[Show abstract][Hide abstract] ABSTRACT: Objectives:
To assess the appropriateness of recommendations for endoscopic surveillance in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT).
74 Italian CRC screening programmes provided aggregated data on the recommendations given after FIT-positive colonoscopies in 2011 and 2013. Index colonoscopies were divided into negative/no adenoma and low- risk, intermediate-risk and high-risk adenomas. Postcolonoscopy recommendations included a return to screening (FIT after 2 years or 5 years), an endoscopic surveillance after 6 months or after 1 year, 3 years or 5 years, surgery or other. We assessed the deviation from the postcolonoscopy recommendations of the European Guidelines in 2011 and 2013 and the correlation between overuse of endoscopic surveillance in 2011 and the process indicators associated with the endoscopic workload in 2013.
49 704 postcolonoscopy recommendations were analysed. High-risk, intermediate-risk and low-risk adenomas, and no adenomas were reported in 5.9%, 19.3%, 15.3% and 51.5% of the cases, respectively. Endoscopic surveillance was inappropriately recommended in 67.4% and 7%, respectively, of cases with low-risk and no adenoma. Overall, 37% of all endoscopic surveillance recommendations were inappropriate (6696/17 860). Overuse of endoscopic surveillance was positively correlated with the extension of invitations (correlation coefficient (cc) 0.29; p value 0.03) and with compliance with post-FIT+ colonoscopy (cc 0.25; p value 0.05), while it was negatively correlated with total colonoscopy waiting times longer than 60 days (cc -0.26; p value 0.05).
In organised screening programmes, a high rate of inappropriate recommendations for patients with low risk or no adenomas occurs, affecting the demand for endoscopic surveillance by a third.
Gut 08/2015; DOI:10.1136/gutjnl-2015-310139 · 14.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Low-volume preparations are gaining attention for higher acceptability but have been never evaluated in IBD. We compare the efficacy, safety, and tolerability of a 2-L PEG with a 4-L PEG solution in patients with ulcerative colitis.
This is a multicenter, randomized, single-blind study. Adult outpatients with ulcerative colitis undergoing colonoscopy received either 2-L PEG plus bisacodyl or 4-L PEG. Bowel cleansing was assessed using the Ottawa Scale and rated as adequate if the score was ≤2 in each colon segment. Patient acceptance, satisfaction, and related symptoms were recorded.
Preparation was adequate in 80% of the 211 patients without any differences between groups. Mean Ottawa scores for whole and right colon were similar in the 2 groups. As concern tolerability, 83% patients in 2-L PEG arm and 44.8% in 4-L PEG arm reported no or mild discomfort (P < 0.0001) and 94.3% and 61.9% expressed their willingness to repeat the preparation (P < 0.001). Palatability was better with 2-L PEG, whereas related symptoms occurred more frequently with 4-L PEG. Regardless of preparation, split dosage was associated with better cleansing. Further predictors of poor cleansing were moderate/severe discomfort during preparation and more than 6 hours between end of preparation and colonoscopy. Extension and severity of colitis did not influence quality of preparation.
Low-volume PEG is not inferior to 4-L PEG for bowel cleansing in ulcerative colitis, but it is better tolerated and accepted. The time interval from solution intake and colonoscopy is the most important factor affecting quality of cleansing in ulcerative colitis.
[Show abstract][Hide abstract] ABSTRACT: Background
The prevalence of resistance to clarithromycin and metronidazole has considerably increased, with a corresponding decrease in the eradication rate for Helicobacter pylori (H. pylori) infection. Primary resistance to amoxicillin is extremely low, and esomeprazole was found to exert a noteworthy antimicrobial activity in vitro against H. pylori. A dual therapy with high-dose of esomeprazole coupled with high-dose amoxicillin might be therefore an ideal first-line treatment for H. pylori eradication. We aimed to assess the efficacy of a first-line 10-day, high-dose dual therapy consisting of amoxicillin and esomeprazole to eradicate H. pylori infection.
Consecutive naïve H. pylori-infected patients, who underwent an upper endoscopy in 4 Italian hospitals due to dyspeptic symptoms and found to be infected at routine histological assessment, were invited to participate. Patients enrolled received a 10-day, high-dose dual therapy comprising esomeprazole (40 mg t.i.d) and amoxicillin (1 g t.i.d.). At least 4 weeks after the end of the treatment a 13C-urea breath test was performed to evaluate the eradication.
A total of 56 patients agreed to participate in the study and were all followed-up. The overall eradication was 87.5% (95% CI=78.8•96.2), without a statistically significant difference among centres. Overall, 5 (8.9%; 1.5•16.4%) patients complained of side-effects.
The 10-day, high-dose dual therapy with esomeprazole and amoxicillin might be an effective and safe first-line regimen. The efficacy of a longer 14-day regimen should be tested.
Annals of Gastroenterology 05/2015; 28(4):448-451.
[Show abstract][Hide abstract] ABSTRACT: Background and aims:
Data on the colon capsule endoscopy (CCE) in evaluating the small bowel (SB) and colon concurrently are rare. This study aims to evaluate the accuracy of CCE in assessing disease activity of the SB and colon in pediatric CD, by comparison with magnetic resonance enterography (MRE), SB contrast ultrasonography (SICUS), and ileocolonoscopy.
We prospective enrolled 40 consecutive patients (22 males, 18 females, mean age 13.1 ± 3.1 years) with CD of SB and colon. All underwent SICUS, MRE, CCE and ileocolonoscopy sequentially over 5 days. All investigators were blinded to the patient history and to test results. Patients were classified as "active" or "inactive" for the SB and the colon according to specific criteria for each tool (SES-CD, Lewis score, US and MR parameters of activity). For colonic mucosa evaluation, ileocolonoscopy was the comparator. For the SB a consensus panel was convened.
Sensitivity of CCE to detect colonic inflammation was 89% and specificity was 100%. The PPV and NPV of CCE for colonic inflammation were 100% and 91% respectively. In the SB, CCE showed 90% SE, 94% SP, with PPV and NPV of 95% and 90% respectively. Accuracy parameters for SICUS (SE: 90%, SP: 83%) and MRE (SE: 85%, SP: 89%) were lower than those for CCE. No serious adverse event related to the CCE procedure or preparation was reported.
CCE is of great usefulness in evaluating both SB and colon mucosa in pediatric CD. This single, non-invasive tool makes it possible to evaluate the SB and the colon concurrently with high diagnostic accuracy. Future multicenter studies need to define the role of CCE in the routine management of pediatric CD patients.