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BMJ Clinical Evidence Jun 2007Nearly two thirds of colorectal cancers occur in the rectum or sigmoid colon. It is the third most common cancer in resource-rich countries, accounting for about 20,000... (Review)
Review
INTRODUCTION
Nearly two thirds of colorectal cancers occur in the rectum or sigmoid colon. It is the third most common cancer in resource-rich countries, accounting for about 20,000 deaths each year in the UK, and 60,000 each year in the USA.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of screening for colorectal cancer? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (BMJ Clinical evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: colonoscopy, computed tomography colography, double contrast barium enema, faecal occult blood testing, flexible sigmoidoscopy.
Topics: Colonoscopy; Colorectal Neoplasms; Evidence-Based Medicine; Humans; Incidence; Mass Screening; Occult Blood; Sigmoidoscopy
PubMed: 19454089
DOI: No ID Found -
World Journal of Gastroenterology Apr 2012Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life, and this fact is consistent with the high rate at...
Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life, and this fact is consistent with the high rate at which health care is sought for this condition. The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation. The commission presents its results in a "Question-Answer" format, including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine. This section represents the consensus for the diagnosis. The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation. The presence of alarm symptoms and risk factors requires investigation. The physical examination should assess the presence of lesions in the anal and perianal region. The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation. Various scoring systems are available to quantify the severity of constipation; the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable. The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life. No single test provides a pathophysiological basis for constipation. Colonic transit and anorectal manometry define the pathophysiologic subtypes. Balloon expulsion is a simple screening test for defecatory disorders, but it does not define the mechanisms. Defecography detects structural abnormalities and assesses functional parameters. Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports. All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.
Topics: Chronic Disease; Constipation; Defecography; Evidence-Based Medicine; Gastrointestinal Transit; Humans; Manometry; Quality of Life; Severity of Illness Index
PubMed: 22529683
DOI: 10.3748/wjg.v18.i14.1555 -
Radiology May 2012To estimate the prevalence of underlying adenocarcinoma of the colon in patients in whom acute diverticulitis was diagnosed at computed tomography (CT) and to compare... (Review)
Review
PURPOSE
To estimate the prevalence of underlying adenocarcinoma of the colon in patients in whom acute diverticulitis was diagnosed at computed tomography (CT) and to compare that to the prevalence of colon cancer in the general population.
MATERIALS AND METHODS
A comprehensive literature review was performed to find articles in which patients with CT diagnosis of acute diverticulitis underwent surgery, colonoscopy, or barium enema study within 24 weeks. Patients meeting these criteria were included for analysis. A pooled prevalence of cancer was calculated on the basis of a random effects model and compared qualitatively with the prevalence of cancer in the general population. The 95% confidence intervals around the prevalence of cancer in the study populations were determined.
RESULTS
Ten articles met the inclusion criteria. Data from these articles included only 771 patients who underwent surgery, colonoscopy, or barium enema study within 24 weeks of diagnosis. Fourteen patients were found to have colon cancer, for a prevalence of 2.1% (95% confidence interval: 1.2%, 3.2%). This compares to a calculated estimated prevalence of 0.68% among U.S. adults older than 55 years.
CONCLUSION
There are limited data to support the recommendation to perform colonoscopy after a diagnosis of acute diverticulitis.
Topics: Adenocarcinoma; Barium Sulfate; Colonic Neoplasms; Colonoscopy; Confidence Intervals; Contrast Media; Diagnosis, Differential; Diverticulitis, Colonic; Humans; Predictive Value of Tests; Prevalence; Tomography, X-Ray Computed
PubMed: 22517956
DOI: 10.1148/radiol.12111869 -
The British Journal of Radiology Jun 2016To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate the impact of radiographer advanced practice on patient outcomes and health service quality.
METHODS
Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma.
RESULTS
407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality.
CONCLUSION
Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited.
ADVANCES IN KNOWLEDGE
This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.
Topics: Health Care Costs; Humans; Internationality; Outcome Assessment, Health Care; Patient Satisfaction; Practice Patterns, Physicians'; Quality Improvement; Radiography; Time-to-Treatment
PubMed: 27008104
DOI: 10.1259/bjr.20151066 -
Annals of Internal Medicine Jul 2002To assess the effectiveness of different colorectal cancer screening tests for adults at average risk. (Review)
Review
PURPOSE
To assess the effectiveness of different colorectal cancer screening tests for adults at average risk.
DATA SOURCES
Recent systematic reviews; Guide to Clinical Preventive Services, 2nd edition; and focused searches of MEDLINE from 1966 through September 2001. The authors also conducted hand searches, reviewed bibliographies, and consulted context experts to ensure completeness.
STUDY SELECTION
When available, the most recent high-quality systematic review was used to identify relevant articles. This review was then supplemented with a MEDLINE search for more recent articles.
DATA EXTRACTION
One reviewer abstracted information from the final set of studies into evidence tables, and a second reviewer checked the tables for accuracy. Discrepancies were resolved by consensus.
DATA SYNTHESIS
For average-risk adults older than 50 years of age, evidence from multiple well-conducted randomized trials supported the effectiveness of fecal occult blood testing in reducing colorectal cancer incidence and mortality rates compared with no screening. Data from well-conducted case-control studies supported the effectiveness of sigmoidoscopy and possibly colonoscopy in reducing colon cancer incidence and mortality rates. A nonrandomized, controlled trial examining colorectal cancer mortality rates and randomized trials examining diagnostic yield supported the use of fecal occult blood testing plus sigmoidoscopy. The effectiveness of barium enema is unclear. Data are insufficient to support a definitive determination of the most effective screening strategy.
CONCLUSIONS
Colorectal cancer screening reduces death from colorectal cancer and can decrease the incidence of disease through removal of adenomatous polyps. Several available screening options seem to be effective, but the single best screening approach cannot be determined because data are insufficient.
Topics: Age Factors; Colonoscopy; Colorectal Neoplasms; Enema; Evidence-Based Medicine; Female; Humans; Male; Mass Screening; Middle Aged; Occult Blood; Physical Examination; Rectum; Sigmoidoscopy; Time Factors
PubMed: 12118972
DOI: 10.7326/0003-4819-137-2-200207160-00015 -
British Journal of Cancer Jan 2010Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in patients with rectal bleeding in relation to risk of colorectal cancer in primary care.
METHODS
Diagnostic accuracy systematic review. Medline (1966 to May 2009), Embase (1988 to May 2009), British Nursing Index (1991 to May 2009) and PsychINFO (1970 to May 2009) were searched. We included cohort studies that assessed the diagnostic utility of rectal bleeding in combination with other symptoms, signs and diagnostic tests in primary care. An eight-point quality assessment tool was produced to assess the quality of included studies. Pooled positive likelihood ratios (PLRs), sensitivities and specificities were calculated.
RESULTS
Eight studies incorporating 2323 patients were included. Average weighted prior probability of colorectal cancer was 7.0% (range: 3.3-15.4%, median: 8.1%). Age > or = 60 years (pooled PLR: 2.79, 95% confidence interval (CI) 2.00-3.90), weight loss (pooled PLR: 1.89, 95% CI: 1.03-3.07) and change in bowel habit (pooled PLR: 1.92, 95% CI: 0.54-3.57) raise the probability of colorectal cancer into the range of referral to secondary care but do not conclusively 'rule in' the diagnosis. Presence of severe anaemia has the highest diagnostic value (pooled PLR: 3.67, 95% CI: 1.30-10.35), specificity 0.95 (95% CI: 0.93-0.96), but still only generates a post-test probability of 21.6%.
CONCLUSIONS
In patients with rectal bleeding who present to their general practitioner, additional 'red flag' symptoms have modest diagnostic value. These findings have implications in relation to recommendations contained in clinical practice guidelines.
Topics: Adenocarcinoma; Adult; Aged; Anemia; Barium Sulfate; Cohort Studies; Colonoscopy; Colorectal Neoplasms; Enema; Family Practice; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Pain; Primary Health Care; Prospective Studies; Radiography; Rectum; Reference Standards; Risk; Sensitivity and Specificity; Sigmoidoscopy; Ultrasonography; Weight Loss
PubMed: 19935790
DOI: 10.1038/sj.bjc.6605426 -
United European Gastroenterology Journal Apr 2019Only a minority of patients with a positive fecal occult blood test (FOBT) undergo a follow-up second diagnostic procedure, thus minimizing its contribution for... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Only a minority of patients with a positive fecal occult blood test (FOBT) undergo a follow-up second diagnostic procedure, thus minimizing its contribution for colorectal cancer (CRC) prevention. We aimed to obtain a precise estimation of this problem and also assess the diagnostic yield of CRC and adenomas by colonoscopy in these patients.
METHODS
Literature searches were conducted for "compliance" OR "adherence" AND "fecal occult blood test" OR "fecal immunohistochemical test" AND "colonoscopy." Comprehensive meta-analysis software was used.
RESULTS
The search resulted in 42 studies (512,496 patients with positive FOBT), published through December 31, 2017. A funnel plot demonstrates a moderate publication bias. Compliance with any second procedure, colonoscopy, or combination of double-contrast barium enema with or without sigmoidoscopy in patients with a positive FOBT was 0.725 with 95% confidence interval (CI) 0.649-0.790 ( = 0.000), 0.804 with 95% CI 0.740-0.856 ( = 0.000) and 0.197 with 95% CI 0.096-0.361 ( = 0.000), respectively. The diagnostic yield for CRC, advanced adenoma and simple adenoma was 0.058 with 95% CI 0.050-0.068 ( = 0.000), 0.242 with 95% CI 0.188-0.306 ( = 0.000) and 0.147 with 95% CI 0.116-0.184 ( < 0.001), respectively.
DISCUSSION
Compliance with diagnostic evaluation after a positive FOBT is still suboptimal. Therefore, measures to increase compliance need to be taken given the increased risk of CRC in these patients.
Topics: Adenoma; Barium Enema; Colorectal Neoplasms; Diagnostic Tests, Routine; Early Detection of Cancer; Feces; Humans; Mass Screening; Occult Blood; Patient Compliance; Sigmoidoscopy
PubMed: 31019712
DOI: 10.1177/2050640619828185 -
Journal of General Internal Medicine Jan 2005Though primary care patients commonly present with rectal bleeding, the optimal evaluation strategy remains unknown. (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Though primary care patients commonly present with rectal bleeding, the optimal evaluation strategy remains unknown.
OBJECTIVE
To compare the cost-effectiveness of four diagnostic strategies in the evaluation of rectal bleeding.
DESIGN
Cost-effectiveness analysis using a Markov decision model.
DATA SOURCES
Systematic review of the literature, Medicare reimbursement data, Surveillance, Epidemiology, and End Results (SEER) Cancer Registry.
TARGET POPULATION
Patients over age 40 with otherwise asymptomatic rectal bleeding.
TIME HORIZON
The patient's lifetime.
PERSPECTIVE
Modified societal perspective.
INTERVENTIONS
Watchful waiting, flexible sigmoidoscopy, flexible sigmoidoscopy followed by air contrast barium enema (FS+ACBE), and colonoscopy.
OUTCOME MEASURES
Incremental cost-effectiveness ratio.
RESULTS OF BASE-CASE ANALYSIS
The incremental cost-effectiveness ratio for colonoscopy compared with flexible sigmoidoscopy was 5,480 dollars per quality-adjusted year of life saved (QALY). Watchful waiting and FS+ACBE were more expensive and less effective than colonoscopy.
RESULTS OF SENSITIVITY ANALYSES
The cost of colonoscopy was reduced to 1,686 dollars per QALY when age at entry was changed to 45. Watchful waiting became the least expensive strategy when community procedure charges replaced Medicare costs, when age at entry was maximized to 80, or when the prevalence of polyps was lowered to 7%, but the remaining strategies provided greater life expectancy at relatively low cost. The strategy of FS+ACBE remained more expensive and less effective in all analyses. In the remaining sensitivity analyses, the incremental cost-effectiveness of colonoscopy compared with flexible sigmoidoscopy never rose above 34,000 dollars.
CONCLUSIONS
Colonoscopy is a cost-effective method to evaluate otherwise asymptomatic rectal bleeding, with a low cost per QALY compared to other strategies.
Topics: Adult; Barium Sulfate; Colonic Polyps; Colonoscopy; Cost-Benefit Analysis; Enema; Gastrointestinal Hemorrhage; Humans; Markov Chains; Mass Screening; Quality-Adjusted Life Years; Rectum; Sigmoidoscopy
PubMed: 15693933
DOI: 10.1111/j.1525-1497.2005.40077.x