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Objective Some patients (10 % – 32 %) with a positive guaiac fecal occult blood test (gFOBT) do not undergo the recommended colonoscopy. The aim of this study was to compare video capsule endoscopy (VCE) and computed tomography colonography (CTC) in terms of participation rate and detection outcomes when offered to patients with a positive gFOBT who did not undergo the recommended colonoscopy. Methods An invitation letter offering CTC or VCE was sent to selected patients after randomization. Acceptance of the proposed (or alternative) procedure and procedure results were recorded. Sample size was evaluated according to the hypothesis of a 13 % increase of participation with VCE. Results A total of 756 patients were targeted. Following the invitation letter, 5.0 % (19/378) of patients underwent the proposed VCE and 7.4 % (28/378) underwent CTC, ( P = 0.18). Following the letter, 9.8 % (37/378) of patients in the VCE group underwent a diagnostic procedure (19 VCE, 1 CTC, 17 colonoscopy) vs. 10.8 % in the CTC group (41/378: 28 CTC, 13 colonoscopy; P = 0.55). There were more potentially neoplastic lesions diagnosed in the VCE group than in the CTC group (12/20 [60.0 %] vs. 8/28 [28.6 %]; P = 0.04). Thus, 15/20 noninvasive procedures in the VCE group (19 VCE, 1 CTC; 75.0 %) vs. 10/28 in the CTC group (35.7 %; P = 0.01) resulted in a recommendation of further colonoscopy, but only 10/25 patients actually underwent this proposed colonoscopy. Conclusion Patients with a positive gFOBT result who do not undergo the recommended colonoscopy are difficult to recruit to the screening program and simply proposing an additional, less-invasive procedure, such as VCE or CTC, is not an effective strategy. ClinicalTrials.govNCT02558881TRIAL REGISTRATION: Randomized, controlled trial NCT02558881 at clinicaltrials.gov.

BACKGROUND AND STUDY AIMS: The high cumulative risk of colorectal cancer in patients with familial adenomatous polyposis (FAP) justifies prophylactic colectomy with either ileorectal (IRA) or ileal-pouch-anal anastomosis (IPAA). Our aim was to evaluate retrospectively the frequency of and time interval to adenoma development in the ileal mucosa of patients with both types of surgery. PATIENTS AND METHODS: Retrospective study of 44 FAP patients with IRA (n = 21) and IPAA (n = 23). All patients were followed with a standardized procedure including chromoscopy and biopsies of visible polyps. In patients with IRA, specific attention was paid to the ileal mucosa above the anastomosis. RESULTS: In the IPAA group, 18/23 patients (78 %) presented with visible polyps [histology: 16 (70 %) had adenoma with low-grade dysplasia; 1 (4 %) had adenoma with high-grade dysplasia; 1 had normal mucosa]. The mean interval between colectomy and the diagnosis of adenoma was 4.7 +/- 3.3 years. In the IRA group, 16/21 patients (77 %) presented visible polyps in the ileal mucosa [adenoma with low-grade dysplasia in 8 patients (38 %), with high-grade dysplasia in 2 (10 %), and lymphoid nodular hyperplasia in 6]. The mean interval between colectomy and adenoma diagnosis was significantly shorter in the IPAA than in the IRA group (4.76 +/- 3.3 vs. 16.4 +/- 8.5 years, P< 0.0001). CONCLUSION: Our results show a high frequency of adenomas in the ileal mucosa of patients with IPAA and IRA (74 % and 48 % respectively), with evolution into high-grade dysplasia in 6.7 % of cases.

BACKGROUND AND STUDY AIMS Colonoscopy is still considered the standard investigation for the detection of colorectal adenomas, but the miss rate, especially for small and flat lesions, remains unacceptably high. Chromoscopy has been shown to increase the yield for lesion detection in inflammatory bowel disease. The aim of this randomized prospective study was to determine whether a combination of chromoscopy and structure enhancement could increase the adenoma detection rate in high-risk patients. PATIENTS AND METHODS All patients included in the trial had a personal history of colorectal adenomas and/or a family history of colorectal cancer (but excluding genetic syndromes). They were randomized to one of two tandem colonoscopy groups, with the first pass consisting of conventional colonoscopy for both groups, followed by either chromoscopy and structure enhancement (the "study" group) or a second conventional colonoscopy (the control group) for the second-pass colonoscopy. All detected lesions was examined histopathologically after endoscopic resection or biopsy. The principal outcome parameter was the adenoma detection rate; the number, histopathology, and location of lesions was also recorded. RESULTS A total of 292 patients were included in the study (146 patients in each group). The patients' demographic characteristics, the indications for colonoscopy, and the quality of bowel preparation were similar in the two groups. There was a significant difference between the two groups with respect to the median duration of the examination (18.9 minutes in the control group vs. 27.1 minutes for the study group, P < 0.001). Although more hyperplastic lesions were detected throughout the colon in the study group ( P = 0.033), there was no difference between the two groups in either the proportion of patients with at least one adenoma or in the total number of adenomas detected. Chromoscopy and structure enhancement diagnosed significantly more diminutive adenomas (< 5mm) in the right colon, compared with controls ( P = 0.039). CONCLUSIONS On the basis of our results we cannot generally recommend the systematic use of chromoscopy and structure enhancement in a high-risk patient population, although the detection of small adenomas in the proximal colon was improved.

BACKGROUND AND STUDY AIM: A video capsule similar to that used in small-bowel capsule endoscopy is now available for esophageal exploration. The aim of our study was to compare the accuracy of upper endoscopy (esophageal gastroduodenoscopy [EGE]) with esophageal capsule endoscopy (ECE) in patients at risk of esophageal squamous cell cancer (SCC). PATIENTS AND METHODS: 68 patients at risk of SCC secondary to a history of head and neck neoplasia were included in this comparison of techniques for detecting SCC and dysplasia. ECE was done using the first generation Pillcam ESO and EGE was performed in accordance with the usual practice of each center, followed by examination with 2 % Lugol staining and biopsy of unstained areas (39 neoplasia comprising 5 low grade dysplasia, 8 high grade dysplasia and 26 SCC). RESULTS: Compared with EGE with and without Lugol staining, the sensitivities of ECE for neoplasia diagnosis were 46 % and 54 %, respectively. On a per-patient basis, the sensitivity, specificity, and positive and negative predictive value of ECE were 63 %, 86 %, 77 % and 76 %, respectively, compared with EGE without staining, and 61 %, 86 %, 77 % and 73 % compared with EGE with iodine staining. Neither the ECE transit time nor the distance between the esopharyngeal line and the neoplastic lesion differed between the 21 false-negative and 18 true-positive cases diagnosed by ECE; the only difference was a smaller median diameter among false negatives ( P < 0.001). CONCLUSION: In a cohort at high risk for esophageal SCC, ECE is not sensitive enough to diagnose neoplastic lesions.

Introduction Les tumeurs carcinoides sont rares (20 a 40% des tumeurs de l'intestin grele). Elles sont souvent de petite taille (inferieures a 1cm), de localisation intra parietale a predominance ileale et seraient multifocales dans 30% des cas. Le pronostic vital des patients et leur survie peuvent dependre de l'evolution tumorale locoregionale rendant importante l'identification de la tumeur primitive avant de discuter une prise en charge chirurgicale. La videocapsule endoscopique (VCE) est un examen non invasif permettant d'explorer la totalite de l'intestin grele. Sa faisabilite et ses resultats dans la detection des tumeurs carcinoides sont en cours d'evaluation. Patients et Methodes Notre travail a porte de facon retrospective sur une serie de 9 patients (6 femmes et 3 hommes; moyenne d'âge 69,7 ans, extremes 49–73), chez qui le diagnostic de tumeur endocrine (TE) bien differencie a ete porte avec une forte presomption pour une atteinte tumorale intestinale (metastases hepatiques, peritoneales ou ganglionnaires, mesenterite retractile au scanner ou decouverte fortuite au cours d'une ileocoloscopie). Les films endoscopiques de videocapsule ont tous ete relus en aveugle par un 2eme lecteur experimente apres une lecture preoperatoire initiale par un premier lecteur. L'identification de la tumeur primitive (selon un score de probabilite faible F0, moyen F1 ou fort F2), sa description et le retentissement local du processus tumoral ont ete apprecies. Ses resultats ont ete compares a ceux de la chirurgie realisee chez tous les patients. Resultats Aucune complication n'a ete observee. La VCE a ete evacuee dans tous les cas. Le bas fond caecal n'a pas ete atteint dans 1 cas. La VCE a permis de detecter 7 tumeurs primitives (4lesions nodulaires, 2 aspects de bombement sous-muqueux et 1 ulceration) dont la taille moyenne etait de 13mm (extremes 4–20mm) sur le compte rendu anatomopathologique apres la chirurgie. Dans un cas, la tumeur primitive n'a pas ete identifiee par la VCE (taille 20mm). Dans 2 cas, des anomalies de la muqueuse ileale ont ete interpretes comme un processus ischemique sur mesenterite retractile confirme par la chirurgie. Aucune tumeur multifocale n'a ete observee. Le champ diagnostique de la VCE pour l'identification de la tumeur primitive (lesions classees F1 et F2) etait de 77%, sa sensibilite de 87,5% et sa VVP de 54%. Conclusion En cas de suspicion de TE intestinale, un examen par VCE semble faisable et pourrait permettre d'identifier la tumeur primitive. Sa presentation endoscopique est variable en fonction de son mode de developpement intra parietal et de sa taille. Sa place reste a valider de facon prospective chez un plus grand nombre de patients par rapport aux moyens d'exploration de reference que sont l'enteroscanner et Octreoscan®.

UNLABELLED BACK AND STUDY AIMS: Endoscopic mucosal resection (EMR) is used to treat premalignant and malignant digestive tract lesions. This report presents the efficacy and safety of EMR for squamous superficial neoplastic esophageal lesions. PATIENTS AND METHODS A retrospective cohort study presented data from 51 patients with 54 lesions over an 8-year period, between November 1997 and September 2005. Dysplasas or mucosal (m) T1 carcinomas were treated with repeated EMR until there was a complete local remission. Patients with submucosal (sm) T1 carcinomas were treated with repeated EMR until there was a complete local remission. Patients with submucosal (sm) T1 carcinomas or more advanced stage were offered surgery or chemoradiotherapy. RESULTS There was no mortality, perforation, or major hemorrhage, and there were three easily dilated stenoses. Of the patients, 16 had lesions graded as T1sm or more advanced and one patient was found to have normal tissue post EMR. Complete local remission was achieved in 31 of the 34 patients with dysplasia or T1 m cancers (91%). There was no distant relapse and there was local disease recurrence in eight of the 31 patients (26%). The 5-year survival rate was 95%. CONCLUSIONS EMR for squamous superficial neoplastic lesions of the esophagus is safe and provides satisfactory survival results.