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Aim: The delivery of the Scottish Bowel Screening Programme (SBoSP) is rooted in the provision of a high quality, effective and participant-centred service. Safe and effective colonoscopy forms an integral part of the process. Additional accreditation as part of a multi-faceted programme for participating colonoscopists, as in England, does not exist in Scotland. This study aimed to describe the quality of colonoscopy in the SBoSP and compare this to the English national screening standards., Methods: Data were collected from the SBoSP between 2007 and 2014. End-points for analysis were caecal intubation, cancer, polyp and adenoma detection, and complications. Overall results were compared with 2012 published English national standards for screening and outcomes from 2006 to 2009., Results: During the study period 53 332 participants attended for colonoscopy. The colonoscopy completion rate was 95.6% overall. The mean cancer detection rate was 7.1%, the polyp detection rate was 45.7% and the adenoma detection rate was 35.5%. The overall complication rate was 0.47%., Conclusion: Colonoscopy quality in the SBoSP has exceeded the standard set for screening colonoscopy in England, despite not adopting a multi-faceted programme for screening colonoscopy. However, the overall adenoma detection rate in Scotland was 9.1% lower than that in England which has implications for colonoscopy quality and may have an impact on cancer prevention rates, a key aim of the SBoSP., (Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.)

Aim: Incomplete colonoscopy occurs in 8-10% of attempted examinations. An incomplete colonoscopy is usually followed by radiological evaluation of the large bowel to complete the colonic assessment. Patients then found to have polyps of > 1 cm represent a significant management dilemma. This study describes our experience using laparoscopy to facilitate complete colonoscopy and polypectomy in patients with fixed angulation and the success of subsequent colonoscopies., Method: All patients from 2008 to 2012 with an incomplete colonoscopy because of fixed angulation and with polyps detected by subsequent imaging underwent standard laparoscopy with colonic mobilization by division of adhesions to facilitate direct vision. Completion of colonoscopy and polypectomy, intra-operative complications, postoperative morbidity and successful standard follow-up colonoscopy were studied., Results: Twelve patients underwent the procedure. Complete colonoscopy to caecum was successful in all, with a median of 2 (range 1-5) polyps per patient and a mean polyp size of 22 mm. One iatrogenic enterotomy was repaired immediately, with no sequelae. Ten patients have since undergone colonoscopy under sedation, with complete colonic evaluation possible in nine of the patients., Conclusion: Laparoscopic-assisted colonoscopy allows safe polypectomy in patients with incomplete colonoscopy, without the need for segmental resection. This less-invasive procedure yields recovery times similar to those of colonoscopy alone, avoiding the morbidity of a segmental resection with the added benefit of successful routine colonoscopy in the future., (Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.)

Aim: Several techniques for temporary abdominal closure have been developed. We systematically review the literature on temporary abdominal closure to ascertain whether the method can be tailored to the indication., Method: Medline, Embase, the Cochrane Central Register of Controlled Trials and relevant meeting abstracts until December 2009 were searched using the following headings: open abdomen, laparostomy, VAC (vacuum assisted closure), TNP (topical negative pressure), fascial closure, temporary abdominal closure, fascial dehiscence and deep wound dehiscence. The data were analysed by closure technique and aetiology. The primary end-points included delayed fascial closure and in-hospital mortality. The secondary end-points were intra-abdominal complications., Results: The search identified 106 papers for inclusion. The techniques described were VAC (38 series), mesh/sheet (30 series), packing (15 series), Wittmann patch (eight series), Bogotá bag (six series), dynamic retention sutures (three series), zipper (15 series), skin only and locking device (one series each). The highest facial closure rates were seen with the Wittmann patch (78%), dynamic retention sutures (71%) and VAC (61%)., Conclusion: Temporary abdominal closure has evolved from simple packing to VAC based systems. In the absence of sepsis Wittmann patch and VAC offered the best outcome. In its presence VAC had the highest delayed primary closure and the lowest mortality rates. However, due to data heterogeneity only limited conclusions can be drawn from this analysis., (© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.)

Aim: Colorectal cancer patients identified with indeterminate pulmonary nodules (IPN) in the absence of other metastasis represent a clinical dilemma. This study aimed to identify characteristics that could predict which nodules truly represented a metastasis in an attempt to optimize therapy and to reduce the number of follow-up chest CT scans performed., Method: All patients with colon or rectal cancer who presented between 2004 and 2008 were analysed. Patients with IPN on staging CT were identified from a dedicated prospective database and the medical records analysed and follow up recorded. Patients with obvious metastatic disease were excluded from analysis. Association of location, number and size of the nodules and metastatic disease were the primary end-points for analysis., Results: Nine hundred and eight patients presenting with cancer of the colon or rectum were identified. Thirty-seven (4%) patients were diagnosed with IPN with no obvious metastatic disease on staging CT. At a median follow up of 23 months there were eight (21%) cases where nodules had progressed. No significant association was detected between nodule size and pulmonary metastasis. Half of the patients with four or more nodules showed progression on serial CT imaging suggestive of pulmonary metastasis (χ(2), P ≤ 0.01)., Conclusion: Colorectal cancer patients with four or more indeterminate pulmonary nodules on preoperative staging CT imaging, even in the absence of metastasis elsewhere, are likely to represent pulmonary metastatic disease. These patients should be followed up with short-term interval CT imaging to enable early detection of progression so that treatment can be tailored appropriately., (© 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.)