Context: Current guidelines do not include an upper age cutoff for colorectal cancer screening with colonoscopy. Although the prevalence of colonic neoplasia increases with age, life expectancy decreases. Thus, the be...Context: Current guidelines do not include an upper age cutoff for colorectal cancer screening with colonoscopy. Although the prevalence of colonic neoplasia increases with age, life expectancy decreases. Thus, the benefit of screening colonoscopy in very elderly patients may be limited. Objective: To compare estimated life-years saved with screening colonoscopy in very elderly vs younger persons. Design, Setting, and Participants: Cross-sectional study conducted among 1244 asymptomatic individuals in 3 age groups (50-54 years [n = 1034], 75-79 years [n = 147], and ≥80 years [n = 63]) who underwent screening colonoscopy at a US teaching hospital and clinic. Main Outcome Measures: Prevalence of various tyes of colon neoplasia; estimated gain in life expectancy, calculated as life expectancy -(life expectancy during polyp lag time +life expectancy after colorectal cancer diagnosis); and comparison of mean gain in life expectancy across the 3 groups. Life expectancy and mortality data were derived from life tables, previous studies, and national databases. Results: The prevalence of neoplasia was 13.8%in the 50-to 54-year-old group, 26.5%in the 75-to 79-year-old group, and 28.6%in the group aged 80 years or older. Despite higher prevalence of neoplasia in elderly patients, mean extension in life expectancy was much lower in the group aged 80 years or older than in the 50-to 54-year-old group (0.13 vs 0.85 years). In sensitivity analysis, with longer polyp lag times the mean extension in life expectancy decreased more in the elderly than in the younger patients; alternatively, if it was assumed that a smaller proportion of adenomas progress to colorectal cancer, the mean extension in life expectancy decreased less in the elderly than in the younger patients. Conclusions: Even though prevalence of neoplasia increases with age, screening colonoscopy in very elderly persons (aged ≥80 years) results in only 15%of the expected gain in life expectancy in younger patients. Screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks, and patient preferences.展开更多
The catheter probe EUS(C-EUS) relies on luminal water for acoustic coupling. However, in tubular structures, such as the esophagus and the duodenum, instilled water drains away rapidly. The use of water-filled balloon...The catheter probe EUS(C-EUS) relies on luminal water for acoustic coupling. However, in tubular structures, such as the esophagus and the duodenum, instilled water drains away rapidly. The use of water-filled balloons is limited by air artifact and other problems. This study evaluated the image quality, the penetration depth, the tumor staging accuracy, and the safety of C-EUS by using carboxymethylcellulose, an edible, nontoxic, transparent jelly-like substance (JC-EUS). Forty patients with an esophageal or a duodenal submucosal lesion or an esophageal carcinoma were evaluated prospectively in a crossover study with both C-EUS and JC-EUS when using a 12-MHz US catheter probe. Based on still images, depth of US penetration and image quality (by using a predefined 1 to 5 scale) were assessed by a blinded, independent endosonographer. JC-EUS was superior in image quality compared with C-EUS overall (mean score: 4.9 vs. 2.6; p < 0.001), as well as in each subgroup (esophageal carcinoma, esophageal submucosal lesion, duodenal submucosal lesion). Penetration depth was not significantly different (2.5 cm). Staging was 100%accurate in 14 patients with esophageal cancer who underwent surgery. There was no procedure-related complication. JC-EUS is safe, provides superior image quality to C-EUS, and is accurate for local staging of esophageal cancer.展开更多
文摘Context: Current guidelines do not include an upper age cutoff for colorectal cancer screening with colonoscopy. Although the prevalence of colonic neoplasia increases with age, life expectancy decreases. Thus, the benefit of screening colonoscopy in very elderly patients may be limited. Objective: To compare estimated life-years saved with screening colonoscopy in very elderly vs younger persons. Design, Setting, and Participants: Cross-sectional study conducted among 1244 asymptomatic individuals in 3 age groups (50-54 years [n = 1034], 75-79 years [n = 147], and ≥80 years [n = 63]) who underwent screening colonoscopy at a US teaching hospital and clinic. Main Outcome Measures: Prevalence of various tyes of colon neoplasia; estimated gain in life expectancy, calculated as life expectancy -(life expectancy during polyp lag time +life expectancy after colorectal cancer diagnosis); and comparison of mean gain in life expectancy across the 3 groups. Life expectancy and mortality data were derived from life tables, previous studies, and national databases. Results: The prevalence of neoplasia was 13.8%in the 50-to 54-year-old group, 26.5%in the 75-to 79-year-old group, and 28.6%in the group aged 80 years or older. Despite higher prevalence of neoplasia in elderly patients, mean extension in life expectancy was much lower in the group aged 80 years or older than in the 50-to 54-year-old group (0.13 vs 0.85 years). In sensitivity analysis, with longer polyp lag times the mean extension in life expectancy decreased more in the elderly than in the younger patients; alternatively, if it was assumed that a smaller proportion of adenomas progress to colorectal cancer, the mean extension in life expectancy decreased less in the elderly than in the younger patients. Conclusions: Even though prevalence of neoplasia increases with age, screening colonoscopy in very elderly persons (aged ≥80 years) results in only 15%of the expected gain in life expectancy in younger patients. Screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks, and patient preferences.
文摘The catheter probe EUS(C-EUS) relies on luminal water for acoustic coupling. However, in tubular structures, such as the esophagus and the duodenum, instilled water drains away rapidly. The use of water-filled balloons is limited by air artifact and other problems. This study evaluated the image quality, the penetration depth, the tumor staging accuracy, and the safety of C-EUS by using carboxymethylcellulose, an edible, nontoxic, transparent jelly-like substance (JC-EUS). Forty patients with an esophageal or a duodenal submucosal lesion or an esophageal carcinoma were evaluated prospectively in a crossover study with both C-EUS and JC-EUS when using a 12-MHz US catheter probe. Based on still images, depth of US penetration and image quality (by using a predefined 1 to 5 scale) were assessed by a blinded, independent endosonographer. JC-EUS was superior in image quality compared with C-EUS overall (mean score: 4.9 vs. 2.6; p < 0.001), as well as in each subgroup (esophageal carcinoma, esophageal submucosal lesion, duodenal submucosal lesion). Penetration depth was not significantly different (2.5 cm). Staging was 100%accurate in 14 patients with esophageal cancer who underwent surgery. There was no procedure-related complication. JC-EUS is safe, provides superior image quality to C-EUS, and is accurate for local staging of esophageal cancer.
