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).
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).
