Study endoscopic and colonoscopy findings in children under 16 years of age with gastrointestinal bleeding from 2018 to 2021

Background: One of the most common reasons for Children to visit clinics is gastrointestinal issues in which endoscopic studies are used occasionally to investigate it’s etiology more accurately. GI bleeding eventhough uncommon in children, can be life threatening. The aim of this study was to study endoscopic and colonoscopic findings in children with GI bleeding. Methods: This descriptive analytical study was done on 73 children under 16 years in Ardabil with the diagnosis of gastrointestinal bleeding. A checklist including demographic and treatment information of patients like severity of bleeding, bleeding type (melena, hematochezia, occult blood), laboratory results (hemoglobin, hematocrit) and clinical findings (abdominal pain, nausea and vomiting, ETC), endoscopic and colonoscopic results were collected and then analyzed by statistical methods in SPSS version 21. Results: Total 38 cases (52.1%) were gone under upper endoscopy and 35 cases (47/9%) were gone under colonoscopy. The most common indications for upper endoscopy was GI bleeding (76.3%) and the most common involved anatomical part was lower portion of esophagus (44.7%). The most common indication for colonoscopy was recurrent abdominal pain (62.9%). Pathologic cases were often seen in sigmoid, rectum and anus (52/8%). The most common colonoscopic findings were nodular hyperplasia (25/7%) and solitary nodule (20%). Conclusions: Results of study showed that, the frequency of endoscopic evaluation has been significantly lower in female children. According to the most common indications for upper and lower endoscopy, it is important to consider the frequency pattern of indications for endoscopic study.

Stomach Cancer and Postendoscopy Colorectal Cancer: Parallel Lives / Cáncer gástrico y cáncer colorrectal posendoscopia: vidas paralelas

Abstract Background and objectives: The rates of (interval) stomach cancer (SC) or postendoscopy (PECRC) or postcolonoscopy (PCCRC) colorectal cancer (CRC) have been little studied in our setting. Data from overseas studies reported PECRC and PCCRC rates of 7-26%. We aim to determine and compare local PECRC and PCCRC rates and characteristics. Patients and methods: With data from three quaternary-care cancer centers, we ambispectively identified patients diagnosed with SC and CRC between 2012 and 2021, in whom a history of endoscopies or colonoscopies in the previous three years was investigated. Cancers diagnosed between 6 and 36 months after an endoscopic study reported as normal were defined as interval cancers. This study compares the clinical, endoscopic, and survival characteristics of both PECRC and PCCRC cohorts. Results: Of 828 patients diagnosed with SC, 66 had PECRC (rate: 7.3%), while in 919 patients with CRC, 68 had PCCRC (rate: 6.9%). There were no significant differences in age or sex, although males predominated (2:1) in the PECRC (0.09). The finding of premalignant lesions was similar in both groups (p = 0.260). The anatomical location was shown to be more proximal (right colon) in the PCCRC than in the PECRC (cardia/fundus) (p = 0.002). Gastric neoplasms were more poorly differentiated (58%) than colon neoplasms (26%) (p = 0.001). There were no differences in early cancers, but tumor status was more advanced in PECRC (p < 0.01). The Kaplan-Meier showed a worse survival for PCCRC than for detected CRC, with no differences in SC and PECRC, suggesting poor survival. Conclusions: The rate of interval cancers is 7.3% and 6.9%, and differences were found between PECRC and PCCRC, proximal locations of the lesions, degree of differentiation, tumor status, and poor survival for the PCCRC. Establishing measures to achieve the World Endoscopy Organization's goal of <5% is necessary.

Resumen Antecedentes y objetivos: Las tasas de cáncer gástrico (CG) o cáncer colorrectal (CCR) posendoscopia (CGPE) o poscolonoscopia (CCRPC) (de intervalo) han sido poco estudiadas en nuestro medio. Los datos de estudios en el exterior informaron tasas de CGPE y CCRPC de 7%-26%. Nuestro objetivo fue determinar y comparar las tasas y características del CGPE y CCRPC locales. Pacientes y métodos: Con datos de tres centros oncológicos de cuarto nivel se identificaron, de forma ambispectiva, pacientes diagnosticados con CG y CCR entre 2012 y 2021, en quienes se investigó el antecedente de endoscopias o colonoscopias en los tres años previos. Los cánceres diagnosticados entre 6 y 36 meses después de un estudio endoscópico reportado como normal se definieron como cánceres de intervalo. En este estudio se comparan las características clínicas, endoscópicas y de sobrevida entre ambas cohortes de cánceres posendoscopia y poscolonoscopia. Resultados: De 828 pacientes diagnosticados con CG, 66 tuvieron CGPE (tasa: 7,3%), mientras que en 919 pacientes con CCR, 68 pacientes presentaron CCRPC (tasa: 6,9%). No hubo diferencias significativas en la edad o el sexo, aunque predominó el masculino (2:1) en el CGPE (0,09). El hallazgo de lesiones premalignas fue similar en ambos grupos (p = 0,260). La ubicación anatómica mostró ser más proximal (colon derecho) en el CCRPC que en el CGPE (cardias/fondo) (p = 0,002). Las neoplasias gástricas fueron más mal diferenciadas (58%) que las de colon (26%) (p = 0,001). No hubo diferencias en los cánceres tempranos, pero el estado tumoral fue más avanzado en el CGPE (p < 0,01). El Kaplan-Meier mostró una peor sobrevida para el CCRPC que para el CCR detectado, sin diferencias en el CG y el CGPE, que mostraron una pobre sobrevida. Conclusiones: La tasa de cánceres de intervalo es de 7,3% y 6,9%, y se encontraron diferencias entre los CGPE y el CCRPC, ubicaciones proximales de las lesiones, grado de diferenciación, estado del tumor y una pobre sobrevida para el CCRPC. Se hace necesario establecer medidas para lograr la meta de la Organización Mundial de Endoscopia de <5%.

Improving Colonoscopy Preparation Using Information and Communication Technologies (ICT), Randomized Clinical Trial / Mejoría de la preparación de colonoscopia usando tecnologías de la información y comunicación (TIC), ensayo clínico aleatorizado

Abstract Objective: Colonoscopy is a handy tool in preventing and diagnosing colorectal cancer. Its optimal performance requires adequate preparation for good visualization of the mucosa. In our endoscopy unit, we use the Boston scale to evaluate the quality of bowel preparation. The present work intends to assess whether or not an additional intervention with an educational video on the Internet could improve the result of preparation using the Boston scale for colonoscopy to enhance the visualization and detection of adenomas. Methods: A double-masked, randomized clinical trial. One group of patients received printed instructions on colonoscopy preparation, and another group received the same preparation plus the form contained a link and instructions to access and view a colonoscopy video posted on YouTube. Results: A highly significant difference was observed between the means of the Boston preparation score for the group that watched the video versus the group that did not (8.16 vs. 6.75; p < 0.0001). A significant difference was also found in the Boston score by segments of the colon: right (2.6 vs. 1.9; p < 0.001), transverse (2.7 vs. 2.3; p < 0.0001), and left (2.8 vs. 2.5; p < 0.0001). Concerning the adenoma detection rate, it was higher in the group that watched the video (28%) than in the group that did not (21%); however, the difference was not significant (p = 0.33). Conclusion: Watching an educational video significantly improves the quality of colonoscopy preparation through the Boston scale and the detection of adenomas; however, this difference was not significant, possibly due to a lack of a larger sample.

Resumen Objetivo: La colonoscopia es una herramienta muy útil en la prevención y diagnóstico del cáncer colorrectal. Su óptimo desempeño requiere una adecuada preparación para una buena visualización de la mucosa. En nuestra unidad de endoscopia utilizamos la escala de Boston para evaluar la calidad de la preparación. El objetivo del presente trabajo fue evaluar si una intervención adicional con un video educativo en internet podría mejorar el resultado de la preparación usando la escala de Boston para colonoscopia, de modo que se mejore la visualización y la detección de adenomas. Métodos: Ensayo clínico aleatorizado doble ciego. Un grupo de pacientes recibió las instrucciones impresas sobre la preparación para la colonoscopia y otro grupo recibió la misma preparación y, además, en el formulario había un enlace e instrucciones para acceder y ver un video de colonoscopia publicado en YouTube. Resultados: Se observó una diferencia altamente significativa entre las medias de la puntuación del Boston de la preparación a favor del grupo que vio el video frente al grupo que no (8,16 frente a 6,75; p < 0,0001). También se encontró una diferencia significativa en el puntaje de Boston por segmentos del colon: Boston derecho (2,6 frente a 1,9; p < 0,001), transverso (2,7 frente a 2,3; p < 0,0001) e izquierdo (2,8 frente a 2,5; p < 0,0001). En relación con la tasa de detección de adenomas, en el grupo que vio el video fue mayor (28%) comparado con el grupo que no (21%); sin embargo, la diferencia no fue significativa (p = 0,33). Conclusión: La visualización de un video educativo mejora significativamente la calidad de la preparación de la colonoscopia a través de la escala de Boston, y también mejora la detección de adenomas; sin embargo, esta última diferencia no fue significativa, posiblemente debido a la falta de una muestra mayor.

An incidental colonoscopy: finding Trichuris trichiura: a case report and review of literature

Trichuris trichiura commonly referred to as whipworm, has a world-wide distribution, particularly countries with warm, humid climates. This parasite is reported from nearly one quarter of the world population, especially from less developed countries. Poor hygiene conditions are associated with trichuris transmission, usually this infection remains asymptomatic in human but heavy infection can lead to chronic bloody diarrhoea associated with complications like rectal prolapsed, appendicitis, proctitis. Very few cases of extensive trichuriasis have been reported world-wide. Usually, diagnosis is confirmed by detection of eggs in stool sample. This case report deals with a patient of trichuriasis, who was diagnosed by detection of the parasite on colonoscopy. Thus, colonoscopy might be a useful diagnostic tool, especially in symptomatic patients who are infected by only few male worms with no eggs in the stool. Hence cannot be diagnosed by conventional methods.

Safety and efficacy of linaclotide combined with polyethylene glycol for bowel preparation / 基础医学与临床

Objective To evaluate safety and efficacy of linaclotide combined with polyethylene glycol(PEG)for bowel preparation.Methods A total of 612 patients from Department of Gastroenterology at the Affiliated Hospital of Qingdao University for colonoscopy examination from January to June 2023 were selected.They were divided into group 1(1 L PEG+2 L PEG),group 2(linaclotide+2 L PEG)and group 3(1 L PEG+linaclotide+1 L PEG)by random number table method,with 204 cases in each group.The Ottawa Bowel Preparation Quality Scale(OBPS),the insertion time of colonoscopy,the time of the first defecation,the frequency of defecations,the occurrence of adverse effects and patients'tolerability were compared among the three groups.Results A total of 601 patients completed bowel preparation and accepted colonoscopy.Group 1 exhibited no statistically significant differences to group 2 with regards to OBPS and insertion time.However,Group 2 demonstrated a shorter duration for the time of the first defecation in comparison to both group 1 and group 3(P＜0.05).Group 1 displayed a higher frequency of defecations as compared to Group 2 and Group 3(P＜0.05).The incidence of adverse reactions was significantly lower in group 2 and group 3 than in group 1(P＜0.05).The overall tolerance score of patients in group 1 was low-er than that in group 2 and group 3(P＜0.05).Conclusions The effect of combining 2 L PEG with 290 μg of lina-clotide for bowel preparation before colonoscopy is similar to that of 3 L PEG.It can reduce the incidence of adverse reactions and patients exhibit good tolerance.For patients who are intolerant to a single high-dose administration of PEG,they need divided-dose regimen of 2 L PEG in combination with linaclotide.

Construction and evaluation of a risk prediction model for hypoglycemia in colonoscopy patients / 中华护理杂志

Objective To analyze the influencing factors of hypoglycemia in patients undergoing colonoscopy and to construct a risk prediction model and evaluate the model.Methods A total of 528 patients who underwent colonoscopy were selected by the convenience sampling method from the gastroenterology department of a tertiary A hospital in Qingdao from March 2022 to August 2022.Their general information,laboratory indicators and operation-related data were collected.Multivariate Logistic regression was used to analyze the risk factors of hypoglycemia in patients with colonoscopy for risk prediction model construction,and its prediction effect was evaluated by drawing a nomogram.Results Hypoglycemia occurred in 66 of 528 patients,with an incidence of 12.50％.The risk factors finally in the risk prediction model in Logistic regression were drinking history,long fasting time after operation,polyethylene glycol(PEG)-electrolyte solutions＞3 L,low quality of bowel preparation.The model passed Hosmer-Lemeshow goodness of fit test x2=10.158(P=0.200).The area under the ROC curve was 0.829,while the cut-off was 0.575,with sensitivity of 92.90％and specificity of 64.60％.Conclusion Patients undergoing colonoscopy have a higher risk of hypoglycemia.Patients with a history of drinking,longer fasting after surgery,more than 3 L of PEG-electrolyte solutions,and low quality of bowel preparation were more likely to develop hypoglycemia.The established risk prediction model has a good effect,providing the reference for screening high-risk group of hypoglycemia and taking preventive and protective measures.

Efficacy of esketamine combined with propofol for colonic transendoscopic enteral tubing in pediatric patients with autism / 中华麻醉学杂志

Objective:To evaluate the efficacy of esketamine combined with propofol for colonic transendoscopic enteral tubing (TET) in pediatric patients with autism.Methods:Sixty pediatric patients with autism of both sexes, aged 3-12 yr, weighing 15-45 kg, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, who underwent painless transendoscopic enteral tubing (TET) from October 2022 to August 2023, were selected and divided into 2 groups ( n=30 each) by a random number table method: normal saline + propofol group (group NP) and esketamine + propofol group (group EP). In group NP, normal saline 10 ml was intravenously injected, and 30 s later propofol 2.0 mg/kg was given. In group EP, esketamine 0.3 mg/kg (diluted to 10 ml in normal saline) was intravenously injected, and 30 s later propofol 2.0 mg/kg was given. TET was performed when the Modified Observer′s Assessment of Alertness/Sedation Scale score ≤2. Propofol 0.5-1.0 mg/kg was added if the sedation depth was not enough, and the Modified Observer′s Assessment of Alertness/Sedation Scale score was maintained ≤2 until the end of surgery. The degree of body movement during TET was observed and recorded. The injection pain during induction, total consumption of propofol, operation time, spontaneous emergence time, and completion of operation were recorded. Adverse reactions such as respiratory depression, nausea and vomiting, hypotension, bradycardia, and postoperative agitation were recorded during operation and in the emergence period. Results:Compared with group NP, the degree of intraoperative body movement was significantly lighter, the total consumption of propofol and incidence of injection pain and intraoperative hypotension were significantly lower, and no significant change was found in the spontaneous emergence time and incidence of adverse reactions during recovery in group EP ( P<0.05). Conclusions:Esketamine (0.3 mg/kg) combined with propofol (2.0 mg/kg) can be safely and effectively used for colonic TET in pediatric patients with autism, and esketamine does not increase the risk of adverse reactions during resuscitation in a resuscitation strategy without early awakening.

Influencing factors for colonoscopic compliance to colorectal cancer screening in outpatients / 中华消化内镜杂志

Objective:To explore the influencing factors for compliance to colonoscopy screening for colorectal cancer in outpatients.Methods:Patients aged 40-74 years who visited the outpatient gastroenterology department of 7 tertiary hospitals in 7 regions of Xinjiang from January 2022 to June 2022 were enrolled. Recommendations for colonoscopy screening were made according to the patient's medical conditions, and the questionnaire was used to collect information. The Chi-square test was used to compare the differences of compliant and non-compliant patients. Multivariate logistic regression was used to analyze the influencing factors of compliance to colonoscopy screening.Results:A total of 463 valid questionnaires were obtained from 7 centers, in which, 427 outpatients (92.2%) followed the recommendation for colonoscopy screening, and 36 (7.8%) did not. Chi-square test results showed that there were statistically significant differences between the two groups in gender, age, education, subjective cognition of intestinal polyps, personal history of colorectal polyps, family history of colorectal cancer, family history of colorectal polyps, abdominal pain or distension, and defecation habit or stool changes ( P<0.05). The results of multivariate regression analysis showed that the screening compliance of patients aged 40-49 years ( P=0.005, OR=0.141, 95% CI: 0.036-0.549) and 50-59 years ( P=0.039, OR=0.257, 95% CI: 0.071-0.932) was lower than that of patients aged 60-74 years. The screening compliance of patients with high school education ( P=0.011, OR=3.121, 95% CI: 1.304-7.473) and college education or above ( P=0.016, OR=3.544, 95% CI: 1.270-9.890) was higher than those with primary school education and below. Patients with personal history of colorectal polyps ( P=0.015, OR=12.288, 95% CI: 1.629-92.719), family history of colorectal cancer ( P=0.038, OR=8.506, 95% CI: 1.124-64.351) and changes in defecation habit or stool trait ( P=0.039, OR=4.794, 95% CI: 1.085-21.192) also had higher compliance. Conclusion:Age, educational level, personal history of colorectal polyps, and family history of colorectal cancer are related to colonoscopy screening compliance in outpatients of 7 tertiary hospitals in 7 regions of Xinjiang. The independent risk factors affecting compliance to colorectal cancer screening in outpatients are age of 40-59 years, lower educational level, no previous history of polyps or family history of colorectal cancer, and no defecation habit or stool changes.

Knowledge, attitudes, and practices in colorectal cancer screening in the Philippines

Background and Objective@#Colorectal cancer (CRC) has the third highest incidence in the Philippines. Currently, there is a paucity in literature that is focused on the knowledge, attitudes, and perceptions of Filipinos regarding CRC screening. This is the first study in the Philippines that describes this. @*Methods@#This is a cross-sectional study that validated a 52-item Filipino questionnaire on the knowledge on colorectal cancer, willingness to undergo CRC screening, and perceived benefits and barriers to fecal occult blood test (FOBT) and colonoscopy. The study enrolled household heads more than 20 years of age residing in both urban and rural communities in the Philippines. @*Results@#The UP-PGH CRC KAP (University of the Philippines – Philippine General Hospital Colorectal Cancer Knowledge, Attitudes, and Practices) and Rawl Questionnaire’s validity and internal consistency were established in a pilot study of 30 respondents. A total of 288 respondents were then enrolled to the main study group with a median age of 54.0. Knowledge scores for prognosis and utility of CRC screening were modest (6.3/12 and 8.4/20, respectively). Perceived benefit scores to FOBT and colonoscopy were high (9.9/12 and 13.9/16, respectively).Median scores to barriers to FOBT and colonoscopy were intermediate (22.5/36 and 35.8/60, respectively). Notably, a vast majority (86.1%) were willing to participate in CRC screening programs initiated by the government, and 46.9% agreed to undergo screening tests even as out-of-pocket expense. @*Conclusion@#The UP-PGH CRC KAP Questionnaire as well as the Filipino translation of the Rawl Questionnaire are reliable and valid tools in extensively assessing the knowledge of Filipinos on CRC and willingness to undergo screening, as well as the benefits of and barriers to FOBT and colonoscopy. Knowledge scores were modest suggesting that directed educational campaigns and awareness programs can aid in increasing awareness about CRC and its screening. Household income and highest educational attainment were significantly positively correlated with knowledge scores, and perceived benefits of and barriers to CRC screening. Scores were generally comparable between urban and rural communities.

A Case of Type 2 Diabetes with Ipragliflozin Administration Developing Euglycemic Diabetic Ketoacidosis Due to Reduced Food Intake Following Colonoscopy / 日本プライマリ・ケア連合学会誌

The patient was an 80-year-old woman with type 2 diabetes mellitus taking ipragliflozin. She underwent a colonoscopy one week prior to admission. After the colonoscopy, she felt exhausted and lost her appetite. On the day of admission, she was admitted to the emergency department because of abdominal pain and repeated vomiting. Physical examination and chest and abdominal CT were performed; however, no cause was identified for the abdominal pain or vomiting. Blood gas analysis showed high anion gap metabolic acidosis. Serum ketones were elevated to 6,045/μL and plasma glucose concentration was 182 mg/dL. We diagnosed ipragliflozin-induced euglycemic diabetic ketoacidosis (euDKA) and discontinued the drug. Ketoacidosis improved with administration of intravenous fluids and insulin injections. Her abdominal pain and vomiting improved. It is important to recognise that patients taking SGLT2 inhibitors may develop euDKA, as in this case, due to fasting after colonoscopy or reduced food intake after the procedure, and to discontinue SGLT2 inhibitors at least 2 days before the procedure.

Asymptomatic intestinal tuberculosis of the terminal ileum diagnosed on colonoscopy: a case report and literature review / Journal of Rural Medicine

Objective: Colonoscopy is useful in diagnosing intestinal tuberculosis. However, the terminal ileum is generally not examined during routine colonoscopy. Therefore, even with colonoscopy, the diagnosis can be missed in patients with lesions confined to the terminal ileum. Herein, we report the case of an asymptomatic patient with intestinal tuberculosis, in whom a colonoscope insertion into the terminal ileum led to the diagnosis.Patient: An asymptomatic 71-year-old man visited our hospital for a colonoscopy after a positive fecal occult blood test.Results: Colonoscopy revealed diffuse edematous and erosive mucosa in the terminal ileum. Mycobacterium tuberculosis was detected by polymerase chain reaction and culture of biopsy specimens from the erosions, leading to the diagnosis of intestinal tuberculosis. The patient was treated with antitubercular agents for 6 months, and a follow-up colonoscopy revealed healing of the lesions.Conclusion: Asymptomatic intestinal tuberculosis may occasionally be detected on colonoscopy following a positive fecal occult blood test and is sometimes confined to the terminal ileum. Therefore, clinicians should consider intestinal tuberculosis in the differential diagnosis of the causes of positive fecal occult blood test results and perform colonoscopies, including observation of the terminal ileum.

Application of opioid-free anesthesia with Esketamine and Ciprofol for the elderly underwent colonoscopy / 中国内镜杂志

Objective To observe the effect of opioid-free anesthesia with esketamine and ciprofol for the elderly underwent colonoscopy.Methods 160 elderly patients underwent colonoscopy were included in this study.Those patients were assigned to esketamine combined with ciprofol group(group E,n = 80)and sufentanil combined with ciprofol(group S,n = 80).Patients were intravenously injected respectively with esketamine 0.2 mg/kg in group E and sufentanil 0.1 μg/kg in group S.Then,all the patients were intravenously injected with ciprofol(0.2 mg/kg).Mean arterial pressure(MAP),heart rate(HR)and percutaneous arterial oxygen saturation(SpO2)were recorded before injection of test drug(T0),when modified observer's assessment of alertness/sedation(MOAA/S)score was 0 points(T1),when colonoscopy through hepatic flexure(T2)and colonoscopy was removed after examination(T3).The induction time of anesthesia,time of fully awake,rate of successful anesthesia,additional dose of ciprofol,satisfaction score and incidence of adverse events were recorded.Results Compared with T0,MAP at T1,T2 and T3 in two groups was decreased,HR at T1 in group E,HR at T1,T2 and T3 in group S and SpO2 at T1 and T2 in group S were decreased,the differences were statistically significant(P<0.05).Compared with T1,MAP and HR at T2 in two groups were increased,the differences were statistically significant(P<0.05).Compared with group E,MAP in group S at T1,T2 and T3,HR and SpO2 at T1 and T2 in group E were decreased,the differences were statistically significant(P<0.05).Compared with the group E,the additional dosage of ciprofol,the incidence of hypoxemia and hypotension were increased,the satisfaction of anesthesiologists was decreased in group S,the differences were statistically significant(P<0.05).Conclusion For opioid-free anesthesia,esketamine is feasible for colonoscopy anesthesia in elderly patient,and the incidence of hypoxemia and hypotension is low.

Detection of upper gastrointestinal disorders in patients with positive fecal immunochemical test (FIT) and normal colonoscopy: a cross-sectional study

Introduction: Colorectal cancer (CRC) is the second most prevalent cancer in the world, and the fecal immunochemical test (FIT) can be mentioned among the CRC screening methods based on the detection of occult blood in the feces, which may indicate upper gastrointestinal (UGI) malignancies; therefore, patients with a positive FIT but normal colonoscopy may be considered for a UGI endoscopy. Materials and Methods: The present study was conducted on patients with a positive FIT who were submitted to colonoscopy with normal results. They subsequently underwent endoscopy for the detection of UGI disorders. Results: We included 121 patients (64.5% of women and 35.5% of men; average age: 58.85 ± 12.93 years), 72.7% of whom were positive for Helicobacter pylori. The predominant result of the UGI endoscopy was normal, followed by erythema of the gastric mucosa, and anemia and dyspepsia were the most common clinical findings. The most common pathological result was chronic gastritis, followed by acute gastritis. Only one patient presented stomach cancer (adenocarcinoma). Conclusion: Considering the small prevalence of cancer in the UGI endoscopies of patients with positive FIT and normal colonoscopy, to the performance of UGI endoscopy in these patients may not be necessary. (AU)

Estrategias para mejorar la tasa de detección de adenomas y pólipos serrados durante una colonoscopia / Strategies to improve the detection rate of adenomas and serrated polyps during a colonoscopy

Adenoma detection rate (ADR) is a key quality indicator in screening colonoscopy, closely linked to colorectal cancer (CRC) prevention. Currently, the minimum recommended ADR is > 30% with an aspirational goal of > 35%; and the sessile serrated lesion detection rate (SSLDR) minimum is > 7% with an aspirational goal of > 10%. Improving the detection of adenomas and serrated lesions involves rigorous bowel preparation, using the validated Boston Bowel Preparation Scale (BBPS) with an adequate or superior score (≥ 6, with each segment ≥ 2: right-transverse-left) (minimum > 90% and > 95% aspirational goal). The most basic strategy is to implement split-dose bowel preparation regimens. A minimum withdrawal time of 6 minutes, ideally extended to 9 minutes, improves ADR and SSLDR, especially in the proximal colon. Incorporating techniques such as double examination of the right colon (retroflexion or second forward view), water-assisted colonoscopy, enhanced imaging endoscopy technologies (e.g., NBI, TXI, LCI, BLI), distal attachment devices, artificial intelligence systems (CADe), along with monitoring, feedback, continuing education, and teamwork, are key strategies to increase ADR and SSLDR, consequently, reduce the risk of post-colonoscopy or interval CRC.

La tasa de detección de adenomas (ADR) es un indicador de calidad fundamental en la colonoscopia de tamizaje, estrechamente relacionado con la prevención del cáncer colorrectal (CCR). Actualmente la ADR mínima reco- mendada es > 30% y aspiracional > 35%; y la tasa de detección de lesiones serradas sésiles (SSLDR) mínima > 7% y aspiracional > 10%. Mejorar la detección de adenomas y pólipos serrados implica una preparación intestinal rigurosa, utilizando la escala validada de Boston con puntuación adecuada o superior (≥ 6, con cada segmento ≥ 2: derecho-transverso-izquierdo) (mínimo > 90% y > 95% meta aspiracional). Siendo la estrategia más básica implementar regímenes de preparación intestinal en dosis divididas. Un tiempo de retirada mínimo de 6 minutos, idealmente extendido a 9 minutos, mejora la ADR y SSLDR, especialmente en el colon proximal. La incorporación de técnicas como la doble inspección del colon derecho (retroflexión o segunda visión frontal), la colonoscopia asistida por agua, tecnologías de endoscopia con imagen mejorada (ej: NBI, TXI, LCI, BLI), dispositivos de fija- ción distal, sistemas de inteligencia artificial (CADe), junto con la monitorización, retroalimentación, educación continua y trabajo en equipo, son estrategias clave para aumentar la ADR y SSLDR, en consecuencia, reducir el riesgo de CCR posterior de colonoscopia o intervalo.

Mucosectomía endoscópica bajo el agua: una técnica segura y efectiva entre la mucosectomía convencional y la disección submucosa / Underwater endoscopic mucosal resection: a safe and effective technique between conventional mucosectomy and submucosal dissection

Background: Underwater endoscopic mucosal resection (UEMR) emerges as a less complex alternative to endos- copic submucosal resection (ESD) for the treatment of colorectal lesions. We present two clinical cases of complex colon adenomas resolved using UEMR technique. Case 1: A 56-years-old male patient with an adenoma identified at the splenic flexure, detected during a screening colonoscopy, whose biopsy revealed low-grade dysplasia. A flat elevated lesion of approximately 30 mm is identified, with a mixed granular lateral spread (LST-GM) and a centra- lly elevated area as the dominant nodule (0-IIa+Is), without signs of deep invasion. UEMR is performed, achieving a complete block resection. Case 2: A 62-year-old female patient referred for endoscopic resection of a complex adenoma in the transverse colon. A type 0-IIa lesion is observed with a smooth convergence of folds towards its periphery, approximately 15 mm in size, and a non-categorical crypt pattern of submucosal invasion. Insufflation and peristalsis tests did not show categorical elements of deep invasion. Resection is performed in sections using the UEMR technique, without complications. Conclusion: UEMR appears as a more effective alternative than conventional endoscopic mucosal resection (CEMR) and simpler and more accessible than ESD for the resection of colon adenomas larger than 20 mm, supported by controlled clinical studies. However, a more in-depth eva- luation of its scope, effectiveness, and safety is still required to establish its role in regular endoscopic practice.

Introducción: La mucosectomía endoscópica bajo agua (UEMR) surge como una alternativa menos compleja que la resección endoscópica submucosa (ESD) para el tratamiento de lesiones colorrectales. Presentamos a continua- ción dos casos clínicos de adenomas complejos de colon resueltos mediante la técnica UEMR. Caso 1: Paciente masculino de 56 años con un hallazgo de adenoma a nivel del ángulo esplénico, detectado en colonoscopía de tamizaje, cuya biopsia evidenció una displasia de bajo grado. Se identifica una lesión plana elevada de aproxi- madamente 30 mm, de extensión lateral granular mixta (LST-GM) con área central solevantada como nódulo dominante (0-IIa+Is), sin signos de invasión profunda. Se realiza una UEMR logrando una resección en bloque. Caso 2: Paciente femenina de 62 años, referida para resección endoscópica de un adenoma complejo de colon transverso. Se observó lesión tipo 0-IIa con confluencia suave de pliegues hacia su periferia de aproximadamente 15 mm con patrón de criptas no categórico de invasión submucosa. Las pruebas de insuflación y peristaltismo no evidenciaron elementos categóricos de invasión profunda. Se realiza resección por parcialidades con técnica de UEMR, sin complicaciones. Conclusión: La UEMR se presenta como una alternativa más efectiva que la CEMR y más simple y accesible que la ESD para la resección de adenomas de colon mayores de 20 mm, respaldada por estudios clínicos controlados. Sin embargo, aún se requiere una evaluación más profunda de sus alcances, efecti- vidad y seguridad, para establecer su papel en la práctica endoscópica regular.

The association between anthropometric indicators and colorectal polyps and diverticulosis

Introduction: Colonic polyps and diverticulosis are common colon findings on colonoscopy. One of the risk factors of colorectal polyps and diverticulosis is the anthropometric index. Therefore, we aimed to investigate the association between the anthropometric index and colorectal findings. Methods: In this cross-sectional study, we included 536 patients referred to Razi Hospital, Rasht, Iran, in 2023 for colonoscopy evaluation. Demographical data, clinical characteristics, and colonoscopy findings were recorded for further analysis. All data were analyzed using SPSS.16 by considering a significant level < 0.05. Results: The results showed that 35.4% of the patients had polyps, with the majority having a single polyp. The patient's mean age was 55.94 ± 13.33 years; most were females (54.1%). The most common type of polyp was pedunculated, and most were located in the sigmoid colon. The prevalence of diverticular was 11.4%, most of which were also located in the sigmoid colon. Obesity was significantly associated with an increased risk of polyps, while overweight individuals had a higher risk of diverticula (P < 0.05). Age, rural residence, and low physical activity level were identified as factors associated with an increased risk of polyps and diverticula. Conclusion: The findings suggest that obesity and overweight are risk factors for polyps and diverticula, respectively. Further research is warranted to explore additional factors and develop preventive strategies for colorectal diseases. These results support the need for preventive strategies and screening programs to reduce the risk of future colorectal lesions. (AU)

Patients' description of rectal effluents help predict the quality of colonoscopy preparation

Introduction: Evaluation of patients' reports of characteristics of rectal effluents as a predictor of the quality of the colonoscopy preparation assessed by the endoscopist. Methods: A total of 270 patients, aged 18 or older, were consecutively included to perform an outpatient colonoscopy, for a period of 8 months. Demographic and clinical data were collected and evaluated, as well as the rectal effluents' characteristics and data concerning the colonoscopy. The quality of bowel preparation was evaluated by employing the Boston Bowel Preparation Scale. The association between rectal effluents and the quality of preparation was verified by binary logistic regression. Results: Of the 270 patients, 67.3% were female, with a mean age of 59.69 ± 12.48 years. Reports of dark and thick, dark orange, or brown and thick effluents produced a higher likelihood of inadequate preparation (OR 4.26, CI 95% 1.51; 11.14, p = 0.004). Conclusions Reports of dark and thick, dark orange, or brown and thick rectal effluents are predictors of inadequate preparation in the endoscopist assessment. (AU)

Alça quente versus alça fria para polipectomias colorretais de até 10 mm: uma revisão sistemática e meta-análise de ensaios clínicos randomizados / Hot versus cold snare for colorectal polypectomies sized up to 10mm: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT Background: Colorectal cancer is the third most common cancer, and prevention relies on screening programs with resection complete resection of neoplastic lesions. Objective: We aimed to evaluate the best snare polypectomy technique for colorectal lesions up to 10 mm, focusing on complete resection rate, and adverse events. Methods: A comprehensive search using electronic databases was conducted to identify randomized controlled trials comparing hot versus cold snare resection for polyps sized up to 10 mm, and following PRISMA guidelines, a meta-analysis was performed. Outcomes included complete resection rate, en bloc resection rate, polypectomy, procedure times, immediate, delayed bleeding, and perforation. Results: Nineteen RCTs involving 8720 patients and 17588 polyps were included. Hot snare polypectomy showed a higher complete resection rate (RD, 0.02; 95%CI [+0.00,0.04]; P=0.03; I 2=63%), but also a higher rate of delayed bleeding (RD 0.00; 95%CI [0.00, 0.01]; P=0.01; I 2=0%), and severe delayed bleeding (RD 0.00; 95%CI [0.00, 0.00]; P=0.04; I 2=0%). Cold Snare was associated with shorter polypectomy time (MD -46.89 seconds; 95%CI [-62.99, -30.79]; P<0.00001; I 2=90%) and shorter total colonoscopy time (MD -7.17 minutes; 95%CI [-9.10, -5.25]; P<0.00001; I 2=41%). No significant differences were observed in en bloc resection rate or immediate bleeding. Conclusion: Hot snare polypectomy presents a slightly higher complete resection rate, but, as it is associated with a longer procedure time and a higher rate of delayed bleeding compared to Cold Snare, it cannot be recommended as the gold standard approach. Individual analysis and personal experience should be considered when selecting the best approach.

RESUMO Contexto: O câncer colorretal é o terceiro câncer mais comum na população, e a prevenção é principalmente baseada em programas de screening, com a ressecção completa de lesões neoplásicas. Múltiplas técnicas de ressecção estão disponíveis, mas ainda há controvérsias sobre a melhor abordagem, especialmente em relação à taxa de ressecção completa e à taxa de sangramento tardio. Objetivo: Nosso objetivo foi avaliar a melhor técnica de polipectomia com alça para lesões colorretais de até 10 mm. Métodos: Foi realizada uma busca abrangente em bancos de dados eletrônicos (MEDLINE e EMBASE) para identificar ensaios clínicos randomizados que comparassem a ressecção com alça quente versus alça fria para pólipos de até 10 mm, seguindo as diretrizes PRISMA. Os desfechos incluíram taxa de ressecção completa, taxa de ressecção em bloco, tempo de polipectomia, tempo total do procedimento, sangramento imediato, sangramento tardio e perfuração. Resultados: Dezenove ensaios clínicos randomizados foram incluídos, totalizando 8.720 pacientes e 17.588 pólipos. A polipectomia com alça quente foi associada a uma maior taxa de ressecção completa (RD, 0,02; IC95% [+0,00, 0,04]; P=0,03; I 2=63%), embora também tenha sido associada a uma taxa mais alta de sangramento tardio (RD 0,00; IC95% [0,00, 0,01]; P=0,01; I 2=0%) e de sangramento tardio grave (RD 0,00; IC95% [0,00, 0,00]; P=0,04; I 2=0%). A polipectomia com alça fria foi associada a um menor tempo de polipectomia (MD -46,89 segundos; IC95% [-62,99, -30,79]; P<0,00001 I 2=90%) e a um menor tempo total de colonoscopia (DM -7,17 minutos; IC95% [-9,10, -5,25]; P<0,00001 I 2=41%). Não houve diferença significativa na taxa de ressecção em bloco (RD, 0,00; IC95% [-0,01, 0,01]; P=0,20; I 2=30%) ou na taxa de sangramento imediato (RD -0,00; IC95% [-0,01, 0,00]; P=0,34; I 2=11%). Não foram relatados casos de perfuração em nenhum dos grupos. Conclusão: A polipectomia com alça quente apresenta uma taxa ligeiramente mais alta de ressecção completa, mas, como está associada a um tempo de procedimento mais longo e a uma taxa mais alta de sangramento tardio em comparação com a polipectomia com alça fria, não pode ser recomendada como a abordagem padrão. A análise individualizada e a experiência pessoal devem ser consideradas ao escolher a melhor abordagem.

Síndrome de Ogilvie: manejo actual a propósito de un caso

Objetivo: Dar a conocer las últimas recomendaciones para la sospecha, el diagnóstico y el tratamiento médico y quirúrgico del síndrome de Ogilvie. Material y método: Estudio descriptivo, retrospectivo, observacional; en formato de caso clínico y revisión de la literatura actual, a través de PubMed, Scielo y otros motores de búsqueda de artículos científicos. Discusión y Conclusiones: La seudoobstrucción colónica aguda o síndrome de Ogilvie consiste en un íleo adinámico severo y dilatación masiva de asas del colon en ausencia de obstrucción mecánica. Se presenta, principalmente, en pacientes postquirúrgicos o severamente enfermos. Tienen riesgo de perforación aproximado del 3% y una mortalidad del 50%, la mayoría de los pacientes responden al manejo médico conservador. La descompresión colonoscópica puede ser necesaria en pacientes que no responden al tratamiento médico de soporte y a la descompresión farmacológica con neostigmina. Distintos grados de isquemia y/o perforación colónica obligan la reso-lución quirúrgica urgente en algunos casos, lo que define la morbimortalidad. Es importante la sospecha clínica de este síndrome para evitar complicaciones posiblemente fatales.

Objective: To present the latest recommendations for the suspicion, diagnosis and medical and surgical treatment of Ogilvie syndrome. Materials and methods: Descriptive, retrospective, observational study; in clinical case format and review of the current literature, through PubMed, Scielo and other search engines for scientific articles Discussion and Conclusions: Acute colonic pseudo-obstruction or Ogilvie syndrome consists of a severe adynamic ileus and massive dilatation of the colonic loops in the absence of mechanical obstruction. It occurs in post-surgical or severely ill patients. They have a risk of perforation of approximately 3% and a mortality of 50%, most patients respond to conservative medical management. Colonoscopic decompression may be necessary in patients who do not respond to supportive medical treatment and drug decompression with neostigmine. Different degrees of colonic ischemia and / or perforation require urgent surgical resolution in some cases, which defines morbidity and mortality. Clinical suspicion of this syndrome is important to avoid possibly fatal complications.

Primary Anorectal Melanoma: Case Report and Review of a Rare Neoplasm

Primary anorectal melanoma is a rare malignant melanocytic neoplasm; its principal manifestation is rectal bleeding. It has an ominous prognosis with a five-year survival rate of 10%. The case of a 56-year-old woman with rectal bleeding and the sensation of a rectal mass is presented. A polypoid lesion, resected transanally, was documented in the distal rectum during the colonoscopy. The histological study confirmed a primary anorectal melanoma.

El melanoma anorrectal primario es una neoplasia melanocítica maligna poco frecuente, su principal manifestación es el sangrado rectal. Tiene un pronóstico ominoso con una tasa de sobrevida del 10% a 5 años. Se presenta el caso de una mujer de 56 años con rectorragia y sensación de masa rectal. Durante la colonoscopia se documentó una lesión polipoide en el recto distal, que se resecó por vía transanal. El estudio histológico confirmó la presencia de un melanoma anorrectal primario.