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Resumen Introduccion y objetivos La calidad de la colonoscopia es clave para asegurar la prevencion del adenocarcinoma colorrectal (ACCR), aunque el riesgo de ACCR existe. Los objetivos del estudio fueron investigar la incidencia, las caracteristicas y los factores predictores de ACCR poscolonoscopia (ACCRPC). Material y metodo Estudio observacional retrospectivo y prospectivo sobre una poblacion sometida a colonoscopia entre 1-01-1997 y 31-12-2014. Se analizaron variables demograficas, caracteristicas de la colonoscopia diagnostica de ACCR, de las previas y de las lesiones encontradas en ellas. Se aplicaron test de contraste de hipotesis para comparar el grupo de ACCRPC con el de ACCR sin colonoscopia previa y regresion logistica multiple para identificar factores independientes de ACCRPC (SPSS ® 15), considerando significacion estadistica una p Resultados Se registraron 56.984 colonoscopias, 1.977 ACCR y 132 pacientes (edad media de 70,8 anos y 56,8% varones) con al menos una colonoscopia en los 10 anos previos (ACCRPC). El 70,5% de las colonoscopias previas fueron completas y el 63,7% tenian una preparacion adecuada. Los factores de riesgo independientes relacionados con la aparicion de ACCRPC fueron los antecedentes personales de polipos colonicos (OR 35,01; IC 95% 11,1-110,8; p Conclusiones La tasa de ACCRPC a 10 anos fue del 6,7%. Realizar un adecuado seguimiento y una colonoscopia de calidad puede evitar la aparicion del ACCRPC, especialmente en los pacientes con factores de riesgo.

A high quality colonoscopy is key in preventing colorectal cancer, but the risk of colorectal cancer (CRC) exists. The aims of the study were to investigate the incidence, characteristics and predictive factors of post-colonoscopy colorectal cancer (PCCRC).A retrospective and prospective observational study was designed. A population undergoing colonoscopy between 1-01-1997 and 31-12-2014 was included. We analysed demographic variables, characteristics of the diagnostic colonoscopy of CRC, of the previous ones and the lesions found in them. To compare the PCCRC group versus the CRC group without previous colonoscopy, the Student's t-test and multiple logistic regression were used to determine predictive factors of PCCRC (SPSSA total of 56,984 colonoscopies, 1,977 CRC and 132 patients (mean 70.8 years old, 56.8% male) with at least one colonoscopy in 10 years before were registered (PCCRC). Seventy and a half percent of the previous colonoscopies were completed and 63.7% had an adequate bowel preparation. Predictive factors of PCCRC were personal history of polyps (OR 35.01; 95% CI 11.1-110.8; P.001), previous CRC (OR 176.64; 95% CI 51.5-606.1); P.001), family history of CRC (OR 3.14; 95% CI 1.5-6.4); P=.002) and proximal CRC (OR 3.15; 95% CI 2.1-4.9; P.001).PCCRC rate in 10 years was 6.7%. An adequate follow-up and a high-quality colonoscopy could prevent PCCRC, especially in patients with risk factors.

Background & aims Sirolimus should not be started within the first month after liver transplantation (LT) because of an increased risk of adverse outcomes. The evidence regarding everolimus is lacking but the manufacturer transposed the same warning. We aimed to evaluate the safety of everolimus started within the first month after LT. Methods A consecutive cohort 187 LT patients (2009–2013) with a tacrolimus-based immunosuppression was evaluated. Patients starting everolimus within the first month after LT (n = 33; 17.6%) were compared with those starting everolimus thereafter (n = 25; 13.4%) or not receiving everolimus (n = 129; 69%). The median follow-up after LT was 21 months (IQR 7–36). Prospective outcomes were evaluated by using Kaplan–Meier curves and Cox's regression. Results The incidence of hepatic artery thrombosis was not significantly different in patients early treated with everolimus when compared with the remaining cohort (0% vs 9.1%; p = 0.12). Other vascular complications occurred in 9.1% of patients with early everolimus vs 7.3% in the remaining cohort (p = 0.72). No wound healing complications were detected with early everolimus. There were similar rates of incisional hernia (p = 0.31), infections (p = 0.15), renal impairment (p = 0.37), and histologically-proven acute rejection (p = 0.24) between groups. The rates of hyperlipidemia were increased with early everolimus (29.9% vs 16.5% at 3 years; p = 0.018). Graft loss and mortality rates were similar between groups (p = 0.34 and p = 0.94 respectively), after adjusting for possible confounding factors. Conclusions Everolimus combined with reduced tacrolimus proved to be safe within the first month after LT. Future trials may be allowed to implement everolimus early after LT.