CT and radiation-related cancer risk-time for a paradigm shift?

The use of CT in the US has been increasing exponentially over the past decade. The greatest increases in CT use have been in pediatric diagnosis and adult screening. Unfortunately, there is little cognizance among health-care providers (or their patients) about the relative latent cancer risks associated with repetitive exposure to ionizing radiation.

Early high C-reactive protein in infants with open abdominal wall defects does not predict sepsis or adverse outcome.

Aim: To study CRP values and relate it to outcome in infants with antenatal diagnosis of gastroschisis, exomphalos and other surgical conditions.

Methods: Over five years, infants admitted to our neonatal unit with gastroschisis, exomphalos and other surgical diagnoses were identified. Serum CRP measurements in first 5 days were studied.

Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001.

Aim: To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007.

Methods: Forty consecutive proximal colon polyps > or = 5 mm in size, removed in 2001, and originally interpreted as hyperplastic polyps by general pathologists at Indiana University, were reviewed in 2007 by 3 GI pathologists.

Results: The gastrointestinal (GI) pathologists interpreted 85%, 43% and 30% of the polyps as sessile serrated polyps (sessile serrated adenomas).

Colorectal anatomy in adults at computed tomography colonography: normal distribution and the effect of age, sex, and body mass index.

Background And Study Aims: Computed tomography colonography (CTC) is an accurate tool for assessing the large intestinal anatomy. Our aims were to determine the normal distribution of in vivo colorectal anatomy and to investigate the effect of age, sex, and body mass index (BMI) on colorectal length.

Patients And Methods: Asymptomatic adults who underwent primary CTC examination at a single institution over an 8-month period were evaluated.

Endoscopist-directed administration of propofol: a worldwide safety experience.

Background & Aims: Endoscopist-directed propofol sedation (EDP) remains controversial. We sought to update the safety experience of EDP and estimate the cost of using anesthesia specialists for endoscopic sedation.

Methods: We reviewed all published work using EDP.

Third Eye Retroscope: rationale, efficacy, challenges.

The most effective colonoscopy misses polyps, and both barium enema and computed tomography colonography studies have identified hidden areas on the proximal sides of folds, flexures, and valves where colonoscopy can miss even substantially sized lesions. This article reviews the rationale, efficacy, and clinical challenges associated with one of the most promising devices for improvement of mucosal exposure during colonoscopy, the Third Eye Retroscope (Avantis Medical, Sunnyvale, CA).

Colon cleansing before colonoscopy: does oral sodium phosphate solution still make sense?

Oral sodium phosphate (NaP) solution has been withdrawn from the market in the United States but remains available for over-the-counter purchase for bowel preparation for colonoscopy in Canada. The present review summarizes recent data regarding the renal toxicity of oral NaP as well as its efficacy and tolerability relative to other preparations. Given the availability of effective alternatives to NaP solution, its use for colonoscopy preparation in Canada should be limited.

Effect of screening colonoscopy on colorectal cancer incidence and mortality.

Background & Aims: Colonoscopy is used widely for colorectal cancer (CRC) screening; however, its long-term impact on the incidence and mortality of CRC is not known.

Methods: We assessed CRC incidence and mortality in a group of asymptomatic average-risk patients who underwent screening colonoscopy between 1989 and 1993 at a university hospital. By using standardized incidence ratios and standardized mortality ratios, we compared our observed CRC rates with expected rates from the Surveillance, Epidemiology, and End Results (SEER) data.

Incidence and predictors of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas.

Background: Large sessile colorectal adenomas (>/=2 cm in size) resected piecemeal have a 0% to 55% rate of residual adenoma at the first follow-up. Guidelines recommend inspection of the polypectomy site 3 to 6 months after resection. Some patients with a negative examination at 3 to 6 months have a subsequent "late" recurrence.

American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected].

This document is the first update of the American College of Gastroenterology (ACG) colorectal cancer (CRC) screening recommendations since 2000. The CRC screening tests are now grouped into cancer prevention tests and cancer detection tests. Colonoscopy every 10 years, beginning at age 50, remains the preferred CRC screening strategy.

Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps.

Background & Aims: The ability to determine colorectal polyp pathology by endoscopy could reduce the risks of polypectomy and the cost of pathologic evaluation. This study evaluated the ability of the Olympus Exera 180 high-definition colonoscope (Olympus America, Inc, Center Valley, PA), with narrow-band imaging, to predict colorectal polyp histology.

Methods: A library of 320 endoscopic photographs with correlated histologic information was used to identify endoscopic features associated with adenomatous and hyperplastic histology.

Advances in colonoscope technique and technology.

To date, no alternative platform for colonoscopy seems prepared to substantially supplant the traditional colonoscopy platform. The Invendoscope and capsule colonoscopy are the most promising of the alternative platforms. With regard to colonoscope insertion, water immersion is quite noteworthy but requires additional study in broader populations.

Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings.

Objectives: The American College of Radiology (ACR) recommends that polyps < or =5 mm in size not be reported on computed tomography (CT) colonography studies. Patients with 1 or 2 polyps 6-9 mm in size can be offered "CTC surveillance" in 3 years in lieu of polypectomy. The aim of the study was to determine the impact of ACR recommendations on resection of high-risk adenoma findings using an endoscopic polyp/histology database.

Routine rectal retroflexion during colonoscopy has a low yield for neoplasia.

Aim: To investigate the value of retroflexion in detecting neoplasia in the distal rectum.

Methods: This was a prospective observational study performed in an academic endoscopy unit. Consecutive patients undergoing colonoscopy had careful forward viewing of the distal rectum by retroflexion.

High detection rates of colorectal neoplasia by stool DNA testing with a novel digital melt curve assay.

Background & Aims: Current stool DNA tests identify about half of individuals with colorectal cancers and miss most individuals with advanced adenomas. We developed a digital melt curve (DMC) assay to quantify low-abundance mutations in stool samples for detection of colorectal neoplasms and compared this test with other approaches.

Methods: We combined a melt curve assay with digital polymerase chain reaction and validated the quantitative range.

Gastroenterologist-directed propofol: an update.

Gastroenterologist directed propofol has been proven safe in more than 220,000 published cases. Administration of low doses of opioid and/or benzodiazepine ("balanced propofol sedation") is the safest format for gastroenterologist directed propofol. Specific training is needed to undertake gastroenterologist directed propofol administration.

Considering double contrast barium enema and its demise: a case for systematic videorecording of colonoscopy.

Double contrast barium enema (DCBE) continues its decline. One area where DCBE and CT colonography surpass colonoscopy is in documentation. Colonoscopy could improve documentation by systematic videorecording of examinations (or at least of the withdrawal portions).

Stool DNA and occult blood testing for screen detection of colorectal neoplasia.

Background: Stool DNA testing is a new approach to colorectal cancer detection. Few data are available from the screening setting.

Objective: To compare stool DNA and fecal blood testing for detection of screen-relevant neoplasia (curable-stage cancer, high-grade dysplasia, or adenomas >1 cm).