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In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;68:250-281. © 2018 American Cancer Society. [ABSTRACT FROM AUTHOR]

Objective: Reliable noninvasive biomarkers for early detection of colorectal cancer (CRC) are highly desirable for efficient population-based screening with high adherence rates. We aimed to discover and validate blood-based protein markers for the early detection of CRC. Patients and methods: A two-stage design with a discovery and a validation set was used. In the discovery phase, plasma levels of 92 protein markers and serum levels of TP53 autoantibody were measured in 226 clinically recruited CRC patients and 118 controls who were free of colorectal neoplasms at screening colonoscopy. An algorithm predicting the presence of CRC was derived by Lasso regression and validated in a validation set consisting of all available 41 patients with CRC and a representative sample of 106 participants with advanced adenomas and 107 controls free of neoplasm from a large screening colonoscopy cohort (N=6018). Receiver operating characteristic (ROC) analyses were conducted to evaluate the diagnostic performance of individual biomarkers and biomarker combinations. Results: An algorithm based on growth differentiation factor 15 (GDF-15), amphiregulin (AREG), Fas antigen ligand (FasL), Fms-related tyrosine kinase 3 ligand (Flt3L) and TP53 autoantibody was constructed. In the validation set, the areas under the curves of this five-marker algorithm were 0.82 (95% CI, 0.74-0.90) for detecting CRC and 0.60 (95% CI, 0.52-0.69) for detecting advanced adenomas. At cutoffs yielding 90% specificity, the sensitivities (95% CI) for detecting CRC and advanced adenomas were 56.4% (38.4%-71.8%) and 22.0% (13.4%-35.4%), respectively. The five-marker panel showed similar diagnostic efficacy for the detection of early- and late-stage CRC. Conclusion: The identified most promising biomarkers could contribute to the development of powerful blood-based tests for CRC screening in the future. [ABSTRACT FROM AUTHOR]

Background: Screening colonoscopy has been offered in Germany since 2002. Complications during colonoscopy were reported to be rare, but data on potential complications after colonoscopy are sparse. We aimed to comprehensively assess the frequency of complications arising during or within four weeks of screening colonoscopy. Methods: Residents of the German federal state of Saarland without a history of colorectal cancer and without previous polypectomy who underwent a screening colonoscopy between 2010 and 2013 were included. A follow-up was conducted three months after the screening colonoscopy, including participant questionnaires and subsequent validation of self-reported complications arising during or within four weeks of screening colonoscopy, by reviewing colonoscopy records and contacting the treating physicians. A comprehensive mortality follow-up was conducted for non-responders. Results: We recruited a total of 5527 participants from 26 practices (median age 61 years, 52% women). 5252 (95%) fully completed the questionnaire on complications and met the inclusion criteria for analysis. Among these participants, 16 cases of physician-confirmed bleeding (0.30%) and four cases of physician-confirmed perforation (0.08%) occurred during or within four weeks of colonoscopy. According to consistent reports from patients and physicians, bleeding and perforation led to hospitalization in 5 (0.095%) and 2 (0.04%) cases, respectively. Three participants died within three months of colonoscopy. In none of these cases was the cause of death related to colonoscopy. Conclusion: We found the risk of complications of screening colonoscopy to be low, even when taking into account a potential delay of up to four weeks. [ABSTRACT FROM AUTHOR]

Background: The introduction of colonoscopic screening in 2002 for persons aged 55 and older was followed by a marked decline in the incidence of colon cancer in the corresponding age groups in Germany. The prevalence of colorec-tal neoplasia among persons aged 50 to 54 has remained unknown until now. Expert committees currently recommend colonoscopic screening for persons aged 50 and older. This option has been offered since 2014 by the AOK Baden-Württemberg and by Bosch BKK in the framework of their specialized medical care program. Methods: In April 2014 and 2015,84 726 insurees aged 50-54 were invited by mail to participate in colonoscopic screening. The utilization and results of colonoscopic screening were studied. A questionnaire about risks was additionally sent to half of the participants, who were selected at random (study registration: DRKS00006268). Results: Within one year, 1.9% of persons to whom invitations had been sent took up the offer of colonoscopic screening; these persons included 3.3% of those already enrolled in the specialized medical care program. The 1396 colonoscopies that were performed revealed advanced neoplasia (colon cancer or advanced adenoma) in 6.8% of cases. The prevalence of advanced neoplasia among men aged 50 to 54 was nearly twice as high as that among women in the same age group (8.6% vs. 4.5%, p = 0.0027). It was also higher than the prevalences documented in the German nationwide cancer registry for women aged 55 to 79. The additional sending of a risk questionnaire along with the invitation had no effect on the rate of detection of relevant findings or on the rate of participation in colonoscopic screening. Conclusion: These findings lend support to the demand that the offer of colonoscopic screening should be extended at least to men aged 50 and above. [ABSTRACT FROM AUTHOR]

Background: No randomized, controlled trials of screening colonoscopy have been completed, and ongoing trials exclude persons aged 75 years or older. The Medicare program, however, reimburses screening colonoscopy without an upper age limit.Objective: To evaluate the effectiveness and safety of screening colonoscopy to prevent colorectal cancer (CRC) in persons aged 70 to 74 and those aged 75 to 79 years.Design: Large-scale, population-based, prospective study. The observational data were used to emulate a target trial with 2 groups: colonoscopy screening and no screening.Setting: United States.Participants: 1 355 692 Medicare beneficiaries (2004 to 2012) aged 70 to 79 years at average risk for CRC who used Medicare preventive services and had no previous diagnostic or surveillance colonoscopies in the past 5 years.Measurements: 8-year risk for CRC and 30-day risk for adverse events.Results: In beneficiaries aged 70 to 74 years, the 8-year risk for CRC was 2.19% (95% CI, 2.00% to 2.37%) in the screening colonoscopy group and 2.62% (CI, 2.56% to 2.67%) in the no-screening group (absolute risk difference, -0.42% [CI, -0.24% to -0.63%]). Among those aged 75 to 79 years, the 8-year risk for CRC was 2.84% (CI, 2.54% to 3.13%) in the screening colonoscopy group and 2.97% (CI, 2.92% to 3.03%) in the no-screening group (risk difference, -0.14% [CI, -0.41 to 0.16]). The excess 30-day risk for any adverse event in the colonoscopy group was 5.6 events per 1000 individuals (CI, 4.4 to 6.8) in the 70- to 74-year age group and 10.3 per 1000 (CI, 8.6 to 11.1) in the 75- to 79-year age group.Limitation: CRC-specific mortality was not available, but CRC incidence and stage were studied at diagnosis.Conclusion: Screening colonoscopy may have had a modest benefit in preventing CRC in beneficiaries aged 70 to 74 years and a smaller benefit in older beneficiaries. The risk for adverse events was low but greater among older persons.Primary Funding Source: National Institutes of Health. [ABSTRACT FROM AUTHOR]

Background and Aim Colorectal cancer (CRC) incidence is rising among <50-year olds. The objective of this study was to determine screening colonoscopy outcomes among 40- to 49-year olds, which are currently limited. Methods Asymptomatic 40- to 49-year olds underwent one time CRC screening colonoscopy at The Chinese University of Hong Kong between 2007 and 2011. Screening outcomes, including prevalence, distribution, and predictive factors for overall and specifically proximal colorectal neoplasia were determined. Results Among 1133 ethnic Chinese, colorectal neoplasia prevalence was 20.5%. In men, distal adenomas were associated with proximal colorectal neoplasia. Men, advancing age, a first degree relative (FDR) with CRC, and diabetes mellitus were independently associated with colorectal neoplasia. A colorectal neoplasia was three times more likely to be found in a 45- to 49-year-old man with FDR of CRC compared with a 40- to 44-year-old woman without a FDR of CRC. The numbers needed to screen one colorectal neoplasia, and one advanced neoplasm in the highest risk group of 45- to 49-year-old men with FDR with CRC were 2.8 (95% CI: 2.2-4.4) and 18.5 (95% CI: 8.9-39.2), respectively. Conclusions Colorectal neoplasia prevalence in this 40- to 49-year-old Chinese cohort was higher than previous studies. Men, advancing age, FDR with CRC, and diabetes mellitus, can be used to risk stratify for neoplasia development. Men 45-49 years old with FDR with CRC represented the highest risk subgroup, with the lowest number needed to screen. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasonography ( EUS) is currently an integral tool for work-up of pancreaticobiliary neoplasms. Tissue acquisition by EUS is possible with fine-needle aspiration ( FNA) cytology and histology. However, FNA still carries some limitations and risks of complications. The use of image-enhanced EUS may improve detection and characterization of pancreaticobiliary neoplasms and complement FNA. The present article aims to provide an overview of the current development of contrast-enhanced imaging and elastography in EUS and their potential application in the diagnosis of pancreaticobiliary diseases. [ABSTRACT FROM AUTHOR]

Background: In some Italian areas, colonoscopic surveillance of first-degree relatives (FDRs) of colorectal cancer (CRC) patients is provided as a part of local population-based faecal occult blood test (FOBT) screening programmes. The objective of the present study was to assess the feasibility and early results of this surveillance model. Methods: Data from district screening centres were used to evaluate the process of identification and selection of eligible FDRs (residence in the Emilia-Romagna Region, age 40- 75 years, no recent colonoscopy) of screen-detected CRC patients and the detected prevalence of disease. The probability for an FDR to undergo colonoscopy and to be diagnosed with CRC and advanced adenoma was estimated using the Kaplan-Meier method. The sex- and age-standardised ratio of detected prevalence to that expected based on results from a colonoscopy screening study of the Italian general population was estimated. Results: Between 2005 and 2011, 9319 FDRs of 2437 screen-detected CRC patients (3.8 per patient) were identified and contacted. Their likelihood of being eligible for, and accepting, colonoscopy was 0.11 (95% confidence interval: 0.11-0.12). Among the 926 subjects undergoing colonoscopy, the prevalence of previous negative screening FOBT was 63%. Eleven CRCs (1.2%) and 100 advanced adenomas (10.8%) were detected. The standardised ratio of detected prevalence to that expected was 0.91 (95% confidence interval: 0.19-2.66) for CRC and 1.48 (1.04-2.05) for advanced adenoma. Conclusions: The procedure of selection of FDRs was extremely ineffective. Due to previous negative screening tests, the prevalence of disease was less than expected. A population-based FOBT screening programme is a highly unsuitable setting for the provision of surveillance to FDRs of CRC patients [ABSTRACT FROM AUTHOR]

Introduction: Narrow-band imaging (NBI), an emerging imaging technology, allows direct visualization of capillaries on the gastrointestinal mucosal surface. The combination of NBI and magnifying endoscopy can be used to identify morphological changes in these capillaries during the process of carcinogenesis. Findings and conclusions: Thus far, pathological predictions based on capillary pattern classifications have been reported to have good diagnostic accuracy. However, most of these studies have been single-center trials based on each institutional classification, and worldwide multicenter trials aimed at their standardization are needed to validate the clinical benefits of the various NBI classification systems. [ABSTRACT FROM AUTHOR]

Background Racial and ethnic differences in the risk of premalignant colorectal neoplasia have not been extensively studied. Aim To measure adenoma prevalence among asymptomatic white, black and Hispanic patients undergoing screening colonoscopy. Methods In this cross sectional cohort study, data from individuals ≥50 years undergoing first-time colonoscopy since 2006 at a single tertiary-care medical centre were obtained from the electronic medical record. Adenoma prevalence among whites, blacks and Hispanics was calculated; multivariate Poisson and logistic regression were used to identify factors independently associated with adenoma rates and the presence of advanced adenomas. Results We identified 5075 eligible subjects: 3542 (70%) whites, 942 (18%) Hispanics and 591 (12%) blacks. The mean age was 62.2 years with 58% women. At least one adenoma was detected in 19%, 22% and 26% of whites, Hispanics and blacks respectively ( Hispanics vs. whites P = 0.09; blacks vs. whites P = 0.0001). Isolated proximal adenomas were present in 9% of whites, 11% of Hispanics ( P = 0.03) and 11% of blacks ( P = 0.03). In multivariate analyses, a higher rate of adenomas was present in Hispanics ( RR: 1.37, 95% CI: 1.20-1.57) and blacks ( RR: 1.76, 95% CI: 1.52-2.04) than whites. Hispanics and blacks also had an increased risk of advanced adenomas compared to whites ( ORHispanics: 2.25, 95% CI: 1.62-3.11; ORblacks: 1.91, 95% CI: 1.27-2.86). Conclusions Adenoma prevalence was higher in blacks and Hispanics than in whites. Both groups were at greater risk of having proximal adenomas in the absence of any distal pathology than whites, where these lesions would have only been detected by colonoscopy. Efforts to promote screening are necessary among diverse, under-represented populations. [ABSTRACT FROM AUTHOR]

Computed tomography colonography is a minimally invasive method for screening for polyps and colorectal cancer, with extremely unusual complications, increasingly used in the clinical practice. In the last decade, developments in bowel preparation, imaging, and in the training of investigators have determined a significant increase in the method sensitivity. Images interpretation is accomplished through a combined analysis of two-dimensional source images and several types of three-dimensional renderings, with sensitivity around 96% in the detection of lesions with dimensions equal or greater than 10 mm in size, when analyzed by experienced radiologists. The present pictorial essay includes examples of diseases and pseudolesions most frequently observed in this type of imaging study. The authors present examples of flat and polypoid lesions, benign and malignant lesions, diverticular disease of the colon, among other conditions, as well as pseudolesions, including those related to inappropriate bowel preparation and misinterpretation [ABSTRACT FROM AUTHOR]

Background Fecal occult blood testing (FOBT) can be adapted to a limited colonoscopy capacity by narrowing the age range or extending the screening interval, by using a more specific test or hemoglobin cutoff level for referral to colonoscopy, and by restricting surveillance colonoscopy. Which of these options is most clinically effective and cost-effective has yet to be established. Methods We used the validated MISCAN-Colon microsimulation model to estimate the number of colonoscopies, costs, and health effects of different screening strategies using guaiac FOBT or fecal immunochemical test (FIT) at various hemoglobin cutoff levels between 50 and 200 ng hemoglobin per mL, different surveillance strategies, and various age ranges. We optimized the allocation of a limited number of colonoscopies on the basis of incremental cost-effectiveness. Results When colonoscopy capacity was unlimited, the optimal screening strategy was to administer an annual FIT with a 50 ng/mL hemoglobin cutoff level in individuals aged 45–80 years and to offer colonoscopy surveillance to all individuals with adenomas. When colonoscopy capacity was decreasing, the optimal screening adaptation was to first increase the FIT hemoglobin cutoff value to 200 ng hemoglobin per mL and narrow the age range to 50–75 years, to restrict colonoscopy surveillance, and finally to further decrease the number of screening rounds. FIT screening was always more cost-effective compared with guaiac FOBT. Doubling colonoscopy capacity increased the benefits of FIT screening up to 100%. Conclusions FIT should be used at higher hemoglobin cutoff levels when colonoscopy capacity is limited compared with unlimited and is more effective in terms of health outcomes and cost compared with guaiac FOBT at all colonoscopy capacity levels. Increasing the colonoscopy capacity substantially increases the health benefits of FIT screening. [ABSTRACT FROM PUBLISHER]

The study aimed to assess the diagnostic yield of a colonoscopy screening programme in first-degree relatives of colorectal cancer (CRC) patients and to identify factors associated with advanced neoplasia. We conducted a cross-sectional study. Individual characteristics, family trees and colonoscopy findings of asymptomatic first-degree relatives of CRC patients were collected. The findings were classified into cancer (invasive carcinoma and/or non-invasive high-grade neoplasia), high-risk adenomas (≥ 10 mm and/or a villous component) and low-risk adenomas (tubular < 10 mm). The dependent variable was the presence of advanced neoplasia, defined as cancer and/or high-risk adenoma. Two hundred and sixty-three relatives (147 females), 50.0 ± 11.5 (range, 25-75) years of age, agreed to participate out of a total of 618 who were invited (acceptance rate 42.5%). Index cases were diagnosed at 63.8 ± 12.4 (range, 37-88) years of age. The closest familial relationship was parent/offspring in 168 (63.9%) participants and sibling in 95 (36.1%) participants; 14.8% had three or more relatives with CRC/cancer associated with Lynch syndrome, and two or more affected generations were identified in 24.0%. Advanced neoplasia was found in 56 (21.3%) participants. Of these, invasive cancer, non-invasive high-grade neoplasia and high-risk adenomas were detected in five (1.9%), six (2.3%) and 45 (17.1%) participants, respectively. Low-risk adenomas were detected in 20 (7.6%) participants. Male sex (odds ratio, 2.59; P = 0.003) and sibling relationship (odds ratio, 2.74; P = 0.001) were independently associated with advanced neoplasia. We detected advanced neoplasia in a considerable number of participants. Our data support colonoscopy screening in first-degree relatives of patients with CRC at an earlier age than in the medium-risk population. Male sex and sibling relationship were predictors of advanced neoplasia. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Reports on the accuracy of computed tomographic colonography (CTC) mainly involve series from expert institutions. The aims of this study were to assess CTC accuracy in a nationwide population and to relate it to radiologist performance in their initial training. DESIGN: Nationwide multicentre trial. SETTING: Twenty-eight radiologists, working in 26 mostly academic clinical units, were involved in the study after having attended a formal specialised 2-day training session on CTC. They worked through a training set of 52 cases with automatic feedback after an attempt at each case. PATIENTS: The study enrolled 845 patients with average and high risk of colorectal cancer, 737 of whom had both complete CTC and videocolonoscopy data, which constituted the dataset. INTERVENTIONS: Patients underwent same-day CTC followed by videocolonoscopy with segmental unblinding of CTC results. MAIN OUTCOME MEASURES: Sensitivity, specificity and positive and negative predictive values for detection of polyps ≥6 mm in per-patient and per-lesion analyses of CTC without computer-aided detection. RESULTS: Sensitivity, specificity and positive and negative predictive values for patients with polyps ≥6 mm were 69% (95% CI 61% to 77%), 91% (95% CI 89% to 94%), 67% (95% CI 59% to 74%) and 92% (95% CI 90% to 94%), respectively. Univariate analysis showed that the detection rate for polyps ≥6 mm was linked to neither radiologist case volume nor number of polyps, but was related to sensitivity achieved in the training set. Pooled sensitivity was 72% (95% CI 63% to 80%) versus 51% (95% CI 40% to 60%) for radiologists achieving above and below median sensitivity in the training set (61%), respectively. Multivariate analysis showed that sensitivity for polyps ≥6 mm in the training set was the only remaining significant predictive factor for subsequent performance. CONCLUSIONS: Radiologist sensitivity CTC for detection of polyps ≥6 mm in training was the sole independent predictor for subsequent sensitivity in detection of such polyps. [ABSTRACT FROM AUTHOR]

Background The Centers for Medicare and Medicaid Services (CMS) considered whether to reimburse computed tomographic colonography (CTC) for colorectal cancer screening of Medicare enrollees. To help inform its decision, we evaluated the reimbursement rate at which CTC screening could be cost-effective compared with the colorectal cancer screening tests that are currently reimbursed by CMS and are included in most colorectal cancer screening guidelines, namely annual fecal occult blood test (FOBT), flexible sigmoidoscopy every 5 years, flexible sigmoidoscopy every 5 years in conjunction with annual FOBT, and colonoscopy every 10 years. Methods We used three independently developed microsimulation models to assess the health outcomes and costs associated with CTC screening and with currently reimbursed colorectal cancer screening tests among the average risk Medicare population. We assumed that CTC was performed every 5 years (using test characteristics from either a Department of Defense CTC study or the National CTC Trial) and that individuals with findings of 6 mm or larger were referred to colonoscopy. We computed incremental cost-effectiveness ratios for the currently reimbursed screening tests and calculated the maximum cost per scan (ie, the threshold cost) for the CTC strategy to lie on the efficient frontier. Sensitivity analyses were performed on key parameters and assumptions. Results Assuming perfect adherence with all tests, the undiscounted number life-years gained from CTC screening ranged from 143 to 178 per 1000 65-year-olds, which was slightly less than the number of life-years gained from 10-yearly colonoscopy (152-185 per 1000 65-year-olds) and comparable to that from 5-yearly sigmoidoscopy with annual FOBT (149-177 per 1000 65-year-olds). If CTC screening was reimbursed at $488 per scan (slightly less than the reimbursement for a colonoscopy without polypectomy), it would be the most costly strategy. CTC screening could be cost-effective at $108-$205 per scan, depending on the microsimulation model used. Sensitivity analyses showed that if relative adherence to CTC screening was 25% higher than adherence to other tests, it could be cost-effective if reimbursed at $488 per scan. Conclusions CTC could be a cost-effective option for colorectal cancer screening among Medicare enrollees if the reimbursement rate per scan is substantially less than that for colonoscopy or if a large proportion of otherwise unscreened persons were to undergo screening by CTC. [ABSTRACT FROM AUTHOR]

Colonoscopists can miss adenomas during colonoscopy screening. A transparent hood attached to the tip of the colonoscope helps detection of colorectal adenomas, but as far as we are aware, there has been no trial indicating its statistically significant effectiveness. Total colonic dye spray might improve the adenoma detection rate but it is complicated and time-consuming for routine clinical usage. Moreover, the efficacy of narrow band imaging for detection of colorectal adenoma is controversial and is still under debate. Autofluorescence imaging (AFI) might be better able to detect flat lesions than white light imaging (WLI), but its ability is influenced easily by the area of the observation. Therefore, we have attached a transparent hood to the tip of an AFI colonoscope during colonoscopy screening in clinical usage. AFI can detect a flat lesion, which is difficult to detect using WLI. A transparent hood can help to detect lesions behind the folds by pushing the colonic fold. We expect that mounting a transparent hood would work complimentary to AFI. Further improvements, including a combination of AFI and a transparent hood, are needed and they would provide optimal surveillance intervals. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) screening can be administered through tests with varied characteristics and is a preference-sensitive decision.Objective: To assess patient experiences with a Maximum Differences Scaling (MDS) tool for eliciting values about CRC screening test characteristics and determine whether patients vary in how they prioritize test characteristics and whether this variation relates to test preferences.Design: MDS survey to elicit patients' values for characteristics related to fecal occult blood testing, sigmoidoscopy, colonoscopy, CT colonography and colon capsule endoscopy.Participants: 92 patients enrolled in primary care clinics at a VA hospital and associated university.Results: Patients reported that the tool was easy to use (95%). On completion 62% would choose colonoscopy, 23% colon capsule endoscopy and 10% CT colonography. Of the attributes evaluated, patients valued sensitivity, risk of tear and need for a second test most. Sensitivity was more important to those choosing colonoscopy than those choosing other tests (median importance = 21.5 versus 19.6, p < 0.01). Concern with complications and sedation was positively associated with age (p < 0.001 and p < 0.001), whereas concern with colon preparation and missing work was negatively associated with age (p < 0.009 and p < 0.03). Patients with fair or poor health status were less concerned with sensitivity than patients in good to excellent health (median importance = 19.3 versus 21.4, p < 0.008).Conclusions: This pilot study suggests that patients vary in how they prioritize colorectal cancer screening test attributes; this variation is associated with test preferences, and this MDS tool is feasible to use and may help patients construct their preferences. [ABSTRACT FROM AUTHOR]

Background and Aim: Visceral hypersensitivity is an important component of the pathophysiology of irritable bowel syndrome (IBS). In the present study, we investigated differences in pain perception during colonoscopy between IBS patients and non-IBS patients. We further assessed the sensitivity, specificity, and predictive values of pain scores to diagnose IBS. Methods: Patients who underwent colonoscopy for the evaluation of gastrointestinal symptoms or for screening purposes were included. All patients completed Rome III criteria questionnaires and reported pain scores on 0–100-mm visual analog scales after colonoscopy. The patients were divided into three groups: (i) IBS; (ii) other functional gastrointestinal disorders (FGID), including functional bloating, functional diarrhea, and functional constipation; and (iii) healthy controls. Results: A total of 217 patients were included. The pain scores (median, interquartile range) of IBS patients (52, 34–71) were higher than those of the healthy controls (22, 12–35) or other FGID patients (18, 10–29) ( P < 0.001). Upper gastrointestinal symptoms were observed more often in the IBS group than in the non-IBS group (83.2% vs 34.5%, P < 0.001). At the pain score level of 31, the sensitivity, specificity, positive predictive value, and negative predictive value for IBS diagnosis were 86.1%, 75.9%, 75.7%, and 86.3%, respectively. Conclusions: The degree of pain perception during colonoscopy was higher in IBS patients than in non-IBS patients. We concluded that colonoscopy can be useful in identifying IBS patients, with the additional benefit of excluding organic disorders of the lower gastrointestinal tract. [ABSTRACT FROM AUTHOR]

Colorectal cancer is a leading cause of cancer death throughout the world. There is evidence that screening of average-risk individuals can result in mortality reduction with early cancer detection and cancer prevention by detection and removal of cancer precursor lesions. The optimal form of screening is not clear. Fecal screening tests can be performed at home at low initial cost, but current versions lack high sensitivity for cancer precursor lesions, and tests need to be repeated at regular intervals. Adherence to repeat testing for negative tests and referral for colonoscopy for positive tests are important elements of program effectiveness. Structural examinations of the colon are more invasive and may result in detection of both early cancer and cancer precursor lesions. Every screening program has advantages and limitations, but each program ultimately depends on quality and patient adherence. [Copyright &y& Elsevier]

Background: Guidelines underline the role of individual preferences in the selection of a screening test, as insufficient evidence is available to recommend one screening test over another. We conducted a study to determine the preferences of individuals and to predict uptake for colorectal cancer (CRC) screening programmes using various screening tests.Methods: A discrete choice experiment (DCE) questionnaire was distributed among naive subjects, yet to be screened, and previously screened subjects, aged 50-75 years. Subjects were asked to choose between scenarios on the basis of faecal occult blood test (FOBT), flexible sigmoidoscopy (FS), total colonoscopy (TC) with various test-specific screening intervals and mortality reductions, and no screening (opt-out).Results: In total, 489 out of 1498 (33%) screening-naïve subjects (52% male; mean age+/-s.d. 61+/-7 years) and 545 out of 769 (71%) previously screened subjects (52% male; mean age+/-s.d. 61+/-6 years) returned the questionnaire. The type of screening test, screening interval, and risk reduction of CRC-related mortality influenced subjects' preferences (all P<0.05). Screening-naive and previously screened subjects equally preferred 5-yearly FS and 10-yearly TC (P=0.24; P=0.11), but favoured both strategies to annual FOBT screening (all P-values <0.001) if, based on the literature, realistic risk reduction of CRC-related mortality was applied. Screening-naive and previously screened subjects were willing to undergo a 10-yearly TC instead of a 5-yearly FS to obtain an additional risk reduction of CRC-related mortality of 45% (P<0.001).Conclusion: These data provide insight into the extent by which interval and risk reduction of CRC-related mortality affect preferences for CRC screening tests. Assuming realistic test characteristics, subjects in the target population preferred endoscopic screening over FOBT screening, partly, due to the more favourable risk reduction of CRC-related mortality by endoscopy screening. Increasing the knowledge of potential screenees regarding risk reduction by different screening strategies is, therefore, warranted to prevent unrealistic expectations and to optimise informed choice. [ABSTRACT FROM AUTHOR]

Colorectal cancer is second only to lung cancer as the leading cause of death among North Americans of both sexes. Although screening rates for colorectal cancer in the United States have increased over the past decade, these rates (in the range of 45%-60%) are still lower than the screening rates for breast cancer (approximately 80%). Optical colonoscopy has been recognized as the preferred method for colorectal cancer screening in the United States, but computed tomography colonography has recently been gaining favor. This article compares the 2 methods with respect to both advantages and disadvantages. Mt Sinai J Med 77:214–224, 2010. © 2010 Mount Sinai School of Medicine [ABSTRACT FROM AUTHOR]

Objective: Genetic testing and colonoscopy is recommended for people with a strong history of colorectal cancer (CRC). However, families must communicate so that all members are aware of the risk. The study aimed to explore the factors influencing family communication about genetic risk and colonoscopy among people with a strong family history of CRC who attended a genetic clinic with a view to having a genetic test for hereditary non-polyposis colon cancer (HNPCC). Methods: Interviews were held with 30 people with a high familial risk of colon cancer. The transcripts were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. Results: The family context, family history and perceptions about family duties and responsibilities were important motivators for communication about risk, genetic testing and colonoscopy and influenced participation in genetic testing and screening programmes. Participants reported usually communicating openly with their relatives about genetic risk and colonoscopy. Individuals felt a duty towards affected relatives and to their own children. The influence of the spouse and other relatives, particularly those affected by CRC, was also important. Colonoscopy was perceived to be embarrassing, unpleasant and sometimes painful. While there was sometimes anxiety about the result of the colonoscopy the results were usually reassuring. Conclusions: The family context and the experience of the family history can have an impact on communication, genetic testing and screening in HNPCC and this should be explored during counselling. Some individuals might benefit from support in communicating with relatives about genetic risk. Ways of improving the individual's experience of colonoscopy should also be examined. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The last few years have seen a burgeoning interest in the measurement of clinical performance and its impact on quality standards. The advent of the National Bowel Cancer Screening Program has highlighted the many deficiencies that exist in the provision of colonoscopy services in Australia. These include the absence of an agreed tool to measure the quality of colonoscopy on either an individual, departmental or regional basis and the absence of an endoscopic or colonoscopy training curriculum or an agreed standard for colonoscopy trainers. This review will discuss the current status and shortfalls of measuring quality in colonoscopy, highlight some recent initiatives by the Gastroenterological Society of Australia and articulate a direction for the future. [ABSTRACT FROM AUTHOR]

The article presents the research done by Thomas D. Sequist and colleagues on the ways of promoting colorectal cancer screening of patients in the U.S. It mentions that colorectal cancer is the second leading cause of cancer mortality in the country and to mitigate its detrimental effect, it is important for doctors to implement screening programs. Researchers did a randomized controlled trial of patient and physician reminders in 11 ambulatory health care centers, wherein they receive mailings containing an educational pamphlet, fecal occult blood test kit and instructions for direct scheduling of flexible sigmoidoscopy or colonoscopy. Result reveals that these mailed reminders to patients are the most effective tool in promoting colorectal cancer screening.

Colonoscopy is a screening modality for the early detection of colonic polyps and cancers but is underutilized, particularly among minorities. To identify potential barriers to screening colonoscopy among low income Latino and white non-Latino patients in an urban community health center. We conducted semistructured interviews with a convenience sample of patients 53 to 70 years old, eligible for colorectal cancer screening that spoke English or Spanish. Open-ended questions explored knowledge, beliefs, and experience with or reasons for not having screening colonoscopy. We performed content analysis of transcripts using established qualitative techniques. Of 40 participants recruited, 57% were women, 55% Latino, 20% had private health insurance, and 40% had a prior colonoscopy. Participants described a wide range of barriers categorized into 5 major themes: (1) System barriers including scheduling, financial, transportation, and language difficulties; (2) Fear of pain or complications of colonoscopy and fear of diagnosis (cancer); (3) Lack of desire or motivation , including “laziness” and “procrastination”; (4) Dissuasion by others influencing participants’ decision regarding colonoscopy; and (5) Lack of provider recommendation including not hearing about colonoscopy or not understanding the preparation instructions. Understanding of the range of barriers to colorectal cancer screening can help develop multimodal interventions to increase colonoscopy rates for all patients including low-income Latinos. Interventions including systems improvements and navigator programs could address barriers by assisting patients with scheduling, insurance issues, and transportation and providing interpretation, education, emotional support, and motivational interviewing. [ABSTRACT FROM AUTHOR]

Background & Aims: Screening guidelines for colorectal cancer include colonoscopy starting at age 50 years based on the prevalence of adenomas and the incidence of colon cancer at that age. However, only one prior study has investigated the prevalence of colorectal neoplasia with colonoscopic screening in asymptomatic average-risk individuals ages 40–49 years in the United States. Methods: We analyzed the results of screening colonoscopies offered to patients of a health care provider that offers screening services as part of an employer-provided wellness program. The primary end points were prevalence of adenomas and cancers for those aged 40–49 years vs those 50–59 years. Results: We analyzed 553 screening colonoscopies for patients ages 40–49 years and 352 screening colonoscopies for patients ages 50–59 years. In the 40–49 years age group, 79 patients (14%) had 1 or more adenomas, of which 11 (2% of screened) had an advanced neoplasm (>1 cm). In the 50–59 years age group, 56 patients (16%) had 1 or more adenomas detected. Of those patients, 13 (3.7% of screened) had an advanced neoplasm, and 1 patient (0.3%) had an adenocarcinoma detected. Conclusions: We found on colonoscopic screening that the prevalence of total adenomas was similar in individuals ages 40–49 and in those 50–59 years, although the prevalence of advanced neoplasia in the 50–59 years age group may be higher than that in the 40–49 years age group. [Copyright &y& Elsevier]

OBJECTIVES: Completion rates, pain, and difficulties during the exam are still problems in colonoscopy. New methods of lubrication, rarely considered a matter of study, may help in this respect. Our aim was to compare an oil-assisted technique with a modified warm water method applied during colonoscopy. METHODS: A prospective, randomized, and controlled study was planned in which three groups of patients were submitted to colonoscopy: a standard lubricating method (water-soluble jelly: group A, 170 patients) was adopted in a control group, whereas the standard method plus injection into the colon of corn seed oil (group B, 170 patients) or warm water (group C, 170 patients) were employed in the other groups. The main variables evaluated were: the success rate for total intubation, the time required to reach the cecum and the time needed to examine the colon at withdrawal, and the level of pain and degree of difficulty associated with the examination. RESULTS: Successful intubation to the cecum was significantly more frequent ( P < 0.01 and P < 0.001, respectively) in the oil group (group B, 155/166) and in the warm water group (group C, 156/163) than in the control group (group A, 138/164), and less time was needed ( P < 0.001); no significant difference was found between group B and C. Furthermore, no significant differences were found with regard to time for examination at withdrawal among the three groups. Level of pain and degree of difficulty during colonoscopy were significantly lower in the oil ( P < 0.001) and in the warm water ( P < 0.001) groups than in the control group, but no significant difference was found between group B and C. Neither side effects were observed for patients nor damage to the instrument. CONCLUSIONS: Warm water and oil-assisted colonoscopy could be simple, safe, and inexpensive methods for easier and less painful examinations. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: Colonoscopy is an excellent but imperfect modality for colorectal cancer screening and prevention. We studied the effects of a retractable transparent extension device on adenoma detection rate as well as on intubation and withdrawal times. METHODS: Colonoscopy with or without the transparent retractable extension (TRE) was performed by one endoscopist. A subset of patients with colonic adenomas were randomized to repeat colonoscopy with or without a TRE device. Adenoma removal was done at the second colonoscopy. The principal outcome parameters were the cecal intubation time, withdrawal time, and the number, size, and location of adenomas detected. RESULTS: The study was done in two parts. First, 835 patients underwent colonoscopy with or without the TRE. The patients' demographic characteristics, the indications for colonoscopy, the cecal intubation time and withdrawal time, and the proportion of patients with adenomas (29.0% vs 24.1%) ( P= 0.11) were similar between the two techniques. The number of adenomas detected with the TRE was significantly higher than that without the extension (205 vs 150) ( P= 0.04). Second, 60 patients with adenomas found at colonoscopy without the device were randomized to repeat colonoscopy within 3 months. Hood-assisted colonoscopy revealed 20% more adenomas than the initial procedure compared to a 4% increase without the hood ( P= 0.029). CONCLUSIONS: Colonoscopy with a TRE device improved the adenoma detection rate without affecting intubation and withdrawal times. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The potential effect of CT colonography (CTC) on endoscopic colonoscopy (EC) has been the topic of much speculation. The aim of this study was to evaluate the impact of a CTC screening program on colonoscopy in clinical practice. METHODS: At our institution a third-party reimbursed CTC colorectal cancer (CRC) screening program was established in 2004. The number of CTC monthly exams performed, monthly EC total and screening exams performed, EC with polypectomy performed, and the number of referrals for EC screening exams requested were prospectively examined in the first 33 months after introduction of a CTC CRC screening program. RESULTS: The mean number of overall (378.5 vs 413.1) and screening (150.7 vs 162.9) colonoscopy exams performed per month did not change significantly after screening CTC was introduced. The mean number of monthly CTC exams performed rose significantly throughout the first year of the study from 39 initially to a peak of 147.6 cases per month but decreased slightly to 114.3 monthly exams at the end of 2006. A mean 10.0 patients per month were sent for EC after a positive CTC exam. The mean number of monthly colonoscopies with polypectomy remained constant after the introduction of CTC (197.0 vs 180.2). Monthly referrals for screening EC exams initially decreased but were unchanged 3 yr after institution of a CTC screening program (255.0 vs 253.5). CONCLUSIONS: (a) In our tertiary care center the initiation of a screening CTC program did not result in a decrease in the number of total colonoscopy exams, screening colonoscopy exams performed, nor requests for screening colonoscopy. (b) Only a small number of CTC exams were referred for EC with polypectomy, therefore a CTC screening program may not increase the overall number of therapeutic colonoscopies performed. [ABSTRACT FROM AUTHOR]

Background: Colonoscopy is one of the methods of choice for screening relatives of patients with colorectal cancer. Objective: To evaluate the rate of adherence to colonoscopy in first-degree relatives of patients with colorectal cancer and describe the lesions found. Methods: A prospective, cross-sectional, multicentre, nationwide study was conducted. The study population was composed of first-degree relatives of patients with colorectal cancer selected randomly from the EPICOLON study. Seventy-four index patients were included. These had 342 living first-degree relatives (parents, siblings and children), of whom 281 were interviewed. Results: The adherence rate was 38% (107/281). Adherence was greater in families with a higher degree of familial aggregation for colorectal cancer (88.9% for Amsterdam vs 33.3% for Bethesda and sporadic cancer; p<0.05), an index patient aged under 65 years (60% for patients <65 years vs 32.9% for patients ⩾65 years; p<0.05) and an index patient who was female (46.2% for women vs 31% for men; p=0.28). Adherence was also greater in relatives under 65 years (54% in patients <65 years vs 18% in patients ⩾65 years; p=0.05), in female relatives (49% in female relatives vs 27.3% in male relatives; p<0.05) and in siblings and children (40% in siblings and children vs 13% in parents; p<0.05). Lesions were found in 26% (28/107) of the study population. Nine (8.4%) individuals had a total of 18 advanced lesions. Conclusions: These results indicate that adherence to colonoscopy in our population of first-degree relatives was low. The adherence was more frequently associated with a higher degree of familial aggregation, a relative age of under 65 years, a sibling or offspring relationship, and female sex. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To measure the amount of time patients spend in the screening colonoscopy process. METHODS: We recruited patients from a university endoscopy center scheduled to undergo screening colonoscopy. Participants completed a time diary for the screening colonoscopy process to account for time spent in preparation, travel, waiting, colonoscopy, and recovery. RESULTS: A total of 110 subjects completed the study. The sample was 57% female, 85% white, and 90% insured (40% Medicare, 4% Medicaid). Patients spent a median of about 21 h in the screening colonoscopy process for preparation, travel, waiting, colonoscopy, and onsite recovery. They invested a median of 16.5 h in preparation, 1.1 h traveling, 1.4 h waiting, 12 minutes for sedation, and 20 minutes for colonoscopy. Median time spent at the endoscopy center was 2.8 h. Median onsite recovery time was 47 minutes. Median time from the completion of the colonoscopy procedure until returning to routine activities was 17.7 h. Median time from the completion of the colonoscopy procedure until feeling completely back to normal was 19.9 h. Patient time requirements were sensitive to having a history of depression, type of person accompanying the patient, income, and employment status. CONCLUSIONS: Screening colonoscopy requires a substantial commitment of time. A small portion of that time is spent at the endoscopy center or having the colonoscopy. The majority of that time is spent in preparation and recovery. Time is a potential barrier to screening, but advances in preparation and sedation practices could reduce the time required for patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: The cost of an individual colonoscopy is an important determinant of the overall cost arid cost-effectiveness of colorectal cancer screening. Published cost estimates vary widely and typically report institutional costs derived from gross-costing methods. OBJECTIVE: Perform a cost analysis of colonoscopy using micro-costing and time-and-motion techniques to determine the total societal cost of colonoscopy, which includes direct health care costs as well as direct non-health care costs and costs related to patients' time. The design is prospective cohort. The participants were 276 contacted, eligible patients who underwent colono-scopy between July 2001 and June 2002, at either a Veterans' Affairs Medical Center or a University Hospital in the Southeastern United States. MAJOR RESULTS: The median direct health care cost for colonoscopy was $379 (25%, 75%; $343, $433). The median direct non-health care and patient time costs were $226 (25%, 75%; $187, $323) and $274 (25%, 75%; $186, $368), respectively. The median total societal cost of colonoscopy was $923 (25%, 75%; $805, $1047). The median direct health care, direct non- health care, patient time costs, and total costs at the VA were $391, $288, $274, and $958, respectively; analogous costs at the University Hospital were $376, $189, $368, and $905, respectively. CONCLUSION: Microcosting techniques and time-and- motion studies can produce accurate, detailed cost estimates for complex medical interventions. Cost estimates that inform health policy decisions or cost- effectiveness analyses should use total costs from the societal perspective. Societal cost estimates, which include patient and caregiver time costs, may affect colonoscopy screening rates. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare optical colonoscopy to fecal-tagging-based MR colonography in a screening population in terms of comfort and acceptance ratings as well as for future preferences as colorectal cancer screening examinations. Two hundred eighty-four asymptomatic patients (mean age 59 years) underwent MRC and OC within 4 weeks. While MRC was based on a fecal tagging technique, OC was performed after bowel cleansing. For OC, sedatives and analgesics were used. Patients evaluated both modalities and certain aspects of the examination according to a 10-point-scale with higher scores denoting a worse experience. Furthermore, preferences for future examinations were evaluated. No significant difference was noted for the overall acceptance of OC (mean value 3.0) and MRC (mean value 3.4). For MRC, the placement of the rectal tube was rated as the most unpleasant part, whereas bowel purgation was regarded most inconvenient for OC. Patients aged 55 years and older perceived most aspects less unpleasant than younger patients. Of the patients, 46% preferred MRC for future screening examinations (OC: 44%). OC and MRC have comparable general acceptance levels in a screening population. Especially for patients declining endoscopy as a screening method MRC may evolve as an attractive alternative. [ABSTRACT FROM AUTHOR]

Objective The goal of this prospective research was to determine genetic and endoscopic changes in patients with sporadic colorectal cancer and to diagnose HNPCC. Patients and Methods The group consisted of 40 patients, having colorectal cancer. Colonoscopy was performed, genetic testing for the loss of heterozygousity and microsatellite instability (MSI). Results HNPCC was diagnosed using the Amsterdam and Bethesda criteria in the group of sporadic colorectal cancer in 15% of the cases, and exhibited an MSI-H for the chromosome 2p where the hMSH2 mismatch repair gene is localized. The greatest number of patients with sporadic colon cancer and HNPCC displayed Astler-Coller B2 and C1 spread levels. Conclusion The research results indicate that the colonoscopy should be used as a screening method for colorectal cancer. It is necessary to design a colorectal cancer screening program for the general population and high risk individuals. There is a need to form National colorectal cancer, HNPCC and FAP registries. [ABSTRACT FROM AUTHOR]

Colorectal cancer is a major cause of cancer death in European countries and differences in screening implementation may in part explain USA vs European survival differences. Despite the evidence, no study has evaluated the population colorectal cancer screening (CCS) coverage in any European country. We aimed to index the current CCS practices among a large sample of Greek healthy adults. The study was designed as a cross-sectional survey. Screening practice habits of 5,259 healthy adults, aged 50–80, were surveyed. Both overall and screening practices of stool occult blood test (SOBT), digital rectal examination (DRE), and colonoscopy or sigmoidoscopy (COL/SIG) were analyzed. Of the population analyzed, 90.1% declared that they were interested in cancer prevention activities. Overall SOBT practice rate within the last 2 years was 4.77%. When only screening procedures were analyzed, this percentage shrank to 1.73%. Overall and screening COL/SIG rates within the last 10 years were 8.76 and 1.74%, respectively. The respective proportions of individuals who underwent DRE were 14.54 and 5.2%. Evidence-based screening practices were influenced by age, family history of colorectal cancer, profession, and educational level; however, SOBT and colonoscopy/sigmoidoscopy did not overcome 4.1 and 4.6% in any subpopulation analyzed. The level of CCS coverage among the examined sample of Greek adults was discouraging. Surveys among other European countries are encouraged. [ABSTRACT FROM AUTHOR]

Colorectal cancer remains a leading cause of cancer death in the UK. With the advent of screening programmes and developing techniques designed to treat and stage colorectal neoplasia, there is increasing pressure on the colonoscopist to keep up to date with the latest practices in this area. This review looks at the basic principles behind endoscopic mucosal resection and forward to the potential endoscopic tools, including high-magnification chromoscopic colonoscopy, high-frequency miniprobe ultrasound and confocal laser scanning endomicroscopic colonoscopy, that may soon become part of routine colorectal cancer management. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Unsedated colonoscopy is an uncomfortable procedure for most patients. Discomfort during colonoscopy is largely related to looping of the colonoscope, which displaces the colon from its native configuration and stretches attachments to the mesentery. A novel computer-assisted colonoscope utilizes a fully articulated, computer-controlled insertion tube. On manual insertion of the colonoscope, the position and angle of the scope's tip are encoded into a computer algorithm. As the colonoscope is advanced, the computer directs each successive segment to take the same shape that the tip had at a given insertion depth. The insertion tube thus changes its shape at different insertion depths in a “follow-the-leader” manner. METHODS: This initial clinical trial with this novel colonoscopy system was designed as a prospective, nonrandomized, unblinded, feasibility study. Three physicians of varying levels of experience participated in the study. RESULTS: Eleven consecutive patients (seven men, four women, age range 19–80) meeting inclusion criteria for screening or diagnostic colonoscopy were enrolled in the study. The cecum was reached in 10 consecutive patients (100%). Findings included diverticular disease in two cases and multiple colonic polyps in two cases. Postprocedure assessment at discharge, 48 h, and 30 days revealed no complications or adverse effects. Physician satisfaction and patient acceptance of this new technique were high. CONCLUSIONS: In this limited, first of its kind feasibility study, the computer-assisted colonoscope was shown to perform colonoscopy safely and effectively. The colonoscope's unique design limited loop formation during colonoscopy. Large-scale clinical trials are indicated. [ABSTRACT FROM AUTHOR]

Background: Recommendations by primary care physicians for colorectal screening after polypectomy will influence rates of colonoscopy in open-access systems that do not require consultation by a gastroenterologist before colonoscopy. Objective: To determine the surveillance recommendations of primary care physicians after polypectomy and compare them with recommendations from the U.S. Multisociety Task Force on Colorectal Cancer. Design: Cross-sectional study of physicians. Setting: United States. Participants: A random sample of 500 physicians from the American College of Physicians and 500 physicians from the American Academy of Family Physicians, obtained by using a mail survey. Measurements: Physicians were asked when they would recommend repeated colonoscopy for a hypothetical 55-year-old man with no family history of colorectal cancer after the following 6 results on colonoscopy: hyperplastic polyp, one 6-mm tubular adenoma, two 6-mm tubular adenomas, one 12-mm tubulovillous adenoma, one 12-mm tubular adenoma with focal high-grade dysplasia, and no polyp but a previous tubular adenoma. Results: The overall response rate was 57% (568 physicians). Of the respondents, 48% were internists and 52% were family practitioners. Sixty-one percent of respondents would survey a hyperplastic polyp in 5 years or less, 71% would survey a single tubular adenoma in 3 years or less, and 80% would survey 2 tubular adenomas in 3 years or less. Limitations: The results are based on physicians' self-reported practices from clinical vignettes and may not match actual practice. Conclusion: Primary care physicians recommend postpolypectomy colonoscopic surveillance more frequently than is recommended by practice guidelines, especially if the colonoscopy showed a hyperplastic polyp or a single small adenoma. [ABSTRACT FROM AUTHOR]

The article presents a study which analysed whether colonoscopy in 40- to 50-year-old first-degree relatives of patients with colorectal cancer (CRC) is cost-effective compared with the current practice of first screening beyond age 55 in the general population. A detailed cost-benefit analysis of screening colonoscopy and possible repeat endoscopies according to current expenditures for endoscopic procedures in Germany was prepared. Results revealed that screening colonoscopy is cost beneficial when participation is high.

Objective: To compare the frequency of Pap test results in a prospective series of direct to vial ThinPrep tests to a cohort of conventionally prepared tests. To follow-up all test results for a minimum of 2 years and assess performance based on this outcome. Methods: All women presenting for either routine screening or colposcopic examination in 2001 were enrolled in the ThinPrep cohort. A similar, population of conventionally prepared tests was extracted from the year 2000 laboratory data. Information on all concurrent and follow-up cervical specimens over the ensuing 2 years was retrieved. Results: The ThinPrep cohort comprised 2288 Pap tests and the conventional, 2211. The frequency of normal [within normal limits (WNL) and benign cellular changes (BCC)] results in the ThinPrep cohort was 6% lower and the frequency of abnormal [≥atypical squamous cells of undetermined significance (ASCUS)] results was 6.8% higher. Respective ThinPrep and conventional cohort results were 1156 (51%) and 1291 (58%) WNL, 625 (27%) and 561 (25%) BCC, 101 (4%) and 65 (3%) ASCUS, 21 (1%) and 2 (0.1%) atypical glandular cells of undetermined significance, 301 (13%) and 224 (10%) low-grade squamous intraepithelial lesion (LSIL), and 74 (3%) and 40 (2%) high-grade SIL (HSIL) ( P < 0.0001). Follow-up was available for nearly 80% of each cohort. LSIL or higher was confirmed in 57.5% ( n = 266) of the abnormal ThinPrep and 60.9% ( n = 190) of the abnormal conventional tests. The ThinPrep yield of confirmed tests however was almost 50% higher than the conventional test. Conclusion: In this population, ThinPrep was superior to the conventional Pap test. [ABSTRACT FROM AUTHOR]

Colonoscopic screening for colon cancer was suggested in 1988 [17], but it has only recently received significant acceptance. It is a topic of much current discussion among both health care providers and the general public, especially since the nationally broadcasted colonoscopy of a well-known television anchor person [8]. This brief discussion presents the role of colonoscopy in colon cancer screening. It sets forth the rationale for endoscopic screening, evaluates it using World Health Organization guidelines, and briefly considers the timing and termination of screening. By screening is meant the testing of asymptomatic individuals in a large population. This is to be distinguished from surveillance, which involves ongoing follow-up testing of individuals at known risk. The former is the subject of this discussion. [ABSTRACT FROM AUTHOR]

The article looks at the case of a 71-year-old woman, Ms G, who has a past medical history of mitral valve prolapse, osteoporosis, hypothyroidism, and mild rheumatoid arthritis and is contemplating whether to undergo a colonoscopy to screen for colon cancer. The article discusses the three main reasons why Ms G is reluctant to have a colonoscopy, which include her adverse reactions to anesthetic agents in the past and the negative family history of colon cancer. On a yearly basis Ms G completes the home-based fecal occult blood testing and the tests have always been negative. The article explores the epidemiology and pathophysiology of colon cancer, supporting evidence for colon cancer screening, screening patients that are older than 65 years, and recommendations for Ms G.

First introduced in 1994, CT colonography (Virtual colonoscopy) has emerged as an accurate, non-invasive test that will likely play a future role in colorectal cancer screening. Over the past 3 years, there have been dramatic improvements in both hardware and software technology relating to CT colonography resulting in shorter scan times, enhanced user-friendliness and improved performance statistics. Published results show the accuracy of CT colonography to be comparable to conventional colonoscopy for detection of polyps >6mm in size with few false-positives. While many of the technical aspects of CT colonography have now been standardised current interest focuses on the development of faecal tagging agents to avoid full bowel catharsis and the use of low dose multislice CT acquisition to reduce patient radiation exposure. This chapter will summarise the development of CT colonography to date, document its published performance in detection of colorectal polyps and cancers, and review its current and potential future uses. [Copyright &y& Elsevier]

OBJECTIVES: Although variable-stiffness colonoscopes have been developed, difficult or incomplete colonoscopies occasionally occur. The aim of this study was to evaluate the usefulness of a small-caliber, variable-stiffness colonoscope (scVSC) as a backup in patients with difficult or incomplete colonoscopies.METHODS: First, we retrospectively reviewed the cecal intubation rate of colonoscopies in which an adult standard colonoscope (AC) was immediately switched to an scVSC in all patients in whom a colonoscopy with an AC was incomplete. Second, 374 consecutive patients were randomized to undergo colonoscopy with a pediatric variable-stiffness colonoscope (PVSC, n= 123), AC (n= 125), or scVSC (n= 126). The scVSC was used by the same endoscopist to reattempt colonoscopy immediately after colonoscopy with a PVSC or an AC had been assessed as difficult or incomplete. The cecal intubation rate and time and the ancillary maneuvers used were evaluated.RESULTS: Fifty-two (2.5%) of the 2,056 attempted colonoscopies with an AC did not reach the cecum. Fifty-one of the 52 patients (98.1%) had complete colonoscopies after the switch from the AC to the scVSC. The initial intubation rate and time were not statistically different among the groups: PVSC, 95% and 6.8 min; AC, 91% and 7.5 min; and scVSC, 98% and 8.2 min. Cecal intubation was achieved in all five patients (100%) and in 10 out of 11 (91%) patients, respectively, after the PVSC or AC was switched to the scVSC.CONCLUSIONS: The completion rate markedly improved after switching from an AC or PVSC to an scVSC in difficult or incomplete colonoscopies, although the scVSC does not appear to offer any distinct advantage over the AC or PVSC for routine colonoscopies.(Am J Gastroenterol 2004;99:1936-1940) [ABSTRACT FROM AUTHOR]

PURPOSE: This study was designed to assess the predictive value for advanced proximal neoplasms (cancer, adenoma ≤ 10 mm, or villous component ≤20 percent, or severe dysplasia) of the characteristics of distal polyps. METHODS: The study was conducted among patients, aged 55 to 64 years, referred for colonoscopy in the Italian trial of sigmoidoscopy screening for colorectal cancer. Patients reporting a history of colorectal cancer, adenomas, inflammatory bowel disease, recent colorectal endoscopy, or two first-degree relatives with colorectal cancer were excluded. We compared the prevalence of advanced proximal neoplasia in patients with ‘low-risk’ (1–2 tubular adenomas, >10 mm, with low-grade dysplasia, or hyperplastic polyp) and in those with ‘high-risk’ (size, ≤10 mm, or ≤3 adenomas, or villous component <20 percent, or severe dysplasia) polyps in the distal colon. RESULTS: Of 426 patients with polyps < 5 mm, 29 (6.9 percent) were detected with an advanced proximal neoplasm (including 4 colorectal cancers). The prevalence of proximal advanced neoplasia was 9.4 percent among patients with high-risk distal polyps and 2.5 percent among those with low-risk lesions (adjusted odds ratio, 3.19; 95 percent confidence interval, 1.06-9.59). Approximately 40 people with low-risk distal polyps 6 to 9 mm should undergo colonoscopy to detect one proximal advanced neoplasm; the corresponding number for patients with high-risk distal polyps is 10. CONCLUSIONS: The 2.5 percent prevalence of proximal advanced neoplasms among people with low-risk 6-mm to 9-mm distal polyps is similar to the prevalence observed among people without distal polyps. Restricting colonoscopy referral to patients with high-risk distal polyps might represent a cost-effective strategy in a screening context. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Visualizing the entire colorectum in screening is an advantage of colonoscopy, and also computed tomographic (CT) colonography, another potentially suitable screening test. Our objective was to compare screening CT colonography and colonoscopy in an asymptomatic average-risk population, and to determine whether providing a choice of tests increased participation.METHODS: One thousand and four hundred subjects from the general community, randomly selected from the parliamentary electoral roll, were allocated one of three screening groups: colonoscopy, CT colonography, or a choice of these tests, and were sent an institutional letter of invitation. Those with symptoms, colorectal cancer in first-degree relatives, or colonoscopy within 5 yr were ineligible. Outcome measures were participation, acceptability of screening, and yield for advanced colorectal neoplasia in participants.RESULTS: Of the subjects, 24.9% were ineligible; the overall participation rate was 18.2% (184/1,009). Participation in each screening group was not different. Both tests were accompanied by the same high levels of acceptability; most participants found colonoscopy (87%) and CT colonography (67%,p<0.001) less unpleasant than expected. About 29% (26/89) CT colonography subjects had a positive screening test. The yield of advanced colorectal neoplasia was 8.7% (95% CI 5–14%), with no difference in yield between tests.CONCLUSION: Colorectal neoplasia screening by colonoscopy or CT colonography was associated with modest participation, high levels of acceptability, and similar yield for advanced colorectal neoplasia. Providing a choice of test did not increase participation. [ABSTRACT FROM AUTHOR]

Virtual colonoscopy is a promising new technique that combines rapid spiral CT scanning of the abdomen with advanced computer programs capable of re-creating two- and three-dimensional views of the colon and rectum. Recent studies comparing this method with conventional colonoscopy show that virtual colonoscopy already is more accurate than barium enema X-ray studies for the detection of colorectal polyps, and that it approaches the accuracy of colonoscopy for diagnosing advanced lesions. Before virtual colonoscopy can be promoted for population-based screening for colorectal cancer, a number of issues discussed in this review need to be addressed. These include questions of accuracy, availability, acceptability, and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Discusses the safety and efficacy of using flexible and rigid sigmoidoscope. Use of sigmoidoscopy; Screening for colorectal carcinoma; Physicians qualified to perform flexible sigmoidoscopy.

Colonoscopy has become the leading procedure for early detection and prevention of colorectal cancer. Patients' experience of colonic endoscopic procedures is scarcely reported, even though it is considered a major factor in colorectal cancer screening participation. Pain due to air inflation or stretching the colon with an endoscope is not rare during examination and may be the main obstacle to cooperation and participation in a screening program. We propose a four-stage study for developing a tool dedicated to pain monitoring during colonoscopy, as follows: (1) comparison of patient, nurse, and endoscopist questionnaire responses about patient pain and technical details of the procedure using the PAINAD tool during colonoscopy; (2) observation of the correlation between patients' facial expressions and other parameters (using the short PAINAD); (3) development of a device for continuous monitoring of the patient's facial expression during the procedure; (4) assessment of the usability of such a tool and its contribution to the outcomes of colonoscopy procedures. Early intervention by the staff performing the procedure, in reaction to alerts encoded by this tool, may prevent adverse events during the procedure. [ABSTRACT FROM AUTHOR]

Narrow band-imaging (NBI) enhances mucosal visualization of the vascular network and surface structure and helps to increase the visibility of neoplasia by improving contrast. Studies on the detectability of colorectal neoplastic lesions using NBI have primarily been reported in Western countries, but the published opinions and conclusions remain controversial at the present time. Our earlier prospective pilot study demonstrated that NBI colonoscopy significantly improved detection of flat lesions, which are more likely to be missed, particularly on the right side of the colon. It is especially important that even examiners performing routine screening colonoscopies become sufficiently familiar with flat and depressed lesions and then take full advantage of the endoscopic systems and specific image enhancement functions currently available for improved detection of flat and diminutive lesions. Adequate bowel preparation is another important consideration. [ABSTRACT FROM AUTHOR]