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Are we ready to use new endoscopic scores for ulcerative colitis?

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World Journal of Gastroenterology 2024年第10期30卷 1466-1469页

作者： Rodrigo Quera Paulina Núñez F Universidad de los Andes Inflammatory Bowel Disease ProgramClinica Universidad de los AndesDigestive Disease CenterSantiago 7600976RMChile Digestive Disease Center Inflammatory Bowel Disease ProgramClínica Universidad de los AndesSantiago 7620157Chile Department of Gastroenterology Universidad de Chile-Hospital San Juan de DiosSantiago 770123Chile

For ulcerative colitis(UC),the variability in inflammatory activity along the colon poses a challenge in *** focus on achieving endoscopic healing in UC is evident,where the UC Endoscopic Index of Severity and Mayo Endoscopic Subscore are commonly used for ***,these indices primarily consider the most severely affected *** et al recent study validates the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting(TIGER)score offering a comprehensive assessment of inflammatory activity across diverse segments of the colon and rectum and a reliable index correlating strongly with UC Endoscopic Index of Severity and moderately with Mayo Endoscopic Subscore(MES).Despite recommendation,certain aspects warrant further *** calprotectin,an intermediate target,correlates with TIGER and should be *** TIGER scores defining endoscopic remission and response,evaluating agreement with histological activity,and assessing inter-endoscopist agreement for TIGER require *** the correlation between TIGER and intestinal ultrasound,akin to MES,adds value.

关键词： Ulcerative colitis sigmoidoscopy Colonoscopy Score index

Optimal Noninvasive Colon Cancer Screening Modality in Patients Not Receiving Colonoscopy

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Advances in Aging Research 2022年第1期11卷 1-15页

作者： Akshay N. Narendra Saint James School of Medicine Park Ridge IL USA

Colon cancer is the third most common among cancer deaths in the US for both men and women. The incidence of colonoscopy has been soaring in younger patients, which led to changes in recent United States Preventive Services Task Force (USPSTF) guidelines to reduce the age for screening from 50 years to 45 years. Demand for colonoscopy services is surging due to increased incidences of colorectal cancer (CRC) in the both aging and younger population. Increased referrals have led to an insufficient workforce in hospitals and long waiting lists. Further, results from colonoscopy reveal a low percentage of CRC or another severe bowel disease (SBD). Therefore, colon cancer screening is a growing concern, particularly in patients who otherwise have a very long-life expectancy, and who are most likely to benefit from screening. Another reason to boost CRC screening is to minimize the load on hospitals by reducing the patients that undergo colonoscopy unnecessarily because only a low percentage of CRC occurrence is observed in individuals undergoing colonoscopy. In recent years, there are a variety of screening options available for CRC. Noninvasive alternatives include fecal immunochemical test (FIT), multitarget stool DNA testing (MT-sDNA, available under the brand name Cologuard), computed tomography (CT) colonography (previously called virtual colonoscopy), guaiac-based fecal occult blood testing (gFOBT), and capsule colonoscopy (CC). These tests have varied the degree of evidence supporting their use. This study focuses on the most recent survey an

关键词： Colonoscopy sigmoidoscopy Fecal Immunochemical Test Fecal Occult Blood Test CT Colonography

Colonoscopic perforation:Incidence,risk factors,management and outcome

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World Journal of Gastroenterology 2010年第4期16卷 425-430页

作者： Varut Lohsiriwat Department of Surgery Faculty of MedicineSiriraj HospitalMahidol UniversityBangkok 10700Thailand

This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic *** perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple *** of CP is mainly based on patients' clinical grounds and their underlying colorectal *** therapeutic approaches include conservative management(bowel rest plus the administration of broadspectrum antibiotics),endoscopic management,and operative management(open or laparoscopic approach).The applications of each treatment are *** outcomes of patients with CP are also addressed.

关键词： Colonoscopic perforation Colonoscopy sigmoidoscopy Complication Postpolypectomy syndrome Incidence Risk factors Treatment Management Outcome

Does flexible small-diameter colonoscope reduce insertion pain during colonoscopy?

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World Journal of Gastroenterology 2000年第5期6卷 659-663页

作者： Yoshiharu Uno Akihiro Munakata First Department of Medicine School of MedicineHirosaki University036- 8216Japan

AIM It is well known that colonoscopy can bedifficult due to abdominal pain induced duringcolonoscope insertion,if sedative agents are ***,an extra-flexible,small-diameter colonoscope(CF-SV,Olympus Inc.,Japan)was developed in order to improve safetyand *** aim of this study was toaccess the usefulness of the *** One hundred patients undergoingsigmoidoscopy were recruited and colonoscopywas performed by one ***,a routine-type colonoscope(CF-2301)was inserted into the colon *** the patient complained ofabdominal pain(even if mild),the scope wasnot advanced further and was withdrawn afterthe anatomic location of its tip was ***,the CF-SV was inserteduntil it reached the cecun or the site whereabdominal pain *** abdominalsurgery and abdominal disease were consideredas unfavorable factors(UF)and the relationshipbetween abdominal pain and UF,age and genderwere ***,the colonicinsertion pressures in 36 patients with abdominalpain were measured with a force *** Thirty-four cases(34%)felt no painwith the CF-2301 and successful pancolon-0scopies to the cecum were ***-six cases(66%)complained of abdominal *** procedure was painless for 47% of men and24% of women,*** CF-2301 scopefailed to reach the sigmoid-descending colon junctions in 59(89.4%)of the 66 patientscomplaining of abdominal ***,CF-SVreached proximal area in 94.9% of those whofailed with *** median pressure forpain-inducing was 700 g/cm^*** Unsedated patients with UFwere prone to complain of pain when thestandard-type CF-2301 scope was *** developed extra-flexible CF-SV is usefulfor the aged and for those with UF or being proneto suffer from abdominal *** agentsmay be unnecessary if this new type ofcolonoscope is used.

关键词： colonoscopy abdominal pain flexible colonoscope insertion pressure unfavorable factors sigmoidoscopy

Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations

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World Journal of Gastroenterology 2018年第1期24卷 124-138页

作者： Florence Bénard Alan N Barkun Myriam Martel Daniel von Renteln Department of Medicine University of Montreal (UdeM )and University of Montreal Hospital Research Center (CRCHUM) Division of Gastroenterology McGill University Health Center McGill University Department of Medicine Division of Gastroenterology University of Montreal Hospital (CHUM)University of Montreal Hospital Research Center (CRCHUM)

AIM To summarize and compare worldwide colorectal cancer(CRC) screening recommendations in order to identify similarities and *** A systematic literature search was performed using MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge identifying all average-risk CRC screening guideline publications within the last ten years and/or position statements published in the last 2 years. In addition, a hand-search of the webpages of National Gastroenterology Society websites, the National Guideline Clearinghouse, the BMJ Clinical Evidence website,Google and Google Scholar was performed. RESULTS Fifteen guidelines were identified. Six guidelines were published in North America, four in Europe, four in Asia and one from the World Gastroenterology Organization. The majority of guidelines recommend screening average-risk individuals between ages 50 and 75 using colonoscopy(every 10 years), or flexible sigmoidoscopy(FS, every 5 years) or fecal occult blood test(FOBT, mainly the Fecal Immunochemical Test, annually or biennially). Disparities throughout the different guidelines are found relating to the use of colonoscopy, rank order between test, screening intervals and optimal age ranges for screening. CONCLUSION Average risk individuals between 50 and 75 years should undergo CRC screening. Recommendations for optimal surveillance intervals, preferred tests/test cascade as well as the optimal timing when to start and stop screening differ regionally and should be considered for clinical decision making. Furthermore, local resource availability and patient preferences are important to increase CRC screening uptake, as any screening is better than none.

关键词： Guidelines Systematic review fecal occult blood test Fecal immunochemical test Colonoscopy Colorectal cancer Screening Flexible sigmoidoscopy

Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2018年第4期9卷 31-38页

作者： Abhilash Perisetti Hafiz Khan Nayana E George Rachana Yendala Aamrin Rafiq Summre Blakely Drew Rasmussen Nathan Villalpando Hemant Goyal Department of Gastroenterology University of Arkansas for Medical Sciences Department of Public Health Texas Tech University Health Sciences Department of Internal Medicine University of Arkansas Medical Sciences Department of Hematology and Oncology Texas Tech University Health Sciences Department of Biological Sciences Texas Tech University School of Medicine Texas Tech University Health Sciences Center Department of Internal Medicine Mercer University School of Medicine

AIM To describe the characteristics of adults who needed to see a doctor in the past year but could not due to the extra cost and assess the impact of limited financial resources on the receipt of routine fecal occult blood test, sigmoidoscopy, or colonoscopy for colon cancer screening among insured patients. METHODS Data obtained from the 2012 Behavioral Risk Factor Surveillance System included 215436 insured adults age 50-75 years. We computed frequencies, adjusted odds ratios(a ORs), and 95%CIs using SAS v9.3 software. RESULTS Nine percent of the study population needed to see a doctor in the past year but could not because of cost. The numbers were significantly higher among those aged 50-64(P sigmoidoscopy within last year a OR = 0.72; 95%CI: 0.48-1.07, colonoscopy within the last year a OR = 0.91; 95%CI: 0.81-1.02. CONCLUSION We found that the limited financial resources within the past 12 mo were significantly associated with colorectal cancer(CRC) non-screening. Patients with risk factors identified in this study should adhere to CRC guidelines and should receive financial help if needed.

关键词： Fecal occult blood Healthcare delivery sigmoidoscopy Colorectal cancer Screening Access to care Behavioral Risk Factor Surveillance System

Increasing trend in retained rectal foreign bodies

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World Journal of Gastrointestinal Surgery 2016年第10期8卷 679-684页

作者： Abraham A Ayantunde Zynep Unluer Department of Surgery Southend University Hospital Westcliff-on-Sea SS0 0BY United Kingdom

AIM To highlight the rising trend in hospital presentation of foreign bodies retained in the rectum over a 5-year *** Retrospective review of the cases of retained rectal foreign bodies between 2008 and 2012 was ***' clinical data and yearly case presentation with data relating to hospital episodes were *** analysis was by SPSS ***,IL,United *** Twenty-five patients presented over a 5-year period with a mean age of 39(17-62) years and M: F ratio of 2:1.A progressive rise in cases was noted from 2008 to 2012 with 3,4,4,6,8 recorded patients per year *** majority of the impacted rectal objects were used for self-/*** commonest retained foreign bodies were sex vibrators and ***-six percent of the patients required extraction while one passed *** and three patients had retrieval in the Emergency Department and on the ward respectively while 19 patients needed examination under anaesthesia for *** mean hospital stay was 19(2-38) *** psychosocial issues included depression,deliberate self-harm,illicit drug abuse,anxiety and *** were no psychosocial problems identified in 15 *** There is a progressive rise in hospital presentation of impacted rectal foreign bodies with increasing use of different objects for sexual arousal.

关键词： Rectal foreign bodies Rigid sigmoidoscopy Eroticism Examination under anaesthesia Psychosocial issues

Should a colonoscopy be offered routinely to patients with CT proven acute diverticulitis? A retrospective cohort study and meta-analysis of best available evidence

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World Journal of Gastrointestinal Endoscopy 2019年第7期11卷 427-437页

作者： Peter Asaad Shahab Hajibandeh Mariam Rahm Theo Johnston Supria Chowdhury Christine Bronder Department of General Surgery Stepping Hill Hospital Stockport SK2 7JE United Kingdom Department of General Surgery North Manchester General Hospital Manchester M8 5RB United Kingdom Department of General and Colorectal Surgery Royal Lancaster Infirmary Lancaster LA1 4RP United Kingdom

BACKGROUND The current guidelines suggest that patients should undergo endoscopic evaluation of the colonic lumen after an episode of computed tomography (CT) proven acute diverticulitis to rule out malignancy. The usefulness of routine endoscopic evaluation of CT proven diverticulitis remains unknown. AIM To establish whether routine colonoscopy should be offered to patients after an episode of diverticulitis. METHODS We performed a retrospective study, comparing two groups: a diverticulitis group and a control group. The diverticulitis group consisted of patients undergoing a colonoscopy after an episode of diverticulitis. The control group consisted of asymptomatic patients undergoing a screening sigmoidoscopy. We also performed a systematic review and meta-analysis. We searched electronic data resources to identify all relevant studies. The primary outcome was the number of adenomas found, while the secondary outcomes were the number of cancers and polyps identified, and the adenoma risk. RESULTS 68 and 1309 patients were included in the diverticulitis and control groups respectively. There was no difference in the risk of adenomas (5.9% vs 7.6%, P =0.59), non-advanced adenomas (5.9% vs 6.9%, P = 0.75), advanced adenomas (0% vs 0.8%, P = 1), cancer (0% vs 0.15%, P = 1.00), and polyps (16.2% vs 14.2%, P = 0.65) between both groups. Meta-analysis of data from 4 retrospective observational studies, enrolling 4459 patients, showed no difference between the groups in terms of risk of adenomas (RD =-0.05, 95%CI:-0.11, 0.01, P = 0.10), non-advanced adenomas (RD =-0.02, 95%CI:-0.08, 0.04, P = 0.44), advanced adenomas (RD =-0.01, 95%CI:-0.04, 0.02, P = 0.36), cancer (RD = 0.01, 95%CI:- 0.01, 0.03, P = 0.32), and polyps (RD =-0.05, 95%CI:-0.12, 0.02, P = 0.18). CONCLUSION Routine colonoscopy may not be appropriate in patients with acute diverticulitis. High quality prospective studies are required for more robust conclusions.

关键词： Diverticulitis Colon cancer Screening, Colonoscopy sigmoidoscopy

Colorectal cancer in patients under 50 years of age:A retrospective analysis of two institutions' experience

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World Journal of Gastroenterology 2013年第34期19卷 5651-5657页

作者： Elizabeth A Myers Daniel L Feingold Kenneth A Forde Tracey Arnell Joon Ho Jang Richard L Whelan Department of Colon and Rectal Surgery St. Luke’s Roosevelt Hospital Department of Surgery College of Physicians and SurgeonsColumbia University

AIM:To investigate the epidemiological characteristics of colorectal cancer(CRC)in patients under 50 years of age across two ***:Records of patients under age 50 years of age who had CRC surgery over a 16 year period were assessed at two *** following documents where reviewed:admission notes,operative notes,and discharge *** main study variables included:age,presenting symptoms,family history,tumor location,operation,stage/differentiation of disease,and post operative *** of disease was classified according to the American Joint Committee on Cancer TNM staging system:tumor depth;node status;and ***:CRC was found in 180 patients under age50 years(87 females,93 males;mean age 41.4±6.2years).Young patients accounted for 11.2%of cases during a 6 year period for which the full data set *** percent had a 1stdegree and 12%a 2nd degree family CRC *** all patients(94%)were symptomatic at diagnosis;common symptoms included:bleeding(59%),obstruction(9%),and abdominal/rectal pain(35%).Evaluation was often delayed and bleeding frequently attributed to *** stage CRC(Stage 3 or 4)was noted in 53%of *** tumors were distal to the splenic flexure(77%)and 39%involved the *** patients(95%)had segmental resections;6 patients had subtotal/total *** differentiated tumors were noted in 12%and mucinous lesions in 19%of patients of which most had Stage 3 or 4 ***-two patients(13%)developed recurrence and/or progression of disease to *** patients(ages 42,42and 49 years)went on to develop metachronous primary colon cancers within 3 to 4 years of their initial ***:CRC was common in young patients with no family *** patients with symptoms merit a timely evaluation to avoid presentation with late stage CRC.

关键词： Colorectal cancer Colorectal cancer screening Sporadic colorectal cancer Early-age onset colorectal cancer sigmoidoscopy