Colonoscopic screening and follow-up in patients with acromegaly: a multicenter study in Italy

Acromegaly is an infrequent disease attributable to endogenous excess of GH and IGF-I. Human studies have associated the GH-IGF-I axis with the development of colorectal cancer; however, the question of whether colorectal cancer is a problem in acromegaly is currently unresolved. We performed a cross-sectional study to assess the risk of colonic neoplasia in patients with acromegaly. Colonoscopic screening was performed in 235 patients with acromegaly at five tertiary care hospitals in Italy between January 1, 1996, and December 31, 2001. A repeat colonoscopy was performed in 121 patients after a mean interval of 32.1 months. Colonoscopic findings in patients with acromegaly were compared with those of 233 patients with nonspecific abdominal complaints who were referred for endoscopy during the study period. A total of 65 patients (27.7%) and 36 controls (15.5%) had colonic neoplasia. In 55 patients (23.4%) and 34 control subjects (14.6%), the most important findings were adenomas (odds ratio, 1.7; range, 1.1-2.5), whereas 10 patients (4.3%) and two control subjects (0.9%) had carcinoma (odds ratio, 4.9; range, 1.1-22.4). The risk of colonic neoplasia was higher for younger patients with acromegaly compared with age-matched controls. Patients with acromegaly with or without colonic neoplasia did not differ significantly for IGF-I levels or duration of disease. A neoplastic recurrence was found in 16.5% of patients who underwent follow-up; 90% of them had had a neoplasm removed at the first colonoscopy. Acromegaly carries with it a moderate, but definitive, increase in the risk of colonic neoplasia that occurs at a younger age than in the general population. Patients who are found to harbor a colonic neoplasia are at risk for recurrence.     

Colonoscopic screening of asymptomatic patients with a family history of colon cancer

The records of 201 asymptomatic patients who underwent colonoscopy based solely on a family history of colon cancer were reviewed. Eighty-five patients (42 percent) had a total of 166 lesions. Fifty-four (27 percent) patients of the screened population had neoplastic lesions, while 31 (15 percent) patients had nonneoplastic polyps. Four carcinomas were found. Twenty-five of the patients with polyps (29 percent) had no polyps distal to the splenic flexure; these proximal polyps (and two carcinomas) would have been missed on screening with fiberoptic sigmoidoscopy. Nineteen of these 25 patients had polyps smaller than 0.5 cm, which likely would have been missed with contrast enemas. Almost one half (47 percent) of all polyps discovered at screening colonoscopy were proximal to the descending colon. Only one patient younger than 40 years old had adenomas. The yield of polyps and cancer in patients with familial risk indicates screening colonoscopy should be considered after age 40.Read at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989. This paper received the Harry E. Bacon Foundation award.     

Preferred options for receiving sexual health screening results: a population and patient survey

Current genitourinary medicine patients (202) and potential future patients (542) completed a questionnaire-based survey to determine their preference for obtaining test results, their acceptability of including a named infection on contact slips and to report expectations about the acceptable length of an appointment. Overall, most respondents (78% [n = 582]) felt it unacceptable to be only contacted if their results were positive ('no news is good news'). In the clinic, a majority preferred a contact slip to be coded (68% [n = 137]), in the general public views were balanced. Significantly, more people in the general population expected an appointment to last no longer than 30 min (32% [n = 173] cf. 10% [n = 21], P < 0.001). A clear preference was expressed to receive sexually transmitted infection test results even if they are negative. Telephone and face-to-face contact were most popular with relatively few choosing mobile telephone text messaging or email as their preferred option.     

A decrease in total bilirubin predicted hyper-LDL cholesterolemia in a health screening population

Objective

To investigate cross-sectional and longitudinal associations between serum total bilirubin (TB) and LDL cholesterol.

Methods

It is a retrospective observational study. Cross-sectional and longitudinal associations between TB and hyper-LDL cholesterolemia were investigated in a health screening population. Odds ratios (ORs) of coexisting hyper-LDL cholesterolemia for TB were calculated in 3,866 subjects, Spearman's correlation coefficients between baseline TB and LDL cholesterol at baseline and after 4 years were calculated in 1,735 subjects who did not use antihyperlipidemic drugs and hazard ratios (HRs) of incident hyper-LDL cholesterolemia for TB were calculated in 1,992 followed subjects.

Results

The ORs (p values) of coexisting hyper-LDL cholesterolemia for each 1 SD increase in TB was 1.04 (0.998) adjusted for sex, age, smoking, LDL cholesterol and other confounders. Spearman's correlation coefficients (p values) between baseline TB and LDL cholesterol at baseline and after 4 years and changes in LDL cholesterol were −0.026 (0.271), −0.078 (0.001) and −0.062 (0.010), respectively. Among 1,992 followed subjects, 481 developed hyper-LDL cholesterolemia during 4 years (60.4 per 1,000 person-years). The HRs (95% confidence intervals; p values) of incident hyper-LDL cholesterolemia for each 1 SD increase in TB was 0.86 (0.77–0.96; 0.006) adjusted for sex, age, smoking, LDL cholesterol, body mass index, triglycerides, HDL cholesterol, fasting glucose and other confounders. The quintiles of TB were significantly associated with the incident hyper-LDL cholesterolemia adjusted for the above covariates (p for trend = 0.008).

Conclusion

A decrease in TB predicted incident hyper-LDL cholesterolemia in a health screening population.     

新型胃癌筛查评分系统在卫生系统健康体检人员早期胃癌筛查中的应用

目的:探讨新型胃癌筛查评分系统在卫生系统健康体检人员早期胃癌筛查中的应用效能。方法:利用新型胃癌筛查评分系统,对卫生系统健康体检人员进行胃癌危险度评分,向中、高危体检人员发送筛查告知书,对愿意行胃镜检查的体检人员进行胃镜检查。分析胃镜检查结果。结果:2019年1—4月,卫生系统从业人员在南京医科大学上海松江临床医学院体...     

Colonoscopic screening and follow—up for colorectal cancer in the elderly

AIM: To improve the prevention and treatment of senile patients with colorectal cancer by evaluating the importance of colonoscopy in clinical screening and follow-up. METHODS: Clinical screening of colonoscopy was performed for 2196 patients aged 60-90 years old according to the protocol,and 1740 of them (79.2%) were followed-up. RESULTS: Colorectal cancer was found in 52 patients, and the detectable rate was 2.4%. Among them, 19 were diagnosed as early colorectal cancer, accounting for 36.5% of the detected colorectal cancer. Among the followed-up patients, early colorectal cancer was found in 9, accounting for 45.0% of the detected colorectal cancer. The resectable rate and 5 years survival rate of colorectal cancer were 97.7% and 80.9% respectively. The incidence of complication was 0.05%, and the successful rate of cecum intubation was 98.9%. CONCLUSION: Colonoscopic screening and follow-up of the elderly for colorectal cancer and pre-cancerous lesion (adenomatoid polyp) can increase the detectable rate of early colorectal cancer and improve its prevention and treatment.     

Colonoscopic appendectomy: Report of a case

A persistent appendix occurred after inversion appendectomy. Colonoscopic removal was straightforward and would appear to be the treatment of choice in this unusual circumstance.     

A randomized controlled trial in a training institution comparing a pediatric variable stiffness colonoscope, a pediatric colonoscope, and an adult colonoscope

BACKGROUND: There are few comparative data on the efficacy of different colonoscopes. This study compared the efficacy of a new pediatric variable stiffness colonoscope with that of standard pediatric and adult colonoscopes in the performance of routine colonoscopy. METHODS: Three hundred sixty-three consecutive patients were randomized to undergo colonoscopy with a pediatric variable stiffness (n = 122), pediatric (n = 114), or adult colonoscope (n = 127). Primary outcomes recorded were minutes to the cecum and completeness of the examination. Secondary outcomes included patient tolerance, use of abdominal compression, and endoscopists' assessment of the difficulty of the procedure. RESULTS: Cecal intubation rates were not statistically different between the groups: variable stiffness (94.3%), pediatric (96.5%), and adult (89.8%) (p = 0.099). There was no significant difference in mean insertion time, patient tolerance, use of abdominal compression, or endoscopists' global assessment or examination difficulty between groups. Overall, the initial completion rate of 93% increased to 97% on switching to a different colonoscope. Colonoscopy was unsuccessful more often and was more time consuming in women who had undergone hysterectomy. CONCLUSION: The variable stiffness colonoscope performs well, but does not appear to offer any distinct advantage over standard pediatric or adult colonoscopes for routine colonoscopy. Further study may identify subgroups of patients that benefit from this new technology.     

Technical performance of colonoscopy in patients sedated with nurse-administered propofol

OBJECTIVES: Nurse-administered propofol has gained attention as a safe and effective means of sedation for patients undergoing endoscopic procedures. However, little is known about the effect of propofol on the technical performance of colonoscopy. METHODS: Three separate studies were conducted. In the first study, we reviewed procedure notes from consecutive colonoscopies performed by a single experienced endoscopist at our hospital endoscopy unit on patients sedated with either nurse-administered propofol (n = 162) or midazolam/narcotic (n = 164). In the second study, 100 eligible colonoscopy outpatients were randomized to receive either nurse-administered propofol (n = 50) or midazolam/fentanyl (n = 50). In both studies, the measured parameters included visualization of the cecum, time required to reach the cecum, repositioning of the patient, and the application of abdominal counterpressure. In a third study, we reviewed the rate of cecal intubation and colonic perforation in the first 2357 patients in our unit receiving nurse-administered propofol. RESULTS: In the retrospective comparative study, there was no difference in the cecal intubation rate in those receiving propofol (99.4%) compared to those receiving midazolam/narcotic (97%; p= 0.1), and three of five failed cecal intubations in the latter group resulted from obstructing masses. Patients sedated with propofol were repositioned less frequently compared to those receiving midazolam/narcotic (3.7%vs 26.2%) (p < 0.0001). Abdominal pressure was employed in 9.9% of patients sedated with propofol compared to 19.5% (p= 0.01) of those given midazolam/narcotic. The mean time to reach the cecum was lower in the propofol group than in the midazolam/narcotic group (4.6 min vs 6.0 min, p= 0.002). In the prospective randomized study, the endoscopist intubated the cecum in all 100 patients. Patients in the propofol group were repositioned less frequently than those in the midazolam/fentanyl group (2%vs 24%, respectively, p= 0.001). The number of cases requiring abdominal counterpressure was not significantly different between the propofol and midazolam/fentanyl groups (12%vs 24%, respectively, p= 0.1). The mean time to reach the cecum in the propofol group (3.2 min) was similar to that in the midazolam/fentanyl group (3.8 min, p= 0.08). Among the first 2357 patients in our unit undergoing colonoscopy with nurse-administered propofol, the rate of complete colonoscopy was 99.2% and there were no perforations. CONCLUSION: Nurse-administered propofol sedation is safe and simplifies the technical performance of colonoscopy compared to midazolam/narcotic sedation.     

The efficacy of mass screening for chronic obstructive pulmonary disease using screening questionnaires in a medical health check-up population

BackgroundChronic obstructive pulmonary disease (COPD) is a preventable and treatable disease, highlighting the need for efficient screening strategies to identify patients with COPD. However, there is little evidence regarding the efficacy of mass screening for COPD, and no epidemiological studies on COPD have been conducted in the Shikoku region of Japan.MethodsIn this cross-sectional study, we originally investigated the efficacy of mass screening for COPD among community residents in the aforementioned region using two COPD screening questionnaires.ResultsFrom July 2018 through January 2019, 688 participants were enrolled. COPD was diagnosed using the Global Initiative for the Chronic Obstructive Lung Disease criteria. Twenty-one patients were newly diagnosed with COPD and 19 (90.5%) had early stages COPD. The prevalence of COPD in this study was 3.1%. The COPD Population Screener (COPD-PS) questionnaire and the International Primary Care Airways Guidelines (IPAG) questionnaire had extremely high negative predictive values in discriminating participants with COPD from those without. The scores of both questionnaires were correlated with spirometric tests and with each other. The COPD-PS questionnaire had significantly better specificity and area under the receiver operating characteristic curve value than the IPAG questionnaire. Moreover, only the COPD-PS questionnaire was identified as an independent factor for predicting COPD diagnosis in the multivariate analysis.Conclusions: Mass screening for COPD using screening questionnaires, particularly the COPD-PS questionnaire, might be useful to identify the early stages of COPD in a medical health check-up population.     

Feasibility of the transparent cap-fitted colonoscope for screening and mucosal resection

PURPOSE: A transparent plastic cap of 17 mm in outer diameter, 15 mm in inner diameter, and 10 mm in length can be easily attached to the tip of a colonoscope. By using the cap, a better view of the lesions hiding at the opposite side of the fold can be obtained. When a flat colonic lesion is found, a submucosal injection of saline solution is performed, the target mucosa is sucked inside the cap, snared under a full endoscopic suction, and resected by an electrical current. This procedure is called endoscopic mucosal resection using transparent cap-fitted endoscope (EMRC). Feasibility of the cap-fitted colonoscope for screening colonoscopic examination and mucosal resection was evaluated. MATERIALS AND METHODS: One hundred forty patients were randomly allocated for screening with a normal colonoscope (NCF) or that with the cap-fitted colonoscope (CCF). Average time for insertion up to the cecum, patients' discomfort during insertion expressed in 4 degrees, and average number of lesions found in one patient were compared. Thirty lesions randomly allocated for mucosal resection with conventional strip biopsy or EMRC were also evaluated. RESULTS: Time consumed for insertion up to the cecum with the CCF (12.4±6.6 minutes) was the same as that with the NCF (12.3±5.2 minutes), and there was no significant difference in patients' discomfort; however, the average number of lesions found in one patient was larger when using the CCF (0.86±0.96) than when using the NCF (0.58±0.81). For mucosal resection, 40 flat or wide-based lesions including 6 mucosal carcinomas were resected with EMRC. We experienced only one pinhole perforation of the ascending colon by heat damage, which was treated successfully by surgery. There was no other major complication or recurrence. CONCLUSION: The cap-fitted endoscope was equal in maneuverability, was excellent in sensitivity in comparison with the regular colonoscope, and was thought to be feasible both in screening and mucosal resection.Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9–14, 1996.     

The use of the 130-cm colonoscope for screening flexible sigmoidoscopy

The 130-cm colonoscope was utilized to determine whether a deeper insertion could be accomplished after the usual enema preparation for routine flexible sigmoidoscopy and, if so, to what extent that would enhance the yield of neoplastic findings. Sixty-four patients were examined, and intubation was accomplished to the level of 69 cm compared with 48.1 cm for a matched control group that had flexible sigmoidoscopy with the 60-cm endoscope. Another 24 patients who had a barium enema prep had a significantly greater depth of insertion (81.4 cm). Only two polyps were found proximal to 60 cm. The 130-cm colonoscope does not offer any substantial advantage over the standard 60-cm sigmoidoscope unless a bowel preparation more thorough than enemas is given and then it would probably only be worthwhile using the colonoscope in patients who are above average risk for colorectal neoplasia.     

Colonoscopic screening for neoplasms in asymptomatic first-degree relatives of colon cancer patients

Individuals with a family history of colorectal cancer are believed to be at an increased risk of developing colorectal neoplasia. To estimate this risk and the potential yield of screening colonoscopy in this population, we recruited and prospectively colonoscoped 181 asymptomatic first-degree relatives (FDR) of colorectal cancer patients and 83 asymptomatic controls (without a family history of colorectal cancer). The mean ages for the FDR and control groups were 48.2 ± 12.5 and 54.8 ± 11.0, respectively. Adenomatous polyps were detected in 14.4 percent of FDRs and 8.4 percent of controls. Although 92 percent of our FDRs had only one FDR afflicted with colon cancer, those subjects with two or more afflicted FDRs had an even higher risk of developing colonic adenomas (23.8 percent) than those with only one afflicted FDR (13.1 percent). A greater proportion of adenomas was found to be beyond the reach of flexible sigmoidoscopy in the FDR group than in the controls (48 percent vs.25 percent, respectively). Logistic regression analysis revealed that age, male sex, and FDR status were independent risk factors for the presence of colonic adenomatous polyps (RR=2.32, 2.86, and 3.49, respectively;P <0.001). Those at greatest risk for harboring an asymptomatic colonic adenoma are male FDRs over the age of 50 (40 percent ts.20 percent for age-matched male controls). Based on probability curves, males with one FDR afflicted with colon cancer appear to have an increased risk of developing a colonic adenoma beginning at 40 years of age. Our results document, for the first time, an increased prevalence of colonoscopically detectable adenomas in asymptomatic first-degree relatives of colon cancer patients, as compared with asymptomatic controls, and support the use of colonoscopy as a routine screening tool in this high-risk group.Read at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 7 to 12, 1992.Funded in part by the Aaron Diamond Foundation Colon Cancer Program of Columbia University and the Jean and Louis Dreyfus Foundation.     

Pit pattern type analyses of colon polyps with high-resolution colonoscope

BACKGROUND/AIMS: Correlations among pit pattern types and some characteristics of colon polyps were assessed with high-resolution colonoscope in Turkish patients. METHODOLOGY: Sixty-five patients were included in the study. All visible polyps and distal 30cm of colon were stained with indigo carmine 0.4% after standard colonoscopic examination. Then, pit pattern analyses were done. Correlations were evaluated and results were interpreted as significant if p < 0.05. RESULTS: There were correlations among the pit pattern types of polyps and their size, location, morphology and histology. Adenomatous polyps (type III,IV,V) were mostly located in the right colon, nonadenomatous polyps (type I/II) were mostly in the left. Ratio of having adenomatous structure increased in a parallel course with increase in polyp's size. While most of the nonadenomatous polyps were with type I,II, adenomatous polyps were with type III, IV, V patterns. Most of the type II, III, IV polyps were sessile and type I polyps were flat. Sensitivity and specificity of adenomatous and nonadenomatous polyps were 80% and 89% respectively and overall accuracy rate was 87%. Type III/IV were the best estimated type among the others. After chromoendoscopy, 35% increase in polyp number was also detected. CONCLUSIONS: High-resolution endoscope is successful for prediction of histology of colorectal polyps.     

Tapered colonoscope performs better than the pediatric colonoscope in female patients: a direct comparison through tandem colonoscopy

BACKGROUND: The pediatric variable-stiffness colonoscope (PVSC) is used by many endoscopists to negotiate the colon that requires a flexible colonoscope; it has a smaller diameter, but may lead to excessive looping. A prototype colonoscope tapers from an adult width to a pediatric diameter at approximately 25 cm. The tapered colonoscope (TC), while retaining the flexibility of the PVSC, has the column strength of the adult colonoscope to help negotiate the proximal colon. OBJECTIVE: Our hypothesis is that use of the TC in female patients would be associated with less looping than the PVSC during the procedure, fewer required maneuvers, and thus a quicker examination. DESIGN: Direct comparison through tandem colonoscopies. SETTING: University endoscopy suite. PATIENTS: Forty unselected female patients. INTERVENTIONS: Tandem colonoscopies with PVSC and TC. MAIN OUTCOME MEASUREMENTS: Time to the cecum and the ability to retroflex in the cecum. RESULTS: Compared with the PVSC, the TC had faster times to achieve cecal intubation (mean [standard deviation], 8.83+/-4.68 minutes versus 6.88+/-4.08 minutes; P=.013) and a higher rate of retroflexion in the cecum (31/40 patients vs 39/40 patients; P<.01). Use of the TC was associated with a decreased need for abdominal pressure (P<.001). CONCLUSIONS: The TC achieved faster cecal intubation rates and had a higher success of cecal retroflexion than a PVSC. This performance likely was because of diminished looping and thus a decreased need for maneuvers. The TC may be preferable to the PVSC for female patients.     

Serum uric acid is an independent predictor of metabolic syndrome in a Japanese health screening population

Serum levels of uric acid (UA) are associated with metabolic syndrome (MetS). However, no study has been aimed to investigate whether baseline UA is a predictor of MetS in a Japanese population. The multivariable adjusted hazard ratios (HRs) of MetS through 3 years were calculated for each 1 SD increase in baseline UA, for the higher quartiles of baseline UA compared with the lowest quartile, and for baseline hyperuricemia defined as ≥7.0 mg/dl for men and ≥6.0 mg/dl for women in apparently healthy 1,606 men aged 51.7 ± 9.4 years and 953 women aged 51.6 ± 9.4 years who visited a medical check-up center in Japan. The HRs (95 % confidence interval; p value) were 1.282 (1.097–1.499; 0.002) in men and 1.354 (1.041–1.762; 0.024) in women for 1 SD increase in baseline UA, 2.206 (1.344–3.620; 0.002) in men and 3.110 (1.121–8.627; 0.029) in women for the highest quartile of baseline UA compared with the lowest quartile, and 1.900 (1.376–2.622; <0.001) in men and 2.088 (1.040–4.190; 0.038) in women for baseline hyperuricemia adjusting for the pre-existing components of MetS, age, smoking, drinking, physical activity, use of antihypertensive, antihyperlipidemic, and antidiabetic medications and histories of coronary heart disease and stroke. However, no significant association was found between longitudinal changes in UA and incident MetS. Baseline UA is an independent predictor of MetS in a Japanese health screening population.