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Backgrounds: The adenoma‐carcinoma and serrated pathways offer a window of opportunity for the removal of pre‐malignant polyps and prevention of colorectal cancer (CRC) through the use of colonoscopy. The aim of this study was to investigate variation in polyp incidence in different age groups, gender and indications for undertaking colonoscopy. We also address histological types of polyps found and where in the bowel they are located. Methods: This study is based on the colonoscopy data collected prospectively over a one‐year period in multiple South Australian rural centres, 24 general surgeons contributed to this study. All histopathology results were subsequently entered into the dataset. Results: A total of 3497 colonoscopies were performed, with a total of 2221 adenomatous and serrated polyps removed. Both serrated and adenomatous polyps were more common in the distal colon. Patients of male gender, aged 70 years and over and with an indication of polyp surveillance had higher adenoma and serrated polyp detection rates (ADR and SPDR). Patients aged 40–49 years old who underwent colonoscopy for positive faecal occult blood had an ADR and SPDR of 25.0% and 6.3%, respectively. Conclusions: This study has shown variation in ADR and SPDR depending on age, gender and indication for colonoscopy. This variation will help further develop key performance indicators in colonoscopy. The high ADR and SPDR in patients aged 40–49 years old whom underwent colonoscopy for positive faecal occult blood may support lowering the age of commencement of CRC screening in Australia. [ABSTRACT FROM AUTHOR]

Algorithms for the surveillance of colorectal adenomas have recently undergone revision in Australia and abroad. Despite a shared evidence base, significant differences are observed and optimal intervals for surveillance remain controversial. We sought to explore their differences in relation to current evidence, practical aspects and how we may improve our own approach to adenoma surveillance in Australia. [ABSTRACT FROM AUTHOR]

Background: The incidence of colonic diverticulitis is increasing. In Australia the majority of diverticulitis occurs in the left colon and patients typically undergo colonoscopy following an attack. At present debate exists regarding the utility of this costly procedure and a flexible sigmoidoscopy has been proposed as a cheaper, less invasive alternative. This paper seeks to examine whether significant pathology is being detected in the right and transverse colon to warrant colonoscopy, as opposed to a flexible sigmoidoscopy. Methods: A retrospective review of colonoscopies performed between August 2016 and August 2018, indicated by diverticulitis alone, performed in a single Australian metropolitan hospital. Results: 189 patient colonoscopies were reviewed in combination with the pathology forms. Only 1 primary colonic malignancy was detected, found in the left colon. 110 traditional adenomas and 35 sessile serrated adenomas were detected. 41.8% of patients had a polyp detected with an average of 1.9 polyps per patient. 38.6% of polyps were resected from the left colon while 61.4% were removed from the right and transverse colon. In total 30 polyps > 10 mm or with high-risk histological features were resected, 18 (60%) from the left colon and 12 (40%) from the right and transverse. 20 patients (10.6%) met the criteria for high-risk adenomas and 50% of those had > 40% of their polyps in the right and transverse colon. There was no significant difference in age between patients with polyps and those without. Conclusion: Despite over half the patients having no polyps and only one left sided malignancy. This study demonstrates that the right and transverse colon is responsible for over 50% of the polyps removed and similar proportion of the advanced polyps. Where endoscopic surveillance after acute colonic diverticulitis is performed, this study supports the use of colonoscopy and cautions against flexible sigmoidoscopy alone. [ABSTRACT FROM AUTHOR]

Epidemiological and molecular biological data suggest that β‐human papillomavirus (HPV) can cause epithelial skin tumors, but the relationship remains unclear. A new approach to the diagnosis of HPV is based on the measurement of viral consistence. We examined 52 immune‐compromised and immune‐competent patients in order to identify the association of epithelial neoplasms with β‐HPV. Determination of HPV was performed by polymerase chain reaction with hybridization‐fluorescence detection in real‐time. Amplification and detection were carried out with "Rotor‐Gene" 3000 ("Corbett Research," Australia). To quantify the beta HPV genus, we used recombinant plasmid positive controls as well as control plasmid of β‐globin fragments taken from human genes (Central Scientific Institute of Epidemiology Rospotrebnadzor). We have found that β‐HPV DNA predominated in fibroepithelial polyps (64%) and in the apparently healthy skin (54%) of immune‐compromised patients versus 47% in the skin of healthy donors. Mixed infection was detected in fibroepithelial polyps of 57% in the immune‐compromised patients. Viral consistence in the fibroepithelial polyps was higher than in the apparently normal donors' skin. The high detection of HPV DNA was found in fibroepithelial polyps and in the apparently healthy skin of immune‐compromised patients whereas a high level of HPV DNA was only found in fibroepithelial polyps. [ABSTRACT FROM AUTHOR]

Background: In Australia, colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer death. It is more common in patients over 50 years, with previous evidence showing patients under 50 years account for only 9% of CRC. However, recent Australian and International studies have shown an increase in CRC incidence in patients under 50 years of age. The main aim of this study was to analyse the incidence of CRC in patients under 50 and to determine if screening would be beneficial in this population. Methods: A retrospective cohort study was performed on all patients under 50 years of age who underwent a colonoscopy, performed by a colorectal surgeon, at the Gold Coast Hospital and Health Service between January 2013 and December 2017. Results: A total of 557 patients were included in the study; 120 (21.5%) colonoscopies had a significant finding (CRC or adenoma with malignant potential). 1.9% of patients were diagnosed with CRC, all were symptomatic at time of diagnosis, the majority were stage 3 or 4. Conclusion: A total of 1.9% of patients under 50 who underwent colonoscopy were diagnosed with CRC, whilst 21.5% of patients had significant findings. These rates are greater than previously quoted figures and data for patients under 50, and provides evidence to support lowering of the CRC faecal occult blood testing screening age. [ABSTRACT FROM AUTHOR]

Background and Aim: Adenoma detection rate (ADR) is an important quality metric in colonoscopy. However, there is conflicting evidence around factors that influence ADR. This study aims to investigate the effect of time of day and endoscopist background on ADR and sessile serrated adenoma/polyp detection rate (SSA/P‐DR) for screening colonoscopies. Methods: Consecutive patients undergoing colonoscopy in 2016 were retrospectively evaluated. Primary outcome was the effect of time of day and endoscopist specialty on screening ADR. Secondary outcomes included evaluation of the same factors on SSA/P‐DR and other metrics and collinearity of ADR and SSA/P‐DR. Linear regression models were used for association between ADR, time of day, and endoscopist background. Bowel preparation, endoscopist, session, patient age, and gender were adjusted for. Linear regression model was also used for comparing ADR and SSA/P‐DR. Chi‐square was used for difference of proportions. Results: Two thousand six hundred fifty‐seven colonoscopies, of which 558 were screening colonoscopies, were performed. The adjusted mean ADR (screening) was 36.8% in the morning compared with 30.5% in the afternoon (P < 0.0001) and was 36.8% for gastroenterologists compared with 30.4% for surgeons (P < 0.0001). For every 1‐h delay in commencing the procedure, there was a reduction in mean ADR by 3.4%. Using a linear regression model, a statistically significant positive association was found between ADR and SSA/P‐DR (P < 0.0001). Conclusions: Morning and afternoon sessions and gastroenterologists and surgeons achieved the minimum standards recommended for ADR. Afternoon lists and surgeons were associated with a lower ADR compared with morning and gastroenterologists, respectively. Additionally, SSA/P‐DR showed collinearity with ADR. [ABSTRACT FROM AUTHOR]

Background: High-quality colonoscopy is vital for the detection and removal of adenomatous polyps and early diagnosis of colorectal cancer. The aim of this study was to prospectively assess the quality and safety of colonoscopies performed in the non-metropolitan setting. Key performance indicators measured include completion, polypectomy and adenoma/serrated polyp detection rates, rate of adequate bowel preparation, withdrawal time and complications., Methods: Prospective data collection for all colonoscopies performed over a one-year period in seven non-metropolitan South Australian hospitals. Two general surgeons and twelve registrars working in rural South Australian hospitals (Mount Gambier, Millicent, Naracoorte, Port Lincoln, Port Augusta, Whyalla and Berri) contributed to this study., Results: In total 3497 colonoscopies were analysed. Complete colonoscopy was achieved in 96.1%. The adenoma detection and serrated polyp detection rates were 25.6% and 5.4% respectively. Cancer was detected in 71 patients (2%). Colonic perforation occurred in five patients (0.1%). There was no procedure-related mortality., Conclusions: Colonoscopy performed in the non-metropolitan Australian setting outperforms key performance indicators set by national institutions. This is the first Australian prospective multi-centre study investigating the quality and safety of endoscopic procedures., (© 2022 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)