Background and study aims:
Adenoma detection is a key objective of colonoscopy, particularly in the context of colorectal cancer screening. The aim of this observational study was to identify the ...technical colonoscopy factors associated with adenoma detection.
Patients and methods:
The study analyzed data from the English Bowel Cancer Screening Programme. The indication for all colonoscopies was a positive fecal occult blood test. The relationships between the following colonoscopy factors and adenoma detection (one or more adenomas, advanced adenomas, right-sided adenomas, and total number of adenomas) were examined in multivariable analyses: bowel preparation quality, cecal intubation, withdrawal time, rectal retroversion, colonoscopist experience, antispasmodic use, sedation use, and start time of procedure. The following patient factors were controlled for: age, sex, body mass index, smoking, alcohol, deprivation, and geographical location.
Results:
A total of 31088 colonoscopies were analyzed. The following technical factors increased the relative risk of adenoma detection (
P
< 0
.
001 in multivariable analysis unless otherwise stated): cecal intubation, increased withdrawal time, higher quality bowel preparation, intravenous antispasmodic use, earlier procedure start time within a session (
P =
0
.
018), and greater colonoscopist experience. Detection of advanced and right-sided adenomas also increased with these factors. Adenoma detection did not differ between sedated and unsedated colonoscopy (
P
= 0.143).
Conclusion:
This study demonstrated important associations between colonoscopy practice and adenoma detection. Use of intravenous antispasmodic was associated with increased adenoma detection. The effect of the start time of colonoscopy suggests that endoscopist fatigue may have a deleterious impact on adenoma detection.
Following the results of a major UK study showing that once-only flexible sigmoidoscopy (FSIG) screening significantly reduced colorectal cancer (CRC) incidence and mortality, an FSIG screening ...program in England was announced in late 2010. Three "early pilot" sites were selected in 2011 in Derby, South of Tyne, and Tees to assess the practicalities of the delivery of FSIG screening.
Eligible people aged 55 from selected practices in the three early pilot areas received postal invitations to participate. The South of Tyne and Derby sites employed interactive models of screening invitation, while Tees used a simple invitation. Data were collected to assess uptake, process, and outcome. A self-completion participant satisfaction questionnaire was sent to all participants 1 month after attendance.
A total of 4023 55-year-olds were invited to participate. Uptake was 29 %, with 1151 people screened over a 3-month period. Screening uptake differed by method of invitation: a simple approach was significantly more successful than an interactive one (32 % vs. 27 %, P = 0.0015). Uptake decreased significantly with increasing deprivation. Adenomas were found in 111 (9.8 %) of those screened and cancer in two. The procedure was rated "very" or "fairly" acceptable by 97 % of participants. Over 90 % of respondents said they would participate in future cancer screening and a similar proportion would recommend doing so to others.
Delivery of an FSIG screening program to prevent CRC is feasible and should be implemented using a simple invitation system. The national Bowel Scope program subsequently commenced at pilot sites in May 2013, with full implementation planned by 2016.
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these ...performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve.
We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators.
•A range of practical, psychological & social barriers to colonoscopy were reported.•Psychological barriers (e.g., fear of pain) were considered to be the most pertinent.•Several new barriers, ...including fear of getting and spreading COVID were described.•The results advocate a multifaceted approach to reducing barriers to colonoscopy.•Providing information on the risk of COVID might increase uptake during lockdowns.
People who are referred for colonoscopy, following an abnormal colorectal cancer (CRC) screening result, are at increased risk of CRC. Despite this, many individuals decline the procedure. The aim of this study was to investigate why.
As little is currently known about non-attendance at follow-up colonoscopy, and follow-up of abnormal screening results is a nurse-led process, we decided to conduct key informant interviews with Specialist Screening Practitioners (SSPs nurses working in the English Bowel Cancer Screening Program). Interviews were conducted online. Transcripts were assessed using inductive and deductive coding techniques.
21 SSPs participated in an interview. Five main types of barriers and facilitators to colonoscopy were described, namely: Sociocultural, Practical, Psychological, Health-related and COVID-related. Key psychological and sociocultural factors included: ‘Fear of pain and discomfort associated with the procedure’ and ‘Lack of support from family and friends’. Key practical, health-related and COVID-related factors included: ‘Family and work commitments’, ‘Existing health conditions as competing priorities’ and ‘Fear of getting COVID-19 at the hospital'.
A range of barriers and facilitators to follow-up colonoscopy exist. Future studies conducted with patients are needed to further explore barriers to colonoscopy.
Strategies to reduce non-attendance should adopt a multifaceted approach.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
ABSTRACT
The ~25.5‐ka Ōruanui supereruption (Taupō volcano, New Zealand) erupted >1100 km3 of pyroclastic material during the Last Glacial Maximum. The impacts of this event on climate and the New ...Zealand environment remain unresolved, particularly on ecological timescales. Using sediment cores from Onepoto maar palaeolake, Auckland (~240 km upwind from source), we have analysed pollen assemblages at contiguous 1‐mm intervals, around an intact 3‐cm layer of the Kawakawa‐Ōruanui Tephra to resolve and assess post‐eruption vegetation impacts and landscape recovery. Sediments immediately above the tephra record a decline in the relative abundance of the dominant canopy species of Fuscospora, and concurrent increase in the abundances of grasses, herbs, ferns and shrubs. These changes reflect a brief (<10 years) part‐defoliation of canopy trees, permitting more light to penetrate and to encourage sub‐canopy vegetation growth. A short‐lived volcanogenic cooling inferred from Antarctic ice core records may have contributed to the changes but cannot be separated from the immediate and direct ecological impacts of ashfall on vegetation following the eruption. Our results, here applied to the world's most recent supereruption, more generally demonstrate the value of millimetre‐scale stratigraphic pollen analysis from non‐varved lacustrine sediments as a tool for assessing past eruptive impacts on sub‐decadal timescales.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
PURPOSE:Clostridium difficile diarrhea is common in elderly patients and leads to prolonged hospitalization. Patients with severe or recurrent Clostridium difficile diarrhea have poor antitoxin ...antibody responses. Intravenous immunoglobulin has been advocated in these patients. This study was designed to assess the response of patients with refractory, recurrent, or severe Clostridium difficile diarrhea to intravenous immunoglobulin.
METHODS:Retrospective review (November 2003-January 2005) of 14 patients with severe, refractory, recurrent Clostridium difficile diarrhea treated with intravenous immunoglobulin (Flebogamma, 150-400 mg/kg) from 264 Clostridium difficile toxin-positive patients.
RESULTS:Median age was 79 (range, 54-91) years. Median length of symptoms before intravenous immunoglobulin was 29 (range, 3-90) days. Patients received a median of three (range, 1-5) courses of vancomycin or metronidazole before intravenous immunoglobulin. All had hypoalbuminemia (median, 22 g/l; range, 18-33) and raised C-reactive protein (median, 47 mg/l; range, 25-255) at time of infusion. The median white cell count was 15.3 × 10/liters (range, 4-24). Eight patients had evidence of pancolitis on abdominal imaging, suggesting severe Clostridium difficile diarrhea. All patients tolerated intravenous immunoglobulin without side effects. Nine (64 percent) responded with bowels normalizing in a median of ten (range, 2-26) days; one patient received two doses. One patient had a partial response from two doses but died two months later after a recurrence. The other four patients died of other causes within three weeks of infusion.
CONCLUSIONS:Intravenous immunoglobulin may be effective for severe, refractory, or recurrent Clostridium difficile diarrhea after failed conventional treatment.
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KISLJ, NUK, OILJ, PNG, SAZU, UL, UM, UPUK
Summary
Background
The seAFOod polyp prevention trial was a randomised, placebo‐controlled, 2 × 2 factorial trial of aspirin 300 mg and eicosapentaenoic acid (EPA) 2000 mg daily in individuals who ...had a screening colonoscopy in the English Bowel Cancer Screening Programme (BCSP). Aspirin treatment was associated with a 20% reduction in colorectal polyp number at BCSP surveillance colonoscopy 12 months later. It is unclear what happens to colorectal polyp risk after short‐term aspirin use.
Aim
To investigate colorectal polyp risk according to the original trial treatment allocation, up to 6 years after trial participation.
Methods
All seAFOod trial participants were scheduled for further BCSP surveillance and provided informed consent for the collection of colonoscopy outcomes. We linked BCSP colonoscopy data to trial outcomes data.
Results
In total, 507 individuals underwent one or more colonoscopies after trial participation. Individuals grouped by treatment allocation were well matched for clinical characteristics, follow‐up duration and number of surveillance colonoscopies. The polyp detection rate (PDR; the number of individuals who had ≥1 colorectal polyp detected) after randomization to placebo aspirin was 71.1%. The PDR was 80.1% for individuals who had received aspirin (odds ratio OR 1.13 95% confidence interval 1.02, 1.24; p = 0.02). There was no difference in colorectal polyp outcomes between individuals who had been allocated to EPA compared with its placebo (OR for PDR 1.00 0.91, 1.10; p = 0.92).
Conclusion
Individuals who received aspirin in the seAFOod trial demonstrated increased colorectal polyp risk during post‐trial surveillance. Rebound elevated neoplastic risk after short‐term aspirin use has important implications for aspirin cessation driven by age‐related bleeding risk. ISRCTN05926847.
There was an increase in colorectal polyp risk during colonoscopy surveillance after seAFOod trial participation in individuals who originally received aspirin compared with those who received placebo aspirin.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Urinary prostaglandin (PG) E metabolite (PGE‐M) and 11‐dehydro (d)‐thromboxane (TX) B2 are biomarkers of cyclooxygenase‐dependent prostanoid synthesis. We investigated (1) the effect of aspirin 300 ...mg daily and eicosapentaenoic acid (EPA) 2000 mg daily, alone and in combination, on urinary biomarker levels and, (2) whether urinary biomarker levels predicted colorectal polyp risk, during participation in the seAFOod polyp prevention trial. Urinary PGE‐M and 11‐d‐TXB2 were measured by liquid chromatography‐tandem mass spectrometry. The relationship between urinary biomarker levels and colorectal polyp outcomes was investigated using negative binomial (polyp number) and logistic (% with one or more polyps) regression models. Despite wide temporal variability in PGE‐M and 11‐d‐TXB2 levels within individuals, both aspirin and, to a lesser extent, EPA decreased levels of both biomarkers (74% P ≤ .001 and 8% P ≤ .05 reduction in median 11‐d‐TXB2 values, respectively). In the placebo group, a high (quartile Q 2‐4) baseline 11‐d‐TXB2 level predicted increased polyp number (incidence rate ratio IRR 95% CI 2.26 1.11,4.58) and risk (odds ratio 95% CI 3.56 1.09,11.63). A low (Q1) on‐treatment 11‐d‐TXB2 level predicted reduced colorectal polyp number compared to placebo (IRR 0.34 0.12,0.93 for combination aspirin and EPA treatment) compared to high on‐treatment 11‐d‐TXB2 values (0.61 0.34,1.11). Aspirin and EPA both inhibit PGE‐M and 11‐d‐TXB2 synthesis in keeping with shared in vivo cyclooxygenase inhibition. Colorectal polyp risk and treatment response prediction by 11‐d‐TXB2 is consistent with a role for platelet activation during early colorectal carcinogenesis. The use of urinary 11‐d‐TXB2 measurement for a precision approach to colorectal cancer risk prediction and chemoprevention requires prospective evaluation.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
Uptake of colorectal cancer screening programmes needs to be improved or at least maintained in order to achieve projected reductions in mortality and morbidity. Understanding the origins ...of non‐participation in screening is therefore important.
Objective
To explore the beliefs and experiences of individuals who had not responded either to their screening invitation or reminder.
Design
A qualitative study using in‐depth interviews with non‐participants from England's population‐based colorectal cancer screening programme. Data collection and analysis were carried out using a grounded theory approach, with an emphasis on the constant comparison method, and continued until saturation (27 interviews).
Findings
The interviews provided an in‐depth understanding of a range of reasons and circumstances surrounding non‐participation in screening, including contextual and environmental influences as well as factors specific to the screening test. Non‐participation in screening was not necessarily associated with negative attitudes towards screening or a decision to not return a kit. Reasons for non‐participation in screening included not feeling that participation is personally necessary, avoiding or delaying decision making, and having some degree of intention to take part but failing to do so because of practicalities, conflicting priorities or external circumstances. Beliefs, awareness and intention change over time.
Discussion and conclusions
A range of approaches may be required to improve screening uptake. Some non‐participants may already have a degree of intention to take part in screening in the future, and this group may be more responsive to interventions based on professional endorsement, repeat invitations, reminders and aids to making the test more practical.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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