Improved bowel preparation increases polyp detection and unmasks significant polyp miss rate

AIM: To retrospectively compare previous-day vs splitdose preparation in terms of bowel cleanliness and polyp detection in patients referred for polypectomy. METHODS: Fifty patients underwent two colonoscopies: one diagnostic in a private clinic and a second for polypectomy in a University Hospital. The latter procedures were performed within 12 wk of the index ones. Examinations were accomplished by two experienced endoscopists, different in each facility. Twenty-seven patients underwent screening/surveillance colonoscopy, while the rest were symptomatic. Previous day bowel preparation was utilized initially and splitdose for polypectomy. Colon cleansing was evaluated using the Aronchick scale. We measured the number of detected polyps, and the polyp miss rates per-polyp.RESULTS: Excellent/good preparation was reported in 38 cases with previous-day preparation(76%) vs 46 with split-dose(92%), respectively(P = 0.03). One hundred and twenty-six polyps were detected initially and 169 subsequently(P < 0.0001); 88 vs 126 polyps were diminutive(P < 0.0001), 25 vs 29 small(P = 0.048) and 13 vs 14 equal or larger than 10 mm. The miss rates for total, diminutive, small and large polyps were 25.4%, 30.1%, 13.7% and 6.6%, respectively. Multivariate analysis revealed that split-dose preparation was significantly associated(OR, P) with increased number of polyps detected overall(0.869, P < 0.001), in the right(0.418, P = 0.008) and in the left colon(0.452, P = 0.02). CONCLUSION: Split-dose preparation improved colon cleansing, enhanced polyp detection and unmasked significant polyp miss rates.

Omeprazole maintenance therapy prevents recurrent ulcer bleeding after surgery for duodenal ulcer

AIM： To evaluate the omeprazole maintenance therapy in patients with recurrent ulcer bleeding after surgery for duodenal ulcer. METHODS： We studied 15 consecutive patients with recurrent ulcer bleeding after surgery for duodenal ulcer. Omeprazole （20 mg/d） maintenance therapy was given after ulcer healing. In addition to clinical follow-up, ambulatory 24-h gastric pH assay was performed before and during omeprazole therapy in those patients and controls with previous duodenal ulcer surgery but no ulcer recurrence. RESULTS： All the 15 ulcers were healed after being treated with omeprazole （40 mg/d） for 2 too. Eleven patients with two （1-9） episodes of recurrent ulcer bleeding completed the follow-up （43, 12-72 too）. None of them had a bleeding episode while on omeprazole. One patient discontinued the therapy and had recurrent bleeding. The median 24-h fraction time of gastric pH 〈4 in patients was 80, 46-95%, and was reduced to 32, 13-70% by omeprazole （P= 0.002）. CONCLUSION： Long-term maintenance therapy with omeprazole （20 rag/day） is effective in preventing recurrent ulcer bleeding.

Awareness and attitudes of Greek medical students on colorectal cancer screening

AIM: To prospectively assess the knowledge and attitudes of medical students (MS), as tomorrow’s physicians, about colorectal cancer (CRC) and its screening modalities.METHODS: Three hundred fourth year MS of the University of Athens were enrolled in this survey. Their selection was random, based on student identification card number. All participants completed an anonymous written questionnaire over a 4 month period. The questionnaire was divided into 4 sections and included queries about CRC-related symptoms, screening with colonoscopy and MS awareness and attitudes in this field. Following collection and analysis of the data, the results are presented as percentages of answers for each separate question. RESULTS: Two hundred and sixty-five students an-swered the questionnaire over a 4 mo period. Interestingly, only 69% of the study population considered CRC to be a high-risk condition for public health. However, the vast majority of participants identified CRC-related symptoms and acknowledged its screening to be of great value in reducing CRC incidence and mortality. A very small proportion (38%) had received information material regarding CRC screening (either during their medical training or as a part of information provided to the general public) and only 60% of the participants declared willingness to receive further information. Regarding colonoscopy, 85% would prefer an alternative to colonoscopy methods for CRC screening. Moreover, 53% considered it to be a painful method and 68% would appreciate more information about the examination.CONCLUSION: MS in Greece need to be better informed about CRC screening and screening colonoscopy.