AIM: To determine the miss rate for colorectal flat adenomas during colonoscopy and the risk factors.METHODS: Flat adenomas are frequently missed during colonoscopy. However, the risk factors that influence their miss...AIM: To determine the miss rate for colorectal flat adenomas during colonoscopy and the risk factors.METHODS: Flat adenomas are frequently missed during colonoscopy. However, the risk factors that influence their miss rates are unclear. This was a multicenter,retrospective study in which patients diagnosed with colorectal adenomas at a diagnostic colonoscopy and followed within 3 mo by a second therapeutic colonos-copy were pooled out from the established database. The "per-patient" and "per-adenoma" adenoma miss rates(AMR) for overall adenomas and flat adenomas, and patient-, adenoma-, and procedure-related risk factors potentially associated with the "per-adenoma" AMR for flat adenomas were determined.RESULTS: Chromoscopy and high-definition colonoscopy were not taken under consideration in the study. Among 2093 patients with colorectal adenomas, 691(33.0%) were diagnosed with flat adenomas, 514 with concomitant protruding adenomas and 177 without. The "per-patient" AMR for flat adenomas was 43.3%(299/691); the rates were 54.3% and 11.3%, respectively, for those with protruding adenomas and those without(OR = 9.320, 95%CI: 5.672-15.314, χ2 = 99.084, P < 0.001). The "per-adenoma" AMR for flat adenomas was 44.3%(406/916). In multivariate analysis, older age, presence of concomitant protruding adenomas, poor bowel preparation, smaller adenoma size, location at the right colon, insufficient experience of the colonoscopist, and withdrawal time < 6 min were associated with an increased "per-adenoma" AMR for flat adenomas. The AMR for flat adenomas was moderately correlated with that for overall adenomas(r = 0.516, P < 0.0001). The AMR for flat adenomas during colonoscopy was high.CONCLUSION: Patient's age, concomitant protruding adenomas, bowel preparation, size and location of adenomas, proficiency of the colonoscopist, and withdrawal time are factors affecting the "per-adenoma" AMR for flat adenomas.展开更多
We report a case of multiple flat adenomas and cancer of the rectum that occurred 15 years after pelvic irradiation following surgery for uterine cancer.Adenoma borders were diagnosed accurately by magnifying chromoen...We report a case of multiple flat adenomas and cancer of the rectum that occurred 15 years after pelvic irradiation following surgery for uterine cancer.Adenoma borders were diagnosed accurately by magnifying chromoendoscopy,leading to their adequate excision using endoscopic submucosal dissection.This enabled minimal dissection of the irradiated pelvis that would have otherwise been difficult.Furthermore,our approach probably helped minimize loss of bowel function,thereby preserving the patient's quality of life as much as possible.Pathology of the resected specimens revealed thickened walls of the submucosal layer vessels,indicating chronic radiation proctitis.Pelvic irradiation of the bowel carries a high risk of causing flat adenomas and cancer.Close and long-term surveillance may be useful in such cases,using not only conventional colonoscopy but also chromoendoscopy with indigo carmine dye spray and magnifying endoscopy.展开更多
AIM: To investigate the impact of Jet Prep cleansing on adenoma detection rates.METHODS: In this prospective,randomized,crossover trial,patients were blindly randomized to an intervention arm or a control arm.In accor...AIM: To investigate the impact of Jet Prep cleansing on adenoma detection rates.METHODS: In this prospective,randomized,crossover trial,patients were blindly randomized to an intervention arm or a control arm.In accordance with the risk profile for the development of colorectal carcinoma,the study participants were divided into high-risk and low-risk groups.Individuals with just one criterion(age > 70 years,adenoma in medical history,and first-degree relative with colorectal cancer) were regarded as high-risk patients.Bowel preparation was performed in a standardized manner one day before the procedure.Participants in the intervention arm underwent an initial colonoscopy with standard bowel cleansing using a 250-m L syringe followed by a second colonoscopy that included irrigation by the use of the Jet Prep cleansing system.The reverse sequence was used in the control arm.The study participants were divided into a high-risk group and a low-risk group according to their respective risk profiles for the development of colorectal carcinoma.RESULTS: A total of 64 patients(34 men and 30 women) were included in the study; 22 were included in the high-risk group.After randomization,30 patients were assigned to the control group(group A) and 34 to the intervention group(group B).The average Boston Bowel Preparation Scale score was 5.15 ± 2.04.The withdrawal time needed for the first step was significantly longer in group A using the Jet Prep system(9.41 ± 3.34 min) compared to group B(7.5 ± 1.92 min).A total of 163 polyps were discovered in 64 study participants who underwent both investigation steps.In group A,49.4% of the polyps were detected during the step of standard bowel cleansing while the miss rate constituted 50.7%.Group B underwent cleansing with the Jet Prep system during the first examination step,and as many as 73.9% of polyps were identified during this step.Thus,the miss rate in group B was a mere 26.1%(P < 0.001).When considering only the right side of the colon,the miss rate in group A during the first examination was 60.6%,in contrast to a miss rate of 26.4% in group B(P < 0.001).CONCLUSION: Jet Prep is recommended for use during colonoscopy because a better prepared bowel enables a better adenoma detection,particularly in the proximal colon.展开更多
AIM:To prospectively investigate the detection rate of laterally spreading tumors(LSTs)of the colorectum by computed tomography(CT)colonography(CTC).METHODS:Patients with LSTs measuring≥20 mm detected during colonosc...AIM:To prospectively investigate the detection rate of laterally spreading tumors(LSTs)of the colorectum by computed tomography(CT)colonography(CTC).METHODS:Patients with LSTs measuring≥20 mm detected during colonoscopy were prospectively enrolled in the study.All patients underwent colonoscopy and subsequent CTC on the same day.CTC was performed using multi-detector CT without contrast in the prone and supine positions.Two radiologists blinded to the existence of LSTs read the virtual endoscopic images as well as 2-D images.LSTs were classified into granular and non-granular types based on colonoscopic appearance.RESULTS:Forty-seven pathologically proven LSTs were evaluated prospectively.Histology included adenomas in 19,mucosal cancers in 19 and T1 cancers in 9.The mean diameter of the LSTs was 35.1 mm.Twenty-eight(60%)LSTs were correctly identified by CTC,and the configuration was similar to the colonoscopic appearance in most cases.Detection rate for the granular type was significantly higher than that for the nongranular type(71%vs 31%,P=0.013).Detection rate of adenomas was significantly lower than mucosal cancers(32%vs 79%,P=0.008)and T1 cancers(32%vs 78%,P=0.042).CONCLUSION:The detection rate of LSTs by CTC,particularly the non-granular type was not acceptable.Practitioners should be aware of the relatively low detection rate when using CTC.展开更多
基金Supported by Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme(2011)
文摘AIM: To determine the miss rate for colorectal flat adenomas during colonoscopy and the risk factors.METHODS: Flat adenomas are frequently missed during colonoscopy. However, the risk factors that influence their miss rates are unclear. This was a multicenter,retrospective study in which patients diagnosed with colorectal adenomas at a diagnostic colonoscopy and followed within 3 mo by a second therapeutic colonos-copy were pooled out from the established database. The "per-patient" and "per-adenoma" adenoma miss rates(AMR) for overall adenomas and flat adenomas, and patient-, adenoma-, and procedure-related risk factors potentially associated with the "per-adenoma" AMR for flat adenomas were determined.RESULTS: Chromoscopy and high-definition colonoscopy were not taken under consideration in the study. Among 2093 patients with colorectal adenomas, 691(33.0%) were diagnosed with flat adenomas, 514 with concomitant protruding adenomas and 177 without. The "per-patient" AMR for flat adenomas was 43.3%(299/691); the rates were 54.3% and 11.3%, respectively, for those with protruding adenomas and those without(OR = 9.320, 95%CI: 5.672-15.314, χ2 = 99.084, P < 0.001). The "per-adenoma" AMR for flat adenomas was 44.3%(406/916). In multivariate analysis, older age, presence of concomitant protruding adenomas, poor bowel preparation, smaller adenoma size, location at the right colon, insufficient experience of the colonoscopist, and withdrawal time < 6 min were associated with an increased "per-adenoma" AMR for flat adenomas. The AMR for flat adenomas was moderately correlated with that for overall adenomas(r = 0.516, P < 0.0001). The AMR for flat adenomas during colonoscopy was high.CONCLUSION: Patient's age, concomitant protruding adenomas, bowel preparation, size and location of adenomas, proficiency of the colonoscopist, and withdrawal time are factors affecting the "per-adenoma" AMR for flat adenomas.
文摘We report a case of multiple flat adenomas and cancer of the rectum that occurred 15 years after pelvic irradiation following surgery for uterine cancer.Adenoma borders were diagnosed accurately by magnifying chromoendoscopy,leading to their adequate excision using endoscopic submucosal dissection.This enabled minimal dissection of the irradiated pelvis that would have otherwise been difficult.Furthermore,our approach probably helped minimize loss of bowel function,thereby preserving the patient's quality of life as much as possible.Pathology of the resected specimens revealed thickened walls of the submucosal layer vessels,indicating chronic radiation proctitis.Pelvic irradiation of the bowel carries a high risk of causing flat adenomas and cancer.Close and long-term surveillance may be useful in such cases,using not only conventional colonoscopy but also chromoendoscopy with indigo carmine dye spray and magnifying endoscopy.
文摘AIM: To investigate the impact of Jet Prep cleansing on adenoma detection rates.METHODS: In this prospective,randomized,crossover trial,patients were blindly randomized to an intervention arm or a control arm.In accordance with the risk profile for the development of colorectal carcinoma,the study participants were divided into high-risk and low-risk groups.Individuals with just one criterion(age > 70 years,adenoma in medical history,and first-degree relative with colorectal cancer) were regarded as high-risk patients.Bowel preparation was performed in a standardized manner one day before the procedure.Participants in the intervention arm underwent an initial colonoscopy with standard bowel cleansing using a 250-m L syringe followed by a second colonoscopy that included irrigation by the use of the Jet Prep cleansing system.The reverse sequence was used in the control arm.The study participants were divided into a high-risk group and a low-risk group according to their respective risk profiles for the development of colorectal carcinoma.RESULTS: A total of 64 patients(34 men and 30 women) were included in the study; 22 were included in the high-risk group.After randomization,30 patients were assigned to the control group(group A) and 34 to the intervention group(group B).The average Boston Bowel Preparation Scale score was 5.15 ± 2.04.The withdrawal time needed for the first step was significantly longer in group A using the Jet Prep system(9.41 ± 3.34 min) compared to group B(7.5 ± 1.92 min).A total of 163 polyps were discovered in 64 study participants who underwent both investigation steps.In group A,49.4% of the polyps were detected during the step of standard bowel cleansing while the miss rate constituted 50.7%.Group B underwent cleansing with the Jet Prep system during the first examination step,and as many as 73.9% of polyps were identified during this step.Thus,the miss rate in group B was a mere 26.1%(P < 0.001).When considering only the right side of the colon,the miss rate in group A during the first examination was 60.6%,in contrast to a miss rate of 26.4% in group B(P < 0.001).CONCLUSION: Jet Prep is recommended for use during colonoscopy because a better prepared bowel enables a better adenoma detection,particularly in the proximal colon.
文摘AIM:To prospectively investigate the detection rate of laterally spreading tumors(LSTs)of the colorectum by computed tomography(CT)colonography(CTC).METHODS:Patients with LSTs measuring≥20 mm detected during colonoscopy were prospectively enrolled in the study.All patients underwent colonoscopy and subsequent CTC on the same day.CTC was performed using multi-detector CT without contrast in the prone and supine positions.Two radiologists blinded to the existence of LSTs read the virtual endoscopic images as well as 2-D images.LSTs were classified into granular and non-granular types based on colonoscopic appearance.RESULTS:Forty-seven pathologically proven LSTs were evaluated prospectively.Histology included adenomas in 19,mucosal cancers in 19 and T1 cancers in 9.The mean diameter of the LSTs was 35.1 mm.Twenty-eight(60%)LSTs were correctly identified by CTC,and the configuration was similar to the colonoscopic appearance in most cases.Detection rate for the granular type was significantly higher than that for the nongranular type(71%vs 31%,P=0.013).Detection rate of adenomas was significantly lower than mucosal cancers(32%vs 79%,P=0.008)and T1 cancers(32%vs 78%,P=0.042).CONCLUSION:The detection rate of LSTs by CTC,particularly the non-granular type was not acceptable.Practitioners should be aware of the relatively low detection rate when using CTC.
