超声内镜微探头进行术前结肠直肠癌分期:能否改进手术治疗方法?

Background and study aims: Miniprobe ultrasound technology allows in-vivo luminal staging of colorectal cancer with a probe that passes directly through the colonoscope’s instrument port. Conventional rigid radial echoscopes are limited by the need for a second examination, an inability to image stenotic lesions, and the inaccessibility of proximal tumours. Since minimally invasive resection techniques are now possible, a sensitive preoperative staging tool is needed to optimize patient selection. The aim of this study was to examine the accuracy of miniprobe ultrasound imaging in the preoperative staging of colorectal cancer and to examine the value of the technique for management decisions. Patients and methods: In a prospective study, a total of 131 consecutive patients with adenocarcinoma or broad-based polyps of the colorectum underwent 12.5-MHz miniprobe ultrasonography examinations conducted by a single endoscopist. Staging criteria for depth of tumour infiltration and nodal status were determined. Nodal disease was defined as the presence of a hypoechoic, round, defined boundary lesion larger than 10 mm in diameter. T0-T1N0 lesions were resected using endoscopic mucosal resection, and patients with lesions staged as T2N1 were referred for surgical resection. Tumour staging using endoscopic ultrasonography was then compared with the histopathological specimens. Results: The accuracy of T staging using endoscopic ultrasonography was 96% in comparison with the histopathological specimen. Five lesions (4% ) were incorrectly overstaged as T3 - pathology stage T2. Understaging occurred in three lesions (endosco-pic ultrasound stage T3 - pathology stage T4). The overall accuracy of nodal staging using endoscopic ultrasonography was 87% (sensitivity 0.95, specificity 0.71, positive predictive value 0.87, negative predictive value 0.88). Conclusions: Miniprobe ultrasonography has a high overall accuracy for both T staging and N staging of colorectal cancer andmay have an important role in selecting patients suitable for minimally invasive resection techniques.

胃肠病患者自行使用口服补充和替代治疗的概率

Goals: To assess the incidence of oral complementary and alternative medicine (CAM) usage by gastroenterology patients at a single university center and comp are against controls. Background: The public awareness and usage of CAM have inc reased. The use of CAM has been described in patients with functional bowel diso rders; however, their role in patients with gastrointestinal disease is less cle ar. Study: Patients attending luminal gastroenterology clinics and customers at local supermarkets completed a 30- point, structured questionnaire assessing th eir use of CAM. Results: A total of 1,409 subjects were recruited. The incidence of CAM use was 49.5% for inflammatory bowel disease, 50.9% for irritable bo wel syndrome, 20% for general gastrointestinal diseases, and 27% for control s. Pearson’ s χ 2 tests showed that patients with inflammatory bowel disease ( IBD) or irritable bowel syndrome were more likely to use CAM than controls (P < 0.001). Binary logistic regression analysis showed that females were more likely to take CAM than men (P < 0.05). Conclusions: The percentage of CAM users among patients with IBD is similar to those with a functional diagnosis. Increasing n umbers of IBD patients are using CAM in addition to conventional therapy. Awaren ess of this may prevent adverse CAM and conventional drug interactions.

20兆赫高频超声内镜下黏膜切除治疗结肠直肠黏膜下层病变:一项前瞻性分析

Goals: To prospectively assess the safety and efficacy of high- frequency ultrasound assisted mini- probe endoscopic mucosal resection for the treatment of colorectal submucosal tumors. Primary endpoints were tumor free vertical/horizontal resection margins and positive histopathologic diagnosis. Outcome data over a 24- month period were assessed. Background: A 20- MHz high- frequency mini- probe ultrasound is an accurate modality for the diagnosis of stage T1m and T1 colorectal lesions. Few studies have addressed the safety and efficacy of this technology as applicable to submucosal lesions of the colorectum. Methods: Thirty patients underwent high- frequency mini- probe ultrasound- guided endoscopic mucosal resection of 30 lesions (< 20 mm diameter) using the inject and cut technique. Repeat endoscopy and ultrasound was performed at 3, 6, and 12 months post- “ index" resection. Results: A total of 27 lesions (90% ) underwent complete resection with negative histologic margin status (median diameter, 8 mm; range, 3- 20 mm). No statistical difference (P >0.1 ) was observed between submucosal lesion position and histologic resection margin negativity. Three rectal lesions (10% ) within the submucosal layer 3 failed to separate from the muscularis and underwent transanal excision of tumor. Bleeding occurred in 1 patient (3% ). No recurrence was evident at the resection site in 27 cases (median follow- up, 9 months; range, 4- 18 months). Conclusions: High- frequency mini- probe ultrasound- guided endoscopic mucosal resection is a safe and effective therapeutic modality for submucosal lesions of the colorectum. The technique offers a single- stage diagnostic and therapeutic technique for selected submucosal lesions and may offer an alternative to surgical resection.

老年人结肠镜检安全且诊断价值高:一项2000例患者的前瞻性对比研究

Background and Study Aims:Optical colonoscopy is considered the gold standard for colorectal examination and has the advantage of allowing biopsies and polypectomy.However,the data on its safety and effectiveness in the elderly population are limited and somewhat conflicting.We prospectively assessed whether there are differences in completion rates,diagnostic yield,complication rates and 30-day mortality between patients aged ≥65 years and patients aged < 65 undergoing colonoscopy at our centre.Patients and Methods:Data were collected prospectively on 2000 colonoscopies performed over a 2-year period(January 2002 to January 2004).We compared 1000 consecutive colonoscopies in patients aged≥65 with 1000 consecutive colonoscopies in patients aged < 65(control group).Data were collected on sedation;on completion rates,both crude and adjusted to discount failures due to obstructive disease;on diagnostic yield;complications,and on 30-day mortality.Results:The median age was 75 years(51%women)for the elderly group and 54 years(59%women)for controls.The proportion of patients who received sedation was similar for both groups(59%vs.62%,P=0.97)but the mean dose of midazolam was lower in the elderly group(3.8 mg vs.4.5 mg,P < 0.0001).The crude completion rate was lower for the elderly group(81.8%vs.86.5%,P=0.004),but the adjusted rate was similar for both groups(88.1%elderly vs.87.6%control,P=0.18).The overall diagnostic yield was higher in the elderly group(65%vs.45%,P < 0.0001)with higher rates of carcinoma detected(7.1%vs.1.3%,P< 0.0001).The complication rate was low(0.2%per group).Conclusions:Colonoscopy in the elderly is safe and effective with a high diagnostic yield.Colonoscopy may now be the imaging modality of choice in the elderly population.

内镜检查前签订知情同意书需了解的信息:对患者期望了解信息的观察研究

Background and study aims: The aim of this study was to determine how much information patients require about the risk of complications in order to provide informed consent to undergo endoscopy. Patients and methods: Endoscopic complications and their consequences were discussed with consecutive patients who had undergone endoscopy. The patients were asked how common each complication would have to be for them to require information about the complication before providing adequately informed consent. Results: Data were obtained from 150 gastroscopy patients (51%male, median age 55.5 years) and 150 colonoscopy patients (60%male, median age 54.4 years). Patients in both groups were more likely to want to know about major rather than minor complications at a lower level of risk (P < 0.001 at a risk greater than one in 1000). Similar proportions of gastroscopy patients (n = 29, 19%) and colonoscopy patients (n = 21, 14%) wanted to know about all possible complications, no matter how inconsequential or rare. Colonoscopy patients were less likely to want no information about any complications than gastroscopy patients (n = 1, 0.7%and n = 15,10%, respectively; P < 0.001). Conclusions: The information patients require in order to provide informed consent is very variable. Many appear to make a judgement about the need for information depending on the perceived severity of the complication, but some want information about all complications, irrespective of risk and severity. The level of risk at which they require this information is likely to be higher than the level used by doctors who are obtaining consent from patients. The process may be improved by providing procedure-specific information leaflets that offer information regarding common and serious complications.