to be conducted and supported.
基金Supported by Gastroenterology and Liver Diseases Research Center,Research Institute for Gastroenterology and Liver Diseases,Shahid Beheshti University of Medical Sciences,Tehran,Iran
文摘AIMTo identify the prevalence, and clinical and pathologic characteristic of colonic polyps among Iranian patients undergoing a comprehensive colonoscopy, and determine the polyp detection rate (PDR) and adenoma detection rate (ADR). METHODSIn this cross-sectional study, demographics and epidemiologic characteristics of 531 persons who underwent colonoscopies between 2014 and 2015 at Mehrad gastrointestinal clinic were determined. Demographics, indication for colonoscopy, colonoscopy findings, number of polyps, and histopathological characteristics of the polyps were examined for each person. RESULTSOur sample included 295 (55.6%) women and 236 (44.4%) men, with a mean age of 50.25 ± 14.89 years. Overall PDR was 23.5% (125/531). ADR and colorectal cancer detection rate in this study were 12.8% and 1.5%, respectively. Polyps were detected more significantly frequently in men than in women (52.8% vs 47.2%, P vs 56.4 years, P CONCLUSIONThe prevalence of polyps and adenomas in this study is less than that reported in the Western populations. In our patients, distal colon is more susceptible to developing polyps and cancer than proximal colon.
文摘Colorectal cancer (CRC) remains a leading cancer killer worldwide. But the disease is both curable and preventable at an early stage. Regular CRC cancer screening has been shown to reduce the risk of dying from CRC. However, the importance of large-scale screening is only now starting to be appreciated. This article reviews a variety of imaging procedures available for detecting ulcerative colitis (UC) and Crohn's disease (CD), polyps and CRC in their early stage and also presents details on various screening options. Detecting, staging and re-staging of patients with CRC also require multimodality, multistep imaging approaches. Staging and re-staging with conventional colonoscopy (CC), computer tomography colonography (CTC), magnetic resonance colonography (MRC) and positron emission tomography/computer tomography colonography (PET/CTC) are of paramount importance in determining the most appropriate therapeutic method and in predicting the risk of tumor recurrence and overall prognosis. The advantages and limitations of these modalities are also discussed.
文摘In the United States,colorectal cancer(CRC)is the second leading cause of mortality in men and women.We are now seeing an increasing number of patients with advanced-stage diagnosis and mortality from colorectal cancer before 50 years of age,which requires earlier screening.With the increasing need for CRC screening through colonoscopy,and thus endoscopists,easier and simpler techniques are needed to train proficient endoscopists.The most widely used approach by endoscopists is air insufflation colonoscopy,where air distends the colon to allow visualization of the colonic mucosa.This technique is uncomfortable for patients and requires an anesthetist to administer sedation.In addition,patients commonly complain about discomfort post-op as air escapes into the small bowel and cannot be adequately removed.Current research into the use of water insufflation colonoscopies has proved promising in reducing the need for sedation,decreasing discomfort,and increasing the visibility of the colonic mucosa.Future direction into water insufflation colonoscopies which have shown to be simpler and easier to teach may increase the number of proficient endoscopists in training to serve our aging population.
基金Supported by Proportion of UCLH/UCL funding from the Department of Health’s NIHR Biomedical Research Centres funding schemeA grant from the UCL experimental cancer medicine centreUnrestricted educational grant support from Pentax United Kingdom (Lovat LB)
文摘AIM： To compare high resolution colonoscopy （Olympus Lucera） with a megapixel high resolution system （Pentax HiLine） as an in-service evaluation. METHODS： Polyp detection rates and measures of performance were collected for 269 colonoscopy procedures. Five colonoscopists conducted the study over a three month period, as part of the United Kingdom bowel cancer screening program. RESULTS：There were no differences in procedure duration （x^2 p = 0.98）, caecal intubation rates （x^2 P = 0.67）, or depth of sedation （x^2 P = 0.64）. Mild discomfort was more common in the Pentax group （x^2 p = 0.036）. Adenoma detection rate was significantly higher in the Pentax group （x^2 test for trend P = 0.01）. Most of the extra polyps detected were flat or sessile adenomas. CONCLUSION： Megapixel definition colonoscopes improve adenoma detection without compromising other measures of endoscope performance. Increased polyp detection rates may improve future outcomes in bowel cancer screening programs.
文摘AIM： TO assess the gender preferences, specifically the gender of the nursing staff （endoscopy assistants） and the impact on acceptance for screening colonoscopy （SC）. METHODS： Patients or relatives attending the clinics or health care workers working in a tertiary center were invited to participate in this questionnaire study. The questionnaire enquired on the general demographics （1） age, gender, ethnicity, education level, and employ- ment status, previous history of colonoscopy, family or personal history of colonic pathologies, personal and family history of any cancers; （2） subjects were asked if they would go for an SC if they had appropriate indi- cations （age over 50 years, family history of colorectal cancer （CRC）, fecal occult blood positive, anemia espe- cially iron deficiency anemia, bleeding per rectum with or without loss of appetite, weight loss and abdominal pain） with and without symptoms attributable to CRC; and （3） preferences for the gender of the endoscopists and assistants and whether they would still undergo SC even if their preferences were not met. RESULTS： Eighty-four point seven percent （470/550） completed questionnaire were analysed. More female subjects expressed gender preferences for the endos- copists [overall 70%; female （67.7%） and male （2.3%）] compared to male subjects [overall 62.8%; male （56%） and female （6.8%）, P = 0.102]. Similarly, more female subjects expressed gender preferences for the assis- tants [overall 74.5%; female （73.4%） and male （1.1%）] compared to male subjects [overall 58%, male （49.3%） and female （8.7%）, P 〈 0.001]. Overall, a third would decline an SC, despite having appropriate indications, if their preferences were not met. On univariate analysis, male gender, non-Malay ethnicity （Chinese and others） and previous colonoscopy experience were more likely to undergo an SC, even if their preferences were not met （all P 〈 0.05）. Gender and previous experience fodds ratio （OR） 1.68, 95% confidence interval （CI） 1.00-2.82, P 〈 0.05] with colonoscopy （OR 4.70, 95% CI 1.41-15.66, P 〈 0.05） remained significant on multi variate analysis. CONCLUSION： Genders preference for the endoscopy nurses/assistants is more common than for the endos- copist among women and has implications for the suc cess of a screening colonoscopy program.
文摘Colorectal cancer is a term used to describe colon and rectal cancer,which is the third most common type of cancer.A MEDLINE and PubMed search resulted in the inclusion of manuscripts written in the last 10 years,using keywords relevant to the topic of the manuscript.By analyzing the aim of the searched studies and manuscripts,adequate articles were included that described the stated problem.The frequency of colorectal cancer varies with climate,nutrition,and many other factors,primarily endogenous,hereditary,intestinal microbiome,as well as external factors,such as exposure of the individual to stress,and bad eating habits.Colon cancer and rectal cancer or colorectal cancer in general in the early stages of the disease,may not show symptoms or are barely noticeable.Colorectal cancer symptoms will most often not develop until the disease has progressed to stage 2 or beyond.Regular screening tests for colon or rectal cancer,especially colonoscopy,are recommended as part of a regular checkup for people aged 50 years or younger who are at high risk due to a family history of the disease or other cancers.Diet and colonoscopy as an early screening method play an important role in the prevention of colorectal cancer.
文摘BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors,and early screening is crucial to improving the survival rate of patients.The combination of colonoscopy and immune fecal occult blood detection has garnered significant attention as a novel method for CRC screening.Colonoscopy and fecal occult blood tests,when combined,can improve screening accuracy and early detection rates,thereby facilitating early intervention and treatment.However,certain risks and costs accompany it,making the establishment of a risk classification model crucial for accurate classification and management of screened subjects.AIM To evaluate the feasibility and effectiveness of colonoscopy,immune fecal occult blood test(FIT),and risk-graded screening strategies in CRC screening.METHODS Based on the randomized controlled trial of CRC screening in the population conducted by our hospital May 2020 to May 2023,participants who met the requirements were randomly assigned to a colonoscopy group,an FIT group,or a graded screening group at a ratio of 1:2:2(after risk assessment,the high-risk group received colonoscopy,the low-risk group received an FIT test,and the FITpositive group received colonoscopy).The three groups received CRC screening with different protocols,among which the colonoscopy group only received baseline screening,and the FIT group and the graded screening group received annual follow-up screening based on baseline screening.The primary outcome was the detection rate of advanced tumors,including CRC and advanced adenoma.The population participation rate,advanced tumor detection rate,and colonoscopy load of the three screening programs were compared.RESULTS A total of 19373 subjects who met the inclusion and exclusion criteria were enrolled,including 8082 males(41.7%)and 11291 females(58.3%).The mean age was 60.05±6.5 years.Among them,3883 patients were enrolled in the colonoscopy group,7793 in the FIT group,and 7697 in the graded screening group.Two rounds of follow-up screening were completed in the FIT group and the graded screening group.The graded screening group(89.2%)and the colonoscopy group(42.3%)had the lowest overall screening participation rates,while the FIT group had the highest(99.3%).The results of the intentional analysis showed that the detection rate of advanced tumors in the colonoscopy group was greater than that of the FIT group[2.76%vs 2.17%,odds ratio(OR)=1.30,95%confidence interval(CI):1.01-1.65,P=0.037].There was no significant difference in the detection rate of advanced tumors between the colonoscopy group and the graded screening group(2.76%vs 2.35%,OR=1.9,95%CI:0.93-1.51,P=0.156),as well as between the graded screening group and the FIT group(2.35%vs 2.17%,OR=1.09%,95%CI:0.88-1.34,P=0.440).The number of colonoscopy examinations required for each patient with advanced tumors was used as an index to evaluate the colonoscopy load during population screening.The graded screening group had the highest colonoscopy load(15.4 times),followed by the colonoscopy group(10.2 times),and the FIT group had the lowest(7.8 times).CONCLUSION A hierarchical screening strategy based on CRC risk assessment is feasible for screening for CRC in the population.It can be used as an effective supplement to traditional colonoscopy and FIT screening programs.
文摘AIM:To compare the bowel cleansing efficacy,tolerability and acceptability of split 2-L polyethylene glycol(PEG)-citrate-simethicone(PEG-CS)plus bisacodyl(BIS)vs 4-L PEG for fecal occult blood test-positive screening colonoscopy.METHODS:This was a randomised,observer-blind comparative study.Two hundred and sixty-four subjects underwent screening colonoscopy(mean age 62.5±7.4years,male 61.7%).The primary objective of the study was to compare the bowel cleansing efficacy of the two preparations.Interventions:BIS plus PEG-CS:3 tablets of 5-mg BIS at 16:00,PEG-CS 1-L at 19:00 and 1-L at7:00,4-L PEG:3-L at 17:00,and 1-L at 7:00.Colonoscopy was carried out after 11:00,at least 3 h after the completion of bowel preparation.Bowel cleansing was evaluated using the Harefield Cleansing Scale.RESULTS:Bowel preparation was successful for 92.8%of subjects in the PEG-CS group and for 92.1%of subjects in the 4-L PEG(RR=1.01;95%CI:0.94-1.08).BIS+PEG-CS was better tolerated than 4-L PEG.A greater rate of patients in the BIS+PEG-CS group had no difficulty and/or were willing to repeat the same preparation compared to split-dose 4-L PEG group.Subjects in the BIS+PEG-CS group rated the prep as good or satisfactory in 90.6%as compared to 77%in the 4-L PEG(P=0.003).Subjects receiving BIS+PEGCS stated they fully adhered to instructions drinking all the 2-L solution in 97.1%compared with 87.3%in the4-L PEG(P=0.003).CONCLUSION:BIS plus split 2-L PEG-CS was as effective as but better tolerated and accepted than split4-L PEG for screening colonoscopy.This new procedure may increase the positive attitude and participation to colorectal cancer screening colonoscopy.
文摘AIM To identify risk factors for a suboptimal preparation among a population undergoing screening or surveillance colonoscopy.METHODS Retrospective review of the University of Michigan and Veteran's Administration(VA) Hospital records from 2009 to identify patients age 50 and older who underwent screening or surveillance procedure and had resection of polyps less than 1 cm in size and no more than 2 polyps. Patients with inflammatory bowel disease or a family history of colorectal cancer were excluded. Suboptimal procedures were defined as procedure preparations categorized as fair, poor or inadequate by the endoscopist. Multivariable logistic regression was used to identify predictors of suboptimal preparation.RESULTS Of 4427 colonoscopies reviewed, 2401 met our inclusion criteria and were analyzed. Of our population, 16% had a suboptimal preparation. African Americans were 70% more likely to have a suboptimal preparation(95%CI: 1.2-2.4). Univariable analysis revealed that narcotic and tricyclic antidepressants(TCA) use, diabetes, prep type, site(VA vs non-VA), and presence of a gastroenterology(GI) fellow were associated with suboptimal prep quality. In a multivariable model controlling for gender, age, ethnicity, procedure site and presence of a GI fellow, diabetes [odds ratio(OR) = 2.3; 95%CI: 1.6-3.2], TCA use(OR = 2.5; 95%CI: 1.3-4.9), narcotic use(OR = 1.7; 95%CI: 1.2-2.5) and Miralax-Gatorade prep vs 4L polyethylene glycol 3350(OR = 0.6; 95%CI: 0.4-0.9) were associated with a suboptimal prep quality. CONCLUSION Diabetes, narcotics use and TCA use were identified as predictors of poor preparation in screening colonoscopies while Miralax-Gatorade preps were associated with better bowel preparation.
文摘AIM:To investigate the changes in renal function at 12-24 mo in patients following sodium phosphate(NaP) preparation for screening colonoscopy.METHODS:We carried out a retrospective study on the results from patients who received health check-up services as part of an employer-provided wellness program performed between August 2006 and May 2008 and who were followed up for 12-24 mo.Prior to screening colonoscopy,224 patients underwent bowel cleansing with NaP(NaP group) and 113 patients with polyethylene glycol(PEG group).The control group comprised 672 age-matched patients.We compared the changes in the creatinine levels and the glomerular filtration rates(GFRs) from baseline to 12-24 mo between the NaP,PEG,and control groups using two-way repeated measured analysis of variance.In addition,multivariate linear regression analysis was performed to assess the risk factors for a decreased GFR.RESULTS:The baseline mean serum creatinine level in the NaP,PEG,and control groups was 1.12 ± 0.15,1.12 ± 0.16,and 1.12 ± 0.15 mg/dL,which increased to 1.15 ± 0.15,1.15 ± 0.18,and 1.15 ± 0.15 mg/dL,respectively,after 12-24 mo.The baseline mean GFR in the NaP,PEG,and control groups was 69.0 ± 7.7,68.9 ± 8.0,and 69.6 ± 6.7 mL/min per 1.73 m2,which decreased to 66.5 ± 7.8,66.5 ± 8.3,and 67.4 ± 6.4 mL/min per 1.73 m2,respectively,after 12-24 mo.The changes in serum creatinine levels and GFRs were not significantly between the NaP,PEG,and control groups(P = 0.992 and P = 0.233,respectively).Using multivariate linear regression analysis,only the baseline GFR was associated with the change in GFR(P < 0.001).Indeed,the bowel preparations were not associated with the change in GFR(P = 0.297).CONCLUSION:NaP bowel preparation in subjects with normal renal function was not associated with renal injury,and NaP can thus be used safely for screening colonoscopy.
文摘AIM:To compare the performance characteristics of Pentax HiLine(PHL)(with i-scan) and Olympus Lucera(OL) systems in a screening population.METHODS:Screening colonoscopies in asymptomatic guaiac faecal occult blood test-positive patients with PHL(n = 58) and OL(n = 425) colonoscopes were analysed.All procedures were performed by a single colonoscopist.PHL used white-light endoscopy(WLE) on scope insertion and contrast/surface enhancement(i-scan 1) on withdrawal,and OL utilised WLE both on insertion and withdrawal.Patient age,sex,instrument insertion and withdrawal times,nurse assessed patient comfort scores,midazolam and fentanyl doses,procedure completion and rates of lesion detection were recorded separately for each group.Comparisons between the groups were made using either Fisher's exact test(for dichotomous variables) or Mann-Whitney U test(for ordinal and continuous variables).RESULTS:Colonoscopy completion rates were similar in both groups:413/425(97.2%) for OL and 55/58(94.9%) for PHL(P = 0.24).For complete colonoscopies,the two groups were well matched for age,sex,colonoscope insertion times(mean 11.1 min in OL vs 11.6 min in PHL,P = 0.93) and normal colonoscopy withdrawal times(mean 15.6 min in OL vs 14.7 min in PHL,P = 0.2).Patients in the PHL group experienced a small increase in discomfort(mean patient comfort scores were 0.49 in the OL and 0.95 in the PHL group,P < 0.0001).While Fentanyl doses required were similar between groups(mean 57.5 μg in OL vs 61.4 μg in PHL,P = 0.13),slightly more Midazolam was required in the PHL group(mean 2.1 mg in OL vs 2.4 mg in PHL,P = 0.035).There was no difference in polyp(58% in OL vs 67% in PHL) or adenoma(49% in OL vs 56% in PHL) detection rates between the groups.Neither the total number of polyps and adenomas,nor the characteristics of these(including size,location or presence of advanced features) were different between the two systems.CONCLUSION:This study suggests that there is no advantage of either colonoscope system in lesion detection.
文摘Background and Aims: The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there in increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients. Methods: A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45 - 75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas. Results: Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance was associated with adenoma detection. Conclusion: In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.
