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Preventive Medicine Oct 2023Since satisfaction with cancer screening experience can increase adherence to programs and contribute to reduce morbidity and mortality, its assessment is crucial for... (Review)
Review
INTRODUCTION
Since satisfaction with cancer screening experience can increase adherence to programs and contribute to reduce morbidity and mortality, its assessment is crucial for programs´ effectiveness. Our aim was to conduct a systematic review about satisfaction of participants with organized colorectal cancer screening.
METHODS
We searched relevant scientific databases (MEDLINE, EMBASE, PsycINFO, and CINAHL) from inception to May 2022. We selected cross-sectional studies and clinical trials reporting a quantitative survey-based measure of satisfaction towards CRC screening.
RESULTS
A total of 15 studies were included, being published from 1992 to 2019 for an overall number of 21 surveys. Of those, 16 (76%) investigated satisfaction with screening tests (fecal occult blood test, fecal immunochemical test, sigmoidoscopy, colonoscopy, computed tomographic colonography), 4 (19%) with colonoscopy as assessment test after suspicious findings, and 2 (10%) with both the screening and assessment phase. None of the included surveys used a validated questionnaire. Most surveys reported a high level of satisfaction for both screening and further assessment phases. Temporary pain, discomfort, embarrassment, and anxiety while waiting for results were the commonest negative aspects perceived, with some variability across studies and considered procedures.
CONCLUSIONS
Satisfaction with the information and communication about screening was generally good, but some authors reported participants' sub-optimal understanding of informative material. Satisfaction with CRC screening is generally high, but its evaluation is performed using non-validated instruments, which limits the interpretation of results and prevents comparability of the current body of evidence.
PubMed: 37722458
DOI: 10.1016/j.ypmed.2023.107706 -
BMJ Case Reports May 2024A man in his 80s was undergoing immunotherapy with pembrolizumab, an anti-PD-1 monoclonal antibody, following his diagnosis of adenocarcinoma of primary lung origin. 24...
A man in his 80s was undergoing immunotherapy with pembrolizumab, an anti-PD-1 monoclonal antibody, following his diagnosis of adenocarcinoma of primary lung origin. 24 weeks into treatment, the patient reported experiencing loose stools associated with malaise and poor appetite but no further symptoms. This progressed in frequency and a clinical diagnosis of grade 2 immune checkpoint inhibitor colitis was made. Management with oral prednisolone was commenced but symptoms persisted. Common enteric infections had been ruled out, as were coeliac disease and hyperthyroidism. Flexible sigmoidoscopy and colonoscopy results were not in keeping with colitis, having revealed normal looking mucosa. Following this, a faecal elastase level was found to be low. A diagnosis of pembrolizumab-induced pancreatic exocrine insufficiency was made, and stool frequency and consistency swiftly improved following the use of pancreatic enzyme replacement therapy.
Topics: Humans; Male; Immune Checkpoint Inhibitors; Diarrhea; Antibodies, Monoclonal, Humanized; Aged, 80 and over; Lung Neoplasms; Exocrine Pancreatic Insufficiency; Colitis; Adenocarcinoma
PubMed: 38719255
DOI: 10.1136/bcr-2023-259057 -
Scandinavian Journal of Gastroenterology Jun 2024Long-time follow-up of sigmoidoscopy screening trials has shown reduced incidence and mortality of colorectal cancer (CRC), but inadequate bowel cleansing may hamper...
BACKGROUND AND STUDY AIMS
Long-time follow-up of sigmoidoscopy screening trials has shown reduced incidence and mortality of colorectal cancer (CRC), but inadequate bowel cleansing may hamper efficacy. The aim of this study was to assess the impact of bowel cleansing quality in sigmoidoscopy screening.
PATIENTS AND METHODS
Individuals 50 to 74 years old who had a screening sigmoidoscopy in a population-based Norwegian, randomized trial between 2012 and 2019, were included in this cross-sectional study. The bowel cleansing quality was categorised as excellent, good, partly poor, or poor. The effect of bowel cleansing quality on adenoma detection rate (ADR) and referral to colonoscopy was evaluated by fitting multivariable logistic regression models.
RESULTS
35,710 individuals were included. The bowel cleansing at sigmoidoscopy was excellent in 20,934 (58.6%) individuals, good in 6580 (18.4%), partly poor in 7097 (19.9%) and poor in 1099 (3.1%). The corresponding ADRs were 17.0%, 16.6%, 14.5%, and 13.0%. Compared to participants with excellent bowel cleansing, those with poor bowel cleansing had an odds ratio for adenoma detection of 0.66 (95% confidence interval 0.55-0.79). We found substantial differences in the assessment of bowel cleansing quality among endoscopists.
CONCLUSIONS
Inadequate bowel cleansing reduces the efficacy of sigmoidoscopy screening, by lowering ADR. A validated rating scale and improved bowel preparation are needed to make sigmoidoscopy an appropriate screening method.
UNLABELLED
Clinicaltrials.gov (NCT01538550).
PubMed: 38850200
DOI: 10.1080/00365521.2024.2364213 -
Therapeutische Umschau. Revue... Dec 2023Endoscopic examinations play a very important role in the diagnosis, progress assessment, and therapy of inflammatory bowel diseases (IBD). This includes not only...
Endoscopic examinations play a very important role in the diagnosis, progress assessment, and therapy of inflammatory bowel diseases (IBD). This includes not only esophagogastroduodenoscopy, sigmoidoscopy, and ileo-colonoscopy, but also assessment of the small intestine. The work-up of the small intestine is primarily carried out using non-invasive techniques (intestinal ultrasound, magnetic resonance enterography (MRE)). However, if the diagnosis remains unclear, a histological proof is necessary or an endoscopic intervention is required, capsule endoscopy and balloon-assisted enteroscopy are used. Furthermore, endoscopic ultrasound is available to assess perianal fistulizing Crohn's disease, and ERCP (endoscopic retrograde cholangiopancreatography) is used in certain patients with IBD-associated primary sclerosing cholangitis (PSC). Given the high resolution of modern endoscopes and the availability of chromoendoscopy, dysplastic lesions are detected earlier and can often be resected endoscopically. In addition, short strictures/stenoses can be treated using balloon dilatations.
Topics: Humans; Crohn Disease; Inflammatory Bowel Diseases; Intestine, Small; Colonoscopy; Capsule Endoscopy
PubMed: 38095255
DOI: No ID Found -
World Journal of Gastrointestinal... May 2024Despite colorectal cancer's (CRC) high global incidence, residents of low- and middle- income countries, as well as low-income minorities in advanced economies have low...
Despite colorectal cancer's (CRC) high global incidence, residents of low- and middle- income countries, as well as low-income minorities in advanced economies have low screening rates. Observational studies demonstrate that in these groups higher incidence of CRC is observed, yet screening rates remain low for consistent reasons. Low income, low educational background, and lack of awareness in combination with inadequate social security of certain population groups impede access and compliance rates to CRC screening. On the other hand, despite the global availability of multiple screening approaches (colonoscopy, sigmoidoscopy, faecal occult blood test, faecal immunochemical test, computed tomography-colonography, ) with proven diagnostic validity, many low-income countries still lack established screening programs. The absence of screening guidelines in these countries along with the heterogeneity of guidelines in the rest of the world, demonstrate the need for global measures to tackle this issue comprehensively. An essential step forward is to develop a global approach that will link specific elements of screening with the incidence and available resources in each country, to ensure the achievement of at least a minimum screening program in low-income countries. Utilizing cheaper, cost-effective techniques, which can be carried out by less specialized healthcare providers, might not be equivalent to endoscopy for CRC screening but seems more realistic for areas with fewer resources. Awareness has been highlighted as the most pivotal element for the effective implementation of any screening program concerning CRC. Moreover, multiple studies have demonstrated that outreach strategies and community-based educational programs are associated with encouraging outcomes, yet a centrally coordinated expansion of these programs could provide more consistent results. Additionally, patient navigator programs, wherever implemented, have increased CRC screening and improved follow-up. Therefore, global coordination and patient education seem to be the main areas on which policy making needs to focus.
PubMed: 38764845
DOI: 10.4251/wjgo.v16.i5.1683 -
Intestinal Research May 2024Patients of ulcerative colitis (UC) on follow-up are routinely evaluated by sigmoidoscopy. There is no prospective literature to support this practice. We assessed...
BACKGROUND/AIMS
Patients of ulcerative colitis (UC) on follow-up are routinely evaluated by sigmoidoscopy. There is no prospective literature to support this practice. We assessed agreement between sigmoidoscopy and colonoscopy prospectively in patients with disease extent beyond the sigmoid colon.
METHODS
We conducted a prospective observational study at a tertiary care institute for agreement between sigmoidoscopy and colonoscopy. We assessed endoscopic activity using the Mayo Endoscopic Score (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and histological activity using the Nancy Index (NI), Robarts Histopathology Index (RHI), and Simplified Geboes Score (SGS).
RESULTS
Sigmoidoscopy showed a strong agreement with colonoscopy for MES and UCEIS with a kappa (K) of 0.96 and 0.94 respectively. The misclassification rate for MES and UCEIS was 3% and 5% respectively. Sigmoidoscopy showed perfect agreement (K = 1.00) with colonoscopy for assessment of the presence of endoscopic activity in the colon using MES ??1 as activity criteria and strong agreement (K = 0.93) using MES > 1 as activity criteria. Sigmoidoscopy showed strong agreement with colonoscopy for assessment of the presence of endoscopic activity using UCEIS (K = 0.92). Strong agreement was observed between sigmoidoscopy and colonoscopy using NI (K = 0.86), RHI (K = 1.00), and SGS (K = 0.92) for the detection of histological activity. The misclassification rate for the detection of histological activity was 2%, 0%, and 1% for NI, RHI, and SGS respectively.
CONCLUSIONS
Sigmoidoscopy showed strong agreement with colonoscopy for endoscopic and histologic disease activity. Sigmoidoscopy is adequate for assessment of disease activity in patients with UC during follow-up evaluation.
PubMed: 38751349
DOI: 10.5217/ir.2023.00174 -
Frontiers in Public Health 2023Organized cancer screening programs should be equally accessible for all groups in society. We assessed differences in participation in colorectal cancer (CRC) screening...
INTRODUCTION
Organized cancer screening programs should be equally accessible for all groups in society. We assessed differences in participation in colorectal cancer (CRC) screening among different immigrant groups.
METHODS
Between 2012 and 2019, 140,000 individuals aged 50 to 74 years were randomly invited to sigmoidoscopy or repeated faecal immunochemical test (FIT) in a CRC screening trial. In this study, we included 46,919 individuals invited to sigmoidoscopy and 70,018 invited to the first round of FIT between 2012 and 2017. We examined difference in participation between non-immigrants and immigrants, and within different immigrant groups by geographic area of origin, using logistic regression models, adjusted for several sociodemographic factors and health factors.
RESULTS
In total, we included 106,695 non-immigrants and 10,242 immigrants. The participation rate for FIT was 60% among non-immigrants, 58% among immigrants from Western countries and 37% among immigrants from non-Western countries. The participation rate for sigmoidoscopy was 53% among non-immigrants, 48% among immigrants from Western countries and 23% among immigrants from non-Western countries. Compared to non-immigrants, multivariate adjusted odds ratio for non-participation in FIT screening was 1.13 (95% confidence interval 1.04-1.23) and 1.82 (1.69-1.96) for immigrants from Western and non-Western countries. The corresponding numbers in sigmoidoscopy screening were 1.34 (1.21-1.48) and 2.83 (2.55-3.14). The lowest participation was observed in immigrants from Eastern Europe, Northern Africa and Western Asia, and South-Central Asia.
CONCLUSION
Participation in CRC screening in Norway was particularly low among non-Western immigrants, which could put them at increased risk for late stage diagnosis of CRC. Participation was lower in sigmoidoscopy screening than in FIT screening, especially among immigrants from non-Western countries.
Topics: Humans; Early Detection of Cancer; Norway; Sigmoidoscopy; Colorectal Neoplasms; Emigrants and Immigrants
PubMed: 37822535
DOI: 10.3389/fpubh.2023.1254905 -
American Journal of Obstetrics and... May 2024Thorough evaluation of a rectovaginal fistula is essential to optimize surgical repair. The underlying cause should be addressed and treated, which can affect the timing...
Thorough evaluation of a rectovaginal fistula is essential to optimize surgical repair. The underlying cause should be addressed and treated, which can affect the timing and the approach to repair. It is imperative to be well prepared because the highest chance of successful closure occurs during the initial repair attempt. Our objective was to demonstrate how multidisciplinary colorectal surgery and urogynecology teams use specific methods during the examination under anesthesia to evaluate a complex rectovaginal fistula and to optimize the surgical approach to repair. Anesthesia may be provided with monitored anesthesia care and a posterior perineal block. This pain control allows for a wide range of techniques to evaluate the fistula using anoscopy, fistula probe, hydrogen peroxide, and sigmoidoscopy. In addition, the teams show how curettage and subsequent seton placement can encourage closure by secondary intention and decrease the risk of abscess formation, respectively.
PubMed: 38703939
DOI: 10.1016/j.ajog.2024.04.029 -
Biology Dec 2023Colorectal cancer (CRC) is one of the most diagnosed cancers worldwide, with a high incidence and mortality rate when diagnosed late. Currently, the methods used in... (Review)
Review
Colorectal cancer (CRC) is one of the most diagnosed cancers worldwide, with a high incidence and mortality rate when diagnosed late. Currently, the methods used in healthcare to diagnose CRC are the fecal occult blood test, flexible sigmoidoscopy, and colonoscopy. However, the lack of sensitivity and specificity and low population adherence are driving the need to implement other technologies that can identify biomarkers that not only help with early CRC detection but allow for the selection of more personalized treatment options. In this regard, the implementation of omics technologies, which can screen large pools of biological molecules, coupled with molecular validation, stands out as a promising tool for the discovery of new biomarkers from biopsied tissues or body fluids. This review delves into the current state of the art in the identification of novel CRC biomarkers that can distinguish cancerous tissue, specifically from fecal samples, as this could be the least invasive approach.
PubMed: 38248446
DOI: 10.3390/biology13010015 -
Cureus Aug 2023Background/aims Colorectal cancer cases are on the rise in developing countries, necessitating dependable detection tests. Moreover, medical procedures have become...
Background/aims Colorectal cancer cases are on the rise in developing countries, necessitating dependable detection tests. Moreover, medical procedures have become increasingly burdensome for both patients and healthcare professionals. This study aims to delve deeper into the fecal occult blood test (FOBT) as a potential solution. Settings and design The research took place at the Gastroenterology Specialized Clinic (Human Clinic) in Riyadh, Saudi Arabia. The study gathered results from colonoscopy/sigmoidoscopy, histopathology, and FOBT screening. Essential variables linked to colorectal cancer, including gastrointestinal symptoms, chronic diseases, hemoglobin (Hgb), body mass index (BMI), and medication usage, were documented to evaluate their potential predictive significance for positive outcomes. Methods and materials In line with the study aims, inclusion criteria covered Saudi adults aged 18 and above, experiencing lower GI symptoms, with colonoscopy or sigmoidoscopy, FOBT, and histopathological results. The resultant sample size was 72 patients. Non-Saudi individuals, symptoms-free patients, and those below 18 years were excluded. This retrospective analysis spanned from September 2021 to September 2022. For statistical analysis, after the data rationality was checked, parametric or non-parametric tests were used. P ≤ 0.05 was set as the significant level. Results Among the 72 patients, ranging in age from 18 to 80 (mean 42.94), males (57) outnumbered females (15). The average BMI was 27.56, with one-third of patients classified as overweight or obese. A majority of 47 (65.2%) exhibited normal Hgb levels while only five (7%) had abnormal levels. Results from colonoscopy or sigmoidoscopy and FOBT displayed statistical similarity between positive and negative outcomes. Additionally, the notable prevalence of positive results compared to negative ones underscores the resemblance between FOBT and colonoscopy/sigmoidoscopy findings. Conclusion Chronic illness, constitutional symptoms, BMI, and Hgb did not display a significant predictive value, However, the group with GI symptoms exhibited a strong prediction for favorable colonoscopy/sigmoidoscopy and histology outcomes. Additional research is necessary to validate these observed patterns.
PubMed: 37700965
DOI: 10.7759/cureus.43312