Cumulative effects of genetic markers and the detection of advanced colorectal neoplasias by population screening

Genetic markers associated with colorectal cancer may be used in population screening for the early identification of patients at elevated risk of disease. We genotyped 3059 individuals with no cancer family history for eight markers previously associated with colorectal cancer. After colonoscopy, the genetic profile of cases with advanced colorectal neoplasia (213) was compared with the rest (2846). rs2066847 and rs6983267 were significantly associated with the risk of advanced colorectal neoplasia but with limited effect on their own [odds ratio (OR) 1.59; 95% confidence interval (CI) 1.02–2.41; p = 0.033 and OR 1.45; 95% CI 1.02–2.12; p = 0.044, respectively]. Cumulative effects, in contrast, were associated with high risk: the combination of rs2066847, rs6983267, rs4779584, rs3802842 and rs4939827 minimized the number of markers considered, while maximizing the relative size of the carrier group and the risk associated to it, for example, for at least two cumulated risk markers, OR is 2.57 (95% CI 1.50–4.71; corrected p‐value 0.0079) and for three or more, OR is 3.57 (95% CI 1.91–6.96; corrected p‐value 0.00074). The identification of cumulative models of – otherwise – low‐risk markers could be valuable in defining risk groups, within an otherwise low‐risk population (no cancer family history).     

个体化肠道准备方案在静脉麻醉下老年患者肠镜检查中的应用

 目的 探讨个体化肠道准备方案在老年患者肠镜检查中的应用。方法 选取2021-03至2022-03在解放军总医院第二医学中心消化内镜中心丙泊酚镇静麻醉下、接受无痛肠镜检查的老年患者98例,随机分为对照组与观察组,每组49例。对照组采用常规肠道准备,观察组采用个体化的肠道准备方案下的肠镜检查前肠道准备。对比两组肠道准备清洁度及患者对此肠道准备方案的满意度。结果 观察组波士顿肠道准备量表得分为(7.83±0.35)分,高于对照组的(6.91±0.73)分,差异有统计学意义(P＜0.05);两组患者满意度比较,观察组满意率98.00%高于对照组的79.60%,差异有统计学意义(P＜0.05)。结论 应用个体化肠道准备方案,波士顿评分高,清洁度好,患者满意度更高,值得推广。     

Screening of patients after colectomy: virtual colonography

Background Virtual colonography is a powerful new method of imaging the entire colon and is useful to assess polyps and diagnose colon cancer. We evaluated virtual colonography in the postoperative screening of patients who had colon cancer. Methods Fifty-three patients were examined with virtual colonography 12 to 48 months postoperatively. Forty-four patients had received segmental colectomy with restoration of the gastrointestinal tract, and nine patients underwent abdominoperineal resection and permanent colostomy. After proper cleaning of the colon and distention with air, spiral computed tomographic examination of the abdomen with a slice thickness of 5 mm (table speed [TS] 10 mm, reconstruction interval [RI] 2.5 mm) was performed in the supine and prone positions (including intravenous contrast medium infusion). Images were transferred to a separate workstation (Philips Easy Vision) for postprocessing, three-dimensional rendering, and endoluminal viewing. Results Eleven recurrences (16.41%) were identified in 10 patients by virtual colonography, but one recurrence was missed. Conventional colonoscopy was incomplete in six cases, and two patients with colostomy refused colonoscopy. In these eight cases (15%), virtual colonoscopy was completed without problems. A second tumor in one patient who had received abdominoperineal resection was demonstrated by virtual colonography, but conventional colonoscopy failed to demonstrate the lesion. Liver metastases were identified in only one patient. Conclusions Virtual colonography seems to provide a good alternative in the follow-up of patients after colectomy. The technique is effective in the diagnosis of locoregional recurrences and distant metastases and is well accepted by patients, and results are equal to those of the conventional colonoscopy.     

Value of a negative colonoscopy in patients with non-specific gastrointestinal symptoms

BACKGROUND: The yield of colonoscopy for neoplasia among patients aged <50 years with non-specific gastrointestinal symptoms is very low. However, a negative colonoscopy may benefit these patients by decreasing anxiety and thereby reducing subsequent health resource utilization. This study sought to characterize the effect of a negative colonoscopy in terms of: (i) reassurance value; and (ii) decreasing health resource utilization, in patients under 50 years of age with non-specific gastrointestinal symptoms (abdominal pain, diarrhea, constipation). METHODS: Consecutive patients, aged 18-49 years, undergoing their first colonoscopy for evaluation of non-specific gastrointestinal symptoms (abdominal pain, diarrhea, constipation) were prospectively enrolled. Health-related anxiety was evaluated before and immediately after disclosure of the negative result of colonoscopy using a validated questionnaire and at 1-, 2- and 6-month intervals postcolonoscopy by telephone follow-up. Symptom scores and health resource utilization were assessed prior to colonoscopy and at 2 and 6 months postcolonoscopy. RESULTS: Fifty-nine patients were prospectively enrolled. Mean health anxiety score declined immediately after colonoscopy from 20.6 to 17.8. Sustained improvement was seen in anxiety scores at 1, 2 and 6 months. Symptom scores also decreased at 6 months for abdominal pain (2.3 to 1.5), diarrhea (2.3 to 1.6) and constipation (1.9 to 1.6). There was a significant decrease in all four measures of health resource utilization at 6 months postcolonoscopy. CONCLUSIONS: Despite minimal diagnostic yield, colonoscopy for non-specific gastrointestinal symptoms in patients <50 years of age is associated with a decline in health-related anxiety and symptom scores. These effects appear to translate into reductions in health resource utilization.     

Staging of Early Colorectal Cancers: Magnifying Colonoscopy versus Endoscopic Ultrasonography for Estimation of Depth of Invasion

BACKGROUND AND AIMS: Preoperative estimation of depth of invasion in early colorectal cancers (CRCs) is essential for patient management. This study was conducted to compare the diagnostic accuracies of magnifying colonoscopy and endoscopic ultrasonography (EUS) for estimating the depth of invasion of early CRCs. SUBJECTS AND METHODS: A total of 438 early CRCs were removed endoscopically or surgically from July 1993 through March 1999 at our hospital. Before removal, 102 lesions were evaluated with both magnifying colonoscopy and EUS and were included in this analysis. The diagnostic accuracy of each method, referring to the histology of the resected specimens, was evaluated. RESULTS: The overall diagnostic accuracies were 87% (89/102) for magnifying colonoscopy and 75% (76/102) for EUS (P = 0.0985). Subgroup analysis was also done for polypoid and non-polypoid lesions. For polypoid lesions, the overall diagnostic accuracies of magnifying colonoscopy and EUS were 88% (60/68) and 72% (49/68), (P = 0.0785), and for non-polypoid lesions, they were 85% (29/34) and 79% (27/34), (P = 0.7169). CONCLUSION: Although, there is a substantial difference in the overall diagnostic accuracies, it is not statistically significant. Therefore, we conclude that magnifying colonoscopy is at least as accurate as EUS for preoperative staging of early CRCs.