Guidelines for designing a digestive disease endoscopy unit: report of the World Endoscopy Organization.

A dedicated digestive disease endoscopy unit is structurally and functionally differentiating rapidly as a result of increasing diagnostic and therapeutic possibilities in the last 10-20 years. Publications with practical details are scarce, imposing a challenge in the construction of such a unit. The lack of authoritative information about endoscopy unit design means that architects produce their own design with or without consulting endoscopists working in such a unit.

Development and validation of the Bowel Cleansing Impact Review (BOCLIR).

Objective: Acceptability and tolerability of bowel cleansers influence whether patients are able to complete the prescribed dose and, consequently, the quality of the cleansing achieved. No standardised means of assessing patients' experience of using bowel cleansing is currently available. The aim of the study was to develop the Bowel Cleansing Impact Review (BOCLIR) to assess patient response to bowel cleansing products.

European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication.

Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.

The WIMAT colonoscopy suitcase model: a novel porcine polypectomy trainer.

Aim: Simulation allows the acquisition of complex skills within a safe environment. Endoscopic polypectomy has a long learning curve. Our novel polypectomy simulator may be a useful adjunct for training.

Budget-impact model for colonoscopy cost calculation and comparison between 2 litre PEG+ASC and sodium picosulphate with magnesium citrate or sodium phosphate oral bowel cleansing agents.

Objective: With the availability of several bowel cleansing agents, physicians and hospitals performing colonoscopies will often base their choice of cleansing agent purely on acquisition cost. Therefore, an easy to use budget impact model has been developed and established as a tool to compare total colon preparation costs between different established bowel cleansing agents.

Methods: The model was programmed in Excel and designed as a questionnaire evaluating information on treatment costs for a range of established bowel cleansing products.

Eicosapentaenoic acid reduces rectal polyp number and size in familial adenomatous polyposis.

Objective: The omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) has anticolorectal cancer activity in vitro and in preclinical models. The present study tested whether a novel, enteric-coated formulation of EPA, as the free fatty acid (EPA-FFA), has chemopreventative efficacy in patients with familial adenomatous polyposis (FAP), in a randomised, double-blind, placebo-controlled trial.

Methods: Patients undergoing endoscopic surveillance of their retained rectum postcolectomy were randomised to EPA-FFA (SLA Pharma) 2 g daily or placebo for 6 months.

Apoptosis in the colonic crypt, colorectal adenomata, and manipulation by chemoprevention.

This review discusses the biology and the methods of assessment of apoptosis, of which, the monoclonal antibody M30 would seem to be the most useful; the role of apoptosis in the etiology of colorectal cancer; and its use as a marker to monitor the beneficial effects of chemopreventative interventions to reduce the development of colorectal cancer within the context of clinical trials.

Colorectal cancer screening in Europe: differences in approach; similar barriers to overcome.

Worldwide diagnoses of bowel cancer approximate an estimated one million new cases per year, comprising 9% of all cancer cases, and this has continued to increase over the last 25 years. With the association between cancer risk and increasing age, together with the suggestion that by 2015 there will be a 22% increase in the proportion of the population aged over 65 years and a 50% increase in the proportion of people aged over 80 years, there is likely to be a significant increase in the demand on cancer services throughout Europe and the rest of the world. This article discusses the current state of bowel cancer screening within Europe.

Extramural vascular invasion is an adverse prognostic indicator of survival in patients with colorectal cancer.

Background/aims: Extramural vascular invasion (EVI) in colorectal cancer is reported to be a stage-independent adverse prognostic factor, and is a core item in the Royal College of Pathologists minimum data set for colorectal cancer histopathology reporting. The detection of EVI is also highly variable amongst pathologists. Our aims were to analyse both the frequency of EVI in colorectal cancer resections, and the effect of EVI on survival, in patients operated on over a 5-year period.

The NHS Bowel Cancer Screening Programme--a realistic approach with additional benefits.

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer death in the UK with 36 100 new cases diagnosed each year in England and Wales and 55% of all patients presenting with lymph node metastases at the time of diagnosis. Early detection, before the development of symptoms, may be an effective way of reducing mortality and it is this which a screening programme seeks to address. The NHS Bowel Cancer Screening Programme (NHS BCSP) commenced in April 2006 and invites men and women aged 60-69 to participate via submission of a faecal occult blood test every 2 years; those with a positive result will be offered colonoscopy as the next investigation of choice.

Eicosapentaenoic acid (EPA) reduces crypt cell proliferation and increases apoptosis in normal colonic mucosa in subjects with a history of colorectal adenomas.

Background And Aims: Omega-3 fatty acids in fish oil exert a protective effect on the development of colorectal cancer in animal models. Patients with colorectal adenomas have been shown to have increased crypt cell proliferation and decreased apoptosis in macroscopically normal appearing colonic mucosa. We investigated whether dietary supplementation with eicosapentaenoic acid (EPA) could alter crypt cell proliferation and apoptosis in such patients.

Eight years experience of high-powered endoscopic diode laser therapy for palliation of colorectal carcinoma.

Purpose: Endoscopic laser therapy using neodymium: yttrium-aluminum-garnet (Nd:YAG) laser has been shown to be effective in palliating symptoms of obstruction, bleeding, and discharge in patients with colorectal cancer. These patients usually have advanced inoperable disease at presentation or are unfit for surgery. We have used high-powered diode laser to palliate patients with inoperable colorectal cancer since 1994.

Diverticular disease of the colon: ethnic differences in frequency.

Background: Colonic diverticular disease is more common in Western populations than in developing countries.

Aim: To determine whether the frequency of colonic diverticular disease is different in British patients of Indian-subcontinent Asian origin compared with other ethnic groups.

Methods: All colonoscopies performed over a 3-year period in a London hospital were studied.

A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?

Aim: To study the availability and quality of adult and paediatric colonoscopy in three National Health Service (NHS) regions.

Method: A prospective four month study of colonoscopies in North East Thames, West Midlands, and East Anglia.

Patients: Subjects undergoing colonoscopy in 68 endoscopy units.

Review article: chemoprevention of colorectal cancer.

Colorectal cancer is a disease with a high mortality at present, due to the late stage at which many cases present. Attention is therefore focusing on preventative strategies for colorectal cancer given that polyps appear to be identifiable and treatable precursor lesions of this disease. Endoscopic polypectomy has been shown to reduce the incidence of colorectal cancer and there is a good case for endoscopic screening of the general population.

Results of anterior levatorplasty for rectocele.

Objective: Transanal and transvaginal repair of rectocele have been advocated in the treatment of rectocele, with mixed results. The aim of this study was to assess our experience using anterior levatorplasty in the surgical management of rectocele.

Patients And Methods: Sixty of 90 women who had undergone anterior levatorplasty for rectocele over a seven year period were traced, and 44 (33 with rectocele only and 11 with rectocele and faecal incontinence) responded to a standardized questionnaire 6 months to 7 years (mean 3.

Postoperative stay following colorectal surgery: a study of factors associated with prolonged hospital stay.

Aim: To study the factors that contribute to postoperative stay following colorectal surgery.

Design: A prospective observational study.

Setting: Three colorectal surgical units - a teaching hospital, a large district general hospital and a district general hospital.

Complications of adjuvant radiotherapy for rectal cancer.

The incidence of rectal cancer in the US is 45,000 per ann um. The 5-year survival is between 40 and 70%. This has not improved over the last 50 years despite improvements in techniques, the aid of new technology (surgical stapling devices in particular) and safer anesthesia.

Colonoscopy in asymptomatic individuals with a family history of colorectal cancer.

Background: This study was performed to evaluate the use of total colonoscopy as the optimal screening test in asymptomatic individuals with a family history of colorectal cancer (CRC).

Methods: Colonoscopy was performed in 249 asymptomatic individuals who had one or two first-degree relatives (FDRs) with CRC; individuals with three or more FDRs with CRC were excluded.

Results: Eighty-six colonic lesions were found in 51 individuals (51 of 249; 20.