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Health Economics Nov 2021Although colorectal cancer (CRC) screening is highly effective, screening rates lag far below recommended levels, particularly for low-income people. The Colorectal...
Although colorectal cancer (CRC) screening is highly effective, screening rates lag far below recommended levels, particularly for low-income people. The Colorectal Cancer Control Program (CRCCP) funded $100 million in competitively awarded grants to 25 states from 2009-2015 to increase CRC screening rates among low-income, uninsured populations, in part by directly providing and paying for screening services. Using data from the 2001-2015 Behavioral Risk Factor Surveillance System (BRFSS) and a difference-in-differences strategy, we find no effects of CRCCP on the use of relatively cheap fecal occult blood tests (FOBT). We do, however, find that the CRCCP significantly increased the likelihood that uninsured 50-64-year-olds report ever having a relatively expensive endoscopic CRC screening (sigmoidoscopy or colonoscopy) by 2.9 percentage points, or 10.7%. These effects are larger for women, minorities, and individuals who did not undertake other types of preventive care. We do not find that the CRCCP led to significant changes in CRC cancer detection. Our results indicate that the CRCCP was effective at increasing CRC screening rates among the most vulnerable.
Topics: Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Mass Screening; Occult Blood; Sigmoidoscopy
PubMed: 34342362
DOI: 10.1002/hec.4397 -
BMJ Case Reports May 2021A 21-year-old woman visited out hospital for lower abdominal pain and bloody diarrhoea at 19 weeks of pregnancy. Endoscopic findings revealed longitudinal ulcerations...
A 21-year-old woman visited out hospital for lower abdominal pain and bloody diarrhoea at 19 weeks of pregnancy. Endoscopic findings revealed longitudinal ulcerations with hyperaemia and oedema in the sigmoid colon. These findings and clinical presentation confirmed the diagnosis of ischaemic colitis. Conservative treatment, including fasting and intravenous hydration, was administered, and the patient made a good recovery. After discharge, there was no recurrence during pregnancy and postpartum period. It is important to make early diagnosis and treatment, and multidisciplinary teamwork between obstetricians, gastroenterologist and endoscopist is required.
Topics: Abdominal Pain; Adult; Colitis; Colitis, Ischemic; Female; Gastrointestinal Hemorrhage; Humans; Pregnancy; Sigmoidoscopy; Young Adult
PubMed: 33947673
DOI: 10.1136/bcr-2020-239975 -
The British Journal of Surgery Jan 2014The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis... (Review)
Review
BACKGROUND
The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis has evolved towards more conservative and minimally invasive strategies. The aim of this review is to highlight recent concepts and advances in management.
METHODS
A literature review was performed on the electronic databases MEDLINE from PubMed, Embase and the Cochrane Library for publications in English. The keywords 'diverticulitis', 'diverticular' were searched for the past decade (to September 2013).
RESULTS
Diverticulitis occurs frequently in the Western world, but only one in five patients develops complications (such as abscess and perforation) during the first acute presentation. The reported perforation rate is 3.5 per 100,000 population. Based on recent data, including the AVOD and DIVER trials, antibiotic therapy for mild episodes may be unnecessary and outpatient management reasonable in most patients. Antibiotics and admission to hospital is required for complicated diverticulitis confirmed on imaging and for patients with sepsis. Diverticular abscesses (about 5 per cent of patients) may require percutaneous drainage if antibiotics alone fail. Laparoscopic management of non-faecal perforated diverticulitis is feasible in selected patients, and peritoneal lavage in combination with antibiotic therapy may avoid colonic resection and a stoma. However, the collective, published worldwide experience is limited to fewer than 800 patients, and results from ongoing randomized trials (LapLAND, SCANDIV, DILALA and LADIES trials) are needed to inform better decision-making.
CONCLUSION
The treatment of diverticulitis continues to evolve with a trend towards a more conservative and minimally invasive management approach. Judicious use of antibiotics in uncomplicated cases, greater application of laparoscopic techniques, and primary resection and anastomosis are of benefit in selected patients.
Topics: Acute Disease; Anastomosis, Surgical; Anti-Bacterial Agents; Colectomy; Diverticulitis, Colonic; Forecasting; Humans; Intestinal Perforation; Peritoneal Lavage; Sigmoid Diseases; Sigmoidoscopy; Tomography, X-Ray Computed
PubMed: 24258427
DOI: 10.1002/bjs.9359 -
The Lancet. Gastroenterology &... Feb 2019Screening flexible sigmoidoscopy reduces incidence and mortality of colorectal cancer. Previously reported results from the Prostate, Lung, Colorectal, and Ovarian... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Screening flexible sigmoidoscopy reduces incidence and mortality of colorectal cancer. Previously reported results from the Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) screening trial had a median follow-up of 12 years. Whether the benefit is sustained over the long term and remains so in both sexes and all age groups is uncertain. We report long-term results after an additional 5 years of follow-up.
METHODS
Participants in the PLCO trial were recruited from the general population in the catchment areas of ten screening centres across the USA, without previous diagnosis of a prostate, lung, colorectal, or ovarian cancer or current cancer treatment. From 1993 to 2001, participants aged 55-74 years were randomly assigned to usual care or flexible sigmoidoscopy at baseline and again at 3 years or 5 years. Randomisation was done within blocks and stratified by centre, age, and sex. The primary endpoint was cause-specific mortality and secondary endpoints included incidence and tumour staging; cause of death was determined without knowledge of study arm. In this analysis, we assessed incidence and mortality rates overall, by time-period, and by combinations of sex, age at baseline (55-64 years/65-74 years), location (distal/proximal), and stage, on an intent-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT00002540.
FINDINGS
After a median follow-up of 15·8 years (IQR 13·2-18·0) for incidence and 16·8 years (14·4-18·9) for mortality, the incidence of colorectal cancer was significantly lower in the intervention arm (1461 cases; 12·55 per 10 000 person-years) than with usual care (1761 cases; 15·33 per 10 000 person-years; relative risk [RR] 0·82, 95% CI 0·76-0·88). Similarly, mortality was lower in the intervention arm (417 deaths; 3·37 per 10 000 person-years) than the usual care arm (549; 4·48 per 10 000 person-years; RR 0·75, 95% CI 0·66-0·85). The reduction in mortality was limited to the distal colon, with no significant effect in the proximal colon. Reductions in incidence were significantly larger in men than women (p=0·04) and reductions in mortality were significantly larger in the older age group (65-74 years vs 55-64 years at baseline; p=0·01).
INTERPRETATION
Reductions in colorectal cancer incidence and mortality from flexible sigmoidoscopy screening are sustained over the long term. Differences by sex and age should be examined in other ongoing trials of colorectal cancer screening to help clarify if different screening strategies would achieve greater risk reduction.
FUNDING
Extended follow-up was funded under NIH contract HHSN261201600007I.
Topics: Adenoma; Aged; Carcinoma; Colorectal Neoplasms; Early Detection of Cancer; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Mortality; Sigmoidoscopy; United States
PubMed: 30502933
DOI: 10.1016/S2468-1253(18)30358-3 -
European Journal of Vascular and... Jul 2018Colonic ischaemia (CI) is a devastating complication after abdominal aortic aneurysm (AAA) surgery. The aim of this review was to evaluate the diagnostic test accuracy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Colonic ischaemia (CI) is a devastating complication after abdominal aortic aneurysm (AAA) surgery. The aim of this review was to evaluate the diagnostic test accuracy of routine endoscopy in diagnosing CI after treatment for elective and acute AAA.
PATIENTS AND METHODS
The Pubmed and Embase database searches resulted in 1188 articles. Prospective studies describing routine post-operative colonoscopy or sigmoidoscopy after elective or emergency AAA repair were included. The study quality was assessed with the QUADAS-2 tool. Sensitivity and specificity forest plots were drawn. Diagnostic odds ratios were calculated by a random effect model.
RESULTS
Twelve articles were included consisting of 718 AAA patients of whom 44% were treated electively, 56% ruptured and, 6% by endovascular repair. Of all patients, 20.8% were identified with CI (all grades), and 6.5% of patients had Grade 3 CI. The pooled diagnostic odds ratio for all grades of CI on endoscopy was 26.60 (95% CI 8.86-79.88). The sensitivity and specificity of endoscopy for detection of Grade 3 CI after AAA repair was 0.52 (95% CI, 0.31-0.73) and 0.97 (95% CI 0.95-0.99) respectively. The positive post-test probability is up to 60% in all kinds of AAA patients and 68% in ruptured AAA patients.
CONCLUSION
Routine endoscopy is highly accurate for ruling out CI after AAA repair. Clinicians should be aware that endoscopy is less accurate in diagnosing the presence of the clinically relevant transmural CI. Endoscopy is a safe diagnostic test to use routinely as none of the studies reported adverse events.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Colon; Colonoscopy; Elective Surgical Procedures; Endovascular Procedures; Humans; Ischemia; Laparotomy; Postoperative Complications; Sensitivity and Specificity; Sigmoidoscopy
PubMed: 29555253
DOI: 10.1016/j.ejvs.2018.02.008 -
Medicine May 2019Ulcerative colitis (UC) typically begins in the rectum and progresses proximally in a contiguous fashion without skip lesions. Post-treatment inflammation distribution... (Observational Study)
Observational Study
Ulcerative colitis (UC) typically begins in the rectum and progresses proximally in a contiguous fashion without skip lesions. Post-treatment inflammation distribution can change over time. Colonoscopy is unpleasant for the patient and clinical trials often use sigmoidoscopy for evaluation of disease severity. The aim of this study is to evaluate whether sigmoidoscopy is adequate to assess disease activity and therapeutic response as colonoscopy.We retrospectively reviewed patients who underwent colonoscopy for the initial diagnosis and follow-up by evaluating their mucosal inflammation in our hospital from January 2012 and December 2017.A total of 69 patients were analyzed. During follow up, the inflamed segment changed post-treatment in 62% (43/69). Extensive UC was common in the changed disease extent group (P < .01). Patients treated with oral mesalazine had a higher rate of changed disease extent (P < .01). The sigmoid segment was the most commonly involved segment, and the rectum was the severely inflamed segment during initial diagnosis and follow-up. According to Mayo endoscopic subscore (MES) in the most severely inflamed colonic and rectosigmoid segment, there were high degrees of correlation in the initial UC diagnosis (r = .90, P < .01) and follow-up (r = .74, P < .01).Our findings suggest that sigmoidoscopy is effective as colonoscopy for detecting disease activity and evaluating therapeutic response in UC patients during follow-up.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Biological Products; Child; Child, Preschool; Colitis, Ulcerative; Colon, Sigmoid; Colonoscopy; Female; Humans; Immunomodulation; Inflammation; Male; Mesalamine; Middle Aged; Retrospective Studies; Severity of Illness Index; Sigmoidoscopy; Young Adult
PubMed: 31124958
DOI: 10.1097/MD.0000000000015748 -
California Medicine Sep 1961There being no new or advanced technical aids to help the clinician in evaluating colon dysfunction, he must still depend on a careful history, knowledge of the patient,...
There being no new or advanced technical aids to help the clinician in evaluating colon dysfunction, he must still depend on a careful history, knowledge of the patient, physical examination, which includes sigmoidoscopy, and a few appropriate diagnostic laboratory procedures to arrive at the proper diagnosis. With these means, it is possible to make a positive diagnosis of irritable bowel syndrome, and differentiate it from diverticulitis, ulcerative proctitis and polypoid disease.
Topics: Colitis, Ulcerative; Colon; Disease; Humans; Irritable Bowel Syndrome; Male; Proctitis; Sigmoidoscopy
PubMed: 13703114
DOI: No ID Found -
Gastroenterology Mar 2021The comparative effectiveness of sigmoidoscopy and fecal immunochemical testing (FIT) for colorectal cancer (CRC) screening is unknown. (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND & AIMS
The comparative effectiveness of sigmoidoscopy and fecal immunochemical testing (FIT) for colorectal cancer (CRC) screening is unknown.
METHODS
Individuals aged 50-74 years living in Southeast Norway were randomly invited between 2012 and 2019 to either once-only flexible sigmoidoscopy or FIT screening every second year. Colonoscopy was recommended after sigmoidoscopy if any polyp of ≥10 mm, ≥3 adenomas, any advanced adenomas, or CRC was found or, subsequent to, FIT >15 μg hemoglobin/g feces. Data for this report were obtained after complete recruitment in both groups and included 2 full FIT rounds and part of the third round. Outcome measures were participation, neoplasia detection, and adverse events. Age-standardized detection rates and age-adjusted odds ratios (ORs) were calculated.
RESULTS
We included 139,291 individuals: 69,195 randomized to sigmoidoscopy and 70,096 to FIT. The participation rate was 52% for sigmoidoscopy, 58% in the first FIT round, and 68% for 3 cumulative FIT rounds. Compared to sigmoidoscopy, the detection rate for CRC was similar in the first FIT round (0.25% vs 0.27%; OR, 0.92; 95% confidence interval [CI], 0.75-1.13) but higher after 3 FIT rounds (0.49% vs 0.27%; OR, 1.87; 95% CI, 1.54-2.27). Advanced adenoma detection rate was lower in the first FIT round compared to sigmoidoscopy at 1.4% vs 2.4% (OR, 0.57; 95% CI, 0.53-0.62) but higher after 3 cumulative FIT rounds at 2.7% vs 2.4% (OR, 1.14; 95% CI, 1.05-1.23). There were 33 (0.05%) serious adverse events in the sigmoidoscopy group compared to 47 (0.07%) in the FIT group (P = .13).
CONCLUSIONS
Participation was higher and more CRC and advanced adenomas were detected with repeated FIT compared to sigmoidoscopy. The risk of perforation and bleeding was comparable. Clinicaltrials.gov, Number: NCT01538550.
Topics: Aged; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Male; Mass Screening; Middle Aged; Norway; Occult Blood; Odds Ratio; Pilot Projects; Sigmoidoscopy
PubMed: 33227280
DOI: 10.1053/j.gastro.2020.11.037 -
JAMA Aug 2014Colorectal cancer is a major health burden. Screening is recommended in many countries. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Colorectal cancer is a major health burden. Screening is recommended in many countries.
OBJECTIVE
To estimate the effectiveness of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality in a population-based trial.
DESIGN, SETTING, AND PARTICIPANTS
Randomized clinical trial of 100,210 individuals aged 50 to 64 years, identified from the population of Oslo city and Telemark County, Norway. Screening was performed in 1999-2000 (55-64-year age group) and in 2001 (50-54-year age group), with follow-up ending December 31, 2011. Of those selected, 1415 were excluded due to prior colorectal cancer, emigration, or death, and 3 could not be traced in the population registry.
INTERVENTIONS
Participants randomized to the screening group were invited to undergo screening. Within the screening group, participants were randomized 1:1 to receive once-only flexible sigmoidoscopy or combination of once-only flexible sigmoidoscopy and fecal occult blood testing (FOBT). Participants with positive screening test results (cancer, adenoma, polyp ≥10 mm, or positive FOBT) were offered colonoscopy. The control group received no intervention.
MAIN OUTCOMES AND MEASURES
Colorectal cancer incidence and mortality.
RESULTS
A total of 98,792 participants were included in the intention-to-screen analyses, of whom 78,220 comprised the control group and 20,572 comprised the screening group (10,283 randomized to receive a flexible sigmoidoscopy and 10,289 to receive flexible sigmoidoscopy and FOBT). Adherence with screening was 63%. After a median of 10.9 years, 71 participants died of colorectal cancer in the screening group vs 330 in the control group (31.4 vs 43.1 deaths per 100,000 person-years; absolute rate difference, 11.7 [95% CI, 3.0-20.4]; hazard ratio [HR], 0.73 [95% CI, 0.56-0.94]). Colorectal cancer was diagnosed in 253 participants in the screening group vs 1086 in the control group (112.6 vs 141.0 cases per 100,000 person-years; absolute rate difference, 28.4 [95% CI, 12.1-44.7]; HR, 0.80 [95% CI, 0.70-0.92]). Colorectal cancer incidence was reduced in both the 50- to 54-year age group (HR, 0.68; 95% CI, 0.49-0.94) and the 55- to 64-year age group (HR, 0.83; 95% CI, 0.71-0.96). There was no difference between the flexible sigmoidoscopy only vs the flexible sigmoidoscopy and FOBT screening groups.
CONCLUSIONS AND RELEVANCE
In Norway, once-only flexible sigmoidoscopy screening or flexible sigmoidoscopy and FOBT reduced colorectal cancer incidence and mortality on a population level compared with no screening. Screening was effective both in the 50- to 54-year and the 55- to 64-year age groups.
TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT00119912.
Topics: Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Incidence; Intention to Treat Analysis; Male; Middle Aged; Norway; Occult Blood; Sigmoidoscopy
PubMed: 25117129
DOI: 10.1001/jama.2014.8266 -
Alimentary Pharmacology & Therapeutics Aug 2010Nitrous oxide gas (N(2)O) has been proposed as an alternative to intravenous (i.v.) analgesia in patients undergoing lower gastrointestinal endoscopy. (Review)
Review
BACKGROUND
Nitrous oxide gas (N(2)O) has been proposed as an alternative to intravenous (i.v.) analgesia in patients undergoing lower gastrointestinal endoscopy.
AIM
To perform a systematic review of randomized studies where N(2)O was compared against control in patients undergoing either flexible sigmoidoscopy or colonoscopy.
METHODS
Electronic databases were searched; reference lists were checked and letters were sent to authors requesting data. Methodological quality was assessed. Data were tabulated on the duration and difficulty of the procedure, quality of sedation and speed of patient recovery.
RESULTS
A total of 11 studies were identified containing 623 patients. No differences were seen between groups for duration, difficulty of procedure or complications. Patient-reported pain was similar for N(2)O when undergoing flexible sigmoidoscopy vs. no sedation and when undergoing colonoscopy vs. i.v. sedation. Differences in delivery of N(2)O were identified. In all studies, N(2)O was associated with a more rapid recovery than i.v. sedation.
CONCLUSION
For patients undergoing colonoscopy, N(2)O provides comparable analgesia to i.v. sedation. The rapid psychomotor recovery with N(2)O enables quicker patient discharge and removes the need for a patient to be chaperoned. Benefit was not seen from N(2)O in patients undergoing flexible sigmoidoscopy possibly because it was delivered on demand rather than continuously.
Topics: Adult; Aged; Analgesia; Analgesia, Patient-Controlled; Anesthesia Recovery Period; Anesthetics, Inhalation; Colonoscopy; Endoscopy, Gastrointestinal; Female; Humans; Male; Middle Aged; Nitrous Oxide; Pain Measurement; Sigmoidoscopy; Young Adult
PubMed: 20491748
DOI: 10.1111/j.1365-2036.2010.04359.x