Efficacy and tolerability of a low-residue diet for bowel preparation: systematic review and meta-analysis.

BACKGROUND: Colorectal cancer (CRC) contributes significantly to cancer mortality worldwide. In an effort to reduce the risk of death, detection of polyps through colonoscopy is crucial. The success of the colonoscopy depends on the diet administered the day before the test. Our aim was to evaluate the efficacy, tolerability, and adverse effects of bowel preparation when using a low-residual diet (LRD) compared to a clear-liquid diet (CLD) the day before a scheduled colonoscopy. METHODS: PubMed/Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases were searched. We included studies of patients undergoing a scheduled colonoscopy for CRC screening and surveillance or for diagnostic purposes that compared a LRD with a CLD the day before the colonoscopy. Efficacy, the primary outcome, was evaluated as the rate of adequate bowel preparation. Secondary outcomes were tolerability and adverse effects of bowel preparation. RESULTS: Thirteen RCTs (N = 2587) were included. Patients receiving a LRD compared to a CLD showed no difference in adequate bowel preparations (RR 1.02; 95% CI 0.99-1.05; I2 = 60%). However, the LRD improved patient tolerability (RR 1.17; 95% CI 1.12-1.23; I2 = 66%) and had fewer adverse effects (RR 0.89; 95% CI 0.84-0.94; I2 = 73%) compared to the CLD. Groups using a LRD with 4L of polyethylene glycol in a single dose or a LRD with < 2000 kcal < 32 g of fibres/day had better tolerability. CONCLUSION: Based on these findings, our recommendation is strong in favour of a LRD for bowel preparation of patients undergoing a scheduled colonoscopy. This diet could also be useful as a preoperative colonic preparation, but this requires further research.

Finding sessile serrated adenomas: is it possible to identify them during conventional colonoscopy?

BACKGROUND AND AIM: Proximal colorectal cancer may arise from sessile serrated adenomas (SSAs). Recognition of these lesions during colonoscopy can optimize the endoscopic approach. We aimed to identify specific endoscopic features of SSA with conventional colonoscopy. METHODS: Patients undergoing screening colonoscopies from January 2011 to September 2012, in whom colonic polyps were found, were prospectively included in our study. Polyp morphology, location, polyp pit pattern (Kudo classification), and other previously reported features of SSA were evaluated. Histological examination was conducted independently by two pathologists. Multivariate analysis was performed to identify independent predictors of SSA. RESULTS: A total of 272 patients were included, and 440 polyps were evaluated (1.6 polyps per patient). Thirty-four polyps (8%) were SSA, 135 (31%) hyperplastic, and 249 (56%) adenomas. The most prevalent endoscopic features of SSA were right-side location (94%), type II Kudo pit pattern (91%), mucus cap (41%), flat morphology (29%) and red-colored surface (26%). Multivariate analysis revealed that flat morphology (p = 0.002, OR = 3.81 CI 1.53-9.09), red-colored surface (p < 0.001, OR = 12.97 CI 4.43-37.69), right-side location (p < 0.001, OR = 22.21 CI 5.09-135.94) and mucus cap (p < 0.001, OR 8.77 CI 3.76-20.44) were independent predictors of SSA. CONCLUSION: We were able to identify specific features of SSA during conventional colonoscopy, which may help to identify, and therefore to optimize the endoscopic approach of these lesions.

[Celiac disease and risk of colorectal neoplasia]. / Riesgo de cáncer colorrectal en pacientes con enfermedad celíaca.

BACKGROUND: Although small bowel and esophagus neoplasia are recognized to occur more frequently in patients with celiac disease, the association with colorectal cancer is still controversial. OBJECTIVE: To determine the risk of colorectal neoplasia among patients with celiac disease. METHODS: A case-control study was conducted using the gastroenterology and endoscopy unit electronic data base. Patients with celiac disease and colonoscopy were regarded as cases and those without celiac disease and colonoscopy as controls. Patients were matched for age, sex, colonoscopy purpose and family history of colorectal cancer. The main outcome was the risk of colorectal polyps, adenomas, advanced lesions and cancer. The risk was expressed as odds ratio (OR) with the respective 95% confidence intervals (95% CI). RESULTS: Out of 178 celiac disease patients, 44 were included as cases. Eighty-eight non-celiac patients were included as controls. In cases, the presence of polyps, adenomas and advanced colonic lesions was 20%, 16% and 4.5%, respectively. In controls, it was 15%, 9% and3.4%, respectively. The risk of polyps, adenomas and advanced colonic lesions was similar in both groups: OR 1.48 (95% CI 0.59-3.73), OR 1.89 (95% CI 0.66-5.42) and OR 1.34 (95% CI 0.26-7.05). No colorectal cancer was identified. CONCLUSION: The risk of colorectal neoplasia within this cohort of patients with celiac disease was similar to the control population.

[Role of antibodies in celiac disease after one year of treatment to predict the adherence to gluten-free diet]. / Rol de los anticuerpos en la enfermedad celíaca luego de un año de tratamiento para predecir la adherencia a la dieta libre de gluten.

INTRODUCTION: The celiac disease (CD) is characterized by a permanent sensitivity to gluten. The treatment for this disease is the life-long strict compliance with a gluten-free diet (GFD). The average of compliance with GFD ranges between 15% and 80%. Antibodies' role in the follow up of these patients regarding the adherence to the GFD is not well established. Objective. To determine the relationship between the antibodies for CD and the adherence to the GFD in patients with over a year of treatment. MATERIAL AND METHODS: Patients with CD with a minimum of one year of GFD were prospectively included They were asked to complete a self-survey regarding to the compliance to GFD and the level of adherence was determined: low (no compliance or more than 2 gluten intakes per week), medium (1 or 2 gluten intakes per week or 2 or 3 gluten intakes per month), or high (1 gluten intake per month or less than 3 intakes per year). The follow up was performed by their general practitioners. From one year of GFD onwards, the results of the available antibodies at the time of the last follow up were assessed: antigliadine IgA (AGA) and IgG (AGG), anti-endomysium IgA (EMA) and IgG (EMG), anti-transglutaminase (ATG), and deaminated peptides of gliadine IgA and IgG, considering them as positive or negative. Through an univariate analysis, the above-mentioned antibodies were correlated (independent variables) in order to identify predicting factors of high and low adherence to the GFD (dependent variables). RESULTS: Ninety patients were analyzed, age 43.6 +/- 15.3 years old, 89% women, 58% classic celiacs. The average time of GFD was 7.9 years and 63% had been on a GFD for over 3 years. A 71% of patients (95% CI 69%-80%) showed high adherence to the GFD, and a 67% (95% CI 2%-13%) showed low adherence. GFD of less than 3 years was a determining factor for low adherence [relative risk (RR) 2.41 (95% CI 1.2-2.89)]. The predictive antibodies for GFD high adherence were: (1) negative EMA [RR 1.27 (95% CI 1.03-1.54)], (2) negative ATG [RR 1.62 (95% CI 1.12-2.47)], and (3) all negative requested ones [RR 1.60 (95% CI 1.17-2.18)]. The predictive antibodies for GFD low adherence were: (1) positive AGA [RR 15.5 (95% CI 2.29-105)], (2) positive EMA [RR 10.2 (95% CI 2.19-47.7)], (3) positive ATG [RR 9.63 (95% CI 1.53-63.4)], and 4) all negative requested ones [RR 0.11 (95% CI 0.018-0.71)]. CONCLUSION: After one year of treatment, the negativity of EMA or ATG antibodies had a significant correlation with the high adherence to GFD and the positivity of AGA, EMA or ATG antibodies had a significant correlation with a low adherence.

Resultados de la pesquisa del cáncer colorrectal mediante videocolonoscopía en una población cerrada / Results of the colonoscopic colorectal cancer screening a community hospital

Antecedentes: La detección de lesiones preneoplásicas y del cáncer colorrectal a través de distintos estudios es efectiva para la prevención y el tratamiento de la enfermedad. Objetivo: Evaluar los resultados obtenidos con videocolonoscopías efectuadas a pacientes asintomáticos, sin riesgo de enfermedad neoplásica colorrectal. Diseño: Estudio retrospectivo. Población: Pacientes sometidos a videocolonoscopías, cuyo motivo de estudio fue pesquisa. Método: Se analizaron características demográficas, tipo y localización de los hallazgos patológicos. Resultados: De 1788 videocolonoscopías realizadas entre Marzo de 2005 y Marzo de 2006. 214 (12 %) fueron por pesquisa. 115 (54 %) pacientes fueron hombres y 99 (46 por ciento) mujeres, con una edad promedio de 59.6 (50-79) años. El estudio fue completo en el 96,7 por ciento. En 71 (33 %) estudios se halló patología. En el 60 por ciento de éstos se encontraron pólipos. La prevalencia de pólipos en esta población fue del 20 por ciento y de cáncer colorrectal del 1,4 %. Se hallaron 59 pólipos en 43 pacientes. 42,4 % fueron hiperplásicos, 52.5 por ciento adenomatosos y el 5,1 % cánceres. El 76.3 % de los pólipos se localizaron en colon izquierdo y recto y el 23,7 % en colon derecho. De los 31 pólipos adenomatosos, 7 (22,6 %) se hallaron en colon derecho (3 con displasia) y 24 (77.4 %) en el izquierdo (19 con diplasia). Los 3 cánceres se localizaron en el colon derecho. 7/59 pólipos midieron más de 10 mm, 5 en rectosigma (adenomatosos con displasía) y 2 en colon derecho (cánceres). No hubo complicaciones ni mortalidad asociadas al método. Conclusión: La videocolonoscopía es eficaz como método de pesquisa en una población cerrada.

Background: Colonoscopy is considered the most effective screening tool for detecting premalignant lesions and early colorectal cancer (CRC). Aim: To evaluate the results with colonoscopy for colorectal cancer screening in average risk patients. Design: Retrospective study. Patients and Methods: All patients that underwent colonoscopy for screening were included. Screening was defined as colonoscopic examination in asymptomatic patients, older than 50 years, within family history of CRC and within history of colon diseases. Demographic characteristics, type and location of pathological findings were analyzed. Results: From 1788 colonoscopies achieved between March 2005 and March 2006, 214 (12 %) were for screening. The mean age of the patients was 59,6 (50-79) years, and 54 % (115) were men. Colonoscopy to the level of the cecum was completed in 96,7 % of the patients. 71 (33 %) procedures showed some pathological finding. 60 per cent of them were polyps, 33per cent diverticular disease and other things in 7 per cent. The prevalence of polyps was 20 %, adenomas 11,2 % and CRC 1.4 %. We found 59 polyps in 43 patients, 76,3 % in the left colon, 31 were adenomas, 25 hyperplastic polyps and 3 CRC. 7 (22,6 %) of 31 adenomas were found in the proximal colon. And all (3) CRC were situated in the right colon. 7/59 polyps had a diameter of at least 10 mm, five of them were adenomas with some grade of dysplasia and two CRC. There were no morbidity and mortality associated with this procedure. Conclusion: Colonoscopy is an effective tool for colorectal cancel' screening in a Community Hospital.