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The article discusses the safety, importance, and limitations of standard endoscopy for the diagnosis and treatment of inflammatory bowel. The researchers have evaluated the medical appliances used in patients for colonoscopy in colorectal cancer screening, polyp surveillance, and diagnostic evaluation. The findings indicate potential limitations such as non-randomized approach, no comparison in forward viewing, and limited sampling size.

The article discusses the study on the adverse effects and complications from propofol-based sedation used in colonoscopy. The researchers examine the colonoscopy-related complications from a deep level of sedation such as aspiration pneumonia, colonic perforation, and splenic injury. The findings indicate an increase in risk for aspiration pneumonia and raise a concern on the increasing use of propofol during screening colonoscopy.

Background and study aims: Carbon dioxide (CO2) insufflation during colonoscopy can significantly decrease abdominal pain and bloating after the procedure, but its impact on the frequency and duration of toilet use remains unknown. The aim of this studywas to assess the impact of CO2 insufflation on toilet use after screening colonoscopy. Methods: From 138 average-risk individuals who underwent screening colonoscopy during March to August 2013, 120 were enrolled and randomized to receive either CO2 or air insufflation at colonoscopy. Both the colonoscopist and participant were blinded to the type of gas used. Abdominal pain and distension were assessed using a visual analog scoring system. The frequency and duration of toilet visits during a 2-hour postcolonoscopy periodwere recorded using a radiofrequency identification system. Results: Baseline characteristics were similar in both groups in terms of age, sex, and procedure time. In the 2 hours after colonoscopy, 50 participants (83 %) in the air group and 18 participants (30 %) in the CO2 group (P<0.001) used the toilet at least once. The mean (± SD) duration of each toilet visit was 5.93±4.65 minutes in the air group and 1.53±2.84 minutes in the CO2 group (P<0.001). The abdominal discomfort score was lower in the CO2 group than in the air group both at the end of the colonoscopy (P<0.001) and 2 hours later (P<0.001). Conclusion: Insufflation with CO2 can significantly reduce abdominal discomfort and toilet use after colonoscopy. Use of this technique may help reduce patient burden and allow more efficient use of space in the endoscopy unit. [ABSTRACT FROM AUTHOR]

Background and study aims: The quality of colonoscopy can only be measured if colonoscopy reports include all key quality indicators. In daily practice, reporting is often incomplete and not standardized. This study describes a novel, structured colonoscopy reporting system, which aims to generate standardized and complete reports and to facilitate the automatic analysis of colonoscopy quality indicators. Methods: A new colonoscopy reporting system (EndoALPHA) was developed. The system reports all colonoscopy quality indicators, as well as pathological findings, in a systematic manner using structured terminology. All essential items carry specific codes, which enables statistical analysis and the automatic generation of reports of all quality indicators. The EndoALPHA reporting system was tested with regard to completeness of reporting and evaluation of quality indicators both for individual endoscopists and the endoscopy unit. Results: In 2012, all 810 colonoscopies performed at one colonoscopy center were documented using EndoALPHA. Overall, 94% of performed colonoscopies were reported completely using the encoded terminology. Individual unadjusted cecal intubation rates were above 90% for all endoscopists (mean 96.7 %), and the adenoma detection rate was above 20% for all endoscopists (35.4% for the unit). Conclusion: The novel EndoALPHA reporting system enables automatic quality assessment on two levels: the completeness of reporting can be evaluated, and if this is adequate, the quality of the colonoscopies can also be assessed. Integrated with feedback, benchmarking and training, the reporting system may facilitate quality improvement for colonoscopy services. [ABSTRACT FROM AUTHOR]

The practice of colonoscopy has changed considerably over the last decade. The growth of image-enhanced endoscopy have altered our concepts of how we perform colonoscopy. This article examines the evidence base behind these techniques and looks at where future research needs to be directed. [ABSTRACT FROM AUTHOR]

Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is used in the imaging workup of various malignancies. Incidental gastrointestinal observations on FDG PET/CT may be of clinical significance. The aim of the present study was to evaluate endoscopic and histopathological observations in patients referred for colonoscopy due to incidental FDG colonic uptake on a PET/CT study. Fifty-six patients with incidental colonic findings on FDG PET/CT underwent colonoscopy. Normal colonoscopies were observed in 63% of the patients. In 37% of the colonoscopies, we identified an endoscopic observation, including 67% with benign adenomatous polyps, 3% with hyperplastic polyps, 20% with advanced histological lesions and 10% with a malignancy. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents the first fully automated reconstruction technique of 3D virtual colon segments from individual colonoscopy images. It is the basis of new software applications that may offer great benefits for improving quality of care for colonoscopy patients. For example, a 3D map of the areas inspected and uninspected during colonoscopy can be shown on request of the endoscopist during the procedure. The endoscopist may revisit the suggested uninspected areas to reduce the chance of missing polyps that reside in these areas. The percentage of the colon surface seen by the endoscopist can be used as a coarse objective indicator of the quality of the procedure. The derived virtual colon models can be stored for post-procedure training of new endoscopists to teach navigation techniques that result in a higher level of procedure quality. Our technique does not require a prior CT scan of the colon or any global positioning device. Our experiments on endoscopy images of an Olympus synthetic colon model reveal encouraging results with small average reconstruction errors (4.1mm for the fold depths and 12.1mm for the fold circumferences). [Copyright &y& Elsevier]

Background. Although the size of colon polyps is an important risk factor for colorectal cancer, a standardized measurement technique has yet to be determined. In clinical practice, most endoscopists estimate polyp size by uncertain visual estimation; however, colonoscopic polypectomy is indicated for adenomatous polyps more than 5 mm in diameter. We have therefore developed a novel calibrated hood that enables accurate measurement of polyp size during colonoscopy. Method. We compared prepolypectomy estimates using the calibrated hood against measurements of preformalin-fixed samples immediately after polypectomy. Results. Sixty-five polyps removed from 44 patients were included in the present study. The mean size of polyps was significantly larger at prepolypectomy (6.06 ± 1.23 mm) than after polypectomy (5.48 ± 1.31 mm, P < 0.05). Conclusion. Accurately measuring the size of polyps during colonoscopy is important, since polyps are shrunk by polypectomy. Attaching the calibrated hood appears useful in the measurement of polyp size to determine indications for polypectomy in patients with colon polyps. [ABSTRACT FROM AUTHOR]

For realistic virtual dissection, the sectioned images of a cadaver are a desirable material because of their high resolution and real body color. After a volume model is made of the sectioned images, it can be piled or peeled at the intended thickness as if a structure's surface is expanded and shrunken. The purpose of our study was to confirm whether laparoscopic and endoscopic exploration of the processed volume model plays a part in anatomy investigation. The ascending colon was outlined in serially sectioned images and accumulated to build a volume model. While the volume model was being piled or peeled, the ascending colon was observed laparoscopically and endoscopically in comparison with the original sectioned image. The trial efficiently demonstrated layers of the colon wall and surrounding tissues which could not be visualized by conventional macroscopic or microscopic techniques. The availability and contribution of this new method will be confirmed by application to other various organs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to document CT doses for common CT examinations performed throughout the province of Manitoba. Survey forms were sent out to all provincial CT sites. Thirteen out of sixteen (81 %) sites participated. The authors assessed scans of the brain, routine abdomen–pelvis, routine chest, sinuses, lumbar spine, low-dose lung nodule studies, CT pulmonary angiograms, CT KUBs, CT colonographies and combination chest–abdomen–pelvis exams. Sites recorded scanner model, protocol techniques and patient and dose data for 100 consecutive patients who were scanned with any of the aforementioned examinations. Mean effective doses and standard deviations for the province and for individual scanners were computed. The Kruskal–Wallis test was used to compare the variability of effective doses amongst scanners. The t test was used to compare doses and their provincial ranges between newer and older scanners and scanners that used dose saving tools and those that did not. Abdomen–pelvis, chest and brain scans accounted for over 70 % of scans. Their mean effective doses were 18.0±6.7, 13.2±6.4 and 3.0±1.0 mSv, respectively. Variations in doses amongst scanners were statistically significant. Most examinations were performed at 120 kVp, and no lower kVp was used. Dose variations due to scanner age and use of dose saving tools were not statistically significant. Clinical CT doses in Manitoba are broadly similar to but higher than those reported in other Canadian provinces. Results suggest that further dose reduction can be achieved by modifying scanning techniques, such as using lower kVp. Wide variation in doses amongst different scanners suggests that standardisation of scanning protocols can reduce patient dose. New technological advances, such as dose-reduction software algorithms, can be adopted to reduce patient dose. [ABSTRACT FROM PUBLISHER]

Background: Conflicting data regarding the impact of fellow involvement during colonoscopy on the adenoma detection rate (ADR) and polyp detection rate (PDR) have been reported in the literature. Aims: Our aim was to perform a meta-analysis to determine the impact of fellow participation during colonoscopy on the ADR and PDR. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, pertinent articles that reported ADR and/or PDR between attending physicians alone compared to gastroenterology fellows with attending physicians were obtained through database searches. Data was abstracted and pooled using a random effects model. The quality of each included study was ascertained using a modified version of the Quality Assessment of Diagnostic Accuracy Studies tool, and potential publication bias was assessed. Results: A total of 14 articles that included 21,504 colonoscopies met the inclusion criteria. The overall PDR and ADR were 44.4 and 30.8 %, respectively. No significant differences were found between participant characteristics and colonoscopies performed with or without fellow participation. No significant differences were found in the relative rate of ADR (1.04, 95 % CI 0.94–1.15) or PDR (1.03, 95 % CI 0.93–1.14) with or without a fellow. An important limitation is that none of the included studies randomized fellow involvement. Conclusions: Involvement of a fellow during colonoscopy did not affect adenoma and polyp detection rates. [ABSTRACT FROM AUTHOR]

Background: The Simulated Colonoscopy Objective Performance Evaluation (SCOPE) was developed to fill the need for a lower-cost, non-virtual-reality (VR)-based assessment tool. This study aimed to evaluate the ability of SCOPE to assess endoscopic skills objectively. Methods: Four tasks were created using the Kyoto Kagaku colonoscopy model (Kyoto Kagaku Co., Ltd., Kyoto, Japan). The SCOPE tasks included Scope Manipulation (SM) requiring torque and tip deflection to align a shape in the colon with a matching shape on the monitor; Tool Targeting (TT) requiring coordination with biopsy forceps to contact a metal target; Loop Management (LM) requiring prevention, recognition, and reduction of a redundant sigmoid colon with navigation to the cecum; and Mucosal Inspection (MI) requiring identification of simulated polyps during withdrawal and retroflexion. Key performance metrics were identified, and a normalized scoring system was developed. For the study, 35 subjects were stratified into three cohorts based on colonoscopy experience: novice (0-50 colonoscopies; n = 11), intermediate (51-139 colonoscopies; n = 13), and experienced (>140 colonoscopies; n = 11). The subjects performed two trials of all four tasks. Results: Across all four tasks, the experienced endoscopists (E) consistently outperformed the intermediates (I), who in turn outperformed the novices (N). The mean normalized scores with 95 % confidence intervals (CI) are as follows: SM: N (54; range, 26-82), I (92; range, 79-106), E (106; range, 93-118) ( p = 0.0006). TT: N (40; range, 24-55), I (77; range, 63-91), E (88; range, 72-105) ( p < 0.0001). LM: N (51; range, 24-79), I (80; range, 59-101), E (101; range, 98-105) ( p = 0.003). MI: N (73; range, 53-92), I (85; range, 76-95), E (100; range, 91-108) ( p = 0.013). Total score: N (218; range, 155-280), I (335; range, 299-371), E (395; range, 371-419) ( p < 0.0001). The test-retest reliability (0.6) for the expert total score was respectable. Conclusions: The validity evidence from this study shows that scores on SCOPE tasks can differentiate between groups expected to have different levels of technical skill. This model shows promise as a low-technology tool for objective assessment or training of endoscopic skills. [ABSTRACT FROM AUTHOR]

Background: We evaluated the performance of a newly developed small-caliber (SC) colonoscope (PCF-PQ260L). This colonoscope (diameter 9.2 mm) is designed with passive-bending and high-force transmission. The SC colonoscope was used for rescue colonoscopy following incomplete colonoscopy with a standard (SD) colonoscope caused by sharp angulation, loop formation, or pain. Methods: Records of SC colonoscopy given to patients following an incomplete colonoscopy with the SD colonoscope and in the same session were analyzed. Cecal intubation rate, pain using a visual analog scale (0 = none, 100 = extremely painful) in the first and second colonoscopy, total time, new lesions detected with the SC colonoscopy, dosage of sedation used, and any complications were assessed. Examinations that could not be completed, because the colonoscope was not long enough to reach the cecum due to a redundant colon were excluded. Results: The records of 43 patients who were given SC colonoscopy following incomplete examinations using the SD colonoscope were reviewed. In 97.7 % of cases (42/43), cecal intubation was achieved with the SC colonoscope in the same session. The mean pain score during colonoscopy was significantly lower for the second SC colonoscopy than for the first SD colonoscopy (40.6 ± 14.1 vs. 74.5 ± 10.8, P < 0.001). Lesions were detected with the SC colonoscope in 41.8 % of cases (18/43). Conclusions: When a colonoscopy with SD colonoscope failed due to sharp angulations, loop formation, or pain, subsequent colonoscopy with a SC colonoscope increased cecal intubation and lesion detection rates and decreased severity of reported pain. [ABSTRACT FROM AUTHOR]

This paper presents a wireless power transfer system integrated with an active locomotion and biopsy module in an endoscopic capsule for colon inspection. The capsule, which can move automatically, is designed for non-invasive biopsy and visual inspection of the intestine. To supply enough power for multiple functions and ensure safety for the human body, the efficiency of the current power transmission system needs to be improved. To take full advantage of the volume in the capsule body, a novel structure of receiving coils wound on a multi-core of MnZn ferrite hollow cylinder was used; with this new core, the efficiency increased to more than 7.98%. Up to 1.4 W of dc power can be delivered to the capsule as it travels along the gastrointestinal tract. Three micro motors were integrated for pumping, anchoring, locomotion and biopsy. A user interface and RF communication enables the operator to drive the capsule in an intuitive manner. To gauge the efficacy of the wireless power supply in a simulated real-world application, the biopsy and locomotion capabilities of the device were successfully tested in a slippery, soft tube and gut environment in vitro. [ABSTRACT FROM AUTHOR]

Background and study aims: Novel imaging techniques need to be evaluated for their ability to improve the detection of polyps. Critical appraisal of reported studies reveals remarkable differences in study designs, despite their similar objectives. The aim of the current study was to compare frequently used study designs for their required sample size to detect relevant differences in polyp detection rates. Patients and methods: Three commonly reported study designs were compared: design 1, the parallel randomized design; design 2, the randomized cross-over design with direct removal of polyps; and design 3, the randomized cross-over design without direct removal of polyps. A total of five different scenarios were analyzed per study design, representing a variety of clinical settings. Each scenario was repeated 1000 times for each study design and the sample size that produced a significant result per study design in each scenario was recorded. Results: In many scenarios, study design 1 required 10-15 times more patients to reach the same statistical power of 80% compared with study design 2. Further reductions in sample size could be achievedwhen study design 3 was used, although this design is limited by its impracticality. Conclusions: The randomized parallel design requires a larger sample size to achieve equivalent power to the cross-over design. Researchers should carefully consider whether the latter design could be used instead, as it requires a lower number of subjects, although it may be more cumbersome for patients, endoscopists, and researchers. [ABSTRACT FROM AUTHOR]

Background/Aims: Split-dose polyethylene glycol (PEG) is a standard bowel preparation regimen for colonoscopy, but the large volume is burdensome to ingest and the night dose causes sleep disturbance. This study was performed to evaluate the efficacy and tolerability of a bowel preparation protocol using low-volume morning-only PEG with specially designed low-residue test meals (LV-PEG with TM) compared to a standard-volume split-dose PEG bowel preparation with a standard diet (SV-PEG with SD). Methods: This was a single-center, prospective, randomized, investigator-blinded, noninferiority study. The primary end point was bowel preparation quality according to the Ottawa scale. Tolerability, compliance, adverse events, sleep quality and polyp/adenoma detection were also assessed. Results: Among 197 patients analyzed (mean age 54.6 years, 51.3% men), 97 received LV-PEG with TM and 100 received SV-PEG with SD. The Ottawa score for the total colon was 3.76 ± 2.07 in the LV-PEG with TM group and 3.67 ± 1.57 in the SV-PEG with SD group (p = 0.723; difference 0.09, 95% confidence interval -0.60 to 0.42). The compliance was high (more than 95%) in both groups (p = 0.621). PEG was easier to ingest for patients in the LV-PEG with TM group compared to the SV-PEG with SD group [visual analogue scale (VAS) for difficulty: 4.64 ± 2.46 vs. 5.97 ± 2.42, respectively; p < 0.001]. Diet instructions were also easier to comply with for patients in the LV-PEG with TM group compared to the SV-PEG with SD group (VAS for difficulty: 3.11 ± 2.25 vs. 4.00 ± 2.39, respectively; p = 0.008). Patients in the LV-PEG with TM group had a lower incidence of abdominal bloating (p = 0.012) and better sleep quality (p < 0.001). There was no difference between the groups regarding polyp and adenoma detection. Conclusions: LV-PEG with TM and SV-PEG with SD have similar efficacy with regard to bowel preparation for colonoscopy. LV-PEG with TM provided easier PEG intake and diet compliance, less abdominal bloating and better sleep quality than SV-PEG with SD. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Laterally spreading tumors (LSTs) are generally defined as superficial lesions ⩾10 mm in diameter that typically extend laterally rather than vertically along the colonic wall. LSTs are usually categorized into 2 subtypes: granular type and nongranular type. Large nodules or depressed areas in granular-type LSTs (LST-Gs) are endoscopic findings of a cancerous component and sometimes represent submucosal invasion. However, the lateral growth and development of LST-Gs remains unclear. Case presentation: This case report describes a case of 79-year-old woman who underwent total colonoscopy due to a positive fecal occult blood test and was detected a LST-G, about 30 mm in diameter in the lower rectum. The lesion consisted of not only aggregated small and large nodules typically seen in LST-Gs but also the hardly elevated flat parts. In the flat part, there were dilated round pits and no evident capillary vessels. Three months later, the flat part increased in height, the dilated round pits were partly replaced by type IIIL pits, and capillary vessels were evident. The lesion was removed by endoscopic submucosal dissection, and diagnosed pathologically as tubular adenoma. We performed the sequence analyses on KRAS, BRAF, NRAS and PIK3CA genes in flat part and nodular part separately, and a mutation of KRAS gene at codon 146 was observed at only nodular part, suggesting probable that nodular part be a precancerous lesion. Conclusion: This is a unique and suggestive case, providing information on progression of LST-Gs at the very early stage to carcinogenesis. [ABSTRACT FROM AUTHOR]

Background and study aims: Colonoscopy without sedation has several advantages over sedated colonoscopy, but a considerable proportion of patients experience pain. The aim of this study was to develop a risk stratification model of pre-examination risk factors to enable targeted sedation during colonoscopy. Patients and methods: Between October 2011 and January 2012, consecutive outpatients who were willing to start colonoscopy without sedation at 11 Norwegian centers were prospectively recruited. Patients recorded pain on a validated 4-point scale (none, slight, moderate, or severe pain). Potential risk factors for a painful procedure (defined as moderate or severe pain) were evaluated using multivariate logistic regression analyses, and the area under the receiver operating characteristics curve (AUROC) was calculated to assess the discriminatory ability of the derived model. Results: A total of 1198 patients (635 men and 563 women) were included. Seven independent, pre-procedural risk factors for patient pain were identified: female sex, age<40 years, previous abdominal surgery, abdominal pain as indication for colonoscopy, anticipation of pain, previous painful colonoscopy, and a history of diverticulitis. In patients with 0, 1, 2, or ⩾3 risk factors, a painful colonoscopy was experienced by 35%, 43%, 52%, and 63% of women and 18%, 24%, 35%, and 63% of men, respectively. The model showed modest discrimination abilities (AUROC=0.69). Conclusion: Female sexwas a strong risk factor for pain during colonoscopy, and sedation or analgesia should be considered for all women prior to colonoscopy. For male patients, the presence of multiple risk factors should encourage the endoscopist to offer sedation. [ABSTRACT FROM AUTHOR]

Abstract: Clostridium difficile treatment failures and recurrences occur at rates of 22.3% and 22.1%, respectively. For patients who have refractory/recurrent disease, there are limited treatment options. The use of a fecal suspension from a healthy donor instilled via a nasogastric tube, during colonoscopy, or by enema in a patient with recurrent or refractory C. difficile infection has shown a response rate of 75 to 100% with minimal adverse effects. There are multiple published case series that provide variations in administration procedures. The main barrier is the need for institutions and clinics to develop protocols to ensure this treatment modality is available to patients with this debilitating and potentially fatal disease. [Copyright &y& Elsevier]

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]

Due to the increasing demand for colonoscopy, devices to advance examination techniques are highly sought after. Several studies have examined the use of a transparent cap attached to the tip of the colonoscope, but the data are inconsistent. The aim of our study was to establish whether transparent cap colonoscopy is beneficial in the improvement of caecal intubation rate, time and polyp detection. We undertook a systematic review and meta-analysis in the form of a Cochrane review to evaluate these outcomes. We included fourteen randomised controlled trials that have been published to date. Transparent cap colonoscopy demonstrates a significant reduction in caecal intubation time, by an average of 48 s, when compared to standard colonoscopy. There was no significant difference in caecal intubation rate or polyp detection between the two groups. Despite a significant difference in caecal intubation time, the clinical significance of the transparent cap remains to be seen. We believe further research is needed to investigate this adjunct. [ABSTRACT FROM AUTHOR]

Familial adenomatous polyposis (FAP) is characterized by large numbers of adenomatous polyps in the colon and inherited as an autosomal dominant disease. Gardner's syndrome is a form of FAP accompanied by extra-colonic tumors and desmoid tumors. Desmoid tumors are rare, and benign tumors characterized by fibroblastic proliferation of fascial and musculoaponeurotic components. There is an approximate 1,000 times higher incidence of desmoid tumors in patients with FAP compared with the general population. Desmoid tumors in Gardner's syndrome occur in the small bowel mesentery in 80% of all cases, and the other 20% in the abdominal wall or the extremities. Almost all cases of desmoid tumors in Gardner's syndrome were incidentally found after prophylactic total proctocolectomy for colon cancer prevention in the patients with FAP. We report a case of Gardner's syndrome associated with codon 1099 mutation of the adenomatous polyposis coli gene, in which the patient was initially found to have desmoid tumors and subsequently diagnosed as FAP by screening colonoscopy. [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection has been a useful treatment of selected colorectal neoplasia cases. The incidence of perforation related to colorectal endoscopic submucosal dissection is 5-20%. However, while there have been numerous reports regarding retroperitoneal, mediastinal, pleural and subcutaneous emphysema after therapeutic colonoscopy, pneumoscrotum is a relatively rare manifestation of perforation associated with colorectal endoscopic submucosal dissection. In particular, pneumorrhachis, or air within the spinal cord, following therapeutic colonoscopy, is extremely rare. Herein, we report a conservatively treated perforation case as having pneumorrhachis, penumoscrotum, and pneumoperitoneum after colorectal endoscopic submucosal dissection. [ABSTRACT FROM AUTHOR]

Background/Aims: Although the quality of colonoscopy is considered important to improve screening efficacy, there is little evidence and few statistical reports which properly reflects the colonoscopy quality of clinical practices in Korea. We aimed to investigate the quality indicators of colonoscopy performing in clinical practice. Methods: We analyzed the computerized photo-documentation files of patients who were transferred to tertiary academic hospital from private clinics or primary and secondary hospitals from January 2012 to October 2012. Quality indicators including cecal intubation rate, withdrawal time, bowel preparation status, colonoscopy report form were analyzed. Bowel preparation was assessed by 4 steps on the preparation scale (excellent, good, fair, poor). Results: A total of 198 patients (134 male, 64 female) were enrolled and analyzed. Cecal intubation rate was 91.4% (181/198) and photo-documentation of appendiceal orifice and ileocecal valve was achieved as 84.3% (167/198) and 71.7% (142/198), relatively. Overall, 83.3% of cases were adequate bowel preparation state (excellent 52%, good 31.3%). Withdrawal time could be estimated at 94.4% (187/198) of cases and mean withdrawal time of diagonostic colonoscopy (n=165) was 8.6 minutes. However, the rate of cases which withdrawal time was more than 6 minutes was 69.7% (115/165). Total of 30 institution's colonoscopy report forms were analyzed and among nearly half enrolled institutions (46.6%, 14/30) were just recording patient's information and colonoscopic diagnosis. Conclusions: Considerable portion of colonoscopy examination in the primary clinical practice has been performed with low procedure quality. We thus need careful attention to maintain the quality of colonoscopy in daily practice routines. [ABSTRACT FROM AUTHOR]

Introduction: Water-aided colonoscopy can be categorized by the timing of removal of infused water, predominantly during withdrawal (water immersion) or during insertion (water exchange), respectively. Objective: To assess the impact of water immersion and water exchange on insertion pain and adenoma detection rate, when compared with air insulation colonoscopy. Setting: published randomized controlled trial (RCT) that compared water immersion or water exchange with air insulation. Patients: patients undergoing colonoscopy. Interventions: Medline, pubMed, Google searches (January 2008 to December 2011) to identify appropriate RCTs. Main Outcome Measurements: pain during insertion phase and adenoma detection rate. Method: Review Manager Software (Version 5.1, Cochrane Collaboration, UK). Results: pain scores of both water-aided methods are lower than that of the air insulation method. Subgroup analysis shows that compared with air insulation, the water exchange group had a greater mean reduction of maximum pain during insertion -2.73 (-3.29, -2.18) than the water immersion group -1.31 (-1.64, -0.97). There is no significant diference in overall adenoma detection rate between water-aided methods and air insulation. Subgroup analysis shows that compared with air insulation, the water exchange group had higher adenoma detection rate, OR 1.52, (95% CI: 1.08-2.14) than the water immersion group, OR 0.92, (95%CI: 0.70-1.21). Limitation: Unblinded colonoscopists exposed observations to uncertain bias. Conclusion: compared with air insulation, the data presentation in a meta-analysis format show that both water immersion and water exchange significantly reduce insertion pain. Water exchange may be superior to water immersion in minimizing insertion pain and in increasing adenoma detection rate. [ABSTRACT FROM AUTHOR]

Background: Water-aided methods for colonoscopy are distinguished by timing of removal of infused water, predominantly during withdrawal (water immersion, WI), or during insertion (water exchange, WE). Objective: In a prospective randomized controlled trial (RCT) we assessed the hypothesis that compared with air insulation (AI), We produces significantly greater reduction in insertion pain than WI. Methods: The study was approval by local IRB and registered (NCT0090555). 200 patients were allocated into 3 groups by computerized randomization. AI, WI and WE were implemented as previously described. In all groups, during the insertion phase of colonoscopy, a study nurse asked the patient to report the level of pain (0=none, 10=most severe) at 2 to 3-min intervals or at any time the patient voiced discomfort. During the withdrawal phase, the pain was recorded in a similar manner. procedural outcomes were recorded. Results: Demographic variables and final cecal intubation rates were comparable. compared with AI, WI and WE both produced significantly better bowel preparation scores during colonoscope withdrawal and significantly lowered pain scores (AI 3.8±3.0, WI 2.4±2.6, WE 1.5±2.4, p<0.001) during colonoscope insertion. compared with AI, We produces significantly greater reduction in insertion pain than WI. The cecal intubation time was the longest in the We group (AI vs. WI vs. WE, 8.9±7.3, 6.6±3.6 and 17.5±6.4 min, p<0.001) Conclusion: Both WI and WE significantly reduced insertion pain compared with AI. Water exchange is superior to water immersion in attenuating insertion pain. [ABSTRACT FROM AUTHOR]

Background: Reports of water exchange (WE) colonoscopy did not describe complications, but the safety of the WE method has not been critically evaluated. Aim: We report the vital signs, cardiac rhythm and serum electrolyte levels before and after large volume water exchange. Unsedated patients are chosen for evaluation to avoid the confounding effects of sedation medications. Patient and method: patients in two randomized controlled trials (RCT) comparing the use of air insulations (AI) vs. WE method for unsedated colonoscopy without missing data of interest were identified. Study 1: patients' vital signs and cardiac rhythm before (immediately before insertion of the colonoscope into the rectum) and after (immediately after removal of the colonoscope from the rectum) colonoscopy were tabulated. Study 2: In patients who agreed to have pre and post colonoscopy electrolyte evaluation, blood samples (2 mL each) were drawn within 5 to 10 min before and after colonoscopy for measuring the serum Na+ and K+ levels. Results: Study 1: There were no significant differences in vital signs before and after colonoscopy in either the AI or WE group. All patients were in normal sinus rhythm before and after the colonoscopy. Study 2: There were no significant differences between the serum Na+ and K+ before and after colonoscopy in either the AI or WE group. Conclusion: Vital signs, cardiac rhythm and serum electrolyte levels are well preserved after large volume WE in the colonic lumen. The We method is a safe modality in these regards. [ABSTRACT FROM AUTHOR]

Background and Aim: The presence of an association between Barrett's metaplasia and colonic neoplasia has remained controversial. The aim of the study was to test the presence of this association, using a large national database. Methods: From a computerized database of surgical pathology reports, we selected 203,000 subjects who underwent colonoscopy and esophago-gastro-duodenoscopy with biopsy results available from both procedures. In a case-control study we compared the occurrence of Barrett's metaplasia in patients with and without various types of colonic neoplasms. Results: Barrett's metaplasia occurred more frequently among patients with hyperplastic polyps (OR = 2.14, 95 % CI 2.02-2.27), adenomatous polyps (2.52, 2.41-2.64), advanced adenomas (2.10, 1.90-2.32), villous adenomas or adenomas with high-grade (HG) dysplasia (2.45, 2.28-2.64), and colonic adenocarcinomas (1.75, 1.39-2.22). The association between Barrett's metaplasia and colonic neoplasm applied similarly to polyps of different size, number and location within the large bowel. These types of association could also be confirmed when analyzed separately for Barrett's metaplasia characterized by low-grade or HG dysplasia, as well as esophageal adenocarcinoma. Conclusions: The data support the existence of a true association between Barrett's metaplasia and various types of colonic neoplasm. The association may be more interesting for its potential insights into the pathogenesis of the two disorders than its actual clinical implications. [ABSTRACT FROM AUTHOR]

Background: There are limited data on recommendations and adherence to complete colon evaluation (CCE) after incomplete colonoscopy (IC). Aims: Our objectives were to (1) identify recommendations and adherence to recommendations after IC, (2) determine the diagnostic yield of CCE after IC, and (3) determine the effect of an IC referral program on recommendations for CCE. Methods: We conducted a retrospective review of IC procedures at a teaching hospital over two time periods (January 1 to May 1 2004 and July 1 to November 1 2010). A referral process for repeat colonoscopy after IC was instituted in April 2009. Outcomes included (1) recommendations (2) adherence, and (3) yield of CCE after IC. Results: A total of 222 patients underwent at least one IC (overall rate of 2.5 %). In 120 patients (54.1 %), CCE was recommended within 1 year; the rate did not change from 2004 to 2010. Patients with IC due to poor preparation were more likely to have specific CCE recommendations (85.5 vs. 72.2 %, P = 0.03) and recommendations of endoscopic follow-up (76.3 vs. 10.4 %, P < 0.0001) than those with IC due to difficult anatomy. When IC was due to difficult colonoscopy, there was increase in endoscopic follow-up recommended (16.3 vs. 2.8 %, P = 0.01) in 2010 compared to 2004. Adherence to recommendations was similar regardless of modality recommended, inpatient/outpatient status, polyps on initial exam, or extent of initial exam. Polyp detection rate was greater utilizing colonoscopy than barium enema (34.3 vs. 3.6 %, P < 0.0001). Conclusions: There is a lack of consensus in management strategies for patients after IC. Implementation of a referral program has had minimal impact on provider recommendations. [ABSTRACT FROM AUTHOR]

Background: Currently, there are no data on adherence to guidelines for colorectal cancer (CRC) screening in patients with a family history. Aim: We conducted a retrospective study to assess if such patients were being appropriately screened according to American Gastroenterological Association (AGA) guidelines. Methods: Two independent reviewers performed a comprehensive medical record review of family and CRC screening history on 362 adults with a family history of CRC in a first-degree relative who had recently undergone screening colonoscopy. The endpoint was appropriate initiation of screening and endoscopist-recommended subsequent screening intervals, as compared to AGA guideline recommendations. Results: Of 362 subjects, only 146 (40.3 %) were screened appropriately; 213 (58.9 %) had late initiation of screening (i.e., screening was started ≥5 years later than the age recommended by guidelines) and three (0.8 %) had premature initiation (i.e., screening was started ≥1 year too early). Of cases involving delayed screening initiation, 126 were not under primary care at the time when screening was supposed to have started, while most of the remaining received either no or incorrect screening recommendations from their primary care provider. Of 270 subjects with no neoplasia found on initial screening, 112 (41.5 %) had endoscopist-recommended subsequent screening intervals that were ≥2 years shorter than that recommended by guidelines. Results were similar if American Society of Gastrointestinal Endoscopy or American College of Gastroenterology guidelines were used. Conclusions: Patients with a family history often suffer from late initiation of screening and overly short endoscopist-recommended subsequent intervals for colonoscopy. Further education of patients and providers on screening recommendations may be helpful. [ABSTRACT FROM AUTHOR]

Background and Aims: To prospectively evaluate the role of contrast-enhanced computed tomography (CE-CT) in the detection of colonic diverticular bleeding (CDB). Patients and Methods: Consecutive patients who presented with hematochezia and were clinically suspected of CDB were prospectively enrolled. Those who could undergo both CE-CT and total colonoscopy, and who were finally diagnosed as CDB, were included in the analysis. Results: Fifty-two cases were finally included in the analysis. The detection rate of CDB by CT was 15.4 % (8/52). Univariate analysis showed that the interval from the latest episode of hematochezia to the performance of CT and the presence of a past history of CDB were contributing factors for detection. The interval was 1.6 ± 4.6 h (mean ± SD) in patients detected by CT, and 3.4 ± 3.2 h in those without detection. The detection rate of CDB by total colonoscopy was 38.5 % (20/52). The overall detection rate was 46.2 % (24/52), which was superior to what CT or colonoscopy alone achieved. Conclusions: CE-CT may play a complementary role to colonoscopy in patients with suspected CDB, but is not recommended for all cases due to its low detection rate. Patients who can be examined within 2 h of last hematochezia would be candidates for urgent CT. [ABSTRACT FROM AUTHOR]

Background: Experts have stated that adenoma detection rates (ADR) of individual endoscopists should be measured to assess colonoscopy quality. Aim: The purpose of this study was to quantify the reliability of the ADR as a quality marker. Methods: We simulated a population of endoscopists and patients using published data on adenoma prevalence and adenoma miss rates. For each endoscopist, the ADR was calculated. The proportion of ADR variance attributable to endoscopist and the area under the ROC (AUROC) curve for low-performing endoscopists (lowest quartile or decile) were also calculated. Results: In the base-case analysis (200 patients per endoscopist, miss rate 22 %, adenoma prevalence 24 %), only 13 % of ADR variance was attributable to endoscopist performance (AUROC up to 0.73). An ADR cutoff of <16.5 % identified approximately half of endoscopists in the lowest performance decile (test sensitivity = 53 %), but most (79 %) of the endoscopists identified by this cutoff were NOT low performers (i.e., false positives). In sensitivity analysis, increasing the number of patients per endoscopist, reducing the variance of adenoma prevalence between endoscopists (i.e., performing case-mix adjustment), and increasing the variance in performance between endoscopists all improved ADR test characteristics (AUROC up to 0.88). However, regardless of assumptions, a substantial proportion of endoscopists would be misclassified if a simple ADR cutoff were utilized. Conclusions: The ADR has limited reliability as a quality marker under real-world assumptions. Simple cutoffs are likely to either be insufficiently sensitive or have high false positive rates. Future studies should identify alternative means for assessing endoscopist performance. [ABSTRACT FROM AUTHOR]

Background: Pain is common during colonic insufflation required for CT colonography. We therefore evaluate whether a single intravenous alfentanil bolus has a clinically relevant analgesic effect compared with placebo in patients undergoing CT colonography. Methods: A prospective multi-centre randomised double-blind placebo-controlled trial was performed in patients scheduled for elective CT colonography. Patients were randomised to receive either a bolus of 7.5 μg/kg alfentanil (n = 45) or placebo (n = 45). The primary outcome was the difference in maximum pain during colonic insufflation on an 11-point numeric rating scale. We defined a clinically relevant effect as a maximum pain reduction of at least 1.3 points. Secondary outcomes included total pain and burden of CT colonography (5-point scale), the most burdensome aspect and side effects. Our primary outcome was tested using a one-sided independent samples t-test. Results: Maximum pain scores during insufflation were lower with alfentanil as compared with placebo, 5.3 versus 3.0 (P < 0.001). Total CT colonography pain and burden were also lower with alfentanil (2.0 vs. 1.6; P = 0.014 and 2.1 vs. 1.7; P = 0.007, respectively). With alfentanil fewer patients rated the insufflation as most burdensome aspect (56.1% vs. 18.6%; P = 0.001). Episodes with desaturations < 90% SpO2 were more common with alfentanil (8.1% vs. 44.4%; P < 0.001, but no clinically relevant desaturations occurred. Conclusions: A low-dose intravenous alfentanil bolus provides a clinically relevant reduction of maximum pain during CT colonography and may improve the CT colonography acceptance, especially for patients with a low pain threshold. [ABSTRACT FROM AUTHOR]

Background and study aims: The assessment of indications for follow-up colonoscopy may help to improve the allocation of available endoscopy resources. The aim of this study was to assess the timing of early follow-up colonoscopy and surveillance utilization in relation to adenoma detection rate (ADR) at follow-up. Methods: An assessment of the timing and yield of follow-up colonoscopies was performed in patients with non-inflammatory bowel disease (IBD) in a Dutch multicenter study. The primary outcome was the number of patients with a prior (index) colonoscopy. The necessity for follow-up procedures was assessed using the ADR. Results: Of 4800 consecutive patients undergoing a colonoscopy, 1249 non-IBD patients had undergone an index colonoscopy. Of these, follow-up procedures were performed within 1 year in 27% (331/1249). Excluding incomplete colonoscopy, incomplete polypectomy, or poor bowel preparation on index, the ADR on early follow-up was 4% for symptomatic and 26% for asymptomatic patients. Among the asymptomatic patients with a follow-up colonoscopy at >1 year (n=463), an ADR of 23% (108/463) was found. In 27% of these patients, the observed surveillance intervals were in accordance with American Gastroenterological Association (AGA) surveillance recommendations; 60% were classified as over-utilization and 13% as under-utilization according to the AGA. Optimal utilization follow-up colonoscopies had higher ADRs on follow-up compared with overutilized procedures (31% vs. 17%; P<0.001). Conclusions: Follow-up colonoscopy in symptomatic patients within a year has limited value in terms of adenoma detection. A considerable proportion of surveillance colonoscopies are performed too early according to current guidelines, resulting in low detection rates. Both aspects can be targeted for optimal usage in endoscopic capacity. [ABSTRACT FROM AUTHOR]

Background and study aims: After screening colonoscopy, additional colonoscopies may be required for adenoma surveillance or diagnostic reasons. The aim of the present study was to explore their utilization and findings in routine practice. Patients and methods: The study comprised an historical cohort of individuals participating in colonoscopy screening in 2006.Utilization and yield of neoplasms of additional colonoscopies performed in these individuals by the same physician (<6 months and 6-36 months after screening) between 2006 and 2009 were assessed using data of a colonoscopy quality assurance program in Bavaria, Germany. Screening including polypectomy, and short-term follow-up colonoscopy was assumed to have been completed within⩽6 months. Multivariate logistic regression was used to identify predictors of additional colonoscopy and advanced neoplasms (high risk adenoma or colorectal cancer [CRC]) among those with additional colonoscopy during the period of 6-36 months after screening. Results: A total of 51 301 individuals undergoing screening colonoscopy were included. Of these, 10.1% (95% confidence interval [CI] 9.8%-10.3 %) had an additional colonoscopy performed by the same physician between 6 and 36 months after screening. The percentages of those with additional colonoscopy were 5.7% (95 %CI 5.5%-5.9 %), 18.6% (95 %CI 17.8%-19.4 %), and 33.7% (95 %CI 32.2%-35.2 %) after negative screening, low risk adenoma at screening, and high risk adenoma at screening, respectively. The overall findings were negative colonoscopy, lowrisk adenoma, high risk adenoma, and CRC in 68.6% (95 %CI 67.3%-69.8 %), 24.1% (95 %CI 23.0%-25.3 %), 6.7% (95 %CI 6.0%- 7.4 %), and 0.6% (95 %CI 0.4%-0.8 %), respectively. Younger age, male sex, screen-detected adenomas, inflammatory bowel disease, and early repeat colonoscopy within 6 months were predictors of additional colonoscopy. Older age, male sex, screen-detected adenomas, and surveillance indications were associated with increased risk of advanced neoplasms at post-screening colonoscopy. Conclusion: The results indicate frequent utilization of additional colonoscopies along with substantial adenoma yield in the first 3 years after screening colonoscopy. [ABSTRACT FROM AUTHOR]

The National Health Service Bowel Cancer Screening Program (NHS BCSP) was developed to improve outcomes from colorectal cancer, the third most frequent cancer and the second highest cause of cancer deaths in the UK. Screening pilot programs were developed after previous trials demonstrated a reduction in mortality with the use of fecal occult blood population screening. A successful pilot period led to the roll out of national biennial screening for all 60-69 year olds in 2006, and extended to 60-74 year olds in 2010. To the end of 2012, there have been over 16 million invitations to screening, with uptake of 55.35%. FOBt positivity was 2.08%. Almost 15,000 cancers have been identified; screen-detected cancers have been shown to be at an earlier stage than non-screen-detected, with 35% Dukes' stage A. The BCSP provides high quality colonoscopy with low adverse events rates. It is also a rich data source for research. [ABSTRACT FROM AUTHOR]

Background/Aims: Colonoscopy may be less effective in preventing cancer in the proximal colon. We evaluated whether risk factors for adenoma recurrence exhibit differential effect on adenoma recurrence by colon subsite. Methods: We examined the association of age, sex, body mass index, smoking status and use of nonsteroidal anti-inflammatory drugs (NSAIDs) on proximal and distal adenoma recurrence among 1,864 participants in the Polyp Prevention Trial. We used multinomial logistic regression models to calculate the relative risk ratios (RRR) and 95% CI. Results: 733 (39.3%) participants had adenoma recurrence (228 distal only, 369 proximal only and 136 synchronous proximal and distal adenoma). When compared to participants without adenoma recurrence, no factor was associated with an increased risk of distal only adenoma recurrence. Age 65-69 years (RRR = 1.47, 95% CI 1.00-2.16), age ≥70 years (RRR = 2.24, 95% CI 1.57-3.20), and male sex (RRR = 1.73, 95% CI 1.32-2.27) were positively associated with proximal only adenoma recurrence. NSAIDs use was associated with a reduced risk of adenoma recurrence by similar magnitude in distal (RRR = 0.78, 95% CI 0.58-1.07) and proximal colon (RRR = 0.77, 95% CI 0.60-1.00). Conclusions: We did not find any modifiable risk factor that differentially increases proximal as compared to distal adenoma recurrence to be clinically useful for targeted intervention. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background/Aims: Surveillance colonoscopy is recommended after polypectomy of adenoma and surgery for colorectal cancer. The purpose of this study was to assess the frequency of advanced adenoma and cancer in colonoscopies performed for surveillance compared to screening colonoscopies. Methods: Analysis of relative frequencies of findings in colonoscopies performed for post-adenoma surveillance (post-ad), post-cancer surveillance (post-crc), screening, and follow-up of a positive fecal occult blood test (FOBT). Logistic regression was used to identify the risk for advanced adenoma (adenoma ≥10 mm, containing high-grade dysplasia, or villous histology) and cancer. Results: 324,912 colonoscopies were included in the analysis: 81,877 post-ad, 26,896 post-crc, 178,305 screening, 37,834 positive FOBT. Advanced adenoma (cancer) was diagnosed in 8.0% (0.4%) of post-ad, 5.0% (1.0%) of post-crc, 7.4% (1.1%) of screening, and 11.7% (3.6%) of positive FOBT colonoscopies. Compared to screening, the odds ratios for finding advanced adenoma were 0.93 (95% CI 0.88-0.98) for post-ad, 0.96 (0.86-1.08) for post-crc, and 1.18 (1.09-1.28) for positive FOBT colonoscopies. The odds ratios for the diagnosis of cancer were 0.29 (0.24-0.36) for post-ad, 0.81 (0.61-1.07) for post-crc, and 2.77 (2.43-3.17) for positive FOBT. Conclusion: Colonoscopy for post-ad surveillance but not colonoscopy for post-crc surveillance is associated with a lower risk of diagnosis of advanced adenoma and cancer. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

In this paper, we propose an electronic cleansing method using a novel reconstruction model for removing tagged materials (TMs) in computed tomography (CT) images. To address the partial volume (PV) and pseudoenhancement (PEH) effects concurrently, material fractions and structural responses are integrated into a single reconstruction model. In our approach, colonic components including air, TM, an interface layer between air and TM, and an interface layer between soft-tissue (ST) and TM (ILST/TM) are first segmented. For each voxel in ILST/TM, the material fractions of ST and TM are derived using a two-material transition model, and the structural response to identify the folds submerged in the TM is calculated by the rut-enhancement function based on the eigenvalue signatures of the Hessian matrix. Then, the CT density value of each voxel in ILST/TM is reconstructed based on both the material fractions and structural responses. The material fractions remove the aliasing artifacts caused by a PV effect in ILST/TM effectively while the structural responses avoid the erroneous cleansing of the submerged folds caused by the PEH effect. Experimental results using ten clinical datasets demonstrated that the proposed method showed higher cleansing quality and better preservation of submerged folds than the previous method, which was validated by the higher mean density values and fold preservation rates for manually segmented fold regions. [ABSTRACT FROM PUBLISHER]

Abstract: The aim of this work was to apply flow cytometry in order to assess and compare the viability of freeze-dried entrapped bacteria with an usual technique by quantification by plate count techniques. It also aimed at studying the effect of various cryoprotectants on the viability of an entrapped Bifidobacterium bifidum subjected to freeze-drying to check their ability to be delivered all along the gastro-intestinal tract. The alginate–pectinate beads were chosen as the encapsulation matrix added with different protectants. The beads were characterized by scanning electron microscopy and the viability was checked by both methods. The best combination to improve viability of entrapped bacteria subjected to freeze-drying is made of glycerol 20% (one cryoprotectant) and sodium ascorbate 10% (one anti-oxidative compound). This study also demonstrates that flow cytometry allows assessment of entrapped bacteria viability. Indeed we showed that viability evaluated by plate method is correlated to that obtained by flow cytometry. So, flow cytometry is a rapid method to determine cell viability after encapsulation and freeze-drying. Finally, these beads seem to be a promising probiotic delivery system to target the colon. [Copyright &y& Elsevier]

The article discusses a survey of patients undergoing elective colonoscopy in a major regional hospital regarding their perceptions and expectations of sedation/anesthesia for this procedure. Results show that patient perception about their sedation/anaesthesia was highly variable. Perception was also affected both by having had a previous colonoscopy and by having had a discussion with an anaesthetist before the day of procedure. Procedural awareness produced the highest level of concern.

Background/Aims: Ischemic colitis has a clinical spectrum ranging from mild reversible colitis to an acute fulminant course. Early and accurate diagnosis is therefore mandatory for a good clinical outcome. The aim of this study is to evaluate the efficacy and safety of a colonoscopy and histological examination with biopsy in the early and accurate diagnosis of ischemic colitis. Methods: We investigated the clinical characteristics and endoscopic findings with the histopathology of 89 cases of ischemic colitis from October 2002 to August 2012 in a tertiary-care hospital. All patients underwent a colonoscopy with biopsy within a few days of the onset of symptoms, and the histological features from the biopsy specimens were reviewed. In addition, the occurrence of complications by colonoscopy with biopsy was evaluated. Results: The mean age of the patients was 65.8±12.6 years (male:female, 1:2.2). The major combined disorders were hypertension (51.7%), diabetes (31.5%), and arrhythmia (19.1%). The clinical features usually presented with hematochezia (83.1%), abdominal pain (77.5%), and diarrhea (60.7%). The involved patterns were the left colon (56.2%), right colon (39.3%), and pancolon (4.5%). Based on the main histological features of ischemic colitis, including glandular atrophy (67.4%), hemorrhage (61.8%), capillary thrombi (42.7%), and coagulative necrosis of mucosa (29.2%), 67 of the 89 cases (75.3%) could be confirmed with ischemic colitis. There were no serious complications such as bowel perforation or major bleeding following the colonoscopy with biopsy. Conclusions: A colonoscopy with biopsy is beneficial and safe for the early and precise diagnosis of ischemic colitis. [ABSTRACT FROM AUTHOR]

Background: The water method of colonoscopy has been shown to increase adenoma detection rate in the United states veteran population, but this has not yet been demonstrated in a non-veteran community setting in the United states. Aims: Our aim is to perform a retrospective study to compare adenoma detection rate between the air and the water colonoscopy methods for screening colonoscopies at a non-veteran community site. Methods: We performed a retrospective review of 100 patients from before and after a single community endoscopist transitioned from air colonoscopy to water colonoscopy. The patients selected were the 50 most recent patients who presented for air colonoscopy and the first 50 patients who underwent water colonoscopy after the transition. patients who presented for indications other than colon cancer screening or surveillance were excluded. The primary end point was overall adenoma detection rate; secondary end points included cecal intubation time, procedure time, polyp detection rate, proximal colon adenoma detection rate, and sedation requirement. Results: There was no significant difference between the two methods in total adenoma detection rate, polyp detection rate, cecal intubation time, total procedure time, or sedation requirement. however, there was a significantly higher proximal adenoma detection rate (34%) with the water method compared to the air method (18%), p=0.015. Conclusion: In a non-veteran community setting, screening colonoscopy done with the water method resulted in a significantly higher proximal colon adenoma detection rate without significantly adding to total procedure time or sedation requirement. [ABSTRACT FROM AUTHOR]

Purpose: Water-aided colonoscopy, immersion (WI) or exchange (We), minimizes insertion pain and reduces sedation. We improves adenoma detection rates (ADR). In a performance improvement program, we assessed water-aided methods in a busy community GI practice in Canada. Methods: Over a 13 month period patients were offered water-aided colonoscopy with an option to complete the examination with on-demand sedation. WI was used in the first 1-2 months and replaced exclusively with We thereafter. procedural outcomes were compared to a continuous retrospective cohort of standard sedated air insulation (AI) colonoscopy. Results: 200 (106M/94F) water-aided colonoscopies were completed. cecal intubation without air insulation was achieved in 93%. sedation was not required in 95% of patients accepting on-demand sedation. Average insertion time was 15 min with an average withdrawal time of 6 min. 145 (87M/58F) water-aided colonoscopies, completed for screening or surveillance were compared to a cohort of 145 (77M/68F) AI colonoscopies in the immediate prior period. The overall ADR of water-aided colonoscopy was 30% (43/145) with a proximal ADR of 21%. Using AI the overall ADR was 27.6% (40/145) with a proximal ADR of 14.5% (21/145). In males, the proximal colon ADR was 25% in water-aided colonoscopies and 14.3% using AI (p=0.0397). Conclusions: Water-aided colonoscopy is feasible in a busy community practice with respectable cecal intubation rates. A large percentage of patients consenting to on-demand sedation completed without sedation. ADR in male subjects is consistent with similar prior reports of a significantly higher ADR in the proximal colon using We when compared to AI. [ABSTRACT FROM AUTHOR]

Over the past 10 years, investigators at four Veterans Affairs Medical Centers in the United States devoted considerable expertise reining the method of water immersion colonoscopy. During that period, and through collective, accumulated experience, the technique evolved to its current iteration - water exchange colonoscopy. Water immersion is characterized by suction removal of infused water predominantly during the withdrawal phase of colonoscopy and has a long history of acceptance by colonoscopists. Water exchange is characterized by suction removal of infused water predominantly during endoscope insertion to minimize distention of the colonic lumen. Acquisition of a novel set of skills is necessary for its proper implementation, and its acceptance by practicing colonoscopists is uncertain. The initial goal was to develop a less painful method to accomplish cecal intubation in scheduled unsedated patients. A serendipitous observation revealed that adenoma detection rate was higher in the water exchange group. Accumulating data support the hypothesis that compared with air insulation the water immersion and water exchange methods both significantly reduce pain during colonoscopy, and water exchange is superior to water immersion in minimizing pain and enhancing adenoma detection. Observations confirm that water exchange is efficacious in potentially difficult colonoscopy (unsedated colonoscopy in patients with a history of abdominal surgery). Combined with other adjuncts (indigo carmine or cap) water exchange further enhances adenoma detection. Limited cost benefit analysis data favor water exchange compared to air insulation. The role of water exchange in training novice endoscopists is still being explored. Whether the option of scheduled unsedated colonoscopy facilitated by water exchange will have benefits in minimizing no shows due to unavailability of escort or in optimizing resource utilization by obviating the need for nursing staff for monitoring and recovery remain to be further studied. [ABSTRACT FROM AUTHOR]

Background and Aims: Mast cells, which are important effector cells in food allergy, require a special histologic treatment for quantification in endoscopic gastrointestinal samples. The objective of this study was to investigate whether mast cell tryptase (T), a typical mast cell-associated marker, may help to detect patients with food allergy. Methods: Mast cell T was investigated from 289 colorectal samples of 73 controls, 302 samples from 43 patients with food allergy and gastrointestinal symptoms, and 72 samples from 12 patients with partial or complete remission of allergic symptoms. Endoscopically taken samples were immediately put into liquid nitrogen, mechanically homogenized by a micro-dismembrator with three homogenization steps and tissue T content (ng T/mg wet weight) was measured by fluoroenzyme immunoassay. Results: Tissue T levels from the lower gastrointestinal tract were significantly elevated (p < 0.0001) in patients with manifest gastrointestinal allergy (median: 55.7, range: 9.3-525.0) compared with controls (median: 33.5, range: 8.0-154.6). A subgroup of 12 patients with remission of allergy showed markedly decreased symptom scores and mucosal T levels after more than 1 year of antiallergic therapy (pretreatment median: 54.1, range: 37.0-525.0 and posttreatment median: 28.4, range: 19.8-69.1; p = 0.01). Conclusions: High T levels in the gut of food-allergic patients support the role of stimulated mast cells or an increased mast cell number. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Human colon has complex structures mostly because of the haustral folds. The folds are thin flat protrusions on the colon wall, which complicate the shape analysis for computer-aided detection (CAD) of colonic polyps. Fold segmentation may help reduce the structural complexity, and the folds can serve as an anatomic reference for computed tomographic colonography (CTC). Therefore, in this study, based on a model of the haustral fold boundaries, we developed a level-set approach to automatically segment the fold surfaces. To evaluate the developed fold segmentation algorithm, we first established the ground truth of haustral fold boundaries by experts’ drawing on 15 patient CTC datasets without severe under/over colon distention from two medical centers. The segmentation algorithm successfully detected 92.7% of the folds in the ground truth. In addition to the sensitivity measure, we further developed a merit of segmented-area ratio (SAR), i.e., the ratio between the area of the intersection and union of the expert-drawn folds and the area of the automatically segmented folds, to measure the segmentation accuracy. The segmentation algorithm reached an average value of SAR = 86.2%, showing a good match with the ground truth on the fold surfaces. We believe the automatically segmented fold surfaces have the potential to benefit many postprocedures in CTC, such as CAD, taenia coli extraction, supine-prone registration, etc. [ABSTRACT FROM PUBLISHER]

Aim Management of malignant colorectal polyps (MCP) is contentious, with no randomized controlled trials comparing endoscopic with surgical management. This study reviews the management and outcomes of MCPs across a UK region. Method Patients with a malignant polyp were identified using the NORCCAG (NORthern Colorectal Cancer Audit Group) database between April 2006 and July 2010. All histopathology reports and follow-up procedures were reviewed. Results Of 386 patients identified, 165 (42.7%) had the polyp biopsied and 221 (57.3%) had an endoscopic local excision (37 piecemeal excision, 184 polypectomy). All patients having an endoscopic biopsy underwent surgery. 103 (46.6%) having a local excision had follow-up surgery, of whom 79 (76.7%) had no residual cancer. Of the 118 patients managed endoscopically, none had residual cancer on follow-up endoscopy. The 21 (5.4%) Dukes C cancers were associated with Kikuchi SM3/Haggitt 4 lesions (χ2 = 10.85, P = 0.005) and lesions with an involved/unsure excision margin (χ2 = 7.44, P = 0.017). Predictors of finding residual tumour at surgery after local excision were Kikuchi SM3/Haggitt Level 4 (χ2 = 17.07, P < 0.001) and an involved/unsure excision margin (χ2 = 20.45, P < 0.001). An excision margin > 0 mm was associated with the finding of no residual tumour (χ2 = 25.21, P < 0.001). There was no difference in survival between surgical and endoscopic management (χ2 = 0.634, P = 0.426) after a mean follow-up of 25.1 months. Conclusion Endoscopic management of a subgroup of MCPs appears safe. A clear resection margin (> 0 mm) appears sufficient to avoid surgery, except in locally advanced lesions (Kikuchi 3/Haggitt 4) which have a greater risk of residual cancer at surgery and lymph node metastasis. [ABSTRACT FROM AUTHOR]

Background/Aims: Colonoscopic polypectomy is an effective tool for the treatment of colonic polyps. With the recent widespread use of colonoscopic polypectomy, there is a growing concern about iatrogenic complications, such as bleeding and perforation. The aim of this study is to analyze the clinical presentation and management of complications during colonoscopic polypectomy. Methods: We retrospectively reviewed the medical records of colonoscopic examinations performed at 5 hospitals of Hallym University Medical Center between June 2005 and June 2008. Results: A total of 26,773 colonoscopies and 4,123 colonoscopic polypectomy were performed. The overall rate of complication was 1.04% (43/4,123). Perforation occurred in 0.19% (8/4,123) of cases, and bleeding occurred in 0.85% (35/4,123) of cases. Perforation occurred in 0.05% of snare polypectomies, 1.09% of endoscopic mucosal resections (EMR), and 7.14% of endoscopic submucosal dissections (ESD). Bleeding occurred in 0.8% of snare polypectomies, 1.09% of EMRs, and 3.57% of ESDs. The complication rate of ESDs was higher than in EMRs and snare polypectomies (P<0.001). Endoscopic clippings were performed in 25% of perforation and 66.7% of bleeding cases. Medical treatment was successful in 75% of perforation and 100% of bleeding cases. Conclusions: Colonoscopic polypectomy is a safe procedure for the treatment of colonic polyps, but rarely, serious complications occur. Compared to a snare polypectomy or an EMR, the complication of an ESD occurs more frequently. Endoscopic treatment and further conservative management seems to be appropriate in most cases with complication. [ABSTRACT FROM AUTHOR]

Background/Aims: Conventional colonoscopy is limited in some patients with several causes, such as fixed angulation, extensive loop or adhesion. Therefore, small-caliber scopes are considered alternatives to unsuccessful conventional colonoscopy. The aim of this study is to evaluate the usefulness of gastroscope in patients with unsuccessful colonoscopy. Methods: From May 2008 to April 2009, a total of 2,548 colonoscopies were performed in Wonkwang University Hospital. The gastroscope was used subsequently when conventional colonoscopy failed. Results: There were 27 cases (1.06%) of unsuccessful colonoscopy. The causes of failure were assessed as fixed angulation of the sigmoid colon (59.2%, 16/27), excessive looping (14.8%, 4/27), stricture (14.8%, 4/27), sigmoid diverticulosis (7.4%, 2/27), and adhesion of transverse colon (3.7%, 1/27). The average time of intubation to cecum with the gastroscope was 7 minutes and 28 seconds (range, 2 to 20 minutes). With the gastroscope, 77.8% (21/27) were intubated to the cecum. The pain score of gastroscope was reduced, as compared with that of conventional colonoscopy (4.95 vs. 5.94, P<0.001). Conclusions: Gastroscope would be a useful alternative tool in patients with unsuccessful colonoscopy. [ABSTRACT FROM AUTHOR]