Endocuff Vision-assisted colonoscopy: a randomized controlled trial.

BACKGROUND: Adenoma detection rate (ADR) has shown to be an independent predictor, to reduce the rate of interval colorectal cancer. Endocuff Vision is a relatively new device that has shown promise to improve the ADR. The primary objective was to conduct a randomized controlled trial to compare Endocuff Vision-assisted colonoscopy (EVAC) with standard colonoscopy (SC). The primary outcome of the study is ADR and the secondary outcomes are caecal intubation rate, terminal ileum intubation rate, scope withdrawal time, quality of bowel preparation and adverse events. METHODS: A randomized controlled trial was performed to compare EVAC versus SC. All patients who presented to the endoscopy suite at the Queen Elizabeth Hospital were assessed for eligibility. Patients were recruited from 15 June 2016 to 20 January 2017. A total of 360 patients were included; 40 were excluded. The patients were randomized using block randomization; 138 patients were recruited to SC and 182 to EVAC. RESULTS: A total of 231 polyps were retrieved during the study period. Polyp detection rate (PDR) was high in both groups: 53% in the EVAC group versus 41.1% in SC. This was statistically significant with a P-value of 0.035. ADR was similarly high in both groups: 36.81% in EVAC group versus 28.99% in SC group. ADR did not reach statistical significance. CONCLUSIONS: EVAC does improve the PDR. Though the ADR did not reach statistical significance, there is a trend towards improved adenoma detection and there is statistical significance in the overall PDR.

Minimally invasive calcaneal osteotomy: A cadaveric and clinical evaluation.

BACKGROUND: A cadaveric and clinical study was performed to assess whether a minimally invasive technique is a potentially safer alternative compared to a calcaneal osteotomy through an open lateral approach. METHODS: Cadaveric: A minimally invasive calcaneal osteotomy (MICO) was performed on nine cadaveric specimens. These were examined to identify any nerve injury and to quantify the displacement achieved with the osteotomy. Clinical: A retrospective review of a sequential case series of medializing MICO's performed by the senior author between October 2011 and November 2014 was undertaken. RESULTS: Cadaveric: Neurological structures remained uninjured in all specimens. The distance of the sural nerve and the main trunk of the tibial nerve to the superior limb of the oblique osteotomy was 6.2±4.8mm (range 0-14mm) and 7.3±3.6mm (range 4-12mm), respectively. The mean coronal shift achieved was 16.7±3.4mm (range 12-21mm). Clinical: The senior author carried out 35 medializing MICO procedures. Radiological and clinical union occurred in all 35 cases (100%). There were no neurovascular or wound complications. CONCLUSION: Minimally invasive calcaneal osteotomy offers a safe alternative to an open procedure with promising clinical results.

Six-year prospective analysis of the rectal bleeding clinic at the Queen Elizabeth Hospital, Adelaide, South Australia.

BACKGROUND: One-stop rectal bleeding clinics (RBC) are designed to diagnose and treat colorectal diseases that present with rectal bleeding. The Queen Elizabeth Hospital RBC is an open access clinic and is unique in South Australia. It offers flexible sigmoidoscopy and facilities for treating common anorectal conditions. METHODS: Data of all patients presenting to the RBC were prospectively recorded into a database. Data were collected on the patient details, presentation, medical history, physical examination, treatment and intended follow-up. RESULTS: A total of 1539 cases was seen in the clinic between March 2000 and February 2006. Flexible sigmoidoscopy was carried out in 1145 cases (75.03%). Banding or injection of haemorrhoids was carried out in 383 cases. A total of 590 patients was referred for colonoscopy and of these, 27 were diagnosed with colorectal adenocarcinoma or squamous cell cancer of the anus. Most of these patients were more than 50 years old (26 of 27; 96.30%) and had associated symptoms, such as weight loss or altered bowel habit with their rectal bleeding (23 of 27; 85.19%). CONCLUSION: Rectal bleeding clinics can facilitate early diagnosis of colorectal malignancy and can also provide a 'one-stop shop' for treating benign anorectal conditions.

Randomized prospective controlled trial of lateral internal sphincterotomy versus injection of botulinum toxin for the treatment of idiopathic fissure in ano.

BACKGROUND: Chronic anal fissure is a significant cause of morbidity. Internal sphincterotomy has long been the operative treatment of choice. Concerns remain, however, on its effects on continence. Botulinum toxin has been used as an agent for chemical sphincterotomy, causing temporary alleviation of sphincter spasm and allowing the fissure to heal. The aim of the present study was to compare the results of sphincterotomy to botulinum toxin. METHODS: The study was designed as a randomized controlled trial. All adult patients over the age of 18 with chronic idiopathic fissure in ano who had failed conservative treatment were included in the trial. Patients were randomized to receive either Botox or sphincterotomy. Pain, healing of fissure and continence scores were the outcomes assessed. RESULTS: A total of 38 patients were studied. Seventeen patients were randomized to receive Botox and 21, sphincterotomy. Patients in the Botox group were found to have significantly higher 2-week pain scores and reoperation rates, and poor healing. Continence scores were not significantly different in the two groups. CONCLUSION: Sphincterotomy gives better results than Botox in the treatment of fissure. Botox, however, is safe with no complications and no detriment to continence and could be used in certain situations.