The impact of low- versus standard-volume bowel preparation on participation in primary screening colonoscopy: a randomized health services study.

BACKGROUND: The aim of this study was to evaluate the impact of low-volume vs. standard-volume bowel preparation on participation in screening colonoscopy, bowel preparation quality, and lesion detection rates. METHODS: This was a multicenter, randomized, health services study within the population-based primary colonoscopy screening program in Poland. Individuals aged 55 - 62 years were randomized in a 1:1 ratio to bowel preparation with a low-volume (0.3 L sodium picosulfate with magnesium citrate) or standard-volume (4 L polyethylene glycol) regimen and then invited to participate in screening colonoscopy. The primary outcome measure was the rate of participation in screening colonoscopy. Compliance with the assigned bowel preparation, bowel preparation quality, and lesion detection rates were also evaluated. RESULTS: A total of 13 621 individuals were randomized and 13 497 were analyzed (6752 in the low-volume group and 6745 in the standard-volume group). The participation rate (16.6 % vs. 15.5 %; P = 0.08) and compliance rate (93.3 % vs. 94.1 %; P = 0.39) did not differ significantly between the groups. In the low-volume group, fewer participants had adequate bowel preparation compared with the standard-volume group (whole colon 79.0 % vs. 86.4 %, P < 0.001; proximal colon 80.1 % vs. 87.3 %, P < 0.001). Detection rates of advanced adenoma (AADR) and advanced serrated polyps (ASPDR) were lower in the low-volume group than in the standard-volume group (AADR in the proximal colon 2.6 % vs. 4.3 %, P = 0.02; ASPDR in the whole colon 2.0 % vs. 3.3 %, P = 0.04; ASPDR in the proximal colon 1.0 % vs. 1.9 %, P = 0.048). CONCLUSION: When compared with a standard-volume bowel preparation with polyethylene glycol, low-volume bowel preparation with sodium picosulfate/magnesium citrate did not improve participation rate or lesion detection rates, and negatively affected bowel preparation quality.

Benign mesocolon schwannoma in PET/CT and immunohistochemistry assessment: a case report.

Schwannoma is a common soft tissue tumour, but it appears to be very rare in the gastrointestinal tract. Benign schwannoma develops extremely rarely in the mesocolon, with only 2 patients reported in the literature. A 75-year-old woman was admitted to our Department of Oncological Surgery with an abdominal mass, which was discovered incidentally during abdominal ultrasound examination. Positron emission tomography/ computed tomography imaging with the use of 18F-fluorodeoxyglucose (FDG PET/CT) showed an abnormal mass in the upper right abdomen with the presence of diffuse FDG uptake. A laparotomy revealed an encapsulated, non-invasive mesocolon tumour in the hepatic flexure region. Definitive diagnosis was confirmed by the histopathological examination of the postoperative preparation. Immunohistochemical staining confirmed benign mesocolon schwannoma. Previous cases indicate that schwannomas in the mesocolon are benign tumours. Our patient had a good prognosis even after enucleation treatment. Although schwannomas are very rare and generally asymptomatic, the differential diagnosis of schwannomas and gastrointestinal stromal tumours is important for practical purposes.

Clinical value of colonoscopy and positron emission tomography with computed tomography for colorectal cancer diagnosis.

INTRODUCTION: Colonoscopy and PET / CT are among the major diagnostic tests for colorectal cancer. The sensitivity, specificity, and accuracy of these studies are still being assessed differently. OBJECTIVE: The aim of the study was to compare the sensitivity, specificity and accuracy of colonoscopy and PET / CT in the diagnosis of colorectal cancer. MATERIAL AND METHODS: The medical records of 125 patients with colonoscopy and PET / CT in the years 2014-2015 were analyzed retrospectively. The research was done at the Professor Franciszek Lukaszczyk Oncology Center in Bydgoszcz. Based on the macroscopic description of colonoscopy, the results were divided into two groups: with and without probability of cancer. The average SUV value in PET / CT for colorectal cancer was calculated and without this diagnosis. The average value of SUV 14 and higher was considered probable, while 11 or less had no probability of cancer. Standardized mathematical formulas were used to evaluate the sensitivity, specificity and accuracy. RESULTS: More than half of the patients - 78 (62.4%) were males. The majority of patients -42 (36.6%) were aged 65-74. The majority (106) (68.8%) were diagnosed as polyps and 24 (15.6%) as tumor-like lesions. Polyps were placed in the rectum -32 (30.2%), in the sigmoid colon - 26 (24.5%) and 15 (13.2%) in the ascending colon. Tumors were located in the rectum - 11 (45.8%) and 4 (16.7%) in the recto-sigmoid junction. 38 (24.6%) adenocarcinomas and 67 (43.5%) adenomas were diagnosed. The detection rate of RJG was 32% in colonoscopy and PET / CT. The sensitivity of the colonoscopy was 80%, the specificity - 68.4% and the accuracy - 71.4%. The sensitivity, specificity and accuracy of PET / CT were 65%, 75%, 4% and 72.7%, respectively. CONCLUSIONS: Colonoscopy has a higher sensitivity in colorectal cancer diagnosis, but specificity and accuracy are higher in PET / CT.

Diagnosis and treatment of early gastric cancer: experience of one center.

INTRODUCTION: Gastric cancer is one of the most common malignant neoplasms in the world. Currently it constitutes the third cause of death among all malignancies. New endoscopic techniques have a potential to improve treatment results due to more frequent detection of early gastric cancer. AIM: To summarize our experience in diagnosis and treatment of early gastric cancer patients. MATERIAL AND METHODS: We analyzed the results of endoscopic examination, histopathological findings and treatment methods in 16 patients who were diagnosed with early gastric cancer in the Endoscopy Unit of the Oncology Center in Bydgoszcz between 2014 and 2016. RESULTS: Between 2014 and 2016 sixteen patients, 12 (75.0%) male and 4 (25.0%) female, were diagnosed with early gastric cancer. The average age of patients was 65.5 years. Surgery qualification concerned mainly G2 and G3 adenocarcinomas. In 12 (75.0%) patients total gastrectomy was performed, and 1 patient underwent wedge resection of the prepyloric part of the stomach. In 3 cases endoscopic submucosal dissection (ESD) was performed. Histopathological examination of both biopsy and postoperative material indicated 8 (50.0%) cases of intestinal-type adenocarcinoma, 7 (43.75%) cases of diffuse-type adenocarcinoma and 1 (6.25%) case of mixed-type adenocarcinoma. During the follow-up after treatment, none of the patients was diagnosed with local or distant recurrence. CONCLUSIONS: Accurate examination technique allows for detection of early gastric cancer. Selected cases of early gastric cancer may be treated with advanced endoscopic techniques.

Barrett's esophagus and gland cancer - the experience of one center.

OBJECTIVE: The aim of the study was to evaluate the prevalence and clinical aspects of Barrett's esophagus and adenocarcinoma of the lower part of esophagus in gastroscopy. MATERIAL AND METHODS: Retrospective review of 10000 upper gastrointestinal endoscopic examinations were performed at the Department of Oncology Endoscopy in Bydgoszcz from 2004 to 2014 in terms of incidence of Barrett's esophagus and adenocarcinoma in the lower part of esophagus. RESULTS: The medical records of 5378 (53.8%) women and 4622 (46.2%) men were analyzed. The average age of men and women was 62.4 and 62.7, respectively. Barrett's esophagus was diagnosed in 67 patients, including 38 (56.7%) of men where the average age of men and women was 56.9 and 60.2 years, respectively. The most commonly reported symptom was heartburn occurred in 45 (67.2%) of patients. During ten years of follow-up PB examination the adenocarcinomas were detected in 3 (4.47%) cases. Adenocarcinoma was diagnosed in 46 patients, of whom 37 in men. In the case of 27 patients (58.7%), esophageal cancer was treated with the intention of radicalization. The probability of 5-year survival in these patients was 10.2% for women and 9.2% for men. CONCLUSIONS: The number of Barrett's esophagus and adenocarcinoma are increasing at 0.67% and 0.46% annually, respectively. The risk of adenocarcinoma developed from Barrett's esophagus during endoscopic follow-up period was 4.47%. Barrett's esophagus is more common in men before the age of 60, and nearly half of them have intestinal metaplasia without dysplasia. Probability of 5-year survival in patients with adenocarcinoma was 9.7%.

[Evaluation of positron emission tomography by using F-18-fluorodeoxyglucose in diagnosis of recurrent colorectal cancer]. / Ocena pozytonowej tomografii emisyjnej z uzyciem F-18-fluorodeoksyglukozy w rozpoznawaniu wznowy raka jelita grubego.

UNLABELLED: Accurate detection of recurrent colorectal carcinoma remains a clinical challenge. 18-F-fluorodeoxyglucose-positron emission tomography is new imaging technique that allows direct evaluation of cellular metabolism. This method is mainly used in oncology, especially in fusion with computer tomography (FDG-PET/CT, PET/CT Fusion). The aim of the study was to evaluate the usefulness of FDG-PET/CT in diagnosis of recurrent colorectal cancer. MATERIAL AND METHODS: The results of FDG-PET/CT scan performed in 120 patients who had suspected recurrence disease were analyzed retrospectively. The definite diagnosis was established on the basis of histopathological examination or clinical follow-up. FDG-PET/CT results were compared with 76 computer tomography (CT), 30 magnetic resonance imaging (MRI), 81 ultrasonography (US), 75 chest roentgenogram (X-ray) and 91 carcinoembryonic antigen (CEA) test. RESULTS: Recurrence colorectal cancer was demonstrated on FDG-PET-CT in 69 patients (57.5%). In 24 patients local recurrence, 33 liver metastases, 23 pulmonary metastases and in 36 other metastases were found. A total of 116 suspicious lesions were identified. The final diagnosis of recurrence was obtained in 56 patients (46.6%). Sensitivity, specificity, and accuracy for malignant findings were: for FDG-PET/CT 98, 94 and 97%; for CEA test 68, 82 and 72%; for CT scan 85, 91 and 89%; for RMI scan 96, 86 and 93%; for ultrasound test 71, 96 and 82%; for X-ray 87, 96 and 92%, respectively. FDG-PET-CT influenced surgical decisions in 23.6% of cases. CONCLUSIONS: FDG-PET/CT is a very useful diagnostic method in case of patients with suspected recurrence of colorectal carcinoma. Its usefulness is higher than the serum level of CEA and other conventional imaging modalities (CT MRI, US, X-ray).