Extracolonic findings at virtual colonoscopy: an important consideration in asymptomatic colorectal cancer screening.

Background: Virtual colonoscopy has been evaluated for use as a colorectal cancer screening tool, and in prior studies, it has been estimated that the evaluation of extra-colonic findings adds $28-$34 per patient studied.

Methods: As an ancillary study to a prospective cohort study comparing virtual colonoscopy to conventional colonoscopy for colorectal cancer detection, the investigators retrospectively determined the number and estimated costs of all clinic visits, imaging and laboratory studies, and medical procedures that were generated as a direct result of extra-colonic findings at virtual colonoscopy.

Results: We enrolled 143 subjects who underwent CTC followed by conventional colonoscopy.

Sensitivity of upper endoscopy in diagnosing esophageal cancer.

Esophageal cancer is a common cause of dysphagia and upper endoscopy is the accepted standard for making the diagnosis; however, the accuracy of endoscopy is not known. The purpose of this study is to determine the sensitivity of upper endoscopy in making the diagnosis of esophageal cancer in clinical practice. All patients with a new diagnosis of esophageal cancer from 1997 to 2001 in the Tumor Registry of Wake Forest University Baptist Medical Center were identified.

Determination of qualitative telomerase activity as an adjunct to the diagnosis of pancreatic adenocarcinoma by EUS-guided fine-needle aspiration.

Background: Telomerase activity is up-regulated in pancreatic cancer. Hence, measurement of telomerase activity in pancreatic needle-biopsy specimens could assist in establishing a positive diagnosis in specimens that are inadequate for cytology.

Objective: To determine the sensitivity and specificity of telomerase activity for neoplasia in a series of EUS-guided fine-needle aspirate (EUS-FNA) biopsies of pancreatic mass lesions.

The association between cigarette smoking and colorectal polyp recurrence (United States).

Objective: Although evidence exists linking smoking to precancerous colorectal adenomatous polyps, few studies have examined the association between cigarette smoking and recurrence of colorectal polyps. This association was investigated prospectively with data from the Polyp Prevention Trial.

Methods: Cigarette smoking data were collected through baseline interviews.

AGA future trends report: CT colonography.

Background & Aims: Computed tomographic colonography (CTC) was first described more than a decade ago. Recent advances in imaging hardware and software and results of clinical trials based on new methods for performing and interpreting images suggest that CTC may now be assessed as a method for colorectal cancer screening.

Methods: The Research Policy Committee of the American Gastroenterological Association assembled a task force to review the results of recent clinical trials and quantitative mathematical models pertaining to CTC.

Infectious complications of pancreatitis: diagnosis and management.

Infected pancreatic necrosis is the leading cause of death in patients with severe acute pancreatitis. Early prophylactic antibiotic treatment is effective in preventing conversion of sterile necrosis to pancreatic infection, but its effect on mortality remains unproven. Fungal infections may predict a worse outcome, but no evidence supports the use of antifungal prophylaxis.

Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia.

Context: Conventional colonoscopy is the best available method for detection of colorectal cancer; however, it is invasive and not without risk. Computed tomographic colonography (CTC), also known as virtual colonoscopy, has been reported to be reasonably accurate in the diagnosis of colorectal neoplasia in studies performed at expert centers.

Objective: To assess the accuracy of CTC in a large number of participants across multiple centers.

Isolated proximal esophageal injury from blunt trauma: endoscopic stricture dilatation.

Blunt neck trauma can cause isolated esophageal injuries that may be difficult to recognize. A high index of suspicion is necessary for optimal identification and management of this condition. We report a case of blunt esophageal trauma resulting from a motor vehicle accident that was initially unrecognized until the patient developed a tight stricture of the cervical esophagus.

Virtual colonoscopy using oral contrast compared with colonoscopy for the detection of patients with colorectal polyps.

Background & Aims: Virtual colonoscopy using abdominal spiral computed tomography scanning allows total colonic evaluation with minimal invasiveness. Two-dimensional images and selective 3-dimensional images of the colon are used to detect colorectal lesions. This trial used conventional colonoscopy with segmental unblinding to determine the ability of virtual colonoscopy to identify patients with colorectal lesions who need conventional colonoscopy.

Motion - computerized tomographic colography is a better method for screening for polyps: arguments for the motion.

Colorectal cancer is an important public health problem that is amenable to prevention and early treatment. Traditional screening techniques - fecal occult blood testing, flexible sigmoidoscopy, barium enema and colonoscopy - each have limitations in terms of diagnostic accuracy, cost and/or patient acceptability. Compliance with recommendations for screening has been poor, in part, because of negative perceptions about the available modalities.

The virtual colonoscopy study: a large multicenter clinical trial designed to compare two diagnostic screening procedures.

This paper reviews the design of a large multicenter clinical trial currently being conducted to test the equivalence of two screening procedures for colorectal polyps. The primary outcome is the sensitivity and specificity of the new and standard procedures for detecting subjects with and without polyps of a size > or =6 mm, respectively. An important secondary outcome is the accuracy of these procedures in detecting individual polyps.