Colonoscopy screening and surveillance guidelines.

The Colonoscopy Screening and Surveillance Guidelines were developed by the Japan Gastroenterological Endoscopy Society as basic guidelines based on the scientific methods. The importance of endoscopic screening and surveillance for both detection and post-treatment follow-up of colorectal cancer has been recognized as essential to reduce disease mortality. There is limited high-level evidence in this field; therefore, we had to focus on the consensus of experts. These clinical practice guidelines consist of 20 clinical questions and eight background knowledge topics that have been determined as the current guiding principles.

The influence of esophagogastroduodenoscopy using carbon dioxide insufflation on abdominal ultrasonographic imaging efficiency.

PURPOSE: The ability to perform abdominal ultrasonography after esophagogastroduodenoscopy (EGD) is hypothesized to improve examination efficiency. Therefore, we performed abdominal ultrasonography before and after EGD to verify the effects of EGD on abdominal ultrasonographic imaging efficiency. METHODS: We performed abdominal ultrasonography before, immediately after, 30 min after, and 60 min after EGD with carbon dioxide (CO2) insufflation in 23 consecutive patients who visited our center between July 2015 and December 2016. We examined the visualization status of the head, body, and tail of the pancreas; extrahepatic bile duct; and inferior pole of the right kidney. RESULTS: The visualization status of the pancreas decreased immediately after EGD in approximately 50% of patients; however, at 30 min and after, the status was almost the same as for imaging performed before endoscopy. Visualization of the extrahepatic bile duct decreased slightly immediately after the procedure; however, 30 min and later, it was almost the same as before endoscopy. The inferior pole of the right kidney was observable from the dorsal side and could be visualized at all examination points in all patients. CONCLUSION: There was no difficulty in performing abdominal ultrasonography at 30 min or later following EGD with CO2 insufflation. Additionally, visualization of the head, body, and tail of the pancreas as well as the extrahepatic bile duct was improved in some patients.

Bone formation in a rectal inflammatory polyp.

Heterotopic bone formation (osseous metaplasia) is rarely detected in the gastrointestinal tract. Most of reported cases are associated with malignant lesions. We herein report a case of osseous metaplasia in a rectal inflammatory polyp and a review of the literature on suggested mechanisms for its aetiology. A 39-year-old man visited our hospital with a chief complaint of melena. Total colonoscopy revealed a slightly reddish subpedunculated polyp, about 12 mm in diameter, in the lower rectum. Endoscopic resection was performed. Histologically, several foci of heterotopic bone formation were found. From the review of the literature, all of the polyps described were larger than 10mm in diameter, 55.6% showed inflammatory changes, and 62.5% were detected in the rectum. Osteogenic stimulation was considered to be a result of the inflammatory process. As our inflammatory polyp was located in the rectum, the pathogenesis could be a reactive change stimulated by the repeated local trauma, or be on a peculiar characteristic of the rectal mucosa itself.

A retrospective study of immunochemical fecal occult blood testing for colorectal cancer detection.

BACKGROUND: Colonoscopic examination is the common pathway for positive screening tests detecting colorectal lesions. We evaluated a specific, quantitative high-throughput automatic immunochemical fecal occult blood test (Auto iFOBT) method for colorectal cancer (CRC) screening and to determine its concordance with physician assessments informed by complete colonoscopy, the gold-standard technique for evaluation of the colonic mucosa. METHODS: 1200 CRC symptomatic patients were recruited for a retrospective investigation. Colorectal neoplasia were localized by colonoscopy and cancer outcomes were enumerated according to severity. In addition, stool samples were collected and analyzed by Auto iFOBT to derive sensitivity, specificity, and positive predictive value. Qualitative colonoscopy and Auto iFOBT results were correlated, as were cancer severities and quantitative hemoglobin concentrations. RESULTS: Ninety-one patients were found positive for CRC; 50 mucosal, 20 submucosal, and 21 advanced. At standard cutoff, sensitivity was 60%, 90%, and 95%, respectively. Specificity and positive predictive value for all neoplasia and cancers were 89.6% and 86.4%, and 60.9% and 33.7%, respectively. Cancer severities could be approximated roughly according to hemoglobin concentrations. CONCLUSIONS: Specific qualitative 2-day Auto iFOBT is an accurate tool for the detection of colorectal cancer and therefore provides the basis for a large-scale screening program.

Progression of a sessile serrated adenoma to an early invasive cancer within 8 months.

Recent studies suggest that serrated polyps, including hyperplastic polyps, traditional serrated adenomas, and sessile serrated adenomas, may be morphologically and genetically distinct and linked to microsatellite unstable colorectal cancers, and thus the concept of a hyperplastic polyp-serrate adenoma-carcinoma pathway has been suggested. Furthermore, it has been suggested that transformation from serrated polyps to invasive cancers can be rapid and occurs when the lesions are small; however, direct evidence for this issue is scant. We herein describe a case of a sessile serrated adenoma showing rapid transformation into a submucosal invasive carcinoma with remarkable morphological change in a short period of 8 months. This case is unique and suggestive, as it provided information about the natural history of a sessile serrated adenoma.