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The American Journal of Gastroenterology Dec 2018Addressing procedure-related anxiety should improve adherence to colorectal cancer screening programs and diagnostic colonoscopy. We performed a systematic review to...
OBJECTIVES
Addressing procedure-related anxiety should improve adherence to colorectal cancer screening programs and diagnostic colonoscopy. We performed a systematic review to assess anxiety among individuals undergoing colonoscopy or flexible sigmoidoscopy (FS).
METHODS
We searched multiple electronic databases for studies evaluating anxiety associated with colonoscopy or FS published from 2005 to 2017. Two reviewers independently identified studies, extracted data, and assessed study quality. The main outcomes were the magnitude of pre-procedure anxiety, types of concerns, predictors of anxiety, and effectiveness of anxiety-lowering interventions in individuals undergoing lower endoscopy. The protocol was prospectively registered in PROSPERO.
RESULTS
Fifty-eight studies (24,490 patients) met the inclusion criteria. Patients undergoing colonoscopy had a higher mean level of anxiety than that previously reported in the general population, with some studies reporting more than 50% of patients having moderate-to-severe anxiety. Areas of anxiety-related concern included bowel preparation, difficulties with the procedure (embarrassment, pain, possible complications, and sedation), and concerns about diagnosis; including fear of being diagnosed with cancer. Female gender, higher baseline anxiety, functional abdominal pain, lower education, and lower income were associated with greater anxiety prior to colonoscopy. Providing higher-quality information before colonoscopy, particularly with a video, shows promise as a way of reducing pre-procedure anxiety but the studies to date are of low quality.
CONCLUSIONS
A large proportion of patients undergoing colonoscopy report anxiety before the procedure. Improvement in pre-procedure information delivery and evaluation of approaches to reduce anxiety is required, especially for those with predictors of pre-procedure anxiety.
Topics: Anxiety; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Humans; Patient Education as Topic; Preoperative Period; Prevalence; Severity of Illness Index; Sigmoidoscopy
PubMed: 30385831
DOI: 10.1038/s41395-018-0398-8 -
BMC Gastroenterology Aug 2019To evaluate the role of colonoscopy in infants and young children and clarify the distribution of colonoscopy-requiring diseases in this age group.
BACKGROUND
To evaluate the role of colonoscopy in infants and young children and clarify the distribution of colonoscopy-requiring diseases in this age group.
METHODS
Cohorts of colonoscopies performed at three children's hospitals in Japan between April 2011 and March 2016 including infants and children younger than six years of age were retrospectively reviewed.
RESULTS
In total, 453 colonoscopies were performed in 276 infants and young children. Of these 275 (60.8%) were for diagnostic purposes, 177 (39.2%) were performed as follow-up, and one case was performed for treatment. The median patient age at the time of diagnostic colonoscopy was 2.49 years, and there was a male-to-female ratio of 1.72:1. Abnormal macroscopic and/or histopathological findings were noted in 212 (77.1%) cases. Of these, definite diagnoses were established for the presence of eosinophilic gastrointestinal disorders (EGIDs), inflammatory bowel disease (IBD), and polyp/polyposis in 23, 18.5, and 14% of patients, respectively. Among 51 IBD cases, ulcerative colitis, Crohn's disease, and IBD-unclassified were identified in 47.1, 33.3, and 7.8%, retrospectively via endoscopic examination. Of these, 11 (22%) were eventually diagnosed with monogenic diseases via genetic testing. Of those with rectal bleeding, EGIDs, polyps/polyposis, and IBD were found in 27, 19, and 18%, retrospectively. There were significantly more cases of EGIDs and fewer ones of IBD and polyps/polyposis in patients with rectal bleeding younger than two years of age. Furthermore, 68% of all follow-up colonoscopies were performed in children with IBD. There were no serious complications in our study cohort.
CONCLUSION
We determined the role of colonoscopy in infants and young children. Diseases diagnosed using colonoscopy in this age group included IBD, EGIDs, and polyps/polyposis. The increasing trend of patients with IBD and EGIDs worldwide means that the role of colonoscopy in infants and younger children will be more important in the future.
Topics: Child, Preschool; Colonoscopy; Female; Gastrointestinal Diseases; Humans; Infant; Japan; Male; Outcome and Process Assessment, Health Care; Retrospective Studies; Sex Factors
PubMed: 31429721
DOI: 10.1186/s12876-019-1060-7 -
Journal of Digestive Diseases Apr 2019Advances in the field of robotics have allowed modern technology to be integrated into medicine and that can minimize patients suffering from the side effects that are... (Review)
Review
Advances in the field of robotics have allowed modern technology to be integrated into medicine and that can minimize patients suffering from the side effects that are inherent to procedures for improving their quality of life. Conventional devices that are used for colonoscopies are rigid and require a high level of expertise from endoscopists to perform the procedure. Advances in robot-assisted colonoscopic systems now produce softer, more slender, automated designs that no longer require the operator to use forceful pushing to advance the colonoscope inside the colon, reducing risks to the patient of perforation and pain. It is challenging to reprocess these scopes for reuse as the materials used can be damaged during decontamination, leading to the possible risks of cross-infection by pathogenic microorganisms when reused by patients. An ideal solution is to eliminate these contamination risks to patients by adopting sterile, single-use scopes straight from the manufacturer's package to the patient. With this idea in mind, emerging developments that push the boundaries in this area will benefit patients and encourage the public to participate in and adhere better to colonoscopy screening to reduce the development of colorectal cancer. Thus, in light of these concerns and challenges, to encourage patients undergoing colorectal screening to comply with colonoscopy procedures that they are less invasive, changes in the design and materials are necessary. One of the more promising technological advances in this area is the advent of robotic colonoscopy.
Topics: Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Humans; Robotics
PubMed: 30834714
DOI: 10.1111/1751-2980.12718 -
The Korean Journal of Gastroenterology... Dec 2016Early detection and removal of adenomatous polyps can prevent the development of colorectal cancer. However, it is fairly common-up to 20%-for polyps to be undetected in... (Review)
Review
Early detection and removal of adenomatous polyps can prevent the development of colorectal cancer. However, it is fairly common-up to 20%-for polyps to be undetected in a colonoscopy due to poor visualization of the proximal aspect of colonic folds and anatomical flexures. To overcome these limitations, many new endoscopes and accessories have been developed. A wide-angle colonoscopy did not improve the detection of adenoma compared with the standard colonoscopy. An extra-wide angle and Retroview colonoscopies showed a significantly lower miss rate of polyps in the colon model. However, clinical trials are mandatory in the future. The recently introduced full spectrum endoscopy system showed a significantly higher adenoma detection rate than the standard forward-viewing colonoscopy. In accessories, The cap-assisted colonoscopy showed only a marginal or no benefit on the detection of polyps and adenomas. In contrast, a colonoscopy with Endocuff, EndoRings, and G-eye have showed significantly lower adenoma miss rates. The Third Eye, which provides additional retrograde viewing, has revealed a significant improvement in the detection of adenoma and polyp. However, the Third Eye Retroscope was limited by its deployment through the working channel of the scope. Recently, the Third Eye Panoramic cap, which was designed to overcome the limitation of the Third Eye Retroscope, was introduced. In the future, this would be needed to evaluate the effectiveness, efficiency and safety for these new colonoscopies and accessories.
Topics: Adenoma; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Humans
PubMed: 28025471
DOI: 10.4166/kjg.2016.68.6.293 -
Endoscopy May 2022To optimize colonoscopy quality, several performance measures have been developed. These are usually assessed without distinction between the indications for...
BACKGROUND
To optimize colonoscopy quality, several performance measures have been developed. These are usually assessed without distinction between the indications for colonoscopy. This study aimed to assess the feasibility of linking two national registries (one for colonoscopy and one for adverse events of gastrointestinal endoscopies in the Netherlands), and to describe the results of colonoscopy quality per indication.
METHODS
This retrospective study was conducted with prospectively collected data of the Dutch Gastrointestinal Endoscopy Audit (DGEA) and the Dutch Registration of Complications in Endoscopy (DRCE). Data between 01-01-2016 and 01-01-2019 were analyzed. To calculate adverse event rates, data were linked at the level of endoscopy service.
RESULTS
During the 3-year study period, 266 981 colonoscopies were recorded in DGEA. Of all indications, cecal intubation rate was highest in fecal immunochemical test (FIT)-positive screening colonoscopies (97.1 %), followed by surveillance (93.2 %), diagnostic (90.7 %), and therapeutic colonoscopies (83.1 %). The highest rate of adequate bowel preparation was observed in FIT-positive screening colonoscopies (97.1 %). A total of 1540 colonoscopy-related adverse events occurred (0.58 % of all colonoscopies). Bleeding and perforation and rates were highest for therapeutic (1.56 % and 0.51 %, respectively) and FIT-positive screening (0.72 % and 0.06 %, respectively) colonoscopies. The colonoscopy-related mortality was 0.006 %.
CONCLUSION
This study describes the first results of the Dutch national colonoscopy registry, which was successfully linked to data from the national registry for adverse events of gastrointestinal endoscopies. In this large dataset, performance varied between indications. Our results emphasize the importance of defining benchmarks per indication in future guidelines.
Topics: Cecum; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Humans; Netherlands; Registries; Retrospective Studies
PubMed: 34293811
DOI: 10.1055/a-1556-5914 -
Journal of General Internal Medicine Mar 2015Ongoing efforts to increase colorectal cancer (CRC) screening rates have raised concerns that these exams may be overused, thereby subjecting patients to unnecessary...
BACKGROUND
Ongoing efforts to increase colorectal cancer (CRC) screening rates have raised concerns that these exams may be overused, thereby subjecting patients to unnecessary risks and wasting healthcare resources.
OBJECTIVE
Our aim was to measure overuse of screening and surveillance colonoscopies among average-risk adults, and to identify correlates of overuse.
DESIGN, SETTING, AND PARTICIPANTS
Our approach was a retrospective cohort study using electronic health record data for patients 50-65 years old with no personal history of CRC or colorectal adenomas with an incident CRC screening colonoscopy from 2001 to 2010 within a multispecialty physician group practice.
MAIN OUTCOME MEASURES
We measured time to next screening or surveillance colonoscopy and predictors of overuse (exam performed more than one year earlier than guideline recommended intervals) of colonoscopies.
KEY RESULTS
We identified 1,429 adults who had an incident colonoscopy between 2001 and 2010, and they underwent an additional 871 screening or surveillance colonoscopies during a median follow-up of 6 years. Most follow-up screening colonoscopies (88%) and many surveillance colonoscopies (49%) repeated during the study represented overuse. Time to next colonoscopy after incident screening varied by exam findings (no polyp: median 6.9 years, interquartile range [IQR]: 5.1-10.0; hyperplastic polyp: 5.7 years, IQR: 4.9-9.7; low-risk adenoma: 5.1 years, IQR: 3.3-6.3; high-risk adenoma: 2.9 years, IQR: 2.0-3.4, p < 0.001). In logistic regression models of colonoscopy overuse, an endoscopist recommendation for early follow-up was strongly associated with overuse of screening colonoscopy (OR 6.27, 95% CI: 3.15-12.50) and surveillance colonoscopy (OR 13.47, 95% CI 6.61-27.46). In a multilevel logistic regression model, variation in the overuse of screening colonoscopy was significantly associated with the endoscopist performing the previous exam.
CONCLUSIONS
Overuse of screening and surveillance exams are common and should be monitored by healthcare systems. Variations in endoscopist recommendations represent targets for interventions to reduce overuse.
Topics: Aged; Cohort Studies; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Follow-Up Studies; Humans; Male; Middle Aged; Population Surveillance; Retrospective Studies; Unnecessary Procedures
PubMed: 25266407
DOI: 10.1007/s11606-014-3015-6 -
Inflammatory Bowel Diseases Feb 2023Treatment of ulcerative colitis (UC) now includes mucosal healing. Adoption of histologic end points is hindered by a lack of evidence guiding optimal sampling,... (Review)
Review
INTRODUCTION
Treatment of ulcerative colitis (UC) now includes mucosal healing. Adoption of histologic end points is hindered by a lack of evidence guiding optimal sampling, interpretation, and reproducibility of results.
METHODS
We analyzed biopsy fragments from colonoscopies in 92 patients with UC. Fragments were scored using 6-point histologic inflammatory activity (HIA) scale. Variability was determined using ordinal representations of HIA scores. The most frequently observed score and percentage of biopsy fragments with that score were determined for each biopsy, each segment, and across all 3 segments for each colonoscopy. Mean percentages and 95% confidence intervals (CIs) were calculated.
RESULTS
We reviewed 1802 biopsy fragments. The mean percentages of intrasegment biopsy fragments with the same HIA score were 85.5% (95% CI, 80.9% to 92.9%), 79.6% (95% CI, 76.0% to 87.3%), and 82.7% (95% CI, 79.1% to 90.0%) for the rectum, left colon, and right colon, respectively. The mean percentage of intersegment biopsy fragments with the same HIA score was 70.2% (95% CI, 65.7% to 82.5%). The mean percentages of intrabiopsy fragments with the same HIA score were 83.3% (95% CI, 77.6% to 93.5%), 83.6% (95% CI, 80.1% to 89.7%), and 90.2% (95% CI, 87.6% to 94.7%) for the rectum, left colon, and right colon, respectively. All 3 analyses revealed increased variation when a greater degree of histologic inflammation was present in the biopsies (mean HIA score ≥2).
CONCLUSIONS
We found minimal variability between degree of inflammation among biopsy fragments within and among different colorectal segments in UC, suggesting that even a single biopsy would adequately reflect the inflammation of the entire colorectum. These findings have significant implications for the use of histology as a clinical target and trial end point in UC.
Topics: Humans; Colitis, Ulcerative; Reproducibility of Results; Inflammation; Colonoscopy
PubMed: 35436339
DOI: 10.1093/ibd/izac070 -
Clinical Gastroenterology and... May 2022Older adults with colorectal polyps undergo frequent surveillance colonoscopy. There is no specific guidance regarding when to stop surveillance. We aimed to...
BACKGROUND & AIMS
Older adults with colorectal polyps undergo frequent surveillance colonoscopy. There is no specific guidance regarding when to stop surveillance. We aimed to characterize endoscopist recommendations regarding surveillance colonoscopy in older adults and identify patient, procedure, and endoscopist characteristics associated with recommendations to stop.
METHODS
This was a retrospective cohort study at a single academic medical center of adults aged ≥75 years who underwent colonoscopy for polyp surveillance or screening during which polyps were found. The primary outcome was a recommendation to stop surveillance. Predictors examined included patient age, sex, family history of colorectal cancer, polyp findings, and endoscopist sex and years in practice. Associations were evaluated using multilevel logistic regression.
RESULTS
Among 1426 colonoscopies performed by 17 endoscopists, 34.6% contained a recommendation to stop and 52.3% to continue. Older patients were more likely to receive a recommendation to stop, including those 80-84 years (odds ratio [OR], 7.7; 95% confidence interval [CI], 4.8-12.3) and ≥85 years (OR, 9.0; 95% CI, 3.3-24.6), compared with those 75-79 years. Family history of colorectal cancer (OR, 0.42; 95% CI, 0.24-0.74) and a history of low-risk (OR, 0.17; 95% CI, 0.11-0.24) or high-risk (OR, 0.02; 95% CI, 0.01-0.04) polyps were inversely associated with recommendations to stop. The likelihood of a recommendation to stop varied significantly across endoscopists.
CONCLUSIONS
Only 35% of adults ≥75 years of age are recommended to stop surveillance colonoscopy. The presence of polyps was strongly associated with fewer recommendations to stop. The variation in endoscopist recommendations highlights an opportunity to better standardize recommendations following colonoscopy in older adults.
Topics: Aged; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Humans; Mass Screening; Retrospective Studies
PubMed: 34216826
DOI: 10.1016/j.cgh.2021.06.041 -
European Review For Medical and... Mar 2019Colonoscopy is recognized as the primary screening test for colorectal cancer. However, its inaccuracy in identifying the exact tumor localization is still high. As a...
OBJECTIVE
Colonoscopy is recognized as the primary screening test for colorectal cancer. However, its inaccuracy in identifying the exact tumor localization is still high. As a consequence, repeated colonoscopies and changes in the surgical management have been reported. This study aims to evaluate the quality of 216 colonoscopies, to define colonoscopy accuracy and to investigate the surgical sequelae of an incorrect localization.
PATIENTS AND METHODS
A retrospective analysis of 216 colonoscopies has been conducted. Colonoscopy quality was assessed on: quality of bowel preparation, completeness of the examination, video and/or photographic documentation, and reported the distance of the lesion from the anal verge. Colonoscopy accuracy was evaluated in terms of correspondence between the endoscopic and intra-operative tumor localization.
RESULTS
Bowel preparation adequateness was reported in 121 out of 216 (56%) colonoscopies, with an adequate grade in 68.6% of cases. A complete colonoscopy was accomplished in 86.9% of cases with photo documentation in only 59 colonoscopies (27.3%). The lesion distance from the anal verge was documented only in 93 out of 216 colonoscopies. Of the 157 lesions described at the colonoscopy, 117 matched with the intra-operative localization (accuracy 74.5%). Fifteen of the 40 incorrectly localized lesions (37.5%) required changes in the surgical management. At multivariate analysis, the colonoscopy completeness was the only influencing factor on the concordance between endoscopic and intra-operative localization.
CONCLUSIONS
Colonoscopy demonstrated adequate accuracy in localizing lesions. However, the incorrect tumor localization leads to a high rate of changes in surgical management. Increase in.
Topics: Adult; Aged; Aged, 80 and over; Colonoscopy; Colorectal Neoplasms; Data Accuracy; Early Detection of Cancer; Female; Humans; Male; Middle Aged; Radiographic Image Enhancement; Retrospective Studies
PubMed: 30964180
DOI: 10.26355/eurrev_201903_17401 -
Romanian Journal of Gastroenterology Mar 2005To date, colonoscopy is considered the gold standard for the investigation of the colon and also the gold standard method for colorectal cancer screening. AIM of this...
BACKGROUND
To date, colonoscopy is considered the gold standard for the investigation of the colon and also the gold standard method for colorectal cancer screening. AIM of this paper was to assess if and how is Romania prepared to cope with screening of colon cancer by means of colonoscopy.
METHOD
We sent a study-type questionnaire addressed to all the centers in Romania known to perform digestive endoscopy and we inquired about the total number of colonoscopies and flexible sigmoidoscopies performed in 2003 (the questionnaire was sent to 43 centers).
RESULTS
Thirty-eight centers responded to the question-naire. The total number of colonoscopies performed in Romania in 2003, obtained by collecting the data from the study centers, was 22,324. The number of sigmoidoscopies performed during the same period was 12,349. The ratio between the number of colonoscopies and sigmoidoscopies was 1.8/1. There were 106.3 colonoscopies /100,000 inhabitants.
CONCLUSION
Considering the population of Romania (about 21 million inhabitants), the number of colonoscopies performed is insufficient for our country. The number of centers performing colonoscopy in Romania is also insufficient.
Topics: Colonic Neoplasms; Colonoscopy; Health Care Surveys; Humans; Practice Patterns, Physicians'; Romania
PubMed: 15800687
DOI: No ID Found