Is there a difference in adenoma detection rates between gastroenterologists and surgeons?

AIM To compare the adenoma detection rate(ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.METHODS A total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.RESULTS The ADR was not significantly different between gastroenterologists and colorectal surgeons(34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1^(st) degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19(0.69-2.05).CONCLUSION Both specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.

Staged liver resection for colorectal metastases:a valuable strategy or a waste of time?

BACKGROUND:The use of staged liver resections for colorectal metastases has been increasing in recent times.The aim of this study was to determine the practices and outcomes of those surgeons attending the Australia and New Zealand Hepatic, Pancreatic and Biliary Association(ANZHPBA)meeting in 2008 who perform staged resections. METHODS:A questionnaire was sent to all members of the ANZHPBA and the international faculty who were invited to attend the annual meeting held in Coolum,Queensland, Australia in October 2008. RESULTS:There were 30 responses from 7 centres across the UK,Germany and Australia.Twenty-eight patients completed treatment.The study population was predominantly male (n=20,67%),with an average age of 59.4 years.All patients had bilobar disease.A right-sided first resection was planned in 39%of cases.Seventeen percent of patients underwent portal vein embolization prior to first resection.A second operation was performed at an average of 2.8 months from the first resection.Overall,50%(n=14)of patients eventually achieved a complete(R0)staged procedure.Twelve complications after the first resection were seen in 32%patients(n=9).Twenty- three patients underwent a second liver resection.Twenty-five complications after the second resection were present in 57% (n=13). CONCLUSIONS:Two-stage liver resections are beneficial if both stages are completed and an R0 resection is achieved. While there is increased morbidity and mortality,we believe that staged liver resection for colorectal metastases is a valuable strategy in selected cases.

Triradiate caecal fold:Is it a useful landmark for caecal intubation in colonoscopy?

AIM: To determine the frequency of identification of the triradiate fold during colonoscopy and evaluate its reliability as a marker of caecal intubation. METHODS: One hundred consecutive patients undergoing colonoscopy in a tertiary hospital colorectal unit from May to September 2013 were studied. Video documentation of the caecum was recorded and shown to consultant colorectal surgeons on the unit. Each reviewer was asked through a series of questions to independently identify the triradiate fold. The main outcome was the frequency of visualisation of the triradiate fold in the caecum.RESULTS: The triradiate fold was seen on average in 18% of cases, but inter-observer agreement was poor. There were only four patients(4%) in which all reviewers agreed on the presence of a triradiate fold. In patients who had undergone previous appendicectomy, the appendiceal orifice was less frequently seen compared with patients who had not undergone appendicectomy.CONCLUSION: The triradiate fold is infrequently seen during colonoscopy and is therefore an unreliable landmark of caecal intubation.