Should we perform sigmoidoscopy for colorectal cancer screening in people under 45 years?

BACKGROUND The strategy for preventing colorectal cancer is screening by colonoscopy,which offers a direct way for detection and removal of adenomatous polyps(APs).American College of Gastroenterology guidelines recommend that people aged≥45 years should undergo colonoscopy;however,how to deal with people aged≤45 years is still unknown.AIM To compare the prevalence of APs and high-grade neoplasia between the left and right colon in patients≤45 years.METHODS A retrospective observational study was conducted at a single tertiary III hospital in China.This study included patients aged 18-45 years with undergoing initial colonoscopy dissection and pathological diagnosis AP or high-grade neoplasia between February 2014 and January 2021.The number of APs in the entire colon while screening and post-polypectomy surveillance in following 1-3 years were evaluated.RESULTS A total of 3053 cases were included.The prevalence of APs in the left and right colon was 55.0%and 41.6%,respectively(OR 1.7,95%CI 1.6-2.4;P<0.05).For APs with high-grade neoplasia,the prevalence was 2.7%and 0.9%,respectively(OR 3.0,95%CI 2.0-4.6;P<0.05).Therefore,the prevalence of APs and high-grade neoplasia in the left colon was significantly higher than in the right colon in patients aged≤45 years.There were 327 patients who voluntarily participated in post-polypectomy surveillance in following 1-3 years,and APs were found in 216 cases(66.1%);170 cases had 1-3 polyps(52.0%)and 46 cases had>3 polyps(14.1%;OR 0.3,95%CI 0.1-0.6;P<0.05).CONCLUSION This study suggests that flexible sigmoidoscopy would be an optimal approach for initial screening in people aged≤45 years and would be a more cost-effective and safe strategy.

Reduced incidence and mortality from colorectal cancer with flexible-sigmoidoscopy screening: A meta-analysis

AIM: To conduct a systematic review and meta-analysis of published population-based randomized controlled trials (RCTs).

Does music reduce anxiety and discomfort during flexible sigmoidoscopy?A systematic review and meta-analysis

To investigate the role of music in reducing anxiety and discomfort during flexible sigmoidoscopy. METHODSA systematic review of all comparative studies up to November 2016, without language restriction that were identified from MEDLINE and the Cochrane Controlled Trials Register (1960-2016), and EMBASE (1991-2016). Further searches were performed using the bibliographies of articles and abstracts from major conferences such as the ESCP, NCRI, ASGBI and ASCRS. MeSH and text word terms used included “sigmoidoscopy”, “music” and “endoscopy” and “anxiety”. All comparative studies reporting on the effect of music on anxiety or pain during flexible sigmoidoscopy, in adults, were included. Outcome data was extracted by 2 authors independently using outcome measures defined a priori. Quality assessment was performed. RESULTSA total of 4 articles published between 1994 and 2010, fulfilled the selection criteria. Data were extracted and analysed using OpenMetaAnalyst. Patients who listened to music during their flexible sigmoidoscopy had less anxiety compared to control groups [Random effects; SMD: 0.851 (0.467, 1.235), S.E = 0.196, P < 0.001]. There was no statistically significant heterogeneity (Q = 0.085, df = 1, P = 0.77, I2 = 0). Patients who listened to music during their flexible sigmoidoscopy had less pain compared to those who did not, but this difference did not reach statistical significance [Random effects; SMD: 0.345 (-0.014, 0.705), S.E = 0.183, P = 0.06]. Patients who listened to music during their flexible sigmoidoscopy felt it was a useful intervention, compared to those who did not (P < 0.001). There was no statistically significant heterogeneity (P = 0.528, I2 = 0). CONCLUSIONMusic appeared to benefit patients undergoing flexible sigmoidoscopies in relation to anxiety and was deemed a helpful intervention. Pain may also be reduced however further investigation is required to ascertain this.

Are we ready to use new endoscopic scores for ulcerative colitis?

For ulcerative colitis(UC),the variability in inflammatory activity along the colon poses a challenge in management.The focus on achieving endoscopic healing in UC is evident,where the UC Endoscopic Index of Severity and Mayo Endoscopic Subscore are commonly used for evaluation.However,these indices primarily consider the most severely affected region.Liu et al recent study validates the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting(TIGER)score offering a comprehensive assessment of inflammatory activity across diverse segments of the colon and rectum and a reliable index correlating strongly with UC Endoscopic Index of Severity and moderately with Mayo Endoscopic Subscore(MES).Despite recommendation,certain aspects warrant further invest-igation.Fecal calprotectin,an intermediate target,correlates with TIGER and should be explored.Determining TIGER scores defining endoscopic remission and response,evaluating agreement with histological activity,and assessing inter-endoscopist agreement for TIGER require scrutiny.Exploring the correlation between TIGER and intestinal ultrasound,akin to MES,adds value.

Colonoscopic perforation:Incidence,risk factors,management and outcome

This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic interventions.The perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple comorbidities.Management of CP is mainly based on patients' clinical grounds and their underlying colorectal diseases.Current therapeutic approaches include conservative management(bowel rest plus the administration of broadspectrum antibiotics),endoscopic management,and operative management(open or laparoscopic approach).The applications of each treatment are discussed.Overall outcomes of patients with CP are also addressed.

Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations

AIM To summarize and compare worldwide colorectal cancer(CRC) screening recommendations in order to identify similarities and disparities.METHODS A systematic literature search was performed using MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge identifying all average-risk CRC screening guideline publications within the last ten years and/or position statements published in the last 2 years. In addition, a hand-search of the webpages of National Gastroenterology Society websites, the National Guideline Clearinghouse, the BMJ Clinical Evidence website,Google and Google Scholar was performed. RESULTS Fifteen guidelines were identified. Six guidelines were published in North America, four in Europe, four in Asia and one from the World Gastroenterology Organization. The majority of guidelines recommend screening average-risk individuals between ages 50 and 75 using colonoscopy(every 10 years), or flexible sigmoidoscopy(FS, every 5 years) or fecal occult blood test(FOBT, mainly the Fecal Immunochemical Test, annually or biennially). Disparities throughout the different guidelines are found relating to the use of colonoscopy, rank order between test, screening intervals and optimal age ranges for screening. CONCLUSION Average risk individuals between 50 and 75 years should undergo CRC screening. Recommendations for optimal surveillance intervals, preferred tests/test cascade as well as the optimal timing when to start and stop screening differ regionally and should be considered for clinical decision making. Furthermore, local resource availability and patient preferences are important to increase CRC screening uptake, as any screening is better than none.

Colorectal cancer in patients under 50 years of age:A retrospective analysis of two institutions' experience

AIM:To investigate the epidemiological characteristics of colorectal cancer(CRC)in patients under 50 years of age across two institutions.METHODS:Records of patients under age 50 years of age who had CRC surgery over a 16 year period were assessed at two institutions.The following documents where reviewed:admission notes,operative notes,and discharge summaries.The main study variables included:age,presenting symptoms,family history,tumor location,operation,stage/differentiation of disease,and post operative complications.Stage of disease was classified according to the American Joint Committee on Cancer TNM staging system:tumor depth;node status;and metastases.RESULTS:CRC was found in 180 patients under age50 years(87 females,93 males;mean age 41.4±6.2years).Young patients accounted for 11.2%of cases during a 6 year period for which the full data set wasavailable.Eight percent had a 1stdegree and 12%a 2nd degree family CRC history.Almost all patients(94%)were symptomatic at diagnosis;common symptoms included:bleeding(59%),obstruction(9%),and abdominal/rectal pain(35%).Evaluation was often delayed and bleeding frequently attributed to hemorrhoids.Advanced stage CRC(Stage 3 or 4)was noted in 53%of patients.Most tumors were distal to the splenic flexure(77%)and 39%involved the rectum.Most patients(95%)had segmental resections;6 patients had subtotal/total colectomy.Poorly differentiated tumors were noted in 12%and mucinous lesions in 19%of patients of which most had Stage 3 or 4 disease.Twenty-two patients(13%)developed recurrence and/or progression of disease to date.Three patients(ages 42,42and 49 years)went on to develop metachronous primary colon cancers within 3 to 4 years of their initial resection.CONCLUSION:CRC was common in young patients with no family history.Young patients with symptoms merit a timely evaluation to avoid presentation with late stage CRC.

Does flexible small-diameter colonoscope reduce insertion pain during colonoscopy?

AIM It is well known that colonoscopy can bedifficult due to abdominal pain induced duringcolonoscope insertion,if sedative agents are notgiven.Recently,an extra-flexible,small-diameter colonoscope(CF-SV,Olympus Inc.,Japan)was developed in order to improve safetyand comfort.The aim of this study was toaccess the usefulness of the CF-SV.METHODS One hundred patients undergoingsigmoidoscopy were recruited and colonoscopywas performed by one experiencedcolonoscopist.First,a routine-type colonoscope(CF-2301)was inserted into the colon withoutsedation.When the patient complained ofabdominal pain(even if mild),the scope wasnot advanced further and was withdrawn afterthe anatomic location of its tip was determinedfluoroscopically.Then,the CF-SV was inserteduntil it reached the cecun or the site whereabdominal pain occurred.Previous abdominalsurgery and abdominal disease were consideredas unfavorable factors(UF)and the relationshipbetween abdominal pain and UF,age and genderwere investigated.Furthermore,the colonicinsertion pressures in 36 patients with abdominalpain were measured with a force gauge.RESULTS Thirty-four cases(34%)felt no painwith the CF-2301 and successful pancolon-0scopies to the cecum were performed.Sixty-six cases(66%)complained of abdominal pain.The procedure was painless for 47% of men and24% of women,respectively.The CF-2301 scopefailed to reach the sigmoid-descending colon junctions in 59(89.4%)of the 66 patientscomplaining of abdominal pain.However,CF-SVreached proximal area in 94.9% of those whofailed with CF-2301.The median pressure forpain-inducing was 700 g/cm^2.CONCLUSION Unsedated patients with UFwere prone to complain of pain when thestandard-type CF-2301 scope was used.Thenewly developed extra-flexible CF-SV is usefulfor the aged and for those with UF or being proneto suffer from abdominal pain.Sedative agentsmay be unnecessary if this new type ofcolonoscope is used.

Choice of laxatives and colonoscopic preparation in pregnant patients from the viewpoint of obstetricians and gastroenterologists

AIM： To elucidate the preferences of gastroenterologists at our institution and compare them to those of obstetricians when making decisions in the pregnant patient, including which type of bowel preparations to use for flexible sigmoidoscopy or colonoscopy, as well as which laxatives can be used safely.METHODS： Surveys were mailed to all attending gastroenterologists （n = 53） and obstetricians （n = 99） at our institution. Each survey consisted of the 14 most common laxative or motility agents used in pregnancy and inquired about the physician＇s prescribing habits in the past as well as their willingness to prescribe each medication in the future. The survey also listed four common bowel preparations used prior to colonoscopy and sigmoidoscopy and asked the physician to rank the order of the preferred agent in each case.RESULTS： With regard to common laxatives, both gastroenterologists and obstetricians favor the use of Metamucil, Colace, and Citrucel. Both groups appear to refrain from using Fleets Phosphosoda and Castor oil. Of note, obstetricians are less inclined to use PEG solution and Miralax, which is not the case ,with gastroenterologists. In terms of comparing bowel preparations for colonoscopy, 50% of gastroenterologists prefer to use PEG solution and 50% avoid the use of Fleets Phosphosoda. Obstetricians seem to prefer Fleets Phosphosoda （20%） and tend to avoid the use of PEG solution （26%）. With regard to bowel preparation for sigmoidoscopy, both groups prefer Fleets enema the most （51%）, while magnesium citrate is used least often （38%）.CONCLUSION： It is clear that preferences in the use of bowel cleansing preparations between the two groups exist, but there have not been many case controlled human studies in the pregnant patient that give clear cut indications for using one versus another drug. In light of the challenge of performing controlled trials in pregnant women, more extensive surveys should be undertaken to gather a larger amount of data on physicians＇ experiences and individual preferences.

Increasing trend in retained rectal foreign bodies

AIM To highlight the rising trend in hospital presentation of foreign bodies retained in the rectum over a 5-year period.METHODS Retrospective review of the cases of retained rectal foreign bodies between 2008 and 2012 was performed.Patients' clinical data and yearly case presentation with data relating to hospital episodes were collected.Data analysis was by SPSS Inc.Chicago,IL,United States.RESULTS Twenty-five patients presented over a 5-year period with a mean age of 39(17-62) years and M: F ratio of 2:1.A progressive rise in cases was noted from 2008 to 2012 with 3,4,4,6,8 recorded patients per year respectively.The majority of the impacted rectal objects were used for self-/partner-eroticism.The commonest retained foreign bodies were sex vibrators and dildos.Ninty-six percent of the patients required extraction while one passed spontaneously.Two and three patients had retrieval in the Emergency Department and on the ward respectively while 19 patients needed examination under anaesthesia for extraction.The mean hospital stay was 19(2-38) h.Associated psychosocial issues included depression,deliberate self-harm,illicit drug abuse,anxiety and alcoholism.There were no psychosocial problems identified in 15 patients.CONCLUSION There is a progressive rise in hospital presentation of impacted rectal foreign bodies with increasing use of different objects for sexual arousal.

Role of virtual reality simulation in endoscopy training

Recent advancements in virtual reality graphics and models have allowed virtual reality simulators to be incorporated into a variety of endoscopic training programmes. Use of virtual reality simulators in training programmes is thought to improve skill acquisition amongst trainees which is reflected in improved patient comfort and safety. Several studies have already been carried out to ascertain the impact that usage of virtual reality simulators may have upon trainee learning curves and how this may translate to patient comfort. This article reviews the available literature in this area of medical education which is particularly relevant to all parties involved in endoscopy training and curriculum development. Assessment of the available evidence for an optimal exposure time with virtual reality simula-tors and the long-term benefits of their use are also discussed.

Familial colorectal cancer screening: When and what to do?

Colorectal cancer(CRC) is the third leading cause of death worldwide and represents a clinical challenge.Family members of patients affected by CRC have an increased risk of CRC development.In these individuals,screening is strongly recommended and should be started earlier than in the population with average risk,in order to detect neoplastic precursors,such as adenoma,advanced adenoma,and nonpolypoid adenomatous lesions of the colon.Fecal occult blood test(FOBT) is a non invasive,widespread screening method that can reduce CRC-related mortality.Sigmoidoscopy,alone or in addition to FOBT,represents another screening strategy that reduces CRC mortality.Colonoscopy is the best choice for screening highrisk populations,as it allows simultaneous detection and removal of preneoplastic lesions.The choice of test depends on local health policy and varies among countries.

Gastrointestinal endoscopy in the pregnant woman

About 20000 gastrointestinal endoscopies are performed annually in America in pregnant women. Gastrointestinal endoscopy during pregnancy raises the critical issue of fetal safety in addition to patient safety. Endoscopic medications may be potentially abortifacient or teratogenic. Generally, Food and Drug Administration category B or C drugs should be used for endoscopy. Esophagogastroduodenoscopy(EGD) seems to be relatively safe for both mother and fetus based on two retrospective studies of 83 and 60 pregnant patients. The diagnostic yield is about 95% when EGD is performed for gastrointestinal bleeding. EGD indications during pregnancy include acute gastrointestinal bleeding, dysphagia > 1 wk, or endoscopic therapy. Therapeutic EGD is experimental due to scant data, but should be strongly considered for urgent indications such as active bleeding. One study of 48 sigmoidoscopies performed during pregnancy showed relatively favorable fetal outcomes, rare bad fetal outcomes, and bad outcomes linked to very sick mothers. Sigmoidoscopy should be strongly considered for strong indications,including significant acute lower gastrointestinal bleeding, chronic diarrhea, distal colonic stricture, suspected inflammatory bowel disease flare, and potential colonic malignancy. Data on colonoscopy during pregnancy are limited. One study of 20 pregnant patients showed rare poor fetal outcomes. Colonoscopy is generally experimental during pregnancy, but can be considered for strong indications: known colonic mass/stricture, active lower gastrointestinal bleeding, or colonoscopic therapy. Endoscopic retrograde cholangiopancreatography(ERCP) entails fetal risks from fetal radiation exposure. ERCP risks to mother and fetus appear to be acceptable when performed for ERCP therapy, as demonstrated by analysis of nearly 350 cases during pregnancy. Justifiable indications include symptomatic or complicated choledocholithiasis, manifested by jaundice, cholangitis, gallstone pancreatitis, or dilated choledochus. ERCP should be performed by an expert endoscopist, with informed consent about fetal radiation risks, minimizing fetal radiation exposure, and using an attending anesthesiologist. Endoscopy is likely most safe during the second trimester of pregnancy.

Psychological effects of colorectal cancer screening: Participants vs individuals not invited

AIM To investigate the possible long-term psychological harm of participating in colorectal cancer(CRC)screening in Norway.METHODS In a prospective, randomized trial, 14294 participants(aged 50-74 years) were invited to either flexible sigmoidoscopy(FS) screening, or a faecal immunochemical test(FIT)(1:1). In total, 4422 screening participants(32%) completed the questionnaire, which consisted of the Hospital Anxiety and Depression Scale and the SF-12, a generic health-related quality of life(HRQOL) measurement, when invited to screening and one year after the invitation. A control group of 7650 individuals was invited to complete the questionnaire only, at baseline and one year after, and 1911(25%) completed the questionnaires.RESULTS Receiving a positive or negative screening result and participating in the two different screening modalities did not cause clinically relevant mean changes in anxiety, depression or HRQOL after one year. FS screening, but not FIT, was associated with an increased probability of being an anxiety case(score ≥ 8) at the one-year follow-up(5.6% of FS participants transitioned from being not anxious to anxious, while 3.0% experienced the reverse). This increase was moderately significantly different from the changes in the control group(in which the corresponding numbers were 4.8% and 4.5%, respectively), P = 0.06. CONCLUSION Most individuals do not experience psychological effects of CRC screening participation after one year, while FS participation is associated with increased anxiety for a smaller group.

Should a colonoscopy be offered routinely to patients with CT proven acute diverticulitis? A retrospective cohort study and meta-analysis of best available evidence

BACKGROUND The current guidelines suggest that patients should undergo endoscopic evaluation of the colonic lumen after an episode of computed tomography (CT) proven acute diverticulitis to rule out malignancy. The usefulness of routine endoscopic evaluation of CT proven diverticulitis remains unknown. AIM To establish whether routine colonoscopy should be offered to patients after an episode of diverticulitis. METHODS We performed a retrospective study, comparing two groups: a diverticulitis group and a control group. The diverticulitis group consisted of patients undergoing a colonoscopy after an episode of diverticulitis. The control group consisted of asymptomatic patients undergoing a screening sigmoidoscopy. We also performed a systematic review and meta-analysis. We searched electronic data resources to identify all relevant studies. The primary outcome was the number of adenomas found, while the secondary outcomes were the number of cancers and polyps identified, and the adenoma risk. RESULTS 68 and 1309 patients were included in the diverticulitis and control groups respectively. There was no difference in the risk of adenomas (5.9% vs 7.6%, P =0.59), non-advanced adenomas (5.9% vs 6.9%, P = 0.75), advanced adenomas (0% vs 0.8%, P = 1), cancer (0% vs 0.15%, P = 1.00), and polyps (16.2% vs 14.2%, P = 0.65) between both groups. Meta-analysis of data from 4 retrospective observational studies, enrolling 4459 patients, showed no difference between the groups in terms of risk of adenomas (RD =-0.05, 95%CI:-0.11, 0.01, P = 0.10), non-advanced adenomas (RD =-0.02, 95%CI:-0.08, 0.04, P = 0.44), advanced adenomas (RD =-0.01, 95%CI:-0.04, 0.02, P = 0.36), cancer (RD = 0.01, 95%CI:- 0.01, 0.03, P = 0.32), and polyps (RD =-0.05, 95%CI:-0.12, 0.02, P = 0.18). CONCLUSION Routine colonoscopy may not be appropriate in patients with acute diverticulitis. High quality prospective studies are required for more robust conclusions.

Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?

AIM To describe the characteristics of adults who needed to see a doctor in the past year but could not due to the extra cost and assess the impact of limited financial resources on the receipt of routine fecal occult blood test, sigmoidoscopy, or colonoscopy for colon cancer screening among insured patients. METHODS Data obtained from the 2012 Behavioral Risk Factor Surveillance System included 215436 insured adults age 50-75 years. We computed frequencies, adjusted odds ratios(a ORs), and 95%CIs using SAS v9.3 software. RESULTS Nine percent of the study population needed to see a doctor in the past year but could not because of cost. The numbers were significantly higher among those aged 50-64(P < 0.0001), Non-Hispanic Whites(P < 0.0001), and those with a primary care physician(P < 0.0001) among other factors. Adjusting for possible confounders, a ORs for not seeing the doctor in the past year because of cost were: stool occult blood test within last year a OR = 0.88; 95%CI: 0.76-1.02, sigmoidoscopy within last year a OR = 0.72; 95%CI: 0.48-1.07, colonoscopy within the last year a OR = 0.91; 95%CI: 0.81-1.02. CONCLUSION We found that the limited financial resources within the past 12 mo were significantly associated with colorectal cancer(CRC) non-screening. Patients with risk factors identified in this study should adhere to CRC guidelines and should receive financial help if needed.

Continuous quality improvement of colorectal cancer screening

Quality assurance is a key issue in colorectal cancer screening, because effective screening is able to improve primary prevention of the cancer. The quality measure may be described in terms:how well the screening test tells who truly has a disease (sensitivity) and who truly does not have a disease (specificity). This paper raises concerns about identification of the optimal screening test for colorectal cancer. Colonoscopy vs flexible sigmoidoscopy in colorectal cancer screening has been a source of ongoing debate. A multicentre randomised controlled trial comparing flexible sigmoidoscopy with usual care showed that flexible sigmoidoscopy screening is able to diminish the incidence of distal and proximal colorectal cancer, and also mortality related to the distal colorectal cancer. However, colonoscopy provides a more complete examination and remains the more sensitive exam than flexible sigmoidoscopy. Moreover, colonoscopy with polypectomy significantly reduces colorectal cancer incidence and colorectal cancer-related mortality in the general population. The article considers the relative merits of both methods and stresses an ethical aspect of patient's involvement in decision-making. Patients should be informed not only about tests tolerability and risk of endoscopy complications, but also that different screening tests for bowel cancer have different strength to exclude colonic cancer and polyps. The authorities calculate effectiveness and costs of the screening tests, but patients may not be interested in statistics regarding flexible sigmoidoscopy screening and from an ethical point of view, they have the right to chose colonoscopy, which is able to exclude a cancer and precancerous lesions in the whole large bowel.

Assessing the yield and safety of endoscopy in acute graft-vs-host disease after hematopoietic stem cell transplant

BACKGROUND Acute gastrointestinal(GI)graft-vs-host disease(aGVHD)is the most complication of hematopoietic stem cell transplant(HSCT)in patients with hematologic malignancy.Limited data exists on endoscopic evaluation of GVHD in post-HSCT patients with differing GI symptoms.Further,the diagnostic value of gross endoscopic findings as well as the safety of endoscopy in this commonly thrombocytopenic and neutropenic patient population remains unclear.AIM To understand the diagnostic value of symptoms and gross endoscopic findings as well as safety of endoscopy in aGVHD patients.METHODS We analyzed 195 endoscopies performed at City of Hope in patients who underwent allogeneic HSCT less than 100 d prior for hematologic malignancy and were subsequently evaluated for aGVHD via endoscopy.The yield,sensitivity,and specificity of diagnosing aGVHD were calculated for upper and lower endoscopy,various GI tract locations,and presenting symptoms.RESULTS Combined esophagogastroduodenoscopy(EGD)and flexible sigmoidoscopy(FS)demonstrated a greater diagnostic yield for aGVHD(83.1%)compared to EGD(66.7%)or FS(77.2%)alone with any presenting symptom.The upper and lower GI tract demonstrated similar yields regardless of whether patients presented with diarrhea(95.7%vs 99.1%)or nausea/vomiting(97.5%vs 96.8%).Normalappearing mucosa was generally as specific(91.3%)as abnormal mucosa(58.7%-97.8%)for the presence of aGVHD.Adverse events such as bleeding(1.0%),infection(1.0%),and perforation(0.5%)only occurred in a small proportion of patients,with no significant differences in those with underlying thrombocytopenia(P=1.000)and neutropenia(P=0.425).CONCLUSION Combined EGD and FS with biopsies of normal and inflamed mucosa demonstrated the greatest diagnostic yield regardless of presenting symptom and appears to be safe in this population of patients.

Rectal bleeding in adults over 20 years: Endoscopic investigations and results in current hospital practices in Yaoundé, Cameroon

Introduction: In order to identify the modes of investigation and the results of the assessment of rectal bleeding in the Cameroonian adult, we retrospectively analysed the records of 287 patients aged above 20 years diagnosed with rectal bleeding with the aim to know the prescription patterns according to age, the diagnostic performance of tests and the results. Methodology: Between the 1st of January 2009 and the 30th of June 2010, we examined patients at the University Teaching Hospital and the “La Cathédrale” Medical Centre in Yaounde. Age, sex, endoscopic tests and results were evaluated. Results: 287 protocols met our selection criteria, sex ratio (M/F) 2.4/1, median age 46 years interquartile range [36, 55]. Normal tests were 57 (19.2%). Main lesions: haemorrhoids (42.4% CI95 36.7 -48.3), colorectal cancer (10.8% CI95 7.5 -14.9), anal fissure (8.8% CI95 5.8 -12.6) and colorectal polyps (8.4% CI95 5.5 -12.2). The prevalence of significant lesions (polyps and cancer) recorded 7% for those under age 40. 20.5% in those were between 40?-50 years, and 28.9% for those over 50 years. For anoscopies, 44.4% were under 40 years, 39.3% of cases of sigmoidoscopy affected those between 40 -50 years and colonoscopy affected 54% of those over 50 years. For the diagnostic yield, 26.2% had a significant lesion for flexible sigmoidoscopy and only 16.7% and 1.6% for colonoscopy and anoscopy respectively. Conclusion: The study shows that anoscopy and sigmoidoscopy are the main initial tests conducted in Cameroon in the assessment of rectal bleeding in adults of less than 50 years and they are quite sufficient. Haemorrhoids and colorectal cancer are the main pathologies.

Optimal Noninvasive Colon Cancer Screening Modality in Patients Not Receiving Colonoscopy

Colon cancer is the third most common among cancer deaths in the US for both men and women. The incidence of colonoscopy has been soaring in younger patients, which led to changes in recent United States Preventive Services Task Force (USPSTF) guidelines to reduce the age for screening from 50 years to 45 years. Demand for colonoscopy services is surging due to increased incidences of colorectal cancer (CRC) in the both aging and younger population. Increased referrals have led to an insufficient workforce in hospitals and long waiting lists. Further, results from colonoscopy reveal a low percentage of CRC or another severe bowel disease (SBD). Therefore, colon cancer screening is a growing concern, particularly in patients who otherwise have a very long-life expectancy, and who are most likely to benefit from screening. Another reason to boost CRC screening is to minimize the load on hospitals by reducing the patients that undergo colonoscopy unnecessarily because only a low percentage of CRC occurrence is observed in individuals undergoing colonoscopy. In recent years, there are a variety of screening options available for CRC. Noninvasive alternatives include fecal immunochemical test (FIT), multitarget stool DNA testing (MT-sDNA, available under the brand name Cologuard), computed tomography (CT) colonography (previously called virtual colonoscopy), guaiac-based fecal occult blood testing (gFOBT), and capsule colonoscopy (CC). These tests have varied the degree of evidence supporting their use. This study focuses on the most recent survey and efficacy of noninvasive methods to prevent and detect colorectal cancer (CRC).