SEARCH · PubMed Health

Results for “Colonoscopy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources

PubMed1995

Colonoscopy in the elderly. Low risk, high yield.

An evaluation of the utility, morbidity, and patient tolerance of colonoscopy in elderly (> or = 70 years) patients was undertaken and compared to data for a similar group of younger patients (50-70 years) who underwent colonoscopy during the same 48 months. Data reviewed for both groups included demographics, indications for colonoscopy, effectiveness of bowel preparation, colonoscopy completion, endoscopic findings, and complications. The mean age of the entire 656-patient population was 69 +/- 10 years; 87 (25%) of the 354 elderly patients were greater than 80 years of age and the average age of the 302-member control group was 59.8 +/- 5.8 years. Indications for colonoscopy were the same in both groups and included rectal bleeding, 134 (20%); prior colorectal operation, 115 (18%); a history of adenomatous polyps, 82 (12%); guaiac-positive stools, 49 (8%); abnormal finding on barium enema, 19 (3%); and miscellaneous other gastrointestinal symptoms, 151 (23%). Screening colonoscopy was performed in 106 (16%). Colonoscopy was successfully completed to the cecum or the ileocolic anastomosis in 85% (555/656) of the entire population. Only 78% (275/354) of elderly patients had colonoscopy successfully completed compared to 93% (281/302) of their younger counterparts (P = 0.001). Elderly patients were significantly more likely to have an abnormality than younger patients (74% vs 60%, P < 0.05). Malignant colorectal neoplasia was more common in the elderly (6% vs 2%, P = 0.03); however, benign neoplasia was equally present in both age groups (30% vs 27%, P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed2005

Preoperative colonoscopy decreases the need for laparoscopic management of colonic polyps.

PURPOSE: Patients are commonly referred to surgeons for surgical resection of polyps that cannot be excised colonoscopically. Repeating the colonoscopy may be met with resistance by both the patient and the referring endoscopist. However, there are two distinct benefits. First, if the lesion was not marked, tattooing facilitates laparoscopic resection. Second, and more importantly, many of these polyps can be removed endoscopically by an experienced colorectal surgeon, avoiding unnecessary colon resection. Over a period of five years, we have reviewed preoperative colonoscopy in patients who were referred for surgical treatment of benign polyps. METHODS: From January 1999 through September 2003 all patients referred for surgical resection of a benign polyp were consecutively entered into a database by a single group of colorectal surgeons. All patients underwent preoperative colonoscopy on the day before the planned colon resection. Patient charts were reviewed, and demographics were recorded. The referral and preoperative colonoscopy reports and all pathology results were reviewed to record the polyp size, location, histology, and subsequent treatment. RESULTS: Altogether, 71 patients were included in this study. The average size of the polyps was 24 mm (range, 10-60 mm). The location of the polyp as determined by preoperative colonoscopy differed from the location noted on referral colonoscopy in nine patients (13 percent). Surgery was canceled in 23 patients (32 percent), primarily because of complete polypectomy at preoperative colonoscopy. Of the 48 who underwent surgery, 23 (47 percent) had a colonic tattoo placed, at the discretion of the surgeon. Lesions clearly located in the cecum were not tattooed routinely. Of the 48 patients who underwent surgery, 45 (94 percent) underwent laparoscopic colon resection. CONCLUSIONS: We concluded that patients referred for surgical resection of a polyp should undergo repeat colonoscopy preoperatively, given that in our study one-third of patients were spared unnecessary colectomy. In addition, repeat endoscopy by the operating surgeon offers an opportunity to confirm the location of the lesion and place a colonic tattoo to facilitate laparoscopic resection.

Aged↗

PubMed1994

Do characteristics of adenomas on flexible sigmoidoscopy predict advanced lesions on baseline colonoscopy?

BACKGROUND/AIMS: Colonoscopy is presently recommended for patients with any benign neoplasm found on sigmoidoscopy. The purpose of this study was to determine whether characteristics of adenomas on flexible sigmoidoscopy predict advanced lesions on baseline colonoscopy. METHODS: A total of 226 asymptomatic and symptomatic patients with adenomas noted on flexible sigmoidoscopy at a large, multispecialty medical group were prospectively studied. The histology, size, and number of benign polyps on flexible sigmoidoscopy were compared with those on subsequent colonoscopy. Advanced lesions were defined as adenomas > 1 cm in diameter or with villous or severe dysplasia histology. Univariate comparisons were assessed using the chi 2 test and multivariate analysis with stepwise logistic regression. RESULTS: There was a 24% prevalence of new adenomas found on colonoscopy. Six percent of the patients had advanced lesions on colonoscopy, and none had cancer. Multivariate analysis indicated that findings on flexible sigmoidoscopy predict (P < 0.01) those on colonoscopy. Patients with advanced lesions on sigmoidoscopy had a > 10% prevalence of an advanced lesion on colonoscopy. Patients with small (< or = 1 cm) tubular adenoma(s) on sigmoidoscopy had a < 1% occurrence of an advanced synchronous lesion. CONCLUSIONS: The histology and size of benign neoplasms found on flexible sigmoidoscopy predict findings on baseline colonoscopy.

Adenoma↗

PubMed2006

Colonoscopy demand and capacity in New Hampshire.

BACKGROUND: Screening for colorectal cancer has been clearly shown to decrease the incidence and mortality from this disease. Accurate information about the demand and capacity for screening, particularly with colonoscopy, is critical in planning screening strategies. National assessments have recently begun; estimates of smaller geographic regions should improve the accuracy of national estimates, as well as inform strategies for individual states. This study evaluates the demand and capacity for colonoscopy in the state of New Hampshire. METHODS: All endoscopy sites in the state of New Hampshire were contacted to determine their number of endoscopists, monthly colonoscopies, and estimates of the percentage of colonoscopy done for screening. Barriers to increasing current capacity were also assessed. The capacity estimates were compared to demand estimates based on population census figures. Data were collected in 2003 to 2004 and analyzed in 2005 to 2006. RESULTS: One hundred fourteen endoscopists at 36 centers performed 49,352 colonoscopies in 2002, an average of 39 to 43 total monthly colonoscopies per endoscopist. Approximately 60% were estimated to have been done for screening. Estimated demand was approximately twice the available capacity for screening and surveillance. The impact of factors such as compliance, percent screening, and population growth were assessed to inform future screening strategies. CONCLUSIONS: In 2002, demand for screening colonoscopy in New Hampshire for patients aged more than 50 years was approximately twice the available capacity. However, if the assessed screening capacity of 2002 were to increase by 20%, combined with a target of 60% population compliance with screening as an initial goal, the demand for colonoscopy in New Hampshire would be met.

Aged↗

PubMed2005

Patient factors influencing the completion rate in colonoscopy.

BACKGROUND: Since its introduction in the late 1960s, the technology of colonoscopy has developed rapidly, and the competence of the endoscopists has increased. Still, a complete colonoscopy is not always possible to perform. AIM: To assess, in a population-based setting, which patient factors influence the success rate. PATIENTS AND METHODS: All colonoscopy records during 1979-1995 in one Swedish county (population 258,000) were retrieved. Information was obtained about each patient's sex and age, date of examination, the endoscopist and indications for colonoscopy, findings, type of colonoscopy and reasons for an incomplete colonoscopy. Results were assessed by univariate and multivariate analyses. RESULTS: Of 5145 colonoscopies, 4153 (81%) were complete. Completion rates were influenced by (odds ratio for completion [95% confidence intervals]): sex, male versus female (2.00 [1.39-2.86]); age, youngest quartile versus oldest quartile (1.49 [1.04-2.13]); indication for colonoscopy, previous colonic surgery or long-standing colitis versus other indications (2.08 [1.23-3.45]); and diverticulosis, presence versus no presence (0.79 [0.62-0.99]). The time period (proxy variable for the development of endoscopes) had no impact on completion rates. CONCLUSIONS: The completion rate was lower than that has been reported from previous hospital-based studies. Lower completion rates were found in women, older patients and in patients with diverticulosis. Higher completion rates were noted in patients with previous colonic surgery and long-standing colitis. The completion rates were not influenced by the development of the endoscopes.

Adult↗

PubMed2005

Success rate and duration of paediatric outpatient colonoscopy.

BACKGROUND: The paediatric colonoscopy completion rates have rarely been reported. AIMS: We sought to evaluate colonoscopy completion rate and compare the rates using colonoscope versus enteroscope. METHODS: We prospectively investigated 60 patients who underwent colonoscopy between July 1999 and June 2001. The following data were collected: demographics, type of endoscope used, extent of colonoscopy, indication for procedure, histology, adverse events and time to reach the caecum and the terminal ileum. RESULTS: Sixty colonoscopies were performed during the study period, 30 with an enteroscope and 30 with a colonoscope. The caecum was reached in 56/60 (93%) and the terminal ileum in 50/60 (83%). An average time of 12.61 min (S.D. 7.3) was necessary to advance the instrument from the anus to the caecum, and additional 3.67 min (S.D. 3.62) to terminal ileum. There was no difference in the success rate between enteroscope and colonoscope. Six patients (10%) had definitive diagnosis established because a full colonoscopy was performed. No serious adverse events occurred. CONCLUSION: Paediatric colonoscopy to the caecum can be completed safely and expeditiously in more than 90% of procedures. Various types of instruments do not appear to influence completion rate. Full colonoscopy contributes to the establishment of a definitive diagnosis.

Adolescent↗

PubMed2006

Colonoscopies in Portuguese district hospitals: a multicentric transverse study.

OBJECTIVE: To characterise the colonoscopies performed in the Portuguese District Hospitals. METHODS: Transverse study conducted between 7 and 18 March 2005 amongst the 33 District Hospitals throughout Portugal. Data collected included the following: gender, age, geographical origin, ambulatory or hospitalised, routine or emergency, type of preparation, sedation practice (if any), informed consent, indication, extent of the visualisation of the colon and final result (endoscopic and histological). RESULTS: Thirty-one of the 33 District Hospitals (94%) sent the reports of colonoscopies and biopsies performed during the aforementioned period, resulting in 1245 colonoscopies. The majority of colonoscopies were ambulatory (80.7%); in 12 centres informed consent was obtained. The main indications were the following: polipectomy (20%), haematochezia (15%) and polyp follow-up (10%), whereas screening for colorectal cancer was the sixth most frequent indication. Sedation was administered in 24.5% of procedures. Colonoscopies were complete in 69.6% of cases. The main reasons for incomplete colonoscopies were poor bowel preparation, patient discomfort or technical difficulty. Colonoscopies were normal in 36% of cases; 40.3% had polyps, 16.4% had diverticulosis, 4.8% had colorectal cancer, 3.5% had inflammatory bowel disease and 1.1% had angiodisplasias. CONCLUSION: There was a high interest in participating in this study by Endoscopy Units in Portuguese District Hospitals. There is a low number of units using informed consent, which is mandatory by law, and this should be corrected. There is a need to increase sedation practice and to find better ways for preparing the colon, in order to achieve a higher percentage of complete colonoscopies and of polypectomies. The numbers of polyps detected and of colorectal cancers diagnosed confirm the importance of screening for colorectal cancer.

Adolescent↗

PubMed2006

Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE).

BACKGROUND: Screening for colorectal cancer (CRC) has been shown to decrease mortality. OBJECTIVE: To examine determinants associated with having (1) a screening colonoscopy, (2) an appropriate indication for screening, and (3) a significant diagnosis at screening. DESIGN: Prospective observational study. SETTING: Twenty-one endoscopy centers from 11 countries. PATIENTS: Asymptomatic patients who underwent a colonoscopy for the purpose of detecting CRC and who did not have a history of polyps or CRC, a lesion observed at a recent barium enema or sigmoidoscopy, or a recent positive fecal occult blood test. INTERVENTION: Screening colonoscopy. MAIN OUTCOME MEASUREMENTS: Appropriateness according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria and significant diagnoses (cancer, adenomatous polyps, new diagnoses of inflammatory bowel disease, angiodysplasia). RESULTS: Of 5069 colonoscopies, 561 (11%) were performed for screening purposes. Patients were more likely to have a screening colonoscopy if they were aged 45 to 54 years (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.60-3.99). Screening colonoscopies were appropriate, uncertain, and inappropriate in 26%, 60%, and 14% of cases, respectively. Eighty-one significant diagnoses were made, including 4 cancers. Significant diagnoses were more often made for uncertain/appropriate indications (OR 3.20, 95% CI 1.12-9.17) than for inappropriate indications. LIMITATIONS: Although data completeness was asked of all centers, it is possible that not all consecutive patients were included. Participating centers were a convenience sample and thus may not be representative. CONCLUSIONS: About 1 of 10 colonoscopies were performed for screening, preferentially in middle-aged individuals. A higher diagnostic yield in uncertain/appropriate indications suggests that the use of appropriateness criteria may enhance the efficient use of colonoscopy for screening.

Adult↗

PubMed2006

Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy.

BACKGROUND: Few studies address the development of minor complications after screening or surveillance colonoscopy. OBJECTIVES: Our purpose was to examine in previously asymptomatic people the incidence of new symptoms after colonoscopy, risk factors for symptoms, and patients' perceptions of this examination. DESIGN: Prospective cohort study. Patients completed a standardized interview at 7 and 30 days after colonoscopy. PATIENTS: A total of 502 patients aged 40 years and older undergoing colonoscopy for colorectal cancer screening, surveillance, or follow-up of another abnormal screening test result. Patients were excluded if they had a history of inflammatory bowel disease, visible GI bleeding, or anemia. MAIN OUTCOME MEASURES: Incidence of minor complications and patient perceptions about colonoscopy. RESULTS: Minor complications occurred in 162 subjects (34%) before day 7 and in 29 subjects (6%) between day 7 and day 30, most commonly bloating (25%) and abdominal pain (11%). Six subjects had unexpected emergency department visits or hospitalizations within 30 days, including 2 with postpolypectomy bleeding. On multivariate analysis, minor complications were more common in women (odds ratio 1.78, 95% CI 1.21-2.62) and when the procedure lasted 20 minutes or longer. Bowel preparation was rated the most difficult part of the examination for 77%. Most subjects (94%) lost 2 or fewer days from normal activities for the colonoscopy itself, preparation, or recovery. CONCLUSIONS: Minor complications were common after screening and surveillance colonoscopy. The bowel preparation was the most difficult part of the examination for most patients. Most subjects lost 2 or fewer days from normal activities because of colonoscopy.

Adult↗

PubMed1996

Colonoscopy without premedication versus barium enema: a comparison of patient discomfort.

BACKGROUND: Colonoscopy is considered a painful procedure requiring routine intravenous sedation. We investigated whether unsedated colonoscopy causes more discomfort than barium enema. METHODS: Procedure-related discomfort was determined in 100 consecutive patients undergoing colonoscopy without premedication and in an equal number of patients referred for sigmoidoscopy and barium enema. All patients underwent such examinations for the first time and had no history of previous bowel surgery. During colonoscopy, sedation was offered if significant pain or discomfort occurred. RESULTS: In patients without stenosis and with satisfactory preparation, the completion rate of colonoscopy was 95%. Five percent of all patients undergoing endoscopy required sedation. On an analog scale ranging from 1 to 9, patients undergoing colonoscopy and barium enema reported similar ratings for procedure related discomfort (3.2 +/- 1.7 and 3.1 +/- 1.9) and for discomfort caused by bowel preparation (3.2 +/- 2.1 and 3.1 +/- 1.8). Eighty-seven percent of all patients undergoing colonoscopy stated that they would prefer no premedication in the event of repeated examinations. CONCLUSIONS: Colonoscopy with sedation on demand does not cause more discomfort than barium enema and will be accepted by the vast majority of patients undergoing this procedure.

Barium Sulfate↗

PubMed1996

Photodocumentation of total colonoscopy: how successful are endoscopists? Do reviewers agree?

BACKGROUND: Documentation of total colonoscopy usually rests on a statement in the endoscopy report indicating that cecal landmarks were visualized. We sought to determine whether providing photographs of cecal landmarks provided an objective marker of complete colonoscopy. METHODS: We had 12 outside experienced endoscopists review 120 photographs of cecal landmarks that had been included with colonoscopy reports from our center that included 20 consecutive cases of reported total colonoscopy from each of 6 endoscopists. Reviewers graded whether they believed each set of photographs documented that at least the cecal inlet was reached as definite, probable, or uncertain. RESULTS: There was considerable disparity among reviewers as to whether individual photographs documented total colonoscopy. The frequency of combined, definite, and probable scores that they gave for the 120 photographs ranged from 97% down to 44% (median 82%). Different endoscopists also seemed to be variably successful in photodocumenting total colonoscopy. Four of the endoscopists received definite and probable scores for their 20 cases at least 80% of the time (86% for the highest ranked endoscopist). The lowest ranked endoscopist received such scores just 64% of the time. CONCLUSIONS: Documenting total colonoscopy with static images of cecal landmarks is only partially successful as an objective measure of the extent of total colonoscopy.

Cecum↗

PubMed1997

Randomized controlled trial of rectal tube placement for the management of abdominal distension following colonoscopy.

BACKGROUND: Traditionally, endoscopists have sought to provide maximum comfort for patients undergoing colonoscopy but may have been less concerned with the level of patient discomfort following the procedure. The aim of this study was to examine the effectiveness of rectal tube placement for abdominal decompression following colonoscopy in an effort to limit patient discomfort. METHODS: We conducted a prospective, single-blind, randomized controlled trial in 67 consecutive men undergoing elective colonoscopy. At the end of the procedure, patients were randomized to rectal tube placement or standard management without tube placement. Patients were evaluated by standardized criteria 30 minutes after completion of colonoscopy, and again 24 hours later. RESULTS: Thirty patients were randomized to rectal tube placement and 37 served as controls. The two groups were well matched with respect to age, duration of colonoscopy, quality of bowel preparation, prevalence of diverticulosis, frequency of polypectomy, and degree of difficulty in colonoscopy. At 30 minutes after colonoscopy, patients' overall satisfaction rating (mean +/- SD) from a 10-point scale was 9.1 +/- 3.2 in treated patients and 5.7 +/- 3.9 in controls (p < 0.05; 2-tailed unpaired t test). CONCLUSION: Placement of a rectal tube at the conclusion of colonoscopy reduces patient discomfort, and improves satisfaction.

Abdomen↗

PubMed1998

Performance of panel-based criteria to evaluate the appropriateness of colonoscopy: a prospective study.

BACKGROUND: Prospective data describing the appropriateness of use of colonoscopy based on detailed panel-based clinical criteria are not available. METHODS: In a cohort of 553 consecutive patients referred for colonoscopy to two university-based Swiss outpatient clinics, the percentage of patients who underwent colonoscopy for appropriate, equivocal, and inappropriate indications and the relationship between appropriateness of use and the presence of relevant endoscopic lesions was prospectively assessed. This assessment was based on criteria of the American Society for Gastrointestinal Endoscopy and explicit American and Swiss criteria developed in 1994 by a formal panel process using the RAND/UCLA appropriateness method. RESULTS: The procedures were rated appropriate or equivocal in 72.2% by criteria of the American Society for Gastrointestinal Endoscopy, in 68.5% by explicit American criteria, and in 74.4% by explicit Swiss criteria (not statistically significant, NS). Inappropriate use (overuse) of colonoscopy was found in 27.8%, 31.5%, and 25.6%, respectively (NS). The proportion of appropriate procedures was higher with increasing age. Almost all reasons for using colonoscopy could be assessed by the two explicit criteria sets, whereas 28.4% of reasons for using colonoscopy could not be evaluated by the criteria of the American Society for Gastrointestinal Endoscopy (p < 0.0001). The probability of finding a relevant endoscopic lesion was distinctly higher in the procedures rated appropriate or equivocal than in procedures judged inappropriate. CONCLUSIONS: The rate of inappropriate use of colonoscopy is substantial in Switzerland. Explicit criteria allow assessment of almost all indications encountered in clinical practice. In this study, all sets of appropriateness criteria significantly enhanced the probability of finding a relevant endoscopic lesion during colonoscopy.

Algorithms↗

PubMedDate not supplied

Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison.

BACKGROUND: The usefulness of currently available colon imaging tests, including air contrast barium enema (ACBE), computed tomographic colonography (CTC), and colonoscopy, to detect colon polyps and cancers is uncertain. We aimed to assess the sensitivity of these three imaging tests. METHODS: Patients with faecal occult blood, haematochezia, iron-deficiency anaemia, or a family history of colon cancer underwent three separate colon-imaging studies--ACBE, followed 7-14 days later by CTC and colonoscopy on the same day. The primary outcome was detection of colonic polyps and cancers. Outcomes were assessed by building an aggregate view of the colon, taking into account results of all three tests. FINDINGS: 614 patients completed all three imaging tests. When analysed on a per-patient basis, for lesions 10 mm or larger in size (n=63), the sensitivity of ACBE was 48% (95% CI 35-61), CTC 59% (46-71, p=0.1083 for CTC vs ACBE), and colonoscopy 98% (91-100, p<0.0001 for colonoscopy vs CTC). For lesions 6-9 mm in size (n=116), sensitivity was 35% for ACBE (27-45), 51% for CTC (41-60, p=0.0080 for CTC vs ACBE), and 99% for colonoscopy (95-100, p<0.0001 for colonoscopy vs CTC). For lesions of 10 mm or larger in size, the specificity was greater for colonoscopy (0.996) than for either ACBE (0.90) or CTC (0.96) and declined for ACBE and CTC when smaller lesions were considered. INTERPRETATION: Colonoscopy was more sensitive than other tests, as currently undertaken, for detection of colonic polyps and cancers. These data have important implications for diagnostic use of colon imaging tests.

Barium Sulfate↗

PubMed2005

A prospective national study on colonoscopy and sigmoidoscopy in 2000 in France.

AIM: The aim of this study was to evaluate the practice of colonoscopy and sigmoidoscopy in France in 2000. METHODS: A prospective study was conducted in November 2000 using questionnaires sent to all gastroenterologists practicing in France (N=2858) who were asked to reply to items concerning colonoscopies and sigmoidoscopies performed on two workdays chosen in advance. The response rate was 32.8%. Data were extrapolated to establish estimates for the entire year. RESULTS: An estimated 894000 colonoscopies and 115320 sigmoidoscopies were performed in 2000. Single-use material was used in 22.1% of the procedures. Indications for endoscopy were mainly hematochezia (21.6%), gastrointestinal symptoms (35%) and surveillance of patients with a history of previous polypectomy (15%). Colorectal cancer screening was the indication for 20% of colonoscopies. Abnormal findings were reported for 54.8% of the endoscopies (polyps for 287218 procedures and cancer for 32799). Failure was noted in 4.9% of colonoscopies. The complication rate was 0.48%. Most polyps were adenomas (64.4%) or hyperplasic polyps (28.1%). The overall estimated number of colonoscopies with polypectomy was 224133. CONCLUSION: In 2000 there was an increased rate of colonoscopy for colorectal cancer screening (20%) but an overall decrease (2.5%) in the total number of colonoscopies compared to 1999. Abnormal findings were disclosed by 54.8% of the procedures. Extrapolation from these data indicates that colonoscopic screening enabled the diagnosis of 32799 colorectal cancers.

Aged↗

PubMed2004

Appropriateness of colonoscopy in a tertiary referral centre.

The aim of this study was to determine the appropriateness of colonoscopy in relation to its diagnostic yield, with reference to the guidelines set by the American Society of Gastrointestinal Endoscopy (ASGE). A prospective 90-day audit was performed at Hospital Kualal Lumpur, which is a tertiary referral centre in Malaysia, to examine the appropriateness of colonoscopy by indication. During that time, 257 colonoscopies were performed in 244 patients. The predominant indications for colonoscopy were altered bowl habit (37%) and rectal bleeding (18%). Of the 257 colonoscopies, 216 (84%) were judged to be appropriate by ASGE guidelines. Only 43% of all colonoscopies had positive findings. Positive findings were found in 93% of cases judged appropriate compared with only 7% found in cases deemed inappropriate. There were statistically significant relationships between appropriateness and overall positive yield and between appropriateness and neoplastic findings (p < 0.05). Colonoscopy performed for appropriate indications yield more significant findings, this, we advocate the use of accepted guidelines to maintain or improve the standard colonoscopy services.

Adolescent↗

PubMed2005

Chromoendoscopic colonoscopy for detecting preneoplastic lesions in hereditary nonpolyposis colorectal cancer syndrome.

BACKGROUND & AIMS: In hereditary nonpolyposis colorectal cancer (HNPCC) syndrome, flat and small adenomas are particularly prone to malignant transformation but might be missed by standard colonoscopy. We prospectively studied the diagnostic yield of high-resolution colonoscopy coupled with chromoendoscopy for preneoplastic and neoplastic colorectal lesions in patients with HNPCC syndrome. METHODS: Thirty-six consecutive asymptomatic patients (mean age, 42 years) belonging to HNPCC families and receiving genetic counseling were enrolled in this prospective study. Colonoscopy was performed in 2 steps. Conventional colonoscopy was performed first, followed by a second colonoscopy with chromoendoscopy with indigo carmine (.4%) dye sprayed onto the entire proximal colon. RESULTS: Conventional colonoscopy identified 25 lesions (mean size, 4 +/- 3 mm) in 13 patients. Seven lesions, detected in 5 patients, were adenomas, 3 of which were located in the proximal colon. Chromoendoscopy identified additional 45 lesions (mean size, 3 +/- 1 mm) in 20 patients; most of these lesions were flat and hyperplastic. Eleven additional adenomas were detected in the proximal colon of 8 patients, and 8 of these 11 lesions were flat. The use of chromoendoscopy significantly increased the detection rate of adenomas in the proximal colon, from 3 of 33 patients to 10 of 33 patients (P = .045). CONCLUSION: Relative to conventional colonoscopy, high-resolution colonoscopy with chromoendoscopy markedly improves the detection of adenomas in patients with HNPCC syndrome and might help to prevent colorectal carcinoma in these patients with a very high risk of colorectal cancer.

Adaptor Proteins, Signal Transducing↗

PubMed2026

Colonoscopy and fecal immunochemical testing versus usual care in diagnostic colorectal cancer screening: the SCREESCO randomized controlled trial.

There is a need to quantify the benefits and harms of colorectal cancer (CRC) screening using primary colonoscopy or fecal immunochemical testing (FIT) compared with usual care with no screening. Guidelines recommend screening in individuals aged 50-75 years using colonoscopy or FIT, and many screening programs use one-sample biennial FIT. Here we compare incidence of diagnosed CRCs and gastrointestinal and cardiovascular events between screening and usual care during the diagnostic phase of the SCREESCO trial. A randomized block method (no masking) assigned 278,280 individuals aged 60 years to once-only colonoscopy, 2 rounds of two-stool FIT with a low cutoff (10 μg g-1 feces) or usual care (control group) in a ratio of 1:6 for colonoscopy versus control and 1:2 for FIT versus control. In the analysis, 31,113 individuals were in the primary colonoscopy arm and 60,267 were in the FIT arm, and there were 186,671 primary colonoscopy controls, of whom 120,521 were also controls for comparison with the FIT arm. After a median follow-up of 4.8 years, the incidence rate of CRC was 107.9 in the colonoscopy arm and 99.9 in controls per 100,000 person-years (incidence rate ratio (IRR): 1.08, 95% confidence interval (CI): 0.91-1.28) and 96.0 in the FIT arm and 103.9 in controls (IRR: 0.92, 95% CI: 0.81-1.05). Rates of stage I-II CRC were higher in the colonoscopy arm (IRR: 1.38, 95% CI: 1.09-1.74) and in the FIT arm (IRR: 1.19, 95% CI: 0.99-1.43) versus controls. Rates of cardiovascular and gastrointestinal events were slightly higher in the intervention arms during the first year and were subsequently more similar to controls. Our findings of an increase in CRC detection implies a benefit of screening while the increase in adverse events suggests some initial harm. ClinicalTrials.gov: NCT02078804 .

Humans↗