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Aim: The faecal immunochemical test (FIT) is now widely used in English primary care to triage people who exhibit signs or symptoms of colorectal cancer (CRC). National guidelines for FIT implementation were based on data that acknowledged limitations. This study examines FIT accuracy in primary care patients with low‐ and high‐risk symptoms of CRC. Methods: This study describes a retrospective cohort study in South Yorkshire, UK (n = 2029). Consecutive symptomatic adult patients in primary care undergoing a FIT between 01/04/2021 and 30/04/2021 were assessed. A threshold > 10 μg Hb/g was defined as a positive FIT result. Lower gastrointestinal tract (LGI) investigations were the reference standard. Follow‐up over 24 months was used to identify serious colorectal diseases (CRC, high‐risk polyps and inflammatory bowel disease [IBD]). Results: Five hundred and fifteen (25.4%) patients had a positive FIT. The CRC prevalence was 1.2% (24/2029). Nineteen (79.1%) of the 24 CRC cases had NG12 symptoms, with two (8.3%) having a negative FIT. For CRC detection, FIT showed 91.7% sensitivity (95% CI: 71.5%–98.5%), 75.4% specificity (95% CI: 73.4%–77.2%), 4.3% positive predictive value (PPV) (95% CI: 2.8%–6.5%) and 99.9% negative predictive value (NPV) (95% CI: 99.5%–99.97%). Combining CRC, high‐risk polyps and IBD increased PPV and specificity but decreased sensitivity and NPV. Conclusions: In primary care, FIT safely triages patients having at‐risk CRC risk symptoms. Negative FIT results indicate a low likelihood of CRC and supports safety‐netting interventions. [ABSTRACT FROM AUTHOR]

Background To address mismatch between routine endoscopy capacity and demand, centers often implement initiatives to increase capacity, such as weekend working or using locums/agency staff (insourcing). However, there are concerns that such initiatives may negatively impact quality. We investigated polyp detection for weekend vs. weekday and insourced vs. standard procedures using data from the UK National Endoscopy Database. Methods We conducted a national, retrospective, cross-sectional study of diagnostic colonoscopies performed during 01/01–04/04/2019. The primary outcome was mean number of polyps (MNP) and the secondary outcome was polyp detection rate (PDR). Multi-level mixed-effect regression, fitting endoscopist as a random effect, was used to examine associations between procedure day (weekend/weekday) and type (insourced/standard) and these outcomes, adjusting for patient age, sex, and indication. Results 92 879 colonoscopies (weekends: 19 977 [21.5 %]; insourced: 9909 [10.7 %]) were performed by 2496 endoscopists. For weekend colonoscopies, patients were less often male or undergoing screening-related procedures; for insourced colonoscopies, patients were younger and less often undergoing screening-related procedures (all P < 0.05). Fully adjusted MNP was significantly lower for weekend vs. weekday (incidence rate ratio [IRR] 0.86 [95 %CI 0.83–0.89]) and for insourced vs. standard procedures (IRR 0.91 [95 %CI 0.87–0.95]). MNP was highest for weekday standard procedures and lowest for weekend insourced procedures; there was no interaction between procedure day and type. Similar associations were found for PDR. Conclusions Strategies to increase colonoscopy capacity may negatively impact polyp detection and should be monitored for quality. Reasons for this unwarranted variation require investigation. [ABSTRACT FROM AUTHOR]

The aim is to understand the patient experience of living with chronic rhinosinusitis with nasal polyposis (CRSwNP), clinician interactions and how symptoms, smell and taste disturbance are managed. An anonymized, online survey was distributed through a UK charity, Fifth Sense, a UK otolaryngology clinic and online support groups to capture qualitative and quantitative data. Data were collected from 1st December 2022 to 1st February 2023. A total of 124 individuals participated. The majority were female (66%) and in the age range of 41–70 years; 74.2% of participants were from the UK with the rest from North America, Europe and Asia. A total of 107 participants declared they had CRSwNP. Rhinologists and general otolaryngology clinicians scored the highest for patient satisfaction whilst general practitioners scored the lowest. Satisfaction with the management of smell and taste disturbance was lower amongst all clinicians compared to overall satisfaction. Ratings correlated with response to therapy and clinician interactions. Respondents reported hyposmia/anosmia to be the most debilitating symptom. Surgery and oral steroids were considered to be effective; however, the benefit lasted less than six months (62%). Hyposmia/anosmia is a key CRSwNP symptom that has limited treatment options and is frequently undervalued by clinicians. There is a need for more effective management options, education and patient support. [ABSTRACT FROM AUTHOR]

Aim: The management of malignant polyps is a treatment dilemma in selecting between polypectomy and colorectal resection. To assist clinicians, guidelines have been developed by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to provide treatment recommendations. Methods: This study compared management strategy based on the ACPGBI risk categorization for malignant polyps. Univariable and multivariable statistical analysis was undertaken to assess the factors predicting management strategy. A population‐wide analysis was performed of 1646 malignant polyps and the factors that predicted their management strategy, from Queensland, Australia, from 2011 to 2019. Results: Overall, 31.55% of patients with very low or low risk disease proceeded to resection. Of those with high or very high risk disease, 36.69% did not proceed to resection. In very low and low risk polyps, age (P = 0.003) and polyp location (P < 0.001) were significantly different between the colorectal resection group and the polypectomy alone group. In those with very high or high risk polyps age (P < 0.001), type of facility (public or private) for the colonoscopy (P = 0.037), right colonic polyps compared to left colonic polyps (P = 0.015) and rectal polyps (P < 0.001) and mismatch repair mutations present (P = 0.027) were predictive of resection in high risk disease using a multivariable model. Conclusion: Over 30% of patients with very low and low risk malignant polyps proceeded to resection, against the advice of guidelines. Furthermore, over 35% of patients with very high or high risk malignant polyps did not proceed to resection. Education strategies may improve management decision choices. Furthermore, improvements in data collation will improve the understanding of management choices in the future. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relative rates of malignancy in women with single and multiple polyps presenting to a UK Cancer Centre with postmenopausal bleeding (PMB).Study Design: A retrospective review of patients treated at Royal Derby Hospital (RDH) for PMB who underwent outpatient hysteroscopy based on ultrasonographic suspicion of endometrial polyps between May 2014 to December 2019. The main outcome measure was the rates of precancerous and malignant histology for single or multiple polyps. The secondary outcomes assessed the influence of risk factors on the rates of malignancy within the single and multiple polyps groups.Results: The study population was 851 women of which 533 were in the single polyp group and 318 in the multiple polyps group. The multiple polyps group (mean age 65.2 years) was older compared to the single polyp group (mean age 62.1 years), P = 0.0001. Elevated rates of cancer was driven most significantly by endometrioid cancer in the multiple polyps compared to single polyp group, with rates of 50/314 (16 %) and 28/512 (5.5 %) respectively, P=< 0.00001. For rarer histologies there was no significant difference between the proportion of serous, carcinosarcomas and clear cell cancers between those with single compared to multiple polyps (P > 0.05). Significantly more endometrial hyperplasia with atypia (AEH) was found in the multiple polyps compared to single polyp group, with rates of 18/314 (5.7 %) and 15/512 (2.9 %) respectively, P = 0.046.Conclusion: Our study found increased rates of endometrioid cancer and its precursor, AEH within the multiple polyps compared to the single polyps groups. Future risk predicting algorithms should consider incorporating single and multiple polyps as part of their risk model. [ABSTRACT FROM AUTHOR]

Objectives: There is uncertainty regarding the efficacy of artificial intelligence (AI) software to detect advanced subtle neoplasia, particularly flat lesions and sessile serrated lesions (SSLs), due to low prevalence in testing datasets and prospective trials. This has been highlighted as a top research priority for the field. Methods: An AI algorithm was evaluated on four video test datasets containing 173 polyps (35,114 polyp‐positive frames and 634,988 polyp‐negative frames) specifically enriched with flat lesions and SSLs, including a challenging dataset containing subtle advanced neoplasia. The challenging dataset was also evaluated by eight endoscopists (four independent, four trainees, according to the Joint Advisory Group on gastrointestinal endoscopy [JAG] standards in the UK). Results: In the first two video datasets, the algorithm achieved per‐polyp sensitivities of 100% and 98.9%. Per‐frame sensitivities were 84.1% and 85.2%. In the subtle dataset, the algorithm detected a significantly higher number of polyps (P < 0.0001), compared to JAG‐independent and trainee endoscopists, achieving per‐polyp sensitivities of 79.5%, 37.2% and 11.5%, respectively. Furthermore, when considering subtle polyps detected by both the algorithm and at least one endoscopist, the AI detected polyps significantly faster on average. Conclusions: The AI based algorithm achieved high per‐polyp sensitivities for advanced colorectal neoplasia, including flat lesions and SSLs, outperforming both JAG independent and trainees on a very challenging dataset containing subtle lesions that could have been overlooked easily and contribute to interval colorectal cancer. Further prospective trials should evaluate AI to detect subtle advanced neoplasia in higher risk populations for colorectal cancer. [ABSTRACT FROM AUTHOR]

Background: Conventionally, endometrial pathologies of varying complexity have been surgically treated as inpatients under a general or regional anesthetic. Aim: In this paper, we evaluate the safety and efficacy of hysteroscopic morcellation of endometrial pathology in the form of endometrial polyps (EPs) and submucosal fibroids in an outpatient setting for both simple and complex lesions using the Myosure™ device. Methods: Two hundred and forty-nine hysteroscopic resections were performed in an outpatient setting at the < BLINDED FOR REVIEW > from May 2014 to March 2021. The median age of the patients was 54 years. More than half of the patients presented with postmenopausal bleeding; 64% were diagnosed with EPs and 24% with submucous fibroids (SMFs). The size, topography, extension, penetration, and wall classification system scoring system were used to grade them as simple (≤4) or complex (≥5) pathologies. Results: 90% of pathologies were simple (≤4), of which complete resection was carried out in 95% of patients; 10% of the pathologies were complex (≥5), of which 63% had complete resection. Two patients with complex pathologies returned for completion surgery as a two-step procedure. No procedure was abandoned due to the patient intolerance. The median intraprocedure pain score visual analog scale was 5/10 and immediate postprocedure pain score was 1/10. Notably, there was no intra- or post-procedure complications. Conclusion: Outpatient resection of endometrial pathology, both simple and complex, can be safely and effectively performed using hysteroscopic morcellator (Myosure™) and is accepted and well tolerated by patients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the hysteroscopic morcellation service in office-setting in everyday practice outside the context of clinical trials. The primary objectives were to assess level of acceptability and factors affecting women satisfaction. The secondary objectives included assessment of complete resection rate, complications rate, pain score during the procedure and on discharge, and the correlation between the lesion size as subjectively estimated by the hysteroscopists versus the volume of morcellated tissues as semi-quantitively measured by the laboratory.Method: The clinical data was compiled for 287 consecutive women undergoing hysteroscopic morcellation in office-setting from 1 January 2017 to 31 March 2021 in a teaching hospital in the UK. A questionnaire, formulated on the Visual Analogue Scale (VAS), was completed immediately after the procedure by the last 110 women undergoing the procedure.Results: The mean age of the cohort (n = 278) was 54.5 years (SD ± 12.5). Only 7 (2.4%) women required two-stage procedure because of size (fibroid ≥ 4 cm), vascularity or multiplicity of lesions. No complications were encountered. The majority of women completing the questionnaire (n = 110) found office procedure acceptable (105, 95.5%, VAS ≥ 7), were willing to have it again if indicated (102, 92.7%, VAS ≥ 7), would recommend it to family and friends (105, 95.5%, VAS ≥ 7) and confirmed receiving adequate preoperative information by doctors and nurses (107, 97.3%, VAS ≥ 7). The level of preoperative explanation and information-giving showed significant (p < 0.01) positive correlation with the level of acceptability and recommendation to others and significant (p = .007) negative correlation with the pain experienced on discharge. The median (IQR) estimated size at hysteroscopy was 2 cm (1-6 cm) for polyps and 2.5 cm (1-4 cm) for fibroid. The median (IQR) volume of the morcellated specimens as estimated by laboratory was 2000 mm3 (1100-3800 mm3). The estimated size at hysteroscopy was positively correlated with the specimen's volume (Spearman's rho (r) = 0.31, 95% = CI, 0.14-0.45, p < 0.01).Conclusion: Office hysteroscopic morcellation is associated with high satisfaction rate and low pain score on discharge. Good preoperative explanation and information-giving was the crucial factor that increased women satisfaction. Subjective estimation of lesion size by hysteroscopists may be an accurate and simple method of measurement. [ABSTRACT FROM AUTHOR]

Objectives: To undertake a cost-effectiveness analysis of outpatient uterine polypectomy compared with standard inpatient treatment under general anaesthesia.Design: Economic evaluation carried out alongside the multi-centre, pragmatic, non-inferiority, randomised controlled Outpatient Polyp Treatment (OPT) trial. The UK National Health Service (NHS) perspective was used in the estimation of costs and the interpretation of results.Setting: Thirty-one secondary care UK NHS hospitals between April 2008 and July 2011.Participants: Five hundred and seven women with abnormal uterine bleeding and hysteroscopically diagnosed endometrial polyps.Interventions: Outpatient uterine polypectomy versus standard inpatient treatment. Clinicians were free to choose the technique for polypectomy within the allocated setting.Main Outcome Measures: Patient-reported effectiveness of the procedure determined by the women's self-assessment of bleeding at 6 months, and QALY gains at 6 and 12 months.Results: Inpatient treatment was slightly more effective but more expensive than outpatient treatment, resulting in relatively high incremental cost-effectiveness ratios. Intention-to-treat analysis of the base case at 6 months revealed that it cost an additional £9421 per successfully treated patient in the inpatient group and £ 1,099,167 per additional QALY gained, when compared with outpatient treatment. At 12 months, these costs were £22,293 per additional effectively treated patient and £445,867 per additional QALY gained, respectively.Conclusions: Outpatient treatment of uterine polyps associated with abnormal uterine bleeding appears to be more cost-effective than inpatient treatment at willingness-to-pay thresholds acceptable to the NHS.Tweetable Abstract: HTA-funded OPT trial concluded that outpatient uterine polypectomy is cost-effective compared with inpatient polypectomy. [ABSTRACT FROM AUTHOR]

Background:Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed.Methods:A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated.Results:There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421).Conclusion:Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure. [ABSTRACT FROM PUBLISHER]

Background: Guidelines from the United Kingdom and the United States on risk stratification after polypectomy differ, as do recommended surveillance intervals. Objective: To compare risk for advanced colorectal neoplasia at 1-year colonoscopy among patients cross-classified by U.S. and U.K. surveillance guidelines. Design: Pooled analysis of 4 prospective studies between 1984 and 1998. Design: Pooled analysis of 4 prospective studies between 1984 and 1998. Patients: 3226 postpolypectomy patients with 6- to 18-month follow-up colonoscopy. Measurements: Rates of advanced neoplasia (an adenoma≥1 cm, high-grade dysplasia, <25% villous architecture, or invasive cancer) at 1 year, compared across U.S. and U.K. risk categories. Results: Advanced neoplasia was detected 1 year after polypectomy in 3.8% (95% CI, 2.7% to 4.9%) of lower-risk patients and 11.2% (CI, 9.8% to 12.6%) of higher-risk patients by U.S. criteria. According to U.K. criteria, 4.4% (CI, 3.3% to 5.4%) of low-risk patients, 9.9% (CI, 8.3% to 11.5%) of intermediate-risk patients, and 18.7% (CI, 14.8% to 22.5%) of high-risk patients presented with advanced neoplasia; U.K. high-risk patients comprised 12.1% of all patients. All U.S. lower-risk patients were low-risk by U.K. criteria; however, more patients were classified as low-risk, because the U.K. guidelines do not consider histologic features. Higher-risk U.S. patients were distributed across the 3 U.K. categories. Among all patients with advanced neoplasia, 26.3% were reclassified by the U.K. criteria to a higher-risk category and 7.0% to a lower-risk category, with a net 19.0% benefiting from detection 2 years earlier. Overall, substitution of U.K. for U.S. guidelines resulted in an estimated 0.03 additional colonoscopy every 5 years per patient. Limitations: Patients were enrolled 15 to 20 years ago, and quality measures for colonoscopy were unavailable. Patients lacking follow-up colonoscopy or with surveillance colonoscopy after 6 to 18 months and those with cancer or insufficient baseline adenoma characteristics were excluded (2076 of 5302). Conclusion: Application of the U.K. guidelines in the United States could identify a subset of high-risk patients who may warrant a 1-year clearing colonoscopy without substantially increasing rates of colonoscopy. Primary Funding Source: European Union Public Health Programme. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics which include the gastroscopy rate in general practitioner practice populations in Great Britain, randomised prospective trial of transnasal and standard upper diagnostic endoscopy under local anesthetic, and guidelines on the endoscopic assessment of gastric polyps.

Aim St Mark's Bowel Cancer Screening Centre commenced screening in October 2006 as a contributor to the national programme. The first 35 months' experience is reported. Method Individuals with a positive faecal occult blood test (FOBT) were offered colonoscopy or alternatives if they had significant comorbidity. All screening data were collected prospectively. Results Of the 98 815 FOBT kits issued, 42 523 were returned (43% uptake; 20.79% men). In total, 1339/1488 (90%) FOBT-positive participants attended the nurse clinic (57% men). Of these, 1057 had an index colonoscopy, 115 had a computed tomography colonoscopy (CTC) and eight had a flexible sigmoidoscopy. Five hundred and seventeen (44%) procedures were 'normal' (no polyps/cancers). Eighty (6%) individuals had colorectal cancer. The polyp detection rate in index procedures, including colonoscopy, CTC and flexible sigmoidoscopy, was 50%. The adenoma detection rate of all colonoscopies was 62.8%. The median polyp size was 5 (1-80) mm. In total, 1200 colonoscopies were performed by five accredited colonoscopists (96% completion rate). There were 13 (1%) adverse events with < 1 in 500 patients undergoing polypectomy requiring a transfusion. There was one 30-day postsurgical mortality, one perforation and no colonoscopy-related mortality. Almost all 39/40 (97%) patients in the BCS programme felt that the findings were adequately explained compared with 21/32 (64%) elective patients ( P < 0.001) within the same unit. Conclusions At this bowel cancer screening single centre, colonoscopy completion rates were high (unadjusted caecal intubation rate of 96%) and complication rates were low. In contrast to other published data, the uptake and cancer-detection rates were lower. [ABSTRACT FROM AUTHOR]

The NHS Bowel Cancer Screening Programme is currently being introduced following three rounds of pilot screening. The study outlines the important characteristics of polyps detected by pilot screening and compares the location of polyps with those of symptomatic cancers to challenge the circumstantial evidence for the adenoma carcinoma pathway. The first 100 patients with screen-detected polyps from University Hospitals Coventry and Warwickshire (UHCW) were identified from the colorectal cancer screening database. Important characteristics of the polyps were identified from the endoscopy reporting system and entered into a database. Polyp location was compared with the location of symptomatic cancers detected in the UHCW colorectal cancer database. One hundred patients were selected for investigation and 202 polyps were detected. The average age of the patients with polyps was 61 years, 35% were under the age of 60. There were 67% male subjects. The average size of the largest polyp in each of the different patients was 13.5 mm. Eighty-five per cent of polyps were excised. Histology was available for 181 polyps of which 40% were tubulovillous, 33% tubular, 14% metaplastic and 1% villous. Eighty-eight per cent showed low-grade dysplasia and 8% high-grade one. The location of screen-detected polyps was significantly different from that of symptomatic cancers in our database, with proportionally more sigmoid and proportionally less rectal and caecal polyps detected. The study outlines the important characteristics of screen-detected polyps. The significant difference in location of polyps from that of cancer suggests a variation in the malignancy potential of polyps depending on the location. [ABSTRACT FROM AUTHOR]

Abstract: Colorectal neoplasia is amongst the most common cancers in women and men. In the UK, the NHS Bowel Cancer Screening Programme has been established for the early detection of the precursor lesions of colorectal cancers. Endoscopic screening, surveillance and provision of biopsies for histological assessment are the basis for ensuring the diagnosis of a lesion and for informing research regarding epidemiology, biology and evidence-based management. A wide variety of pathological entities may be encountered at endoscopy which may present as a polyp. Amongst others, classical adenomas, serrated adenomas, inflammatory lesions, hamartomas and non-epithelial neoplasms all occur. Understanding the detailed histological layout of the large intestine is important for ensuring understanding of histopathological classifications which now go beyond the classical Dukes and TNM (tumour, node, metastasis) systems. Recently, the molecular biological properties of colorectal neoplasia have become better understood. Five major categories of genetic abnormality have recently been described which correlate with the morphology of the respective entity. The clinical management of a colorectal lesion nowadays comprises a multidisciplinary approach to diagnosis and treatment. It is vital that everyone persistently strives for good communication among gastroenterologists, endoscopists, histopathologists, surgeons and radiologists so that the establishment of management protocols is ensured in order to achieve optimal patient outcome. [ABSTRACT FROM AUTHOR]

Objective Current British Society of Gastroenterology guidelines use adenomatous polyp size as one of the key factors in determining polyp follow-up. This study aimed to compare polyp size assessment by colonoscopists and pathologists before and after fixation to determine the optimal method for measurement. Method Thirty-five colorectal polyps were found during pre-arranged colonoscopies in one centre. Polyp size was measured to the nearest 1 mm by three different methods: 1. by the endoscopist at colonoscopy; 2. by the pathologist fresh, following removal; 3. by the pathologist fixed, following fixation. The endoscopist and the pathologist were blinded to each other’s measurements. Results Seventeen men, eighteen women with mean age of 66.2 years (SD: 9.4, range: 38.7–85.5) underwent polypectomy/s with all polyps removed intact. Polypectomies were performed by consultants (43%), nurse specialists (34%) and specialist registrars (23%). The median size (mm) of polyps measured were endoscopically, 6.5 (2–25 mm); fresh specimen 7.0 (4–28 mm) and fixed 7.0 (4–28 mm). Endoscopic measurements were significantly lower than that of fresh and fixed sizes ( P < 0.001 and P = 0.003 respectively), with poor correlation [correlation of variance (CV): 21.0% and intraclass correlation coefficient (ICCC): 0.841 for endoscopic and fresh measurements; CV: 21.1% and ICCC: 0.838 for endoscopic and fixed measurements]. There was no statistical difference between fresh and fixed specimen measurements ( P > 0.05; CV: 4.2%, ICCC: 0.974). In three patients, the endoscopic measurement was < 1 cm in polyps that were found to be ≥ 1 cm on pathological measurement. Conclusions Endoscopists consistently underestimated polyp size. Fixation had no effect on polyp size. Pathologists’ measurement of polyp size on fixed specimens should determine the need for further colonoscopic follow-up. [ABSTRACT FROM AUTHOR]

Objectives To examine the psychological impact of being assigned to colonoscopic surveillance following detection of adenomatous polyps at flexible sigmoidoscopy (FS) screening. Setting Participants invited for screening in 12 of the 14 study centres in the UK FS Trial. Methods A postal survey following FS screening assessed bowel cancer worry, psychological distress, generalized anxiety, bowel symptoms, general practitioner (GP) visits, positive emotional consequences of screening, and reassurance among people with no polyps (n = 26,573), lowerrisk polyps removed at FS (n = 7401) and higher-risk polyps who underwent colonoscopy and were either assigned to colonoscopic surveillance (n = 1543) or discharged (n = 183). A subsample (n = 6389) also completed a questionnaire prior to screening attendance that measured bowel cancer worry, generalized anxiety, bowel symptoms and GP visits, making it possible to examine longitudinal changes in this group. Results People offered surveillance reported lower psychological distress and anxiety than those with either no polyps or lower-risk polyps. The surveillance group also reported more positive emotional benefits of screening than the other outcome groups. Post-screening bowel cancer worry and bowel symptoms were higher in people assigned to surveillance, but both declined over time, reaching levels observed in either one or both of the other two groups found to have polyps, suggesting these results were a consequence of polyp detection rather than surveillance per se. Few differences were observed between the group assigned surveillance and the group discharged following colonoscopy. Conclusion The results of the current study are broadly reassuring and indicate that referral for colonoscopic surveillance is not associated with adverse psychological consequences. [ABSTRACT FROM AUTHOR]

Background: There are 50,000 practitioners of complementary and alternative medicine (CAM) within the United Kingdom. The current U.K. prevalence of CAM use is reported to be 25% and is rising. The national expenditure on CAM is an estimated £1.6 billion. The aim of this study was to explore the pattern of CAM use in patients attending a rhinology outpatient clinic in Aberdeen. Methods: Questionnaires were provided to 100 patients over a 2-month period. The questionnaire consisted of demographic sections and whether they had ever used CAM from a list of 49 herbal and nonherbal alternative therapies. Subjects were also asked why they used CAM, where they learned of CAM, whether they found it efficacious, and whether their general practitioner was aware they were using it. Results: One hundred subjects completed questionnaires. Patients attending the clinic were suffering from the most common rhinological complaints including rhinosinusitis and nasal polyps. Sixty-five percent of patients had ever used CAM. Women were statistically significantly more likely to use CAM than men (p = 0.012). Patients who were employed were more likely to use CAM, but there was no significant difference in CAM usage depending on marital status, social class, and age. Only 6% of patients felt CAM use was definitely ineffective. Only 43% of users of CAM had informed their doctor about its use. Conclusion: CAM usage is growing in popularity. All health care professionals should be aware of this and of the potential for adverse drug reactions occurring. The dangers of noncompliance with conventional medications should be emphasized to CAM users. [ABSTRACT FROM AUTHOR]

Objectives Endometrial polyps are a common cause of abnormal uterine bleeding. Rarely, a hyperplasia, either complex or atypical in type, is identified within a polyp in a biopsy or polypectomy specimen. Currently, it is not known whether the hyperplasia is likely to be confined to the polyp or also involve nonpolypoid endometrium. We aim to assess the likelihood of hyperplasia being confined to an endometrial polyp. Design In this study, we identified 32 women from pathology archives in whom endometrial hyperplasia was present within a polyp. The number of endometrial polyps during the study period was 1031 and therefore 3.1% of all endometrial polyps diagnosed during the study period contained a hyperplasia. Setting A major teaching hospital in the UK. Methods The biopsies were retrieved from the pathology archives of Royal Group of Hospitals, Belfast, between 2000 and 2006. We traced any follow-up biopsy or hysterectomy specimens to evaluate the status of the surrounding endometrium. Results The hyperplasias were complex ( n= 23) or atypical ( n= 9) in type. In 14 of 27 (52%) women in whom nonpolypoid endometrium was available for histological evaluation, either on the original biopsy or in a follow-up specimen, hyperplasia involved the nonpolypoid endometrium, and in three other women, hyperplasia was present in a polyp in follow-up specimens. Women with atypical hyperplasia in a polyp were slightly more likely to have hyperplasia in the surrounding endometrium than those with complex hyperplasia. Conclusions Our study illustrates that the risk of endometrial hyperplasia in a polyp concurrently involving nonpolypoid endometrium is significant. We suggest a strategy for the management of women with hyperplasia identified within an endometrial polyp in a biopsy or polypectomy specimen. [ABSTRACT FROM AUTHOR]

A randomised, controlled trial in progress in 14 United Kingdom and six Italian centres is evaluating screening for colorectal cancer using a single flexible sigmoidoscopy (FS) at around the age of 60 with removal during FS of all small adenomas, and colonoscopy for "high risk" polyps. The regimen aims to ensure that 95% of people (with either no polyps or only low risk polyps) complete the entire screening process in a single visit. This paper describes the rationale and design of the trial. Participants were patients aged between 55 and 64 on the lists of designated general practitioners (GPs) who were not excluded by their GP. A two stage recruitment procedure was employed to raise compliance rates in the intervention group. Potentially eligible persons were sent an "interest in screening" questionnaire; those who responded positively were randomised to the intervention or control groups. The trial is sufficiently large to estimate within narrow confidence intervals the magnitude of benefit and the duration of effect and optimum age for a single screen. It also examines the feasibility and acceptability of the screening regimen, and will identify training and quality assurance issues. Recruitment and screening are now complete and all baseline data have been collected. The first analysis of the effect on colorectal cancer incidence and mortality rates and suitability for a national screening programme can be expected in 2004.8 [ABSTRACT FROM AUTHOR]

Background: The concept of significant polyps and early colorectal cancer encompasses complex polyps not amenable to routine snare polypectomy or where malignancy cannot be excluded. The assessment and management of these lesions is contentious and increasingly important due to the significant risk of over- or undertreatment., Objective: Following the recommendations of the Significant Polyps and Early Colorectal Cancer National Program, we implemented a dedicated multidisciplinary team meeting and analyzed the influence on patient outcomes., Design: This was a retrospective study using a prospectively collected database of patients discussed at the dedicated multidisciplinary team meeting., Settings: This study was conducted in a single tertiary-care center., Patients: Consecutive patients with significant polyps and early colorectal cancer were identified either through the Bowel Cancer Screening Program or colonoscopy for symptomatic patients., Main Outcome Measures: Proportions of patients who had organ preservation, and secondary treatment and recurrence rate served as outcome measures., Results: Overall, 135 patients discussed at the dedicated multidisciplinary team meeting were included, with a median age of 71 years. Median size of the lesions was 25 mm, and 39% were in the rectum. Patients were discussed either after the lesion was removed during the initial colonoscopy (n = 38), of whom 16 (42%) had unexpected cancer, or had no initial treatment with subsequent case review (n = 97). Of these 97 patients, 46 underwent endoscopic excision (26% cancer), 20 trans-anal excision (10% cancer), 23 primary surgical resection (35% cancer), and 8 had no treatment. In 104 (82%) patients, organ preservation was achieved. Secondary surgery was required in 7 of 104 (6.7%) patients after local excision due to radical treatment of high-risk T1 lesions, local recurrence, or patients' decisions. The cumulative hazard estimates for recurrence after a median follow-up of 18.5 months was less than 10% for both benign and malignant lesions., Limitations: This study was limited by its relatively small sample size and single-center setting., Conclusions: A dedicated multidisciplinary team meeting improved the management of significant polyps and early colorectal cancer, safely refining organ preservation for patients, with low recurrence rates. See Video Abstract at http://links.lww.com/DCR/B826., Manejo De Specc Plipo Complejo Y Cncer Colorrectal Temprano Es Optimizado Mediante La Implementacin De Reuniones De Un Equipo Multidisciplinario Especializados Lecciones Aprendidas Del Programa Nacional Del Reino Unido: ANTECEDENTES:El concepto de pólipos complejos y cáncer colorrectal temprano abarca engloba pólipos avanzados que no es posible la reseccion endoscopica rutinaria, o aquellos en los que no se puede excluir malignidad. La evaluación y el manejo de estas lesiones es controversial y cada vez más importante debido al riesgo significativo de ser tratadas o no.OBJETIVO:Siguiendo las recomendaciones del Programa Nacional de Pólipos Complejos y Cáncer Colorrectal Temprano, implementamos reuniónes del equipo multidisciplinario especializado y analizamos el impacto en los resultados de los pacientes.DISEÑO:Estudio retrospectivo sobre una base de datos recopilada prospectivamente de los pacientes discutidos en la reunión del equipo multidisciplinario especializado.AJUSTE:Este estudio se realizó en un centro de atención terciaria.PACIENTES:Pacientes consecutivos con pólipos complejos y cáncer colorrectal temprano identificado a través del Programa de detección de cáncer intestinal o colonoscopia para pacientes sintomáticos.PRINCIPALES MEDIDAS DE RESULTADO:Proporción de pacientes que tuvieron preservación de órganos, tratamiento secundario y tasa de recurrencia.RESULTADOS:En total, se incluyeron 135 pacientes discutidos en la reunión del equipo multidisciplinario especializado dedicada, con una media de edad de 71 años. El tamaño medio de las lesiones fue de 25 mm y el 39% estaban en el recto. Se discutio de los pacientes después de que se resecara la lesión durante la colonoscopia inicial [n = 38, de los cuales 16 (42%) tenían un cáncer imprevisto] o no recibieron tratamiento de inicio, con revisión posterior del caso (n = 97). De estos, 46/97 fueron sometidos a resección endoscópica (26% cáncer), 20/97 resección transanal (10% cáncer), 23/97 resección quirúrgica primaria (35% cáncer) y 8/97 no recibieron tratamiento. En 104 (82%) pacientes, se logró la preservación de órgano. Cirugía secundaria fue requeria en 7/104 (6,7%) pacientes después de la resección local debido a tratamiento radical de lesiones T1 de alto riesgo, recidiva local o decisión del paciente. Las estimaciones de riesgo acumulativo de recurrencia después de una media de seguimiento de 18,5 meses fue inferior al 10% tanto para las lesiones benignas como para las malignas.LIMITACIONES:Tamaño de muestra relativamente pequeño y entorno de un solo centro.CONCLUSIONES:La Reunion del equipo multidisciplinario especializado mejoró el manejo de los pólipos complejos y cáncer colorrectal temprano, refinando de manera segura la preservación de órganos para los pacientes, con bajas tasas de recurrencia. Consulte Video Resumen en http://links.lww.com/DCR/B826. (Traducción- Dr. Francisco M. Abarca-Rendon)., (Copyright © The ASCRS 2021.)

Purpose: The present study aimed to elucidate the hysteroscopic tissue removal system (MyoSure) efficacy and safety amongst uterine cavity pathologies (UCPs), and to determine its feasibility in an outpatient setting. We also sought to identify possible factors that could adversely affect complete lesion excision., Methods: 124 women underwent MyoSure procedure and 135 UCPs were excised, between January 2017 and January 2018. The MyoSure efficacy was evaluated, and potential factors correlated with increased incomplete excision rate were assessed, using both univariate and multivariate analysis., Results: The overall MyoSure excision rate was 94.8%. 107/109 polyps and 14/19 leiomyomas were completely resected with a success rate of 98.1% and 73.7% respectively. The complete excision rate amongst retained products of conception (RPOC) cases was 100%. A significant correlation between leiomyomas and incomplete excision was found when compared to polyps and RPOC (p < 0.001). In this cohort, type II leiomyomas (OR = 1.8, p = 0.01) and maximal diameter > 4 cm (OR = 1.6, p = 0.02) were independently correlated with incomplete leiomyomas excision. Nine out of 124 women (7.3%) experienced severe pain during the procedure, while 17% and 73% reported moderate and mild pain respectively. Furthermore, 99% of women (123/124) would undergo the procedure again in the future or recommend it to a friend, for a similar pathology removal., Conclusions: MyoSure is an efficient, safe and feasible operative hysteroscopic procedure in an office-outpatient setting. It is associated with high patient acceptability and, it is highly recommended by the vast majority of the women. Large, and type II leiomyomas are seemingly procedure limitations., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The article discusses research which examined the effectiveness of outpatient and inpatient polypectomy for women with abnormal uterine bleeding. Topics covered include the use of miniature instruments for outpatient polyp removal, the percentage of women in the outpatient group who reported successful treatment and the failure to removal polyps in the outpatient group.

Cites a study conducted by the authors on the management of gastric submucosal polyps by gastroenterologist specialists in the Great Britain. Difficulties in the diagnosis of gastric submucosal polyps; Underestimation of the potential risk of neoplasia; Need of a histological diagnosis using endoscopic techniques for the management of the polyps.

Focuses on the diagnosis of fundic gland polyps in Great Britain. Distinction between body and fungus; Incidence of fundic gland polyps in patients with upper gastrointestinal endoscopy; Application of histological examination in the diagnosis of polyps.