scholarly journals The importance of colonoscopy bowel preparation for the detection of colorectal lesions and colorectal cancer prevention

2020 ◽  
Vol 08 (05) ◽  
pp. E673-E683 ◽  
Author(s):  
Prateek Sharma ◽  
Carol A. Burke ◽  
David A. Johnson ◽  
Brooks D. Cash
Keyword(s):  
Colorectal Cancer ◽  
Bowel Preparation ◽  
Clinical Importance ◽  
High Volume ◽  
High Quality ◽  
Crc Screening ◽  
Incidence And Mortality ◽  
Low Volume ◽  
Split Dosing ◽  
Bowel Preparations

Abstract Background and study aims Colonoscopy for colorectal cancer (CRC) screening has reduced CRC incidence and mortality and improved prognosis. Optimal bowel preparation and high-quality endoscopic technique facilitate early CRC detection.This review provides a narrative on the clinical importance of bowel preparation for colonoscopy and highlights available bowel preparations. Methods A PubMed search was conducted through June 2019 to identify studies evaluating clinical outcomes, efficacy, safety, and tolerability associated with bowel preparation for CRC screening-related colonoscopy. Results Selecting the optimal bowel preparation regimen is based on considerations of efficacy, safety, and tolerability, in conjunction with individual patient characteristics and preferences. Available bowel preparations include high-volume (4 L) and low-volume (2 L and 1 L), polyethylene glycol (PEG) solutions, sodium sulfate, sodium picosulfate/magnesium oxide plus anhydrous citric acid, sodium phosphate tablets, and the over-the-counter preparations magnesium citrate and PEG-3350. These preparations may be administered as a single dose on the same day or evening before, or as two doses administered the same day or evening before/morning of colonoscopy. Ingesting at least half the bowel preparation on the day of colonoscopy (split-dosing) is associated with higher adequate bowel preparation quality versus evening-before dosing (odds ratio [OR], 2.5; 95 % confidence interval [CI], 1.9−3.4). Conclusions High-quality bowel preparation is integral for optimal CRC screening/surveillance by colonoscopy. Over the last 30 years, patients and providers have gained more options for bowel preparation, including low-volume agents with enhanced tolerability and cleansing quality that are equivalent to 4 L preparations. Split-dosing is preferred for achieving a high-quality preparation.

scholarly journals Colorectal cancer screening behaviors of general surgeons and first-degree family members: a survey-based study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Suleyman Utku Celik ◽  
Hasan Gorkem Cay ◽  
Ersin Bayrakdar ◽  
Aysima Ince ◽  
Esra Nur Ince ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Family Members ◽  
High Volume ◽  
Routine Screening ◽  
Care Providers ◽  
Crc Screening ◽  
First Degree Relatives ◽  
General Surgeons ◽  
Low Volume ◽  
Screening Behaviors

Abstract Background Colorectal cancer (CRC) screening rates are low in the general population and among health care providers. The aim of this study was to evaluate the CRC screening practices of general surgeons who provide specialized diagnostic testing and CRC treatment and to examine the CRC screening behaviors of their first-degree family members. Methods A cross-sectional survey was conducted among general surgeons who attended the 21st National Surgical Congress in Turkey held from April 11th to 15th, 2018. The survey included items on demographics, screening-related attitude, CRC screening options, barriers to CRC screening, and surgeons’ annual volumes of CRC cases. Results A total of 530 respondents completed the survey. Almost one-third of the responding surgeons (29.4%, n = 156) were aged over 50 years, among whom approximately half (47.1%, n = 74) reported having undergone CRC screening and preferring a colonoscopy as the screening modality (78.4%). Among general surgeons aged 50 years and older, high-volume surgeons (≥25 CRC cases per year) were more likely to undergo screening compared with low-volume surgeons (< 25 CRC cases per year). The respondents aged below 50 years reported that 56.1% (n = 210) of their first-degree relatives were up-to-date with CRC screening, mostly with colonoscopy. Compared to low-volume surgeons aged below 50 years, high-volume surgeons’ first-degree relatives were more likely to be up-to-date with CRC screening. Conclusion The survey results demonstrated that routine screening for CRC among surgeons and/or their first-degree relatives is currently not performed at the desired level. However, high-volume surgeons are more likely to participate in routine screening.

New Ultra Low Volume Bowel Preparation and Overview of Existing Bowel Preparations

2020 ◽  
Vol 21 (11) ◽  
pp. 844-849 ◽  
Author(s):  
Hein Htet ◽  
Jonathan Segal
Keyword(s):  
Clinical Trials ◽  
Side Effects ◽  
Bowel Preparation ◽  
High Volume ◽  
Extensive Literature ◽  
Electrolyte Disturbances ◽  
Bowel Cleansing ◽  
Bowel Prep ◽  
Low Volume ◽  
Bowel Preparations

Background: Adequate bowel cleansing is essential in achieving a good quality colonoscopy. However, one of the barriers to achieving high-quality bowel cleansing is the patient's tolerability. Different bowel preparations have been developed to improve tolerability while maintaining adequate bowel cleansing. Objectives: We aim to explore the pros and cons of commonly used bowel preparations, particularly highlighting the new ultra-low volume bowel preparation. Methods:: Extensive literature search was carried out on various databases to evaluate the effectiveness and side effects of different bowel cleansing agents, including findings of recent clinical trials on ultra-low bowel preparation. Results:: Polyethylene glycol (PEG) has been commonly used as a bowel prep. Due to its high volume required to ingest to achieve an adequate effect, it has been combined with various adjuncts to reduce the volume to make it more tolerable. Magnesium and phosphate-based preps can achieve low volume, but they can be associated with multiple side effects, mainly electrolyte disturbances. Ultra low volume prep (NER1006) was achieved by combing PEG with ascorbic acid, and its efficacy and side effects were demonstrated in three noninferiority studies. Conclusion: It is important to consider patient preferences, co-morbidities and tolerability, and efficacy and side effect profiles when choosing bowel prep for patients undergoing colonoscopy. New ultra-low bowel prep showed promising results in initial clinical trials, but further real-world post-marketing data will inform its value in clinical practice.

scholarly journals P280 Sodium picosulfate low-volume and split-dosed bowel preparation facilitates endoscopic monitoring of patients with inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S291-S292
Author(s):  
K Fasoulas ◽  
A Katsimpeli ◽  
P Kevrekidou ◽  
N Kafalis ◽  
E Stergiou ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Preparation ◽  
Bowel Disease ◽  
High Volume ◽  
Cancer Surveillance ◽  
Number Of Patients ◽  
Sodium Picosulfate ◽  
Inflammatory Bowel ◽  
Low Volume ◽  
Split Dosing

Abstract Background The concept of Treat to Target and Tight Control relies heavily on bowel mucosa assessment. This implies that multiple endoscopies should be performed for any patient with moderate to severe inflammatory bowel disease (IBD). Improving patient tolerance of bowel preparation is important as we stride for frequent endoscopic monitoring. We aimed to compare low-volume (2 litres) Sodium Picosulfate (Pico) and high-volume (4 litres) Polyethylene Glycol (PEG) bowel preparation regimens, as well as split dosing, in terms of tolerance, efficacy and safety. Methods We included all adult IBD patients of our IBD clinic who underwent colonoscopy in the last 2 years for the sole purpose of mucosal healing assessment. We excluded patients with an indication of cancer surveillance, acute severe colitis, bowel strictures with obstructive symptoms, and patients with renal or liver failure. We used a Visual Analog Scale (VAS) assessed by patients to evaluate tolerance, and Boston Bowel Preparation Scale (BBPS) assessed by physicians to evaluate efficacy. Results A total of 139 patients were included in the study: 70 (50,4%) male patients, 86 (61,8%) with Crohn’s disease and 53 (38,2%) with ulcerative colitis, with a mean age of 46,14 years (range 17–74) and mean disease duration of 10.12 years. We included 21 patients (15.1%) with a previous ileocecal resection. Low-volume Pico preparation was received by 48 (34,5%) patients. High-volume PEG preparation was received by 91 (65,5%) patients. Split dosed preparation was received by 49 (35.2%) patients. Low-volume Pico preparation was significantly better tolerated than high-volume PEG preparation (VAS 81,75 vs. 65,69, p &lt; 0,001) without a negative impact on bowel preparation quality (BBPS 7,65 vs. 7,32, p = 0.237). Split dosing did not improve tolerance (VAS 74,96 vs. 67,75, p = 0.221) but it improved the quality of the preparation (BBPS 7,94 vs. 7.13, p = 0,002). No meaningful differences were observed in terms of isolated aphthous ulcers (0% vs. 4%, p = 0,325). Complete intake of preparation was significantly higher in the low-volume Pico group (94,7% vs. 74,7%, p = 0,002). Complete colonoscopy was achieved in all patients. No serious adverse events related to the bowel preparation were reported. Patients in the low-volume Pico group were slightly younger (42,54 vs. 48,03 years, p = 0,034) and more likely to have had surgery (25% vs. 9,9%, p = 0,018). Conclusion Although this was a single-centre non-randomised study with a relatively small number of patients, it clearly demonstrated that low-volume PICO split dosed bowel preparation is superior for IBD patients scoped to check for endoscopic remission, as it improves tolerance and quality without compromising efficacy. Further evidence from randomised studies is needed.

scholarly journals Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

Endoscopy ◽  
2019 ◽  
Vol 51 (08) ◽  
pp. 775-794 ◽  
Author(s):  
Cesare Hassan ◽  
James East ◽  
Franco Radaelli ◽  
Cristiano Spada ◽  
Robert Benamouzig ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
High Volume ◽  
High Quality ◽  
Strong Recommendation ◽  
Split Dose ◽  
Moderate Quality ◽  
High Quality Evidence ◽  
Patients At Risk ◽  
Split Dosing ◽  
Quality Evidence

Main RecommendationsESGE recommends a low fiber diet on the day preceding colonoscopy.Strong recommendation, moderate quality evidence.ESGE recommends the use of enhanced instructions for bowel preparation.Strong recommendation, moderate quality evidence.ESGE suggests adding oral simethicone to bowel preparation.Weak recommendation, moderate quality evidence.ESGE recommends split-dose bowel preparation for elective colonoscopy.Strong recommendation, high quality evidence.ESGE recommends, for patients undergoing afternoon colonoscopy, a same-day bowel preparation as an acceptable alternative to split dosing.Strong recommendation, high quality evidence.ESGE recommends to start the last dose of bowel preparation within 5 hours of colonoscopy, and to complete it at least 2 hours before the beginning of the procedure.Strong recommendation, moderate quality evidence.ESGE recommends the use of high volume or low volume PEG-based regimens as well as that of non-PEG-based agents that have been clinically validated for routine bowel preparation. In patients at risk for hydroelectrolyte disturbances, the choice of laxative should be individualized.Strong recommendation, moderate quality evidence.

scholarly journals Center-Level Procedure Volume Does Not Predict Failure-to-Rescue After Severe Complications of Oncologic Colon and Rectal Surgery

2021 ◽  
Author(s):  
Miriam Lillo-Felipe ◽  
Rebecka Ahl Hulme ◽  
Maximilian Peter Forssten ◽  
Gary A. Bass ◽  
Yang Cao ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
High Volume ◽  
Cancer Surgery ◽  
Colon And Rectal Surgery ◽  
Surgical Volume ◽  
Failure To Rescue ◽  
Colorectal Cancer Surgery ◽  
Procedure Volume ◽  
Low Volume

Abstract Background The relationship between hospital surgical volume and outcome after colorectal cancer surgery has thoroughly been studied. However, few studies have assessed hospital surgical volume and failure-to-rescue (FTR) after colon and rectal cancer surgery. The aim of the current study is to evaluate FTR following colorectal cancer surgery between clinics based on procedure volume. Methods Patients undergoing colorectal cancer surgery in Sweden from January 2015 to January 2020 were recruited through the Swedish Colorectal Cancer Registry. The primary endpoint was FTR, defined as the proportion of patients with 30-day mortality after severe postoperative complications in colorectal cancer surgery. Severe postoperative complications were defined as Clavien–Dindo ≥ 3. FTR incidence rate ratios (IRR) were calculated comparing center volume stratified in low-volume (≤ 200 cases/year) and high-volume centers (> 200 cases/year), as well as with an alternative stratification comparing low-volume (< 50 cases/year), medium-volume (50–150 cases/year) and high-volume centers (> 150 cases/year). Results A total of 23,351 patients were included in this study, of whom 2964 suffered severe postoperative complication(s). Adjusted IRR showed no significant differences between high- and low-volume centers with an IRR of 0.97 (0.75–1.26, p = 0.844) in high-volume centers in the first stratification and an IRR of 2.06 (0.80–5.31, p = 0.134) for high-volume centers and 2.15 (0.83–5.56, p = 0.116) for medium-volume centers in the second stratification. Conclusion This nationwide retrospectively analyzed cohort study fails to demonstrate a significant association between hospital surgical volume and FTR after colorectal cancer surgery. Future studies should explore alternative characteristics and their correlation with FTR to identify possible interventions for the improvement of quality of care after colorectal cancer surgery.

scholarly journals The CRCbiome study: a large prospective cohort study examining the role of lifestyle and the gut microbiome in colorectal cancer screening participants

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ane Sørlie Kværner ◽  
Einar Birkeland ◽  
Cecilie Bucher-Johannessen ◽  
Elina Vinberg ◽  
Jan Inge Nordby ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Gut Microbiome ◽  
Precancerous Lesions ◽  
Colorectal Carcinogenesis ◽  
Screening Tools ◽  
Screening Methods ◽  
Crc Screening ◽  
Link Type ◽  
Incidence And Mortality

Abstract Background Colorectal cancer (CRC) screening reduces CRC incidence and mortality. However, current screening methods are either hampered by invasiveness or suboptimal performance, limiting their effectiveness as primary screening methods. To aid in the development of a non-invasive screening test with improved sensitivity and specificity, we have initiated a prospective biomarker study (CRCbiome), nested within a large randomized CRC screening trial in Norway. We aim to develop a microbiome-based classification algorithm to identify advanced colorectal lesions in screening participants testing positive for an immunochemical fecal occult blood test (FIT). We will also examine interactions with host factors, diet, lifestyle and prescription drugs. The prospective nature of the study also enables the analysis of changes in the gut microbiome following the removal of precancerous lesions. Methods The CRCbiome study recruits participants enrolled in the Bowel Cancer Screening in Norway (BCSN) study, a randomized trial initiated in 2012 comparing once-only sigmoidoscopy to repeated biennial FIT, where women and men aged 50–74 years at study entry are invited to participate. Since 2017, participants randomized to FIT screening with a positive test result have been invited to join the CRCbiome study. Self-reported diet, lifestyle and demographic data are collected prior to colonoscopy after the positive FIT-test (baseline). Screening data, including colonoscopy findings are obtained from the BCSN database. Fecal samples for gut microbiome analyses are collected both before and 2 and 12 months after colonoscopy. Samples are analyzed using metagenome sequencing, with taxonomy profiles, and gene and pathway content as primary measures. CRCbiome data will also be linked to national registries to obtain information on prescription histories and cancer relevant outcomes occurring during the 10 year follow-up period. Discussion The CRCbiome study will increase our understanding of how the gut microbiome, in combination with lifestyle and environmental factors, influences the early stages of colorectal carcinogenesis. This knowledge will be crucial to develop microbiome-based screening tools for CRC. By evaluating biomarker performance in a screening setting, using samples from the target population, the generalizability of the findings to future screening cohorts is likely to be high. Trial registration ClinicalTrials.gov Identifier: NCT01538550.

scholarly journals Is Colorectal Cancer Screening Appropriate in Nigeria?

2019 ◽  
pp. 1-10
Author(s):  
Gregory C. Knapp ◽  
Olusegun I. Alatise ◽  
Olalekan O. Olasehinde ◽  
Ademola Adeyeye ◽  
Omobolaji O. Ayandipo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Parasitic Infection ◽  
Molecular Profile ◽  
Future Research ◽  
Middle Income ◽  
Crc Screening ◽  
Middle Income Countries ◽  
Incidence And Mortality ◽  
Prospective Trials ◽  
The Impact

PURPOSE The global burden of colorectal cancer (CRC) will continue to increase for the foreseeable future, largely driven by increasing incidence and mortality in low- and middle-income countries (LMICs) such as Nigeria. METHODS We used the Wilson-Jungner framework (1968) to review the literature relevant to CRC screening in Nigeria and propose areas for future research and investment. RESULTS Screening is effective when the condition sought is both important and treatable within the system under evaluation. The incidence of CRC is likely increasing, although the exact burden of disease in Nigeria remains poorly understood and access to definitive diagnosis and treatment has not been systematically quantified. In high-income countries (HICs), CRC screening builds on a well-known natural history. In Nigeria, a higher proportion of CRC seems to demonstrate microsatellite instability, which is dissimilar to the molecular profile in HICs. Prospective trials, tissue banking, and next-generation sequencing should be leveraged to better understand these potential differences and the implications for screening. Fecal immunochemical test for hemoglobin (FIT) is recommended for LMICs that are considering CRC screening. However, FIT has not been validated in Nigeria, and questions about the impact of high ambient temperature, endemic parasitic infection, and feasibility remain unanswered. Prospective trials are needed to validate the efficacy of stool-based screening, and these trials should consider concomitant ova and parasite testing. CONCLUSION Using the Wilson-Jungner framework, additional work is needed before organized CRC screening will be effective in Nigeria. These deficits can be addressed without missing the window to mitigate the increasing burden of CRC in the medium to long term.

Low-volume PEG plus ascorbic acid versus high-volume PEG as bowel preparation for colonoscopy

2010 ◽  
Vol 45 (11) ◽  
pp. 1380-1386 ◽  
Author(s):  
Sietske Corporaal ◽  
Jan H. Kleibeuker ◽  
Jan J. Koornstra
Keyword(s):  
Ascorbic Acid ◽  
Bowel Preparation ◽  
High Volume ◽  
Acid Versus ◽  
Low Volume

scholarly journals Combining Serum DNA Methylation Biomarkers and Protein Tumor Markers Improved Clinical Sensitivity for Early Detection of Colorectal Cancer

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Guoying Zhang ◽  
Fang He ◽  
Guodong Zhao ◽  
Zihui Huang ◽  
Xiang Li ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Tumor Markers ◽  
Clinical Performance ◽  
Screening Method ◽  
Blood Chemistry ◽  
Advanced Adenoma ◽  
Crc Screening ◽  
Control Subjects ◽  
Incidence And Mortality ◽  
Small Polyp

Background. Colorectal cancer (CRC) is one of the leading causes of cancer deaths worldwide and in China. Early CRC screening is the best approach to reduce its incidence and mortality rates. The ColoDefense test, a multiplex qPCR assay simultaneously detecting both methylated SEPT9 and SDC2 genes, has demonstrated improved clinical performance on either methylation biomarker alone for CRC screening with both blood and stool samples. Method. Leftover blood chemistry test samples from 125 CRC, 35 advanced adenoma, and 35 small polyp patients and 92 healthy control subjects were examined by the ColoDefense test. Among these samples, the levels of three circulating tumor markers, CEA, AFP, and CA19-9, were also measured for 106 CRC, 28 advanced adenoma, and 20 small polyp patients and all control subjects. Results. Due to the smaller volume and extended storage in nonfrozen state, the ColoDefense test with these samples exhibited reduced performance for all stages of CRC and advanced adenomas. The performance of CEA, AFP, and CA19-9 and their various combinations was also evaluated for CRC screening to identify the tumor marker combinations with the best performance. When combined with the ColoDefense test, the identified combinations did improve the clinical performance. Conclusion. These results suggested a rational path towards developing a CRC screening method that takes advantage of leftover blood chemistry test samples. The successful development of such a method will undoubtedly help promote early CRC screening by increasing its accessibility for the general public.

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