Aug 2016 DOI 10.14302/issn.2471-7061.jcrc-14-426
Background: Colorectal cancer (CRC) screening by Fecal Immunohistochemical Testing (FIT) followed by colonoscopy reduces colorectal cancer mortality. Barriers to colonoscopy should be minimised. Objective: To compare psychological “risks” of colonoscopy in FIT positive (FIT+) subjects and those with Inflammatory Bowel Disease (IBD). Method: IBD patients undergoing colonoscopic CRC surveillance were age and gender matched with FIT+ individuals awaiting colonoscopy. Subjects completed Spielberger State and Trait Scales for current levels of anxiety, depression, anger and curiosity, versus long term personality tendencies. Results: 70 IBD respondents were matched with 70 FIT+ respondents, (57% male, mean age 57.6 years). FIT+ subjects demonstrated greater scores for state Anxiety (22.3 vs 20.3 p=0.024), Curiosity (24.3 vs 21.8 p=0.036), Anger (13.7 vs11.5 p=0.037) and Depression (23.8 vs21.2 p=0.002). Conclusion: FIT+ patients experience more anxiety and depression prior to their colonoscopy than IBD patients, which may reduce colonoscopy uptake and is important to address.
Mar 2016 DOI 10.14302/issn.2471-7061.jcrc-15-899
Missed cancers have been reported at higher frequencies in the right colon despite optical colonoscopy screening. The purpose of this study was to determine if there are regional differences in haustral fold height between the ascending, transverse, and descending colon using CT colonography (CTC). 50 supine CTC datasets from 50 asymptomatic, adult patients were analyzed (NCI-CBIIT instance of the National Biomedical Imaging Archive). At least 5 consecutive, pairs of unobscured haustral folds in each colonic segment were necessary to be included in this study. Of an initial 201 patients, 151 were excluded due to suboptimal colonic distension, retained fluid, tortuosity, and diverticulosis. For each dataset, the heights of the non-dependent haustral folds were measured in the ascending, transverse, and descending colon on 2D multiplanar reformations. Differences in mean HFHs were assessed using a hierarchical generalized linear mixed model. A total of 2079 colonic folds were measured: 625 in the ascending colon (including the cecum), 687 in the transverse colon, and 767 in the descending colon. The mean number of folds measured per segment was 6.87 ± 2.11. Mean HFHs were significantly taller in the ascending colon (14.62 ± 5.47 mm) than in the transverse (9.49 ± 3.65mm) or descending (6.53 ± 3.12mm) colon; mean HFHs were also significantly taller in the transverse than the descending colon, (P<0.0001, for all comparisons). In conclusion, taller colonic haustral folds are present in the proximal colon and may contribute to more frequently missed lesions (e.g. polyps) in the right colon by conventional, optical colonoscopy.
Jan 2015 DOI 10.14302/issn.2471-7061.jcrc-13-375
Colorectal polyps were traditionally classified as hyperplastic or adenomatous polyps. Adenomatous polyps were thought to be the precursor lesions of most of the colorectal cancers, but later serrated lesions were recognized as precursors of nearly one-third of colorectal cancers. Serrated lesions are a distinct group of polyps with special morphologic and histologic properties and a different carcinogenesis pathway to colorectal cancers. They are pale, flat or depressed lesions which may result in failure of detection on colonoscopy. So the endoscopist should be aware of these lesions and should follow the patients according to the surveillance guidelines.