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Objective: We aimed to investigate the efficacy of a split-dose 4-L polyethylene glycol (PEG) regimen for the quality of bowel preparation in Asian patients with previous colorectal surgery for colorectal cancer (CRC)., Methods: This was a prospective, single-center, randomized controlled, endoscopist-blinded study. Patients with previous colorectal surgery for CRC were randomly allocated to a routine, morning-only 2-L PEG (2-MO) group or a split-dose 4-L PEG (4-SD) group. The primary outcome was a successful bowel preparation rate. Secondary outcomes were polyp detection rate (PDR), adenoma detection rate (ADR), patient compliance, satisfaction, tolerance, willingness to repeat the preparation and difficulty of the bowel preparation process., Results: In total, 187 patients were included (93 in the 2-MO group, 94 in the 4-SD group) in this study. The rate of successful bowel preparation in the 4-SD group was higher than in the 2-MO group (89.4% vs 66.7%, P < 0.001) in an intention-to-treat analysis according to the Aronchick score. Patients' satisfaction with the bowel preparation process in the 4-SD group was superior to that in the 2-MO group (93.4% vs 82.2%, P = 0.021). No significant differences were detected in PDR, ADR, patient compliance, tolerance, willingness to repeat the preparation or difficulty of the bowel preparation process., Conclusions: The 4-SD PEG regimen was superior to a routine, morning-only 2-L PEG preparation for bowel preparation in an Asian population with previous colorectal surgery., (© 2018 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Colonoscopy remains the mainstay in diagnosing and monitoring colorectal cancer and other colorectal lesions. The diagnostic efficiency of colonoscopy greatly depends on the quality of bowel preparation, which is closely associated with the patient's compliance with the preparation instructions. In addition, the procedural requirements of bowel preparation are often complex and difficult for patients to comprehend and memorize, especially those with lower health literacy and motivation. Therefore, in recent years, many educational methods have been developed, such as educational booklets, cartoon visual aids, educational videos, short message service, telephone, social media and smart phone applications. These educational methods have significantly improved compliance with the instructions for bowel preparation and ultimately promoted the visualization of the colon in patients undergoing colonoscopy., (© 2017 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Objective: To evaluate the feasibility and accuracy of confocal laser endomicroscopy (CLE) for the in vivo diagnosis of colorectal cancer (CRC) compared with conventional histology., Methods: Consecutive patients who had undergone CLE examination for screening or surveillance colonoscopy were recruited. Suspected malignant lesions and adjacent mucosal sites were first examined by confocal imaging and then biopsied specimens of these sites were obtained. The confocal images were independently interpreted by two endoscopists. The diagnosis made with CLE was compared with the conventional histological diagnosis in a prospective and blinded fashion., Results: In total, 71 patients with suspected malignant lesions were included in the study. A total of 74 lesions and 92 adjacent mucosal sites were observed. The sensitivity, specificity and accuracy of CLE in diagnosing CRC were 97.1%, 99.0% and 98.2% for endoscopist A, and 98.6%, 96.9% and 97.6% for endoscopist B, respectively. The interobserver agreement between the two endoscopists was excellent (κ = 0.950). The accuracy of diagnosing poorly differentiated CRC using CLE was 97.0% for endoscopist A and 95.6% for endoscopist B., Conclusion: CLE has the potential to enable an immediate diagnosis of CRC and the degree of differentiation of CRC during ongoing endoscopy in vivo., (© 2013 The Authors. Journal of Digestive Diseases © 2013 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.)

Objectives Confocal laser endomicroscopy ( CLE) consists of endoscope-based CLE ( eCLE) and probe-based CLE ( pCLE). This study aimed to compare e CLE and pCLE in their diagnostic yield in different parts of the gastrointestinal ( GI) tract. Methods Consecutive patients were scheduled for CLE examination due to GI symptoms. All patients were randomly assigned to eCLE or pCLE group and underwent a programmed procedure using one type of CLE. Differences in procedure time, complication rate, CLE image quality and image acquisition feasibility between these two types of CLE for esophagogastroduodenoscopy (EGD) and colonoscopy were calculated. Results Altogether 513 CLE procedures were performed, including 324 EGD and 189 colonoscopy. The procedure time of pCLE was significantly shorter than that of eCLE both in EGD and colonoscopy (16.78 min vs 18.13 min for EGD, P = 0.027; 32.48 min vs 39.89 min for colonoscopy, P < 0.001). No significant difference was found between these two types of CLE in diagnostic utility, including the detection and prediction of histopathological results of the lesions. The CLE image quality of both e CLE and p CLE were comparable in the stomach and colon, but eCLE seemed to be superior to pCLE in examining the esophagus. Colonoscopy using pCLE had a higher complete rate than that of eCLE, although the difference was not statistically significant ( P = 0.065). Conclusions pCLE is more flexible in diagnosing GI diseases with a shorter procedure time than eCLE regardless of comparable diagnostic yields, except the diagnosis of esophageal diseases in which eCLE provides better image quality. [ABSTRACT FROM AUTHOR]