Maximizing the Effectiveness of Colonoscopy in the Prevention of Colorectal Cancer

What is the current state of anxiety and its related factors in Chinese patients undergoing colonoscopy? A cross-sectional study

BACKGROUND

Anxiety in patients undergoing colonoscopy may also result in adverse effects, including altered vital signs such as elevated heart rate and blood pressure, exacerbation of symptoms like bloating and gastrointestinal discomfort, a decline in cooperation and satisfaction, and even colonoscopy failure. However, limited studies have explored the level of anxiety, factors that influence it, and its specific causes.

METHODS

A cross-sectional study was conducted, recruiting 825 patients undergoing colonoscopy in Hunan Province between January and July 2023 using stratified sampling. The Spielberger State-Trait Anxiety Inventory (STAI), a self-designed demographic characteristics questionnaire, and a colonoscopy patient anxiety influencing factor questionnaire were used. The data were analyzed in SPSS (version 26) using Mann-Whitney U, Kruskal-Wallis, and multiple regression analysis tests.

RESULTS

The final study included 825 participants, of whom 19.8% exhibited mild anxiety, 37.0% exhibited moderate anxiety, and 43.2% exhibited severe anxiety. The results indicated that insomnia (β=-0.080, p = 0.013), no comorbidities (β=-0.147, p < 0.001), not smoking or drinking (β=-0.158, p < 0.001), and poor health (moderate: β=-0.183, p < 0.001; poor: β=-0.164, p < 0.001) were negatively associated with anxiety levels. In contrast, marital status (β = 0.177, p < 0.001), education level (β = 0.204, p < 0.001), age (β = 0.114, p = 0.007), medical insurance (Basic Medical Insurance for Urban Residents β = 0.204, p < 0.001; Commercial medical insurance: β = 0.112, p < 0.001), care provided by relatives (β = 0.102, p = 0.002), diarrhoea (β = 0.089, p = 0.005), occupation (farmers: β = 0.099, p = 0.009; self-employed: β = 0.082, p = 0.014), and paternal upbringing (β = 0.067, p = 0.034) were positively correlated with anxiety. Several factors had a greater impact on the anxiety level of the patients: education level (β = 0.204), health status (moderate: β=-0.183; not good: β=-0.164), and marital status (β = 0.177). It probably because higher education levels may increase awareness of potential risks associated with colonoscopy, contributing to greater anxiety. The five common reasons for anxiety included the presence of bloody faeces, enemas, need for further treatment, lack of timely feedback from the physician, lack of an accurate diagnosis.

CONCLUSION

The level of anxiety experienced by patients during the colonoscopy phase was more severe and should be alleviated with targeted interventions based on the cause of anxiety, such as pre-procedural counseling, patient education materials, and enhanced communication with healthcare providers.

A preliminary study of further attempt at the development, testing and application of an auxiliary equipment for electronic colonoscopy

Colonoscopy is a valuable tool for colorectal cancer screening and health checkups, with increasing utilization annually. Assisted entry is a standard procedure during electronic colonoscopy. In China, most clinically assisted colonoscopy procedures involve a nurse directly applying abdominal pressure to the patient's abdomen. This maneuver provides a fulcrum for the physician performing the procedure, facilitating smoother access to the colon. To reduce labor, optimize resource utilization, and enhance efficiency, this preliminary study aimed to develop and evaluate an adjunctive pressurized removable lap band for colonoscopy. This prospective randomized controlled trial randomized participants into control and experimental groups for observational comparison during follow-up, mitigating retrospective bias. Data were collected from 150 participants in a tertiary hospital endoscopy department between March and September 2023. Participants were evenly divided into groups using a randomized number table. Demographic data, including gender, age, height, weight, and abdominal circumference, were collected to ensure group representativeness and comparability. No significant pre-test differences were found between the groups. The experimental group demonstrated a significant reduction in examination-only insertion time compared to the control group (p < 0.001), median respectively 2.5, 3. Additionally, compared with control group (41.3%), the experimental group (24%) required fewer nurse assistance (p = 0.024). No significant differences were observed in systolic and diastolic blood pressure changes between the groups (p = 0.07, p = 0.43). However, compared with control group (0.89 ± 1.17), the experimental group (2.19 ± 0.94) reported lower pain scores (p < 0.001). Overall, this preliminary study validates the adjunctive pressurized removable lap band as an effective tool for improving colonoscopy efficiency, reducing patient pain, and conserving medical resources.Trial registration: Registration Authority: Chinese Clinical Trial Registry (ChiCTR). Number: ChiCTR2400082664.

THE ESOPHAGEAL, GASTRIC, AND COLORECTAL TUMORS AND THE ESOPHAGOGASTRODUODENOSCOPIES AND COLONOSCOPIES BY THE BRAZILIAN UNIFIED HEALTH SYSTEM: WHAT IS THE IMPORTANCE?

Esophagogastroduodenoscopies and colonoscopies are the main diagnostic examinations for esophageal, stomach, and colorectal tumors.

Rapid, High-Resolution, Label-Free, and 3-Dimensional Imaging to Differentiate Colorectal Adenomas and Non-Neoplastic Polyps With Micro-Optical Coherence Tomography

INTRODUCTION

"Resect and discard" paradigm is one of the main strategies to deal with colorectal diminutive polyps after optical diagnosis. However, there are risks that unrecognized potentially malignant lesions are discarded without accurate diagnosis. The purpose of this study is to validate the potential of micro-optical coherence tomography (μOCT) to improve the diagnostic accuracy of colorectal lesions and help endoscopists make better clinical decision without additional pathology costs.

METHODS

Fresh tissue samples were obtained from patients with colorectal polyps or colorectal cancer who received endoscopic therapy or laparoscopic surgery. These samples were instantly imaged by μOCT and then sent to pathological evaluation. Then, μOCT images were compared with corresponding HE sections. We created consensus μOCT image criteria and then tested to determine sensitivity, specificity, and accuracy of our system to discriminate neoplastic polyps from non-neoplastic polyps.

RESULTS

Our μOCT system achieved a resolution of 2.0 μm in both axial and lateral directions, clearly illustrated both cross-sectional and en face subcellular-level microstructures of colorectal lesions ex vivo, demonstrating distinctive patterns for inflammatory granulation tissue, hyperplastic polyp, adenoma, and cancerous tissue. For the 58 cases of polyps, the accuracy of the model was 94.83% (95% confidence interval [CI], 85.30%-98.79%), the sensitivity for identification of adenomas was 96.88% (95% CI, 82.89%-99.99%), and the specificity was 92.31% (95% CI, 74.74%-98.98%). Our diagnostic criteria could help both expert endoscopists and nonexpert endoscopists to identify neoplastic from non-neoplastic polyps with satisfactory accuracy and good interobserver agreement.

DISCUSSION

We propose a new strategy using μOCT to differentiate benign polyps and adenomas after the lesions are resected. The application of μOCT can potentially reduce the cost of pathological examination and minimize the risk of discarding malignant lesions during colonosocpy examination.

Does Increased Adenoma Detection Reduce the Risk of Colorectal Cancer, and How Good Do We Need to Be?

PURPOSE OF REVIEW

Colorectal cancer (CRC) is largely preventable with colonoscopy and other screening modalities. However, the effectiveness of screening and surveillance depends on the quality of the colonoscopy exam. Adenoma detection rate (ADR) is the best-validated metric by which we measure individual physicians' performance.

RECENT FINDINGS

Recent evidence suggests that ADR benchmarks may be inappropriately low. There is proof that improving ADR leads to significant reductions in post-colonoscopy CRC (PCCRC). Two studies have demonstrated that when a colonoscopy is performed by physicians with higher ADRs, patients are less likely to have advanced adenomas on surveillance and less likely to develop or die from PCCRC. Finally, there is at least some evidence that higher ADRs do not lead to more cumulative surveillance exams. The ADR is a useful outcome measure that can provide individual endoscopists and their patients with information about the likelihood of developing PCCRC. To achieve the lowest possible PCCRC rate, we should be striving for higher ADRs. While strategies and innovations may help a bit in improving ADRs, our efforts should focus on ensuring a complete mucosal exam for each patient. Behavioral psychology theories may provide useful frameworks for studying motivating factors that drive a careful exam.