Quality of Preoperative Colonoscopy Affects Missed Postoperative Adenoma Detection in Colorectal Cancer Patients

New predictors of recurrence in post-polypectomy surveillance - A retrospective analysis of risk stratification for advanced adenomas and polyps

BACKGROUND AND AIMS

recent guidelines emphasized that not all patients with recurrent polyps benefit from post-polypectomy surveillance, except for advanced adenomas recurrence. This study aimed to analyze the recurrence risk factors for advanced adenomas and investigated the difference from any polyp recurrence.

METHODS

this retrospective observational study included patients who underwent colonoscopy and at least one post-polypectomy surveillance. Multivariate regression models identified risk factors for the recurrence of polyps and advanced adenomas. The Youden index determined the optimal cut-off value for risk factors. Kaplan-Meier curve estimated the cumulative recurrence rates, and the log-rank tests compared the differences between these curves.

RESULTS

a total of 1,818 patients had polyps at baseline examination. During post-polypectomy surveillance, 1,063 patients had recurrent polyps, and 64 patients experienced recurrent advanced adenomas. Multivariate logistic analysis identified age as an independent risk factor for both advanced adenoma (OR [95 % CI]: 1.028 [1.003-1.056]) and polyps (OR [95 % CI]: 1.019 [1.009-1.028]), with cut-off values of 57 years and 53 years, respectively. A cut-off value of 40 years can increase the predictive sensitivity to 95 %. Polyps size (OR [95 % CI]: 1.070 [1.014-1.147]) and high-risk pathology (OR [95 % CI]: 6.339 [2.057-23.919]) were significantly associated with recurrence of advanced adenomas, but not with any polyps, with a size cut-off value of 7.5 mm. Except for high-risk pathology, neither hyperplastic polyps nor tubular adenomas with low-grade dysplasia increased the recurrence risk of advanced adenomas.

CONCLUSIONS

a cut-off value of 40 years can increase the predictive sensitivity to 95 % for both advanced adenomas and any polyps. Polyps size and high-risk pathology were associated with the recurrence of advanced adenoma, but not with any polyps.

Smartphone education improves embarrassment, bowel preparation, and satisfaction with care in patients receiving colonoscopy: A randomized controlled trail

BACKGROUND

Colonoscopy is considered a safe and effective tool for detecting colorectal cancer. Nevertheless, the proportion of patients are hesitating to receive colonoscopy. Smartphone education may decrease the barrier of colonoscopy. The aim of this study is to examine the effectiveness of smartphone education in colonoscopy.

METHODS

We conducted a prospective, double-blinded, randomized, controlled study to examine the effectiveness of smartphone education on embarrassment, bowel preparation, and satisfaction in colonoscopy. The patients' embarrassment was measured by the colonoscopy embarrassment scale. The quality of the bowel preparation was evaluated by gastroenterologists according to the Aronchik Scale. The satisfaction of colonoscopy care was assessed by a satisfaction scale developed by the authors.

RESULTS

A total of 150 patients were analyzed in the smartphone education and control groups (n = 75 in each group). The smartphone education group reported fewer embarrassment (B = -2.78, P = .02) than those of the control group, the patients who were older (B = .15, P = .001) and who were male (B = 2.91, P = .003) showed higher embarrassment. Additionally, smartphone education group were likely to have better colon preparation (odds ratio = 2.46, 95% confidence interval: 1.20-5.02) than that of the control group. Smartphone education also improved the satisfaction with care (β = 4.60, P < .001), and above normal body mass index decreased the satisfaction with care (β = -0.19, P < .05).

CONCLUSION

Smartphone education improves embarrassment, bowel preparation, and satisfaction with care in patients receiving colonoscopy.

Efficacy and Patient Tolerability Profiles of Probiotic Solution with Bisacodyl Versus Conventional Cleansing Solution for Bowel Preparation: A Prospective, Randomized, Controlled Trial

Although adequate bowel preparation is essential in screening colonoscopy, patient intolerability to bowel cleansing agents is problematic. Recently, a probiotic mixture solution with bisacodyl emerged to improve patient tolerability. We investigated the efficacy, safety, and patient tolerability profiles of probiotics with bisacodyl versus conventional polyethylene glycol (PEG) solution for bowel preparation for screening colonoscopies in healthy patients in this prospective, randomized, case-control study. In total, 385 volunteers were randomly assigned to receive 2 L of water + 200 mL of probiotic solution (case group, n = 195) or 4 L of PEG solution (control group, n = 190). The efficacy of the bowel cleansing was evaluated using the Ottawa scale system, polyp detection rate, and adenoma detection rate, and the patient tolerability profiles were assessed using a questionnaire. The demographics were not significantly different between groups. When the Ottawa score for each bowel segment was stratified into an adequate vs. inadequate level (Ottawa score ≤ 3 vs. >3), there were no statistical differences between groups in each segment of the colon. There were no significant differences in the polyp and adenoma detection rates between groups (38.42% vs. 32.42, p = 0.30; 25.79% vs. 18.97%, p = 0.11). The case group showed significantly fewer events than the control group, especially nausea, vomiting, and abdominal bloating events. Regarding the overall satisfaction grade, the case group reported significantly more “average” scores (95% vs. 44%, p < 0.001) and were more willing to use the same agents again (90.26% vs. 61.85%, p < 0.001). As patient compliance with bowel preparation agents is associated with an adequate level of bowel cleansing, a probiotic solution with bisacodyl might be a new bowel preparation candidate, especially in patients who show a poor compliance with conventional bowel preparation agents.

Clinicopathological and molecular features of colorectal cancer with synchronous adenoma

OBJECTIVE

To investigate the clinicopathological and molecular features of colorectal cancer (CRC) with synchronous adenoma and to describe features of synchronous adenomas in CRC patients.

METHODS

Single-centre retrospective cohort of 180 patients were included. The clinicopathological and endoscopic data were collected. The expression mismatch repair (MMR) proteins were detected by immunohistochemistry. The determination of microsatellite instability (MSI) was performed by multiple fluorescence PCR, and the mutations of genes were detected by real-time PCR.

RESULTS

Among all cases, 49 were diagnosed as CRC with synchronous adenoma, and 131 were diagnosed as solitary CRC. Some of the differences between the groups are: higher incidence was found in male (71.4 vs. 52.6%, p = .023) and in patients with habit drinking (34.7 vs. 14.5%, p = .030) and with other neoplastic diseases (42.7 vs. 26%, p = .028). Less tumors in the synchronous group were diagnosed as stage III and IV than in the solitary group (28.6 vs. 45%, p = .045). One and four mutant subtypes of KRAS gene mutations were detected insynchronous group and solitary group respectively.The prevalence of BRAF mutations in solitary group was higher than that in the synchronous group (7.4 vs. 0%, p = .045). A total of 123 adenomas were found in synchronous group and they tend to be smaller than 10 mm (74%).

CONCLUSION

Gender, a habit of drinking and other neoplastic diseases are risk factors for the development of a synchronous adenoma. With a low rate of BRAF mutations, the responses to monoclonal antibody and prognosis of patients with synchronous adenomas may be better than that of solitary CRC.