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Background: Demonstrating mortality reduction in new colorectal cancer (CRC) screening programs through randomized clinical trials (RCTs) is challenging. We systematically reviewed single-round program performance outcomes using a stepwise approach proposed by the World Endoscopy Organization CRC Screening Committee framework. Methods: The MEDLINE, EMBASE, Central, and Ichushi Web databases were searched until October 28, 2024, to find RCTs comparing guaiac-based and immunochemical fecal occult blood testing (gFOBT and FIT), flexible sigmoidoscopy (FS), computed tomographic colonography (CTC), and total colonoscopy (TCS). Paired reviewers screened studies, extracted data, and assessed bias risk. A Bayesian random-effects network meta-analysis was conducted, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. The primary outcome was advanced neoplasia (AN) detection, and the secondary outcomes were participation and colorectal cancer (CRC) detection, all during the first screening round. Results: Eighteen RCTs (437,072 invitees) were included. The risk of bias was low or raised some concerns for screening participation, but it was high for detection outcomes. In the network meta-analysis of 15 RCTs not allowing crossover, the FIT-based program had a higher AN detection rate than the gFOBT-based program (relative risk [RR] 2.48; 95% credible interval [CrI] 1.52–4.21; moderate certainty). AN detection rates were not different in the CTC- (RR 1.01; CrI 0.43–2.23; very low certainty) and TCS-based (RR 1.03; CrI 0.54–1.78; low certainty) programs compared with the FS-based program. All the visualization modality programs had higher AN detection rates than the FIT-based program (FS: RR 2.13 [CrI 1.38–3.77]; CTC 2.16 [1.11–4.51]; and TCS 2.19 [1.43–3.48]; all with low certainty). Low event rates precluded definitive conclusions regarding CRC detection (very low to low certainty). The TCS-based program had the worst participation rate (very low to low certainty). Comparative data allowing crossover were limited. Conclusions: This is the first network meta-analysis that evaluates program-level initial performance indicators. FIT-based programs likely detect more AN cases than gFOBT-based programs, while FS-, CTC-, and TCS-based programs may outperform FIT. Due to limitations in first-round results, long-term outcomes should be assessed after 10–15 years. [ABSTRACT FROM AUTHOR]

Introduction: Direct oral anticoagulants (DOACs) are frequently used to prevent embolism in atrial fibrillation. Gastrointestinal bleeding is frequent, but its drug-specific characteristics remain unclear. This study examined the frequency and characteristics of gastrointestinal bleeding in patients with nonvalvular atrial fibrillation for different DOACs. Methods: The present study included 978 patients receiving treatment with DOACs for nonvalvular atrial fibrillation between 2011 and 2018 and examined the frequencies of clinically significant events including major cardiovascular and cerebrovascular events, hemorrhagic events, or death during the first 5 years of prescription. Gastrointestinal bleeding was evaluated for the frequency, source and severity of gastrointestinal bleeding by DOAC type. Results: The median age of subjects was 73 years (interquartile range, 65–80 years), and 622 (64%) were male. The overall observation period was 2499 person-years. During this period, 102 (4.1/100 person-years) major cardiovascular events and 107 (4.3/100 person-years) clinically significant bleeding were reported, including 60 cases (2.4/100 person-years) of gastrointestinal bleeding and 37 cases (1.5/100 person-years) of all-cause mortality. Gastrointestinal bleeding accounted for more than half of all bleeding events among DOAC users, and bleeding from the lower gastrointestinal tract was more common than that from the upper gastrointestinal tract, particularly with dabigatran. No significant difference was seen in the rate of gastrointestinal bleeding by drug type. Peptic ulcer accounted for half of the events of upper gastrointestinal bleeding, all of which were severe. Conclusions: Gastrointestinal bleeding is frequent among patients taking DOACs, especially from the lower alimentary tract. The tendency was more pronounced with dabigatran. In the upper gastrointestinal tract, severe peptic ulcer bleeding is common and requires caution. [ABSTRACT FROM AUTHOR]

Introduction: Colonoscopy screening has been suggested as a potential primary screening method for colorectal cancer (CRC). A 10-year screening interval has been recommended by some academic societies, but the scientific evidence for this needs to be more comprehensive. We performed a systematic review of interval cancer rates in colonoscopy screening in an asymptomatic population. Methods: We searched the PubMed and Ichushi-Web bibliographic databases for papers published from inception to September 2022. The search terms were "colorectal cancer screening", "interval cancer", and "total colonoscopy". Randomized controlled trials and observational studies were included. The target population was an asymptomatic average-risk population with no polyps or adenomas at the index colonoscopy. Advanced neoplasia (AN) was defined as CRC or an adenoma at least 10 mm in size with a villous component or high-grade dysplasia. The incidence rates of interval CRC and AN per 100,000 person-years (PYs) were estimated. Results: Of the 694 potentially eligible articles, 15 were included. Rates of interval CRC and AN were reported in 15 and 11 studies, respectively. For the meta-analysis, 287,602 patients with negative colonoscopy results were included, with an average follow-up of 7.98 years. Negative colonoscopy results were defined as no adenoma present. The incidence rate per 100,000 PYs was 9.57 (95% confidence interval [CI]: 2.06, 29.94) for interval CRC and 311.5 (95%CI: 153.4, 550.7) for AN. Similar results were obtained even when a negative colonoscopy result was defined as no polyps present. Conclusions: The selected studies were heterogeneous with respect to the target population, follow-up years, and patient characteristics. Although interval AN was reported in all studies, the interval cancer rate was low after a negative result at the index colonoscopy. While the screening interval might be defined as long term, a definitive screening interval could not be recommended because of insufficient evidence. [ABSTRACT FROM AUTHOR]