Role of endoscopic ultrasonography in the loco-regional staging of patients with rectal cancer.

The prognosis of rectal cancer (RC) is strictly related to both T and N stage of the disease at the time of diagnosis. RC staging is crucial for choosing the best multimodal therapy: patients with high risk locally advanced RC (LARC) undergo surgery after neoadjuvant chemotherapy and radiotherapy (NAT); those with low risk LARC are operated on after a preoperative short-course radiation therapy; finally, surgery alone is recommended only for early RC. Several imaging methods are used for staging patients with RC: computerized tomography, magnetic resonance imaging, positron emission tomography, and endoscopic ultrasound (EUS). EUS is highly accurate for the loco-regional staging of RC, since it is capable to evaluate precisely the mural infiltration of the tumor (T), especially in early RC. On the other hand, EUS is less accurate in restaging RC after NAT and before surgery. Finally, EUS is indicated for follow-up of patients operated on for RC, where there is a need for the surveillance of the anastomosis. The aim of this review is to highlight the impact of EUS on the management of patients with RC, evaluating its role in both preoperative staging and follow-up of patients after surgery.

Quality of bowel cleansing in hospitalized patients undergoing colonoscopy: A multicentre prospective regional study.

BACKGROUND: Quality of bowel cleansing in hospitalized patients undergoing colonoscopy is often unsatisfactory. No study has investigated the inpatient or outpatient setting as cause of inadequate cleansing. AIMS: To assess degree of bowel cleansing in inpatients and outpatients and to identify possible predictors of poor bowel preparation in the two populations. METHODS: Prospective multicentre study on consecutive colonoscopies in 25 regional endoscopy units. Univariate and multivariate analysis with odds ratio estimation were performed. RESULTS: Data from 3276 colonoscopies were analyzed (2178 outpatients, 1098 inpatients). Incomplete colonoscopy due to inadequate cleansing was recorded in 369 patients (11.2%). There was no significant difference in bowel cleansing rates between in- and outpatients in both colonic segments. In the overall population, independent predictors of inadequate cleansing both at the level of right and left colon were: male gender (odds ratio, 1.20 [1.02-1.43] and 1.27 [1.05-1.53]), diabetes mellitus (odds ratio, 2.35 [1.68-3.29] and 2.12 [1.47-3.05]), chronic constipation (odds ratio, 1.60 [1.30-1.97] and 1.55 [1.23-1.94]), incomplete purge intake (odds ratio, 2.36 [1.90-2.94] and 2.11 [1.68-2.65]) and a runway time >12h (odds ratio, 3.36 [2.40-4.72] and 2.53 [1.74-3.67]). CONCLUSIONS: We found no difference in the rate of inadequate bowel preparation between hospitalized patients and outpatients.

Bone mass in women with celiac disease: role of exercise and gluten-free diet.

BACKGROUND AND AIM: Celiac patients report fatigue and reduced social activities, which may decrease physical activity. This study investigated the physical activity, fatigue and bone mineral density in celiac women at diagnosis and during diet. MATERIALS AND METHODS: The first group (n=48) had the bone mineral density measured at diagnosis and after 2 years of a gluten-free diet; in the second group (n=47) bone mineral density was measured at diagnosis and after 5 years of a gluten-free diet. Both groups completed a physical activity questionnaire and visual analogue scale for the perception of fatigue at diagnosis and follow-up. Data about smoking habits, alcohol use, presence of gastrointestinal symptoms, drug therapy and body mass index were also collected. RESULTS: At diagnosis, the two groups were similar for all considered variables. At follow-up, the mean body mass index and physical activity questionnaire's score were similar to baseline. The bone density increased in both groups, whilst the physical activity questionnaire and visual analogue scale remained unchanged. CONCLUSION: The improvement in bone density following a gluten-free diet was significant after 2 years; physical activity is frequently low and plays a minor role in determining the changes in bone mineral density.