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Abu Baker F, Samhat A, Taher Natour R, Zeina AR, Kopelman Y. Colonoscopy in the young: An indication-based analysis of outcome. J Investig Med 2023; 71:797-803. [PMID: 37530168 DOI: 10.1177/10815589231193953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND Data on colonoscopy's diagnostic yield in young adults with lower gastrointestinal symptoms are scarce. We evaluated this yield in young patients by performing an indication-based analysis of outcomes. METHODS We reviewed diagnostic colonoscopies performed in young adults (age <50 years) over 10 years. We created two groups of young adults (18-39 years, n = 4941) and quadragenarians (40-49 years; n = 6605), included a control group of average-risk patients referred for screening colonoscopies during the same period (50-60 years, n = 1453). We evaluated clinical indications for colonoscopies among the young and performed an indication-based analysis of patients' outcomes. RESULTS Chronic diarrhea and abdominal pain (42.4 and 36.2%), rectal bleeding (19.8 and 18.4%), and constipation were major indications for colonoscopy performance in quadragenarian and younger patients, respectively. Overall, diverticulosis (8.7 vs 1.3 and 3.9%; p1,2 < 0.000) and polyp detection rates (PDR) (19.6 vs 6.1 and 12.1; p1,2 < 0.000) were significantly higher in the control group, while inflammatory bowel disease (10.9 and 3.6% vs 0.1%; p1,2 < 0.000) was more prevalent in both young patients' groups. Indication-based analysis revealed that rectal bleeding was linked with increased PDR and significantly and independently associated with colorectal cancer (CRC) development (odds ratio = 10.160. p < 0.001 and 95% confidence interval = 6.201-16.647), even in the younger patients. In contrast, performing a colonoscopy for the evaluation of constipation was associated with the lowest yield. CONCLUSION We outlined the expected diagnostic yields of colonoscopy performed in young patients for multiple indications, showing that rectal bleeding was consistently associated with CRC and polyp detection.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe medical center, Hadera, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Ahmad Samhat
- Technion Faculty of Medicine, Haifa, Israel
- Department of internal medicine, Hillel Yaffe medical center, Hadera, Israel
| | - Randa Taher Natour
- Technion Faculty of Medicine, Haifa, Israel
- Department of internal medicine, Hillel Yaffe medical center, Hadera, Israel
| | - Abdel-Rauf Zeina
- Technion Faculty of Medicine, Haifa, Israel
- Department of Radiology, Hillel Yaffe medical center, Hadera, Israel
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe medical center, Hadera, Israel
- Technion Faculty of Medicine, Haifa, Israel
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Yaccob A, Mari A. Colonoscopy in the young: Rethinking the yield. J Investig Med 2023; 71:795-796. [PMID: 37776212 DOI: 10.1177/10815589231201521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Afif Yaccob
- Center for Liver Diseases, Rambam Healthcare Campus, Rappaport Faculty of Medicine, Haifa, Israel
| | - Amir Mari
- Gastroenterology Unit, Nazareth Hospital EMMS, Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
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Colles T, Ziegelmann PK, Damin DC. The role of colonoscopy in young patients with rectal bleeding: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:230. [PMID: 37712988 DOI: 10.1007/s00384-023-04524-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Anal bleeding is a frequent complaint in the coloproctological practice. Although usually associated with common anorectal disorders, it may represent a sign of an occult colorectal carcinoma. Our purpose was to evaluate the accuracy of the colonoscopy for detection of neoplastic lesions in patients under 50 years of age with rectal bleeding. METHODS This systematic review and meta-analysis searched publications in PubMed, Web of Science, and Cochrane Library databases up to August, 2023. Cross-sectional and case-control studies including patients under 50 years with rectal bleeding evaluated by colonoscopy were included. Primary outcome was prevalence of neoplastic lesions (adenomas and adenocarcinomas). Secondary outcomes were prevalence of those lesions according to age and anatomic location. The study was registered on PROSPERO (CRD42021257859) on July 5, 2021. RESULTS Nine studies comprising 4162 patients were analyzed. A total of 398 patients with adenomas and 40 patients with adenocarcinoma were identified. Prevalence of neoplastic lesions (adenomas and carcinomas) was 10%. In patients under 40 years, the prevalence of neoplastic lesions was 7% (6% of adenomas, 1% of carcinomas). Among patients aged 40-50 years the prevalence was 15%, 14%, and 1%, respectively. Most lesions (71%) were located distally to splenic flexure. CONCLUSION About 10% of patients under 50 years with anal bleeding will have a neoplastic lesion detected through colonoscopy. The greatest benefit of the procedure is observed between 40 and 50 years. Almost 30% of the neoplastic lesions were found in the proximal colon and could not be detected without the performance of a complete colonoscopy.
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Affiliation(s)
- Tuane Colles
- Postgraduate Program in Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Patrícia K Ziegelmann
- Postgraduate Program in Epidemiology, Department of Statistics, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniel C Damin
- Postgraduate Program in Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
- Division of Coloproctology, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos 2350, sala (room) 600, Porto Alegre, RS, Brazil.
- Department of Surgery, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Singh A, Mishra R, Ranjan R. Gastrointestinal Lesions and Its Associated Factors in Adult Males With Iron Deficiency Anaemia: A Cross-Sectional Study From Tertiary Care Centre of North India. Cureus 2022; 14:e26905. [PMID: 35983390 PMCID: PMC9376560 DOI: 10.7759/cureus.26905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/14/2022] Open
Abstract
Background Around 30% of the world's population suffers from iron deficiency anaemia (IDA). The standard evaluation for IDA involves upper and lower endoscopy, which allows for the confirmation of pathology of the gastrointestinal tract (GIT) induced due to IDA through iron malabsorption mechanism or loss of blood. Assessing the prevalence of lesions of GIT of significant nature among males having IDA, was the goal of our study. Methods Our cross-sectional study was conducted for two years and involved 152 males (adults) with confirmed cases of IDA from the Outpatient (OPD) and In-patient (IPD) in the present hospital. Following collecting consent (both informed and written in nature), patient-specific data was collected in a standardized form, and a blood sample was taken for laboratory testing. The analyses were done at a 5% level of significance; an association was considered significant if the p-value < 0.05. Results The average age of the study participants was 59.6 years. The commonest lesions reported were antral gastritis (9.9%) and H. pylori gastritis (7.2%) in upper GI; and haemorrhoid (9.2%) and anal fissure (3.9%) in lower GI. The overall prevalence of any GI lesions was 65.1%. The GI lesions were significantly associated higher among men with age > 50 years (73.7%). The presence of occult blood in stools (p < 0.0001) and parasites in stools (p=0.0001) were significantly related to the presence of GI lesions. Conclusion GI lesions are frequently detected in males with IDA. Whether it is symptomatic male or asymptomatic male with anaemia refractory to iron treatment, GIT should be evaluated in them.
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Enwerem N, Cho MY, Demb J, Earles A, Heskett KM, Liu L, Singh S, Gupta S. Systematic Review of Prevalence, Risk Factors, and Risk for Metachronous Advanced Neoplasia in Patients With Young-Onset Colorectal Adenoma. Clin Gastroenterol Hepatol 2021; 19:680-689.e12. [PMID: 32428708 PMCID: PMC7702214 DOI: 10.1016/j.cgh.2020.04.092] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The incidence and mortality of early-onset colorectal cancer (CRC) are increasing. Adenoma detection, removal, and subsequent endoscopic surveillance might modify risk of CRC diagnosed before age 50 years (early-onset CRC). We conducted a systematic review of young-onset adenoma (YOA) prevalence, associated risk factors, and rate of metachronous advanced neoplasia after YOA diagnosis. METHODS We performed a systematic search of multiple electronic databases through February 12, 2019 and identified studies of individuals 18 to 49 years old that reported prevalence of adenoma, risk factors for adenoma, and/or risk for metachronous advanced neoplasia. Summary estimates were derived using random effects meta-analysis, when feasible. RESULTS The pooled overall prevalence of YOA was 9.0% (95% CI, 7.1%-11.4%), based on 24 studies comprising 23,142 individuals. On subgroup analysis, the pooled prevalence of YOA from autopsy studies was 3.9% (95% CI, 1.9%-7.6%), whereas the prevalence from colonoscopy studies was 10.7% (95% CI, 8.5%-13.5). Only advancing age was identified as a consistent risk factor for YOA, based on 4 studies comprising 78,880 individuals. Pooled rate of metachronous advanced neoplasia after baseline YOA diagnosis was 6.0% (95% CI, 4.1%-8.6%), based on 3 studies comprising 1493 individuals undergoing follow-up colonoscopy, with only 1 CRC case reported. Overall, few studies reported metachronous advanced neoplasia and no studies evaluated whether routine surveillance colonoscopy decreases risk of CRC. CONCLUSIONS In a systematic review, we estimated the prevalence of YOA to be 9% and to increase with age. Risk for metachronous advanced neoplasia after YOA diagnosis is estimated to be 6%. More research is needed to understand the prevalence, risk factors, and risk of CRC associated with YOA.
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Affiliation(s)
- Ngozi Enwerem
- VA San Diego Healthcare System, San Diego; Division of Gastroenterology, University of California San Diego, La Jolla
| | - Moo Y Cho
- Division of Gastroenterology, University of California San Diego, La Jolla; Rady Children's Hospital, San Diego
| | - Joshua Demb
- VA San Diego Healthcare System, San Diego; Division of Gastroenterology, University of California San Diego, La Jolla
| | | | - Karen M Heskett
- Biomedical Library, University of California San Diego, La Jolla, California
| | - Lin Liu
- Veterans Medical Research Foundation, San Diego
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla
| | - Samir Gupta
- VA San Diego Healthcare System, San Diego; Division of Gastroenterology, University of California San Diego, La Jolla; Moores Cancer Center, La Jolla.
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Granular Data: A Rare Submucosal Tumor of the Colon-Case Report and Review of the Literature. Dig Dis Sci 2021; 66:714-722. [PMID: 33433808 DOI: 10.1007/s10620-020-06753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Granular cellular tumors are unusual lesions that can occur in the gastrointestinal tract, where they localize most commonly to the esophagus followed by the colon. AREAS COVERED We report a case of a young man with a sub-epithelial lesion of the ascending colon, removed by endoscopic submucosal dissection. Histological examination revealed a granular cellular tumor without features of malignancy. We present a systematic review of the English literature evaluating granular cellular tumors of lower gastrointestinal tract. EXPERT COMMENTARY These tumors are usually asymptomatic and discovered incidentally during endoscopy performed for other reasons. Though their histological behavior is usually benign, 1-2% are malignant. Therefore, it is important that these lesions are excised and adequately pathologically characterized.
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Yang HC, Kim SW. Usefulness of Colonoscopy in Patients with Hematochezia Aged under 40 Years. Clin Endosc 2020; 53:385-386. [PMID: 32746535 PMCID: PMC7403012 DOI: 10.5946/ce.2020.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/09/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hee Chan Yang
- Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Sang Wook Kim
- Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
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Tang MH, Foo FJ, Ng CY. Endoscopic Findings in Patients Under the Age of 40 Years with Hematochezia in Singapore. Clin Endosc 2020; 53:466-470. [PMID: 32549525 PMCID: PMC7403014 DOI: 10.5946/ce.2019.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/11/2020] [Indexed: 01/27/2023] Open
Abstract
Background/Aims Sigmoidoscopy is performed in most medical centers to evaluate the distal colons of young adults presenting with hematochezia who are at risk of developing proximal lesions. Colonoscopies offer more complete evaluations but are associated with a higher incidence of complications and possible low yield.
Methods An analysis was conducted on colonoscopies performed in our center on patients 40 years of age or younger. The study population was sub-divided into 2 age groups for analysis: <30 years of age and 30–39 years of age.
Results We recruited 453 patients for the study. Patients were 115 and 338 individuals that were <30 and 30–39 years of age, respectively. Hemorrhoids was identified as the cause of bleeding in the majority of cases. The overall incidence of polyps was 6.5%; this was significantly higher in the 30–39 age group (7.4% vs. 1.7%, p=0.026). There were two cases of advanced/malignant polyps. While the majority of the polyps were in the distal colon, 28% of the polyps in the older age group were found in the proximal colon. There was one case of colonic perforation.
Conclusions Colonic polyps are more prevalent in patients aged 30–39. Colonoscopies should be considered for patients over the age of 30 with rectal bleeding.
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Affiliation(s)
- Man Hon Tang
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Fung Joon Foo
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Chee Yung Ng
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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Kim J, Dobson B, Ng Liet Hing C, Cooper M, Lu CT, Nolan G, Von Papen M. Increasing rate of colorectal cancer in younger patients: a review of colonoscopy findings in patients under 50 at a tertiary institution. ANZ J Surg 2020; 90:2484-2489. [DOI: 10.1111/ans.16060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Jason Kim
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Benjamin Dobson
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Cedric Ng Liet Hing
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Michelle Cooper
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
- Griffith University Brisbane Queensland Australia
| | - Cu Tai Lu
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Gregory Nolan
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Michael Von Papen
- General Surgery Department Gold Coast University Hospital Gold Coast Queensland Australia
- Griffith University Brisbane Queensland Australia
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Shabbir A, Qureshi MA, Akram S, Mirza T. Spectrum of Preneoplastic and Neoplastic lesions of intestine in a Tertiary Care Hospital of Karachi, Pakistan. Pak J Med Sci 2019; 36:75-79. [PMID: 32063935 PMCID: PMC6994908 DOI: 10.12669/pjms.36.2.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives To present 7 years data mentioning the spectrum of preneoplastic & neoplastic cases of intestine received at Dow Diagnostic Research and Reference Laboratory. Methods All the cases of preneoplastic & neoplastic lesions of intestine received during 2009 - 2015 were reviewed. The data obtained were subjected to descriptive statistical analysis using SPSS version 22. Furthermore, the association of diagnosis was seen with various other variables including age, gender & site of the lesion. A p-value of < 0.05 was considered as significant. Results The total samples were 486, out of which 33 cases were of premalignant and 453 were of malignant lesions. Out of total 33 cases of premalignant lesions of intestine, it consisted adenomatous polyp = 39.4% (n=13), dysplasia = 36.4% (n=12) and adenoma = 24.2% (n=8). From the total of 453 cases diagnosed as malignant lesions; adenocarcinoma as Grade-I were 14.2% (n=64), Grade-II were 7.6% (n=260) and Grade-III were 22% (n=99). Squamous cell carcinoma Grade-I were 0.4% (n=2), Grade-II 1.6% (n=7) and Grade-III 0.9% (n=4). 2.4% (n=11) cases were of metastatic adoncarcinoma, 0.9% (n=4) were diagnosed as neuroendocrine tumors and 0.4% (n=2) as lymphoma. A significant association was seen between site of the tumor and diagnosis, rectum was the commonest site for adenocarcinomas (p=0.001). Moderately differentiated adenocarcinoma was predominantly present in young age (p=0.001). Conclusion Colorectal carcinoma is on rise in Pakistan, predominantly in young males, and rectum being the commonest site. In our study, all the lesions showed male predominance with adenomatous polyp as the commonest premalignant lesion & Grade-II adenocarcinoma the most common malignancy of intestine.
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Affiliation(s)
- Asma Shabbir
- Asma Shabbir, Assistant Professor, Department of Pathology, Sindh Medical College, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Muhammad Asif Qureshi
- Muhammad Asif Qureshi, Associate Professor, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan. Sindh Medical College, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Saadia Akram
- Prof. Saadia Akram, Sindh Medical College, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Talat Mirza
- Prof. Talat Mirza, Department of Pathology & Head of Histopathology, Dean of Researc Department, Dr. Ziauddin Hospital & University, Karachi, Pakistan
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Bashir Y, McGovern B, Tahtouh M, Abbasi T, Murphy M, Neary P. Coloproctology procedure clinic: a novel service developed to reduce suffering of patients with bleeding per rectum. Ir J Med Sci 2018; 188:119-124. [PMID: 29569071 DOI: 10.1007/s11845-018-1796-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/14/2018] [Indexed: 01/14/2023]
Abstract
AIMS Evaluation of the role and impact of introducing a dedicated coloproctology procedure clinic in tertiary referral colorectal unit. METHODS A retrospective analysis of 126 consecutive patients managed in the coloproctology clinic between March2015 and September 2016 was carried out. All patients were preselected for attendance based on symptom-based protocol. RESULTS Based on the information available in GP referrals, 126 patients with bleeding per rectum with low risk of cancer were re-triaged from the general outpatient to dedicated coloproctology procedure clinic. Those patients accounted for 14% of waiting list. The average waiting time to attend clinic was 27 months from referral to undergoing definitive procedure. A proctoscopy or/and rigid sigmoidoscopy was performed in patients. Seventy-nine (89.7%) patients were completely managed and discharged after attending their first visit. Sixty-seven (76%) patients had 2nd- or 3rd-degree haemorrhoids and were treated with rubber band ligation (RBL) or phenol injection in outpatient setting. Two patients had an anal fissure and were managed conservatively with medication. After clinic, follow-up was through telephone clinic. This avoids attendance physically in the hospital. Symptoms persisted in nine patients and were subsequently scheduled for colonoscopy, three had benign polyps. With the introduction of the procedure clinic, the waiting time from referral to treatment was reduced from 27 to 6 months (p < 0.05). CONCLUSIONS Establishing a dedicated "Coloproctology procedure clinic" is an effective strategy in reducing number of hospital visits per patient and hospital waiting list. This innovative clinic reduces utilisation of precious endoscopy unit resources. This ultimately will improve endoscopy efficiency.
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Affiliation(s)
- Yasir Bashir
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland. .,Professorial Surgical Unit, Department of Surgery, The University of Dublin Trinity College, Tallaght Hospital, Dublin, Ireland.
| | - Bernadette McGovern
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland
| | - Mohammed Tahtouh
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland
| | - Tahir Abbasi
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland
| | - Maria Murphy
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland
| | - Paul Neary
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland
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Kim KO, Yang HJ, Cha JM, Shin JE, Kim HG, Cho YS, Boo SJ, Lee J, Jung Y, Lee HJ, Huh KC, Joo YE, Park J, Moon CM. Risks of colorectal advanced neoplasia in young adults versus those of screening colonoscopy in patients aged 50 to 54 years. J Gastroenterol Hepatol 2017; 32:1825-1831. [PMID: 28370235 DOI: 10.1111/jgh.13798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/10/2017] [Accepted: 03/28/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM The role of screening or diagnostic colonoscopy to detect advanced neoplasia in young cohorts of age < 50 is unclear. This study compared the risk of colorectal neoplasia in a young age cohort against that in 50-54s screening cohort. METHODS A multi-center retrospective study was conducted at 14 university hospitals to compare the detection rates of neoplasia and advanced neoplasia in screening or diagnostic colonoscopy in the young cohort of < 50s against those in screening colonoscopy in the 50-54s cohort. RESULTS Among 10 477 eligible subjects, 9765 subjects were enrolled after excluding 712 subjects. Advanced neoplasia detection rates in the young screening cohort was significantly lower than that in the 50-54s screening cohort (5.9% vs 9.3%, P < 0.001). Compared with 50-54s screening cohort, the risk of advanced neoplasia was significantly reduced by 23%, 53%, and 54% in the 45-49s, 40-44s, and 20-39s screening cohorts, respectively. The detection rates of advanced neoplasia in the young diagnostic cohort was 5.0%, which was much lower than 11.8% in 50-54s screening cohort (P < 0.001). Compared with the 50-54s screening cohort, the risk of advanced neoplasia was significantly reduced by 50%, 66%, and 71% in the 45-49s, 40-44s, and 20-39s diagnostic cohorts, respectively. CONCLUSIONS Colonoscopy to detect advanced neoplasia in young adults aged < 50 years should be reconsidered as their risk of advanced neoplasia on screening or diagnostic colonoscopy was much lower than those of 50-54s screening cohort; however, colonoscopy screening may be justified for high-risk 45-49s cohorts.
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Affiliation(s)
- Kyeong Ok Kim
- Department of Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyo-Joon Yang
- Department of Medicine, Sungkyunkwan University College of Medicine, Suwon, Korea
| | - Jae Myung Cha
- Department of Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Department of Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hyun Gun Kim
- Department of Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Young-Seok Cho
- Department of Medicine, Catholic University College of Medicine, Seoul, Korea
| | - Sun-Jin Boo
- Department of Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jun Lee
- Department of Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Yunho Jung
- Department of Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Jung Lee
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Chan Huh
- Department of Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Young-Eun Joo
- Department of Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jongha Park
- Department of Medicine, Inje University College of Medicine, Seoul, Korea
| | - Chang Mo Moon
- Department of Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Kim YW, Choi H, Kim GJ, Ryu SJ, Park SM, Kim JS, Ji JS, Kim BW, Lee BI, Choi MG. [Role of Colonoscopy in Patients with Hematochezia]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 67:87-91. [PMID: 26907484 DOI: 10.4166/kjg.2016.67.2.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND/AIMS Although colonoscopy is not indicated in patients with hematochezia, many surgeons, internists, and physicians are recommending colonoscopy for these patients in Korea. The aim of this study is to evaluate the diagnostic value of colonoscopy for patients with hematochezia. METHODS We retrospectively reviewed the data of colonoscopy between January 2010 and December 2010. A total of 321 patients among 3,038 colonoscopies (10.6%) underwent colonoscopy to evaluate the cause of hematochezia. The patients with previous colorectal surgery (2) or polypectomy (5) were excluded. We analyzed endoscopic diagnoses. Advanced neoplastic polyps were defined as adenomas with villous histology or high grade dysplasia, or adenomas more than 10 mm in diameter. RESULTS Hemorrhoid was the most common diagnosis (217 cases, 67.6%). Polyps were detected in 93 patients (29.0%), but advanced neoplastic polyps were found in only 14 cases (4.4%). Colorectal cancers were diagnosed in 18 patients (5.6%) including 14 rectal cancers. There was no cancer located above sigmoid-descending junction. Diverticuli were detected in 41 patients (12.8%) but there was only one case of suspected diverticular bleeding. Colitis was diagnosed in 24 patients (7.5%). Other lesions included acute anal fissure, rectal tumor, stercoral ulcer, and radiation proctitis. CONCLUSIONS The colonoscopy had little value in patients with hematochezia because the most pathologic lesions were located below sigmoid colon. The first choice of diagnosis in patients with hematochezia is sigmoidoscopy.
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Affiliation(s)
- Young Wook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hwang Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gi Jun Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Jee Ryu
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Min Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Sung Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Seon Ji
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Wook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo-in Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Xu BB, Zhao XL, Xu GP. Clinical study of anesthetization by dezocine combined with propofol for indolent colonoscopy. World J Gastroenterol 2016; 22:5609-5615. [PMID: 27350739 PMCID: PMC4917621 DOI: 10.3748/wjg.v22.i24.5609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/12/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the use of dezocine combined with propofol for the anesthetization of patients undergoing indolent colonoscopy.
METHODS: A cross-sectional survey of patients undergoing indolent colonoscopy in the Xinjiang People’s Hospital was conducted from April 1 to April 30, 2015. The survey collected patient general information and anesthesia data, including overall medical experience and pain management. Thirty minutes after colonoscopy surgery, samples of venous blood were collected and the biochemical indicators of gastrointestinal function were analyzed.
RESULTS: There were 98 female and 62 male respondents. Indolent colonoscopy was found to be more suitable for mid to older-aged patients. The necessary conditions for the diagnosis of digestive diseases were required in 65 of the 73 inpatients. Adverse reactions to the intraoperative process included two cases of body movement and two cases of respiratory depression. Gastrin and vasoactive intestinal peptide levels were slightly increased. However, somatostatin and endothelin levels were slightly decreased.
CONCLUSION: This study revealed that dezocine combined with propofol can be successfully used for the anesthetization of indolent colonoscopy patients without pain and should be widely used.
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Saks K, Enestvedt BK, Holub JL, Lieberman D. Colonoscopy Identifies Increased Prevalence of Large Polyps or Tumors in Patients 40-49 Years Old With Hematochezia vs Other Gastrointestinal Indications. Clin Gastroenterol Hepatol 2016; 14:843-849. [PMID: 26804386 PMCID: PMC4875818 DOI: 10.1016/j.cgh.2015.12.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is an unclear role for colonoscopy in the evaluation of symptomatic individuals younger than 50 years old. We aimed to determine the prevalence of large polyps (>9 mm) or tumors in individuals 40 to 49 years old who underwent colonoscopy for various signs and symptoms, and compare the results with those from average-risk individuals ages 50 to 54 years who underwent screening colonoscopy. METHODS We collected data from a national endoscopy database, from 2000 through 2012, and identified patients 40 to 49 years old who underwent colonoscopy for bleeding and nonbleeding indications. The prevalence of large polyps (>9 mm) or tumors was compared with the prevalence in a reference group (n = 99,713 average-risk individuals ages 50-54 undergoing screening colonoscopy). RESULTS A total of 65,892 patients ages 40 to 49 years underwent colonoscopy for a variety of indications. Significantly larger proportions of male and female patients with hematochezia without anemia or iron-deficiency anemia (IDA) had large polyps or tumors (7.2%) compared with the reference group (men, 7.2% vs 6.2%; P = .0001; and women, 5.5% vs 4.1%; P < .0001). Patients with weight loss, anemia or IDA, or hematochezia with anemia or IDA did not have a significantly higher prevalence of large polyps or tumors than the reference group. Significantly lower proportions of patients with general gastrointestinal symptoms (pain, bloating, or change in bowel habits) had advanced neoplasia compared with the reference group (men, 3.9% vs 6.2%; P < .0001; and women, 2.7% vs 4.1%; P < .0001). CONCLUSIONS An analysis of a national endoscopy database supports the role of colonoscopy to evaluate hematochezia in patients 40 to 49 years old. A lower proportion of patients with anemia, weight loss, and general abdominal symptoms had large polyps or tumors compared with average-risk patients 50 to 54 years old. A significantly lower proportion of patients younger than 50 years with general gastrointestinal symptoms had large polyps-these patients are therefore less likely to benefit from colonoscopy.
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Affiliation(s)
- Karen Saks
- Division of Gastroenterology, Oregon Health and Science University, Portland, Oregon.
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Cha JM, Kozarek RA, La Selva D, Gluck M, Ross A, Chiorean M, Koch J, Lin OS. Findings of diagnostic colonoscopy in young adults versus findings of screening colonoscopy in patients aged 50 to 54 years: a comparative study stratified by symptom category. Gastrointest Endosc 2015; 82:138-45. [PMID: 25843617 DOI: 10.1016/j.gie.2014.12.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/21/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The threshold for diagnostic colonoscopy in symptomatic patients aged <50 years remains controversial. Previous studies on the prevalence of neoplasia or other serious pathology in young patients mostly have been uncontrolled, providing only limited data on the risk associated with specific symptoms. OBJECTIVE To compare colonoscopy findings in patients aged <50 years who have various symptoms (diagnostic cohort) against those of concurrent patients aged 50 to 54 years who are asymptomatic (screening cohort). DESIGN Retrospective controlled cohort study. SETTING Teaching hospital. PATIENTS Symptomatic patients aged between 18 and 49 years and asymptomatic patients aged between 50 and 54 years. INTERVENTIONS Colonoscopy. MAIN OUTCOME MEASUREMENTS Prevalence of advanced neoplasia. RESULTS During the study period, 1638 patients underwent colonoscopy in the screening cohort (mean [± standard deviation{SD}] age 51.7 ± 1.4 years) and 1266 underwent colonoscopy in the diagnostic cohort (40.4 ± 8.0 years). Despite the age difference, the prevalence of advanced neoplasia in patients with rectal bleeding was comparable with that in the screening controls: 28 of 472 (5.9%) versus 113 of 1638 patients (6.9%) (P = .459). Furthermore, 10 patients (2.1%) with rectal bleeding were newly diagnosed with inflammatory bowel disease. In contrast, other symptoms that commonly lead to colonoscopy, such as abdominal pain, changes in bowel habits, and weight loss, were associated with much lower risks for neoplasia. As a result, the overall prevalences of neoplasia and advanced neoplasia were significantly higher in the screening cohort than in the diagnostic cohort: 467 of 1638 patients (28.5%) versus 179 of 1266 patients (14.1%), and 113 patients (6.9%) versus 48 patients (3.8%), respectively (both P < .001). LIMITATIONS No data on duration of symptoms; discrepant sex ratios between cohorts. CONCLUSION The threshold for diagnostic colonoscopy in symptomatic young adults should be individualized for each symptom category. Rectal bleeding warrants colonoscopy to detect advanced neoplasia or inflammatory bowel disease in most young patients, especially those aged 40 to 49 years, whereas non-bleeding symptoms, including some traditionally regarded as "alarm" symptoms, were associated with a much lower risk for neoplasia compared with the risk in screening patients aged 50 to 54 years.
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Affiliation(s)
- Jae-Myung Cha
- Gastroenterology Division, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, South Korea; Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Richard A Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Danielle La Selva
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael Gluck
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Andrew Ross
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael Chiorean
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Johannes Koch
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Otto S Lin
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
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Hussain M, Khalid AB, Ahsan S, Jafri W, Hamid S, Javed A, Wahab S. Age and site of Colonic Neoplastic Lesions: Implications of screening in South Asia. Pak J Med Sci 2015; 30:1277-80. [PMID: 25674123 PMCID: PMC4320715 DOI: 10.12669/pjms.306.5701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 05/27/2014] [Accepted: 07/28/2014] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED Objective : To evaluate the Age of patients and the site of Colonic Neoplastic Lesions (CNL) and to determine the appropriate screening strategy for Colorectal Carcinoma (CRC) (sigmoidoscopy versus colonoscopy) in our population. Methods : This is a cross sectional study. Data of all patients more than 16 years of age who underwent full colonoscopic examination at the Aga Khan University hospital between January 2011 till December 2013 and were diagnosed to have CRC or advanced adenomas (defined as polyp more than 1 cm and/or having villous morphology on histology) was recorded. Lesions found distal to the splenic flexure were characterized as distal lesions and while lesions found between the splenic flexure and the cecum were characterized as proximal lesions. RESULTS During the study period colonic neoplastic lesions were found in 217 patients; 186 (85.7%) patients had CRC and 31(14.3%) patients had advanced adenomatous polyps. Mean age was 55.8±14 years and amongst them 72 (33.2%) patients were less than 50 years of age while 145 (66.8%) were more than 50 years. In 144 (66.4%) patients lesions were located in the distal colon, 65 (30%) had lesions in the proximal colon while in 8 (3.7%) patients the neoplastic lesions were found both in the proximal and distal colon. The predominant symptoms were bleeding per rectum in 39.6% of patients followed by weight loss in 31.8% of patients. Only 3 patients had familial syndromes with multiple polyps. When patients younger than 50 years of age were compared with patients more than 50 years there was no statistically significant difference between the site of neoplastic lesion as well as the presenting symptoms. (p value 0.85). CONCLUSION Colonic Neoplastic Lesions presented at younger age in our study population and one third of the lesions were found in the right sided colon. Hence screening for CNLs should be implied at an earlier age preferably with colonoscopy. More population based data is required to further validate our results.
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Affiliation(s)
- Manzoor Hussain
- Manzoor Hussain, FCPS Medicine, Fellow Gastroenterology, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi
| | - Abdullah Bin Khalid
- Abdullah bin Khalid, FCPS Medicine, FCPS Gastro, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Ahsan
- Syed Ahsan Ali, FCPS Medicine, Instructor in Dept. of Medicine, Pakistan. National Institute of Liver and Gastrointestinal Diseases, Dow University of Health Sciences, Karachi, Pakistan
| | - Wasim Jafri
- SM Wasim Jafri, FRCP, FACG, Professor of Medicine, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Saeed Hamid
- Saeed S Hamid. FRCP, FACG, Professor and Chair of Medicine, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Anam Javed
- Anam Javed, Medical Student, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Sana Wahab
- Sana Wahab, Medical Student, National Institute of Liver and Gastrointestinal Diseases, Dow University of Health Sciences, Karachi, Pakistan. National Institute of Liver and Gastrointestinal Diseases, Dow University of Health Sciences, Karachi, Pakistan
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Shields HM, Stoffel EM, Chung DC, Sequist TD, Li JW, Pelletier SR, Spencer J, Silk JM, Austin BL, Diguette S, Furbish JE, Lederman R, Weingart SN. Disparities in evaluation of patients with rectal bleeding 40 years and older. Clin Gastroenterol Hepatol 2014; 12:669-75; quiz e33. [PMID: 23891918 PMCID: PMC4378237 DOI: 10.1016/j.cgh.2013.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 06/14/2013] [Accepted: 07/08/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Rectal bleeding is associated with colorectal cancer. We characterized the evaluation of patients aged 40 years and older with rectal bleeding and identified characteristics associated with inadequate evaluation. METHODS We conducted a retrospective review of records of outpatient visits that contained reports of rectal bleeding for patients aged 40 years and older (N = 480). We studied whether patient characteristics affected whether or not they received a colonoscopy examination within 90 days of presentation with rectal bleeding. Patient characteristics included demographics; family history of colon cancer and polyps; and histories of screening colonoscopies, physical examinations, referrals to specialists at the index visit, and communication of laboratory results. Data were collected from medical records, and patient income levels were estimated based on Zip codes. RESULTS Nearly half of the patients presenting with rectal bleeding received colonoscopies (48.1%); 81.7% received the procedure within 90 days. A history of a colonoscopy examination was more likely to be reported in white patients compared with Hispanic or Asian patients (P = .012 and P = .006, respectively), and in high-income compared with low-income patients (P = .022). A family history was more likely to be documented among patients with private insurance than those with Medicaid or Medicare (P = .004). A rectal examination was performed more often for patients who were white or Asian, male, and with high or middle incomes, compared with those who were black, Hispanic, female, or with low incomes (P = .027). White patients were more likely to have their laboratory results communicated to them than black patients (P = .001). CONCLUSIONS Sex, race, ethnicity, patient income, and insurance status were associated with disparities in evaluation of rectal bleeding. There is a need to standardize the evaluation of patients with rectal bleeding.
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Affiliation(s)
- Helen M Shields
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
| | - Elena M Stoffel
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel C Chung
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Thomas D Sequist
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Health Care Policy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Harvard Vanguard Medical Associates, Harvard Medical School, Boston, Massachusetts
| | - Justin W Li
- Center for Patient Safety, Harvard Medical School, Boston, Massachusetts
| | | | - Justin Spencer
- Center for Patient Safety, Harvard Medical School, Boston, Massachusetts
| | - Jean M Silk
- Division of Gastroenterology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bonita L Austin
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Susan Diguette
- Harvard Vanguard Medical Associates, Harvard Medical School, Boston, Massachusetts
| | - Jean E Furbish
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Ruth Lederman
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Saul N Weingart
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Center for Patient Safety, Harvard Medical School, Boston, Massachusetts
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Carter D, Levi G, Tzur D, Novis B, Avidan B. Prevalence and predictive factors for gastrointestinal pathology in young men evaluated for iron deficiency anemia. Dig Dis Sci 2013. [PMID: 23192647 DOI: 10.1007/s10620-012-2496-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence of gastrointestinal lesions in young men with iron deficiency anemia (IDA) is unknown, and there are no evidence-based recommendations for the evaluation of the gastrointestinal tract in this population. AIMS The purpose of this study was to assess the prevalence of significant GI lesions among young males with IDA, and to shed light on potential predictors of their presence. METHODS Clinical, endoscopic, and histological data was retrospectively collected from medical records of 347 young males with IDA. RESULTS Clinically significant GI lesions were diagnosed in 62 %. Upper GI lesions were found in 35 %. Peptic disease was the most common finding, diagnosed in 30 %. Celiac disease was diagnosed in 4 %. Lower GI tract lesions were diagnosed in 34 %. The most common findings were hemorrhoids (17 %) and inflammatory bowel disease (16 %). Malignant lesions were not detected. GI lesions were encountered more frequently when respective symptoms were obtained. Multivariate analysis showed that the presence of GI symptoms and the use of proton pump inhibitors were associated with an increased likelihood of significant GI lesions. CONCLUSIONS GI lesions are common among young men with IDA. GI evaluation is mandatory in symptomatic men and in asymptomatic men when the anemia is resistant to iron therapy. Symptoms may dictate the order of evaluation.
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Affiliation(s)
- Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel.
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20
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Hata K, Shinozaki M, Toyoshima O, Toyoshima A, Matsumoto S, Saisho T, Tsurita G. Impact of family history of gastric cancer on colorectal neoplasias in young Japanese. Colorectal Dis 2013; 15:42-6. [PMID: 22642814 DOI: 10.1111/j.1463-1318.2012.03108.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM The aim of this study was to elucidate risk factors for the development of colorectal neoplasia in the young population. In particular, we focused on the family history of gastric cancer. METHOD Young Japanese subjects aged 30-49 years old who underwent colonoscopy for the first time from August 2007 to August 2008 were included in this study. A total of 300 unselected consecutive patients (mean age 40.5 years) were eligible for analysis, and family history of colorectal cancer and gastric cancer, sex, age, body mass index, positivity of faecal occult blood test and the presence of symptoms were evaluated. Risk factors for developing colorectal adenoma and/or carcinoma were assessed. RESULTS Colorectal neoplasias were detected in 83 (27.7%) cases. Two were found to have invasive carcinoma. Univariate and multivariate analyses revealed that family history of gastric cancer (OR 2.09, 95% CI 1.12-3.92, P = 0.02) was an independent risk factor for the development of colorectal neoplasia, as well as male sex (OR 1.89, 95% CI 1.10-3.27, P = 0.02), older age (OR 2.05, 95% CI 1.18-3.55, P = 0.01) and positive faecal occult blood test (OR 1.99, 95% CI 1.14-3.48, P = 0.02). CONCLUSION In the young population under 50 years of age, a family history of gastric cancer is an independent risk factor for the development of colorectal neoplasia.
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Affiliation(s)
- K Hata
- Department of Surgery, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
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Kang KJ, Min BH, Ryu K, Kim KM, Kim ER, Kim JY, Chang DK, Kim JJ, Rhee JC, Kim YH. Clinical usefulness of microsatellite instability test in Korean young patients with high-risk features associated with adenoma. Clin Res Hepatol Gastroenterol 2012; 36:378-83. [PMID: 22361441 DOI: 10.1016/j.clinre.2012.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/14/2012] [Accepted: 01/17/2012] [Indexed: 02/04/2023]
Abstract
The aim of this study was to determine the correlation between microsatellite instability (MSI) and young age in patients with advanced colorectal adenomas. We retrospectively analyzed young patients (≤ 40 years of age) with advanced adenomas (n=84) between January 1996 and December 2006. We randomly selected the control group as patients ≥ 50 years of age with advanced adenomas (n=84) during the same time period. Of these patients, the MSI test and MLH1 immunohistochemistry were performed in the available tissue samples from patients with advanced adenomas. The number of patients who had the two tests was 52 in the young group and 49 in the old group. The monomorphic nature of the BAT26 panel for MSI analysis was used without comparison of normal tissue. MSI was detected in three young patients (n=52) and none of the old patients (n=49). There was no statistical difference between the two groups (P=0.243). All three young patients with MSI had a strong family history of colorectal cancer. MSI analysis was not a useful method of screening for HNPCC in young patients with advanced colorectal adenoma, at least in cases without a family history of colorectal cancer.
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Affiliation(s)
- Ki Joo Kang
- Department of Medicine, Samsung Medical Center, Division of Gastroenterology, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea
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Maximizing the general success of cecal intubation during propofol sedation in a multi-endoscopist academic centre. BMC Gastroenterol 2010; 10:123. [PMID: 20961451 PMCID: PMC2975653 DOI: 10.1186/1471-230x-10-123] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 10/20/2010] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Achieving the target of 95% colonoscopy completion rate at centres conducting colorectal screening programs is an important issue. Large centres and teaching hospitals employing endoscopists with different levels of training and expertise risk achieving worse results. Deep sedation with propofol in routine colonoscopy could maximize the results of cecal intubation. METHODS The present study on the experience of a single centre focused on estimating the overall completion rate of colonoscopies performed under routine propofol sedation at a large teaching hospital with many operators involved, and on assessing the factors that influence the success rate of the procedure and how to improve this performance, analyzing the aspects relating to using of deep sedation. Twenty-one endoscopists, classified by their level of specialization in colonoscopic practice, performed 1381 colonoscopies under deep sedation. All actions needed for the anaesthesiologist to restore adequate oxygenation or hemodynamics, even for transient changes, were recorded. RESULTS The "crude" overall completion rate was 93.3%. This finding shows that with routine deep sedation, the colonoscopy completion rate nears, but still does not reach, the target performance for colonoscopic screening programs, at centers where colonoscopists of difference experience are employed in such programs.Factors interfering with cecal intubation were: inadequate colon cleansing, endoscopists' expertise in colonoscopic practice, patients' body weight under 60 kg or age over 71 years, and the need for active intervention by the anaesthesiologist. The most favourable situation--a patient less than 71 years old with a body weight over 60 kg, an adequate bowel preparation, a "highly experienced specialist" performing the test, and no need for active anaesthesiological intervention during the procedure--coincided with a 98.8% probability of the colonoscopy being completed. CONCLUSIONS With routine deep sedation, the colonoscopy completion rate nears the target performance for colonoscopic screening programs, at centers where colonoscopists of difference experience are employed in such programs. Organizing the daily workload to prevent negative factors affecting the success rate from occurring in combination may enable up to 85% of incomplete procedures to be converted into successful colonoscopies.
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Hematochezia in the young patient: a review of health-seeking behavior, physician attitudes, and controversies in management. Dig Dis Sci 2010; 55:233-9. [PMID: 19238544 DOI: 10.1007/s10620-009-0750-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 01/27/2009] [Indexed: 12/09/2022]
Abstract
Hematochezia, defined as the passage of blood or clots from the rectum, is common and can be quite alarming. Few patients in general consult their physicians for this symptom. Various reasons have been explored for this behavior. Physician attitudes also shed some light onto why some patients are referred and others are not. Hematochezia may be associated with an anal cause in most healthy young adults (<50 years of age), but some may end up being diagnosed with colorectal cancer (CRC). Many studies have looked at the usefulness of clinical presentation in helping to decide which patients need further evaluation and what the optimal mode of investigation should be. Of note, studies on patients less than 50 years of age presenting with rectal bleeding have been few and far between. The results of these studies have been contradictory to the point where, today, there is no single set of consensus guidelines on the approach to hematochezia in young patients. In this review, the value of clinical symptoms and the underlying risk of CRC in guiding this clinical decision will be discussed.
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Nikpour S, Asgari AA. Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer. World J Gastroenterol 2008; 14:6536-40. [PMID: 19030208 PMCID: PMC2773342 DOI: 10.3748/wjg.14.6536] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the prevalence of clinically significant lesions in patients with minimal bright red bleeding per rectum (BRBPR).
METHODS: Consecutive outpatients prospectively underwent colonoscopy at Loghman Hakim Hospital, Tehran. Minimal BRBPR was defined as small amounts of red blood after wiping or in the toilet bowl. Patients with the following alarm signs were excluded: Positive personal history of colorectal neoplasms or inflammatory bowel disease (IBD), positive first degree family history of colorectal neoplasms, history of altered bowel habits, recent significant weight loss, and presence of iron deficiency anemia. Neoplastic polyps, colorectal carcinoma, and IBD were defined as significant lesions.
RESULTS: A total of 402 patients (183 female and 219 male, aged 43.6 ± 15.7 years) were studied. Hemorrhoids (54.2%), anal fissures (14.2%) and ulcerative colitis (14.2%) were the most common lesions and colonoscopy was normal in 8.0%. Significant lesions were found in 121 (30.1%) patients, including 26 patients (6.5%) with adenocarcinoma and 30 (7.5%) with adenomatous polyps. Almost all patients with significant lesions had at least one lesion in the distal colon; an adenocarcinoma and an adenomatous polyp in the proximal colon were found in 2 patients with hemorrhoids.
CONCLUSION: Flexible sigmoidoscopy appears to be sufficient for the evaluation of average risk patients with minimal BRBPR. Rigid sigmoidoscopy may be used as an alternative in patients less than 40 years of age in settings where the former is not available. The choice of colonoscopy over flexible sigmoidoscopy in patients aged over 50 years should be individualized.
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