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INTRODUCTION: Variation in endoscopist performance contributes to poor-quality colonoscopy. Audit and feedback (A/F) can be used to improve physician performance, particularly among lower performing physicians. In this large pragmatic randomized controlled trial, we compared A/F to improve endoscopists’ colonoscopy performance to usual practice. METHODS: Endoscopists practicing in Ontario, Canada, in 2014 were randomly assigned in October 2015 (index date) to receive (intervention group, n 5 417) or not receive (control group, n 5 416) an A/F report generated centrally using health administrative data. Colonoscopy performance was measured in both groups over two 12-month periods: prereport and postreport (relative to the index date). The primary outcome was polypectomy rate (PR). Secondary outcomes were cecal intubation rate, bowel preparation, and premature repeat after normal colonoscopy. A post hoc analysis used adenoma detection rate as the outcome. Outcomes were compared between groups for all endoscopists and for lower performing endoscopists using Poisson regression analyses under a difference-in-difference framework. RESULTS: Among all endoscopists, PR did not significantly improve from prereport to postreport periods for those receiving the intervention (relative rate [RR], intervention vs control: 1.07 vs 1.05, P 5 0.09). Among lower performing endoscopists, PR improved significantly (RR, intervention vs control 1.34 vs 1.11, P 5 0.02) in the intervention group compared with controls. In this subgroup, adenoma detection rate also improved but not significantly (RR, intervention vs control 1.12 vs 1.04, P 5 0.12). There was no significant improvement in secondary outcomes between the intervention and control groups. DISCUSSION: A/F reports for colonoscopy improve performance in lower performing endoscopists. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The present study aims to report the incidence of colorectal cancer patients under 50 years of age and to compare its aggressiveness with colorectal cancer patients over 50 years of age. BACKGROUND: Recently, the incidence of colorectal cancer at younger ages has increased, and colorectal cancers in young people have a more aggressive course due to late screening programs. METHOD: The files of patients who were operated for colorectal cancer were reviewed retrospectively. Information on the patients such as gender, age, BMI, type and duration of symptoms, location of the tumor, TNM staging, pathology results, operative procedure, morbidity and mortality rates were recorded. Admission complaints, symptom onset time, tumor locations, pathological findings and tumor stages were compared between patients under and over the age of 50. RESULTS: The incidence of colorectal cancer under 50 was 21 % (56/267). The age group of 40-49 was found to be the most common age range under the age of 50, with a colorectal cancer rate of 68%. In patients under the age of 50, higher invasion of the tumor to the serosa, low differentiation of the tumor in terms of histological findings in a higher number of patients and higher mucin component of the tumors and higher N2 lymph node involvement ratio and the tumor was located more in the lower rectum were statistically significant when compared to patients over the age of 50 (p=0.026, p=0.018, p=0.002, p=0.042, p=0.006; respectively). CONCLUSION: The incidence of colorectal cancer has increased at younger ages and has a more aggressive course. [ABSTRACT FROM AUTHOR]

The article reports on sending information about the result of a colonoscopy in Germany. Sending a doctor's letter by post is a common means of maintaining the flow of information. It is not reasonable to ensure that every doctor's letter arrives. The situation is different only if problems with delivery are known from previous cases or if a highly pathological finding is to be reported that requires further time-critical treatment steps.

The article focus on Colonoscopy, which is being performed routinely for colorectal cancer (CRC) screening. Topics include the primary goals of colonoscopy screening and post-polypectomy surveillance are to reduce CRC incidence andmortality; risk for incident and fatal CRC among individuals with baseline SSP is uncertain; and CRC incidence and mortality are decreasing secondary to improvements in risk factor exposures, screening, treatment to surveillance among patients with polyps.

OBJECTIVES: Some neoplastic lesions remain undetected on colonoscopy. To date, no studies have investigated whether combining cap-assisted colonoscopy with chromoendoscopy increases the adenoma detection rate (ADR). This study aimed to compare cap-assisted chromoendoscopy (CAP/CHROMO) with standard colonoscopy (SC) with respect to their efficacy in detecting adenomas. METHODS: This prospective, multicenter, randomized controlled trial included asymptomatic subjects aged 45-75 years who underwent colonoscopy for the first time at 14 university hospitals. Subjects were randomized to either the CAP/CHROMO group (with 0.09% indigo carmine spraying using a capmounted catheter at the tip of the colonoscope) or the SC group. All polyps were resected, but only histologically confirmed neoplastic lesions were considered for analysis. The primary outcome was ADR, defined as the proportion of subjects with at least 1 adenoma. RESULTS: A total of 1,905 subjects were randomized to the CAP/CHROMO (n5948) or SC (n5957) group at 14 centers. Subjects' demographic characteristics were similar between both groups. The CAP/CHROMO group had significantly higher ADR than the SC group (54.4% vs 44.9%, P < 0.001). Significantly, more subjects with at least 1 proximal colon adenoma were identified by CAP/CHROMO (38.6%) than by SC (31.2%) (P 5 0.001). The proximal serrated polyp detection rate by CAP/CHROMO was significantly higher in the female subgroup vs SC. However, advanced ADR was not different between the CAP/CHROMO and SC groups (9.3% vs 7.6%, P 5 0.180). DISCUSSION: CAP/CHROMO markedly improved the ADR and enhanced the detection of proximal adenoma. CAP/CHROMO is feasible for routine application and will allow for a more effective surveillance program. [ABSTRACT FROM AUTHOR]

One of the main challenges in designing diagnostic devices able to move along the colon is their locomotion method. Generating friction without applying high normal forces is a key requirement in order to eliminate the risk of tissue damage. One possible solution is to generate friction by means of adhesive forces. For this reason, the device can be covered with mucoadhesive films, which are able to stick on the colonic surface. This paper identifies that the friction of mucoadhesive films depends strongly on their geometry. It seems therefore feasible to adapt the level of the friction to the properties of the colonic surface by altering the geometry of the films covering the device. Moreover, an eventual influence of the film geometry on the generated friction can reveal film shapes which create high grip despite their small size, leading to a decrease in the overall size of the device. The aim of the paper is to test in vitro the relationship between film geometry and generated friction, to fit the experimental findings in a simplified but generic macroscopic theoretical model able to predict the behavior of various geometries, and to embed those findings in the principles of the design implementation. [ABSTRACT FROM AUTHOR]

Purpose: To compare the distribution of extracolonic findings and clinical outcomes between screening and diagnostic CT colonography (CTC) populations.Methods: 388 consecutive patients (369 men, 19 women; mean ± SD age 67.8 ± 10 years) who underwent first-time CTC (4/2011-4/2017) at a Veteran's Affairs Medical Center were divided into screening (asymptomatic) or diagnostic (symptomatic) cohorts based on CTC indication. CTC reporting and data system E-scores for extracolonic findings were retrospectively assigned based on prospective CTC radiologic reports. Multinomial logistic regression was used to examine the association between E-scores and CTC indication. Electronic medical records of all patients with E3 or E4 scores were reviewed (median follow-up 2.8 years) to determine clinical outcomes.Results: 68% (262/388) underwent screening and 32% (126/388) diagnostic CTC. 7.2% (28/388) had extracolonic findings considered potentially significant (E4), 4.4% (17/388) had indeterminate but likely unimportant findings (E3), and 88.4% (347/388) had normal or unimportant findings (E1 or E2). E-scores were not significantly different between screening and diagnostic CTC when adjusted for age, gender, and prior imaging (p = 0.44). 4.6% (12/262) of patients with E3/E4 findings in the screening cohort demonstrated clinically significant outcomes, compared with 4.0% (5/126) in the diagnostic cohort, including a total of three extracolonic malignancies (0.8%) and three abdominal aortic aneurysms (0.8%). 4.6% (18/388) underwent follow-up imaging studies to confirm a benign outcome after detection of a category E3/E4 finding.Conclusions: The distribution of extracolonic findings and clinical outcomes were not statistically significantly different between screening and diagnostic CTC populations. [ABSTRACT FROM AUTHOR]

Objective: To assess the utility of virtual monochromatic imaging (VMI) using a dual-layer spectral detector CT for electronic cleansing in fecal-tagging CT colonography (CTC).Methods: This study included 35 patients who underwent fecal-tagging CTC with a dual-layer detector spectral CT scanner. Conventional images at 120 kVp and VMI at 40, 50, and 60 keV were reconstructed. Quantitative image quality parameters, i.e., tagging density and image noise, were compared and the visual image quality was scored on a four-point scale. We recorded the number of the colon segments with appropriate tagging density (≥300 HU) for each patient and used these data to compare the reconstructions. In addition, electronic cleansing performance was semi-quantitatively assessed using a four-point scale.Results: The mean tagging density on VMI was significantly higher than that on conventional 120 kVp images. The number of colon segments with appropriate tagging density on VMI were significantly higher than that on conventional 120 kVp images. There was no significant difference among the reconstructed images with respect to image noise. Scores for subjective image quality and electronic cleansing performance on VMI were significantly higher than those on conventional 120 kVp images.Conclusion: With dual-layer spectral detector CT, VMI can yield significantly better fecal-tagged CTC image quality and improve electronic cleansing performance. [ABSTRACT FROM AUTHOR]

Colon capsule endoscopy (CCE) is designed for direct visualization of the colonic mucosa through passive propulsion. The role of CCE in the detection of colonic polyps has been extensively evaluated. As mucosal healing has emerged as a pivotal target for treatment of inflammatory bowel disease (IBD), there is increasing data to suggest that CCE can also be used in the monitoring of mucosal inflammation in patients with active IBD, particularly in ulcerative colitis (UC) and Crohn's disease (CD). Despite advantages such as its non‐invasive nature, patient's comfort, safety, and access to anatomical regions not easily reached by conventional endoscopy, CE has limitations including the lack of ability to obtain biopsies or therapeutic capabilities and no control over movement. In this review, the role and diagnostic value of CCE on diagnosis and monitoring of UC and CD patients, its safety and limitations are discussed. [ABSTRACT FROM AUTHOR]

In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;68:250-281. © 2018 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Bowel cancer is the second most common internal malignancy in Australia. Bowel cancer is suited to community screening methods such as faecal occult blood testing and colonoscopy. Typical reporting of histopathology results after colonoscopy takes 3–5 days. Patients were given written instructions to call the clinician within 3–5 days to discuss the histopathology results. The objective of the study was to perform an audit whether patients call the clinician to discuss their histopathology results after undergoing a colonoscopy, gastroscopy or both. Methods: A retrospective study was performed of patients attending for gastroscopy or colonoscopy at a single colorectal clinic at Cabrini Hospital, Melbourne, between 1 January and 31 December 2014. Age, pre‐scope category and compliance with written instructions to callback were analysed. Results: A total of 176 patients met the selection criteria, of whom 32.9% did not callback to discuss their histopathology results. Age and pre‐scope category were independent predictors for patients to callback after endoscopy. The mean age of the patients who called back was higher (P < 0.01). Compared with patients who had a previous polyp or resection, patients in the pre‐scope category of faecal occult blood testing/screening were more likely to callback (odds ratio: 4.37; 95% confidence interval: 1.17–16.31). Conclusion: Patients undergoing a colonoscopy for the purposes of screening and older patients were more likely to callback. Patients aged 62 years and younger were less likely to callback and should be targeted. Enhancements to the way information is presented to patients (e.g. video) should be considered for future studies. [ABSTRACT FROM AUTHOR]

The article presents author's views on improvement in standard surgical practice and quality of care for improved in patient outcomes. Topics discussed include adenoma detection rate (ADR) and caecal intubation rate; bowel cancer screening programme in Great Britain and quality of colonoscopy; and Cancer Council Australia (CCA).

Aims: The integrity of the band of indigenous macrophages in the subepithelial layer of the lamina propria (SLP) is crucial in preventing the commensal gut microbiota from attacking the host. The breakdown of the SLP macrophage barrier results in microbiota inflow and improper immune responses; this might lead to inflammatory bowel disease (IBD). During inflammation, the SLP macrophage barrier is reinforced by inflammation‐elicited macrophages (IEMs), which are derived from blood‐circulating monocytes. The aim was to explore the characteristics of the SLP macrophage band in a cohort of biopsies without inflammation, in patients with ulcerative colitis in remission (UCre), and in patients with right‐sided Crohn's colitis (RCC). Methods and results: Endoscopic biopsies were taken from endoscopically normal descending colon in 247 patients; 80 with IBD (27 UCre and 53 RCC), and 167 without IBD [90 had colonic diarrhoea, 63 were enrolled in a colorectal cancer (CRC) surveillance programme, seven had microscopic colitis in remission, and seven had miscellaneous colonic ailments]. Sections showed no inflammatory changes; they were immunostained with CD68. Among patients with UCre and RCC, the SLP band of CD68+ macrophages was fragmented or minute in 59% (47/80) and negative in 9% (7/80). In contrast, only 31% (51/167) of the biopsies from control patients had a fragmented/minute SLP band of CD68+ macrophages, and none had a negative SLP band of CD68+ macrophages (IBD versus controls, P < 0.05). Conclusions: The finding that the SLP macrophage barrier was fragmented to totally abrogated in UCre and RCC patients suggests a longlasting defect in the SLP CD68+ macrophage barrier in these patients. The lack of ongoing inflammation in colonic biopsies should rule out the participation of bone marrow‐derived IEMs in the abrogation of the SLP macrophage barrier reported here. [ABSTRACT FROM AUTHOR]

Background: With the aging of the population and rising incidence of thromboembolic events, the usage of antiplatelet agents is also increasing. There are few reports yet on the management of antiplatelet agents for patients undergoing colorectal endoscopic submucosal dissection (ESD).Aims: The aim of this study is to evaluate whether continued administration of antiplatelet agents is associated with an increased rate of delayed bleeding after colorectal ESD.Methods: A total of 1022 colorectal neoplasms in 927 patients were dissected at Yokohama City University Hospital and its three affiliate hospitals between July 2012 and June 2017. We included the data of 919 lesions in the final analysis. The lesions were divided into three groups: the no-antiplatelet group (783 neoplasms), the withdrawal group (110 neoplasms), and the continuation group (26 neoplasms).Results: Among the 919 lesions, bleeding events occurred in a total of 31 (3.37%). The rate of bleeding after ESD was 3.3% (26/783), 4.5% (5/110), and 0% (0/26), respectively. There were no significant differences in the rate of bleeding after ESD among the three groups (the withdrawal group vs. the no-antiplatelet group, the continuation group vs. the no-antiplatelet group, and the withdrawal group vs. the continuation group).Conclusions: Continued administration of antiplatelet agents is not associated with any increase in the risk of delayed bleeding after colorectal ESD. Prospective, randomized studies are necessary to determine whether treatment with antiplatelet agents must be interrupted prior to colorectal ESD in patients who are at a high risk of thromboembolic events. [ABSTRACT FROM AUTHOR]

Aim: Two major ways to locate the ileocecal valve (ICV) are to look for a thickening or bulge on the ileocecal fold, and the other is the "bow and arrow" method or the "appendix trick". The aim of this study was to determine the accuracy of "bow and arrow" method to locate the ICV during colonoscopy. Patients and Methods: Colonoscopy was performed with the patients in the left lateral position. After cecal intubation had been confirmed, the appendiceal opening was identified, with the curve serving as the bow, an imaginary arrow was placed across the curve toward the appendix lumen. The tip of the imaginary arrow was then followed to confirm if it correlated to the location of the ICV. Results: The "bow and arrow" accurately located the ICV in 105 (76.6%) patients, but failed in 32 (23.4%) patients. The mean age (56.2 ± 13.1 years) of the patients in whom the "bow and arrow" located the ICV was lower than that (62.7 ± 0.9 years) of the patients in whom it failed to locate the ICV. Males, 58 (71.6%) had positive "bow and arrow", while this was observed in 47 (83.9%) females. It correctly located the ICV in 73 (53.3%) of those with thin-lip ICV, 20 (14.6%) of those with volcanic type, and 12 (8.8%) of those with double bulge ICV. Conclusion: The bow and arrow sign could not locate the ICV in all cases in our practice and so where it failed, alternative method should be employed to locate the ICV. [ABSTRACT FROM AUTHOR]

Background. Adenoma detection rate (ADR) is a validated quality measure for screening colonoscopy, but there are little data for other indications. The distribution of adenomas is not well described for these indications. Aim. To describe ADR and the adenoma distribution in the proximal and distal colon based on colonoscopy indication. Methods. Outpatient colonoscopies are subdivided by indication. PDR and ADR for the entire colon and for proximal and distal colon. Data were compared using generalized estimating equations to adjust for clustering amongst endoscopists while controlling for patient age and gender. Results. 3436 colonoscopies were reviewed (51.2%: men (n=1759)). Indications are screening 49.2%, surveillance 29.3%, change in bowel habit 8.4%, bleeding 5.8%, colitides 3.0%, pain 2.8%, and miscellaneous 1.5%. Overall ADR was 37% proximal ADR 28%, and distal ADR 17%. PDR and ADR were significantly higher in surveillance than in screening (PDR: 69% versus 51%; ADR: 50% versus 33%; p=0.0001). Adenomas were more often detected in the proximal than in the distal colon, for all indications. Conclusions. Prevalence of polyps and adenomas differs based on colonoscopy indication. Adenoma detection is highest in surveillance and more commonly detected in the proximal colon. For quality assurance, distinct ADR and PDR targets may need to be established for different colonoscopy indications. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Effective screening colonoscopy depends on the quality of colon preparation. This study aimed to compare pulsed irrigation evacuation (PIE), polyethylene glycol (PEG) and sodium phosphate colon preparations. METHODS: Outpatients at a VA hospital were randomized using sealed envelopes. Preparations consisted of polyethylene glycol 4L, Fleet sodium phosphate 90 mL with four to six glasses water twice daily and 296 mL of magnesium citrate in the evening with PIE prior to colonoscopy. Colon cleansing was assessed blindly using a five‐point scale: 0 (very poor) to 4 (excellent). RESULTS: Altogether 391 patients participated in the study (129 in the PEG group, 127 in the sodium phosphate and 135 in the PIE group), with a mean age of 62 years, of whom 75% were men. PIE and sodium phosphate were superior to PEG: median cleansing scored 4 (excellent) versus 3 with PEG (P < 0.01). Inadequate preparations were more common with PEG than PIE (18% vs 5%) (P < 0.01). Side‐effects included vomiting: 37% in the sodium phosphate group versus 5% in the PEG and 2% in the PIE groups (P < 0.01). The three preparations were judged intolerable in ≤ 5%. CONCLUSIONS: PIE and sodium phosphate are superior to PEG for colon preparations. PIE is the preferred preparation for those at high risk of unsatisfactory preparations or with unsatisfactory traditional preparations. [ABSTRACT FROM AUTHOR]

Background and Aim The role of screening or diagnostic colonoscopy to detect advanced neoplasia in young cohorts of age < 50 is unclear. This study compared the risk of colorectal neoplasia in a young age cohort against that in 50-54s screening cohort. Methods A multi-center retrospective study was conducted at 14 university hospitals to compare the detection rates of neoplasia and advanced neoplasia in screening or diagnostic colonoscopy in the young cohort of < 50s against those in screening colonoscopy in the 50-54s cohort. Results Among 10 477 eligible subjects, 9765 subjects were enrolled after excluding 712 subjects. Advanced neoplasia detection rates in the young screening cohort was significantly lower than that in the 50-54s screening cohort (5.9% vs 9.3%, P < 0.001). Compared with 50-54s screening cohort, the risk of advanced neoplasia was significantly reduced by 23%, 53%, and 54% in the 45-49s, 40-44s, and 20-39s screening cohorts, respectively. The detection rates of advanced neoplasia in the young diagnostic cohort was 5.0%, which was much lower than 11.8% in 50-54s screening cohort ( P < 0.001). Compared with the 50-54s screening cohort, the risk of advanced neoplasia was significantly reduced by 50%, 66%, and 71% in the 45-49s, 40-44s, and 20-39s diagnostic cohorts, respectively. Conclusions Colonoscopy to detect advanced neoplasia in young adults aged < 50 years should be reconsidered as their risk of advanced neoplasia on screening or diagnostic colonoscopy was much lower than those of 50-54s screening cohort; however, colonoscopy screening may be justified for high-risk 45-49s cohorts. [ABSTRACT FROM AUTHOR]

Background and Aim In Western countries, endoscopic removal of all adenomas during colonoscopy is recommended. The present study evaluates the usefulness of magnifying colonoscopy without removal of diminutive (≤5 mm) colorectal polyps. Methods Patients with diminutive polyps who were observed for over 5 years using magnification at Hiroshima University Hospital were selected retrospectively. Lesions ≥6 mm in size, depressed lesions, and lesions with type V pit pattern were indications for endoscopic resection. We investigated the characteristics of lesions indicated for endoscopic resection detected on surveillance colonoscopy and the risk factors for the incidence of lesions indicated for endoscopic resection. Results A total of 706 consecutive patients were enrolled. Sixty-eight lesions indicated for endoscopic resection were detected, averaging 9.0 ± 4.8 mm, and 33 (49%) lesions were located in the right colon. Pathological diagnoses were adenoma, Tis carcinoma, and T1 carcinoma in 58 (85%), eight (12%), and two (3%) lesions, respectively. Five lesions were considered to grow from previously detected diminutive polyps. Relative risks for the incidence of a lesion indicated for endoscopic resection were 1.76 (95% confidence interval [ CI], 1.004-3.23) for males compared with females, 3.76 (95% CI, 2.03-7.50) for more than three polyps at initial colonoscopy compared with one polyp, and 2.84 (95% CI, 1.43-5.24) for patients with carcinoma at initial colonoscopy compared with patients with no lesion indicated for endoscopic resection. Nine carcinomas were resected endoscopically. Conclusion Diminutive low-grade adenomas detected by using magnifying colonoscopy may not necessarily require removal. [ABSTRACT FROM AUTHOR]

Objective: Reliable noninvasive biomarkers for early detection of colorectal cancer (CRC) are highly desirable for efficient population-based screening with high adherence rates. We aimed to discover and validate blood-based protein markers for the early detection of CRC. Patients and methods: A two-stage design with a discovery and a validation set was used. In the discovery phase, plasma levels of 92 protein markers and serum levels of TP53 autoantibody were measured in 226 clinically recruited CRC patients and 118 controls who were free of colorectal neoplasms at screening colonoscopy. An algorithm predicting the presence of CRC was derived by Lasso regression and validated in a validation set consisting of all available 41 patients with CRC and a representative sample of 106 participants with advanced adenomas and 107 controls free of neoplasm from a large screening colonoscopy cohort (N=6018). Receiver operating characteristic (ROC) analyses were conducted to evaluate the diagnostic performance of individual biomarkers and biomarker combinations. Results: An algorithm based on growth differentiation factor 15 (GDF-15), amphiregulin (AREG), Fas antigen ligand (FasL), Fms-related tyrosine kinase 3 ligand (Flt3L) and TP53 autoantibody was constructed. In the validation set, the areas under the curves of this five-marker algorithm were 0.82 (95% CI, 0.74-0.90) for detecting CRC and 0.60 (95% CI, 0.52-0.69) for detecting advanced adenomas. At cutoffs yielding 90% specificity, the sensitivities (95% CI) for detecting CRC and advanced adenomas were 56.4% (38.4%-71.8%) and 22.0% (13.4%-35.4%), respectively. The five-marker panel showed similar diagnostic efficacy for the detection of early- and late-stage CRC. Conclusion: The identified most promising biomarkers could contribute to the development of powerful blood-based tests for CRC screening in the future. [ABSTRACT FROM AUTHOR]

BACKGROUND Patient, physician, and environmental factors were identified, and the authors examined the contribution of these factors to demographic and health variation in colonoscopy follow-up after a positive fecal occult blood test/fecal immunochemical test (FOBT/FIT) screening. METHODS In total, 76,243 FOBT/FIT-positive patients were identified from 120 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011 and were followed for 6 months. Patient demographic (race/ethnicity, sex, age, marital status) and health characteristics (comorbidities), physician characteristics (training level, whether primary care provider) and behaviors (inappropriate FOBT/FIT screening), and environmental factors (geographic access, facility type) were identified from VHA administrative records. Patient behaviors (refusal, private sector colonoscopy use) were estimated with statistical text mining conducted on clinic notes, and follow-up predictors and adjusted rates were estimated using hierarchical logistic regression. RESULTS Roughly 50% of individuals completed a colonoscopy at a VHA facility within 6 months. Age and comorbidity score were negatively associated with follow-up. Blacks were more likely to receive follow-up than whites. Environmental factors attenuated but did not fully account for these differences. Patient behaviors (refusal, private sector colonoscopy use) and physician behaviors (inappropriate screening) fully accounted for the small reverse race disparity and attenuated variation by age and comorbidity score. Patient behaviors (refusal and private sector colonoscopy use) contributed more to variation in follow-up rates than physician behaviors (inappropriate screening). CONCLUSIONS In the VHA, blacks are more likely to receive colonoscopy follow-up for positive FOBT/FIT results than whites, and follow-up rates markedly decline with advancing age and comorbidity burden. Patient and physician behaviors explain race variation in follow-up rates and contribute to variation by age and comorbidity burden. Cancer 2017;123:3502-12. Published 2017. This article is a US Government work and is in the public domain in the USA. [ABSTRACT FROM AUTHOR]

Background/Aims: Few studies have evaluated the use of a smartphone application (app) for educating people undergoing colonoscopy and optimizing bowel preparation. Therefore, this study was designed to develop a smartphone app for people to use as a preparation guide and to evaluate the efficacy of this app when used prior to colonoscopy. Methods: In total, 142 patients (male:female=84:58, mean age=43.5±9.3 years), who were scheduled to undergo a colonoscopy at Myongji Hospital, were enrolled in this study. Seventy-one patients were asked to use a smartphone app that we had recently developed to prepare for the colonoscopy, while the 71 patients of the sex and age-matched control group were educated via written and verbal instructions. Results: The quality of bowel cleansing, evaluated using the Boston Bowel Preparation Scale, was significantly higher in the smartphone app group than in the control group (7.70±1.1 vs. 7.24±0.8, respectively, p=0.007 by t-test). No significant differences were found between the two groups regarding work-up time and the number of patients with polyps. Conclusions: In this study, targeting young adults (⩽50 years), the bowel preparation achieved by patients using the smartphone app showed significantly better quality than that of the control group. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the anatomical aspects, mechanisms, risk factors and appropriate management of development of pneumothorax during a routine colonoscopy. A systematic search of the literature (MEDLINE, Embase and Google Scholar) revealed 21 individually documented patients of pneumothorax following a colonoscopy, published till December 2015. One additional patient treated at our center was added. A pooled analysis of these 22 patients was performed including patient characteristics, indication of colonoscopy, any added procedure, presenting symptoms,risk factors and treatment given. The review suggested that various risk factors may be female gender, therapeutic interventions, difficult colonoscopy and underlying bowel pathology. Diagnosis of this condition requires a high index of suspicion and treatment should be tailored to individual needs. [ABSTRACT FROM AUTHOR]

Aim We aimed to determine colorectal length with the 3D-Transit system by describing a 'centreline' of capsule movement and comparing it with known anatomy, as determined by magnetic resonance imaging ( MRI). Further, we aimed to test the day-to-day variation of colorectal length assessed with the system. Method The 3D-Transit system consists of electromagnetic capsules that can be tracked as they traverse the gastrointestinal tract. Twenty-five healthy subjects were examined with both 3D-Transit and MRI. Another 21 healthy subjects were examined with 3D-Transit on two consecutive days. Results Computation of colorectal length from capsule passage was possible for 60 of the 67 3D-Transit recordings. The length of the colorectum measured with MRI and 3D-Transit was 95 (75-153) cm and 99 (77-147) cm, respectively ( P = 0.15). The coefficient of variation ( CV) between MRI and 3D-Transit was 7.8%. Apart from the caecum/ascending colon being 26% ( P = 0.002) shorter on MRI, there were no other differences in total or segmental colorectal lengths between methods (all P > 0.05). The length of the colorectum measured with 3D-Transit on two consecutive days was 102 (73-119) cm and 103 (75-123) cm ( P = 0.67). The CV between days was 7.3%. Conclusion The 3D-Transit system allows accurate and reliable determination of colorectal length compared with MRI-derived colorectal length and between days. Antegrade or retrograde capsule movement relative to this centreline, as well as the length and speed of movements, may be determined by future studies to allow better classification and treatment in patients with dysmotility. [ABSTRACT FROM AUTHOR]

Bowel preparation regimens for colon capsule endoscopy are not yet standardized since they are not well optimized. The aim of the present study was to evaluate the feasibility of a novel low-volume and sodium phosphate-free bowel preparation regimen for colon capsule endoscopy. A total of 31 patients were prospectively enrolled. In the novel regimen, on the day prior to examination, a low-fiber diet was permitted, 5 mg mosapride citrate was administered twice (1 h prior to lunch and supper) and 1 l polyethylene glycol was administered in the evening. On the day of the examination, an additional 1 l polyethylene glycol, 5 mg mosapride citrate and 200 mg simethicone were administered before capsule ingestion. Polyethylene glycol booster (0.5 l) was administered twice, at 1 and 4 h following capsule ingestion. Colon cleansing levels, ileocecal valve transit time and completion rate were evaluated. A total of 29 patients were included in the final analysis, 90% of whom achieved adequate preparation of the overall colon. Ileocecal valve transit time was 2.35±0.82 h and completion rate was 79.3%. The results revealed that the novel low-volume and sodium phosphate-free bowel preparation regimen for colon capsule endoscopy was feasible, with adequate colon cleansing and completion rates, and has the potential to be used as an alternative regimen. [ABSTRACT FROM AUTHOR]

Background and study aims Previous studies describing the incidence of infection after colonoscopy and sigmoidoscopy are limited. The aim of this study was to determine the incidence of infection, and to propose a nomogram to predict the probability of infection following colonoscopy and sigmoidoscopy in symptomatic patients. Patients and methods A nationwide retrospective study was conducted by analyzing the National Health Insurance Research Database of Taiwan. The incidence of infection within 30 days after colonoscopy and sigmoidoscopy was assessed and compared with a control group matched at a ratio of 1:1 based on age, sex, and the date of examination. Results  In all, 112 543 patients who underwent colonoscopy or sigmoidoscopy and 112 543 matched patients who did not undergo these procedures were included. The overall incidence of infection within 30 days after colonoscopy and sigmoidoscopy was 0.37 %, which was significantly higher than that of the control group (0.04 %; P < 0.001). Diverticulitis, peritonitis, and appendicitis were the most common infections. Patients who underwent colonoscopy or sigmoidoscopy had a 9.38-fold risk of infection (95 % confidence interval, 6.81 - 12.93; P < 0.001) compared with the control group. The predicted infection-free rates of the nomogram were closely aligned with the actual infection-free rates, with a bootstrapping concordance index of 0.763. Conclusions Colonoscopy and sigmoidoscopy are associated with an increased risk of infection, which may occur after these procedures. Our nomogram may provide clinicians with an easy tool to evaluate the risk of infection after colonoscopy and sigmoidoscopy in symptomatic patients. [ABSTRACT FROM AUTHOR]

Background and aims Patient-reported outcome measures are increasingly important in healthcare. European guidelines have recommended inclusion of patient feedback to capture adverse events due to colonoscopy, but this is rarely implemented. Methods The Norwegian Quality Assurance network for endoscopy (Gastronet) collects patient-reported outcome for colonoscopies. Free-text comments on patient reports from January to December 2015 were characterized as positive or negative. All negative free-text comments were scrutinized for information that might suggest colonoscopy-related adverse events. We identified severe adverse events with and without admission to hospital. Results We included 16 552 outpatient colonoscopies performed at 21 hospitals. A total of 11 248 procedures (68 %) were accompanied by a patient feedback report, of which 2628 (23 %) had free-text comments (2196 [20 %] characterized as positive and 432 [3.8 %] as negative). These negative free texts on patient reports revealed 15 post-colonoscopy hospital admissions due to adverse events that had not been registered in the colonoscopy report. This increased the number of hospital admissions caused by adverse events from 3 (0.03 %) to 18 (0.16 %). In addition, there were 14 patient reports of severe events without hospital admission. Therefore, a total of 29 severe adverse events reported by patients were missed by conventional documentation in the colonoscopy form. Conclusion It is feasible to implement patient feedback as routine reporting to capture the full picture of colonoscopy-related adverse events. Some patients experience significant complications that are not recorded through any registries. Patient feedback forms should be tailored to capture adverse events after colonoscopy that are otherwise not easily disclosed. [ABSTRACT FROM AUTHOR]

Background Methods for the artificial three-dimensional (3D) culture of mouse and human small-intestinal and large-intestinal stem cells have been established with CD24 + or Paneth cell niches. In contrast, no studies have established stable 3D culture for rat colon stem cells. In this study, we established an advanced method for efficient rat colonic stem cell culture. Methods Using various tissue homogenates, we investigated the colonic organoid forming capacity under the TMDU protocol immediately adjacent to Ootani's 3D culture assembly in the same culture dish. Next, we examined whether the supernatant from the colon could be replaced by a colon homogenate. Finally, we identified the bioactive substances that were indispensable for efficient organoid culture using protein purification by three-step column chromatography and proteomic analysis with a quantitative nanoflow liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results By combining Ootani's method with the TMDU protocol, we established a refined culture method for Lewis rat colon organoids, which we refer to as the modified TMDU protocol. Furthermore, we confirmed that PGE 2 and galection-4 promoted rat colonic organoid formation. Conclusions We established efficient rat colonic stem cell cultures in vitro. This success will contribute to the study of rat intestinal-disease models. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of colonoscopy for diagnosing and preventing colon cancer is largely dependent on the ability of endoscopists to fully inspect the colonic mucosa, which they achieve primarily through skilled manipulation of the colonoscope during withdrawal. Performance assessment during live procedures is problematic. However, a virtual withdrawal simulation can help identify and parameterise actions linked to successful inspection, and offer standardised assessments for trainees. Methods: Eleven experienced endoscopists and 18 endoscopy novices (medical students) completed a mucosal inspection task during three simulated colonoscopic withdrawals. The two groups were compared on 10 performance metrics to preliminarily assess the validity of these measures to describe inspection quality. Four metrics were related to aspects of polyp detection: percentage of polyp markers found; number of polyp markers found per minute; percentage of the mucosal surface illuminated by the colonoscope (≥0.5 s); and percentage of polyp markers illuminated (≥2.5 s) but not identified. A further six metrics described the movement of the colonoscope: withdrawal time; linear distance travelled by the colonoscope tip; total distance travelled by the colonoscope tip; and distance travelled by the colonoscope tip due to movement of the up/down angulation control, movement of the left/right angulation control, and axial shaft rotation. Results: Statistically significant experienced-novice differences were found for 8 of the 10 performance metrics (p's < .005). Compared with novices, experienced endoscopists inspected more of the mucosa and detected more polyp markers, at a faster rate. Despite completing the withdrawals more quickly than the novices, the experienced endoscopists also moved the colonoscope more in terms of linear distance travelled and overall tip movement, with greater use of both the up/down angulation control and axial shaft rotation. However, the groups did not differ in the number of polyp markers visible on the monitor but not identified, or movement of the left/right angulation control. All metrics that yielded significant group differences had adequate to excellent internal consistency reliability (α = .79 to .90). Conclusions: These systematic differences confirm the potential of the simulated withdrawal task for evaluating inspection skills and strategies. It may be useful for training, and assessment of trainee competence. [ABSTRACT FROM AUTHOR]

Background: Incidental colorectal fluorodeoxyglucose (FDG) uptake can be observed during a positron emission tomography/computed tomography (PET/CT) scan. For clinical and/or histological assessment of the cause, a colonoscopy is then performed. A systematic review was conducted to investigate the relationship between incidental colorectal FDG uptake and lesions observed during a subsequent colonoscopy. Methods: A literature search was conducted using PubMed, Embase, and Web of Science with the keywords concerning PET/CT scan and colonoscopy. The studies were selected using inclusion criteria defined a priori and were described individually to examine the correlation between incidental colorectal FDG uptake and the lesions found at colonoscopy. Results: Twenty-six of 1606 studies found were included. In total, 108,578 patients underwent an FDG-PET/CT scan as part of a diagnostic work-up or cancer staging. In total, 2546 incidental colorectal FDG uptakes were described in 2121 patients (mean age 62.7 years SD ± 5.1), of which 2045 uptakes in 1635 patients were examined by colonoscopy, within a mean of 37 days (SD ± 28). The colonoscopic lesions included neoplasms ( n = 1097; 322 cancers), benign lesions ( n = 273), and inflammatory lesions ( n = 71). Colonoscopies were normal in 604 patients. In total, 82% of lesions were located in the same location as the FDG uptakes. The positive predictive value was 70% (95% CI [68-72]). Conclusions: Incidental colorectal FDG uptake, as evaluated by subsequent colonoscopy, often reveals neoplastic lesions. Predominantly, lesions were located at the same location as FDG uptake. Further investigation is warranted before recommending that incidental colorectal FDG uptake should always result in referral to diagnostic colonoscopy. [ABSTRACT FROM AUTHOR]

Ingestion of foreign bodies and particularly of button or/and cylindrical batteries is frequent in children and adults with underlying psychiatric diseases. We present a case of a 30-year-old woman with unstable borderline disorder, where overall 4 button and 2 cylindrical batteries were endoscopically removed from her digestive system. During the last session of colonoscopy a peculiar incident was observed, as a cylindrical battery of 15 mm diameter and 43 mm length moved retrograde through ileocecal valve into the small bowel. The foreign body removal from terminal ileum was effective and safe using an endoscopic loop. This report suggests that endoscopic insertion in terminal ileum should be attempted in every colonoscopy session conducted under the indication of foreign body removal, as the possibility of retrograde movement of even large foreign bodies in the colon and through ileocecal valve is given. [ABSTRACT FROM AUTHOR]

Background: Screening colonoscopy has been offered in Germany since 2002. Complications during colonoscopy were reported to be rare, but data on potential complications after colonoscopy are sparse. We aimed to comprehensively assess the frequency of complications arising during or within four weeks of screening colonoscopy. Methods: Residents of the German federal state of Saarland without a history of colorectal cancer and without previous polypectomy who underwent a screening colonoscopy between 2010 and 2013 were included. A follow-up was conducted three months after the screening colonoscopy, including participant questionnaires and subsequent validation of self-reported complications arising during or within four weeks of screening colonoscopy, by reviewing colonoscopy records and contacting the treating physicians. A comprehensive mortality follow-up was conducted for non-responders. Results: We recruited a total of 5527 participants from 26 practices (median age 61 years, 52% women). 5252 (95%) fully completed the questionnaire on complications and met the inclusion criteria for analysis. Among these participants, 16 cases of physician-confirmed bleeding (0.30%) and four cases of physician-confirmed perforation (0.08%) occurred during or within four weeks of colonoscopy. According to consistent reports from patients and physicians, bleeding and perforation led to hospitalization in 5 (0.095%) and 2 (0.04%) cases, respectively. Three participants died within three months of colonoscopy. In none of these cases was the cause of death related to colonoscopy. Conclusion: We found the risk of complications of screening colonoscopy to be low, even when taking into account a potential delay of up to four weeks. [ABSTRACT FROM AUTHOR]

Background and Aim: There is controversy about the surveillance interval after colonoscopy when 5–10 adenomas have been found on index colonoscopy. This study aimed to investigate the risk of colorectal neoplasm (CRN) according to the number of adenomas at index colonoscopy. Methods: A retrospective, multicenter study was conducted at 10 university hospitals in Korea. We included 1394 patients with ≥ 3 adenomas at index colonoscopy. The risk of advanced CRN was compared according to the number of adenomas (intermediate risk group, 3–4 small adenomas or at least one ≥ 10 mm, and high risk group, ≥ 5 small adenomas or ≥ 3 at least one ≥ 10 mm). Results: Overall, 164 (11.8%) developed an advanced CRN after a mean of 4.0 years from baseline colonoscopy. The 3-year and 5-year risk of advanced CRN was 2.1% (95% CI 2.09–2.11) and 14.4% (95% CI 14.36–14.44) in intermediate risk group and 3.2% (95% CI 3.19–3.21) and 23.3% (95% CI 19.15–19.25) in high risk group (P = 0.01). Having ≥ 5 adenomas (OR = 1.57, 95% CI 1.11–2.23, P = 0.01) detected at index colonoscopy was a significant risk factor for developing advanced CRN. Conclusions: Although risk of advanced CRN in patients with 5–10 adenomas was significantly higher than that in patients with 3–4 adenomas, the cumulative risk at 3 years was low at 3.2%. Thus, we suggest that a 3-year surveillance interval might be appropriate for the patients with 5–10 adenomas, and further prospective studies are needed to investigate whether more intensive surveillance is needed in this group. [ABSTRACT FROM AUTHOR]

Background and Aim To compare the efficacy and safety of esophagogastroduodenoscopy ( EGD)-colonoscopy and colonoscopy- EGD sequences for patients subjected to same-day bidirectional endoscopy under remifentanil and propofol sedation. Methods A total of 209 eligible outpatients scheduled for diagnostic same-day bidirectional endoscopy between 16 February 2016 and 30 April 2016 were randomly assigned to the EGD-colonoscopy ( n = 106) and colonoscopy- EGD ( n = 103) sequence groups. Primary endpoint was total dose of propofol required for the procedure. Secondary endpoints included duration of endoscopy, patient satisfaction, adverse effects, endoscopy findings, and cardiopulmonary responses of the patients. Results Patients in the two groups were similar in terms of demographic and clinical data ( P > 0.05). EGD-colonoscopy sequence group had lesser requirement of propofol for sedation ( P < 0.05), faster recovery ( P < 0.001), and lesser influence on mean arterial pressure ( MAP) during the endoscopy ( P < 0.05). Duration of EGD and colonoscopy, patient satisfaction, adverse effects, and pathological findings did not differ between the two groups. Conclusions The EGD-colonoscopy sequence may be considered the preferred sequence for same-day bidirectional endoscopy as a result of less cardiovascular stress, lessened need for sedation with propofol, and faster recovery. [ABSTRACT FROM AUTHOR]

Many patients are reluctant to undergo optical colonoscopy for colorectal cancer screening. The Check-Cap colon imaging system is a non-invasive test that comprises an ingestible imaging capsule that emits and detects ultra-low-dose radiation. The capsule generates a 3D reconstruction of the colonic lumen for detection of polyps and cancer. Preliminary preclinical and clinical testing has demonstrated safety and feasibility. Mean radiation dose is estimated at 0.04 mSv. In conclusion, we describe a novel capsule-based, patient-friendly colorectal test that holds potential for non-invasive screening. [ABSTRACT FROM AUTHOR]

The serosal slow waves in the human colon are complex, since their amplitude and frequency vary over time. Therefore, this study employed a simulation to investigate the consistency between serosal slow waves and cutaneous electrical activity by evaluating whether changes of the cutaneous waveform features due to anatomical and physiological parameters are detectable in the cutaneous electrical activity. The simulation results indicated that (a) changes in the dipole moment involve detectable changes in the amplitude of the cutaneous electrical activity; (b) changes in the annular band velocity induce modifications in the cutaneous signal frequency; and (c) changes in the anatomical factors affect both the amplitude and the frequency of the cutaneous signal. Therefore, we observed that there is consistency between serosal slow waves and cutaneous electrical activity. On these bases, we think that modifications in the cutaneous electrical activity observed in our study could represent the marker of specific physiological motor activity of the colon, and such information can improve the recording of the experimental measurements of the cutaneous electrical activity of the colon in humans. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) diagnosed at <50 years is predominantly located in the distal colon and rectum. Little is known about which lesion subtypes may serve as CRC precursors in young adults. The aim of this work was to document the prevalence and histological subtype of lesions seen in patients aged <50 years, and any associated clinical features.Methods: An audit of the colonoscopy database at The Queen Elizabeth Hospital in Adelaide, South Australia over a 12-month period was undertaken. Findings were recorded from both colonoscopy reports and corresponding histological examination of excised lesions.Results: Data were extracted from colonoscopies in 2064 patients. Those aged <50 comprised 485 (24%) of the total. CRC precursor lesions (including sessile serrated adenoma/polyps (SSA/P), traditional serrated adenomas, tubular adenomas ≥10 mm or with high-grade dysplasia, and conventional adenomas with villous histology) were seen in 4.3% of patients aged <50 and 12.9% of patients aged ≥50 (P <0.001). Among colonoscopies yielding CRC precursor lesions in patients under 50 years, SSA/P occurred in 52% of procedures (11/21), compared with 27% (55/204) of procedures in patients aged 50 and older (P = 0.02). SSA/P were proximally located in (10/11) 90% of patients aged under 50, and 80% (43/54) of those aged 50 and older (P = 0.46).Conclusions: SSA/P were the most frequently observed CRC precursor lesions in patients aged <50. Most CRCs in this age group are known to arise in the distal colon and rectum suggesting that lesions other than SSA/P may serve as the precursor for the majority of early-onset CRC. [ABSTRACT FROM AUTHOR]

Introduction: Computed tomography colonography (CTC) for the detection of colorectal disease is gaining popularity as an alternative to colonoscopy. This has been associated with an increase in incidental extra-colonic findings such as abdominal aortic aneurysms. However, due to the patient selection process of obtaining a CTC, it was hypothesised that this patient cohort might represent a high-risk group. The primary aim of this study was to determine the impact that CTC had on small aneurysm referrals. Owing to the potential selection bias, the secondary aim was to compare baseline characteristics referred by CTC to the cohort referred by other radiological modalities.Methods: Consecutive patients attending the small aneurysm clinic at a single tertiary centre were included. Baseline patient comorbidities were collected and recorded on a prospective database. The characteristics of patients who had a CTC-detected aneurysm were compared to patients referred by other radiological modalities.Results: There were 566 patients with small aneurysms included. Of these, 96 (17.0%) had their aneurysm detected from CTC and the remaining aneurysms were detected by other radiological modalities. These patients were on average 2 years older and were less likely to have a smoking history. There was no difference in other patient characteristics.Conclusion: Computed tomography colonography contributed to the initial diagnosis of one in five patients with small aneurysms. Despite a potential selection bias for patients undergoing CTC, there were no major baseline differences between the CTC cohort and patients referred by other radiological modalities. Routine assessment of the aorta during a CTC may aid in aneurysm detection. [ABSTRACT FROM AUTHOR]

Background and study aims Colonoscopy should reliably intubate the cecum with minimal patient discomfort and without complications. Use of thinner endoscopes to overcome pain during the procedure has shown promise. However, the use of thinner scopes could lead to excess looping and difficulty with therapeutic procedures. The aim of this meta-analysis was to analyze the performance of ultrathin colonoscopes (UTC) and standard colonoscopes for routine colonoscopy. Patients and methods We searched several electronic databases for all randomized controlled trials and nonrandomized (prospective) studies that compared the efficacies of UTC (diameter ≤ 9.8 mm) and standard colonoscopes. We used fixed effect or random effects models to compare cecal intubation rate, cecal intubation time, pain score, and polyp and adenoma detection rates using standard mean differences (SMD) or odds ratios (OR) with 95 % confidence intervals (CI). Results Seven studies (2191 patients) met the inclusion criteria. There was no significant heterogeneity among studies except for pain scores. The cecal intubation rate was higher with UTC (OR 2.30; 95 %CI 1.31 to 4.03). There was no difference in the cecal intubation time between UTC and standard colonoscopes. Pain scores were significantly lower with UTC than with standard colonoscopes (SMD - 0.59, 95 %CI - 0.93 to - 0.25). Polyp and adenoma detection rates were similar for both types of colonoscope. Conclusion Use of UTC appears to improve the cecal intubation rate and reduce abdominal pain but does not affect polyp detection. Future trials are needed to evaluate the therapeutic performance of UTC vs. standard colonoscopes. [ABSTRACT FROM AUTHOR]

Background: Tumour stem cells are considered important to promote disease progression, recurrence and treatment resistance following chemotherapy in colon cancer. However, genomic analyses of colorectal cancer have mainly been performed on integrated tumour tissue consisting of several different cell types in addition to differentiated tumour cells. The purpose of the present study was to compare genomic alterations in two cell fractions enriched of CD133+ and CD133-/EpCAM+ cells, respectively, obtained from fresh intraoperative human tumour biopsies.Methods: The tumour biopsies were fractionated into CD133+ and CD133-/EpCAM+ cells by immunomagnetic separation, confirmed by immunocytochemistry and Q-PCR. DNA were extracted and used for array comparative genome hybridization (aCGH) after whole genome amplification. Frozen tumour tissue biopsies were used for DNA/RNA extraction and Q-PCR analyses to check for DNA alterations detected in the cell fractions.Results: The number and size of DNA alterations were equally distributed across the cell fractions; however, large deletions were detected on chromosome 1, 7 and 19 in CD133-/EpCAM+ cells. Deletions were frequent in both cell fractions and a deletion on chromosome 19p was confirmed in 90% of the patients.Conclusion: Isolation of enriched cells derived from tumour tissue revealed mainly genomic deletions, which were not observed in tumour tissue DNA analyses. CD133+ cells were genetically heterogeneous among patients without any defined profile compared to CD133-/EpCAM+ cells. [ABSTRACT FROM AUTHOR]

Background and Aim Small-caliber endoscopes such as gastroscopes or pediatric colonoscopes are occasionally required to negotiate fixed or angulated colons. However, the use of a new ultrathin instrument (diameter 7.0 mm) narrower than other conventional colonoscopes has not been evaluated. The aim of the present study was to compare the use compare the use of an ultrathin colonoscope ( UTC) with a pediatric colonoscope ( PDC) for colonoscopy in older female patients. Methods A prospective, randomized, controlled trial was conducted in a single academic endoscopy unit. A total of 77 female patients aged ≥70 years undergoing unsedated colonoscopy were randomized to colonoscopy with a UTC ( n = 39) or PDC ( n = 38). Primary outcome measurement was the degree of pain using a numerical rating scale, and secondary outcomes were cecal intubation rate, ileal intubation rate, time to cecum and adenoma detection rate. Results There was a significant difference in reported pain using the numerical rating scale (median, UTC 1 vs PDC 4, P < 0.0001). Cecal intubation rates were 97.4% in UTC and 92.1% in PDC ( P = 0.36), and ileal intubation rates were 82.0% and 89.4% ( P = 0.76), respectively. However, median times to cecum were significantly longer using UTC compared with PDC (15.2 min vs 11.1 min, P = 0.022). Adenoma detection rates were 30.7% in UTC and 26.3% in PDC ( P = 0.80). Conclusions Colonoscopy using UTC was almost equivalent to that of PDC in older female patients, with significantly less pain compared with PDC. UTC may be an alternative to PDC for the difficult colon. [ABSTRACT FROM AUTHOR]

Background: The introduction of colonoscopic screening in 2002 for persons aged 55 and older was followed by a marked decline in the incidence of colon cancer in the corresponding age groups in Germany. The prevalence of colorec-tal neoplasia among persons aged 50 to 54 has remained unknown until now. Expert committees currently recommend colonoscopic screening for persons aged 50 and older. This option has been offered since 2014 by the AOK Baden-Württemberg and by Bosch BKK in the framework of their specialized medical care program. Methods: In April 2014 and 2015,84 726 insurees aged 50-54 were invited by mail to participate in colonoscopic screening. The utilization and results of colonoscopic screening were studied. A questionnaire about risks was additionally sent to half of the participants, who were selected at random (study registration: DRKS00006268). Results: Within one year, 1.9% of persons to whom invitations had been sent took up the offer of colonoscopic screening; these persons included 3.3% of those already enrolled in the specialized medical care program. The 1396 colonoscopies that were performed revealed advanced neoplasia (colon cancer or advanced adenoma) in 6.8% of cases. The prevalence of advanced neoplasia among men aged 50 to 54 was nearly twice as high as that among women in the same age group (8.6% vs. 4.5%, p = 0.0027). It was also higher than the prevalences documented in the German nationwide cancer registry for women aged 55 to 79. The additional sending of a risk questionnaire along with the invitation had no effect on the rate of detection of relevant findings or on the rate of participation in colonoscopic screening. Conclusion: These findings lend support to the demand that the offer of colonoscopic screening should be extended at least to men aged 50 and above. [ABSTRACT FROM AUTHOR]

Background: No randomized, controlled trials of screening colonoscopy have been completed, and ongoing trials exclude persons aged 75 years or older. The Medicare program, however, reimburses screening colonoscopy without an upper age limit.Objective: To evaluate the effectiveness and safety of screening colonoscopy to prevent colorectal cancer (CRC) in persons aged 70 to 74 and those aged 75 to 79 years.Design: Large-scale, population-based, prospective study. The observational data were used to emulate a target trial with 2 groups: colonoscopy screening and no screening.Setting: United States.Participants: 1 355 692 Medicare beneficiaries (2004 to 2012) aged 70 to 79 years at average risk for CRC who used Medicare preventive services and had no previous diagnostic or surveillance colonoscopies in the past 5 years.Measurements: 8-year risk for CRC and 30-day risk for adverse events.Results: In beneficiaries aged 70 to 74 years, the 8-year risk for CRC was 2.19% (95% CI, 2.00% to 2.37%) in the screening colonoscopy group and 2.62% (CI, 2.56% to 2.67%) in the no-screening group (absolute risk difference, -0.42% [CI, -0.24% to -0.63%]). Among those aged 75 to 79 years, the 8-year risk for CRC was 2.84% (CI, 2.54% to 3.13%) in the screening colonoscopy group and 2.97% (CI, 2.92% to 3.03%) in the no-screening group (risk difference, -0.14% [CI, -0.41 to 0.16]). The excess 30-day risk for any adverse event in the colonoscopy group was 5.6 events per 1000 individuals (CI, 4.4 to 6.8) in the 70- to 74-year age group and 10.3 per 1000 (CI, 8.6 to 11.1) in the 75- to 79-year age group.Limitation: CRC-specific mortality was not available, but CRC incidence and stage were studied at diagnosis.Conclusion: Screening colonoscopy may have had a modest benefit in preventing CRC in beneficiaries aged 70 to 74 years and a smaller benefit in older beneficiaries. The risk for adverse events was low but greater among older persons.Primary Funding Source: National Institutes of Health. [ABSTRACT FROM AUTHOR]

Background and Aim Colorectal cancer (CRC) incidence is rising among <50-year olds. The objective of this study was to determine screening colonoscopy outcomes among 40- to 49-year olds, which are currently limited. Methods Asymptomatic 40- to 49-year olds underwent one time CRC screening colonoscopy at The Chinese University of Hong Kong between 2007 and 2011. Screening outcomes, including prevalence, distribution, and predictive factors for overall and specifically proximal colorectal neoplasia were determined. Results Among 1133 ethnic Chinese, colorectal neoplasia prevalence was 20.5%. In men, distal adenomas were associated with proximal colorectal neoplasia. Men, advancing age, a first degree relative (FDR) with CRC, and diabetes mellitus were independently associated with colorectal neoplasia. A colorectal neoplasia was three times more likely to be found in a 45- to 49-year-old man with FDR of CRC compared with a 40- to 44-year-old woman without a FDR of CRC. The numbers needed to screen one colorectal neoplasia, and one advanced neoplasm in the highest risk group of 45- to 49-year-old men with FDR with CRC were 2.8 (95% CI: 2.2-4.4) and 18.5 (95% CI: 8.9-39.2), respectively. Conclusions Colorectal neoplasia prevalence in this 40- to 49-year-old Chinese cohort was higher than previous studies. Men, advancing age, FDR with CRC, and diabetes mellitus, can be used to risk stratify for neoplasia development. Men 45-49 years old with FDR with CRC represented the highest risk subgroup, with the lowest number needed to screen. [ABSTRACT FROM AUTHOR]

Background and Aim The present study aimed to evaluate the non-inferiority of low-volume oral sulfate solution (OSS) to 4-L polyethylene glycol (PEG) solutions administered in a split-dose regimen as bowel preparation for colonoscopy. The safety and tolerability were also compared between the two regimens. Methods In this prospective, randomized, single-blind, active-control, parallel group, and non-inferiority trial, consecutive outpatients and health checkup recipients aged 19-65 years undergoing elective colonoscopy were enrolled to receive OSS or 4-L PEG in a split-dose regimen. The quality of bowel preparation was evaluated using the Boston Bowel Preparation Scale. The occurrence of any adverse events, acceptance, compliance, and satisfaction during bowel preparation were evaluated by participant interviews. Results Overall, 210 participants were randomized, and 199 were administered by the study agents. Adequate bowel preparation was achieved in 98.0% (97/99) of the OSS group, which was non-inferior to the PEG group (96%; 96/100) with a difference of +2.8% (95% confidence interval; −2.8, +6.8). There were no differences in the incidence of adverse events except for abdominal pain, which was more frequent in the OSS (7.1%, 7/99) than in the PEG (1.0%, 1/100; P = 0.035) group. Acceptance, compliance, and satisfaction were significantly higher in the OSS than in the PEG group (all P < 0.05). Conclusions Split-dose OSS was non-inferior to split-dose 4-L PEG with regard to bowel preparation efficacy before colonoscopy in adult outpatients or screening colonoscopy recipients aged ≤65 years with acceptable safety and superior tolerability. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Inflammatory myofibroblastic tumors (IMTs) are scarce tumors with discrete immunohistochemical and molecular attributes which are not related to a particular location. There are different reports about the intrinsic nature of these tumors as benign to possibly malignant. Case Report: Here we report the case of a 68-year-old man referred to the Internal Medicine Department of Razi Hospital in Rasht (a city in the north of Iran) due to right lower quadrant (RLQ) discomfort with no specific symptoms. Colonoscopy revealed a mass-like lesion. Polymorphonuclear cells (PMNCs) admixed by some eosinophils were demonstrated histopathologically. Immunohistochemical evaluation was positive for vimentin, CD34, smooth muscle actin, and ALK, and negative for CD117 and desmin. The tumor was successfully removed by surgery with no chemotherapy. No recurrence was reported. Conclusions: We have performed surgical excision of the mass with no chemotherapy and no recurrence. Although recurrence is reported to be low, we recommend long-term follow-up after surgery. [ABSTRACT FROM AUTHOR]

We present a method for registration and visualization of corresponding supine and prone virtual colonoscopy scans based on eigenfunction analysis and fold modeling. In virtual colonoscopy, CT scans are acquired with the patient in two positions, and their registration is desirable so that physicians can corroborate findings between scans. Our algorithm performs this registration efficiently through the use of Fiedler vector representation (the second eigenfunction of the Laplace-Beltrami operator). This representation is employed to first perform global registration of the two colon positions. The registration is then locally refined using the haustral folds, which are automatically segmented using the 3D level sets of the Fiedler vector. The use of Fiedler vectors and the segmented folds presents a precise way of visualizing corresponding regions across datasets and visual modalities. We present multiple methods of visualizing the results, including 2D flattened rendering and the corresponding 3D endoluminal views. The precise fold modeling is used to automatically find a suitable cut for the 2D flattening, which provides a less distorted visualization. Our approach is robust, and we demonstrate its efficiency and efficacy by showing matched views on both the 2D flattened colons and in the 3D endoluminal view. We analytically evaluate the results by measuring the distance between features on the registered colons, and we also assess our fold segmentation against 20 manually labeled datasets. We have compared our results analytically to previous methods, and have found our method to achieve superior results. We also prove the hot spots conjecture for modeling cylindrical topology using Fiedler vector representation, which allows our approach to be used for general cylindrical geometry modeling and feature extraction. [ABSTRACT FROM PUBLISHER]

Novice doctors may watch tutorial videos in training for actual or computed tomographic (CT) colonoscopy. The conventional learning videos can be complemented by virtual colonoscopy software made with a cadaver’s sectioned images (SIs). The objective of this study was to assist colonoscopy trainees with the new interactive software. Submucosal segmentation on the SIs was carried out through the whole length of the large intestine. With the SIs and segmented images, a three dimensional model was reconstructed. Six-hundred seventy-one proximal colonoscopic views (conventional views) and corresponding distal colonoscopic views (simulating the retroflexion of a colonoscope) were produced. Not only navigation views showing the current location of the colonoscope tip and its course, but also, supplementary description views were elaborated. The four corresponding views were put into convenient browsing software to be downloaded free from the homepage ( anatomy.co.kr ). The SI colonoscopy software with the realistic images and supportive tools was available to anybody. Users could readily notice the position and direction of the virtual colonoscope tip and recognize meaningful structures in colonoscopic views. The software is expected to be an auxiliary learning tool to improve technique and related knowledge in actual and CT colonoscopies. Hopefully, the software will be updated using raw images from the Visible Korean project. [ABSTRACT FROM AUTHOR]