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Aim Colonic surveillance reduces the lifetime risk of colorectal cancer in patients with Lynch syndrome (hereditary nonpolyposis colorectal cancer) from 60 to 80% to 10% and confers a 7-year survival advantage. The British Society of Gastroenterologists recommends colonoscopy at least every 2 years from the age of 25. Currently in the UK, genetic diagnosis is made by a regional genetics service, and screening recommendations are made to the referring clinician. The aim of this study was to investigate compliance with and the effectiveness of large bowel surveillance in Lynch syndrome. Method A retrospective longitudinal study of Lynch syndrome mutation carriers on the Regional Familial Colorectal Cancer Registry under and not under screening was conducted. To investigate screening compliance, patients were included if they were alive at the start of the study. Data were gathered on timeliness, quality and outcome of screening. To examine the effectiveness of screening, the cumulative incidence of colorectal cancer was estimated using Kaplan-Meier curves and the screened population compared with patients not being screened. Results A total of 227 Lynch syndrome mutation carriers were under screening at 26 hospitals. We assessed 439 colonoscopies for timeliness, of which 68% were compliant (interval < 27 months). Compliance on the 1 November 2011 was 87%. The cumulative incidence of colorectal cancer to the age of 70 was 25% (95% CI 17-32%) in the surveillance population and 81% (95% CI 78-84%) in 689 mutation-positive patients not being screened ( P < 0.0001). Conclusion Overall, 68% of colonoscopies were on time. The incidence of colorectal cancer was greatly reduced by screening but remained significant. Patients with Lynch syndrome need proactive surveillance management. [ABSTRACT FROM AUTHOR]

Objective To assess the compliance of the surveillance colonoscopy waiting list with ACPGBI/BSG guidelines for colonoscopy follow-up and to measure the impact of adjusting referrals to be inline with the guidelines. Design and Setting This is a quantitative five-stage clinical audit cycle involving a large patient cohort from the Kent and Medway Cancer Network, which includes seven hospitals across four NHS Hospital Trusts and an estimated population of 1.8 million. Participants 3020 patients were waiting for a surveillance colonoscopy. Their notes were reviewed and the indications for colonoscopy were compared with the ACPGBI/BSG 2002 guidelines. Interventions Those patients whose referral to the surveillance colonoscopy waiting list was not found to be compliant were adjusted to be inline with the guidelines. Main outcome measures The impact of adjusting the surveillance colonoscopy waiting list on the diagnostic colonoscopy service was assessed by measuring the average waiting times for a colonoscopy before and after the intervention. Results Around 22% ( n = 664) of surveillance colonoscopy referrals were inline with the guidelines, 51% ( n = 1540) could be cancelled from the list and 27% ( n = 816) could be given a new date. Implementing these recommendations reduced the average wait for a diagnostic colonoscopy from 76.8 to 56.0 days ( P = 0.0022). Conclusion Following guidelines for surveillance colonoscopy can reduce waiting times for diagnostic colonoscopy. This allows a faster patient journey for diagnostic colonoscopy and a uniform plan for duration and frequency of surveillance colonoscopy. However, this action promoted serious debate on the social, moral and ethical issues. [ABSTRACT FROM AUTHOR]

Background: the main colonic imaging modalities, including barium enema, colonoscopy and computed tomography colonography, require bowel preparation. Performing these imaging procedures in the elderly can difficult due to immobility, incontinence and poor tolerance of bowel cleansing. Minimal preparation CT (MPCT) colon was introduced in the early 1990s in the UK. Much of the published literature on MPCT colon is limited by small patient numbers and short duration of follow-up. Objective: the aim of this study is to review our experience with the MPCT technique involving a large consecutive cohort of patients with long follow-up. Methods: all studies of MPCT performed in a 1-year period between July 2000 and July 2001 at our institution were reviewed retrospectively. MPCT reports were cross-referenced with the cancer registry to allow for an average period of 30 months follow-up. A definite diagnosis of cancer was only given following the appearance on the cancer registry. Those patients who had negative MPCT colon were assumed to be true negatives if no corresponding name was identified on the cancer registry. In the event of data mismatch, patient notes were reviewed to ascertain a diagnosis. Results: 391 MPCT examinations were performed during the period of the study (209 males, median age 82: age range 56-91 years). Thirty-four patients who had MPCT colon during the study period appeared on the cancer registry. A further three patients with disseminated colorectal malignancy identified on MPCT colon died without histological confirmation (tumour prevalence = 9.5%). Thirty-two of the registry confirmed 34 cases were detected on MPCT colon, giving a sensitivity of 0.94 (95% confidence interval 0.86-1.00). Including the three cases without histological confirmation gives a slightly higher sensitivity of 0.95. There were seven patients with definitely abnormal MPCT colons, who did not appear on the registry, resulting in specificity for definite abnormality of 0.98 (confidence interval 0.97-1.0). However, three of these seven are those who died of disseminated colorectal malignancy as above, raising the specificity to 0.99. Fourteen cases (3.5%) of extra-colonic malignancies were observed in this study. Conclusion: even with the longer follow-up of this large cohort of patients the sensitivity and specificity in our study for the diagnosis of colorectal cancer with MPCT remains comparable with that of other studies and this technique competes well with other common colonic imaging modalities. [ABSTRACT FROM AUTHOR]

The article focuses on the status of the fecal occult blood testing (FOBT) as a strategy for colorectal cancer screening in Great Britain. The whole screening program in the country comprises biyearly FOBT screening on a centralized basis. FOBT screening in the country is cheap and safe. It is intended to reduce the burden of colorectal cancer on the population.

This article focuses on the colonoscopy practice in Great Britain. Success rates have been reported in excess of 97% for achieving total colonoscopy, coupled with low complication rates and detection of significant pathology in asymptomatic populations. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) states that approved endoscopy units should achieve completion rates greater than 90%, without resort to excessive sedation. This year marks four major initiatives concerned with training in endoscopy. The first major undertaking will be publishing of the third JAG document with new sections devoted to the assessment of both trainees and training units.

The author reflects on the development of colorectal cancer services by the Department of Health due to increasing demand for colonoscopy in Great Britain. He asserts that clinical practice needs to be evaluated, since colonoscopy is a skilled procedure. Thus, structured training program for both trainers and trainees are required, despite apprenticeship. He believes that if only the initiatives are supported, the National Health Service will be able to provide satisfactory and safe colonoscopy.

The article focuses on the issues examined in the study concerning colonoscopy practice in Great Britain by endoscopists. New endoscopic technologies like magnification imaging, chromoscopy, narrow band imaging and confocal endomicroscopy have been developed to help both detection and in vivo characterization of lesions to increase adenoma and cancer detection. The study undertaken related to the issue revealed large differences between colonoscopists.

In this article, authors study the British Society of Gastroenterology lead audit into colonoscopy practice within Great Britain. In common with many endoscopy units, authors send out an information leaflet with the patient's appointment details. This explains the preparation required, what to expect on the day, and any potential complications, with advice as to what to do, should these complications arise. Authors' study demonstrates that patients fail to fully appreciate the risks of colonoscopy despite the distribution of detailed written information prior to the procedure.