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      Call for Papers: Artificial Intelligence in Gastroenterology

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      About Digestion: 3.2 Impact Factor I 6.4 CiteScore I 0.914 Scimago Journal & Country Rank (SJR)

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      Flexible Sigmoidoscopy Does Not Significantly Increase Polyp and Cancer Detection Yield when Used to Supplement CT Colonography

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          Abstract

          Background and Aims: Flexible sigmoidoscopy (FS) increases polyp and carcinoma detection in addition to double contrast barium enema (DCBE). However, CT colonography (CTC) is now the preferred technique. Our aim was to explore whether FS increases polyp and carcinoma detection rates when used in addition to CTC. Methods: Patients who underwent FS and CTC between 2007 and 2009 were included and data were collected from patient records. Yields of polyp, adenoma and carcinoma detection were calculated for FS and CTC. Results: In a cohort of 294 patients, CTC detected 36 patients with carcinomas while FS detected 28. One rectal cancer not seen on CTC was diagnosed by FS. Polyps were seen by CTC in 66 and FS in 45 patients. In 5 patients FS found polyps that were not detected by CTC; 3 of which were small adenomas. FS detected extra adenomas or carcinomas in 1.36% (4/294). Adding FS to CTC neither increased the cancer nor the polyp detection yield significantly. Conclusions: This first study investigating the use of FS in addition to CTC detected little additional pathology. The routine use of FS as a supplement to CTC for adenoma and carcinoma detection is of questionable utility.

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          Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy.

          F Macrae, B C Morson, C Lindsay DeVane … (1984)
          The histopathological features and results of treatment of malignant polyps removed by endoscopic polypectomy from 60 patients are presented. The patients were followed for a minimum of five years. Forty six patients were treated by polypectomy alone as local excision was judged complete and the invasive carcinoma was well or moderately well differentiated. Thirty seven of these patients are alive and well after five years and the remaining nine have died of other causes up to four years later: there was no evidence of recurrence in any of these cases. Fourteen patients underwent a subsequent major surgical resection and residual tumour was found at the site of polypectomy in two cases but regional lymph nodes were not involved. Only one patient from this group with a high grade tumour developed metastases although the operative specimen was free of tumour. Malignant polyps can be successfully treated by polypectomy alone provided both the laboratory techniques of examination and the histopathological criteria are strictly applied.
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            Patient preferences for CT colonography, conventional colonoscopy, and bowel preparation.

            Alexander McFarland, B Weinstock-Guttman, Stephen Ristvedt … (2003)
            The aim of this study was to determine patient pre-examination expectations and postexamination appraisals for CT colonography, conventional colonoscopy and bowel preparation. Prospective evaluation of 120 patients at defined risk for colorectal neoplasia was performed with CT colonography followed by colonoscopy on the same day. Subjects were stratified by age and sex (67 women and 53 men) and were randomized to receive either manual air (n = 61) or CO(2) (n = 59) insufflation during CT colonography. Patients' expectations were assessed just before the two examinations, and appraisals were assessed 2 to 3 days afterward regarding pain/discomfort, embarrassment, difficulty, overall assessment, preference for future testing, and bowel preparation. No significant differences were found in appraisals of manual air versus CO(2) insufflation techniques. For both CT colonography and colonoscopy, patients' appraisals after the procedure were significantly more positive than prior expectations. Patients expressed more favorable appraisals of colonoscopy for pain (p < 0.001) and embarrassment (p < 0.001), with most responses being "none" to "a little" for both examinations. Overall appraisals of the tests were favorable and similar between CT and colonoscopy: patients mainly expressed "not unpleasant" to "a little unpleasant" (95%, 114/120 for both examinations). Overall, appraisal of the bowel preparation was the most negative. Preferences for future testing were more favorable toward CT: of the patients, 58% (69/120) preferred CT, 14% (17/120) preferred colonoscopy, and 28% (34/120) had no preference. Overall appraisals were similar and positive for both CT colonography and colonoscopy, with less favorable appraisals of the bowel preparation. Most patients stated that they would prefer CT for future evaluation.
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              Meta-analysis comparing CT colonography, air contrast barium enema, and colonoscopy.

              Mark A Korsten, M Rosman (2007)
              Published studies have reported a wide range of sensitivities and specificities for computed tomographic (CT) colonography for polyp detection, generating controversy regarding its diagnostic accuracy. A meta-analysis of published studies comparing the accuracies of CT colonography and colonoscopy for polyp detection was performed. The pooled per-patient sensitivities and specificities were calculated at various thresholds for polyp size. Summary receiver operating characteristic (sROC) curves were also constructed. Thirty studies were included in the meta-analysis of CT colonography. The pooled per-patient sensitivity of CT colonography was higher for polyps greater than 10 mm (0.82, 95% confidence interval [CI], 0.76-0.88) compared with polyps 6 to 10 mm (0.63, 95% CI, 0.52-0.75) and polyps 0 to 5 mm (0.56, 95% CI, 0.42-0.70). Similarly, the exact area under the sROC curve (area +/- standard error) was higher using a threshold greater than 10 mm (0.898 +/- 0.063) compared with thresholds of greater than 5 mm and any size (0.884 +/- 0.033 and 0.822 +/- 0.059, respectively). There were no significant differences in the diagnostic characteristics of 2-dimensional versus 3-dimensional CT colonography. At a threshold greater than 5 mm, the exact area under the sROC curve was significantly higher for endoscopic colonoscopy compared with CT colonography (0.998 +/- 0.006 vs 0.884 +/- 0.033, P < .005). CT colonography has a reasonable sensitivity and specificity for detecting large polyps but was less accurate than endoscopic colonoscopy for smaller polyps. Thus, CT colonography may not be a reasonable alternative in situations in which a small polyp may be clinically relevant.
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                Author and article information

                Journal
                Journal ID (publisher-id): DIG
                Journal ID (nlm-ta): Digestion
                Journal ID (doi): 10.1159/issn.0012-2823
                Title: Digestion
                Publisher: S. Karger AG
                ISSN (Print): 0012-2823
                ISSN (Electronic): 1421-9867
                Publication date Subscription-year: 2012
                Publication date (Print): January 2012
                Publication date (Electronic): 29 December 2011
                Volume: 85
                Issue: 1
                Pages: 55-60
                Affiliations
                Departments of aGastroenterology and bRadiology, University Hospitals of South Manchester NHS Foundation Trust, Manchester, UK
                Author notes
                *Christian Selinger, Department of Gastroenterology, University Hospitals of South Manchester NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (UK), E-Mail christian.Selinger@web.de
                Article
                Publisher ID: 334702 Other ID: Digestion 2012;85:55–60
                DOI: 10.1159/000334702
                PubMed ID: 22212742
                SO-VID: e9019283-193e-4e2f-9901-f82563405a3e
                Copyright © © 2011 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 17 June 2011
                Date accepted : 25 October 2011
                Page count
                Figures: 4, Tables: 3, Pages: 6
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Oncology & Radiotherapy,Gastroenterology & Hepatology,Surgery,Nutrition & Dietetics,Internal medicine
                Keywords: Double contrast barium enema,Polyp and cancer detection,CT colonography,Flexible sigmoidoscopy
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy, Gastroenterology & Hepatology, Surgery, Nutrition & Dietetics, Internal medicine
                Keywords: Double contrast barium enema, Polyp and cancer detection, CT colonography, Flexible sigmoidoscopy

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