Recent trends in the prevalence and distribution of colonic diverticula in Japan evaluated using computed tomography colonography

BACKGROUND Computed tomography colonography(CTC)may be superior to colonoscopy and barium enema for detecting diverticula.However,few studies have used CTC to diagnose diverticula.AIM To evaluate the current prevalence and distribution of colonic diverticula in Japan using CTC.METHODS This study was conducted as part of the Japanese National Computed Tomographic Colonography Trial,which included 1181 participants from 14 hospitals in Japan.We analyzed the prevalence and distribution of colonic diverticula and their relationships with age and sex.The relationship between the diverticula and the length of the large intestine was also analyzed.RESULTS Diverticulosis was present in 48.1%of the participants.The prevalence of diverticulosis was higher in the older participants(P<0.001 for trend).The diverticula seen in younger participants were predominantly located in the right-sided colon.Older participants had a higher frequency of bilateral type(located in the rightand left-sided colon)diverticulosis(P<0.001 for trend).The length of the large intestine with multiple diverticula in the sigmoid colon was significantly shorter in those without diverticula(P<0.001).CONCLUSION The prevalence of colonic diverticulosis in Japan is higher than that previously reported.The prevalence was higher,and the distribution tended to be bilateral in older participants.

Computed tomography colonography and radiation risk:How low can we go?

Computed tomography colonography(CTC)has become a key examination in detecting colonic polyps and colorectal carcinoma(CRC).It is particularly useful after incomplete optical colonoscopy(OC)for patients with sedation risks and patients anxious about the risks or potential discomfort associated with OC.CTC's main advantages compared with OC are its non-invasive nature,better patient compliance,and the ability to assess the extracolonic disease.Despite these advantages,ionizing radiation remains the most significant burden of CTC.This opinion review comprehensively addresses the radiation risk of CTC,incorporating imaging technology refinements such as automatic tube current modulation,filtered back projections,lowering the tube voltage,and iterative reconstructions as tools for optimizing low and ultra-low dose protocols of CTC.Future perspectives arise from integrating artificial intelligence in computed tomography machines for the screening of CRC.

Colorectal cancer screening:The role of CT colonography

Computed tomography colonography(CTC) in colorectal cancer(CRC) screening has two roles:one present and the other potential.The present role is,without any further discussion,the integration into established screening programs as a replacement for barium enema in the case of incomplete colonoscopy.The potential role is the use of CTC as a first-line screening method together with Fecal Occult Blood Test,sigmoidoscopy and colonoscopy.However,despite the fact that CTC has been officially endorsed for CRC screening of average-risk individuals by different scientif ic societies including the American Cancer Society,the American College of Radiology,and the US Multisociety Task Force on Colorectal Cancer,other entities,such as the US Preventive Services Task Force,have considered the evidence insuff icient to justify its use as a mass screening method.Medicare has also recently denied reimbursement for CTC as a screening test.Nevertheless,multiple advantages exist for using CTC as a CRC screening test:high accuracy,full evaluation of the colon in virtually all patients,non-invasiveness,safety,patient comfort,detection of extracolonic findings and cost-effectiveness.The main potential drawback of a CTC screening is the exposure to ionizing radiation.However,this is not a major issue,since low-dose protocols are now routinely implemented,delivering a dose comparable or slightly superior to the annual radiation exposure of any individual.Indirect evidence exists that such a radiation exposure does not induce additional cancers.

Screening of colorectal cancer: Methods and strategies

Colorectal cancer(CRC)has high incidence and mortality rates,and the em-ergence and application of CRC screening have helped us effectively control the occurrence and development of CRC.Currently,common international screening methods include tests based on feces and blood,and examination methods that allow for visualization,such as sigmoidoscopy and colonoscopy.Some methods have been widely used,whereas others such as multi-target stool RNA test are still being explored and developed,and are expected to become front-line screening methods for CRC in the future.The choice of screening method is affected by external conditions and the patients'situation,and the clinician must choose an appropriate strategy according to the actual situation and the patient's wishes.This article introduces various CRC screening methods and analyzes the factors relevant to the screening strategy.

Rare case of fecal impaction caused by a fecalith originating in a large colonic diverticulum: A case report

BACKGROUND Fecal impaction is defined as a large mass of compacted feces in the colon and has the potential to induce a serious medical condition in elderly individuals.Fecal impaction is generally preventable,and early recognition of the typical radiological findings is important for making an early diagnosis.The factors that lead to fecal impaction are usually similar to those causing constipation.Few cases with fecal impaction associated with a diverticulum have been reported.CASE SUMMARY We present the case of a 62-year-old woman who suffered from abdominal pain and vomiting,had a medical history of repeated acute abdomen and was diagnosed with fecal impaction in the descending colon based on X-ray and computed tomography(CT)imaging.After examination by gastrografinenhanced colonography following colonoscopy and CT colonography,the fecalith was suspected to have been produced at the site of a large diverticulum in the transverse colon.The fecalith was surgically resected,and a histological diagnosis of pseudodiverticulum was made.There was no recurrence during 33 mo of follow-up.CONCLUSION This case highlights the importance of accurate identification and treatment of a fecal impaction.This case indicated that the endoscopic evacuation and subsequent colonography were effective for identifying a diverticulum that might have caused fecal impaction.A fecal impaction was associated with the diverticulum.Consequently,the planned diverticulectomy was performed.Appropriate emergency medical treatment and maintenance treatments should be selected in such cases to prevent recurrence.